Allergy immunotherapies for allergic rhinitis: systematic review and assessment of evolving quality.

Summary: Background. Heterogeneity in the design and quality of trials evaluating allergy immunotherapies (AITs) limits their comparability, making it difficult for physicians, patients, and payers to select the best treatment option. Methods. This systematic review evaluated the quality of randomised controlled trials (RCTs) of registered grass AITs using the National Institute of Health and Care Excellence checklist. Results. 17 of 44 unique RCTs (38.6%) (sample size range: 18-1,501 subjects) were subcutaneous grass immunotherapy trials and 27 (61.4%) were sublingual grass immunotherapy trials (Allergovit, 5 trials; Alutard, 8; Grazax, 13; Oralair, 6; Staloral, 8; Pollinex, 2; Phostal and Purethal, 1 each). Three trials (6.8%; all Grazax) fulfilled every quality criterion. Quality assessments revealed inconsistencies in study quality and reporting. Study quality trended towards improvement over time, particularly after 2009. Conclusions. When as-sessing grass AIT, it is important to focus not only on endpoints but also on the quality of evidence.

The T cell response to major grass allergens is regulated and includes IL-10 production in atopic but not in non-atopic subjects.

BACKGROUND: The incidence of allergic diseases is increasing in industrialized countries and the immunological mechanisms leading to tolerance or allergy are poorly understood. Cytokines with suppressive abilities and CD4(+)CD25(+) regulatory T cells have been suggested to play a central role in allergen-specific responses. The aim was to determine whether major grass allergens induce production of suppressive cytokines in allergic and healthy subjects and to examine the inhibitory effect of these cytokines on allergic responses. METHODS: Peripheral blood mononuclear cells (PBMCs) were isolated from healthy and grass-allergic donors and stimulated with the major grass allergens Phl p 1 or Phl p 5. The effects of endogenous IL-10 and/or TGF-beta on proliferation and cytokine production were determined by use of blocking antibodies. In addition, the number of CD4(+)CD25(+) T cells and their expression of chemokine receptors were investigated by flow cytometry. RESULTS: Phl p 1 and Phl p 5 induced IL-10 production, which down-regulated proliferation and cytokine production, in PBMC cultures from atopic but not from non-atopic donors. Comparable frequencies of CD4(+)CD25(+) T cells were present in PBMCs in the two groups, but fewer cells from atopic donors were CD4(+)CD25(+)CCR4(+) and more cells were CD4(+)CD25(+)CLA(+) compared to healthy donors. CONCLUSION: Allergen-specific responses of grass allergic patients but not in non-atopic subjects are influenced by regulatory cytokines produced in response to the important allergens. Differences in CD4(+)CD25(+) T cell expression of chemokine receptors in allergic compared to non-atopic donors could suggest that the homing of CD4(+)CD25(+) T cells is important for the regulation of allergen-specific responses.

[Telephone case management: is it beneficial for the care of depression patients in Germany? A systematic literature survey]. / Telefonisches Fall-Management: Ist ein Benefit für die Versorgung depressiver Menschen in Deutschland zu erwarten? Systematische Literaturübersicht.

BACKGROUND: Strategies are needed to effectively improve the management of depression in Germany. Can telephone case management (TCM) be a promising strategy to improve depression care in the German health-care system? METHODS: A systematic literature review in PubMed, Cochrane Library, ISI Web of Science, PsycINFO and PSYNEXplus for randomised controlled trials (RCT) that evaluate TCM was carried out. RESULTS: Ten RCTs that compared TCM to treatment as usual were found. TCM was more effective in reducing depressive symptoms and in increasing satisfaction with care than treatment as usual. Whether TCM was capable of significantly improving pharmacotherapy compliance remained controversial. DISCUSSION: The effectiveness of TCM seemed to be related to the health-care system structure in which it was implemented. Most studies on TCM were conducted in US-American Health Maintenance Organizations. Thus, it is unclear to what extent these results can be transferred to the German health system. However, in the light of the promising results of these studies it seems to be worthwhile to test TCM also under conditions of the German health-care system.