R. Ariano

Possible role of climate changes in variations in pollen seasons and allergic sensitizations during 27 years

BACKGROUNDnClimate changes may affect the quality and amount of airborne allergenic pollens. The direct assessment of such an effect requires long observation periods and a restricted geographic area.nnnOBJECTIVEnTo assess variations in pollens and allergic sensitizations across 27 years in relation to climate change in a specific region.nnnMETHODSnWe recorded pollen counts, season durations, and prevalences of sensitizations for 5 major pollens (birch, cypress, olive, grass, and Parietaria) in western Liguria between 1981 and 2007. Pollen counts were performed using a Hirst-type trap, and sensitizations were assessed by means of skin prick testing. Meteorologic data for the same period included average temperatures, direct radiation, humidity, number of sunny days, and rainfall.nnnRESULTSnThere was a progressive increase in the duration of the pollen seasons for Parietaria (+85 days), olive (+18 days), and cypress (+18 days), with an overall advance of their start dates. For Parietaria, there was an advance of 2 months in 2006 vs 1981. Also, the total pollen load progressively increased for the considered species (approximately 25% on average) except for grasses. Percentages of patients sensitized to the pollens increased throughout the years, whereas the percentage of individuals sensitized to house dust mite remained stable. These behaviors paralleled the constant increase in direct radiation, temperature, and number of days with a temperature greater than 30 degrees C.nnnCONCLUSIONnThe progressive climate changes, with increased temperatures, may modify the global pollen load and affect the rate of allergic sensitization across long periods.

Economic evaluation of sublingual immunotherapy vs symptomatic treatment in allergic asthma

BACKGROUNDnThe worldwide increased prevalence of allergic diseases, and especially of respiratory allergy, is paralleled by increased health costs. This requires consideration of the cost to efficacy ratio of the available treatment to identify the optimal choice.nnnOBJECTIVEnTo compare the different economic relevance, over a long evaluation time, of symptomatic pharmacologic therapy and sublingual immunotherapy (SLIT) in patients with allergic asthma.nnnMETHODSnSeventy patients with perennial allergic asthma, sensitized to dust mites, were enrolled; 50 of these patients were treated with SLIT against house dust mites and 20 were treated with symptomatic drugs. The patients were evaluated for 2 years after discontinuing immunotherapy, which was performed for 3 years, to obtain a more complete follow-up. Symptom scores, medication scores, and all other direct medical costs were evaluated with a specific questionnaire.nnnRESULTSnPatients treated with SLIT plus drugs had a higher mean annual cost in the first year of SLIT treatment compared with patients only receiving drug treatment, but the mean annual cost became significantly lower since the end of SLIT both in the whole population and in the subgroups defined by disease severity.nnnCONCLUSIONnThe economic advantage measured alongside this prospective observational study was long lasting and still present at the fifth year of the follow-up (2 years after discontinuing SLIT) and could positively be related to the persistent good clinical control of patients.

Safety of sublingual immunotherapy started during the pollen season

ABSTRACT Background: Sublingual immunotherapy (SLIT) is safer than subcutaneous immunotherapy (SCIT) and this has lead to the reconsideration of the use of ultra-rush schedules for SLIT. The aim of this study was to assess the safety of ultra-rush SLIT in pollen-allergic children according to different timing of administration in relation to the pollen season. Methods: In total, 34 children with pollen-induced rhinitis and 36 with pollen-induced asthma and rhinitis, were enrolled and assigned to three study groups: groupu20091 (nu2009=u200917 patients): conventional pre-seasonal-SLIT treatment; groupu20092 (nu2009=u200923 patients), seasonal SLIT ended before the pollen seasonal peak; groupu20093 (nu2009=u200930 patients), SLIT began after the pollen seasonal peak and ended after the pollen season. SLIT was performed using extracts from Stallergenes (Antony, France) and following an ultra-rush schedule, consisting in four doses at a 30-min intervals, and maintenance treatment by administering the top dose three times a week. Results: In all, 54 adverse events (AEs) were reported: 12 in nine patients in groupu20091 (9/17, 52.9%), 22 in 14 patients in groupu20092 (14/23, 60.9%), and 20 in 13 patients in groupu20093 (13/30, 43.3%). No statistically significant differences were found between the three groups. Local AEs (oral itching and burning) were short lasting and self-resolving. Systemic AEs were also mild, except for a case of asthma, which lasted 5u2009days, in a patient from groupu20091. There were no severe reactions, and none of the patients dropped out. Conclusions: This study suggests that SLIT with pollen extracts may be safely started at the beginning and also during the pollen season, with a tolerability profile comparable to the conventional pre-seasonal SLIT.

Cost-Effectiveness of Allergen Immunotherapy

The current burden of allergic diseases, considering both direct and indirect costs, is very relevant. In fact the estimated cost for allergic rhinitis (AR) is 4-10 billion dollars/year in the US and averages an annual cost of 1089 euros per child/adolescent and 1543 euros per adult in Europe. The cost is obviously higher when including also allergic asthma. Strategies aimed at reducing the clinical severity of allergy are therefore most relevant from both a societal and healthcare system’s perspective. Among them, allergen immunotherapy (AIT) showed preventive capacity and also a carryover effect once treatment is discontinued, thus further reducing the costs. A number of studies demonstrated a favorable cost-benefit ratio for AIT. The first studies in the 1990s evaluating subcutaneous AIT in patients with allergic rhinitis and asthma, reported significant reductions of direct and indirect costs in subjects treated with AIT, as compared to those treated with symptomatic drugs. This was fully confirmed in recent studies conducted in European countries, also including sublingual immunotherapy, as well as in studies conducted in the US. In particular, the conclusion of a recent study on health care cost benefits of AIT in children with AR suggesting that “Greater use of this treatment in children could significantly reduce AR-related morbidity and its economic burden” should be kept in mind when considering the optimal choice of medical treatment in patients with AR or asthma.