Association Between Caregiver Burden and Treatment Adherence in Japanese Children With Allergic Rhinitis Receiving...

Sublingual immunotherapy (SLIT) leads to the long-term remission of allergic rhinitis and requires long-term daily adherence. There are limited studies on the treatment burden or satisfaction of SLIT among caregivers of children treated using SLIT. We aimed to evaluate the association between the treatment burden and satisfaction for pediatric allergic rhinitis caregivers and the clinical factors of their children's SLIT.

We conducted a questionnaire survey with 115 caregivers of SLIT-treated children from May to August 2023 and retrospectively reviewed their children`s medical records. A single caregiver had at least one child, all undergoing SLIT at the time of the survey. Of the total 139 SLIT-treated children, 78 children over eight years of age were interviewed regarding adherence to SLIT and subjective symptoms of allergic rhinitis. We performed a comparative analysis of caregivers' impressions of SLIT and their children's clinical factors regarding SLIT.

A runny nose was the most common symptom experienced by children before the start of SLIT. After the children started SLIT, 74 (64.3%) of the 115 caregivers felt satisfied and 30 (26.1%) felt burdened by SLIT. The most frequent reasons for being satisfied and burdened by SLIT were because it improved or relieved allergic rhinitis and the preparation and encouragement for children to take SLIT tablets, respectively. Of the 115 caregivers, 96 (83.4%) recommended SLIT to others. A comparative analysis showed that caregivers had already felt burdened from the first one to six months of SLIT initiation and the proportion of caregivers who answered that they felt burdened by SLIT was significantly lower for children with appropriate adherence than for those with inappropriate adherence (11.1% vs. 30.9%,P = 0.034).

Most caregivers of SLIT-treated children reported higher treatment satisfaction than treatment burden. Caregiver burden emerged shortly after the start of SLIT and was also associated with lower adherence in children. This study emphasized the need for strategies to support caregivers and optimize adherence in the early stages of SLIT.