Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Allergy
Published in: Clinical and Translational Allergy 1/2019

Open Access 01-12-2019 | Allergic Rhinitis | Review

Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement

Authors: P. W. Hellings, B. Pugin, G. Mariën, C. Bachert, C. Breynaert, D. M. Bullens, J. L. Ceuppens, G. Clement, T. Cox, D. Ebo, P. Gevaert, S. Halewyck, V. Hox, K. Ladha, R. Jacobs, P. Rombaux, R. Schrijvers, K. Speleman, X. Van der Brempt, L. Van Gerven, O. Vanderveken, B. Verhaeghe, K. Vierstraete, S. Vlaminck, J. -B. Watelet, J. Bousquet, S. F. Seys

Published in: Clinical and Translational Allergy | Issue 1/2019

Login to get access

Abstract

Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.
Literature
1.
Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950–8.PubMedCrossRef
2.
Hellings PW, Klimek L, Cingi C, Agache I, Akdis C, Bachert C, et al. Non-allergic rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy. 2017;72(11):1657–65.PubMedCrossRef
3.
Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011;378(9809):2112–22.PubMedCrossRef
4.
Asher MI, Montefort S, Björkstén B, Lai CKW, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733–43.PubMedCrossRef
5.
Blomme K, Tomassen P, Lapeere H, Huvenne W, Bonny M, Acke F, et al. Prevalence of allergic sensitization versus allergic rhinitis symptoms in an unselected population. Int Arch Allergy Immunol. 2013;160(2):200–7.PubMedCrossRef
6.
Bachert C, van Cauwenberge P, Olbrecht J, van Schoor J. Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium. Allergy. 2006;61(6):693–8.PubMedCrossRef
7.
Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004;24(5):758–64.PubMedCrossRef
8.
Bousquet J, Arnavielhe S, Bedbrook A, Fonseca J, Morais Almeida M, Todo Bom A, et al. The Allergic Rhinitis and its Impact on Asthma (ARIA) score of allergic rhinitis using mobile technology correlates with quality of life: The MASK study. Allergy. 2018;73(2):505–10.PubMedCrossRef
9.
Bousquet J, Caimmi DP, Bedbrook A, Bewick M, Hellings PW, Devillier P, et al. Pilot study of mobile phone technology in allergic rhinitis in European countries: the MASK-rhinitis study. Allergy. 2017;72(6):857–65.PubMedCrossRef
10.
Léger D, Annesi-Maesano I, Carat F, Rugina M, Chanal I, Pribil C, et al. Allergic rhinitis and its consequences on quality of sleep: an unexplored area. Arch Intern Med. 2006;166(16):1744–8.PubMedCrossRef
11.
Demoly P, Allaert F-A, Lecasble M, PRAGMA. ERASM, a pharmacoepidemiologic survey on management of intermittent allergic rhinitis in every day general medical practice in France. Allergy. 2002;57(6):546–54.PubMedCrossRef
12.
Bousquet J, Bewick M, Arnavielhe S, Mathieu-Dupas E, Murray R, Bedbrook A, et al. Work productivity in rhinitis using cell phones: the MASK pilot study. Allergy. 2017;72(10):1475–84.PubMedCrossRef
13.
Vandenplas O, Vinnikov D, Blanc PD, Agache I, Bachert C, Bewick M, et al. Impact of rhinitis on work productivity: a systematic review. J Allergy Clin Immunol Pract. 2018;6(4):1274–1286.e9.PubMedCrossRef
14.
Bousquet J, Vandenplas O, Bewick M, Arnavielhe S, Bedbrook A, Murray R, et al. The work productivity and activity impairment allergic specific (WPAI-AS) questionnaire using mobile technology: the MASK study. J Investig Allergol Clin Immunol. 2018;28(1):42–4.PubMedCrossRef
15.
Guerra S, Sherrill DL, Martinez FD, Barbee RA. Rhinitis as an independent risk factor for adult-onset asthma. J Allergy Clin Immunol. 2002;109(3):419–25.PubMedCrossRef
16.
Antó JM, Sunyer J, Basagaña X, Garcia-Esteban R, Cerveri I, de Marco R, et al. Risk factors of new-onset asthma in adults: a population-based international cohort study. Allergy. 2010;65(8):1021–30.PubMedCrossRef
17.
