Criteria for Control and Remission of Respiratory Allergic Disease With Allergen Immunotherapy: A Delphi Consensus

Abstract

Background

Allergic rhinitis, conjunctivitis and asthma are prevalent IgE-mediated respiratory diseases that frequently coexist and impair quality of life. Allergen immunotherapy (AIT) has clinical benefits and potential disease-modifying effects. Until recently, standardised definitions of disease control and remission were lacking in routine clinical practice, particularly for allergic rhinitis and conjunctivitis. This study aimed to propose preliminary definitions of control and remission in patients receiving AIT and to assess expert consensus using the Delphi methodology.

Methods

A scientific committee developed a survey based on a literature review and expert input, addressing symptoms, medication use, quality of life, exacerbations and tools for objective and subjective assessment. Forty allergists participated in a two-round Delphi study. Consensus was predefined as ≥ 70% agreement on a 9-point Likert scale.

Results

Consensus was achieved for all items after two rounds. The panel agreed on proposed definitions of disease control and clinical remission for allergic rhinitis, conjunctivitis and asthma in the context of AIT, integrating symptom severity, medication use, validated questionnaires and objective measures.

Conclusions

This study presents preliminary expert-consensus definitions of control and remission in allergic rhinitis, conjunctivitis and asthma in patients undergoing AIT. These definitions should not be interpreted as validated clinical criteria or endpoints. As a preliminary proposal, they aim to provide a structured approach for assessing treatment response in clinical practice by integrating symptom burden, medication use, patient-reported outcomes and objective measures. They should be regarded as an initial conceptual step, and further prospective studies are needed to validate these criteria and confirm their relevance, feasibility and applicability.