Determinants of patient compliance with allergen immunotherapy

Allergen immunotherapy (AIM) has been demonstrated to be safe and effective in the treatment of allergic respiratory disease. Although it requires considerable patient commitment, little attention has been paid to the factors that contribute to patient compliance.

Patients in a practice based at an urban university hospital, who discontinued AIM, were contacted to determine their reasons for stopping treatment. Results were correlated with demographic and disease data obtained from the patient charts.

Review of practice records identified 217 patients on AIM. One hundred forty-eight had allergic rhinitis, (R), 66 had allergic rhinitis and asthma (RA), and 3 had allergic asthma without evidence of rhinitis (A). Seventy-four (50%) of the patients in the R group, 32 (48%) of the patients in the RA group, and three (100%) of those in the A group discontinued treatment. The groups differed in that 55% of the patients in the R group discontinued treatment because of inconvenience, compared with only 22% of the patients in the RA group (p < 0.01). By contrast, 25% of the patients in the RA group stopped because they thought that they were "better" with medication, compared with none of the patients in the R group (p < 0.001). All of the patients in the RA group who stopped because they were better completed at least the first four-vial treatment series.

Inconvenience is the major contributing factor in noncompliance with AIM. Regulations designed to protect patients from adverse reactions should balance the potential risk of reactions against the benefits of treatment and the effect of more stringent guidelines on patient compliance.