Symptom-relieving Medications Research Articles

The SQ tree sublingual immunotherapy tablet is effective and well tolerated in children-A pivotal phase III trial.

Allergic rhinitis and/or conjunctivitis (AR/C) induced by tree pollen is common and negatively impacts quality of life in children and adolescents. This phase III trial investigated the efficacy and safety of the SQ tree SLIT-tablet in a paediatric population (5-17 years) with moderate-to-severe AR/C induced by pollen from birch and trees in the birch homologous group. Nine hundred and fifty-two subjects were randomized (1:1) to daily treatment with SQ tree SLIT-tablet or placebo for up to 52 weeks and had free access to AR/C symptom-relieving medications. The primary endpoint was the average total combined score (TCS); sum of average daily symptom score (DSS) and average daily medication score (DMS) during the birch pollen season (BPS). Key secondary endpoints included average DSS and DMS during BPS and average TCS, DSS and DMS during tree pollen season (TPS). SQ tree SLIT-tablet demonstrated a statistically significant and clinically relevant treatment effect compared with placebo for the TCS during BPS with an absolute treatment difference of 1.29 (95% CI: 0.58, 2.00; p = .0004) and a relative reduction of 21.9% (95% CI: 10.6, 31.9). Results were substantiated by reductions in both DSS and DMS versus placebo during the BPS and in DSS, DMS and TCS during the TPS. Treatment was generally well tolerated. Most treatment-related adverse events were mild or moderate local administration site reactions. This is the first paediatric trial to provide robust evidence of efficacy and safety of the SQ tree SLIT-tablet in tree pollen-induced AR/C in a paediatric population (5-17 years).

Comparative evaluation of efficacy of Pippalyadi Agada as an adjuvant drug vs. standard drug therapy in the management of acute food poisoning: A Study Protocol

Antimicrobial resistance, a pressing challenge in modern medicine, arises from excessive antibiotic use in veterinary and human care. Underreporting and complex links between food contamination and illnesses have led to underestimating foodborne disease impacts. The World Bank’s 2019 analysis projected $15B annual treatment costs and $95.2B productivity loss in low- to middle-income countries due to foodborne diseases. “Agada” refers to symptom-relieving medications, like “Vishaghnakalpa.” Pippalyadi Agada, from Vishaghana plants, treats “Dooshivisha Chikitsa,” e.g., Kitibha, rashes, shwas. It has anti-inflammatory, antioxidant properties, aiding acute food poisoning with nausea, vomiting, fever, diarrhea. It is a carminative, curbing prolonged diarrhea, and anti-toxic. Pippalyadi Agada pacifies imbalanced Vata and Kapha, promising better relief than Agni and Pittastana interventions. As an Ayurvedic remedy, it is administered as Vati, 500mg twice daily with Anuapan Honey for 7 days. This study aims to comparatively evaluate the effectiveness of Pippalyadi Agada as an adjunct to standard drug therapy in managing acute food poisoning. Following a comprehensive drug analysis, a total of 60 eligible participants will be selected and assigned to two groups, each comprising 30 individuals. Group A will receive standard drug therapy, while Group B will receive standard drug therapy alongside Pippalyadi Agad, administered twice daily for 7 days. Assessments will occur on days 0, 3, 5, and 8, both before and after the intervention. The study anticipates that the use of Pippalyadi Agada as an adjunct to standard drug therapy will lead to improved symptom relief and faster recovery in individuals with acute food poisoning, as demonstrated by significant reductions in symptoms such as nausea, vomiting, fever, and diarrhea. The observed outcomes will contribute to a more comprehensive understanding of the potential benefits of Ayurvedic interventions in managing foodborne illnesses.

Application of different treatment methods for autism

Today, more than 70 million people around the world suffer from autism, and scientists around the world are working hard to invest in research into autism treatment, hoping to identify the possibility of a cure among the various attempts. At present, there are a large number of studies on various treatment options for autism, but not many summaries of the studies. Due to the complex causes of autism, this research only summarizes some of the therapeutic and training programs that have made progress in autism. This research of existing research suggests that the adverse symptoms of autism can be improved through applied behavior analysis (ABA) therapy, symptom-relieving medications, talk-based cognitive-behavior therapy (CBT), behavioral therapy, gene therapy, gut probiotics supplementation, and web-based training. Although autism is a very complex disease, with the development of technology and in-depth research into its causes, autism is controllable and mitigated. In the future, with more in-depth research, there may be more ways to alleviate the suffering of people with autism.

