# ARIA-EAACI care pathways for allergen immunotherapy in respiratory allergy

Jean Bousquet, Oliver Pfaar, Ioana Agache, Anna Bedbrook, Cezmi Akdis, G Walter Canonica, Tomas Chivato, Mona Al-ahmad, Amir Abdul Latiff, Ignacio Ansotegui, et al.

► To cite this version:

Jean Bousquet, Oliver Pfaar, Ioana Agache, Anna Bedbrook, Cezmi Akdis, et al. ARIA-EAACI care pathways for allergen immunotherapy in respiratory allergy. Clinical and Translational Allergy, 2021, 11 (4), pp.e12014. 10.1002/clt2.12014. hal-03642028

HAL Id: hal-03642028

https://hal.umontpellier.fr/hal-03642028

Submitted on 14 Apr 2022

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<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
ARIA-EAACI care pathways for allergen immunotherapy in
respiratory allergy

Jean Bousquet<sup>1,2,3</sup> | Oliver Pfaar<sup>4</sup> | Ioana Agache<sup>5</sup> | Anna Bedbrook<sup>3</sup> |
Cezmi A Akdis<sup>6</sup> | G. Walter Canonica<sup>7,174</sup> | Tomas Chivato<sup>8</sup> | Mona Al-Ahmad<sup>9,175</sup> |
Amir H Abdul Latiff<sup>10</sup> | Ignacio J Ansotegui<sup>11</sup> | Claus Bachert<sup>12,176,177</sup> |
Abdullah Baharuddin<sup>13</sup> | Karl-Christian Bergmann<sup>1</sup> |
Carsten Bindslev-Jensen<sup>14,177,178</sup> | Leif Bjermer<sup>15</sup> | Matteo Bonini<sup>16,179</sup> |
Sinthia Bosnic-Anticevich<sup>17,180</sup> | Isabelle Bosse<sup>18</sup> | Helen A. Brough<sup>19</sup> |
Luisa Brussino<sup>20</sup> | Moises A Calderon<sup>21</sup> | Luis Caraballo<sup>22,181</sup> |
Victoria Cardona<sup>23</sup> | Pedro Carreiro-Martins<sup>24,182</sup> | Tomas Casale<sup>25</sup> |
Lorenzo Cecchi<sup>26</sup> | Alfonso M Cepeda Sarabia<sup>27,183</sup> | Ekaterine Chkhartishvili<sup>28</sup> |
Derek K Chu<sup>29</sup> | Ieva Cirule<sup>30</sup> | Alvaro A Cruz<sup>31</sup> | Wienczyslawa Czarlewski<sup>32</sup> |
Stefano del Giacco<sup>33</sup> | Pascal Demoly<sup>34,184</sup> | Philippe Devillier<sup>35</sup> | Dejan Dokic<sup>36</sup> |
Stephen L Durham<sup>37</sup> | Motohiro Ebisawa<sup>38</sup> | Yehia El-Gamalt<sup>39</sup> |
Regina Emuzyte<sup>40</sup> | Amiran Gamkrelidze<sup>41</sup> | Jean Luc Fauquert<sup>42</sup> |
Alessandro Fiocchi<sup>43</sup> | Wytske J Fokkens<sup>44,185</sup> | Joao A Fonseca<sup>45,186</sup> |
Jean-François Fontaine<sup>46</sup> | Radoslaw Gawlik<sup>47</sup> | Asli Gelincik<sup>48</sup> |
Bilun Gemicioglu<sup>49</sup> | Jose E Gereda<sup>50</sup> | Roy Gerth van Wijk<sup>51</sup> |
R Maximiliano Gomez<sup>52</sup> | Maia Gotua<sup>53</sup> | Ineta Grisle<sup>54</sup> |
Maria-Antonieta Guzmán<sup>55</sup> | Tari Haahtela<sup>56</sup> | Susanne Halken<sup>57</sup> |
Enrico Heffler<sup>7</sup> | Karin Hoffmann-Sommergruber<sup>58</sup> | Elham Hossny<sup>59</sup> |
Martin Hrubiško<sup>60</sup> | Carla Irani<sup>61</sup> | Juan Carlos Ivancevich<sup>62</sup> | Zhanat Ispayeva<sup>63</sup> |
Kaja Julge<sup>64</sup> | Igor Kaidashev<sup>65</sup> | Omer Kalayci<sup>66</sup> | Musa Khaitov<sup>67</sup> |
Ludger Klimek<sup>68,187</sup> | Edward Knol<sup>69</sup> | Marek L Kowalski<sup>70</sup> | Helga Kraxner<sup>71</sup> |
Inger Kull<sup>72,188</sup> | Piotr Kuna<sup>73</sup> | Violeta Kvedariene<sup>74,189</sup> | Vicky Kritikos<sup>75,190</sup> |
Antti Lauerma<sup>76</sup> | Susanne Lau<sup>77</sup> | Daniel Laune<sup>78</sup> | Michael Levin<sup>79</sup> |
Desiree E Larenas-Linnemann<sup>80</sup> | Karin C Lodrup Carlsen<sup>81,191</sup> | Carlo Lombardi<sup>82</sup> |
Olga M Lourenço<sup>83</sup> | Bassam Mahboub<sup>84</sup> | Hans-Jørgen Malling<sup>85</sup> |
Patrick Manning<sup>86</sup> | Gailen D Marshall<sup>87</sup> | Erik Melén<sup>88,188</sup> | Eli O Meltzer<sup>89</sup> |
Neven Miculinic<sup>90</sup> | Branislava Milenkovic<sup>91,193</sup> | Mostafa Moin<sup>92</sup> |

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.

