This meta-analysis compared the health-related quality of life (HRQL) of patients with allergic rhinitis (AR) and/or allergic asthma (AA) caused by perennial house dust mite (HDM) versus AR and/or AA caused by seasonal pollen allergy. Following a systematic search, the identified studies used the disease-specific rhinitis quality of life questionnaire or generic instruments (SF-36 and SF-12). Summary estimates obtained by meta-analysis showed that HRQL in patients with perennial HDM allergy was significantly worse than that of patients with seasonal pollen allergy, when measured by both disease-specific and generic HRQL instruments, and was reflected by an impact on both physical and mental health. A systematic review of cost data on AR and AA in selected European countries demonstrated that the majority of the economic burden was indirectly caused by high levels of absenteeism and presenteeism; there was little or no evidence of increasing or decreasing cost trends. Increased awareness of the detrimental effects of AR and/or AA on patients’ HRQL and its considerable cost burden might encourage early diagnosis and treatment, in order to minimize the disease burden and ensure beneficial and cost-effective outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12948-016-0049-9) contains supplementary material, which is available to authorized users.

Medication persistence and adherence in allergy immunotherapy (AIT) has been reported to be lower in real life than in clinical studies, 1 with manufacturers' sales figures often indicating poorer adherence and persistence than postmarketing studies. 2,3 This might result from patients tending to be more compliant when their behavior is being recorded, which is commonly known as the Hawthorne effect. The low risk of anaphylaxis and serious adverse reactions with sublingual immunotherapy (SLIT) 4,5 has resulted in orodispersible SLIT-tablets being approved in Europe and the United States for self-administration provided that the first dose is tolerated under medical supervision. For many patients, self-administration of SLIT-tablets is an advantage over injection during subcutaneous immunotherapy (SCIT). However, dosing regimen and frequency of physician's office visits differ considerably between the 2 administration routes, and efficacy and safety profiles of individual products administered through each route vary widely. Because these factors have been reported to affect persistence and adherence, 6 we compared medication persistence and adherence with a SLIT-tablet versus SCIT products in patients with grass pollen allergy over a 3-year period from treatment initiation. This retrospective cohort study used prescription renewal rates for a 75,000 standardized quality units tablet (SQ-T), 2,800 BAU grass pollen SLIT-tablet, and 100 to 100,000 SQ-U/mL or 600 to 30,000 SQ1/mL suspension for subcutaneous injection from the German IMS Health Disease Analyzer database for the period of January 2006 to August 2014 to obtain an accurate picture of persistence and adherence in real life. More information about the products and database can be found in the Methods section in this article's

Background Allergic asthma causes substantial morbidity and constitutes a public health burden, which increases with asthma severity. There is evidence that allergy immunotherapy (AIT) prevents the progression of allergic rhinitis (AR) to asthma. However, evidence is missing on the potential of AIT to prevent progression from milder to more severe asthma. Methods This population‐based cohort study utilized healthcare data (2005 to 2014) from a statutory health insurance in Germany. The severity of asthma was classified according to the treatment steps recommended by the global initiative for asthma (GINA). The effect of AIT on the transition between the GINA steps was analyzed using multivariable Cox regression models adjusted for age and sex. Results From the total cohort of 1,739,440 patients, 39,167 individuals aged 14 years or older were classified as having incident asthma during the observation period and were included in the study. From these, 4111 patients (10.5%) received AIT. AIT exposure was associated with a significantly decreased likelihood of asthma progression from GINA step 1 to GINA step 3 (HR 0.87; 95% CI 0.80‐0.95) and GINA step 3 to GINA step 4 (HR 0.66; 95% CI 0.60‐0.74). GINA medication for step 2 and step 5 was rarely prescribed. Conclusions This observational study in a real‐world setting indicates that patients with allergic asthma who receive AIT are less likely to experience progression of asthma severity than asthma patients not receiving AIT.

BackgroundAllergic Rhinitis (AR) is a common disorder in Europe with Allergic Asthma (AA) as a frequent comorbidity. Allergy immunotherapy (AIT) is the only causal therapy of AR and AA, and can be administered as subcutaneous injections at the physician or as sublingual drops or tablets at home. The usual treatment duration is 3 years.ObjectiveThis study aimed to elicit patient preferences to identify the AIT administration mode preferred by patients.MethodsA discrete-choice-experiment (DCE) was developed to determine how people weight different treatment options using a paper-based questionnaire from June to September 2014, including 16 study centres. Main inclusion criteria: >18 years, grass, birch and/or house dust mite AR with moderate to severe symptoms, AIT-naïve and AIT-indicated. DCE-attributes were: Administration form, number and duration of physician visits, frequency of life-threatening anaphylactic shocks, local side-effects and co-payments.ResultsTwo-hundred thirty-nine subjects participated, resulting in analysable 1842 choices. All attributes were significant predictors for the treatment-choice. Ranked by importance, the following first three attributes are most preferred by patients:1st Number and duration of physician visits:Fewer visits with shorter duration preferred (0.658*)2nd Frequency of life-threatening anaphylactic shocks:Lower risk of shocks preferred (0.285*)3rd Local side-effects:Preference for rash/swelling on upper arm over itching/swelling under the tongue (0.210*)(*coefficient-size represents relative importance of the attributes)ConclusionThe most important attribute is the number and duration of visits to a physician. A lower risk of life-threatening anaphylactic shocks was ranked as the second whereas co-payments and administration form play a limited role.

This study linking diagnoses from EHRs to claims data collected valid information on PAR management, with or without concomitant AA, and on related costs. There was a clear increase in costs with severity of PAR and control of AA.