Meta-analysis of peritoneal lavage in appendicectomy.

Background: The use of peritoneal lavage to prevent postoperative intra-abdominal abscess (IAA) after appendicectomy has been debated widely. Methods: A systematic review and meta-analysis of suction alone versus lavage for appendicitis was performed to determine the relative benefit of lavage. Primary outcomes were postoperative IAA and wound infection (WI). Inclusion criteria were human studies reporting a comparison of appendicectomy with or without peritoneal lavage. Results: Eight studies met the inclusion criteria, the majority of which were retrospective. Only three were RCTs. Four studies included analysis only of the paediatric population. The rate of IAA was 1·0-19·5 per cent in patients receiving suction alone and 1·5-18·6 per cent in those having lavage. WI rates were 1·0-29·2 per cent for suction alone and 0·8-20·5 per cent for lavage. The pooled risk difference for IAA was 0·01 (95 per cent c.i. -0·03 to 0·06; P = 0·50) and that for WI was 0·00 (-0·05 to 0·05; P = 0·98). Analyses of both outcomes indicated a medium degree of heterogeneity between effect estimates with I 2 values of 71 per cent (P = 0·001) and 70 per cent (P = 0·010) for IAA and WI respectively. Conclusion: There is no evidence of benefit of lavage over suction for postoperative infective complications, and no individual study demonstrated a significant benefit in patients receiving lavage.

Towards an evidence-based management of right iliac fossa pain in the over 50-year-old patient.

Introduction Right iliac fossa pain is a common presenting complaint to general surgery. The differential diagnosis is wide, particularly in the elderly. Computed tomography (CT) is often used in the 'older' population, as they have a higher prevalence of acute colonic diverticulitis and colonic neoplasia, both of which should be identified prior to surgery. There is, however, no published evidence to support this practice. Methods We retrospectively reviewed the records of all patients aged over 50 years who presented with right iliac fossa (RIF) pain to a district general hospital. We determined whether tenderness was predominantly right- or left-sided and whether systemic inflammatory response syndrome (SIRS) was present on admission. The use of imaging modalities, their results and, if performed, operative findings were recorded. Results Of 3160 patients identified, 89 met the inclusion criteria. Diagnoses included appendicitis (27%), neoplasia (15%), non-specific abdominal pain (15%) and acute colonic diverticulitis (10%). CT was performed in 82% of patients, with a sensitivity of 97% based on operative findings. Six patients underwent surgery without a scan, two of whom required a change in the planned procedure due to unexpected findings. Conclusions Unless contraindicated, CT scanning should be mandatory in patients aged over 50 years presenting with signs of peritonism in the RIF or lower abdomen.

Parietaria sublingual allergoid immunotherapy with a co-seasonal treatment schedule.

BACKGROUND: Sublingual immunotherapy (SLIT) with monomeric allergoid, given according to the standard scheme, resulted effective and safe. However, the achievement of a clinical benefit requires a long time. We thus performed this study using an administration protocol starting in the co-seasonal period with a 3-day build-up phase and lasting only 6 months, in order to obtain the above benefit in a shorter time. METHODS AND RESULTS: The study, prospective, randomised and controlled versus drug therapy, was conducted on 65 rhinitic and/or asthmatic patients allergic to Parietaria with or without other sensitisations. Twenty-four were allocated to 1,000 AU/week, 21 to 3,000 AU/week and 21 to drug therapy. They were treated from April to September 2006. At baseline, 3 and 6 months a Visual Analogue Scale (VAS) was performed to assess the patients' well-being. Drug consumption was evaluated by means of monthly diary cards. Bronchial reactivity was investigated at baseline and 6 months by methacholine challenge test. There was a greater VAS improvement in both the SLIT groups than in the controls after 6 months (p<0.05). In patients taking 3,000 AU/week this was already evident after 3 months. There was a significant reduction in rescue medication consumption between 3 and 6 months (p<0.05) in all three groups. The bronchial reactivity was reduced only in the SLIT groups (p<0.001). No adverse events were observed. CONCLUSIONS: At 6 months the allergoid SLIT showed itself to be effective and safe. In addition the subjective clinical benefit was obtained in a more rapid period, i.e. 3 instead of 6 months, when a higher maintenance dose was administered.

