Good clinical practice recommendations in allergen immunotherapy: Position paper of the Brazilian Association of Allergy and Immunology - ASBAI

Fernando Monteiro Aarestrup; Ernesto Akio Taketomi; Clóvis Eduardo Santos Galvão; Elaine Gagete; Anna Caroline Nóbrega Machado Arruda; Gil Bardini Alves; Geórgia Véras de Araújo Gueiros Lira; Marcos Reis Gonçalves; Mariana Graça Couto Miziara; Sidney Souteban Maranhão Casado; Simone Valladão Curi; Veridiana Aun Rufino Pereira; Valéria Sales; Dirceu Solé; Norma de Paula Motta Rubini; Emanuel Savio Cavalcanti Sarinho

doi:10.1016/j.waojou.2022.100697

Good clinical practice recommendations in allergen immunotherapy: Position paper of the Brazilian Association of Allergy and Immunology - ASBAI

World Allergy Organ J. 2022 Sep 24;15(10):100697. doi: 10.1016/j.waojou.2022.100697. eCollection 2022 Oct.

Authors

Fernando Monteiro Aarestrup^{1

2

3}, Ernesto Akio Taketomi^{4

5

6}, Clóvis Eduardo Santos Galvão^{7

8

9}, Elaine Gagete^{10

11}, Anna Caroline Nóbrega Machado Arruda^{10

11}, Gil Bardini Alves^{9

10

12}, Geórgia Véras de Araújo Gueiros Lira^{13

11}, Marcos Reis Gonçalves^{14

15

16

11}, Mariana Graça Couto Miziara^{17

11}, Sidney Souteban Maranhão Casado^{18

11}, Simone Valladão Curi^{18

11}, Veridiana Aun Rufino Pereira^{8

11}, Valéria Sales^{19

20}, Dirceu Solé^{21

22

20}, Norma de Paula Motta Rubini^{23

20}, Emanuel Savio Cavalcanti Sarinho^{24

20}

Affiliations

¹ Federal University of Juiz de Fora (UFJF), MG, Brazil.
² Allergy and Immunology Service, Hospital Maternity Therezinha de Jesus -Faculty of Medical and Health Sciences of Juiz de Fora (FCMS/JF - SUPREMA), Brazil.
³ Scientific Department of Immunotherapy, Brazilian Association of Allergy and Immunology (ASBAI), Brazil.
⁴ Immunology and Laboratory of Allergy and Clinical Immunology, Department of Immunology, Institute of Biomedical Sciences (ICBIM) of the Federal University of Uberlandia (UFU), Brazil.
⁵ Postgraduate Program in Applied Immunology and Parasitology, Master's and Doctoral Levels, ICBIM/UFU, Brazil.
⁶ Scientific Departments of Immunotherapy and Allergens, ASBAI, Brazil.
⁷ Clinical Immunology and Allergy Service, Clinics Hospital, Faculty of Medicine, University of Sao Paulo(HC/FMUSP), Brazil.
⁸ Faculty of Medicine, University of the City of São Paulo (UNICID), Brazil.
⁹ Department of Immunotherapy, ASBAI, Brazil.
¹⁰ Allergy and Immunology, Brazilian Medical Association (AMB) and ASBAI, Brazil.
¹¹ Scientific Department of Immunotherapy, ASBAI, Brazil.
¹² Faculty of Medicine at the University of Southern Santa Catarina (UNISUL), Brazil.
¹³ Medical Sciences Center of the Federal University of Pernambuco (UFPE), Brazil.
¹⁴ Pediatric Allergy and Immunology by the Brazilian Society of Pediatrics (SBP), Brazil.
¹⁵ Faculty of Medicine, Tiradentes University Center- Campus Alagoas (UNIT/AL), Brazil.
¹⁶ Elective Discipline of Allergy and Immunology, Faculty of Medicine of the Federal University of Alagoas (UFAL), Brazil.
¹⁷ José Alencar Child's Hospital, Brasilia, DF, Brazil.
¹⁸ Allergy and Immunology, Brazil.
¹⁹ Faculty of Medicine, Federal University of Rio Grande do Norte, Brazil.
²⁰ ASBAI Brazil.
²¹ Paulista School of Medicine, Federal University of São Paulo, Brazil.
²² Scientific Department of the Brazilian Society of Pediatrics, Brazil.
²³ Federal University of the State of Rio de Janeiro - UNIRIO, Brazil.
²⁴ Department of Pediatrics, Clinics Hospital of the Federal University of Pernambuco (UFPE), Brazil.

Abstract

Background: Allergen Immunotherapy (AIT) represents one of the pillars in the treatment of allergic diseases. AIT is the only therapeutic strategy with curative potential, promoting the reduction of drug use and long-term symptom control even after the end of the treatment. The European Academy of Allergy, Asthma and Immunology (EAACI) guidelines, position papers of World Allergy Organization (WAO), and the US Practice Parameters are the leading official documents that set scientific standard for the use of AIT in the world. The use of AIT in Brazil has specific regional conditions due to the pattern of allergen sensitization, as well as genetic, socioeconomic, and cultural characteristics, climate conditions, and the availability of allergenic extracts. The most prevalent house dust mites are Dermatophagoides pteronyssinus, Dermatophagoides farinae and their allergens have the highest clinical relevance. Blomia tropicalis is also very frequent. This position paper has been prepared by the Brazilian Association of Allergy and Clinical Immunology (ASBAI) Taskforce on AIT for respiratory allergy and Hymenoptera venom allergy.

Objective: According to the current scientific literature adapted to the Brazilian reality, this position paper aims to establish the main recommendations for the good clinical practice parameters for AIT in Brazil.

Methods: A systematic review using the Pub Med and Cochrane databases was performed, and the websites of major allergy and immunology organizations were consulted. The research was limited to English language literature and was conducted between March 30, 2002, and March 30, 2022. The terms used for the research were: Allergen Immunotherapy, sublingual immunotherapy (SLIT), subcutaneous immunotherapy (SCIT), venom-specific immunotherapy (VIT), and allergen extract.

Results: The several recommendations that establish the clinical practices for AIT recommended by the main Allergy, Asthma and Immunology world organizations were analyzed and adapted to the Brazilian situation.

Conclusion: This position paper establishes the main recommendations for the effective clinical practice of AIT in Brazil, using current knowledge of evidence-based medicine and precision medicine.

Keywords: Clinical practice; HDM; House dust mite; SCIT; SLIT; Subcutaneous allergen immunotherapy; Sublingual allergen immunotherapy; VIT; Venom-specific immunotherapy.

Publication types

Review