Abstract
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders, including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines, as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
Highlights
In all societies, the burden and cost of allergic diseases are increasing rapidly and “change management” strategies are needed to support the transformation of the health care system for integrated care
Biomarkers associated with mHealth and a clinical decision support system (CDSS) [46] may change the scope of Allergen immunotherapy (AIT) as they will help monitor the patient’s disease control [47, 48] for (i) patient stratification, (ii) clinical trials and real-world evidence, (iii) monitoring efficacy and safety of targeted therapies and (iv) implementation of stopping rules (Figure 3)
Evidence-based communication, strategy-patient-centred care, motivational interviewing, and shared-decision making underscore the importance of taking time to establish trust, understand patient concerns and priorities, and involve the patient in decisions regarding AIT [74]
Summary
The burden and cost of allergic diseases are increasing rapidly and “change management” strategies are needed to support the transformation of the health care system for integrated care. Integrated Care Pathways (ICPs) are structured multi-disciplinary care plans detailing the key steps of patient care [5]. They promote the translation of guideline recommendations into local protocols and their application to clinical practice [6, 7]. Many international and national guidelines on AIT [8,9,10,11,12,13,14, 17] have been produced but the evidence-based method varies, many are complex and none propose ICPs. The aim of the present publication is to develop the ARIA ICPs for both SCIT and SLIT that were proposed by a EAACI Task Force [18]
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