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The Cochrane Database of Systematic... Apr 2005Pulmonary sarcoidosis is a common condition with an unpredictable course. Oral (OCS) or inhaled steroids (ICS) are widely used in its treatment, but there is no... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pulmonary sarcoidosis is a common condition with an unpredictable course. Oral (OCS) or inhaled steroids (ICS) are widely used in its treatment, but there is no consensus about when and in whom therapy should be initiated, what dose should be given and for how long. Corticosteroids given for several months have deleterious side-effects so it is important to know whether they have any maintained benefit in pulmonary sarcoidosis.
OBJECTIVES
To determine the randomised controlled trial (RCT) evidence for the benefit of corticosteroids (oral or inhaled) in the treatment of pulmonary sarcoidosis.
SEARCH STRATEGY
MEDLINE, EMBASE and CENTRAL were searched using predefined terms. Bibliographies of retrieved RCTs and reviews were searched for additional RCTs. Pharmaceutical companies and authors of identified RCTs were contacted for other published and unpublished studies. Searches are current as of May 2004.
SELECTION CRITERIA
Two reviewers independently assessed full text articles for inclusion based upon the following criteria: the study had to be a RCT or controlled clinical trial in adults with histological evidence of pulmonary sarcoidosis, treated with OCS (oral steroids) or ICS (oral steroids), compared with a control.
DATA COLLECTION AND ANALYSIS
Study quality was assessed and data extracted independently by two reviewers. The primary outcome was CXR (chest x-ray). Outcomes were analysed as continuous and dichotomous outcomes, using standard statistical techniques. Heterogeneity was explored where it was identified.
MAIN RESULTS
Twelve RCTs of variable quality involving 1051 participants met the inclusion criteria of the review. The oral steroid dose was equivalent to prednisolone 4-40 mg/day. OCS: there was an improvement in CXR over 3-24 months (Relative Risk (RR): 1.46 [1.01 to 2.09], 3 studies), but this finding requires cautious interpretation. No other significant differences were identified on secondary outcomes. ICS: Data were inadequate to perform meaningful analysis of data on CXR. Two studies showed no improvement in lung function, In one study there was an improvement in diffusing capacity in the treated group. There were no data on side-effects. In one study symptoms improved at the end of six months of treatment.
AUTHORS' CONCLUSIONS
Oral steroids improved the chest X-ray and a global score of CXR, symptoms and spirometry over 3-24 months. However, there is little evidence of an improvement in lung function. There are limited data beyond two years to indicate whether oral steroids have any modifying effect on long-term disease progression. Oral steroids may be of benefit for patients with Stage 2 and 3 disease with moderate to severe or progressive symptoms or CXR changes.
Topics: Administration, Inhalation; Administration, Oral; Glucocorticoids; Humans; Radiography; Randomized Controlled Trials as Topic; Sarcoidosis, Pulmonary
PubMed: 15846612
DOI: 10.1002/14651858.CD001114.pub2 -
Anais Brasileiros de Dermatologia 2016The number of studies on patch-test results in children and adolescents has gradually increased in recent years, thus stimulating reviews. This paper is a systematic... (Review)
Review
The number of studies on patch-test results in children and adolescents has gradually increased in recent years, thus stimulating reviews. This paper is a systematic review of a 15-year period devoted to studying the issue. Variations pertaining to the number and age groups of tested children and/or adolescents, the number of subjects with atopy/atopic dermatitis history, the quantity, type and concentrations of the tested substances, the test technique and type of data regarding clinical relevance, must all be considered in evaluating these studies, as they make it harder to formulate conclusions. The most common allergens in children were nickel, thimerosal, cobalt, fragrance, lanolin and neomycin. In adolescents, they were nickel, thimerosal, cobalt, fragrance, potassium dichromate, and Myroxylon pereirae. Knowledge of this matter aids health professionals in planning preventive programs aimed at improving children's quality of life and ensuring that their future prospects are not undermined.
Topics: Adolescent; Age Factors; Allergens; Child; Dermatitis, Allergic Contact; Dermatitis, Atopic; Female; Humans; Male; Patch Tests; Sex Factors; Time Factors
PubMed: 26982781
DOI: 10.1590/abd1806-4841.20163927 -
Journal of Investigational Allergology... Dec 2022Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by... (Review)
Review
Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by TH2 inflammation (at least 15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Although this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play a role in pathogenesis and disease course. Some studies support seasonal variations in the diagnosis of eosinophilic esophagitis and disease exacerbations owing to the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be caused by extensive, identifiable exposure to aeroallergens and after treatment with specific immunotherapy based on food or aeroallergens. It was recently postulated that treatment of allergic rhinoconjunctivitis can improve the symptoms of eosinophilic esophagitis, although data are limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Nevertheless, there are high hopes for dupilumab. This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis, since many of them, in addition to being airborne and inhalant, can also be ingested as food. Clearly, we must try to identify the cause of the disease to ensure remission.
