Monthly Archives

December 2019

optimizacion evaluacion urticaria

Optimizing Value in the Evaluation of Chronic Spontaneous Urticaria: A Cost-effectiveness Analysis

By | Artículos seleccionados, Selected articles

Shaker M, Oppenheimer J, Wallace D, Lang DM, Rambasek T, Dykewicz M, Greenhawt M.

J Allergy Clin Immunol Pract. 2019 Nov 18. pii: S2213-2198(19)30938-9. doi: 10.1016/j.jaip.2019.11.004. [Epub ahead of print]

Chronic spontaneous urticaria can occur in both children and adults, however it is more common in adults, affecting approximately 1% of the population. It usually has an impact in quality of life, sleep and anxiety.

The aim of this study was to assess the cost-effectiveness of routine laboratory testing for secondary causes of chronic spontaneous urticaria.

Patients with more than 20 years old, over a 10-year time horizon, were randomized to receive screening laboratory testing or a no-testing approach. Laboratory results were derived from previously published retrospective studies of patients with chronic spontaneous urticaria. Cost-effectiveness was evaluated at a Willingness to Pay (WTP) threshold of $100,000/quality-adjusted life-year (QALY) using the incremental cost-effectiveness ratio (ICER) in people with untreated urticaria, and patients treated with antihistamines, cyclosporine, or omalizumab.

Average laboratory costs per simulated urticaria patient were $572.97, with only 0.16% (SD, 3.99%) of tests resulting in improved clinical outcomes. Testing costs per laboratory-associated positive outcome were $358,052 (no therapy), $357,576 (antihistamine therapy), $354,115 (cyclosporine), and $262,121 (omalizumab). Screening tests were not cost effective, with ICERs of $856,905 (no therapy), $855,764 (antihistamine therapy), $847,483 (cyclosporine), and $627,318 (omalizumab). In the omalizumab-treated subgroup, testing could be cost-effective below $220 or if it resulted in a 0.73% rate of CSU resolution. From a simulated US population perspective, nation-wide screening costs could reach $941,750,741 – $1,833,501,483.

This study concluded that the likelihood of clinical improvement from laboratory testing is very low, and that testing is not cost-effective in people with urticaria. Therefore, it is not recommended to routinely perform laboratory testing in urticaria patients with normal clinical and physical evaluations.

This document is only available for registered healthcare professionals

temporada polen sintomas

Pollen season is reflected on symptom load for grass and birch pollen-induced allergic rhinitis in different geographic areas – an EAACI Task Force Report

By | Selected articles

Pfaar O, Karatzas K, Bastl K, Berger U, Buters J, Darsow U, Demoly P, Durham SR, Galán C, Gehrig R, Gerth van Wijk R, Jacobsen L, Katsifarakis N, Klimek L, Saarto A, Sofiev M, Thibaudon M, Werchan B, Bergmann KC.

Allergy. 2019 Nov 13. doi: 10.1111/all.14111. [Epub ahead of print]

Allergic rhinitis is a condition that affects quality of life and has a high economic burden. Allergen immunotherapy (AIT) may be effective in seasonal and perennial allergic rhinitis, depending on the intensity and duration of pollen exposure. The European Academy of Allergy and Clinical Immunology (EAACI) task force evaluated pollen and symptom data from German and aimed at extrapolating these data in other European geographical areas such as Austria, Finland and France and assess their suitability for AIT and clinical support.

They used data from 23 pollen monitoring stations from Austria, Finland and France from 2014-2016. Afterwards, they studied the correlation between birch and grass pollen concentration during the birch and grass pollen season defined by the EAACI criteria and total nasal symptoms and medication scores reported by allergic rhinitis patients.

The analysis showed that there is a correlation of peak pollen period start and end and pollen-induced symptom loads reported by allergic rhinitis patients during birch and grass pollen season.

This task force concluded that the EAACI definitions on pollen season for both birch and grass are also valid for Austria, Finland and France, which may be of interest of use in clinical trials on AIT and also in daily clinical routine.

This document is only available for registered healthcare professionals

vitamina modulador rinitis

Vitamin D: A Modulator of Allergic Rhinitis

By | Selected articles

Agarwal S, Singh SN, Kumar R, Sehra R.

Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 3):2225-2230. doi: 10.1007/s12070-019-01697-9. Epub 2019 Jun 27.

Allergic rhinitis is a disease with an increasing prevalence and impact on medical practice. People suffering from allergic rhinitis often see their quality of life decreased. Allergic rhinitis treatment consists of a set of oral treatments and nasal drops and sprays, and many patients often don’t see their symptoms fade with this common approach.

This case-control observational study reviewed vitamin D as a therapeutic agent for allergic rhinitis. 80 participants were included, 40 healthy participants and 40 allergic rhinitis patients. Participants with allergic rhinitis were supplemented with oral vitamin D (cholecalciferol-1000 IU once daily). Serum vitamin D, total nasal symptom score (TNSS) and total eosinophilic count (TEC) were calculated and compared at baseline, 1 and 3 months. Serum vitamin D levels at baseline were 20.15 + 10.26 ng/ml for patients and 27.94 + 13.38 ng/ml for healthy controls. The TNSS score of allergic rhinitis of patients was 7.43 + 1.87 and of controls was 5.00 + 1.52. TEC of people with allergic rhinitis was 546.15 + 113.39 and of healthy controls was 313.33 + 125.08. After vitamin D treatment, participants with allergic rhinitis, serum vitamin D level was 38.05 + 14.62 and of controls was 27.43 + 12.76. TNSS of people with allergic rhinitis was 3.53 + 0.68 and 4.43 + 1.17 in healthy control group, TEC of participants with allergic rhinitis was 68.13 + 38.95 and of healthy controls was 197.03 + 123.36. Investigators concluded that vitamin D can act as disease modulator and that in people with allergic rhinitis, vitamin D supplementation offers symptomatic relief and lowers TNSS and TEC values.

