International Consensus on Allergen Immunotherapy II: Mechanisms, standardization, and pharmacoeconomics

Marek Jutel; Ioana Agache; Sergio Bonini; A Wesley Burks; Moises Calderon; Walter Canonica; Linda Cox; Pascal Demoly; Antony J Frew; Robyn O'Hehir; Jörg Kleine-Tebbe; Antonella Muraro; Gideon Lack; Désirée Larenas; Michael Levin; Bryan L Martin; Harald Nelson; Ruby Pawankar; Oliver Pfaar; Ronald van Ree; Hugh Sampson; James L Sublett; Kazunari Sugita; George Du Toit; Thomas Werfel; Roy Gerth van Wijk; Luo Zhang; Mübeccel Akdis; Cezmi A Akdis

doi:10.1016/j.jaci.2015.12.1300

International Consensus on Allergen Immunotherapy II: Mechanisms, standardization, and pharmacoeconomics

J Allergy Clin Immunol. 2016 Feb;137(2):358-68. doi: 10.1016/j.jaci.2015.12.1300.

Authors

Marek Jutel¹, Ioana Agache², Sergio Bonini³, A Wesley Burks⁴, Moises Calderon⁵, Walter Canonica⁶, Linda Cox⁷, Pascal Demoly⁸, Antony J Frew⁹, Robyn O'Hehir¹⁰, Jörg Kleine-Tebbe¹¹, Antonella Muraro¹², Gideon Lack¹³, Désirée Larenas¹⁴, Michael Levin¹⁵, Bryan L Martin¹⁶, Harald Nelson¹⁷, Ruby Pawankar¹⁸, Oliver Pfaar¹⁹, Ronald van Ree²⁰, Hugh Sampson²¹, James L Sublett²², Kazunari Sugita²³, George Du Toit²⁴, Thomas Werfel²⁵, Roy Gerth van Wijk²⁶, Luo Zhang²⁷, Mübeccel Akdis²³, Cezmi A Akdis²³

Affiliations

¹ Department of Clinical Immunology, Wroclaw Medical University, and "ALL-MED" Medical Research Institute, Wroclaw, Poland. Electronic address: marek.jutel@umed.wroc.pl.
² Faculty of Medicine, Transylvania University, Brasov, Romania.
³ Second University of Naples and IFT-CNR, Rome, and Expert-on-Secondment European Medicines Agency, London, United Kingdom.
⁴ Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
⁵ Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom.
⁶ Allergy & Respiratory Diseases Clinic, DIMI University of Genoa, IRCCS AOU San Martino, Genova, Italy.
⁷ Allergy and Asthma Center, Fort Lauderdale, Fla.
⁸ University Hospital of Montpellier-INSERM U657, Montpellier, France.
⁹ Department of Respiratory Medicine, Royal Sussex County Hospital, Brighton, United Kingdom.
¹⁰ Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia.
¹¹ Allergy & Asthma Center Westend, Berlin, Germany.
¹² Department of Mother and Child Health, Padua General University Hospital, Padua, Italy.
¹³ Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and the Children's Allergy Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
¹⁴ Hospital Médica Sur, Mexico City, Mexico.
¹⁵ Division of Allergy, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
¹⁶ Department of Allergy and Immunology, Walter Reed Army Medical Center, Silver Spring, Md.
¹⁷ National Jewish Health, Denver, Colo.
¹⁸ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
¹⁹ Center for Rhinology and Allergology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany.
²⁰ Academic Medical Center, Departments of Experimental Immunology and of Otorhinolaryngology, University of Amsterdam, Amsterdam, The Netherlands.
²¹ Department of Pediatrics, Division of Allergy-Immunology, and the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, New York, NY.
²² Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, Louisville, Ky.
²³ Swiss Institute for Allergy and Asthma Research, University of Zurich, and Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
²⁴ Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
²⁵ Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany.
²⁶ Erasmus Medical Center, Rotterdam, The Netherlands.
²⁷ Beijing Institute of Otolaryngology, Beijing, China.

PMID: 26853128
DOI: 10.1016/j.jaci.2015.12.1300

Abstract

This article continues the comprehensive international consensus (ICON) statement on allergen immunotherapy (AIT). The initial article also recently appeared in the Journal. The conclusions below focus on key mechanisms of AIT-triggered tolerance, requirements in allergen standardization, AIT cost-effectiveness, and regulatory guidance. Potential barriers to and facilitators of the use of AIT are described in addition to future directions. International allergy specialists representing the European Academy of Allergy and Clinical Immunology; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the World Allergy Organization critically reviewed the existing literature and prepared this summary of recommendations for best AIT practice. The authors contributed equally and reached consensus on the statements presented herein.

Keywords: International consensus; allergen standardization; allergen vaccine; allergy; cost-effectiveness; immunotherapy; marketing authorization; mechanisms; pharmacoeconomics; regulatory authorities; tolerance; unmet needs.

Publication types

Review

MeSH terms

Allergens / administration & dosage
Allergens / immunology*
Consensus
Cost-Benefit Analysis
Desensitization, Immunologic* / economics
Desensitization, Immunologic* / methods
Desensitization, Immunologic* / standards
Economics, Pharmaceutical / legislation & jurisprudence
Humans
Hypersensitivity / immunology*
Hypersensitivity / therapy*
Immune Tolerance

Substances

Allergens