Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

The prevalence of food allergy has increased in recent years, especially in children. Food allergen avoidance and symptomatic drugs in case of an allergic reaction remain the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanuts, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.

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Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

Frontiers in Immunology ◽

10.3389/fimmu.2021.636612 ◽

2021 ◽

Vol 12 ◽

Author(s):

Francesca Mori ◽

Mattia Giovannini ◽

Simona Barni ◽

Rodrigo Jiménez-Saiz ◽

Daniel Munblit ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Food Allergy ◽

Meta Analysis ◽

Scientific Evidence ◽

Standard Of Care ◽

Oral Immunotherapy ◽

Patient Reported

The prevalence of food allergy has increased in recent years, especially in children. Allergen avoidance, and drugs in case of an allergic reaction, remains the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanut, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization through the consumption of an increasing amount of a food allergen, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current pediatric OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, pediatric OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.

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A systematic review and meta-analysis examining the effects of cannabis and its derivatives in adults with malignant CNS tumors

Neuro-Oncology Practice ◽

10.1093/nop/npaa013 ◽

2020 ◽

Vol 7 (4) ◽

pp. 376-383

Author(s):

Jesus-Eduardo Rodriguez-Almaraz ◽

Susan Chang ◽

Jennifer Clarke ◽

Nancy Ann Oberheim-Bush ◽

Jennie Taylor ◽

...

Keyword(s):

Quality Of Life ◽

Meta Analysis ◽

Scientific Evidence ◽

Progression Free Survival ◽

Cochrane Collaboration ◽

Standard Of Care ◽

Cns Tumors ◽

The Impact ◽

Quality Evidence

Abstract Background Primary CNS tumors constitute a heterogeneous group of neoplasms that share a considerable morbidity and mortality rate. To help control tumor growth and clinical outcomes (overall survival, progression-free survival, quality of life) symptoms, patients often resort to alternative therapies, including the use of cannabis. Despite rapidly growing popularity, cannabis and its impact on patients with primary malignant CNS tumors is understudied. Methods To shed light on the lack of scientific evidence in this field, in November 2018 we conducted a search and examination of cannabis in neuro-oncology in major journal databases and bibliographies of selected articles, and through abstracts of annual meetings using prespecified criteria in line with the Cochrane Collaboration guidelines. Results We identified 45 publications, of which 9 were selected. Five studies were included. Publication dates ranged from 2004 to 2018 and included varying histologies of primary brain tumors. The average survival at 1 year was 56.09% (95% CI: 48.28-63.9). There was no difference in risk ratio (RR) for death at 1 year between groups (RR: 1.069 [95% CI: 0.139-8.25]). We found strong evidence of heterogeneity (Q = 74.0%; P = .021). We found no statistical evidence of publication bias (P = .117; SD = 1.91). Conclusions There was limited moderate-quality evidence that supports the use of cannabinoids as adjuvant to the standard of care in the treatment of brain and CNS tumors. There was very low-quality evidence suggesting that cannabinoids were associated with adult-onset gliomas. Further prospective clinical trials are necessary to adequately evaluate the impact of cannabinoids on CNS tumors, specifically on survival and quality of life.

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Impact of aquatic exercise on persons with kidney disease: a systematic review and meta-analysis

Archivos de Medicina del Deporte ◽

10.18176/archmeddeporte.0008 ◽

2020 ◽

Vol 37 (5) ◽

pp. 339-347

Author(s):

D Rodríguez Rey ◽

MA Sanchez-Lastra ◽

C Ayán Pérez

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Kidney Disease ◽

Physical Exercise ◽

Meta Analysis ◽

Scientific Evidence ◽

Aquatic Exercise ◽

The Impact

Objective: Analyze the scientific evidence on the effects that aquatic physical exercise has on people with chronic kidney disease (CKD). Material and method: A systematic review was carried out following the checklist Preferred Reporting Items for Systematic review and Meta-Analysis Protocols, with the objective of locating the largest number of investigations that aimed to identify the effects of the practice of aquatic physical exercise in people with ERC. A search of the PubMed, PEDro, Scopus and Cochrane databases were carried out until March 2019, using the PEDro, CERT, MINORS and NIH scales to determine the methodological quality of the same. Results: Five investigations were located, two of them were randomized control trials, another two studies comparatives and one was uncontrolled. The mean score and the median obtained after applying PEDro scale were 4 and 4 respectively. All the interventions proposed aerobic exercise programs, being generally of short duration and highly supervised, without any adverse effects arising from their practice. In a large part of the studies, significant effects were observed in physical condition, physiological parameters and quality of life, to a lesser extent. The practice of exercise had no significant impact on either the activity of the disease or the perceived pain in patients. Conclusions: Practice of aquatic exercise is beneficial in people with ERC. More longitudinal studies are needed to assess the impact of aquatic exercises as well as its effect and quality of life in long term.

