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EAACI position paper on the clinical use of the bronchial allergen challenge: Unmet needs and research priorities
Author(s) -
Agache Ioana,
AntolinAmerigo Dario,
Blay Frederic,
Boccabella Cristina,
Caruso Cristiano,
Chanez Pascal,
Couto Mariana,
Covar Ronina,
Doan Serge,
Fauquert JeanLuc,
Gauvreau Gail,
Gherasim Alina,
Klimek Ludger,
Lemiere Catherine,
Nair Parameswaran,
Ojanguren Iñigo,
Peden David,
PerezdeLlano Luis,
Pfaar Oliver,
Rondon Carmen,
Rukhazde Maia,
Sastre Joaquin,
Schulze Johannes,
Silva Diana,
Tarlo Susan,
ToppilaSalmi Sanna,
WalusiakSkorupa Jolanta,
Zielen Stefan,
EguiluzGracia Ibon
Publication year - 2022
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.15203
Subject(s) - medicine , asthma , position paper , allergen immunotherapy , allergy , sensitization , house dust mite , allergen , task force , intensive care medicine , immunology , clinical trial , immunoglobulin e , pathology , antibody , public administration , political science
Abstract Allergic asthma (AA) is a common asthma phenotype, and its diagnosis requires both the demonstration of IgE‐sensitization to aeroallergens and the causative role of this sensitization as a major driver of asthma symptoms. Therefore, a bronchial allergen challenge (BAC) would be occasionally required to identify AA patients among atopic asthmatics. Nevertheless, BAC is usually considered a research tool only, with existing protocols being tailored to mild asthmatics and research needs (eg long washout period for inhaled corticosteroids). Consequently, existing BAC protocols are not designed to be performed in moderate‐to‐severe asthmatics or in clinical practice. The correct diagnosis of AA might help select patients for immunomodulatory therapies. Allergen sublingual immunotherapy is now registered and recommended for controlled or partially controlled patients with house dust mite‐driven AA and with FEV1 ≥ 70%. Allergen avoidance is costly and difficult to implement for the management of AA, so the proper selection of patients is also beneficial. In this position paper, the EAACI Task Force proposes a methodology for clinical BAC that would need to be validated in future studies. The clinical implementation of BAC could ultimately translate into a better phenotyping of asthmatics in real life, and into a more accurate selection of patients for long‐term and costly management pathways.