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1.
Kuo-Tung Tang Kai-Chen Ku Der-Yuan Chen Ching-Heng Lin Ben-Jei Tsuang Yi-Hsing Chen 《Annals of allergy, asthma & immunology》2017,118(3):351-355
Background
There is a trend toward an increased worldwide prevalence of allergic diseases. It is speculated that industrialization with resultant air pollution plays a role. However, there are sparse epidemiologic data on the relation between air pollution and atopic dermatitis (AD) in adults.Objective
To investigate the relation between exposure to air pollutants and adult AD in a cross-sectional study based on data from the National Health Insurance Research Database in Taiwan.Methods
We identified 1,023 adult patients with AD and 4,092 age- and sex-matched controls without allergic diseases in 2011. Using data from 71 Environmental Protection Agency monitoring stations across Taiwan, levels of exposure to air pollutants were determined by the location of a subject's place of residence. Multivariate logistic regression analysis, adjusted for age, sex, levels of urbanization, and family income, was performed.Results
We found an association between particulate matter <2.5 μm in diameter or the Pollutant Standards Index (the highest sub-index of the concentrations of 5 main air pollutants after transformation) and the development of adult AD. The adjusted odds ratios were 1.05 (95% confidence interval 1.02–1.08) and 1.02 (95% confidence interval 1.01–1.03), respectively.Conclusion
These results demonstrated that air pollution, represented by particulate matter <2.5 μm in diameter or the Pollutant Standards Index, was modestly associated with the development of AD in adults. 相似文献2.
Derek A. DuBay Nataliya Ivankova Ivan Herby Yu-Mei Schoenberger David T. Redden Cheryl Holt Laura Siminoff Mona Fouad Michelle Y. Martin 《Journal of the National Medical Association》2017,109(4):287-293
Background
African Americans (AA) are a third as likely as Caucasians to become registered organ donors at the Department of Motorized Vehicles (DMV). The Department of Health and Human Services has set the goal that at least 50% of adults in each state are registered donors.Aims
The purpose of this study was to explore the personal, behavioral and environmental factors associated with AA donor registration decision-making at the DMV.Methods
Guided by the Social Cognitive Theory, 13 focus groups (n = 100 participants) were conducted with AAs within 3 months of visiting a DMV and making a decision regarding whether to become or to not become a registered donor. The data were analyzed using inductive thematic and qualitative content analyses.Results
Study participants expressed a desire to learn more information while waiting in line at the DMV. Knowing a family member or friend in need of an organ transplant, and the desire to make one's own decision were two salient factors associated with the decision to become a registered organ donor. Several aspects of the DMV environment (e.g., noisy, overcrowded, lacking privacy) were cited as deterrents to becoming a registered donor.Discussion
This study highlights the personal, behavioral and environmental factors associated with AA organ donor registration decision-making at the DMV.Conclusion
The DMV is a setting where many adults make a decision about organ donation. Policies that create an environment in the DMV to support informed decision-making (e.g., privacy, informed clerks, available educational materials, etc.) are indicated. 相似文献3.
Background
The reported associations of blood lipid profiles with asthma are ambiguous.Objective
To explore the association between asthma and the serum levels of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C).Methods
A systematic search was performed in the PubMed, MEDLINE, Cochrane Library, and Chinese Biomedical Literature databases. Ten studies were identified. We divided these studies into 2 subgroups according to age: children (<18 years old) and adults (≥18 years old).Results
In children, the asthma group had lower HDL-C levels (weighted mean difference, ?3.44; 95% confidence interval [CI], ?5.83 to ?1.04; P = .005) compared with the nonasthma group, whereas the serum levels of LDL-C in these 2 groups were not statistically different. In contrary, in adults, the asthma group had higher LDL-C levels (weighted mean difference, 8.95; 95% confidence interval, 3.55–14.35; P = .001) compared with the nonasthma group, whereas the HDL-C levels were not statistically different.Conclusion
There is a significant association between asthma and the serum levels of HDL-C and LDL-C. Moreover, this association differs in children and adults. 相似文献4.
