Aktuelle Empfehlungen zur praktischen Durchführung von SCIT und SLIT

Success factors for adherence in hyposensitization

For the success of an immunotherapy regimen, adherence is a major success factor. The goal of our study was to identify the factors that positively and negatively influence patient compliance, and to create strategies to improve it. Four questionnaires were designed for different patient groups: A – after immunotherapy; B – during immunotherapy; C – before immunotherapy; D – no experience with immunotherapy. From March to October 2008, 790 questionnaires were collected. For the first group, questionnaire A was answered by 272 patients. Of these, 15.8% had dropped out of immunotherapy. Women had higher dropout rates than men (16.8% vs. 12.3%). The following aspects of immunotherapy were viewed by the patients as negative: time consuming (69.5%), adverse reactions (62.5%), insufficient patient information (53.7%), no change in use of symptomatic medication (33.8%) and no change in symptoms (60.7%). Despite the mentioned drawbacks, 74% of all patients would still recommend allergen immunotherapy. Questionnaire B was completed by 281 patients. In this group, 8.7% had already considered dropping out. The following unfavourable aspects were identified: time consuming (66.2%), adverse reactions (61.9%), insufficient patient information (54.8%), no change in symptoms (51.2%) and use of symptomatic medication (47.0%). Despite this, up to 95.4% of all patients would recommend immunotherapy. Questionnaire C was filled-out by 55 patients. The following reasons were rated by the patients as “important” or “very important” for the decision to start hyposensitization: long-lasting symptom alleviation (100%), few adverse reactions (98.2%), comprehensive patient information (96.3%), easy integration into daily routine (89.1%), re-assessment of therapy by doctor (83.3%) and reduced need for symptomatic medication (81.8%). Questionnaire D was filled in by 182 participants. 89% had already heard the term hyposensitization before. Their general knowledge regarding this therapy was average (3.23 on a scale of 1 – 6; where 1 = optimum). Long-lasting symptom alleviation (99.5%), comprehensive patient information (97.8%), easy integration into daily routine (96.1%), reduced symptomatic medication use (92.6%) and re-assessment by doctor (88.8%) were considered “very important” or “important” characters in the desired immunotherapy regime. Adherence to the hyposensitization schedule is essential for its success. The treating doctor should aim at choosing the right therapy and working out an individualized patient treatment plan. Equally important is providing information to the patient throughout the duration of the treatment. The doctor should assist the patient to create an optimized time schedule to help make the therapy less time-consuming.

Long-term allergen-specific immunotherapy correlates with long-term allergen-specific immunological tolerance

INTRODUCTION

One method of treatment for allergic diseases is allergen-specific immunotherapy (SIT). The clinical efficacy of SIT in pollen-induced allergic rhinitis has been demonstrated in several controlled clinical trials. There is no consensus about the protective effect of SIT. In this study, we evaluated the correlation between the duration of SIT and relapse of allergic rhinoconjunctivitis.

METHODS

We evaluated 148 patients who had received SIT between 1998 and 2006. All of the patients had allergic rhinoconjunctivitis. According to the data 116 had sensitivity to grass pollen and 32 to house dust. SIT was performed on 87 patients for 4 y (Group A) and 61 patients for 6 y (Group B).

RESULTS

All of the 148 patients were monitored regularly with no medication for 2 y after SIT. Thirty-one patients in Group A relapsed (36%); 11 patients in Group B relapsed (18%). Mean duration until relapse was 11.1+/-1.99 mo in Group A and 19.64+/-1.86 mo in Group B. During evaluation, symptom scores were 2.32+/-0.74 in Group A and 1.81+/-0.75 in Group B and serum total immunoglobulin E levels were 432.4+/-78.5 KU/lt in Group A and 288.6+/-55.3 KU/lt in Group B. There was significant difference between the groups (P < 0.05).

CONCLUSION

According to these results, long-term SIT therapy correlates with long-term, allergen-specific, acquired immunological tolerance.