Vandenplas O, Dramaix M, Joos G, Louis R, Michils A, Verleden G, et al. The impact of concomitant rhinitis on asthma-related quality of life and asthma control. Allergy. 2010;65(10):1290–7.PubMedCrossRef
18.
Lamb CE, Ratner PH, Johnson CE, Ambegaonkar AJ, Joshi AV, Day D, et al. Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective. Curr Med Res Opin. 2006;22(6):1203–10.PubMedCrossRef
19.
Zuberbier T, Lötvall J, Simoens S, Subramanian SV, Church MK. Economic burden of inadequate management of allergic diseases in the European Union: a GA(2) LEN review. Allergy. 2014;69(10):1275–9.PubMedCrossRef
20.
Cardell L-O, Olsson P, Andersson M, Welin K-O, Svensson J, Tennvall GR, et al. TOTALL: high cost of allergic rhinitis—a national Swedish population-based questionnaire study. NPJ Prim Care Respir Med. 2016;26:15082.PubMedPubMedCentralCrossRef
21.
Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–76.PubMedCrossRef
22.
Berger W, Bousquet J, Fox AT, Just J, Muraro A, Nieto A, et al. MP-AzeFlu is more effective than fluticasone propionate for the treatment of allergic rhinitis in children. Allergy. 2016;71(8):1219–22.PubMedPubMedCentralCrossRef
23.
Bachert C, Bousquet J, Hellings P. Rapid onset of action and reduced nasal hyperreactivity: new targets in allergic rhinitis management. Clin Transl Allergy. 2018;8:25.PubMedPubMedCentralCrossRef
24.
Fokkens WJ, Bachert C, Bernal-Sprekelsen M, Bousquet J, Djandji M, Dorenbaum A, et al. Rhinology future debates, an EUFOREA report. Rhinology. 2017;55(4):298–304.PubMedCrossRef
25.
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.PubMedCrossRef
26.
Bousquet PJ, Bachert C, Canonica GW, Casale TB, Mullol J, Klossek JM, et al. Uncontrolled allergic rhinitis during treatment and its impact on quality of life: a cluster randomized trial. J Allergy Clin Immunol. 2010;126(3):666–8.PubMedCrossRef
27.
Droessaert V, Timmermans M, Dekimpe E, Seys S, Ceuppens JJ, Fokkens WJ, et al. Real-life study showing better control of allergic rhinitis by immunotherapy than regular pharmacotherapy. Rhinology. 2016;54(3):214–20.PubMedCrossRef
28.
Hellings PW, Fokkens WJ, Akdis C, Bachert C, Cingi C, de Loos DD, et al. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today? Allergy. 2013;68(1):1–7.PubMedCrossRef
29.
Hellings PW, Fokkens WJ, Bachert C, Akdis CA, Bieber T, Agache I, et al. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis—a EUFOREA-ARIA-EPOS-AIRWAYS ICP statement. Allergy. 2017;72(9):1297–305.PubMedCrossRef
30.
Hellings PW, Dobbels F, Denhaerynck K, Piessens M, Ceuppens JL, De Geest S. Explorative study on patient’s perceived knowledge level, expectations, preferences and fear of side effects for treatment for allergic rhinitis. Clin Transl Allergy. 2012;2(1):9.PubMedPubMedCentralCrossRef
31.
32.
De Greve G, Hellings PW, Fokkens WJ, Pugin B, Steelant B, Seys SF. Endotype-driven treatment in chronic upper airway diseases. Clin Transl Allergy. 2017;7:22.PubMedPubMedCentralCrossRef
33.
Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, van Wijk RG, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. 2018;73(4):765–98.PubMedCrossRef
34.
Ryan D, van Wijk RG, Angier E, Kristiansen M, Zaman H, Sheikh A, et al. Challenges in the implementation of the EAACI AIT guidelines: a situational analysis of current provision of allergen immunotherapy. Allergy. 2018;73(4):827–36.PubMedCrossRef
35.
Dhami S, Nurmatov U, Roberts G, Pfaar O, Muraro A, Ansotegui IJ, et al. Allergen immunotherapy for allergic rhinoconjunctivitis: protocol for a systematic review. Clin Transl Allergy. 2016;6:12.PubMedPubMedCentralCrossRef
36.
Dhami S, Kakourou A, Asamoah F, Agache I, Lau S, Jutel M, et al. Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis. Allergy. 2017;72(12):1825–48.PubMedCrossRef
37.
