Lee Ji Ho, Lee So Hee, Ban Ga Young, Ye Young Min, Nahm Dong Ho, Park Hae Sim, Shin Yoo Seob
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
Yonsei Med J. 2019 Jun;60(6):570-577. doi: 10.3349/ymj.2019.60.6.570.
Allergen-specific immunotherapy (AIT) is known to be the only therapeutic modality to alter the natural course of allergic diseases. However, at least 3 years of treatment is recommended for achieving long-term disease modifying effect. This study aimed to investigate factors associated with immunotherapy non-adherence in real practice.
We retrospectively reviewed medical records of patients who were diagnosed with allergic rhinitis, asthma, or atopic dermatitis, and received AIT to common allergens such as house dust mite and/or pollens from January 2007 to August 2014. In this study, non-adherence was defined as not completing 3 years of AIT.
Among 1162 patients enrolled, 228 (19.6%) failed to complete 3 years of AIT. In multivariate analysis, age less than 20 years [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.70-5.69] and 20 to 40 years (OR 2.01, 95% CI 1.17-3.43), cluster build-up (OR 1.78, 95% CI 1.05-3.02) and ultra-rush build-up schedules (OR 5.46, 95% CI 2.40-12.43), and absence of visit to other departments in the same hospital (OR 1.87, 95% CI 1.05-3.32) were independently associated with immunotherapy non-adherence. Disease duration of 5-10 years was negatively associated with non-adherence compared to shorter disease duration of less than 5 years (OR 0.61, 95% CI 0.40-0.94). Although male sex and commercial product of AIT, Tyrosine S®, compared to Novo-Helisen® were non-adherent factors in univariate analysis, no statistical significances were identified in multivariate analysis.
Various factors are associated with immunotherapy adherence affecting the utility of immunotherapy. Clinicians should be aware of factors associated with adherence to maximize the utility of allergen-specific subcutaneous immunotherapy.
变应原特异性免疫疗法（AIT）是已知唯一可改变过敏性疾病自然病程的治疗方式。然而，为实现长期疾病改善效果，建议至少进行3年治疗。本研究旨在调查实际临床中与免疫疗法不依从相关的因素。
我们回顾性分析了2007年1月至2014年8月期间被诊断为过敏性鼻炎、哮喘或特应性皮炎，并接受针对屋尘螨和/或花粉等常见变应原的AIT治疗的患者的病历。在本研究中，不依从被定义为未完成3年的AIT治疗。
在纳入的1162例患者中，228例（19.6%）未完成3年的AIT治疗。多因素分析显示，年龄小于20岁[比值比（OR）3.11，95%置信区间（CI）1.70 - 5.69]和20至40岁（OR 2.01，95% CI 1.17 - 3.43）、集群递增方案（OR 1.78，95% CI 1.05 - 3.02）和超快速递增方案（OR 5.46，95% CI 2.40 - 12.43），以及未在同一家医院就诊于其他科室（OR 1.87，95% CI 1.05 - 3.32）与免疫疗法不依从独立相关。与病程小于5年的较短病程相比，病程5至10年与不依从呈负相关（OR 0.61，95% CI 0.40 - 0.94）。虽然在单因素分析中男性以及AIT的商业产品酪氨酸S®（与新海利森®相比）是不依从因素，但在多因素分析中未发现统计学意义。
多种因素与免疫疗法依从性相关，影响免疫疗法的效用。临床医生应了解与依从性相关的因素，以最大限度地发挥变应原特异性皮下免疫疗法的效用。
