The impact of telemonitoring on adherence to nasal corticosteroid treatment in children with seasonal allergic rhinoconjunctivitis.

BACKGROUND: Adherence to controller therapy in allergic diseases is low. Telemonitoring has been proposed to improve adherence to treatment in chronic diseases. However, this strategy has never been tested in allergic rhinoconjunctivitis. OBJECTIVE: To test whether Internet-based telemonitoring during the grass-pollen season of children with allergic rhinoconjunctivitis may enhance adherence to treatment. METHODS: Children and adolescents, 5-18 years old, with moderate-to-severe seasonal allergic rhinoconjunctivitis to grass pollen requiring daily administration of nasal corticosteroid (NCS) (mometasone) were recruited (April 2013) in a paediatric allergy practice. Participants were randomized to Internet-based monitoring (AllergyMonitor(™) , AM) or to usual care (no diary at all, controls) and followed from 13 May (T0) to 15 June 2013 (T2). An intermediate visit (T1) was performed between 31 May and 2 June. Optimal adherence to therapy was expressed as the use of at least 0.190 g/day of mometasone, corresponding to 1 puff/nostril/day, and it was measured by canister weights during (T1) and at the end (T2) of the study period. Main secondary outcomes included the reported disease severity (validated self-questionnaire) and quality of life (AdoIRQLQ questionnaire), disease knowledge (multiple-choice questionnaire), nasal flow and resistance at baseline and at T2. RESULTS: The use of mometasone, expressed as both optimal adherence rate (48.4% vs. 12.5%; P = 0.002) and average daily use (0.20 ± 0.12 g/day vs. 0.15 ± 0.07 g/day; P = 0.037), was higher in the AM group (n = 31) than among controls (n = 32). Disease knowledge improved among the patients using AM (83.3% vs. 68.3%; P < 0.001) but not among controls (68.2% vs. 67.7% right answers; P > 0.05). No differences were observed in the reported severity of disease, nasal flow and resistance and quality of life both at baseline and at follow-up visits. CONCLUSIONS: Internet-based telemonitoring improves adherence to NCS treatment and disease knowledge among children and adolescents with seasonal allergic rhinoconjunctivitis.

Immunoglobulin G subclass antibody responses of mice to influenza virus antigens given in different forms.

Total IgG and IgG subclass antibody responses in mice were studied after infection with virulent and non-virulent influenza viruses, and after vaccination with inactivated whole virus or purified surface glycoproteins (HANA-flu). Infection induced high IgG2a, low IgG1 and IgG2b, and very low IgG3 levels of antibody in serum. Whole virus vaccine induced high IgG2a, moderate IgG2b, and very low IgG1 and IgG3 levels of antibody. In marked contrast, HANA-flu preparations induced high IgG1, low IgG2a, and very low IgG2b and IgG3 levels of antibody. Booster doses of whole virus and HANA-flu significantly elevated serum antibody levels, but the relative distribution of anti-influenzal antibody among the IgG subclasses was unchanged. Mice primed with HANA-flu prior to infection with mouse-adapted virus, produced high IgG2a, moderate IgG1, and low IgG2b and IgG3 levels of serum antibody. These data indicate that the physical form in which viral protein antigens are presented to the immune system can influence the subclass distribution of antibodies produced during primary immune responses and that once priming has occurred, responses to antigen presented in a different form are altered.