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BMJ Clinical Evidence Jan 2012Childhood asthma is the most common chronic paediatric illness. There is no cure for asthma but good treatment to palliate symptoms is available. Asthma is more common... (Review)
Review
INTRODUCTION
Childhood asthma is the most common chronic paediatric illness. There is no cure for asthma but good treatment to palliate symptoms is available. Asthma is more common in children with a personal or family history of atopy, increased severity and frequency of wheezing episodes, and presence of variable airway obstruction or bronchial hyperresponsiveness. Precipitating factors for symptoms and acute episodes include infection, house dust mites, allergens from pet animals, exposure to tobacco smoke, and exercise.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of single-agent prophylaxis in children taking as-needed inhaled beta(2) agonists for asthma? What are the effects of additional prophylactic treatments in childhood asthma inadequately controlled by standard-dose inhaled corticosteroids? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 48 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta(2) agonists (long-acting), corticosteroids (inhaled standard or higher doses), leukotriene receptor antagonists (oral), omalizumab, and theophylline (oral).
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Anti-Asthmatic Agents; Asthma; Child; Humans; Leukotriene Antagonists; Respiratory Sounds; Theophylline
PubMed: 22305975
DOI: No ID Found -
BMJ Clinical Evidence May 2011Eczema, as defined by the World Allergy Organization (WAO) revised nomenclature in 2003, affects 15% to 20% of school children and 2% to 5% of adults worldwide. About... (Review)
Review
INTRODUCTION
Eczema, as defined by the World Allergy Organization (WAO) revised nomenclature in 2003, affects 15% to 20% of school children and 2% to 5% of adults worldwide. About 50% of people with eczema demonstrate atopy, with specific immunoglobulin E responses to allergens.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of topical medical treatments, and dietary interventions in adults and children with established eczema? What are the effects of breastfeeding, reducing allergens, or dietary interventions for primary prevention of eczema in predisposed infants? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 54 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: breastfeeding, controlling house dust mites, corticosteroids, dietary exclusion of eggs or cow's milk, elementary diets, emollients, essential fatty oils, few-foods diet, multivitamins, pimecrolimus, probiotics, pyridoxine, reducing maternal dietary allergens, tacrolimus, vitamin E, and zinc supplements.
Topics: Adrenal Cortex Hormones; Animals; Dermatitis, Atopic; Eczema; Emollients; Humans; Hypersensitivity; Pyroglyphidae
PubMed: 21609512
DOI: No ID Found -
Canadian Journal of Public Health =... 2011We calculated the population attributable fraction (PAF) of Canadian childhood asthma due to modifiable environmental exposures, in order to estimate their relative... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We calculated the population attributable fraction (PAF) of Canadian childhood asthma due to modifiable environmental exposures, in order to estimate their relative contributions to asthma development based on the current literature.
METHODS
We conducted a systematic review to determine Canadian childhood asthma incidence, Canadian prevalence of exposure to airborne pollutants and indoor allergens, and international estimates of the risk of developing physician-diagnosed asthma (PDA) associated with each exposure. Combining risk estimates by meta-analysis where possible, PAF was calculated by the formula: PAF = Attributable risk *Exposure prevalence* 100%/Asthma incidence.
SYNTHESIS
Age-specific Canadian childhood asthma incidence ranged from 2.8%-6.9%. Canadian exposure prevalences were: PM10 16%, PM2.5 7.1%, NO2 25%, environmental tobacco smoke (ETS) 9.0%, cat 22%, dog 12%, mouse 17%, cockroach 9.8%, dust mite 30%, moisture 14% and mould 33%. Relative risk estimates of PDA were: PM10 1.64, PM2.5 1.44, NO2 1.29, ETS 1.40, mouse 1.23, cockroach 1.96, and spanned 1.00 for cat, dog, dust mites, moisture and mould. PAF estimates for incident asthma among preschool children were: PM10 11%, PM2.5 1.6%, NO2 4.0%, ETS 2.9%, mouse 6.5% and cockroach 13%.
