title: Non-adherence to subcutaneous allergen immunotherapy: inadequate health insurance coverage is the leading cause.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vaswani
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Akshay
authors.initials: A
authors.lastname: Garg
authors.affiliation: St Agnes Hospital, Baltimore, Maryland.
authors.forename: Leena
authors.initials: L
authors.lastname: Parikh
authors.affiliation: Howard County General Hospital, Johns Hopkins, Columbia, Maryland. Electronic address: drvaswani@gmail.com.
authors.forename: Surender
authors.initials: S
authors.lastname: Vaswani
mesh_terms: D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D003888:Desensitization, Immunologic / Q000191:economics* / Q000523:psychology*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000191:economics; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D017057:Medically Uninsured / Q000523:psychology*; D010349:Patient Compliance; D065631:Rhinitis, Allergic / Q000188:drug therapy
chemical_list: D000485:Allergens