Effects of allergen immunotherapy in the MASK-air study: a proof-of-concept analysis

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Cost Utility of Omalizumab Compared with Standard of Care for the Treatment of Chronic Spontaneous Urticaria.

BACKGROUND: Chronic spontaneous urticaria (CSU) negatively impacts patient quality of life and productivity and is associated with considerable indirect costs to society. OBJECTIVE: The aim of this study was to assess the cost utility of add-on omalizumab treatment compared with standard of care (SOC) in moderate or severe CSU patients with inadequate response to SOC, from the UK societal perspective. METHODS: A Markov model was developed, consisting of health states based on Urticaria Activity Score over 7 days (UAS7) and additional states for relapse, spontaneous remission and death. Model cycle length was 4 weeks, and total model time horizon was 20 years in the base case. The model considered early discontinuation of non-responders (response: UAS7 ≤6) and retreatment upon relapse (relapse: UAS7 ≥16) for responders. Clinical and cost inputs were derived from omalizumab trials and published sources, and cost utility was expressed as incremental cost-effectiveness ratios (ICERs). Scenario analyses included no early discontinuation of non-responders and an altered definition of response (UAS7 <16). RESULTS: With a deterministic ICER of £3183 in the base case, omalizumab was associated with increased costs and benefits relative to SOC. Probabilistic sensitivity analysis supported this result. Productivity inputs were key model drivers, and individual scenarios without early discontinuation of non-responders and adjusted response definitions had little impact on results. ICERs were generally robust to changes in key model parameters and inputs. CONCLUSIONS: In this, the first economic evaluation of omalizumab in CSU from a UK societal perspective, omalizumab consistently represented a treatment option with societal benefit for CSU in the UK across a range of scenarios

EczemaNet: automating detection and severity assessment of atopic dermatitis

Atopic dermatitis (AD), also known as eczema, is one of themost common chronic skin diseases. AD severity is primarily evaluatedbased on visual inspections by clinicians, but is subjective and has largeinter- and intra-observer variability in many clinical study settings. Toaid the standardisation and automating the evaluation of AD severity,this paper introduces a CNN computer vision pipeline, EczemaNet, thatfirst detects areas of AD from photographs and then makes probabilisticpredictions on the severity of the disease. EczemaNet combines trans-fer and multitask learning, ordinal classification, and ensembling overcrops to make its final predictions. We test EczemaNet using a set of im-ages acquired in a published clinical trial, and demonstrate low RMSEwith well-calibrated prediction intervals. We show the effectiveness of us-ing CNNs for non-neoplastic dermatological diseases with a medium-sizedataset, and their potential for more efficiently and objectively evaluatingAD severity, which has greater clinical relevance than mere classification

Influence heat-reflective coating on the decrease of heat losses of window constructions

Developed theoretical and methodological foundations of the optimal choice of space-planning and constructive decisions of low-rise buildings blocked type, aimed at improving efficiency of investment, energy and resource saving, creation of comfortable conditions for the population, ensure sustainable development of low-rise construction in the context of socio-economic priorities in the climatic zoning of the area of construction

The economics of children’s mental health

Background: There is an increasing push towards policy-makers approving interventions for childhood mental disorders based on clinical effectiveness and cost considerations. To this end, high-quality economic evaluations of these interventions are starting to accumulate. Consequently, we set out to review the available data to help determine which prevention programs constitute the wisest use of limited public funds. Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of mental disorder prevention programs that also had an economic evaluation. Applying our inclusion criteria, we accepted four RCTs. Results: Coping With Stress resulted in significantly more depression-free days for participants with an average incremental cost-effectiveness ratio of id="mce_marker"0 per depression-free day. &nbsp;Fast Track significantly lowered the incidence of conduct disorder but only among the high-risk children. However, the cost per averted case of conduct disorder was still more than $752,000 for this group of children. Nurse Home Visitation resulted in significantly fewer serious behavioural problems many years after the program ended, including fewer criminal convictions. It also resulted in a net saving among the highest risk families by reducing other service use. Finally, Perry Preschool similarly resulted in less criminal activity as well as higher educational achievement and employment earning years after the program ended. It also produced a net savings. Conclusions: Prevention programs can not only avert needless suffering for children and families, they can also produce cost-savings for society.&nbsp

Risk factors for severe reactions in food allergy: Rapid evidence review with meta‐analysis

This rapid review summarizes the most up to date evidence about the risk factors for severe food-induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta-analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food-dependent exercise-induced anaphylaxis may be an exception. Some medications such as beta-blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life-threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. An absence of prior anaphylaxis does not exclude its future risk

Allergologische Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel

Überempfindlichkeitsreaktionen auf Arzneimittel müssen ausreichend geklärt werden mit dem Ziel, den Auslöser zu identifizieren. Die Anamnese umfasst neben der allgemeinen Anamnese auch Informationen zu angewandten Arzneimitteln, zur Klassifikation und zu den Umständen der Reaktion. Hauttests erfolgen bei allen Reaktionen mit Symptomen allergischer Überempfindlichkeiten mit geeigneten Testkonzentrationen, möglichst zwischen 4 Wochen und 6 Monate nach Abheilung der Reaktion durch Pricktest, Intrakutantest, Epikutantest oder Photopatchtest. Validierte Tests zum Nachweis spezifischer IgE-Antikörper im Serum sind nur für wenige Arzneistoffe (vor allem Betalaktamantibiotika) verfügbar; andere immunologische Labormethoden, z.B. der Basophilen-Aktivierungstest, werden nur in ausgewählten Fällen angewendet. Provokationstests sind indiziert, wenn der Auslöser durch bisherige Untersuchungen nicht mit Sicherheit identifiziert werden kann. Die Bewertung der Ergebnisse von Provokationstests sollte möglichst anhand objektiver Parameter erfolgen. Das Ergebnis der abschließenden Gesamtbeurteilung wird mit dem Patienten ausführlich besprochen und in einem Allergiepass niedergeleg

Allergologische Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel

Drug hypersensitivity reactions have to be tested to identify the culprit substance. The history includes the general information and specific data concerning used drugs, the classification and circumstances of the reaction. Skin tests are performed in all hypersensitivity reactions with allergic symptoms. Tests should be done between four weeks and six months after clearance of the symptoms by performing skin prick test, intradermal test, patch test or photopatch test. Validated tests for the detection of specific IgE antibodies in the serum are available for only few drugs, especially betalactam antibiotics. Other laboratory tests, e.g., the basophil activation test are done only in special cases. Provocation tests are indicated, if the culprit drug cannot be identified by the above mentioned tests. If possible, the evaluation of provocation tests should rely on objective parameters. The concluding assessment will be discussed with the patient and will be documented in an allergy pass