A systematic review and cost-effectiveness analysis of specialist services and adrenaline auto-injectors in anaphylaxis

Research type:	HTA Technology Assessment Report
Title (lead author) etc:	A systematic review and cost-effectiveness analysis of specialist services and adrenaline auto-injectors in anaphylaxis  (Armstrong) 117 pages, Volume 17, number 17
DOI	10.3310/hta17170
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Headline:	Study found a lack of good data to inform the effectiveness of anaphylaxis intervention but concluded that both referral to a specialist service (SS) and prescription of adrenaline injectors are likely to be cost-effective, and so consideration of randomised controlled trials of the components of care in SSs was recommended.
This report should be referenced as follows:	Armstrong N, Wolff R, van Mastrigt G, Martinez N, Hernandez A, et al. A systematic review and cost-effectiveness analysis of specialist services and adrenaline auto-injectors in anaphylaxis. Health Technol Assess 2013;17(17).
Project ref:	10/158/01
Original project title:	Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode.
Chief Investigator:	Kleijnen Systematic Reviews Ltd (KSR), Kleijnen Systematic Reviews Ltd
Start Date:	February 2011
Date of publication in HTA journal series	April 2013
Cost:	This project was commissioned by the HTA programme on a call-off contract basis.
Project Protocol:	Project protocol (pdf format, 198 kbytes)
Printed copies of this title despatched:	0 (Figures relate to the previous calendar month)
URL of this page:	http://www.hta.ac.uk/2486

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Dairy Science & Technology

Dairy Sci Technol. 2013 May; 93(3): 211–223.

Published online 2013 March 13. doi:  10.1007/s13594-013-0113-x

PMCID: PMC3634986

Milk processing as a tool to reduce cow’s milk allergenicity: a mini-review

Guanhao Bu, Yongkang Luo, Fusheng Chen, Kunlun Liu, and Tingwei Zhu

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Abstract

Milk processing technologies for the control of cow’s milk protein allergens are reviewed in this paper. Cow’s milk is a high nutritious food; however, it is also one of the most common food allergens. The major allergens from cow’s milk have been found to be β-lactoglobulin, α-lactalbumin and caseins. Strategies for destroying or modifying these allergens to eliminate milk allergy are being sought by scientists all over the world. In this paper, the main processing technologies used to prevent and eliminate cow’s milk allergy are presented and discussed, including heat treatment, glycation reaction, high pressure, enzymatic hydrolysis and lactic acid fermentation. Additionally, how regulating and optimizing the processing conditions can help reduce cow’s milk protein allergenicity is being investigated. These strategies should provide valuable support for the development of hypoallergenic milk products in the future.

Keywords: Cow’s milk protein, Allergen, Milk processing, Control technologies

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: Therapeutics and Clinical Risk Management

Critical appraisal of bilastine for the treatment of allergic rhinoconjunctivitis and urticaria

Review

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Authors: Sadaba B, Azanza JR, Gomez-Guiu A, Rodil R

Published Date May 2013 Volume 2013:9 Pages 197 - 205

DOI: http://dx.doi.org/10.2147/TCRM.S16079

Received:	04 March 2013
Accepted:	05 April 2013
Published:	03 May 2013

Belen Sadaba, Jose Ramon Azanza, Almundena Gomez-Guiu, Raquel Rodil

Clinical Pharmacology Service, Clinica Universidad de Navarra, Navarra, Spain

Abstract: Bilastine is a second generation antihistamine indicated for the treatment of seasonal or perennial allergic rhinoconjunctivitis and chronic urticaria with a daily dose of 20 mg, in adults and children over 12 years of age. The efficacy of bilastine has been shown to be similar to that of the comparator drugs for the control of the nasal and nonnasal symptoms of allergic rhinoconjunctivitis, while also showing a subjective improvement in the quality of life and in overall clinical impression. For chronic urticaria the symptoms (itching and the development of papules) lessens from the second day of treatment onwards, in a similar way to other antihistamines used as comparators. Bilastine should not be administered at meal times to avoid interference with the absorption process. It is not distributed to the central nervous system, is scarcely metabolized, and elimination is through the kidneys and feces, with a 14-hour elimination half-life. It has no effect on cytochrome P450. During clinical development, bilastine was shown to be a drug that is adequately tolerated, with a similar effect to placebo with regard to drowsiness and changes in heart rate. In relation to its use, headaches were the most frequent adverse effect to be reported. No cardiotoxic effects have been observed, and the therapeutic dose does not alter the state of alertness.

