Severity Of Allergic Diseases Research Articles

Evaluation of respiratory allergies burden and management in primary care and comparative analysis of health care data from Romania, Poland, Czech Republic and Bulgaria - preliminary study.

Respiratory allergies mostly allergic rhinitis and asthma represent an important and increasing public health problem and one of the priorities for the European health systems. There is an increasing public concern regarding the persistence and severity of allergic diseases and many difficulties of health systems in providing prompt specialized medical assistance. Our study aims to highlight the main results of the Alliance 4Life project focused on the evaluation of the burden and management of respiratory allergies in primary care from Romania and comparative health-related data from four Central and Eastern European countries. We developed a questionnaire focused on patients with allergic rhinitis and asthma directly addressed to general practitioner (GP) specialists from Romania who attended the annual national conference in Bucharest. The main results showed that patients with respiratory allergies are frequently encountered in primary care practice, only a few patients are evaluated by allergists and there is a clear need for education in this field. This preliminary study confirms that respiratory allergies represent a considerable burden in primary care and the questionnaire may be a useful tool in further studies considering the experience of other healthcare systems. More advanced studies integrating epidemiology with data on air pollution and environmental conditions should be envisaged.

Multifactorial analysis of willingness to undergo subcutaneous allergen immunotherapy in pediatric patients

Objective: To explore factors influencing the acceptance of allergen immunotherapy (AIT) for the treatment of allergic respiratory diseases by pediatric patients and their families.
 Methods: A total of 406 children (210 males and 196 females) attending the pediatric outpatient clinics and wards of the Renji Hospital, Shanghai Jiao Tong University School of Medicine from June 2020 to April 2022. Those who met the criteria for the AIT treatment, were included in the survey. An online 20-item questionnaire was developed. Data on patient’s general characteristics, allergic disease status, family history of allergies, general family information, parental knowledge of allergic diseases, and whether the AIT treatment was recommended by a physician, were collected. The patients were divided into two groups according to their willingness to receive AIT: a reluctant or neutral group (n = 182), and a willing group (n = 224). A univariate analysis of the willingness to undergo AIT was done to detect parameters that significantly differed between the groups, and the identified factors were used as independent variables in the multifactorial logistic regression analysis.
 Results: The severity of allergic disease, presence of drug allergy, occurrence of severe allergic reactions, mother’s education, distance from home to the hospital, parental knowledge of allergic diseases, and whether the doctor recommended AIT were all statistically different between the groups (p < 0.05). Multifactorial logistic regression analysis showed that the degree of allergic rhinitis (AR), or asthma (AS), parental knowledge of allergic diseases, and doctor’s recommendation of AIT were the factors that influenced the willingness of pediatric patients to receive AIT.
 Conclusions: The severity of AR and AS, parental knowledge of allergic diseases, and doctor’s recommendation influenced the willingness of pediatric patients to receive AIT.
 doi: https://doi.org/10.12669/pjms.40.5.8581
 How to cite this: Ding B, Zhong J, Jiang C, Ma T, Shen Q, Lu Y. Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi. Pak J Med Sci. 2024;40(5):820-828. doi: https://doi.org/10.12669/pjms.40.5.8581
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Analysis of the sensitization spectrum in patients with severe allergic diseases using the ImmunoCAP ISAC method

BACKGROUND: An important advance in modern allergology has been made by the introduction of allergenic molecules/components, including their detection by the ImmunoCAP ISAC method. This method is useful in patients with a complex spectrum of sensitization and severe forms of allergic diseases, where various predictors of severe course are actively searched for.
 AIM: To evaluate the informativeness of component resolved diagnostic by ISAC ImmunoCAP method in patients with severe bronchial asthma and severe atopic dermatitis.
 MATERIALS AND METHODS: A single-center retrospective study was conducted from January to August 2023. 100 patients who were candidates for biologicals for severe bronchial asthma (group 1; 63 patients), severe atopic dermatitis (group 2; 20 patients), or their combination (group 3; 17 patients) were included. Component restlved diagnostic was performed by ImmunoCAP ISAC method.
 RESULTS: Polysensitization and high occurrence of food and fungal allergens were more frequently detected in the groups of patients with severe atopic dermatitis. When analyzing the pollen sensitization spectrum in groups 2 and 3, Bet v 1 and PR-10 family cross-linked molecules (Mal d 1, Pru p 1, Ara h 8, Gly m 4, Cor a 1.04), as well as Ole e 9, Cyn d 1, Ph p 1 and Par j 2 were the most common. Epidermal allergens were common in all three groups. Lipocains (Can f 1, Can f 4, Can f 6, Ecu q 1, Mus m 1), kallikreins (Can f 5), and albumin (Fel d 2) dominated among them. The presence of sensitization to household allergens was detected only in group 2 and only to the molecule Der p 23. Among fungal allergens, the allergen Asp f 6 was predominant in the groups with severe atopic dermatitis, and the component Alt a 1 in patients with severe bronchial asthma. Among food allergens, one of the most common allergens was the molecule Gad c 1, Gal d 1, Gal d 2, Gal d 5 and Bos d 6.
 CONCLUSION: Component resolved diagnostic is an accurate assay suitable for determining the spectrum of sensitization in patients; its result can serve as a distinct biomarker for severe allergic diseases.

