RUDN Journal of MedicineRUDN Journal of MedicineВестник Российского университета дружбы народов. Серия: Медицина2313-02452313-0261Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)1967910.22363/2313-0245-2018-22-3-288-301ALLERGOLOGY. DERMATOLOGYАЛЛЕРГОЛОГИЯ. ДЕРМАТОЛОГИЯResearch ArticleALLERGEN IMMUNOTHERAPY: EFFICACY, PERSISTENCE, CONSISTENCY, AND COST EFFECTIVENESSАЛЛЕРГЕН-СПЕЦИФИЧЕСКАЯ ИММУНОТЕРАПИЯ: ЭФФЕКТИВНОСТЬ, ПРОДОЛЖИТЕЛЬНОСТЬ, МЕТОДЫ И ФАРМАКОЭКОНОМИКАWallaceDanaУоллесДdrdanawallace@gmail.comNova Southeastern University School of Medicine, Fort Lauderdale, Florida, USAСовременная Школа медицины Юго-Восточного Университета, Форт-Лодердейл, Флорида, США15122018223VOL 22, NO3 (2018)ТОМ 22, №3 (2018)28830111112018Copyright ©; 2018, Wallace D.Copyright ©; 2018, Уоллес Д.2018Wallace D.Уоллес Д.http://creativecommons.org/licenses/by/4.0https://journals.rudn.ru/medicine/article/view/19679Although allergen immunotherapy (AIT) has been used for the treatment of allergic rhinitis (AR), allergic conjunctivitis, asthma, stinging insect hypersensitivity, and atopic dermatitis for over 100 years, it has been slow to gain universal acceptance. With the publication of the “World Health Organization Position Paper, Allergen Immunotherapy” in 1998 which summarized the scientific evidence for the efficacy and long-term benefit of this therapy, it has become an accepted and respected modality of treatment. In this review there are discussed following topics of allergen immunotherapy: the reasons for recommending AIT, mechanism of action, subcutaneous and sublingual methods of application, duration, adherence and cost effectiveness. It is necessary to support, not blame, the patient for nonadherence as it is the responsibility of the patient, the physician, and the health-care system to create an environment in which the patient can be adherent. Nonadherence is multifactorial in most every patient and the physician must address all of the factors if adherence is to be improved. The greatest challenge is taking the time to create an individualized patient-tailored strategy to improve adherence, as one size does not fit all. Adherence is dynamic and selecting the best time to start AIT and assuring that there is close follow-up through AIT years of treatment is essential. The patient who is persistent and consistent in year one of AIT may not continue to be so in year three without added encouragement and support. The health-care systems and professional organizations need to help train physicians and their staff both in efficient and accurate ways to assess nonadherence and in implementing interventions to optimize adherence. The multidisciplinary approach to treating this disease of nonadherence will require the involvement of all healthcare professionals, researchers, professional organizations, insurance companies, and policy-makers.Несмотря на то, что аллерген-специфическая иммунотерапия (АСИТ) более ста лет применяется для лечения аллергического ринита (АР), аллергического конъюнктивита, астмы, атопического дерматита и гиперчувствительности к укусам насекомых, она постепенно достигла всеобщего признания. С опубликованием в 1998 году «Позиционного документа Всемирной организации здравоохранения аллерген-специфической иммунотерапии», в котором обобщены научные данные об эффективности и долгосрочной пользе этого способа терапии, аллерген-специфическая иммунотерапия стала признанной и уважаемой формой лечения. В обзоре обсуждаются следующие темы аллерген-специфической иммунотерапии: причины рекомендации по терапии АСИТ, механизм действия, подкожные и сублингвальные методы применения, продолжительность лечения, соблюдение пациентом назначений врача и экономическая эффективность. Особое внимание уделяется необходимости поддерживать, а не обвинять пациента в несоблюдении назначений врача, поскольку пациент, врач и система здравоохранения в целом должны заботиться о создании среды, в которой пациент будет неукоснительно соблюдать назначения врача. Несоблюдение пациентом назначений врача является следствием большого количества факторов, и врач должен учитывать все факторы с целью обеспечения соблюдения пациентом всех рекомендаций. Желание пациента соблюдать назначения врача необходимо рассматривать в динамике с целью выбора наилучшего времени для начала АСИТ, также необходимо обеспечить наблюдение за пациентом в течение нескольких лет после проведенной АСИТ. Пациент, неукоснительно исполняющий назначения врача в первый год лечения, не сможет быть столь же последовательным на третьем году терапии без дополнительной поддержки. Система здравоохранения и профессиональные организации должны помочь в обучении врачей эффективным и точным способам оценки причин несоблюдения пациентами назначений врача и осуществления мер по оптимизации приверженности пациентов к лечению на продолжении длительного срока. Междисциплинарный подход к решению этой проблемы потребует участия медицинских работников, исследователей, профессиональных организаций, страховых компаний и лиц, определяющих политику в сфере здравоохранения.allergen immunotherapysubcutaneoussublingualadherencecost effectivenessаллерген-специфическая иммунотерапия (АСИТ)подкожный и сублингвальный способы применениянесоблюдение назначений врачаэкономическая эффективность1.Bousquet J, Lockey R, Malling HJ, Alvarez-Cuesta E, Canonica GW, Chapman MD, et al. 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