Adherence to subcutaneous immunotherapy with aeroallergens in real‐life practice during the COVID‐19 pandemic

Abstract

Background The success of subcutaneous immunotherapy (SCIT) mostly depends on regular injections. Our aim was to investigate adherence to SCIT with aeroallergens during the COVID‐19 pandemic and demonstrate clinical consequences of treatment disruptions in real life. Methods Visual analogue scale for quality of life (VAS‐QoL), VAS for symptom scores (VAS‐symptom), medication scores (MSs), and total symptom scores (TSS‐6) were recorded during the pandemic in 327 adult allergic rhinitis and/or asthmatic patients receiving maintenance SCIT, and these scores were compared with the pre‐pandemic data. Patients were grouped according to SCIT administration intervals; no delay (Group 1), <2 months (Group 2), and ≥2‐month intervals (Group 3). Results A total of 104 (31.8%) patients (Group 3) were considered as nonadherent which was mostly related to receiving SCIT with HDMs and using public transportation for reaching the hospital. Median MS, VAS‐symptom, and TSS‐6 scores of Group 3 patients during the pandemic were higher than the pre‐pandemic scores (p = 0.005, p < 0.001, p < 0.001, respectively), whereas median VAS‐QoL scores of Group 3 during the pandemic were lower than the pre‐pandemic scores (p < 0.001). Median TSS‐6 and VAS‐symptom scores were the highest in Group 3 compared with other groups (p < 0.001 for each comparison). Median VAS‐QoL scores were the lowest in Group 3 compared with Group 1 and Group 2 (p < 0.001, p = 0.043, respectively). Conclusion When precautions in allergy clinics are carefully applied, adherence to SCIT can be high during a pandemic. Patients must be encouraged to regularly adhere to SCIT injections since delays in SCIT administration can deteriorate clinical symptoms.

The effect of allergy and asthma as a comorbidity on the susceptibility and outcomes of COVID-19

“…Corticosteroids reduced the expression of ACE2 but not TMPRSS2 in HNECs ( 109 ), which also supports the continuation of INCS use in AR patients during COVID-19. Ongoing allergen immunotherapy (AIT) should be continued in AR patients without COVID-19 to avoid deterioration of clinical symptoms during COVID-19 ( 110 ). New sublingual immunotherapy (SLIT) but not subcutaneous immunotherapy (SCIT) can be started in selected AR patients ( 105 ).…”

“…As there is a potential protecting effect driven by a Th2 response and inflammatory cytokine storm associated with Th1 responses in COVID-19, AIT should be discontinued in confirmed COVID-19 patients ( 73 , 129 ). AIT, both SCIT and SLIT, should be continued in non-infected individuals during the COVID-19 pandemic ( 129 ), since delayed SCIT with aeroallergen during the COVID-19 pandemic resulted in deteriorated symptom scores and life quality of AR and asthma ( 110 ). In patients recovered from COVID-19 or with a sufficient SARS-CoV-2 antibody response after (asymptomatic) disease, AIT can be started or continued as planned ( 129 ).…”

Recent advances and developments in COVID‐19 in the context of allergic diseases

“…96 Therefore, patients should be encouraged to adhere to treatment during the pandemic to ensure a successful outcome of immunotherapy. 94,97,98 Biological therapeutics targeting type 2 inflammation pathways have been adopted in a wide range of allergic diseases. [99][100][101] The safety of biologicals during the pandemic has come into question as these are known to interact with T2 cytokines and may interfere with eosinophil-mediated antiviral activity.…”

“… 40 Unfortunately, patients with non‐adherent subcutaneous immunotherapy (SCIT) for house dust mite allergy (≥2‐month delay) had higher median medication scores, visual analogue scale for quality of life, and total symptom scores. 94 On the other hand, venom‐specific immunotherapy was safely administered in Spanish clinics following a strict sanitary protocol. 95 Additionally, there was no reduced tolerability even among patients combined with early COVID‐19 symptoms and/or with positive SARS‐CoV‐2 results.…”

“… 96 Therefore, patients should be encouraged to adhere to treatment during the pandemic to ensure a successful outcome of immunotherapy. 94 , 97 , 98 …”