Subcutaneous Immunotherapy and Pharmacotherapy in Seasonal Allergic Rhinitis: A Comparison based on Meta-Analyses
ABSTRACT Allergen-specific subcutaneous immunotherapy (SCIT) of seasonal allergic rhinitis (SAR) is usually considered a "second-line," slow-acting, disease-modifying treatment.
We sought to test whether SCIT is as effective as antisymptomatic treatment in the control of symptoms in patients with SAR in the first year of treatment.
We reviewed meta-analyses with 5 or more randomized, double-blind, placebo-controlled trials of SCIT or antisymptomatic treatment in patients with SAR. We then selected trials measuring the total nasal symptom score (TNSS), the total symptom score (TSS), or both during the first pollen season after treatment initiation. Efficacy was determined as the percentage reduction in TSSs and TNSSs obtained with active treatment compared with placebo (relative clinical impact [RCI]) and the standardized mean difference (SMD) of treatment verses placebo (effect size [ES]).
The weighted mean RCI of SCIT on TNSSs (-34.7% ± 6.8%) was higher than those of mometasone (-31.7% ± 16.7%, P < .00001) and montelukast (-6.3% ± 3.0%, P < .00001). The weighted mean RCI of SCIT on TSSs (-32.9% ± 12.7%) was higher than that of desloratadine (-12.0% ± 5.1%, P < .00001). The overall ES of SCIT in terms of TNSSs (SMD, -0.94; 95% CI, -1.45 to -0.43) was similar to that of mometasone (SMD, -0.47; 95% CI, -0.63 to -0.32; P > .05) and higher than that of montelukast (SMD, -0.24; 95% CI, -0.33 to -0.16; P < .05). The overall ES of SCIT in terms of TSSs (SMD, -0.86; 95% CI, -1.17 to -0.55) was comparable with that of desloratadine (SMD, -1.00; 95% CI, -1.68 to -0.32; P > .05).
Our data provide indirect but consistent evidence that SCIT is at least as potent as pharmacotherapy in controlling the symptoms of SAR as early as the first season of treatment.
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Conference Paper: Energy and luminosity limits of hadron supercolliders[Show abstract] [Hide abstract]
ABSTRACT: Extending the frontiers of experimental high energy physics in a manner that maximizes discovery potential requires the building accelerators of ever higher particle energies and luminosities. Both hadron and e<sup>+</sup>e<sup>-</sup>-colliders have been proposed for this role. Based on a self-consistent computational model, this paper explores the features of hadron supercolliders beyond the SSC. The application of the presently available accelerator technologies embodied in the designs of the LHC and SSC to an ELOISATRON operating at 100 TeV per beam would yield a collider with a luminosity of 10<sup>34</sup> cm <sup>-2</sup> s<sup>-1</sup>. Even higher energies and luminosities are clearly possible. The paper concludes with an examination of the ultimate potential of synchrotron-based colliders to explore PeV energiesParticle Accelerator Conference, 1993., Proceedings of the 1993; 06/1993
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ABSTRACT: Since Noon first described allergen immunotherapy a century ago the basic premise of subcutaneous injections (SCIT) of relevant aeroallergens to induce clinical tolerance has remained true . Indeed, allergen immunotherapy did not change dramatically over the first 75 years, but over the past 25 years there have been a number of important advancements leading to newer approaches and novel formulations. Here we review the top 50 articles published in the past 2 years on allergens, environmental control, and immunotherapy for asthma and allergic rhinitis and the use of immunomodulators in allergic disease.Current opinion in immunology 08/2011; 23(6):808-13. DOI:10.1016/j.coi.2011.07.015 · 7.87 Impact Factor
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ABSTRACT: The purpose of this review is to highlight recently published important articles on upper airway diseases and allergen immunotherapy. We review articles on rhinitis, sinusitis, conjunctivitis, and immunotherapy. New insights into epidemiology, pathophysiology, diagnosis, and therapy are described for each of the above diseases.The Journal of allergy and clinical immunology 03/2012; 129(3):646-52. DOI:10.1016/j.jaci.2012.01.050 · 11.25 Impact Factor