Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines
Por:
Larenas-Linnemann D., Rodríguez-Pérez N., Luna-Pech J.A., Rodríguez-González M., Blandón-Vijil M.V., Del-Río-Navarro B.E., Costa-Domínguez M.D.C., Navarrete-Rodríguez E.M., Macouzet-Sánchez C., Ortega-Martell J.A., Pozo-Beltrán C.F., Estrada-Cardona A., Arias-Cruz A., Rodríguez Galván K.G., Brito-Díaz H., Canseco-Raymundo M.D.R., Castelán-Chávez E.E., Escalante-Domínguez A.J., Gálvez-Romero J.L., Gómez-Vera J., González-Díaz S.N., Guerrero-Núñez M.G.B., Hernández-Colín D.D., Macías-Weinmann A., Mendoza-Hernández D.A., Meneses-Sánchez N.A., Mogica-Martínez M.D., Moncayo-Coello C.V., Montiel-Herrera J.M., O'Farril-Romanillos P.M., Onuma-Takane E., Ortega-Cisneros M., Rangel-Garza L., Stone-Aguilar H., Torres-Lozano C., Venegas-Montoya E., Wakida-Kusunoki G., Partida-Gaytán A., López-García A.I., Macías-Robles A.P., Ambriz-Moreno M.D.J., Azamar-Jácome A.A., Beltrán-De Paz C.Y., Caballero-López C., Fernández de Córdova-Aguirre J.C., Fernández-Soto J.R., Lozano-Sáenz J.S., Oyoqui-Flores J.J., Osorio-Escamilla R.E., Ramírez-Jiménez F., Rivero-Yeverino D., Martínez Infante E., Medina-Ávalos M.A.
Publicada:
1 ene 2020
Resumen:
Background: 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. Methods: 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: Results: 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. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed. © 2020 The Authors
Filiaciones:
Larenas-Linnemann D.:
Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
Rodríguez-Pérez N.:
Immunology. Universidad Autonoma de Tamaulipas, Matamoros, Tamaulipas, Mexico
Luna-Pech J.A.:
Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
Rodríguez-González M.:
Hospital Españoly, Mexico City, Mexico
Blandón-Vijil M.V.:
Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
Del-Río-Navarro B.E.:
Hospital Infantil de México Federico Gómez, México City, Mexico
Costa-Domínguez M.D.C.:
Hospital Españoly, Mexico City, Mexico
Navarrete-Rodríguez E.M.:
Hospital Infantil de México Federico Gómez, México City, Mexico
Macouzet-Sánchez C.:
State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
Ortega-Martell J.A.:
Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
Pozo-Beltrán C.F.:
Hospital con Especialidades Juan María Salvatierra, La Paz, Baja California Sur, Mexico
Estrada-Cardona A.:
Costamed, Playa Del Carmen, Quintana Roo, Mexico
Arias-Cruz A.:
State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
Rodríguez Galván K.G.:
Hospital Infantil de México Federico Gómez, México City, Mexico
Brito-Díaz H.:
HOSPITAL MATERNO INFANTIL. ISSEMyM, TOLUCA, Mexico
Canseco-Raymundo M.D.R.:
Hospital de Especialidades, “Dr. Antonio Fraga Mouret”. Centro Médico Nacional “La Raza”, Mexico City, Mexico
Castelán-Chávez E.E.:
Hospital San Ángel Inn Universidad, Mexico City, Mexico
Escalante-Domínguez A.J.:
Hospital General de Tijuana, Servicio de Alergia, Tijuana, Baja California, Mexico
Gálvez-Romero J.L.:
Hospital Regional ISSSTE Puebla, Puebla, Mexico
Gómez-Vera J.:
Institute of Security and Social Services of State Workers, López Mateos Regional Hospital, Mexico City, Mexico
González-Díaz S.N.:
State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
Guerrero-Núñez M.G.B.:
Clinica de Alergia Integral, Tampico, Tamaulipas, Mexico
Hernández-Colín D.D.:
Hospital Civil de Guadalajara Juan I Menchaca, Guadalajara, Jalisco, Mexico
Macías-Weinmann A.:
State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
Mendoza-Hernández D.A.:
Instituto Nacional de Pediatría, México City, Mexico
Meneses-Sánchez N.A.:
Centro Médico Nacional Siglo Xxi. Unidad Médica De Alta Especialidad. Hospital De Pediatria Dr. Silvestre Frenk Freund., Mexico City, Mexico
Mogica-Martínez M.D.:
Mexican Social Security Institute, La Raza National Medical Center, Mexico City, Mexico
Moncayo-Coello C.V.:
Hospital Juárez de México, Mexico City, Mexico
Montiel-Herrera J.M.:
The American British Cowdray Medical Center I.A.P., Mexico City, Mexico
O'Farril-Romanillos P.M.:
Mexican Social Security Institute, 21st Century National Medical Center (IMSS), Mexico City, Mexico
Onuma-Takane E.:
Fundación Clínica y Hospital Médica Sur, Ciudad de México, Mexico
Ortega-Cisneros M.:
UMAE Hospital de Especialidades CMNO IMSS, Guadalajara, Jalisco, Mexico
Rangel-Garza L.:
Private practice, San Luis Potosí, Mexico
Stone-Aguilar H.:
Hospital San José de Hermosillo, Hermosillo, Sonora, Mexico
Torres-Lozano C.:
Umae-Hecmno-IMSS, Guadalajara, Jalisco, Mexico
Venegas-Montoya E.:
Mexican Social Security Institute, High Specialty Medical Unit 25, Department of Clinical Immunology and Allergy, Monterrey, Nuevo León, Mexico
Wakida-Kusunoki G.:
Hospital Central sur Petroleoes Mexicanos, Mexico City, Mexico
Partida-Gaytán A.:
GlaxoSmithKline Mexico, Healthy Kids Polanco, Mexico City, Mexico
López-García A.I.:
Hospital Universitario de Puebla, BUAP, Puebla, Mexico
Macías-Robles A.P.:
Instituto Mexicano del Seguro Social, Centro Medico Nacional de Occidente Unidad de Alta Especialidad Hospital de Pediatria, Guadalajara, Jalisco, Mexico
Ambriz-Moreno M.D.J.:
Hospital Alfredo Pumarejo, Matamoros, Tamaulipas, Mexico
Azamar-Jácome A.A.:
Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
Beltrán-De Paz C.Y.:
Mexican Social Security Institute, 21st Century National Medical Center (IMSS), Mexico City, Mexico
Caballero-López C.:
Hospital Universitario de Puebla, BUAP, Puebla, Mexico
Fernández de Córdova-Aguirre J.C.:
Hospital Del Instituto Ecuatoriano De Seguridad Social Cuenca, Cuenca, Azuay, Ecuador
Fernández-Soto J.R.:
Instituto Mexicano del Seguro Social, Hospital General Regional N. 58, León, Guanajuato, Mexico
Lozano-Sáenz J.S.:
Private practice, San Luis Potosí, Mexico
Oyoqui-Flores J.J.:
Private practice, San Luis Potosí, Mexico
Osorio-Escamilla R.E.:
Private practice, San Luis Potosí, Mexico
Ramírez-Jiménez F.:
Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
Rivero-Yeverino D.:
Hospital Universitario De Puebla. Benemerita Universidad Autonoma De Puebla, Puebla, Mexico
Martínez Infante E.:
Mexican Social Security Institute, Zone 1 General Hospital, Oaxaca, Mexico
Medina-Ávalos M.A.:
Institute of Security and Social Services of State Workers (ISSSTE), Regional Hospital, Veracruz, Mexico
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