Doreen McBride

The prevalence of plant food allergies: A systematic review

BACKGROUND There is uncertainty regarding the prevalence of allergies to plant food. OBJECTIVE To assess the prevalence of allergies to plant food according to the different subjective and objective assessment methods. METHODS Our systematic search of population-based studies (since 1990) in the literature database MEDLINE focused on fruits, vegetables/legumes, tree nuts, wheat, soy, cereals, and seeds. Prevalence estimates were categorized by food item and method used (food challenges, skin prick test, serum IgE, parent/self-reported symptoms), complemented by appropriate meta-analyses. RESULTS We included 36 studies with data from a total of over 250,000 children and adults. Only 6 studies included food challenge tests with prevalences ranging from 0.1% to 4.3% each for fruits and tree nuts, 0.1% to 1.4% for vegetables, and < 1% each for wheat, soy, and sesame. The prevalence of sensitization against any specific plant food item assessed by skin prick test was usually < 1%, whereas sensitization assessed by IgE against wheat ranged as high as 3.6% and against soy as high as 2.9%. For fruit and vegetables, prevalences based on perception were generally higher than those based on sensitization, but for wheat and soy in adults, sensitization was higher. Meta-analyses showed significant heterogeneity between studies regardless of food item or age group. CONCLUSION Population-based prevalence estimates for allergies to plant products determined by the diagnostic gold standard are scarce. There was considerable heterogeneity in the prevalence estimates of sensitization or perceived allergic reactions to plant food.

Incidence and natural history of challenge-proven cow's milk allergy in European children – EuroPrevall birth cohort

Cows milk allergy (CMA) is one of the most commonly reported childhood food problems. Community‐based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria.

The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries

To cite this article: McBride D, Keil T, Grabenhenrich L, Dubakiene R, Drasutiene G, Fiocchi A, Dahdah L, Sprikkelman AB, Schoemaker AA, Roberts G, Grimshaw K, Kowalski ML, Stanczyk‐Przyluska A, Sigurdardottir S, Clausen M, Papadopoulos NG, Mitsias D, Rosenfeld L, Reche M, Pascual C, Reich A, Hourihane J, Wahn U, Mills ENC, Mackie A, Beyer K. The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries. Pediatric Allergy Immunology 2012: 23: 230–239.

The Costs of Care in Atrial Fibrillation and the Effect of Treatment Modalities in Germany

OBJECTIVE Atrial fibrillation (AF) is an increasing burden on health-care systems because of an aging population. This study aimed to estimate health-care resource use and costs of treating AF in Germany. METHOD A 6-month multicenter prospective observational cohort study with additional 3-month retrospective clinical data collection was performed in physician practices. AF-related resource use was documented by 3-month retrospective and 6-month prospective clinical data from physician charts and prospectively by patient questionnaires at 3 and 6 months. Cost calculation was from the health-care payer perspective. RESULTS A total of 361 patients (mean age 71 +/- 9 years, 61% male) were recruited from 45 physician practices. Of 311 (86.1%) patients with complete data, 75% had persistent AF; oral anticoagulation and/or aspirin were prescribed in 98%. A rhythm-control strategy was applied in 27%, rate control in 58%, and 15% received neither antiarrhythmic medication nor cardioversion. A higher proportion of rhythm-control patients had paroxysmal AF (P < 0.001). Mean annual AF-related per-patient cost was 827 Euro +/- 1476 (median 386 Euro). 50% of total costs were incurred by 11% of patients, driven by AF-related hospitalizations (44%). Antiarrhythmics and stroke prophylaxis accounted for 20% and 15% of expenditures, respectively. Mean annualized costs were higher for rhythm-control patients than for rate-control patients or those without antiarrhythmic treatment (1572 vs. 780 vs. 544 Euro, P < 0.001). CONCLUSION This evaluation provides an overview of current treatment modalities and cost of AF management in Germany. Efforts to reduce the economic burden of AF should focus on avoidance of AF hospital admissions and optimization of stroke prevention and rhythm control.

Systematic review of treatments for chronic spontaneous urticaria with inadequate response to licensed first‐line treatments

Patients with chronic spontaneous urticaria (CSU) are sometimes unresponsive to nonsedating, second‐generation, H1 antihistamines; this study summarizes published clinical evidence for patients who remain symptomatic despite treatment.

Assessing Changes in Chronic Spontaneous/Idiopathic Urticaria: Comparisons of Patient-Reported Outcomes Using Latent Growth Modeling.