SQ HDM sublingual immunotherapy tablet for the treatment of HDM allergic rhinitis and asthma improves subjective sleepiness and insomnia: an exploratory analysis of the real-life CARIOCA study.

There are still gaps in the knowledge regarding the effectiveness of house dust mite (HDM) sublingual immunotherapy (SLIT) on allergic rhinitis (AR) and asthma (AA)-associated sleep disorders. A non-interventional study was conducted to assess the effect of the Standardized quality (SQ) HDM SLIT-tablet on safety and symptoms in adults with HDM respiratory allergies. The aim was to describe the status of insomnia and daytime sleepiness in AR and/or AA patients treated with the SQ HDM SLIT-tablet. This was a 12-month multicenter, longitudinal and prospective study. Participants started the SQ HDM SLIT-tablet for moderate-to-severe HDM AR, persistent despite the use of symptom-relieving medication; or HDM AA not well controlled by inhaled corticosteroids and associated with mild-to-severe HDM AR. Sleep symptoms were measured using the Insomnia Severity Index (ISI) questionnaire and the Epworth Sleepiness Scale (ESS). A total of 1,526 adult patients were enrolled and 1,483 were included in the analysis. At baseline, 41.5% of patients reported sleep disorders: 77.0% of them had insomnia and 28.9% suffered from excessive daytime sleepiness. Insomnia was significantly more frequent among patients with uncontrolled AR (83.1%) than those with controlled AR (52.6%) (p<0.0001). Over time, 48.3% and 59.7% of patients reported an improvement greater than the minimal clinically important difference on the ISI and ESS scales respectively. In patients with HDM AR and/or asthma associated sleep disorders, an improvement in subjective insomnia and sleepiness was observed after one year of treatment with the SQ HDM SLIT-tablet in a real-life setting.

Glucagon-like peptide-1 receptor agonists as a disease-modifying therapy for knee osteoarthritis mediated by weight loss: findings from the Shanghai Osteoarthritis Cohort

ObjectiveObesity is a risk factor for knee osteoarthritis (KOA) development and progression. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are indicated for type 2 diabetes mellitus (T2DM) and obesity. However, whether KOA...

A Cost-Utility Analysis of SQ® Tree SLIT-Tablet versus Placebo in the Treatment of Birch Pollen Allergic Rhinitis from a Swedish Societal Perspective.

Allergic rhinitis (AR) is an immunoglobulin E antibody-mediated inflammatory condition that arises in response to inhaled allergens such as pollen. Pollens from trees in the birch homologous group are the most common allergenic tree pollens in Northern and Central Europe and North America. SQ® Tree SLIT-Tablet (ITULAZAX®) is a sublingual immunotherapy tablet indicated for moderate-to-severe AR and/or conjunctivitis induced by pollen from the birch homologous group. The present analysis evaluated the cost-utility of treating adults with AR with SQ Tree SLIT-Tablet versus placebo, both in combination with symptom-relieving medications, from a Swedish societal perspective. A model was developed to evaluate changes in cost and quality of life associated with using SQ Tree SLIT-Tablet relative to placebo in an adult population of individuals with AR. The model captured costs associated with symptom-relieving medications, healthcare professional interactions, SQ Tree SLIT-Tablet, and indirect costs arising from absenteeism and reduced workplace productivity. The analysis was conducted over 10 years with costs captured in 2021 Swedish Krona (SEK) and future costs and effects discounted at 3% per annum. One-way and probabilistic sensitivity analyses were conducted. Treatment with SQ Tree SLIT-Tablet resulted in an improvement of 0.041 quality-adjusted life years (QALYs) over 10 years versus placebo. From a Swedish societal perspective, costs increased by SEK 9077 over the same period, resulting in an incremental cost-utility ratio of SEK 223,445 per QALY gained. One-way sensitivity analysis showed that the model was most sensitive to assumptions around the disease-modifying effect of SQ Tree SLIT-Tablet. SQ Tree SLIT-Tablet improved quality of life in moderate-to-severe AR and/or conjunctivitis induced by pollen from the birch homologous group in Sweden, with only a modest increase in societal costs over a medium-term time horizon, representing good value for money at a willingness-to-pay threshold of SEK 700,000 per QALY.