Generation of a virus-like particles based vaccine against IgE.

Anti-IgE immunotherapy with monoclonal antibodies represents a breakthrough in treatment of severe allergic diseases. However, drawbacks such as short half-life and high price are not negligible. Our objective is to develop an anti-IgE vaccine based on virus-like particles (VLPs) which can induce long-lasting neutralizing IgG anti-IgE antibodies reducing allergic responses without causing intrinsic mast cell activation due to IgE cross-linking. The vaccines were made by chemically coupling three synthetic mouse IgE-Fc fragments to plant-derived immunologically optimized CuMVTT VLPs. The immunogenicity of the vaccines was tested by immunizing naive or allergic mice either with the coupled vaccines or the VLP control followed by systemic or local allergen challenge. Mice immunized with the vaccines exhibited high titers of anti-IgE antibodies in the sera and high levels of anti-IgE secreting plasma cells in lymphoid organs. Moreover, free IgE in serum were reduced by the induced anti-IgE antibodies; therefore, less IgE was bound to FcεRI on the surface of basophils. In line with these reduced IgE levels on effector cells after vaccination, immunized mice were protected from challenge with allergens. Importantly, despite presence of anti-IgE antibodies, no signs of acute or chronic allergic response were seen in immunized allergic mice. The generated vaccines can effectively induce anti-IgE antibodies that did not cause allergic responses in sensitized mice but were able to decrease the level of free and cell bound IgE and protected sensitized animals from allergic responses upon allergen challenge.

Food allergy as one of the faces of primary immunodeficiency

Food allergy is characterized by an abnormal immune reaction that occurs reproducibly upon exposure to a specific food. This immune response can lead to a variety of symptoms, the prevalence of food allergies has increased in recent decades, most likely due to environmental factors that likely play a role in the expression of genetic susceptibility. Recent understanding of the immunopathogenesis of allergic diseases has suggested that these atopic diseases may be due to monogenic mutations associated with inborn errors of immunity (IEI). Aspects to be assessed in suspected IEI involve the onset of atopic disease within the initial months of life, the progression of the condition, and the response to conventional therapy. A prospective study was conducted on 385 patients admitted to the clinic with suspected immunodeficiency. Most children were referred for recurrent respiratory infections, but almost half had concurrent atopy (44%), atopy and autoimmunity (3%), autoimmunity (6%) and malignancy (1%). The results of the study underline the importance of the allergic phenotype and suggest that children with more severe allergic diseases should be screened for possible underlying inborn defects of immunity. If a congenital disorder of immunity is suspected, comprehensive immunologic testing is required, and genetic testing is essential to identify the specific genetic abnormalities. Molecular diagnosis provides a comprehensive understanding of congenital immune disorders, allowing tailored interventions and personalized surveillance strategies.

