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Letters to the Editor: Assessing the cost-effectiveness of allergen immunotherapy in allergic rhinitis
No full textThe authors of the article, “Decision-Making Analysis for Allergen Immunotherapy versus Nasal Steroids in the Treatment of Nasal Steroid-Responsive Allergic Rhinitis,” must be commended,
because they introduce an original approach to assess the cost-effectiveness of subcutaneous immunotherapy (SCIT).
It is a pity that they did not take into account also sublingual immunotherapy (SLIT), which is going to be available in the United States after the demonstration of efficacy of the recent pharmaceutical-quality
preparations in tablets. Indeed, the authors cite the article by Podladnikova et al., who showed that SLIT had an economic advantage over SCIT, but they do not discuss this. Moreover, the finding is based on the prices of immunotherapy products in the Czech Republic, while in other countries the prices may be largely variable and often they are much higher. Globally, pharmacoeconomic studies from Europe have shown that immunotherapy (in both SCIT and SLIT forms) may be very beneficial to the health care systems. In particular, a budget impact analysis showed that SLIT with grass tablets is a cost-saving alternative to SCIT in patients with grass pollen–induced allergic rhinoconjunctivitis. Applying the model proposed by Kennedy et al. would have been (and surely will be in future studies) very interesting to further evaluate this issu
Mechanisms in adverse reactions to foods. The mouth and pharynx
No full textSymptoms appear immediately at the site of contact with the food when a susceptible allergic patients eats the offending food. Allergy to fresh fruits and vegetables, associated with all kinds of pollinosis, is the more frequent cause of Oral Allergy Syndrome
Diagnosis and monitoring of Hymenoptera venom allergy : clinical aspects and new tools
No full textDiagnosis of Hymenoptera venom allergy is commonly based on history, skin tests and in vitro IgE tests, which however are unable to predict the outcome of a subsequent sting from the culprit insect. The in hospital sting challenge is currently the only reliable procedure to assess the reactivity or tolerance to venom in patients with positive history and diagnostic tests and thus selecting those who need venom immunotherapy. The challenge as a diagnostic tool must be performed in specialized Centers because of the risk of life-threatening events in subjects with further reactions. This risk is negligible in patients treated with venom immunotherapy, therefore the sting challenge can be safely used as a tool to which the immunological monitoring, including the changes in venom specific IgE and IgG antibodies, the release of mediators and especially the switch from a TH2 to a TH1-type cytokine pattern has to be referred
Arguing the misconceptions in allergen-specific immunotherapy
No full textAllergen immunotherapy (AIT) has a clear evidence of efficacy and safety, as shown by a number of meta-analyses. However, a number of issues limit the use of AIT, many of them being not actually supported by solid data from the literature. In particular, several contraindications to AIT deserve to be argued, being needed to accurately balance in single cases the benefits versus the disadvantages. This concerns comorbidities, such as autoimmune diseases and malignancies, concomitant drug treatments, particularly β-blockers and angiotensin-converting enzyme inhibitors, pregnancy, patient's age, the severity of asthma, allergen polysensitization and the period of starting the treatment. Another important aspect producing misconceptions on AIT is the quality of the allergen extracts, because currently a patient with respiratory allergy to a given source may be prescribed to treat his allergyby products with very different quality. Improving characterization and standardization of allergen extracts will pave the way to the general acknowledgment of AIT as an effective treatment
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