Severity and disease control before house dust mite immunotherapy initiation: ANTARES a French observational survey

Abstract

BackgroundAllergen immunotherapy (AIT) may be prescribed for patients with allergic rhinitis (AR) induced by house dust mites (HDM) whether asthma is present or not. Current guidelines provide insufficient support for therapeutic management strategy of these patients. Allergists however have long-term experience with AIT. This study aims to describe the characteristics of the patients seen in clinical practice with HDM allergy and the process used to determine whether AIT should be initiated.MethodsThis was an observational, multicenter, prospective and cross-sectional study, conducted in France from 2013 to 2014 with a representative sample of allergy specialists. Any patient over 5 years of age with confirmed HDM allergy untreated with AIT within the last 12 months was eligible. Data were prospectively collected using physician and patient questionnaires.ResultsA total of 1589 patients (60 % adults, 40 % children) were included by 195 randomly selected allergists. A subgroup of 1212 patients (median age: 22 years; 52 % women) were selected for AIT treatment with a median time of AR diagnosis of 3 years. Amongst these, 59 % had a moderate to severe persistent AR according to AR and its Impact on Asthma guidelines, 57.5 % were polysensitized, and 56.5 % also suffered from conjunctivitis (median rhinitis total symptom score: 11). Asthma was present in 42 % of patients, and was controlled according to Global Initiative for Asthma guidelines in 62 % of patients. The asthma control questionnaire score was 1–1.5 in 20 % and ≥1.5 in 37 % of patients. A total of 57 % patients received a prescription of ≥2 medications (mainly antihistamines). Usual daily activities and sleep quality were slightly-to-moderately impaired as the mean rhinoconjunctivitis quality of life questionnaire score was 2.7 ± 1.5. The major driver of AIT prescription is AR uncontrolled by previous medications leading to patient dissatisfaction.ConclusionsHDM-AR associated conjunctivitis was present in 60 % and asthma in 40 % of cases. In >40 % of these cases, asthma was inadequately controlled at the start of AIT.

Is Quantitative sIgE Serology Suitable for Distinguishing Between Silent Sensitization and Allergic Rhinitis to Dermatophagoides pteronyssinus?

“…However, the study populations analyzed were heterogeneous [29]. In a recent observational survey on 1589 patients with proven HDM allergy in France, approximately 42% of patients with HDM-related allergic rhinitis had allergic asthma [30]. In our study population, only 30% of patients with allergic rhinitis due to D pteronyssinus also had asthma.…”

European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): a real-life clinical assessment

“…This finding correlates with data from the Paul‐Ehrlich Institute (collected between 1991 and 2000) from which the incidence of SRs was calculated to be higher for natural allergen extracts than for allergoids . Absence of symptomatic medications (for either the allergic condition or a nonallergic disease). This could be related to the disease severity and the need for proper symptom control prior to initiation of AIT Up‐dosing schedule. Rush schedules were less strongly associated with SRs.…”

Pilot study of mobile phone technology in allergic rhinitis in European countries: the MASK‐rhinitis study

“…Rhinorrhea is thought to be more severe in patients with pollen allergy than in those with mite allergy. However, it appears that the vast majority of mite allergic patients present rhinorrhea during nasal challenge (K. C. Bergmann, personal communication) or during clinical trials . Thus, in general, ‘sneezers’ and ‘runners’ may be ascribed to AR, whereas ‘blockers’ may be ascribed to NAR .…”