Dupilumab in the treatment of severe adopic dermatitis and respiratory allergy: a case report

The use of biological targeted therapy for allergic diseases has significantly increased the effectiveness of the treatment of patients with atopic dermatitis, bronchial asthma, and combined allergopathology. Dupilumab, a monoclonal antibody drug that blocks signaling from IL-4 and IL-13, is one of the options for biological therapy aimed at modifying the Th2 immune response. The article discusses current ideas about the pathogenesis of allergic Th2-dependent inflammation, about the key mechanisms of the formation of atopic dermatosis and its role in inducing the progressive course of atopy. A clinical example of successful treatment of an 8-year-old child with severe atopic dermatitis, moderate partially controlled bronchial asthma, allergic rhinitis, and multisensitization to food and pollen allergens is given. The use of biological targeted therapy with dupilumab made it possible to achieve sustainable remission in the course of atopic dermatitis and bronchial asthma. The SCORAD index, which was 66.8 points before dupilumab treatment, decreased to 8.9 points. Immunobiological therapy with an IL-4Rα inhibitor, dupilumab, is indicated for patients with moderate to severe allergic diseases when it is not possible to achieve adequate control with standard treatment methods. The presented clinical case of the use of the drug contributes to the study of the clinical efficacy and safety of dupilumab during its long-term use.

Allergy-associated biomarkers in early life identified by Omics techniques.

The prevalence and severity of allergic diseases have increased over the last 30 years. Understanding the mechanisms responsible for these diseases is a major challenge in current allergology, as it is crucial for the transition towards precision medicine, which encompasses predictive, preventive, and personalized strategies. The urge to identify predictive biomarkers of allergy at early stages of life is crucial, especially in the context of major allergic diseases such as food allergy and atopic dermatitis. Identifying these biomarkers could enhance our understanding of the immature immune responses, improve allergy handling at early ages and pave the way for preventive and therapeutic approaches. This minireview aims to explore the relevance of three biomarker categories (proteome, microbiome, and metabolome) in early life. First, levels of some proteins emerge as potential indicators of mucosal health and metabolic status in certain allergic diseases. Second, bacterial taxonomy provides insight into the composition of the microbiota through high-throughput sequencing methods. Finally, metabolites, representing the end products of bacterial and host metabolic activity, serve as early indicators of changes in microbiota and host metabolism. This information could help to develop an extensive identification of biomarkers in AD and FA and their potential in translational personalized medicine in early life.

A cross talk between microbial metabolites and host immunity: Its relevance for allergic diseases.

Allergic diseases, including respiratory and food allergies, as well as allergic skin conditions have surged in prevalence in recent decades. In allergic diseases, the gut microbiome is dysbiotic, with reduced diversity of beneficial bacteria and increased abundance of potential pathogens. Research findings suggest that the microbiome, which is highly influenced by environmental and dietary factors, plays a central role in the development, progression, and severity of allergic diseases. The microbiome generates metabolites, which can regulate many of the host's cellular metabolic processes and host immune responses. Our goal is to provide a narrative and comprehensive literature review of the mechanisms through which microbial metabolites regulate host immune function and immune metabolism both in homeostasis and in the context of allergic diseases. We describe key microbial metabolites such as short-chain fatty acids, amino acids, bile acids and polyamines, elucidating their mechanisms of action, cellular targets and their roles in regulating metabolism within innate and adaptive immune cells. Furthermore, we characterize the role of bacterial metabolites in the pathogenesis of allergic diseases including allergic asthma, atopic dermatitis and food allergy. Future research efforts should focus on investigating the physiological functions of microbiota-derived metabolites to help develop new diagnostic and therapeutic interventions for allergic diseases.

Impact of climate change-related environmental factors on the allergens production and the epidemiology and severity of allergic pathologies.

Allergic disease affects up to 40% of the global adult population, a proportion that is increasing with environmental changes related to global warming. We undertook a systematic review of the literature to identify and evaluate the current evidence of the impact of climate change-related environmental factors on the allergen production and the epidemiology and severity of allergic pathologies. PECO criteria were established and guided the literature searches of the PubMed and Cochrane databases (Jan 1, 2016 to Dec 31, 2021). Study outcomes were categorized and grouped to facilitate data synthesis. Outcomes were classified as significant (statistical significance <0.05), non-significant (p>0.05) or undetermined (p value not reported). Study quality was assessed using MMAT analysis. Of 195 studies, 40 were considered relevant and 9 of them provided data to be included in the data quantitative synthesis. Environmental factors, including the presence of pollutants, temperature, and drought, influenced the type, volume, and timing of exposure to local aeroallergens. The most relevant environmental factor was the presence of environmental pollutants, of which tropospheric ozone was the most frequently associated to changes in allergen production, prevalence, and severity of allergic disease. Also, several publications demonstrated the impact of environmental factors on the healthcare burden. Climate-change related environmental factors increased allergic disease in terms of prevalence, severity, and healthcare burden due to alterations in allergen exposure (volume and type) with the presence of pollutants such as ozone being the most commonly reported driver of such increase.

