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. 2019 Mar;74(3):594-604.
doi: 10.1111/all.13598. Epub 2018 Oct 10.

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

Ulrich Wahn  1 , Claus Bachert  2 , Joachim Heinrich  3 , Hartmut Richter  4 , Stefan Zielen  5
Affiliations

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

Ulrich Wahn et al. Allergy. 2019 Mar.

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.

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Conflict of interest statement

U Wahn has received consulting fees from Allergopharma, Danone, Hipp, Merck, Novartis, IMS Health GmbH & Co and Stallergenes Greer; honoraria for lectures from ALK‐Abelló, Allergopharma, Allergy Therapeutics, LETI, MSD, Nestlé, Novartis, Nutricia and Stallergenes Greer; and research funding from Stallergenes Greer. C Bachert has received consulting fees or honoraria for lectures from ALK‐Abelló, Stallergenes Greer, HAL Allergy and IMS Health GmbH & Co. S Zielen has received fees for lectures and advisory boards from ALK‐Abelló Arzneimittel GmbH, Allergopharma GmbH, Allergy Therapeutics, Lofarma GmbH, bene‐Arzneimittel GmbH, Biotest, Boehringer Ingelheim, GlaxoSmithKline GmbH, IMS Health GmbH & Co. OHG, Novartis AG and Vifor Pharma Deutschland GmbH. J Heinrich has received consulting fees from Boehringer Ingelheim, IMS Health GmbH & Co. OHG and Kabi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1
Figure 1
Proportion of patients not using AR symptomatic medication (A) and percentage‐point reduction from baseline in AR symptomatic medication prescriptions (B) during follow‐up. *P < 0.001 vs non‐AIT control group. AIT, allergen immunotherapy; AR, allergic rhinitis; OR, odds ratio; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy
Figure 2
Figure 2
Proportion of patients with birch family pollen‐associated AR but no concomitant asthma at baseline who started asthma medication use by end of study. AIT, allergen immunotherapy; AR, allergic rhinitis; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy
Figure 3
Figure 3
Odds of starting asthma medication use during the treatment (A), post‐treatment (B) or full‐analysis (C) periods in patients with birch family pollen‐associated AR but no concomitant asthma at baseline. AIT, allergen immunotherapy; CI, confidence interval; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy
Figure 4
Figure 4
Proportion of patients not using asthma medication (A) and percentage‐point reduction from baseline in asthma medication use (B) during follow‐up. *P < 0.001 vs non‐AIT control group. AIT, allergen immunotherapy; OR, odds ratio; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy
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