Yonsei Med J.  2019 May;60(5):446-453. 10.3349/ymj.2019.60.5.446.

Clinical Efficacy of Allergen-Specific Immunotherapy from Patient and Physician Perspectives

Affiliations
  • 1Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
  • 2Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Pulmonology and Allergy, Hallym University College of Medicine, Chuncheon, Korea.
  • 5Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 6Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.
  • 7Division of Pulmonology and Allergy, Konyang University College of Medicine, Daejeon, Korea.
  • 8Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
  • 9Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea. aym3216@eulji.ac.kr
  • 10Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea. drmesh@gmail.com

Abstract

PURPOSE
Allergen-specific immunotherapy (AIT) is the only curative treatment for allergic diseases, but a few allergic patients receive AIT. In this multicenter cross-sectional study, we aimed to explore patient and physician perspectives on AIT through a questionnaire survey.
MATERIALS AND METHODS
Allergic patients who received subcutaneous immunotherapy for at least 1 year were asked to answer a questionnaire developed by an expert panel of allergen and immunotherapy workgroup in Korea.
RESULTS
A total of 267 patients (adults, 60.3%) with allergic rhinitis (91.4%), asthma (42.7%), or atopic dermatitis (20.2%) from referred hospitals completed the survey. Among patients and physicians, respectively, the overall rates of satisfaction with AIT for allergic rhinitis were 86.4% and 83.3% (kappa agreement=0.234, p<0.001), and those for asthma were 85.3% and 72.9% (kappa agreement=0.373, p<0.001). Moreover, pediatric asthmatic patients reported a significantly higher satisfaction rate than adult asthmatic patients after AIT (p=0.040). Symptom severity (p<0.001, respectively) and drug use for allergic rhinitis and asthma decreased after AIT. However, there was no significant difference in satisfaction rates between children and adults in allergic rhinitis (p=0.736). Interestingly, 35.7% and 35% of allergic rhinitis and asthma patients, respectively, reported experiencing improvement in their symptoms within 6 months of starting AIT.
CONCLUSION
In this study evaluating the perspectives of patients and physicians on AIT, the majority of patients were satisfied with the efficacy and safety of AIT, but not its cost. AIT should be recommended for AR and allergic patients.

Keyword

Allergen immunotherapy; patient satisfaction; surveys and questionnaire

MeSH Terms

Adult
Asthma
Child
Cross-Sectional Studies
Dermatitis, Atopic
Desensitization, Immunologic
Humans
Immunotherapy*
Korea
Patient Satisfaction
Rhinitis, Allergic
Treatment Outcome*

Figure

  • Fig. 1 Changes in allergy symptom and severity after AIT. (A) Symptom changes in patients with asthma. (B) Symptom changes in patients with allergic rhinitis. (C) Asthma severity change based on the GINA guideline. (D) Allergic rhinitis severity change based on the ARIA guideline. AIT, allergen-specific immunotherapy; SABA, short-acting bata-agonist; QoL, quality of life.

  • Fig. 2 Time to symptom improvement after allergen-specific immunotherapy.

  • Fig. 3 Changes in drug prescription patterns after AIT. (A) Prescription patterns after AIT in patients with asthma. (B) Prescription patterns after AIT in patients with allergic rhinitis. AIT, allergen-specific immunotherapy; ICS, inhaled corticosteroids; LTRA, leukotriene receptor antagonists; INS, intranasal corticosteroid.

  • Fig. 4 The subjective advantage of AIT in medical (A) and economic and methodologic aspects (B) from the patients' perspective. AIT, allergen-specific immunotherapy.

  • Fig. 5 Overall satisfaction of allergen-specific immunotherapy in patients (A) and physicians (B).


