Expanded Use of Allergy Immunotherapy for Allergic Rhinitis Lowers Health Care Costs and Improves Outcomes

At the 2014 Annual Meeting of the American Academy of Allergy, Asthma & Immunology, held February 28 — March 4, 2014, in San Diego, CA, during a session highlighting current research developments in asthma, rhinitis, and rhinosinusitis, Cheryl S. Hankin, PhD, President and Chief Scientific Officer of BioMedEcon, LLC, challenged the public perception of allergic rhinitis as a trivial disorder. On the contrary, she claimed that without adequate diagnosis and appropriate treatment, the disease can be devastating. Furthermore, she pointed out that health care spending for chronic sinusitis alone (which affects 14% of the US population) makes it one of the top ten most costly health conditions to US employers, exceeding spending for ulcers and acute asthma. The combination of nasal polyps and sinusitis can add greatly to the costs.

Hankin presented the most recent data from studies by her and colleagues in California and Fort Lauderdale, FL, showing that allergy immunotherapy significantly reduces the use of outpatient services for allergy and respiratory conditions in patients with newly-diagnosed allergic rhinitis.

Evaluating a Florida Medicaid database, which has supported a HIPAA-approved longitudinal study in large cohorts of patients, over a period of 12 years (1997-2009), the investigators compared 4,967 adults and children with newly-diagnosed allergic rhinitis who subsequently received allergy immunotherapy with 4,967 carefully matched control subjects who also had newly diagnosed allergic rhinitis but who did not receive treatment.

At 18-month follow-up, allergy immunotherapy (AIT) led to a significantly reduced need for outpatient services for patients with allergic rhinitis (AR) with chronic upper respiratory tract infections (URIs), nasal polyps, influenza, allergic reactions, or emphysema.

Comparing pre- to post-18-month evaluation, there was a 24.6% (p<0.0001) decrease in the proportion of AIT patients with URIs receiving outpatient care, whereas the matched controls declined only 14.3% (p<0.0005). The decrease in service utilization for AIT patients versus controls was significant (p<0.0001). Similarly significant differences (AIT vs controls) were observed for nasal polyps, influenza, (p<0.0001) allergic reactions (p<0.004), and emphysema (p<0.03).

Hankin said these findings were consistent with the unified airway model in that improving the control of allergic rhinitis with AIT can mitigate the development and severity of other allergic and respiratory diseases. Furthermore, the adults and children who received allergy immunotherapy achieved significant cost savings (30% and 42%, respectively) within the first three months of treatment initiation and throughout the 18-month duration of analysis compared to the matched controls.

Unfortunately, Hankin said there are institutional barriers to the referral of allergic rhinitis patients for specialist care and allergy immunotherapy. According to various estimates, only 2-9% of qualified AR patients receive AIT. Boys are more likely to receive treatment than girls and Caucasian patients are more likely to get AIT than Hispanics and other minorities.

Hankin’s larger message for public health and policy is that allergic rhinitis is not merely a nuisance but is a serious and expensive allergy-related chronic disease that may develop into full-blown asthma.

In a news release, Hankin said, “these new findings from our continuing research suggest that the benefits of allergy immunotherapy extend far beyond the patient, to include our US health care system… In an era of health care cost containment, our results suggest that health systems could significantly and quickly reduce the burden of outpatient care for chronic diseases of the upper respiratory tract by appropriately identifying and treating patients with allergic rhinitis.”