Patient’s compliance with allergen immunotherapy

Cristoforo Incorvaia¹, Marina Mauro², Erminia Ridolo³, Paola Puccinelli⁴, Massimiliano Liuzzo⁴, Silvia Scurati⁴, Franco Frati^4,5

¹Allergy/Pulmonary rehabilitation Unit, ICP Hospital, Milan, Italy; ²Allergy Unit, Sant’Anna Hospital, Como, Italy; ³University Department of Clinical Sciences, Parma, Italy; ⁴Medical and Scientific Department, Stallergenes, Milan, Italy; ⁵Pediatrics, University Department of Medical and Surgical Specialty and Public Health, Perugia, Italy

Background: Allergen immunotherapy (IT) is an effective treatment of respiratory allergy, but requires strict rules of performance. This makes compliance particularly relevant, but thus far only a few studies have investigated this issue.

Methods: We reviewed all the available articles on compliance and adherence with IT in its different forms of administration, ie, subcutaneous (SCIT), sublingual (SLIT), and local nasal (LNIT).

Results: Early studies, when only SCIT was available, reported a low compliance, ranging from 45% to 60%, but the demanding schedules used, with very frequent injections, accounted for this outcome, as shown by patients’ recognition of inconvenience as the major cause of noncompliance. The most recent studies reported a good compliance, estimated in 75% to 90%, to both SCIT and SLIT, inconvenience remaining the major cause of noncompliance, followed by cost of the treatment. The only study addressing LNIT found a very poor compliance (27%), the major cause being the side effects, with repeated nasal reactions to the allergen extract.

Conclusions: Adequate education of patients and optimization of administration schedules, with fine balancing between dose effectiveness and cost, are the factors most likely to achieve further improvement of compliance with IT.

Keywords: allergen immunotherapy, subcutaneous, sublingual, local nasal, compliance, adherence