Randomized controlled trial of ragweed sublingual immunotherapy tablet in the subpopulation of Canadian children and adolescents with allergic rhinoconjunctivitis

BackgroundPost hoc analyses of randomized placebo-controlled trials have demonstrated efficacy and tolerability of the ragweed sublingual immunotherapy (SLIT)-tablet in Canadian adults with ragweed pollen-induced allergic rhinitis/conjunctivitis (AR/C). This post hoc analysis evaluated the efficacy and tolerability of the ragweed SLIT-tablet in the subpopulation of Canadian children and adolescents with AR/C in a previously described randomized, double-blind, placebo-controlled trial.MethodsThe trial (NCT02478398) was conducted in North American and European children/adolescents ages 5–17 years with ragweed pollen-induced AR/C with or without asthma (FEV1 ≥ 80% predicted). Participants were randomized to daily ragweed SLIT-tablet (12 Amb a 1-U) or placebo for up to 28 weeks. The primary endpoint was the average total combined score (TCS; sum of rhinoconjunctivitis daily symptom score [DSS] and daily medication score [DMS]) during peak ragweed pollen season (RPS). Key secondary endpoints were TCS during the entire RPS, and DSS and DMS during peak RPS. Post hoc analyses of the primary and key secondary endpoints were conducted in the subpopulation of Canadian participants.ResultsOf the 1025 randomized participants, 246 (SLIT-tablet, n = 116; placebo, n = 130) were in the Canadian subpopulation. In the total study population, relative TCS (95% CI) improvement with ragweed SLIT-tablet versus placebo was − 38.3% (− 46.0%, − 29.7%; least square [LS] mean difference, − 2.73; P < 0.001) during peak RPS. In the Canadian subpopulation, relative TCS improvements with ragweed SLIT-tablet versus placebo were − 40.8% (− 54.5%, − 20.2%; LS mean difference, − 1.59; P = 0.001) during peak RPS and − 36.6% (− 50.2%, − 16.5%; LS mean difference, − 1.36; P = 0.002) during the entire RPS. DSS and DMS during peak RPS in the Canadian subpopulation improved with SLIT-tablet versus placebo by − 30.6% (− 45.2%, − 7.7%; LS mean difference, − 0.94; P = 0.010) and − 77.2% (− 97.5%, − 44.2%; LS mean difference, − 0.66; P = 0.003), respectively. No events of anaphylaxis, airway compromise, intramuscular epinephrine administration, eosinophilic esophagitis, or severe treatment-related systemic allergic reactions were reported in the overall population or Canadian subpopulation.ConclusionEfficacy and safety of the ragweed SLIT-tablet in Canadian children/adolescents with ragweed pollen-induced AR/C was consistent with the total study population. The ragweed SLIT-tablet resulted in clinically meaningful improvement in symptoms, decreased symptom-relieving medication use, and was well tolerated in Canadian children/adolescents.Trial registration: clinicaltrials.gov, NCT02478398. Registered June 23, 2015, https://clinicaltrials.gov/ct2/show/NCT02478398?term=NCT02478398&draw=2&rank=1

Latent Myofascial Trigger Points Injection Reduced the Severity of Persistent, Moderate to Severe Allergic Rhinitis: A Randomized Controlled Trial.

Background: Myofascial trigger points (MTrPs) injection has been effectively used for the management of chronic painful diseases. Latent MTrPs can induce autonomic nerve phenomena. In our clinic, we observed that allergic rhinitis (AR) symptoms significantly improved when latent MTrPs injection was performed for migraine.Objective: To compare the efficacy and safety between latent MTrPs injection and sublingual immunotherapy (SLIT) in patients with persistent, moderate to severe AR.Methods: This randomized controlled trial was conducted with 112 patients with AR. Patients were randomized to receive SLIT (n = 56) or latent MTrPs injection. Total nasal symptom score (TNSS, n = 56), nasal symptoms, medication days, and adverse events were evaluated during the 9 months follow-up period after treatment in both groups.Results: Latent MTrPs injection significantly reduced TNSS to a greater level from baseline (from 8.36 ± 1.96 to 4.43 ± 2.18) than SLIT (from 8.66 ± 2.31 to 7.80 ± 2.47) at week 1 (P < 0.001), and sustained the improvement in symptoms throughout to month 9. Latent MTrPs showed statistically significant differences vs. SLIT for the TNSS reduction both at month 2 (6.59 ± 2.37 vs. 2.64 ± 2.38; p < 0.001) and month 3 (4.59 ± 2.77 vs. 2.62 ± 2.43; p <0.001). Latent MTrPs also showed a better improvement in the onset time of efficacy compared with SLIT. Adverse reactions were few and non-serious in both treatment groups.Conclusions: Latent MTrPs injection significantly improved symptoms and decreased symptom-relieving medication use in patients with AR and was well tolerated.Clinical Trials Registration: Chinese Clinical Trial Registry, ChiCTR1900020590. Registered 9 January 2019, http://www.chictr.org.cn/index.aspx.