William H. Coe Leslie Redmond Jeanine M. Parisi Janice V. Bowie Elizabeth Y. Liu Tin Yee Ng Alberta M.A. Onyuka Marcia Cort Lawrence J. Cheskin 《Journal of the National Medical Association》2017,109(2):79-85
Background
African American adults achieve smaller amounts of weight loss than their white counterparts when exposed to the same intervention and are more likely to regain weight during long-term follow-up.Objective
To identify perceived motivators, barriers, and facilitators to weight loss and behavior change among African American adults.Methods
Two focus groups were conducted between April and May 2015 at an urban community health center in Baltimore City, Maryland. A total of 13 participants took part in the discussions. Eligible participants were obese (BMI 30+) African American adults aged 21–70 who had at least one obesity-related comorbidity. Discussion questions were designed to identify the personal, social, and environmental factors that influence weight loss and behavior change among urban minority populations.Results
Statements were first classified as a motivator, barrier, or facilitator, then divided further as a personal, social, or environmental factor influencing weight loss and behavior change. Among the findings, several novel motivators (reducing or eliminating medication, improving physical intimacy) and barriers (personal transportation, lack of access to scales) emerged that were not previously characterized in the existing literature.Conclusions
This study was intended to provide preliminary evidence that may be used to guide the development of innovative and culturally relevant weight-loss interventions in the future. Results are applicable to similar urban minority populations. 相似文献5.
Robert L. Jacobs Daniel A. Ramirez Cynthia G. Rather Charles P. Andrews Daniel C. Jupiter Fernando Trujillo David G. Shulman 《Annals of allergy, asthma & immunology》2017,118(1):86-93.e2
Background
There are few direct data concerning symptom dynamics of allergic conjunctivitis (AC) in an allergen challenge chamber (ACC).Objective
To determine the AC dynamics on subsequent exposures to ragweed pollen (RW) in individuals with allergic rhinitis in an ACC. To determine whether consecutive exposures in an ACC have any persistent detrimental ocular physical effects.Methods
Participants underwent 3 exposures to RW in an ACC. Ocular symptoms of itching and tearing were self-assessed. Ocular redness and lid swelling were assessed by trained ophthalmic technicians. Complete ophthalmic examinations (COEs) were performed by an ophthalmologist.Results
A total of 188 of 201 participants (93%) developed an ocular redness score of 2 or more in each eye in ACC exposure 1. Reproducibility of redness occurred in approximately 70% of individuals completing ACC exposures 1 through 3. There were no significant changes between baseline COE and end of study COE. Phenotypes were identified by redness responses during and after exposure. Baseline total ocular symptom scores, at 24 hours after a priming exposure, were identified as late-phase reactions rather than enhanced sensitivity.Conclusion
When assessed by trained professionals, AC was present with a very high frequency in selected individuals allergic to RW monitored in an ACC. Intrasubject reproducibility of redness was consistent across 3 ACC allergen exposures. Phenotypes were identified as early-phase responses, protracted early-phase responses, dual responses, and late-phase responses.6.
Alexei Gonzalez-Estrada Stacy K. Silvers Asaf Klein Katrina Zell Xiao-Feng Wang David M. Lang 《Annals of allergy, asthma & immunology》2017,118(1):80-85
Background
Recent data reveal that the rate of anaphylaxis is increasing and suggest that idiopathic anaphylaxis may account for most of these cases.Objective
To determine the pattern of anaphylaxis at a tertiary care referral center.Methods
A retrospective electronic medical record review spanning 12 years (2002–2013) identified patients with anaphylaxis.Results
Of the 4,777 records reviewed, 730 patients met our anaphylaxis definition. Median age was 34.0 years; 72.7% were adults, 58.6% were female, and 86.8% were white. Median time to evaluation by an allergist was 8.8 months. Foods were the most common cause (29.9%), followed by Hymenoptera venom (24.6%), idiopathic anaphylaxis (13.7%), and medications (13.3%). The most common foods were peanuts (23.9%), tree nuts (21.6%), shellfish (16.1%), and egg and milk (both 10.1%). The most common cause of anaphylaxis in adults was Hymenoptera venom. The most frequent symptoms were urticaria and/or angioedema, reported in 84.7% of cases. Atopy was present in 43.8%. In 15.4% of cases, anaphylaxis was not the chief reason for the office visit.Conclusion
We found food allergy was the most common overall cause of anaphylaxis, with peanut the most frequent food trigger. Idiopathic anaphylaxis was not the most common cause but accounted for 13.7% of all cases. Approximately 1 in 6 cases of anaphylaxis may be missed if a comprehensive evaluation is not performed. 相似文献7.
