Extrapolating Evidence Based Medicine of AIT into Clinical Practice in the US


Moisés A. Calderon, Department of Medicine, University of Costa Rica, San Jose, Costa Rica. Electronic address: moises24uk@yahoo.co.uk.
Thomas B. Casale, Food Allergy Research and Education Clinical Network, and Departments of Medicine and Pediatrics and Division of Allergy and Immunology, Joy McCann Culverhouse Clinical Research Center, University of South Florida, Tampa, FL.
Harold S. Nelson, Department of Medicine, National Jewish Health, Denver, CO, USA.
Leonard B. Bacharier, Monroe Carell Jr Children's Hospital, Vanderbilt University, Nashville, TN, USA.
Priya Bansal, Asthma and Allergy Wellness Center, St Charles, IL, USA.
David I. Bernstein, Bernstein Allergy Group Inc, and Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Michael Blaiss, Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Jonathan Corren, Departments of Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Lawrence DuBuske, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C, USA.
Shahnez Fatteh, Larkin Community Hospital, South Miami, FL, USA.
Rémi Gagnon, Clinique Spécialisée en Allergie de la Capitale, Québec, QC, Canada.
Justin Greiwe, Bernstein Allergy Group Inc, and Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Hunter Hoover, Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, NC, USA.
Nicholas C. Kolinsky, The Allergy, Asthma and Sinus Center, Knoxville, TN, USA.
Jennifer A. Namazy, Division of Allergy and Immunology, Scripps Clinic, San Diego, CA, USA.
Wanda Phipatanakul, Department of Pediatrics, Harvard Medical School, and Asthma, Allergy, Dermatology, Rheumatology, Immunology, Boston Children's Hospital, Boston, MA.
Greg Plunkett, Independent consultant, Mead, WA.
Marcus Shaker, Dartmouth Geisel School of Medicine, Hanover, NH, and Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Susan Waserman, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Tonya Winders, Allergy & Asthma Network, Vienna, VA, USA.
Karen Rance, ALK, Bedminster, NJ, USA.
Hendrik Nolte, ALK, Bedminster, NJ, USA.

Document Type

Journal Article

Publication Date



The journal of allergy and clinical immunology. In practice




Allergy/immunology specialists in the US prescribing allergy immunotherapy (AIT) have placed a heavy value on practical experience and anecdotal evidence rather than research-based evidence. With the extensive research on AIT conducted in the last few decades, the time has come to better implement evidence-based medicine (EBM) for AIT. The goal of this review was to critically assess EBM for debated concepts in US AIT practice for respiratory allergies in the context and quality of today's regulatory standards. Debated topics reviewed were the efficacy and safety of AIT in various subgroups (e.g., polyallergic patients, older patients, patients with asthma, pregnant women), diagnosis topics (e.g., skin prick test vs allergen-specific serum IgE, factors affecting skin prick tests, use of nasal or conjunctival allergen challenges, and telemedicine for diagnosis), and dosing topics (e.g., optimal dosing for subcutaneous immunotherapy and sublingual immunotherapy tablets, US liquid allergen extract history, duration of treatment, biomarkers of efficacy). In addition, EBM for patient-centered AIT issues (e.g., adherence, use of practice guidelines, pharmacoeconomics) and the approach to implementation of AIT EBM in future clinical practice was also addressed. The EBM for each concept was briefly summarized, and when possible, a practical, concise recommendation was given.