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Patient management plan for sublingual allergen specific immunotherapy with birch pollen allergen and the maintenance of patient compliance
- Authors: Trusova O.V. 1, Kamaev A.V. 1, Makarova I.V. 1
- Affiliations:
- Pavlov First Saint Petersburg Medical University
- Issue: Vol 17, No 3 (2020)
- Pages: 64-73
- Section: Original studies
- URL: https://rusalljournal.ru/raj/article/view/1403
- DOI: https://doi.org/10.36691/RJA1403
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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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About the authors
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
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| 2. |
Fig. 2. Stage epicrisis after the course ASIT Staloral birch
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| 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
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| 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)
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| 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
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| 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.
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