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Variability in pollen season immunotherapy suggests need for treatment standards

Establishing pollen season guidelines for the dose and frequency of subcutaneous aeroallergen immunotherapy might help standardize global variability in practice styles, according to researchers who conducted a worldwide survey.

A self-reported electronic survey was completed by 1,201 allergists — all members of the American Academy of Allergy, Asthma and Immunology — in September 2010. Most responders tended to practice in urban or suburban areas of the United States and had more than 10 years of experience with variable-sized practices.

Allergists who had practiced for more than a decade were most likely to dose-adjust during peak pollen season. The researchers examined the following variables:

• Dose adjustment during peak pollen season: 11% change doses for all patients, 31% change doses for select patients; remainder do not dose-adjust.
• Dose adjustment based on symptoms and skin test reactivity: 58% adjust doses for upper airway allergic symptoms.
• Frequency adjustment during pollen season: 85% follow the current practice parameter guidelines, giving subcutaneous aeroallergen immunotherapy (SCIT) every 2 to 4 weeks during the maintenance phase, regardless of demographics.
• Frequency adjustment based on symptoms: 75% (of responders who change frequency of maintenance SCIT) decrease the interval between injections.

“Of note, however, was a sizeable minority [10-15%] who did not adhere to the recommended target doses or the standardized extracts,” the researchers wrote. “Not surprisingly, when some decisions … are not fully addressed in the current practice guidelines, the variability is amplified.”