Clinical practice improvement program for immunotherapy of respiratory allergic diseases

The aim of this study was to develop a clinical practice improvement (CPI) program for the allergen immunotherapy of allergic respiratory diseases. The study was conducted between 1994 and 1999, using an observational methodology in line with normal clinical practice, in a Hospital allergy center. The program comprised four basic steps: setting up a decisional tree, standardizing the main diagnostic-therapeutic aspects, recording of the data and statistical evaluation of the main clinical endpoints in a long period (36 months). A total of 256 patients were admitted, all with dust mite allergy; if pharmacological therapy failed after 12 months, they were assigned to immunotherapy (95 patients), either by subcutaneous injection or by the intranasal or sublingual route, depending on the main clinical-prognostic features taken into consideration. For each group of patients a control group was set up, given proper pharmacological therapy (40 patients). Allergen-specific immunotherapy was effective and well tolerated. Bronchial hyper-reactivity (BHR) tests indicated that subcutaneous or sublingual immunotherapy seemed to give some protection against asthma or BHR worsening. In the group only given pharmacological therapy, an increasing percentage of patients gradually became non-responders, hence potential candidates for allergen immunotherapy. The present findings, even though obtained by a non-randomized approach, are based on a large, selected case list and show that setting up a CPI program can render possible a better overall efficacy of immunotherapy, through appropriate selection and continuous follow-up of patients.