Survey on immunotherapy practice patterns: dose, dose adjustments, and duration

Ann Allergy Asthma Immunol. 2012 May;108(5):373-378.e3. doi: 10.1016/j.anai.2012.03.009.

Abstract

Background: Practical issues dealing with the administration of allergen immunotherapy (AIT) by European and US allergists are not well known. Several concerns are only partially covered by guidelines.

Objective: To survey AIT practice patterns among worldwide members of the American Academy of Allergy, Asthma and Immunology (AAAAI).

Methods: A web-based survey was conducted among AAAAI members on dosing, dose adjustment after missed doses, and duration of AIT.

Results: A total of 1,201 replies (24.7% response rate of which 10% of responses were from non-US and non-Canada members). A total of 57% to 65% of the US-Canadian dosing falls within the recommended Practice Parameter ranges (9.4%-19% too low). Dose adjustment after missed doses is based on time elapsed since the last administered dose by 77% of US-Canadian and 58% of non-US-Canadian allergists. Doses are reduced when a patient comes in more than 14 days for 5 weeks after the last administration and initial dosing restarted after more than 30 days for 12 weeks since last administration during the build-up or maintenance stage. After missing 1 to 3 doses, the dosing schedules were mostly followed (build-up phase: repeat last dose, reduce by 1 dose, reduce by 2doses; maintenance phase: reduce by 1 dose, reduce by 2 doses, reduce by 3 doses). AIT is prescribed for a median of 3 years by non-US-Canadian allergists but for a median of 5 years by 75% of US-Canadian allergists. Main reasons for continuing beyond 5 years were "after stopping, symptoms reappeared" or "patient afraid to relapse."

Conclusion: Many patients receive less than recommended doses. Two areas in which to plan further research are establishment of an optimal dose-adjustment plan for missed applications and exploration of the maximum appropriate duration of immunotherapy.

MeSH terms

  • Allergens / administration & dosage*
  • Allergens / immunology
  • Allergens / therapeutic use
  • Allergy and Immunology / standards
  • Canada
  • Desensitization, Immunologic / methods*
  • Desensitization, Immunologic / standards*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Health Care Surveys
  • Humans
  • Hypersensitivity / immunology
  • Hypersensitivity / therapy*
  • Internet
  • Male
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Surveys and Questionnaires
  • Time
  • United States

Substances

  • Allergens