Responders and nonresponders to pharmacotherapy and allergen immunotherapy

Abstract

Allergen immunotherapy (AIT) is a very useful therapy for allergic rhinitis. However, some patients do not achieve the expected results. The aim of the study was to investigate the potential factors that could affect the result, either good or poor, from AIT. Methods: A retrospective analysis of 1624 patients with allergic rhinitis who underwent AIT and 1519 matched patients who underwent only symptomatic therapy (without AIT) was performed. Symptoms, medications scores and quality of life related to allergic diseases before and after therapy were recorded. Cluster analysis on all of the patients was performed to find any associations between responsiveness to therapy and the analyzed parameters. Responsiveness to therapy was assessed by the Mailing criteria. Results: A total of 1266 (77.8%) patients from the AIT group met the criterion of 30% or greater improvement, and 1061 (65.2%) of these patients met the threshold of 60% or greater improvement according to the Mailing criteria. Patients who had a frequently better response to AIT were highly represented in the two clusters. There were subjects with a short history of allergic rhinitis and concomitant allergy to grass pollen or house dust mites. Patients with a prolonged duration of allergic rhinitis before therapy and with polysensitization were more frequently worse responders to AIT. Conclusion: Responsiveness to therapy, including that to AIT, is difficult to assess. However, there were associations suggesting that short-term allergic rhinitis and monovalent allergies to grass pollen or mites could correspond to a better response to AIT.

Nasal cytology can predict clinical efficacy of subcutaneous immunotherapy in intermittent allergic rhinitis

“…Allergen immunotherapy is a long-term therapeutic process and can cause some side effects; therefore qualification for this treatment should be considered very carefully [18,19]. The new treatment strategies for SCIT require identification of factors predicting better effectiveness of this treatment [20,21]. The efficacy of SCIT has been confirmed by numerous clinical trials and a meta-analysis [22,23].…”

Worsening of chronic house-dust-mite-induced respiratory allergies: An observational survey in three European countries

“…For example, the Jakalski et al retrospective analysis of 1624 patients with AR found that AIT was less likely to be effective in polysensitized individuals and in those with a prolonged duration of AR prior to treatment initiation. 29 Similarly, Qi et al classified 284 patients having received subcutaneous AIT for HDM-induced AR as responders or non-responders. 30 The researchers found that a better response was associated with a short duration of allergy, a higher baseline symptom score, and local reactions.…”

Illustrative Case Series and Narrative Review of Therapeutic Failure of Immunotherapy for Allergic Rhinitis

“…Therapeutic failure can be considered as resulting from either inadequate clinical response or intolerable side effects. 14,15 The possible reasons for inadequate clinical response are summarized in Table 1. The current published guidelines and the medical literature (Pubmed, Cochrane Library, National Institute of Health, and Care Excellence) have been reviewed to look for guidance as to appropriate management when therapeutic failure arises.…”

“…We have considered therapeutic failure as either inadequate symptomatic response or intolerable side effects, which are both well recognized. 14,15 This is a series of 4 cases (3 therapeutic failure and 1 early relapse) encountered in our AIT clinic, where patients are treated using either SCIT or SLIT protocols, depending on clinical evaluation and patient preference. All patients provided informed consent to be included.…”