key: cord-0929384-icgd6t3u
authors: Celik, Ilknur Kulhas; Metbulut, Azize Pinar; Uneri, Ozden Sukran; Dinc, Gulser Senses; Misirlioglu, Emine Dibek
title: Effect of Patient and Parental Anxiety on Adherence to Subcutaneous Allergen Immunotherapy During COVID-19 Pandemic
date: 2021-01-23
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2021.01.025
sha: 2eb11a8a0c53c28c87d2ca87286b34633ea9c5c3
doc_id: 929384
cord_uid: icgd6t3u

nan

substantial contributions to design of study, drafted the article and agrees to be accountable for all aspects of the study related to its accuracy or integrity.

Ozden Sukran Uneri: She made substantial contributions to analysis of data; reviewed the article critically for important intellectual content; gave final approval of the version to be published and agrees to be accountable for all aspects of the study related to its accuracy Gulser Senses Dinc: She made substantial contributions to analysis of data; reviewed the article critically for important intellectual content; gave final approval of the version to be published and agrees to be accountable for all aspects of the study related to its accuracy . Emine Dibek Misirlioglu: She made substantial contributions to analysis of data; reviewed the article critically for important intellectual content; gave final approval of the version to be published and agrees to be accountable for all aspects of the study related to its accuracy All of authors certify that they have collectively written at least 90 percent of the manuscript.

The global spread of SARS-CoV-2 has resulted in over a million deaths to date, despite many 1 strategies implemented to limit transmission, such as social distancing, wearing face mask 2 and quarantining/isolation 1,2 .These strategies were also applied in health care facilities, 3

including recommendations for minimizing face-to-face meetings in allergy and immunology 4 clinics and taking necessary precautions to minimize the risk of transmission 3 . 5

Discontinuing SCIT is not recommended in patients who do not have COVID-19 or were 6 previously infected.It is also recommended that the interval between doses can be extended to 7 2 weeks in the build-up phase and up to 6 weeks in the maintenance phase 3-5 . 8 A recent study showed that the anxiety levels of the parents of children hospitalized during 9 the COVID-19 pandemic were higher than those of parents whose children were hospitalized 10 before the pandemic 6 . Patients receiving SCIT and their parents must continue to come to the 11 hospital for SCIT during the pandemic. 12

We aimed to evaluate effect of patient and parental anxiety on adherence to SCIT during 13 COVID-19 pandemic 14

Patients who underwent venom and aeroallergen SCIT in our pediatric allergy and 15 immunology clinic in hospital during the COVID-19 pandemic between May 1 and 16 September 1, 2020 and their parents were included in our study. The patients' age, sex, SCIT 17 type, phase, and duration, adherence to SCIT since the start of the pandemic were recorded 18

The study was approved by the ethics review committee of Ankara City Hospital and by the 19

Turkish Ministry of Health. Written informed consent was obtained from the parents of the 20 patients. 21

As per recommendations, the interval between doses was extended to 2 weeks in the build-up 22 phase and 6 weeks in the maintenance phase, and the patients were informed. The patients 23 were classified as adherent(patients who continued SCIT according to schedule during the maintenance phase), or discontinued treatment (patients who did not present for SCIT at all 27 since the pandemic started). 28

The anxiety levels of our patients were assessed using the State-Trait Anxiety Inventory for 29

Children(STAI-C),which is a tool to evaluate state and trait anxiety in children aged 8 to 18 30 years [7] [8] .Patients older than 18 and parents were assessed using the STAI 9 showed no statistically significant difference in patient state anxiety score or parental state 59 and trait anxiety scores, while trait anxiety score was higher among nonadherent patients 60 compared to adherent patients(p=0.02)(Table1). 61

It is recommended to continue treatment with extended dose intervals for patients 62 already receiving SCIT 8 . All of our patients started SCIT before the pandemic. Patients in the 63 build-up phase accounted for a significant proportion of patients who discontinued treatment. 64

Patients in the build-up phase had only been receiving treatment for a few months and had to 65 come every 2 weeks until this phase was complete. In contrast, patients in the maintenance 66 phase had been visiting our clinic in the hospital for treatment for years and needed to come 67 every 6 weeks during the pandemic. The higher rate of treatment cessation during the build-up 68 phase may be due to these patients having invested less time in treatment before the pandemic 69 and being required to visit clinic in the hospital more frequently. 70

Yuan et al. reported that anxiety was more pronounced in the parents of children 71 hospitalized during the pandemic 6 .Our patients were present in the hospital for approximately 72 one hour to receive SCIT.Our evaluation showed that there was no difference in patient or 73 parental state anxiety and parental trait anxiety between the adherent and nonadherent 74 indicating that in this age group, patients themselves have a greater effect on treatment 77 processes 10 . 78

In conclusion, half of our patients were fully adherent to SCIT during the pandemic. 79

Trait anxiety level of the patients was the only patient or parental anxiety factor associated 80 with poorer SCIT adherence.Therefore, we believe that treatment adherence may be improved 81 if allergists refer patients observed to be particularly anxious for child psychiatric evaluation. 82 

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Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A)

The Adolescent Perspective on Participation in Treatment Decision Making: A Pilot Study

The authors thank the following members of Division of Pediatrics Allergy and Immunology of Ankara City Hospital for their assistance