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Real‐world benefits of allergen immunotherapy for birch pollen‐associated allergic rhinitis and asthma
Author(s) -
Wahn Ulrich,
Bachert Claus,
Heinrich Joachim,
Richter Hartmut,
Zielen Stefan
Publication year - 2019
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13598
Subject(s) - medicine , asthma , allergen immunotherapy , odds ratio , confidence interval , medical prescription , allergy , retrospective cohort study , cohort , allergen , immunology , pharmacology
Background Real‐world evidence is sparse on the benefits of allergen immunotherapy [ AIT ; subcutaneous/sublingual immunotherapy ( SCIT / SLIT )], the only disease‐modifying intervention for allergic rhinitis ( AR ) with long‐term efficacy. This real‐life study evaluated the effect of six AIT s (native pollen SLIT / SCIT , four allergoid SCIT s) vs symptomatic medication use, on AR symptoms and asthma symptoms/onset, in patients with birch pollen‐associated AR and/or asthma. Methods In this retrospective cohort analysis of a German longitudinal prescription database, AIT patients received ≥2 successive seasonal treatment cycles; non‐ AIT patients had ≥3 AR prescriptions in three seasons or previous month. Patients were matched for: index year, age, gender, main indication at index, number of seasonal cycles within treatment period, baseline AR /asthma treatment prescriptions. Multiple regression analysis compared prescription data in AIT and non‐ AIT groups as proxy for clinical status/disease progression. Results Up to 6 years of follow‐up, significantly more AIT (65.4%) vs non‐ AIT (47.4%) patients were AR medication‐free; odds ratio ( OR ) [95% confidence interval ( CI )]: 0.51 [(0.48‐0.54); P < 0.001] (28.6% covariate‐adjusted reduction vs non‐ AIT ; P < 0.001), and significantly more AIT (49.1%) vs non‐ AIT (35.1%) patients were asthma medication‐free [ OR (95% CI ): 0.59 (0.55‐0.65); P < 0.001] (32% reduction vs non‐ AIT ; P < 0.001), or reduced existing asthma medication use (32% covariate‐adjusted reduction vs non‐ AIT ; P < 0.001). During treatment, new‐onset asthma risk was significantly reduced in the AIT vs non‐ AIT group ( OR : 0.83; P = 0.001). Conclusions Birch pollen AIT demonstrated real‐world benefits up to 6 years post‐treatment cessation through significantly reduced AR and asthma medication intake, and significantly decreased risk of new‐onset asthma medication use on‐treatment.