Causes of SLIT discontinuation and strategies to improve the adherence: a pragmatic approach

Savi, Eleonora; Peveri, Silvia; Senna, Gianenrico; Passalacqua, Giovanni

doi:10.1111/all.12198

Cited by 49 publications

(45 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The first group achieved a significantly higher adherence rate than did the latter. It is important to note that the first month of treatment in this study was identified as the more important period, with the highest rate of discontinuation [80].…”

Section: Educational Plansmentioning

confidence: 74%

Allergen Immunotherapy Adherence in the Real World: How Bad Is It and How Can It Be Improved?

Senna

Caminati

Lockey

2014

Curr Treat Options Allergy

View full text Add to dashboard Cite

Opinion StatementAllergen immunotherapy (AIT) is the only available causal treatment for allergic respiratory diseases; however, data demonstrate a high discontinuation rate for both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). The complex mechanism of action of allergen immunotherapy (AIT) includes an interaction of innate and adaptive immune processes, resulting in immune tolerance, as illustrated by a decrease in specific immunoglobulin (Ig)-E, an increase in specific IgG1 and IgG4, and inhibition of inflammation involving mast cells, basophils, and eosinophils. This induction of immune tolerance leads to a significant improvement in symptoms and decreased medication scores. A 3-to 5-year course of AIT is required to obtain this disease-modifying effect, which substantially differentiates AIT frompharmacologic treatment. A carry-over effect can persist for up to 12 years. Furthermore, AIT may prevent the onset of asthma in patients with allergic rhinitis, as well as decreasing the onset of new sensitizations to inhalant allergens. Several meta-analyses and controlled studies, involving adult and pediatric subjects, have indicated that both sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) are relatively safe, effective, and well tolerated. AIT may also have a positive impact on the cost to the healthcare system, as evidence indicates the cost-benefit of such treatment. Adherence to AIT is crucial for a positive clinical outcome and non-adherence represents a major drawback for such therapy. It actually concerns not only AIT but also various pharmacologic treatments for allergic respiratory diseases, as well as for other chronic illnesses. The issue of non-adherence is an emerging and worldwide problem for chronic diseases and could be an important factor responsible for an overall decrease in treatment efficacy and increased rates of hospitalization, morbidity, and mortality. This review provides an overview of the different reasons that may account for the low adherence rate for AIT. Some of these reasons can be related to the patient's age when they begin such therapy, the allergic disease being treated, and questions about the efficacy, costs, inconvenience, and safety of AIT. Well-structured educational programs,especially by healthcare professionals, the print media, and the Internet, are needed to improve adherence to AIT.

show abstract

Section: Educational Plansmentioning

confidence: 74%

Allergen Immunotherapy Adherence in the Real World: How Bad Is It and How Can It Be Improved?

Senna

Caminati

Lockey

2014

Curr Treat Options Allergy

View full text Add to dashboard Cite

show abstract

“…Among the reasons cited for discontinuing treatment, SLIT patients indicated efficacy concerns as the major basis for withdrawal [267]. Improvement of adherence is likely to be achieved by improving the patient information provided by prescribers [266,268,269] and reducing the interval between follow-up visits [269,270]. …”

Section: Chapter 10: Methodology Of Clinical Trialsmentioning

confidence: 99%

Sublingual immunotherapy: World Allergy Organization position paper 2013 update

Canonica

Cox

Pawankar

et al. 2014

World Allergy Organization Journal

447

421

View full text Add to dashboard Cite

We have prepared this document, “Sublingual Immunotherapy: World Allergy Organization Position Paper 2013 Update”, according to the evidence-based criteria, revising and updating chapters of the originally published paper, “Sublingual Immunotherapy: World Allergy Organization Position Paper 2009”, available at http://www.waojournal.org. Namely, these comprise: “Mechanisms of sublingual immunotherapy;” “Clinical efficacy of sublingual immunotherapy” – reporting all the data of all controlled trials published after 2009; “Safety of sublingual immunotherapy” – with the recently published Grading System for adverse reactions; “Impact of sublingual immunotherapy on the natural history of respiratory allergy” – with the relevant evidences published since 2009; “Efficacy of SLIT in children” – with detailed analysis of all the studies; “Definition of SLIT patient selection” – reporting the criteria for eligibility to sublingual immunotherapy; “The future of immunotherapy in the community care setting”; “Methodology of clinical trials according to the current scientific and regulatory standards”; and “Guideline development: from evidence-based medicine to patients' views” – including the evolution of the methods to make clinical recommendations.Additionally, we have added new chapters to cover a few emerging crucial topics: “Practical aspects of schedules and dosages and counseling for adherence” – which is crucial in clinical practice for all treatments; “Perspectives and new approaches” – including recombinant allergens, adjuvants, modified allergens, and the concept of validity of the single products. Furthermore, “Raising public awareness about sublingual immunotherapy”, as a need for our patients, and strategies to increase awareness of allergen immunotherapy (AIT) among patients, the medical community, all healthcare stakeholders, and public opinion, are also reported in detail.

show abstract

“…[163][164][165][166][167][168][169] are key (Grade C). 169 One randomized study suggests that adherence is much better with 3-monthly follow-up appointments compared to 6 or 12-monthly follow-up (Grade B). 171 Recommendations are summarized in Table 6.…”

Section: Adherencementioning

confidence: 99%

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

561

705

View full text Add to dashboard Cite

drawn on data from a systematic review of the literature, more recent published studies and multistakeholder expert clinical opinion. This Guideline is aimed at healthcare professionals who are encouraged to take the recommendations into account in the context of delivering clinical care. This Guideline is not a substitute for professional clinical judgment, which professionals need to exercise in the context of delivering personalised healthcare. AbstractAllergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach.The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass 766 | ROBERTS, PFAAR ET AL. tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children. | ME TH ODOLOGYThis Guideline was produced using the Appraisal of Guidelines forResearch & Evaluation (AGREE II) approach, 17,18 a structured approach to guideline production (see Table S1). This is designed to ensure appropriate representation of the full range of stakeholders, a careful search for and critical appraisal of the relevant literature, a systematic approach to the formulation and presentation of recommendations and steps to ensure that the risk of bias is minimized at each step of the process. The process started on April 2015 beginning with detailed face-to-face discussions agreeing on the process and the key clinical areas to address, followed by face-to-face meetings, and regular web conferences in which professional and lay representatives participated. | Clarifying the scope and purpose of the guidelinesThe scope of this EAACI Guideline is multifaceted...

show abstract

Causes of SLIT discontinuation and strategies to improve the adherence: a pragmatic approach

Cited by 49 publications

References 14 publications

Allergen Immunotherapy Adherence in the Real World: How Bad Is It and How Can It Be Improved?

Allergen Immunotherapy Adherence in the Real World: How Bad Is It and How Can It Be Improved?

Sublingual immunotherapy: World Allergy Organization position paper 2013 update

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Contact Info

Product

Resources

About