580 Reasons for discontinuing allergen subcutaneous immunotherapy Silva, D; Pereira, A; Santos, N; Placido, J Immunoallergology, Hospital Sao Joao, Porto, Portugal Background: Several factors affect allergen subcutaneous immunotherapy (SCIT) com- pliance. Non-immediate efficacy, economi- cal burden and adverse reactions are some examples. This study aimed to describe the reasons leading to discontinuing SCIT and to compare a group of compliant with non-compliant patients. Method: Observational, transversal study of an intentional sample of 181 patients under SCIT treatment at a Tertiary Hospi- tal, without a register of immunotherapy administration in the previous 3 months and without any indication of continuing SCIT elsewhere. From the main group, 122 patients were submitted to a telephonic questionnaire approaching reasons for dis- continuing treatment namely economical impact, treatment efficacy and adverse reactions. Due to inappropriate number or invalid contact after three attempts, 59 patients were excluded. Patients inter- viewed had a mean age (SD) of 26.8 (11.0) years, 65% female, lived a mean distance of 21.1 (25.6) km from the Hospital, 96% had rhinitis, 40% asthma and 25% con- junctivitis; 85% were under polymerized SCIT and 73% with perennial administra- tion. No differences were found between interviewed and non-interviewed groups. Result: Thirty-three patients continued treatment, 33 had completed treatment and 56 discontinued SCIT after a mean (SD) 10.8 (8.8) months of treatment. Main rea- sons for discontinuing were economical cost of immunotherapy (39%), change of residence (9%), new working place (5%), inability to conciliate schedules (5%) and treatment inefficacy (5%). When specifi- cally questioned, the most influent factors for discontinuing treatment were economi- cal cost (57%) and travelling expenses (25%). Most participants (73%) referred improvement during SCIT and 77% con- sidered to re-initiate treatment. No differ- ences were seen between groups that had continued and suspended immunotherapy (age, sex, allergy disease, immunotherapy type, adverse reaction, profession, scholar- ship and distance from home to Hospital). Conclusion: Cost was the main factor for discontinuing immunotherapy. Due to the present financial situation of Portugal, this scenario may worsen. Compliance to the treatment should be re-enforced and the economical impact of immunotherapy should be considered. 581 Safety survey of immunotherapy in a Swiss private primary care allergist unit over 15 years Schneeberger, D 1 ; Eigenmann, P 2 1 Private allergist practice, General allergist practice, Fribourg, Switzerland; 2 Pediatric Allergy Department, Geneva University Hospital, Geneva, Switzerland Background: Albeit subcutaneous immuno- therapy (SCIT) constitutes the unique cau- sal therapeutic option in allergic respiratory diseases and insect venom-induced anaphy- laxis, there remain concerns, particularly with regard to safety issues. No data are available about comparative safety of aller- gen vaccines from different manufacturers. Thus, we examined and compared safety between several aeroallergens and insect venom vaccines in a 15 years survey. Methods: All anaphylactic reactions (AR) of immediate or late onset induced by SCIT with five injectable aeroallergen vac- cines, mostly to grass/tree pollen, mites, animal dander, rarely molds, administered by conventional perennial, or preseasonal administration, as well as aqueous extract to insect venom were recorded. AR were classified according to EAACI (grade I– IV). Incidence rate of AR (AR per 1000 injections) and the ratio of patients having had AR were calculated for each vaccine. Results: Seven hundred and ninty-four patients were identified, with a total of 32 504 injections. The overall rate of AR was 4.9 per 1000 injections. The lowest rate of AR was seen with aeroallergen prepara- tions from manufacturer A (perennial; AR 1.5&) and B (the only preseasonal vaccine; AR 1.1&) and E (perennial: AR 3.0 per 1000 injections). Only two AR were seen with F (insect venom SCIT; AR 0.7&). A higher rate of AR was seen to aeroallergen preparations C (perennial; AR 7.3&) and D (perennial; AR 5.9&). AR were in majority mild (n = 63, 39%) to moderate (n = 66, 41%) and easily treatable by con- ventional treatment (oral corticosteroids and antihistamines). Approximately half of mild and moderate AR were late onset. Thirty-one AR (19.4%) were severe (grade III) and needed i.m. adrenaline administra- tion; no anaphylactic shock occurred and no patient was hospitalized. Conclusions: There are substantial differ- ences in AR between allergen products. The preseasonal vaccine (B) and two perennial vaccines (A, E) seem safer, as well as insect venom IT which provoked only two AR. These differences have to be further analyzed with regard to severity of the primary allergic disease (in particular the presence of asthma and polyallergy/- sensitisation), and other known risk factors of AR as well as the potency of vaccine. 582 Observational study on immunotherapy practice by ear, nose, throat specialists in Belgium Cornelis, M 1 ; Hellings, P 1 ; Jorissen, M 1 ; Rombaux, P 2 1 Otorhinolaryngology, University Hospital Leuven, Leuven, Belgium; 2 Otorhinolaryngology, Clinique Universitaire St-Luc, Lie ` ge, Belgium Background: Among different medical spe- cialties in Belgium, ENT doctors perform most skin prick tests for the diagnosis of allergic rhinitis (AR). However, the clinical practice of immunotherapy performed by ENT doctors is not known. Objective: The aim of this observational study was to obtain insight into the percent- age of ENT doctors performing immuno- therapy (IT), the types of IT performed and the reasons for not starting with IT. Methods: A self-made questionnaire was sent to the 648 Belgian registered ENT doctors. Besides general questions on type and duration of ENT practice, the ques- tionnaire asked for IT practice, type of IT performed, and reasons not to perform IT. All questionnaire responses were coded, verified, and registered in computer files. Analyses were performed with the SPSS statistical software package (20.0). Results: The response rate was 55%, 68% of Belgian ENT specialists (237/351) are practising immunotherapy for allergic rhi- nitis. Six percentage (23/351) of ENT doc- tors do not diagnose AR, and are excluded from the study. Ninteen percentage of the ENT doctors that diagnose AR do not make the indication for IT (63/328). The main reasons for not making the indication for IT are: lack of enough expertise (26%) and a too expensive therapy (20%). A long history of ENT practice is associated with a higher percentage of IT practice: 74% (46/62) of doctors with more than 30 years of ENT-practice compared to 54% (43/79) of those with < 10 years of ENT-practice. The type of ENT profile influences IT practice: 59% (34/58) of the doctors work- ing in an academic hospital are performing IT compared to 70% (158/227) in a general hospital and 74% (103/139) in private practice. Belgian ENT specialists mostly perform sublingual IT (57%, 189/328), fol- lowed by subcutaneous (28%, 94/328), oral (14%; 46/328) and transcutaneous (1%, 2/ 328) IT. Conclusion: In spite of the high prevalence of AR in daily ENT practice, IT remains a treatment that is often not indicated and/ or performed by ENT doctors. IT is most frequently performed by ENT specialists with a long history of ENT practice and/or working in private practice. Sublingual IT is most frequently performed by ENT doctors. Poster Session 14 – Recent Clinical Trials in Immunotherapy Allergy 67, Suppl. 96 (2012): 166–306 Ó 2012 John Wiley & Sons A/S 235 View publication stats View publication stats