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EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts, G., Pfaar, O., Akdis, C. A., Ansotegui, I. J., Durham, S. R., Gerth van Wijk, R., Halken, S., Larenas‐Linnemann, D., Pawankar, R., Pitsios, C., Sheikh, A., Worm, M., Arasi, S., Calderon, M. A., Cingi, C., Dhami, S., Fauquert, J. L., Hamelmann, E., Hellings, P., Jacobsen, L., Knol, E. F., Lin, S. Y., Maggina, P., Mösges, R., Oude Elberink, J. N. G., Pajno, G. B., Pastorello, E. A., Penagos, M., Rotiroti, G., Schmidt‐Weber, C. B., Timmermans, F., Tsilochristou, O., Varga, E.‐M., Wilkinson, J. N., Williams, A., Zhang, L., Agache, I., Angier, E., Fernandez‐Rivas, M., Jutel, M., Lau, S., van Ree, R., Ryan, D., Sturm, G. J., Muraro, A.·2018·Allergy

Abstract

Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side‐effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease‐modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project “EAACI Guidelines on Allergen Immunotherapy.” It aims to provide evidence‐based clinical recommendations and has been informed by a formal systematic review and meta‐analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product‐specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short‐term benefit. The strongest evidence for long‐term benefit is documented for grass AIT (especially for the grass tablets) where long‐term benefit is seen. To achieve long‐term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long‐term benefit and use in children.

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Authors
Roberts, G., Pfaar, O., Akdis, C. A., Ansotegui, I. J., Durham, S. R., Gerth van Wijk, R., Halken, S., Larenas‐Linnemann, D., Pawankar, R., Pitsios, C., Sheikh, A., Worm, M., Arasi, S., Calderon, M. A., Cingi, C., Dhami, S., Fauquert, J. L., Hamelmann, E., Hellings, P., Jacobsen, L., Knol, E. F., Lin, S. Y., Maggina, P., Mösges, R., Oude Elberink, J. N. G., Pajno, G. B., Pastorello, E. A., Penagos, M., Rotiroti, G., Schmidt‐Weber, C. B., Timmermans, F., Tsilochristou, O., Varga, E. ‐., Wilkinson, J. N., Williams, A., Zhang, L., Agache, I., Angier, E., Fernandez‐Rivas, M., Jutel, M., Lau, S., van Ree, R., Ryan, D., Sturm, G. J., & Muraro, A.
Affiliations
  • The David Hide Asthma and Allergy Research Centre St Mary's Hospital Newport, Isle of Wight UK
  • Department of Otorhinolaryngology, Head and Neck Surgery Universitätsmedizin Mannheim Medical Faculty Mannheim Heidelberg University Mannheim Germany
  • Swiss Institute of Allergy and Asthma Research (SIAF) University Zurich Davos Switzerland
  • Department of Allergy and Immunology Hospital Quironsalud Bizkaia Erandio, Bilbao Spain
  • Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
  • Section of Allergology Department of Internal Medicine Erasmus Medical Center Rotterdam The Netherlands
  • Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark
  • Center of Excellence in Asthma and Allergy Hospital Médica Sur Mexico City Mexico
  • Department of Pediatrics Nippon Medical School Tokyo Japan
  • Medical School University of Cyprus Nicosia Cyprus
  • Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
  • Department of Dermatology and Allergy Charité Campus Mitte Universitätsmedizin Berlin Berlin Germany
  • Department of Pediatrics Allergy Unit University of Messina Messina Italy
  • Department of Otorhinolaryngology Medical Faculty Eskisehir Osmangazi University Eskisehir Turkey
  • Evidence Based Health Care Ltd Edinburgh UK
  • CHU Clermont‐Ferrand University Hospital (CHU Estaing) Unité d'allergologie de l'enfant Clermont‐Ferrand France
  • Children's Hospital Bethel EvKB Bielefeld University Bielefeld Germany
  • Department of Otorhinolaryngology University Hospitals Leuven Leuven Belgium
  • Allergy Learning and Consulting Copenhagen Denmark
  • Departments of Immunology and Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
  • Johns Hopkins Department of Otolaryngology – Head and Neck Surgery Baltimore MD USA
  • Allergy and Clinical Immunology Unit 2nd Department of Pediatrics NKUA Athens University Athens Greece
  • Clinical Research International Ltd Hamburg Germany
  • Department of Allergology University of Groningen University Medical Center Groningen Groningen The Netherlands
  • Department of Allergy and Immunology Asst Grande Ospedale Metropolitano Niguarda University of Milano Milano Italy
  • Department of Allergy and Medical Rhinology The Royal National Throat Nose and Ear Hospital University College Hospital London UK
  • Center of Allergy and Environment (ZAUM) &amp; Institute of Allergy Research Helmholtz Center Munich Munich Germany
  • European Anaphylaxis Taskforce – Nederlands Anafylaxis Netwerk Dordrecht The Netherlands
  • Division of Asthma, Allergy and Lung Biology Department of Paediatric Allergy Children's Allergy Service King's College London Guy's and St. Thomas’ National Health Service Foundation Trust London UK
  • Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division Medical University of Graz Graz Austria
  • Pharmaceutical Group of the European Union Brussels Belgium
  • Allergy Department Guys and St Thomas’ NHS Foundation Trust London UK
  • Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Capital Medical University Beijing China
  • Faculty of Medicine Department of Allergy and Clinical Immunology Transylvania University Brasov Brasov Romania
  • Department of Clinical Immunology and Allergy Northern General Hospital Sheffield UK
  • Allergy Department Hospital Clinico San Carlos, IdISSC Madrid Spain
  • ALL‐MED Medical Research Institute Wroclaw Poland
  • Department of Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany
  • Departments of Experimental Immunology and of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
  • Usher Institute of Population Health Sciences and Informatics University of Edinburgh Medical School Edinburgh UK
  • Department of Dermatology and Venerology Medical University of Graz Graz Austria
  • Department of Women and Child Health Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region University of Padua Padua Italy
Venue
Allergy
Publisher
Wiley
Published
2017-10-30
Volume
73
Issue
4
Pages
765-798
ISSN
  • 0105-4538
  • 1398-9995
Cited by
702
References
10
Language
en
Funders
  • EAACI
  • BM4SIT project (601763)

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Roberts, G., Pfaar, O., Akdis, C. A., Ansotegui, I. J., Durham, S. R., Gerth van Wijk, R., Halken, S., Larenas‐Linnemann, D., Pawankar, R., Pitsios, C., Sheikh, A., Worm, M., Arasi, S., Calderon, M. A., Cingi, C., Dhami, S., Fauquert, J. L., Hamelmann, E., Hellings, P., . . . Muraro, A. (2018). EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy. https://doi.org/10.1111/all.13317