Decision-making for pediatric allergy immunotherapy for aeroallergens: a narrative review

  • Miguel Tortajada-Girbés
  • María Mesa del Castillo
  • Helena Larramona
  • José Manuel Lucas
  • Montserrat Álvaro Lozano
  • Ana Isabel Tabar
  • Begoña Soler LópezEmail author
  • Ana Martínez-Cañavate
  • on behalf of the Immunotherapy Working Group of the Spanish Society of Pediatric Clinical Immunology and Allergology (SEICAP)


There has been exciting progress in diagnosis and in the treatment of allergic patients. The objective of this review is to summarize the most relevant contributions in the past 10 years with a special focus on the pediatric population allergic to aeroallergens and provide the most relevant references and practical issues for the decision-making. Current guidelines on allergy diagnosis recommend a thorough clinical history as the first step, followed by allergen extract testing using an in vivo prick test and/or an in vitro specific IgE test. Molecular diagnosis is recommended when previous tests are inconclusive. In practice, the most important factors to decide the AIT treatment are the actual intensity and duration of the patient’s symptoms and the availability of appropriate AIT products for the patient’s sensitization profile at high allergen concentrations and with confirmed efficacy and safety from clinical trials. This document summarizes outstanding references for allergic immunotherapy decision-making and provides summary tables and figures analyzing the most important factors related to the decision for allergen immunotherapy and the safety risks related. The experts concluded that AIT is efficacious and safe for the treatment of allergic patients that is available for the most frequent aeroallergens.

What is Known:

• The prevalence of allergic asthma and rhinitis in children has increased in recent decades.

• The efficacy and safety of allergen immunotherapy has been shown in multiple studies and systematic reviews.

What is New:

• This document summarizes outstanding references for allergic immunotherapy decision-making and provides summary tables and figures analyzing the most important factors related to the decision for allergen immunotherapy and the safety risks related. Recommendations of expert authors for the decision of the patients more suitable for allergen immunotherapy are included.


Allergen immunotherapy Aeroallergens Allergic rhinitis Asthma Subcutaneous immunotherapy Sublingual immunotherapy 



American College of Allergy, Asthma and Immunology


Allergen immunotherapy


Allergic Rhinitis and its Impact on Asthma


European Academy of Allergy and Clinical Immunology


European Medicines Agency


Global Initiative for Asthma


Histamine equivalent prick






Immuno-solid phase allergen chip


ISAC standardized units


Subcutaneous immunotherapy


Sublingual immunotherapy


Transforming growth factor beta


World Allergy Organization


Funding source

All phases of this document were supported by a Merck, S.L.U. grant.

Authors’ contributions

Dr. Tortajada-Girbés conceptualized and drafted the initial manuscript and reviewed and revised the manuscript. The remaining authors critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitter and agree to be accountable for all aspects of the work.

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Miguel Tortajada-Girbés
    • 1
    • 2
  • María Mesa del Castillo
    • 3
  • Helena Larramona
    • 4
  • José Manuel Lucas
    • 5
  • Montserrat Álvaro Lozano
    • 6
  • Ana Isabel Tabar
    • 7
  • Begoña Soler López
    • 8
    Email author
  • Ana Martínez-Cañavate
    • 9
  • on behalf of the Immunotherapy Working Group of the Spanish Society of Pediatric Clinical Immunology and Allergology (SEICAP)
  1. 1.Paediatric Allergology and Pulmonology UnitDr. Peset University HospitalValenciaSpain
  2. 2.Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
  3. 3.Paediatric Allergology and Neumology UnitHospital El EscorialMadridSpain
  4. 4.Paediatric Allergology and Pulmonology Unit, Department of PaediatricsUniversity Autonoma of Barcelona, and Corporacio Sanitaria Parc Tauli, Hospital of SabadellBarcelonaSpain
  5. 5.Pediatric Allergy and Immunology UnitVirgen Arrixaca Clinic Universitary HospitalMurciaSpain
  6. 6.Allergy and Clinical Immunology Section, Hospital Sant Joan de DéuUniversitat de BarcelonaBarcelonaSpain
  7. 7.Complejo Hospitalario de Navarra; IdiSNANavarra Institute for Health ResearchPamplonaSpain
  8. 8.Medical DepartmentE-C-BIO, S.L.MadridSpain
  9. 9.Paediatric Allergology and Neumology UnitComplejo Hospitalario Universitario de Granada, Coordinator of the SEICAP Immunotherapy Working GroupGranadaSpain

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