EAACI guidelines on allergen immunotherapy—Out with the old and in with the new

Abstract

EAACI guidelines on allergen immunotherapy-Out with the old and in with the newOccurring in both developed and developing countries and across all ethnic groups and ages, allergic diseases represent a global health problem. During the last few decades, there has been an increase in the prevalence of allergic diseases and it has been predicted that by 2025, half of the entire EU population will be affected. 1 The 3 major management strategies are avoidance, symptom control by pharmacotherapy, and allergen immunotherapy (AIT). By contrast with symptom control by pharmacotherapy, AIT aims to modify the immune system via tolerance induction 2 and is potentially able to alter the course of allergic diseases. 3 The potential preventive effect of AIT is currently being explored for pollen. 4Introduced by Noon and Freeman in 1911 for the treatment of allergic rhinitis (AR), the procedure of desensitization using allergen extracts has been used around for more than 100 years. 5 A significant body of data accumulated regarding the safety and efficacy of AIT vaccines in adults and children both for respiratory allergy and for venom hypersensitivity and recent data look promising also for food allergy. However, AIT remains underused mainly due to lack of agreement between documented efficacy, insufficient data on its cost-effectiveness, educational level and different specialty of physicians taking care of allergic subjects, lack of awareness on AIT, scattered worldwide availability of regimens, and/or products for application, varying selection of potential responders. 6 AIT studies reached to high standards during recent years, with the requirements for study design reaching a satisfactory standard with a focus on solid end-points, evaluation of dose-response and optimal dosage, use of large patient cohorts, accurate statistical assessment, and reporting. These standards should be followed today, and GMP products with solid proof of efficacy and safety and well-defined immune mechanisms should be used to optimize the effectiveness of AIT as a key intervention in allergic diseases. been informed by a formal systematic review and meta-analysis. 9-12Pragmatic evidence synthesis and real-life studies were also considered where appropriate. Recommendations for clinical care were formulated using an adapted Oxford Centre for Evidence-BasedMedicine approach, which included highlighting the evidence base underpinning each recommendation and other potentially relevant contextual information. 13-16The key limitations of the EAACI AIT guidelines derive from the heterogeneity and gaps in the support literature. There are many areas for which there is no evidence or no high-quality evidence. Many gaps in the evidence base exist, particularly around AIT long-term benefit, use in the pediatric population or in polysensitized patients, rare allergens, the value of AIT for primary prevention, availability of biomarkers to select responders and evaluate the efficacy objectively or of strong cost-effectiveness analysis adjusted to socio-eco...

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