CONCLUSIONS
This systematic review suggests contributions to childhood asthma development from exposure to particulates, NO2, ETS, mouse and cockroach. The associations appeared to be more complex for cat, dog and dust mite allergens and more variable for mould and moisture. Additional prospective, population-based studies of childhood asthma development with objectively-measured exposures are needed to further quantify these associations.
Topics: Adolescent; Air Pollutants; Allergens; Asthma; Canada; Child; Child, Preschool; Environmental Exposure; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Prevalence; Risk; Young Adult
PubMed: 21485964
DOI: 10.1007/BF03404874 -
The Canadian Journal of Infectious... 2011Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics.
BACKGROUND
Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics.
OBJECTIVE
To systematically review the accuracy and precision of history, physical examination and tests for diagnosing scabies.
METHODS
Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. Data were extracted using standard criteria.
RESULTS
History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. Dermatoscopy by a trained practitioner has a positive likelihood ratio of 6.5 (95% CI 4.1 to 10.3) and a negative likelihood ratio of 0.1 (95% CI 0.06 to 0.2) for diagnosing scabies. The accuracy of other diagnostic tests could not be calculated from the data in the literature.
CONCLUSIONS
In the face of such diagnostic inaccuracy, clinical judgment is still practical in diagnosing scabies. Two tests are used - the burrow ink test and handheld dermatoscopy. The burrow ink test is a simple, rapid, noninvasive test that can be used to screen a large number of patients. Handheld dermatoscopy is an accurate test, but requires special equipment and trained practitioners. Given the morbidity and costs of scabies infection, and that studies to date lack adequate internal and external validity, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.
PubMed: 23205026
DOI: 10.1155/2011/698494 -
Acta Dermatovenerologica Alpina,... Oct 2010Lais® allergoid tablets contain allergens that are modified by carbamylation. Due to their modified chemical structure, they are suitable for sublingual immunotherapy... (Meta-Analysis)
Meta-Analysis Review
Carbamylated monomeric allergoids as a therapeutic option for sublingual immunotherapy of dust mite- and grass pollen-induced allergic rhinoconjunctivitis: a systematic review of published trials with a meta-analysis of treatment using Lais® tablets.
Lais® allergoid tablets contain allergens that are modified by carbamylation. Due to their modified chemical structure, they are suitable for sublingual immunotherapy (SLIT) (13, 16, 17, 24). Based on their small molecule size of 12 to 40 kDa, they can be easily absorbed via the oral mucosa (1). In this review, we studied the efficacy of SLIT with carbamylated monomeric allergoid tablets in the treatment of grass pollen- and dust mite-induced allergic rhinoconjunctivitis on the basis of symptom and medication score improvements. Following a selective internet and databank search, six trials-some placebo-controlled-regarding the treatment of grass pollen- (n = 266) and dust mite-induced (n = 241) allergic rhinoconjunctivitis were used to draw conclusions regarding the clinical efficacy of allergoid tablets. The primary endpoints in these trials were decreases in the need for allergy medications and/or reductions in the occurrence of rhinoconjunctivitis symptoms. Data was recorded from patient diaries regarding their symptoms and medications used and conclusions were then drawn about the effectiveness and tolerabieity of Lais® tablets. The average improvement in symptom score in three trials of grass pollen allergy treatment was 34% in comparison to the placebo group. The treatment of dust mite-induced rhinoconjunctivitis produced an average symptom score improvement of 22% compared to the placebo or control groups. The intake of symptomatic rescue medication during allergoid tablet therapy declined. Treatment of grass pollen allergies and dust mite-induced rhinoconjunctivitis showed an average medication score improvement of 49% and 24%, respectively. Few side effects were documented in the trials and predominantly local effects were observed. Severe systemic side effects did not occur. On the basis of the trial results summarized in this review, we suggest that SLIT using Lais® sublingual tablets is an effective and well-tolerated form of treatment.
