Factors affecting compliance with allergen immunotherapy at a military medical center

More, Daniel; Hagan, Larry L.

doi:10.1016/s1081-1206(10)62370-8

Cited by 95 publications

(68 citation statements)

References 10 publications

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“…This rate is smaller than the 8% reported in a study on conventional VIT [19]. In a previous study on allergen immunotherapy which included patients who were allergic to various allergens and continued to follow them after maintenance dose was reached, the overall compliance rate was 77.4% [20]. It was higher in patients on conventional schedule (80%) compared with those on a rush schedule (48.4%).…”

Section: Discussionmentioning

confidence: 72%

Three Days Rush Venom Immunotherapy in Bee Allergy: Safe, Inexpensive and Instantaneously Effective

Goldberg

Yogev

Confino‐Cohen

2011

Int Arch Allergy Immunol

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Background: Rush venom immunotherapy (VIT) is highly effective in vespid venom allergy, but comparable data regarding bee venom (BV) allergy are sparse. We evaluated its safety, efficacy and cost in BV-allergic patients. Methods: Conventional or rush VIT were offered to all patients with systemic reaction to insect sting. Rush VIT was also given to hyperreactive patients who failed to reach the maintenance dose with conventional VIT due to multiple systemic reactions. In BV-allergic patients, honeybee sting challenge was performed within 1 week after reaching the maintenance dose. Results: 179 patients, some of them allergic to more than one venom, received 246 rush VIT courses. Bee VIT was administered to 132 patients (73.7%); 173 patients (96.6%) reached the maintenance dose. The incidence of systemic reactions was 29.6%. They were more common in VIT with BV than with vespid venoms (31.1 and 16.3%, respectively, p = 0.01). After excluding the hyperreactive subgroup (n = 20), this difference was not significant (23.7 and 16%, respectively, p = 0.19). Despite the high incidence of systemic reactions (15 of 20, 75%) among hyperreactive patients, 17 patients (85%) achieved the maintenance dose. Sting challenges resulted in systemic reaction in 4 of 8 (50%) hyperreactive patients and in 2 of 47 (4.3%) ordinary patients. The cost of rush VIT was 41% of that of conventional VIT. Conclusions: Rush VIT with BV is safe, instantaneously effective, less expensive and enables most patients with previous failures of conventional VIT to reach the maintenance dose.

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Section: Discussionmentioning

confidence: 72%

Three Days Rush Venom Immunotherapy in Bee Allergy: Safe, Inexpensive and Instantaneously Effective

Goldberg

Yogev

Confino‐Cohen

2011

Int Arch Allergy Immunol

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“…However, some SCIT studies report a slightly higher discontinuation rate in the younger [33,48] versus older age group [33,34,40]. Likewise, a few studies observe that males are more compliant than females when treated with SCIT [29].…”

Section: Reasons For Discontinuation Of Treatmentmentioning

confidence: 99%

“…AIT-related severe adverse reactions are rare, in particular for SLIT, but also for SCIT, which has a low rate of severe reactions, unless the SCIT is not properly administered under optimal conditions [29,34]. Local side effects, e.g., itching and swelling of the oral pharynx, crucially influence SLIT adherence [39, 45, 46, 53•, 54, 58].…”

Section: Causes Related To Treatmentmentioning

confidence: 99%

Allergen Immunotherapy Adherence in the Real World: How Bad Is It and How Can It Be Improved?

Senna

Caminati

Lockey

2014

Curr Treat Options Allergy

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Opinion StatementAllergen immunotherapy (AIT) is the only available causal treatment for allergic respiratory diseases; however, data demonstrate a high discontinuation rate for both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). The complex mechanism of action of allergen immunotherapy (AIT) includes an interaction of innate and adaptive immune processes, resulting in immune tolerance, as illustrated by a decrease in specific immunoglobulin (Ig)-E, an increase in specific IgG1 and IgG4, and inhibition of inflammation involving mast cells, basophils, and eosinophils. This induction of immune tolerance leads to a significant improvement in symptoms and decreased medication scores. A 3-to 5-year course of AIT is required to obtain this disease-modifying effect, which substantially differentiates AIT frompharmacologic treatment. A carry-over effect can persist for up to 12 years. Furthermore, AIT may prevent the onset of asthma in patients with allergic rhinitis, as well as decreasing the onset of new sensitizations to inhalant allergens. Several meta-analyses and controlled studies, involving adult and pediatric subjects, have indicated that both sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) are relatively safe, effective, and well tolerated. AIT may also have a positive impact on the cost to the healthcare system, as evidence indicates the cost-benefit of such treatment. Adherence to AIT is crucial for a positive clinical outcome and non-adherence represents a major drawback for such therapy. It actually concerns not only AIT but also various pharmacologic treatments for allergic respiratory diseases, as well as for other chronic illnesses. The issue of non-adherence is an emerging and worldwide problem for chronic diseases and could be an important factor responsible for an overall decrease in treatment efficacy and increased rates of hospitalization, morbidity, and mortality. This review provides an overview of the different reasons that may account for the low adherence rate for AIT. Some of these reasons can be related to the patient's age when they begin such therapy, the allergic disease being treated, and questions about the efficacy, costs, inconvenience, and safety of AIT. Well-structured educational programs,especially by healthcare professionals, the print media, and the Internet, are needed to improve adherence to AIT.

