Prospective adherence to specific immunotherapy in Europe (PASTE) survey protocol

Impact of Kayumidas© app on subjective symptoms and treatment adherence in allergic Rhinoconjunctivitis: Prospective Single-Arm interventional pilot study

INTRODUCTION

In the spring of 2021, a physician-supervised application (app) "Kayumidas© - Itchy Eye Alert" was released for allergy sufferers, which implements a function to predict pollen dispersal status for each user based on weather forecasts and notify users of the results. This app provides push notifications of warning levels of itchiness and other symptoms, countermeasures, and the time to use medication. However, no evaluation has been conducted to determine whether the use of app improves compliance with treatment. This study aimed to verify whether the use of a smartphone app is effective in relieving the symptoms of allergic conjunctivitis and rhinitis and how it changes patients' eye drop behavior.

METHODS

This was an investigator-initiated, observational, prospective cohort study that was conducted between February 2022 and May 2022. In 62 patients diagnosed with allergic conjunctivitis, the scores of nine subjective eye and nose symptoms (1-4) and eye itchiness (1-7) before and after using the app were compared using a questionnaire. The adherence scores for eye drops (1-4) were also investigated using a questionnaire.

RESULTS

The scores for all five ocular subjective symptoms and all four nasal subjective symptoms improved significantly after app use (p < 0.01). Both itching scores (4.1 ± 1.1 vs. 1.6 ± 0.5, p < 0.01) and eye drop compliance scores (2.0 ± 0.7 vs. 3.9 ± 0.3, p < 0.01) improved significantly after app use.

CONCLUSION

The use of the Kayumidas© app improved adherence to eye drops and the subjective symptoms of allergic conjunctivitis and rhinitis. Thus, app use effectively improves symptoms by changing behavior and improving self-care awareness regarding treatment in patients with allergic diseases.

Adherence in allergen immunotherapy: Current situation and future implications

Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy. However clinical trials as well as real-life studies revealed poor treatment adherence. This article is intended to provide an overview of the current literature of the last 10 years, to outline reasons for poor treatment adherence in AIT and to provide possible solutions for improving adherence.

Adherence to Subcutaneous Allergen Immunotherapy in Southeast Turkey: A Real-Life Study

BACKGROUND Subcutaneous immunotherapy (SCIT) in allergic rhinitis (AR) and asthma is a very effective treatment, but adherence is still a serious problem. Studies addressing real-life adherence to SCIT are rare in the literature. The aim of this study was to evaluate the adherence to SCIT in AR and asthma. MATERIAL AND METHODS The medical records of patients prescribed SCIT for treatment of AR and/or asthma were evaluated. Patients who continued the SCIT treatment as prescribed were defined as adherent, patients who stopped the treatment before the recommended period were defined as nonpersistent, and those who never started the treatment were defined as primary poor adherence. Age, gender, residence, type of SCIT, comorbidities, occupation, income, and adverse reactions were evaluated between these groups. RESULTS Ninety-five patients prescribed SCIT for the treatment of AR and/or asthma formed our cohort (female/male: 51/44). The mean (SD) age and duration of SCIT were 32.2±10.0 (range, 17-63) years, 14.4±12.7 (1.0-58.5) months, respectively. Sixty-two (65.3%) patients were adherent, (28.4%) patients were nonpersistent, and 6 (6.3%) patients were primary poor adherent. Nineteen (21.4%) patients had local adverse reactions and one (1.1%) had anaphylaxis. There were no differences between groups for age, gender, residence, type of SCIT, comorbidities, income, or occupation. The most frequent reason of nonpersistence was the cost of treatment. CONCLUSIONS Our study found that adherence to SCIT is low in a real-life setting in southeast Turkey, similar to most previous adherence studies.

Novel Delivery Routes for Allergy Immunotherapy: Intralymphatic, Epicutaneous, and Intradermal

Current allergy immunotherapy protocols suffer from two main problems: long treatment duration and systemic allergic side effects of the allergen administrations. The immunologic effects of allergen administration could be enhanced and the number of allergen administrations and treatment duration reduced by choosing a tissue for administration that contains a high density of antigen-presenting cells. Local side effects could be reduced by choosing a route characterized by a low density of mast cells, and systemic side effects could be reduced by administration to nonvascularized tissues, so that inadvertent systemic distribution of the allergen and consequent systemic allergic side effects are minimized.

Patient selection for subcutaneous versus sublingual immunotherapy

PURPOSE OF REVIEW

With the Food and Drug Administration's approval of sublingual allergen-specific immunotherapy (SL-AIT) tablets for grass and ragweed pollen, SL-AIT is progressively gathering importance not only in Europe, but also in the United States and other parts of the world. We reviewed issues related to the selection of patients for the sublingual or the subcutaneous route for allergic patients, based on what has been published since January 2014 on subcutaneous-versus-SL-AIT efficacy, safety and other issues. (Figure is included in full-text article.)

RECENT FINDINGS

As patient's adherence seems one of the major problems in real-life AIT, investigators have sought how to enhance AIT simplicity by changing the route to home-administrated SL-AIT, and by shortening the subcutaneous-allergen-specific immunotherapy (SC-AIT) build-up or maintenance phase. The latter was safe with several hypoallergenic extracts. As for SL-AIT, double blind placebo-controlled large trials in patients with allergic rhinitis and asthma have shown the efficacy and safety of ragweed pollen and house dust mite SLIT tablets and highly concentrated liquid formulations, primarily in adults. A large trial with SLIT in 3-year-old children was effective.

SUMMARY

With the improvement of SL-AIT efficacy, the selection of SC-versus-SL-AIT will probably increasingly be based not on efficacy, but on practical aspects, without losing sight of which SL-AIT products have proven efficacy.

Adherence to Sublingual Immunotherapy

Adherence is a major issue in any medical treatment. Allergen immunotherapy (AIT) is particularly affected by a poor adherence because a flawed application prevents the immunological effects that underlie the clinical outcome of the treatment. Sublingual immunotherapy (SLIT) was introduced in the 1990s, and the early studies suggested that adherence and compliance to such a route of administration was better than the traditional subcutaneous route. However, the recent data from manufacturers revealed that only 13% of patients treated with SLIT reach the recommended 3-year duration. Therefore, improved adherence to SLIT is an unmet need that may be achieved by various approaches. The utility of patient education and accurate monitoring during the treatment was demonstrated by specific studies, while the success of technology-based tools, including online platforms, social media, e-mail, and a short message service by phone, is currently considered to improve the adherence. This goal is of pivotal importance to fulfill the object of SLIT that is to modify the natural history of allergy, ensuring a long-lasting clinical benefit, and a consequent pharmaco-economic advantage, when patients complete at least a 3-year course of treatment.