English: The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.

• If alternative treatment is used and response is inadequate, discontinue it and use the preferred treatment before stepping up.
• Zileuton is a less desirable alternative due to limited studies as adjunctive therapy and the need to monitor liver function. Theophylline requires monitoring of serum concentration levels.
• In step 6, before oral systemic corticosteroids are introduced, a trial of high-dose ICS + LABA + either LTRA, theophylline, or zileuton may be considered, although this approach has not been studied in clinical trials.
• Step 1, 2, and 3 preferred therapies are based on Evidence A; step 3 alternative therapy is based on Evidence A for LTRA, Evidence B for theophylline, and Evidence D for zileuton.
• Step 4 preferred therapy is based on Evidence B, and alternative therapy is based on Evidence B for LTRA and theophylline and Evidence D for zileuton.
• Step 5 preferred therapy is based on Evidence B.
• Step 6 preferred therapy is based on (EPR-2 1997) and Evidence B for omalizumab.
• Immunotherapy for steps 2-4 is based on Evidence B for house-dust mites, animal danders, and pollens; evidence is weak or lacking for molds and cockroaches.
• Evidence is strongest for immunotherapy with single allergens.
• The role of allergy in asthma is greater in children than in adults.
• Clinicians who administer immunotherapy or omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur.