EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

G Roberts; O Pfaar; C A Akdis; I J Ansotegui; S R Durham; R Gerth van Wijk; S Halken; D Larenas-Linnemann; R Pawankar; C Pitsios; A Sheikh; M Worm; S Arasi; M A Calderon; C Cingi; S Dhami; J L Fauquert; E Hamelmann; P Hellings; L Jacobsen; E F Knol; S Y Lin; P Maggina; R Mösges; J N G Oude Elberink; G B Pajno; E A Pastorello; M Penagos; G Rotiroti; C B Schmidt-Weber; F Timmermans; O Tsilochristou; E-M Varga; J N Wilkinson; A Williams; L Zhang; I Agache; E Angier; M Fernandez-Rivas; M Jutel; S Lau; R van Ree; D Ryan; G J Sturm; A Muraro

doi:10.1111/all.13317

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Allergy. 2018 Apr;73(4):765-798. doi: 10.1111/all.13317. Epub 2017 Oct 30.

Authors

G Roberts^{1

2

3}, O Pfaar^{4

5}, C A Akdis^{6

7}, I J Ansotegui⁸, S R Durham⁹, R Gerth van Wijk¹⁰, S Halken¹¹, D Larenas-Linnemann¹², R Pawankar¹³, C Pitsios¹⁴, A Sheikh¹⁵, M Worm¹⁶, S Arasi^{17

18}, M A Calderon⁹, C Cingi¹⁹, S Dhami²⁰, J L Fauquert²¹, E Hamelmann²², P Hellings^{23

24}, L Jacobsen²⁵, E F Knol²⁶, S Y Lin²⁷, P Maggina²⁸, R Mösges²⁹, J N G Oude Elberink^{30

31}, G B Pajno¹⁷, E A Pastorello³², M Penagos⁹, G Rotiroti³³, C B Schmidt-Weber³⁴, F Timmermans³⁵, O Tsilochristou³⁶, E-M Varga³⁷, J N Wilkinson³⁸, A Williams³⁹, L Zhang⁴⁰, I Agache⁴¹, E Angier⁴², M Fernandez-Rivas⁴³, M Jutel^{44

45}, S Lau⁴⁶, R van Ree⁴⁷, D Ryan⁴⁸, G J Sturm^{49

50}, A Muraro⁵¹

Affiliations

¹ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.
² NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³ Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.
⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
⁵ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁶ Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland.
⁷ Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.
⁸ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Erandio, Bilbao, Spain.
⁹ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁰ Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
¹¹ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹² Center of Excellence in Asthma and Allergy, Hospital Médica Sur, Mexico City, Mexico.
¹³ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
¹⁴ Medical School, University of Cyprus, Nicosia, Cyprus.
¹⁵ Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
¹⁶ Department of Dermatology and Allergy, Charité Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
¹⁸ Molecular Allergo'logy and Immunomodulation - Department of Pediatric Pneumology and Immunology, Charite Medical University, Berlin, Germany.
¹⁹ Department of Otorhinolaryngology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey.
²⁰ Evidence Based Health Care Ltd, Edinburgh, UK.
²¹ CHU Clermont-Ferrand University Hospital (CHU Estaing), Unité d'allergologie de l'enfant, Clermont-Ferrand, France.
²² Children's Hospital Bethel, EvKB, Bielefeld University, Bielefeld, Germany.
²³ Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.
²⁴ Department of Otorhinolaryngology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
²⁵ Allergy Learning and Consulting, Copenhagen, Denmark.
²⁶ Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
²⁷ Johns Hopkins Department of Otolaryngology - Head and Neck Surgery, Baltimore, MD, USA.
²⁸ Allergy and Clinical Immunology Unit, 2nd Department of Pediatrics, NKUA Athens University, Athens, Greece.
²⁹ Clinical Research International Ltd, Hamburg, Germany.
³⁰ Department of Allergology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³¹ GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³² Department of Allergy and Immunology, Asst Grande Ospedale Metropolitano Niguarda, University of Milano, Milano, Italy.
³³ Department of Allergy and Medical Rhinology, The Royal National Throat Nose and Ear Hospital, University College Hospital, London, UK.
³⁴ Center of Allergy and Environment (ZAUM) & Institute of Allergy Research, Helmholtz Center Munich, Munich, Germany.
³⁵ European Anaphylaxis Taskforce - Nederlands Anafylaxis Netwerk, Dordrecht, The Netherlands.
³⁶ Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, Children's Allergy Service, King's College London, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK.
³⁷ Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria.
³⁸ Pharmaceutical Group of the European Union, Brussels, Belgium.
³⁹ Allergy Department, Guys and St Thomas' NHS Foundation Trust, London, UK.
⁴⁰ Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
⁴¹ Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania.
⁴² Department of Clinical Immunology and Allergy, Northern General Hospital, Sheffield, UK.
⁴³ Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
⁴⁴ ALL-MED Medical Research Institute, Wroclaw, Poland.
⁴⁵ Wroclaw Medical University, Wroclaw, Poland.
⁴⁶ Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
⁴⁷ Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁴⁸ Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, Edinburgh, UK.
⁴⁹ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
⁵⁰ Outpatient Allergy Clinic Reumannplatz, Vienna, Austria.
⁵¹ Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Padua, Italy.

PMID: 28940458
DOI: 10.1111/all.13317

Abstract

Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children.

Keywords: allergen immunotherapy; allergic conjunctivitis; allergic rhinitis; allergy; rhinoconjunctivitis.

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't

MeSH terms

Conjunctivitis, Allergic / prevention & control*
Desensitization, Immunologic / methods*
Desensitization, Immunologic / standards*
Humans
Rhinitis, Allergic / prevention & control*

Grants and funding

G1000758/MRC_/Medical Research Council/United Kingdom