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EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma

机译：EAACI对过敏原免疫疗法指南：房屋粉尘螨驱动过敏性哮喘

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Allergen immunotherapy (AIT) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence-based recommendations for the use of house dust mites (HDM) AIT as add-on treatment for HDM-driven allergic asthma. This guideline was developed by a multi-disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT-tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add-on to regular asthma therapy for adults with controlled or partially controlled HDM-driven allergic asthma (conditional recommendation, moderate-quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM-driven allergic asthma as the add-on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low-quality evidence).
机译：过敏原免疫疗法（AIT）已用于治疗过敏性疾病超过100年。哮喘治疗主要依赖于皮质类固醇等控制器建议达到和维持哮喘控制，防止加剧，提高生活质量。 AIT在儿童和成年人中患有哮喘。值得注意的是，过敏性哮喘患者未对药物疗法（包括生物制剂）的充分控制（包括生物学）表示未满足的健康需求。欧洲过敏和临床免疫学院校开发了一种临床实践指南，为使用房屋粉尘（HDM）AIT作为HDM驱动过敏性哮喘的附加治疗提供了循证建议。该指南由多学科工作组开发，使用建议评估，开发和评估（等级）方法进行评分。通过行政和儿童和成人的途径分别评估HDM AIT：皮下（SCIT）和舌下AIT（缝隙），滴剂和片剂。为每个建议制定了建议。用HDM AIT成功治疗的重要先决条件是（a）选择最有可能响应AIT和（b）用于验证疗效的过敏原提取物和脱敏协议的患者的选择。迄今为止，只有HDM Slit-Tablet的AIT在成年人中展示了临界终点（恶化，哮喘控制和安全性）的强大效果。因此，建议作为具有受控或部分控制的HDM驱动过敏性哮喘的成人常规哮喘治疗（条件推荐，适度质量证据）的加载项。对于成人和儿童建议使用HDM Scit，并为具有受控HDM驱动过敏性哮喘的儿童推荐狭缝滴作为常规哮喘治疗的加载项，以降低症状和药物需求（条件推荐，低质量证据）。

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