title: Sublingual versus subcutaneous immunotherapy: patient adherence at a large German allergy center.
abstract: BACKGROUND
  Many placebo-controlled studies have demonstrated that allergen immunotherapy (AIT) is an effective therapy for treating allergies. Both commonly used routes, subcutaneous (SCIT) and sublingual immunotherapy (SLIT), require high patient adherence to be successful. In the literature, numbers describing adherence vary widely; this investigation compares these two routes of therapy directly.
  
  
  METHODS
  All data were retrieved from the patient data management system of a center for dermatology, specific allergology, and environmental medicine in Germany. All 330 patients (aged 13-89 years) included in this study had commenced AIT between 2003 and 2011, thus allowing a full 3-year AIT cycle to be considered for each investigated patient.
  
  
  RESULTS
  In this specific center, SCIT was prescribed to 62.7% and SLIT to 37.3% of all included patients. The total dropout rate of the whole patient cohort was 34.8%. Overall, SLIT patients showed a higher dropout rate (39.0%) than did SCIT patients (32.4%); however, the difference between these groups was not significant. Also, no significant difference between the overall dropout rates for men and for women was observed. A Kaplan-Meier curve of the patient collective showed a remarkably high dropout rate for the first year of therapy.
  
  
  CONCLUSIONS
  The analysis presented in this single-center study shows that most patients who discontinue AIT do so during the first year of therapy. Patients seem likely to finish the 3-year therapy cycle if they manage to adhere to treatment throughout the first year. Strategies for preventing nonadherence in AIT, therefore, need to be developed and standardized in future investigations.
authors.affiliation: Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Lemberg
authors.affiliation: Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Till
authors.initials: T
authors.lastname: Berk
authors.affiliation: Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Kija
authors.initials: K
authors.lastname: Shah-Hosseini
authors.affiliation: Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany; Center for Dermatology, Specific Allergology and Environmental Medicine, Hamburg, Germany.
authors.forename: Elena-Manja
authors.initials: EM
authors.lastname: Kasche
authors.affiliation: Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Mösges
keywords: SCIT; SLIT; adherence; allergen immunotherapy; allergic rhinitis; allergy; dropout; nonadherence