Coexistence of Allergic Diseases in Pediatric Systemic Lupus Erythematosus Patients: Prevalence, Clinical manifestation and Severity.

Objective. This study aimed to evaluate allergic diseases in pediatric patients with SLE and their association with SLE disease activity. Method. Patients with SLE aged ≤18 years were enrolled. Allergic diseases were screened using the International Study of Asthma and Allergies in Childhood questionnaire. Patients with a positive allergic disease screen were evaluated by a pediatric allergist for diagnostic confirmation and severity assessment. Results. Out of 118 patients, 16 patients (13.56%) were confirmed to have 1 or more allergic diseases; fourteen with allergic rhinitis, 4 with asthma, and 2 with atopic dermatitis. Two patients had severe-persistent allergic rhinitis and one patient had undiagnosed, uncontrolled severe asthma. No statistically significant correlations between the severity of allergic diseases and SLE disease activity were identified. Conclusions. The overall prevalence of allergic disease among pediatric patients with SLE is within the range of the general population. Severe and undiagnosed allergic diseases and SLE can coexist.

Elevated IgE Levels-An Allergy or an Underlying Inborn Error of Immunity in Children with Recurrent Infections?

Elevated immunoglobulin E (IgE) is a hallmark of allergic diseases. However, high IgE levels also occur in a number of other infectious and noninfectious diseases. In most cases, elevated IgE levels indicate allergy, eczema, or chronic skin infection. Very high IgE levels are not uncommon in patients with active eczema but more often indicate monogenic atopic disorder or inborn errors of immunity with an atopic phenotype. We conducted a retrospective study of 385 children with suspected immune deficiency referred to the clinic over a 9-year period. Measurement of IgE, IgG, IgA, IgM, and IgG subclasses in blood samples revealed that nearly one-third of the patients had elevated serum IgE levels. Most of the cases with elevated IgE were children with underlying atopy-mainly atopic dermatitis and, to a lesser extent, bronchial asthma-whereas 40.12% (37 children) had no atopy at all. In the most severe cases (with extremely elevated IgE or severe dermatitis), we confirmed genetic mutations for underlying immunodeficiency. Our results indicate that allergic phenotype should not be underestimated and that children with more severe allergic disease should be evaluated for an underlying inborn error of immunity. If inborn error of immunity (IEI) is suspected, a comprehensive immunologic evaluation is required. Genetic testing helps identify the specific genetic abnormality, which provides important insight into the immunopathogenesis of the disease and accurate determination of optimal therapy.

CAR T Cells for Treating Severe Atopic Allergic Diseases.

The prevalence of allergic diseases is rising rapdly in the US and the world. While antibody drugs and corticosteroids can provide symptom relief, they cannot cure allergic diseases. Described herein is a novel approach to treating severe atopic allergic diseases - chimeric antigen receptor-engineered T cells - that target and eliminate the cells that produce the causative agent of all atopic allergic diseases, immunoglubulin E (IgE).

Significance of Self-Injectable Biologics in Japanese Patients with Severe Allergic Diseases: Focusing on Pen-Type Devices and Copayment.

A questionnaire survey was administered to 18, 14, and 3 patients introduced to home self-injection of dupilumab or mepolizumab using a pen-type device for atopic dermatitis, asthma alone, and asthma plus chronic rhinosinusitis with nasal polyps, respectively. All but one participant wished to continue self-injection. Most participants affirmed the reduction in copayment (88.6%) and saving time and labor for hospital visits (88.6%). Six patients who received dupilumab complained of side effects, but all, except for one, continued the treatment. Of the 13 patients who had previously used a syringe-type device, 10 preferred the pen type because of its ease of use, while 3 (23%) preferred the syringe type because of the self-adjustable injection speed for pain control. Administration of biologics using pen-type devices is easier, and the introduction of home self-injection leads to a reduction in outpatient visits and copayment.

