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Masuno S. The impact of adverse reactions on adherence to sublingual immunotherapy for Japanese cedar pollinosis and house dust mite allergy in Japan. Acta Otolaryngol 2024:1-9. [PMID: 39264318 DOI: 10.1080/00016489.2024.2397054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Allergen immunotherapy is the only treatment that can achieve remission for allergic diseases. AIMS/OBJECTIVES To investigate the three-year adherence to sublingual immunotherapy for Japanese cedar pollinosis and house dust mite allergy at a clinic in Japan and identify factors that influence adherence and severe adverse reactions. MATERIAL AND METHODS In total, 174 patients aged 12 years or older who started sublingual immunotherapy for Japanese cedar pollinosis (n = 72), house dust mite allergy (n = 55), or both (n = 47) between May 2017 and June 2018. Patient age, sex, type of pharmacotherapy used, adverse reactions, blood test results, and duration of continuous treatment were investigated. RESULTS The three-year treatment continuation rate was 40.8%. Adverse reaction rates were 12.6% for cedar pollinosis and 40.2% for house dust mite allergy. Patients with dose reductions due to severe reactions had lower first-year continuation rates. In the MITICURE® group, patients with severe reactions had significantly higher serum total IgE levels. Severe reactions were more common in MITICURE® patients with seven or more positive antigen types. CONCLUSIONS AND SIGNIFICANCE Severe adverse reactions reduced early adherence.
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Affiliation(s)
- Satoru Masuno
- Makinohara Nanohana Otorhinolaryngology Clinic, Chiba, Japan
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2
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Aarestrup FM, Taketomi EA, Santos Galvão CE, Alves GB, de Araújo Gueiros Lira GV, Gonçalves MR, Miziara MGC, Casado SSM, Pereira VAR, Solé D, Goudouris ES, Kuschnir FC. Transition between subcutaneous and sublingual allergen immunotherapy: Recommendations of the Brazilian Association of Allergy and Immunology (ASBAI). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100281. [PMID: 38975257 PMCID: PMC11226966 DOI: 10.1016/j.jacig.2024.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/31/2023] [Accepted: 02/15/2024] [Indexed: 07/09/2024]
Abstract
The use of allergen immunotherapy (AIT) in Brazil has specific regional conditions owing to the pattern of allergen sensitization, as well as to genetic, socioeconomic, and cultural characteristics. This review article aims to discuss the clinical practice of AIT by the subcutaneous or sublingual route in Brazil, addressing the possibilities of transition between these forms of administration. A systematic review using the PubMed and Cochrane databases was performed, and the websites of major allergy and immunology organizations were consulted. Knowledge of the mechanism of action of subcutaneous immunotherapy and sublingual immunotherapy, together with Brazilian real-life experience, allowed us to establish recommendations regarding switching routes of AIT administration in selected cases. Careful analysis of each clinical situation is necessary to perform the transition between subcutaneous and sublingual allergen immunotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dirceu Solé
- Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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Li Y, Xiong Y, Fan W, Wang K, Yu Q, Si L, van der Smagt P, Tang J, Chen N. Sequential model for predicting patient adherence in subcutaneous immunotherapy for allergic rhinitis. Front Pharmacol 2024; 15:1371504. [PMID: 39101142 PMCID: PMC11294208 DOI: 10.3389/fphar.2024.1371504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/24/2024] [Indexed: 08/06/2024] Open
Abstract
Objective Subcutaneous Immunotherapy (SCIT) is the long-lasting causal treatment of allergic rhinitis (AR). How to enhance the adherence of patients to maximize the benefit of allergen immunotherapy (AIT) plays a crucial role in the management of AIT. This study aims to leverage novel machine learning models to precisely predict the risk of non-adherence of AR patients and related local symptom scores in 3 years SCIT. Methods The research develops and analyzes two models, sequential latent-variable model (SLVM) of Stochastic Latent Actor-Critic (SLAC) and Long Short-Term Memory (LSTM). SLVM is a probabilistic model that captures the dynamics of patient adherence, while LSTM is a type of recurrent neural network designed to handle time-series data by maintaining long-term dependencies. These models were evaluated based on scoring and adherence prediction capabilities. Results Excluding the biased samples at the first time step, the predictive adherence accuracy of the SLAC models is from 60% to 72%, and for LSTM models, it is 66%-84%, varying according to the time steps. The range of Root Mean Square Error (RMSE) for SLAC models is between 0.93 and 2.22, while for LSTM models it is between 1.09 and 1.77. Notably, these RMSEs are significantly lower than the random prediction error of 4.55. Conclusion We creatively apply sequential models in the long-term management of SCIT with promising accuracy in the prediction of SCIT nonadherence in AR patients. While LSTM outperforms SLAC in adherence prediction, SLAC excels in score prediction for patients undergoing SCIT for AR. The state-action-based SLAC adds flexibility, presenting a novel and effective approach for managing long-term AIT.
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Affiliation(s)
- Yin Li
- Department of Otorhinolaryngology, The First People’s Hospital of Foshan, Foshan, China
| | - Yu Xiong
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Wenxin Fan
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Shenzhen, China
| | - Kai Wang
- Department of Otorhinolaryngology, The First People’s Hospital of Foshan, Foshan, China
| | - Qingqing Yu
- Department of Otorhinolaryngology, The First People’s Hospital of Foshan, Foshan, China
| | - Liping Si
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Patrick van der Smagt
- Faculty of Informatics, ELTE University, Budapest, Hungary
- Machine Learning Research Lab, Volkswagen Group, Munich, Germany
| | - Jun Tang
- Department of Otorhinolaryngology, The First People’s Hospital of Foshan, Foshan, China
| | - Nutan Chen
- Machine Learning Research Lab, Volkswagen Group, Munich, Germany
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4
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Wan WJ, Xu QY, Lu MP, Lyu Q, Gu ZJ, Yuan J, Zhu XJ, Cui XY, Xu Q, Cheng L. Patient compliance to sublingual immunotherapy for mite-induced allergic rhinitis: A retrospective study. World Allergy Organ J 2024; 17:100926. [PMID: 39040084 PMCID: PMC11261089 DOI: 10.1016/j.waojou.2024.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/16/2024] [Accepted: 06/07/2024] [Indexed: 07/24/2024] Open
Abstract
Background Compliance to sublingual immunotherapy (SLIT) is generally low, resulting in reduced short- and long-term clinical efficacy. Compliance is a critical factor determining the success of allergic rhinitis (AR) treatment. Objective To analyze the compliance of patients with house dust mite (HDM)-induced AR to SLIT and the impact of coronavirus disease 2019 (COVID-19) on compliance. Methods The clinical data of 3117 patients with HDM-induced AR who started SLIT between July 2018 and April 2022 were retrospectively reviewed. We assessed the reasons for non-compliance and the changes in non-compliance during the COVID-19 pandemic compared to the pre-pandemic period. Results Of 3117 patients, 507 (16.27%) patients (ages, 5-67 years) were identified as non-compliant. The most common reason for non-compliance was poor efficacy (27.22%). The non-compliance rate was highest during 24-36 months of SLIT (28.13%, 153/544), followed by 12-24 months (7.02%, 91/1296). Non-compliance was significantly higher in adolescents/adults than in children (P = 0.000). Although the generalized linear model analysis indicated that compliance was affected by the COVID-19 pandemic during 3-6 months of SLIT, the overall compliance to SLIT was not significantly affected by the pandemic, according to the Kaplan-Meier survival analysis. Conclusions The non-compliance rate of SLIT in this study was low, and poor efficacy was the most common reason for non-compliance. The compliance of adolescents/adults was lower than that of children. The COVID-19 pandemic did not significantly impact compliance to SLIT, which is an appropriate strategy for the home treatment of AR patients during major public health events.