Treatment Effect of the Tree Pollen SLIT-Tablet on Allergic Rhinoconjunctivitis During Oak Pollen Season

Birch, alder, hazel, and oak are members of the birch homologous group based on cross-reactivity toward the birch pollen allergen Betula verrucosa 1. Theoretically, allergy to these tree pollens may be treated by immunotherapy with one representative allergen extract. To evaluate post hoc whether treatment of birch pollen-induced allergic rhinoconjunctivitis with a standardized tree sublingual immunotherapy (SLIT)-tablet containing birch pollen extract reduces symptoms and symptom-relieving medication use during the oak pollen season (OPS). In a randomized, multinational, double-blind trial (EudraCT-2015-004821-15), 634 participants (ages 12-65 years) received daily tree SLIT-tablet (12 SQ-Bet) or placebo before and during tree pollen season (alder/hazel plus birch pollen season [BPS]). Symptom-relieving medication was allowed. The primary end point was the average total combined score (sum of rhinoconjunctivitis daily symptom score and daily medication score) during BPS. Outcomes during the OPS (excluding overlapping BPS days) were analyzed post hoc. Relative improvements in average total combined score, daily symptom score, and daily medication score with the tree SLIT-tablet versus placebo during the OPS were 25%, 22%, and 32%, respectively (all P < .001). Significant correlations were observed between birch and oak serum immunoglobulin E (sIgE) at baseline (r= 0.86) and between birch and oak IgG4 after treatment (r= 0.72). Oak sIgE and IgG4 kinetics in response to tree SLIT-tablet treatment were similar to birch. The tree SLIT-tablet leads to significant improvement of rhinoconjunctivitis outcomes during the OPS, supporting the clinical relevance of immunological cross-reactivity toward birch and oak allergens.

Efficacy and Safety of Ragweed SLIT-Tablet in Children with Allergic Rhinoconjunctivitis in a Randomized, Placebo-Controlled Trial

Ragweed sublingual immunotherapy (SLIT) tablet reduces symptoms and symptom-relieving medication use in adults with allergic rhinitis with or without conjunctivitis (AR/C) but has not been evaluated in children. This international, multicenter, double-blind, placebo-controlled trial evaluated the efficacy and safety of ragweed SLIT-tablet in children with AR/C. Children (N= 1025; 77.7% polysensitized) aged 5 to 17 years with ragweed pollen-induced AR/C with or without asthma (FEV1 ≥80% predicted) were randomized 1:1 to daily ragweed SLIT-tablet (12 Amb a 1-Unit) or placebo for up to 28 weeks (NCT02478398). The primary end point was the average total combined score (TCS; sum of rhinoconjunctivitis daily symptom score [DSS] and daily medication score [DMS]) during peak ragweed pollen season (RPS). Key secondary end points were TCS during the entire RPS, and DSS and DMS during the peak RPS. Relative TCS (95% CI) improvements with ragweed SLIT-tablet versus placebo were-38.3% (-46.0% to-29.7%; least square [LS] mean difference,-2.73; P < .001) during peak RPS and-32.4% (-40.7% to-23.3%; LS mean difference,-1.86; P < .001) during the entire RPS. DSS and DMS during peak RPS improved with SLIT-tablet versus placebo by-35.4% (-43.2% to-26.1%; LS mean difference,-1.40; P < .001) and-47.7% (-59.8% to-32.5%; LS mean difference,-1.84; P < .001), respectively. Asthma DSS, short-acting β-agonist use, and nocturnal awakenings during peak RPS improved with SLIT-tablet versus placebo by-30.7%,-68.1%, and-75.1%, respectively (all nominal P ≤ .02). No events of anaphylaxis, airway compromise, or severe treatment-related systemic allergic reactions were reported. Ragweed SLIT-tablet significantly improved symptoms and decreased symptom-relieving medication use in children with ragweed pollen-induced AR/C and was well tolerated.

Adenovirus-mediated Gene Therapy for Allergy

Allergy poses a heavy health burden in modern society. Other than symptom-relieving medications, the only available treatment approach is allergen-specific immunotherapy, which in spite of offering a potential cure, requires a long treatment duration with multiple doses of allergen administration and carries a risk of anaphylaxis. Gene therapy has shown advantages in experimental studies for treatment of tumors, genetic diseases, chronic infections, and allergy. To date, adenovirus has been the most extensively used gene transfer vector, and offers high efficiency and safety. Here, we review studies of adenovirus-mediated gene therapy targeting different steps in the development of allergic diseases. Adenovirus-mediated gene therapy might be a promising add-on therapy for allergy treatment.

