Practice Patterns of Allergen Immunotherapy in Korea: Where Are We?

© Copyright The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease http://e-aair.org Allergen immunotherapy has been used for more than a century to treat allergic diseases, including allergic rhinitis and asthma, as well as venom-induced anaphylaxis. The efficacy of immunotherapy has been established by many double-blind, placebo-controlled studies that have been reviewed in meta-analyses. Indications and prescription rules for immunotherapy have been clearly defined in the literature. However, prescription patterns of immunotherapy may differ by country. The article in the issue studied the practice patterns of immunotherapy in Korea for the first time. The authors e-mailed a questionnaire to 690 Korean allergists with clinical practice experience. About 70% of the respondents answered that they prescribed immunotherapy. Subcutaneous immunotherapy (SCIT) was performed by 82% and sublingual immunotherapy (SLIT) by the rest. Thirty percent of respondents replied that they did not perform immunotherapy; however, two thirds of them desired using it in future practice. The results of this study are worthy of comment despite the limitations due to response rate and demographics. In this survey, 30.4% of the respondents performing SCIT answered that they had experienced anaphylaxis related to immunotherapy. Adverse reactions of immunotherapy can be classified into 2 categories: local reactions and systemic reactions that can range in severity from mild to very severe life-threatening anaphylaxis. Unfortunately, the authors did not use a severity grading system for systemic reactions but asked simply “Have you ever experienced anaphylaxis?”. Variability in how the term ‘anaphylaxis’ is interpreted may make it difficult to compare the risk of systemic reactions with those of other studies. In addition, attention must be paid to the interpretation of the percentage of respondents who experienced anaphylaxis. Notably, about 28% of the respondents prescribing immunotherapy used rush or cluster immunotherapy during the build-up phase. These accelerated schedules offer the advantage of achieving a therapeutic dose earlier; however, they are associated with a greater Practice Patterns of Allergen Immunotherapy in Korea: Where Are We?