IntroductionAssessing the consequences of chronic spontaneous/idiopathic urticaria (CSU) requires the evaluation of health-related quality of life (HRQoL) associated with the severity of CSU signs and symptoms. It is important to understand how signs, symptoms, and HRQoL change over time in CSU. Evidence is lacking on how closely changes in signs and symptoms of CSU are related to changes in HRQoL. The objective of this study was to assess the correlation between changes in patient-reported outcome measures (PROMs) of signs and symptoms, dermatologic quality of life (QoL), and urticaria-specific QoL.MethodsLatent growth models (LGMs) were applied to longitudinal data from three randomized, Phase 3 clinical trials investigating the efficacy and safety of omalizumab in CSU.ResultsA near-perfect association between changes in signs and symptoms and changes in dermatologic and urticaria-specific QoLs was identified in each clinical trial when using LGMs (correlation coefficient range 0.88–0.92).ConclusionEvidence showed that changes in signs and symptoms are closely related to changes in HRQoL. However, analyses were performed on clinical trial results of an extremely effective treatment; a less effective treatment with much smaller changes over time may not show such close correlations. Results suggest that any of these PROMs may be used to understand changes in CSU.

Management patterns of thrombosis prophylaxis and related costs in hip and knee replacement in Germany

The objective of the study was to depict treatment strategies, health care utilisation and cost evaluation of hip and knee replacement surgery in Germany, with a particular emphasis on thrombosis prophylaxis (TP) for the prevention of deep vein thrombosis (DVT). In this multi-centre prospective cohort study, medical record data (socio-demographics, risk factors for thrombosis, thrombosis prophylaxis, course of hospital stay) were collected for patients undergoing either total hip replacement (THR) or total knee replacement (TKR). One and three months post-operatively, post-operative outcomes and health care resource use were documented by patient and physician questionnaires. A total of 309 patients participated in the study (59% female, mean age 66 [SD 10] years). Parenteral anticoagulation was administered for a mean of 38 (SD 16) days. 27 (9%) patients received subsequent oral anticoagulation for a mean of 38 (SD 21) additional days. Symptomatic DVT was reported by four (1.3%) patients. Mean overall direct costs associated with surgery from baseline to 3 months were EUR 11 264 (median 11 564, SD 2 481). Hospital and rehabilitation accounted for 97% of direct costs; costs for medications, physical therapy, physician office visits, out-of-pocket expenses, as well as complication costs accounted for an additional 3% of direct costs. Within these direct costs, a mean of EUR 348 (SD 361) was related to thrombosis prophylaxis, accounting for 3% of direct costs. Mean overall cost was EUR 11 926 (SD 2 481), including 6% indirect costs of productivity loss. Extended thrombosis prophylaxis was observed in the usual care setting of the study and associated with low incidence of symptomatic DVT. Thrombosis prophylaxis is — within the considerable economic burden of joint replacement surgery — a relatively small cost component.

Work Productivity and Activity Impairment Among Chronic Spontaneous/Idiopathic Urticaria Patients: ResultsFrom The First International Burden of Illness Study (Assure-Csu).

SPONTANEOUS/IDIOPATHIC URTICARIA PATIENTS: RESULTS FROM THE FIRST INTERNATIONAL BURDEN OF ILLNESS STUDY (ASSURE-CSU) Balp MM1, Chambenoit O2, Chiva-Razavi S2, Lynde C3, Sussman G4, Chapman-Rothe N5, Weller K6, Maurer M6, Koenders J7, Knulst AC8, Halliday A9, Alexopoulos ST9, Nakonechna A10, Grattan C11, Abuzakouk M12, Sweeney C13, Radder C13, Wolin D14, McBride D15, Hollis K13, Tian H16, Oude Elberink JNG17 1Novartis Pharma AG, Basel, Switzerland | 2Novartis Pharmaceuticals Canada Inc., Dorval, QC, Canada | 3Lynderm Research Inc., Toronto, ON, Canada | 41St Michael’s Hospital, University of Toronto, Toronto, ON, Canada | 5Novartis Pharma GmbH, Nuernberg, Germany | 6Charite Universitatsmedizin Berlin, Berlin, Germany | 7Novartis Pharma B.V., Arnhem, Netherlands | 8University Medical Center Utrecht, Utrecht, Netherlands, 9Novartis Pharmaceuticals UK Limited, Surrey, United Kingdom | 10Royal Liverpool and Broadgreen University Hospitals NHS Trust, United Kingdom | 11Norfolk and Norwich University Hospital, Norwich, United Kingdom, 12Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE | 13RTI Health Solutions, Research Triangle Park, NC, USA | 14RTI Health Solutions, Ann Arbor, MI, USA | 15RTI Health Solutions, Manchester, United Kingdom | 16Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA | 17University Medical Center Groningen, Groningen, Netherlands

Cost‐effectiveness of secukinumab as first biologic treatment, compared with other biologics, for moderate to severe psoriasis in Germany

Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin 17A, has demonstrated strong and sustained efficacy in adults with moderate to severe psoriasis in clinical trials.

Cost-Utility of Omalizumab Compared With Standard of Care for The Treatment of Chronic Spontaneous Urticaria (Csu).

Background Chronic spontaneous urticaria (CSU) negatively impacts patient quality of life and productivity and is associated with considerable indirect costs to society.