Improved Patient Adherence to Subcutaneous Allergen Immunotherapy Using a Modified Rush Immunotherapy Protocol
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Jordan N. Teachout, Stason Vandegrift, Christine M. Schafer, MD FAAAAI, Mark Trottier, PhD, Sara J. Uekert, MD FAAAAI, Karyn E. Gell, MD FAAAAI, Tracy Koehler, PhD, Alan Davis, PhD
RATIONALE: Allergen immunotherapy (AIT) is effective in treating allergic disease, yet patient adherence is poor. We hypothesized increased adherence would occur with a modified rush protocol, defined as an accelerated one day build for the first two dilutions, followed by a conventional build to successfully reach maintenance dose.

METHODS: Patients 12 years and older who began immunotherapy at Grand Rapids Allergy in 2014 were offered a modified rush or a conventional build protocol. Patients were retrospectively analyzed for adherence, defined as ordering a maintenance vial, and systemic reactions.

RESULTS: There were 623 subjects, 392 in the conventional group and 231 in the rush group. There was no significant difference in age between the two groups (p=0.212). Of the 392 subjects in the conventional group, 253 reached maintenance (64.5%). Of the 231 modified rush subjects, 195 reached maintenance (84.4%). There was a statistically significant difference (p<0.001) in the proportion of patients who reached maintenance dose between the two immunotherapy groups. As age increased, so did the likelihood of reaching maintenance dose (95% CI: 1.01-1.03). Safety data analyzing the systemic reaction rate of the modified rush group is pending.

CONCLUSIONS: AIT with a modified rush protocol significantly improves adherence to reach a maintenance dose compared to patients with a pure conventional build. Maintenance dosing improves symptom control and allows patients to lengthen injections to monthly intervals, lessening the time commitment. Improved adherence may also decrease the medical complications of undertreated allergic rhinitis and the financial burden of allergic disease.