title: Allergy immunotherapy prescribing trends for grass pollen-induced allergic rhinitis in Germany: a retrospective cohort analysis.
abstract: BACKGROUND
  Allergy immunotherapy is an effective treatment for patients with allergic rhinitis whose symptoms are unresolved with pharmacotherapy. Allergy immunotherapy for grass pollen-induced allergic rhinitis is available in three modalities: subcutaneous immunotherapy and sublingual immunotherapy as a tablet or drop. This study aimed to understand trends in allergy immunotherapy prescribing and practice patterns for grass allergies in adult and paediatric patients in Germany.
  
  
  METHODS
  A retrospective cohort study was conducted using IMS Disease Analyzer in Germany. Patients with an allergy immunotherapy prescription for grass pollen (Anatomical Therapeutic Chemical [ATC] classification code V01AA02) from September 2005 to December 2012 were included in the study. General Practitioners (GPs), dermatologists, Ear, Nose and Throat (ENT)-specialists, paediatricians and pneumologists were included as the allergy immunotherapy prescribing physicians in the study. Descriptive analyses were conducted on patient characteristics at index and prescribing physician specialty; a test for trend was conducted for timing of initiation of first allergy immunotherapy prescription in each annual prescribing season.
  
  
  RESULTS
  Eighteen thousand eight hundred fifty eligible patients were identified during the study period. The majority of patients received subcutaneous immunotherapy; however, the proportion of patients receiving sublingual immunotherapy tablets increased from 8 % in 2006/2007 to 29 % in 2011/2012 (p < 0.001). Initiation of subcutaneous immunotherapy and Oralair® generally peaked during each prescribing year in two seasons (September-October and January) while GRAZAX® prescriptions peaked in autumn (September-October). ENT-specialists and dermatologists were the largest allergy immunotherapy prescribers in adults, while paediatricians and ENT-specialists were the largest prescribers of allergy immunotherapy in paediatric patients.
  
  
  CONCLUSIONS
  Subcutaneous immunotherapy remained the dominant allergy immunotherapy modality for grass pollen-induced allergic rhinitis in Germany for adult and paediatric patients; however, there was a marked increase in proportion of patients receiving sublingual immunotherapy tablets from 2006/2007 to 2011/2012, after their introduction to the market in 2006. ENT-specialists, dermatologists and paediatricians were responsible for the majority of prescribing. The predominance of particular modalities within certain physician specialties likely reflects different treatment goals or needs.
authors.affiliation: Real-World Evidence Solutions and Health Economics & Outcomes Research, IMS Health, 210 Pentonville Road, London, N1 9JY UK.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: McDonell
authors.affiliation: Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wahn
authors.affiliation: Real-World Evidence Solutions and Health Economics & Outcomes Research, IMS Health, 210 Pentonville Road, London, N1 9JY UK.
authors.forename: Dirk
authors.initials: D
authors.lastname: Demuth
authors.affiliation: Real-World Evidence Solutions and Health Economics & Outcomes Research, IMS Health, 210 Pentonville Road, London, N1 9JY UK.
authors.forename: Catrina
authors.initials: C
authors.lastname: Richards
authors.affiliation: Worked at IMS Health at time of study, Real-World Evidence Solutions and Health Economics & Outcomes Research, London, UK.
authors.forename: Charlie
authors.initials: C
authors.lastname: Hawes
authors.affiliation: Global Market Access, ALK-Abelló A/S, Hørsholm, Denmark.
authors.forename: Jakob Nørgaard
authors.initials: JN
authors.lastname: Andreasen
authors.affiliation: Global Health Outcomes, Merck & Co., West Point, PA 19486 USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Allen-Ramey
keywords: Allergens; Clinical immunology; Grass pollen allergy; Paediatrics; Rhinitis