scholarly journals Practice parameters for sublingual immunotherapy

2016 ◽  
Vol 65 (1) ◽  
Author(s):  
C. Ortolani ◽  
F. Agostinis ◽  
S. Amoroso ◽  
R. Ariano ◽  
A. Barbato ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Sublingual Immunotherapy ◽  
Clinical History ◽  
Practice Parameters ◽  
Post Marketing ◽  
Skin Prick Tests ◽  
Severity Of The Disease ◽  
Recommendation Grade ◽  
Perennial Allergens ◽  
Made In

The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, metaanalysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre coseasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient’s tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).

Post-marketing surveillance study on the safety of sublingual immunotherapy in pediatric patients

Allergy ◽  
1999 ◽  
Vol 54 (10) ◽  
pp. 1110-1113 ◽  
Author(s):  
V. Di Rienzo ◽  
A. Pagani ◽  
S. Parmiani ◽  
G. Passalacqua ◽  
G.W. Canonica
Keyword(s):  
Pediatric Patients ◽  
Sublingual Immunotherapy ◽  
Surveillance Study ◽  
Post Marketing Surveillance ◽  
Post Marketing

scholarly journals Antibiotic Allergies – Is De-labeling Based on Clinical History Feasible?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S342-S342
Author(s):  
Adrienne Torda ◽  
Victor Chan
Keyword(s):  
Task Force ◽  
Medical Condition ◽  
Skin Testing ◽  
Clinical History ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Patient Acceptance ◽  
Cross Sectional ◽  
Antibiotic Allergy ◽  
Practice Parameters

Abstract Background Up to 25% of patients admitted to hospital have an antibiotic allergy label (AAL), most of which are towards penicillin. However, up to 90% of patients who claim to be allergic to penicillin are actually able to tolerate them1. Whilst skin testing is safe and efficacious in de-labeling patients with a penicillin allergy label, it is usually not widely available. Therefore, we investigated the feasibility of de-labeling based solely upon clinical grounds. Quality of allergy documentation and subsequent antibiotic use was also assessed. Methods This was a cross-sectional study assessing all patients admitted to a tertiary referral teaching hospital over a 5-month period in 2016. All newly admitted patients were prospectively screened for the presence of an antibiotic allergy documented in their electronic medical record. Unless unable to participate, patients were interviewed regarding the detailed nature of their antibiotic allergy. Information regarding allergy documentation, medical condition and antibiotic use was obtained from medical records. Results 3855 patients were screened, 553 (14.35%) had an AAL, and 352 were interviewed. There were 426 allergies, 276 (64.8%) towards a penicillin. Only 52% of patients had a convincing history consistent with antibiotic allergy, and 48% of these were mild cutaneous reactions. It was felt that de-labeling and direct re-challenge would be relatively safe in 70% (298/42) of AALs (if the mild cutaneous allergic group were included). In patients who were prescribed antibiotics during study admission, 25.6% (41/160) of antibiotic prescriptions in our cohort were found to be inappropriate in patients with AALs. Conclusion Direct re-challenge based upon clinical grounds appears to be a feasible clinical option in many patients with AALs and would allow de-labeling of these patients. The major barriers continue to be patient acceptance and risk of severe adverse reactions. Our study also found that major improvements could be made in the specific documentation of allergy and also in selection of guideline-recommended alternate antibiotics. 1. Joint Task Force on Practice Parameters. Drug Allergy: An Updated Practice Parameter. Ann Allergy Asthma Immunol. 2010; 105(4): p. 259–273. Disclosures All authors: No reported disclosures.

The clinical effect of vitamin D supplementation combined with grass-specific sublingual immunotherapy in children with allergic rhinitis

2016 ◽  
Vol 37 (2) ◽  
pp. 105-114 ◽  
Author(s):  
Joanna Jerzynska ◽  
Wlodzimierz Stelmach ◽  
Blażej Rychlik ◽  
Joanna Lechańska ◽  
Daniela Podlecka ◽  
...  
Keyword(s):  
Vitamin D ◽  
Allergic Rhinitis ◽  
Clinical Effect ◽  
Sublingual Immunotherapy ◽  
Vitamin D Supplementation

scholarly journals Sensitization to rodents (mouse/rat) in urban atopic populations without occupational exposure living in Campania district (Southern Italy): a multicenter study

2013 ◽  
Vol 8 ◽  
Author(s):  
Gennaro Liccardi ◽  
Gennaro Baldi ◽  
Anna Ciccarelli ◽  
Marina Cutajar ◽  
Maria D’Amato ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Western Europe ◽  
Southern Italy ◽  
Allergic Sensitization ◽  
Clinical History ◽  
Specific Ige ◽  
Moderate Degree ◽  
Skin Prick Tests ◽  
Few Data ◽  
Indoor Conditions