Topics: Administration, Sublingual; Allergens; Allergoids; Animals; Anti-Allergic Agents; Anti-Asthmatic Agents; Antigens, Plant; Conjunctivitis, Allergic; Desensitization, Immunologic; Humans; Immunotherapy; Mites; Plant Extracts; Pollen; Rhinitis, Allergic, Seasonal; Treatment Outcome
PubMed: 20976414
DOI: No ID Found -
The Cochrane Database of Systematic... Jul 2010This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2001 and previously updated in 2003 and 2007.It is estimated that in developed... (Review)
Review
BACKGROUND
This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2001 and previously updated in 2003 and 2007.It is estimated that in developed countries approximately 30% of the general population suffer from one or more allergic disorders, of which allergic rhinitis is particularly common. Perennial rhinitis is most often due to allergy to the house dust mite. In such patients house dust mite avoidance is logical, but there is considerable uncertainty regarding the efficacy and effectiveness of interventions designed to reduce dust mite exposure.
OBJECTIVES
To assess the benefit (and harm) of measures designed to reduce house dust mite exposure in the management of house dust mite sensitive allergic rhinitis.
SEARCH STRATEGY
Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials Register (CENTRAL) (The Cochrane Library Issue 4, 2009), MEDLINE and EMBASE. The date of the last search was 31 December 2009.
SELECTION CRITERIA
Randomised controlled trials, with or without blinding, in which house dust mite control measures have been evaluated in comparison with placebo or other dust mite avoidance measures, in patients with clinician-diagnosed allergic rhinitis and confirmed allergy to dust mite.
DATA COLLECTION AND ANALYSIS
Two authors independently screened titles and abstracts, graded methodological quality using the Cochrane approach and extracted data. Meta-analysis was neither possible nor appropriate due to heterogeneity of the patient groups studied.
MAIN RESULTS
Nine trials involving 501 participants satisfied the inclusion criteria. Only two studies investigating the effectiveness of mite impermeable bedding covers were of good quality; the remaining seven studies were small and of poor quality. Two trials investigated the efficacy of acaricides, another two trials investigated the role of high-efficiency particulate air (HEPA) filters. One trial, using a factorial design, investigated the efficacy of both acaricide and house dust mite impermeable bedding covers in isolation and combination; the remaining four trials investigated the efficacy of bedroom environmental control programmes involving use of house dust mite impermeable bedding covers. Seven of the nine trials reported that, when compared with control, the interventions studied resulted in significant reductions in house dust mite load. Of the interventions studied to date, acaricides appear to be the most promising type of intervention, although the findings from these studies need to be interpreted with care because of their methodological limitations. House dust mite impermeable bedding as an isolated intervention is unlikely to offer clinical benefit. No serious adverse effects were reported from any of the interventions.
AUTHORS' CONCLUSIONS
Trials to date have on the whole been small and of poor methodological quality, making it difficult to offer any definitive recommendations on the role, if any, of house dust mite avoidance measures in the management of house dust mite sensitive perennial allergic rhinitis. The results of these studies suggest that use of acaricides and extensive bedroom-based environmental control programmes may be of some benefit in reducing rhinitis symptoms and, if considered appropriate, these should be the interventions of choice. Isolated use of house dust mite impermeable bedding is unlikely to prove effective.
Topics: Acaricides; Animals; Bedding and Linens; Dust; Humans; Mites; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial; Tick Control
PubMed: 20614426
DOI: 10.1002/14651858.CD001563.pub3 -
The Cochrane Database of Systematic... Apr 2008This 2011 review predates current reporting standards and methodological expectations for Cochrane Reviews. It should not be used for clinical decision‐making. (Meta-Analysis)
Meta-Analysis Review
EDITORIAL NOTE
This 2011 review predates current reporting standards and methodological expectations for Cochrane Reviews. It should not be used for clinical decision‐making.
BACKGROUND
The major allergen in house dust comes from mites. Chemical, physical and combined methods of reducing mite allergen levels are intended to reduce asthma symptoms in people who are sensitive to house dust mites.
