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Allergic asthma (AA) is a common asthma phenotype, and its diagnosis requires both the demonstration of IgE-sensitization to aeroallergens and the causative role of this sensitization as a major driver of asthma symptoms. Therefore, a bronchial allergen challenge (BAC) would be occasionally required to identify AA patients among atopic asthmatics. Nevertheless, BAC is usually considered a research tool only, with existing protocols being tailored to mild asthmatics and research needs (eg long washout period for inhaled corticosteroids). Consequently, existing BAC protocols are not designed to be performed in moderate-to-severe asthmatics or in clinical practice. The correct diagnosis of AA might help select patients for immunomodulatory therapies. Allergen sublingual immunotherapy is now registered and recommended for controlled or partially controlled patients with house dust mite-driven AA and with FEV1 ≥ 70%. Allergen avoidance is costly and difficult to implement for the management of AA, so the proper selection of patients is also beneficial. In this position paper, the EAACI Task Force proposes a methodology for clinical BAC that would need to be validated in future studies. The clinical implementation of BAC could ultimately translate into a better phenotyping of asthmatics in real life, and into a more accurate selection of patients for long-term and costly management pathways. © 2021 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.


Ioana Agache, Dario Antolin-Amerigo, Frederic de Blay, Cristina Boccabella, Cristiano Caruso, Pascal Chanez, Mariana Couto, Ronina Covar, Serge Doan, Jean-Luc Fauquert, Gail Gauvreau, Alina Gherasim, Ludger Klimek, Catherine Lemiere, Parameswaran Nair, Iñigo Ojanguren, David Peden, Luis Perez-de-Llano, Oliver Pfaar, Carmen Rondon, Maia Rukhazde, Joaquin Sastre, Johannes Schulze, Diana Silva, Susan Tarlo, Sanna Toppila-Salmi, Jolanta Walusiak-Skorupa, Stefan Zielen, Ibon Eguiluz-Gracia. EAACI position paper on the clinical use of the bronchial allergen challenge: Unmet needs and research priorities. Allergy. 2022 Jun;77(6):1667-1684

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PMID: 34978085

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