Background: Up to now very few data on allergic sensitization to rodent allergens in Western Europe and Italy are available, and there are no information at district level. The aim of this report was to investigate clinical significance and characteristics of allergic sensitization to mouse/rat (M/ Rt) allergens in atopic subjects living in Campania district (Southern Italy). Methods: Allergists from the whole Campania district were required to report the results of skin prick tests of at least 100 consecutive subjects. In 1,477 consecutive outpatients, we selected all subjects with an immediate skin reaction to M/Rt dander. Clinical history including a careful evaluation of the modality of exposure and the results of skin-prick tests (SPTs) were recorded. Results: Fifty seven patients were sensitized to M/Rt dander (5.78%). Two patients were mono-sensitized. Fourteen patients reported indoor conditions suggesting presence of rodents allergens at home. All patients exhibited low-moderate degree of SPT positivity to M/Rt. High frequency of concomitant allergic sensitization to dust mites was found. Conclusions: Our results suggest that the role of allergic sensitization to rodents is not negligible in atopic subjects without occupational exposure living in Campania district area; these values are higher in comparison to those previously found in Naples area. Highly atopic individuals should be tested by SPTs/evaluation of serum specific IgE to rodents in the case they should begin an occupational exposure to M/Rt or keep these animals as pets.

The safety of carbamylated monomeric allergoids for sublingual immunotherapy. Data from a pharmacovigilance study

Immunotherapy ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Enrico Compalati ◽  
Cristoforo Incorvaia ◽  
Sara Urbano ◽  
Paola Strada ◽  
Franco Frati
Keyword(s):  
Adverse Drug Reactions ◽  
Sublingual Immunotherapy ◽  
Systemic Reaction ◽  
Subcutaneous Immunotherapy ◽  
Drug Reactions ◽  
Safety Database ◽  
Systemic Reactions ◽  
Spontaneous Reports ◽  
Post Marketing

Aim: Sublingual immunotherapy (SLIT) is significantly less concerned by systemic reactions than subcutaneous immunotherapy. Allergoids were introduced to reduce systemic reaction to subcutaneous immunotherapy, but may also be used for SLIT. Methods: This pharmacovigilance study evaluated the post-marketing reports collected in a safety database, including the number and the type (serious or not serious) of adverse drug reactions (ADRs) in Italy by SLIT with the carbamylated monomeric allergoid (CMA). Results: More than 15,000,000 CMA tablets were administered, with 25 spontaneous reports of ADRs, only two being serious. Conclusion: The rate of ADRs to CMA we found in this pharmacovigilance survey, corresponding to 0.0004% of all administered doses, is far lower than the rates commonly reported for allergen SLIT products.

scholarly journals Clinical History and Colliquative Myocytolysis Are Keys to the Diagnosis of Shoshin Beriberi

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Toshiki Kuno ◽  
Hiroshi Nakamura ◽  
Yutaka Endo ◽  
Kohei Saito ◽  
Hiroyuki Yamazaki ◽  
...  
Keyword(s):  
Present Report ◽  
Fatal Outcome ◽  
Clinical History ◽  
Lactate Accumulation ◽  
Appropriate Treatment ◽  
Clinical Presentations ◽  
Detailed Clinical History ◽  
Leg Edema ◽  
Thiamine Level ◽  
Made In

Cardiovascular beriberi presents as either the fulminant (Shoshin beriberi) or chronic form. Shoshin beriberi is a rare disease that may lead to a fatal outcome if the patient does not receive appropriate treatment. In the present report, we describe the case of a 66-year-old man presenting with leg edema and dyspnea at rest. Clinical presentations were nonalcoholic Shoshin beriberi and lactate accumulation; however, clinical improvement was observed after the administration of thiamine. His pretherapy thiamine level (2.1 μg/dL) was consistent with a diagnosis of beriberi. Based on the findings of the present case, we believe that a diagnosis can be made in patients with a clinical history that is consistent with that of Shoshin beriberi, combined with low thiamine levels, lactate accumulation, and colliquative myocytolysis.Learning Objective.Shoshin beriberi is often misdiagnosed because of its rarity; a detailed clinical history and characteristic myocardial histopathology changes may be useful for making a definite diagnosis.