© 2021 The Authors. Clinical and Translational Allergy published by John Wiley and Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.
Stephen Montefort⁹³ | Mario Morais-Almeida⁹⁴ | Charlotte G Mortz<fnref n="14" /> |
Ralph Mösges⁹⁵ | Joaquim Mullol⁹⁶,¹⁹⁴ | Leyla Namazova Baranova⁹⁷ |
Hugo Neffen⁹⁸ | Kristof Nekam⁹⁹ | Marek Niedoszytko¹⁰⁰ | Mikaëla Odemyr¹⁰¹ |
Robyn E O'Hehir¹⁰²,¹⁹⁵ | Markus Ollert¹⁰³,¹⁹⁶ | Liam O'Mahony¹⁰⁴ | Ken Ohta¹⁰⁵ |
Yoshitaka Okamoto¹⁰⁶ | Kimi Okubo¹⁰⁷ | Giovanni B Pajno¹⁰⁸ |
Oscar Palomares¹⁰⁹ | Susanna Palkonen¹¹⁰ | Petr Panzner¹¹⁰ |
Nikolaos G Papadopoulos¹¹¹ | Hae-Sim Park¹¹² | Giovanni Passalacqua¹¹³ |
Vincenzo Patella¹¹⁴ | Ruby Pawankar¹¹⁵ | Nhân Pham-Thi¹¹⁶ | Davor Plavec¹¹⁷ |
Todor A Popov¹¹⁸ | Marysia Recto¹⁹² | Frederico S Regateiro¹¹⁹,¹⁹⁷,¹⁹⁸ |
Carmen Riggioni¹²⁰,¹⁹⁹ | Graham Roberts¹²¹ | Monica Rodriguez-Gonzales¹²² |
Nelson Rosario¹²³ | Menachem Rottem¹²⁴,²⁰⁰ | Philip W Rouadi¹²⁵ |
Dermot Ryan¹²⁶ | Boleslaw Samolinski¹²⁷ | Mario Sanchez-Borgest¹²⁸ |
Faradiba S Serpa¹²⁹ | Joaquin Sastre¹³⁰ | Glenis K. Scadding¹³¹ |
Mohamed H Shamji¹³²,²⁰¹ | Peter Schmid-Grendelmeier¹³³ | Holger J Schünemann²⁹ |
Aziz Sheikh¹³⁴ | Nicola Scichilone¹³⁵ | Juan Carlos Sisul¹³⁶ | Mikhail Sofiev¹³⁷ |
Dirceu Solé¹³⁸ | Talant Sooronbaev¹³⁹ | Manuel Soto-Martinez¹⁴⁰ |
Manuel Soto-Quiros¹⁴¹ | Milan Sova¹⁴² | Jürgen Schwarze¹⁴³ |
Isabel Skypala¹⁴⁴ | Charlotte Suppli-Ulrik¹⁴⁵,²⁰² | Luis Taborda-Barata¹⁴⁶,²⁰³ |
Ana Todo-Bom¹⁴⁷,²⁰⁴ | Maria J Torres¹⁴⁸ | Marylin Valentin-Rostan¹⁴⁹ |
Peter-Valentin Tomazic¹⁵⁰ | Antonio Valero¹⁵¹ | Sanna Toppila-Salmi⁵⁶ |
Ioanna Tsiligianni¹⁵²,¹⁷² | Eva Untersmayr¹⁵³ | Marilyn Urrutia-Pereira¹⁵⁴ |
Arunas Valiulis¹⁵⁵,¹⁷³ | Erkka Valovirta¹⁵⁶,²⁰⁵ | Olivier Vandenplas¹⁵⁷ |
Maria Teresa Ventura¹⁵⁸ | Pakit Vichyanond¹⁵⁹ | Martin Wagenmann¹⁶⁰ |
Dana Wallace¹⁶¹ | Jolanta Walusiak-Skorupa¹⁶² | De Yun Wang¹⁶³ |
Susan Waserman¹⁶⁴ | Gary WK Wong¹⁶⁵ | Arzu Yorgancioglu¹⁶⁶ |
Osman M Yusuf¹⁶⁷ | Mario Zernotti¹⁶⁸ | Luo Zhang¹⁶⁹,²⁰⁶ | Mihaela Zidarn¹⁷⁰ |
Torsten Zuberbier<fnref n="1" /> | Marek Jutel¹⁷¹,²⁰⁷

