The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) survey: provider practices and beliefs about allergen immunotherapy

1. Bryan Leatherman MD^1,*, 
2. David P. Skoner MD^2,3, 
3. James A. Hadley MD, FACS⁴,
4. Nicole Walstein PA-C⁵, 
5. Michael S. Blaiss MD⁶, 
6. Mark S. Dykewicz MD⁷, 
7. Timothy Craig DO⁸, 
8. Nancy Smith MS⁹ and
9. Felicia Allen-Ramey PhD¹⁰

10. 1. International Forum of Allergy & Rhinology

       Volume 4, Issue 10, pages 779–788, October 2014

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Keywords:

• physician's practice patterns;
• allergens;
• subcutaneous immunotherapy;
• sublingual immunotherapy;
• administration and dosage;
• immunology

Background

The practices and beliefs of the provider specialties that treat allergic rhinoconjunctivitis (ARC) with allergen immunotherapy (AIT) may vary.

Methods

A telephone survey of 500 randomly selected health care practitioners in 7 specialties, conducted in 2012.

Results

AIT was provided as a subcutaneous injection (SCIT) by 91% of allergist/immunologists, 54% of otolaryngologists, and 18% to 24% of other specialties. Otolaryngologists were the most frequent providers of sublingual drops of AIT (SLIT; 33%), compared to 2% to 10% of other specialties. AIT was recommended for adults with allergic rhinoconjunctivitis by 100% of allergist/immunologists vs 62% to 84% of the other specialties (p < 0.001). The primary reason for recommending AIT for adults (52%) or children (46%) was that other therapies did not work. Between 48% (nurse practitioners/physician assistants) and 93% (allergist/immunologists) of practitioners always or often decreased symptomatic medications over the course of AIT treatment. Most practitioners in all specialties (82–100%) thought that AIT was appropriate for patients with severe allergy symptoms. Significantly more allergist/immunologists and otolaryngologists than other specialists thought AIT was appropriate for mild allergy symptoms (p < 0.001 and p = 0.004, respectively, vs other specialties). Significantly more allergist/immunologists than other specialists thought that AIT was more effective than symptomatic medications (p < 0.001), could reduce the further development of allergies (p = 0.03), and could prevent the development of asthma.

Conclusion

SCIT was more frequently provided than SLIT by all the specialties. Otolaryngologists were the most likely to offer SLIT, while very few allergist/immunologists offered SLIT. Allergist/immunologists differed from other specialties in some beliefs about the effectiveness of AIT.

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