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The Safety of Specific Immunotherapy for Patients Allergic to House-Dust Mites and Pollen in Relation to the Development of Neoplasia and Autoimmune Disease: A Long-Term, Observational Case-Control Study.

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Specific immunotherapy (SIT) safety has been well documented. However, the prolonged late side effects in patients who terminated SIT several years previously have been reported on in only a limited number of studies. The aim of this study was to perform a 20-year post-SIT observational evaluation for the assessment of any manifestation of serious immunological disease.

Materials and Methods: In total, 1,144 patients (521 women and 623 men), with a mean age of 22.8 ± 16.9 years (at the moment of SIT completion) and who had atopic bronchial asthma and/or allergic rhinitis, were observed 20 years after immunotherapy. New neoplastic and autoimmune disease cases were monitored. The SIT group was compared to a control group consisting of 1,154 allergic patients who had never received SIT and had only had symptomatic treatment.

Results: There was an inverse association between SIT treatment and the prevalence of new chronic myeloid leukemia and chronic lymphoblastic leukemia cases (OR 0.32, 95% CI 0.18-0.81 and OR 0.58, CI 0.44-0.78, respectively). In other neoplastic diseases, however, prevalences similar to those observed in the control group were confirmed. There were also no significant differences in the autoimmune disease prevalence between the analyzed groups.

Conclusion: The results of this long-term observational study indicate a lack of a significant prevalence for new instances of neoplastic and autoimmune diseases, which suggests that SIT in the long term is indeed safe. © 2014 S. Karger AG, Basel.

Lung diffusion capacity in children with respiratory symptoms and untreated GERD.

GERDGastroesophageal reflux disease (GERD) is associated with many respiratory disorders, among which, chronic cough, laryngitis, and asthma are among the most common.

We investigated lung function, including gas diffusion capacity, in children with poor asthma control or chronic laryngitis with untreated GERD. Material and Methods A total of 71 children, aged 6-17 years, with chronic respiratory and other symptoms suggestive for GERD, were enrolled and divided into 2 groups: chronic laryngitis and asthma. Participants underwent 24-hour pH monitoring and lung function assessment, measurement of single-breath diffusing capacity of the lung for carbon monoxide (DLCO), and fraction of exhaled nitric oxide (FENO) measurement.

Results 24-hour pH monitoring was positive for GERD in 92.1% of preselected children with asthma and 90.1% of children with chronic recurrent laryngitis. All flows (PEF, MEF75, MEF50, and MEF25) were significantly lower in the asthma group, while FENO and DLCO were significantly lower in the laryngitis group. A significant inverse relationship was found between DLCO and all reflux indexes in the laryngitis group. Each unit change of Johnson-DeMeester score and Boix-Ochoa score increased the odds for significantly lower DLCO in laryngitis patients by 3.9% and 5.5%, respectively.

Conclusions In children with uncontrolled asthma and chronic laryngitis, the regurgitation of gastric contents due to GERD contributes to poor asthma control and aggravation of chronic laryngitis. Despite having normal lung function, the gas diffusion capacity should be controlled in patients with GERD and chronic laryngitis, and it might be the very first abnormality in distal airways.

Long-term adherence to a 5 day antibiotic course guideline for treatment of intensive care unit (ICU)-associated Gram-negative infections

Conclusions This study demonstrates long-term adherence to a 5 day course antibiotic guideline for treatment of ICU-associated GNB infections. This guideline is a potential antibiotic-sparing alternative to currently recommended dual empirical courses extending to ≥7 days. (Source: Journal of Antimicrobial Chemotherapy)

Safety of tiotropium through the Handihaler: why did meta-analyses and database studies appear to give a false alarm?

Concerns about the safety of long-acting antimuscarinic agents for the treatment of COPD,1 2 particularly the use of tiotropium through the Respimat device, led to the TIOSPIR study.3 This large well-conducted randomised study compared the use of tiotropium through the Handihaler (18 µg) with tiotropium at two doses (2.5 µg and 5.0 µg) through the Respimat in over 17 000 patients with COPD. It showed no difference in mortality or efficacy between the two delivery systems, nor even a trend for a mortality difference. It is now worth reviewing the data that led to these concerns and the lessons that may be learned. Two systematic reviews played a key role in raising concerns over tiotropium. Antimuscarinic agents were generally considered safe and well tolera...

Initial Oxygen Saturation Values Can Predict The Need To Hospitalise Children With Mild Wheezing

ConclusionAn initial SaO2 >93% reflects a mild course of acute wheezing and using this cut‐off point could have almost halved hospital admissions.This article is protected by copyright. All rights reserved. (Source: Acta Paediatrica)

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