Respiratory allergies are a major global health issue due to their high prevalence and burden on patients, societies, and the health care system. In addition to symptom-relieving pharmacotherapy, allergen immunotherapy (AIT) is the only disease-modifying treatment option currently available that has the potential to prevent disease progression and the onset of asthma. The importance of AIT varies greatly from country to country. To discuss the different aspects of AIT, 20 experts from 12 European countries met for the First European Think Tank on Allergen Immunotherapy. The aim of the meeting was to formulate an expert position for improving the clinical care of patients with respiratory allergies in Europe, particularly concerning the use of AIT. The lacking class effect requires a product-specific assessment of AIT products for the most common allergens available in different European countries. Adherence, appropriate prescription, and early initiation - potentially to prevent disease progression - were identified as most important challenges for practical use of AIT. The shared decision-making on either sublingual or subcutaneous AIT may be based on safety and efficacy profiles, patient preferences, and clinical setting. Future challenges with regard to the application of AIT are as follows: to increase awareness for AIT among payers, health care providers, pharmacists, and patients; to better define patients who benefit the most of AIT; to improve the training of general practitioners on AIT as the first point of contact for allergy patients regarding allergy diagnosis and treatment, including AIT; to increase the awareness of AIT as a causal treatment option; to improve the training of primary care pediatricians with regard to AIT to ensure early initiation of AIT in cooperation with allergy specialists; to enhance the guidance of physicians through relevant AIT guidelines; and to provide them with more detailed scientific guidance for selecting the adequate products to achieve optimal benefits for their patients.

Allergology and Immunology Department of Dermatology Venereology and Allergology Charité Universitätsmedizin Berlin Germany

Allergy Unit Department of Internal Medicine Ospedali Riuniti Ancona University Hospital University Hospital of Marche Ancona Italy

AP HP Hôpital Universitaire Necker Enfants Malades Service de Pneumologie Pédiatrique Paris France

Department of Allergy Fuenlabrada University Hospital Madrid Spain

Department of Allergy La Paz University Hospital Institute for Health Research Madrid Spain

Department of Clinical and Molecular Sciences Marche Polytechnic University Ancona Italy

Department of Clinical Sciences and Education Södersjukhuset Karolinska Institutet Stockholm Sweden

Department of Internal Diseases Allergy and Clinical Immunology Medical University of Silesia Katowice Poland

Department of ORL Sørlandet Hospital Haukeland University Hospital University of Bergen Bergen Norway

Department of Otorhinolaryngology Cliniques Universitaires Saint Luc Brussels Belgium

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

Department of Pulmonology STZ Centre of Excellence for Asthma COPD and Respiratory Allergy Franciscus and Vlietland Rotterdam the Netherlands

Evangelisches Krankenhaus Düsseldorf Children's Hospital Düsseldorf Germany

Faculty of Medicine and Health Technology Center for Child Adolescent and Maternal Health Research Tampere University Tampere Finland

Federation of Translational Medicine EA 3070 Strasbourg University Strasbourg France

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

Immunomodulation and Tolerance Group Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK

Institute of Clinical Immunology and Allergy University Hospital in Hradec Kralove Charles University Prague Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic

Institute of Experimental and Clinical Research Pole of Pulmonology Otorhinolaryngology and Dermatology UCLouvain Brussels Belgium

Personalized Medicine Asthma and Allergy Unit IRCCS Humanitas Research Hospital Milan Italy

Technische Universität Dresden Faculty of Medicine Carl Gustav Carus Department of Otorhinolaryngology Head and Neck Surgery Fetscherstrasse 74 D 01307 Dresden Germany

Université Paris Cité Paris France

Upper Airways Research Laboratory Department of Otorhinolaryngology Ghent University Ghent Belgium

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