Task force report Allergen immunotherapy: A practice parameter third update Chief Editors: Linda Cox, MD, Harold Nelson, MD, and Richard Lockey, MD Workgroup Contributors: Christopher Calabria, MD, Thomas Chacko, MD, Ira Finegold, MD, Michael Nelson, MD, PhD, and Richard Weber, MD Task Force Reviewers: David I. Bernstein, MD, Joann Blessing-Moore, MD, David A. Khan, MD, David M. Lang, MD, Richard A. Nicklas, MD, John Oppenheimer, MD, Jay M. Portnoy, MD, Christopher Randolph, MD, Diane E. Schuller, MD, Sheldon L. Spector, MD, Stephen Tilles, MD, and Dana Wallace, MD Key words: Allergy immunotherapy, subcutaneous immunotherapy, These parameters were developed by the Joint Task Force on sublingual immunotherapy, allergic rhinitis, asthma, Hymenoptera, Practice Parameters, representing the American Academy of atopic dermatitis, anaphylaxis, epinephrine, b-blockers, angioten- Allergy, Asthma & Immunology (AAAAI); the American Col- sin-converting enzyme inhibitor, epicutaneous immunotherapy, in- lege of Allergy, Asthma & Immunology (ACAAI); and the Joint tralymphatic immunotherapy, nasal immunotherapy Council of Allergy, Asthma & Immunology. The American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology have jointly accepted responsibility for establishing ‘‘Allergen immunotherapy: A practice parameter third update.’’ This is a complete and com- Disclosure of potential conflict of interest: L. Cox is a consultant for Genentech/Novartis, Hollister-Stier, and Stallergenes; is a speaker for Novartis; has received research prehensive document at the current time. The medical environ- support from Stallergenes; is on the Board of Directors for the American Board of ment is a changing environment, and not all recommendations Allergy and Immunology; and is on the US Food and Drug Administration (FDA)’s will be appropriate for all patients. Because this document Allergenic Product Advisory Committee. H. Nelson is a consultant for Merck and incorporated the efforts of many participants, no single individ- Planet Biopharmaceuticals, is a Data and Safety Monitoring Board member of DBV Technologies, and has received research support from ALK-Abello. M. Nelson has re- ual, including those who served on the Joint Task Force, is ceived research support from the Department of Defense, is a speaker for the American authorized to provide an official AAAAI or ACAAI interpretation College of Allergy, Asthma & Immunology (ACAAI), and is a member of the FDA’s of these practice parameters. Any request for information about or Advisory Committee on Allergic Products. R. Weber is on the speakers’ bureau for As- an interpretation of these practice parameters by the AAAAI or traZeneca and Genentech, has received research support from Novartis and Glaxo- the ACAAI should be directed to the Executive Offices of the SmithKline, and is Committee Chair of the ACAAI. D. I. Bernstein is a consultant and on the advisory board for ALK America, is on the advisory board for Merck, AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & and has received research support from Merck and Schering-Plough. J. Blessing- Immunology. These parameters are not designed for use by Moore is a speaker for Merck-Schering/AstraZeneca, Novartis, TEVA, and Meda pharmaceutical companies in drug promotion. A current list of Alcon and has received research support from Meda. D. A. Khan is a speaker for As- published practice parameters of the Joint Task Force on Practice traZeneca and Merck, has received research support from the Vanberg Family Foun- dation and the Sellars Family Foundation, is Conjoint Board Review Chair for the Parameters for Allergy and Immunology can be found in Table E1 ACAAI, and is a past president of the Texas Allergy, Asthma and Immunology Society. in this article’s Online Repository at www.jacionline.org. D. M. Lang is a speaker and consultant for GlaxoSmithKline; is a speaker for Astra- Zeneca, Merck, TEVA, Sanofi-Aventis, and Genentech/Novartis; and has received re- search support from Genentech/Novartis. R. A. Nicklas is a fellow for the ACAAI. J. CONTRIBUTORS Oppenheimer is a consultant and has provided lectures for AstraZeneca, Merck, and The Joint Task Force has made a concerted effort to acknowl- GlaxoSmithKline; and has received research support from AstraZeneca, Merck, Glax- oSmithKline, and Genentech. J. M. Portnoy is a speaker for Phadia, Merck, and CSL edge all contributors to this parameter. If any contributors have Behring; has received research support from the US Department of Housing and Urban been excluded inadvertently, the Task Force will ensure that Development; and is a board member of the ACAAI board of regents. S. L. Spector has appropriate recognition of such contributions is made subse- received