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

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 3^rd 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 1^st and 2^nd 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.