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Shifts in allergy practice in a COVID-19 world: Implications of pre‐COVID-19 national health care provider and patient surveys of treatments for nasal allergies

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Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available.


Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools.


From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management.


Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7%, and 8% had ever received subcutaneous immunotherapy (SCIT), sublingual allergy drops, or SLIT-tablets, respectively; 56% and 85% reported that they had never discussed SCIT or SLIT, respectively, with their health care provider. Of the health care provider respondents, 45%, 58%, and 20% were very likely to discuss OTC medications, SCIT, or SLIT, respectively. Allergists were more inclined to discuss SCIT with their patients than other health care providers (82% versus 33%, respectively). Most allergists (67%) and other health care providers (62%) reported that they did not use an AIT shared decision-making tool, primarily because of unawareness.


The patients with nasal allergies continued to report inadequate symptom control and activity impairment. SLIT-tablets and AIT shared decision-making tools were underused. In the coronavirus disease 2019 era, social distancing may limit office visits, which impacts SCIT administration and prompts increased use of telemedicine and a possible advantage for at-home‐administered SLIT-tablets over SCIT.
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Keywords: COVID; allergic rhinitis; clinical practice; immunotherapy; pharmacotherapy; rhinoconjunctivitis; shared decision-making; subcutaneous immunotherapy; sublingual immunotherapy; survey; telemedicine

Document Type: Research Article

Affiliations: 1: From the Allergy & Asthma Network, Vienna, Virginia; 2: Division of Allergy and Immunology, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C.; 3: Allergy, Asthma & Sinus Center, Milwaukee, Wisconsin; 4: Division of Allergy and Immunology, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California; 5: Department of Clinical Sciences, Nova Southeastern Allopathic Medical School, Davie, Florida; and 6: ALK, Bedminster, New Jersey

Publication date: July 1, 2021

This article was made available online on May 24, 2021 as a Fast Track article with title: "Shifts in allergy practice in a COVID-19 world: Implications of preā€“COVID-19 national health care provider and patient surveys of treatments for nasal allergies".

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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