Non-adherence to subcutaneous allergen immunotherapy: inadequate health insurance coverage is the leading cause.

BACKGROUND: To sustain the long-lasting beneficial effects of subcutaneous allergen immunotherapy, the recommended duration of treatment is 3 to 5 years. Nevertheless, many patients discontinue allergy injections prematurely and therefore might not appreciate the full therapeutic benefit. OBJECTIVE: To examine factors leading to premature discontinuation of subcutaneous allergen immunotherapy (cessation before completion of the recommended duration). METHODS: Patients who discontinued immunotherapy before the completion of the prescribed duration and received their final injection from January 2008 through September 2013 were contacted to identify the reason for stopping the allergy injections. Phase of treatment (escalation or maintenance) was used to measure the duration of treatment at the time of cessation and patients were grouped accordingly. RESULTS: The study population consisted of 555 patients with allergic rhinitis and/or asthma who terminated immunotherapy prematurely. Two hundred thirteen (38%) were men and 342 (62%) were women. The following reasons were cited by patients for non-adherence to immunotherapy: requirement of copayment for allergy injections and/or payment for allergen extract by their health insurer (40%); inconvenience of travel (15%); change of residence (8%); concurrent health problems (5%); patient-perceived ineffectiveness (4%); patient-perceived lack of need to continue immunotherapy (2%); adverse effects from injection (local reaction 1%; systemic allergic reaction 0.5%); and trial of alternative medicine (0.1%). The remaining 24.4% did not provide a reason for discontinuation. CONCLUSION: Of the various factors, inadequate reimbursement for allergen extract and allergy injections by health insurers is the most common reason cited for non-adherence to subcutaneous allergen immunotherapy.

Contact allergy to dimethacrylate.

Contact allergy to methacrylates is uncommon. We present a 55-year-old woman with a 10-year history of persistent pruritus and burning sensation of the gums every time she wore her dentures. Initially she developed swelling and erythema of the face soon after the dentures were placed on the gums. These symptoms abated after a barrier liner was applied between her gums and the dentures. However, the burning sensation and pruritus of the gums progressively worsened and she started to develop blisters on the gums. The skin allergen patch test was 3+ positive with erythema, edema, papules, ulceration, and pruritus for the denture component dimethacrylate. The diagnosis was supported by the patient's medical history, notably positive patch test, and complete amelioration of the symptoms upon cessation of dimethacrylate denture usage.

Inadequate health insurance coverage: a major factor in premature discontinuation of subcutaneous immunotherapy for allergic rhinitis.

We conducted a study of 155 patients with allergic rhinitis who prematurely discontinued subcutaneous allergen immunotherapy to determine the reasons for their discontinuation. The most commonly cited factor, which was cited by 62 patients (40.0%), was the issue of cost-specifically, inadequate or nonexistent insurance coverage. Studies have shown that subcutaneous allergen immunotherapy is more cost-effective than pharmacologic treatment for patients with allergic rhinitis. Therefore, improved insurance coverage for this treatment of proven efficacy would not only improve quality of life, it would also be economically beneficial to the healthcare system in general.

Evaluation of factors affecting peak expiratory flow in healthy adults: is it necessary to stand up?

BACKGROUND: Guidelines for the Diagnoses and Management of Asthma recommend that the peak flow meter should be used in a standing position. OBJECTIVE: To determine whether the peak expiratory flow (PEF) varies with the position of the subject and to evaluate the impact of application of nose clip on PEF measurement. METHODS: Using a Mini Wright Peak Flow Meter, the PEF was measured in 33 healthy adults in sitting and standing positions, with and without application of a nose clip. Each subject blew into the peak flow meter three times and best of the 3 blows was recorded. RESULTS: The PEF was not significantly higher in standing than in sitting position. Application of nose clip had no significant impact on the PEF. CONCLUSION: The position of the subject and application of nose clip has no significant impact on PEF measurement.

Severe allergic contact eyelid dermatitis caused by swimming goggles.

BACKGROUND: Contact dermatitis of the eyelids is the most common cutaneous reaction that affects the eyelids. It is frequently caused by the cosmetics used on face, hair, and fingernails. Rarely, eyelid contact dermatitis can be caused by direct contact with either irritant or allergen. OBJECTIVE: To report a case of severe eyelid dermatitis caused by swimming goggles. METHODS: Patch skin tests were performed in duplicate using a small piece of black rubber foam padding from the swimming goggles. Allergy skin prick tests for inhalant aeroallergens were also performed. RESULTS: The results of the patch skin tests were strongly positive. The results of allergy skin prick tests for inhalant aeroallergens were positive for both seasonal and perennial aeroallergens. CONCLUSIONS: This case illustrates that sensitization to the black, foam rubber padding on swimming goggles can occur after long-term contact with the goggles and should be considered in the differential diagnosis of eyelid dermatitis in an appropriate setting.