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EDITORIAL
Year : 2017  |  Volume : 31  |  Issue : 1  |  Page : 1-2

Guidelines for allergen immunotherapy in India: 2017-An update


Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi - 110 007, Chennai, Tamil Nadu, India

Date of Web Publication12-May-2017

Correspondence Address:
S N Gaur
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi - 110 007, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijaai.ijaai_9_17

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How to cite this article:
Gaur S N. Guidelines for allergen immunotherapy in India: 2017-An update. Indian J Allergy Asthma Immunol 2017;31:1-2

How to cite this URL:
Gaur S N. Guidelines for allergen immunotherapy in India: 2017-An update. Indian J Allergy Asthma Immunol [serial online] 2017 [cited 2017 Nov 17];31:1-2. Available from: http://www.ijaai.in/text.asp?2017/31/1/1/206194

Allergen immunotherapy (AIT) is an immunomodulatory treatment for IgE-mediated allergic diseases. Guidelines for AIT are available in Western/developed countries,[1],[2],[3] but a separate Guideline focusing on India is also necessitated due to a multitude of factors, such as climate, environment, temperature, soil characteristics, presence of an allergen in the area, feasibility, and cost of treatment.

The 2017 update of the “Guidelines for Practice of Allergen Immunotherapy in India” published in this issue of the journal have been developed by the Indian College of Allergy, Asthma, and Applied Immunology (ICAAI). The objective of this update is to optimize the practice of AIT by allergy trained clinicians for optimal management of patients with allergic diseases. In addition, this update follows the previous guideline “Guidelines for practice of Allergen Immunotherapy in India” published in the Indian Journal of Allergy Asthma and Immunology in 2009.[4] Therefore, this 2017 update by the ICAAI has been prepared to review and include the recent data available, criteria for diagnosis and management, efficacy, safety, standardization and selection of allergens, etc., and thus to guidelines published earlier.

The ICAAI proposed to update the AIT in 2015, and a core committee of eminent clinicians and researchers (list provided with the guidelines document) was formed to prepare the working draft of the guidelines. The working draft of “Guidelines for Practice of Allergen Immunotherapy in India: a 2017 update” was then forwarded four times and reviewed by a large number of members of the ICAAI (acknowledged as contributors). The authors considered all of the comments received in view of the published literature and incorporated the suggestions in the final version of the guidelines, which was then presented and approved in the brainstorming session.

In addition to the evidence provided for the safety and efficacy of AIT, an algorithm for allergy management has been provided in the document that can be referred by the allergists for diagnosing and initiating AIT. Among the diagnostic modalities, the skin prick test is recommended as the gold standard for the detection of allergen sensitization. AIT has been specifically recommended for patients with respiratory allergies (allergic rhinitis/rhinoconjunctivitis and/or asthma) and stinging insect hypersensitivity. Patients with atopic dermatitis with aeroallergen sensitivity may also benefit from AIT. AIT for food is in the experimental stages and should not be practiced until it has shown to have clinical efficacy and safety. Clinicians should be vigilant of the specific contraindications for AIT which have also been highlighted in the guidelines. The success of AIT is dependent on the proper selection of patients, allergens, doses, quality of allergens, and compliance to the treatment. The optimal dose for subcutaneous immunotherapy (SCIT) to be used during maintenance regimen is crucial for the efficacy and outcomes of AIT. Specific sections pertaining to diagnosis/AIT in children and pregnant women have been included and should be referred during such clinical presentations.

Evidence available in the recent years led to the creation of the following new sections in the guidelines-medicines to avoid before the skin prick tests, studies comparing SCIT and sublingual immunotherapy, risk factors for systemic reactions during AIT, and mono AIT and mixed AIT.

The ICAAI intends to establish these guidelines for the practice of AIT thereby resolving the queries the clinicians may have from various parts of the country. Furthermore, it is also reemphasized that AIT should be practiced only by allergy trained physicians and in appropriate clinical settings with the availability of facilities to manage any untoward reaction including anaphylaxis.

I wish you a happy reading, and I am sure that it will be a useful document for those practicing allergy and immunotherapy.



 
  References Top

1.
Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol 2013;131:1288-96.e3.  Back to cited text no. 1
    
2.
Zuberbier T, Bachert C, Bousquet PJ, Passalacqua G, Walter Canonica G, Merk H, et al. GA2 LEN/EAACI pocket guide for allergen-specific immunotherapy for allergic rhinitis and asthma. Allergy 2010;65:1525-30.  Back to cited text no. 2
    
3.
Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: A practice parameter third update. J Allergy Clin Immunol 2011;127 1 Suppl: S1-55.  Back to cited text no. 3
    
4.
Gaur SN, Singh BP, Singh AB, Vijayan VK, Agarwal MK. Guidelines for practice of allergen immunotherapy in India. Indian J Allergy Asthma Immunol 2009;23:1-21.  Back to cited text no. 4
    




 

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