Efficacy and perceived satisfaction of 3-year SLIT in children with allergic rhinitis and asthma: a pilot study
Main Article Content
Keywords
adherence, children, follow-up, perceived satisfaction, SLIT
Abstract
Background: Despite the presence of robust evidence, there is very limited data on the efficacy of allergen immunotherapy (AIT) for selected patients. Accordingly, we aimed to evaluate the efficacy and perceived satisfaction of a 3-year course of sublingual immunotherapy (SLIT) in a paediatric population with allergic rhinitis and/or asthma.
Methods: A pilot, monocentre, retrospective cohort study was performed. One hundred fifty-three children who fulfilled the criteria for allergic rhinitis and asthma and were either mono- or poly-sensitized were enrolled. A standardized questionnaire assessing perceived efficacy, use of rescue medication, disease control, number of exacerbations, quality of life, and perceived satisfaction was administered to each patient.
Results: Seventy patients (49 males, 21 females; mean age, 14.3±1.9 years) were included in the final analysis. All 70 patients received SLIT for up to 3 years, with 100% adherence to the treatment throughout the study. Significant improvements in symptoms and quality of life were reported (p<0.01). There was also a significant decrease in disease severity, use of rescue medication, and sleep disturbances (p<0.01). Additionally, a significant improvement in school performance was also recorded (p<0.01). Of the enrolled patients, 60 out of 70 (85.7%) reported being very satisfied, 6 out of 70 (8.57%) were much satisfied, and 4 out of 60 (5.71%) were satisfied.
Conclusions: We were the first to demonstrate the efficacy and perceived satisfaction of a 3-year SLIT in a paediatric population, with 100% treatment adherence throughout the study.
References
2 Calamita Z, Saconato H, Bronhara Pelà A, Nagib Atallah A. Efficacy of sublingual immunotherapy in asthma. Systematic review of randomized clinical trials. Allergy. 2006; 61:1162–72. 10.1111/j.1398-9995.2006.01205.x
3 Melaranci C, Matteoli MC. Efficacy of allergoid sublingual immunotherapy in children with asthma and/or allergic rhinoconjunctivitis. JACI. 2004; 113:S111. 10.1016/j.jaci.2003.12.388
4 Cuppari C, Leonardi S, Manti S, Filippelli M, Alterio T, Spicuzza L, et al. Allergen immunotherapy, routes of administration and cytokine networks: an update. Immunotherapy. 2014; 6(6):775–86. 10.2217/imt.14.47
5 Pastorello EA, Losappio L, Milani S, Manzotti G, Fanelli V, Pravettoni V, et al. 5-grass pollen tablets achieve disease control in patients with seasonal allergic rhinitis unresponsive to drugs: a real-life study. J Asthma Allergy. 2013; 6:127–33. 10.2147/JAA.S53801
6 Kabisch M, Ruckes C, Seibert-Grafe M, Blettner M. Randomized controlled trials: part 17 of a series on evaluation of scientific publications. Dtsch Arztebl Int. 2011; 108(39):663–8. 10.3238/arztebl.2011.0663
7 Bousquet J, Khaltaev N, Cruz AA, et al. World Health Organization; GA(2)LEN; AllerGen. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN and AllerGen). Allergy. 2008;63(Suppl. 86):8–160. 10.1111/j.1398-9995.2007.01620.x
8 Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Available at: https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf. Last Access: July 26, 2022
9 Pfaar O, Demoly P, Gerth van Wijk R, Bonini S, Bousquet J, Canonica GW, et al. Recommendations for the standardization of clinical outcomes used in allergen immunotherapy trials for allergic rhinoconjunctivitis: an EAACI Position Paper. Allergy. 2014; 69(7), 854–867. 10.1111/all.12383
10 Klimek L, Bergmann KC, Biedermann T, Bousquet J, Hellings P, Jung K, et al. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC). Allergo J Int. 2017; 26(1):16–24. 10.1007/s40629-016-0006-7
11 Rhee H, Belyea M, Mammen J. Visual analogue scale (VAS) as a monitoring tool for daily changes in asthma symptoms in adolescents: a prospective study. Allergy Asthma Clin Immunol. 2017; 13:24. 10.1186/s13223-017-0196-7
12 Meltzer EO, Busse WW, Wenzel SE, Belozeroff V, Weng HH, Feng J, et al. Use of the asthma control Questionnaire to predict future risk of asthma exacerbation. J Allergy Clin Immunol. 2011; 127:167–172. 10.1016/j.jaci.2010.08.042
