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Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro 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.
UNASSIGNED: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.
UNASSIGNED: 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.
UNASSIGNED: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro 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.
UNASSIGNED: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.
摘要：
■变应原免疫疗法（AIT）有着悠久的历史，至今仍是变应性鼻炎和哮喘的唯一改变疾病的治疗方法。多年来，2个不同的学校制定了他们的策略：美国（美国）和欧洲。这些地区可用的过敏原提取物适合当地实践。在世界其他地方,来自区域和本地的提取物都被商业化，就像在墨西哥一样。这里,当地专家制定了国家AIT指南（GUIMIT2019），以寻求两所学校之间的妥协。
■使用ADAPTE方法进行迁移指南和AGREE-II评估指南质量，GUIMIT选择了3个高质量的主要参考指南（MRGs）：欧洲过敏学会，哮喘和免疫学（EAACI）指南，各种德语医学学会的S2k指南(2014)，和2011年美国变应原免疫治疗实践参数。我们制定了临床问题，并根据MRG中可用的融合证据做出了回应，结合当地的可能性，患者的偏好，和成本。我们遇到了MRGs不同意的几个问题。这里介绍了这些以及GUIMIT成员解决这些问题的论点。GUIMIT(完整的英文版本，补充数据)得出以下结论。
■与IgE介导的呼吸道变态反应的诊断有关，除了皮肤点刺测试之外，补充测试(挑战，体外测试和分子如物种特异性过敏原）可能在选定的情况下有用，以告知AIT组成。AIT适用于过敏性鼻炎，并建议用于过敏性哮喘（一旦控制）和IgE介导的特应性皮炎。关于根据美国学校的复合小瓶的正确皮下AIT剂量：给出了剂量表和配方;最多可混合4种非相关过敏原，避免混合高与低蛋白酶提取物。使用欧洲提取物时：应遵循制造商的适应症；在多过敏患者中，可以同时注射2次（100％共识）；不鼓励混合。在墨西哥，只有类过敏片剂可用；根据MRGs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是：每天给予的每月SCIT剂量的50-200％，最大混合4过敏原。此外，一份关于非证据存在问题的实用建议的表格，用简化的德尔菲法开发，已添加。最后,简要讨论了准则的传播和实施，解释我们如何在墨西哥使用在线工具。
■有欧美AIT摘录的国家/地区应根据遵循哪个学校来调整AIT。
■使用ADAPTE方法进行迁移指南和AGREE-II评估指南质量，GUIMIT选择了3个高质量的主要参考指南（MRGs）：欧洲过敏学会，哮喘和免疫学（EAACI）指南，各种德语医学学会的S2k指南(2014)，和2011年美国变应原免疫治疗实践参数。我们制定了临床问题，并根据MRG中可用的融合证据做出了回应，结合当地的可能性，患者的偏好，和成本。我们遇到了MRGs不同意的几个问题。这里介绍了这些以及GUIMIT成员解决这些问题的论点。GUIMIT(完整的英文版本，补充数据)得出以下结论。
■与IgE介导的呼吸道变态反应的诊断有关，除了皮肤点刺测试之外，补充测试(挑战，体外测试和分子如物种特异性过敏原）可能在选定的情况下有用，以告知AIT组成。AIT适用于过敏性鼻炎，并建议用于过敏性哮喘（一旦控制）和IgE介导的特应性皮炎。关于根据美国学校的复合小瓶的正确皮下AIT剂量：给出了剂量表和配方;最多可混合4种非相关过敏原，避免混合高与低蛋白酶提取物。使用欧洲提取物时：应遵循制造商的适应症；在多过敏患者中，可以同时注射2次（100％共识）；不鼓励混合。在墨西哥，只有类过敏片剂可用；根据MRGs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是：每天给予的每月SCIT剂量的50-200％，最大混合4过敏原。此外，一份关于非证据存在问题的实用建议的表格，用简化的德尔菲法开发，已添加。最后,简要讨论了准则的传播和实施，解释我们如何在墨西哥使用在线工具。
■有欧美AIT摘录的国家/地区应根据遵循哪个学校来调整AIT。