The SQ tree SLIT-tablet is highly effective and well tolerated: Results from a randomized, double-blind, placebo-controlled phase III trial

The SQ tree sublingual immunotherapy (SLIT)-tablet (ALK-Abelló, Hørsholm, Denmark) is developed for treatment of tree pollen-induced allergic rhinoconjunctivitis (ARC). The aim of this pivotal phase III trial was to demonstrate the efficacy and safety of the SQ tree SLIT-tablet. This was a randomized, double-blind, placebo-controlled trial with 634 subjects (12-65years) with moderate-to-severe ARC despite use of symptom-relieving medication. Eligible subjects were randomized 1:1 to active or placebo treatment. The primary end point was the average daily ARC total combined score (TCS) during the birch pollen season (BPS) analyzed for subjects with diary data during the BPS. Secondary end points included average daily symptom scores (DSS) during the BPS, average TCS and DSS during the tree pollen season (TPS), and average daily medication scores (DMS) in the BPS and TPS. The primary and key secondary end points demonstrated statistically significant and clinically relevant effects of the SQ tree SLIT-tablet compared with placebo. For the BPS, absolute (relative) differences from placebo were 3.02 (40%) for TCS, 1.32 (37%) for DSS, and 1.58 (49%) for DMS (all P<.0001). For the TPS, absolute (relative) differences from placebo were 2.27 (37%) for TCS, 0.99 (33%) for DSS, and 1.20 (47%) for DMS (all P<.0001). Treatment was well tolerated. The most frequently reported treatment-related adverse events were mild or moderate local reactions related to sublingual administration. The trial demonstrated the efficacy and safety of the SQ tree SLIT-tablet compared with placebo during the BPS and TPS in adolescents and adults with birch pollen-induced ARC (EudraCT 2015-004821-15).

Medication overuse headache: An entrenched idea in need of scrutiny.

It is a widely accepted idea that medications taken to relieve acute headache pain can paradoxically worsen headache if used too often. This type of secondary headache is referred to as medication overuse headache (MOH); previously used terms include rebound headache and drug-induced headache. In the absence of consensus about the duration of use, amount, and type of medication needed to cause MOH, the default position is conservative. A common recommendation is to limit treatment to no more than 10 or 15 days per month (depending on medication type) to prevent headache frequency progression. Medication withdrawal is often recommended as a first step in treatment of patients with very frequent headaches. Existing evidence, however, does not provide a strong basis for such causal claims about the relationship between medication use and frequent headache. Observational studies linking treatment patterns with headache frequency are by their nature confounded by indication. Medication withdrawal studies have mostly been uncontrolled and often have high dropout rates. Evaluation of this evidence suggests that only a minority of patients required to limit the use of symptomatic medication may benefit from treatment limitation. Similarly, only a minority of patients deemed to be overusing medications may benefit from withdrawal. These findings raise serious questions about the value of withholding or withdrawing symptom-relieving medications from people with frequent headaches solely to prevent or treat MOH. The benefits of doing so are smaller, and the harms larger, than currently recognized. The concept of MOH should be viewed with more skepticism. Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication. Frequent use of symptom-relieving headache medications should be viewed more neutrally, as an indicator of poorly controlled headaches, and not invariably a cause.

Drugs for the acute treatment of migraine in children and adolescents.

Numerous medications are available for the acute treatment of migraine in adults, and some have now been approved for use in children and adolescents in the ambulatory setting. A systematic review of acute treatment of migraine medication trials in children and adolescents will help clinicians make evidence-informed management choices. To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 12 to 17 years of age. We searched seven bibliographic databases and four clinical trial registers as well as gray literature for studies through February 2016. We included prospective randomized controlled clinical trials of children and adolescents with migraine, comparing acute symptom relieving migraine medications with placebo in the ambulatory setting. Two reviewers screened titles and abstracts and reviewed the full text of potentially eligible studies. Two independent reviewers extracted data for studies meeting inclusion criteria. We calculated the risk ratios (RRs) and number needed to treat for an additional beneficial outcome (NNTB) for dichotomous data. We calculated the risk difference (RD) and number needed to treat for an additional harmful outcome (NNTH) for proportions of adverse events. The percentage of pain-free patients at two hours was the primary efficacy outcome measure. We used adverse events to evaluate safety and tolerability. Secondary outcome measures included headache relief, use of rescue medication, headache recurrence, presence of nausea, and presence of vomiting. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created 'Summary of findings' tables. We identified a total of 27 randomized controlled trials (RCTs) of migraine symptom-relieving medications, in which 9158 children and adolescents were enrolled and 7630 (range of mean age between 8.2 and 14.7 years) received medication. Twenty-four studies focused on drugs in the triptan class, including almotriptan, eletriptan, naratriptan, rizatriptan, sumatriptan, sumatriptan + naproxen sodium, and zolmitriptan. Other medications studied included paracetamol (acetaminophen), ibuprofen, and dihydroergotamine (DHE). More than half of the studies evaluated sumatriptan. All but one study reported adverse event data. Most studies presented a low or unclear risk of bias, and the overall quality of evidence, according to GRADE criteria, was low to moderate, downgraded mostly due to imprecision and inconsistency. Ibuprofen was more effective than placebo for producing pain freedom at two hours in two small studies that included 162 children (RR 1.87, 95% confidence interval (CI) 1.15 to 3.04) with low quality evidence (due to imprecision). Paracetamol was not superior to placebo in one small study of 80 children. Triptans as a class of medication were superior to placebo in producing pain freedom in 3 studies involving 273 children (RR 1.67, 95% CI 1.06 to 2.62, NNTB 13) (moderate quality evidence) and 21 studies involving 7026 adolescents (RR 1.32, 95% CI 1.19 to 1.47, NNTB 6) (moderate quality evidence). There was no significant difference in the effect sizes between studies involving children versus adolescents. Triptans were associated with an increased risk of minor (non-serious) adverse events in adolescents (RD 0.13, 95% CI 0.08 to 0.18, NNTH 8), but studies did not report any serious adverse events. The risk of minor adverse events was not significant in children (RD 0.06, 95% CI - 0.04 to 0.17, NNTH 17). Sumatriptan plus naproxen sodium was superior to placebo in one study involving 490 adolescents (RR 3.25, 95% CI 1.78 to 5.94, NNTB 6) (moderate quality evidence). Oral dihydroergotamine was not superior to placebo in one small study involving 13 children. Low quality evidence from two small trials shows that ibuprofen appears to improve pain freedom for the acute treatment of children with migraine. We have only limited information on adverse events associated with ibuprofen in the trials included in this review. Triptans as a class are also effective at providing pain freedom in children and adolescents but are associated with higher rates of minor adverse events. Sumatriptan plus naproxen sodium is also effective in treating adolescents with migraine.

Cost-minimization analysis of sublingual immunotherapy versus subcutaneous immunotherapy for house dust mite respiratory allergic disease in Denmark

Objectives Currently, patients with persistent moderate-to-severe house dust mite (HDM) allergic rhinitis despite use of symptom-relieving medication can be offered subcutaneously administered allergy immunotherapy (SQ SCIT; Alutard SQ) as standard care of treatment in Denmark. Recently, a HDM sublingually administered allergy immunotherapy tablet (SQ SLIT-tablet; ACARIZAX) has been developed for at-home treatment. The purpose of this analysis is to compare the costs related to treatment and administration of SQ SLIT-tablet and SQ SCIT.Methods Assuming equal efficacy between ther SQ SLIT-tablet and SQ SCIT, the cost-minimization analysis was the most appropriate for the comparison. According to guidelines and Summary of Product Characteristics, the treatment duration of SQ SLIT-tablet is 3 years and 3–5 years for SQ SCIT. The courses of treatment vary among patients and, therefore, the costs of treatment have been calculated for an average patient with HDM respiratory allergic disease (RAD) receiving either SQ SLIT-tablet or SQ SCIT. All costs associated with allergy immunotherapy were collected, i.e., cost of medication, administration and treatment setting, and discounted according to Danish guidelines. Comprehensive univariate sensitivity analyses were carried out.Results The treatment costs for an average patient with HDM RAD are €3094 for SQ SLIT-tablet and €3799 for SQ SCIT; however, when adding indirect costs to the calculations the total costs of the treatments are €3697 and €6717 for SQ SLIT-tablet and SQ SCIT, respectively. Therefore, if 2500 patients with HDM RAD were treated with SQ SLIT-tablet instead of SQ SCIT, it would elicit a saving to the healthcare system of ∼€1.8 million. The conclusion was robust to any changes in the sensitivity analysis.Conclusion With regards to the cost of treating Danish patients with HDM RAD, it is clearly cost-saving to treat patients with SQ SLIT-tablet compared to SQ SCIT.

