Health-related quality of life in Polish adolescents with Hymenoptera venom allergy treated with venom immunotherapy

Cross-sectional and longitudinal validation of the Slovene version of the health-related quality of life questionnaire in patients with Hymenoptera venom allergy (HRQLH-S)

BACKGROUND

This study aimed to determine to what degree venom immunotherapy can affect the Quality of Life (QoL) in patients hypersensitive to the Hymenoptera venom and to validate the Slovene version of the "Vespid Allergy Quality of Life Questionnaire."

METHODS

The "Vespid Allergy Quality of Life Questionnaire" (VQLQ), developed by Oude Elberink et al., has become a well-established diagnostic instrument. The Slovene version of the Health-Related Quality of Life Questionnaire for Hymenoptera venom allergy (HRQLH-S) was administered to 288 patients from different groups with a confirmed diagnosis of Hymenoptera venom hypersensitivity to achieve cross-sectional validation. The HRQLH-S results were compared among groups, with an Expectation of Outcome (EoO) questionnaire and a 10-point Likart scale question: (How much is your QoL reduced by being allergic to insect sting?). The questionnaire was administered to 49 patients treated with venom immunotherapy to establish longitudinal validity.

RESULTS

In cross-sectional study, statistically significant differences (p < 0.001) were observed in patients treated with venom immunotherapy compared to untreated patients. The median (Mdn) was used to compare the groups. Patients that have already been treated recorded a rise in QoL only six months into treatment (Mdn = 3.18), compared to the untreated (Mdn = 4.20). Further noticeable improvements in the QoL were recorded in patients treated for three to five years (Mdn = 2.47). Statistically significant correlations between the HRQLH-S results and the EoO were confirmed in cases of patients with wasp venom hypersensitivity (Q15r = 0.82; Q16r = 0.67; Q17r = 0.63; p < 0.001) and those with honeybee venom hypersensitivity (Q15r = 0.79; Q16r = 0.62; Q17r = 0.64; p < 0.001). The cross-sectional validation yielded a correlation coefficient of 0.96 (Cronbach α). In the longitudinal validation, we showed a significant correlation between EoO and HRQLH-S (Q15r = 0.87; Q16r = 0.77; Q17r = 0.71; p < 0.000.1), with a good internal consistency (Cronbach α = 0.97). Furthermore, we found a significant difference (p < 0.001) in the QoL of pretreatment patients (Mdn = 3.91) compared to the value after five years of treatment (Mdn = 2.06).

CONCLUSIONS

Results confirm the efficiency of VIT on QoL in patients with Hymenoptera venom hypersensitivity. The HRQLH-S questionnaire proved suitable for measuring QoL in wasp and honeybee venom-allergic patients.

Venom allergen immunotherapy in children: Short-term efficacy and impact on quality of life

BACKGROUND

Hymenoptera venom allergy (HVA) is a potentially life-threatening reaction to stings from Apis mellifera (honey bee) or Vespula (yellowjacket).

OBJECTIVE

To evaluate re-sting reactions during or after venom immunotherapy (VIT) and the impact of VIT on the quality of life (QoL) of children with HVA.

METHODS

The study included 78 patients who experienced grade III, IV, or V systemic reactions and underwent conventional subcutaneous VIT. The modified World Allergy Organization grading system was used to grade the systemic reactions. Patients were asked whether they were re-stung by the culprit Hymenoptera to which they were allergic, and the re-sting reactions were evaluated using a questionnaire. The Turkish version of the Vespid Allergy Quality of Life Questionnaire was used to assess QoL.

RESULTS

A total of 17 children (21.8%) were allergic to honey bee and 61 (78.2%) to yellowjacket. The most common symptoms before VIT were dyspnea (93.6%), angioedema (93.6%), and generalized urticaria (67.9%); 43 patients (55.1%) were re-stung by the culprit Hymenoptera: 19 during VIT and 24 after VIT; and 7 of 19 patients (36.8%) and 1 of 24 patients (4.1%) who were re-stung reported systemic re-sting reactions during and after VIT, respectively. The median Vespid Allergy Quality of Life Questionnaire score was 2.82 (IQR: 2.07-3.51) before VIT and 5.62 (IQR: 4.61-6.25) after VIT.

CONCLUSION

Children with HVA who had received or were receiving VIT showed a substantial reduction in the severity of re-sting reactions. VIT led to a significant improvement in the QoL of children with HVA.