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Quality-adjusted life years (QALY) for inotuzumab ozogamicin vs standard of care for relapsed/refractory acute lymphoblastic leukemia (R/R ALL).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18506 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18506-e18506 ◽

Cited By ~ 4

Author(s):

Ilse van Oostrum ◽

Yun Su ◽

Bart Heeg ◽

Thomas Wilke ◽

Alexander Smith ◽

...

Keyword(s):

Quality Of Life ◽

Overall Survival ◽

Standard Of Care ◽

Health State ◽

Half Cycle ◽

Inotuzumab Ozogamicin ◽

Health States ◽

Patient Reported

e18506 Background: Inotuzumab Ozogamicin (InO), an anti-CD22 antibody-calicheamicin conjugate, has demonstrated superior clinical activity versus standard of care (SOC; intensive chemotherapy), including clinically meaningful improvement in overall survival (OS), high rates of complete remission (CR) and stem cell transplantation (SCT), and favorable patient-reported outcomes for R/R ALL in the phase 3 INO-VATE trial. Quality of life is an important consideration for R/R ALL patients in both short- and long-term survival. This study aimed to estimate mean overall survival adjusted for QoL (QALY) for patients treated with InO v SOC. Methods: A Markov model was developed with five health states - No CR, CR, post-SCT, progression, and death. Transition probabilities between health states and mortality rates were based on the InO-VATE trial. These rates were extrapolated to a lifetime horizon using parametric survival curves fitted to available OS data, and published literature for survival after SCT. Utilities (QoL valuations) for each health state were based on the patient-reported EQ-5D scores collected in the InO-VATE trial and a literature review. Adverse events experienced during and after treatments, including as a result of subsequent SCT, were taken into account in overall QoL. Outcomes were discounted at 1.5% and half-cycle corrected. Results: The estimated mean LY and QALY in each health state for InO and SOC and their differences are shown in Table. Most gains in LY and QALY for InO over SOC were from Post-SCT. Conclusions: This analysis taking into account both quantity and quality of life estimates InO offers an average of nearly 2 more years of QALY compared to SOC in R/R ALL, based on higher CR and SCT rates and better QOL. This is mainly driven by long-term gains of SCT. This can help inform patients, physicians and payers in decision making. [Table: see text]

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Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-86136-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ismail Zul Khairul Azwadi ◽

Mohd Noor Norhayati ◽

Mohd Shafie Abdullah

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Obstructive Uropathy ◽

Meta Analysis ◽

Percutaneous Nephrostomy ◽

Procedural Pain ◽

Controlled Trials ◽

Failure Rates ◽

Ureteral Stenting

AbstractAcute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.

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What conservative interventions can improve the long-term quality of life, depression, and anxiety of individuals with stable COPD? A systematic review and meta-analysis

Quality of Life Research ◽

10.1007/s11136-021-02965-4 ◽

2021 ◽

Author(s):

Zejun Liang ◽

Qian Wang ◽

Chenying Fu ◽

Rui Liu ◽

Lu Wang ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Meta Analysis ◽

Depression And Anxiety

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Prospective observational study to examine health-related quality of life and develop models to predict long-term patient-reported outcomes 6 months after hospital discharge with blunt thoracic injuries

BMJ Open ◽

10.1136/bmjopen-2021-049292 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049292

Author(s):

Edward Baker ◽

Ceri Battle ◽

Abhishek Banjeri ◽

Edward Carlton ◽

Christine Dixon ◽

...

Keyword(s):

Quality Of Life ◽

Hospital Discharge ◽

Brief Pain Inventory ◽

Thoracic Injuries ◽

Patient Reported ◽

Related Quality ◽

Paindetect Questionnaire ◽

Health Related

ObjectiveThis study aimed to examine the long-term outcomes and health-related quality of life in patients with blunt thoracic injuries over 6 months from hospital discharge and develop models to predict long-term patient-reported outcomes.DesignA prospective observational study using longitudinal survey design.SettingThe study recruitment was undertaken at 12 UK hospitals which represented diverse geographical locations and covered urban, suburban and rural areas across England and Wales.Participants337 patients admitted to hospital with blunt thoracic injuries were recruited between June 2018–October 2020.MethodsParticipants completed a bank of two quality of life surveys (Short Form-12 (SF-12) and EuroQol 5-Dimensions 5-Levels) and two pain questionnaires (Brief Pain Inventory and painDETECT Questionnaire) at four time points over the first 6 months after discharge from hospital. A total of 211 (63%) participants completed the outcomes data at 6 months after hospital discharge.Outcomes measuresThree outcomes were measured using pre-existing and validated patient-reported outcome measures. Outcomes included: Poor physical function (SF-12 Physical Component Score); chronic pain (Brief Pain Inventory Pain Severity Score); and neuropathic pain (painDETECT Questionnaire).ResultsDespite a trend towards improving physical functional and pain at 6 months, outcomes did not return to participants perceived baseline level of function. At 6 months after hospital discharge, 37% (n=77) of participants reported poor physical function; 36.5% (n=77) reported a chronic pain state; and 22% (n=47) reported pain with a neuropathic component. Predictive models were developed for each outcome highlighting important data collection requirements for predicting long-term outcomes in this population. Model diagnostics including calibration and discrimination statistics suggested good model fit in this development cohort.ConclusionsThis study identified the recovery trajectories for patients with blunt thoracic injuries over the first 6 months after hospital discharge and present prognostic models for three important outcomes which after external validation could be used as clinical risk stratification scores.

