2019 ARIA Care pathways for allergen immunotherapy

Abstract

Allergen 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.

Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies

“…The burden and cost of inflammatory, infectious, and allergic disorders involving UA are increasing worldwide. Thus, strategies need to change management to support the transformation of the healthcare system for integrated care as recently proposed [110]. In this regard, integrated care pathways are structured multidisciplinary care plans that detail the key step of patient care [111].…”

Alum impairs tolerogenic properties induced by allergoid‐mannan conjugates inhibiting mTOR and metabolic reprogramming in human DCs

“…[4][5][6] Clinical trials and real-life practice demonstrated AIT as an effective treatment; however, it still faces several drawbacks regarding the long treatment duration, patient compliance, side effects or low efficacy for some patients. 3,7,8 Polymerized allergoids conjugated to mannan (PM) have been recently reported as next-generation vaccines targeting dendritic cells (DCs) that might well contribute to overcome such inconveniences. [9][10][11][12] PM are captured very efficiently by human DCs via mannose receptor and other C-type lectin receptors (CLRs).…”

Recent developments and highlights in allergic rhinitis

“…Mobile applications have been developed to monitor the symptoms, medication usage, and quality of life of the disease more efficiently and in a timely manner, 73-75 becoming of relevant importance for patient stratification. 76 In this regard, a large, cross-sectional, mul- 75 Furthermore, the study demonstrated that MASK diary is useful in evaluating daily AR management in a large population regardless of geographic, cultural, and linguistic differences. 75…”