Long-term adherence to imported fire ant subcutaneous immunotherapy

• Published in: Annals of allergy, asthma, & immunology Vol. 130; no. 1; pp. 106 - 110
• Main Authors: Neaves, Brittanie I., Adams, Karla E., White, Kevin M., Stokes, Shayne C., Sacha, Joshua, Quinn, James M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2023
• Subjects: Adolescent; Adult; Animals; Ant Venoms - therapeutic use; Ants; Asthma; Child; Child, Preschool; Desensitization, Immunologic; Female; Humans; Hypersensitivity; Immunotherapy; Insect Bites and Stings - therapy; Male; Middle Aged; Young Adult
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2022.09.020

Imported fire ant (IFA) whole-body extract subcutaneous immunotherapy (IT) is a safe and effective treatment for IFA hypersensitivity, with a recommended length of treatment of 3 to 5 years.
To evaluate long-term IFA IT adherence in patients with IFA allergy living in an endemic area.
During 2007 to 2014, patients with IFA-sting systemic reactions and a recommendation to start IFA IT were prospectively enrolled in this study. Subjects were contacted annually for interval IT adherence. Institutional review board approval was obtained.
A total of 87 subjects, ages 2 to 64 years, with a recommendation to initiate IFA IT, were enrolled. Subjects were predominantly adult (76%) and female (55%), and 30% had asthma. Of these patients, 77 (89%) initiated treatment within 1 year of recommendation; 18 (23%) adhered to a 3-year course; and 10 (13%) adhered to a 5-year course. At 3 years, there were no significant differences in adherence between male and female subjects (28% vs 19%, P = .33), children and adults (25% vs 22%, P = .79), or those with or without asthma (30% vs 20%, P = .31). Adherence in subjects with mild initial reactions was lower than in subjects with moderate-to-severe reactions (0% vs 25%, P = .05) at 3 years only. Conventional buildup and concurrent flying Hymenoptera venom immunotherapy were predictive of adherence. Reasons for discontinuation were relocation to a nonendemic area (29%) and inconvenience (27%).
This study showed poor long-term adherence to IFA IT at 3 and 5 years. Initial sting severity, buildup protocol, and concurrent flying Hymenoptera venom immunotherapy were predictors for long-term IT adherence.