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Healthcare Providers' Perception Versus Reality In Patient Concerns About Starting Subcutaneous Immunoglobulin
AB146 Abstracts
511
SUNDAY
Clinical Efficacy Of Subcutaneous and Sublingual Immunotherapy In Asthma and Rhinitis Children Sensitized To House Dust Mite Min-Ju Kim1,2, Eun Lee1,3, Keun-Mi Park1, Keum-Hee Hwang1, Young-Ho Jung1,3, Song-Yi Yang1,4, Jae-Eun Lee2, Hee-Kyeong Kim2, Hye-yeong Lee2, Jin-ho Yu1, Prof. Soo-Jong Hong, MD, PhD1,3; 1 Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, South Korea, 2 Department of Children’s Hospital Nursing, Asan Medical Center, South Korea, 3Research Center for Standardization of Allergic Disease, University of Ulsan College of Medicine, Seoul, Korea, 4Research Center for Standardization of Allergic Disease, University of Ulsan College of Medicine, Seoul, Korea, South Korea. RATIONALE: Specific immunotherapy is the one of the treatment modality with the potential to alter the natural course of allergic diseases. In children, the clinical efficacy of subcutaneous immunotherapy (SCIT) compared with sublingual immunotherapy (SLIT) remains unclear. METHODS: We performed a prospective trial in 53 patients with house dust mite-sensitized asthma and rhinitis either SCIT (Allergopharma, Germany,n533) or SLIT (SLITone, Spain, n520). The patients were followed up with symptom questionnaires and skin prick test at baseline and 3, 6, and 12 months after treatment. Specific IgE levels, eosinophil counts, bronchial hyperresponsiveness to methacholine and adenosine-5’-monophosphate (AMP) were performed at baseline and 12 months. RESULTS: The improvement in rhinitis symptoms was significant in both groups, whereas asthma symptoms were improved only in SCIT. In both groups, skin reactivity and the bronchial hyperreactivity by methacholine at 12 months after treatment decreased significantly compared to baseline. The development of new sensitization happened in 9% of the SCIT and 23.5% of the SLIT. A significant reduction in eosinophil counts was observed only in SCIT. No changes were observed for specific IgE levels and bronchial hyperresponsiveness to AMP. No serious adverse effects were reported in both groups. CONCLUSIONS: The symptoms of rhinitis, skin reactivity and bronchial hyperreactivity by methacholine were somewhat improved in both group. SCIT, however, showed better efficacy in the symptoms of asthma, eosinophil counts and new sensitization than SLIT. More studies in children to address the long-term efficacy of these two most often used modes of immunotherapy are needed in a larger scale.
512
A Patient-Reported Symptom-Based Predictor Of Objective Sinus Inflammation Ms. Alcina K. Lidder, BA1, Dr. Rakesh Chandra, MD2, Dr. David Conley, MD1, Dr. Stephanie Shintani-Smith, MD1, Dr. Anju T. Peters, MD, FAAAAI3, Dr. Leslie C. Grammer, MD, FAAAAI3, Dr. Robert C. Kern, MD1, Dr. Brian Schwartz, MD4,5, Dr. Bruce K. Tan, MD1; 1Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, 2Northwestern University, Chicago, IL, 3Department of Medicine, Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, 4 Center for Health Research, Geisinger Clinic, Danville, PA, 5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. RATIONALE: Guidelines for diagnosing chronic rhinosinusits (CRS) require symptoms and evidence for objective sinus inflammation on computed tomography (CT) or endoscopy. Identifying patient reported symptoms that correlate with objective inflammation facilitates accurate diagnosis by providers and can significantly advance epidemiological studies of CRS. METHODS: Consecutive patients presenting with three months of sinonasal complaints without a prior CRS diagnosis were prospectively screened for eligibility. All patients completed a self-administered questionnaire prior to medical evaluation, endoscopy and received a protocolled sinus CT scan to establish objective inflammation. Questionnaire items included medical history (n512), symptom items
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
drawn from the rhinitis, migraine, and rhinosinusitis literature (n547), and quality of life (n532). RESULTS: Of 531 patients screened for eligibility, 300 enrolled in the study. A total of 274 (91.3%) subjects met guideline-based symptom criteria for CRS but only 112 (37.3%) had objective inflammation on CT (Sensitivity 97%; Specificity 12%). Diagnostically relevant symptoms were established by bivariate analysis and modeled using a stepwise logistic regression that identified frequency of ‘‘discolored discharge’’; severity of ‘‘smell loss’’ and ‘‘difficulty breathing through my nose’’; the presence of asthma; and lack of ‘‘recurrent headaches’’ modeled objective inflammation (p<0.05). Notably, allergic rhinitis history, symptoms of facial pain and/or pressure, post-nasal drip and migraine symptoms were not associated with objective inflammation. The predicted probabilities generated by multivariable logistic regression of significant symptoms produced an ROC curve that modeled of CRS status c50.78 (95%CI: 0.730.84). CONCLUSIONS: Three symptoms and two medical history items significantly predict CRS status although further optimization of sensitivity and specificity is needed.
