Francesco Tarantini

Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age: a meta-analysis of randomized, placebo-controlled, double-blind trials

OBJECTIVE To evaluate the efficacy of sublingual immunotherapy (SLIT) in the treatment of allergic rhinitis in children. DATA SOURCES A comprehensive search of the EMBASE, MEDLINE, LILACS, and CINAHL databases from January 1966 to February 10, 2006, was performed. STUDY SELECTION Randomized, double-blind, placebo-controlled trials of SLIT in the treatment of allergic rhinitis in patients 18 years or younger were selected. Outcomes measured were symptom scores and rescue medication use. Analysis was performed with standardized mean differences (SMDs) and a random-effects model. RESULTS Seventy articles were identified and reviewed. Ten studies, published between 1990 and 2004, fulfilled the selection criteria. Five hundred seventy-seven patients were initially included in the studies. Of these patients, 484 (245 SLIT and 239 placebo) had a final clinical evaluation and could be evaluated. A relevant heterogeneity due to widely differing scoring systems was found. Overall, there was a significant reduction in both symptoms (SMD, 0.56, 95% confidence interval, 1.01-0.10; P = .02) and medication use (SMD, 0.76; 95% confidence interval, 1.46-0.06; P = .03) after immunotherapy. The subanalyses performed for treatment duration and type of allergen showed that SLIT for more than 18 months and with pollen extracts was effective compared with SLIT courses shorter than 18 months and with mites. CONCLUSION The results of this meta-analysis showed that,compared with placebo, SLIT with standardized extracts is effective in pediatric patients with allergic rhinitis.

Specific immunotherapy for respiratory allergy: state of the art according to current meta-analyses

OBJECTIVE To evaluate the efficacy of allergen specific immunotherapy in the treatment of allergic asthma and rhinitis as derived by the available meta-analyses. DATA SOURCES Electronic databases were searched up to April 30, 2008, for meta-analyses of randomized, placebo-controlled trials assessing specific immunotherapy in respiratory allergy. We looked for studies that evaluated effects on symptom scores and use of rescue medication. STUDY SELECTION If 2 or more reviews evaluated the same subject, we selected the study with the larger number of patients. We evaluated the quality of individual meta-analyses by following the recommendations of the Cochrane Collaboration and the QUOROM (Quality of Reporting of Meta-analyses) statement. RESULTS Seven of 13 meta-analyses met the inclusion criteria: 5 evaluating sublingual immunotherapy and 2 evaluating subcutaneous immunotherapy. All 7 meta-analyses reported a reduction in symptom and medication scores, although 1 sublingual immunotherapy meta-analysis did not find a significant size effect, probably because of the inclusion criteria. Heterogeneity was significant in all 7 included reviews, and standardized mean differences using the random-effects model were adopted. CONCLUSIONS According to evidence-based criteria, specific immunotherapy can be recommended for the treatment of respiratory allergy because of its efficacy in reducing asthma and rhinitis symptoms. Also, future methodological approaches that consider safety and costs should corroborate this positive evaluation.

Efficacy of desloratadine in the treatment of allergic rhinitis : a meta-analysis of randomized, double-blind, controlled trials

The objective of the study is to assess the efficacy of the nonsedating antihistamine, desloratadine, in the treatment of allergic rhinitis (AR). A search of MEDLINE, EMBASE, LILACS, and CINAHL databases was undertaken from January, 1966 to May, 2006. Double‐blind, randomized, controlled studies of desloratadine in the treatment of AR in adult patients were carried out. The measured outcomes included the total symptoms score, the total nasal symptoms score, nasal airflow, and inflammatory markers (nasal eosinophils, nasal interleukin‐4). The analysis included the calculation of standardized mean difference (SMD). A total of 57 studies were analyzed, and 13 randomized, double‐blind, controlled trials were included in the meta‐analysis. The trials included 3108 subjects who had completed studies involving desloratadine. There was significant heterogeneity among the study results, because of differing study methodologies. Desloratadine was associated with significant reductions in total symptoms scores (SMD −1.63; 95% CI −2.75 to −0.51; P = 0.004) and total nasal symptoms score (SMD −0.66; 95% CI −0.91 to −0.42; P < 0.001), when compared with placebo. Analysis of objective data on nasal blockage demonstrated a significant improvement in nasal airflow with desloratadine, when compared with placebo (SMD 0.32; 95% CI 0.10 to 0.55; P = 0.005). A benefit favoring desloratadine over placebo in terms of nasal eosinophil levels was also noted in the analysis. This meta‐analysis confirms the reduction of AR symptoms and improvement in nasal airflow seen in individual studies of desloratadine. Objective improvements in nasal airflow, total symptoms, and total nasal symptoms seen with desloratadine are supported by Ia evidence.

ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN Review

Allergic diseases constitute a global health problem, as they have an increasing economic and social impact and, especially, they can deeply interfere with the patients’ daily life, being a cause of physical and emotional discomfort. This is why the health‐related quality‐of‐life (HRQoL) has become increasingly important in health care research; in fact, the assessment of the impact the disease and its treatment have on patients, provides a more comprehensive approach in outcome evaluation. Numerous validated questionnaires are available and many studies have been performed evaluating HRQoL in people affected by allergic rhinitis (AR), thus testifying a great interest in this topic. The aims of the present review are: to examine the scientific literature of the last 3 years dealing with the impact of AR treatments suggested by allergic rhinitis and its impact on asthma guidelines on patients’ QoL, and to identify the unexplored or not‐fully‐investigated areas concerning this issue.

A new tool to assess and monitor the burden of chronic cough on quality of life: Chronic Cough Impact Questionnaire.

