D3.195 - Building expert consensus on the positioning of allergen immunotherapy (AIT) within a treatment paradigm for allergic rhinitis/rhinoconjunctivitis led by disease remission: A Delphi consensus

There are clear guidelines for the use of allergen immunotherapy (AIT) in allergic asthma. In allergic rhinitis/rhinoconjunctivitis (AR/ARC), guidelines exist but there is a lack of consensus on the use of AIT in AR/ARC which contributes to its underutilisation or delayed initiation. This study aims to identify limitations in current management practices for AR/ARC, define the terms ‘disease modification’ and ‘clinical remission’ in relation to AR/ARC as appropriate and realistic treatment goals, highlight the long-term benefits of AIT, and develop a standardised treatment algorithm that optimises the treatment of patients with AR/ARC.

A modified Delphi method was used. A targeted literature review was undertaken on PubMed and findings were used to inform discussions at the first steering committee (SC) meeting. The SC is comprised of ten clinicians from Europe, Kuwait, and Lebanon, experienced in managing patients with AR/ARC. Following the first SC meeting, consensus statements were developed and approved by the SC. These statements were shared with an international panel of relevant potential respondents (allergists [including paediatric allergists], pulmonologists, and ear, nose, and throat [ENT] specialists) via an online survey with a 6-point Likert scale of agreement. The consensus agreement threshold was 75%. Following completion of this first Delphi survey round, a further SC meeting is planned to discuss the results and consider recommendations.

Overall, 156 respondents from Europe (88%), Asia (8%), South America (3%), and North America (1%) completed the Delphi survey. Allergists (46%), pulmonologists (29%), and ENT specialists (26%) were well-represented amongst respondents. All 47 statements (Table 1) met the consensus threshold (≥ 75% agreement; Figure 1), with 32 (68%) statements achieving ≥ 90% agreement.

This expert Delphi consensus demonstrates a high level of agreement that AIT is the only therapy which can result in maintenance of remission of AR/ARC after discontinuation of therapy. Clinicians were also in agreement concerning the long-term benefits and eligibility criteria for AIT. These results should facilitate development of a standardised treatment algorithm to ensure optimal utilisation of AIT in patients with AR/ARC and inform recommendations.