Parietaria sublingual allergoid immunotherapy with a co-seasonal treatment schedule

Background: Sublingual immunotherapy (SLIT) with monomeric allergoid, given according to the standard scheme, resulted effective and safe. However, the achievement of a clinical benefit requires a long time. We thus performed this study using an administration protocol starting in the co-seasonal period with a 3-day build-up phase and lasting only 6 months, in order to obtain the above benefit in a shorter time. Methods and results: The study, prospective, randomised and controlled versus drug therapy, was conducted on 65 rhinitic and/or asthmatic patients allergic to Parietaria with or without other sensitisations. Twenty-four were allocated to 1,000 AU/week, 21 to 3,000 AU/week and 21 to drug therapy. They were treated from April to September 2006. At baseline, 3 and 6 months a Visual Analogue Scale (VAS) was performed to assess the patients' well-being. Drug consumption was evaluated by means of monthly diary cards. Bronchial reactivity was investigated at baseline and 6 months by methacholine challenge test. There was a greater VAS improvement in both the SLIT groups than in the controls after 6 months (p < 0.05). In patients taking 3,000 AU/week this was already evident after 3 months. There was a significant reduction in rescue medication consumption between 3 and 6 months (p < 0.05) in all three groups. The bronchial reactivity was reduced only in the SLIT groups (p < 0.001). No adverse events were observed. Conclusions: At 6 months the allergoid SLIT showed itself to be effective and safe. In addition the subjective clinical benefit was obtained in a more rapid period, i.e. 3 instead of 6 months, when a higher maintenance dose was administered

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Evaluation of the antiinflammatory and clinical effects of sublingual immunotherapy with carbamylated allergoid in allergic asthma with or without rhinitis. A 12-month perspective randomized, controlled, trial.

BACKGROUND: The efficacy and safety of sublingual immunotherapy with carbamylated allergoid (allergoid SLIT) is well recognised. Yet, few data concerning its antiinflammatory effects on the respiratory airways are so far available. Thus we decided to evaluate whether it can reduce the allergic inflammation and improve the clinical symptoms in comparison to pharmacotherapy. METHODS: The study was perspective, controlled and randomised. It was conducted on 56 patients allergic to House Dust Mite with (n=36) or without Parietaria. Thirty-three of them were allocated to SLIT (22 M, 11 F mean age 15 years) and 22 (13 M, 10 F, mean age 21 years) to pharmacotherapy They were followed-up for 1 year. Symptoms and drugs consumption were assessed by monthly diary cards. Bronchial reactivity was investigated at baseline and after a 12-month treatment, through a methacholine (MCh) test. An evaluation of the nasal eosinophils was also performed at the same times. RESULTS: There was a greater reduction of the mean symptom score (p < 0.01) and drug consumption (p < 0.001) in the SLIT than in the control group. MCh PD20 increased only in the SLIT group (p < 0.0005) The reduction of nasal eosinophils was statistically greater (p < 0.05) only in the SLIT group. CONCLUSIONS: A 1-year SLIT reduces the allergic symptoms and the respiratory airways inflammation more than pharmacotherapy.

Safety and tolerability of ultra-rush (20 minutes) sublingual immunotherapy in patients with allergic rhinitis and/or asthma.

BACKGROUND: The safety and good tolerability of sublingual immunotherapy (SLIT) has already been proved in allergic patients, but only one study has investigated the occurrence of immediate adverse reactions in allergic patients after a 2-hour ultra-rush regimen of SLIT performed with a chemically modified extract (sublingual monomeric allergoid, Lais, Lofarma S.p.A., Milan). The objective of the present study was to evaluate the occurrence of immediate adverse reactions in allergic patients after a very fast (20 minutes) ultra-rush regimen of sublingual allergoid SLIT. METHODS AND RESULTS: We studied 105 patients: 28 children (20 male, mean age 13.3 +/- 2.1 yr) and 77 adults (29 male, mean age 34.7 +/- 9.9 years) with a history of intermittent/persistent rhinitis or intermittent/mild persistent asthma due to House Dust Mite (n = 56), Parietaria (n = 34) and Timothy-grass (n = 15) The build-up ultra-rush phase involved the administration, every five minutes, of increasing doses of the sublingual allergoid SLIT. All patients tolerated the treatment very well. Only one patient out of 105 (0.9%) had a mild local symptoms (gastric pirosis) that occurred 30 minutes after the last initial dose and spontaneously disappeared as the treatment was continued. CONCLUSIONS: These data show the excellent safety and tolerability profile of an ultra-rush SLIT regimen performed with a chemically modified extract, even when high doses were administered through an extremely short induction phase (20 minutes), thus confirming the previously reported results.

Safety and tolerability of ultra-rush (20 minutes) sublingual immunotherapy in patients with allergic rhinitis and/or asthma

Background: The safety and good tolerability of sublingual immunotherapy (SLIT) has already been proved in allergic patients, but only one study has investigated the occurrence of immediate adverse reactions in allergic patients after a 2-hour ultra-rush regimen of SLIT performed with a chemically modified extract (sublingual monomeric allergoid, Lais®, Lofarma S.p.A., Milan). The objective of the present study was to evaluate the occurrence of immediate adverse reactions in allergic patients after a very fast (20 minutes) ultra-rush regimen of sublingual allergoid SLIT. Methods and results: We studied 105 patients: 28 children (20 male, mean age 13.3 ± 2.1 yr) and 77 adults (29 male, mean age 34.7 ± 9.9 years) with a history of intermittent/persistent rhinitis or intermittent/mild persistent asthma due to House Dust Mite (n = 56), Parietaria (n = 34) and Timothy-grass (n = 15) The build-up ultra-rush phase involved the administration, every five minutes, of increasing doses of the sublingual allergoid SLIT. All patients tolerated the treatment very well. Only one patient out of 105 (0.9 %) had a mild local symptom (gastric pirosis) that occurred 30 minutes after the last initial dose and spontaneously disappeared as the treatment was continued. Conclusions: These data show the excellent safety and tolerability profile of an ultra-rush SLIT regimen performed with a chemically modified extract, even when high doses were administered through an extremely short induction phase (20 minutes), thus confirming the previously reported resultsBackground: The safety and good tolerability of sublingual immunotherapy (SLIT) has already been proved in allergic patients, but only one study has investigated the occurrence of immediate adverse reactions in allergic patients after a 2-hour ultra-rush regimen of SLIT performed with a chemically modified extract (sublingual monomeric allergoid, Lais®, Lofarma S.p.A., Milan). The objective of the present study was to evaluate the occurrence of immediate adverse reactions in allergic patients after a very fast (20 minutes) ultra-rush regimen of sublingual allergoid SLIT. Methods and results: We studied 105 patients: 28 children (20 male, mean age 13.3 ± 2.1 yr) and 77 adults (29 male, mean age 34.7 ± 9.9 years) with a history of intermittent/persistent rhinitis or intermittent/mild persistent asthma due to House Dust Mite (n = 56), Parietaria (n = 34) and Timothy-grass (n = 15) The build-up ultra-rush phase involved the administration, every five minutes, of increasing doses of the sublingual allergoid SLIT. All patients tolerated the treatment very well. Only one patient out of 105 (0.9 %) had a mild local symptoms (gastric pirosis) that occurred 30 minutes after the last initial dose and spontaneously disappeared as the treatment was continued. Conclusions: These data show the excellent safety and tolerability profile of an ultra-rush SLIT regimen performed with a chemically modified extract, even when high doses were administered through an extremely short induction phase (20 minutes), thus confirming the previously reported results

