Larenas-Linnemann Désirée, Rodríguez-Pérez Noel, Luna-Pech Jorge A, Rodríguez-González Mónica, Blandón-Vijil María Virginia, Del-Río-Navarro Blanca E, Costa-Domínguez María Del Carmen, Navarrete-Rodríguez Elsy Maureen, Macouzet-Sánchez Carlos, Ortega-Martell José Antonio, Pozo-Beltrán César Fireth, Estrada-Cardona Alan, Arias-Cruz Alfredo, Rodríguez Galván Karen Guadalupe, Brito-Díaz Herson, Canseco-Raymundo María Del Rosario, Castelán-Chávez Enrique Emanuel, Escalante-Domínguez Alberto José, Gálvez-Romero José Luis, Gómez-Vera Javier, González-Díaz Sandra Nora, Guerrero-Núñez María Gracia Belinda, Hernández-Colín Dante Daniel, Macías-Weinmann Alejandra, Mendoza-Hernández David Alejandro, Meneses-Sánchez Néstor Alejandro, Mogica-Martínez María Dolores, Moncayo-Coello Carol Vivian, Montiel-Herrera Juan Manuel, O'Farril-Romanillos Patricia María, Onuma-Takane Ernesto, Ortega-Cisneros Margarita, Rangel-Garza Lorena, Stone-Aguilar Héctor, Torres-Lozano Carlos, Venegas-Montoya Edna, Wakida-Kusunoki Guillermo, Partida-Gaytán Armando, López-García Aída Inés, Macías-Robles Ana Paola, Ambriz-Moreno María de Jesús, Azamar-Jácome Amyra Ali, Beltrán-De Paz Claudia Yusdivia, Caballero-López Chrystopherson, Fernández de Córdova-Aguirre Juan Carlos, Fernández-Soto José Roberto, Lozano-Sáenz José Santos, Oyoqui-Flores José Joel, Osorio-Escamilla Roberto Efrain, Ramírez-Jiménez Fernando, Rivero-Yeverino Daniela, Martínez Infante Eric, Medina-Ávalos Miguel Alejandro
Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico.
Immunology. Universidad Autonoma de Tamaulipas, Matamoros, Tamaulipas, Mexico.
World Allergy Organ J. 2020 Aug 21;13(8):100444. doi: 10.1016/j.waojou.2020.100444. eCollection 2020 Aug.
Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools.
Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following.
Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico.
Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.
变应原免疫疗法（AIT）历史悠久，至今仍是唯一能改变过敏性鼻炎和哮喘病情的治疗方法。多年来，形成了两种不同的流派：美国流派和欧洲流派。这些地区可用的变应原提取物都适用于当地的实际情况。在世界其他地区，如墨西哥，来自这两个地区的提取物以及当地的提取物都实现了商业化。在这里，当地专家制定了一项国家AIT指南（GUIMIT 2019），试图在两种流派之间寻求折衷方案。
GUIMIT采用ADAPTE方法对指南进行文化转换，并使用AGREE-II评估指南质量，选定了3份高质量的主要参考指南（MRG）：欧洲变态反应、哮喘和免疫学会（EAACI）指南、德语区各医学学会的S2k指南（2014年）以及美国2011年变应原免疫疗法实践参数。我们提出了临床问题，并根据MRG中可用的综合证据、结合当地的可能性、患者的偏好和成本做出回应。我们遇到了一些MRG存在分歧的问题。这里将这些问题以及GUIMIT成员解决这些问题的论点一并列出。GUIMIT（完整英文版本见补充数据）得出了以下结论。
关于IgE介导的呼吸道过敏的诊断，除了皮肤点刺试验外，补充检测（激发试验、检测和分子检测，如种属特异性变应原）在某些特定情况下可能有助于确定AIT的组成。AIT适用于过敏性鼻炎，对于过敏性哮喘（一旦得到控制）和IgE介导的特应性皮炎也有建议作用。关于按照美国流派正确确定复方药瓶皮下AIT剂量：给出了剂量表和公式；最多可混合4种不相关的变应原，避免将高蛋白酶提取物与低蛋白酶提取物混合。使用欧洲提取物时：应遵循制造商的说明；对于多种过敏的患者，可以同时进行2次注射（100%达成共识）；不鼓励混合使用。在墨西哥，只有变应原片剂可用；根据MRG中引用的所有舌下免疫疗法（SLIT）出版物中使用的剂量，GUIMIT建议与皮下免疫疗法（SCIT）相关的可能有效剂量可能为：每日给予的SCIT月剂量的50 - 200%，最多混合4种变应原。此外，还添加了一个用简化德尔菲法制定的关于无证据问题的实用建议表。最后，简要讨论了指南的传播和实施，解释了我们在墨西哥如何为此使用在线工具。
有欧美AIT提取物可用的国家应根据所遵循的流派来调整AIT。
