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Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma

(2019) ALLERGY. 74(3). p.594-604
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Abstract
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 AITs (native pollen SLIT/SCIT, four allergoid SCITs) 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.
Keywords
allergic rhinitis, asthma, real-world evidence, subcutaneous immunotherapy, sublingual immunotherapy, INTERNATIONAL CONSENSUS, RISK-FACTORS, DIAGNOSIS, VACCINES, ADULTS, HEALTH

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Chicago
Wahn, Ulrich, Claus Bachert, Joachim Heinrich, Hartmut Richter, and Stefan Zielen. 2019. “Real-world Benefits of Allergen Immunotherapy for Birch Pollen-associated Allergic Rhinitis and Asthma.” Allergy 74 (3): 594–604.
APA
Wahn, U., Bachert, C., Heinrich, J., Richter, H., & Zielen, S. (2019). Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma. ALLERGY, 74(3), 594–604.
Vancouver
1.
Wahn U, Bachert C, Heinrich J, Richter H, Zielen S. Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma. ALLERGY. 2019;74(3):594–604.
MLA
Wahn, Ulrich et al. “Real-world Benefits of Allergen Immunotherapy for Birch Pollen-associated Allergic Rhinitis and Asthma.” ALLERGY 74.3 (2019): 594–604. Print.
@article{8582264,
  abstract     = {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 AITs (native pollen SLIT/SCIT, four allergoid SCITs) 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 {\textrangle}= 2 successive seasonal treatment cycles; non-AIT patients had {\textrangle}= 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 {\textlangle} 0.001] (28.6\% covariate-adjusted reduction vs non-AIT; P {\textlangle} 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 {\textlangle} 0.001] (32\% reduction vs non-AIT; P {\textlangle} 0.001), or reduced existing asthma medication use (32\% covariate-adjusted reduction vs non-AIT; P {\textlangle} 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.},
  author       = {Wahn, Ulrich and Bachert, Claus and Heinrich, Joachim and Richter, Hartmut and Zielen, Stefan},
  issn         = {0105-4538},
  journal      = {ALLERGY},
  language     = {eng},
  number       = {3},
  pages        = {594--604},
  title        = {Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma},
  url          = {http://dx.doi.org/10.1111/all.13598},
  volume       = {74},
  year         = {2019},
}

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