Antecedentes: La seguridad y la buena tolerancia de la inmunoterapia por via sublingual (ITSL) se ha comprobado en pacientes alérgicos, pero solamente en un estudio se ha investigado la aparición de reacciones adversas inmediatas en pacientes alérgicos que siguen una pauta de inmunoterapia sublingual ultra rápida de dos horas, administrando un extracto químicamente modificado (alergoide monomérico sublingual, Lais®, Lofarma S.p.A., Milan). El objetivo del presente estudio fue evaluar la aparición de reacciones adversas inmediatas en pacientes alérgicos con un régimen de dosificación ultra rápido (20 minutos) de un alergoide sublingual (ITSL). Métodos y resultados: Estudiamos 105 pacientes: 28 niños (20 varones, promedio de edad 13.3 ± 2.1 años) y 77 adultos (29 varones, promedio de edad 34.7 ± 9.9 años) cuyas historias clínicas registraron rinitis intermitente/leve persistente causada por ácaros del polvo (n = 56), Parietaria (n = 34) y fleo de los prados (Timothy grass) (n = 15). La fase de concentración ultra rápida consistió en la administración por via sublingual de dosis crecientes del alergoide cada cinco minutos. Todos los pacientes toleraron el tratamiento satisfactoriamente. Sólo un paciente entre los 105 (0,9 %) presentó síntomas locales level (pirosis gástrica) durante los 30 minutos posteriores a la última dosis inicial que remitieron cuando se discontinuó el tratamiento. Conclusiones: Estos datos demuestran el excelente nivel de seguridad y tolerancia de un régimen de dosificación ultra rápido de ITSL con un extracto químicamente modificado, aún con la administración de dosis elevadas durante una fase de inducción extremamente corta (20 minutos), lo cual confirma los resultados anteriormente presentados

Safety and tolerability of ultra-Rush (20 minutes) sublingual immunotherapy in patients with allergic rhinitis and/or asthma.

BACKGROUND: The safety and good tolerability of sublingual immunotherapy (SLIT) has already been proved in allergic patients, but only one study has investigated the occurrence of immediate adverse reactions in allergic patients after a 2-hour ultra-rush regimen of SLIT performed with a chemically modified extract (sublingual monomeric allergoid, Lais, Lofarma S.p.A., Milan). The objective of the present study was to evaluate the occurrence of immediate adverse reactions in allergic patients after a very fast (20 minutes) ultra-rush regimen of sublingual allergoid SLIT. METHODS AND RESULTS: We studied 105 patients: 28 children (20 male, mean age 13.3 +/- 2.1 yr) and 77 adults (29 male, mean age 34.7 +/- 9.9 years) with a history of intermittent/persistent rhinitis or intermittent/mild persistent asthma due to House Dust Mite (n = 56), Parietaria (n = 34) and Timothy-grass (n = 15) The build-up ultra-rush phase involved the administration, every five minutes, of increasing doses of the sublingual allergoid SLIT. All patients tolerated the treatment very well. Only one patient out of 105 (0.9%) had a mild local symptom (gastric pirosis) that occurred 30 minutes after the last initial dose and spontaneously disappeared as the treatment was continued. CONCLUSIONS: These data show the excellent safety and tolerability profile of an ultra-rush SLIT regimen performed with a chemically modified extract, even when high doses were administered through an extremely short induction phase (20 minutes), thus confirming the previously reported results.

Safety and tolerability of ultra-Rush (20 minutes) sublingual immunotherapy in patients with allergic rhinitis and/or asthma