OBJECTIVES
To assess the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma.
SEARCH STRATEGY
PubMed and The Cochrane Library (last searches Nov 2007), reference lists.
SELECTION CRITERIA
Randomised trials of mite control measures vs placebo or no treatment in people with asthma known to be sensitive to house dust mites.
DATA COLLECTION AND ANALYSIS
Two authors applied the trial inclusion criteria and evaluated the data. Trial authors were contacted to clarify information.
MAIN RESULTS
Fifty-four trials (3002 patients) were included. Thirty-six trials assessed physical methods (26 mattress encasings), 10 chemical methods, and 8 a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning (1565 patients), the standardised mean difference was 0.00 (95% confidence interval (CI) -0.10 to 0.10). There were no statistically significant differences either in number of patients improved (relative risk 1.01, 95% CI 0.80 to 1.27), asthma symptom scores (standardised mean difference -0.04, 95% CI -0.15 to 0.07), or in medication usage (standardised mean difference -0.06, 95% CI -0.18 to 0.07).
AUTHORS' CONCLUSIONS
Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended. It is doubtful whether further studies, similar to the ones in our review, are worthwhile. If other types of studies are considered, they should be methodologically rigorous and use other methods than those used so far, with careful monitoring of mite exposure and relevant clinical outcomes.
Topics: Allergens; Animals; Asthma; Dust; Environment, Controlled; Humans; Insecticides; Mites; Randomized Controlled Trials as Topic
PubMed: 18425868
DOI: 10.1002/14651858.CD001187.pub3 -
Environmental Health Perspectives Dec 2007We assessed whether any household dust reduction intervention has the effect of increasing or decreasing the development or severity of atopic disease. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
We assessed whether any household dust reduction intervention has the effect of increasing or decreasing the development or severity of atopic disease.
DATA SOURCES
Electronic searches on household intervention and atopic disease were conducted in January 2007 in EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. No date or language restriction was placed on the literature search.
DATA EXTRACTION
We included randomized controlled trials comparing asthma outcomes in a household intervention group with either placebo intervention or no intervention.
DATA SYNTHESIS
Fourteen studies met the inclusion criteria. Eight recruited antenatally and measured development of atopic disease. Six recruited known atopic individuals and measured disease status change. Meta-analyses on the prevention studies found that the interventions made no difference to the onset of wheeze but made a significant reduction in physician-diagnosed asthma. Meta-analysis of lung function outcomes indicated no improvement due to the interventions but found a reduction in symptom days. Qualitatively, health care was used less in those receiving interventions. However, in one study that compared intervention, placebo, and control arms, the reduction in heath care use was similar in the placebo and intervention arms.
CONCLUSIONS
This review suggests that there is not sufficient evidence to suggest implementing hygiene measures in an attempt to improve outcomes in existing atopic disease, but interventions from birth in those at high risk of atopy are useful in preventing diagnosed asthma but not parental-reported wheeze.
Topics: Asthma; Dust; Environmental Exposure; Humans; Randomized Controlled Trials as Topic
PubMed: 18087584
DOI: 10.1289/ehp.10382 -
The Cochrane Database of Systematic... Jul 2007In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease, when breast-feeding is... (Review)
Review
BACKGROUND
In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease, when breast-feeding is not possible or supplemental feeding is needed. Most infant formulas are based on cow's milk protein. Alternative choices include soya based and hydrolysed cows milk formulas.
OBJECTIVES
To estimate the effect of dietary avoidance of cow's milk protein on the development of asthma or wheeze in children.
SEARCH STRATEGY
We searched the Cochrane database for eligible trials until February 2002. We obtained the full text papers of all abstracts identified as RCTs and two reviewers independently reviewed them.
SELECTION CRITERIA
We included randomised controlled trials involving children with a family history of atopy in at least one first degree relative, if feeding with cow's milk based standard formula was compared to dietary avoidance of cow's milk protein, using soya or other hypoallergenic formula during the initial four months of life or longer.