Health-related quality of life in food and venom induced anaphylaxis and role of influencing factors

The impact on health-related quality of life (HRQL) plays a key role for patients suffering from allergies and anaphylaxis. In this narrative review we review the HRQL in allergic patients suffering from food and venom allergy, both being the most frequent elicitors of severe allergic, potential life-threatening reactions and provide an overview on the current knowledge and identified gaps. The data show that for food and venom allergy standardized assessment tools to measure HRQL are available and have been successfully applied. Our analysis shows that multiple factors can modulate HRQL in these patient groups. These include sociodemographic data like patients' age and sex, fear of accidental reactions but also external factors like the social environment and the appreciation of the seriousness of the condition by others. External factors may have a significant impact on HRQL and should be considered in patient-related outcome assessments to avoid biased measurements possibly affecting the results. The assessment of the quality of life in the context of specific immunotherapy should consider lifestyle factors and ideally, the individual change in HRQL should be measured. Although there are many data indicating a negative impact on HRQL in food allergic children and their caregivers, limited data are existing from adults with food allergy and venom allergic patients from all age groups. Also, the use of standardized questionnaires should be extended to allow for a better comparability of results between studies. Therefore, translation to additional languages is necessary. Taken together, the eliciting allergen, the severity of the allergic disease but moreover multiple external factors impact the outcome in HRQL and should be considered in HRQL assessment.

Impact of specific immunotherapy and sting challenge on the quality of life in patients with hymenoptera venom allergy

Background

An experienced life-threating anaphylactic reaction to hymenoptera venom can sustainably impair patients’ quality of life (QoL). Besides carrying emergency medication, venom-specific immunotherapy (VIT) exists as a causal treatment of allergy.

Objective

This study aimed to examine QoL, anxiety, depression, and physical and mental health in patients allergic to hymenoptera venom before and during VIT and the impact of a tolerated sting challenge (SC).

Methods

Between July 2017 and August 2017, 142 patients with venom allergy were analyzed using validated questionnaires as the: Vespid Allergy Quality for Life Questionnaire" (VQLQ-d), the "Hospital Anxiety and Depression Scale" (HADS-D) and the "Short Form 36" (SF-36). To evaluate the impact of VIT and SC on the QoL, patients were divided into 3 groups: (A) VIT and tolerated SC (n = 45), (B) VIT before carrying out SC (n = 73), and (C) therapy-naïve before VIT (n = 20). Further parameters like gender, age, insect species, and severity of the anaphylactic reaction were assessed.

Results

A significant correlation between the health-related QoL and the parameters of gender and state of treatment was seen. Especially male patients, as well as patients allergic to yellow jacket venom, benefit from a SC in terms of a significant increase in their QoL. In the total study cohort, a clear trend was observed towards a higher QoL in patients under VIT who tolerated a SC. Overall, neither the patients’ age nor the insect species exerted a relevant influence on QoL, depression or anxiety. However, women showed a lower QoL combined with higher anxiety and depression scores than men.

Conclusion

Immunotherapy leads to an improved QoL, which can be further increased by a SC. A tolerated SC conceivably reassures the patients by objectifying the treatment success. Female patients appear to have a stronger impaired QoL per se. Taken together, a SC can be performed during VIT to strengthen the patients’ QoL.

Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review

BACKGROUND

Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions.

METHODS

A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken.

RESULTS

A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals.

CONCLUSIONS

We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.

Sex Differences in Adults with Insect Venom Allergy regarding Psychological Distress, Attitudes toward the Emergency Medication, and Factual Knowledge about the Disease

BACKGROUND

Hymenoptera venom allergy (HVA) has a prevalence of 3% in adults. Although patients have no ongoing symptoms, they often suffer from an impairment of their psychological well-being and quality of life.

OBJECTIVE

The aim of this study was to analyze sex-specific differences regarding the psychological burden caused by this allergy and handling of the emergency medication.

METHOD

Study participants filled out a questionnaire including sociodemographic and disease-specific characteristics, the Hospital Anxiety and Depression Score (HADS), and theoretical knowledge about the emergency medication set (EMS). Additionally, an objective structured clinical examination was used to assess practical knowledge and handling of the EMS.

