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Background: One main practice gap in allergology that has been detected in several regions of the world is the application of specific immunotherapy (SIT). The prescription and practice of SIT should characterize allergologic specialists, but there are regional discrepancies in such practice. A detailed knowledge of the regulatory and legislation aspects and drawbacks would help improve and harmonize SIT practice., Objective: To describe in Latin America the level of allergy training and the characteristics of the use of SIT, including the medical and legal aspects., Methods: Three sources were used: a 24-item questionnaire sent to 22 allergologic leaders in 11 Latin American countries, 2 face-to-face meetings, and information from health authorities involved in the approval of medical substances., Results: In 56% of countries, the specialty of allergology is a third-level care specialty and/or a subspecialty. Two countries have a special training program for pediatric allergists. Passing a board examination is mandatory in 3 countries, and recertification every 2 to 5 years occurs without examination. Sublingual and subcutaneous SITs are available in all Latin American countries. No legislation restricts SIT prescription and it can be performed by nonspecialists in 7 of 11 countries. In 90% of countries, allergists use allergen extracts from the United States (subcutaneous immunotherapy) and Europe (sublingual and subcutaneous immunotherapies), and 50% also manufacture extracts locally. Only 1 country has legal requirements for the quality of raw materials., Conclusion: The present analysis helps to identify gaps in the field of allergologic training and SIT in Latin America, many of them amendable., (Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Allergic rhinitis and asthma represent global problems of public health affecting all age groups; asthma and allergic rhinitis frequently coexist in the same patients. In Latin American prevalence of allergic rhinitis, although variable, is very high. Allergic rhinitis and its Impact on Asthma (ARIA) started during a workshop of the World Health Organization performed in 1999 and was published in 2001. ARIA proposed a new classification of allergic rhinitis in intermittent or persistent and mild or moderate-severe. This approach of classification reflects more nearly the impact of allergic rhinitis in patients. In its review of 2010 ARIA developed guidelines for diagnosis and treatment of allergic rhinitis and of clinical practices for management of comorbidities of allergic rhinitis and asthma based on GRADE (Grading of Recommendations, Development and Evaluation). ARIA has been spread and implemented in more than 50 countries. In Latin American an intense activity has been developed to spread these recommendations in almost all the countries of the region and it is important to record the obtained goals in the diffusion and implementation of ARIA, as well as to identify the unsatisfied needs from the clinical, research and implementation points of view. Final objective is to reinforce the priority that allergy and asthma should have, especially in children, in the programs of public health, as they have been prioritized in European Union in 2011.

In Latin America, allergic diseases have a very high prevalence, comparable to that of many other countries of the world, and that prevalence is constantly increasing. Within the region, the number of allergy specialists is quite high, although allergy is not recognized as a full specialty in all countries. Specific immunotherapy is the only available allergen-oriented immunomodulator, capable of improving symptoms and modifying the natural course of the disease, and therefore it represents a powerful therapeutic tool for specialists. During the last 20 years, the practice of immunotherapy in Latin America has much improved, especially because of the intensive educational effort, the widespread divulgation of the international guidelines and the adoption of the paradigm of the evidence-based medicine. In this regard, indications, contraindications, and limits of immunotherapy, are currently well acknowledged. In Latin America, immunotherapy is properly prescribed for inhalant allergens and hymenoptera venom by allergy specialists, although some non-evidence based forms of immunotherapy (e.g. bacterial extracts, treatment of atopic dermatitis) are still occasionally practiced. Sublingual immunotherapy is now accepted as a viable alternative to the traditional subcutaneous administration, and it begins to be proposed and studied also in some Latin American countries. Some debate remains on the use of immunotherapy for one or few versus multiple allergens, and also the availability of standardized extracts is not uniform. Finally, this therapeutic modality is not always given for free to low income patients such is the case in some countries and the different modalities of reimbursement among countries often represent a limit to the use of this treatment. Much has been done in improving the use of immunotherapy in Latin America. The main challenges and objectives for the near future are greater diffusion of the evidence-based medicine, a better standardization of extracts and procedures, and the achievement of the availability of immunotherapy for a greater number of subjects.