G. Cadario

Quantitative assessment of the compliance with once‐daily sublingual immunotherapy in children (EASY Project: Evaluation of A novel SLIT formulation during a Year)

Compliance is a major determinant for allergy treatment, especially in children. Sublingual immunotherapy (SLIT) is self‐managed at home, and no quantitative data on pediatric adherence are available. We studied the compliance in a large real‐life setting. A simplified schedule of SLIT was used, consisting of a 10‐day updosing phase followed by maintenance treatment in monodose containers to be taken daily (SLITOne®). Italian specialists throughout Italy assessed the compliance in children who were newly prescribed SLIT according to guidelines. Parents were contacted with unscheduled telephone interviews at the third and sixth month of therapy and asked to count at that moment the remaining vials. Data from 71 children (38 boys, age range 2–13 yr) were enclosed in the database. Thirty had rhinoconjunctivitis, four asthma and 37 rhinoconjunctivitis + asthma. SLIT was prescribed for: mites in 57 (81%) subjects, grasses in 11 (15%) and 3 (4%) grass + olive mixture. Compliance data were available for all children at 3 months, and for 56 at 6 months. At 3 months, 85% of subjects had a compliance rate >75% (69% of them adhered >90%). At 6 months, 84% had a compliance rate >75% (66% of them adhered >90%). In four cases SLIT was discontinued for economical reasons, and in one case (1.4%) for side effects probably related to therapy. These data obtained in a quite large sample of children and in real‐life confirm that the compliance with SLITOne® is good, despite the therapy managed at home.

Sublingual immunotherapy efficacy in patients with atopic dermatitis and house dust mites sensitivity: a prospective pilot study.

ABSTRACT Background: Specific subcutaneous immunotherapy (SCIT) with house dust mite (HDM) preparation has recently been shown to improve eczema in patients with atopic dermatitis (AD). So far, there is less data regarding efficacy and safety of specific sublingual immunotherapy (SLIT) in patients with AD. Study aim: To evaluate in an open non-controlled, non-randomized pilot trial the effect of SLIT with HDM allergen extracts preparation (SLITone, ALK Abellò Italy) on SCORAD in adult patients with mild–moderate AD. Patients and methods: 86 Subjects (53 females and 33 males) between 3 and 60 years of age with AD and IgE-proved (Class > 2) HDM sensitization were enrolled after their informed consent in the trial. Exclusion criteria were severe asthma and treatment with systemic or high potent topical corticosteroids or immunosuppressant agents. Patients were treated with SLIT (Dermatophagoides pteronyssinus and Dermatophagoides farinae extracts: SLITone, ALK-Abellò) for at least 12 months. SCORAD was evaluated at baseline and after 12 months of treatment. Results: Baseline SCORAD value, mean ± SD, was 43.3 ± 13.7 (range 15–84). After 1 year of SLIT, mean ± SD, SCORAD value was reduced to 23.7 ± 13.3 (range: 0–65) (p = 0.0001; unpaired t-test vs. baseline). This was a 46% reduction in SCORAD in comparison with baseline value. A significant improvement, defined as a SCORAD reduction of > 30%, was observed in 51 out of 86 patients (59%). In 5 patients (5.8%) SCORAD values did not change at the end of the observation period. In 30 patients (35%) the SCORAD reduction after SIT was ≤ 30% in comparison with baseline. Total and specific IgE serum levels were significantly (p = 0.001) reduced after SLIT. No severe adverse events were observed during the trial. Conclusion: In this open non-controlled trial SLIT with HDM extracts in patients with mild to moderate AD was effective in reducing the SCORAD after 1 year of SLIT treatment. In addition the treatment was very well tolerated. Treatment with SLIT, furthermore, has allowed a gradual and relevant reduction of concomitant therapies with topical corticosteroids or immunosuppressants. Present results require further controlled trials in order to confirm the potential clinical benefit of SLIT in this clinical setting.

Comparison of costs of sublingual immunotherapy and drug treatment in grass-pollen induced allergy: results from the SIMAP database study

ABSTRACT Objectives: This analysis is focused on the comparison of costs of allergic rhinitis (R) alone or with allergic asthma (R + A) in grass pollen allergy, for subjects treated with sublingual immunotherapy (SLIT) and symptomatic drugs, versus standard care controls. Methods: The SIMAP (Sublingual IMmunotherapy in Allergic Patients) study is a longitudinal observational database operated by a network of Allergy centers. Patients suffering from grass pollen allergy were included in this analysis and assigned to SLIT (plus drugs as needed) or to treatment with drugs alone. Outcome measures included use of medications, SLIT, visits and tests. Costs were assessed from the perspective of the Italian National Health Service; unit costs were obtained from published sources to produce an average cost/patient for the first year after enrolment. Results: One hundred and two patients were analyzed. Demographics were comparable in the two groups. Overall per patient yearly cost of treatment was higher in SLIT patients, both in the whole sample (€311 vs. €180/patient), in the R (€288 vs. €116) and R + A (€362 vs. €230) subpopulations, with R + A patients generating more costs than R patients in both groups. Nevertheless considerable savings were obtained in the cost of symptomatic drugs (−22% for R; −34% for R + A) in SLIT patients. Conclusions: Other studies have shown that SLIT can reduce the use of drugs for asthma and rhinitis, but this is the first time this outcome has been demonstrated in a routine care population (in the medical practice environment of an observational study) within the first year of treatment.