<footnote n="1">¹Department of Dermatology and Allergy, Comprehensive Allergy Center, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany</footnote>

<footnote n="2">²Allergology, University Hospital Montpellier, Montpellier, France</footnote>

<footnote n="3">³MACVIA-France, Montpellier, France</footnote>

<footnote n="4">⁴Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Germany</footnote>

<footnote n="5">⁵Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania</footnote>

<footnote n="6">⁶Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland</footnote>

<footnote n="7">⁷Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, (MI) and Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milano, Italy</footnote>

<footnote n="8">⁸School of Medicine, University CEU San Pablo, Madrid, Spain</footnote>

<footnote n="9">⁹Department of Allergy and Microbiology, Faculty of Medicine, Al-Rashed Allergy Center, Kuwait University, Kuwait City, Kuwait</footnote>

<footnote n="10">¹⁰Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Malaysia</footnote>

<footnote n="11">¹¹Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Erandio, Spain</footnote>

<footnote n="12">¹²ENT Department, Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium</footnote>

<footnote n="13">¹³Department of Otorhinolaryngology—Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia</footnote>

<footnote n="14">¹⁴Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark</footnote>

<footnote n="15">¹⁵Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden</footnote>

<footnote n="16">¹⁶Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy</footnote>

<footnote n="17">¹⁷Woolcock Institute of Medical Research, University of Sydney, Australia</footnote>
¹⁸Allergist, La Rochelle, France

¹⁹Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, Guys' Hospital, King's College London, London, UK

²⁰Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy

²¹Imperial College and National Heart and Lung Institute, London, UK

²²Institute for Immunological Research, University of Cartagena, Cartagena, Colombia

²³Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADYAL Research Network, Barcelona, Spain

²⁴Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal

²⁵Division of Allergy/immunology, University of South Florida, Tampa, Fla, USA

²⁶SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy

²⁷Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia

²⁸David Tatishvili Medical Center, David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia

²⁹Departments of Medicine and Health Research Methods, McMaster University, Hamilton, ON, Canada

³⁰Latvain Association of Allergists, University Children Hospital, Riga, Latvia

³¹Fundação ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Brazil

³²Medical Consulting Czarlewski, Levallois, France

³³Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy

³⁴Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, France

³⁵Unité de Recherche en Pharmacologie Respiratoire, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris Saclay, Suresnes, France

³⁶Medical Faculty, University Clinic of Pulmology and Allergy, Skopje, Republic of Macedonia

³⁷National Heart and Lung Institute, Imperial College London, UK

³⁸Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan

³⁹Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt

⁴⁰Faculty of Medicine, Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania

⁴¹National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia

⁴²CHU Clermont-Ferrand, Unité d'Allergologie de l'Enfant, Pole pédiatrique, Hopital Estaing, Clermont-Ferrand, France

⁴³Division of Allergy, The Bambino Gesù Children's Hospital IRCCS, Rome, Italy

⁴⁴Department of Otorhinolaryngology, Academic Medical Centers, Amsterdam, The Netherland

⁴⁵Faculdade de Medicina, CINTESIS, Center for Health Technology and Services Research, Universidade do Porto, Porto, Portugal

⁴⁶Allergist, Reims, France

⁴⁷Department of Internal Medicine, Allergology and Clinical Immunology, Silesian University of Medicine, Katowice, Poland

⁴⁸Division of Allergy and Immunology, Dışkapi Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

⁴⁹Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey

⁵⁰Allergy and Immunology Division, Clinica Ricardo Palma, Lima, Peru

⁵¹Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, the Netherlands

⁵²Fundacion Ayre, Instituto Medico Alas, Salta, Argentina

⁵³Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia

⁵⁴Latvian Association of Allergists, Center of Tuberculosis and Lung Diseases, Riga, Latvia

⁵⁵Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile

⁵⁶Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland

⁵⁷Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark

⁵⁸Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria

⁵⁹Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt

⁶⁰Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia

⁶¹Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon

⁶²Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina

⁶³Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Kazakhstan Association of Allergology and Clinical Immunology, Kazakhstan

⁶⁴Allergy Center of Children's Clinic of Tartu University Hospital, Tartu, Estonia

⁶⁵Ukrainina Medical Stomatological Academy, Poltava, Ukraine

⁶⁶Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey

⁶⁷National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular Immunology, Russia

⁶⁸Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany

⁶⁹Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, The Netherlands

⁷⁰Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Poland

⁷¹Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary

⁷²Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden

⁷³Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland

⁷⁴Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University Vilnius, Lithuania

⁷⁵Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

⁷⁶Department of Dermatology and Allergology, University of Helsinki and Helsinki University, Helsinki, Finland

⁷⁷Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany

⁷⁸KYomed INNOV, Montpellier, France

⁷⁹Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa

⁸⁰Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico

⁸¹Department of Paediatrics, Oslo University Hospital, Oslo, Norway

⁸²Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
⁸³Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal

⁸⁴Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE

⁸⁵Danish Allergy Centre, University of Copenhagen, Copenhagen, Denmark

⁸⁶Department of Medicine (RCSI), Bon Secours Hospital, Dublin, Ireland

⁸⁷The University of Mississippi Medical Center, Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, Jackson, Mississippi, USA

⁸⁸Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden

⁸⁹Allergy, Allergy and Asthma Medical Group and Research Center, San Diego, California, USA

⁹⁰Croatian Pulmonary Society, Zagreb, Croatia

⁹¹Faculty of Medicine, Clinic for Pulmonary Diseases, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia

⁹²Immunology and Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran

⁹³Faculty of Medicine and Surgery, Mater Dei Hospital Malta, University of Medicine, La Valette, Malta

⁹⁴Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal

⁹⁵CRI-Clinical Research International-Ltd, Hamburg, Germany

⁹⁶ENT Department, Rhinology Unit & Smell Clinic, Hospital Clínic, Barcelona, Spain

⁹⁷Scientific Centre of Children's Health, Russian National Research Medical University, Moscow, Russia

⁹⁸Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina

⁹⁹Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary

¹⁰⁰Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland

¹⁰¹EFA, European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium

¹⁰²Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Victoria, Australia

¹⁰³Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg

¹⁰⁴Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland

¹⁰⁵National Hospital Organization, Tokyo National Hospital, Tokyo, Japan

¹⁰⁶Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan

¹⁰⁷Department of Otolaryngology, Nippon Medical School, Tokyo, Japan

¹⁰⁸Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy

¹⁰⁹Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain

¹¹⁰Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic

¹¹¹Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK

¹¹²Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea

¹¹³Allergy and Respiratory Diseases. Ospedale Policlinico San Martino -University of Genoa, Italy

¹¹⁴Department of Medicine, Division of Allergy and Clinical Immunology, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy

¹¹⁵Department of Pediatrics, Nippon Medical School, Tokyo, Japan

¹¹⁶Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France

¹¹⁷School of Medicine, Children's Hospital Srebrnjak, Zagreb, University J.J. Strossmayer, Osijek, Croatia

¹¹⁸University Hospital 'Sv Ivan Rilski', Sofia, Bulgaria

¹¹⁹Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Coimbra, Portugal

¹²⁰Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

¹²¹Salford Royal NHS Foundation Trust NHS England North, Salford, UK

¹²²Pediatric Allergy and Clinical Immunology, Hospital Angeles Pedregal, Mexico City, Mexico

¹²³Hospital de Clinicas, University of Parana, Brazil

¹²⁴Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel

¹²⁵Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon

¹²⁶Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK

¹²⁷Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland

¹²⁸Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela

¹²⁹Asthma Reference Center - Escola Superior de Ciencias, Santa Casa de Misericórdia of Vitória-Espírito Santo, Vitoria, Brazil

¹³⁰Faculty of Medicine, Fundacion Jimenez Diaz, CIBERES, Autonoma University of Madrid, Spain

¹³¹The Royal National ENT Hospital, University College London, UK

¹³²Immunomodulation and Tolerance Group, Imperial College London, London, UK

¹³³Department of Dermatology, Allergy Unit, University Hospital of Zurich, Zürich, Switzerland

¹³⁴The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK

¹³⁵PROMISE Department, University of Palermo, Palermo, Italy

¹³⁶Sociedad Paraguaya de Alergia Asma e Inmunologia, Clinica Sisul, Allergy & Asthma, Asuncion, Paraguay

¹³⁷Finnish Meteorological Institute (FMI), Helsinki, Finland

¹³⁸Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil

¹³⁹Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan

¹⁴⁰Department of Pediatrics, Division of Respiratory Medicine, Hospital Nacional de Niños, Universidad de Costa Rica, San José, Costa Rica

¹⁴¹Department of Pediatrics, Hospital Nacional de Niños, San José, Costa Rica

¹⁴²Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic

¹⁴³Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK

¹⁴⁴Royal Brompton and Harefield NHS Foundation Trust, London, UK

¹⁴⁵Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark

¹⁴⁶Department of Immunoallergology, Faculty of Health Sciences, Cova da Beira, Covilhã, Portugal

¹⁴⁷Imunoallergologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal

¹⁴⁸Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain

¹⁴⁹Allergist, Montevideo, Uruguay

¹⁵⁰Department of General ORL, H&NS, ENT-University Hospital Graz, Medical University of Graz, Graz, Austria

¹⁵¹Pneumology and Allergy Department, CIBERES, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, University of Barcelona, Barcelona, Spain

¹⁵²Department of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Crete, Greece
¹⁵³Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria

¹⁵⁴Universidade Federal dos Pampa, Uruguaiana, Brazil

¹⁵⁵Faculty of Medicine, Vilnius University, Institute of Clinical Medicine & Institute of Health Sciences, Vilnius, Lithuania