513
Healthcare Providers' Perception Versus Reality In Patient Concerns About Starting Subcutaneous Immunoglobulin Ms. Carla M. Duff, CPNP, MSN1, Ms. Annette R. Zampelli, NP2, Dr. Ann Bullinger, PharmD2; 1University of South Florida, Tampa, FL, 2 CSL Behring, LLC, King of Prussia, PA. RATIONALE: Standard treatment for humoral primary immunodeficiency disease (PIDD) is immunoglobulin replacement via the intravenous or subcutaneous route. Most patients begin treatment with intravenous immunoglobulin (IVIG), but may then switch to subcutaneous immunoglobulin (SCIG) because of patient or physician preference. Healthcare providers (HCPs) and patients were surveyed to gain insight into the perceptions and reasons patients cited for remaining on IVIG. METHODS: Nurses (n551) and physicians (n526) experienced with immunoglobulin therapy participated in surveys conducted at professional conferences. Patients (n5131) with PIDD receiving immunoglobulin therapy participated in unbranded surveys distributed online by the Immune Deficiency Foundation. RESULTS: When asked why some patients were reluctant to start SCIG therapy, physicians (46%) and nurses (33%) stated ‘‘reluctance to selfadminister treatment,’’ followed by ‘‘concern about needle sticks/infusion sites’’ (physicians, 31%; nurses, 29%). In contrast, when patients receiving IVIG were asked why they did not use SCIG, only 4% cited ‘‘concern about learning how to self-infuse’’ and 6% cited ‘‘concern about needle sticks/ infusion sites.’’ The most frequent reason (27%) patients reported for not using SCIG was ‘‘satisfaction with IVIG.’’ Of patients receiving SCIG, 73% reported that any concerns before starting SCIG did not remain; cost had been the main concern (22%). CONCLUSIONS: The perception of HCPs regarding reasons why patients with PIDD are reluctant to choose SCIG therapy appears to differ from those stated by patients. Awareness of patient reasons for choosing IVIG or SCIG may allow HCPs to better educate and communicate with their patients when discussing immunoglobulin therapy options.
511
SUNDAY
Clinical Efficacy Of Subcutaneous and Sublingual Immunotherapy In Asthma and Rhinitis Children Sensitized To House Dust Mite Min-Ju Kim1,2, Eun Lee1,3, Keun-Mi Park1, Keum-Hee Hwang1, Young-Ho Jung1,3, Song-Yi Yang1,4, Jae-Eun Lee2, Hee-Kyeong Kim2, Hye-yeong Lee2, Jin-ho Yu1, Prof. Soo-Jong Hong, MD, PhD1,3; 1 Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, South Korea, 2 Department of Children’s Hospital Nursing, Asan Medical Center, South Korea, 3Research Center for Standardization of Allergic Disease, University of Ulsan College of Medicine, Seoul, Korea, 4Research Center for Standardization of Allergic Disease, University of Ulsan College of Medicine, Seoul, Korea, South Korea. RATIONALE: Specific immunotherapy is the one of the treatment modality with the potential to alter the natural course of allergic diseases. In children, the clinical efficacy of subcutaneous immunotherapy (SCIT) compared with sublingual immunotherapy (SLIT) remains unclear. METHODS: We performed a prospective trial in 53 patients with house dust mite-sensitized asthma and rhinitis either SCIT (Allergopharma, Germany,n533) or SLIT (SLITone, Spain, n520). The patients were followed up with symptom questionnaires and skin prick test at baseline and 3, 6, and 12 months after treatment. Specific IgE levels, eosinophil counts, bronchial hyperresponsiveness to methacholine and adenosine-5’-monophosphate (AMP) were performed at baseline and 12 months. RESULTS: The improvement in rhinitis symptoms was significant in both groups, whereas asthma symptoms were improved only in SCIT. In both groups, skin reactivity and the bronchial hyperreactivity by methacholine at 12 months after treatment decreased significantly compared to baseline. The development of new sensitization happened in 9% of the SCIT and 23.5% of the SLIT. A significant reduction in eosinophil counts was observed only in SCIT. No changes were observed for specific IgE levels and bronchial hyperresponsiveness to AMP. No serious adverse effects were reported in both groups. CONCLUSIONS: The symptoms of rhinitis, skin reactivity and bronchial hyperreactivity by methacholine were somewhat improved in both group. SCIT, however, showed better efficacy in the symptoms of asthma, eosinophil counts and new sensitization than SLIT. More studies in children to address the long-term efficacy of these two most often used modes of immunotherapy are needed in a larger scale.
