D2.220 - US Regional Difference in Allergen Immunotherapy Prescription Patterns: Focus on the South

Little is known about the drivers for the prescription of allergen immunotherapy (AIT). The CHOICE-Global study aims to determine whether international variations exist for these drivers (e.g., allergic disease to warrant AIT, co-existing pharmacotherapy, aeroallergen type, etc.). In this subgroup analysis, we investigated differences in drivers of AIT for patients in the South relative to other US regions.

The CHOICE-Global study is a prospective, multi-center, observational, non-interventional real-life survey performed in 8 regions in the world. US data were collected for 10 months using prescribing clinician-directed, and patient-directed questionnaires, both collected anonymously online. AIT product names were not recorded. Patients were categorized by US region and presented in numbers and percentages. Characteristics for patients from the South vs. other US regions were compared using Chi square testing.

Data were collected on n=491 unique US patients prescribed AIT: 302 (South), 61 (Midwest), 53 (Northeast), 39 (West) and 36 (Puerto Rico). Patients from the South were most likely to have only completed a primary school education (14.9%), whereas this was least common in the Midwest (0%) (p=0.0001). Sensitization to cypress tree pollen was highest in the South (36.8%) and lowest in the Northeast and Puerto Rico (0%) (p<0.0001). Allergy diagnoses were more commonly based on serum IgE and molecular based tests in the South (11.9%) compared with the West and Puerto Rico (0%) (p=0.0002). Patients prescribed AIT were most likely to have previously received AIT in the South (16.9%) compared to those in Puerto Rico (2.8%) (p=0.0212). Patients in the South were most likely to receive sublingual immunotherapy as the route of administration (4%) and not reported in the Midwest, Northeast, and Puerto Rico (0%) (p<0.0001). The prevention of asthma as a reason to prescribe AIT was most common in the South (3%) and least common in the West and Puerto Rico (0%) (p<0.0001).

The patient profile, methods for diagnosis of allergic disease, reasons and methods of AIT administration vary substantially by US region possibly due to differences in the prevalence of aeroallergens and in physician training and may lead to treatment disparities among patients who do not meet certain criteria in a given US region.