Background
Skin prick tests (SPTs) and measurements of serum specific immunoglobulin E (sIgE) antibodies are the most commonly used diagnostic tools for confirming sensitization. However, disagreement between the tests has been observed.Objective
To compare SPT and the CAP system for diagnosis of sensitization to common inhalant allergens.Methods
Subjects included 2,635 patients 10 to 90 years old who underwent analyses by SPT and CAP at the Dong-A University Hospital (Busan, Korea) from June 2011 through May 2016. The 2 test results were compared for 17 inhalant allergens.Results
Agreement between the SPT and sIgE level was 75.3%. Overall agreement was moderate (κ = 0.59), with strong agreement for house dust mites and birch (κ > 0.7) and weak agreement for Tyrophagus putrescentiae and dog (κ < 0.3). When CAP was compared with SPT as the reference, the sensitivity was 75.8% and the specificity was 75.2%. Mean wheal size by SPT showed a positive correlation with sIgE levels (r = 0.59), which decreased with age.Conclusion
There was a discrepancy between SPT and CAP for diagnosing allergic sensitization among inhalant allergens. The allergic sensitization and correlation between the tests decreased with age. Cautious interpretation of the clinical relevance of allergen sensitization based on SPT and CAP results is required, especially in older patients. 相似文献8.
Carl C. Bell 《Journal of the National Medical Association》2017,109(4):224-237
Purpose
This article covers violence prevention (homicide and suicide) activities in the African American community for nearly 50 years.Method
Drawing on lived experience the works of early and recent efforts by African American physicians, the author illustrates we know a great deal about violence prevention in the African American community.Results
There remains challenges of implementation and political will. Further, most physicians, like the public, are confused about the realities of homicide and suicide because of the two different presentations both are given in the media and scientific literature.Conclusions
Responses to homicide and suicides should be based on science not distorted media reports. There are violence prevention principles that, if widely implemented, could stem the tide of violence. 相似文献9.
Gianenrico Senna Marco Caminati Clara Bovo Giorgio Walter Canonica Giovanni Passalacqua 《Annals of allergy, asthma & immunology》2017,118(2):161-165
Objective
Pharmacists play a relevant role in the real-life management of asthma because they are a first-line referral for patients. In fact, the role of pharmacies has been underlined and evidenced also in guidelines. Nonetheless, the true effect of pharmacy-based management of asthma has been assessed in only a few studies. We review the available literature on asthma management in a territorial pharmacy setting.Data Sources
The literature was searched for the keywords pharmacy, bronchial asthma, control, and management.Study Selections
The available studies were subdivided into observational and interventional and described.Results
Seven observational studies and 14 interventional trials were found, involving approximately 20,000 individuals. Most of those studies were performed in Europe and Australia. A high proportion of patients had poorly controlled asthma in the observational studies. The active involvement of pharmacists, in the interventional trials, consistently led to an improvement of the quality of life, a better inhalation technique, and a reduction of exacerbations.Conclusion
The literature analysis confirms the relevance of the role of pharmacists in the real-life management of bronchial asthma and underlines the need for a more specific training for those health care professionals. 相似文献10.
Luis Manuel Teran Fernando Ramirez-Jimenez Gabriela Soid-Raggi Juan Raymundo Velazquez 《Annals of allergy, asthma & immunology》2017,118(2):191-196
Background
Interleukin (IL) 16 and thymus and activation-regulated cytokine (TARC) are chemoattractant cytokines for eosinophils and TH2 cells. Differential levels of these components in aspirin-exacerbated respiratory disease (AERD) and allergic rhinitis with asthma (ARwA) may be related to a different inflammatory response in both asthma phenotypes.Objective
To assess the nasal lavage immunoreactivity of IL-16 and TARC cytokines.Methods
We used multienzyme-linked immunosorbent assays to detect IL-5, IL-13, IL-16, IL-33, I-309/CCL1, TARC/CCL17, monocyte-derived chemokine/CCL22, periostin, and eosinophil cationic protein levels in nasal lavages from patients with AERD and patients with ARwA.Results
The IL-13, IL-16, TARC, and periostin levels were significantly higher in patients with AERD compared with those of patients with ARwA. Correlation analysis of mediator levels in AERD revealed a possible role of IL-16 and TARC in eosinophil recruitment and activation.Conclusion
IL-16, TARC, and periostin distinguish between patients with AERD and those with ARwA. These mediators, taken together rather than individually, may comprise good specific nasal markers in patients with AERD. The effects of IL-16 and TARC on TH1, TH2, and T-regulatory cell functions in AERD cannot be disregarded. 相似文献11.
Amani M. Ali Samah Selim Maggie M. Abbassi Nirmeen A. Sabry 《Annals of allergy, asthma & immunology》2017,118(5):557-563
Background
Despite the use of alfacalcidol in the management of corticosteroid-induced osteoporosis, it has never been considered an adjunct treatment for asthma management. It can target vitamin D deficiency, a possible risk factor for asthma, and, hence, improve pulmonary function of patients with asthma.Objective
To explore the effect of alfacalcidol administration on pulmonary function and study the pattern of vitamin D deficiency in adults with asthma in Egypt.Methods
Serum 25-hydroxyvitamin D was measured in 115 adults: 33 healthy subjects and 82 patients with asthma. Then, patients with asthma were randomized to receive standard asthma treatment only (n = 39) or receive it in addition to 1 μg of alfacalcidol daily for 4 months (n = 43). Randomization was stratified by the stage of asthma severity. Spirometry and measurement of 25-hydroxyvitamin were performed at baseline and end of follow-up.Results
Vitamin D deficiency was more common in patients with asthma (57.3%) than in healthy subjects (21.2%; P < .001). In patients with asthma, alfacalcidol significantly improved forced expiratory volume in the first second and forced vital capacity (P < .001 for the 2 tests). Moreover, more patients in the intervention arm showed improvement in asthma severity stage (P = .04). A nonsignificant difference was observed in improvement of forced expiratory volume in the first second between patients with vitamin D deficiency and those without deficiency in the intervention group (P > .05).Conclusion
Alfacalcidol supplementation improved the pulmonary function and severity stage of adult patients with asthma regardless of deficiency.12.
Linda Jones Herbert Priya Mehta Hemant Sharma 《Annals of allergy, asthma & immunology》2017,118(3):345-350
Background
Food allergies are increasingly prevalent in the pediatric population. Balancing allergen avoidance with the promotion of healthy eating behaviors can be challenging for families.Objective
To characterize mealtime behaviors among parents of young children with food allergy.Methods
Seventy-four parents of young children with food allergies (≤7 years of age) completed measures of mealtime behavior, perceptions of food allergy risk and severity, pediatric parenting stress, and food allergy–related quality of life. Mealtime behavior reports were compared with published data regarding typically developing children, young children with type 1 diabetes, and children with diagnosed feeding disorders (with or without related medical factors).Results
Parents of young children with food allergies reported frequent mealtime concerns. Specifically, they reported significantly more mealtime behavioral concerns than typically developing peers, comparable mealtime behavioral concerns to young children with type 1 diabetes, and significantly fewer mealtime behavioral concerns than children with diagnosed feeding disorders. Parental mealtime concerns were positively correlated with other parent perceptions of food allergy, such as risk of allergen exposure, illness-related parenting stress, and food allergy–related quality of life.Conclusion
Young children with food allergy and their parents are more likely to exhibit mealtime behavioral concerns than typically developing peers and their parents. Future research should investigate the effect of food allergies and maladaptive mealtime behaviors on children's nutrition to provide clinical guidelines for parents who may benefit from psychosocial and/or nutritional support. 相似文献13.
