Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement

Peter Hellings ,Christine Breynaert ,Jean-Baptiste Watelet ,X Van Der Brempt,Laura Van Gerven ,Jan Ceuppens ,Kathie Vierstraete ,Philippe Gevaert ,Olivier M Vanderveken ,R Schrijvers,Stephan Vlaminck ,Jean Bousquet ,Kato Speleman ,Stijn Halewyck ,Gregory Clement ,Philippe Rombaux ,Gert Mariën ,Raf Jacobs ,Tony Cox ,Dominique Bullens ,B Verhaeghe,Claus Bachert ,Karim Ladha ,Valérie Hox ,Benoı̂t Pugin ,Didier G Ebo ,Sven Seys

doi:10.1186/s13601-019-0243-1

Abstract

Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.

Highlights

Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium
A treatment period of 3 years is recommended to achieve long-term efficacy persisting after treatment discontinuation
A consensus meeting organized by the National Institute for Health and Disability Insurance in Belgium (i.e. Rijksinstituut voor ziekte- en invaliditeitsverzekering, RIZIV) concluded that sufficient clinical effectiveness is available and that cost-effectiveness is likely to be present after a minimal treatment with Allergen immu‐ notherapy (AIT) of 3 years, especially given the reduction of other medical treatments and the long-term effects after cessation of the AIT [43]

Summary

Introduction

Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium. A more recent study in Belgium demonstrated that 37% of AR patients receiving currently available pharmacotherapy have uncontrolled disease [27]. This real-life study showed that only 15% of AR patients attending a tertiary referral center for AR received AIT, illustrating the need for better adoption of AIT in daily practice.

Results

Conclusion