scholarly journals Allergen-specific immunotherapy for local allergic rhinitis: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
M.P. Hoang ◽  
J. Samuthpongtorn ◽  
W. Chitsuthipakorn ◽  
K. Seresirikachorn ◽  
K. Snidvongs
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Symptom Score ◽  
Observational Studies ◽  
Specific Immunotherapy ◽  
Allergen Specific Immunotherapy ◽  
Local Allergic Rhinitis ◽  
Medication Score ◽  
Disease Specific

Background: Local allergic rhinitis (LAR) is a phenotype of chronic rhinitis exhibiting a local Th2-driven inflammation without positive clinical markers of atopy. Immunomodulatory effects of allergen-specific immunotherapy (AIT) induce allergen-specific tolerance. However, AIT is not well-recognized as a treatment for LAR. Methodology: Systematic search on six electronic databases and registries was performed. Experimental and observational studies of AIT for LAR patients were retrieved. The primary outcomes were symptom score, medication score, combined symptom medication score, and disease-specific quality of life. Secondary outcomes were serum specific(s) IgG4, sIgE, and adverse events. Results: Four double-blind randomized controlled trials (156 patients) from two research units assessed the effects of subcutaneous immunotherapy (SCIT). Compared with placebo, SCIT showed significant reductions in symptom score, medication score, combined symptom medication score, disease-specific quality of life, and an increase in serum sIgG4. There was no significant change in serum sIgE. Likewise, two observational studies (one using SCIT and one using sublingual immunotherapy) improved post-therapeutic symptom score. No studies assessed the effects after discontinuation of treatment. AIT was safe without serious adverse events. Conclusion: AIT has beneficial effects and safe for LAR. Its effects are restricted to studies with short-term follow-up. AIT may be considered in LAR patients.

scholarly journals Pollen allergy and household budget

2011 ◽  
Vol 8 (4) ◽  
pp. 79-83
Author(s):  
M A Mokronosova ◽  
M A Mokronosova
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Specific Immunotherapy ◽  
Birch Pollen ◽  
Pollen Allergy ◽  
Direct Costs ◽  
Middle Part ◽  
Allergen Specific Immunotherapy ◽  
Severity Of The Disease

The prevalence of the allergy to birch pollen is high in the middle part of russian Federation. the symptoms of allergic intermittent rhinitis appears in the first decade and lasted during all life. the severity of the disease is aggravated annually. the economic burden of allergic rhinitis includes direct, indirect and hidden costs. the indirect cost (disability and loss of productivity, hypoallergenic life arrangements) exceeds direct costs many times. allergen specific immunotherapy by pollen allergovaccines is unique kind of pathogenic management. asIt demonstrates significant improvement of the symptoms of rhinitis and asthma, quality of life. one of the main problems is high costs of asIt. economical models used in investigations on asIt cost effectiveness demonstrated lucre in the following 10 years of life after 3 year's course of asIt. In order to achieve high clinical result it is necessary to follow european standard's guidance on specific immunotherapy strictly.

An Instant, Safe, Antihistamine, Anti-Inflammatory and Decongestant Polymeric Nasal Barrier to Prevent and To Treat Allergic Rhinitis in Children

2021 ◽  
Vol 7 (5) ◽  
pp. 01-09
Author(s):  
Ravi Shrivastava
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Side Effects ◽  
Symptom Score ◽  
Inflammatory Cytokines ◽  
Nasal Mucosa ◽  
Eosinophil Count ◽  
Allergen Exposure ◽  
Glycerol Solution