Objective
To review the use of pollen for the production of allergen extracts to diagnose and treat allergic diseases, examine the associated regulations, and highlight candidate areas for improvement.Data Sources
A PubMed search was performed using focused keywords combined with a review of regulatory documents and industry guidelines.Study Selections
The information obtained through literature, documents, and industry was scrutinized and used with personal experience and expertise to write this article.Results
Both genetic and environmental factors affect the allergenic composition of pollen because it is a biologically active pharmaceutical ingredient obtained from nature. The potential effect of airborne contaminants in pollen requires major attention but can be properly addressed through careful collection practices, combined with a proper interpretation of the data on purity obtained for each pollen lot. The regulations associated with pollen used to manufacture allergen extracts in the United States and Europe and the numbers of pollen allergen extracts commercially available in both areas of the world differ. A critical parameter to select the appropriate extracts for diagnosis and allergen immunotherapy is to understand the phenomenon of cross-reactivity among pollen families, genera, and species.Conclusion
Physicians should be aware of the factors responsible for the qualitative and quantitative composition of pollen allergen extracts and the associated regulations to produce suitable extracts to diagnose and treat allergic diseases. Collaboration and cooperation among allergen manufacturing companies and regulatory agencies are necessary. 相似文献14.
Philipp Badorrek Meike Müller Wolfgang Koch Jens M. Hohlfeld Norbert Krug 《Annals of allergy, asthma & immunology》2017,118(3):290-297
Background
Allergic rhinitis is an inflammatory disease that causes cellular influx and mediator release in the nose. These inflammatory changes might be used as nasal biomarkers to assess the efficacy of novel anti-allergic treatments.Objective
To assess the specificity and reproducibility of nasal biomarkers in patients with allergic rhinitis after grass pollen exposure in an allergen challenge chamber.Methods
In a monocenter pilot study, 15 patients with allergic rhinitis and 19 healthy individuals underwent two 4-hour Dactylis glomerate pollen challenges in the challenge chamber with an interval of 21 days. Before challenge, on exit, and after 2 and 22 hours, a nasal lavage was performed and nasal secretions were collected on filter paper to determine a wide panel of cells and mediators. Furthermore, total nasal symptom score, nasal flow, and nasal nitric oxide were measured.Results
Pollen exposure significantly increased eosinophil, interleukin (IL) 5, IL-6, IL-13, and macrophage inflammatory protein 1β levels in allergic patients but not in healthy individuals. The effect could be reproduced for eosinophils, IL-5, IL-6, and macrophage inflammatory protein 1β after the second allergen challenge. By contrast, the IL-13 levels were higher and eotaxin levels first increased after repetitive allergen challenge. There was no correlation between total nasal symptom score and elevated cell or cytokine levels. Nasal nitric oxide levels were nonspecifically elevated in both patients with allergy and healthy controls.Conclusion
A subset of cellular and soluble biomarkers in nasal lavage and secretion reveals specificity and reproducibility in patients with allergic rhinitis. These can be used to measure the immunologic efficacy of antiallergic treatments in an allergen challenge chamber. Carryover effects attributable to priming must be considered when designing cross-over studies.15.
Vanitha Sampath Dana Tupa Michelle Toft Graham Talal A. Chatila Jonathan M. Spergel Kari C. Nadeau 《Annals of allergy, asthma & immunology》2017,118(1):21-27
Objective
To review our current understanding of immunotherapy, the immune mechanisms underlying food allergy, and the methodological advances that are furthering our understanding of the role of immune cells and other molecules in mediating food allergies.Data Sources
Literature searches were performed using the following combination of terms: allergy, immunotherapy, food, and mechanisms. Data from randomized clinical studies using state-of-the-art mechanistic tools were prioritized.Study Selections
Articles were selected based on their relevance to food allergy.Results
Current standard of care for food allergies is avoidance of allergenic foods and the use of epinephrine in case of severe reaction during unintentional ingestion. During the last few decades, great strides have been made in understanding the cellular and molecular mechanisms underlying food allergy, and this information is spearheading the development of exciting new treatments.Conclusion
Immunotherapy protocols are effective in desensitizing individuals to specific allergens; however, recurrence of allergic sensitization is common after discontinuation of therapy. Interestingly, in a subset of individuals, immunotherapy is protective against allergens even after discontinuation of immunotherapy. Whether this protection is permanent is currently unknown because of inadequate long-term follow-up data. Research on understanding the underlying mechanisms may assist in modifying protocols to improve outcome and enable sustained unresponsiveness, rather than a temporary relief against food allergies. The cellular changes brought about by immunotherapy are still a black box, but major strides in our understanding are being made at an exciting pace. 相似文献16.
Jerónimo Carnés Víctor Iraola Seong H. Cho Robert E. Esch 《Annals of allergy, asthma & immunology》2017,118(3):249-256
Objective
To provide physicians, researchers, and other interested health care professionals with information about how mite source materials and allergen extracts are manufactured, including the critical process parameters that can affect the final composition of allergenic extracts available for clinical use.Data Sources
A PubMed search was performed using focused keywords combined with relevant regulatory documents and industry guidelines.Study Selections
The information obtained through literature and specialized books was evaluated and combined with the personal expertise and experience of the authors.Results
Dermatophagoides farinae and Dermatophagoides pteronyssinus are the primary species responsible for allergen sensitizations and allergy symptoms in genetically predisposed individuals. Storage mites belonging to the families Glycyphagidae, Echimyopodidae, and Acaridae can also be relevant sources of indoor mite allergens. The cultivation and purification processes used to produce mite raw materials play a critical role in the final composition of mite allergen extracts. Mite extract standardization in the United States is based on total allergenic activity with respect to a single national standard, whereas in Europe consistency is ensured by in-house standards and international references. Because of the limitation of allergen avoidance and pharmacotherapy for patients with severe allergic rhinitis and asthma, house dust mite subcutaneous immunotherapy or sublingual immunotherapy can be an invaluable treatment option for them.Conclusion
Differences in manufacturing processes and extract standardization approaches may lead to differences in extract quality and potency. Physicians should be aware of these potential sources of mite extract variability. Use of well-standardized house dust mite extracts would be critical for success in the diagnosis and treatment of house dust mite allergy. 相似文献17.
Background
Comparative studies have demonstrated that asthma education to pediatric patients decreases average hospital usage and that allergy specialists provide stronger asthma education and more improved outcomes.Objective
To evaluate the real-world benefits of allergy subspecialty involvement outside inpatient consultation and the impediments for patients in establishing allergy subspecialty care.Methods
The study population was composed mostly of minority children 0 to 18 years old seen at a large university-affiliated stand-alone children's hospital who had a hospital discharge diagnosis of asthma from 2009 to 2013. The retrospective portion of the study compared all variables pertaining to asthma, teaching, and discharge reconciliation for the following subgroups: patients recommended to allergy and immunology (AI) follow-up who adhered to the appointment (adherent), patients recommended to AI follow-up who did not adhere (nonadherent), and patients not recommended to AI follow-up (non-referred). In the phone interview portion of the study, the nonadherent patients were contacted to identify barriers to AI follow-up.Results
Of the referred sample, the adherent group had significantly fewer visits to the pediatric intensive care unit, days in the pediatric intensive care unit, and days in the hospital. Providing more specific hospital discharge instructions increased AI follow-up and hospital teaching given on the baseline admission decreased hospital visits. Phone interviews showed that nonadherent patients most commonly missed follow-up because the parents believed it unnecessary because their child showed acute improvement or from advice from their primary care physician.Conclusion
These results showed improvement in outcomes for patients who attended AI follow-up and specifically identified key barriers that could be addressed in a standardized form to prevent nonadherence in the future. 相似文献18.
