• Désirée Larenas-Linnemann, Noel Rodríguez-Pérez, Jorge A Luna-Pech, Mónica Rodríguez-González, María Virginia Blandón-Vijil, Blanca E Del-Río-Navarro, María Del Carmen Costa-Domínguez, Elsy Maureen Navarrete-Rodríguez, Carlos Macouzet-Sánchez, José Antonio Ortega-Martell, César Fireth Pozo-Beltrán, Alan Estrada-Cardona, Alfredo Arias-Cruz, Karen Guadalupe Rodríguez Galván, Herson Brito-Díaz, María Del Rosario Canseco-Raymundo, Enrique Emanuel Castelán-Chávez, Alberto José Escalante-Domínguez, José Luis Gálvez-Romero, Javier Gómez-Vera, Sandra Nora González-Díaz, María Gracia Belinda Guerrero-Núñez, Dante Daniel Hernández-Colín, Alejandra Macías-Weinmann, David Alejandro Mendoza-Hernández, Néstor Alejandro Meneses-Sánchez, María Dolores Mogica-Martínez, Carol Vivian Moncayo-Coello, Juan Manuel Montiel-Herrera, Patricia María O'Farril-Romanillos, Ernesto Onuma-Takane, Margarita Ortega-Cisneros, Lorena Rangel-Garza, Héctor Stone-Aguilar, Carlos Torres-Lozano, Edna Venegas-Montoya, Guillermo Wakida-Kusunoki, Armando Partida-Gaytán, Aída Inés López-García, Ana Paola Macías-Robles, María de Jesús Ambriz-Moreno, Amyra Ali Azamar-Jácome, Claudia Yusdivia Beltrán-De Paz, Chrystopherson Caballero-López, Juan Carlos Fernández de Córdova-Aguirre, José Roberto Fernández-Soto, José Santos Lozano-Sáenz, José Joel Oyoqui-Flores, Roberto Efrain Osorio-Escamilla, Fernando Ramírez-Jiménez, Daniela Rivero-Yeverino, Eric Martínez Infante, and Miguel Alejandro Medina-Ávalos.
• Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico.
• World Allergy Organ J. 2020 Aug 1; 13 (8): 100444.

BackgroundAllergen 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.MethodsUsing 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.ResultsRelated 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.ConclusionsCountries where European and American AIT extracts are available should adjust AIT according to which school is followed.© 2020 The Authors.

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