2019 ARIA Care pathways for allergen immunotherapy.

Area of Science:

• Allergy and Immunology
• Respiratory Medicine
• Pharmacotherapy

Background:

• Allergen immunotherapy (AIT) is an established treatment for allergic rhinitis and asthma.
• Existing guidelines for AIT are varied, complex, and lack proposed care pathways.
• There is a need for standardized, evidence-based AIT care pathways.

Purpose of the Study:

• To review existing care pathways for allergen immunotherapy (AIT) based on strict criteria.
• To provide simple, actionable recommendations for AIT implementation for all stakeholders.
• To standardize and improve the application of AIT in clinical practice.

Main Methods:

• Systematic review of AIT care pathways using predefined strict criteria.
• Analysis of guideline recommendations for AIT prescription and patient selection.
• Evaluation of factors influencing AIT efficacy and patient stratification.

Main Results:

• The decision for AIT should be individualized, considering allergen relevance, symptom persistence, and extract quality.
• AIT is typically prescribed by specialists for stratified patients; validated biomarkers for success prediction are lacking.
• AIT is recommended for moderate/severe allergic rhinitis or moderate asthma in adolescents/adults, potentially beneficial in multimorbidity and for preventing asthma in children.
• mHealth tools show promise for patient stratification and follow-up.

Conclusions:

• Development of simplified, evidence-based AIT care pathways is crucial for consistent patient care.
• Individualized patient assessment and specialist involvement are key to successful AIT.
• Future research should focus on predictive biomarkers and leveraging mHealth for AIT management.