Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines
| Autor: | Enrique Emanuel Castelán-Chávez, Aída Inés López-García, Désirée Larenas-Linnemann, Néstor Alejandro Meneses-Sánchez, María del Rosario Canseco-Raymundo, María Dolores Mogica-Martínez, Fernando Ramírez-Jiménez, David Alejandro Mendoza-Hernández, José Antonio Ortega-Martell, Roberto Efrain Osorio-Escamilla, Héctor Stone-Aguilar, Mónica Rodríguez-González, Blanca E. Del-Rio-Navarro, María Gracia Belinda Guerrero-Núñez, José Roberto Fernández-Soto, María Virginia Blandón-Vijil, José Luis Gálvez-Romero, Alan Estrada-Cardona, Amyra Ali Azamar-Jácome, María de Jesús Ambriz-Moreno, Chrystopherson Gengyny Caballero-López, Carlos Torres-Lozano, Juan Carlos Fernández de Córdova-Aguirre, Alejandra Macías-Weinmann, Carlos Macouzet-Sánchez, Ernesto Onuma-Takane, Daniela Rivero-Yeverino, Herson Brito-Díaz, María del Carmen Costa-Domínguez, Armando Partida-Gaytán, Javier Gómez-Vera, Jorge A. Luna-Pech, Sandra Nora González-Díaz, José Joel Oyoqui-Flores, César Fireth Pozo-Beltrán, Claudia Yusdivia Beltrán-De Paz, Eric Martinez Infante, Alberto José Escalante-Domínguez, Edna Venegas-Montoya, Noel Rodríguez-Pérez, Juan Manuel Montiel-Herrera, Guillermo Wakida-Kusunoki, Margarita Ortega-Cisneros, Lorena Rangel-Garza, Carol Vivian Moncayo-Coello, Ana Paola Macías-Robles, Karen Guadalupe Rodríguez Galván, José Santos Lozano-Sáenz, Alfredo Arias-Cruz, Elsy Maureen Navarrete-Rodríguez, Patricia O'Farril-Romanillos, Dante Daniel Hernández-Colín, Miguel Alejandro Medina-Ávalos |
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| Rok vydání: | 2020 |
| Předmět: |
Allergen extract
Pulmonary and Respiratory Medicine GIN Guidelines International Network Allergen immunotherapy medicine.medical_specialty Allergy GINA Global Initiative for Asthma Immunology AGREE-II Appraisal of Guidelines for Research & Evaluation Instrument Guideline Article HDM house dust mite PICO Patient-Intervention-Comparator-Outcome 03 medical and health sciences 0302 clinical medicine CMICA Colegio Mexicano de Inmunología Clínica y Alergia MRG main reference guidelines medicine Immunology and Allergy EAACI European Academy of Allergy US United States of North America 030223 otorhinolaryngology Asthma Sublingual immunotherapy SLIT sublingual allergen immunotherapy House dust mite Subcutaneous immunotherapy double-blind placebo controlled GP grass pollen COMPEDIA Colegio Mexicano de Pediatras Especialistas in Inmunología Clínica y Alergia biology business.industry FASIT Future of the Allergists and Specific Immunotherapy Atopic dermatitis GUIMIT by its Spanish initials of Guía Mexicana de Inmunoterapia medicine.disease biology.organism_classification GRADE grading of recommendations assessment development and evaluation Ig immunoglobulin Asthma and Immunology DBPC Allergoid 030228 respiratory system Family medicine AIT Allergen immunotherapy SCIT subcutaneous allergen immunotherapy business |
| Zdroj: | The World Allergy Organization Journal |
| ISSN: | 1939-4551 |
| DOI: | 10.1016/j.waojou.2020.100444 |
| Popis: | Background Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions Countries where European and American AIT extracts are available should adjust AIT according to which school is followed. |
| Databáze: | OpenAIRE |
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