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Consider patient adherence when prescribing allergy immunotherapy
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HOUSTON — Patient adherence is an important factor for allergists to consider when deciding which allergy immunotherapy to prescribe, according to several discussions held during the American College of Allergy, Asthma and Immunology Annual Scientific Meeting.
“This is, at the end of the day, why we think about individualizing treatments,” John Oppenheimer, MD, FACAAI, of the department of medicine at Rutgers New Jersey Medical School, told attendees.
A few common concerns have emerged among patients who do not adhere to their immunotherapy, according to Oppenheimer. These concerns among patients who received subcutaneous immunotherapy include inconvenience, excessive time commitment, medical comorbidities — particularly psychiatric conditions and pregnancy — symptom improvement, financial problems, family difficulties and adverse events.
All of those factors were also cited as reasons for not adhering by patients who received sublingual immunotherapy, Oppenheimer continued, noting that the only unique characteristic among this latter group was lack of efficacy.
Those findings can provide talking points for allergists and primary care physicians when discussing allergy immunotherapy adherence, Mike Tankersley, MD, MBA, FAAAAI, FACAAI, of the departments of medicine, pediatrics and otolaryngology at the University of Tennessee Medical Center, said.
“Have a 2-minute speech prepared for each therapy that contains its pros and cons, such as time commitment, benefits, risks and financials,” Tankersley told attendees. “For example, our office has the patient’s insurance verification [for each therapy] before the patient even comes in. ... I share that sheet with the patient.”
Another critical part of patient adherence is shared decision-making, Oppenheimer added.
“We need to remember that patients are individuals. There is no one size fits all,” Oppenheimer said. “When a physician’s goals don’t match the patient’s goals, you are not likely to see adherence. But when differences are discussed and resolved, you are more likely to see prolonged adherence.” – by Janel Miller
References:
Oppenheimer J. Identifying appropriate patients for different types of AIT.
Tankersley, M. Practical issues that may impede the success of AIT.
Both presented at: American College of Allergy, Asthma and Immunology Annual Scientific Meeting; Nov. 7-11, 2019; Houston.
Disclosures:
Oppenheimer reports adjudication with AstraZeneca, Novartis Abbvie; data safety and monitoring board responsibilities with GlaxoSmithKline, Novartis, Sanofi/Regeneron; consulting assignments with GlaxoSmithKline and Teva; and serving on the board of directors or council with ABAI and ABIM. Tankersley reports a relationship with ALK.