Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.

Academic Medical Center University of Amsterdam Amsterdam The Netherlands

Allergist La Rochelle France

Allergist Montevideo Uruguay

Allergist Reims France

Allergy and Asthma Center Westend Berlin Germany

Allergy and Clinical Immunology Department Centro Medico Docente La Trinidad Caracas Venezuela

Allergy and Clinical Immunology Imperial College London London UK

Allergy and Clinical Immunology Section National Heart and Lung Institute Imperial College London London UK

Allergy and Respiratory Diseases Ospedale Policlino San Martino University of Genoa Genoa Italy

Allergy and Respiratory Research Group Medical School Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK

Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital P and A Kyriakou University of Athens Athens Greece

Allergy Department IdISSC Hospital Clinico San Carlos Madrid Spain

Allergy Department Pasteur Institute Paris France

Allergy Learning and Consulting Copenhagen Denmark

Allergy Section Department of Internal Medicine Hospital Vall d'Hebron and ARADyAL Research Network Barcelona Spain

Association Asthme et Allergie Paris France

Asthma UK London UK

Center for Rhinology and Allergology Wiesbaden Germany

Center of Excellence in Asthma and Allergy Médica Sur Clinical Foundation and Hospital México City Mexico

Centre for Research in Environmental Epidemiology ISGlobAL Barcelona Spain

Charité Universitätsmedizin Berlin Humboldt Universität zu Berlin Berlin Germany

CIBER Epidemiología y Salud Pública Barcelona Spain

CINTESIS Center for Research in Health Technology and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal

CIRFF Center of Pharmacoeconomics University of Naples Federico 2 Naples Italy

Clinic of Children's Diseases Vilnius University Institute of Clinical Medicine Vilnius Lithuania

Clinical and Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain

Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan

Danish Allergy Centre University of Copenhagen Copenhagen Denmark

David Hide Centre St Mary's Hospital Isle of Wight and University of Southampton Southampton UK

Département de l'Information Médicale Unité Médico Economie University Hospital Montpellier France

Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea

Department of Allergy Immunology and Respiratory Medicine Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia

Department of Clinical Immunology Wrocław Medical University Wrocław Poland

Department of Dermatology and Allergy Berlin Institute of Health Comprehensive Allergy Center Berlin Germany

Department of Dermatology and Allergy Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Berlin Institute of Health Comprehensive Allergy Centre Member of GA2LEN Humboldt Uniersität zu Berlin Berlin Germany

Department of Dermatology and Venerology Medical University of Graz Graz Austria

Department of Health Research Methods Evidence and Impact Division of Immunology and Allergy McMaster University Hamilton Ontario Canada

Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University Prague Pilsen Czech Republic

Department of Immunology and Allergy Healthy Ageing Research Center Medical University of Lodz Lodz Poland

Department of Internal Medicine Section of Allergology Erasmus MC Rotterdam The Netherlands

Department of Lung Diseases and Clinical Immunology Terveystalo Allergy Clinic University of Turku Turku Finland

Department of Medicine Clinical Immunology and Allergy McMaster University Hamilton Ontario

Department of Otorhinolaryngology Academic Medical Centres Amsterdam The Netherlands

Department of Otorhinolaryngology Chiba University Hospital Chiba Japan

Department of Otorhinolaryngology Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps Universität Marburg Marburg Germany

Department of Otorhinolaryngology University Hospitals Leuven Leuven Belgium

Department of Paediatrics Oslo University Hospital Oslo Norway

Department of Pathology Faculty of Medicine Institute of Biomedical Sciences Vilnius University Vilnius Lithuania

Department of Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany

Department of Pediatrics Allergy Unit University of Messina Messina Italy

Department of Pediatrics Nippon Medical School Tokyo Japan

Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland

Department of Public Health Institute of Health Sciences Vilnius Lithuania

Department of Pulmonary Diseases Faculty of Medicine Celal Bayar University Manisa Turkey

Department of Social Medicine Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece

Division of Allergy Immunology and Transplantation National Institute of Allergy and Infectious Diseases NIH Bethesda Maryland

Division of Allergy Immunology University of South Florida Tampa Florida

Division of Infection Immunity and Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK

Division of Internal Medicine Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland

ENT Department Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium

Euforea Brussels Belgium

European Academy of Paediatrics Brussels Belgium

Faculty of Health Sciences and CICS UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal

Faculty of Medicine Institute of Clinical medicine Clinic of Chest diseases and Allergology Vilnius University Vilnius Lithuania

Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway

Faculty of Medicine Transylvania University Brasov Romania

Food Allergy Referral Centre Veneto Region Department of Women and Child Health Padua General University Hospital Padua Italy

Foundation for the Development of Medical and Biological Sciences Cartagena Colombia

Guy's and st Thomas' NHS Trust Kings College London London UK

Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark

Hospital de Clinicas University of Parana Parana Brazil

Hospital Quirónsalud Bizkaia Bilbao Spain

IMIM Barcelona Spain

Immunomodulation and Tolerance Group Imperial College London London UK

Imperial College London National Heart and Lung Institute Royal Brompton Hospital NHS London UK

Imunoalergologia Centro Hospitalar Universitário de Coimbra and Faculty of Medicine University of Coimbra Coimbra Portugal

INSERM U 1168 VIMA Ageing and Chronic Diseases Epidemiological and Public Health Approaches Villejuif France

Institute for Immunological Research University of Cartagena Campus de Zaragocilla Cartagena Colombia

Institute of Biomedicine and Molecular Immunology Palermo Italy

Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular immunology National Research Center Moscow Russian Federation

KYomed INNOV Montpellier France

MACVIA France Fondation partenariale FMC VIA LR Montpellier France

Medical Consulting Czarlewski Levallois France

Medida Lda Porto Portugal

Nova Southeastern University Fort Lauderdale Florida

Outpatient Allergy Clinic Reumannplatz Vienna Austria

Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey

Pediatric Department Charité Berlin Germany

Personalized Medicine Clinic Asthma and Allergy Humanitas Research Hospital Humanitas University Milan Italy

ProAR Nucleo de Excelencia em Asma Federal University of Bahia Salvador Brazil

Rhinology Unit and Smell Clinic ENT Department Hospital Clínic Barcelona Spain

Sach's Children and Youth Hospital Södersjukhuset Stockholm Sweden

Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri

Servicio de Alergia e Immunologia Clinica Santa Isabel Buenos Aires Argentina

Skin and Allergy Hospital Helsinki University Hospital University of Helsinki Helsinki Finland

SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy

The Royal National TNE Hospital University College London London UK

The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK

UCIBIO REQUIMTE Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto University of Porto Porto Portugal

Ukrainian Medical Stomatological Academy Poltava Ukraine

UMR S 1168 Université Versailles St Quentin en Yvelines Montigny le Bretonneux France

Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy

Unité de pneumo allergologie de l'enfant pôle pédiatrique CHU de Clermont Ferrand Estaing Clermont Ferrand France

Universitat Pompeu Fabra Barcelona Spain

University of Medicine and Pharmacy Hochiminh City Vietnam

WHO GARD Planning Group Salvador Brazil

Woolcock Institute of Medical Research Woolcock Emphysema Centre and Local Health District University of Sydney Glebe New South Wales Australia

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Allergen immunotherapy in MASK-air users in real-life: Results of a Bayesian mixed-effects model

Biomarkers for diagnosis and prediction of therapy responses in allergic diseases and asthma