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American Journal of Rhinology & Allergy Sep 2019
Comparative Study Meta-Analysis
Topics: Adult; Anti-Allergic Agents; Anti-Asthmatic Agents; Conjunctivitis; Drug Therapy, Combination; Female; Histamine H1 Antagonists; Humans; Leukotriene Antagonists; Male; Randomized Controlled Trials as Topic; Rhinitis, Allergic; Treatment Outcome
PubMed: 31007040
DOI: 10.1177/1945892419844459 -
Giornale Italiano Di Dermatologia E... Aug 2019Omalizumab, has been used for almost two decades, mainly in allergic asthma and chronic spontaneous urticaria for which it is highly beneficial. Smaller studies have...
INTRODUCTION
Omalizumab, has been used for almost two decades, mainly in allergic asthma and chronic spontaneous urticaria for which it is highly beneficial. Smaller studies have evaluated the effects of omalizumab in atopic dermatitis (AD). Current treatments options, such as cyclosporine and azathioprine have limited effect on AD and numerous side effects. The recently introduced biologic dupilumab (anti-IL4) shows promising results, however with conjunctivitis as a prevalent side effect. We evaluate the current evidence for the use of omalizumab in AD.
EVIDENCE ACQUISITION
Systematic literature searches were performed in PubMed, Web of Science, Embase and Clinicaltrials.gov to identify any study (case reports, case series, and controlled trials) evaluating the effect of treatment with omalizumab in AD.
EVIDENCE SYNTHESIS
Thirty-four studies (12 single case studies, 15 case series, 5 prospective studies and 2 small pilot randomized placebo-controlled trials [RCTs]), including a total of 214 patients with median of 3, ranging from 1-35 patients were identified. A total of 169 patients (79.0%) experienced a beneficial effect from treatment, ranging from little to complete response, whereas 45 patients (21.0%) reported no or negative effect from omalizumab treatment.
CONCLUSIONS
Omalizumab is a safe and well-tolerated treatment with some clinical benefit in AD patients. However, the lack of larger RCTs and possible publication bias limit the recommendation of omalizumab for use in clinical practice for AD. Newer and more effective treatments exist and should be prioritized.
Topics: Anti-Allergic Agents; Dermatitis, Atopic; Humans; Omalizumab; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 30717578
DOI: 10.23736/S0392-0488.19.06302-8 -
International Forum of Allergy &... Nov 2018Allergic conjunctivitis (AC) is a common chronic condition, especially in children. Ocular symptoms are often overlooked during treatment of allergic rhinoconjunctivitis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Allergic conjunctivitis (AC) is a common chronic condition, especially in children. Ocular symptoms are often overlooked during treatment of allergic rhinoconjunctivitis (ARC). Pediatric ARC can be effectively treated using sublingual immunotherapy (SLIT), which is a guideline-recommended safe treatment approach. However, the therapeutic efficacy of SLIT in terms of ameliorating eye symptoms has not been effectively evaluated.
METHODS
We performed a meta-analysis of randomized controlled trials (RCTs) evaluating the use of SLIT for infants, children, and adolescents (aged from 3 to 18 years) with AC or ARC. We searched the Cochrane Library database, EMBASE, and Medline from November 1990 to 2017 to find papers dealing with the effects of SLIT on pediatric AC or ARC. We used standardized mean differences (SMDs) to assess therapeutic effects, employing a random effects model. Subgroup and sensitivity analyses were also conducted. The I metric was used to evaluate heterogeneity.
RESULTS
In total, 13 clinical RCTs were included in our meta-analysis. SLIT reduced ocular symptoms to a level below that of controls (SMD = -0.21; 95% confidence interval [CI], -0.41 to -0.01; p = 0.04; I = 55%). Notably, on subgroup analysis, SLIT clearly reduced pollen-induced pediatric AC (SMD = -0.36; 95% CI, -0.53 to -0.19; p < 0.0001; I = 25%) but not mite-induced AC (SMD = 0.20; 95% CI, -0.20 to 0.60; p = 0.34; I = 46%).
CONCLUSION
SLIT relieved ocular symptoms in children with ARC or AC. To confirm these results, future meta-analyses should evaluate high-quality, large-scale population-based trials.
