Introduction: Venom immunotherapy (VIT) and adrenaline autoinjector (AAI) are important therapies in venom anaphylaxis. Adherence to VIT and AAI in patients with venom allergy has been evaluated in a few studies; however, solid data are lacking. This study aimed to evaluate VIT and AAI retrieval rates in patients with venom allergy with a special focus on adherence to treatment. Adherence was compared to subcutaneous immunotherapy (SCIT) with inhalant allergens. Methods: This was a retrospective study among patients registered for allergen immunotherapy at the Allergy Center, Odense University Hospital, Denmark, from January 1, 2010, to December 31, 2014. Data on purchased immunotherapy and AAI were obtained from the Danish National Health Service Prescription Database. Multivariable logistic regression was used to analyze if allergen, age, sex, mastocytosis, and treatment site affected adherence. Results: The 3-year adherence to VIT was 92.4% (244/264) compared to 87.4% (215/246) in SCIT with inhalant allergens, and the 5-year adherence to VIT was 84.1% (222/264) compared to 74.8% (184/246) in SCIT with inhalant allergens (p = 0.045). Females treated with VIT were more adherent than males (p = 0.45 [3-year], p = 0.008 [5-year]), whereas allergen, age, mastocytosis, or treatment site did not significantly affect adherence. Only 28.6% of patients (12/42) purchased an AAI after premature termination of VIT. Conclusion: In this register-based study, we found that the 3- and 5-year adherences to VIT and SCIT with inhalant allergens are at the upper end of the spectrum hitherto reported. Patients’ 5-year adherence to VIT was higher than patients’ 5-year adherence to SCIT with inhalant allergens. If VIT was prematurely terminated, less than 1/3 would have purchased an AAI.

1.
Sturm GJ, Varga EM, Roberts G, Mosbech H, Bilò MB, Akdis CA, et al. EAACI guidelines on allergen immunotherapy: hymenoptera venom allergy. Allergy. 2018;73(4):744–64.
2.
Jennings A, Duggan E, Perry IJ, Hourihane JO. Epidemiology of allergic reactions to hymenoptera stings in Irish school children. Pediatr Allergy Immunol. 2010;21(8):1166–70.
3.
Bilò BM, Bonifazi F. Epidemiology of insect-venom anaphylaxis. Curr Opin Allergy Clin Immunol. 2008;8(4):330–7.
4.
Bilò MB, Kamberi E, Tontini C, Marinangeli L, Cognigni M, Brianzoni MF, et al. High adherence to hymenoptera venom subcutaneous immunotherapy over a 5-year follow-up: a real-life experience. J Allergy Clin Immunol Pract. 2016;4(2):327–9.e1.
5.
More DR, Hagan LL. Factors affecting compliance with allergen immunotherapy at a military medical center. Ann Allergy Asthma Immunol. 2002;88(4):391–4.
6.
Mendoza J, Carlson G, Nath P, Quinn J. A look at adherence with subcutaneous immunotherapy without out-of-pocket patient costs. Ann Allergy Asthma Immunol. 2023;131(1):96–100.
7.
Makatsori M, Senna G, Pitsios C, Lleonart R, Klimek L, Nunes C, et al. Prospective Adherence to Specific Immunotherapy in Europe (PASTE) survey protocol. Clin Transl Allergy. 2015;5:17.
8.
Passalacqua G, Baiardini I, Senna G, Canonica GW. Adherence to pharmacological treatment and specific immunotherapy in allergic rhinitis. Clin Exp Allergy. 2013;43(1):22–8.
9.
Borg M, Løkke A, Hilberg O. Compliance in subcutaneous and sublingual allergen immunotherapy: a nationwide study. Respir Med. 2020;170:106039.
10.
Goldberg A, Confino-Cohen R. Bee venom immunotherapy - how early is it effective?Allergy. 2010;65(3):391–5.
11.
Bilò MB, Cichocka-Jarosz E, Pumphrey R, Oude-Elberink JN, Lange J, Jakob T, et al. Self-medication of anaphylactic reactions due to hymenoptera stings-an EAACI task force consensus statement. Allergy. 2016;71(7):931–43.
12.
Mahoney B, Walklet E, Bradley E, O'Hickey S. Improving adrenaline autoinjector adherence: a psychologically informed training for healthcare professionals. Immun Inflamm Dis. 2019;7(3):214–28.