Post-marketing survey on the safety of sublingual immunotherapy in children below the age of 5 years

2005 ◽  
Vol 35 (5) ◽  
pp. 560-564 ◽  
Author(s):  
V. Di Rienzo ◽  
M. Minelli ◽  
A. Musarra ◽  
R. Sambugaro ◽  
S. Pecora ◽  
...  
Keyword(s):  
Sublingual Immunotherapy ◽  
Post Marketing

scholarly journals Risk Association of MTHFR Polymorphisms for Severity of the Disease in Children with Sickle Cell Disorder

2021 ◽  
Author(s):  
Suprava Patel ◽  
Santosh Kumar ◽  
Gitismita Naik ◽  
Nanda Rachita ◽  
Nighat Hussain ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Clinical History ◽  
Severity Index ◽  
Plasma Homocysteine ◽  
Significant Implication ◽  
Cross Sectional ◽  
Mthfr Polymorphisms ◽  
Severity Index Score ◽  
Severity Of The Disease ◽  
Cell Disorder

Abstract The MTHFR variants, C677T and A1298C have been reported to contribute towards higher severity in sickle cell disorder. Hence the study was conducted on children with sickle cell disease to find out the association of the genotypes of MTHFR and disease severity. A cross-sectional analytical study was conducted on 249 children aged 5–15 years, diagnosed with sickle cell disorder. Severity Index was assigned to each child based on the clinical history of frequency of episodes of painful crisis, vascular crisis, joint pain, hemoglobin levels and hospitalization required. The children were grouped as SI ≤ 6 (Mild) and SI > 6 (Severe). The study participants comprised of 221 (88.76%) and 28 (11.24%) children in SI ≤ 6 and SI > 6 respectively. The SI score in the children was significantly associated with the MTHFR genotype variants C677T (p = 0.000), A1298C (p = 0.049), plasma homocysteine levels (p = 0.03), blood hemoglobin values (p = 0.000) and frequency of hospitalization (p = 0.000). Weight (p = 0.006), BMI (p = 0.000) and hemoglobin levels (p = 0.000) were significantly lower in children with SI > 6 whereas plasma homocysteine was found higher (p = 0.000). Genotypes CT and TT showed higher odds of SI > 6 as compared to CC genotype and genotype C’C’ showed higher odds of having SI > 6 as compared to genotypes AA and AC’ combined. The genotypes CC-AC’, CT-C’C’ and TT-AA were found to be associated with SI > 6. The study reported significant association of MTHFR polymorphisms, C677T and A1298C with severity index score in children with sickle cell disorder. The variants forms of the studied SNPs (TT and C’C’) were found to have significant implication with the severity of the disease.

How to interpret skin prick tests and serum-specific IgE in children and young people with food allergy

2021 ◽  
pp. edpract-2020-320562
Author(s):  
Kathryn Ferris ◽  
Marianne Cowan ◽  
Christine Williams ◽  
Sinead McAteer ◽  
Caoimhe Glancy ◽  
...  
Keyword(s):  
Food Allergy ◽  
Skin Prick Testing ◽  
Clinical History ◽  
Specific Ige ◽  
Children And Young People ◽  
Subsequent Investigation ◽  
Targeted Testing ◽  
Important Diagnostic Tool ◽  
Skin Prick Tests

Food allergy is common, it can lead to significant morbidity andnegatively impacts on quality of life; therefore, it is vitally important we get the diagnosis right. However, making the diagnosis can be complex. Clinical history is the most important diagnostic tool and subsequent investigation may help confirm the diagnosis. The investigations available to most paediatric departments are skin prick testing and specific IgE so we will focus on these. Within this article we explore the evidence related to targeted testing and how to interpret these within the clinical context.

scholarly journals Certainty in an Uncertain World - A Clinicians' Viewpoint of Sensitivity and Precision

2008 ◽  
Vol 27 (2) ◽  
pp. 135-138
Author(s):  
Patrick Twomey
Keyword(s):  
Cardiovascular Disease ◽  
Thyroid Disease ◽  
Clinical Effect ◽  
Clinical Biochemistry ◽  
Clinical History ◽  
Assay Sensitivity ◽  
Long Term Conditions ◽  
Assay Precision ◽  
The Uk

Certainty in an Uncertain World - A Clinicians' Viewpoint of Sensitivity and PrecisionClinical practice is evolving as research evolves from the bench to the bedside. Similarly, analytical technologies are improving on an annual basis. Rightly or wrongly, increased emphasis is now placed by clinicians on such investigations to the detriment of clinical history and examination. As people live longer, the prevalence of long-term conditions such as thyroid disease, cardiovascular disease and malignancies is increasing. Clinical biochemistry assays play an important part in the management (screening, diagnosis, prognosis and monitoring) of such conditions. This is reflected in the UK since 2004 by the primary care contract where over 100 of the 550 clinical points depend on clinical biochemistry assay results. Inter-assay results may differ due to bias, precision, assay specificity and assay sensitivity. To date, little emphasis has been placed on the potential clinical effect of precision. This presentation will explore the effect that assay precision can have on the management of important long-term conditions such as thyroid disease, cardiovascular disease and malignancies.

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