Improvement of the therapeutic management of allergic patients in Europe - An expert think tank's position paper on allergen immunotherapy.

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.