Introduction: Adherence in allergen immunotherapy is crucial for its efficacy. At least 3 years of treatment are recommended for achieving a long-term modifying effect. Objectives: To assess patient's adherence and to identify determinant factors for allergen subcutaneous immunotherapy (SCIT) suspension in patients with respiratory allergy. Methods: Retrospective analysis of the medical record of patients submitted to SCIT between January 2013 and December 2016 in our Department. Results: 323 patients were included: 52% female; mean age 30±13 years; average treatment time 19±13 months. 52 patients (16%) stopped SCIT: 54% female; mean age 30±9 years; average treatment time 12±6 months; 67% dropped the treatment during the 1 st year, 27% in the 2 nd and 6% during the 3rd year of treatment. Adherence rate determined was 77%. The most frequent reasons for withdrawal were due to economic reasons (47.9%), followed by patients' perception of no clinical improvement (23%) and change to sublingual immunotherapy (11.6%). Conclusion: Adherence rate in our study was 77%. Economic reasons were the main cause of abandonment in the first year, while the perception of non-improvement was the main reason for abandonment in subsequent years. Adequate information on SCIT prescribing and rigorous monitoring of patients during the treatment can improve adherence.
Adenoids play a key role in both respiratory and ear infection in children. It has also been shown that adenoidectomy improves these symptoms in this population. The main goal of the present study was to evaluate adenoid bacterial colonization and document a possible relation with infectious respiratory disease. A prospective observational study was designed to evaluate the proposed hypothesis in a paediatric population submitted to adenoidectomy by either infectious or non-infectious indications and compare these two cohorts. A total of 62 patients with ages ranging from 1 to 12 years old were enrolled in the study. Adenoid surface, adenoid core and middle meatus microbiota were compared. A close association between adenoid colonization and nasal infection was found, supporting that adenoids may function as bacterial reservoir for upper airway infection. The obtained results also contribute to explain the success of adenoidectomy in patients with infectious indications.
To the Editor, Iron products (IP) have been increasingly used in recent years and constitute the firstline treatment for iron deficiency anemia (1). Although hypersensitivity reactions (HSR) to IP are rare and the risk of anaphylaxis with the currently available iron formulations has been shown to be significantly lower compared to iron dextran (2,13-15), there is still a concern regarding the safety of these products, with cases of fatal outcome reported in the literature (2,3). Here, we evaluate the safety of controlled readministration of IP in patients with previous hypersensitivity reactions to these drugs.We performed a retrospective review of patients referred to the Immunoallergology Department in a tertiary hospital for suspected HSR to IP, from 2011 to 2021. The demographic and clinical characterization of a total of 18 patients (mean age 45.6±14.3 years) is summarized in Table I. We observed a higher prevalence of female patients (83%), likely due to the higher frequency of treatment with IP among women (1).Regarding relevant past medical history, six patients (33%) reported previous reaction(s) to non-IP drugs, a similar prevalence found by Steveling-Klein et al. in a group of 22 adult patients out of 59 (37%) (4). Three patients were atopic (16%) and two presented with inflammatory diseases (sarcoidosis and inflammatory bowel disease; 11%). Interestingly, only 67% reported previous exposure to IP (Table I).The IP most frequently involved in hypersensitivity reactions was ferric carboxymaltose (FCM) in 12 patients (63%), followed by oral non-specified iron formulation in four patients (21%) and iron sucrose (IS) in three (16%). One patient presented HSR to both FCM and IS. The severity of reactions was categorized according to the Ring and Messmer Grading Scale for anaphylactic reactions. The majority of the reactions were classified as grade I (n=11, 58%). Grade II occurred in two HSR (11%) and grade III in five (26%), comparable to the distribution reported in the literature (4).
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