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 are presented with descriptive statistics.
Results: 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 2-3y 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 two 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 1-5yrs) onward. As no strict legislation exists IT can be managed by non-allergists in 7/9 countries. Mixed extracts are used with mostly 3-5 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 two countries.
IT is generally paid for by private patients. Insurance companies re-imburse 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 three countries have their own guidelines on IT (one only in pediatrics).
Conclusion: a clearer picture where and how to improve AT and ASIT in LA has been obtained, however unmet needs on ASIT are still pending.