Keywords: bilastine, allergic rhinoconjunctivitis, chronic urticaria, second generation antihistamine, drowsiness, CYP450



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Impact of the prolonged slow expiratory maneuver on respiratory mechanics in wheezing infants

Jornal Brasileiro de Pneumologia

Print version ISSN 1806-3713

J. bras. pneumol. vol.39 no.1 São Paulo Jan./Feb. 2013

http://dx.doi.org/10.1590/S1806-37132013000100010 

ORIGINAL ARTICLE

Impact of the prolonged slow expiratory maneuver on respiratory mechanics in wheezing infants^*

Fernanda de Cordoba Lanza^I; Gustavo Falbo Wandalsen^II; Carolina Lopes da Cruz^III; Dirceu Solé^IV

^IAdjunct professor. Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, Nove de Julho University - São Paulo, Brazil
^IIAdjunct Professor. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil
^IIIMaster's Student. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil. And Physiotherapist. Department of Pediatrics and Neonatology, Hospital Israelita Albert Einstein, São Paulo, Brazil
^IVFull Professor. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil

Correspondence to

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ABSTRACT

OBJECTIVE: To evaluate changes in respiratory mechanics and tidal volume (V_T) in wheezing infants in spontaneous ventilation after performing the technique known as the prolonged, slow expiratory (PSE) maneuver.
METHODS: We included infants with a history of recurrent wheezing and who had had no exacerbations in the previous 15 days. For the assessment of the pulmonary function, the infants were sedated and placed in the supine position, and a face mask was used and connected to a pneumotachograph. The variables of tidal breathing (V_T and RR) as well as those of respiratory mechanics-respiratory system compliance (Crs), respiratory system resistance (Rrs), and the respiratory system time constant (prs)-were measured before and after three consecutive PSE maneuvers.
RESULTS: We evaluated 18 infants. The mean age was 32 ± 11 weeks. After PSE, there was a significant increase in V_T (79.3 ± 15.6 mL vs. 85.7 ± 17.2 mL; p = 0.009) and a significant decrease in RR (40.6 ± 6.9 breaths/min vs. 38.8 ± 0,9 breaths/min; p = 0.042). However, no significant differences were found in the variables of respiratory mechanics (Crs: 11.0 ± 3.1 mL/cmH₂O vs. 11.3 ± 2.7 mL/cmH₂O; Rrs: 29.9 ± 6.2 cmH₂O • mL^-1 • s^-1 vs. 30.8 ± 7.1 cmH₂O • mL^-1 • s^-1; and prs: 0.32 ± 0.11 s vs. 0.34 ±0.12 s; p > 0.05 for all).
CONCLUSIONS: This respiratory therapy technique is able to induce significant changes in V_T and RR in infants with recurrent wheezing, even in the absence of exacerbations. The fact that the variables related to respiratory mechanics remained unchanged indicates that the technique is safe to apply in this group of patients. Studies involving symptomatic infants are needed in order to quantify the functional effects of the technique.

Keywords: Physical Therapy Modalities; Respiratory Mechanics; Infant; Respiratory Function Tests.

Full text: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100010&lng=en&nrm=iso&tlng=en

pdf in English http://www.scielo.br/pdf/jbpneu/v39n1/en_v39n1a10.pdf 

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Eur Rev Med Pharmacol Sci 2013; 17 (1 Suppl): 39-44

Incidence, clinical features and management of acute allergic reactions: the experience of a single, Italian Emergency Department

E.C. Lauritano, A. Novi, M.C. Santoro, I. Casagranda

Emergency Department, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy. cristianolauritano@yahoo.it

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OBJECTIVES: Few data on the incidence, aetiology, clinical features and management of patients with acute allergic reactions presenting to the Emergency Department are currently available. The aim of the study was to report the annual experience of a single Italian adult Emergency Department about anaphylaxis.

PATIENTS AND METHODS: This is a retrospective, case-based study of adult patients attending the Emergency Department in Alessandria, Italy, during the years 2009-2010. We evaluated the medical records of patients satisfying diagnostic codes involving acute allergic reactions. Incidence, demographic data, causative agents, clinical features, management and outcome were reported.

RESULTS: 390 patients with acute allergic reactions were evaluated during the year, corresponding to 0.7% of all Emergency Department visits. Causative agents were recognized in 55.1% of patients and more commonly included drugs (26.9%), insects (14.8%) and foods (8.9%). Cutaneous features were the single most common clinical presentation although two or more clinical features were frequently reported (17.7%). Anaphylaxis was diagnosed in 4.6% of patients. After therapy and a period of monitoring, 92.8% of patients were discharged directly from the Emergency Department, 7.0% were admitted and one patient died, corresponding to a fatality rate of 0.2%.

CONCLUSIONS: Acute allergic reactions are common diseases referring to our Emergency Department. In the half of cases a precipitant agent was identified and cutaneous and/or mucosal changes were often the first feature. Most patients were definitely treated and discharged but about 7.0% of patients required hospitalisation. Observation Unit and Intermediate Care Unit were essential for clinical management of these patients.