¹⁵⁶Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland

¹⁵⁷Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium

¹⁵⁸Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy

¹⁵⁹Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

¹⁶⁰Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Germany

¹⁶¹Nova Southeastern University, Fort Lauderdale, Florida, USA

¹⁶²Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland

¹⁶³Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

¹⁶⁴Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada

¹⁶⁵Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China

¹⁶⁶Department of Pulmonology, Celal Bayar University, Manisa, Turkey

¹⁶⁷The Allergy and Asthma Institute, Islamabad, Pakistan

¹⁶⁸Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Argentina

¹⁶⁹Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China

¹⁷⁰Respiratory and Allergic Diseases, University Clinic, Golnik, Slovenia

¹⁷¹Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland

¹⁷²International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland

¹⁷³European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium

¹⁷⁴Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milano, Italy

¹⁷⁵Department of Allergy, Al-Rashed Allergy Center, Kuwait City, Kuwait

¹⁷⁶International Airway Research Center, First Affiliated Hospital Guangzou, Sun Yat-sen University, Guangzhou, China

¹⁷⁷Division of ENT Diseases, Department of ENT Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

¹⁷⁸Research Center for Anaphylaxis (ORCA), Odense, Denmark

¹⁷⁹National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, UK

¹⁸⁰Woolcock Emphysema Centre and Sydney Local Health District, Glebe, New South Wales, Australia

¹⁸¹Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia

¹⁸²NOVA Medical School, CEDOC, Comprehensive Health Research Center (CHRC), Lisboa, Portugal

¹⁸³Slaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Branquilla, Colombia

¹⁸⁴Equipe EPAR - IPLESP, Sorbonne Université, Paris, France

¹⁸⁵EUFOREA, Brussels, Belgium

¹⁸⁶Allergy Unit, CUF Porto, Portugal

¹⁸⁷Center for Rhinology and Allergology, Wiesbaden, Germany

¹⁸⁸Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden

¹⁸⁹Faculty of Medicine, Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Vilnius University, Vilnius, Lithuania

¹⁹⁰Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia

¹⁹¹Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

¹⁹²Department of Pediatrics, Section of Allergy and Immunology, UP-PGH, Manila, Philipinnes

¹⁹³Serbian Association for Asthma and COPD, Belgrade, Serbia

¹⁹⁴Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Spain

¹⁹⁵Alfred Health, Melbourne, Victoria, Australia

¹⁹⁶Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark

¹⁹⁷Faculty of Medicine, Institute of Immunology, University of Coimbra, Coimbra, Portugal

¹⁹⁸Faculty of Medicine, ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, University of Coimbra, Coimbra, Portugal

¹⁹⁹Institut de Recerca Sant Joan de Déu, Barcelona, Spain

²⁰⁰Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israël

²⁰¹Allergy and Clinical Immunology, Imperial College London, London, UK

²⁰²Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

²⁰³University Hospital Centre, Covilhã, Portugal

²⁰⁴Faculty of Medicine, University of Coimbra, Coimbra, Portugal

²⁰⁵Terveystalo Allergy Clinic, Turku, Finland

²⁰⁶Otolaryngology, Beijing Institute of Otolaryngology, Beijing, China

²⁰⁷ALL-MED Medical Research Institute, Wrocław, Poland

## Funding information

ARIA, Grant/Award Number: N/A

## KEYWORDS

allergic rhinitis, asthma, immunotherapy, precision medicine

# 1 | INTRODUCTION

Allergen immunotherapy (AIT), the gradually increasing repeated administration of high doses of allergens to allergic patients, offers

the potential for immune tolerance against reactions to the natural exposures to specific allergens. AIT may lead to the long-lasting remission of allergic symptoms and is the only disease-modifying intervention in IgE-mediated allergic respiratory diseases.
This Pocket Guide was developed by an ARIA and EAACI joint study group from a background paper of the ARIA-MASK study group and from the EAACI guidelines on allergen immunotherapy.

Bousquet J, Pfaar O, Togias A, et al. (2019). ARIA Care pathways for allergen immunotherapy. Allergy 2019; 74: 2087-2102.

Agache, Lau S, Akdis CA, et al. EAACI guidelines on allergen immunotherapy: house dust mite-driven allergic asthma. Allergy, 2019;74:855-73.

AIT is a proven therapeutic option for the treatment of allergic rhinitis, conjunctivitis, and/or asthma using sublingual (SLIT) or subcutaneous (SCIT) routes.

However, AIT is more expensive than symptomatic treatments for allergic diseases (excluding biologicals). It is justified (i) in patients with rhinitis otherwise uncontrolled by symptomatic treatment or (ii) as an add-on to regular asthma treatment in controlled or partially-controlled asthmatic patients sensitised to house dust mites aiming to decrease asthma exacerbations, rescue and controller medication, and to improve quality of life.

Care pathways are structured multi-disciplinary care plans detailing the key steps of patient care. They promote the translation of guideline recommendations to their application in clinical practice.

Although many international and national AIT guidelines have been produced, this is the first care pathway for AIT.

This pocket guide applies to sublingual (SLIT) and sub-cutaneous (SCIT) immunotherapy for allergic rhinitis.

It has been revised by members from 65 countries (Figure 1).

