Volume 10 Supplement 1

Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2013

Open Access

Administration and burden of subcutaneous immunotherapy for allergic rhinitis in clinical practice in Canada

  • Steven W Blume1,
  • Karen Yeomans2,
  • Harold Kim1,
  • Sunning Tao2,
  • Stephanie M Hubbard3 and
  • Felicia Allen-Ramey4Email author
Allergy, Asthma & Clinical Immunology201410(Suppl 1):A10

https://doi.org/10.1186/1710-1492-10-S1-A10

Published: 3 March 2014

Background

Allergic rhinitis (AR) has been estimated to affect approximately 20–25% of Canadians. [1] Management of AR encompasses allergen avoidance, use of symptomatic medications, and allergen immunotherapy for patients unresponsive to other pharmacotherapy. [2, 3] This study was conducted to characterize patients receiving subcutaneous immunotherapy (SCIT) and the SCIT administration process in Canada and the United States; Canadian results are presented.

Methods

A multi-center, prospective, observational study was conducted at 5 allergy clinics in Quebec and Ontario and 1 primary care clinic in Quebec from March-September 2012. Patients ≥6 years who were scheduled for SCIT on study days were invited to participate in the study. Patients enrolled in a clinical trial, receiving sublingual immunotherapy or allergic only to insect venom, latex, food, or drugs were excluded. Site and patient-specific information were captured via direct observation, questionnaires, and medical chart review. Costs were estimated from time and supply observation and query.

Results

A total of 294 patients were enrolled with a mean age of 44 years (4% <18 years and 9% ≥65 years). Of these, 59% were female, 81% Caucasian, 57% employed full-time and 30% reported household income ≥$100,000. Concomitant allergy medications were reported by 66% of patients; 25% used asthma medications. Two-thirds of patients reported initiating SCIT because they desired a cure “once and for all” for their allergies. Primary symptoms at initiation of SCIT were nasal congestion (62%), rhinorrhea (59%), sneezing (35%) and itchy eyes (32%). Chart data indicated that patients received treatment for several different antigens (mean: 4; SD: 3); those most commonly noted were ragweed (82%), house dust mites (55%), grass (48%) and tree (48%). Sites reported a SCIT build-up phase requiring one injection/week over 12-52 weeks. The SCIT maintenance phase was reported as one injection/month over 4-5 years. Site-specific means (SDs) for total patient time in the clinic for SCIT ranged from 32 (11) to 49 (10) minutes, including a 30-minute required post-injection observation at all but one site. Average patient travel time to the office for SCIT was 20 (SD: 14) minutes. Mean time missed from work in the previous week was 0.7 hours. The direct costs of an injection ranged from $14 to $41 by site, with extract preparation or acquisition and administrative tasks the largest components.

Conclusions

Patients initiated SCIT to permanently resolve allergy symptoms. SCIT requires a long-term commitment, resulting in considerable direct and indirect costs.

Authors’ Affiliations

(1)
Evidera
(2)
United BioSource Corporation
(3)
United BioSource Corporation
(4)
Merck & Co., Inc.

References

  1. Canadian Allergy, Asthma and Immunology Foundation. 2013, Accessed July 11, [http://www.allergyfoundation.ca/website/asthma_allergies_brochure.pdf]
  2. Bahls C: In the clinic. Allergic rhinitis. Ann Intern Med. 2007, 146 (ITC4): 1-13.Google Scholar
  3. Price D, Bond C, Bouchard J: International Primary Care Respiratory Group (IPCRG) Guidelines: management of allergic rhinitis. PrimCare Respir J. 2006, 15: 58-70.View ArticleGoogle Scholar

Copyright

© Blume et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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