L. Cox

Practical guide to skin prick tests in allergy to aeroallergens

To cite this article: Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, Canonica GW, Carlsen KH, Cox L, Haahtela T, Lodrup Carlsen KC, Price D, Samolinski B, Simons FER, Wickman M, Annesi‐Maesano I, Baena‐Cagnani CE, Bergmann KC, Bindslev‐Jensen C, Casale TB, Chiriac A, Cruz AA, Dubakiene R, Durham SR, Fokkens WJ, Gerth‐van‐Wijk R, Kalayci O, Kowalski ML, Mari A, Mullol J, Nazamova‐Baranova L, O’Hehir RE, Ohta K, Panzner P, Passalacqua G, Ring J, Rogala B, Romano A, Ryan D, Schmid‐Grendelmeier P, Todo‐Bom A, Valenta R, Woehrl S, Yusuf OM, Zuberbier T, Demoly P. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012; 67: 18–24.

Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report.

Rhinitis is an umbrella term that encompasses many different subtypes, several of which still elude complete characterization. The concept of phenotyping, being the definition of disease subtypes on the basis of clinical presentation, has been well established in the last decade. Classification of rhinitis entities on the basis of phenotypes has facilitated their characterization and has helped practicing clinicians to efficiently approach rhinitis patients. Recently, the concept of endotypes, that is, the definition of disease subtypes on the basis of underlying pathophysiology, has emerged. Phenotypes/endotypes are dynamic, overlapping, and may evolve into one another, thus rendering clear‐cut definitions difficult. Nevertheless, a phenotype‐/endotype‐based classification approach could lead toward the application of stratified and personalized medicine in the rhinitis field. In this PRACTALL document, rhinitis phenotypes and endotypes are described, and rhinitis diagnosis and management approaches focusing on those phenotypes/endotypes are presented and discussed. We emphasize the concept of control‐based management, which transcends all rhinitis subtypes.

Allergen immunotherapy: a new semantic framework from the European Academy of Allergy and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL consensus report.

Immunotherapy for allergic diseases has entered a new age, marked by the development of a small number of new therapeutic classes of standardized allergen formulations registered as pharmaceutical specialties after large, robust, pivotal Phase III clinical trials (1). Furthermore, concepts in general medicine and our understanding of the immune system’s functions have changed substantially. These developments in pathophysiology, pharmacology, and clinical practice suggest that there is a need to change and align our current semantic frameworks about the terminology used for immunotherapy. With the aim of promoting the broad uptake of a single nomenclature, we reviewed current terminologies and sought a consensus from the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy Asthma and Immunology (AAAAI) via the PRACTALL initiative (2). We propose the term ‘allergen immunotherapy’ for the treatment of an allergic disease with an allergen-containing therapeutic. The rationale for this choice is described below. Going back as far as 1911, Leonard Noon and John Freeman used the terms ‘prophylactic inoculation against hay fever’ and ‘treatment of hay fever by hypodermic inoculation of pollen vaccine’ (3, 4). After more than 100 years of use, many different terms are employed in different languages by the leading allergy societies, working groups and regulatory authorities ((5–16), summarized in Table 1). Statements by the World Allergy Organization, the WHO, the Allergic Rhinitis and its Impact on Asthma initiative and the Global Allergy and Asthma European Network (5–10) have acknowledged the confusion caused by the use of different terms (sometimes even within the same document). We found that the most widely used term at present is ‘specific immunotherapy’ (abbreviated as ‘SIT’). But does this term adequately describe today’s practice? And what does each of the term’s two words mean in today’s context? Let us first consider ‘immunotherapy’. As we gain a better understanding of the immune system’s composition and function (notably thanks to the use of molecular analysis techniques), it is now clear that the term ‘immunotherapy’ encompasses many disease pathways and treatment approaches. Immunotherapy can variously be defined as (i) the treatment for disease by inducing, enhancing, or suppressing immune response, (ii) a therapy designed to produce immunity to a microorganism or a transplanted organ or to enhance resistance or tolerance by the immune system, (iii) any approach aimed at mobilizing or manipulating a patient’s immune system to treat or cure disease, and (iv) a general term encompassing active and passive immunization. Immunotherapy can be prophylactic or therapeutic. It may involve the administration of antibodies, antibody fragments, peptides of antigens, polypeptide allergens, immunosuppressants, immunomodulators, nucleic acids, small molecules, and even immune system cells and can be used to treat cancer, heart failure, organ transplantation, autoimmune disease, and, of course, a number of allergic conditions. Assuming that the term ‘immunotherapy’ is relevant but overly general, does qualifying it with ‘specific’ provide us with a better understanding? The term ‘specific immunotherapy’ is also used outside the field of allergy – notably as a short form of ‘antigen-specific immunotherapy’ in oncology (17). In fact, the word ‘specific’ is no longer specific enough. Indeed, the word may variously refer to a specific medical condition (whether allergic or not), a specific allergen, a specific medicinal product, a specific patient, or even several of these entities at the same time. Of course, it makes more sense to use the term ‘specific’ than the term ‘non-specific’. However, the main problem with ‘specific immunotherapy’ is that the term is concept based. Concepts are changing, so it is time to shift our semantic paradigm and adopt a clear, intuitive, product-based nomenclature. We need to specify what an immunotherapy product contains – that is, one or more allergens. Indeed, this is crucial in view of the significant differences between Europe and the USA regarding the number of allergens that are typically used in a named-patient preparation; in Europe, most administered formulations are single-allergen extracts, while those in the USA contain an average of eight different allergic components (18). Our working group found that the term ‘allergen immunotherapy’ (abbreviated as ‘AIT’) is preferable for an allergen-containing therapeutic, and ‘non-allergen immunotherapy’ is used to describe a therapeutic that does not contain allergen but that is used to treat an allergic disease (such as anti-IgE, antitumor necrosis factor, anti-interleukin-13, and antithymic stromal lymphopoietin approaches). Furthermore, ‘allergen immunotherapy’ has none of the disadvantages associated with the term ‘specific’, because it is immediately clear that the treatment’s specificity is related to the allergen. Although combining the two terms as ‘allergen-specific immunotherapy’ has been suggested (19, 20), this ambiguously implies that ‘non-allergen-specific immunotherapy’ or ‘allergen-non-specific immunotherapy’ also exist.

