The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) survey: Patients' experience with allergen immunotherapy

Abstract

Allergen immunotherapy (AIT) is used for the treatment of allergic rhinoconjunctivitis as a subcutaneous injection (subcutaneous immunotherapy [SCIT]). Extracts used for SCIT are also used off-label to formulate a liquid delivered as sublingual drops (sublingual immunotherapy [SLIT]). This study was designed to survey patients' experiences and beliefs regarding SCIT and SLIT. People who had ever been diagnosed with nasal and/or ocular allergies were identified in a 2012 telephone survey of U.S. households. Respondents were asked questions about their or their child's use of SCIT and SLIT and their beliefs about AIT. Of 2765 respondents, 46.5% had ever heard of AIT and 22.7% had ever initiated it: 20.9% with SCIT and 1.8% with SLIT (p < 0.0001). The most frequently cited reason for beginning AIT was that symptoms were unresolved with other medications (SCIT, 32.1%; SLIT, 14.0%). Some or full symptom relief was reported by 74.9% of respondents treated with SCIT and 66.0% of those treated with SLIT (p = 0.17 for SCIT versus SLIT). Approximately one-third of respondents who had ever heard of or had been treated with AIT said "don't know" when asked if immunotherapy controls allergy symptoms for years (33.6%), is a very safe treatment (29.3%), or can cure allergy symptoms (27.5%). Effective relief of allergy symptoms was cited most often as the primary benefit of SCIT (37.8%) and convenience was the primary benefit of SLIT (14%). Only one-fifth of respondents had ever been treated with AIT, largely with SCIT. More than one-half of respondents had never heard of AIT and respondents' beliefs indicated a need for educational efforts.

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“…Studies have noted that anterior ocular surface diseases (eg, OA, infections, blepharitis, and dry eyes) are prone to misidentification in the primary care setting, leading to inappropriate treatment. 12 Ocular allergy was reported in a UK study as the diagnosis for 13% of "eye problems" in general practice, further supporting the fact that most patients with OA are seen in the general practitioner's office, as noted in a recent US study; these patients are rarely referred to specialists for assessment, even though they may present with other signs and symptoms of a more systemic allergic disorder [6][7][8][9][10][11][12][13] (Fig 1). When the patient is nonresponsive to first-line therapeutic interventions, or in patients who developed a more complex and potentially sight-threatening anterior surface ocular disorder, specialist assistance is necessary (specialists include allergists, immunologists, and ophthalmologists) 1,14,15 (Fig 2).…”

“…4 Ocular allergy has a significant impact on quality of life (QoL) as well as being an economic burden. 2,[5][6][7][8][9]…”

Physician&#39;s recommendation and explanation is important in the initiation and maintenance of allergen immunotherapy

“…Physicians who had taken an allergy rotation during resident training programs had a tendency to view AIT as effective and to have referral patterns for allergic diseases to the allergist compared with those who had not taken 26. In another Korean study,27 less than half of the patients diagnosed with allergic rhinoconjunctivitis had reported they had ever heard of AIT; of those, 40% had ever discussed AIT with physicians, and half of the physicians were allergists. These findings indicate that education about AIT is needed for both patients and physicians.…”

Patient selection for subcutaneous versus sublingual immunotherapy

“…Skoner et al [9] investigated in telephone interviews what might be the most important issues for the patients concerning AIT. Treatment efficacy, fastest onset of action, logistics, side-effects and costs (reimbursement) were the aspects mentioned by the respondents.…”

“…Multiallergen SLIT in the United States has not been approved and there is no reimbursement code for this modality. Even so, SCIT extracts are used off-label to prepare liquid SLIT formulations by some allergists and by almost one-third of ENT physicians [9][10][11]. Care should be taken in such practices, as dual allergen liquid SLIT with two nonrelated allergens has been shown to be effective [7 && ,12], but SLIT with ten allergens mixed in one vial was not [8 && ].…”