EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis.

Area of Science:

• Allergy and Immunology
• Clinical Medicine
• Pharmacology

Background:

• Allergic rhinoconjunctivitis (AR) affects 20% of the population, with symptoms often persisting despite conventional treatments.
• Pharmacotherapy for AR can cause side effects and does not address the underlying disease mechanisms.
• Allergen immunotherapy (AIT) is the only treatment targeting AR pathophysiology, potentially offering disease modification.

Purpose of the Study:

• To provide evidence-based clinical recommendations for allergen immunotherapy (AIT) in allergic rhinoconjunctivitis (AR).
• To offer guidance on subcutaneous (SCIT) and sublingual (SLIT) AIT routes based on systematic review and meta-analysis.
• To inform healthcare professionals on the efficacy and application of AIT for AR management.

Main Methods:

• A formal systematic review and meta-analysis informed the guideline development.
• The Appraisal of Guidelines for Research and Evaluation (AGREE II) approach was followed.
• Involvement of a wide range of stakeholders ensured comprehensive guideline creation.

Main Results:

• Broad evidence supports the clinical efficacy of AIT for AR, though product-specific evaluation is advised.
• SCIT and SLIT are recommended for both seasonal and perennial AR, providing short-term benefits.
• Strongest evidence for long-term benefit is for grass AIT, particularly grass tablets, with a minimum of 3 years of therapy recommended for sustained efficacy.

Conclusions:

• AIT is a recommended treatment for AR, offering both short-term symptom control and potential long-term disease modification.
• A minimum of 3 years of AIT is recommended to achieve long-term efficacy.
• Further research is needed to address evidence gaps, especially regarding long-term benefits and AIT use in pediatric populations.