D1.226 - Allergen Immunotherapy Preferences by Patient in Some Arabic countries: The CHOICE-Middle East Study

Allergen immunotherapy (AIT) is widely used in the Middle East (ME) for respiratory allergic diseases, but regional real-world data on factors influencing AIT prescribing are limited. This study assessed how physician-rated patient-relevant factors vary by age, AIT route, disease phenotype, and biologic co-prescription.

CHOICE-ME is a prospective, cross-sectional, observational e-survey of patients initiating AIT in Saudi Arabia, Qatar, and Lebanon. Physicians rated 13 AIT prescribing attributes on a 4-point Likert scale (High=score 4 vs Low-Med). Chi-square and Fisher's exact tests compared the proportion rated High across four subgroups pairs: pediatric vs adult, SCIT vs SLIT (including allergen type/formulation), rhinitis-only vs asthma+rhinitis, and biologic vs non-biologic.

A total of 1,185 patients were included, 49.1% were female. SLIT predominated overall (86.1%) and across age groups. Only disease severity was rated relevant in pediatric than adult patients (85.5% vs 65.2%, p<0.001). Allergen sensitization pattern was the strongest determinant of AIT route. SLIT use was higher in mite- than pollen-sensitized patients (90.0% vs 77.0%), whereas SCIT use was higher in pollen sensitization (23.0% vs 10.0%; p<0.001). Route patterns reflected different physician-rated factors: safety and fewer clinic visits were more often rated highly in SLIT-treated patients (both p<0.001), while efficacy after discontinuation and biologic activity were more often rated highly in SCIT-treated patients (both p<0.05). In polysensitized patients, biologic activity and major allergen content were rated more relevant in SCIT than SLIT (58.8% vs 16.0% and 39.2% vs 4.0%, respectively; both p<0.001). Within SCIT, natural depot (vs allergoid) was associated with higher relevance ratings for clinical/technical quality across 8/13 attributes (all p<0.001). Rhinitis-only (vs asthma+rhinitis) was associated with higher relevance ratings for efficacy after discontinuation, biologic activity, and cost (all p≤0.001), whereas asthma+rhinitis was associated with greater SCIT use (17.5% vs 11.9%, p=0.010). Biologic co-prescription (3.7%) identified a more severe asthma subgroup (OR 7.7; p<0.001) without differences in attribute relevance.

Allergen sensitization pattern (not age) was the main driver of AIT route in ME. Physician prescribing decisions varied by patient-relevant factors across route, formulation, and phenotype, while biologic co-prescription marked a more severe asthma subgroup without changing attribute relevance.