Evaluation of adherence to allergen immunotherapy in pregnant women and the possible factors impact on adherence

Objective: The aim of this study was to evaluate the possible factors affecting patient compliance and treatment compliance of female patients who got pregnant during allergen immunotherapy treatment (AIT) due to allergic rhinitis, conjunctivitis, asthma and systemic allergic reaction to bee venom. Methods: 35 patients who got pregnant during AIT were included in the study. Patients who were on AIT for less than three years and patients whose treatment had been interrupted or discontinued for two months and more after conception were defined as the non-adherent group. Patients' age, occupation, residence address, education level, monthly income of the household, smoking and alcohol use, means of transportation to the hospital, additional diseases, medications, diagnosis with which AIT was indicated, type of AIT, drugs used along with AIT, pregnancy outcome status , whether the pregnancy was planned or not, duration of AIT until pregnancy and visual analogue score (VAS) for the treatment satisfaction (1-10; 0: Not at all satisfied, 10: Very satisfied) were assessed. The reasons for discontinuation of the treatment in non-compliant patients were determined. Data were compared between adherent and non-adherent groups. Results: 74 % of the patients were compliant with the treatment. The reasons for the discontinuation of treatment were primarily the obstetrician's reluctance to recommend treatment and teratogenicity concerns; other reasons were ineffectiveness of the treatment, reluctance for hospital visits due to the Covid-19 pandemic, long treatment duration and the need for frequent hospital visits. Between adherent and non-adherent groups; no significant difference was found in terms of age, occupation, residence address, education level, monthly income, means of transportation to the hospital, diagnosis and the type of immunotherapy (p>0.05). The median VAS for the treatment satisfaction was higher in the adherent group than non-adherent patients (p=0.025). The duration of AIT until pregnancy was significantly shorter in the non-adherent group (p=0.004). Conclusion: Our study has shown that compliance with AIT is high in pregnant women and the most important reasons for discontinuing AIT were teratogenicity concerns and the obstetrician's reluctance to recommending treatment. It was also found that high treatment satisfaction increased adherence and higher number of patients dropped out of AIT in earlier stages of the treatment.