Physical activity in COPD patients decreases short-acting bronchodilator use and the number of exacerbations

BackgroundPhysically inactive patients with chronic obstructive pulmonary disease (COPD) exhibit higher rates of exacerbations and symptoms of dyspnoea than active patients. Whether the use of COPD medication explains these differences is not known. AimThis study evaluated differences in the use of COPD medication and the number of exacerbations due to physical activity. MethodsA COPD cohort (N = 719) was followed through medical records to identify hospital admissions, and exercise activity was evaluated using mailed questionnaires. The national drug reimbursement registry identified drug purchases for one year. ResultsThe use of maintenance therapies, such as long-acting muscarinic antagonists (LAMAs), long-acting beta agonists (LABAs), inhaled corticosteroids (ICS), and theophylline, did not differ significantly between physically active (N = 346) and inactive (N = 355) COPD patients. The cumulative dose of salbutamol (85 vs. 218 mg, adjusted P = 0.01) and oral corticosteroids (OCS) (621 vs. 1068 mg, adjusted P = 0.02) were significantly higher in inactive patients, regardless of disease severity. LABAs, LAMAs, and ICS were used in reduced doses in both patient groups compared to daily defined doses (DDD). Physical activity was independently associated with the number of hospital admissions and the use of OCS and short-acting bronchodilators. ConclusionPhysical inactivity in COPD was not associated with poorer use of maintenance therapies. In contrast, inactivity was independently associated with the number of exacerbations measured by hospital admissions and the use of OCS and short-acting symptom-relieving medications.

Highlights of IUGA 37th annual meeting in Brisbane 2012

It was a long journey for most of the international delegateswho came to Brisbane, Australia for the 37th InternationalUrogynecological Association (IUGA) annual scientificmeeting this year. Despite the distance, there was not suffi-cient time to digest all the abstracts in-flight. Indeed, 17nations were represented, with 1,400 delegates attending the2012 IUGA. There were 21 workshops in the first 2 days, 7state-of-the-art roundtable addresses and debates, 96podium/video presentations, and 228 poster presentations.The meeting began with interactive workshops which wereall popular, especially Abdul Sultan’s anal sphincter repair,the 3 ultrasound workshops, the anatomy cadaver workshopwith John DeLancey, and the Urogynaecological Society ofAustralasia (UGSA) live surgery demonstration chaired byMickey Karram and Malcolm Fraser.The extensive scientific program, which also included theEuropean Urogynecological Association (EUGA) surgicalcourse and Ibero-American urogynecology session, cateredto a variety of experience and educational needs. The com-plementary nature and high caliber of the scientific programwas evident. Basic science communications gave an over-view of current research interests including one describingthe effects of cyclic mechanical loading on fibroblasts fromwomen with different Pelvic Organ Prolapse Quantification(POP-Q) stage [1]. High-quality studies followed with tworandomized controlled trials on the most controversial topicof the day: the mesh repair [2, 3] and a Cochrane review [4]which was awarded best abstract. Further surgical studiesincluded one where the classical Richter suspension (vagi-nal sacrospinous fixation) at hysterectomy had a higherfailure rate in patients with levator injury and was signifi-cantly inferior to the mesh procedure [5] and another wherebetter anatomical and functional success rates were reportedwith mesh compared with traditional anterior colporrhaphy[2]. Surgical procedures were assessed on quality of life [6]and symptoms [7] with greater emphasis on these thananatomical results, highlighting the importanceof subjectiveoutcomes. Nonrandomized controlled studies included, forexample, in the surgical complication category, the impor-tance of diagnosis of intraoperative visceral injury to thebladder with the methylene blue test and digital rectal examin vaginal surgery [8, 9]. An elegant demonstration of ab-dominal prolapse repair with robotic assistance was shownin the video category [10]. The category of urinary dysfunc-tion included topics such as “Does surgery for urinaryincontinence in women affect their use of symptom-relieving medications?” [11], musculoskeletal pain evalua-tion of patients with interstitial cystitis [12], and a system-atic review of bulking agents for urinary incontinence [13].A wide range of conservative therapies were evaluated,includingthe safe andeffective use of pessary over amedianduration of 35 months [14], a prospective multicenter studyof solifenacin for overactive bladder [15], and the role ofpercutaneous stimulation with sensory response as a predic-tor of success [16]. Bladder reeducation and physiotherapywere reemphasized with regard to their role in the manage-ment of urinary incontinence [17]. Obstetric and perinealcare was highlighted in two studies on anal sphincter inju-ries [18] and episiotomy evaluation [19]. There was a fas-cinating presentation on the utility of an open configurationdynamic magnetic resonance imaging (MRI) proctogram[20], showing that erect sitting and supine MRI proctogramsare similar in assessing functional and anatomical disordersof the anorectum.

