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Sublingual dust mite immunotherapy for asthma
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Clouds Hill Imaging Ltd/SPL
Sublingual dust mite immunotherapy for asthma
Published Online May 9, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30101-1 For the trial see JAMA 2016; 315: 1715–25.
Standardised quality house dust mite (SQ-HDM) sublingual allergen immunotherapy (SLIT) given in tablet form to adults with allergic asthma that is not controlled well by inhaled corticosteroids significantly reduces time to moderate and severe asthma exacerbations, according to a randomised clinical trial in the Journal of the American Medical Association. The 834 participants in the 109 European trial sites of this large double-blinded trial were randomly assigned into three groups; the first dose group 6 SQ-HDM (n=275), the double dose group 12 SQ-HDM (n=282), and placebo (n=277). The primary endpoint of the risk of a moderate or severe asthma exacerbation was significantly reduced in both active groups (hazard ratio 0·72 [95% CI 0·52–0·99], p=0·045 for the 6 SQ-HDM group; and 0·69 [95% CI 0·50–0·96], p=0·03 for the 12 SQ-HDM group) compared with
placebo. The absolute risks compared with placebo did not differ between the two groups—0·09 (95% CI 0·01–0·15) for the 6 SQ-HDM group and 0·10 (95% CI 0·02–0·16) for the 12 SQ-HDM group. All adverse effects were mild to moderate, with no anaphylactic shocks or severe systemic reactions noted. Adverse events differed between dose groups; the most common adverse events noted were oral pruritus (37 [13%] patients with events for the 6 SQ-HDM group; 55 [20%] for the 12 SQHDM group; eight [3%] for the placebo group), mouth oedema (24 [9%]; 28 [10%]; none), and throat irritation (21 [8%]; 27 [10%]; four [1%]). The first author on the paper J Christian Virchow (University of Rostock, Germany), compares the current practice of subcutaneous immunotherapy (SCIT) to this treatment and notes that “SLIT, which can be administered at home, is much more convenient than having
to see the doctor every 4 weeks (or even more frequently during initiation of SCIT) as is necessary for SCIT. In addition, the safety profile of SLIT has been shown to be much better with no anaphylactic reactions in this study.” Moisés Calderón (Imperial College London, London, UK) considers that, overall, “the HDM SLIT tablet represents a real new potential therapeutic intervention and option to provide asthma control in adults.” The treatment might also be useful in children, reasons Virchow: “Theoretically, it might be possible that children could profit even more from this treatment since in this age group allergic reactions are more frequently an important driver of morbidity (whereas in adults a more chronic, allergen independent course is more frequent)”.
Emilia Harding
New guidelines for paediatric invasive ventilation at home Published Online May 9, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30099-6 For the ATS clinical practice guidelines see Am J Respir Crit Care Med 2016; 193: e16–e35.
436
Children who require invasive ventilation should be supported to receive care in their own homes, according to new clinical practice guidelines from the American Thoracic Society (ATS). Standardised criteria should be used to identify ventilated children who could be discharged home, and they should be medically managed by a generalist and respiratory specialist, with family members trained to provide roundthe-clock support and supplied with the equipment to ensure safe ventilation. Thomas Keens (Keck School of Medicine, University of Southern California, CA, USA), explained to The Lancet Respiratory Medicine: “As advances in paediatric and neonatal intensive care improve, increasing numbers of babies and children survive diseases which were once fatal, but they may survive with disabilities. Thus, the number of children with chronic
respiratory failure, who can potentially be cared for at home, is increasing.” He continued, “However, these children are at high risk, and overall there is about a 20% mortality rate in the first 5 years after discharge. Nevertheless, home mechanical ventilation offers some children the chance to grow up with their families, experience a relatively normal life, and maximise their rehabilitative potential.” Laura Sterni ( Johns Hopkins University School of Medicine, Baltimore, MD, USA), lead author of the practice guidelines, outlined the need for expert guidance in this area: “The quality of evidence provided by the scant research literature in this area is poor, and there are no randomised or controlled observational studies”. The ATS convened a workgroup, which used uncontrolled studies available in the literature and their expert opinion and experience to form
recommendations centred around the use of a co-managed medical home model to benefit families through improved care-coordination and guarantee that all of their medical issues are appropriately addressed. “It is our hope the recommendations in the guideline will reduce family stress and burden by helping families navigate the complex health-care and community systems involved in their child’s care and obtain the support they need”, explained Sterni. Commenting on the guidelines, Keens said: “It is always helpful to have an authoritative organisation, like the ATS, publish clinical care guidelines. This makes it so much easier to work with insurance companies to fund the care of these children when you can point to published guidelines representing the standard of care.”
