Trends in Specific Immunotherapy for Allergic Rhinitis: A Survey of Chinese ENT Specialists

Abstract

PurposeSpecific immunotherapy (SIT) is a suitable but uncommon treatment option for allergic rhinitis (AR) in China. The current understanding and attitude of Chinese ENT (ear, nose, and throat) specialists in regards to SIT is unclear. This study investigates current trends in the awareness and application status of SIT among Chinese ENT specialists.MethodsWe performed a nationwide, cross-sectional survey with a specially designed questionnaire given to 800 ENT specialists in China. A member of the trained research group conducted face-to-face interviews with each respondent.ResultsMost of the respondents considered AR (96.0%) and allergic asthma (96.0%) the most suitable indications for SIT. Of all respondents, 77.0% recommended the application of SIT as early as possible; in addition, SIT was considered 'relatively controllable and safe' by most respondents (80.6%). The highest allergen-positive rate in AR was associated with house dust mite (47.7%) and obvious differences existed among geographical regions. Conventional subcutaneous immunotherapy was the most highly recommended treatment option (96.2%). 'The high cost of SIT' (86.6%) and 'lack of patient knowledge of SIT' (85.2%) were probably the main reasons for the lower clinical use of SIT in China.ConclusionsMost cases showed that the opinions of Chinese ENT specialists appeared to be in agreement with recent SIT progress and international guidelines; however, many areas still need to enhance the standardization and use of SIT in China. Clinical guidelines for SIT require improvement; in addition, Chinese ENT specialists need continuing medical education on SIT.

Chinese Guideline on allergen immunotherapy for allergic rhinitis

“…Subcutaneous injection of allergen extract, also known as allergy shots, has since been the historical and predominant method of administration. Indeed, a nationwide cross-sectional survey assessing the trends in specific immunotherapy for AR in China has recently shown that conventional subcutaneous injection was the treatment option, which was most highly recommended by 96.2% of the Chinese ENT Specialists surveyed (30). However, sublingual immunotherapy (SLIT) has rapidly been established with high scientific credibility and become the most viable alternative to SCIT.…”

“…However, sublingual immunotherapy (SLIT) has rapidly been established with high scientific credibility and become the most viable alternative to SCIT. As house dust mites (HDM) have been shown to be the most prevalent allergens in patients with AR and atopic asthma in multi-center study of prevalence of sensitization in patients with AR and atopic asthma in Mainland China (20), the Chinese guidelines recommend that AR patients who are allergic to one or two aeroallergens and particularly sensitized to HDM, should be treated by AIT (30).…”

“…More recently, a prospective, open-IV clinical trial by Qiu and colleagues (29) has confirmed the safety and efficacy of rush immunotherapy (RIT) and conventional immunotherapy in Chinese AR patients. Zhou and colleagues (30) investigated the current trends in the awareness and application status of AIT among Chinese ENT (ear, nose, and throat) specialists across China and concluded that whilst most of the specialists appeared to be in agreement with recent AIT progress and international guidelines, many areas still need to enhance the standardization and use of AIT in China. In order to promote research and clinical practice on AR immunotherapy at all levels in China, the Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G) reviewed the evidence on allergen specific SCIT in AR available in the literature (31).…”

Current Specific Immunotherapy for Allergic Rhinitis: Perspectives from Otorhinolaryngologists

“…Thus, ENT specialists are mainly responsible for the primary treatment of AR. In this regard, important information has been provided by a Chinese survey conducted among ENT specialists on their knowledge and clinical usage of SIT 12. Most of the survey respondents considered AR (96.0%) and allergic asthma (96.0%) the most suitable indications for SIT.…”

“…In contrast, the predominant view in the United States is that one should treat as many of a patient's allergies as possible by administering all the relevant allergens (either as a mixture or as separate extracts). Data suggest that ENT specialists in China tend to use a similar SIT approach to treating patients as that used in the United States 12. According to published data, the use of single- or multi-antigen immunotherapy in polysensitized patients, whether delivered sublingually or subcutaneously, requires more supporting data 20…”