RESULTS

Fifty-six patients were included (55.4% females). Female patients showed higher subjective anxiety levels due to HVA compared to men (mean 7.2 vs. 4.6, p = 0.0003). Furthermore, the HADS revealed that women had a significant higher anxiety level, especially after Mueller grade I-II anaphylactic reactions (mean 6.3 vs. 2.8, p = 0.0134). This was associated with a higher theoretical but not practical knowledge about their disease. On the other hand, males were less inclined to carry the emergency medication "always" or "almost always" (56 vs. 87.1%, p = 0.0015) but showed higher self-assurance in using it (mean 7.3 vs. 6.1, p = 0.0446).

CONCLUSIONS

This clinical study provides evidence for sex differences in coping with HVA. The results suggest that females should be monitored more closely for allergy-associated anxiety symptoms, while men need more encouragement to carry the emergency medication.

Disease Burden, Psychological Well-Being and Attitudes regarding the Set of Emergency Medication in Adults with Insect Venom Allergy

BACKGROUND

Insect venom allergy is common and greatly impairs patients' quality of life. Additionally, low compliance with carrying emergency medication is reported. The aim of our study was to analyze the disease burden, levels of anxiety and depression, and to evaluate attitudes towards the set of emergency medication in affected patients.

METHODS

Between April 2016 and January 2017, patients ≥18 years visiting our department because of an insect venom allergy were asked to complete a paper-based questionnaire. The questionnaire assessed willingness to pay (WTP), the Hospital Anxiety and Depression Scale (HADS), subjective anxiety levels, willingness to carry the set of emergency medication, self-assurance in using it, compliance with carrying it, and reasons for not always carrying it.

RESULTS

55 patients (81.8% wasp allergy) were included. On average, WTP for a complete cure was EUR 1,727 (median: 500). Using the HADS, 14.5% showed definite anxiety disorders while 5.5% had significant depression disorders. Most patients stated to carry the emergency medication "always" (25.5%) or "almost always" (47.3%). "Forgetfulness" (36.4%) was reported as the main reason for not always carrying the medication, followed by "too big" (18.2%).

CONCLUSIONS

In our patient cohort, insect venom allergy was associated with a moderate disease burden and a good compliance with carrying the emergency medication. However, several of our participants demonstrated borderline or significant anxiety and/or depression disorders. In this regard, this study highlights the necessity to regularly ask the patient about the psychological well-being to identify patients needing psychological support.

Quality-of-life in insect venom allergy: validation of the Turkish version of the “Vespid Allergy Quality of Life Questionnaire” (VQLQ-T)

Purpose

Methods

Results

Conclusions

Evaluation of the quality of life of postmenopausal osteoporotic and osteopenic women with or without fractures

INTRODUCTION

Most studies concerned with the quality of life (QoL) of women with reduced bone mineral density (BMD) focus on patients with vertebral and non-vertebral fractures. Our objective was to evaluate QoL among patients with reduced BMD regardless of their fracture history compared to women with normal BMD.

MATERIAL AND METHODS

Eighty-five patients in the study group were classified as osteoporotic, with BMD results measured by densitometry and expressed by T-score ≤ -2.5 SD, 122 women were osteopenic, with -2.5 < T-score ≤ -1.0 SD, and 97 subjects were assessed as normal, with T-score > -1.0 SD. Mean ages of women according to groups were 59.90, 57.67 and 55.68, respectively. Assessment of life quality was conducted using the Polish version of the QUALEFFO-41 scale.

RESULTS

The ratings in the assessment (QUALEFFO-41) of QoL were lower for osteoporotic and osteopenic women than for the normal BMD group with regard to pain (p = 0.006), social function (p = 0.001), health perception (p = 0.001), and mental function (p = 0.001). For total QUALEFFO-41 the associated factors were: secondary and higher education (OR = 0.49; 95% CI: 0.29-0.82), self-perceived deformity of the back (OR = 4.09; 95% CI: 1.88-8.93), previous fractures (OR = 2.52; 95% CI: 1.09-5.82), reduced height (OR = 2.48; 95% CI: 1.13-5.39) and anxiety (OR = 1.42; 95% CI: 1.21-1.66).

CONCLUSIONS

It seems necessary to evaluate QoL of women with reduced BMD before fractures occur, to aid development of health education aiming to reduce the incidence of osteoporosis and prevent fractures.

Development of Parents' of Children with Hymenoptera Venom Allergy Quality of Life Scale (PoCHVAQoLS)

INTRODUCTION

Venom allergy in children, as a potentially life-threatening disease, may have a considerable impact on the quality of life of the parents of the affected patients.

AIM

To present development of the quality of life scale for such parents.