## 2 | ALLERGENS TO BE ADMINISTERED

The decision to prescribe AIT should be based on relevant symptoms during allergen exposure, demonstration of sensitisation to the relevant allergens, and availability of good-quality extracts with proven efficacy and safety.

Some allergen extracts are approved for marketing in the EU (list in annex) with some others also approved by national health agencies.

For certain products, efficacy and safety have been demonstrated in appropriate clinical studies on adults and children. The extrapolation to untested products, allergens or a different population from the one evaluated in the trial is not appropriate and not in line with current guidelines as there is no class-effect in AIT.

Both monosensitised and polysensitised patients can be treated. However, in the latter case, the most clinically relevant allergen(s) should be used when symptoms are clearly present with allergen source exposure and when allergy tests confirm clinical findings.

## 3 | STRATIFICATION OF ALLERGIC PATIENTS

Precision medicine aims at the customisation of healthcare, tailored to the characteristics of each individual patient. The stratification of patients into subpopulations is the basis of clinical decision making (Figure 2).

In allergic diseases, patient stratification is required to:

* Propose the appropriate pharmacotherapy.

* Identify the most suitable candidates for AIT.

* Reduce the amount of time and resources needed to match the right patient to an optimal care management programme.

* Optimise costs as expensive therapeutic interventions are not necessary or suitable for all patients.

Patient stratification may also help to improve the patient's engagement.

### 3.1 | Precision medicine in the indication of AIT

1. Precise diagnosis with history, skin prick tests and/or specific IgE and, if applicable, component-resolved in vitro testing. In some cases, where the above-mentioned diagnostic tools do not allow for precise diagnosis, allergen provocation testing (nasal, ocular and, in some cases, bronchial) may be needed.

2. Proven indications: Allergic rhinitis, conjunctivitis and/or asthma.

3. Symptoms predominantly induced by the relevant allergen exposure.

4. Patient stratification:

* Poor control of nasal or ocular symptoms despite optimal medications according to guidelines with documented adherence to treatment.

* Exceptions to requiring optimum symptomatic treatment prior to considering AIT include unacceptable side effects of the medications.

* Allergic asthma fully controlled under background asthma medication (see EAACI HDM-AIT GL)

* However, for partially controlled asthma, HDM-AIT may facilitate achieving asthma control (see EAACI HDM-AIT GL)

5. Good clinical documentation of efficacy and safety for the AIT product with relevant trials.

6. The patient's (and caregiver's) views represent an essential component.

### 3.2 | Biomarkers

There are currently no in vivo or in vitro biomarkers validated for monitoring the efficacy of AIT although several potential candidates are currently being investigated.
<figure><img src="image_2.png" /><figcaption>FIGURE 1 Countries with Pocket Guide members</figcaption></figure>

<figure><img src="image_3.png" /></figure>

*: There are some exceptions

<caption>FIGURE 2 Proposed Flow of Precision Medicine approach in allergic diseases. *examples of exceptions: Thunderstorm-induced asthma, patient with moderate rhinitis and severe asthma during pollen season</caption>
## 4 | mHEALTH

Apps can be used:

* To acquire real-world evidence to confirm the efficacy of AIT in situations where randomised controlled trials are difficult to perform.

* To assess air quality index including pollen exposure and air pollution.

* By physicians and patients for stratification of patients and follow-up.

## 5 | RHINITIS (WITH OR WITHOUT CONJUNCTIVITIS) IN ADOLESCENTS AND ADULTS

The selection of pharmacotherapy and AIT for patients with AR and/or allergic conjunctivitis may be better supported by evidence algorithms to aid patients and healthcare professionals jointly determine the treatment and its step-up or step-down strategy depending on rhinitis control (shared decision-making).

A simple algorithm is proposed as an aid for physicians to determine the treatment of their patients (Figure 3).

### 5.1 | Treatment algorithm using visual analogue scale (VAS)

In the case of remaining ocular symptoms, add intra-ocular treatment.

## 6 | RHINITIS (WITH OR WITHOUT CONJUNCTIVITIS) IN CHILDREN

AIT is effective, has long-term beneficial effects after cessation, and may delay or prevent the onset of asthma. AIT can be initiated in children with moderate/severe rhinitis that is not controlled by appropriate medications according to guidelines.

## 7 | ASTHMA

An algorithm for HDM-driven allergic asthma diagnosis and management is proposed by the EAACI guidelines.

For patients with concomitant allergic rhinitis and sensitised to house dust mite—with persisting asthma symptoms despite low-moderate dose of inhaled corticosteroids—SLIT can be considered, provided FEV1 is >70% predicted.

House dust mite SLIT should initially be considered as an add-on therapy to controller treatment, and reduction in asthma controllers should be performed gradually under the supervision of a physician.

Immunotherapy is not indicated for the treatment of acute exacerbations, and patients must be informed of the need to seek medical attention immediately if their asthma deteriorates suddenly (Figure 4).

## 8 | MULTIMORBIDITY

One strength of AIT is that it has the potential to control all allergic diseases related to a specific allergen, including rhinitis, conjunctivitis and asthma.