Hannah Cagney www.thelancet.com/respiratory Vol 4 June 2016
Clouds Hill Imaging Ltd/SPL
Sublingual dust mite immunotherapy for asthma
Published Online May 9, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30101-1 For the trial see JAMA 2016; 315: 1715–25.
Standardised quality house dust mite (SQ-HDM) sublingual allergen immunotherapy (SLIT) given in tablet form to adults with allergic asthma that is not controlled well by inhaled corticosteroids significantly reduces time to moderate and severe asthma exacerbations, according to a randomised clinical trial in the Journal of the American Medical Association. The 834 participants in the 109 European trial sites of this large double-blinded trial were randomly assigned into three groups; the first dose group 6 SQ-HDM (n=275), the double dose group 12 SQ-HDM (n=282), and placebo (n=277). The primary endpoint of the risk of a moderate or severe asthma exacerbation was significantly reduced in both active groups (hazard ratio 0·72 [95% CI 0·52–0·99], p=0·045 for the 6 SQ-HDM group; and 0·69 [95% CI 0·50–0·96], p=0·03 for the 12 SQ-HDM group) compared with
placebo. The absolute risks compared with placebo did not differ between the two groups—0·09 (95% CI 0·01–0·15) for the 6 SQ-HDM group and 0·10 (95% CI 0·02–0·16) for the 12 SQ-HDM group. All adverse effects were mild to moderate, with no anaphylactic shocks or severe systemic reactions noted. Adverse events differed between dose groups; the most common adverse events noted were oral pruritus (37 [13%] patients with events for the 6 SQ-HDM group; 55 [20%] for the 12 SQHDM group; eight [3%] for the placebo group), mouth oedema (24 [9%]; 28 [10%]; none), and throat irritation (21 [8%]; 27 [10%]; four [1%]). The first author on the paper J Christian Virchow (University of Rostock, Germany), compares the current practice of subcutaneous immunotherapy (SCIT) to this treatment and notes that “SLIT, which can be administered at home, is much more convenient than having
to see the doctor every 4 weeks (or even more frequently during initiation of SCIT) as is necessary for SCIT. In addition, the safety profile of SLIT has been shown to be much better with no anaphylactic reactions in this study.” Moisés Calderón (Imperial College London, London, UK) considers that, overall, “the HDM SLIT tablet represents a real new potential therapeutic intervention and option to provide asthma control in adults.” The treatment might also be useful in children, reasons Virchow: “Theoretically, it might be possible that children could profit even more from this treatment since in this age group allergic reactions are more frequently an important driver of morbidity (whereas in adults a more chronic, allergen independent course is more frequent)”.
Emilia Harding
New guidelines for paediatric invasive ventilation at home Published Online May 9, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30099-6 For the ATS clinical practice guidelines see Am J Respir Crit Care Med 2016; 193: e16–e35.
436
Children who require invasive ventilation should be supported to receive care in their own homes, according to new clinical practice guidelines from the American Thoracic Society (ATS). Standardised criteria should be used to identify ventilated children who could be discharged home, and they should be medically managed by a generalist and respiratory specialist, with family members trained to provide roundthe-clock support and supplied with the equipment to ensure safe ventilation. Thomas Keens (Keck School of Medicine, University of Southern California, CA, USA), explained to The Lancet Respiratory Medicine: “As advances in paediatric and neonatal intensive care improve, increasing numbers of babies and children survive diseases which were once fatal, but they may survive with disabilities. Thus, the number of children with chronic
respiratory failure, who can potentially be cared for at home, is increasing.” He continued, “However, these children are at high risk, and overall there is about a 20% mortality rate in the first 5 years after discharge. Nevertheless, home mechanical ventilation offers some children the chance to grow up with their families, experience a relatively normal life, and maximise their rehabilitative potential.” Laura Sterni ( Johns Hopkins University School of Medicine, Baltimore, MD, USA), lead author of the practice guidelines, outlined the need for expert guidance in this area: “The quality of evidence provided by the scant research literature in this area is poor, and there are no randomised or controlled observational studies”. The ATS convened a workgroup, which used uncontrolled studies available in the literature and their expert opinion and experience to form
recommendations centred around the use of a co-managed medical home model to benefit families through improved care-coordination and guarantee that all of their medical issues are appropriately addressed. “It is our hope the recommendations in the guideline will reduce family stress and burden by helping families navigate the complex health-care and community systems involved in their child’s care and obtain the support they need”, explained Sterni. Commenting on the guidelines, Keens said: “It is always helpful to have an authoritative organisation, like the ATS, publish clinical care guidelines. This makes it so much easier to work with insurance companies to fund the care of these children when you can point to published guidelines representing the standard of care.”
Hannah Cagney www.thelancet.com/respiratory Vol 4 June 2016