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To cite this article

E.C. Lauritano, A. Novi, M.C. Santoro, I. Casagranda
Incidence, clinical features and management of acute allergic reactions: the experience of a single, Italian Emergency Department

Eur Rev Med Pharmacol Sci 
Year: 2013
Vol. 17 - N. 1 Suppl 
Pages: 39-44

Neonatal Immune Adaptation of the Gut and Its Role during Infections

Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 270301, 17 pages
http://dx.doi.org/10.1155/2013/270301

Review Article

Neonatal Immune Adaptation of the Gut and Its Role during Infections

Emilie Tourneur and Cecilia Chassin

ATIP-Avenir Group, INSERM U699, Université Paris Denis Diderot, Sorbonne Paris Cité, Site Xavier Bichat, 75018 Paris, France

Received 11 February 2013; Accepted 3 April 2013

Academic Editor: Philipp Henneke

Copyright © 2013 Emilie Tourneur and Cecilia Chassin. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The intestinal tract is engaged in a relationship with a dense and complex microbial ecosystem, the microbiota. The establishment of this symbiosis is essential for host physiology, metabolism, and immune homeostasis. Because newborns are essentially sterile, the first exposure to microorganisms and environmental endotoxins during the neonatal period is followed by a crucial sequence of active events leading to immune tolerance and homeostasis. Contact with potent immunostimulatory molecules starts immediately at birth, and the discrimination between commensal bacteria and invading pathogens is essential to avoid an inappropriate immune stimulation and/or host infection. The dysregulation of these tight interactions between host and microbiota can be responsible for important health disorders, including inflammation and sepsis. This review summarizes the molecular events leading to the establishment of postnatal immune tolerance and how pathogens can avoid host immunity and induce neonatal infections and sepsis.

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Original research

Allergic manifestations and cutaneous histamine responses in patients with Mccune Albright Syndrome

Jill D Jacobson, Angela L Turpin and Scott A Sands

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World Allergy Organization Journal 2013, 6:9 doi:10.1186/1939-4551-6-9

Published: 1 May 2013

Abstract (provisional)

Background

McCune Albright syndrome (MAS) is a rare disorder characterized by precocious puberty, cafe-au-lait spots, and fibrous dysplasia. Its cause is an activating mutation in the GNAS gene, encoding a subunit of the stimulatory G protein, Gsalpha (Gsalpha). The action of any mediator that signals via Gsalpha and cyclic AMP can be up regulated in MAS. We had observed gastritis, gastroesophageal reflux, and anaphylaxis in McCune Albright patients.

Objective

As histamine is known to signal via histamine 1 (H1) and histamine 2 (H2) receptors, which couple with stimulatory G proteins, we attempted to mechanistically link histamine responsiveness to the activating GNAS mutation. We hypothesized that responsiveness to histamine skin testing would differ between MAS patients and healthy controls. Patients and methods After obtaining informed consent, we performed a systematic review of histamine responsiveness and allergic manifestations in 11 MAS patients and 11 sex-matched, Tannerstage matched controls. We performed skin prick testing, quantifying the orthogonal diameters of wheals and erythema. We also quantitated G protein mRNA expression.

Results

The peak wheal and flare responses to histamine were significantly higher in MAS patients compared to controls.

Conclusions

This study suggests that MAS patients may be at risk for exaggerated histamine responsiveness compared to unaffected controls.

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Inappropriate prescribing of inhaled corticosteroids

Online first

Research Paper

Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study

Leanne M Poulos¹, Rosario D Ampon¹, Guy B Marks^1,2, ^*Helen K Reddel<sup>1

1</sup> Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia

² Department of Respiratory Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia

Received 6 November 2012 • Accepted 7 January 2013 • Online 25 April 2013


Abstract
BACKGROUND: Guidelines recommend regular use of inhaled corticosteroid (ICS)-containing medications for all patients with persistent asthma and those with moderate to severe chronic obstructive pulmonary disease. It is important to identify indicators of inappropriate prescribing. AIMS: To test the hypothesis that ICS are prescribed for the management of respiratory infections in some patients lacking evidence of chronic airways disease. METHODS: Medication dispensing data were obtained from the Australian national Pharmaceutical Benefits Scheme (PBS) for concessional patients dispensed any respiratory medications during 2008. We identified people dispensed only one ICS-containing medication and no other respiratory medications in a year, who were therefore unlikely to have chronic airways disease, and calculated the proportion who were co-dispensed oral antibiotics. RESULTS: In 2008, 43.6% of the 115,763 patients who were dispensed one-off ICS were co-dispensed oral antibiotics. Co-dispensing was seasonal, with a large peak in winter months. The most commonly co-dispensed ICS among adults were moderate/high doses of combination therapy, while lower doses of ICS alone were co-dispensed among children. In this cohort, one-off ICS co-dispensed with oral antibiotics cost the government $2.7 million in 2008. CONCLUSIONS: In Australia, many people who receive one-off prescriptions for ICS-containing medications do not appear to have airways disease. In this context, the high rate of co-dispensing with antibiotics suggests that ICS are often inappropriately prescribed for the management of symptoms of respiratory infection. Interventions are required to improve the quality of prescribing of ICS and the management of respiratory infections in clinical practice.

Cite as: Poulos LM, Ampon RD, Marks GB, Reddel HK. Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study. Prim Care Respir J 2013; Available from: URL: http://dx.doi.org/10.4104/pcrj.2013.00036

Keywords
inhaled corticosteroids, quality use of medicines, respiratory tract infections, antibiotics, lung diseases, obstructive

* Corresponding author. Helen K Reddel Tel: +61 2 9114 0437 Fax: +61 2 9114 0437 Email: helen.reddel@sydney.edu.au

© 2013 Primary Care Respiratory Society UK. All rights reserved.

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