<figure><img src="image_4.png" /><figcaption>FIGURE 3 Treatment algorithm using visual analogue scale (VAS) for adolescents and adults AIT, allergen immunotherapy; VAS, visual analogue scale.</figcaption></figure>
<figure><img src="image_5.png" /></figure>

<figure><img src="image_6.png" /><figcaption>FIGURE 4 Algorithm for AIT in asthma</figcaption></figure>

## 9 | SAFETY

### 9.1 | Subcutaneous immunotherapy (SCIT)

**Local reactions:** A typical reaction is redness and swelling at the injection site immediately or several hours after the injection. Sometimes, sneezing, nasal congestion or hives can occur.

**Systemic reactions:** Serious reactions to injections are very rare and require immediate medical attention. Symptoms of anaphylactic reaction can include swelling in the throat, wheezing or tightness in the chest, nausea and dizziness. The most serious reactions

develop within 30 min after the injection, and patients are advised to wait in their doctor's surgery for at least 30 min after an injection. Severe bronchospasm can also occur, especially in patients where asthma is not controlled.

### 9.2 | Sublingual immunotherapy (SLIT)

Allergen drops or tablets have a more favourable safety profile than injections. The initial dose should be performed in the doctor's surgery, and patients are advised to remain in the surgery for at least 30 min
after administration. Thereafter, SLIT can be administered at home once the first dose has been given under the supervision of a physician.

**Allergic reactions:** The majority of patients will experience mild local reactions of the oropharyngeal passage. This is usually controlled by predosing with an antihistamine 30 min before the administration of SLIT. Sometimes, sneezing, nasal congestion or hives can occur. Anaphylaxis is rarely described.

In some countries, SLIT tablets include a warning about possible severe allergic reactions, and adrenaline auto-injectors are routinely recommended. This is not the case in Europe.

## CONFLICT OF INTEREST

IAgache is an Associate Editor Allergy and CTA.

CA reports grants from Allergopharma, grants from Idorsia, Swiss National Science Foundation, Christine Kühne-Center for Allergy Research and Education, European Commission's Horison's 2020 Framework Programme, Cure, Novartis Research Institutes, Astra Zeneca, scibase, advisory role in Sanofi/Regeneron, grants from Glakso Smith-Kline, advisory role in scibase.

IA reports personal fees from Hikma, Roxall, Astra Zeneca, Menarini, UCB, Faes Farma, Sanofi, Mundipharma, Bial, Amgen, Stallergenes.

SBA reports grants from TEVA, personal fees from TEVA, AstraZeneca, Boehringer Ingelheim, GSK, Sanofi, Mylan.

VC reports personal fees from ALK, Allergy Therapeutics, LETI, Thermofisher, Merck, AstraZeneca, GSK.

TC reports grants and personal fees from Stallergenes.

PD reports personal fees from ALK-Abello, Stallergenes-Greer, Astra Zeneca, GlaxoSmithKline, Mylan, Sanofi.

SD reports personal fees and non-financial support from ALK Abello, personal fees from Adiga, Biomay, Allergopharma, Anergis, Allergy Therapeutics.

TH reports personal fees from GSK, Mundipharma, Orion Pharma.

SH reports other from ALK-Abelló, other from ALK-Abelló.

EH reports personal fees from Sanofi, Novartis, GSK, AstraZeneca, Circassia, Nestlè Purina.

JCI reports personal fees from Faes Farma, Laboratorios Casasco Argentina, Abbott de Ecuador, EuroFarma Argentina.

MJ reports personal fees from ALK-Abello, Allergopharma, Stallergenes, Anergis, Allergy Therapeutics, Circassia, Leti, Biomay, HAL, during the conduct of the study; personal fees from AstraZeneca, GSK, Novartis, Teva, Vectura, UCB, Takeda, Roche, Janssen, Medimmune, Chiesi.

LK reports grants and personal fees from Allergopharma, MEDA/Mylan, LETI Pharma, Sanofi, grants from Stallergenes, Quintiles, ASIT biotech, grants from ALK Abelló, Lofarma, AstraZeneca, GSK, Inmunotk, personal fees from Allergy Therapeut, HAL Allergie, Cassella med; and Membership: AeDA, DGHNO, Deutsche Akademie für Allergologie und klinische Immunologie, HNO-BV, GPA, EAACI.

PK reports personal fees from Adamed, Berlin Chemie Menarini, Boehringer Ingelheim, AstraZeneca, Lekam, Novartis, Polpharma, GSK, Polpharma, Sanofi, teva.

VK reports other from GSK, non-financial support from Mylan, AstraZeneca, Dimuna, Norameda.

SL reports personal fees from DBV, Sanofi Aventis, Allergopharma, ALK, Nutricia, Bencard.

EM reports personal fees from Sanofi, Novartis, AstraZeneca and Chiesi.

JM reports personal fees and other from SANOFI-GENZYME & REGENERON, NOVARTIS, ALLAKOS, MITSUBISHI-TANABE, MENARINI, UCB, ASTRAZENECA, GSK, MSD, grants and personal fees from MYLAN-MEDA Pharma, URIACH Group.

