Patient characteristics associated with allergen immunotherapy initiation and adherence.

Allergen specific immunotherapy (SIT) is the treatment of choice for patients with systemic allergic reactions to Hymenoptera insects and is an important treatment option for patients with allergic rhinitis (AR), asthma, or both. Compared with pharmacologic therapies, which provide temporary relief of allergy symptoms, SIT is the only potentially allergic diseasemodifying treatment. SIT reduces health care costs within 3 months of initiation, decreases the risk of developing asthma and new allergies, and produces sustained clinical benefits after completion of a treatment course of 3 to 5 years. SIT may be administered subcutaneously or locally. Subcutaneous delivery is the only US Food and Drug Administration–approved SIT formulation and the predominant route of administration in the United States, and is therefore the focus of this editorial. Specific immunotherapy typically involves injections administered at the physician’s office at least every 6 weeks for a duration of 3 to 5 years and does not usually confer immediate symptom relief. Consequently, patients must weigh the deferred but potentially long-term curative benefits of treatment against the immediate and prolonged demands of therapy. Because successful clinical outcomes require strong patient commitment to treatment initiation and adherence, patient characteristics such as demographics, illness burden, and insurance coverage are likely to influence the ultimate success of treatment. However, little is known about the characteristics of US patients who receive and adhere to SIT.