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

Allergen immunotherapy (AIT) has been in use for the treatment of allergic diseasefor more than 100 years. Asthma treatment relies mainly on corticosteroids andother controllers recommended to achieve and maintain asthma control, preventexacerbations, and improve quality of life. AIT is underused in asthma, both in chil-dren and in adults. Notably, patients with allergic asthma not adequately controlledon pharmacotherapy (including biologics) represent an unmet health need. The Euro-pean Academy of Allergy and Clinical Immunology has developed a clinical practiceguideline providing evidence‐based recommendations for the use of house dustmites (HDM) AIT as add‐on treatment for HDM‐driven allergic asthma. This guide-line was developed by a multi‐disciplinary working group using the Grading of Rec-ommendations Assessment, Development and Evaluation (GRADE) approach. HDMAIT was separately evaluated by route of administration and children and adults:subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendationswere formulated for each. The important prerequisites for successful treatment withHDM AIT are (a) selection of patients most likely to respond to AIT and (b) use ofallergen extracts and desensitization protocols of proven efficacy. To date, only AITwith HDM SLIT‐tablet has demonstrated a robust effect in adults for critical endpoints (exacerbations, asthma control, and safety). Thus, it is recommended as anadd‐on to regular asthma therapy for adults with controlled or partially controlledHDM‐driven allergic asthma (conditional recommendation, moderate‐quality evi-dence). HDM SCIT is recommended for adults and children, and SLIT drops are rec-ommended for children with controlled HDM‐driven allergic asthma as the add‐onto regular asthma therapy to decrease symptoms and medication needs (conditionalrecommendation, low‐quality evidence).KEYWORDSallergen immunotherapy, allergy, asthma, asthma control, asthma exacerbations, GRADE, housedust mites, lung function

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