Eun Lee Si Hyeon Lee Young-Ho Kim Hyun-Ju Cho Jisun Yoon Song-I. Yang Young-Ho Jung Hyung Young Kim Ju-Hee Seo Ji-Won Kwon Hyo-Bin Kim So Yeon Lee Ho-Jang Kwon Soo-Jong Hong 《Annals of allergy, asthma & immunology》2017,118(5):542-550.e1
Background
Although previous studies have investigated the association between atopy phenotypes and allergic diseases, atopy characterizations in association with the development of allergic diseases remain poorly understood.Objective
To identify atopy phenotypes in school-age children and to evaluate the association between atopy phenotypes and allergic diseases.Methods
We enrolled 616 children with atopy defined as 1 or more positive allergen responses on skin prick tests and 665 children without atopy from the Children's Health and Environmental Research (CHEER) study. All children were followed up for 4 years at 2-year intervals. Atopy phenotypes were classified using latent class analysis.Results
Four atopy phenotypes were characterized: later sensitization to indoor allergens (cluster 1); multiple early sensitization (cluster 2); early sensitization to outdoor allergens, especially Alternaria, and later sensitization to indoor allergens, including Aspergillus (cluster 3); and early sensitization to indoor allergens and later sensitization to outdoor allergens (cluster 4). New cases of asthma during follow-up were increased in clusters 2 and 3 (adjusted odds ratio [aOR], 2.76 and 4.25, respectively). The risk of new-onset bronchial hyperresponsiveness was highest in cluster 3 (aOR, 5.03). Clusters 2 and 4 had an increased risk of allergic rhinitis (aOR, 7.21 and 2.37, respectively).Conclusion
Identification of atopy phenotypes facilitates prediction of the development of asthma and bronchial hyperresponsiveness in school-age children. Our study suggests prevention of additional sensitization is required to modify the progression of allergic diseases. 相似文献19.
Melanie D. Whittington R. Brett McQueen Daniel A. Ollendorf Jeffrey A. Tice Richard H. Chapman Steven D. Pearson Jonathan D. Campbell 《Annals of allergy, asthma & immunology》2017,118(2):220-225
Background
Adding mepolizumab to standard treatment with inhaled corticosteroids and controller medications could decrease asthma exacerbations and use of long-term oral steroids in patients with severe disease and increased eosinophils; however, mepolizumab is costly and its cost effectiveness is unknown.Objective
To estimate the cost effectiveness of mepolizumab.Methods
A Markov model was used to determine the incremental cost per quality-adjusted life year (QALY) gained for mepolizumab plus standard of care (SoC) and for SoC alone. The population, adults with severe eosinophilic asthma, was modeled for a lifetime time horizon. A responder scenario analysis was conducted to determine the cost effectiveness for a cohort able to achieve and maintain asthma control.Results
Over a lifetime treatment horizon, 23.96 exacerbations were averted per patient receiving mepolizumab plus SoC. Avoidance of exacerbations and decrease in long-term oral steroid use resulted in more than $18,000 in cost offsets among those receiving mepolizumab, but treatment costs increased by more than $600,000. Treatment with mepolizumab plus SoC vs SoC alone resulted in a cost-effectiveness estimate of $386,000 per QALY. To achieve cost effectiveness of approximately $150,000 per QALY, mepolizumab would require a more than 60% price discount. At current pricing, treating a responder cohort yielded cost-effectiveness estimates near $160,000 per QALY.Conclusion
The estimated cost effectiveness of mepolizumab exceeds value thresholds. Achieving these thresholds would require significant discounts from the current list price. Alternatively, treatment limited to responders improves the cost effectiveness toward, but remains still slightly above, these thresholds. Payers interested in improving the efficiency of health care resources should consider negotiations of the mepolizumab price and ways to predict and assess the response to mepolizumab. 相似文献20.
Schweta R. Arakali Todd D. Green Chitra Dinakar 《Annals of allergy, asthma & immunology》2017,118(1):16-20