Background: Iron deficiency anemia is a disease that can significantly compromise a patient's quality of life. Desensitization is a safe and effective treatment option for iron-deficient anemic patients who require intravenous iron despite their hypersensitivity to iron. This report describes a safe desensitization protocol for patients with iron hypersensitivity who require iron treatment for their clinical improvement. Case presentation: Two patients of 20 and 46-year-old diagnosed with secondary iron deficiency anemia hipermenorreas and a clinical history of fail treatment with oral iron, who presented a reaction of the anaphylactic type while they receive iron parenteral sucrose. Therefore, the patients were treated with the desensitization protocol applied for patients with hypersensitivity to iron. Conclusion: Iron deficiency anemia is a disease that can significantly compromise the quality of life of patients. The desensitization protocol for patients with hypersensitivity to iron is a safe and effective treatment option for patients with a history of allergy to intravenous iron. This case report shows the usefulness to use the desensitization protocol for patients with hypersensitivity to iron.
Antecedentes: La dermatitis atópica (EA) es una enfermedad crónica de la piel que afecta de 5 a 20% de los niños. Esta enfermedad compromete la calidad de vida. El omalizumab ofrece un papel prometedor en el tratamiento de la dermatitis atópica severa. Objetivo: Dar a conocer nuestra experiencia con el uso de omalizumab para la dermatitis atópica severa en niños.Métodos: Revisión retrospectiva de los casos de pacientes pediátricos con dermatitis atópica severa tratados con omalizumab como terapia adyuvante en un servicio de consulta externa de alergia. Se incluyeron los pacientes menores de 18 años tratados durante al menos seis meses. Resultados: Se incluyeron 19 pacientes. Al inicio del estudio, todos informaron un compromiso de calidad de vida de 8/10 o más en una escala análoga. La mayoría había recibido previamente esteroides sistémicos u tratamiento de inmunosupresión, sin obtener el control de los síntomas. En el tiempo de tratamiento máximo, las puntuaciones SCORAD obtenidas revelaron 85.7% de los pacientes con enfermedad leve-moderada y 14% con enfermedad grave. El Índice de Calidad de Vida Dermatológica Infantil fue consistente con las puntuaciones SCORAD. Desde el comienzo del tratamiento hasta la última visita al consultorio, ningún paciente requirió tratamiento con esteroides sistémicos.Conclusiones: Omalizumab parece prometedor para el tratamiento de la dermatitis atópica severa en pacientes pediátricos. Los resultados muestran que omalizumab mejora la calidad de vida, reduce la gravedad de la enfermedad y la necesidad de esteroides sistémicos y terapia inmunosupresora, lo que disminuye los efectos secundarios de estos medicamentos.
Background
Atopic dermatitis (AD) is an inflammatory chronic condition that affects the skin of children and adults and has an important impact on the quality of life. Treatments for AD are based on environmental controls, topical and systemic therapies, and allergen-specific immunotherapy (AIT). However, it remains unclear the effectiveness and adverse events of AIT and all conventional topical treatments compared with placebo and each other for AD.
Methods
We will search five electronic databases [Central Cochrane register of controlled trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and LILACS] from inception until November 2019 with no language restriction, and we will include experimental studies [randomized controlled trials (RCTs), and quasi-RCTs]. The primary outcome is global and specific skin symptoms assessment. Secondary outcomes are hospital length of stay, quality of life, and adverse events. Reviewers independently will extract data from the studies that meet our inclusion criteria and will assess the risk of bias of individual primary studies. We will conduct random effects pairwise meta-analyses for the observed pairwise comparisons with at least two trials. Then, we will perform random-effects Bayesian network meta-analysis (NMA) to obtain treatment effects for all possible comparisons and to provide a hierarchy of all interventions for each outcome. Possible incoherence between direct and indirect sources of evidence will be investigated locally (if possible) and globally. To investigate sources of statistical heterogeneity, we will perform a series of meta-regression analyses based on pre-specified important effect modifiers. Two authors will appraise the certainty of the evidence for each outcome applying the GRADE’s framework for NMA.
Discussion
The findings of this systematic review will shed the light on the effectiveness and adverse events of all possible comparisons for treating AD and on the quality of the collated evidence for recommendations. It will also provide critical information to health care professionals to comprehend and manage this disease at different age stages, treatment type, duration, and severity of atopic dermatitis.
Systematic review registration
PROSPERO Protocol ID CRD42019147106
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