Administration and burden of subcutaneous immunotherapy for allergic rhinitis in clinical practice in Canada
Bibliographic record
Abstract
Allergic rhinitis (AR) has been estimated to affect approximately 20–25% of Canadians. [ 1 ] Management of AR encompasses allergen avoidance, use of symptomatic medications, and allergen immunotherapy for patients unresponsive to other pharmacotherapy. [ 2 , 3 ] This study was conducted to characterize patients receiving subcutaneous immunotherapy (SCIT) and the SCIT administration process in Canada and the United States; Canadian results are presented. A multi-center, prospective, observational study was conducted at 5 allergy clinics in Quebec and Ontario and 1 primary care clinic in Quebec from March-September 2012. Patients ≥6 years who were scheduled for SCIT on study days were invited to participate in the study. Patients enrolled in a clinical trial, receiving sublingual immunotherapy or allergic only to insect venom, latex, food, or drugs were excluded. Site and patient-specific information were captured via direct observation, questionnaires, and medical chart review. Costs were estimated from time and supply observation and query. A total of 294 patients were enrolled with a mean age of 44 years (4% <18 years and 9% ≥65 years). Of these, 59% were female, 81% Caucasian, 57% employed full-time and 30% reported household income ≥$100,000. Concomitant allergy medications were reported by 66% of patients; 25% used asthma medications. Two-thirds of patients reported initiating SCIT because they desired a cure “once and for all” for their allergies. Primary symptoms at initiation of SCIT were nasal congestion (62%), rhinorrhea (59%), sneezing (35%) and itchy eyes (32%). Chart data indicated that patients received treatment for several different antigens (mean: 4; SD: 3); those most commonly noted were ragweed (82%), house dust mites (55%), grass (48%) and tree (48%). Sites reported a SCIT build-up phase requiring one injection/week over 12-52 weeks. The SCIT maintenance phase was reported as one injection/month over 4-5 years. Site-specific means (SDs) for total patient time in the clinic for SCIT ranged from 32 (11) to 49 (10) minutes, including a 30-minute required post-injection observation at all but one site. Average patient travel time to the office for SCIT was 20 (SD: 14) minutes. Mean time missed from work in the previous week was 0.7 hours. The direct costs of an injection ranged from $14 to $41 by site, with extract preparation or acquisition and administrative tasks the largest components. Patients initiated SCIT to permanently resolve allergy symptoms. SCIT requires a long-term commitment, resulting in considerable direct and indirect costs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".