Topics: Humans; Eosinophilic Esophagitis; Allergens; Food Hypersensitivity; Eosinophils; Disease Progression
PubMed: 36000828
DOI: 10.18176/jiaci.0853 -
Alimentary Pharmacology & Therapeutics May 2012The associations between clinical efficacy and infusion reactions with anti-TNF-α drug levels and the presence of antibodies against the drug have been described.... (Review)
Review
BACKGROUND
The associations between clinical efficacy and infusion reactions with anti-TNF-α drug levels and the presence of antibodies against the drug have been described. However, the clinical utility of these tests in routine clinical practice remains unclear.
AIMS
To examine the clinical significance of the development of antibodies against anti-TNF-α drugs and the relationship between the efficacy of these drugs and their serum levels. We also studied the clinical utility of testing for anti-TNF-α antibodies and measuring drug serum levels to optimise treatment of patients with inflammatory bowel disease (IBD) receiving these agents.
METHODS
A systematic review was undertaken based on electronic searches of the PubMed database from the earliest record to February 2012. The reference lists of all relevant articles and abstracts from meetings were also consulted.
RESULTS
We observed a close relationship between trough levels of anti-TNF-α drug and maintenance of response to these drugs. The role of antibodies in loss of response seems to be limited to their effect favouring the clearance of the drug. The risk of infusion reactions, but not of delayed hypersensitivity reactions, is higher in patients with antibodies against the anti-TNF-α drug. Testing anti-TNF-α drug and antibody levels, together with clinical and endoscopic or radiological assessment, seems useful when attempting to optimise therapy and prevent inappropriate management of IBD patients.
CONCLUSION
Measurement of serum anti-TNF-α trough levels and antibody titres could prove useful in therapeutic drug monitoring in IBD patients treated with anti-TNF-α agents.
Topics: Animals; Antibodies; Antibodies, Monoclonal; Humans; Inflammatory Bowel Diseases; Tumor Necrosis Factor-alpha
PubMed: 22443153
DOI: 10.1111/j.1365-2036.2012.05057.x -
Contact Dermatitis Dec 2022The use of masks for infection control was common in the COVID-19 pandemic. As numerous cross-sectional studies have suggested a link between the use of such masks and... (Meta-Analysis)
Meta-Analysis Review
The use of masks for infection control was common in the COVID-19 pandemic. As numerous cross-sectional studies have suggested a link between the use of such masks and various facial dermatoses, a systematic review and meta-analysis of published studies was conducted to evaluate this association, as well as potential risk factors for the development of such facial dermatoses. Observational studies were searched for in MEDLINE, EMBASE and the Cochrane Central Register. Thirty-seven observational studies with a total of 29 557 study participants were identified. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist and quality was assessed via the Newcastle-Ottawa Quality Assessment Scale., Overall prevalence of facial dermatoses was 55%. Individually, acne, facial dermatitis, itch and pressure injuries were consistently reported as facial dermatoses, with a pooled prevalence of 31%, 24%, 30% and 31%, respectively. Duration of mask-wear was the most significant risk factor for the development of facial dermatoses (95% CI: 1.31-1.54, p < 0.001). Overall, facial dermatoses associated with mask wear are common, and consist of distinct entities. They are related to duration of use. Appropriate and tailored treatment is important to improve the outcomes for these affected patients.
Topics: Humans; Masks; Pandemics; COVID-19; Cross-Sectional Studies; Dermatitis, Allergic Contact; Facial Dermatoses
PubMed: 35980367
DOI: 10.1111/cod.14203 -
Seizure Nov 2022Antiepileptic drugs (AEDs) are extensively used to manage epilepsy and other comorbidities associated with seizures. Human Leukocyte Antigen (HLA) has a strong... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Antiepileptic drugs (AEDs) are extensively used to manage epilepsy and other comorbidities associated with seizures. Human Leukocyte Antigen (HLA) has a strong association with AED-induced severe cutaneous adverse drug reactions.
OBJECTIVE
We aimed to perform a systematic review and meta-analysis to identify, critically evaluate, and synthesize the best possible evidence on HLA-associated AED-induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN).
METHODS
MEDLINE/PubMed, Scopus, and the Cochrane Library were searched for literature from inception up to July 2022. We included case control studies analyzing association between HLA and AED-induced SJS/TEN. We assessed the studies' risk of bias in using Quality of genetic studies (Q-genie) tool. Outcomes focused on association (risk) between HLA and AED-induced SJS/TEN. The estimated risk was presented in the form of odds ratio (OR).
