Exposure to Allergen-Specific Immunotherapy in Pregnancy and Risk of Congenital Malformations and Other Adverse Pregnancy Outcomes

Effects of drug treatments and types of drugs used by pregnant women at different gestational ages on pregnancy outcomes: A retrospective study

To analyze the effects of drug treatments and types of drugs on pregnancy outcomes in pregnant women at different gestational ages. The records of 526 pregnant women from our hospital from September 2018 to January 2024 were analyzed retrospectively. Women were categorized into 3 groups: normal delivery, artificial abortion, and spontaneous abortion. Data on maternal age, gestational age, smoking, drinking, radiation, medication timing, and types were collected and compared. Pearson correlation analysis assessed relationships between pregnancy outcomes, gestational age at medication, and medication types. After comparing multiple potential influencing factors, it was found that smoking history, timing of medication, and the use of antitussive and phlegm-reducing medications differed significantly among the different pregnancy outcome groups (P < .05). Multiple regression analysis showed that the gestational age at which pregnant women took medication was a significant positive influencing factor for adverse pregnancy outcomes, specifically artificial abortion (Coefficient = 0.210, P = .002). In addition, the use of antitussive and phlegm-reducing medications had a positive directional influence on adverse pregnancy outcomes, specifically spontaneous abortion (Coefficient = 0.294, P = .016). Further analysis showed that as the gestational age at the time of medication increased, the normal delivery rate initially increased and then decreased. The rate of artificial abortion first increased and then stabilized, while the spontaneous abortion rate showed minimal fluctuation. The use of medications by pregnant women and the duration of pregnancy significantly impact induced abortion rates. Cough and mucus-reducing medications can lead to miscarriage, while other drugs in early pregnancy generally do not affect outcomes. Antitussive and mucus-reducing drugs specifically increase the risk of spontaneous abortion. Raising awareness about proper medication use and conducting research on this topic is crucial for enhancing prenatal and postnatal care, reducing induced abortions, and promoting population growth.

The Art of Immunotherapy

Selection of a patient with rhinitis/conjunctivitis or asthma for allergy immunotherapy (AIT) requires several decisions. First, does the patient's sensitization, pattern of exposure to an allergen, and degree of exposure to that allergen reasonably suggest a causal relationship? Does the level and duration of symptoms warrant the cost and inconvenience of immunotherapy, or is the patient motivated by the disease-modifying potential of AIT? If AIT is selected, is the choice to be greater safety and convenience with sublingual immunotherapy (SLIT) tablets, but with treatment probably limited to 2 or 3 allergens, or for subcutaneous immunotherapy where multiple allergen therapy is the rule and efficacy may be somewhat greater, at least initially, or does the physician go off-label into the unknowns of liquid SLIT? Are there extracts of sufficient potency to achieve likely effective doses? How does the physician deal with large local or systemic reactions, with gaps in treatment, with pollen seasons, and the use of premedication or cautionary prescription of epinephrine autoinjectors? How can adherence to AIT be improved? These and other questions are addressed in this paper.

Causes of Non-Adherence to Allergen-Specific Immunotherapy: A Foundation towards a Patient-Personalized Approach

BACKGROUND

Allergen-specific immunotherapy (AIT) is the only disease-modifying therapy for allergic conditions, resulting in a long-lasting tolerance beyond the duration of the treatment. Due to the strong relationship between the effectiveness, its optimal duration (at least three years) and the observation of the correct administration protocol, appropriate adherence to the plan of treatment represents a critical factor for the therapeutical success of AIT.

METHODS

Analysis of studies about the rate of adherence in subcutaneous and sublingual immunotherapy, which are the main routes of administration of AIT.

RESULTS

There are different causes leading to a premature interruption of the therapy or to it being incorrectly carried out; the most reported include erroneous expectations of the effectiveness and the adverse effects, economic issues, inconvenience and unrelated clinical conditions.

CONCLUSIONS

An attentive analysis of the main causes of dropouts may be useful to improve the management of these patients and to develop new strategies for a personalized approach. These strategies should be dynamic, involving attentive communication between the physician and the patient about all the possible criticalities, especially in the initial phase of the therapy, and facilitating, as much as possible, access to healthcare providers over the course of the maintenance phase, including by exploiting technological tools.