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Translating knowledge into clinical practice

European Academy of Allergy and Clinical Immunology

Allergen Immunotherapy

GuidelinesPart 1: Systematic reviews

EAACI GUIDELINESAllergen Immunotherapy Guidelines

Part 1: Systematic reviews

Editors

Antonella Muraro

Graham Roberts

Editorial BoardIoana Agache

Liz AngierAndreas BonertzSangeeta Dhami

Montserrat Fernandez RivasRoy Gerth van Wijk

Susanne HalkenMarek Jutel

Susanne LauGiovanni Pajno

Oliver PfaarDermot Ryan

Aziz SheikhGunter Sturm

Ronald van ReeEva-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 Membersand to our patients

VAllergen Immunotherapy Guidelines

Contents

Prevention of allergy1 Allergen immunotherapy for the prevention of allergy:

a systematic review and meta-analysis12 Venom immunotherapy35 Allergen immunotherapy for insect venom allergy:a systematic review and meta-analysis3 IgE-food allergy65 Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis4 Asthma85 Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis5 Rhinoconjunctivitis121 Allergen immunotherapy for allergic rhinoconjunctivitis:a systematic review and meta-analysis

VIIAllergen Immunotherapy Guidelines

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 MuraroEAACI President

IXAllergen Immunotherapy Guidelines

List of contributors

Ioana AgacheTransylvania University Brasov, Faculty of Medicine, Department of Allergy and Clinical Immunology, Brasov, Romania

Arnav AgarwalSchool of Medicine, University of Toronto, Canada

Cezmi A. Akdis Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland; Christine Khne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland

Ather AkhlaqHealth and Hospital Management Institute of Business Management, Korangi Creek, Karachi, Pakistan

Montserrat Alvaro-LozanoPaediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain

Liz AngierClinical Immunology and Allergy Unit, Northern General Hospital, Sheffield, UK

Ignacio J. AnsoteguiDepartment of Allergy & Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain

Daro Antoln-Amrigo Immune System Diseases Department-Allergy Unit. Prncipe de Asturias University Hospital. Department of Medicine and medical specialties. Universidad de Alcal, Madrid, Spain

Stefania ArasiMolecular Allergology and Immunomodulation-Department of Pediatric Pneumology and Immunology, Charit Medical University, Berlin, Germany

Felix AsamoahCentre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine Barts and the London School of Medicine and Dentistry Queen Mary University of London, London, UK

Miqdad Asaria Research Fellow Centre for Health Economics, University of York, UK

Kirsten BeyerPediatric Pneumology and Immunology, Charite Universittsmedizin, Berlin, Germany

M. Beatrice Bil Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy

Carsten Bindslev-JensenDepartment of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark

Danijela BokanovicDepartment of Dermatology and Venerology, Medical University of Graz, Graz, Austria

Andreas BonertzPaul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany

Matteo BoniniNational Heart and Lung Institute, Imperial College London, UK

Sergio Bonini Department of Clinical and Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy

Wesley BurksDepartment of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Moises A. CalderonSection of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK

Ozlem CavkaytarSami Ulus Womens & Childrens Diseases Training and Research Hospital, Department of Pediatric Allegy and Clinical Immunology, Ankara, Turkey

Ewa Cichocka-Jarosz Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland

Cemal CingiDepartment of ENT, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey

Sangeeta Dhami Evidence-Based Health Care Ltd, Edinburgh, UK

X Allergen Immunotherapy Guidelines

George Du ToitDivision of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, MRC & Asthma Centre in Allergic Mechanisms of Asthma, Kings College London, London, UK; St Thomas NHS Foundation trust, London, UK

Stephen DurhamNational Heart and Lung Institute, Imperial College, London, UK

Motohiro EbisawaDepartment of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan

Philippe EigenmannUniversity Hospitals of Geneva and Medical School of the University of Geneva, Geneva, Switzerland

Montserrat Fernandez-RivasAllergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain

Breda FloodEuropean Federation of Allergy and Airways Diseases Patients Association,

Pawel GajdanowiczWroclaw Medical University, Wroclaw, Poland

Radoslaw Gawlik Department of Internal Medicine, Allergy and Clinical Immunology, Medical University of Silesia, Katowice, Poland

Roy Gerth van WijkSection of Allergology, Department of Internal Medicine, Erasmus MC Ro

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