Introduction:  Chronic cough, one of the most frequent causes for a patient to consult a medical practitioner, limits the course of normal activities in everyday life of the patient affected (work, physical activities, social relations, night sleep). By now, there are few validated questionnaires for the evaluation of the impact of this symptom in the patients quality of life (QoL). For this reason, we created a new questionnaire for the assessment of QoL in patients affected by chronic cough (Chronic Cough Impact Questionnaire, CCIQ).

The impact of GINA suggested drugs for the treatment of asthma on Health-Related Quality of Life: a GA2LEN review

Asthma represents a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that, when uncontrolled, can place severe limits on daily life and can even be fatal. Asthma cannot be removed, but asthmatic symptoms can be cured; as for many other chronic diseases, pharmacotherapy is important to reduce the risk of asthma‐related mortality, decrease disability and improve symptoms and quality of life. The action of antiasthmatic drugs directly contributes to decrease symptoms severity, improve spirometric results, reduce airway hyperresponsiveness and prevent irreversible airway remodelling. Antiasthmatic therapy is necessary for long‐term control of asthma symptoms. Asthma and antiasthmatic drugs can influence patient’s quality of life: this is why healthcare systems have recently focused on research studies about Health‐Related Quality of Life (HRQL) in asthmatic patients. Numerous validated questionnaires are available and many studies have been performed evaluating HRQL in people affected by asthma, thus testifying a great interest in this topic. The aims of the present review are to examine the scientific literature of the last 4 years (January 2004–December 2007) dealing with the impact of asthma treatments suggested by Global Initiative for Asthma guidelines on patients’ quality of life, and to identify the unexplored or not fully investigated areas concerning this issue.

Efficacy of mometasone furoate nasal spray in the treatment of allergic rhinitis. Meta-analysis of randomized, double-blind, placebo-controlled, clinical trials

Rationale:  Several randomized, double‐blind, placebo‐controlled clinical trials have demonstrated the efficacy of mometasone furoate nasal spray (MFNS) in the treatment of allergic rhinitis (AR) thus allowing for a meta‐analysis to determine the overall treatment effect.

Asthma treatment: 'magic bullets which seek their own targets'.

The most fascinating options of the new asthma treatments are probably represented by monoclonal antibodies. In fact, these molecules are virtually able to interact with whatever specific antigen. Anyway, it is mandatory to understand the limits of this group of molecules, in terms of both efficacy and safety. In this review, we have analyzed different ways of interfering along the course of the cascade of the allergic reaction, targeting different molecules (CD4, TNF‐α, IL‐4, IL‐5, IL‐10, IL‐12, endothelial adhesion molecules, IgE), showing the efficacy and the risks of each kind of treatment. In the end, we focused our attention on omalizumab, the monoclonal antibody targeting IgE. Although with some restrictions, represented by the high costs and the limitation of its use only to a specific subset of patients affected by allergic asthma, at present anti‐IgE appear to be the only ‘magic bullet’ for the treatment of allergic asthma. In fact, it proved to reduce exacerbations and symptom scores, and to improve quality of life, with a very good safety profile.

Targeted therapy for allergic asthma: predicting and evaluating response to omalizumab

Evaluation of: Bousquet J, Rabe K, Humbert M et al. Predicting and evaluating response to omalizumab in patients with severe allergic asthma. Respir. Med. 101(7), 1483–1492 (2007). Among new asthma therapies, omalizumab is the only monoclonal antibody that has been proven to be effective and safe in treating severe, inadequately controlled asthma. Nevertheless, it has been pointed out that not all patients respond to it. This paper analyzes the results of a recent study that was aimed at achieving a more accurate evaluation of the response to omalizumab in patients with severe allergic asthma, by identifying possible pretreatment characteristics that can be predictive of a better and superior response to omalizumab. The results established that it is difficult to predict which patients will gain most benefit from treatment, according to pretreatment baseline characteristics.

Review article: Efficacy of desloratadine in the treatment of allergic rhinitis: a meta-analysis of randomized, double-blind, controlled trials: Efficacy of desloratadine in AR treatment

The objective of the study is to assess the efficacy of the nonsedating antihistamine, desloratadine, in the treatment of allergic rhinitis (AR). A search of MEDLINE, EMBASE, LILACS, and CINAHL databases was undertaken from January, 1966 to May, 2006. Double‐blind, randomized, controlled studies of desloratadine in the treatment of AR in adult patients were carried out. The measured outcomes included the total symptoms score, the total nasal symptoms score, nasal airflow, and inflammatory markers (nasal eosinophils, nasal interleukin‐4). The analysis included the calculation of standardized mean difference (SMD). A total of 57 studies were analyzed, and 13 randomized, double‐blind, controlled trials were included in the meta‐analysis. The trials included 3108 subjects who had completed studies involving desloratadine. There was significant heterogeneity among the study results, because of differing study methodologies. Desloratadine was associated with significant reductions in total symptoms scores (SMD −1.63; 95% CI −2.75 to −0.51; P = 0.004) and total nasal symptoms score (SMD −0.66; 95% CI −0.91 to −0.42; P < 0.001), when compared with placebo. Analysis of objective data on nasal blockage demonstrated a significant improvement in nasal airflow with desloratadine, when compared with placebo (SMD 0.32; 95% CI 0.10 to 0.55; P = 0.005). A benefit favoring desloratadine over placebo in terms of nasal eosinophil levels was also noted in the analysis. This meta‐analysis confirms the reduction of AR symptoms and improvement in nasal airflow seen in individual studies of desloratadine. Objective improvements in nasal airflow, total symptoms, and total nasal symptoms seen with desloratadine are supported by Ia evidence.