Responders and nonresponders to pharmacotherapy and allergen immunotherapy.

Allergen immunotherapy (AIT) is a very useful therapy for allergic rhinitis. However, some patients do not achieve the expected results. The aim of the study was to investigate the potential factors that could affect the result, either good or poor, from AIT.Methods: A retrospective analysis of 1624 patients with allergic rhinitis who underwent AIT and 1519 matched patients who underwent only symptomatic therapy (without AIT) was performed. Symptoms, medications scores and quality of life related to allergic diseases before and after therapy were recorded. Cluster analysis on all of the patients was performed to find any associations between responsiveness to therapy and the analyzed parameters. Responsiveness to therapy was assessed by the Mailing criteria.Results: A total of 1266 (77.8%) patients from the AIT group met the criterion of 30% or greater improvement, and 1061 (65.2%) of these patients met the threshold of 60% or greater improvement according to the Mailing criteria. Patients who had a frequently better response to AIT were highly represented in the two clusters. There were subjects with a short history of allergic rhinitis and concomitant allergy to grass pollen or house dust mites. Patients with a prolonged duration of allergic rhinitis before therapy and with polysensitization were more frequently worse responders to AIT.Conclusion: Responsiveness to therapy, including that to AIT, is difficult to assess. However, there were associations suggesting that short-term allergic rhinitis and monovalent allergies to grass pollen or mites could correspond to a better response to AIT.

Fall episodes in elderly patients with asthma and COPD - A pilot study.

OBJECTIVE: Evidence of an increased risk of falls in patients with chronic obstructive pulmonary disease (COPD) exists; however, this has not been studied in elderly asthmatic patients. The aim of the study was to determine the incidence of falls in elderly patients who were diagnosed with bronchial asthma compared to subjects with COPD. METHODS: A 12-month prospective observational study in elderly outpatients with diagnosis of either asthma or COPD was conducted. All of the participants were monitored on the following parameters: falls, comorbidities, drug therapy, and The Berg Balance Scale. The rate of falls was shown as an incidence ratio. Cluster analysis for subgroups with similar features was performed on all patients included in the study. Two clusters of frequent fallers were determined. RESULTS: The fall incidence rate in falls per person per year was 1.41 (95% CI: 0.86-1.96) in asthmatic patients and 1.49 (95% CI: 1.05-2.11) in the COPD group. Frequent fallers were more prevalent in the COPD group, with 32% in this group compared to 28% in the groups of patients with asthma. In cluster analysis, frequent fallers were grouped into two models characterized by polytherapy, depression symptoms, hospitalizations, coronary disease, dementia, and diagnosis of COPD or asthma. CONCLUSION: Elderly asthmatic patients presented a high rate of falls, which is comparable to that of patients with COPD.

Prolonged effect of allergen sublingual immunotherapy to grass pollen.

Background: The prolonged effect of allergen immunotherapy is unknown, especially in older patients. Objective: The three-year effect of sublingual allergen-specific immunotherapy (AIT) to grass pollen on elderly patients with allergic rhinitis was analyzed. Methods: Thirty-eight elderly patients (63.18 ± 3.12 yrs.) underwent AIT to grass pollen, were monitored for three years and were compared to a placebo group. AIT was performed with the use of an oral Staloral 300 SR grass extract (Stallergens Greer, London, UK) or a placebo. Symptoms and medication scores, represented by the average adjusted symptom score (AAdSS), the serum level of IgG4 to Phl p5 and the quality of life were assessed immediately after AIT and three years later. Results: After AIT, the AAdSS was significantly decreased and remained lower than in the placebo group during the three years after AIT. Serum-specific IgG4 against Phl p5 increased during the AIT trial in the study group. For the three years of observation after AIT, there were no significant changes in specific IgG4 levels against the analyzed allergens in comparison to the results immediately after AIT. The quality of life, based on the Rhinoconjunctivitis Quality of Life Questionnaire, was significantly decreased in patients who received AIT, from 1.83 (95%CI: 1.45-1.96) to 0.74 (95%CI: 0.39-1.92) (p < 0.05) to 0.82 (95%CI: 0.45- 1.04) three years after AIT. Conclusion: A prolonged positive effect after AIT to grass pollen was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect.