Demoly Pascal, Passalacqua Giovanni, Pfaar Oliver, Sastre Joaquin, Wahn Ulrich
Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.
Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Genoa, Italy.
Allergy Asthma Clin Immunol. 2016 Jul 29;12:34. doi: 10.1186/s13223-016-0140-2. eCollection 2016.
Allergy immunotherapy (AIT) is acknowledged to produce beneficial mid- and long-term clinical and immunologic effects and increased quality of life in patients with allergic respiratory diseases (such as allergic rhinoconjunctivitis and allergic asthma). However, poor adherence to AIT (due to intentional and/or non-intentional factors) is still a barrier to achieving these benefits. There is an urgent need for patient support programs (PSPs) that encompass communication, educational and motivational components. In the field of AIT, a PSP should be capable of (1) improving adherence, (2) boosting patient engagement, (3) explaining how AIT differs from pharmacological allergy treatments; (4) increasing health literacy about chronic, progressive, immunoglobulin-E-mediated immune diseases, (5) helping the patient to understand and manage local or systemic adverse events, and (6) providing and/or predicting local data on aeroallergen levels. We reviewed the literature in this field and have identified a number of practical issues to be addressed when implementing a PSP for AIT: the measurement of adherence, the choice of technologies, reminders, communication channels and content, the use of "push" messaging and social networks, interactivity, and the involvement of caregivers and patient leaders. A key issue is "hi-tech" (i.e. approaches based mainly on information technology) vs. "hi-touch" (based mainly on interaction with humans, i.e. family members, patient mentors and healthcare professionals). We conclude that multistakeholder PSPs (combining patient-, provider and society-based actions) must now be developed and tested with a view to increasing adherence, efficacy and safety in the field of AIT.
变应性免疫疗法（AIT）被认为能对变应性呼吸道疾病（如变应性鼻结膜炎和变应性哮喘）患者产生有益的中长期临床和免疫学效果，并提高生活质量。然而，由于有意和/或无意因素导致的对AIT的依从性差，仍然是实现这些益处的障碍。迫切需要包含沟通、教育和激励成分的患者支持项目（PSP）。在AIT领域，一个PSP应能够：（1）提高依从性；（2）增强患者参与度；（3）解释AIT与药物性变应性治疗的不同之处；（4）提高对慢性、进行性、免疫球蛋白E介导的免疫疾病的健康素养；（5）帮助患者理解和处理局部或全身不良事件；（6）提供和/或预测空气中变应原水平的局部数据。我们回顾了该领域的文献，并确定了在实施AIT的PSP时需要解决的一些实际问题：依从性的测量、技术的选择、提醒、沟通渠道和内容、“推送”信息和社交网络的使用、交互性以及照顾者和患者领袖的参与。一个关键问题是“高科技”（即主要基于信息技术的方法）与“高接触”（主要基于与人类的互动，即家庭成员、患者导师和医疗保健专业人员）的对比。我们得出结论，现在必须开发和测试多利益相关方的PSP（结合基于患者、提供者和社会的行动），以期提高AIT领域的依从性、疗效和安全性。