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“…VIT has also been shown to improve the health-related quality of life of the patients [7][8] . Although highly efficacious, VIT requires injections every 4-8 weeks over 3-5 years [2,3,9] , and is associated with a risk of treatment-associated allergic side effects in up to 20% of all patients [10] which impedes treatment compliance [11,12] . Furthermore, prediction of the future course of hymenoptera venom allergy (i.e.…”

Section: Introductionmentioning

confidence: 99%

Risk Assessment of Hymenoptera Re-Sting Frequency: Implications for Decision-Making in Venom Immunotherapy

Moos

Graf²,

Johansen³

et al. 2012

Int Arch Allergy Immunol

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BACKGROUND: Venom immunotherapy is highly efficacious in preventing anaphylactic sting reactions. However, there is an ongoing discussion regarding patient selection and whether and how to apply a cost-benefit analysis of venom immunotherapy. In order to help decision-making, we investigated the re-sting frequency of hymenoptera-venom-allergic patients to single out those at high risk. METHODS: In this retrospective study, re-sting data of 96 bee-venom-allergic patients and 95 vespidvenom-allergic patients living mainly in a rural area of Switzerland were analyzed. Hymenoptera venom allergy status was rated according to the classification system of H.L. Mueller [J Asthma Res 1966;3:331-333]. Different risk-groups were defined according to sting exposure and their median sting-free interval was calculated. RESULTS: The risk factors for a wasp or bee re-sting were outdoor occupation, beekeeping and habitation close to a bee-house. Half of all vespid-venom-allergic outdoor workers were re-stung within 3.75 years compared to 7.5 years for indoor workers. Similarly, 50% of the bee-venom-allergic beekeepers or subjects with a bee-house in the vicinity suffered a bee re-sting within 5.25 years compared to 10.75 years for individuals who were not beekeepers. CONCLUSIONS: The high degree of exposure of vespid-venom-allergic outdoor workers and bee-venom-allergic beekeepers and subjects living close to bee-houses underlines the high benefit of venom immunotherapy for these patients even if they suffered a non-life-threatening grade II reaction. Yet, bee-venom-allergic individuals with no proximity to beehouses and with an indoor occupation face a very low exposure risk, which justifies epinephrine rescue treatment for these patients especially if they have suffered from grade II sting reactions. beekeepers or subjects with a bee-house in the vicinity suffered a bee re-sting within 5.25 years compared to 10.75 years for individuals who were not beekeepers. Conclusions: The high degree of exposure of vespid-venom-allergic outdoor workers and bee-venom-allergic beekeepers and subjects living close to bee-houses underlines the high benefit of venom immunotherapy for these patients even if they suffered a non-life-threatening grade II reaction. Yet, bee-venom-allergic individuals with no proximity to beehouses and with an indoor occupation face a very low exposure risk, which justifies epinephrine rescue treatment for these patients especially if they have suffered from grade II sting reactions.

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Factors affecting compliance with allergen immunotherapy at a military medical center

Cited by 95 publications

References 10 publications

Three Days Rush Venom Immunotherapy in Bee Allergy: Safe, Inexpensive and Instantaneously Effective

Three Days Rush Venom Immunotherapy in Bee Allergy: Safe, Inexpensive and Instantaneously Effective

Allergen Immunotherapy Adherence in the Real World: How Bad Is It and How Can It Be Improved?

Risk Assessment of Hymenoptera Re-Sting Frequency: Implications for Decision-Making in Venom Immunotherapy

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