Patient management plan for sublingual allergen specific immunotherapy with birch pollen allergen and the maintenance of patient compliance

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Abstract


BACKGROUND: Sublingual allergen­-specific immunotherapy (SLIT) inefficiencie is mainly caused by non-­compliance with the treatment regimen and premature treatment termination.

AIM: Frequency and causes of dropouts determination in children receiving SLIT with birch pollen according to the pre­-coseasonal protocol, and approbation of the developed visit-­to-­visit patient management plan (Plan).

MATERIALS AND METHODS: 332 cases of treatment with birch pollen in children are analyzed. 290 patients (72.1% boys, aged 5–18 years (9.82 years [5.93; 14.67]), received SLIT with birch pollen in 2012–2019. 42 patients received SLIT according to the Plan (69% boys, 8.95 years old [5.38; 11.79]) in 2017–2019.

RESULTS: A low dropout frequency was noted in the 1st and 2nd year of therapy (2 years after the start of treatment, 85% patients continue it). However, only 63.1% complete 3 years of therapy, and 11% ­– 4 years of therapy. It has been shown that experienced allergists have more efficient patient retention. The implementation of the Plan increased patient retention in treatment at the 3rd year of treatment up to 82.9% (p=0.02).

CONCLUSION: The study confirmed the main reasons for the withdrawal of patients from SLIT: doubts about the effectiveness, cost and side effects. A low dropout frequency was shown according to the results of the 1st and 2nd years of therapy, but only a small proportion of patients (11%) receive 4 or more courses of therapy. Visit-­to-­visit Plan optimizes the patient’s management, reduces patients’ withdrawal from treatment and can be recommended for practical healthcare.


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Olga V. Trusova

Pavlov First Saint Petersburg Medical University

Author for correspondence.
Email: o-tru@mail.ru
ORCID iD: 0000-0002-0854-1536

Russian Federation, Saint Petersburg

associate professor, Department of Therapy with the course on Allergy and Immunology, Pavlov First Saint Petersburg Medical University, MD, PhD

Andrey V. Kamaev

Pavlov First Saint Petersburg Medical University

Email: andykkam@mail.ru
ORCID iD: 0000-0001-9654-3429

Russian Federation, Saint Petersburg

associate professor, Department of General Practice (Family Medicine), Pavlov First Saint Petersburg Medical University, MD, PhD

Irina V. Makarova

Pavlov First Saint Petersburg Medical University

Email: allergist_PI@mail.ru
ORCID iD: 0000-0002-4740-880X

Russian Federation, Saint Petersburg

associate professor, Department of Therapy with the course on Allergy and Immunology, Pavlov First Saint Petersburg Medical University, MD, PhD

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Supplementary files

Supplementary Files Action
1. Fig. 1. Management plan for a patient receiving birch pollen View (1MB) Indexing metadata
2. Fig. 2. Stage epicrisis after the course ASIT Staloral birch View (377KB) Indexing metadata
3. Fig. 3. Retention of patients undergoing treatment with birch pollen in the general group of patients and in patients observed by “experienced” allergists (group 1) and “novice” allergists (group 2); * p = 0.03; ** p = 0.0001 View (204KB) Indexing metadata
4. Fig. 4. The main reasons for dropping out of patients from treatment with birch pollen in the first two years of treatment in patients observed by "experienced" allergists (group 1) and "novice" allergists (group 2). A - treatment failure; B - adverse events; C - financial difficulties; D - frequent respiratory infections; E - persistent exacerbation of allergic diseases; F - indiscipline of the patient; G - organizational reasons (for example, moving the patient); * differences are statistically significant (p <0.05) View (126KB) Indexing metadata
5. Fig. 5. The main reasons for dropping out of patients from treatment with birch pollen in the third and fourth years of treatment in patients observed by "experienced" allergists (group 1) and "novice" allergists (group 2). A - treatment failure; B - adverse events; C - financial difficulties; D - frequent respiratory infections; E - persistent exacerbation of allergic diseases; F - patient's indiscipline; G - organizational reasons (eg, departure, relocation of the patient); H - the onset of the therapy effect, it was decided not to carry out the 4th course View (98KB) Indexing metadata
6. Fig. 6. Retention of patients on treatment with birch pollen in the general group of patients and in patients of allergists who used the Plan. * P = 0.02, the differences are statistically significant. View (179KB) Indexing metadata

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