What changed recently

The 2025 parameter abandons the previous edition's structure of working through individual genetic entities and instead organises recommendations into a diagnosis part and a management part. Diagnosis now covers newborn screening for severe combined immunodeficiency, genetic testing and comorbidity surveillance, while management addresses immunoglobulin replacement, antibiotic prophylaxis, haematopoietic stem cell transplantation, precision medicine and quality-of-life assessment.

This ARIA revision rebuilds the intranasal treatment recommendations around eleven prioritised questions using the GRADE evidence-to-decision framework, drawing on mHealth and pharmacovigilance data and an expert cost survey alongside systematic reviews. It now suggests a fixed combination of intranasal antihistamine plus intranasal corticosteroid ahead of either agent alone, and intranasal corticosteroid ahead of intranasal antihistamine when a single agent is used.

This revision of the 2014 EAACI food allergy management guideline (which also absorbs the 2018 food immunotherapy guideline) shifts the emphasis from avoidance and watchful waiting to active management, recommending oral, sublingual and epicutaneous immunotherapy for peanut allergy plus oral immunotherapy for egg and milk, and incorporating omalizumab following its US approval for IgE-mediated food allergy from age one. It adds a conditional recommendation for psychological support in patients with significant anxiety and a strong recommendation to keep eating tolerated foods to protect nutrition.

Superseding the 2015 practice parameter, the 2023 update revises the diagnostic criteria for anaphylaxis and defines distinct patterns of the reaction, elevates serum tryptase measurement as a route to diagnosis and to detecting underlying mast cell disorders, and flags age-specific presentations in infants and toddlers. It also softens the old caution on beta-blockers and ACE inhibitors, judging that for most indications stopping them carries more risk than continuing, and recommends considering bone marrow biopsy after severe insect-sting or recurrent idiopathic anaphylaxis in adults.

The task force reworked the 2014 EAACI anaphylaxis guideline using AGREE II and GRADE, and set out weight-banded adrenaline autoinjector prescribing: 0.15 mg for children from roughly 7.5 kg up to 25-30 kg and at least 0.3 mg above that, including for adolescents and adults at risk. It also asks manufacturers to publish device pharmacokinetic data and adds recommendations on structured patient training, simulation training for clinicians and aligning school policies with anaphylaxis guidance.

The 2021 revision keeps the six-week cut-off separating acute from chronic urticaria but compresses the treatment algorithm from four steps to three, with explicit guidance on updosing and treatment duration at each step. Second-generation H1-antihistamines remain first line, omalizumab is second line starting at 300 mg every four weeks with updosing or interval shortening for partial responders, and ciclosporin 3.5-5.0 mg/kg is reserved as third line for severe refractory disease.

Updating the 2008 rhinitis practice parameter, the 2020 version keeps intranasal corticosteroids as preferred monotherapy for persistent allergic rhinitis but now recognises added benefit from combining them with intranasal antihistamines in both allergic and non-allergic rhinitis. It also advises against food allergy testing in the routine rhinitis workup, highlights cough as a common symptom of both allergic and non-allergic rhinitis, and reviews the newer concept of local allergic rhinitis.

The 2014 parameter substantially rewrites the 2006 version and folds in developments since the 2010 NIAID guidelines, adding entirely new material on delayed mammalian meat allergy caused by alpha-gal, component-resolved diagnostic testing, food additive and genetically modified food reactions, and recommendations aimed at preventing food allergy rather than only managing it.