How, when and why AIT is prescribed in Italy: a real-life study conducted through a patient association

Allergen immunotherapy (AIT) is the only treatment that modifies the natural course of allergies. However, AIT is not used in all eligible patients, and only a few studies investigated AIT use trends. Understanding AIT utilization patterns might disclose information about why it is underused, thus providing insights on how to broaden the positive impact it can have on the population. The National Patient Society and the Scientific Committee of the Society “Respiriamo Insieme” developed a survey to investigate, in patients with respiratory allergies, AIT use trends, awareness, modes of use, prescription modalities, and patient-specific insights, in real-life. 960 patients with respiratory allergies completed the survey. 46.1% did not know about AIT existence. AIT was prescribed only to 34.9%, and 29.7% of those decided not to initiate therapy; the most frequent reasons for this were costs (23%), duration (10.3%), or concerns about efficacy (8%). Moreover, 21.8% who initiated AIT discontinued it beforehand, usually due to costs (17.8%), inefficacy (13.3%), or pregnancy (11.1%). Finally, 20.1% of patients received indications to undergo therapy for less than 3 years. Our results suggest that there is little awareness about AIT among patients with respiratory allergies and that economic issues remarkably hinder both its utilization and adherence. A high heterogeneity in prescription patterns was noted, possibly interfering with AIT efficacy. Notably, the collaboration with the patient society was crucial, and it would have been challenging to conduct this research otherwise. Improvements in AIT awareness, availability, and knowledge about proper utilization patterns are needed.