Influence of the COVID-19 pandemic on the prescription and adherence to allergen-specific immunotherapyDear Editor, After almost 2 years since the onset of the COVID-19 pandemic, very few articles have published the actual impact of the pandemic on the prescription of allergen immunotherapy (AIT). Recently, Rodriguez Del Rio et al. 1 published a report on the management of AIT during the COVID-19 outbreak in France and Spain, based on a retrospective survey conducted among physicians prescribing AIT from 4 October 2020 to 4 November 2020. In this report, they observed a significant reduction in the number of new AIT courses during the lockdown (75%) and in the post-lockdown period (50%) (mean reduction in both periods 62.5%), as well as changes in qualitative prescribing patterns, in favour of sublingual immunotherapy (SLIT). These findings differ from the results of a retrospective analytical observational real-life study performed by our group in the same period (October and November 2020). The aim of our study was to analyse with real-life data whether pandemic-derived restrictions interfered with the prescription and initiation of treatment with AIT. Our study included 446 patients from the Allergology Unit of the University Hospital of Fuenlabrada who were prescribed the initiation of AIT in the period between 1 March 2020 and 30 September 2020 (pandemic period, including lockdown and post-lockdown

<b><i>Background:</i></b> As the number of allergic sensitizations increases the severity of allergic respiratory diseases worsens. Multiple monoallergen immunotherapy can be accompanied by poor treatment adherence and high costs, single multiallergen immunotherapy needs to prove efficacy whilst maintaining a good safety profile. <b><i>Methods:</i></b> Observational, retrospective, multicenter study using a 2-pollen single undiluted multiallergen subcutaneous immunotherapy (SCIT) in routine clinical practice in Spain. Patients with rhinoconjunctivitis, with/without controlled asthma, sensitized to grass, olive, Parietaria, Cupressus, plane tree and/or Salsola pollen were included. Primary and secondary clinical efficacy endpoints were quality of life (mini Rhinitis Quality of Life Questionnaire (miniRQLQ)) and visual analogue scale (VAS) respectively. All adverse events were documented. <b><i>Results:</i></b> Ten centers included 97 patients, median age 32 years. SCIT treatment included combinations of grass mix with olive, Parietaria, Cupressus, plane tree or Salsola or olive with Parietaria, Cupressus or Salsola. The mean duration of SCIT was 1.8 years with a high treatment adherence (73%). Significant improvement in quality of life, nasal and ocular symptoms, activity limitations and practical problems (<i>p</i>&#x3c; 0.0001) and other symptoms (<i>p</i>= 0.024) was observed. Most patients did not develop asthma-like symptoms and a significant improvement of all allergic symptom severity was perceived. VAS showed a significant improvement in rhinoconjunctivitis and asthma by patients and physicians. Twenty-nine patients experienced adverse reactions, 25 had local and 6 had systemic reactions. <b><i>Conclusions:</i></b> Single undiluted multiallergen SCIT treatment of two different pollens is efficacious and safe in both children and adults, showing that it is a suitable option for the treatment of polyallergic patients.

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