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Ji-Ho Lee, Jae-Hwa Choi, Keun-Bae Jeong, Seok Jeong Lee, Myoung Kyu Lee, Won-Yeon Lee, Suk Joong Yong, Sang-Ha Kim
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Reference

1. Noon L. Prophylactic inoculation against hay fever. Int Arch Allergy Appl Immunol. 1953; 4:285–288. PMID: 13096152.
Article
2. Varney VA, Tabbah K, Mavroleon G, Frew AJ. Usefulness of specific immunotherapy in patients with severe perennial allergic rhinitis induced by house dust mite: a double-blind, randomized, placebo-controlled trial. Clin Exp Allergy. 2003; 33:1076–1082. PMID: 12911781.
Article
3. Blumberga G, Groes L, Haugaard L, Dahl R. Steroid-sparing effect of subcutaneous SQ-standardised specific immunotherapy in moderate and severe house dust mite allergic asthmatics. Allergy. 2006; 61:843–848. PMID: 16792582.
Article
4. Niggemann B, Jacobsen L, Dreborg S, Ferdousi HA, Halken S, Høst A, et al. Five-year follow-up on the PAT study: specific immunotherapy and long-term prevention of asthma in children. Allergy. 2006; 61:855–859. PMID: 16792584.
Article
5. Durham SR, Emminger W, Kapp A, de Monchy JG, Rak S, Scadding GK, et al. SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol. 2012; 129:717–725. PMID: 22285278.
6. Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, Høst A, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy. 2007; 62:943–948. PMID: 17620073.
Article
7. Novembre E, Galli E, Landi F, Caffarelli C, Pifferi M, De Marco E, et al. Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2004; 114:851–857. PMID: 15480326.
Article
8. Inal A, Altintas DU, Yilmaz M, Karakoc GB, Kendirli SG, Sertdemir Y. Prevention of new sensitizations by specific immunotherapy in children with rhinitis and/or asthma monosensitized to house dust mite. J Investig Allergol Clin Immunol. 2007; 17:85–91.
9. Reha CM, Ebru A. Specific immunotherapy is effective in the prevention of new sensitivities. Allergol Immunopathol (Madr). 2007; 35:44–51. PMID: 17428399.
Article
10. Hankin CS, Cox L, Lang D, Levin A, Gross G, Eavy G, et al. Allergy immunotherapy among Medicaid-enrolled children with allergic rhinitis: patterns of care, resource use, and costs. J Allergy Clin Immunol. 2008; 121:227–232. PMID: 18206509.
Article
11. Law AW, Reed SD, Sundy JS, Schulman KA. Direct costs of allergic rhinitis in the United States: estimates from the 1996 Medical Expenditure Panel Survey. J Allergy Clin Immunol. 2003; 111:296–300. PMID: 12589348.
Article
12. Anolik R, Schwartz AM, Sajjan S, Allen-Ramey F. Patient initiation and persistence with allergen immunotherapy. Ann Allergy Asthma Immunol. 2014; 113:101–107. PMID: 24814759.
Article
13. Demoly P, Didier A, Mathelier-Fusade P, Drouet M, David M, Bonnelye G, et al. Physician and patient survey of allergic rhinitis in France: perceptions on prevalence, severity of symptoms, care management and specific immunotherapy. Allergy. 2008; 63:1008–1014. PMID: 18691304.
Article
14. Lombardi C, Canonica GW, Passalacqua G. The perception of allergen-specific immunotherapy among chest physicians: an Italian survey. Eur Ann Allergy Clin Immunol. 2014; 46:132–136. PMID: 25053629.
15. Lombardi C, Bettoncelli G, Canonica GW, Passalacqua G. The perception of allergen-specific immunotherapy among Italian general practitioners. Eur Ann Allergy Clin Immunol. 2012; 44:80–82. PMID: 22768727.
16. Radulovic S, Calderon MA, Wilson D, Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2010; (12):CD002893. PMID: 21154351.
Article
17. Bożek A, Kołodziejczyk K, Kozłowska R, Canonica GW. Evidence of the efficacy and safety of house dust mite subcutaneous immunotherapy in elderly allergic rhinitis patients: a randomized, double-blind placebo-controlled trial. Clin Transl Allergy. 2017; 7:43. PMID: 29214012.
