Comprehensive Study of Patients’ Compliance with Sublingual Immunotherapy in House Dust Mite Perennial Allergic Rhinitis
- 282 Downloads
Allergen immunotherapy is a long-term treatment that has been associated with patient adherence issues. The aim of the study was to increase the knowledge on compliance of patients allergic to house dust mites, receiving sublingual immunotherapy (SLIT).
A retrospective observational study was performed in 53 Spanish allergy units. We enrolled patients undergoing the SLIT treatment for house dust mites including a scheduled control visit 12 months after initiating the therapy. We conducted a comprehensive assessment of compliance using three methods. In the first step, an allergist evaluated the patients according to the results of an interview and the existing medical records. The subjects taking more than 80% of the overall prescription were defined as compliant. The remaining noncompliant patients were divided into groups taking less than 25%, 25–50%, and 50–80% of the prescribed SLIT. In the second stage, we conducted the Morisky–Green test. Finally, the noncompliant patients were asked to fill a self-report assessment form. Data were stratified into age groups. The potential factors affecting compliance were also investigated.
Overall, 380 subjects participated in the study. The compliance rate was 79.7%, and the treatment discontinuation rate was 22.5%, while 66.8% of patients were adherent (both compliant and continuing with the treatment). The results showed that children were the most compliant and adolescents the least compliant (86.6% and 60.9%, respectively). The main reason for noncompliance was “forgetting some doses” in 31.0% of the children, 48.0% of the adolescents, and 53.2% of the adults. Compliance was associated with the following factors: age, number of annual control visits, and reduction in symptomatic medication.
Our results showed that two out of three patients with house dust mite-induced allergic rhinitis adhered to the SLIT treatment. Multidisciplinary and integral solutions are needed to improve the compliance, with special attention paid to adolescents.
Stallergenes Greer Spain.
KeywordsAllergy Adherence Allergen immunotherapy Pulmonary Respiratory Treatment interruption Sublingual immunotherapy
Sponsorship and article processing charges for this study were funded by Stallergenes Greer Spain. All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Editorial assistance in the preparation of this manuscript was provided by Irantzu Izco-Basurko. Support for this assistance was funded by Stallergenes Iberica.
Alfonso Malet, Angel Azpeitia, Diego Gutiérrez, Francisco Moreno, María del Mar San Miguel Moncín, José Angel Cumplido, Magdalena Lluch, Eva Baró, and Albert Roger have nothing to disclose.
Compliance with Ethics Guidelines
All procedures were in accordance with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013. Informed consent was obtained from all patients included in the study.
- 3.Erny-Albrecht K, Valentine WJ, Christensen J, Roze S, Cobden D, Palmer AJ. Sublingual immunotherapy in allergic rhinitis and asthma: a review of recent clinical evidence. J Appl Res. 2007;7(1):17–31.Google Scholar
- 4.World Health Organization Position Paper. Allergen immunotherapy: therapeutical vaccines for allergic diseases. In: Bousquet J, Lockey R, Malling HJ, editors. Allergy 1998; 53(suppl.):1–33, 43.Google Scholar
- 7.Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology. Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol. 2007;120(Suppl. 3):S25–85.Google Scholar
- 8.Christensen AJ. Patient adherence to medical treatment regimens: bridging the gap between behavioral science and biomedicine. Current perspectives in psychology series. New Haven: Yale University Press; 2004.Google Scholar
- 9.Sabaté E, editor. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization. 2003. http://whqlibdoc.who.int/publications/2003/9241545992.pdf. Accessed 10 May 2016.
- 13.Kiel MA, Röder E, Gerth van Wijk R, Al MJ, Hop WC. Rutten-van Mölken MP. Real-life compliance and persistence among users of subcutaneous and sublingual allergen immunotherapy. Allergy. Clin Immunol. 2013;132(2):353–60.Google Scholar
- 18.Passalacqua G, Musarra A, Pecora S, Amoroso S, Antonicelli L, Cadario G, et al. Quantitative assessment of the compliance with once-daily sublingual immunotherapy in children (EASY project: evaluation of a novel SLIT formulation during a year). Pediatr Allergy Immunol. 2007;18(1):58–62.CrossRefPubMedGoogle Scholar
- 19.Passalacqua G, Musarra A, Pecora S, Amoroso S, Antonicelli L, Cadario G, et al. Quantitative assessment of the compliance with a once-daily sublingual immunotherapy regimen in real life (EASY Project: Evaluation of A novel SLIT formulation during a Year). J Allergy Clin Immunol. 2006;117(4):946–8.CrossRefPubMedGoogle Scholar
- 24.The global Initiative for Asthma (GINA). Pocket guide for asthma management and prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/. Accessed 10 May 2016.
- 29.WHO. Adherence to long-term therapies: evidence for action. WHO/MNC/03.01.Google Scholar
- 30.SPSS. Statistical Package for the Social Sciences. Version 13.Google Scholar