Introduction: Allergic rhinitis (AR) in children is a common chronic pathology with a strong impact on patient quality of life. The main physiopathology affects the nasal cavity as a multi-factorial disease involving nasal mucosa damage, nasal inflammation with high concentrations of histamine, pro-inflammatory cytokines such as histamine, TNF-α, IL-4, IL-5, IL-6, IL-10, IL-13, and IgE antibodies on the nasal mucosa. Systemic entry of these proteins through damaged nasal mucosa maintains continued inflammatory and allergen cascades. Therefore, an ideal treatment should be multitarget in order to stop allergen exposure, inflammation, and nasal mucosa barrier degradation, but such treatments are nearly impossible to conceive. We envisaged an osmotic and protective nasal barrier film, not only capable of protecting the nasal mucosa from allergen exposure but also of trapping and neutralizing selected cytokines and cleaning the nasal surface continuously without using any harmful substance for children. Materials and Methods: We associated highly osmotic glycerol solution with specific plant polymers to conceive an osmotic but stable film. As plant polymers (tannins) can bind with selective proteins, a range of glycerol binding non-cytotoxic polymers were screened using the sandwich ELISA method to select those having binding affinity for allergen induced nasal proinflammatory cytokines. After verifying cytotoxicity and irritant potential, a 15-day observational clinical study was performed with approval from the ethics committee on 30 children aged between 4-13, suffering from allergic rhinitis. The test product (TP) was supplied in 15-ml nasal sprays and applied 2-3 times per day for a period of 15 days. Saline solution served as control (CP). The scores of nasal and ocular symptoms, effect on quality of life, eosinophil count in nasal smears, and need for antihistamine treatment was evaluated at the start, at 30 minutes and on days 2, 3 and 15 of treatment. Results: A few specific polymers were able to bind with selected cytokines and histamine at adequate filmogen concentrations. The osmotic film was stable, non-irritant and was able to clean the nasal mucosa continuously for 4-6h after each application. Clinical observations of Total Nasal Symptom Score (TNSS) grouping the scores of nasal congestion, runny nose, sneezing, and itching, revealed a strong decrease right after the 1st treatment in both groups but the reduction was much stronger and faster with the TP. The mean TNSS score reduction was 44.74% in CP vs 83.53% in the TP group after 7 days of treatment (p<0.001). Total Ocular Symptom Score (TOSS) was decreased by 21.13% and 51.41% in CP v/s 35.12 and 99.59% in TP group on days 2 and 7, respectively. Nasal smear eosinophil count was equally strongly reduced in the TP v/s CP group. No treatment-related side effects were recorded in any of the groups. Conclusion: Protecting the nasal mucosa against allergens, neutralizing inflammatory cytokines, and keeping the nasal surface clean with an osmotic polymeric film, constitute a major breakthrough for the treatment of allergic rhinitis in children. This simple but scientific and logical approach should avoid exposing children to chemicals and to their long-term side effects.

scholarly journals Efektivitas imunoterapi terhadap gejala, temuan nasoendoskopik dan kualitas hidup pasien rinosinusitis alergi

2012 ◽  
Vol 42 (2) ◽  
Author(s):  
Yuwan Pradana ◽  
Teti Madiadipoera ◽  
Melati Sudiro ◽  
Arif Dermawan
Keyword(s):  
Quality Of Life ◽  
Visual Analogue Scale ◽  
Disease Severity ◽  
Analogue Scale ◽  
Specific Immunotherapy ◽  
Drug Intake ◽  
Allergen Specific Immunotherapy ◽  
Nasal Symptoms ◽  
Severity Of The Disease