MO reports personal fees from Hycor Diagnostics, Thermo Fisher Phadia.

YO reports personal fees from Torii Pharmaceutical Co., Ltd., Shionogi Pharmaceutical Co.,Ltd.

OP received research grants from Inmunotek S.L., Novartis and MINECO and has received fees for giving scientific lectures or participation in Advisory Boards from: Allergy Therapeutics, Amgen, AstraZeneca, Diater, GlaxoSmithKline, S.A, Inmunotek S.L, Novartis, Sanofi-Genzyme and Stallergenes.

NGP reports personal fees from Novartis, Nutricia, HAL, MENARINI/FAES FARMA, SANOFI, MYLAN/MEDA, BIOMAY, AstraZeneca, GSK, MSD, ASIT BIOTECH, Boehringer Ingelheim, grants from Gerolymatos International SA, Capricare.

OP reports grants and personal fees from ALK-Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, ASIT Biotech Tools S.A., Laboratorios LETI/LETI Pharma, Anergis S.A., Glaxo Smith Kline, grants from Biomay, Circassia, Pohl-Boskamp, Inmunotek S.L., personal fees from MEDA Pharma/ MYLAN, Mobile Chamber Experts (a GA2LEN Partner), Indoor Biotechnologies, Astellas Pharma Global, EUFOREA, ROXALL Medizin, Novartis, Sanofi-Aventis and Sanofi-Genzyme, Med Update Europe GmbH, streamedup! GmbH, John Wiley and Sons, AS.

DPreports grants and personal fees from GlaxoSmithKline, personal fees from Menarini, Pliva, Belupo, AbbVie, Novartis, MSD, Chiesi, Revenio, personal fees and non-financial support from Boehringer Ingelheim, non-financial support from Philips.

MR is on the Advisory board- A. Menarini - Speaker - Astra Zeneca, Novartis, Sanofi, Mylan.

FSRreports speaker and advisory fees from AstraZeneca, Novartis, Sanofi, GSK, Teva and Lusomedicamenta.

GR reports payment to his Institution from Allergo Pharma.

BSreports personal fees from Allergopharma, during the conduct of the study; grants from National Health Programm, grant, personal fees from Polpharma, ASTRA, personal fees from Mylan, Adamed, patient ombudsman, national Centre for Research and Development, Polish Allergology Society.

JS reports grants and personal fees from Sanofi, personal fees from GSK, Novartis, Astra Zeneca, Mundipharma, Faes Farma.

GS reports personal fees from ALK, and leds on the BSACI Rhinitis Guidelines and lead for EUFOREA on Allergic Rhinitis.
PSG reports personal fees from Allergopharma, ALK, grants from Bencard, grants and personal fees from Stallergenes.

JS reports personal fees from Mylan, F2F events.

ATB reports grants and personal fees from Teva, AstraZeneca, GSK Sanofi, Mundipharma, personal fees from Bial, Novartis.

MJ reports grants from European Commission, SEAIC, ISCIII, personal fees from Diater laboratory, Leti laboratory, Aimmune Therapeutics.

MW reports personal fees from ALK-Abello, Allergopharma, AstraZeneca, Bencard, Genzyme, GlaxoSmithKline, HAL Allergy, LETI, Meda Pharma, Novartis, Sanofi, Stallergenes, Teva.

DW reports other from Optinose, ALK, Sanofi; past Co-Chair of the Joint Task Force on Practice Parameters of the AAAAI and ACAAI. Second author of a recently published practice parameter on Rhinitis.

MW reports other from Arahaz (Medexus), Pediapharm, Pfizer, Astra Zeneca, GSK, Alk.

MZ reports personal fees from Takeda.

TZ reports and Organizational affiliations: Committee member: WHO-Initiative "Allergic Rhinitis and Its Impact on Asthma" (ARIA). Member of the Board: German Society for Allergy and Clinical

Immunology (DGAKI). Head: European Centre for Allergy Research Foundation (ECARF). Secretary General: Global Allergy and Asthma European Network (GA²LEN). Member: Committee on Allergy Diagnosis and Molecular Allergology, World Allergy Organization (WAO).

ORCID

Jean Bousquet https://orcid.org/0000-0002-4061-4766

Victoria Cardona https://orcid.org/0000-0003-2197-9767

Ralph Mösges https://orcid.org/0000-0002-1928-810X

Dermot Ryan https://orcid.org/0000-0002-4115-7376

Manuel Soto-Quiros https://orcid.org/0000-0003-3425-3463

Isabel Skypala https://orcid.org/0000-0003-3629-4293

Mihaela Zidarn https://orcid.org/0000-0003-0515-5207

**How to cite this article:** Bousquet J, Pfaar O, Agache I, et al. ARIA-EAACI care pathways for allergen immunotherapy in respiratory allergy. *Clin Transl Allergy*. 2021;e12014. https://doi.org/10.1002/clt2.12014