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Affiliation(s)
- Wen-Jin Wan
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qiu-Yan Xu
- Department of Pediatrics, Suzhou Research Center of Medical School, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Mei-Ping Lu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qian Lyu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zi-Jun Gu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Yuan
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xin-Jie Zhu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xin-Yan Cui
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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5
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Creticos PS, Gunaydin FE, Nolte H, Damask C, Durham SR. Allergen Immunotherapy: The Evidence Supporting the Efficacy and Safety of Subcutaneous Immunotherapy and Sublingual Forms of Immunotherapy for Allergic Rhinitis/Conjunctivitis and Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1415-1427. [PMID: 38685477 DOI: 10.1016/j.jaip.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Allergen immunotherapy (AIT) is a recognized key therapeutic modality for the treatment of allergic respiratory disease. Definitive studies have provided evidence-based data to demonstrate its effectiveness in allergic rhinitis and asthma due to the inhalation of proteinaceous allergic substances from specific seasonal pollens, dust mites, animal allergens, and certain mold spores. Over the ensuing decades, laboratory investigations have provided objective evidence to demonstrate immunologic changes, including production of protective IgG antibody, suppression of IgE antibody, upregulation of regulatory T cells, and induction of a state of immune tolerance to the offending allergen(s). Tangential to this work were carefully designed clinical studies that defined allergen dose and duration of treatment, established the importance of preparing extracts with standardized allergens (or well-defined extracts) based on major protein moieties, and used allergen provocation models to demonstrate efficacy superior to placebo. In the United States, the use of subcutaneous immunotherapy extracts for AIT was grandfathered in by the Food and Drug Administration based on expert literature review. In contrast, sublingual tablet immunotherapy underwent formal clinical development programs (phase I-III clinical trials) that provided the necessary clinical evidence for safety and efficacy that led to regulatory agency approvals for the treatment of allergic rhinitis in properly characterized patients with allergy. The allergy specialist's treatment options currently include traditional subcutaneous AIT and specific sublingual tablets approved for grass, ragweed, house dust mites, trees belonging to the birch-homologous group, and Japanese cedar. Tangential to this are sublingual drops that are increasingly being used off-label (albeit not approved by the Food and Drug Administration) in the United States. This article will review the evidence-based literature supporting the use of these forms of AIT, as well as focus on several current controversies and gaps in our knowledge base that have relevance for the appropriate selection of patients for treatment with specific AIT.
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Affiliation(s)
- Peter Socrates Creticos
- Johns Hopkins Division of Allergy & Clinical Immunology, Baltimore, Md; Creticos Research Group, Crownsville, MD.
| | - Fatma E Gunaydin
- Department of Immunology & Allergy, Ordu University Education & Research Hospital, Ordu, Türkiye
| | | | - Cecilia Damask
- Department of Otolaryngology, Central Florida College of Medicine, Orlando, Fla
| | - Stephen R Durham
- Allergy & Clinical Immunology, Division of Respiratory Science, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
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6
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Owenier C, Barnowski C, Leineweber M, Yu D, Verhagen M, Distler A. Tolerability and Safety of Sublingual Immunotherapy in Patients with Tree Pollen Allergy in Daily Practice-An Open, Prospective, Non-Interventional Study. J Clin Med 2023; 12:5517. [PMID: 37685584 PMCID: PMC10487851 DOI: 10.3390/jcm12175517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
To investigate the tolerability and safety of two sublingual tree pollen extracts approved in 2018, a non-interventional study (NIS) was performed. This NIS was an 8-month observational study conducted at 84 sites throughout Germany. Study participants received either a sublingual liquid allergen extract of birch pollen (SBPE) or a liquid allergen extract consisting of a mixture of birch, hazel, and alder tree pollen (STPE). Data from 432 patients were analyzed for the occurrence of adverse events and patient compliance. At least one local reaction occurred in 69 (22.2%) patients, whereas systemic reactions were only observed in 27 (6.3%) patients. STPE-treated patients developed systemic reactions more frequently than SBPE-treated patients (SBPE: 9 (4.3%) vs. STPE: 18 (8.0%)). Only one patient developed a systemic grade III reaction. Severe systemic grade IV reactions were not observed. A total of 348 (98.6%) of the patients who completed all visits were satisfied or very satisfied with the sublingual immunotherapy (SLIT), and 322 (71%) patients completed all visits. Both investigated products were well tolerated by the patients and demonstrated a good safety profile. AEs were observed less frequently than in the preceding clinical phase III trial, and no new safety concerns were identified.
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Affiliation(s)
| | | | | | - Donghui Yu
- HAL Allergy BV, 2333 CH Leiden, The Netherlands; (D.Y.); (M.V.)
| | - Marjan Verhagen
- HAL Allergy BV, 2333 CH Leiden, The Netherlands; (D.Y.); (M.V.)
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7
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Ridolo E, Nicoletta F, Barone A, Ottoni M, Senna G, Canonica GW. Causes of Non-Adherence to Allergen-Specific Immunotherapy: A Foundation towards a Patient-Personalized Approach. J Pers Med 2023; 13:1206. [PMID: 37623457 PMCID: PMC10455852 DOI: 10.3390/jpm13081206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Allergen-specific immunotherapy (AIT) is the only disease-modifying therapy for allergic conditions, resulting in a long-lasting tolerance beyond the duration of the treatment. Due to the strong relationship between the effectiveness, its optimal duration (at least three years) and the observation of the correct administration protocol, appropriate adherence to the plan of treatment represents a critical factor for the therapeutical success of AIT. METHODS Analysis of studies about the rate of adherence in subcutaneous and sublingual immunotherapy, which are the main routes of administration of AIT. RESULTS There are different causes leading to a premature interruption of the therapy or to it being incorrectly carried out; the most reported include erroneous expectations of the effectiveness and the adverse effects, economic issues, inconvenience and unrelated clinical conditions. CONCLUSIONS An attentive analysis of the main causes of dropouts may be useful to improve the management of these patients and to develop new strategies for a personalized approach. These strategies should be dynamic, involving attentive communication between the physician and the patient about all the possible criticalities, especially in the initial phase of the therapy, and facilitating, as much as possible, access to healthcare providers over the course of the maintenance phase, including by exploiting technological tools.
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Affiliation(s)
- Erminia Ridolo
- Allergology Unit, Parma University Hospital, 43121 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | | | | | - Martina Ottoni
- Allergology Unit, Parma University Hospital, 43121 Parma, Italy
| | | | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
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8
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曹 樱, 冯 彦, 王 倩, 韩 世. [Analysis of adherence and determinants of sublingual immunotherapy in patients with Artemisia pollen-induced allergic rhinitis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:448-452. [PMID: 37253518 PMCID: PMC10495797 DOI: 10.13201/j.issn.2096-7993.2023.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/05/2023] [Indexed: 06/01/2023]
Abstract
Objective:To monitor adherence to specific sublingual immunotherapy (SLIT) in patients with seasonal allergic rhinitis(AR), analyse factors influencing adherence, and provide research support to effectively improve adherence. Methods:Patients with AR who underwent Artemisia pollen SLIT at the Department of Otolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University from May 2021 to April 2022 were retrospectively followed up by telephone to investigate the current status of treatment, count the causes of shedding, and extract relevant information from their medical record data for analysis. Results:Of the 112 patients surveyed, 34 discontinued treatment(30.3%); patients who experienced adverse reactions and SLIT patients who had been on treatment for more than 6 months showed relatively good adherence(P<0.05). The main reasons for discontinuation in patients who dropped out were: asymptomatic discomfort during the non-pollen phase and therefore discontinuation of treatment or feeling that treatment was ineffective 9 cases(26.5%), forced discontinuation due to vaccination or pregnancy, or epidemics 6 cases(17.6%). Conclusion:Long-term adherence of patients to Artemisia pollen SLIT still needs to be brought to the attention of healthcare professionals, especially in the early stages of treatment when good patient education and good channels of trust and communication between doctors and patients need to be established.
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Affiliation(s)
- 樱子 曹
- 山西医科大学护理学院(太原,030000)Department of Nursing, Shanxi Medical University, Taiyuan, 030000, China
- 山西医科大学第一医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, the First Hospital of Shanxi Medical University
| | - 彦 冯
- 山西医科大学第一医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, the First Hospital of Shanxi Medical University
| | - 倩 王
- 山西医科大学护理学院(太原,030000)Department of Nursing, Shanxi Medical University, Taiyuan, 030000, China
| | - 世范 韩
- 山西医科大学第一医院山西医学期刊社Shanxi Medical Periodical Press, the First Hospital of Shanxi Medical University
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9
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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Park DY, Lee YJ, Kim DK, Kim SW, Yang HJ, Kim DH, Jun YJ, Park SC, Kim BS, Yang SI, Lee IH, Kim M, Ryu G, Kang SY, Kim MA, Lee SM, Kim HJ, Choi GS, Chung SJ, Lee HJ, Kim HB, Choi JH. KAAACI Allergic Rhinitis Guidelines: Part 2. Update in Non-pharmacological Management. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:145-159. [PMID: 37021502 PMCID: PMC10079515 DOI: 10.4168/aair.2023.15.2.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 04/07/2023]
Abstract
Allergic rhinitis is the most common chronic disease worldwide. Various upper airway symptoms lower quality of life, and due to the recurrent symptoms, multiple treatments are usually attempted rather than one definitive treatment. There are alternatives to medical (medication-based) and non-medical treatments. A guideline is needed to understand allergic rhinitis and develop an appropriate treatment plan. We have developed guidelines for medical treatment based on previous reports. The current guidelines herein are associated with the "KAAACI Evidence-Based Guidelines for Allergic Rhinitis in Korea, Part 1: Update in pharmacotherapy" in which we aimed to provide evidence-based recommendations for the medical treatment of allergic rhinitis. Part 2 focuses on non-pharmacological management, including allergen-specific immunotherapy, subcutaneous or sublingual immunotherapy, nasal saline irrigation, environmental management strategies, companion animal management, and nasal turbinate surgery. The evidence to support the treatment efficacy, safety, and selection has been systematically reviewed. However, larger controlled studies are needed to elevate the level of evidence to select rational non-medical therapeutic options for patients with allergic rhinitis.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Yong Ju Lee
- Department of Pediatrics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Dong-Kyu Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Hallym University College of Medicine, Chuncheon, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Joon Jun
- Department of Otorhinolaryngology-Head and Neck surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
| | - Sang Chul Park
- Department of Otorhinolaryngology-Head and Neck surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Il Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Minji Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Yoon Kang
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Gil-Soon Choi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Soo Jie Chung
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyun Jong Lee
- Lee and Hong ENT Sleep and Cosmetic Center, Seongnam, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
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11
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Gehrt F, Xu Q, Baiardini I, Canonica GW, Pfaar O. Adherence in allergen immunotherapy: Current situation and future implications. Allergol Select 2022; 6:276-284. [PMID: 36457724 PMCID: PMC9707370 DOI: 10.5414/alx02318e] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/03/2022] [Indexed: 09/26/2023] Open
Abstract
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.
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Affiliation(s)
- Francesca Gehrt
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Qingqing Xu
- Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, PR China
| | - Ilaria Baiardini
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, and
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, and
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
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12
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Rønborg SM, Grand TS, Brandi H, Pollock RF. ITULAZAX ® versus Alutard SQ ® in the treatment of allergic rhinitis induced by pollen from the birch homologous group: A cost-minimization modeling analysis from the Danish societal perspective. Clin Transl Allergy 2022; 12:e12196. [PMID: 36434741 PMCID: PMC9631325 DOI: 10.1002/clt2.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND AIMS Allergic rhinitis (AR) is an inflammatory disorder triggered by an allergic immune response to inhaled allergens. Birch pollen is the major allergenic tree pollen in parts of Europe. ITULAZAX® is a sublingual immunotherapy tablet for the treatment of adults with moderate-to-severe AR and/or conjunctivitis induced by pollen from the birch homologous group. The aim was to compare the costs of treating AR with ITULAZAX® versus subcutaneous ALUTARD SQ® Betula verrucosa (ALUTARD SQ®) from a Danish societal perspective. METHODS A cost-minimization model was developed to capture costs of allergy immunotherapy (AIT), interactions with healthcare professionals (HCPs) in three different care settings (general practice, allergy specialist, and hospital), and indirect costs arising from absenteeism and presenteeism. The cost-minimization analysis was conducted over a 3-year time horizon with costs reported in 2021 Danish Kroner (DKK) and Euros (EUR) based on the European Central Bank 365-day average exchange rate. One-way sensitivity analyses were performed. RESULTS The base case analysis showed that the total cost of treatment over 3 years was estimated to be DKK 49,117 (EUR 6598) per patient with ALUTARD SQ®, compared with DKK 30,996 (EUR 4164) with ITULAZAX®, reflecting a cost saving of DKK 18,121 (EUR 2434) per patient with ITULAZAX® over 3 years. Over the 3-year time horizon, costs of AIT were predicted to increase by DKK 17,928 (EUR 2408) with ITULAZAX®, while costs of interactions with HCPs were predicted to decrease by DKK 22,528 (EUR 3027) versus ALUTARD SQ®, more than offsetting the increased cost of ITULAZAX®. CONCLUSIONS Given the equivalent effectiveness of the two AIT products, and the cost savings with ITULAZAX® versus ALUTARD SQ® from a Danish societal perspective, ITULAZAX® should be considered as a cost-saving alternative to ALUTARD SQ® for the treatment of birch pollen-induced moderate-to-severe AR in adults.
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13
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Abstract
Adherence is crucial for allergen immunotherapy (AIT) efficacy, and a long-term 3-year adherence is indispensable for the long-term benefits beyond AIT administration. Nonadherence causes should be analyzed not only at the patient level but from a broader perspective, including socioeconomic factors, health-care system factors, and disorder- and therapy-related factors. Subcutaneous immunotherapy (SCIT) adherence is ∼50% at best and, for sublingual immunotherapy, the numbers are even much worse in some regions. In this review, causes for AIT loss of adherence and strategies, published and from personal experience, to reduce nonadherence are presented. Although the broader picture of causes of nonadherence has to be taken into account, in all this, the patient-physician and patient-health care professional (AIT nurse, assistant) are still in the center, and, in SCIT, each clinic visit for a shot is an opportunity to exploit this interaction in a positive way and stimulate adherence. Patient factors of nonadherence are not so much forgetfulness but more perception of ineffectiveness and adverse effects. An explanation of what can be expected before starting AIT is crucial because most of those who drop out are seen during the first year. Adherence is especially under risk when administration is temporarily interrupted (lockdown, illness, disease flare, vacation, preseasonal AIT administration schedules). The pandemic has caused higher rates of nonadherence specifically due to a fear of getting infected with severe acute respiratory syndrome coronavirus 2, which can be mitigated with good hygiene techniques and strict sanitization protocols, which ensure the patients. Also, patient mobile discussion networks related to AIT can help encourage adherence and reduce fear of infection, even in these difficult times.
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14
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Compliance with subcutaneous immunotherapy and factors affecting compliance among patients with allergic rhinitis. Am J Otolaryngol 2021; 42:103125. [PMID: 34218068 DOI: 10.1016/j.amjoto.2021.103125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/13/2021] [Indexed: 11/21/2022]
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15
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Koca Kalkan I, Ates H, Aksu K, Yesilkaya S, Topel M, Cuhadar Ercelebi D, Turkyilmaz S, Oncul A, Demir S. Real-life adherence to subcutaneous immunotherapy: What has changed in the era of the COVID-19 pandemic. World Allergy Organ J 2021; 14:100558. [PMID: 34122718 PMCID: PMC8185179 DOI: 10.1016/j.waojou.2021.100558] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Allergen immunotherapy (AIT) must be continued for 3 years, to achieve a long-term modifying effect. Adherence is a key to ensure effectiveness. The objective of this study was, first of all, to evaluate the adherence with subcutaneous immunotherapy (SCIT) and to identify the main causes of SCIT withdrawal in real-life practice in our clinic. Secondly, we also aimed to investigate to what extent the COVID-19 pandemic altered our SCIT receiving patients' treatment adherence behaviors and the factors that affected their decisions. METHODS Retrospective analysis of the medical records of patients ages ≥18 years, who had started SCIT in January 2014 or later until September 2020 in our department for the diagnosis of allergic rhinitis, allergic asthma or venom allergy, were included in the study. Adherence was determined as the accomplishment of 3 years of SCIT. RESULTS A total of 124 patients (72 female [58.1%]; median age, 35 [19-77] years) were included. The adherence rate to SCIT in our tertiary center's real-life setting was 56.25% with a follow-up duration of 3 years before COVID-19 pandemic. Dose modification, defined as reducing patient's planned SCIT dose due to a systemic allergic/large local reaction or missed injection, and its frequency, which is the number of dose adjustments done throughout the SCIT, was found to be the only factor related to nonadherence. But with the pandemic only in 6 months, among 63 patients receiving SCIT, 15 patients (23.81%) dropped out, and the most common reason was fear of being infected with COVID-19 virus during receiving SCIT in hospital (93.33%). The only independent predictor of drop-out during the COVID-19 pandemic was short duration of AIT (p = 0.012). When we compare the dropped-out cases before and after the start of pandemic, AIT duration was significantly shorter in pandemic period (p = 0.005). CONCLUSION Adherence rate to SCIT in our real-world setting study was 56.25% before the COVID-19 pandemic. Our results indicated that patients requiring dose modification were more prone to be non-adherent. Approximately one quarter of patients dropped-out with the start of pandemic, almost all due to fear of being infected during receiving SCIT in hospital. Since short SCIT follow-up time was found to be the only risk factor for drop-out during the COVID-19 pandemic, we believe that patients who are in the early phases of their treatment should be observed more closely and their concerns should be answered by their doctors.
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Affiliation(s)
- Ilkay Koca Kalkan
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Hale Ates
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Kurtulus Aksu
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Selma Yesilkaya
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Musa Topel
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Dilek Cuhadar Ercelebi
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Suleyman Turkyilmaz
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ali Oncul
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Senay Demir
- Department of Allergy and Clinical Immunology, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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16
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Use of allergen immunotherapy for treatment of allergic conjunctivitis. Curr Opin Allergy Clin Immunol 2020; 20:609-615. [DOI: 10.1097/aci.0000000000000692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Bilancia M, Pasculli G, Di Bona D. A non-stationary Markov model for economic evaluation of grass pollen allergoid immunotherapy. PLoS One 2020; 15:e0232753. [PMID: 32407326 PMCID: PMC7224467 DOI: 10.1371/journal.pone.0232753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/21/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction Allergic rhino-conjunctivitis (ARC) is an IgE-mediated disease that occurs after exposure to indoor or outdoor allergens, or to non-specific triggers. Effective treatment options for seasonal ARC are available, but the economic aspects and burden of these therapies are not of secondary importance, also considered that the prevalence of ARC has been estimated at 23% in Europe. For these reasons, we propose a novel flexible cost-effectiveness analysis (CEA) model, intended to provide healthcare professionals and policymakers with useful information aimed at cost-effective interventions for grass-pollen induced allergic rhino-conjunctivitis (ARC). Methods Treatments compared are: 1. no AIT, first-line symptomatic drug-therapy with no allergoid immunotherapy (AIT). 2. SCIT, subcutaneous immunotherapy. 3. SLIT, sublingual immunotherapy. The proposed model is a non-stationary Markovian model, that is flexible enough to reflect those treatment-related problems often encountered in real-life and clinical practice, but that cannot be adequately represented in randomized clinical trials (RCTs). At the same time, we described in detail all the structural elements of the model as well as its input parameters, in order to minimize any issue of transparency and facilitate the reproducibility and circulation of the results among researchers. Results Using the no AIT strategy as a comparator, and the Incremental Cost Effectiveness Ratio (ICER) as a statistic to summarize the cost-effectiveness of a health care intervention, we could conclude that: Conclusions Even though there is a considerable evidence that SCIT outperforms SLIT, we could not state that both SCIT and SLIT (or only one of these two) can be considered cost-effective for ARC, as a reliable threshold value for cost-effectiveness set by national regulatory agencies for pharmaceutical products is missing. Moreover, the impact of model input parameters uncertainty on the reliability of our conclusions needs to be investigated further.
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Affiliation(s)
- Massimo Bilancia
- Ionic Department in Legal and Economic System of Mediterranean (DJSGEM), University of Bari Aldo Moro, Taranto, Italy
- * E-mail:
| | - Giuseppe Pasculli
- Department of Computer, Control, and Management Engineering Antonio Ruberti (DIAG), La Sapienza University, Rome, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
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18
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Passalacqua G, Bagnasco D, Canonica GW. 30 years of sublingual immunotherapy. Allergy 2020; 75:1107-1120. [PMID: 31715001 DOI: 10.1111/all.14113] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
Allergen Immunotherapy (AIT) was introduced in clinical practice on an empirical basis more than 100 years ago. Since the first attempts, AIT was administered subcutaneously. Indeed, other routes of administration were proposed and studied, in particular to improve the safety, but only the sublingual route (SLIT) achieved a credibility based on evidence and was then accepted as a viable "alternative" option to the subcutaneous route. SLIT was largely used in clinical trials and clinical practice in this last 30 years. Thus, a large amount of data is available, coming from either controlled trials and postmarketing surveillance studies. It is clear that SLIT is overall effective, but it is also clear that the efficacy is not "class-related," as derived from meta-analyses, but restricted to each specific product. The 30-year lasting use of SLIT allowed to clarify many clinical aspects, such as efficacy, safety, use in asthma, regimens of administration, and optimal doses. In parallel, the mechanisms of action of AIT were elucidated, and new indications were proposed (eg food allergy, atopic dermatitis). In addition, the introduction of molecular-based diagnosis, allowed to better refine the prescription of SLIT, based on specific sensitization profiles. The present article will describe the origin and evolution of SLIT for respiratory allergy, taking into account the clinical context that suggested this form of treatment, the recently developed aspects, the future perspectives and unmet needs, This is not, therefore, a systematic review, rather a narrative historical description of the past history, and a look forward to the future opportunities.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino ‐University of Genoa Genoa Italy
- Personalized Medicine Asthma & Allergy ‐ Humanitas Clinical and Research Center IRCCS Rozzano (MI) Italy
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19
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Jensen‐Jarolim E, Bachmann MF, Bonini S, Jacobsen L, Jutel M, Klimek L, Mahler V, Mösges R, Moingeon P, O´Hehir RE, Palomares O, Pfaar O, Renz H, Rhyner C, Roth‐Walter F, Rudenko M, Savolainen J, Schmidt‐Weber CB, Traidl‐Hoffmann C, Kündig T. State-of-the-art in marketed adjuvants and formulations in Allergen Immunotherapy: A position paper of the European Academy of Allergy and Clinical Immunology (EAACI). Allergy 2020; 75:746-760. [PMID: 31774179 DOI: 10.1111/all.14134] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 02/06/2023]
Abstract
Since the introduction of allergen immunotherapy (AIT) over 100 years ago, focus has been on standardization of allergen extracts, with reliable molecular composition of allergens receiving the highest attention. While adjuvants play a major role in European AIT, they have been less well studied. In this Position Paper, we summarize current unmet needs of adjuvants in AIT citing current evidence. Four adjuvants are used in products marketed in Europe: aluminium hydroxide (Al(OH)3 ) is the most frequently used adjuvant, with microcrystalline tyrosine (MCT), monophosphoryl lipid A (MPLA) and calcium phosphate (CaP) used less frequently. Recent studies on humans, and using mouse models, have characterized in part the mechanisms of action of adjuvants on pre-existing immune responses. AIT differs from prophylactic vaccines that provoke immunity to infectious agents, as in allergy the patient is presensitized to the antigen. The intended mode of action of adjuvants is to simultaneously enhance the immunogenicity of the allergen, while precipitating the allergen at the injection site to reduce the risk of anaphylaxis. Contrasting immune effects are seen with different adjuvants. Aluminium hydroxide initially boosts Th2 responses, while the other adjuvants utilized in AIT redirect the Th2 immune response towards Th1 immunity. After varying lengths of time, each of the adjuvants supports tolerance. Further studies of the mechanisms of action of adjuvants may advise shorter treatment periods than the current three-to-five-year regimens, enhancing patient adherence. Improved lead compounds from the adjuvant pipeline are under development and are explored for their capacity to fill this unmet need.
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Affiliation(s)
- Erika Jensen‐Jarolim
- Institute of Pathophysiology & Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
- The Interuniversity Messerli Research Institute University of Veterinary Medicine Vienna Medical University of Vienna University of Vienna Vienna Austria
| | - Martin F. Bachmann
- Institute of Immunology Inselspital University of Berne Bern Switzerland
| | - Sergio Bonini
- Institute of Translational Pharmacology Italian National Research Council Rome Italy
| | - Lars Jacobsen
- ALC, Allergy Learning & Consulting Copenhagen Denmark
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wrocław Poland
- ALL‐MED Medical Research Institute Wroclaw Poland
| | - Ludger Klimek
- Center of Rhinology and Allergology Wiesbaden Germany
| | - Vera Mahler
- Division of Allergology Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Ralph Mösges
- CRI‐Clinical Research International Ltd Hamburg Germany
- Institute of Medical Statistics and Bioinformatics University of Cologne Cologne Germany
| | - Philippe Moingeon
- Center for Therapeutic Innovation – Immuno‐Inflammatory Disease Servier Suresnes France
| | - Robyn E. O´Hehir
- Department of Respiratory Medicine, Allergy and Clinical Immunology (Research) Central Clinical School Monash University and Alfred Hospital Melbourne Vic. Australia
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - Harald Renz
- Institute of Laboratory Medicine Universities of Giessen and Marburg Lung Center (UGMLC) German Center for Lung Research (DZL) Philipps Universität Marburg Marburg Germany
| | - Claudio Rhyner
- SIAF – Swiss Institute of Allergy and Asthma Research Davos Switzerland
| | - Franziska Roth‐Walter
- The Interuniversity Messerli Research Institute University of Veterinary Medicine Vienna Medical University of Vienna University of Vienna Vienna Austria
| | | | - Johannes Savolainen
- Department of Pulmonary Diseases and Clinical Allergology University of Turku and Turku University Hospital Turku Finland
| | - Carsten B. Schmidt‐Weber
- Center of Allergy and Environment (ZAUM) German Center of Lung Research (DZL) and Helmholtz I&I Initiative Technical University, and Helmholtz Center Munich Munich Germany
| | - Claudia Traidl‐Hoffmann
- Institute of Environmental Medicine (IEM) Technical University Munich and Helmholtz Center Munich Munich Germany
| | - Thomas Kündig
- Department of Dermatology University Hospital Zurich Zurich Switzerland
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20
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Devillier P, Demoly P, Molimard M. Allergen immunotherapy: what is the added value of real-world evidence from retrospective claims database studies? Expert Rev Respir Med 2020; 14:445-452. [PMID: 32131649 DOI: 10.1080/17476348.2020.1733417] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Randomized controlled trials (RCTs) show that allergen immunotherapy (AIT) has proven long-term efficacy in patients with allergic rhinitis (AR). However, RCTs have limited generalizability and there is growing recognition that real-world evidence (RWE) is necessary to provide complementary data to those of RCTs, and corroborate their findings. Until recently, data from the real-world setting investigating the benefits of AIT for the treatment of patients with grass and birch pollen-associated AR were sparse, but new retrospective claims database studies from France and Germany have confirmed the sustained benefits of grass and birch pollen AIT in terms of significantly reduced progression of AR and asthma, and a significantly decreased risk of new-onset asthma.Areas covered: Here, we review the value of RWE used alongside data from traditional RCTs, and its potential strengths and limitations, and summarize the findings of the recent RWE studies investigating the benefits of AIT for the management of patients with grass and birch pollen-associated AR.Expert opinion: There is growing recognition of the necessity and value of RWE as a complement to data acquired in RCTs, to better understand the effects of AIT treatments in a broader, more representative patient population, and to help guide clinical decision-making.
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Affiliation(s)
- Philippe Devillier
- UPRES EA 220, Department of Airway Diseases, Hôpital Foch, University of Versailles Saint Quentin, University Paris-Saclay, Suresnes, France
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud De Villeneuve, University Hospital of Montpellier, Montpellier, France and Equipe EPAR - IPLESP, Sorbonne Université, Paris, France
| | - Mathieu Molimard
- Pharmacology Department, University of Bordeaux, INSERM Unit CR1219, Bordeaux, France
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Adherence to Allergen Subcutaneous Immunotherapy is Increased by a Shortened Build-Up Phase: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7328469. [PMID: 32149130 PMCID: PMC7049433 DOI: 10.1155/2020/7328469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022]
Abstract
Introduction. The poor long-term adherence is known to affect the efficacy of allergen immunotherapy (AIT). In the case of injection AIT (SCIT), one of the main determinants is the inconvenience for patients to undergo prolonged build-up phases. Thus, simplifying the time schedule of the induction protocol could be effective in increasing the adherence to SCIT. Methods We backtracked the SCIT renewal orders, thanks to the cooperation of the manufacturing company, and we compared the long-term adherence of 152 patients, who were prescribed with an abbreviated build-up schedule (4 injections, allergoid) with that of 302 patients treated with the same product, but with the traditional build-up protocol (7 injections). Results According to the patient-named refills, those patients on the abbreviated build-up were significantly more compliant at the 2nd and 3rd year of treatment compared to the other group (p=0.0001). The drop-out rate after one year was also significantly lower between the two groups (p=0.0001). The drop-out rate after one year was also significantly lower between the two groups (p=0.0001). The drop-out rate after one year was also significantly lower between the two groups (. Conclusions Abbreviating the build-up phase by reducing the number of injections significantly improves patients' adherence to SCIT.