This document is only available for registered healthcare professionals

interacciones contaminacion rinitis

Interactions between air pollution and pollen season for rhinitis using mobile technology: a MASK-POLLAR study

By | Selected articles

Bédard A, Sofiev M, Arnavielhe S, Antó JM, Garcia-Aymerich J, Thibaudon M, Bergmann KC, Dubakiene R, Bedbrook A, Onorato G, Annesi-Maesano I, Pépin JL, Laune D, Zeng S, Bousquet J, Basagaña X.

J Allergy Clin Immunol Pract. 2019 Nov 28. pii: S2213-2198(19)30962-6. doi: 10.1016/j.jaip.2019.11.022. [Epub ahead of print]

The POLLAR project (Impact of Air POLLution in Asthma and Rhinitis) assesses if there are associations between major air pollutants and allergic rhinitis control. Former studies have suggested an interaction between air pollution and pollen exposure with an impact on symptoms.

This study included 3323 participants from Northern and Central Europe who recorded the daily impact of allergic symptoms in a validated mobile tool for rhinitis management using visual analogue scales during 2017 and 2018. Pollutant levels were assesses using a system for integrated modelling of atmospheric composition and pollens were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for gender, age, treatment and country. Analyses were stratified by pollen seasons to investigate interactions between air pollutants and pollen exposure.

Stronger associations between uncontrolled rhinitis and pollutants were observed during the grass pollen season. Also, days with uncontrolled allergic rhinitis increased by 25% for an interquartile range increase in pollutants levels during the grass pollen season.

The MASK-POLLAR study concluded that there may be a relationship between uncontrolled allergic rhinitis and air pollution and that this relationship is modified in the grass pollen season.

This document is only available for registered healthcare professionals

serum ige eosinofilos

Determination of Serum IgE and Eosinophils as a Diagnostic Indicator in Allergic Rhinitis

By | Selected articles

Sharma M, Khaitan T, Raman S, Jain R, Kabiraj A.

Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 3):1957-1961. doi: 10.1007/s12070-018-1383-7. Epub 2018 May 2.

Allergic rhinitis is the most increasing allergic respiratory disorder. It affects 10-20% of the population and is clinically identified by symptoms such as nasal discharge, itching, sneezing and nasal congestion. The objectives of this study were to determine if serum IgE and eosinophil levels have a correlation with allergic rhinitis. A total of 155 participants (113 patients and 42 healthy controls, 81 women) of different ages (1 month – 75 years old) were included in this retrospective study. Blood samples were collected from all participants and analysed to determine serum IgE and eosinophil levels. A Pearson’s correlation was performed to establish a relationship between serum log IgE and eosinophil levels. The statistical analysis of the samples demonstrated that the mean values of serum found that these were higher in participants with allergic rhinitis than in healthy controls. Also, in participants with allergic rhinits, a predominance in men was seen in mean serum log IgE levels, whereas women predominance was seen in mean eosinophil counts. A small positive correlation was established between serum log IgE and eosinophil levels. This study showed that elevated serum IgE and eosinophil levels were observed in patients with allergic rhinitis with predominance in men and younger age group.

Serum IgE and eosinophils can serve as a simple, non-invasive and reliable tool for allergic rhinitis diagnosis.

This document is only available for registered healthcare professionals

enfoque rinitis alergica

Approach to Patients with Allergic Rhinitis: Testing and Treatment

By | Selected articles

Cox L.

Med Clin North Am. 2020 Jan;104(1):77-94. doi: 10.1016/j.mcna.2019.09.001. Review.

Allergic rhinitis is a very common condition, affecting approximately 113 million in Europe and 30 to 60 million in the United States. Allergic rhinitis treatment is usually symptomatic, nevertheless it has both high economic burden and impact in the quality of life of patients.

Allergen immunotherapy (AIT) is a well-established and proven effective treatment of allergic rhinitis because it treats its symptoms but also the underlying cause of allergic rhinitis by stimulating immunologic changes that produce long-term allergen-specific tolerance.

The investigator produced a literature review on AIT and concluded that besides reducing symptoms, it improves overall quality of life of patients with allergic rhinitis. The 2 most commonly prescribed AIT routes are SCIT (subcutaneous immunotherapy) and SLIT (sublingual immunotherapy), which have comparable efficacy. The safety profile of SLIT is superior to SCIT, but both have been shown to have poor adherence in real-life studies. AIT has shown to prevent the progression of allergic rhinitis to asthma and may provide long-term clinical benefits after discontinuation of medications, which can translate into cost savings, when compared to standard treatment. However, more research is needed.

This document is only available for registered healthcare professionals


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