SAN DIEGO -- Treating allergic rhinitis with immunotherapy appeared to reduce the risk of chronic upper respiratory conditions, a Medicaid study showed.
Treatment for those conditions was three-fold more likely to decline in the 18 months after immunotherapy than in matched patients treated for rhinitis pharmacologically or otherwise (down 6% versus 2%, P<0.0001), Cheryl Hankin, PhD, of the health research company BioMedEcon in Moss Beach, Calif., and colleagues found.
The difference was significant in chronic sinusitis, pharyngitis, tonsil or adenoid disease as well as nasal polyps and influenza, they reported here at the American Academy of Allergy, Asthma, and Immunology meeting.
The results weren't unexpected but should help in counseling patients considering immunotherapy for allergic rhinitis, Theodore M. Freeman, MD, an allergist in private practice in San Antonio, Texas, told MedPage Today.
"This is absolutely confirming what I hear from my patients," he said."Now with this data, I can say it's documented that you're going to reduce the number of infections you're going to get and things like that."
Another implication is validating immunotherapy as important for allergic rhinitis, Hankin told reporters at a press conference.
"The public health and public policy message is that allergic rhinitis is not just a nuisance disease but is a precursor for the development of serious and extremely expensive respiratory disease," she said, noting that it also adds impetus to fast referral from primary care.
Her group had previously shown cost-effectiveness of allergy immunotherapy for hay fever using the same Florida Medicaid databases from 1997 through 2009.
The new analysis included 4,967 patients who had immunotherapy (likely almost all subcutaneous, given that the oral form isn't reimbursed) for newly diagnosed allergic rhinitis, and an equal group of matched allergic rhinitis patients who didn't get that treatment.
The likelihood of a decline in use of outpatient services over 18 months after immunotherapy versus controls was:
- 35-fold higher for nasal polyps (down 0.34% versus up 0.14%, P=0.0131)
- Two-fold more likely for chronic sinusitis (down 3.81% versus 2.15%, P<0.0001)
- 35-fold higher for "other" upper respiratory tract disease (down 0.30% versus up 0.06%, P=0.0131)
- Eight-fold more likely for chronic pharyngitis and nasopharyngitis (down 4.57% versus 0.62%, P<0.0001)
- Four-fold more likely for chronic tonsil and adenoid disease (down 1.39% versus 0.34%, P<0.0001)
The same pattern with generally even greater magnitude of difference was seen at 6 and 12 months.
Immunotherapy was also associated with a three-fold higher likelihood of decrease in flu-related treatments (down 1.05% versus 0.34%, P<0.0001), but Harkin said this was not likely causal.
Rather, it suggested "that by getting specialty treatment, they're also getting preventive treatment," she said. "Their specialists are looking out for them."
The results should generalize from the Florida Medicaid population to other settings, Freeman suggested.
The study was supported by AAAAI; the Joint Council of Allergy, Asthma, and Immunology; and the American College of Allergy, Asthma, and Immunology.
Hankin reported relevant financial relationships with Teva and Greer Labs.
Freeman reported relevant financial relationships with McKesson and UpToDate.
Primary source: American Academy of Allergy, Asthma, and Immunology
Source reference: Hankin CS, et al "Allergy immunotherapy significantly reduces outpatient services use for chronic respiratory conditions in patients with newly-diagnosed allergic rhinitis" AAAAI 2014; Abstract 579.
By Crystal Phend
March 4, 2014