Medical Journal Review: February 2010
Juan Carlos Ivancevich, MD, in collaboration with Phil Lieberman, MD, conducted these reviews of premier medical journal articles for practicing allergists. Read their top three picks here, and link to the remaining reviews from the menu. You may also visit the Medical Journal Review section of the WAO Web site.
1. Immunotherapy reduces healthcare costs for children with allergic rhinitis (AR).
To determine whether allergen immunotherapy reduces healthcare costs, the researchers studied Medicaid claims made in Florida between 1997 and 2007 for 2,770 children with newly diagnosed AR who received allergen immunotherapy and who were followed-up for at least 18 months. Each child in the immunotherapy group was matched for age at AR diagnosis, gender, race/ethnicity, and co-morbid asthma, conjunctivitis, or atopic dermatitis, with up to five control children with AR who did not receive immunotherapy. Analysis revealed that immunotherapy-treated children had significantly lower total healthcare costs over the 18-month period after immunotherapy administration than controls, at a median per-person cost of $3,247 (€2269) compared with $4,872 (€3404), respectively. The researchers also note that a significant difference in total healthcare costs between the two groups was evident as early as 3 months after starting immunotherapy. They concluded that this study demonstrated the potential for early and significant cost savings in children with AR treated with immunotherapy.
Editor's comment: Pharmacoeconomics is another reason to indicate immunotherapy in this age group.
Hankin C, Cox L, Lang D et al., Allergen immunotherapy and health care cost benefits for children with allergic rhinitis: a large-scale, retrospective, matched cohort study. Annals of Allergy Asthma and Immunology 2010; 104: 79-85.
2. Secondhand smoke (SHS) exposure linked to sleep problems in asthmatic children.
The goal of this study was to analyze the association between exposure to SHS and child sleep patterns among a group of 219 children with asthma enrolled in an asthma intervention trial and who had regular exposure to tobacco smoke at home. SHS exposure was measured with serum cotinine levels, and the Children's Sleep Habits Questionnaire was used to evaluate sleep patterns based on parental reports. Statistical analyses allowed adjustment for covariates of age, sex, race, maternal marital status, education, income, prenatal tobacco exposure, maternal depression, home observation for measurement of the environment total score, household density, asthma severity, and use of asthma medications. SHS exposure was associated with longer sleep-onset delay (P = .004), sleep-disordered breathing (P = .02), parasomnias (P = .002), daytime sleepiness (P = .022), and overall sleep disturbance (P = .0002). The authors concluded that significant associations exist between SHS exposure, as measured with a biological marker (serum cotinine levels), and sleep problems in children with asthma.
Editor's comment: Reduction in SHS exposure is an area with the potential for significant impact in the pediatric population.
Yolton K, Xu Y, Khoury J et al, Associations between secondhand smoke exposure and sleep patterns in children. Pediatrics, Published online January 18, 2010 [Epub ahead of print]
3. High-dose inhaled corticosteroids (ICS) may be associated with pulmonary tuberculosis (TB).
The use of high-dose ICS in patients with chronic obstructive pulmonary disease (COPD) has recently been shown to increase the incidence of pneumonia. To investigate the impact of high-dose ICS on pulmonary TB, the authors conducted a retrospective study, including 554 patients aged more than 40 years old with irreversible airflow limitation, between August 2000 and July 2008 in a medical center in Taiwan. Among them, patients using high-dose ICS (equivalent to >500 microg/d of fluticasone) were more likely to have more severe COPD and receive oral corticosteroids than those using medium-dose, low-dose, or no ICS. Sixteen (3%) patients developed active pulmonary TB within a follow-up of 25,544 person-months. Multivariate Cox regression analysis revealed that the use of high-dose ICS, the use of 10 mg or more of prednisolone per day, and prior pulmonary TB were independent risk factors for the development of active pulmonary TB. They concluded that chest radiography and sputum smear/culture for Mycobacterium tuberculosis should be performed before initiating high-dose ICS and regularly thereafter.
Editor's comment: Although systemic administration of corticosteroids is a known risk factor for tuberculosis, this finding should alert us to this possibility.
Shu CC, Wu HD, Yu MC et al, Use of high-dose inhaled corticosteroids is associated with pulmonary tuberculosis in patients with chronic obstructive pulmonary disease. Medicine 2010; 89(1):53-61.
Additional Journal Reviews
- The contribution of panallergens to disease manifestation.
- Relieving symptoms in allergic rhinitis (AR).
- Allergy to local anesthetics (LA), although rare, does exist.
- Are sputum eosinophils useful in monitoring asthma control in childhood?
- Does the duration of the diet influence the onset of tolerance to cow's milk allergy (CMA)?
- Clinical outcomes of different particle sizes, delivery devices, and pharmacoeconomics of inhaled corticosteroids (ICS)
- Role of plasmacytoid dendritic cells (pDCs) in the regulation of allergic inflammation.
- Effects of vitamin D on the immune system.
ビタミン D の免疫システムに対する影響（総説）
- Merozoite antigens for malaria vaccine development.
- Biphasic reactions (BR) to allergen immunotherapy are uncommon.
- Possible role of dietary antioxidants in allergic disease (AD).