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EAACI Guidelines on Allergen Immunotherapy: House dust mite‐driven allergic asthma
Author(s) -
Agache Ioana,
Lau Susanne,
Akdis Cezmi A.,
Smolinska Sylwia,
Bonini Matteo,
Cavkaytar Ozlem,
Flood Breda,
Gajdanowicz Pawe,
Izuhara Kenji,
Kalayci Omer,
Mosges Ralph,
Palomares Oscar,
Papadopoulos Nikolaos G.,
Sokolowska Milena,
Angier Elisabeth,
FernandezRivas Montserrat,
Pajno Giovanni,
Pfaar Oliver,
Roberts Graham C.,
Ryan Dermot,
Sturm Gunter J.,
Ree Ronald,
Varga Eva M.,
Wijk Roy Gerth,
YepesNuñez Juan José,
Jutel Marek
Publication year - 2019
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13749
Subject(s) - medicine , asthma , allergen immunotherapy , guideline , house dust mite , allergy , immunology , allergen , pathology
Abstract Allergen immunotherapy ( AIT ) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence‐based recommendations for the use of house dust mites ( HDM ) AIT as add‐on treatment for HDM ‐driven allergic asthma. This guideline was developed by a multi‐disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation ( GRADE ) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous ( SCIT ) and sublingual AIT ( SLIT ), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT ‐tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add‐on to regular asthma therapy for adults with controlled or partially controlled HDM ‐driven allergic asthma (conditional recommendation, moderate‐quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM ‐driven allergic asthma as the add‐on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low‐quality evidence).