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. Theophylline is a less desirable alternative due to the need to monitor serum concentration levels.

• Step 1 and step 2 medications are based on Evidence A.
• Step 3 ICS + adjunctive therapy and ICS are based on Evidence B for efficacy of each treatment and extrapolation from comparator trials in older children and adults - comparator trials are not available for this age group
• steps 4-6 are based on expert opinion and extrapolation from studies in older children and adults.
• 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 should be prepared and equipped to identify and treat anaphylaxis that may occur.