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). In the abbreviated group, as expected, reimbursed patients showed significantly better adherence compared with patients with no reimbursement at all (p<0.05). Conclusions. Abbreviating the build-up phase by reducing the number of injections significantly improves patients’ adherence to SCIT.

Compliance with vaccination is linked to its safety. In Italy, a plan to identify people who could be at an increased risk of adverse events (AEs) was defined so they could be vaccinated in a protected setting. We conducted an audit to describe the process of AE risk assessment and occurrence in the Reggio Emilia Province in Italy in people who received any of the four COVID-19 vaccines currently used in Italy. Incidence of AEs was calculated by dose and type of vaccine and type of setting (standard vs. protected). After 182,056 first doses were administered, 521 (0.3%) AEs were reported. Most of the AEs were non-serious (91.4%) and non-allergic (92.7%). The percentage of AEs was similar in both settings: 0.3% in the standard setting and 0.2% in the protected setting. However, the incidence of AEs was higher among those who had an allergist visit than among those who did not (IR 666.7 vs. 124.9). All deaths (1.6/100.000) occurred in standard settings and after the Pfizer and Moderna vaccines. The incidence of AEs was lower after the second dose (IR 286.2 vs. 190.3), except for mRNA vaccines, for which it was higher after the second dose (IR 169.8 vs. 251.8). Although vaccination in a protected medical setting could reassure patients with a history of allergies to be vaccinated, allergy history and other anamnestic information is not useful in predicting the risk of COVID-19 vaccine-related AEs in the general population.

283We sent a questionnaire to allergy centers that adopted the shortened build-up schedule. The questionnaire included the following items: age, gender, symptoms, extract composition, maximum dose reached (yes/no), number of injections, local reactions (>5 cm, <10 cm), large local reactions (>10 cm), and systemic reactions. The shortened regimen was administered with Allergovit (Allergopharma GmbH & Co. KG), an AIT pollen extract that has been chemically modified with formaldehyde to produce an allergoid. Allergovit is specified in therapeutic units per mL (TU/mL) and provided in 2 strengths (A, 1000 TU/mL; and B, 10 000 TU/mL). The abbreviated updosing regimen consists of 4 injections, and the schedule is completed within 3 weeks only, while the conventional regimen comprises 7 injections. Patients received 2 weekly strength A injections and 2 strength B injections, with volumes of 0.2 and 0.6 mL, respectively. In grass pollen Allergovit extracts, the maximum dose of 0.6 mL corresponds to a content of 25 μg of grass group 5 allergens. The Figure shows a comparison of the classic and abbreviated build-up schedules.We collected 156 cases of patients with seasonal allergic rhinoconjunctivitis who had been chosen for the short buildup; 85 of these patients also had asthma symptoms. Mean age was 36.0 years (range, 7-76), and there were 89 males and 67 females. The distribution by extract was as follows: grasses, 46; Parietaria, 36; ragweed, 26; birch, 13; mixed trees, 10; various mixtures, 25.All patients but one reached the maximum scheduled dose, and 138 patients (88.5%) completed the treatment without reactions. A further 138 patients (88.5%) also reached the maximum dose with the 4 scheduled injections. Eighteen patients required 1 extra injection, 9 for concomitant nontreatment-related events and 9 for adverse reactions.Overall, 12 mild treatment-related local reactions (>5 cm, <10 cm) and 2 severe local reactions (>10 cm) were recorded (2.2% of the total 649 injections; 9.0% of patients). A severe local reaction was the reason why 1 patient did not reach the maximum dose. No systemic reactions were observed.