Despite proven efficacy of subcutaneous allergy immunotherapy, many patients do not complete the prescribed 3-5 year course and fail to derive any therapeutic benefit. This study was undertaken to examine the factors leading to premature discontinuation of subcutaneous immunotherapy.
Methods:
The patients who discontinued immunotherapy prior to the completion of the prescribed duration were contacted in the office, via phone or letter to identify the reason for stopping subcutaneous immunotherapy injections.
Results:
The study population consisted of a total of 555 patients with allergic rhinitis, asthma or both who terminated immunotherapy prematurely. Sixty eight (68%) percent were on maintenance dose and 32% were in the escalation phase. Two hundred and thirteen (38.4%) were males and 342 (61.6%) were females. The following reasons were cited by patients for non-adherence to immunotherapy – requirement of co-payment for allergy injections, payment for allergen extract, or both by their health insurer (40%), inconvenience of travel (15%), change of residence (8%), concurrent health problems (5%), patient-perceived ineffectiveness (4%), patient perceived lack of need to continue immunotherapy (2%), and adverse effects of injection (local reaction– 1%; systemic allergic reaction– 0.5%). There was no reason provided by the remaining 24.5% of patients.
Conclusions:
Of the various factors leading to subcutaneous allergy immunotherapy discontinuation, inadequate reimbursement for allergen extract and allergy injections by health insurers is the most common reason cited for non-adherence.