Background: Rhinosinusitis is one of major health problems which increased the economic burden. With symptoms include nasal congestion, rhinorrhea, facial pain, and sometimes reduced or loss of smell, this condition may impair work productivity and quality of life (QOL). Rhinosinusitis is one of the comorbidity of allergic rhinitis. Allergen specific immunotherapy provides protection against the occurence of allergic symptoms and inflammatory reactions due to allergen exposure, that results in improvement  of QOL of allergic rhinosinusitis patients.   To assess the effectiveness of immunotherapy in the  severity of the disease, nasal symptoms, nasoendoscopic findings, drugs intake, and the QOL in allergic rhinosinusitis patients treated with specific immunotherapy. Methods: A retrospective descriptive study conducted at the Rhinology-Allergy Clinic of ORL-HNS Department, Dr.Hasan Sadikin General Hospital, Bandung, on January - December 2011, towards 25 patients, by anamnesis, severity of the disease using Visual Analogue Scale (VAS), nasal symptoms from Weeke, Davis and Okuda, nasoendoscopic findings from Lund-Kennedy, drug intake score, and QOL assesment using Rhinoconjuctivitis Quality of Life Questionaire. Results: There was a significant correlation (p<0,05) between specific immunotherapy for 1 year observed by reduced disease severity, reduced nasal symptoms, nasoendoscopic findings improvement, reduced drug intake, and increased Quality of Life which shows significant results from 3 months after immunotherapy using Wilcoxon differential test (p<0,001). Conclusion: Immunotherapy for 1 year was significantly reduced disease severity, reduced nasal symptoms, improved nasoendoscopic findings, reduced drug intake, and improvement of QOL in patients with allergic rhinosinusitis began from 3 months after immunotherapy and maintained afterwards. Key words: allergic rhinosinusitis, nasal symptoms, nasoendoscopy, specific immunotherapy, quality of life    Abstrak :  Latar belakang: Rinosinusitis merupakan salah satu masalah kesehatan yang semakin meningkat sehingga menjadi beban besar terhadap perekonomian masyarakat. Dengan gejala berupa hidung tersumbat, rinore, nyeri pada wajah dan dapat disertai berkurang atau hilangnya penciuman, kondisi ini dapat menurunkan produktivitas kerja dan kualitas hidup. Rinosinusitis merupakan salah satu komorbiditas dari rinitis alergi. Imunoterapi alergen spesifik bertujuan untuk memberikan perlindungan terhadap timbulnya gejala alergi dan reaksi inflamasi akibat pajanan alergen, sehingga dapat meningkatkan kualitas hidup pasien rinosinusitis. Tujuan: Membuktikan efektivitas imunoterapi terhadap tingkat beratnya penyakit, gejala hidung, nasoendoskopi, penggunaan obat dan kualitas hidup pasien rinosinusitis alergi yang diberikan pengobatan imunoterapi selama 3, 6, dan 12 bulan. Metode: Dilakukan penelitian deskriptif retrospektif, di Poliklinik Rinologi Alergi Ilmu Kesehatan THT-KL RSHS Bandung, dalam periode JanuariDesember 2011 pada 25 pasien, menggunakan anamnesis, tingkat berat penyakit berdasarkan Visual Analogue Scale (VAS), gejala hidung  berdasarkan Weeke, Davis dan Okuda, pemeriksaan nasoendoskopi berdasarkan Lund-Kennedy, penggunaan obat dan penilaian kualitas hidup dengan Rhinoconjuctivitis Quality of Life Questionaire. Hasil: Didapatkan hubungan bermakna berdasarkan uji chi-kuadrat-Friedman   antara imunoterapi selama 1 tahun (p<0,05) terhadap penurunan tingkat berat penyakit, penurunan gejala hidung, perbaikan temuan nasoendoskopi, penurunan penggunaan obat, serta peningkatan kualitas hidup. Didapat perbaikan secara bermakna sejak 3 bulan pasca imunoterapi (p<0,001) berdasarkan uji beda Wilcoxon. Kesimpulan: Imunoterapi selama 1 tahun efektif terhadap penurunan tingkat berat penyakit, penurunan gejala hidung, perbaikan temuan nasoendoskopi, penurunan penggunaan obat, serta peningkatan kualitas hidup pada pasien rinosinusitis alergi, dengan perbaikan sejak 3 bulan dan bertahan hingga 1 tahun pasca-imunoterapi. Kata kunci: rinosinusitis alergi, gejala hidung, nasoendoskopi, imunoterapi, kualitas hidup 

scholarly journals Efficacy of Allergen Specific Immunotherapy for Treatment of Allergic Rhinitis: A Systematic Review and Meta-analysis

2021 ◽  
pp. 200-213
Author(s):  
Madonna Nader Adly ◽  
Mahmoud Fawzy Mandour ◽  
Mahmoud Foad Abd Elaziz ◽  
Magdy Eisa Saafan
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Allergic Rhinitis ◽  
Sample Size ◽  
Full Text ◽  
Sublingual Immunotherapy ◽  
Current Evidence ◽  
Eligibility Criteria ◽  
Allergen Specific Immunotherapy

