Incorvaia Cristoforo, Heffler Enrico, Peveri Silvia, Pucciarini Francesco, Canonica Giorgio Walter, Ridolo Erminia
Senior Consultant, Post-graduate School of Allergology and Immunology, University of Parma, Parma, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
Front Allergy. 2022 Jun 28;3:886054. doi: 10.3389/falgy.2022.886054. eCollection 2022.
Adherence and compliance, respectively considered as a more positive, proactive behavior, resulting in a patient's lifestyle change to follow a daily regimen, and, as a more enforced response to an external command, are a critical aspect of any medical therapy, since it is estimated that less than half of the patients who are prescribed a therapy perform it, respecting the doses and duration. As far as aeroallergen immunotherapy is concerned, current data show that adherence is respected in about 50% of subcutaneous immunotherapy and in percentages even lower than 20% in sublingual immunotherapy treatments. This review analyzes the adherence to venom immunotherapy (VIT), in which, given its purpose of preventing potentially fatal anaphylactic reactions to insect stings, this aspect plays a critical role. In fact, protection from stings already takes place when the maintenance dose is reached, but VIT interruption before the recommended duration of 5 years exposes patients to new sting reactions. The data on adherence to VIT are far less abundant than that for aeroallergen immunotherapy. One of the first studies reported poor adherence in Austria, but the model used, consisting in the estimate of the percentage of patients with systemic reactions who accepted or rejected VIT, does not meet the criteria that define adherence to treatment. As for appropriate adherence studies, rates higher than 70% were reported in the United States and European countries. Studies from Italy found that good adherence were observed also in patients receiving, after 4 years of VIT, 3 months extended maintenance dose, as well as in patients treated during the COVID-19 pandemic, <10% of whom stopped VIT. Instead, only 35% of the patients treated for allergy to imported fire ant remained adherent after 1 year of treatment. However, also concerning honeybees and vespids, although adherence is satisfactory, it is possible to further improve it by increasing information and support for patients. Health-related quality of life (HRQL) is an efficient measure to estimate the effectiveness and safety of medical treatment. Tools designed to make patients aware of its improvement through VIT and, in particular, of the complete prevention of the risk of fatal reactions have an important role in reinforcing adherence. However, aspects not yet evaluated, such as the possible relationship between the efficacy of VIT and HRQL or its particular features in patients with mastocytosis, deserve specific studies.
依从性和顺从性分别被视为一种更积极、主动的行为，它会导致患者改变生活方式以遵循日常治疗方案；而顺从性则是对外部指令的一种更强制的反应，它们是任何医学治疗的关键方面，因为据估计，接受治疗的患者中不到一半会按照规定的剂量和疗程进行治疗。就变应原免疫疗法而言，目前的数据表明，约50%的皮下免疫疗法患者能做到依从，而在舌下免疫疗法治疗中，这一比例甚至低于20%。本综述分析了毒液免疫疗法（VIT）的依从性，鉴于其预防昆虫叮咬潜在致命过敏反应的目的，这方面起着关键作用。事实上，当达到维持剂量时就已经开始预防叮咬，但在推荐的5年疗程之前中断VIT会使患者面临新的叮咬反应风险。关于VIT依从性的数据远少于变应原免疫疗法。最早的一项研究报告称奥地利的依从性较差，但所采用的模型，即对接受或拒绝VIT的全身反应患者百分比的估计，并不符合定义治疗依从性的标准。至于适当的依从性研究，美国和欧洲国家报告的依从率高于70%。意大利的研究发现，接受4年VIT治疗后再延长3个月维持剂量的患者以及在新冠疫情期间接受治疗的患者中，观察到良好的依从性，其中不到10%的患者停止了VIT治疗。相反，在对进口火蚁过敏的患者中，只有35%在治疗1年后仍保持依从。然而，对于蜜蜂和黄蜂叮咬，尽管依从性令人满意，但通过增加对患者的信息提供和支持仍有可能进一步提高依从性。健康相关生活质量（HRQL）是评估医学治疗有效性和安全性的有效指标。旨在让患者意识到通过VIT其生活质量得到改善，特别是完全预防致命反应风险的工具，在增强依从性方面具有重要作用。然而，尚未评估的方面，如VIT疗效与HRQL之间的可能关系或肥大细胞增多症患者的特殊特征，值得进行专门研究。