Allergy immunotherapy across the life cycle to promote active and healthy ageing: From research to policies: An AIRWAYS Integrated Care Pathways (ICPs) programme item (Action Plan B3 of the European Innovation Partnership on active and healthy ageing) and the Global Alliance against Chronic Respiratory Diseases (GARD), a World Health Organization GARD research demonstration project

Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.

Allergy immunotherapy across the life cycle to promote active and healthy ageing

Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.

PAA10 ALLERGY IMMUNOTHERAPY: PATTERNS AND OUTCOMES OF CARE FOR ALLERGIC RHINITIS

ducted using patient costs from billing records, and three different effectiveness measures [all based on a 0 (worst) to 100 (best) scale]. The primary CE analysis used Subject General Well Being score (SGWB), which was a general health assessment question. Two other effectiveness measures were β-mediated treatment effect (BMTE) and Disease Symptom Assessment (DSA) scores. RESULTS: LEV patients required fewer total nebulizations (median 10 vs 12; p = 0.031), and the two groups were not statistically different with respect to the number of rescue nebulizations, length of hospital stay, and total hospital cost. For the primary CE analysis, LEV was as effective (70.0 vs 68.3) and cost

Allergen Immunotherapy Significantly Reduces Healthcare Costs among U.S. Adults with Allergic Rhinitis: A Retrospective Matched Cohort Study Jointly Funded by the AAAAI and ACAAI

164 less per patient compared with RAC. For CE analyses using BMTE and DSA, LEV was again as effective (86.9 vs 79.0 and 59.2 vs 57.2, respectively) and cost

Does Allergen-specific Immunotherapy Provide Cost Benefits for Children and Adults with Allergic Rhinitis? Results from Large-Scale Retrospective Analyses Jointly Funded by AAAAI and ACAAI

174 less per patient. Bootstrap re-sampling analyses found that approximately 65%–77% of the 10,000 simulations for LEV fell within the dominant quadrant on a CE plane. CONCLUSION: In this study, LEV patients required significantly fewer total nebulizations without an increased need for rescue nebulizations. CE analysis indicated that LEV was at least as effective as RAC with a

Mise à jour sur l’immunothérapie allergénique : Rapport de Consensus PRACTALL de l’AAAAI (American Academy of Allergy, Asthma and Immunology) et de l’EAACI (European Academy of Allergy and Clinical Immunology) ☆

164 savings in costs.