title: International Consensus on Allergen Immunotherapy II: Mechanisms, standardization, and pharmacoeconomics.
abstract: This article continues the comprehensive international consensus (ICON) statement on allergen immunotherapy (AIT). The initial article also recently appeared in the Journal. The conclusions below focus on key mechanisms of AIT-triggered tolerance, requirements in allergen standardization, AIT cost-effectiveness, and regulatory guidance. Potential barriers to and facilitators of the use of AIT are described in addition to future directions. International allergy specialists representing the European Academy of Allergy and Clinical Immunology; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the World Allergy Organization critically reviewed the existing literature and prepared this summary of recommendations for best AIT practice. The authors contributed equally and reached consensus on the statements presented herein.
authors: Department of Clinical Immunology, Wroclaw Medical University, and "ALL-MED" Medical Research Institute, Wroclaw, Poland. Electronic address: marek.jutel@umed.wroc.pl.
authors: Marek
authors: M
authors: Jutel
authors: Faculty of Medicine, Transylvania University, Brasov, Romania.
authors: Ioana
authors: I
authors: Agache
authors: Second University of Naples and IFT-CNR, Rome, and Expert-on-Secondment European Medicines Agency, London, United Kingdom.
authors: Sergio
authors: S
authors: Bonini
authors: Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
authors: A Wesley
authors: AW
authors: Burks
authors: Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom.
authors: Moises
authors: M
authors: Calderon
authors: Allergy & Respiratory Diseases Clinic, DIMI University of Genoa, IRCCS AOU San Martino, Genova, Italy.
authors: Walter
authors: W
authors: Canonica
authors: Allergy and Asthma Center, Fort Lauderdale, Fla.
authors: Linda
authors: L
authors: Cox
authors: University Hospital of Montpellier-INSERM U657, Montpellier, France.
authors: Pascal
authors: P
authors: Demoly
authors: Department of Respiratory Medicine, Royal Sussex County Hospital, Brighton, United Kingdom.
authors: Antony J
authors: AJ
authors: Frew
authors: Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia.
authors: Robyn
authors: R
authors: O'Hehir
authors: Allergy & Asthma Center Westend, Berlin, Germany.
authors: Jörg
authors: J
authors: Kleine-Tebbe
authors: Department of Mother and Child Health, Padua General University Hospital, Padua, Italy.
authors: Antonella
authors: A
authors: Muraro
authors: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and the Children's Allergy Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors: Gideon
authors: G
authors: Lack
authors: Hospital Médica Sur, Mexico City, Mexico.
authors: Désirée
authors: D
authors: Larenas
authors: Division of Allergy, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
authors: Michael
authors: M
authors: Levin
authors: Department of Allergy and Immunology, Walter Reed Army Medical Center, Silver Spring, Md.
authors: Bryan L
authors: BL
authors: Martin
authors: National Jewish Health, Denver, Colo.
authors: Harald
authors: H
authors: Nelson
authors: Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
authors: Ruby
authors: R
authors: Pawankar
authors: Center for Rhinology and Allergology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany.
authors: Oliver
authors: O
authors: Pfaar
authors: Academic Medical Center, Departments of Experimental Immunology and of Otorhinolaryngology, University of Amsterdam, Amsterdam, The Netherlands.
authors: Ronald
authors: R
authors: van Ree
authors: Department of Pediatrics, Division of Allergy-Immunology, and the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Hugh
authors: H
authors: Sampson
authors: Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, Louisville, Ky.
authors: James L
authors: JL
authors: Sublett
authors: Swiss Institute for Allergy and Asthma Research, University of Zurich, and Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
authors: Kazunari
authors: K
authors: Sugita
authors: Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
authors: George
authors: G
authors: Du Toit
authors: Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany.
authors: Thomas
authors: T
authors: Werfel
authors: Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Roy
authors: R
authors: Gerth van Wijk
authors: Beijing Institute of Otolaryngology, Beijing, China.
authors: Luo
authors: L
authors: Zhang
authors: Swiss Institute for Allergy and Asthma Research, University of Zurich, and Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
authors: Mübeccel
authors: M
authors: Akdis
authors: Swiss Institute for Allergy and Asthma Research, University of Zurich, and Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
authors: Cezmi A
authors: CA
authors: Akdis
mesh_terms: D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D003362:Cost-Benefit Analysis; D003888:Desensitization, Immunologic / Q000191:economics / Q000379:methods / Q000592:standards; D017850:Economics, Pharmaceutical / Q000331:legislation & jurisprudence; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology* / Q000628:therapy*; D007108:Immune Tolerance
chemical_list: D000485:Allergens
keywords: International consensus; allergen standardization; allergen vaccine; allergy; cost-effectiveness; immunotherapy; marketing authorization; mechanisms; pharmacoeconomics; regulatory authorities; tolerance; unmet needs