Topics: Child; Conjunctivitis, Allergic; Humans; Randomized Controlled Trials as Topic; Sublingual Immunotherapy
PubMed: 29782067
DOI: 10.1002/alr.22149 -
The Cochrane Database of Systematic... Sep 2017Genital Chlamydia trachomatis (C.trachomatis) infection may lead to pregnancy complications such as miscarriage, preterm labour, low birthweight, preterm rupture of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Genital Chlamydia trachomatis (C.trachomatis) infection may lead to pregnancy complications such as miscarriage, preterm labour, low birthweight, preterm rupture of membranes, increased perinatal mortality, postpartum endometritis, chlamydial conjunctivitis and C.trachomatis pneumonia.This review supersedes a previous review on this topic.
OBJECTIVES
To establish the most efficacious and best-tolerated therapy for treatment of genital chlamydial infection in preventing maternal infection and adverse neonatal outcomes.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (26 June 2017) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs) as well as studies published in abstract form assessing interventions for treating genital C.trachomatis infection in pregnancy. Cluster-RCTs were also eligible for inclusion but none were identified. Quasi-randomised trials and trials using cross-over design are not eligible for inclusion in this review.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion, assessed trial quality and extracted the data using the agreed form. Data were checked for accuracy. Evidence was assessed using the GRADE approach.
MAIN RESULTS
We included 15 trials (involving 1754 women) although our meta-analyses were based on fewer numbers of studies/women. All of the included studies were undertaken in North America from 1982 to 2001. Two studies were low risk of bias in all domains, all other studies had varying risk of bias. Four other studies were excluded and one study is ongoing.Eight comparisons were included in this review; three compared antibiotic (erythromycin, clindamycin, amoxicillin) versus placebo; five compared an antibiotic versus another antibiotic (erythromycin, clindamycin, amoxicillin, azithromycin). No study reported different antibiotic regimens. Microbiological cure (primary outcome) Antibiotics versus placebo: Erythromycin (average risk ratio (RR) 2.64, 95% confidence interval (CI) 1.60 to 4.38; two trials, 495 women; I = 68%; moderate-certainty evidence), and clindamycin (RR 4.08, 95% CI 2.35 to 7.08; one trial, 85 women;low-certainty evidence) were associated with improved microbiological cure compared to a placebo control. In one very small trial comparing amoxicillin and placebo, the results were unclear, but the evidence was graded very low (RR 2.00, 95% CI 0.59 to 6.79; 15 women). One antibiotic versus another antibiotic: Amoxicillin made little or no difference in microbiological cure in comparison to erythromycin (RR 0.97, 95% CI 0.93 to 1.01; four trials, 466 women; high-certainty evidence), probably no difference compared to clindamycin (RR 0.96, 95% CI 0.89 to 1.04; one trial, 101 women; moderate-quality evidence), and evidence is very low certainty when compared to azithromycin so the effect is not certain (RR 0.89, 95% CI 0.71 to 1.12; two trials, 144 women; very low-certainty evidence). Azithromycin versus erythromycin (average RR 1.11, 95% CI 1.00 to 1.23; six trials, 374 women; I = 53%; moderate-certainty evidence) probably have similar efficacy though results appear to favour azithromycin. Clindamycin versus erythromycin (RR 1.06, 95% CI 0.97 to 1.15; two trials, 173 women; low-certainty evidence) may have similar numbers of women with a microbiological cure between groups.Evidence was downgraded for design limitations, inconsistency, and imprecision in effect estimates. Side effects of the treatment (maternal) (secondary outcome) Antibiotics versus placebo: side effects including nausea, vomiting, and abdominal pain, were reported in two studies (495 women) but there was no clear evidence whether erythromycin was associated with more side effects than placebo and a high level of heterogeneity (I = 78%) was observed (average RR 2.93, 95% CI 0.36 to 23.76). There was no clear difference in the number of women experiencing side effects when clindamycin was compared to placebo in one small study (5/41 versus 1/44) (RR 6.35, 95% CI 0.38 to 107.45, 62 women). The side effects reported were mostly gastrointestinal and also included resolving skin rashes. One antibiotic versus another antibiotic: There was no clear difference in incidence of side effects (including