2019 ARIA Care pathways for allergen immunotherapy

Jean Bousquet*, Oliver Pfaar, Alkis Togias, Holger J. Schünemann, Ignacio Ansotegui, Nikolaos G. Papadopoulos, Ioanna Tsiligianni, Ioana Agache, Josep M. Anto, Claus Bachert, Anna Bedbrook, Karl Christian Bergmann, Sinthia Bosnic-Anticevich, Isabelle Bosse, Jan Brozek, Moises A. Calderon, Giorgio W. Canonica, Luigi Caraballo, Victoria Cardona, Thomas CasaleLorenzo Cecchi, Derek Chu, Elisio Costa, Alvaro A. Cruz, Wienczyslawa Czarlewski, Stephen R. Durham, George Du Toit, Mark Dykewicz, Motohiro Ebisawa, Jean Luc Fauquert, Montserrat Fernandez-Rivas, Wytske J. Fokkens, João Fonseca, Jean François Fontaine, Roy Gerth van Wijk, Tari Haahtela, Susanne Halken, Peter W. Hellings, Despo Ierodiakonou, Tomohisa Iinuma, Juan Carlos Ivancevich, Lars Jacobsen, Marek Jutel, Igor Kaidashev, Musa Khaitov, Omer Kalayci, Jörg Kleine Tebbe, Ludger Klimek, Marek L. Kowalski, Piotr Kuna, Violeta Kvedariene, Stefania La Grutta, Désirée Larenas-Linemann, Susanne Lau, Daniel Laune, Lan Le, Karin Lodrup Carlsen, Olga Lourenço, Hans Jørgen Malling, Gert Marien, Enrica Menditto, Gregoire Mercier, Joaquim Mullol, Antonella Muraro, Robyn O’Hehir, Yoshitaka Okamoto, Giovanni B. Pajno, Hae-Sim Park, Petr Panzner, Giovanni Passalacqua, Nhan Pham-Thi, Graham Roberts, Ruby Pawankar, Christine Rolland, Nelson Rosario, Dermot Ryan, Bolesław Samolinski, Mario Sanchez-Borges, Glenis Scadding, Mohamed H. Shamji, Aziz Sheikh, Gunter J. Sturm, Ana Todo Bom, Sanna Toppila-Salmi, Maryline Valentin-Rostan, Arunas Valiulis, Erkka Valovirta, Maria-Teresa Ventura, Ulrich Wahn, Samantha Walker, Dana Wallace, Susan Waserman, Arzu Yorgancioglu, Torsten Zuberbier, the ARIA Working Group

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

140 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)2087-2102
Number of pages16
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number11
Publication statusPublished - 1 Nov 2019
Externally publishedYes


  • allergen immunotherapy
  • asthma
  • children
  • mHealth
  • rhinitis
  • stratification


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