ACAAI MEMBERSHIP AEROALLERGEN IMMUNOTHERAPY (AIT) PRACTICE PATTERNS IN (SEVERE) ASTHMATIC PATIENTS YES/NO ON BIOLOGIC THERAPY

guidelines are starting to suggest subcutaneous/sublingual allergen immunotherapy (SCIT/SLIT) in severe asthmatics, particularly those controlled with biologics. ACAAI asthma committee conducted an online (Surveymonkey®) survey to evaluate ACAAI membership opinion on SCIT/SLIT in asthmatics. 199 respondents, 89% from US, academic/private practice 20/77%, mostly suburban/urban (55/39%), with over 15y experience (62%). SCIT/SLIT is not prescribed by 33/2%. The youngest age (median, IQ1-4) colleagues would start SLIT is 5y (5, 6y); and SCIT 5y (4, 5y), with no upper age-limit in 77%. 6/199 does not prescribe SCIT/SLIT in asthma. In allergic asthma-no comorbidity 58/28% would prescribe SCIT/SLIT, but ratios rise with comorbid allergic rhinoconjunctivitis (92/50%) or atopic dermatitis (64/28%). Once an acute asthma episode is over colleagues would start SCIT in intermittent-moderate persistent asthma, controlled (82-94%) or uncontrolled (21-25%); for severe persistent in 76 and 13%, respectively. 88% prescribes AIT in asthmatics on biologics. 55% contemplates AIT may shorten the biologic therapy course. The severe asthmatic profile for which members might start SCIT/SLIT: controlled, with/without biologic, with allergic comorbidities or flaring on allergen exposure. Which biologic? See figure. 80% considers biologics enhance asthma control allowing some severe patients to start AIT; which biologic: omalizumab 95%, dupilumab 86%, anti-IL5(R) 81%, tezepelumab 69%. Most continue biologics at least 1y into immunotherapy. As for prevention: disease modifying power of SCIT/SLIT/Biologics was given an average of 8.3/5.1/5.4 on a 0-10 scale. 93% considers AIT in AR can prevent development of asthma; here 2/3 prefers SCIT. most members do use SCIT/SLIT in severe allergic asthma , yes/no on biologics. Which biologic(s) have you/would you prescribe to optimize control in severe asthma patients when considering immunotherapy?