nausea, vomiting, diarrhoea and abdominal pain) when amoxicillin was compared to azithromycin based on data from one small study (36 women) (RR 0.56, 95% CI 0.24 to 1.31).However, amoxicillin was associated with fewer side effects compared to erythromycin with data from four trials (513 women) (RR 0.31, 95% CI 0.21 to 0.46; I = 27%). Side effects included nausea, vomiting, diarrhoea, abdominal cramping, rash, and allergic reaction.Both azithromycin (RR 0.24, 95% CI 0.17 to 0.34; six trials, 374 women) and clindamycin (RR 0.44, 95% CI 0.22 to 0.87; two trials, 183 women) were associated with a lower incidence of side effects compared to erythromycin. These side effects included nausea, vomiting, diarrhoea and abdominal cramping.One small study (101 women) reported there was no clear difference in the number of women with side effects when amoxicillin was compared with clindamycin (RR 0.57, 95% CI 0.14 to 2.26; 107 women). The side effects reported included rash and gastrointestinal complaints. Other secondary outcomes Single trials reported data on repeated infections, preterm birth, preterm rupture of membranes, perinatal mortality and low birthweight and found no clear differences between treatments.Many of this review's secondary outcomes were not reported in the included studies.
AUTHORS' CONCLUSIONS
Treatment with antibacterial agents achieves microbiological cure from C.trachomatis infection during pregnancy. There was no apparent difference between assessed agents (amoxicillin, erythromycin, clindamycin, azithromycin) in terms of efficacy (microbiological cure and repeat infection) and pregnancy complications (preterm birth, preterm rupture of membranes, low birthweight). Azithromycin and clindamycin appear to result in fewer side effects than erythromycin.All of the studies in this review were conducted in North America, which may limit the generalisability of the results. In addition, study populations may differ in low-resource settings and these results are therefore only applicable to well-resourced settings. Furthermore, the trials in this review mainly took place in the nineties and early 2000's and antibiotic resistance may have changed since then.Further well-designed studies, with appropriate sample sizes and set in a variety of settings, are required to further evaluate interventions for treating C.trachomatis infection in pregnancy and determine which agents achieve the best microbiological cure with the least side effects. Such studies could report on the outcomes listed in this review.
Topics: Amoxicillin; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Clindamycin; Erythromycin; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Reproductive Tract Infections
PubMed: 28937705
DOI: 10.1002/14651858.CD010485.pub2 -
Allergy Nov 2017The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.
METHODS
We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.
RESULTS
We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.
CONCLUSIONS
AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.
Topics: Allergens; Conjunctivitis, Allergic; Databases, Factual; Desensitization, Immunologic; Humans; Rhinitis, Allergic, Seasonal
PubMed: 28493631
DOI: 10.1111/all.13201 -
BMC Psychiatry Mar 2017Reports of frequent manifestation of allergic diseases in children with attention deficit hyperactivity disorder (ADHD) have been the subject of mounting clinical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Reports of frequent manifestation of allergic diseases in children with attention deficit hyperactivity disorder (ADHD) have been the subject of mounting clinical interest. However, evidence supporting the association between ADHD and allergies is inconsistent and has yet to be systematically reviewed. The objective of this study was to compile and assess available studies on the association between ADHD and allergic diseases in children.
METHODS
A comprehensive search using MEDLINE, EMBASE, the Cochrane library, and CINAHL databases was completed in 23 November 2015. The inclusion criteria for studies were that the research assessed allergic diseases in children, 18 years of age and younger, with a diagnosis of ADHD and that a distinct comparison group was incorporated. Any comparative studies, encompassing both randomized controlled trials and observational studies, were considered for inclusion. Two review authors independently assessed the quality of the selected studies by the use of validated assessment tools, performed data extraction and conducted meta-analysis according to Cochrane Collaboration guidelines.
RESULTS
Five eligible studies were included in this systematic review. Of these studies, three were case-control and two were cross sectional studies. A majority of information from the five studies was classified as having low or unclear risk of bias. The meta-analysis showed an association between children with ADHD and asthma compared with the control groups (OR: 1.80, 95% CI: 1.57 - 2.07; five studies, low quality of evidence), but did not indicate an association between food allergy and ADHD (OR: 1.13, 95% CI: 0.88 - 1.47; three studies very low quality of evidence). The odds of experiencing allergic rhinitis, atopic dermatitis, and allergic conjunctivitis were slightly higher in children with ADHD compared with control groups, though a substantial statistical heterogeneity was notable in the overall effect estimates.
CONCLUSIONS
The findings from this review and meta-analysis show that children with ADHD are more likely to have asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis than their counterparts. Interventions including strategies for managing allergies in children with ADHD would be beneficial.
Topics: Asthma; Attention Deficit Disorder with Hyperactivity; Case-Control Studies; Child; Cross-Sectional Studies; Dermatitis, Atopic; Food Hypersensitivity; Humans; Rhinitis, Allergic
PubMed: 28359274
DOI: 10.1186/s12888-017-1281-7 -
The Cochrane Database of Systematic... Feb 2017Blepharokeratoconjunctivitis (BKC) is a type of inflammation of the surface of the eye and eyelids that involves changes of the eyelids, dysfunction of the meibomian... (Review)
Review
BACKGROUND
Blepharokeratoconjunctivitis (BKC) is a type of inflammation of the surface of the eye and eyelids that involves changes of the eyelids, dysfunction of the meibomian glands, and inflammation of the conjunctiva and cornea. Chronic inflammation of the cornea can lead to scarring, vascularisation and opacity. BKC in children can cause significant symptoms including irritation, watering, photophobia and loss of vision from corneal opacity, refractive error or amblyopia.Treatment of BKC is directed towards modification of meibomian gland disease and the bacterial flora of lid margin and conjunctiva, and control of ocular surface inflammation. Although both topical and systemic treatments are used to treat people with BKC, this Cochrane review focuses on topical treatments.
OBJECTIVES
To assess and compare data on the efficacy and safety of topical treatments (including antibiotics, steroids, immunosuppressants and lubricants), alone or in combination, for BKC in children from birth to 16 years.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE ( January 1946 to 11 July 2016), Embase (January 1980 to 11 July 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 July 2016. We searched the reference lists of identified reports and the Science Citation Index to identify any additional reports of studies that met the inclusion criteria.
SELECTION CRITERIA
We searched for randomised controlled trials that involved topical treatments in children up to 16 years of age with a clinical diagnosis of BKC. We planned to include studies that evaluated a single topical medication versus placebo, a combination of treatments versus placebo, and those that compared two or multiple active treatments. We planned to include studies in which participants received additional treatments, such as oral antibiotics, oral anti-inflammatories, warm lid compresses and lid margin cleaning.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the results of the literature search (titles and abstracts) to identify studies that met the inclusion criteria of the review and applied standards as expected for Cochrane reviews. We graded the certainty of the evidence using GRADE.
MAIN RESULTS
We included one study from the USA that met the inclusion criteria. In the study, 137 children aged zero to six years old with blepharoconjunctivitis were randomised to treatment in one of four trial arms (loteprednol etabonate/tobramycin combination, loteprednol etabonate alone, tobramycin alone or placebo) for 15 days, with assessments on days 1, 3, 7 and 15. We judged the study to be at high risk of attrition bias and bias due to selective outcome reporting. The study did not report the number of children with improvement in symptoms nor with total or partial success as measured by changes in clinical symptoms.All children showed a reduction in blepharoconjunctivitis grade score, but there was no evidence of important differences between groups. Visual acuity was not fully reported but the authors stated that there was no change in visual acuity in any of the treatment groups. The study reported ocular and non ocular adverse events but was underpowered to detect differences between the groups. Ocular adverse events were as follows: loteprednol/tobramycin 1/34 (eye pain); loteprednol 4/35 (eye pain, conjunctivitis, eye discharge, eye inflammation); tobramycin 0/34; placebo (vehicle) 0/34. The evidence was limited for all these outcomes and we judged it to be very low certainty.There was no information on clinical signs (aside from grade score), disease progression or quality of life.
AUTHORS' CONCLUSIONS
There is no high-quality evidence of the safety and efficacy of topical treatments for BKC, which resulted in uncertainty about the indications and effectiveness of topical treatment. Clinical trials are required to test efficacy and safety of current and any future treatments. Outcome measures need to be developed which can capture both objective clinical and patient-reported aspects of the condition and treatments.
Topics: Administration, Topical; Anti-Allergic Agents; Anti-Bacterial Agents; Blepharitis; Child; Child, Preschool; Conjunctiva; Eyelids; Humans; Infant; Infant, Newborn; Keratoconjunctivitis; Loteprednol Etabonate; Randomized Controlled Trials as Topic; Tobramycin
PubMed: 28170093
DOI: 10.1002/14651858.CD011965.pub2 -
Ocular Immunology and Inflammation Oct 2017To assess the safety and efficacy of topical olopatadine versus placebo and other topical anti-allergic medications in treating allergic conjunctivitis. (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
To assess the safety and efficacy of topical olopatadine versus placebo and other topical anti-allergic medications in treating allergic conjunctivitis.
METHODS
We systematically searched the literature for randomized-controlled trials that included patients with allergic conjunctivitis, compared olopatadine versus placebo or alternative anti-allergic medications, and examined itch, conjunctival hyperemia, composite symptom or sign scores, and/or occurrence of adverse events. We assessed the safety and efficacy of topical olopatadine when compared with placebo or alternative anti-allergic medications using meta-analysis.
RESULTS
When compared with placebo, topical olopatadine is associated with a pooled-mean difference (MD) in ocular itch of -1.33 (p < 0.00001) and ocular hyperemia of -0.92 (p < 0.00001). When compared with other agents, olopatadine was inferior to alcaftadine on ocular itch (pooled-MD = 0.39; p < 0.00001) but comparable with epinastine and ketotifen.
CONCLUSIONS
Topical olopatadine is a safe and effective treatment modality for allergic conjunctivitis, whereas alcaftadine appears to be superior to olopatadine in reducing ocular itch.
Topics: Administration, Ophthalmic; Anti-Allergic Agents; Benzazepines; Conjunctivitis, Allergic; Dibenzazepines; Histamine H1 Antagonists; Humans; Imidazoles; Ketotifen; Olopatadine Hydrochloride; Ophthalmic Solutions; Treatment Outcome
PubMed: 27192186
DOI: 10.3109/09273948.2016.1158282 -
The American Journal of Clinical... Jan 2016There is some evidence that increased maternal intake of omega-3 (n-3) long-chain polyunsaturated fatty acids (LC-PUFAs) during pregnancy may reduce the incidence of... (Meta-Analysis)
Meta-Analysis Review
Omega-3 long-chain PUFA intake during pregnancy and allergic disease outcomes in the offspring: a systematic review and meta-analysis of observational studies and randomized controlled trials.
BACKGROUND
There is some evidence that increased maternal intake of omega-3 (n-3) long-chain polyunsaturated fatty acids (LC-PUFAs) during pregnancy may reduce the incidence of immunoglobulin E (IgE)-mediated allergic disease.
OBJECTIVE
We aimed to evaluate prenatal n-3 LC-PUFA dietary exposure in observational studies and n-3 LC-PUFA supplementation in randomized controlled trials (RCTs) on outcomes of IgE-mediated allergic disease.
DESIGN
We conducted searches of the Cochrane Central Register of Controlled Trials, PubMed, Ovid MEDLINE, EMBASE, CINAHL, SCOPUS, and Web of Science to 30 July 2015. We included prospective cohort studies that showed an association between maternal fish or n-3 LC-PUFA intake during pregnancy and RCTs with a prenatal intervention to modify maternal n-3 LC-PUFA intake and outcomes of allergic disease (eczema, rhino-conjunctivitis, asthma) or sensitization in the offspring.
RESULTS
A total of 13 publications from 10 prospective cohort studies and 7 publications representing 5 unique RCTs were included. Three RCTs were combined in a meta-analysis for selected outcomes. Nine of 13 observational study publications and 5 of 7 publications from RCTs found a protective association between increased prenatal n-3 LC-PUFA or fish intake and incidence of allergic disease symptoms in the child. Meta-analysis was limited because of the heterogeneity of the RCTs. Pooled results showed a significant reduction in the incidence of "atopic eczema," "any positive SPT [skin-prick test]," "sensitization to egg," and "sensitization to any food" in the first 12 mo of life [RRs (95% CIs): 0.53 (0.35, 0.81), P = 0.004; 0.68 (0.52-0.89), P = 0.006; 0.55 (0.39-0.76), P = 0.0004; and 0.59 (0.46, 0.76), P < 0.0001, respectively].
CONCLUSIONS
Our systematic review and meta-analysis was suggestive of benefits of increased n-3 LC-PUFAs in the maternal diet and outcomes of childhood allergic disease. However, due to the inconsistency in results, the hypothesis linking maternal n-3 LC-PUFA intake to childhood allergic disease cannot unequivocally be confirmed or rejected.
Topics: Dermatitis, Atopic; Diet; Dietary Supplements; Fatty Acids, Omega-3; Female; Food Hypersensitivity; Humans; Hypersensitivity; Pregnancy; Prenatal Nutritional Physiological Phenomena
PubMed: 26675770
DOI: 10.3945/ajcn.115.111104 -
Recenti Progressi in Medicina Oct 2015The respiratory allergies, including allergic rhinitis and allergic asthma, represent a substantial medical and economic burden worldwide. Despite their dimension and... (Review)
Review
BACKGROUND
The respiratory allergies, including allergic rhinitis and allergic asthma, represent a substantial medical and economic burden worldwide. Despite their dimension and huge economic-social burden, no data are available on the costs associated with the management of respiratory allergic diseases in Italy. The objective of this study was to estimate the average annual cost incurred by the National Health Service (NHS), as well as society, due to respiratory allergies and their main co-morbidities in Italy.
METHODS
A probabilistic prevalence-based cost of illness model was developed to estimate an aggregate measure of the economic burden associated with respiratory allergies and their main co-morbidities in terms of direct and indirect costs. A systematic literature review was performed in order to identify both the cost per case (expressed in present value) and the number of affected patients, by applying an incidence-based estimation method. Direct costs were estimated multiplying the hospitalization, drugs and management costs derived by the literature with the Italian epidemiological data. Indirect costs were calculated based on lost productivity according to the human capital approach. Furthermore, a one-way and probabilistic sensitivity analysis with 5,000 Monte Carlo simulations were performed, in order to test the robustness of the results and define the proper 95% Confidence Interval (CI).
RESULTS
Overall, the total economic burden associated with respiratory allergies and their main co-morbidities was € 7.33 billion (95% CI: € 5.99-€ 8.82). A percentage of 27.5% was associated with indirect costs (€ 2.02; 95% CI: € 1.72-€ 2.34 billion) and 72.5% with direct costs (€ 5.32; 95% CI: € 4.04-€ 6.77 billion). In allergic asthma, allergic rhinitis, combined allergic rhinitis and asthma, turbinate hypertrophy and allergic conjunctivitis, the model estimate an average annual economic burden of € 1,35 (95% CI: € 1,14-€ 1,58) billion, € 1,72 (95% CI: € 1,14-€ 2,43) billion, € 1,62 billion (€ 0,91-€ 2,53) billion, € 0,12 (€ 0,07-€ 0,17) billion, € 0,46 (€ 0,16-€ 0,92) billion respectively.
CONCLUSIONS
To our knowledge, this is the first study in which direct costs (incurred by NHS) and indirect ones (incurred by the society) were taken into account to estimate the overall burden associated with respiratory allergies and their main co-morbidities in our Country. In conclusion, this work may be considered an efficient tool for public decision-makers to correctly understand the economic aspects involved by the management and treatment of respiratory allergies-induced diseases in Italy.
Topics: Asthma; Cost of Illness; Health Care Costs; Hospitalization; Humans; Italy; Monte Carlo Method; National Health Programs; Prevalence; Rhinitis, Allergic
PubMed: 26442978
DOI: 10.1701/2032.22086