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Uncontrolled asthma prior to AIT seen in HDM allergy patients

A majority of patients in this study who underwent allergen immunotherapy for house dust mites showed house dust mite-allergic rhinitis-associated conjunctivitis, with more than 40% of patients showing uncontrolled asthma despite prescription medication prior to therapy, according to a recent study.

Pascal Demoly, MD, PhD, from the department of pulmonology‑division of allergy at Hospital Arnaud-De-Villeneuve, University Hospital of Montpellier, in Montpellier, France, and colleagues performed an observational, prospective cross-sectional study of 1,589 patients (60% adults, 40% children) with house dust mite (HDM) allergy. From those, 1,212 patients (52% women; median age, 22), with a median time to diagnosis of allergic rhinitis (AR) of 3 years, were selected to receive allergen immunotherapy (AIT), according to the abstract.

Within the subgroup, the researchers found 59% of patients had moderate to severe persistent AR, 57.5% were polysensitized and 56.5% had concomitant conjunctivitis with a median rhinitis total score of 11. Demoly and colleagues found 42% of patients had asthma and 62% of patients had controlled asthma according to Global Initiative for Asthma guidelines.

Twenty percent of patients had an asthma control questionnaire score of 1 to 1.5, and 37% of patients had a score that was 1.5 or higher. The mean rhinoconjunctivitis score was 2.7 ± 1.5, which translated to slight to moderate impairment of sleep quality and daily activities.

Patients received a two or more medications in 57% of cases, according to the abstract. Demoly and colleagues noted that the primary reason for prescription medication in cases of AIT was patient satisfaction due to ineffective controlling of AR from previous medication.

“Regardless of the group of patients, 94.5% of physicians reported they would like an improvement of AR symptoms and quality of life. The main expectations stated by about 90% of patients that were considered to be significant to very significant towards their new prescribed treatments were the relief of symptoms, no nasal congestion or runny nose, ease of breathing through the nose, and no sneezing fits, regardless of the group asked,” Demoly and colleagues wrote in their study. “Overall, these expectations were significantly more frequent in patients selected for AIT than others.” – by Jeff Craven

Disclosure: Demoly, Broué-Chabbert and Wessel are on the speaker’s bureau for and have received honoraria for attending advisory boards for ALK, Stallergènes, Thermo Fisher Scientific, Mundi Pharma, Menarini, Circassia, Allergopharma, AstraZeneca, Pierre Fabre Médicaments and Chiesi, and Chartier is the Medical Director for ALK in France.