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Vogelberg C, Brüggenjürgen B, Richter H, Jutel M. Real-World Adherence and Evidence of Subcutaneous and Sublingual Immunotherapy in Grass and Tree Pollen-Induced Allergic Rhinitis and Asthma. Patient Prefer Adherence 2020; 14:817-827. [PMID: 32494127 PMCID: PMC7231771 DOI: 10.2147/ppa.s242957] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Allergen immunotherapy (AIT), when continued for 3 years, is the only disease-modifying treatment for AR and asthma. Adherence is a key to ensure effectiveness, and poor adherence is a contraindication for AIT. The objective of this study was to evaluate real-world adherence to AIT with subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) preparations in patients allergic to grass or tree pollen. The impact of AIT on the consumption of asthma and rhinitis medication was also analyzed. PATIENTS AND METHODS In this retrospective cohort analysis of a German longitudinal prescription database, the adherence of a grass and tree pollen allergoid was examined and compared to two sublingual AIT tablets/drops. Patients receiving grass or tree allergen-specific immunotherapy prescriptions were compared with non-AIT patients receiving symptomatic allergic rhinitis (AR) and asthma prescriptions. The study endpoints included therapy adherence, AR progression, and asthma progression. Multivariate regression analyses were used to estimate the effects of SCIT or SLIT, adjusting for variables related to demographics and prescriptions. RESULTS SCIT adherence was 60.1-61.8% at 2 years and 35.0-37.5% at 3 years for the two allergens. SLIT adherence was distinctly lower (29.5-36.5% and 9.6-18.2%, respectively). Adherence in children was higher compared to adolescents or adults. All products were highly efficacious at reducing symptomatic AR medication consumption. SCIT also reduced asthma medication use for both allergens, whereas for SLIT these results were significant only for grasses but not trees. CONCLUSION Subcutaneous AIT in a real-world setting achieved significantly higher adherence rates compared to sublingual administration. SCIT reduced the use of rhinitis and asthma medication significantly for both allergens, while SLIT reduced the use of rhinitis medication for both allergens and the use of asthma medication for grasses only.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
- Correspondence: Christian Vogelberg University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, Dresden01307, GermanyTel +49 351 458-5699Fax +49 351 458-4334 Email
| | - Bernd Brüggenjürgen
- Institute for Health Economics, Steinbeis University Berlin, Berlin, Germany
| | | | - Marek Jutel
- All-MED Medical Research Institute, Warsaw, Poland
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
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Shen Z, Tan G, Zhong Z, Ding S, Wang F. Interactive Network Platform Improves Compliance and Efficacy of Subcutaneous Immunotherapy for Patients with Allergic Rhinitis. Patient Prefer Adherence 2019; 13:2101-2110. [PMID: 31997878 PMCID: PMC6917540 DOI: 10.2147/ppa.s235711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is a common chronic inflammatory disease of nasal mucosa worldwide, and its symptoms seriously affect the lives of patients. Subcutaneous immunotherapy (SCIT) is an effective treatment for AR, but it is also associated with low patient compliance and difficulties in fully achieving therapeutic effects. OBJECTIVE In this prospective randomized controlled study, we verified the effects of an interactive network platform named "U breath" in improving patient compliance and the efficacy of SCIT in patients with AR. METHODS A total of 148 patients who received SCIT were recruited as participants and randomly assigned to either the standardized management (SM) or the interactive network platform management (INP) group. The SM group experienced the standard management SCIT process. The INP group experienced a new management approach based on an interactive network platform called "U breath". The compliance rate, combined symptom and medication score (CSMS), visual analogue scale score and the rhinoconjunctivitis quality of life questionnaire (RQLQ) results were evaluated at baseline and 1-year postintervention for the two groups. RESULTS Within the first year of treatment, the INP group had a higher compliance rate than did the SM group, with a statistically significant difference (P<0.05). The INP group showed better clinical improvement than the SM group did in terms of the VAS score, and the RQLQ score except the sleep problems (P< 0.05). CONCLUSION This study confirmed that the application of an interactive network platform is of great significance for improving patient compliance and the treatment effects of SCIT in patients with AR.
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Affiliation(s)
- Zhiying Shen
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Guolin Tan
- Department of Otolaryngology Head Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Zhuqing Zhong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Siqing Ding
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Fang Wang
- Department of Otolaryngology Head Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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Li H, Wen Y, Wu S, Chen D, Luo X, Xu R, Ma R, Wen W. Epigenetic Modification of Enhancer of Zeste Homolog 2 Modulates the Activation of Dendritic Cells in Allergen Immunotherapy. Int Arch Allergy Immunol 2019; 180:120-127. [DOI: 10.1159/000500882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/09/2019] [Indexed: 11/19/2022] Open
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Abstract
Adherence to allergen immunotherapy (AIT) is crucial for its efficacy. Subcutaneous AIT requires monthly visits (or more extended in the case of venom immunotherapy), while sublingual AIT is performed with a daily intake of allergen drops. Non-adherence to an AIT schedule and premature discontinuation are common problems. Various studies have shown controversial results on the rate of AIT adherence. The aim of this review is to describe the problem of non-adherence and to offer some evidence-based advice to allergologists on how to increase it. Better patient education at the beginning of treatment, sharing with patients the decision on which type of immunotherapy to select and showing sincere interest in their treatment concerns are some tips that can help to increase adherence. A well organized allergologist time schedule not only increases safety but also offers the possibility of close follow-up and an increase in patient loyalty.
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Affiliation(s)
| | - Nikolas Dietis
- a Medical School, University of Cyprus , Nicosia , Cyprus
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Harrill WC, Setzen G, Farquhar D, Pillsbury HC. Contemporary analysis of otolaryngic allergy. Laryngoscope 2019; 130:283-289. [PMID: 30982993 DOI: 10.1002/lary.28002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Investigate the current trends in otolaryngic allergy (OA). STUDY DESIGN Cross-sectional survey. METHODS Survey of active AAOA membership. RESULTS Response rate was 27.3%. Regional response distribution rates were proportional to the AAOA membership distribution within the United States (R2 = 0.95; P < 0.001), with no significant regional response bias demonstrated (P = 0.428). Self-reported duration to OA competency was 5.8 years. Physicians reporting OA competency were more likely to be board-certified (P < 0.001) and have AAOA fellowship status (P < 0.001). The AAOA was reported to be the most valuable educational resource toward achieving OA competency, with residency training being least valuable (P < 0.001). 91.5% of respondents' practices offered OA services. Subcutaneous injections predominated at twice the utilization of sublingual immunotherapy. Allergy immunotherapy tablets were rarely utilized. Home allergy shots were offered by 45.2% of respondents. In-office immunotherapy vial compounding was preferred (95.8%) to third-party vendors. 94% of AAOA respondents identified patient compliance to be an issue within OA. Non-inhalant allergy service integration included food allergy (63.5%), asthma (44.9%), allergic fungal sinusitis (43.8%), penicillin allergy (18%), stinging insect allergy (12.6%), and aspirin desensitization (3.9%). CONCLUSION Reported duration to OA competency after residency was surprisingly long. Further investigation of current and future educational/clinical training is warranted given clinical integration reported for OA. Otolaryngology is in the unique position to develop a comprehensive sino-allergy evidence-based strategy integrating the extensive diagnostic and medical treatment arms alongside the surgical expertise of the specialty within a clinical sino-allergy home concept. LEVEL OF EVIDENCE 5 Laryngoscope, 130:283-289, 2020.
