A Delphi consensus on diagnosis, management, and treatment with allergen immunotherapy of polysensitized children in Spain

Background: The study aimed to evaluate the level of agreement between specialists in pediatric allergology regarding the diagnosis and indications for allergen immunotherapy (AIT) for dust mites, molds, animal dander, and Hymenoptera venom allergen, as well as mixtures of several allergen sources in polysensitized children in Spain.Materials and methods: A Delphi study was performed using an online survey designed by a committee of pediatric AIT experts: 46 and 44 panelists participated in Rounds 1 and 2, respectively. In Round 1, 204 statements on 8 dimensions were evaluated (Diagnosis, Therapeutic management, and Pollens - Part I; Mites, molds, animals, hymenoptera venom, and mixtures - Part II). A total of 148 statements were finally accepted after Round 2. Panel members rated their level of agreement with assessments on a 9-point Likert scale based on acceptance by ≥ 66.7 of them.Results: Panel experts recommended molecular diagnosis for dust mite allergy diagnosis in polysensitized pediatrics and mixtures of nonhomologous mites (Dermatophagoides and Lepidoglyphus) for optimal AIT management. Subcutaneous AIT with mold extracts is recommended, but no agreement was reached on mixing different mold types. Panel experts agreed that Fel d 1 and Can f 1 sIgE are better predictors for animal dander allergy , but no agreement exists on the acceptance of AIT with dander mixtures. Panelists accepted that Api m 2 (hyaluronidase) sIgE indicates Vespid and Apis mellifera cross-reactivity in children; and Api m 4 (melittin) sIgE is a marker of risk for systemic reaction with AIT in Apis mellifera allergy. According to the consensus, SCIT is more suitable for allergen mixtures than SLIT. and agreement was reached for pollen allergens and Alternaria alternata mixtures if stability, safety, and efficacy have been demonstrated.Conclusions: This Delphi study provides, where evidence is lacking, current expert-based opinions on clinical decision-making for managing polysensitized children.