EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Abstract

drawn on data from a systematic review of the literature, more recent published studies and multistakeholder expert clinical opinion. This Guideline is aimed at healthcare professionals who are encouraged to take the recommendations into account in the context of delivering clinical care. This Guideline is not a substitute for professional clinical judgment, which professionals need to exercise in the context of delivering personalised healthcare. AbstractAllergic 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 766 | ROBERTS, PFAAR ET AL. 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. | ME TH ODOLOGYThis Guideline was produced using the Appraisal of Guidelines forResearch & Evaluation (AGREE II) approach, 17,18 a structured approach to guideline production (see Table S1). This is designed to ensure appropriate representation of the full range of stakeholders, a careful search for and critical appraisal of the relevant literature, a systematic approach to the formulation and presentation of recommendations and steps to ensure that the risk of bias is minimized at each step of the process. The process started on April 2015 beginning with detailed face-to-face discussions agreeing on the process and the key clinical areas to address, followed by face-to-face meetings, and regular web conferences in which professional and lay representatives participated. | Clarifying the scope and purpose of the guidelinesThe scope of this EAACI Guideline is multifaceted...

EAACI guidelines on allergen immunotherapy: Executive statement

“…Allergic rhinoconjunctivitis 8 • AIT should be considered in patients with allergic rhinitis (AR), with or without conjunctivitis; evidence of IgE-sensitization to 1 or more clinically relevant allergens; and moderate to severe symptoms despite regular and/or avoidance strategies.…”

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

“…[13][14][15][16] The 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-economical differences within and between countries, and preparedness of primary care to participate in the delivery of AIT. [13][14][15][16][17] Harmonization and validation of clinical outcomes, standardization of products between companies, consistent use of the uniform classification systems for grading AIT systemic and local reactions both in clinical trials, and surveillance studies will allow better comparisons and best practices for all AIT treatments. 14-18 Regulations on AIT have profound effects on allergy practice, allergen manufacturers, and research programs.…”

Liposomal Eye Spray Is as Effective as Antihistamine Eye Drops in Patients with Allergic Rhinoconjunctivitis Induced by Conjunctival Provocation Testing

“…Through artificial allergen exposure, the CPT serves as a model for the allergy season by triggering typical symptoms of ARC [18, 19]. Current guidelines recommend carrying out the CPT either before initiating allergen immunotherapy (AIT) to determine the allergens which induce the symptoms or conducting the CPT throughout the course of AIT to monitor its therapeutic effect [20]. …”