152 Patterns of Initiation and Adherence to de novo Allergen-Specific Immunotherapy Among Adults and Children with Newly-Diagnosed Allergic Rhinitis: Findings From Research Jointly Funded by the AAAAI AND ACAAI

BACKGROUND: Although allergen-specific immunotherapy (SIT) is the only disease-modifying treatment currently available for allergic rhinitis (AR), few potentially appropriate United States patients initiate or sufficiently adhere to treatment.(1,2) We compared SIT initiation and adherence between AR-diagnosed children and adults. METHODS: Selected were child (age <18 years) and adult (age ≥18 years) Florida Medicaid enrollees (1997–2009) with newly-diagnosed AR (no AR claim within 1 year preceding the first identified AR diagnosis) who received de novo SIT (no SIT preceding the first AR diagnosis), had ≥4 years of follow-up from first AR diagnosis, and 6 months of follow-up from first SIT administration. T tests, Wilcoxon signed-rank tests, and chi-squares compared differences between children and adults. RESULTS: Overall, 8% (330,993/4,193,986) of children and 3% (105,380/3,330,245) of adults received ≥1 AR diagnosis (P < 0.0001). Among these, 2,913 children and 1,332 adults met study criteria. Adults were 3.6 times more likely than children to immediately initiate SIT (ie on the date of their first AR diagnosis) (OR 3.6, 95 % CI, 3.1-4.2, P < 0.0001); children were twice as likely as adults to receive SIT ≥1 year from the first AR diagnosis (OR 2.2, 95 % CI, 1.9-2.6, P < 0.0001). The median number of SIT administrations was 13 for children and 5 for adults (P < 0.0001). Fourteen percent of children and 20% of adults discontinued SIT after 1 administration; 33% of children and 52% of adults discontinued after 5 administrations. Adults were 1.6 and 2.3 times more likely than children to discontinue SIT following 1 only administration (OR 1.6, 95% CI, 1.3-1.9, P < 0.0001) and 5 administrations (OR 2.3, 95% CI, 2.0-2.6, P < 0.0001), respectively. CONCLUSIONS: Although adults were significantly more likely to immediately initiate SIT, they were also significantly more likely to discontinue treatment within the first 5 administrations. These preliminary findings may guide development of future patient-specific interventions to improve SIT access and continuity of care.