@IT2020: An innovative algorithm for allergen immunotherapy prescription in seasonal allergic rhinitis

Abstract

Background: Allergen immunotherapy (AIT) is the only disease-modifying treatment in patients with seasonal allergic rhinoconjunctivitis (SAR). Its efficacy depends on the precise identification of the triggering allergen. However, diagnostics based on retrospective clinical history and sensitization to whole extracts (SWE) often leads to equivocal results. Objectives: To assess the usability and impact of a recently established algorithm for a clinical decision support system (@IT2020-CDSS) for SAR and its diagnostic steps [anamnesis, SWE (skin prick test or serum IgE), component resolved diagnosis, CRD, and real-time digital symptom recording, eDiary] on doctor's AIT prescription decisions. Methods: After educational training on the @IT2020-CDSS algorithm, 46 doctors (18 allergy specialists, AS, and 28 general practitioners, GP) expressed their hypothetical AIT prescription for 10 clinical index cases. Decisions were recorded repeatedly based on different steps of the algorithm. The usability and perceived impact of the algorithm were evaluated. Results:The combined use of CRD and an eDiary increased the hypothetical AIT prescriptions, both among AS and GP (p < .01). AIT prescription for pollen and Alternaria allergy based on anamnesis and SWE was heterogeneous but converged towards a consensus by integrating CRD and eDiary information. Doctors considered the algorithm useful and recognized its potential in enhancing traditional diagnostics. Conclusions and clinical implications:The implementation of CRD and eDiary in the @IT2020-CDSS algorithm improved consensus on AIT prescription for SAR among AS and GP. The potential usefulness of a CDSS for aetiological diagnosis of SAR and AIT prescription in real-world clinical practice deserves further investigation.

Validation Parameters of Patient-Generated Data for Digitally Recorded Allergic Rhinitis Symptom and Medication Scores in the @IT.2020 Project: Exploratory Study

“…In the context of this project, 101 patients experiencing seasonal allergic rhinitis were recruited in the Sandro Pertini Hospital in Rome. The detailed study protocol has been published previously [ 26 , 27 ]. Briefly, recruited patients underwent a medical examination first (T0), including skin prick testing, blood sampling, and clinical questionnaires.…”

“…After 3 days of missed recording, the patient received an individual email or phone call from the study center to ensure that no technical problems had occurred. Adherence was measured as the percentage of days with completed electronic diary recording in the monitoring period [ 26 ]. Patients with adherence to recording above or below the arbitrary threshold of 80% were defined as high or low adherence, respectively.…”

“…The purpose of this study is to retrospectively investigate 4 putative validation criteria to assess the quality of data longitudinally collected by patients with seasonal allergic rhinitis and defined as follows: (1) intravariation index, (2) percentage of zero values, (3) coefficient of variation, and (4) percentage of changes in trends. To this end, we have taken advantage of the patient-generated symptom and medication data set, which has been acquired via a mobile app in a cohort of patients with seasonal allergic rhinitis in the context of the @IT.2020 pilot project [ 26 , 27 ].…”

Heterogeneous validity of daily data on symptoms of seasonal allergic rhinitis recorded by patients using the e‐diary AllergyMonitor®

“…The study design and procedures have been approved by the local ethical committees. Further details on the study population are published elsewhere 21 …”

“…In the case of not entering any data for two consecutive days, users received an automatic alert message on their mobile phone or by email; after 3 days of missed reporting, the alert was followed by a phone call from the study physician or nurse. Further details on the @IT.2020 pilot study are available elsewhere 21 …”