MATERIAL AND METHODS

The study sample included 70 parents of children with a history of insect sting reaction, referred for consultations to the allergy centre of the University Children's Hospital of Krakow, Krakow, Poland, in 2000-2010. An initial pool of 56 items divided into 6 domains was prepared. The items with intercorrelations higher than 0.7 were removed from each domain and principal component analysis was conducted for each domain separately to provide a one-dimensional subscale for each domain. Reliability of the subscales was assessed using the Cronbach α coefficient in terms of the Classical Test Theory and with the rho coefficient in terms of the Item Response Theory. The multidimensionality of the scale was tested using multitrait scaling.

RESULTS

Two to four items from each domain were selected to constitute five subscales. Both the rho and α coefficients for all the subscales were 0.75 or higher. The multitrait method showed that almost all the items indicated stronger correlations with their own subscale than with other subscales. Correlations between subscales were lower than 0.5.

CONCLUSIONS

The presented scale consists of high validity and reliability subscales measuring the quality of life of parents of Hymenoptera venom allergic children. As their quality of life is strongly related to the health of their children, such information may be helpful in everyday clinical practice.

Quality of life (QOL) evaluation after acute coronary syndrome with simultaneous clopidogrel treatment

INTRODUCTION

Double antiplatelet therapy with clopidogrel and acetylsalicylic acid is a standard procedure after acute coronary syndrome. This treatment carries a higher risk of complications. The main goal of this research was to assess the patients' quality of life after undergoing antiplatelet therapy with clopidogrel after acute coronary syndrome (ACS).

MATERIAL AND METHODS

In the questionnaire research 3220 patients after ACS and treated with clopidogrel were included. The evaluation was carried out with the quality of life questionnaire SF-12.

RESULTS

37.9% of the interviewees experienced ACS-ST-elevation myocardial infarction (STEMI), 62.1% non-ST-elevation myocardial Infarction (NSTEMI), on average within 23 ±42 weeks (p < 0.05). 7.2% of the interviewees were receiving non-invasive treatment and in 2.4% cases it was fibrinolysis. 90.4% were treated with primary angioplasty and stenting. In 53.8% of cases a covered stent (DES) was implanted. 95.6% of the patients received, besides clopidogrel, acetylsalicylic acid. The lowest quality of life was observed after non-invasive treatment or fibrinolytic only (p < 0.05). The quality of life in those patients who underwent angioplasty and stent implantation was similar (p < 0.05). With time, a progressive improvement of all assessed quality of life aspects was observed (p < 0.05). The improvement was noted regardless of the ACS treatment method (p < 0.001). The differences between the patients were smaller at each successive evaluation (p < 0.05). In the case of vitality, emotional and psychic condition, they disappeared completely (p < 0.05).

CONCLUSIONS

The quality of life rises along with time passed after acute coronary syndrome. Invasive methods provide better quality of life than fibrinolysis and non-invasive treatment in the acute coronary syndrome patients.

Development of children's hymenoptera venom allergy quality of life scale (CHVAQoLS)

Background

Venom allergy is a rare but life-threatening disease and may have a considerable impact on the health-related quality of life (HRQoL) of patients, especially children. This paper presents development of the HRQoL scale for children and adolescents with Hymenoptera venom allergy (HVA).

Methods

The study sample consisted of 71 children, born between 1992 and 2000, who presented with a history of insect sting reaction when referred for consultation in the allergy center of Polish-American Children’s Hospital, Krakow, Poland, during the period from 2000 to 2010. The initial pool of 60 items - divided into 6 domains - was prepared. The items with intercorrelations higher than 0.7 were removed from each domain and then principal component analysis was conducted for each domain separately, to provide a one-dimensional subscale for each domain. Reliability of the subscales was assessed using Cronbach alpha coefficient in terms of Classical Test Theory and with rho coefficient in terms of Item Response Theory. The multidimensionality of the scale was tested using multi-trait scaling.

Results

Three to four items from each domain were subsequently selected to constitute six subscales. Rho coefficients for all the subscales reached 0.8, similar results were achieved with the Cronbach alpha coefficients. Multi-trait method showed that the majority of the items indicated stronger correlations with their own subscales than with other subscales, which proves that our constructed subscales measure different dimensions of HRQoL.

Conclusions

The presented scale comprises high validity and reliability subscales measuring six dimensions of HRQoL related to Hymenoptera venom allergy in children and adolescents. Such information may be useful in everyday clinical practice.