ESID and focused AAAAI respondents differed in this regard in only two disease categories: IgAD and SCID. Only 28·1% of ESID respondents perceived moderate to extreme utility in prophylaxis in IgAD, whereas 54·4% of focused AAAAI respondents held this opinion (P = 0·002); again, this may be the result of different definitions of IgAD between the two groups [9,15]. In SCID, 78·7% of ESID compared to 55·3% of focused AAAAI Selleckchem Trametinib respondents found moderate to extreme utility in prophylaxis for these patients (P = 0·002). The other statistically significant differences were between ESID and general AAAAI respondents across a wide range of fairly rare conditions (Fig. 5a, P < 0·05

for all comparisons), where the perceived utility of antibiotic prophylaxis was greater among ESID members. The use of rotating prophylactic antibiotics is also controversial, as there are no supporting

studies. More ESID respondents (58·7%) than focused AAAAI respondents (41·8%) reported that they do not rotate antibiotics (P = 0·043). Conversely, more AAAAI respondents overall would rotate the prophylactic antibiotic on a monthly basis compared with ESID respondents (focused P = 0·023, general P = 0·002). Why ESID members were less likely to rotate antibiotics when used as prophylaxis remains unclear, but represents an important direction for future interventional clinical research. There was little variability in the chosen interval for follow-up for healthy PID patients; all MAPK Inhibitor Library manufacturer Avelestat (AZD9668) three subgroups agreed that every 6 months was the most appropriate (Fig. 6a). ESID respondents more frequently recommended quarterly evaluations (35·7%) compared with the general AAAAI respondents (23·6%, P = 0·015), and were less likely to recommend annual follow-up (P = 0·021). The fact that clinical immunology has been a separate subspeciality in several countries in Europe may explain the trend towards more regular routine PID patient evaluations than in the United States, where immunology is combined most typically with a large allergy practice. The most striking difference across the entire questionnaire, however, arose when providers were asked to assess the risk

to their patients of reimbursement policies for IVIg therapies. Within the ESID respondents, there was a general trend towards no or slight perceived risk, whereas there was a strong concern among AAAAI respondents, with the majority reporting extreme or serious risk (Fig. 6b). While this is due probably to the differences in health-care models that exist between Europe and the United States, it underscores a need for the collection of clinical outcome data on newly diagnosed patients in both continents and standardized quality of life information for existing patients; these will enable health technology assessments to be made to inform payers – whether insurers or government agencies – and to ensure appropriate health-care provisions.

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