207 Approach of Paediatric Allergists to Allergen Immunotherapy in Severe Persistent Allergic Rhinitis

BACKGROUND: Hospital-based allergists manage children with allergic rhinitis (AR) in Lombardy (paediatric population 900,000 ca). These specialists' perception of severity in referrals was assessed by questionnaire. METHODS: During May 2011, a spreadsheet was e-mailed to 51 paediatric allergy units, followed up by telephone interviews by trained volunteers providing online assistance for compilation. Data were collected in pre-schoolers (group I), school-age (group II) and adolescents (group III). RESULTS: Overall response was 66.6%. AR estimates among these referrals were 75.6% (70.6% in group I, 75.5% in group II and 82.9% in group III). AR alone occurred in 18.7% (21.4%, 17.2%, and 19.1%) of cases. Co-morbidities included asthma in 18.1% (30.1%, 14.1%, and 13.4%), conjunctivitis in 25.5% (13.8%, 27.8%, and 34.6%), or both in 13.4% (5.3%, 16.4%, and 15.7%). Specialists report intermittent AR in 51.4% (52.9%, 49.5%, and 54.7%), persistent disease in 48.6% (47.1%, 50.5%, and 45.3%), mild in 61.5% (53.6%, 64.1%, and 63.9%) and moderate/severe in 38.5% (48.4%, 35.9%, and 36.1%) of cases. In moderate/severe persistent rhinitis (18.4%), allergy was considered relevant for 42.2% (46.4%, 35.9%, and 36%) of cases. SIT was considered appropriate for mild persistent grass-induced rhinitis in 22.5% (10.1%, 29.2%, and 22.7%, respectively) and for 10.3% of moderate/severe persistent rhinitis (3.8%, 18.9%, and 15.8%). [Table: see text] CONCLUSIONS: Rhinitis was the most frequent symptom, though rarely alone. From the Italian ISAAC, AR affects 18.9% schoolchildren and 35.5% adolescents, while severe persistent rhinitis affects 30,700 (3.42%) in Lombardy. Some severe persistent rhinitis was considered indicative for SIT in Group I, and incidence was higher in other groups. SIT is likely to be considered particularly in the subset of patients not completely controlled by symptomatic drugs. In the absence of clinical surveys and given referral study limitations, epidemiological surveys are needed to quantify demand in the pediatric population.