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January 3, 2017

Percentage of people with allergy start SCIT or SLIT

Question

I am starting a PhD in Allergy Immunotherapy and I have been searching the literature for months for an answer to the following: What percent of people who have an allergy start subcutaneous and/or sub-lingual immunotherapy? I have found several reports on noncompliance but none on initiation. Any publications you may know of would be greatly appreciated!

Answers

From the Editor: While the percentage of allergic individuals who receive allergy immunotherapy (AIT) may not be known, Dr Cardona gives insight in the worldwide variation in AIT including  subcutaneous (SCIT) and sublingual  (SLIT). 

By Prof Vicky Cardona

Currently, the two most used and accepted routes of allergen immunotherapy (AIT) delivery are subcutaneous (SCIT) and sublingual (SLIT). Very few data are available in the literature regarding the percentage of use of each of these types of AIT. Historically, there have been great geographical differences, in the USA SCIT is the most frequent modality, while in Europe where SLIT was first used, this form has grown in the last decades. However, even within Europe, we can find heterogeneous prescription trends, in France and Italy SLIT vastly surpasses SCIT use, but in other countries such as Spain or Germany, SCIT still prevails.

In a study performed in Germany, Worm et al. assessed the prescription of AIT for allergic rhinitis according to causal allergens and specialty of the attending physician¹. They report a use of SCIT ranging between 50 and 98.7%, being this modality preferred by dermatologists, and also more frequently used in house dust mite allergy compared with grass pollen allergy.

In 2013, in an interview Prof Linda Cox, president at that time of the American Academy of Allergy and Clinical Immunology², reported that according to two surveys, in the USA SLIT was only used in 5.7% in 2007³ and by 11.4% in 2011⁴.  The current status of sublingual immunotherapy in the United States has recently been reviewed by Elenburg et al⁵.

Even less information is available from the rest of the world. In Korea, Hur et al report that the percentage of allergists prescribing SCIT is 82% while 18% perform SLIT⁶.

Due to the increasing and robust evidence based on large randomized trials on its efficacy and safety, the use of SLIT will probably be growing in the following years.

References

1. Worm M, Lee HH, Kostev K. Prevalence and treatment profile of patients with grass pollen and house dust mite allergy. J Dtsch Dermatol Ges. 2013 Jul;11(7):653-61
2. Allergen Immunotherapy: Best Practices. Medscape, May 06, 2013. http://www.medscape.com/viewarticle/803436
3. Tucker MH, Tankersley MS; ACAAI Immunotherapy and Diagnostics Committee. Perception and practice of sublingual immunotherapy among practicing allergists. Ann Allergy Asthma Immunol. 2008 Oct; 101(4):419-25.
4. Sikora JM, Tankersley MS; ACAAI Immunotherapy and Diagnostics Committee. Perception and practice of sublingual immunotherapy among practicing allergists in the United States: a follow-up survey. Ann Allergy Asthma Immunol. 2013 Mar;110(3):194-197
5. Elenburg S, Blaiss MS. Current status of sublingual immunotherapy in the United States. World Allergy Organ J. 2014 Oct 8; 7(1):24. doi:10.1186/1939-4551-7-24.
6. Hur GY, Kim TB, Han MY, Nahm DH, Park JW; Allergen and Immunotherapy Work Group of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI). A survey of the prescription patterns of allergen immunotherapy in Korea. Allergy Asthma Immunol Res. 2013 Sep; 5(5):277-82.

Vicky Cardona
Allergy Section, Department of Internal Medicine
Vall d'Hebron University Hospital
Barcelona, Spain

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