Abstract
Introduction
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).
Methods
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.
Results
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.
Conclusion
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.
Funding
Stallergenes Greer Spain.
Similar content being viewed by others
References
Radulovic S, Calderón MA, Wilson D, Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2010;12:CD002893. doi:10.1002/14651858.CD002893.pub2.
Sikora JM, Tankersley MS, ACAAI Immunotherapy and Diagnostics Committee. Perception and practice of sublingual immunotherapy among practicing allergists in the United States: a follow-up survey. Ann Allergy Asthma Immunol. 2013;110(3):194–7.
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.
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.
Bousquet J, Khaltaev N, Cruz AA, Papadopoulos NG, Bousquet PJ, Burney PG. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):S8–160.
Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S. Sub-lingual immunotherapy: World Allergy Organization Position Paper 2013 update. Allergy. 2009;64(Suppl. 91):1–59.
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.
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.
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.
Köberlein J, Kothe A, Schaffert C. Determinants of patient compliance in allergic rhinoconjunctivitis. Curr Opin Allergy Clin Immunol. 2011;11(3):192–9.
Passalacqua G, Baiardini I, Senna G, Canonica GW. Adherence to pharmacological treatment and specific immunotherapy in allergic rhinitis. Clin Exp Allergy. 2013;43(1):22–8.
Aboshady OA, Elghanam KM. Sublingual immunotherapy in allergic rhinitis: efficacy, safety, adherence and guidelines. Clin Exp Otorhinolaryngol. 2014;7(4):241–9.
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.
Senna G, Lombardi C, Canonica GW, Passalacqua G. How adherent to sublingual immunotherapy prescriptions are patients? The manufacturers’ viewpoint. J Allergy Clin Immunol. 2010;126(3):668–9.
Chang H, Han DH, Mo J, Kim JW, Kim DY, Lee CH, et al. Early compliance and efficacy of sublingual immunotherapy in patients with allergic rhinitis for house dust mites. Clin Exp Otorhinolaryngol. 2009;2(3):136–40.
Vita D, Caminiti L, Ruggeri P, Pajno GB. Sublingual immunotherapy: adherence based on timing and monitoring control visits. Allergy. 2010;65(5):668–9.
Marogna M, Tomassetti D, Bernasconi A, Colombo F, Massolo A, Businco AD, et al. Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study. Ann Allergy Asthma Immunol. 2008;101(2):206–11.
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.
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.
Lombardi C, Gani F, Landi M, Falagiani P, Bruno M, Canonica GW, et al. Quantitative assessment of the adherence to sublingual immunotherapy. J Allergy Clin Immunol. 2004;113(6):1219–20.
Marogna M, Spadolini I, Massolo A, Canonica GW, Passalacqua G. Randomized controlled open study of sublingual immunotherapy for respiratory allergy in real-life: clinical efficacy and more. Allergy. 2004;59(11):1205–10.
Köberlein J, Kothe AC, Sieber J, Mösges R. Determining factors of patient compliance to treatment in allergic rhinitis. Asian Pac J Allergy Immunol. 2013;31(2):148–56.
Pajno GB, Vita D, Caminiti L, et al. Children’s compliance with allergen immunotherapy according to administration routes. J Allergy Clin Immunol. 2005;116(6):1380–1.
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.
Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–76.
Valero A, Ferrer M, Baro E, Sastre J, Navarro AM, Martí-Guadaño E, et al. Discrimination between moderate and severe disease may be used in patients with either treated or untreated allergic rhinitis. Allergy. 2010;65(12):1609–13.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.
Val Jiménez A, Amorós Ballestero G, Martínez Visa P, Fernández Ferré ML, León Sanromà M. Estudio descriptivo del cumplimiento del tratamiento farmacológico antihipertensivo y validación del test Morisky y Green. Aten Primaria. 1992;10(5):767–70.
WHO. Adherence to long-term therapies: evidence for action. WHO/MNC/03.01.
SPSS. Statistical Package for the Social Sciences. Version 13.
Lee S, Nolte H, Benninger MS. Clinical considerations in the use of sublingual immunotherapy for allergic rhinitis. Am J Rhinol Allergy. 2015;29(2):106–14.
Fitzgerald D. Non-compliance in adolescents with chronic lung disease: causative factors and practical approach. Paediatr Respir Rev. 2001;2(3):260–7.
Incorvaia C, Rapetti A, Scurati S, Puccinelli P, Capecce M, Frati F. Importance of patient’s education in favoring compliance with sublingual immunotherapy. Allergy. 2010;65(10):1341–2.
Bernaola G, Corzo JL, Domínguez-Ortega J, Lucas C, Ojeda I, Torres-Borrego J, et al. Sublingual immunotherapy: factors influencing adherence. J Investig Allergol Clin Immunol. 2012;22(6):458–9.
Taddeo D, Eggedy M, Frappier JY. Adherence to treatment in adolescents. Paediatr Child Health. 2008;13(1):19–24.
Gidaro GB, Marcucci F, Sensi L, Incorvaia C, Frati F, Ciprandi G. The safety of sublingual-swallow immunotherapy: an analysis of published studies. Clin Exp Allergy. 2005;35(5):565–71.
Gold DT, McClung B. Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med. 2006;119(4 Suppl 1):S32–7.
Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566–77.
Strandbygaard U, Thomsen SF, Backer V. A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study. Respir Med. 2010;104(2):166–71.
Bender BG. Motivating patient adherence to allergic rhinitis treatments. Curr Allergy Asthma Rep. 2015;15(3):10.
Acknowledgments
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.
Disclosures
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Enhanced content
To view enhanced content for this article go to http://www.medengine.com/Redeem/13D4F06010476126.
Rights and permissions
About this article
Cite this article
Malet, A., Azpeitia, A., Gutiérrez, D. et al. Comprehensive Study of Patients’ Compliance with Sublingual Immunotherapy in House Dust Mite Perennial Allergic Rhinitis. Adv Ther 33, 1199–1214 (2016). https://doi.org/10.1007/s12325-016-0347-0
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12325-016-0347-0