Yonsei Med J.  2019 Jun;60(6):570-577. 10.3349/ymj.2019.60.6.570.

Factors Associated with Adherence to Allergen Specific Subcutaneous Immunotherapy

• Lee JH
• Lee SH
• Ban GY
• Ye YM
• Nahm DH
• Park HS
• Shin YS

• KMID: 2446963
• DOI: http://doi.org/10.3349/ymj.2019.60.6.570

Abstract

PURPOSE
Allergen-specific immunotherapy (AIT) is known to be the only therapeutic modality to alter the natural course of allergic diseases. However, at least 3 years of treatment is recommended for achieving long-term disease modifying effect. This study aimed to investigate factors associated with immunotherapy non-adherence in real practice.
MATERIALS AND METHODS
We retrospectively reviewed medical records of patients who were diagnosed with allergic rhinitis, asthma, or atopic dermatitis, and received AIT to common allergens such as house dust mite and/or pollens from January 2007 to August 2014. In this study, non-adherence was defined as not completing 3 years of AIT.
RESULTS
Among 1162 patients enrolled, 228 (19.6%) failed to complete 3 years of AIT. In multivariate analysis, age less than 20 years [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.70-5.69] and 20 to 40 years (OR 2.01, 95% CI 1.17-3.43), cluster build-up (OR 1.78, 95% CI 1.05-3.02) and ultra-rush build-up schedules (OR 5.46, 95% CI 2.40-12.43), and absence of visit to other departments in the same hospital (OR 1.87, 95% CI 1.05-3.32) were independently associated with immunotherapy non-adherence. Disease duration of 5-10 years was negatively associated with non-adherence compared to shorter disease duration of less than 5 years (OR 0.61, 95% CI 0.40-0.94). Although male sex and commercial product of AIT, Tyrosine S®, compared to Novo-Helisen® were non-adherent factors in univariate analysis, no statistical significances were identified in multivariate analysis.
CONCLUSION
Various factors are associated with immunotherapy adherence affecting the utility of immunotherapy. Clinicians should be aware of factors associated with adherence to maximize the utility of allergen-specific subcutaneous immunotherapy.

Keyword

Allergen specific immunotherapy; adherence; cluster; ultra-rush

MeSH Terms

Allergens
Appointments and Schedules
Asthma
Dermatitis, Atopic
Humans
Immunotherapy*
Male
Medical Records
Multivariate Analysis
Pollen
Pyroglyphidae
Retrospective Studies
Rhinitis, Allergic
Tyrosine
Allergens
Tyrosine

Figure

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  Fig. 1 Starting age of immunotherapy in age categories by 10-year age groups.

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  Fig. 2 Proportion of adherence and non-adherence to immunotherapy among study subjects (A) and cumulative proportion of immunotherapy in non-adherent patients over time (B).

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  Fig. 3 Proportion of patients on immunotherapy over time by Kaplan-Meier analysis regarding age (A), sex (B), type of build-up schedule (C), disease duration (D), pharmaceutical product (E), and follow-up at other departments (F).

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