Valovirta E, Petersen TH, Piotrowska T, Laursen MK, Andersen JS, Sørensen HF, et al. Results from the 5-year SQ grass sublingual immunotherapy tablet asthma prevention (GAP) trial in children with grass pollen allergy. J Allergy Clin Immunol. 2018;141(2):529–538.e13.PubMedCrossRef
38.
Epstein TG, Liss GM, Murphy-Berendts K, Bernstein DI. AAAAI/ACAAI surveillance study of subcutaneous immunotherapy, years 2008–2012: an update on fatal and nonfatal systemic allergic reactions. J Allergy Clin Immunol Pract. 2014;2(2):161–7.PubMedCrossRef
39.
Vuurman EF, van Veggel LM, Uiterwijk MM, Leutner D, O’Hanlon JF. Seasonal allergic rhinitis and antihistamine effects on children’s learning. Ann Allergy. 1993;71(2):121–6.PubMed
40.
Callebaut I, Vandewalle E, Hox V, Bobic S, Jorissen M, Stalmans I, et al. Nasal corticosteroid treatment reduces substance P levels in tear fluid in allergic rhinoconjunctivitis. Ann Allergy Asthma Immunol. 2012;109(2):141–6.PubMedCrossRef
41.
Asaria M, Dhami S, van Ree R, van Wijk RG, Muraro A, Roberts G, et al. Health economic analysis of allergen immunotherapy for the management of allergic rhinitis, asthma, food allergy and venom allergy: a systematic overview. Allergy. 2018;73(2):269–83.PubMedCrossRef
42.
Timmins N, Rawlins M, Appleby J. A terrible beauty a short history of NICE The National Institute for health and Care Excellence. Bangkok: Amarin Printing and Publishing Public Co., Ltd.; 2016.
43.
RIZIV. Doelmatige behandeling van allergische aandoeningen (rhinoconjunctivitis, astma, anafylaxie op hymenopteragif), anafylaxie en angio-oedeem. In: Folia Pharmacotherapeutica, vol. 39, no. 2; 2012.
44.
Cornelis M, Rombaux P, Jorissen M, Hellings PW. Nationwide survey on immunotherapy practice by ENT specialists. Rhinology. 2014;52(1):72–7.PubMed
45.
Haahtela T, Valovirta E, Bousquet J, Mäkelä M. The Finnish allergy programme 2008–2018 works. Eur Respir J. 2017;49(6):1700470.PubMedCrossRef
46.
Dekhuijzen R, Lavorini F, Usmani OS, van Boven JFM. Addressing the impact and unmet needs of nonadherence in asthma and chronic obstructive pulmonary disease: where do we go from here? J Allergy Clin Immunol Pract. 2018;6(3):785–93.PubMedCrossRef
47.
Bousquet J, Schünemann HJ, Hellings PW, Arnavielhe S, Bachert C, Bedbrook A, et al. MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis. J Allergy Clin Immunol. 2016;138(2):367–74.PubMedCrossRef
48.
49.
Bousquet J, Barbara C, Bateman E, Bel E, Bewick M, Chavannes NH, et al. AIRWAYS-ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation. Eur Respir J. 2016;47(4):1028–33.PubMedCrossRef
Metadata
Title
Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement
Authors
P. W. Hellings
B. Pugin
G. Mariën
C. Bachert
C. Breynaert
D. M. Bullens
J. L. Ceuppens
G. Clement
T. Cox
D. Ebo
P. Gevaert
S. Halewyck
V. Hox
K. Ladha
R. Jacobs
P. Rombaux
R. Schrijvers
K. Speleman
X. Van der Brempt
L. Van Gerven
O. Vanderveken
B. Verhaeghe
K. Vierstraete
S. Vlaminck
J. -B. Watelet
J. Bousquet
S. F. Seys
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Clinical and Translational Allergy / Issue 1/2019
Electronic ISSN: 2045-7022
DOI
https://doi.org/10.1186/s13601-019-0243-1

Other articles of this Issue 1/2019

Clinical and Translational Allergy 1/2019 Go to the issue

Review

The roadmap for the Allergology specialty and allergy care in Europe and adjacent countries. An EAACI position paper

Review

Is chronic urticaria more than skin deep?

Letter to the Editor

Health-related quality of life worsens by school age amongst children with food allergy

Review

Genetic associations of the response to inhaled corticosteroids in asthma: a systematic review

Review

Vilnius Declaration on chronic respiratory diseases: multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases

Review

Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis