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Journal of Integrative Medicine Nov 2022Filiform needle acupuncture (FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Filiform needle acupuncture (FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in the treatment of allergic rhinitis (AR).
OBJECTIVE
To evaluate the efficacy, safety, cost-effectiveness, and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture, no treatment, and conventional medication.
SEARCH STRATEGY
Eight electronic databases were systematically searched from inception to October 14, 2021. Additional studies were acquired from clinical trial registration platforms and reference lists.
INCLUSION CRITERIA
Randomized controlled trials were included if they compared FNA with either sham acupuncture, no treatment or conventional medication for AR.
DATA EXTRACTION AND ANALYSIS
Two researchers extracted data independently of each other using a predesigned data acquisition form, and results were cross-checked after completion. The primary outcome was symptom score (Total Nasal Symptom Score or Visual Analogue Scale), and the secondary outcomes were the AR control questionnaire, quality of life (QoL) score (Different versions of Rhinoconjunctivitis Quality of Life Questionnaire), medication score (use of rescue medication), mental health score, total IgE, adverse event rate, clinical economic indicators, and patient satisfaction score. Standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval was used to calculate the effect size for continuous data, while risk ratio with 95% CI was used for dichotomous data.
RESULTS
Thirty studies were included in this review. Compared with sham acupuncture, FNA significantly reduced the symptom score (SMD: -0.29 [-0.43, -0.15]), AR's impact on QoL (SMD: -0.23 [-0.37, -0.08]) and medication score (SMD: -0.3 [-0.49, -0.11]). Compared with no treatment, FNA dramatically reduced the symptom score (SMD: -0.8 [-1.2, -0.39]) and AR's impact on QoL (SMD: -0.82 [-1.13, -0.52]). There were no increased rates of adverse events with FNA compared to sham acupuncture and no treatment. FNA increased patient satisfaction and may be cost-effective. Most pieces of evidence from the above two comparisons were of high confidence. Moreover, FNA significantly outperformed conventional medication in reducing the symptom score (SMD: -0.48 [-0.85, -0.1]) and displayed a lower rate of adverse events, but the quality of evidence was very low.
CONCLUSION
FNA is an effective and safe intervention for AR and can help with symptom relief, QoL improvement, reducing medication usage, and increasing patient satisfaction. Further studies are needed to verify its cost-effectiveness and superiority over conventional medication and the best therapeutic strategies.
Topics: Humans; Acupuncture Therapy; Pain Measurement; Quality of Life; Rhinitis, Allergic
PubMed: 36068161
DOI: 10.1016/j.joim.2022.08.004 -
Allergy Apr 2011There is a need for new treatment options of allergic respiratory diseases based on a better knowledge of their pathogenesis. An association between bacterial products... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a need for new treatment options of allergic respiratory diseases based on a better knowledge of their pathogenesis. An association between bacterial products and allergic airway diseases has been suggested by the results of human and animal studies that describe a link between Staphylococcus aureus enterotoxins and atopic diseases. The aim of the systematic review is to assess the evidence for a role of Staphylococcus aureus enterotoxins, as an environmental risk factor, for the development and/or the severity of asthma and allergic rhinitis.
METHODS
We performed a systematic review of controlled clinical studies in adults and/or children affected by asthma/early wheeze and/or allergic rhinitis. To be eligible, studies had to use reproducible methods to provide evidence of exposure to S. aureus, clinical outcome and disease severity.
RESULTS
Ten studies, published between 2000 and 2007, fulfilled all eligibility criteria. Patients with asthma or allergic rhinitis showed an increased prevalence of positivity for measures of exposure to S. aureus in nine studies: differences were statistically significant (P < 0.05) in seven studies. In a meta-analysis of study results, patients with asthma were more likely than controls to have serum-specific IgE to Staphylococcus aureus enterotoxins (OR = 3.3, 95% CI: 1.6-7.1, P = 0.002); similarly, patients with allergic rhinitis were more likely than controls to test positive for local or systemic exposure to Staphylococcus aureus and/or or its enterotoxins (OR = 2.4, 95% CI: 1.3-4.7, P = 0.008).
CONCLUSIONS
A potential role of S. aureus superantigens in allergic respiratory diseases is supported by results of this meta-analysis of clinical studies.
Topics: Adult; Asthma; Child; Humans; Rhinitis; Staphylococcus; Superantigens
PubMed: 21087214
DOI: 10.1111/j.1398-9995.2010.02502.x -
American Journal of Rhinology & Allergy 2015Because acupuncture may modulate the immune system, it has been proposed as a useful treatment for patients with allergic rhinitis (AR). Here, we assessed the evidence... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Because acupuncture may modulate the immune system, it has been proposed as a useful treatment for patients with allergic rhinitis (AR). Here, we assessed the evidence for the clinical efficacy of acupuncture for the management of AR patients by performing a systematic review and meta-analysis of the published literatures.
METHODS
By searching PubMed, EMBASE, the Cochrane clinical trials database, and the China National Knowledge Infrastructure from 1980 through July 11, 2013, we collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of AR patients to assess its efficacy and safety.
RESULTS
Thirteen full papers that met our inclusion criteria were included, and a total of 2365 participants, including 1126 as treatment group and 1239 as control group, were enrolled. Compared with control group, acupuncture treatment group exerted a significant reduction in nasal symptom scores (weighted mean difference [WMD]: -4.42, 95% confidence interval [CI]: -8.42 to -0.43, p = 0.03), medication scores (WMD: 1.39, 95% CI: -2.18 to -0.61, p = .0005), and serum IgE (WMD: -75.00, 95% CI: -91.17 to -58.83, p < 0.00001). Data relating to Rhinitis Quality of Life Questionnaire (RQLQ) and 36-Item Short-Form (SF-36) component score in included studies were analyzed, which ultimately point to the efficacy of acupuncture treatment in improving quality of life in AR patients. No fatal events were reported in any of the included studies, and no serious systemic reaction, which needed treatment in the hospital, was related to the acupuncture treatment.
CONCLUSION
Our meta-analysis suggests that that acupuncture could be a safe and valid treatment option for AR patients.
Topics: Acupuncture Therapy; Humans; Immunoglobulin E; Publication Bias; Quality Assurance, Health Care; Randomized Controlled Trials as Topic; Rhinitis, Allergic
PubMed: 25590322
DOI: 10.2500/ajra.2015.29.4116 -
American Journal of Rhinology & Allergy Jul 2023ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis.
OBJECTIVE
The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS).
METHODS
A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).
RESULTS
There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be -3.48 points (95% CI: -3.73 to -3.23, = 0.13). and -3.50 (95% CI: -3.71 to -3.29, = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be -1.53 (95% CI: -1.74 to -1.31, = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%).
CONCLUSIONS
The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
Topics: Humans; Rhinitis; Cryosurgery; Quality of Life; Sinusitis; Nose
PubMed: 36691694
DOI: 10.1177/19458924231152331 -
International Forum of Allergy &... Sep 2017The diagnosis of allergic rhinitis (AR) is based on cutaneous and serological assessment to determine immunoglobulin E (IgE)-mediated disease. However, discrepancies... (Review)
Review
BACKGROUND
The diagnosis of allergic rhinitis (AR) is based on cutaneous and serological assessment to determine immunoglobulin E (IgE)-mediated disease. However, discrepancies between these tests and nasal provocation exist. Patients diagnosed as non-allergic rhinitis (NAR) but with positive nasal allergen provocation test (NAPT) may represent a local allergic condition or entopy, still suitable to allergy interventions. The objective of this study was to determine the frequency of nasal reactivity toward allergens among AR and NAR patients, and to describe the diagnostic characteristics of NAPT methodologies.
METHODS
EMBASE (1947-) and Medline (1946-) were searched until December 8, 2015. A search strategy was used to identify studies on AR or NAR patients subjected to diagnostic local nasal provocation. All studies providing original NAPT data among the AR or NAR population were included. Meta-analysis of proportion data was presented as a weighted probability % (95% confidence interval [CI]).
RESULTS
The search yielded 4504 studies and 46 were included. The probability of nasal allergen reactivity for the AR population was 86.3% (95% CI, 84.4 to 88.1) and in NAR was 24.7% (95% CI, 22.3 to 27.2). Reactivity was high with pollen for both AR 97.1% (95% CI, 94.2 to 99.2) and NAR 47.5% (95% CI, 34.8 to 60.4), and lowest with dust for both AR 79.1% (95% CI, 76.4 to 81.6) and NAR 12.2% (95% CI, 9.9 to 14.7). NAPT yielded high positivity when defined by subjective end-points: AR 91.0% (95% CI, 86.6 to 94.8) and NAR 30.2% (95% CI, 22.9 to 37.9); and lower with objective end-points: AR 80.8% (95% CI, 76.8 to 84.5) and NAR 14.1% (95% CI, 11.2 to 17.2).
CONCLUSION
Local allergen reactivity is demonstrated in 26.5% of patients previously considered non-allergic. Similarly, AR, when defined by skin-prick test (SPT) or serum specific IgE (sIgE), may lead to 13.7% of patients with inaccurate allergen sensitization or non-allergic etiologies.
Topics: Allergens; Humans; Nasal Provocation Tests; Rhinitis
PubMed: 28727909
DOI: 10.1002/alr.21988 -
European Annals of Otorhinolaryngology,... Nov 2023There is no consensus on the role of surgery in the treatment of chronic rhinitis (CR). Should it be considered when nasal symptoms are not controlled by medical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is no consensus on the role of surgery in the treatment of chronic rhinitis (CR). Should it be considered when nasal symptoms are not controlled by medical treatment? Various targets (turbinates and secretory nerves) and techniques (surgical, laser, cryotherapy, radiofrequency and phototherapy) have been reported, but benefit varies between reports. The aim of this systematic review and meta-analysis was to evaluate results of surgical and instrumental procedures in CR care.
METHODS
Two systematic reviews of the US National Library of Medicine, Cochrane Library, Web of Science and Embase databases were conducted in October 15, 2021 (registration numbers CRD42021284257 and CRD42021295227). A database watch was performed until submission of the manuscript. The review focuses on total nasal symptom score (TNSS) and quality of life (QoL) after treatment. All controlled studies reporting nasal surgery/instrumental procedures in adult patients with CR were included.
RESULTS
The database search yielded a total of 5628 articles; after eligibility screening, 2091 patients were included from 21 studies. QoL results favored surgery/instrumental procedures over medical treatment (SMD -1.27; 95% CI [-2.38; -0.16]; I=97%), as did TNSS (SMD -1.40; 95% CI [-2.30; -0.50]; I=98%). The small number of studies and their heterogeneity did not allow meta-regression to be performed.
CONCLUSION
This systematic review supports the use of surgical/instrumental procedures to improve nasal symptom score and QoL of adult patients with CR poorly controlled by medical treatment.
Topics: Adult; Humans; Rhinitis; Quality of Life; Research Design; Nose; Rhinitis, Allergic
PubMed: 37867008
DOI: 10.1016/j.anorl.2023.10.009 -
Clinical and Translational Allergy Sep 2022The Control of Allergic Rhinitis and Asthma Test (CARAT) is a patient-reported outcome measurement (PROM) assessing the control of asthma and allergic rhinitis (AR) at a... (Review)
Review
The Control of Allergic Rhinitis and Asthma Test (CARAT) is a patient-reported outcome measurement (PROM) assessing the control of asthma and allergic rhinitis (AR) at a 4 week interval. This systematic review aimed to evaluate the measurement properties of CARAT. Following PRISMA and COSMIN guidelines, we searched five bibliographic databases and retrieved studies concerning the development, assessment of properties, validation, and/or cultural adaption of CARAT. The studies' methodological quality, the quality of measurement properties, and the overall quality of evidence were assessed. We performed meta-analysis of CARAT measurement properties. We included 16 studies. Control of Allergic Rhinitis and Asthma Test displayed sufficient content validity and very good consistency (meta-analytical Cronbach alpha = 0.83; 95% CI = 0.80-0.86;I = 62.6%). Control of allergic rhinitis and Asthma Test meta-analytical intraclass correlation coefficient was 0.91 (95% CI = 0.64-0.98;I = 93.7%). It presented good construct validity, especially for correlations with Patient-reported outcome measures assessing asthma (absolute Spearman correlation coefficients range = 0.67-0.73; moderate quality of evidence), and good responsiveness. Its minimal important difference is 3.5. Overall, CARAT has good internal consistency, reliability, construct validity and responsiveness, despite the heterogeneous quality of evidence. Control of Allergic Rhinitis and Asthma Test can be used to assess the control of asthma and AR. As first of its kind, this meta-analysis of CARAT measurement properties sets a stronger level of evidence for asthma and/or AR control questionnaires.
PubMed: 36178185
DOI: 10.1002/clt2.12194 -
Frontiers in Immunology 2023To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR). (Meta-Analysis)
Meta-Analysis
AIM
To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR).
METHODS
PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison.
RESULTS
Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26).
CONCLUSION
Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42023460693).
Topics: Child; Humans; Allergens; Asthma; Desensitization, Immunologic; Pollen; Rhinitis, Allergic; Immunotherapy; Sublingual Immunotherapy
PubMed: 38162647
DOI: 10.3389/fimmu.2023.1274241