205 Allergy Training and Immunotherapy in Latin America: How Survey-Results Lead to a Regional Overview

BACKGROUND: In April 2011 a group of Latin American (LA) allergy experts, leaders in their countries in the area of immunotherapy, met in Cordoba, Argentina, to discuss how allergy and allergen-specific immunotherapy (ASIT) can be improved in the region. The need for a situational sketch was expressed. METHODS: A questionnaire on allergy training (AT), ASIT, extracts and legislation was sent out to 22 leaders in the field of nine LA countries to obtain an overview of the LA situation. RESULTS: Results are presented with descriptive statistics. All 22 questionnaires were returned (9 countries). AT in 56% of the surveyed LA countries is at the third-level of medical care, after a core-training of 2 to 3 years internal medicine or pediatrics; in 3 countries it is a second-level career and in one country there is no AT. Board certification with exam is only mandatory in a third of the countries; recertification being obtained without exam. Mostly, training is in general allergy; pediatric AT only exists in 2 countries. Both sublingual (SLIT, only in the form of drops) and subcutaneous (SCIT) immunotherapy are practiced in all countries, from the age of 3 years (mean, range 1–5 years) onward. As no strict legislation exists IT can be managed by non-allergists in 7/9 countries. Mixed extracts are used with mostly 3 to 5 allergens/vial (range 2 to 6-10 allergens/vial) and all countries have bacterial vaccine. SCIT extracts come from US and European (89%) and 56% local providers. SLIT extracts are almost exclusively from Europe (Spain), but in Argentine, Brazil, and Mexico also local SLIT extracts exist. There is rudimentary regulation concerning extract potency in 2 countries. IT is generally paid for by private patients. Insurance companies reimburse IT in 56% of the countries, the social security system in 33% and in one country selected third level governmental hospitals supply IT. Publications on adverse events with IT are starting to appear (3 countries) and 3 countries have their own guidelines on IT (one only in pediatrics). CONCLUSIONS: A clearer picture where and how to improve AT and ASIT in LA has been obtained; however, unmet needs on ASIT are still pending.