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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

DOI 10.1111/all.13317

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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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Self-citation
Allergen immunotherapy: A practice parameter third update
Cox, L., Nelson, H., Lockey, R., Calabria, C., Chacko, T., Finegold, I., Nelson, M., Weber, R., Bernstein, D. I., Blessing-Moore, J., et al. (2011) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2010.09.034 · Cited by 1,256
Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis
Casale, T. B., Busse, W. W., Kline, J. N., Ballas, Z. K., Moss, M. H., Townley, R. G., Mokhtarani, M., Seyfert-Margolis, V., Asare, A., Bateman, K., et al. (2006) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2005.09.036 · Cited by 355
Effective treatment of house dust mite–induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: Results from a randomized, double-blind, placebo-controlled phase III trial
Demoly, P., Emminger, W., Rehm, D., Backer, V., Tommerup, L., & Kleine-Tebbe, J. (2016) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2015.06.036 · Cited by 240
Evaluation of Impermeable Covers for Bedding in Patients with Allergic Rhinitis
Terreehorst, I., Hak, E., Oosting, A. J., Tempels-Pavlica, Z., de Monchy, J. G. R., Bruijnzeel-Koomen, C. A. F. M., Aalberse, R. C., & Gerth van Wijk, R. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa023171 · Cited by 224
Fel d 1–derived peptide antigen desensitization shows a persistent treatment effect 1 year after the start of dosing: A randomized, placebo-controlled study
Patel, D., Couroux, P., Hickey, P., Salapatek, A. M., Laidler, P., Larché, M., & Hafner, R. P. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2012.07.028 · Cited by 198
Epicutaneous allergen-specific immunotherapy ameliorates grass pollen–induced rhinoconjunctivitis: A double-blind, placebo-controlled dose escalation study
Senti, G., von Moos, S., Tay, F., Graf, N., Sonderegger, T., Johansen, P., & Kündig, T. M. (2012) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2011.08.036 · Cited by 158
Response to sublingual immunotherapy with grass pollen extract: Monotherapy versus combination in a multiallergen extract
Amar, S. M., Harbeck, R. J., Sills, M., Silveira, L. J., O'Brien, H., & Nelson, H. S. (2009) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2009.04.037 · Cited by 152 · cited 1×
“SLIT drops that employed a monomeric Phleum pratense grass pollen extract was more effective when given alone compared to when given in an equivalent dose as part of a combination with a 9-pollen, multi-allergen, sublingual extract.(100) There are a number of potential drawbacks of mixing allergens including a dilutio…”
Method
Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis
Rondón, C., Campo, P., Herrera, R., Blanca-Lopez, N., Melendez, L., Canto, G., Torres, M. J., & Blanca, M. (2011) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2011.06.012 · Cited by 108
Three-injection intralymphatic immunotherapy in adolescents and young adults with grass pollen rhinoconjunctivitis
Patterson, A. M., Bonny, A. E., Shiels, W. E., & Erwin, E. A. (2016) · Annals of Allergy, Asthma & Immunology · doi:10.1016/j.anai.2015.11.010 · Cited by 74 · cited 1×
“The intra-lymphatic route, using a grass pollen extract and a modified cat allergen extract, showed efficacy in some trials [127,128] but not in others [129].”
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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) & 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
ORCID: Roberts, G.
Pfaar, O.
Venue: Allergy
Publisher: Wiley
Published: 2017-10-30
Volume: 73
Issue: 4
Pages: 765-798
ISSN: 0105-4538
1398-9995
DOI: 10.1111/all.13317
Cited by: 702
References: 10
Language: en
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Funders: EAACI
BM4SIT project (601763)

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Metadata

Record

About these checks