13.
Abrams EM, Singer AG, Lix L, Katz A, Yogendran M, Simons FER. Adherence with epinephrine autoinjector prescriptions in primary care. Allergy Asthma Clin Immunol. 2017;13:46.
14.
Clausen SS, Stahlman SL. Food-allergy anaphylaxis and epinephrine autoinjector prescription fills, active component service members, U.S. Armed Forces, 2007-2016. Msmr. 2018;25(7):23–9.
15.
Parke L, Senders AS, Bindslev-Jensen C, Lassen AT, Oropeza AR, Halken S, et al. Adherence to adrenaline autoinjector prescriptions in patients with anaphylaxis. Clin Transl Allergy. 2019;9:59.
16.
Pourang D, Batech M, Sheikh J, Samant S, Kaplan M. Anaphylaxis in a health maintenance organization: international Classification of diseases coding and epinephrine auto-injector prescribing. Ann Allergy Asthma Immunol. 2017;118(2):186–90.e1.
17.
Johnson TL, Parker AL. Rates of retrieval of self-injectable epinephrine prescriptions: a descriptive report. Ann Allergy Asthma Immunol. 2006;97(5):694–7.
18.
Goldberg A, Confino-Cohen R. Insect sting-inflicted systemic reactions: attitudes of patients with insect venom allergy regarding after-sting behavior and proper administration of epinephrine. J Allergy Clin Immunol. 2000;106(6):1184–9.
19.
Richter AG, Nightingale P, Huissoon AP, Krishna MT. Risk factors for systemic reactions to bee venom in British beekeepers. Ann Allergy Asthma Immunol. 2011;106(2):159–63.
20.
Manmohan M, Müller S, Myriam Rauber M, Koberne F, Reisch H, Koster J, et al. Current state of follow-up care for patients with Hymenoptera venom anaphylaxis in southwest Germany: major impact of early information. Allergo J Int. 2018;27(1):4–14.
21.
Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy. 2018;73(4):765–98.
22.
Johannesdottir SA, Horváth-Puhó E, Ehrenstein V, Schmidt M, Pedersen L, Sørensen HT. Existing data sources for clinical epidemiology: the Danish national database of reimbursed prescriptions. Clin Epidemiol. 2012;4:303–13.
23.
Pfaar O, Devillier P, Schmitt J, Demoly P, Hilberg O, DuBuske L, et al. Adherence and Persistence in Allergen Immunotherapy (APAIT): a reporting checklist for retrospective studies. Allergy. 2023;78(8):2277–89.
24.
Kiel MA, Röder E, Gerth van Wijk R, Al MJ, Hop WC, Rutten-van Mölken MPMH. Real-life compliance and persistence among users of subcutaneous and sublingual allergen immunotherapy. J Allergy Clin Immunol. 2013;132(2):353–60.e2.
25.
Pajno GB, Vita D, Caminiti L, Arrigo T, Lombardo F, Incorvaia C, et al. Children’s compliance with allergen immunotherapy according to administration routes. J Allergy Clin Immunol. 2005;116(6):1380–1.
26.
Cox LS, Hankin C, Lockey R. Allergy immunotherapy adherence and delivery route: location does not matter. J Allergy Clin Immunol Pract. 2014;2(2):156–60.
27.
Silva D, Pereira A, Santos N, Plácido JL. Costs of treatment affect compliance to specific subcutaneous immunotherapy. Eur Ann Allergy Clin Immunol. 2014;46(2):87–94.
28.
Rhodes BJ. Patient dropouts before completion of optimal dose, multiple allergen immunotherapy. Ann Allergy Asthma Immunol. 1999;82(3):281–6.
29.
Lower T, Henry J, Mandik L, Janosky J, Friday GAJr. Compliance with allergen immunotherapy. Ann Allergy. 1993;70(6):480–2.
30.
Guenechea-Sola M, Hariri SR, Galoosian A, Yusin JS. A retrospective review of veterans’ adherence to allergen immunotherapy over 10 years. Ann Allergy Asthma Immunol. 2014;112(1):79–81.
31.
Tinkelman D, Smith F, Cole WQ3rd, Silk HJ. Compliance with an allergen immunotherapy regime. Ann Allergy Asthma Immunol. 1995;74(3):241–6.
You do not currently have access to this content.