Intermittent and Persistent Allergic Rhinitis and Association with Asthma in Children

The natural history of allergic rhinitis (AR) is commonly characterized by worsening of symptom severity, frequent comorbidity with asthma, and polysensitization to aeroallergens. The polysensitization phenomenon starts in early childhood. AR classification has been recently revised, and some studies investigated the new types: intermittent (IAR) and persistent (PER) AR. However, no study has been carried out on children regarding this issue. This preliminary study was performed on a large cohort of children with allergic rhinitis to evaluate the type and severity of rhinitis and its possible association with asthma, including severity grade. One hundred and thirty-nine children (86 males, 53 females, mean age 11.8 years, range 3.5–17.7 years) with allergic rhinitis were prospectively and consecutively evaluated. Seventy-one children had rhinitis alone and 68 had rhinitis associated with asthma. Forty children had IAR, 30 of whom with moderate-severe grade. Ninety-nine children had PER, 65 of whom had moderate-severe grade. The severity of AR was not associated with asthma presence (Fisher χ2 = 0.5765; Prob.=0.9018). Regarding asthma severity, 30 children had the intermittent form, whereas 38 had the persistent form: 15 mild, 22 moderate, and 1 severe. This study provides the first evidence concerning the ARIA classification in children, partially confirming findings obtained in adulthood.

Anaphylaxis after application of topical bacitracin-neomycin powder

FEV1 but also DN2 (correlation coefficients: 0.575 vs 0.367), indicating that the correlation was stronger with central airway obstruction thanwith peripheral ventilation inhomogeneity.4 These findings suggest that R5-R20 is not a parameter specific to peripheral airways but one to central airways instead. Further studies are needed to clarify the meaning of R5-R20 and to establish the interpretation of forced oscillatory parameters in asthma.

PAA2 EFFECT OF SUBLINGUAL IMMUNOTHERAPY (SLIT) ON DIRECT MEDICAL COSTS FOR PATIENTS WITH ALLERGIC RHINITIS AND ASTHMA: RESULTS FROM THE SIMAP DATABASE STUDY

PSU4 VENTRAL, UMBILICAL,AND INGUINAL HERNIA: REVIEW OF THE CURRENT LITERATURE De Jonge P, Llyod A,Tan R, Narewska J, Doyle S, Nafees B UBC, UK, UK, Ethicon, Livingston, UK, United Biosource Corporation, London, London, UK OBJECTIVES: To provide a comprehensive overview of existing literature on inguinal, ventral, and umbilical hernias in the UK, US, France, Germany, and Italy in four independent areas: 1) epidemiology; 2) treatment guidelines and management; 3) healthrelated quality of life; and 4) economic burden. METHODS: Systematic reviews and meta-analyses were reviewed ahead of any single studies. Studies included in the systematic reviews were not reviewed independently. Where systematic reviews were not available, the next highest level of evidence was identified. RESULTS: Seven studies examining incidence of inguinal (5), ventral (2), and umbilical hernia (0); 17 studies of HRQL in inguinal hernia repair (none in ventral or umbilical hernia repair); 4 systematic reviews and 22 costing studies of inguinal hernia repair (4 ventral hernia costing studies; none for umbilical); and 10 published guidelines on inguinal hernia repair only (none for France, Italy, or Germany) were identified. No prevalence studies were found and incidence data was limited to hernia repair procedures and recurrences versus true incidence of hernia. Open mesh repair appears most common due to safety, ease of technique, low recurrence rates and cost although laparoscopic repair has potential benefits over open mesh. Hernia repair generally leads to improved HRQL regardless of surgical technique. Mixed evidence supports LH patients having better HRQL, post-operative pain outcomes, return to work and usual daily activities profile following inguinal hernia surgery than OH patients. The inclusion of indirect costs such as absenteeism and presenteeism can significantly reduce or eliminate cost differences between laparoscopic and open repair as noted in TEP procedures. CONCLUSIONS: Although hernia repair is a common procedure, its epidemiology, treatment guidelines and management recommendations are not well referenced in the literature. Evidence based decision-making would be improved through reporting of real world, observational, longitudinal hernia repair data.