Article
18. Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. 2016; 315:1715–1725. PMID: 27115376.
19. Serrano P, Justicia JL, Sánchez C, Cimarra M, Fernández-Távora L, Orovitg A, et al. Systemic tolerability of specific subcutaneous immunotherapy with index-of-reactivity-standardized allergen extracts administered using clustered regimens: a retrospective, observational, multicenter study. Ann Allergy Asthma Immunol. 2009; 102:247–252. PMID: 19354072.
Article
20. Ciprandi G, Cadario G, Valle C, Ridolo E, Verini M, Di Gioacchino M, et al. Sublingual immunotherapy in polysensitized patients: effect on quality of life. J Investig Allergol Clin Immunol. 2010; 20:274–279.
21. Wyrzykowska N, Czarnecka-Operacz M, Adamski Z. Long-term efficacy of allergen specific immunotherapy in atopic dermatitis patients in relation to quality of life. Eur Ann Allergy Clin Immunol. 2015; 47:5–9. PMID: 25599552.
22. Rak S, Yang WH, Pedersen MR, Durham SR. Once-daily sublingual allergen-specific immunotherapy improves quality of life in patients with grass pollen-induced allergic rhinoconjunctivitis: a double-blind, randomised study. Qual Life Res. 2006; 16:191–201. PMID: 17033900.
Article
23. Lombardi C, Senna G, Passalacqua G. Specific immunotherapy among Italian specialists. Allergy. 2006; 61:898–899. PMID: 16792594.
Article
24. Coifman RE, Cox LS. Immunotherapy and Allergy Diagnostics Committee of the AAAAI. 2006 American Academy of Allergy, Asthma & Immunology member immunotherapy practice patterns and concerns. J Allergy Clin Immunol. 2007; 119:1012–1013. PMID: 17418663.
25. Baiardini I, Puggioni F, Menoni S, Boot JD, Diamant Z, Braido F, et al. Patient knowledge, perceptions, expectations and satisfaction on allergen-specific immunotherapy: a survey. Respir Med. 2013; 107:361–367. PMID: 23218454.
Article
26. Antolín-Amerigo D, Tabar IA, Del Mar Fernández-Nieto M, Callejo-Melgosa AM, Muñoz-Bellido FJ, Martínez-Alonso JC, et al. Satisfaction and quality of life of allergic patients following sublingual five-grass pollen tablet immunotherapy in Spain. Drugs Context. 2017; 6:212309. PMID: 29225657.
Article
27. Han DH, Choi YS, Lee JE, Kim DY, Kim JW, Lee CH, et al. Clinical efficacy of sublingual immunotherapy in pediatric patients with allergic rhinitis sensitized to house dust mites: comparison to adult patients. Acta Otolaryngol. 2012; 132(Suppl 1):S88–S93. PMID: 22582789.
Article
28. Frew AJ, Ljørring C, Wolf H, Wüstenberg E, Durham SR, Corrigan CJ, et al. UK Immunotherapy study: reanalysis by a combined symptom and medication score. J Allergy Clin Immunol. 2018; 142:1998–1999. PMID: 30149039.
Article
29. Grouin JM, Vicaut E, Devillier P. Comparison of scores associating symptoms and rescue medication use for evaluating the efficacy of allergy immunotherapy in seasonal allergic rhinoconjunctivitis: results from five trials. Clin Exp Allergy. 2017; 47:254–263. PMID: 27790763.
Article
30. Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol. 2013; 131:1288–1296. PMID: 23498595.
31. Tordesillas L, Mondoulet L, Blazquez AB, Benhamou PH, Sampson HA, Berin MC. Epicutaneous immunotherapy induces gastrointestinal LAP+ regulatory T cells and prevents food-induced anaphylaxis. J Allergy Clin Immunol. 2017; 139:189–201. PMID: 27417020.
32. Hur GY, Kim TB, Han MY, Nahm DH, Park JW. Allergen and Immunotherapy Work Group of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI). A survey of the prescription patterns of allergen immunotherapy in Korea. Allergy Asthma Immunol Res. 2013; 5:277–282. PMID: 24003383.
Article
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