research support from Genentech, GlaxoSmithKline, Schering-Plough, quently. The Joint Task Force gratefully acknowledges the Aventis, Novartis, Pharmaxis, Boehringer Ingelheim, AstraZeneca, Johnson & John- son, Xyzal, Alcon, Centocor, Sepracor, UCB, Amgen, Capnia, and IVAX. S. Tilles AAAAI Board of Directors and the ACAAI Board of Regents is a speaker for Alcon; is on the advisory board for ALK, Ista, Merck, and Stallergenes; for their review and support of this document. has received research support from Alcon, Amgen, Amphastar, Astellas, Boehringer The authors and editors gratefully acknowledge Susan Grupe Ingelheim, Ception, Genentech, Icagen, MAP Pharma, MEDA, Merck, Novartis, Rox- and Jessica Karle for their administrative assistance. ane, and Sepracor; is Associate Editor of Allergy Watch and Annals of Allergy; and is a task force member for the Joint Task Force for Practice Parameters. D. Wallace is a speaker and advisor for Alcon, is a speaker for Merck and Sanofi-Aventis, and is President-Elect of the ACAAI. The rest of the authors have declared that they have CHIEF EDITORS no conflict of interest. Linda Cox, MD Received for publication September 18, 2010; accepted for publication September 23, Department of Medicine Nova Southeastern University 2010. College of Osteopathic Medicine Available online December 3, 2010. Reprint requests: Joint Council of Allergy, Asthma & Immunology, 50 N Brockway St, Davie, Florida #3-3, Palatine, IL 60067. E-mail: [email protected]. 0091-6749/$36.00 Richard Lockey, MD Ó 2010 American Academy of Allergy, Asthma & Immunology Division of Allergy and Immunology doi:10.1016/j.jaci.2010.09.034 Department of Internal Medicine S1 S2 COX ET AL J ALLERGY CLIN IMMUNOL JANUARY 2011 University of South Florida College of Medicine and James A. University of Missouri–Kansas City School of Medicine Haley Veterans’ Hospital Kansas City, Missouri Tampa, Florida Christopher Randolph, MD Harold Nelson, MD Yale University Department of Medicine New Haven, Connecticut National Jewish Health Diane E. Schuller, MD Denver, Colorado Department of Pediatrics Pennsylvania State University WORK GROUP MEMBERS Milton S. Hershey Medical College Hershey, Pennsylvania Christopher Calabria, MD Glen Burnie, Maryland Sheldon L. Spector, MD Department of Medicine Thomas Chacko, MD UCLA School of Medicine Roswell, Georgia Los Angeles, California Ira Finegold, MD Stephen A. Tilles, MD New York, New York Department of Medicine Michael Nelson, MD, PhD University of Washington School of Medicine Washington, DC Redmond, Washington Richard Weber, MD Dana V. Wallace, MD Denver, Colorado Department of Medicine Nova Southeastern University Davie, Florida JOINT TASK FORCE REVIEWERS David Bernstein, MD Department of Medicine and Environmental Health INVITED REVIEWERS University of Cincinnati College of Medicine Don Aaronson, MD, JD, MPH Cincinnati, Ohio Chicago, Illinois David A. Khan, MD Desiree Larenas-Linnemann, MD Department of Internal Medicine Mexico city, Mexico University of Texas Southwestern Medical Center Bryan Leatherman, MD Dallas, Texas Gulfport, Mississippi Joann Blessing-Moore, MD Sandra Y. Lin, MD Departments of Medicine and Pediatrics Johns Hopkins Department of Otolaryngology–Head & Neck Stanford University Medical Center Surgery Department of Immunology Baltimore, Maryland Palo Alto, California Oral and sublingual immunotherapy for food hypersensitivity David M. Lang, MD Wesley Burkes, MD Allergy/Immunology Section Duke University Division of Medicine Allergy and Immunology Fellowship Raleigh, North Carolina Training Program Venom hypersensitivity Cleveland Clinic Foundation Cleveland, Ohio David Golden, MD Baltimore, Maryland Richard A. Nicklas, MD Department of Medicine Theodore M. Freeman, MD George Washington Medical Center Helotes, Texas Washington, DC Allergen extract section John Oppenheimer, MD Derek Constable, PhD Department of Internal Medicine Spokane, Washington New Jersey Medical School Robert Esch, PhD Pulmonary and Allergy Associates Lenoir, North Carolina Morristown, New Jersey Larry Garner, CPT, BA Jay M. Portnoy, MD Spokane, Washington Section of Allergy, Asthma & Immunology The Children’s Mercy Hospital Richard Lankow, PhD Department of Pediatrics Round Rock, Texas J ALLERGY CLIN IMMUNOL COX ET AL S3 VOLUME 127, NUMBER 1 Greg Plunkett, PhD Extract Manufacturers were invited through their organization, Round Rock, Texas the Allergenic Products Manufacturing Association, to review and comment on the allergen extract section. All of these in- Ronald Rabin, MD vited reviewers who contributed to the document are acknowl- Rockville, Maryland edged for their efforts within the particular section that they reviewed. In addition, the draft was posted on the ACAAI and