[Effectiveness of a classical homeopathic treatment in atopic eczema. A randomised placebo-controlled double-blind clinical trial]. / Wirksamkeit einer klassisch-homöopathischen Therapie bei atopischem Ekzem. Eine randomisierte, placebokontrollierte Doppelblindstudie.

BACKGROUND: Atopic dermatitis (atopic eczema) is one of those diseases where homeopaths claim to have good success although this has never been proven by rigorously controlled trials. METHODS: Single-centre, randomised, double-blind clinical trial comparing homeopathic remedies with placebo in young adults (age 18-35) with atopic dermatitis. Homeopathic remedies were individually administered according to the rules of classical homeopathy. After an untreated baseline period of 4 weeks, all patients were treated and monitored for 32 weeks. Throughout the study, co-medication was allowed only with indifferent emollients. The main outcome parameter was disease severity as assessed by Costa and Saurat's multi-parameter atopic dermatitis score (MP-score). RESULTS: 744 patients were screened out of which 24 (10 verum, 14 placebo) were randomised and analysed. Treatment groups were balanced in most baseline parameters but MP-scores were significantly higher in verum patients (p = 0.034, t-test). 10 patients (5 per group) dropped out of the study, mainly because the treatment was perceived as ineffective and co-medication was needed. The MP-score decreased from 54.5 +/- 11.0 to 40.7 +/- 12.5 in the verum group and from 45.9 +/- 7.6 to 32.7 +/- 21.8 in the placebo group, resulting in a non-significant group difference of 5.6 in favour of placebo (CI: -9.0 to 20.2; p = 0.46; ANCOVA). No secondary parameter (quality of life, coping, global assessments of treatment success) showed significant differences between groups (all p > 0.15). CONCLUSIONS: In this study, individualised homeopathic remedies did not prove to be superior to placebo in atopic dermatitis. Yet, generalisability of results is limited due to the small number of patients and the high percentage of ineligible patients.

[Quality control in medical education and continuing medical education in allergology in Germany]. / Qualitätssicherung in der Aus-, Weiter- und Fortbildung im Bereich Allergologie in Deutschland.

Quality control in education and training in allergology comprises activities at the different levels of the curriculum of medical schools, residency programs and postgraduate education. Unfortunately, until now allergology in Germany has not yet been regularly embedded in the medical curriculum of all medical schools. Therefore, the German Society for Allergology and Clinical Immunology (DGAI) has demanded for years that chairs and departments of allergology be introduced at every Medical Faculty in Germany. The new Medical Licensure Rules (Approbationsordnung) offer the possibility to select allergology, amongst others, as an obligatory subject in the medical state examination. Furthermore, allergological topics can now be introduced into the newly established interdisciplinary fields (Querschnittsbereiche). At the level of residency training, doctors who want to become allergists have to undergo a special curriculum in the field of allergology, formerly called additional specialisation in allergology (Zusatzbezeichnung) after having finished their board examination in an organ-related specialty subject. Following a decision of the German "Arztetag" in May 2003, this 24-months curriculum has unfortunately been reduced to 18 months. 12 months of this 18 months requirement may be fulfilled during a residency programme in either dermatovenerology, otolaryngology, internal medicine, pulmology and/or paediatrics. Compared to previous years, this results in a drastic deterioration of allergy training in Germany. The DGAI has decided to take up the fight for its improvement in both a quantitative and qualitative respect. The crucial issue is to develop quality criteria for persons as well as institutions eligible as training centres in allergology. As regards post-graduate education, the German Academy of Allergology and Environmental Medicine (Deutsche Akademie für Allergie und Umweltmedizin, DAAU) has introduced a system of certified continuing medical education (CME), which has been widely accepted in Germany. CME credit points are awarded in co-operation with the regional physicians' chambers ("Landesärztekammer"). Quality control in allergology has to be re-enforced and improved at all levels of medical curricula, training programmes and post-graduate education in order to achieve sustainable improvements in patient care for the large number of people in Germany suffering from allergies.

Efficacy of sublingual immunotherapy in grass pollen allergy.

Sublingual immunotherapy (SLIT) was developed to improve the safety of specific immunotherapy; however, its effectiveness is still subject to discussion although the balance sheet for SLIT is improving. In SLIT laboratory parameters and objective measures of allergen reactivity are nonuniform even in studies showing clinical effectiveness, thus subjective symptom scores remain the principal end points. For allergic rhinitis an expert panel collaborating with the WHO recently proposed that SLIT was a viable alternative for injectable immunotherapy (SIT) since a multitude of double-blind placebo-controlled studies had proved the effectiveness of SLIT. Unfortunately, there are only a small number of studies comparing effectiveness of SLIT directly with subcutaneous SIT. These studies demonstrated comparable effectiveness of both therapies. According to the data so far SLIT can be recommended for the therapy of allergic rhinitis in adults and children refusing injectable therapy. For the treatment of allergic asthma both positive and disappointing results have been published. Effectiveness in preventing the onset of allergic asthma in patients with allergic rhinitis has been demonstrated for SIT, while for SLIT this question cannot yet be answered.