Abstract
BackgroundComplete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording.ObjectiveThe objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach.MethodsThe @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season.ResultsOverall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P<.001; Pordenone: ρ=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (ρ=–0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone.ConclusionsAdherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts.
Highlights
Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts
We examined the rate and cofactors of adherence to recording of an e-diary among Italian patients with Seasonal allergic rhinoconjunctivitis (SAR) participating in the @IT-2020 project, a study of combined molecular diagnostics and mobile health for allergen immunotherapy in patients with SAR
At T0, according to the ARIA questionnaire, the population in Pordenone was characterized by a higher prevalence of moderate to severe allergic rhinitis than in Rome (90/93, 97% vs 51/101, 50.5%, respectively)
Summary
Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. The etiological diagnosis and therapy of SAR require a demonstration that exposure to the sensitizing pollen triggers allergic symptoms [1]. This link is established by a positive outcome to nasal allergen provocation tests [2] or allergen exposure in pollen chambers [3]. Both these tests are costly and time consuming and are mostly used in clinical trials [4]. Recall biases make the diagnosis based on retrospective data somewhat imprecise, especially in patients apparently sensitized to multiple pollens that share the same pollination periods [6], which is a frequent setting in Mediterranean countries [7]
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