[Allergen-specific immunotherapy in the treatment of pollen allergy].

Rev Mal Respir. 2013 Feb;30(2):142-51

Authors: Mailhol C, Didier A

Abstract
Since its description by Noon in 1911, desensitization or allergen-specific immunotherapy (SIT) has been largely given by sub cutaneous injection in the treatment of allergic diseases. It remains the only treatment for allergic diseases aimed at the etiology. The development of sublingual route as an alternative to sub cutaneous injection, and of new forms of medication, has led to large-scale clinical trials, many of them performed with allergen tablets, particularly in the field of pollen allergy. These studies have confirmed that SIT is efficient in reducing allergic respiratory symptoms. Data on long term benefits and sustained efficacy after stopping treatment have also been published. These show an impact on the natural history of allergic disease and, in particular, a reduction in the risk of asthma in desensitized rhinitic subjects and in the acquisition of new sensitivities. The basic mechanisms of immunotherapy are becoming better understood and allow us to envisage improvements in this technique in the future. The sublingual route improves the risk/benefit ratio of desensitization and reduces the risk of serious side effects. These data suggest that the indications for SIT may be extended in a large number of patients with allergic respiratory diseases.

PMID: 23419445 [PubMed - in process]

Quality of Life and Acceptance of Illness among Patients with Chronic Respiratory Diseases.

Respir Physiol Neurobiol. 2013 Feb 15;

Authors: Kurpas D, Mroczek B, Knap-Czechowska H, Bielska D, Nitsch-Osuch A, Kassolik K, Andrzejewski W, Gryko A, Steciwko A

Abstract
The purpose of this study was to determine quality of life (QoL) and acceptance of illness in patients with chronic respiratory diseases. The study involved 315 adult patients of the mean age of 63.9±15.7 years. The World Health Organization Quality of Life Instrument Short Form and the Acceptance of Illness Scale were used. The mean score for QoL was 2.0 ±1.3. The highest scores were obtained in the Social Relationship Domain (13.9 ±2.7) and the lowest in the Environmental Domain (10.5 ±2.2). The strongest correlations within QoL domains were noted between Physical and Psychological Domains: r=0.611 (p<0.001), Psychological and Social Domains: r=0.605 (p<0.001). The overall degree of illness acceptance was low (26.0 ±7.8). The strongest correlations were observed between illness acceptance and Physical: r=0.591 (p<0.001) and Psychological Domains: r=0.450 (p<0.001). We conclude that illness acceptance can be augmented by improving the patient's clinical state and by the provision of psychological support and QoL by improving the Psychological and Environmental Domains.

PMID: 23419519 [PubMed - as supplied by publisher]

Influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination among adults 25 to 64 years of age with high-risk conditions-United States, 2010.

Am J Infect Control. 2013 Feb 15;

Authors: Lu PJ, Gonzalez-Feliciano A, Ding H, Bryan LN, Yankey D, Monsell EA, Greby SM, Euler GL

Abstract
BACKGROUND: Seasonal influenza vaccination has been routinely recommended for adults with high-risk conditions. The Advisory Committee on Immunization Practices recommended that persons 25 to 64 years of age with high-risk conditions be one of the initial target groups to receive H1N1 vaccination during the 2009-2010 season. METHODS: We used data from the 2009-2010 Behavioral Risk Factor Surveillance System survey. Vaccination levels of H1N1 and seasonal influenza vaccination among respondents 25 to 64 years with high-risk conditions were assessed. Multivariable logistic regression models were performed to identify factors independently associated with vaccination. RESULTS: Overall, 24.8% of adults 25 to 64 years of age were identified to have high-risk conditions. Among adults 25 to 64 years of age with high-risk conditions, H1N1 and seasonal vaccination coverage were 26.3% and 47.6%, respectively. Characteristics independently associated with an increased likelihood of H1N1 vaccination were as follows: higher age; Hispanic race/ethnicity; medical insurance; ability to see a doctor if needed; having a primary doctor; a routine checkup in the previous year; not being a current smoker; and having high-risk conditions other than asthma, diabetes, and heart disease. Characteristics independently associated with seasonal influenza vaccination were similar compared with factors associated with H1N1 vaccination. CONCLUSION: Immunization programs should work with provider organizations to review efforts made to reach adults with high-risk conditions during the recent pandemic and assess how and where they can increase vaccination coverage during future pandemics.