13 Manti S, Licari A. How to obtain informed consent for research. Breathe. 2018; 14(2):145–52. 10.1183/20734735.001918
14 De Vos C, Mitchev K, Pinelli ME, Derde MP, Boev R. Non-interventional study comparing treatment satisfaction in patients treated with antihistamines. Clin Drug Investig. 2008; 28:221–30. 10.2165/00044011-200828040-00003
15 Ferrer M, Morais-Almeida M, Guizova M, Khanferyan R. Evaluation of treatment satisfaction in children with allergic disease treated with an antihistamine: an international, non-interventional, retrospective study. Clin Drug Investig. 2010; 30:15–34. 10.2165/11530910-000000000-00000
16 Zicari AM, Indinnimeo L, De Castro G, Incorvaia C, Frati F, Dell’Albani I, et al. A survey on features of allergic rhinitis in children. Curr Med Res Opin. 2013; 29(5):415–20. 10.1185/03007995.2013.779238
17 Wang T, Li Y, Wang F, Zhou C. Nonadherence to sublingual immunotherapy in allergic rhinitis: a real-life analysis. Int. Forum Allergy Rhinol. 2017; 7:389–392. 10.1002/alr.21909
18 Kiotseridis H, Arvidsson P, Backer V, Braendholt V, Tunsäter A. Adherence and quality of life in adults and children during 3-years of SLIT treatment with Grazaxa real life study. NPJ Prim Care Respir Med. 2018; 28(1):4. 10.1038/s41533-018-0072-z
19 Ras L, de Groot H, Stengs CH, van Weissenbruch R. Persistence of treatment with 5-grass pollen tablets in patients with allergic rhinitis: a real-life study. Ann Allergy Asthma Immunol. 2016; 116(1):52–8.e2. 10.1016/j.anai.2015.10.018
20 Pajno GB, Caminiti L, Crisafulli G, Barberi S, Landi M, Aversa T, et al. Adherence to sublingual immunotherapy in preschool children. Pediatr Allergy Immunol. 2012; 23(7):688–9. 10.1111/j.1399-3038.2012.01317.x
21 Halken S, Larenas-Linnemann D, Roberts G, Calderón MA, Angier E, Pfaar O, et al. EAACI guidelines on allergen immunotherapy: prevention of allergy. Pediatr Allergy Immunol. 2017; 28(8):728–745. 10.1111/pai.12807
22 Valovirta E, Petersen TH, Piotrowska T, Laursen MK, Andersen JS, Sørensen HF, et al. Results from the 5-year SQ grass sublingual immunotherapy tablet asthma prevention (GAP) trial in children with grass pollen allergy. J Allergy Clin Immunol. 2018; 141(2):529–538 e513. 10.1016/j.jaci.2017.06.014
23 Eng PA, Borer-Reinhold M, Heijnen IA, Gnehm HP. Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood. Allergy. 2006; 61(2):198–201. 10.1111/j.1398-9995.2006.01011.x
24 Passalacqua G, Frati F, Puccinelli P, Scurati S, Incorvaia C, Canonica GW, et al. Adherence to sublingual immunotherapy: the allergists’ viewpoint. Allergy. 2009; 64(12):1796–7. 10.1111/j.1398-9995.2009.02136.x
25 Brüggenjürgen B, Reinhold T. Cost-effectiveness of grass pollen subcutaneous immunotherapy (SCIT) compared to sublingual immunotherapy (SLIT) and symptomatic treatment in Austria, Spain, and Switzerland. J Med Econ. 2018; 21(4):374–81. 10.1080/13696998.2017.1419959
26 Osterberg L, Blashke T. Adherence to medication. N Engl J Med. 2005; 353:487–93. 10.1056/NEJMra050100
27 Sabaté E. Adherence to long-term therapies: evidence for action. Switzerland: World Health Organization; 2003. World Health Organization. https://apps.who.int/iris/handle/10665/42682
28 Bidwal M, Lor K, Yu J, Ip E. Evaluation of asthma medication adherence rates and strategies to improve adherence in the underserved population at a Federally Qualified Health Center. Res Soc Adm Pharm. 2017; 13:759–66. 10.1016/j.sapharm.2016.07.007
29 Senna G, Caminati M, Lockey RF. Allergen immunotherapy adherence in the real world: how bad is it and how can it be improved? Curr Treat Options Allergy. 2015; 2:14. 10.1007/s40521-014-0037-6
30 Paoletti G, Di Bona D, Chu DK, Firinu D, Heffler E, Agache I, et al. Allergen immunotherapy: The growing role of observational and randomized trial “Real-World Evidence”. Allergy. 2021; 76(9):2663–72. 10.1111/all.14773
31 Di Bona D, Paoletti G, Chu DK, Pepys J, Macchia L, Heffler E, et al. Allergen immu-notherapy for respiratory allergy: Quality appraisal of observational comparative effectiveness studies using the REal Life Evidence AssessmeNt Tool. An EAACI methodology committee analysis. Clin Transl Allergy. 2021; 11(4):e12033. 10.1002/clt2.12033
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.