EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy
Por:
Pajno GB, Fernandez-Rivas M, Arasi S, Roberts G, Akdis CA, Alvaro-Lozano M, Beyer K, Bindslev-Jensen C, Burks W, Ebisawa M, Eigenmann P, Knol E, Nadeau KC, Poulsen LK, van Ree R, Santos AF, du Toit G, Dhami S, Nurmatov U, Boloh Y, Makela M, O'Mahony L, Papadopoulos N, Sackesen C, Agache I, Angier E, Halken S, Jutel M, Lau S, Pfaar O, Ryan D, Sturm G, Varga EM, van Wijk RG, Sheikh A and Muraro A
Publicada:
1 abr 2018
Ahead of Print:
5 dic 2017
Resumen:
Food allergy can result in considerable morbidity, impairment of quality of life, and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergen immunotherapy (FA-AIT) through the oral (OIT), sublingual (SLIT), or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE-mediated Food Allergy, aims to provide evidence-based recommendations for active treatment of IgE-mediated food allergy with FA-AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post-discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA-AIT has most frequently been assessed: here, the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow's milk, hen's egg, and peanut allergies. A benefit post-discontinuation is also suggested, but not confirmed. Adverse events during FA-AIT have been frequently reported, but few subjects discontinue FA-AIT as a result of these. Taking into account the current evidence, FA-AIT should only be performed in research centers or in clinical centers with an extensive experience in FA-AIT. Patients and their families should be provided with information about the use of FA-AIT for IgE-mediated food allergy to allow them to make an informed decision about the therapy.
Filiaciones:
Pajno GB:
Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
Fernandez-Rivas M:
Allergy Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
Arasi S:
Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
Roberts G:
The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
Faculty of Medicine, University of Southampton, Southampton, UK
Akdis CA:
Swiss Institute for Allergy and Asthma Research, University of Zurich, Davos, Switzerland
Alvaro-Lozano M:
Paediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
Beyer K:
Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
Icahn School of Medicine at Mount Sinai, New York, NY, USA
Bindslev-Jensen C:
Department of Dermatology and Allergy Center, Odense Research Center for anaphylaxis, Odense, Denmark
Burks W:
Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Ebisawa M:
Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
Eigenmann P:
Medical School of the University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
Knol E:
Department of Immunology and Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
Nadeau KC:
Division of Immunology, Allergy and Rheumatology, Department of Pediatrics, Stanford University, Stanford, CA, USA
Poulsen LK:
Allergy Clinic, Copenhagen University Hospital, Gentofte, Denmark
van Ree R:
Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
Santos AF:
Division of Asthma Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, London, UK
Guy's & St Thomas' Hospital, London, UK
MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
du Toit G:
Division of Asthma Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, London, UK
Guy's & St Thomas' Hospital, London, UK
MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
Dhami S:
Evidence-Based Health Care Ltd, Edinburgh, UK
Nurmatov U:
Division of Population Medicine Neuadd Meirionnydd, School of Medicine, Cardiff University, Cardiff, UK
Boloh Y:
EAACI Patient Organization Committee, Region de Mans, France
Makela M:
Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
O'Mahony L:
Swiss Institute for Allergy and Asthma Research, University of Zurich, Davos, Switzerland
Papadopoulos N:
2nd Pediatric Clinic, Allergy, University of Athens, Athens, Greece
Sackesen C:
Koç University Hospital, Istanbul, Turkey
Agache I:
Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
Angier E:
Sheffield Teaching Hospital, Sheffield, UK
Halken S:
Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
Jutel M:
Wroclaw Medical University, Wroclaw, Poland
ALL-MED Medical Research Institute, Wroclaw, Poland
Lau S:
Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
Pfaar O:
Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Center for Rhinology and Allergology, Wiesbaden, Germany
Ryan D:
Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
Sturm G:
Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
Outpatient Allergy Clinic Reumannplatz, Vienna, Austria
Varga EM:
Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria
van Wijk RG:
Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
Sheikh A:
Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
Muraro A:
Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy
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