512
A Patient-Reported Symptom-Based Predictor Of Objective Sinus Inflammation Ms. Alcina K. Lidder, BA1, Dr. Rakesh Chandra, MD2, Dr. David Conley, MD1, Dr. Stephanie Shintani-Smith, MD1, Dr. Anju T. Peters, MD, FAAAAI3, Dr. Leslie C. Grammer, MD, FAAAAI3, Dr. Robert C. Kern, MD1, Dr. Brian Schwartz, MD4,5, Dr. Bruce K. Tan, MD1; 1Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, 2Northwestern University, Chicago, IL, 3Department of Medicine, Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, 4 Center for Health Research, Geisinger Clinic, Danville, PA, 5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. RATIONALE: Guidelines for diagnosing chronic rhinosinusits (CRS) require symptoms and evidence for objective sinus inflammation on computed tomography (CT) or endoscopy. Identifying patient reported symptoms that correlate with objective inflammation facilitates accurate diagnosis by providers and can significantly advance epidemiological studies of CRS. METHODS: Consecutive patients presenting with three months of sinonasal complaints without a prior CRS diagnosis were prospectively screened for eligibility. All patients completed a self-administered questionnaire prior to medical evaluation, endoscopy and received a protocolled sinus CT scan to establish objective inflammation. Questionnaire items included medical history (n512), symptom items
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
drawn from the rhinitis, migraine, and rhinosinusitis literature (n547), and quality of life (n532). RESULTS: Of 531 patients screened for eligibility, 300 enrolled in the study. A total of 274 (91.3%) subjects met guideline-based symptom criteria for CRS but only 112 (37.3%) had objective inflammation on CT (Sensitivity 97%; Specificity 12%). Diagnostically relevant symptoms were established by bivariate analysis and modeled using a stepwise logistic regression that identified frequency of ‘‘discolored discharge’’; severity of ‘‘smell loss’’ and ‘‘difficulty breathing through my nose’’; the presence of asthma; and lack of ‘‘recurrent headaches’’ modeled objective inflammation (p<0.05). Notably, allergic rhinitis history, symptoms of facial pain and/or pressure, post-nasal drip and migraine symptoms were not associated with objective inflammation. The predicted probabilities generated by multivariable logistic regression of significant symptoms produced an ROC curve that modeled of CRS status c50.78 (95%CI: 0.730.84). CONCLUSIONS: Three symptoms and two medical history items significantly predict CRS status although further optimization of sensitivity and specificity is needed.
513
Healthcare Providers' Perception Versus Reality In Patient Concerns About Starting Subcutaneous Immunoglobulin Ms. Carla M. Duff, CPNP, MSN1, Ms. Annette R. Zampelli, NP2, Dr. Ann Bullinger, PharmD2; 1University of South Florida, Tampa, FL, 2 CSL Behring, LLC, King of Prussia, PA. RATIONALE: Standard treatment for humoral primary immunodeficiency disease (PIDD) is immunoglobulin replacement via the intravenous or subcutaneous route. Most patients begin treatment with intravenous immunoglobulin (IVIG), but may then switch to subcutaneous immunoglobulin (SCIG) because of patient or physician preference. Healthcare providers (HCPs) and patients were surveyed to gain insight into the perceptions and reasons patients cited for remaining on IVIG. METHODS: Nurses (n551) and physicians (n526) experienced with immunoglobulin therapy participated in surveys conducted at professional conferences. Patients (n5131) with PIDD receiving immunoglobulin therapy participated in unbranded surveys distributed online by the Immune Deficiency Foundation. RESULTS: When asked why some patients were reluctant to start SCIG therapy, physicians (46%) and nurses (33%) stated ‘‘reluctance to selfadminister treatment,’’ followed by ‘‘concern about needle sticks/infusion sites’’ (physicians, 31%; nurses, 29%). In contrast, when patients receiving IVIG were asked why they did not use SCIG, only 4% cited ‘‘concern about learning how to self-infuse’’ and 6% cited ‘‘concern about needle sticks/ infusion sites.’’ The most frequent reason (27%) patients reported for not using SCIG was ‘‘satisfaction with IVIG.’’ Of patients receiving SCIG, 73% reported that any concerns before starting SCIG did not remain; cost had been the main concern (22%). CONCLUSIONS: The perception of HCPs regarding reasons why patients with PIDD are reluctant to choose SCIG therapy appears to differ from those stated by patients. Awareness of patient reasons for choosing IVIG or SCIG may allow HCPs to better educate and communicate with their patients when discussing immunoglobulin therapy options.