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Affiliation(s)
- Willard C Harrill
- Carolina Ear, Nose & Throat/Sinus and Allergy Center, PA, Hickory, North Carolina, U.S.A.,Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A
| | - Douglas Farquhar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
| | - Harold C Pillsbury
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
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Mao J, Heithoff KA, Koep E, Murphy T, Hammerby E. Cost of subcutaneous immunotherapy in a large insured population in the United States. Curr Med Res Opin 2019; 35:351-358. [PMID: 30091647 DOI: 10.1080/03007995.2018.1510386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Allergic rhinitis (AR) affects up to 40% of the United States population, with approximately $11 billion annual medical costs. Allergy immunotherapy is the best option for long-term symptomatic relief, but treatment compliance can be low. The objective was to describe subcutaneous immunotherapy (SCIT)-related costs for patients overall and those with inconsistent treatment. METHODS This study observed commercial and Medicare Advantage with Part D health plan enrollees. Included subjects had claims with AR diagnostic codes during 1 January 2011-31 December 2015 and ≥1 SCIT claim during 1 January 2013-31 December 2015 (index date = first SCIT claim date). A control sample was chosen randomly at a 1:3 ratio of SCIT to controls. Inconsistent use was defined as a ≥90 day gap after ≥1 SCIT. Patient characteristics were compared between SCIT patients and controls. Costs were calculated for all SCIT patients and the inconsistent subgroup. RESULTS Compared with controls (n = 394,479), SCIT (n = 131,493) patients were younger (39.3 vs. 41.4 years), more likely female (56.4% vs. 50.7%) and more likely in a commercial plan (91.6% vs. 83.6%); all p < .001. Among SCIT patients, 15.1% had inconsistent use. Among all SCIT patients, the 3 year total plan-paid SCIT-related costs were $205,741,125 (18% was for inconsistent subgroup) and patient-paid costs were $47,560,450 (15% for inconsistent). Per-member-per-month costs were $0.48 plan-paid and $0.11 patient-paid, with $0.09 plan-paid and $0.02 patient-paid for inconsistent use. CONCLUSIONS This study showed 15% of patients may have costly inconsistent SCIT treatment. Greater understanding is needed regarding the reasons for inconsistent use of subcutaneous allergy immunotherapy.
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Affiliation(s)
| | - Kim A Heithoff
- b Center for Observational and Real-World Evidence , Merck, Sharp, & Dohme Inc. , Lebanon , NJ , USA
| | | | - Thomas Murphy
- c Charleston ENT and Allergy , North Charleston , SC , USA
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Baiardini I, Novakova S, Mihaicuta S, Oguzulgen IK, Canonica GW. Adherence to treatment in allergic respiratory diseases. Expert Rev Respir Med 2018; 13:53-62. [PMID: 30518277 DOI: 10.1080/17476348.2019.1554438] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Asthma and allergic rhinitis (AR) are chronic conditions in which management needs adherence to prescribed drugs. Despite the benefits of regular maintenance of asthma and AR therapy, low adherence is a frequent issue in clinical practice. Areas covered: The aim of this review is to provide a targeted analysis of the more recent literature on adherence in asthma and AR, focused on the following areas: adherence extent, barriers and consequences, effects of educational interventions and use of new technologies to improve the level of adherence. Expert commentary: Despite the extent, reasons and effects of this problem being well known, non-adherence in asthma and allergic AR remains worryingly high. Poor adherence leads to unsatisfactory health outcomes, with a negative impact on patients and society. Recent literature suggests that successful programs to improve adherence should include a combination of strategies. The new technologies represent a promising tool to improve adherence.
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Affiliation(s)
- Ilaria Baiardini
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy
| | - Silviya Novakova
- b Allergy Unit of Internal Consulting Department , University Hospital "St. George" , Plovdiv , Bulgaria
| | - Stefan Mihaicuta
- c Pulmonology Department, CardioPrevent Foundation , University of Medicine and Pharmacy "Dr Victor Babes" , Timisoara , Romania
| | | | - Giorgio Walter Canonica
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy.,e Personalized Medicine, Asthma and Allergy Clinic , Humanitas Research Hospital, Milano, Italy
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Mueller RS, Jensen‐Jarolim E, Roth‐Walter F, Marti E, Janda J, Seida AA, DeBoer D. Allergen immunotherapy in people, dogs, cats and horses - differences, similarities and research needs. Allergy 2018; 73:1989-1999. [PMID: 29675865 DOI: 10.1111/all.13464] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 12/28/2022]
Abstract
In human patients with seasonal allergic rhinoconjunctivitis sensitized to grass pollen, the first successful allergen immunotherapy (AIT) was reported in 1911. Today, immunotherapy is an accepted treatment for allergic asthma, allergic rhinitis and hypersensitivities to insect venom. AIT is also used for atopic dermatitis and recently for food allergy. Subcutaneous, epicutaneous, intralymphatic, oral and sublingual protocols of AIT exist. In animals, most data are available in dogs where subcutaneous AIT is an accepted treatment for atopic dermatitis. Initiating a regulatory response and a production of "blocking" IgG antibodies with AIT are similar mechanisms in human beings and dogs with allergic diseases. Although subcutaneous immunotherapy is used for atopic dermatitis in cats, data for its efficacy are sparse. There is some evidence for successful treatment of feline asthma with AIT. In horses, most studies evaluate the effect of AIT on insect hypersensitivity with conflicting results although promising pilot studies have demonstrated the prophylaxis of insect hypersensitivity with recombinant antigens of biting midges (Culicoides spp.). Optimizing AIT using allergoids, peptide immunotherapy, recombinant allergens and new adjuvants with the different administration types of allergen extracts will further improve compliance and efficacy of this proven treatment modality.
