Patient management plan for sublingual allergen specific immunotherapy with birch pollen allergen and the maintenance of patient compliance

Cover Page

Cite item

Full Text

Abstract

BACKGROUND: Sublingual allergen­-specific immunotherapy (SLIT) inefficiencie is mainly caused by non-­compliance with the treatment regimen and premature treatment termination.

AIM: Frequency and causes of dropouts determination in children receiving SLIT with birch pollen according to the pre­-coseasonal protocol, and approbation of the developed visit-­to-­visit patient management plan (Plan).

MATERIALS AND METHODS: 332 cases of treatment with birch pollen in children are analyzed. 290 patients (72.1% boys, aged 5–18 years (9.82 years [5.93; 14.67]), received SLIT with birch pollen in 2012–2019. 42 patients received SLIT according to the Plan (69% boys, 8.95 years old [5.38; 11.79]) in 2017–2019.

RESULTS: A low dropout frequency was noted in the 1st and 2nd year of therapy (2 years after the start of treatment, 85% patients continue it). However, only 63.1% complete 3 years of therapy, and 11% ­– 4 years of therapy. It has been shown that experienced allergists have more efficient patient retention. The implementation of the Plan increased patient retention in treatment at the 3rd year of treatment up to 82.9% (p=0.02).

CONCLUSION: The study confirmed the main reasons for the withdrawal of patients from SLIT: doubts about the effectiveness, cost and side effects. A low dropout frequency was shown according to the results of the 1st and 2nd years of therapy, but only a small proportion of patients (11%) receive 4 or more courses of therapy. Visit-­to-­visit Plan optimizes the patient’s management, reduces patients’ withdrawal from treatment and can be recommended for practical healthcare.

About the authors

Olga V. Trusova

Pavlov First Saint Petersburg Medical University

Author for correspondence.
Email: o-tru@mail.ru
ORCID iD: 0000-0002-0854-1536

associate professor, Department of Therapy with the course on Allergy and Immunology, Pavlov First Saint Petersburg Medical University, MD, PhD

Russian Federation, Saint Petersburg

Andrey V. Kamaev

Pavlov First Saint Petersburg Medical University

Email: andykkam@mail.ru
ORCID iD: 0000-0001-9654-3429

associate professor, Department of General Practice (Family Medicine), Pavlov First Saint Petersburg Medical University, MD, PhD

Russian Federation, Saint Petersburg

Irina V. Makarova

Pavlov First Saint Petersburg Medical University

Email: allergist_PI@mail.ru
ORCID iD: 0000-0002-4740-880X

associate professor, Department of Therapy with the course on Allergy and Immunology, Pavlov First Saint Petersburg Medical University, MD, PhD

Russian Federation, Saint Petersburg

References

  1. ginasthma.org [Internet]. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2018 [cited 2018 Dec 10]. Available from: https://ginasthma.org/
  2. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 Suppl 86:8–160. doi: 10.1111/j.1398-9995.2007.01620.x
  3. Ziselson AD. Pollinoz u detei. Leningrad: Meditsina; 1989. 160 p. (In Russ.).
  4. Federal’nye klinicheskie rekomendatsii po provedeniyu allergen-spetsificheskoi immunoterapii [Internet]. 2013 [cited 2018 Dec 10]. Available from: https://raaci.ru/ (In Russ.).
  5. Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI Guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. 2018;73(4):765–798. doi: 10.1111/all.13317
  6. Dhami S, Kakourou A, Asamoah F, Agache I, Lau S, Jutel M, et al. Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis. Allergy. 2017;72(12):1825–1848. doi: 10.1111/all.13208
  7. Dhami S, Nurmatov U, Arasi S, Khan T, Asaria M, Zaman H, et al. Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis. Allergy. 2017;72(11):1597–1631. doi: 10.1111/all.13201
  8. Nam YH, Lee SK. Physician’s recommendation and explanation is important in the initiation and maintenance of allergen immunotherapy. Patient Prefer Adherence. 2017;11:381–387. doi: 10.2147/PPA.S118368
  9. Makatsori M, Scadding GW, Lombardo C, Bisoffi G, Ridolo E, Durham SR, et al. Dropouts in sublingual allergen immunotherapy trials – a systematic review. Allergy. 2014;69(5):571–580. doi: 10.1111/all.12385
  10. Savi E, Peveri S, Senna G, Passalacqua G. Causes of SLIT discontinuation and strategies to improve the adherence: a pragmatic approach. Allergy. 2013;68(9):1193–1195. doi: 10.1111/all.12198
  11. Senna G, Lombardi C, Canonica GW, Passalacqua G. How adherent to sublingual immunotherapy prescriptions are patients? The manufacturers’ viewpoint. J Allergy Clin Immunol. 2010;126(3):668–669. doi: 10.1016/j.jaci.2010.06.045
  12. Kiel MA, Röder E, van Wijk RG, Al MJ, Hop WC, Rutten-van Mölken MP. Real-life compliance and persistence among users of subcutaneous and sublingual allergen immunotherapy. J Allergy Clin Immunol. 2013;132(2):353–360. doi: 10.1016/j.jaci.2013.03.013
  13. Vita D, Caminiti L, Ruggeri P, Pajno GB. Sublingual immunotherapy: adherence based on timing and monitoring control visits. Allergy. 2010;65(5):668–669. doi: 10.1111/j.1398-9995.2009.02223.x
  14. Scurati S, Frati F, Passalacqua G, Puccinelli P, Hilaire C, Incorvaia C. Adherence issues related to sublingual immunotherapy as perceived by allergists. Patient Prefer Adherence. 2010;4:141–145. doi: 10.2147/ppa.s10217

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Management plan for a patient receiving birch pollen

Download (1MB)
Indexing metadata
3. Fig. 2. Stage epicrisis after the course ASIT Staloral birch

Download (377KB)
Indexing metadata
4. Fig. 3. Retention of patients undergoing treatment with birch pollen in the general group of patients and in patients observed by “experienced” allergists (group 1) and “novice” allergists (group 2); * p = 0.03; ** p = 0.0001

Download (204KB)
Indexing metadata
5. Fig. 4. The main reasons for dropping out of patients from treatment with birch pollen in the first two years of treatment in patients observed by "experienced" allergists (group 1) and "novice" allergists (group 2). A - treatment failure; B - adverse events; C - financial difficulties; D - frequent respiratory infections; E - persistent exacerbation of allergic diseases; F - indiscipline of the patient; G - organizational reasons (for example, moving the patient); * differences are statistically significant (p <0.05)

Download (126KB)
Indexing metadata
6. Fig. 5. The main reasons for dropping out of patients from treatment with birch pollen in the third and fourth years of treatment in patients observed by "experienced" allergists (group 1) and "novice" allergists (group 2). A - treatment failure; B - adverse events; C - financial difficulties; D - frequent respiratory infections; E - persistent exacerbation of allergic diseases; F - patient's indiscipline; G - organizational reasons (eg, departure, relocation of the patient); H - the onset of the therapy effect, it was decided not to carry out the 4th course

Download (98KB)
Indexing metadata
7. Fig. 6. Retention of patients on treatment with birch pollen in the general group of patients and in patients of allergists who used the Plan. * P = 0.02, the differences are statistically significant.

Download (179KB)
Indexing metadata

Copyright (c) 2020 Pharmarus Print Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies