The Dermatophagoides Pteronyssinus Molecular Sensitization Profile Of Allergic Rhinitis Patients In Central China And The Real-life Study Of Adherence With Subcutaneous Immunotherapy

Part 1.The Dermatophagoides pteronyssinus Molecular Sensitization Profile of Allergic Rhinitis Patients in Central China Objective: House dust mites(HDMs)are the major aeroallergens in patients with allergic rhinitis(AR)and/or asthma in China.However,there are certain differences between dust mite species and their main sensitizing components in different regions.And the molecular sensitization of HDM is varied in different regions.This study aimed to investigate the Dermatophagoides pteronyssinus(Der p)molecular sensitization profile of AR patients in Central China.Methods: AR patients with positive skin prick tests(SPT)to Der p were enrolled in our study.Specific immunoglobulin E(sIgE)for Der p,Dermatophagoides farinae(Der f),Acarus siro(Aca s),Blomia tropicalis(Blo t),and Der p components Der p1,Der p2,and Der p10 were measured by Phadia UniCAP 250 in all patients.Results: A total of 130 AR patients(57 women)were included.The mean age was 26.3 years,and 60(46.2%)patients had asthma.The overall prevalence of positive serum sIgE was 99.2% for Der p,98.5% for Der f,81.5% for Aca s,83.1% for Blo t,71.5% for Der p1,64.6% for Der p2,and 11.5% for Der p10.HDM-AR patients with asthma displayed significantly higher concentrations of sIgE to Der p,Der f,Der p1,and Der p2 than did those without asthma(P < 0.001).The prevalence of asthma in HDM-AR patients was higher among the patients sensitized to both Der p1 and Der p2(62.8%)than those sensitized to only 1 allergen(Der p1 26.7% or Der p2 16.7%;P < 0.05)or non-sensitized to Der p1 and Der p2(19.4%;P < 0.001).Conclusion: Der p has high cross-reactivity with other mite species.Der p1 and Der p2 are the major components to induce Der p sensitization among AR patients in central China.Sensitization to both Der p1 and Der p2 may be a risk factor for developing asthma in HDM-AR patients.Part 2.A Real-life Study of Adherence with Subcutaneous ImmunotherapyObjective: Allergen immunotherapy(AIT)is still the only causal treatment for allergic diseases.However,conventional subcutaneous immunotherapy(SCIT)administration schedules are time-consuming and patient nonadherence is a major barrier to achieving a satisfactory therapeutic effect.Our study aimed to analyze the causes leading to discontinuation of SCIT and to determine risk factors associated with nonadherence in respiratory allergies.Methods: This was a prospective study.Patients with respiratory allergies who had received standardized dust mite SCIT were enrolled from January 2012 to January 2014.And a follow-up study on these subjects was conducted via telephone interviews on an interval of 3 months and online communication through social network applications.Reasons for discontinuation were documented when patients claimed to stop treatment.Results: A total of 311 patients were enrolled in the study.The adherence rate at year 3 was 64.6%.Fifty-nine patients(19.0%)dropped out in year 1,31(10.0%)in year 2,and 20(6.4%)in year 3.Reasons for nonadherence included inconvenience(32.7%),ineffectiveness(25.5%),improvement of symptoms(22.7%),and adverse reactions(14.5%).Children had higher adherence than adults(70.7% vs 55.0%)(p < 0.05).The dropout reasons were different among the children and adults groups(p < 0.005).In addition,the reasons for dropout patients in year 1,year 2 and year 3 were different(p < 0.05).Conclusion: Adherence to SCIT was less than satisfactory in the real-life study.Children had higher adherence than adults.Inconvenience,ineffectiveness,improvement of symptoms and adverse reactions accounted for nonadherence.Understanding and addressing these barriers should help to enhance both SCIT adherence and consequently benefit patients.A close communication between doctors and patients is helpful in enhancing adherence with AIT in clinical practice.