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Affiliation(s)
- R. S. Mueller
- Centre for Clinical Veterinary Medicine LMU Munich Munich Germany
| | - E. Jensen‐Jarolim
- The Interuniversity Messerli Research Institute University of Veterinary Medicine Vienna Medical University Vienna Vienna Austria
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology Infectiology and Immunology, Medical University Vienna Austria
| | - F. Roth‐Walter
- The Interuniversity Messerli Research Institute University of Veterinary Medicine Vienna Medical University Vienna Vienna Austria
| | - E. Marti
- Department of Clinical Research and Veterinary Public Health University of Bern Bern Switzerland
| | - J. Janda
- Faculty of Science Charles University Prague Czech Republic
| | - A. A. Seida
- Immunology and Microbiology Department Faculty of Veterinary Medicine Cairo University Giza Egypt
| | - D. DeBoer
- School of Veterinary Medicine University of Wisconsin Madison WI USA
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Novak N, Buhl T, Pfaar O. Adherence During Early Allergen Immunotherapy and Strategies to Motivate and Support Patients. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10312545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Allergic rhinitis is one of the most common chronic inflammatory conditions, affecting up to 30% of people in Europe. Allergen immunotherapy (AIT) is the only treatment for allergic rhinitis and asthma that has a disease-modifying effect, and it is recommended in European guidelines for use in conjunction with patient education, specific allergen avoidance, and symptomatic pharmacotherapy. Reported AIT adherence rates vary widely but are often low in real-world settings. Factors known to affect adherence are patient, treatment, or physician-related, and vary between healthcare settings. Misconceptions or a lack of AIT knowledge among patients with regard to efficacy and side effects may contribute to high rates of discontinuation observed during the first year of AIT treatment. Interventions to improve patient adherence are multifaceted and should focus on patient education, particularly the provision of accurate information regarding adverse effects of AIT and when to expect an improvement in symptoms, patient-support programmes, and the use of regular eHealth reminders via a telephone call, text message, or social media. Serum-based biomarkers also have the potential to play a role in evaluating early response to AIT and in monitoring treatment adherence in clinical practice. In this review, the authors explore barriers to continuation with AIT and discuss initiatives to motivate and support patients through the challenging early months of treatment, prior to the onset of clinical effect and when side effects are most common, to encourage long-term adherence to therapy and achieve optimal patient outcomes.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University of Bonn Medical Center, Bonn, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Georg-August University, Göttingen, Germany; Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen and University of Osnabrück, Osnabrück, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
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Brüggenjürgen B, Reinhold T. Cost-effectiveness of grass pollen subcutaneous immunotherapy (SCIT) compared to sublingual immunotherapy (SLIT) and symptomatic treatment in Austria, Spain, and Switzerland. J Med Econ 2018; 21:374-381. [PMID: 29271271 DOI: 10.1080/13696998.2017.1419959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND While specific immunotherapy (SIT) has been proven to be cost-effective for the treatment of allergic rhinitis compared to symptomatic treatment, there is a lack of European studies in which sublingual (SLIT) and subcutaneous (SCIT) immunotherapy were compared. The present analysis is focused on the cost-effectiveness of SCIT compared to SLIT and symptomatic treatment of grass pollen allergy in Austria, Spain, and Switzerland. It will address specific properties of the underlying healthcare systems. METHODS The investigation is based on a previously published health economic model calculation. This was designed as a Markov model with pre-defined health stages and a duration of 9 years covering specific preparations for SCIT (Allergovit) and SLIT (Oralair). The effectiveness was assessed as symptom-score based quality-adjusted life years (QALYs). Additionally, total cost has been determined as well as the cost-effectiveness of SCIT. The robustness of model results was proved in further sensitivity analyses. RESULTS With regard to the effectiveness of both SCIT and SLIT, preparations were dominant compared to pharmacological symptomatic therapy. Both strategies were associated with additional cost, but, combined with the results on effectiveness, both have to be regarded as cost-effective. A direct comparison of the SCIT (Allergovit) and SLIT (Oralair) showed lower total costs of SCIT vs SLIT for Austria, Spain, and Switzerland (€1,368 vs €2,012, €2,229 vs €2,547, and €1,901 vs €2,220) and superior effectiveness (SCIT =8.02 QALYs; SLIT =7.98 QALYs; and symptomatic therapy =7.90 QALYs). CONCLUSION In patients with allergic rhinitis, SIT offers cost-effective treatment options compared to symptomatic treatment. When comparing SCIT (Allergovit) and SLIT (Oralair), SCIT was dominant in terms of QALYs as well as costs, in particular due to a slightly higher patient compliance and lower drug costs.
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Affiliation(s)
- Bernd Brüggenjürgen
- a Institute for Health Economics, Steinbeis-Hochschule Berlin (SHB) , Berlin , Germany
| | - Thomas Reinhold
- b Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin , Germany
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Hur GY, Lee JH, Park HS. Allergen immunotherapy for the treatment of respiratory allergies in the elderly. Curr Opin Allergy Clin Immunol 2018; 17:304-308. [PMID: 28525399 DOI: 10.1097/aci.0000000000000370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Respiratory allergies, including asthma and allergic rhinitis can also occur in the elderly. Allergen immunotherapy for allergic diseases is the only disease-modifying treatment for patients with allergies available thus far. Here, we review current evidence supporting the use of allergen immunotherapy in the elderly and discuss its efficacy and utility for the treatment of respiratory allergic diseases in this setting. RECENT FINDINGS Subcutaneous and/or sublingual immunotherapy are effective therapeutic options in not only young but also older patients. Allergen immunotherapy reduces medication and symptom scores in the elderly and can thus be safely prescribed in this population. SUMMARY Elderly individuals with proven, clinically relevant immunoglobulin E sensitization to inhalant allergens may benefit from allergen immunotherapy for respiratory allergic diseases. Older patients without contraindications should therefore be considered for treatment, with the additional benefit of reduced medication and symptom scores.
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Affiliation(s)
- Gyu-Young Hur
- aDepartment of Internal Medicine, Korea University College of Medicine, Seoul bDepartment of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Kiotseridis H, Arvidsson P, Backer V, Braendholt V, Tunsäter A. Adherence and quality of life in adults and children during 3-years of SLIT treatment with Grazax-a real life study. NPJ Prim Care Respir Med 2018; 28:4. [PMID: 29434271 PMCID: PMC5809499 DOI: 10.1038/s41533-018-0072-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/06/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
Respiratory allergic disease represents a global health problem, 30% of the population suffers from allergic rhinoconjunctivitis and 20% suffer from asthma. Allergy immunotherapy induce immunological tolerance and thereby modify the response to allergens and sublingual immunotherapy (SLIT) offers the possibility of home administration of allergen therapy, but adherence is more uncertain. The aim of the study was to investigate the adherence with GRAZAX in adults and children ≥ 5 years during three consecutive years of treatment. This was a non-interventional, prospective, observational, multi-center, open-label study to investigate adherence, quality of life, safety and tolerability of GRAZAX in adult and pediatric patients in a real-life setting. During the 3-years study period estimation of adherence was done regularly. Quality of life as well as symptom score was also assessed. In total, 399 patients (236 adults and 163 children) were included in the study. At baseline, 100% suffered from moderate-severe eyes and nose symptoms, and 31% had asthma in the grass pollen season. Overall, 55% completed a 3-years treatment period, whereas 37% stopped before end of study and 8% were lost to follow up. After 3 years, the adherence rate decreased from 98.2% (first month), 93.7% (first year), 93.2% (second year) and 88.9% (third year) and adverse events were the main reason for pre-term termination. The study suggests a good adherence to treatment in a real life setting among the patients finalizing 3-years SLIT therapy. The treatment was effective both on symptoms and HRQL. A three-year trial of the allergy immunotherapy GRAZAX shows good adherence and tolerance among adults and children. Respiratory allergic disease is a significant global health burden, with 30 per cent of Europe’s population suffering from hayfever and 20 per cent from allergic asthma. While antihistamines and steroids can treat symptoms successfully, they do not tackle the underlying allergy. Recent progress in immunotherapies such as GRAZAX—a therapy specifically targeting grass pollen allergy—have shown promise. Hampus Kiotseridis at Lund University, Sweden, and co-workers tracked patient adherence and health in 399 adults and children taking GRAZAX over three years. 55 per cent of patients completed the study treatment, with 85 per cent taking GRAZAX six to seven times a week. GRAZAX proved to be well-tolerated overall, effectively tackling symptoms and improving patients’ quality of life.
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Affiliation(s)
- Hampus Kiotseridis
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
| | | | - Vibeke Backer
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vagn Braendholt
- Vagn Braendholt, Department of medicine, Holbæk Sygehus, Holbæk, Denmark
| | - Alf Tunsäter
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
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Abstract
Allergies are steadily gaining in importance in the Western world. For over one hundred years, immunology has been the only causal treatment. Specific immunotherapy (SIT) aims at the cure of allergy or at least freedom from allergy symptoms. In association with this, adherence poses a complex problem. Both treatment applications commonly used in Germany-sublingual and subcutaneous immunotherapy-show poor persistence on the part of the patients. In most cases, SIT is not carried out to the end of the recommended duration and instead is discontinued prematurely. Corresponding figures from 3‑year studies in the literature range from 41- 93% for uncompleted SLIT and from 40-77% for uncompleted SCIT. Patient adherence is subject to influencing factors of various dimensions that are interdependent in complex relationships. The physician-patient relationship is just as decisive a factor for treatment success as the patient's understanding of allergy, treatment, and the importance of adherence.
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