Plessis Amy A, Cameron Scott B, Invik Rosemary, Hanna Mariam, Mack Douglas P, Cook Victoria E
Department of Pediatrics, Faculty of Medicine, University of British Columbia Island Medical Program, Victoria, BC, Canada.
Division of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
Allergy Asthma Clin Immunol. 2024 Oct 15;20(1):54. doi: 10.1186/s13223-024-00912-9.
Oral immunotherapy (OIT) is an increasingly utilized management strategy for IgE-mediated food allergy. Despite promising efficacy and effectiveness, there is still a lack of data surrounding the reasons for discontinuation of OIT. The primary reason stated in the literature for discontinuation is adverse gastrointestinal effects. Social factors contributing to OIT discontinuation have not been well reported. We hypothesize that social considerations are significant contributors to treatment discontinuation.
We completed a retrospective chart review of 50 patients treated in community pediatric allergy practices who discontinued OIT out of 507 patients who were started on OIT between October 1, 2017-October 27, 2022. Reasons for discontinuation were identified and classified into five main categories: unsafe care decisions, anxiety, adverse effects of OIT, uncontrolled comorbidity and social factors. Categories were not exclusive.
507 patients were started on OIT, with data available for 50 patients who discontinued OIT, aged 10 months to 18 years and 2 months. The overall discontinuation rate was 9.8%, of which 40 patients (80%) discontinued during buildup, 9 patients (18%) discontinued during maintenance and one patient on two food OIT discontinued one food during buildup and one during maintenance (2%). Thirty-four patients (68%) had multiple reasons for discontinuing OIT. Social factors were the most common reason for discontinuation and were identified in 32 patients (64%). Twenty-four patients (48%) discontinued OIT due to adverse effects. Gastrointestinal symptoms were the most prevalent, while anaphylaxis contributed to discontinuation in 15 patients (30%). Anxiety led to discontinuation in 17 patients (34%).
Our data highlights the importance of social factors and anxiety in the success of OIT completion. Our results support the need to consider not only the patient's medical history, but also their social history and support networks when selecting patients who are good candidates for OIT to optimize the successful completion of OIT.
口服免疫疗法（OIT）是一种越来越多地用于治疗IgE介导的食物过敏的管理策略。尽管其疗效和有效性令人期待，但围绕OIT停药原因的数据仍然匮乏。文献中指出的停药主要原因是胃肠道不良反应。导致OIT停药的社会因素尚未得到充分报道。我们推测社会因素是导致治疗中断的重要原因。
我们对2017年10月1日至2022年10月27日期间开始接受OIT治疗的507例患者中的50例在社区儿科过敏诊所接受治疗后停止OIT的患者进行了回顾性病历审查。确定停药原因并分为五个主要类别：不安全的护理决策、焦虑、OIT的不良反应、未控制的合并症和社会因素。这些类别并非相互排斥。
507例患者开始接受OIT治疗，有50例停止OIT治疗的患者的数据，年龄在10个月至18岁零2个月之间。总体停药率为9.8%，其中40例患者（80%）在剂量递增期停药，9例患者（18%）在维持期停药，1例接受两种食物OIT治疗的患者在剂量递增期停用一种食物，在维持期停用另一种食物（2%）。34例患者（68%）有多种停药原因。社会因素是最常见的停药原因，32例患者（64%）存在该因素。24例患者（48%）因不良反应而停止OIT治疗。胃肠道症状最为普遍，15例患者（30%）因过敏反应而停药。焦虑导致17例患者（34%）停药。
我们的数据突出了社会因素和焦虑对OIT治疗成功的重要性。我们的结果支持在选择适合OIT的患者时，不仅要考虑患者的病史，还要考虑他们的社会史和支持网络，以优化OIT的成功完成。
