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Decision-making for pediatric allergy immunotherapy for aeroallergens: a narrative review

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Abstract

There has been exciting progress in diagnosis and in the treatment of allergic patients. The objective of this review is to summarize the most relevant contributions in the past 10 years with a special focus on the pediatric population allergic to aeroallergens and provide the most relevant references and practical issues for the decision-making. Current guidelines on allergy diagnosis recommend a thorough clinical history as the first step, followed by allergen extract testing using an in vivo prick test and/or an in vitro specific IgE test. Molecular diagnosis is recommended when previous tests are inconclusive. In practice, the most important factors to decide the AIT treatment are the actual intensity and duration of the patient’s symptoms and the availability of appropriate AIT products for the patient’s sensitization profile at high allergen concentrations and with confirmed efficacy and safety from clinical trials. This document summarizes outstanding references for allergic immunotherapy decision-making and provides summary tables and figures analyzing the most important factors related to the decision for allergen immunotherapy and the safety risks related. The experts concluded that AIT is efficacious and safe for the treatment of allergic patients that is available for the most frequent aeroallergens.

What is Known:

• The prevalence of allergic asthma and rhinitis in children has increased in recent decades.

• The efficacy and safety of allergen immunotherapy has been shown in multiple studies and systematic reviews.

What is New:

• This document summarizes outstanding references for allergic immunotherapy decision-making and provides summary tables and figures analyzing the most important factors related to the decision for allergen immunotherapy and the safety risks related. Recommendations of expert authors for the decision of the patients more suitable for allergen immunotherapy are included.

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Abbreviations

ACAAI:

American College of Allergy, Asthma and Immunology

AIT:

Allergen immunotherapy

ARIA:

Allergic Rhinitis and its Impact on Asthma

EAACI:

European Academy of Allergy and Clinical Immunology

EMA:

European Medicines Agency

GINA:

Global Initiative for Asthma

HEP:

Histamine equivalent prick

Ig:

Immunoglobulin

IL:

Interleukin

ISAC:

Immuno-solid phase allergen chip

ISU:

ISAC standardized units

SCIT:

Subcutaneous immunotherapy

SLIT:

Sublingual immunotherapy

TGF-b:

Transforming growth factor beta

WAO:

World Allergy Organization

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Funding source

All phases of this document were supported by a Merck, S.L.U. grant.

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Authors and Affiliations

  1. Paediatric Allergology and Pulmonology Unit, Dr. Peset University Hospital, Valencia, Spain

    Miguel Tortajada-Girbés

  2. Fundación IVI, Valencia, Spain

    Miguel Tortajada-Girbés

  3. Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain

    Miguel Tortajada-Girbés

  4. Paediatric Allergology and Neumology Unit, Hospital El Escorial, Madrid, Spain

    María Mesa del Castillo

  5. Paediatric Allergology and Pulmonology Unit, Department of Paediatrics, University Autonoma of Barcelona, and Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain

    Helena Larramona

  6. Pediatric Allergy and Immunology Unit, Virgen Arrixaca Clinic Universitary Hospital, Murcia, Spain

    José Manuel Lucas

  7. Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain

    Montserrat Álvaro Lozano

  8. Complejo Hospitalario de Navarra; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    Ana Isabel Tabar

  9. Medical Department, E-C-BIO, S.L., c/ Rosa de Lima, 1, Edificio ALBA, Office 016, Las Rozas, 28230, Madrid, Spain

    Begoña Soler López

  10. Paediatric Allergology and Neumology Unit, Complejo Hospitalario Universitario de Granada, Coordinator of the SEICAP Immunotherapy Working Group, Granada, Spain

    Ana Martínez-Cañavate

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  1. Miguel Tortajada-Girbés
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  8. Ana Martínez-Cañavate
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on behalf of the Immunotherapy Working Group of the Spanish Society of Pediatric Clinical Immunology and Allergology (SEICAP)

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Dr. Tortajada-Girbés conceptualized and drafted the initial manuscript and reviewed and revised the manuscript. The remaining authors critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitter and agree to be accountable for all aspects of the work.

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Correspondence to Begoña Soler López.

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Tortajada-Girbés, M., Mesa del Castillo, M., Larramona, H. et al. Decision-making for pediatric allergy immunotherapy for aeroallergens: a narrative review. Eur J Pediatr 178, 1801–1812 (2019). https://doi.org/10.1007/s00431-019-03444-2

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