Gaps in allergen immunotherapy administration and subcutaneous allergen immunotherapy dose adjustment schedules

Larenas‐Linnemann, Désiree; Epstein, Tolly; Ponda, Punita; Bernstein, David I.; Williams, Paul V.; Creticos, Peter S.

doi:10.1016/j.anai.2020.07.015

Cited by 13 publications

(12 citation statements)

References 5 publications

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“…As an important issue, the extended spacing interval of injections may result in a diminution of therapeutic efficacy. Thus, as soon as the risk for SARS-CoV-2 transmission and infection can be reduced to levels considered safe by health authorities, to make appropriate dose adjustments to restart SCIT and to return to the maintenance AIT schedule known to be effective has been suggested after gaps in the administration [ 22 ]. In 97.1% of our patients, SCIT injections were interrupted at least one dose and maximum 5 doses.…”

Section: Discussionmentioning

confidence: 99%

Allergen-specific immunotherapy practices and course of coronavirus disease 2019 (COVID-19) in patients during COVID-19

Erkoç

Öztürk

Mungan

et al. 2022

Asia Pacific Allergy

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Background Allergen-specific immunotherapy (AIT) is accepted as the only disease-modifying therapy for IgE-mediated allergic airway diseases and hymenoptera venom allergy. AIT requires repeated contact between patient and physician or nurse in the hospital. Because it is a long-term treatment, compliance is essential issue to obtain maximal efficacy. Coronavirus disease 2019 (COVID-19) pandemic reshaped doctor-patient interaction and pattern of hospital admissions. Objective We aimed to determine the possible changes in the administration of AIT and associated factors, in addition to the characteristics of patients diagnosed with COVID-19 infection. Methods Adult patients who underwent AIT for hymenoptera venom allergy, allergic rhinitis or allergic asthma between 11 March 2020 and 31 January 2021 were included in our retrospective study. Perennial and preseasonal AIT practices were evaluated. We identified patients with COVID-19 infection among the ones who received AIT. Results The mean age of 215 patients was 37.8±11.9 years and 52.1% of the patients were female. In our study, 35.4% of perennial AIT patients did not continue treatment after the COVID-19 pandemic, and the cause was patient-related in 66.7% of the cases. Compliance was 70.7% in patients receiving perennial AIT. The highest compliance rate for AIT was for venom allergy (86.5%). Thirty-four patients (15.8%) were diagnosed with COVID-19 infection. No mortality due to COVID-19 infection was observed in those who underwent AIT. Conclusion COVID-19 pandemic has reduced compliance to AIT. Compliance was higher in venom immunotherapy than in aeroallergens. Severe COVID-19 infection and COVID-19 related death were not observed in patients receiving AIT.

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Section: Discussionmentioning

confidence: 99%

Allergen-specific immunotherapy practices and course of coronavirus disease 2019 (COVID-19) in patients during COVID-19

Erkoç

Öztürk

Mungan

et al. 2022

Asia Pacific Allergy

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“…Therefore, we suggest that it is important to continue SCIT injections without giving intervals more than recommended in order not to affect the short-term effectiveness of AIT even during a pandemic 16 . Prolonged intervals in the SCIT applications is also an important issue to make appropriate dose adjustments to restart SCIT after gaps in the administration 17 . In our study, after interruptions of maintenance doses especially in non-adherent patients, dose adjustments starting with frequent lower dose injections caused frequent hospital visits which can probably bring additional burden on the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

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

Yeğit

Demir

Erdoğdu

et al. 2021

Preprint

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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: 104 (31.8%) patients (Group 3) were considered as non-adherent 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 to other groups (p<0.001 for each comparison). Median VAS-QoL scores were the lowest in Group 3 compared to 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 warned about adhering to SCIT injections since delays in SCIT administration can deteriorate clinical symptoms.

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“…Additional factors of relevance noted include the concentration of extract to be administered as well as the individual patient’s history of systemic reaction [ 5 ]. Also, the clinical features of each individual patient must be examined, including the severity of underlying allergic disease, time of year for pollen allergy, history of anaphylaxis or mast-cell disorder, and health status including comorbid conditions and medication usage, as well as asthma severity and control [ 11 ]. In a 2012 study, in which 1201 members of the AAAAI were surveyed, it was shown that the vast majority of allergy specialists dose adjust based on the date of the last administered dose.…”

Section: Resuming Allergy Immunotherapymentioning

confidence: 99%

Allergy and Immunotherapy During the Pandemic

Davis

2022

Curr Otorhinolaryngol Rep

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Purpose of Review To summarize and review recent literature on the role of allergen immunotherapy in the setting of a worldwide pandemic. Recent Findings At the start of the SARS-CoV-2 pandemic, most elective ambulatory patient care services, including allergen immunotherapy, were suspended. Now with medical practices reopening, allergists must establish plans and protocols for resuming care of allergy patients, including strategies for restarting allergen immunotherapy. While there are no published evidence-based protocols for resuming allergen immunotherapy, limited scientific data and expert opinion suggest that the major factor in dose adjustment is the time elapsed from the last dose. Summary Resuming outpatient allergy services in the setting of the COVID-19 pandemic poses many challenges to the practitioner. Allergy specialists are now faced with developing prudent and evidence-based strategies for safely resuming allergen immunotherapy, while also maintaining a safe environment for staff and patients.

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Gaps in allergen immunotherapy administration and subcutaneous allergen immunotherapy dose adjustment schedules

Cited by 13 publications

References 5 publications

Allergen-specific immunotherapy practices and course of coronavirus disease 2019 (COVID-19) in patients during COVID-19

Allergen-specific immunotherapy practices and course of coronavirus disease 2019 (COVID-19) in patients during COVID-19

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

Allergy and Immunotherapy During the Pandemic

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