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Mini-Implant-Retained Overdentures for the Rehabilitation of Completely Edentulous Maxillae: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084377 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4377

Author(s):

Serena Vi ◽

Damon Pham ◽

Yu Yian Marina Du ◽

Himanshu Arora ◽

Santosh Kumar Tadakamadla

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Survival Rate ◽

Data Extraction ◽

Meta Analysis ◽

Empirical Studies ◽

Implant Survival ◽

Patient Reported ◽

Full Text Review

Purpose: Mini-dental implants (MDIs) have been used to support and retain overdentures, providing patients with a less invasive placement procedure. Although lucrative, the use of MDIs to retain a maxillary overdenture is still not an established treatment modality. This systematic review aims to answer the question: Do mini-implant-retained maxillary overdentures provide a satisfactory treatment outcome for complete edentulism? Methods: A systematic search for relevant articles was conducted to include articles published until April 2021 in the following electronic databases: CINAHL, Cochrane, EMBASE, PubMed, and Web of Science. All empirical studies evaluating the biological, survival, or patient-reported outcomes after placing mini-implant-retained overdentures in maxilla were considered for inclusion. The risk of bias was assessed by utilizing the Joanna Briggs Institute critical appraisal checklist. Study screening and data extraction were conducted by three reviewers independently. Results: The electronic search retrieved 1276 titles after omitting duplicates. Twenty articles were considered for full-text review, of which six studies were included in this systematic review. The included studies evaluated a total of 173 participants with a mean age of 66.3 years. The overall mini-implant survival rate was 77.1% (95% CI: 64.7–89.5%) with a mean follow-up time of 1.79 years (range: 6 months to 3 years). Implant survival differed significantly when comparing complete and partial palatal coverage overdentures. Those with complete palatal coverage exhibited less bone loss overall compared to partial coverage overdentures. Participants of all studies reported an increase in the quality of life and in satisfaction after rehabilitation treatment with MDIs. Conclusions: The survival rate of mini-implants retaining an overdenture in the maxilla was observed to be lower than the values reported for traditional implants in the literature. Improvements were observed in all aspects in terms of patient satisfaction, quality of life, oromyofunction, and articulation after the treatment.

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Association of Progressive Supranuclear Palsy Rating Scale with Progressive Supranuclear Palsy Quality of Life Scale

Neurodegenerative Diseases ◽

10.1159/000514519 ◽

2021 ◽

pp. 1-8

Author(s):

Alexander Pantelyat ◽

Lenora Higginbotham ◽

Liana Rosenthal ◽

Diane Lanham ◽

Vanessa Nesspor ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Progressive Supranuclear Palsy ◽

Rating Scale ◽

Linear Regression Analysis ◽

Disease Evolution ◽

Quality Of Life Scale ◽

Patient Reported ◽

Scale Scores

Introduction: There is growing interest in using patient-reported outcomes as end points in clinical trials, such as the progressive supranuclear palsy quality of life (PSP-QoL) scale. However, this tool has not been widely validated and its correlation with validated motor scales has not been explored. To evaluate the potential utility of using PSP-QoL as an outcome, it is important to examine its relationship with a standard scale used to evaluate neurologic parameters, such as the PSP Rating Scale. Methods: PSP-QoL and PSP Rating Scale scores were gathered from 60 clinically diagnosed PSP patients, including patients with Richardson syndrome PSP (PSP-RS, n = 43) and those with non-RS PSP variants (n = 17). Linear regression analysis adjusted for age, sex, and disease duration was used to evaluate the cross-sectional relationship between the total and subscale scores of the 2 instruments. Results: Among 60 PSP patients, there was a significant correlation between total PSP-QoL and PSP Rating Scale scores. The physical and mentation subscales of each instrument also demonstrated significant correlations. Comparisons among PSP subtypes indicated that worsening PSP-QoL Total and Physical subscale scores correlated with worsening PSP Rating Scale gait subscale scores more strongly for the non-RS PSP variants than for PSP-RS. Discussion: There is a significant association between the total scores and many of the subscale scores of the PSP-QoL and the PSP Rating Scale. Additionally, the relationship between these measures may differ for PSP-RS and non-RS variants. These findings suggest that the PSP-QoL may be useful in clinical trials as a patient-reported outcome measure. Large prospective multicenter studies utilizing the PSP-QoL are necessary to examine its relationship to disease evolution and changes in the PSP Rating Scale.

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