The impact of public health emergencies on allergen immunotherapy practices: A cross-sectional study on COVID-19 and physicians’ perspectives in China

Objective: To systematically evaluate how the COVID-19 pandemic transformed the clinical management of allergen-specific immunotherapy (AIT) in China and to establish an evidence-based AIT management strategy during future infectious disease outbreaks. Methods: This multicenter, cross-sectional survey was conducted in January 2025, involving 224 physicians with practical experience in AIT across 3 regions in China. Using a structured electronic questionnaire distributed via the Wenjuanxing platform, we systematically evaluated: physicians’ basic information, the impact of the pandemic on AIT-related clinical decision-making, and the influence of COVID-19 vaccination on AIT. Data were analyzed using descriptive statistics, Pearson chi-square/Fisher exact tests, and multinomial logistic regression. Results: Among surveyed physicians, 70.5% maintained standard AIT initiation during the pandemic. Most physicians (64.9% for subcutaneous injections, 57% for sublingual administration) implemented a conservative 8- to 14-day interval between AIT and COVID-19 vaccination, exceeding the 7-day EAACI recommendation, with variations based on physician AIT experience ( P = 0.048) and patient volume ( P = 0.034). And most physicians recommended for no AIT dose adjustments after vaccination. Conclusion: This study documents how Chinese physicians adapted AIT practices during COVID-19. These clinician-developed strategies provide an applicable framework for maintaining AIT safety and efficacy during future public health crises while informing evidence-based guideline development.