2019 ARIA Care pathways for allergen immunotherapy
Authors: Bousquet Jean , Pfaar Oliver , Togias Alkis , Schünemann Holger J. , Ansotegui Ignacio , Papadopoulos Nikolaos G. , Tsiligianni Ioanna , Agache Ioana , Anto Josep M. , Bachert Claus , Bedbrook Anna , Bergmann Karl‐Christian , Bosnic‐Anticevich Sinthia , Bosse Isabelle , Brozek Jan , Calderon Moises A. , Canonica Giorgio W. , Caraballo Luigi , Cardona Victoria , Casale Thomas , Cecchi Lorenzo , Chu Derek , Costa Elisio , Cruz Alvaro A. , Czarlewski Wienczyslawa , Durham Stephen R. , Du Toit George , Dykewicz Mark , Ebisawa Motohiro , Fauquert Jean Luc , Fernandez‐Rivas Montserrat , Fokkens Wytske J. , Fonseca João , Fontaine Jean‐François , Gerth van Wijk Roy , Haahtela Tari , Halken Susanne , Hellings Peter W. , Ierodiakonou Despo , Iinuma Tomohisa , Ivancevich Juan Carlos , Jacobsen Lars , Jutel Marek , Kaidashev Igor , Khaitov Musa , Kalayci Omer , Kleine Tebbe Jörg , Klimek Ludger , Kowalski Marek L. , Kuna Piotr , Kvedariene Violeta , La Grutta Stefania , Larenas‐Linemann Désirée , Lau Susanne , Laune Daniel , Le Lan , Lodrup Carlsen Karin , Lourenço Olga , Malling Hans‐Jørgen , Marien Gert , Menditto Enrica , Mercier Gregoire , Mullol Joaquim , Muraro Antonella , O’Hehir Robyn , Okamoto Yoshitaka , Pajno Giovanni B. , Park Hae‐Sim , Panzner Petr , Passalacqua Giovanni , Pham‐Thi Nhan , Roberts Graham , Pawankar Ruby , Rolland Christine , Rosario Nelson , Ryan Dermot , Samolinski Bolesław , Sanchez‐Borges Mario , Scadding Glenis , Shamji Mohamed H. , Sheikh Aziz , Sturm Gunter J. , Todo Bom Ana , Toppila‐Salmi Sanna , Valentin‐Rostan Maryline , Valiulis Arunas , Valovirta Erkka , Ventura Maria‐Teresa , Wahn Ulrich , Walker Samantha , Wallace Dana , Waserman Susan , Yorgancioglu Arzu , Zuberbier Torsten ,   the ARIA Working Group
Published: April 2019

AbstractAllergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence‐based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good‐quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow‐up of patients.