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Archives of Disease in Childhood Jul 2004To evaluate the clinical efficacy of sublingual immunotherapy (SLIT) in respiratory allergy in children. (Review)
Review
AIMS
To evaluate the clinical efficacy of sublingual immunotherapy (SLIT) in respiratory allergy in children.
METHODS
A systematic literature review was conducted. The search was focused on all the double blind (and double dummy if necessary) studies.
SEARCH STRATEGY
Medline, Embase, Cochrane Controlled Trial Register, Abstract of Cochrane Airways Group, hand search, and archives of some SLIT producers. All the selected studies were assessed and evaluated for quality in a standardised independent way.
RESULTS
Eight randomised, double blind, placebo controlled studies on SLIT were selected. Five studies were run with house dust mite (HDM), one with olive pollen, one with wall pellitory (Parietaria) pollen, and one with grass pollen. A quantitative evaluation of the studies was not possible because the outcomes and the results of single studies were presented according to different criteria. Therefore only qualitative analysis was performed. No clinically relevant results were shown, independently from statistical significance, in the use of SLIT for respiratory allergies due to seasonal allergens (olive, wall pellitory, and grass pollens) and, on the whole, for rhinoconjunctivitis due to HDM in children. For mild to moderate persistent asthma due to HDM, statistically significant and low to moderate relevant clinical effects were observed.
CONCLUSIONS
SLIT can be currently considered to have low to moderate clinical efficacy in children of at least 4 years of age, monosensitised to HDM, and suffering from mild to moderate persistent asthma. This benefit seems to be adjunctive with respect to the environmental preventive measures against HDM.
Topics: Administration, Sublingual; Allergens; Animals; Asthma; Child; Conjunctivitis, Allergic; Humans; Immunotherapy; Mites; Pollen; Randomized Controlled Trials as Topic; Research Design; Respiratory Hypersensitivity; Rhinitis, Allergic, Seasonal; Treatment Outcome
PubMed: 15210490
DOI: 10.1136/adc.2003.030411 -
House dust mite avoidance measures for perennial allergic rhinitis: a systematic review of efficacy.The British Journal of General Practice... Apr 2003Perennial allergic rhinitis is a common chronic disorder that results most frequently from sensitivity to house dust mites. National and international guidelines for the... (Review)
Review
Perennial allergic rhinitis is a common chronic disorder that results most frequently from sensitivity to house dust mites. National and international guidelines for the management of allergic rhinitis recommend that house dust mite avoidance measures be considered in all patients with house dust mite-provoked rhinitis. 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, published and unpublished randomised controlled trials were systematically searched. A methodological assessment of trial quality was conducted using the Cochrane approach. Four trials satisfied the inclusion criteria, all of which were small and judged to be of poor quality. The results indicate that, when compared with controls, significant reductions of allergen load can be achieved by physical and chemical means, but there is little evidence at present that these reductions translate into sustained improvements in clinical outcomes. No serious adverse effects were reported from the interventions.
Topics: Adolescent; Adult; Allergens; Child; Child, Preschool; Chronic Disease; Dust; Environmental Exposure; Female; Humans; Male; Middle Aged; Pyroglyphidae; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial
PubMed: 12879834
DOI: No ID Found -
Health Technology Assessment... 2000Atopic eczema is the commonest inflammatory skin disease of childhood, affecting 15-20% of children in the UK at any one time. Adults make up about one-third of all... (Review)
Review
BACKGROUND
Atopic eczema is the commonest inflammatory skin disease of childhood, affecting 15-20% of children in the UK at any one time. Adults make up about one-third of all community cases. Moderate-to-severe atopic eczema can have a profound effect on the quality of life for both sufferers and their families. In addition to the effects of intractable itching, skin damage, soreness, sleep loss and the social stigma of a visible skin disease, other factors such as frequent visits to doctors, special clothing and¿the need to constantly apply messy topical applications all add to the burden of disease. The cause of atopic eczema is unknown, though a genetic pre-disposition and a combination of allergic and non-allergic factors appear to be important in determining disease expression. Treatment of atopic eczema in the UK is characterised by a profusion of treatments aimed at disease control. The evidential basis of these treatments is often unclear. Most people with atopic eczema are managed in primary care where the least research has been done.
OBJECTIVES
The objectives of this scoping review are two-fold. To produce an up-to-date coverage 'map' of randomised controlled trials (RCTs) of treatments of atopic eczema. To assist in making treatment recommendations by summarising the available RCT evidence using qualitative and quantitative methods.
DATA SOURCES
Data sources included electronic searching of MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register, the Cochrane Skin Group specialised register of trials, hand-searching of atopic eczema conference proceedings, follow-up of references in retrieved articles, contact with leading researchers and requests to relevant pharmaceutical companies.
INCLUSION/EXCLUSION CRITERIA
Only RCTs of therapeutic agents used in the prevention and treatment of people with atopic eczema of any age were considered for inclusion. Only studies where a physician diagnosed atopic eczema or atopic dermatitis were included.
DATA EXTRACTION
Data extraction was conducted by two observers onto abstraction forms, with discrepancies resolved by discussion.
QUALITY ASSESSMENT
The quality assessment of retrieved RCTs included an assessment of: a clear description of method and concealment of allocation of randomisation, the degree to which assessors and participants were blinded to the study interventions, and whether all those originally randomised were included in the final main analysis.
DATA SYNTHESIS
Where possible, quantitative pooling of similar RCTs was conducted using the Cochrane Collaboration's methods. Where statistical heterogeneity was found, sources of heterogeneity in terms of study participants, formulation or posology of intervention, and use of co-treatments were explored. Where pooling was not deemed to be appropriate, detailed descriptions of the study characteristics and main reported results were presented along with comments on study quality.
RESULTS
A total of 1165 possible RCTs were retrieved in hard copy form for further scrutiny. Of these, 893 were excluded from further analysis because of lack of appropriate data. The 272 remaining RCTs of atopic eczema covered at least 47 different interventions, which could be broadly categorised into ten main groups. Quality of reporting was generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only then after considerable data transformation. There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy. There was insufficient evidence to make recommendations on maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin. (ABSTRACT TRUNCATED)
Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Anti-Infective Agents; Clinical Trials as Topic; Complementary Therapies; Dermatitis, Atopic; Desensitization, Immunologic; Diet; Drugs, Chinese Herbal; Eczema; Histamine H1 Antagonists; Humans; Immunosuppressive Agents; Randomized Controlled Trials as Topic; Research Design
PubMed: 11134919
DOI: No ID Found