Cluster subcutaneous allergen immunotherapy as a sustainable practice towards net zero healthcare

To the Editor, As health care sector accounts for approximately 5% of global greenhouse-gases (GHG) emissions, several systems are calling adoption transparent and standardized metrics GHG accounting, paving way towards net zero healthcare.1 Although allergen immunotherapy (AIT) has been proposed as a prototype individualized medicine in terms clinical response safety allergic disease, commuting to medical facilities lengthy build-up schedules have described limiting factors treatment compliance among subjects on subcutaneous (SCIT).2 Cluster AIT variations conventional regimes, which timeframe from induction maintenance phase is much shorter compared AIT.3 Hence, we assessed contribution SCIT cluster scheduled intervention reduction carbon footprint starting SCIT. In this single-center retrospective analysis, sociodemographic data, profile, dosing schedule number required physical visits, road travelled distance our Institution during was collected patients' electronic records November 2021 January 2022. Following routine practise, only with confirmed Allergist SCIT-prescription, following positive skin prick test and/or specific IgE corresponding panel aeroallergen were included.4 The investigation approved by local Ethical Committee (institutional code Complejo Hospitalario Universitario de Canarias 2022-13, 2022, February 24th) funded Fundación Canaria Instituto Investigación Sanitaria Canarias, Servicio Canario Salud, grant OA17/042. authors declare no conflict interest funders had role design study; collection, analyses, or interpretation data; writing manuscript, decision publish results. A total 710 doses administered 145 patients 12-week study period (Table 1). All successfully completed protocol, including administration 2 injections at 30-min interval weekly visits reach dose 1–4 weeks. 97 out (66.8%) allergoids (adsorbed aluminium hydroxide L-tyrosine Glutaraldehyde-modified extracts), while 48 (33.2%) followed regime solely adsorbed extracts. Regarding composition prescribed SCIT, combination House Dust Mites (HDM) most frequently 64 (44.13%), HDM Blomia tropicalis 50 (34.48%). mean per patient significantly (<0.001) reduced regime. overall 16,613 km all completing schedule, contrast 31,808 addition, estimated annual 8960 kg Co2e potential 8204 related (Figure 1).5 Ten adverse events (AE) reported 6 (4.13%), increasing (SD) outpatients extra-visits Unit (AIU) 1.5 ± 1.2 times dose. Nine these 10 AEs mild non-immediate reactions after injection. remaining AE considered Grade-II late moderate reaction, treated home regular patient's medication telephone consultation AIU.6 (A) Contribution partial (CO2, CH4, NO2) (CO2e) emissions 2022 January. (B) Annual CO2e schedules. Asterisks indicate statistical significance (****p < 0.001). knowledge, first investigate scope 1 part shared responsibility decarbonize 2). Health professionals called participate implement sustainable practice principles routinely practice. may contribute reduce direct healthcare achieve neutrality. Potential benefits patient, community environmental (SCIT). Alicia Domínguez Estirado: Data curation (Equal); Investigation Validation Writing – original draft review & editing (Equal). Inmaculada Sánchez-Machín: Formal analysis Methodology Resources Supervision Visualization Paloma Poza-Guedes: Software Ruperto Gonzalez Perez: Conceptualization Funding acquisition (FIISC)