Treatment of asthma and eosinophilic allergic diseases using biological products

Background: Asthma and other eosinophilic allergic diseases are heterogeneous syndromes encompassing various endotypes and phenotypic characteristics. The recent development of several targeted biological products has enabled the personalized treatment for heterogeneous pathophysiology in these diseases.Current Concepts: Biological products approved by the US Food and Drug Administration for such diseases primarily comprise monoclonal antibodies that block the pathway of type 2 inflammation, such as immunoglobulin E, interleukin (IL)-5, IL-5 receptor, IL-4α receptor, and thymic stromal lymphopoietin. A practical strategy for selecting the optimal biological products for patients with severe eosinophilic allergic diseases is a shared decision-making process between the patient and physician on the basis of measurable biomarkers, co-morbidity, and patient preferences considering drug characteristics and costs.Discussion and Conclusion: The emergence of biological products in chronic eosinophilic allergic diseases has not only heralded an era of precise treatment but has also improved our understanding of the endogenous types through various treatment responses for each patient. The development of new biological products that affect various pathways and the discovery of novel biomarkers will facilitate the provision of optimized precision medicine to patients with severe uncontrolled diseases.

Biological products in allergy practice: the beginning of a new era

Background: Recently, the treatment of allergic diseases has significantly progressed with the development and increased use of biological products (BPs) or molecularly targeted drugs. Based on cases with asthma, using BPs in allergic diseases has expanded to include chronic rhinosinusitis with nasal polyps, atopic dermatitis, and chronic spontaneous urticaria.Current Concepts: BPs are effective in treating severe allergic diseases, which often have limitations with current treatments and limited therapeutic options available. The added efficacy of BPs includes reduced risk of side effects from using systemic corticosteroids. Additional to transforming clinical care, BPs have provided insights into disease mechanisms and identified biomarkers to predict therapeutic responses. This has opened a new era towards personalized and precise treatment.Discussion and Conclusion: BPs for patients with severe asthma reduce symptoms and risks of exacerbations. Because of these observations, whether the remission of allergic diseases can be achieved by BPs has been pondered. Another agonizing problem is that BPs are expensive and many patients require prolonged administration for disease control. As more BPs become available, costs will likely decrease, leading to their more widespread use. Indeed, a new era in the treatment of allergic diseases has begun.

Impact of climate change on allergic diseases in Germany.

Allergic diseases, especially inhalation allergies, have reached epidemic levels and environmental factors play an important role in their development. Climate change influences the occurrence, frequency, and severity of allergic diseases. The contents of this article were selected by the authors and developed section by section according to their expertise and the current state of knowledge. The sections were then discussed and agreed upon amongst all authors. The article highlights direct and indirect effects of climate change on allergies. It goes into detail about the connections between climate change and (new) pollen allergens as well as (new) occupational inhalation allergens, explains the effects of climate change on the clinical picture of atopic dermatitis, discusses the connections between air pollutants and allergies, and provides information about the phenomenon of thunderstorm asthma. There is a need for action in the field of pollen and fungal spore monitoring, allergy and sensitisation monitoring, urban planning from an allergological perspective, and changes in the working environment, among others.

Screening of Strawberry Allergy in Egyptian Atopic Children

Background Strawberries are included in the list of allergenic foods. However, definite figures in many countries including Egypt are lacking. Children with food allergy are 2 to 4 times more likely to have asthma, eczema, and allergic rhinitis than their non-allergic peers. We therefore sought to investigate IgE-mediated strawberry sensitization among a group of atopic children and correlate it to their clinical and laboratory parameters. Patients and Methods This study comprised 256 children, 1 to 18 years old, with physician-diagnosed bronchial asthma (98 patients), allergic rhinitis (28 patients), atopic dermatitis (53 patients), food allergy (10 patients) and combined allergies (67 patients). They were enrolled consecutively from the Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo. Sensitization to strawberry was assessed using prick-prick test (PPT). Results Strawberry sensitization was observed in 7.8% of the studied children. Confirmed strawberry allergy was elicited in 2% of them. Strawberry sensitization was more prevalent in patients with food allergy followed by those with atopic dermatitis. Severity of allergic disease, frequency of flare ups and response to treatment did not influence the rate of strawberry sensitization in our series. Conclusion Strawberry allergy is not as common as claimed to be among Egyptian children with allergic disorders. Sensitization to strawberry did not impact the severity of allergy or response to treatment. The findings are limited by the sample size.

The Role of Diet and Nutrition in Allergic Diseases.

Allergic diseases are a set of chronic inflammatory disorders of lung, skin, and nose epithelium characterized by aberrant IgE and Th2 cytokine-mediated immune responses to exposed allergens. The prevalence of allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, has increased dramatically worldwide in the past several decades. Evidence suggests that diet and nutrition play a key role in the development and severity of allergic diseases. Dietary components can differentially regulate allergic inflammation pathways through host and gut microbiota-derived metabolites, therefore influencing allergy outcomes in positive or negative ways. A broad range of nutrients and dietary components (vitamins A, D, and E, minerals Zn, Iron, and Se, dietary fiber, fatty acids, and phytochemicals) are found to be effective in the prevention or treatment of allergic diseases through the suppression of type 2 inflammation. This paper aims to review recent advances in the role of diet and nutrition in the etiology of allergies, nutritional regulation of allergic inflammation, and clinical findings about nutrient supplementation in treating allergic diseases. The current literature suggests the potential efficacy of plant-based diets in reducing allergic symptoms. Further clinical trials are warranted to examine the potential beneficial effects of plant-based diets and anti-allergic nutrients in the prevention and management of allergic diseases.

Air Pollen Monitoring in a Specific Region as a Part of the Pollinosis Prevention

Background: The prevalence and severity of allergic diseases, including pollinosis, are increasing worldwide. Hay fever develops due to the complex interaction of genes and manifests itself due to exogenous factors. The main environmental etiology of allergy is plant pollen. Continuous study and analysis of the air pollen spectrum constitute the basis of air monitoring and are important in developing preventive measures for allergic diseases. Objective: To perform an air pollen monitoring in Kr snodar and to assess the treatment of patients with pollinosis in various cities and districts of the Krasnodar Region according to the Krasnodar Regional Allergy Center data. Materials and methods: We retrospectively analyzed the patients seeking medical care due to allergy in the Krasnodar Region using the statistical data obtained in 2022 from the Krasnodar Regional Allergy Center. We assessed the effects of air pollen pollution according to the data of air pollen monitoring in Krasnodar during the main activity of herbaceous plants’ taxa (from April 1, 2022 to October 31, 2022). We used AeRobiology and Microsoft Excel 2010 tools for data processing and development of the main parameters of the pollen season. Results: According to the Krasnodar Regional Allergy Center data, there were 37,212 people diagnosed with J45.0, J46 and 20,012 people diagnosed with J30.1-30.4 in 2022. We identified 8 allergenic taxa of herbaceous plants in the Krasnodar air. We found that the total seasonal pollen concentration increased by an average of 1.8 in 2022 compared to previous monitoring periods in 2018-2021. Conclusions: Comparative assessment of the prevalence of pollinosis and the air pollen monitoring are important for effective medical care.

CHOICE international survey: Clusters of allergen immunotherapy prescription from French and Spanish cohorts

BackgroundThere is no description of the drivers of prescription for allergen immunotherapy (AIT) for respiratory allergic diseases. MethodsA prospective, multicentre, observational, non-interventional real-life study was performed in France and Spain for 20 months. Data were gathered using 2 different questionnaires, anonymously collected in an online platform. No names of AIT products were recorded. Multivariate analysis and unsupervised cluster analysis were performed. ResultsOne hundred and three physicians (50.5% from Spain and 49.5% from France) reported 1735 patients (433 in France and 1302 in Spain), 47.9% males, 64.8% adults with a mean age 26.2 years old. They suffered from allergic rhinitis (99%), allergic conjunctivitis (70.4%), allergic asthma (51.8%), atopic dermatitis (13.9%), and food allergy (9.9%). A clustering analysis based on 13 predefined relevant variables for AIT-prescription identified 5 different clusters, each of them including information regarding doctor's profile and patient demographics, baseline disease characteristics, and main AIT indication: 1) Looking at the future: focusing on asthma prevention (n = 355), 2) Efficacy after discontinuation of AIT (n = 293), 3) Fighting severe allergic disease (n = 322), 4) Looking at the present, facing current symptoms (n = 265) and 5) Doctor's own clinical experience (n = 500). Each one of these clusters have specific patients' and doctors' characteristics, representing distinctive AIT prescription drivers. ConclusionUsing data-driven analysis, we identified for the first time some reasons and patterns of AIT prescriptions in real-life clinical settings. There is no uniform indication for prescribing AIT, which varies amongst patients and doctors with multiple but specific drivers, taking into account several relevant parameters.