DATA COLLECTION AND ANALYSIS
Two reviewers extracted data independently. A priori defined subgroups were the types of hypoallergenic artificial feed and dietary restrictions on mother and/or child's diet.
MAIN RESULTS
Six trials used hydrolysed formula for at least four months, in addition to dietary restrictions and in some cases dust-mite reduction measures. The risk of infants experiencing asthma or wheeze during the first year of life was reduced compared to standard cow's milk based formula (Relative Risk 0.40, 95% Confidence Intervals 0.19 to 0.85). Feeding soya-based formula as opposed to standard cow's milk formula did not reduce the risk of having asthma or wheeze at any age.
AUTHORS' CONCLUSIONS
Breast-milk should remain the feed of choice for all babies. In infants with at least one first degree relative with atopy, hydrolysed formula for a minimum of four months combined with dietary restrictions and environment measures may reduce the risk of developing asthma or wheeze in the first year of life. There is insufficient evidence to suggest that soya-based milk formula has any benefit.
Topics: Asthma; Family; Humans; Infant; Infant Food; Infant, Newborn; Milk Hypersensitivity; Milk Proteins; Randomized Controlled Trials as Topic; Respiratory Sounds
PubMed: 17636737
DOI: 10.1002/14651858.CD003795.pub2 -
The Cochrane Database of Systematic... Jul 2007Scabies is an intensely itchy parasitic infection of the skin caused by the Sarcoptes scabiei mite. It is a common public health problem with an estimated global... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Scabies is an intensely itchy parasitic infection of the skin caused by the Sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 million cases. Serious adverse effects have been reported for some drugs used to treat scabies.
OBJECTIVES
To evaluate topical and systemic drugs for treating scabies.
SEARCH STRATEGY
In February 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE, EMBASE, LILACS, and INDMED. In March 2007, we also searched the grey literature and sources for registered trials. We also checked the reference lists of retrieved studies.
SELECTION CRITERIA
Randomized controlled trials of drug treatments for scabies.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. Results were presented as relative risks with 95% confidence intervals and data combined where appropriate.
MAIN RESULTS
Twenty small trials involving 2392 people were included. One trial was placebo controlled, 16 compared two or more drug treatments, two compared treatment regimens, and one compared different drug vehicles.Fewer treatment failures occurred by day seven with oral ivermectin in one small trial (55 participants). Topical permethrin appeared more effective than oral ivermectin (85 participants, 1 trial), topical crotamiton (194 participants, 2 trials), and topical lindane (753 participants, 5 trials). Permethrin also appeared more effective in reducing itch persistence than either crotamiton (94 participants, 1 trial) or lindane (490 participants, 2 trials). One small trial did not detect a difference between permethrin (a synthetic pyrethroid) and a natural pyrethrin-based topical treatment (40 participants). No significant difference was detected in the number of treatment failures between crotamiton and lindane (100 participants, 1 trial), lindane and sulfur (68 participants, 1 trial), benzyl benzoate and sulfur (158 participants, 1 trial), and benzyl benzoate and natural synergized pyrethrins (240 participants, 1 trial); all were topical treatments. No trials of malathion were identified. No serious adverse events were reported. A number of trials reported skin reactions in participants randomized to topical treatments. There were occasional reports of headache, abdominal pain, diarrhoea, vomiting, and hypotension.
AUTHORS' CONCLUSIONS
Topical permethrin appears to be the most effective treatment for scabies. Ivermectin appears to be an effective oral treatment. More research is needed on the effectiveness of malathion, particularly when compared to permethrin, and on the management of scabies in an institutional setting and at a community level.
Topics: Adult; Benzoates; Child; Hexachlorocyclohexane; Humans; Insecticides; Ivermectin; Pyrethrins; Scabies; Sulfur; Toluidines
PubMed: 17636630
DOI: 10.1002/14651858.CD000320.pub2