High baseline prevalence of atopic comorbidities and medication use in children treated with allergy immunotherapy in the REAl-world effeCtiveness in allergy immunoTherapy (REACT) study

Abstract

BackgroundRespiratory allergy, commonly manifesting as allergic rhinitis (AR) and asthma, is a chronic progressive disease that frequently starts in childhood. Allergy immunotherapy (AIT) is the only causal treatment for respiratory allergy with the potential to modify the underlying cause of allergy and, ultimately, prevent disease progression. This analysis aimed to determine if AIT is received sufficiently early to halt the progression of allergic disease, by characterizing the burden and progression of disease in children prior to AIT initiation in real-life clinical practice.MethodsThe REAl-world effeCtiveness in allergy immunoTherapy (REACT) study was a large retrospective cohort study using German claims data between 2007 and 2017. Characteristics of two pre-defined AIT age cohorts from the REACT study – children (aged <18 years) and adults (aged ≥18 years) – were evaluated during the 1-year period before the first AIT prescription. For comparison, a control group of all subjects with a confirmed diagnosis of AR and without prescriptions for AIT was included. Burden of disease was assessed using diagnostic codes for atopic comorbidities [e.g., atopic dermatitis (AD), asthma, and acute allergic conjunctivitis] and non-atopic comorbidities (e.g., migraine, headache); medication use, recorded as prescriptions for symptom-relieving AR medication and reliever/controller medication for asthma, was also assessed. Data were analyzed descriptively, using summary statistics.ResultsBoth children (n = 11,036) and adults (n = 30,037) showed a higher prevalence of atopic comorbidities and a greater drug burden prior to AIT initiation compared to AR patients not treated with AIT (n = 1,003,332). In the two age-specific AIT cohorts, children consistently showed the highest prevalence of atopic comorbidities compared to adults (AIT children, AIT adults – asthma: 41.4%, 34.5%; AD: 19.9%, 10.2%; acute allergic conjunctivitis: 13.6%, 10.2%). Generally, prescriptions per year for symptom-relieving AR and asthma treatments were also higher for children initiating AIT vs. adults (AIT children, AIT adults – AR prescriptions per subject: 1.72, 0.73; asthma prescriptions per subject: 1.42, 0.79).ConclusionsChildren with AR who are offered AIT in real-life show considerable disease burden prior to initiation. As AIT may alleviate the burden and halt the progression of allergic disease, considering AIT earlier in the disease course may be warranted.

SQ sublingual immunotherapy tablets for children with allergic rhinitis: A review of phase three trials

“…Long‐term data have also been generated for SQ grass and tree pollen SCIT in children, 13 and for the Japanese cedar SLIT tablet, 18 supporting the disease‐modifying role of AIT in children. However, despite its reported benefits in children with allergic rhinitis that is poorly controlled by symptom‐relieving medication, 45 AIT is underutilised in the paediatric population 11 . AIT is often initiated only when the allergic disease has progressed and comorbidities, such as asthma, have developed 11 .…”

“…However, despite its reported benefits in children with allergic rhinitis that is poorly controlled by symptom‐relieving medication, 45 AIT is underutilised in the paediatric population 11 . AIT is often initiated only when the allergic disease has progressed and comorbidities, such as asthma, have developed 11 . To ensure optimal management and reduce the burden of allergic disease, physicians could consider initiating AIT earlier in the disease course in eligible children 11,12 …”

“…AIT is often initiated only when the allergic disease has progressed and comorbidities, such as asthma, have developed 11 . To ensure optimal management and reduce the burden of allergic disease, physicians could consider initiating AIT earlier in the disease course in eligible children 11,12 …”

“…Asthma is present in up to 50% of children with allergic rhinitis 9,10 . The presence of asthma and other comorbidities can further increase the burden of disease 4,11 …”