Zastosowanie izotonicznego roztworu NaCl u chorych z ostrym zapaleniem błony śluzowej nosa i zatok przynosowych

The mucous membrane of the nose and paranasal sinuses has several important physiological functions. Inflammation of the nose and paranasal sinuses impairs filtration, humidification and warming of the inhaled air. It also affects the beating of cilia and the mucociliary clearance within the nose and lumen of the sinuses. The result is impairment of the mechanism by which the removal of the stagnant pathological discharge from the paranasal sinuses and of foreign matter (environmental pollutants) from the nasal mucosa would be otherwise effected. The use of special products to cleanse the nasal mucosa may considerably improve its function. Day-to-day ENT practice offers evidence of beneficial effects of nasal douching with isotonic sea water solutions. Products which cleanse nasal mucosa are now used as an adjunct to treatment of rhinosinusitis and rhinitis co-existing with nasal polyps. was a retrospective assessment of symptoms in patients with acute rhinosinusitis depending on the therapeutic modality used, especially in a group of patients using an isotonic solution (0.9% NaCl) in addition to standard treatment. Medical records of 80 patients, males and females with symptoms of acute rhinosinusitis were included in the final evaluation. The following medical records including fully documented medical history and physical findings in compliance with the EP3OS were randomly selected from the medical records at the ENT Outpatient Clinic: 40 patients with acute rhinosinusitis treated symptom-relieving medication (Group A) and symptom-relieving medication with topical nasal corticosteroids (Group C); 40 patients with acute rhinosinusitis treated symptom-relieving medication plus isotonic NaCl solution twice a day (Group B) and symptom-relieving medication with topical nasal corticosteroids plus isotonic NaCl solution twice a day (Group D). Seven-days-treatment resulted in the decreasing of severity of the disease by 39.59% in control group and by 73.62% in patients using isotonic solution NaCl. The use of isotonic NaCl solutions as an adjunct to the treatment of acute rhinosinusitis results in highly statistically significant improvement of nasal patency (by 45.1% in control group and by 72.0% in patients using isotonic solutions) due to decreased swelling of the mucosa of the nasal turbinate. The use of isotonic NaCl solutions as an adjunct to the treatment of acute rhinosinusitis results in a highly statistically significant improvement in function of smell. Treatment with local nasal corticosteroids in combination with isotonic NaCl solutions produces a significant reduction in the severity of symptoms in patients with rhinosinusitis. The therapeutic effect in these patients is statistically significantly better than in patients treated with local nasal corticosteroids alone. The findings of the present study support the investigators' opinion that the isotonic solution (0.9% NaCl) should be recommended for nasal douching may be a valuable adjunct to the standard medical treatment of acute rhinosinusitis.

Changing providers is associated with poor asthma control

In this issue of The Journal, Dombkowski et al from the University of Michigan have studied the relationship between continuity of medical providers and exacerbations of asthma. The results showed that children with multiple prescribers in different practices had an increased risk of requiring a visit to the emergency room; this relationship was true for those with both high and those with low prescription frequency. The results suggest that relative disorganization of care is associated with poor asthma control. They also show that providers may not be able to identify high risk patients based simply on the number of prescriptions for symptom-relieving medication. Article page 788▸

New strategies in the treatment and prevention of allergic diseases

Allergic diseases (AD) are more prevalent today than 30 years ago but over the same period, few novel efficacious drugs have been discovered to treat, control or even cure these disorders. Topical or systemic glucocorticosteroids combined with symptom-relieving medications, such as β2-adrenoceptor agonists, leukotriene inhibitors or antihistamines, are still the mainstay of antiallergic treatment. Modified glucocorticosteroids with less adverse effects, better bronchodilators and new selective mediator inhibitors may improve symptom control in the future. Only specific immunotherapy has shown potential for long-lasting disease-modifying effects. Immunomodulation is a therapeutic goal, aiming to modify the dominant helper T cell Type 2 inflammation to a helper T cell Type 1 response using modified allergens, mycobacteria or CpG oligodeoxynucleotides. Humanised monoclonal anti-IgE antibodies are an exciting new immunomodulatory medication that are expected to reach the clinical practice and have recently been licensed in Australia and the US. Advances in molecular, cellular and genetic research of the immunopathophysiology of AD have led to the development of new antagonists for cytokines, chemokines, receptors, second messengers and transcription factors that may become available for clinical use in the next 10 years. Specific diets supplemented with antioxidants or probiotics need further study but offer promise as safe and cheap preventative medicine. The strong genetic component of AD and the Human Genome Project have opened a new field of research, and modification or replacement of target genes has a curative potential with exciting new therapeutic developments in the years ahead.