RESULTS
We included 37 studies (51,422 participants; 7027 cases and 44,395 controls). There was a significantly higher risk of Carbamazepine-induced SJS/TEN with HLA-A (OR: 1.50; 95% CI: 1.03 to 2.17), HLA-B (OR: 1.94; 95% CI: 1.45 to 2.58), HLA-C (OR: 7.83; 95% CI: 4.72 to 12.98), and HLA-DRB1 (OR: 2.82; 95% CI: 1.94 to 4.12). Lamotrigine-induced SJS/TEN posed a higher risk with HLA-A (OR: 2.38; 95% CI: 1.26 to 4.46) and HLA-B (OR: 2.79; 95% CI: 1.75 to 4.46). Phenytoin-induced SJS/TEN showed a higher risk with HLA-A (OR: 3.47; 95% CI: 2.17 to 5.56), HLA-B (OR: 1.72; 95% CI: 1.38 to 2.15), and HLA-C (OR: 2.92; 95% CI: 1.77 to 4.83). Phenobarbital-induced SJS/TEN had a higher risk with HLA-A (OR: 6.98; 95% CI: 1.81 to 26.84), HLA-B (OR: 2.40; 95% CI: 1.39 to 4.17), and HLA-C (OR: 3.37; 95% CI: 1.03 to 11.01). Zonisamide-induced SJS/TEN was significantly associated with HLA-A*02:07 (OR: 9.77; 95% CI: 3.07 to 31.1), HLA-B*46:01 (OR: 6.73; 95% CI: 2.12 to 21.36), and HLA-DRB1×08:03 (OR: 3.78; 95% CI: 1.20 to 11.97). All other alleles of HLA were observed to have a non-significant association with AED-induced SJS/TEN. All included studies were of good quality, with a score of >50 and a mean score of 54.96 out of 77.
CONCLUSION
Our study showed a significant association between few variants of HLA alleles and AED-induced SJS/TEN. Evidences from our study could help in population-based studies and in implementation of individualized treatment regimens. These findings could be part of translational research helping in precision therapy.
Topics: Humans; Stevens-Johnson Syndrome; HLA-DRB1 Chains; HLA-C Antigens; Asian People; HLA-B Antigens; Anticonvulsants; HLA Antigens
PubMed: 36183454
DOI: 10.1016/j.seizure.2022.09.011 -
The European Respiratory Journal May 2022Cardiac sarcoidosis (CS) is a life-threatening condition in which clear recommendations are lacking. We aimed to systematically review the literature on cardiac... (Review)
Review
BACKGROUND
Cardiac sarcoidosis (CS) is a life-threatening condition in which clear recommendations are lacking. We aimed to systematically review the literature on cardiac sarcoidosis treated by corticosteroids and/or immunosuppressive agents in order to update the management of CS.
METHODS
Using PubMed, Embase and Cochrane Library databases, we found original articles on corticosteroid and standard immunosuppressive therapies for CS that provided at least a fair Scottish Intercollegiate Guidelines Network (SIGN) overall assessment of quality and we analysed the relapse rate, major cardiac adverse events (MACEs) and adverse events. We based our methods on the PRISMA statement and checklist.
RESULTS
We retrieved 21 studies. Mean quality provided by SIGN assessment was 6.8 out of 14 (range 5-9). Corticosteroids appeared to have a positive impact on left ventricular function, atrioventricular block and ventricular arrhythmias. For corticosteroids alone, nine studies (45%, n=351) provided data on relapses, representing an incidence of 34% (n=119). Three studies (14%, n=73) provided data on MACEs (n=33), representing 45% of MACEs in patients treated by corticosteroid alone. Nine studies provided data on adjunctive immunosuppressive therapy, of which four studies (n=78) provided data on CS relapse, representing an incidence of 33% (n=26). Limitations consisted of no randomised control trial retrieved and unclear data on MACEs in patients treated by combined immunosuppressive agents and corticosteroids.
CONCLUSION
Corticosteroids should be started early after diagnosis but the exact scheme is still unclear. Studies concerning adjunctive conventional immunosuppressive therapies are lacking and benefits of adjunctive immunosuppressive therapies are unclear. Homogenous data on CS long-term outcomes under corticosteroids, immunosuppressive therapies and other adjunctive therapies are lacking.
Topics: Adrenal Cortex Hormones; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Recurrence; Sarcoidosis
PubMed: 34531273
DOI: 10.1183/13993003.00449-2021 -
International Journal of Clinical... Dec 2021Earlier diagnosis and the best management of virus-related, drug-related or mixed severe potentially life-threatening mucocutaneous reactions of COVID-19 patients are of... (Review)
Review
OBJECTIVES
Earlier diagnosis and the best management of virus-related, drug-related or mixed severe potentially life-threatening mucocutaneous reactions of COVID-19 patients are of great concern. These patients, especially hospitalised cases, are usually in a complicated situation (because of multi-organ failures), which makes their management more challenging. In such consultant cases, achieving by the definite beneficial management strategies that therapeutically address all concurrent comorbidities are really hard to reach or even frequently impossible.
