Translating knowledge into clinical practice European Academy of Allergy and Clinical ...

192 Pages·2017·2.57 MB·English

Allergen
Immunotherapy
Guidelines
Part 1: Systematic reviews
Translating knowledge into clinical practice
European Academy of Allergy and Clinical Immunology

EAACI GUIDELINES
Allergen Immunotherapy Guidelines
Part 1: Systematic reviews
Editors
Antonella Muraro
Graham Roberts
Editorial Board
Ioana Agache
Liz Angier
Andreas Bonertz
Sangeeta Dhami
Montserrat Fernandez Rivas
Roy Gerth van Wijk
Susanne Halken
Marek Jutel
Susanne Lau
Giovanni Pajno
Oliver Pfaar
Dermot Ryan
Aziz Sheikh
Gunter Sturm
Ronald van Ree
Eva-Maria Varga
Stefan Vieths
EAACI
Hagenholzsltrasse 111
3rd Floor
8050 Zurich
CH-Switzerland
The European Academy of Allergy and Clinical Immunology (EAACI) is a non-profit organisation active in the
field of allergic and immunologic diseases such as asthma, rhinitis, eczema, occupational allergy, food and
drug allergy and anaphylaxis. EAACI was founded in 1956 in Florence and has become the largest medical
association in Europe in the field of allergy and clinical immunology. It includes over 10,000 members from
122 countries, as well as over 60 national and international member societies.
© European Academy of Allergy and Clinical Immunology (EAACI) 2017
All rights reserved
ISBN Number: 978-3-9524815-0-9.
For all EAACI Members
and to our patients

Contents
1 Prevention of allergy
1 Allergen immunotherapy for the prevention of allergy:
a systematic review and meta-analysis
2 Venom immunotherapy
35 Allergen immunotherapy for insect venom allergy:
a systematic review and meta-analysis
3 IgE-food allergy
65 Allergen immunotherapy for IgE-mediated food allergy:
a systematic review and meta-analysis
4 Asthma
85 Allergen immunotherapy for allergic asthma:
a systematic review and meta-analysis
5 Rhinoconjunctivitis
121 Allergen immunotherapy for allergic rhinoconjunctivitis:
a systematic review and meta-analysis
Allergen Immunotherapy Guidelines V

Foreword
EAACI has a long history and strong ethos in implementing the latest research findings to deliver better healthcare
for patients with allergies. Over the last decades this mission has become even more important with allergic diseases
now affecting the lives of millions of people around the world. This represents a major burden for patients as well as
their clinicians, governments, legislators and regulators. The current challenge is to deliver appropriate treatments
that are able to prevent lifetime disabilities, shifting from “treating a disease “ to “promote health” in a sustainable
context.
Allergen immunotherapy (AIT) has been used for a century. Several terms including “desensitization”,
“hyposensitization“ and “vaccines” have been used, and often misused, to indicate administration of incremental
doses of allergenic substances to reduce the clinical manifestations of allergy. However AIT has also been the subject
of considerable controversy in terms of its efficacy. The dispute has impacted on the dissemination of knowledge
about AIT, the availability of the products in many countries and the relevant policies for their reimbursement. Some
of these issues result from an inadequate translation of the scientific data into daily practice, with clinical judgment
being established on expert opinion instead of the objective evaluation of valid scientific studies.
These Guidelines for clinical practice aim to define the current literature and they have synthesized the scientific
evidence in a well structured, systematic and reproducible process. This has been combined with the expertise of
clinicians, the preferences of patients and the needs of policy makers. The purpose has been to develop clinically
valid, operational recommendations which serve as a strong basis to help the allergist to advocate for AIT,
practitioners to refer patients onto appropriate management, the patient to request the best standard of care for
their disease and quality of life and the regulators to evaluate the sustainability for the health-care system. Of note,
these recommendations cannot, and will not, stand forever but will need to be revised as soon as new research
developments are available.
These guidelines follow the previous guidelines on Food Allergy and Anaphylaxis. Together, they have defined a
crucial change resulting in a framework of a rigorous methodological approach for future guidelines. The ambition
for EAACI is to drive the perception of clinicians and stakeholders from relying on old “pre-cooked recipes“ to
focusing on critical thinking and applicability of the recommendations.
Almost all the EAACI groups have worked on these AIT Guidelines. It is thanks to the tireless efforts of the many
task forces Chairs, to the Sections and to the Interest Groups that we have been able to develop comprehensive
Guidelines. We also need to thank the commitment of the EAACI members who contributed through the public
comment, the Board of Officers and the Executive Committee and almost 100 experts from all over the world who
have worked with enthusiasm and who have been instrumental to maintain the pace over the last 2 years. I feel
privileged for their vision and continuous support.
This is, indeed, the start of the journey. Implementing the Guidelines both nationally and internationally will measure
the success of this project. We are sure that EAACI members have the strength and dedication to accomplish this
achievement.
Antonella Muraro
EAACI President
Allergen Immunotherapy Guidelines VII