Allergen immunotherapy in MASK-air users in real-life: Results of a Bayesian mixed-effects model

Bernardo Sousa-Pinto, Luís Filipe Azevedo, Ana Sá-Sousa, Rafael José Vieira, Rita Amaral, Ludger Klimek, Wienczyslawa Czarlewski, Josep M. Anto, Anna Bedbrook, Violeta Kvedariene, Maria Teresa Ventura, Ignacio J. Ansotegui, Karl-Christian Bergmann, Luisa Brussino, G. Walter Canonica, Victoria Cardona, Pedro Carreiro-Martins, Thomas Casale, Lorenzo Cecchi, Tomás ChivatoDerek K. Chu, Cemal Cingi, Elisio M. Costa, Alvaro A. Cruz, Giulia De Feo, Philippe Devillier, Wytske J. Fokkens, Mina Gaga, Bilun Gemicioğlu, Tari Haahtela, Juan Carlos Ivancevich, Zhanat Ispayeva, Marek Jutel, Piotr Kuna, Igor Kaidashev, Helga Kraxner, Désirée E Larenas-Linnemann, Daniel Laune, Brian Lipworth, Renaud Louis, Michaël Makris, Riccardo Monti, Mario Morais-Almeida, Ralph Mösges, Joaquim Mullol, Mikaëla Odemyr, Yoshitaka Okamoto, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham-Thi, Frederico S Regateiro, Sietze Reitsma, Philip W. Rouadi, Boleslaw Samolinski, Milan Sova, Ana Todo-Bom, Luis Taborda-Barata, Peter Valentin Tomazic, Sanna Toppila-Salmi, Joaquin Sastre, Ioanna Tsiligianni, Arunas Valiulis, Dana Wallace, Susan Waserman, Arzu Yorgancioglu, Mihaela Zidarn, Torsten Zuberbier, João Almeida Fonseca, Jean Bousquet (Lead / Corresponding author), Oliver Pfaar

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Background: Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real-life studies.

Objective: To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK-air® app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT.

Methods: We assessed the MASK-air® data of European users with self-reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales-VASs), and a combined symptom-medication score (CSMS). We applied Bayesian mixed-effects models, with clustering by patient, country and pollen season.

Results: We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT-tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = -12.1;-2.8), lower VAS Work (average difference = 5.0; 95%CrI = -8.5;-1.5), and a lower CSMS (average difference = 3.7; 95%CrI = -9.3;2.2). When compared to SCIT, SLIT-tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = -17.2;-2.8), lower VAS Work (average difference = 7.8; 95%CrI = -15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = -18.5;0.2).

Conclusion: In patients with grass pollen allergy, SLIT-tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally-harmonised standards for performing and reporting real-world data in AIT are needed to better understand its 'real-world' effectiveness.

Original languageEnglish
Article numbere12128
Number of pages12
JournalClinical and Translational Allergy
Issue number3
Early online date28 Mar 2022
Publication statusPublished - Mar 2022


  • allergic rhinitis
  • immunotherapy
  • mobile health
  • patient-reported outcomes
  • real-life data analysis


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