METHODS
According to the lack of any relevant systematic review, we thoroughly searched the databases until 5 October 2020 and finally found 57 articles including 93 patients. It is needed to know clinical presentations of these severe skin eruptions, signs and symptoms of COVID in these patients, time of skin rash appearance, classifying drug-related or virus-related skin lesions, classifying the type of skin rash, patients' outcome and concurrent both COVID-19 therapy and skin rash treatment.
RESULT
Severe and potential life-threatening mucocutaneous dermatologic manifestations of COVID-19 usually may be divided into three major categories: virus-associated, drug-associated, and those with uncertainty about the exact origin. Angioedema, vascular lesions, toxic shock syndrome, erythroderma, DRESS, haemorrhagic bulla, AGEP, EM, SJS and TEN, generalised pustular figurate erythema were the main entities found as severe dermatologic reactions in all categories.
CONCLUSION
We can conclude vascular injuries may be the most common cause of severe dermatologic manifestations of COVID-19, which is concordant with many proposed hypercoagulation tendencies and systemic inflammatory response syndrome as one of the most important pathomechanisms of COVID-19 so the skin may show these features in various presentations and degrees.
Topics: COVID-19; Erythema; Exanthema; Humans; SARS-CoV-2; Stevens-Johnson Syndrome
PubMed: 34411409
DOI: 10.1111/ijcp.14720 -
Journal of the American Heart... Sep 2021Background Corticosteroid therapy for the treatment of clinically manifest cardiac sarcoidosis is generally recommended. Our group previously systematically reviewed the...
Background Corticosteroid therapy for the treatment of clinically manifest cardiac sarcoidosis is generally recommended. Our group previously systematically reviewed the data in 2013; since then, there has been increasing quality and quantity of data and also interest in nonsteroid agents. Methods and Results Studies were identified from MEDLINE, EMBASE, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and the National Institutes of Health ClinicalTrials.gov database. The quality of included articles was rated using Scottish Intercollegiate Guidelines Network 50. Outcomes examined were atrioventricular conduction, left ventricular function, ventricular arrhythmias, and mortality. A total of 3527 references were retrieved, and 34 publications met the inclusion criteria. There were no randomized trials, and only 2 studies were rated good quality. In the 34 reports (total of 1297 patients), 1125 patients received corticosteroids, 235 received additional or other immunosuppressant therapy, and 97 patients received no therapy. There were 178 patients treated for atrioventricular conduction disease, with 76/178 (42.7%) improving. In contrast, 21 patients were not treated with corticosteroids and/or immunosuppressant therapy, and none of them improved. Therapy was associated with the prevention of deterioration in left ventricular function. A total of 8 publications reported on ventricular arrhythmia burden, and 19 reported on mortality; the data quality was too limited to draw conclusions for the latter 2 outcomes. Conclusions The best quality data relate to atrioventricular nodal conduction and left ventricular function recovery. In both situations, therapy with corticosteroids and/or immunosuppressant therapy were sometimes associated with positive outcomes. The data quality is too limited to draw conclusions for ventricular arrhythmias and mortality.
Topics: Humans; Adrenal Cortex Hormones; Arrhythmias, Cardiac; Immunosuppressive Agents; Myocarditis; Sarcoidosis
PubMed: 34472360
DOI: 10.1161/JAHA.121.021183 -
Journal of Neuroimmunology Oct 2022Neurosarcoidosis is a rare disorder in children. We identified 30 pediatric NS cases through a systematic review. Twenty-one (70%) had systemic sarcoidosis with 30%...
Neurosarcoidosis is a rare disorder in children. We identified 30 pediatric NS cases through a systematic review. Twenty-one (70%) had systemic sarcoidosis with 30% having primary neurosarcoidosis. Eyes (37%), lymph nodes (37%) and lungs (30%) were most commonly involved. Isolated neurosarcoidosis were more likely in children (30%) than in adults (6%, p = 0.0005). Seizures and optic neuritis were also more common in children than adults (33% vs 14%, p = 0.002; and 30% versus 6%, p = 0.008, respectively). Evaluation, imaging, laboratory findings, and treatments are discussed. Additional research, including multi-center studies, is needed.
Topics: Adult; Central Nervous System Diseases; Child; Humans; Lung; Optic Neuritis; Sarcoidosis
PubMed: 35944453
DOI: 10.1016/j.jneuroim.2022.577938