Real life report of allergen immunotherapy management during the COVID-19 outbreak in France and Spain, a CHOICE project

ABSTRACT

Background: The COVID-19 pandemic represents a challenging global crisis. Guidelines have provided recommendations on allergen immunotherapy (AIT) practice, but very few real-life data have been reported on how AIT has been managed. In the framework of an ongoing project on AIT (The CHOICE project) in France and Spain, we developed a sub-study to evaluate the impact of COVID-19 in AIT clinical practice. The objective was to assess how the pandemic crisis affected aeroallergen AIT prescription patterns during the first hard lockdown and the following period. The survey was open for 30 days and was closed on November 4th, 2020. Method: An online questionnaire gathering information on physicians' profile and a questionnaire on possible issues concerning AIT, related to COVID-19, were developed and run among participants Results: 95 doctors participated to the survey 62.1% were Spanish and 37.9% French, 72.7% females, with a mean age 48.2 years (±SD10.2). During the lockdown phase, 70.9% of participants received significantly less respiratory patients, than in 2019. Besides, 90.7% of physicians acknowledged a reduction in AIT prescriptions, with a median reduction of 75% [0-100], which was significantly beyond the decrease in examined patients (median 50% [0-100], p < 0.001). For new prescriptions, 57.6% of participants reported qualitative changes, with more sublingual immunotherapy (SLIT) than usual, especially in Spain (26.9% vs. 5.9% in France, p = 0.021). For SCIT on maintenance, 54.5% of doctors applied modifications, mainly temporarily pausing the treatment. After the lockdown, clinic normalization was only partially achieved, and still 32.6% of physicians (p = 0.001) reported a maintained decrease in the number of patients. The reduction in new AIT prescriptions was still very marked (52.6%). Also, qualitative changes were less frequent (23.5%), but prescribing more SLIT remained the most common modification (18.9%). Conclusion: Our novel real-life data show that the COVID-19 pandemic correlates to a reduction in respiratory patients consulting allergy specialists, and in new AIT prescription, with changes in qualitative prescription patterns. Our results are highly relevant to understand how AIT has been handled in real life, have insights on the amplitude of the impact of the crisis, and implement new strategies to ensure a quality and timely healthcare not only for those who missed their consultations, but also for future patients.