How an online survey on the treatment of allergic rhinitis and its impact on asthma (ARIA) detected specialty-specific knowledge-gaps

Background To enhance the dissemination of the ARIA document (Allergic rhinitis (AR) and its impact on asthma) in Mexico, a Working Group composed of 35 specialists of 8 professional medical societies developed a transculturized ARIA México 2014 guideline. The ARIA guidelines use the GRADE system, which builds recommendations and suggestions around clinical questions (CQ).Methods As part of the dissemination strategy and to detect the physicians’ view and knowledge-gaps concerning the treatment of AR an online survey was sent out to members of participating societies containing the CQ of ARIA México. Replies were analyzed per specialty against the ARIA México 2014 experts’ recommendations/suggestions; differences between specialties were analyzed with Pearson’s Chi-squares.Results 807 surveys were returned, 657 completed (81%). We analyze replies from 158 alergists, 188 ENTs, 64 pulmonologists, 220 pediatricians and 177 GPs/family doctors. More than half of the surveyed physicians of all specialties would give an allergen reduced diet to pregnant/lactating women and avoid pets at home, which is against ARIA experts’ suggestions. ARIA experts suggest intranasal antihistamines can be part of the AR treatment: 46-63% of the ENTs, pulmonologists and pediatricians disagree; and experts prefer oral H1-antihistamines over leukotriene receptor antagonists (LTRA) for the treatment of AR: 52-36% of the pulmonologists, pediatricians and GPs prefer LTRAs. Concerning glucocorticosteroids (GCS): GPs are more reluctant to use intranasal GCS (p < 0.001) and 47% prefers oral H1-antihistamines. As for the treatment of recalcitrant AR ARIA experts suggest the use of oral, but not intramuscular, GCS: a quarter of pulmonologists, pediatricians and GPs considers they should not be used. Contrarily, 40% of ENTs favors intramuscular GCS. In patients with AR and comorbid asthma several physicians of all specialties –except pulmonologists- erroneously considers antihistamines, intranasal GCS and LTRAs useful for the treatment of asthma, while first-line recommended asthma treatment is inhaled GCS.Conclusion On certain issues in the treatment of AR the physicians’ opinion diverges from the recommendations/suggestions of ARIA experts. Moreover, physicians’ opinions depend on their specialty. As such, an online survey can help to detect knowledge-gaps and guide the development of more focused and specialty-specific postgraduate learning tools. Keywords: Guideline dissemination, Medical education, Allergic rhinitis, Asthma, Antihistamines, Intranasal corticosteroids, Leukotriene receptor antagonists, Allergen immunotherap

Relative potency in SPT of solution and tablet SLIT allergen extracts of Timothy grass pollen from 2 European manufacturers compared to a US reference extract

Forma parte de los materiales formativos del servicio LSDS de la UAB (Laboratorio de Simulación de Dinámicas Socio-Históricas)Demostración de la metodología de simulación social. Siguiendo este tutorial paso a paso construirás una pequeña sociedad artificial y le darás "vida" para poder estudiar los mecanismos que generan procesos sociales

Allergen immunotherapy on the way to product-based evaluation - a WAO statement

Allergen immunotherapy (AIT) is widely used in clinical practice for patients with moderate to severe allergic rhinitis due to inhalant allergens and may be delivered via subcutaneous (SCIT) and sublingual routes (SLIT). However, the quality of evidence for individual AIT products is very heterogeneous, and extensions of overall conclusions ("class effects") on the efficacy and disease-modifying effects to all AIT products are unjustified. In contrast, each product needs to be evaluated individually, based on available study results, to justify efficacy and specific claims on sustained and disease modifying effects per allergen and targeted patient group (children vs. adults, allergic rhinitis vs. asthma). WAO intends to support the current development to evidence-based AIT, which ultimately will lead to a more efficacious treatment of allergic patients and the appropriate recognition of AIT

National clinical practice guidelines for Allergen Immunotherapy:an international assessment applying AGREE-II

International audienc

Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020.

This update on chronic urticaria (CU) focuses on the prevalence and pathogenesis of chronic spontaneous urticaria (CSU), the expanding spectrum of patient-reported outcome measures (PROMs) for assessing CU disease activity, impact, and control, as well as future treatment options for CU. This update is needed, as several recently reported findings have led to significant advances in these areas. Some of these key discoveries were first presented at past meetings of the Collegium Internationale Allergologicum (CIA). New evidence shows that the prevalence of CSU is geographically heterogeneous, high in all age groups, and increasing. Several recent reports have helped to better characterize two endotypes of CSU: type I autoimmune (or autoallergic) CSU, driven by IgE to autoallergens, and type IIb autoimmune CSU, which is due to mast cell (MC)-targeted autoantibodies. The aim of treatment in CU is complete disease control with absence of signs and symptoms as well as normalization of quality of life (QoL). This is best monitored by the use of an expanding set of PROMs, to which the Angioedema Control Test, the Cholinergic Urticaria Quality of Life Questionnaire, and the Cholinergic Urticaria Activity Score have recently been added. Current treatment approaches for CU under development include drugs that inhibit the effects of signals that drive MC activation and accumulation, drugs that inhibit intracellular pathways of MC activation and degranulation, and drugs that silence MCs by binding to inhibitory receptors. The understanding, knowledge, and management of CU are rapidly increasing. The aim of this review is to provide physicians who treat CU patients with an update on where we stand and where we will go. Many questions and unmet needs remain to be addressed, such as the development of routine diagnostic tests for type I and type IIb autoimmune CSU, the global dissemination and consistent use of PROMs to assess disease activity, impact, and control, and the development of more effective and well-tolerated long-term treatments for all forms of CU

Correction to: Is diet partly responsible for differences in COVID-19 death rates between and within countries?

An amendment to this paper has been published and can be accessed via the original article

Correction to: Is diet partly responsible for differences in COVID-19 death rates between and within countries?

An amendment to this paper has been published and can be accessed via the original article

EAACI Guidelines on Allergen Immunotherapy:Prevention of allergy

Allergic diseases are common and frequently coexist. Allergen immunotherapy (AIT) is a disease-modifying treatment for IgE-mediated allergic disease with effects beyond cessation of AIT that may include important preventive effects. The European Academy of Allergy and Clinical Immunology (EAACI) has developed a clinical practice guideline to provide evidence-based recommendations for AIT for prevention of i) development of allergic comorbidities in those with established allergic diseases, ii) development of first allergic condition and iii) allergic sensitization. This guideline has been developed using the Appraisal of Guidelines for Research &amp; Evaluation (AGREE II) framework, which involved a multi-disciplinary expert working group, a systematic review of the underpinning evidence and external peer-review of draft recommendations. Our key recommendation is that a three year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate to severe allergic rhinitis (AR) triggered by grass/birch pollen allergy to prevent asthma for up to two years post-AIT in addition to its sustained effect on AR symptoms and medication. Some trial data even suggest a preventive effect on asthma symptoms and medication more than two years post AIT. We need more evidence concerning AIT for prevention in individuals with AR triggered by house dust mites or other allergens and for the prevention of allergic sensitization, the first allergic disease or for prevention of allergic co-morbidities in those with other allergic conditions. Evidence for the preventive potential of AIT as disease modifying treatment exists but there is an urgent need for more high-quality clinical trials