PMID: 23419613 [PubMed - as supplied by publisher]

Review: Corticosteroid plus LABA inhalers, vs LABAs alone, reduce morbidity in COPD.

Ann Intern Med. 2013 Feb 19;158(4):JC9

Authors: Aaron SD

Abstract
QUESTION In adults with chronic obstructive pulmonary disease (COPD), how effective are combined inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA) preparations compared with LABAs alone? REVIEW SCOPE Included studies compared combined ICS plus LABA (ICS/LABA) inhalers (fluticasone and salmeterol [FPS] or budesonide and formoterol [BDF]) with the same LABA alone in adults &gt; 40 years of age who had stable COPD and had not had an exacerbation in the past month. Studies of patients who had partial reversibility on pulmonary function testing were included. Studies that included patients with asthma, cystic fibrosis, bronchiectasis, thoracic surgery, or other lung or significant diseases were excluded. Outcomes included mortality, exacerbation (as defined by individual studies, but usually ≥ 48 h of increased COPD symptoms requiring a change in treatment = moderate exacerbation) rate ratio, number of patients with ≥ 1 exacerbation, pneumonia, and health-related quality of life (St. George's Respiratory Questionnaire [SGRQ], minimal clinically important difference 10 units). REVIEW METHODS Cochrane Airways Group Specialised Register of trials (Nov 2011), which includes studies identified from Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE/Excerpta Medica, CINAHL, AMED, PsycINFO, and hand searches of respiratory journals and meeting abstracts; LILACS (Mar 2011); Cochrane CENTRAL (Issue 1, 2011); and reference lists were searched for randomized, double-blind trials. Online trial registries of GlaxoSmithKline and AstraZeneca, and ClinicalTrials.gov were consulted. 14 trials (n = 11 794) met the selection criteria: 10 assessed FPS, and 4 assessed BDF. Study durations included 8 weeks (1 trial), 24 weeks (4 trials), 52 weeks (8 trials), and 156 weeks (1 trial). Quality of evidence, assessed with the Grading of Recommendations Assessment, Development, and Evaluation criteria, was low for exacerbation rate and moderate for mortality, patients with ≥ 1 exacerbation, and pneumonia. MAIN RESULTS Compared with LABAs alone, ICS/LABA preparations reduced the number of patients with exacerbations and the exacerbation rate ratio, increased risk for pneumonia, and did not affect mortality (Table). FPS (difference in change 1.58 SGRQ units, 95% CI 1.01 to 2.15) and BDF (difference in change 2.69 SGRQ units, CI 1.55 to 3.82) each increased quality of life more than LABAs alone. CONCLUSION In adults with chronic obstructive pulmonary disease, combined inhaled corticosteroid plus long-acting β2-agonist (LABA) preparations reduce risk for exacerbations, increase pneumonia, and improve quality of life, but do not affect mortality, compared with LABAs alone.Combined ICS/LABA inhalers vs LABA alone in chronic obstructive pulmonary disease*OutcomesNumber of trials (n)Weighted event ratesAt a median 1 yICS/LABALABARRR (95% CI)Mortality10 (10 681)5.1%5.1%7% (-10 to 21)Patients with ≥ 1 exacerbation6 (3357)45%47%10% (3 to 16)RRI (CI)Pneumonia12 (11 076)6.4%5.4%50% (17 to 91)Rate ratio (CI)Exacerbation rate†9 (9921)NANA0.76 (0.68 to 0.84)*ICS = inhaled corticosteroid; LABA = long-acting β2-agonist; NA = not applicable; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH, and CI calculated from data in article using a random effects model.†Compares exacerbations per patient-year between treatment groups.

PMID: 23420259 [PubMed - in process]