EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Fecha: Lunes 1 de abril

EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy

Authors: 

Pajno GB1, Fernandez-Rivas M2, Arasi S1,3, Roberts G4,5,6, Akdis CA7, Alvaro-Lozano M8, Beyer K3,9, Bindslev-Jensen C10, Burks W11, Ebisawa M12, Eigenmann P13, Knol E14, Nadeau KC15, Poulsen LK16, van Ree R17, Santos AF18,19,20, du Toit G18,19,20, Dhami S21, Nurmatov U22, Boloh Y23, Makela M24, O'Mahony L7, Papadopoulos N25, Sackesen C26, Agache I27, Angier E28, Halken S29, Jutel M30,31, Lau S3, Pfaar O32,33, Ryan D34, Sturm G35,36, Varga EM37, van Wijk RG38, Sheikh A34, Muraro A39

1 Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
2 Allergy Department, IdISSC, Hospital Clínico San Carlos, Madrid, Spain.
3 Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
4 The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK.
5 NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
6 Faculty of Medicine, University of Southampton, Southampton, UK.
7 Swiss Institute for Allergy and Asthma Research, University of Zurich, Davos, Switzerland.
8 Paediatric Allergy and Clinical Immunology Section, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
9 Icahn School of Medicine at Mount Sinai, New York, NY, USA.
10 Department of Dermatology and Allergy Center, Odense Research Center for anaphylaxis, Odense, Denmark.
11 Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
12 Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.
13 Medical School of the University of Geneva, University Hospitals of Geneva, Geneva, Switzerland.
14 Department of Immunology and Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
15 Division of Immunology, Allergy and Rheumatology, Department of Pediatrics, Stanford University, Stanford, CA, USA.
16 Allergy Clinic, Copenhagen University Hospital, Gentofte, Denmark.
17 Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
18 Division of Asthma Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, London, UK.
19 Guy's & St Thomas' Hospital, London, UK.
20 MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
21 Evidence-Based Health Care Ltd, Edinburgh, UK.
22 Division of Population Medicine Neuadd Meirionnydd, School of Medicine, Cardiff University, Cardiff, UK.
23 EAACI Patient Organization Committee, Region de Mans, France.
24 Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland.
25 2nd Pediatric Clinic, Allergy, University of Athens, Athens, Greece.
26 Koç University Hospital, Istanbul, Turkey.
27 Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University Brasov, Brasov, Romania.
28 Sheffield Teaching Hospital, Sheffield, UK.
29 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
30 Wroclaw Medical University, Wroclaw, Poland.
31 ALL-MED Medical Research Institute, Wroclaw, Poland.
32 Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
33 Center for Rhinology and Allergology, Wiesbaden, Germany.
34 Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK.
35 Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
36 Outpatient Allergy Clinic Reumannplatz, Vienna, Austria.
37 Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria.
38 Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
39 Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy.

Abstract:
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.

DOI: 10.1111/all.13319