Background: Allergic rhinitis is a common disease that affect nose causing sneezing, watery nose, nasal itching and redness that affect quality of life, productivity at work or school and may underlies complications (e.g. Asthma) for patients and are often accompanied by itchy eye, redness and lacrimation. Aim of the Work: The objective of this study is to systematically assess the efficacy and safety of immunotherapy treatment for patients with Allergic Rhinitis. Method: Our initial search generated a total of 23330 possible relevant titles. Titles, abstracts were preliminary screening so that 22565 were excluded. 154 articles were retrieved in full text the number of studies excluded after assessment of the full text 145, 9 articles met the eligibility criteria and fulfilled the inclusion and exclusion criteria for the review. Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available on the Internet upto 2018. Data Extraction: If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion: Our systematic review provides evidence that Sublingual Immunotherapy (SLIT) tablets effectively relieve rhinitis symptoms in adults with allergic rhinitis, improve their quality of life and provide data about safety of Sublingual Immunotherapy as there were no serious side effects of using SLIT tablets. Nevertheless, the current evidence may be limited due to sample size and the heterogeneity between studies. Large sample size and multiple center RCTs on the efficacy of different formulations of SLIT drugs are still needed to provide further evidence and more precise recommendations.

scholarly journals Assessing the impact of cardiovascular events on health-related quality of life outcomes in DAPA-HF

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P McEwan ◽  
L Qin ◽  
P.S Jhund ◽  
K.F Docherty ◽  
J.J.V McMurray
Keyword(s):  
Quality Of Life ◽  
Symptom Score ◽  
Cardiovascular Events ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Impact ◽  
Disease Specific ◽  
Patient Utility

Abstract Background Heart failure (HF) patients are at increased risk of cardiovascular (CV) events, including hospitalisation for HF (hHF), myocardial infarction (MI) and stroke, imposing a significant burden on health related quality of life (HRQoL). DAPA-HF was a multinational clinical trial (NCT03036124) investigating the efficacy and safety of dapagliflozin for the treatment of HF with reduced ejection fraction. Patient reported outcomes were collected. The objective of this study was to estimate the impact of CV events on patient HRQoL over time, as assessed through EQ-5D-5L and Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score (TSS) and clinical symptom score (CSS). Methods Mixed effects regression models were developed based on pooled individual patient data from DAPA-HF to estimate the impact of hHF, MI and stroke on patient utility (EQ-5D-5L questionnaire responses weighted according to the societal value placed on given health states), and KCCQ TSS score. Utility was estimated using UK-specific tariffs after mapping EQ-5D-5L to EQ-5D-3L values in line with NICE guidance. A subject-specific intercept was incorporated, and estimates were adjusted for the incidence of events occurring within one month prior, two to four months prior, and 4 to 12 months prior to questionnaire completion. Results Mean patient baseline utility was 0.716 (95% CI: 0.711, 0.722), with KCCQ TSS 73.6 (73.0, 74.2). The incidence of CV events was consistently associated with reduced patient HRQoL, assessed through either EQ-5D or KCCQ TSS. In the first month following the event, hHF was associated with a 0.083 (0.06, 0.107) reduction in patient utility, and 16.9 (14.5, 19.4) reduction in KCCQ TSS (Fig. 1). Comparing measures, the disease specific measure KCCQ appeared more sensitive than EQ-5D to changes in HRQoL following hHF events and less sensitive to changes following MI and stroke events. Comparing events using the generic EQ-5D measure, at two months post-event, patients with MI and stroke returned to baseline utility; patients with hHF remained below baseline utility at each assessment point for 12 months (Fig. 2); where patients had a mean reduction of 0.02 (0.005, 0.035) utility and 0.5 (−1.1, 2.1) KCCQ-TSS compared to those without an hHF event. Conclusion The incidence of cardiovascular events imposes a considerable burden on HRQoL in patients with HFrEF. HF specific events may be better characterised with a disease specific tool, whereas for wider CV events a generic tool may be preferable. The impact of hHF on HRQoL was noteworthy in its persistence across the measures used up to one year. Interventions that reduce the risk of these events have the potential to significantly improve patient quality of life. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): AstraZeneca

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