Background: The safety and good tolerability of sublingual immunotherapy (SLIT) has already been proved in allergic patients, but only one study has investigated the occurrence of immediate adverse reactions in allergic patients after a 2-hour ultra-rush regimen of SLIT performed with a chemically modified extract (sublingual monomeric allergoid, Lais®, Lofarma S.p.A., Milan). The objective of the present study was to evaluate the occurrence of immediate adverse reactions in allergic patients after a very fast (20 minutes) ultra-rush regimen of sublingual allergoid SLIT. Methods and results: We studied 105 patients: 28 children (20 male, mean age 13.3 ± 2.1 yr) and 77 adults (29 male, mean age 34.7 ± 9.9 years) with a history of intermittent/persistent rhinitis or intermittent/mild persistent asthma due to House Dust Mite (n = 56), Parietaria (n = 34) and Timothy-grass (n = 15) The build-up ultra-rush phase involved the administration, every five minutes, of increasing doses of the sublingual allergoid SLIT. All patients tolerated the treatment very well. Only one patient out of 105 (0.9 %) had a mild local symptom (gastric pirosis) that occurred 30 minutes after the last initial dose and spontaneously disappeared as the treatment was continued. Conclusions: These data show the excellent safety and tolerability profile of an ultra-rush SLIT regimen performed with a chemically modified extract, even when high doses were administered through an extremely short induction phase (20 minutes), thus confirming the previously reported resultsBackground: The safety and good tolerability of sublingual immunotherapy (SLIT) has already been proved in allergic patients, but only one study has investigated the occurrence of immediate adverse reactions in allergic patients after a 2-hour ultra-rush regimen of SLIT performed with a chemically modified extract (sublingual monomeric allergoid, Lais®, Lofarma S.p.A., Milan). The objective of the present study was to evaluate the occurrence of immediate adverse reactions in allergic patients after a very fast (20 minutes) ultra-rush regimen of sublingual allergoid SLIT. Methods and results: We studied 105 patients: 28 children (20 male, mean age 13.3 ± 2.1 yr) and 77 adults (29 male, mean age 34.7 ± 9.9 years) with a history of intermittent/persistent rhinitis or intermittent/mild persistent asthma due to House Dust Mite (n = 56), Parietaria (n = 34) and Timothy-grass (n = 15) The build-up ultra-rush phase involved the administration, every five minutes, of increasing doses of the sublingual allergoid SLIT. All patients tolerated the treatment very well. Only one patient out of 105 (0.9 %) had a mild local symptoms (gastric pirosis) that occurred 30 minutes after the last initial dose and spontaneously disappeared as the treatment was continued. Conclusions: These data show the excellent safety and tolerability profile of an ultra-rush SLIT regimen performed with a chemically modified extract, even when high doses were administered through an extremely short induction phase (20 minutes), thus confirming the previously reported results

Antecedentes: La seguridad y la buena tolerancia de la inmunoterapia por via sublingual (ITSL) se ha comprobado en pacientes alérgicos, pero solamente en un estudio se ha investigado la aparición de reacciones adversas immediatas en pacientes alérgicos con un protocolo con inmunoterapia sublingual con dosificación ultra rápida en dos horas, administrando un extracto químicamente modificado (alergoide monomérico sublingual, Lais®, Lofarma S.p.A., Milan). El objetivo del presente estudio fue evaluar la aparición de reacciones adversas inmediatas en pacientes alérgicos con un protocolo de dosificación ultra rápido (20 minutos) de un alergoide sublingual (ITSL). Métodos y resultados: Estudiamos 105 pacientes: 28 niños (20 varones, promedio de edad 13,3 ± 2,1 años) y 77 adultos (29 varones, promedio de edad 34,7 ± 9,9 años) con historia clínica de rinitis intermitente/persistente o asma intermitente/leve persistente causada por ácaros del polvo (n = 56), Parietaria (n = 34) y fleo de los prados (Timothy grass) (n = 15). La fase de concentración ultra rápida consistió en la administración por via sublingual de dosis crecientes del alergoide, cada cinco minutos. Todos los pacientes toleraron el tratamiento satisfactoriamente. Sólo un paciente entre los 105 (0,9 %) presentó síntomas locales leves (pirosis gástrica) durante los 30 minutos posteriores a la última dosis inicial que remitieron cuando se discontinuó el tratamiento. Conclusiones: Estos datos demuestran el excelente nivel de seguridad y tolerancia de un régimen de dosificación ultra rápido de ITSL con un extracto químicamente modificado, aún con la administración de dosis elevadas durante una fase de inducción extremamente corta (20 minutos), lo cual confirma los resultados anteriormente presentados

Specific immunotherapy [correction of immunotheraphy] of allergic diseases: a three years perspective observational study.

In order evaluate the long-term benefit of Specific ImmunoTherapy (SIT), administered either subcutaneously or sublingually, in comparison with drug therapy, in terms of efficacy, tolerability and patients' adherence to the treatment, a three year perspective, observational study was carried out over tree years in a rather large number of allergic subjects. One hundred and ten patients of both sex (50F, 60M; age: 22.4 - 35.5 years) were admitted. Sixty of them were rhinitics, some with concomitant mild intermittent asthma or conjunctivitis; 43 had a persistent asthma, often with concomitant rhinitis. Seven had urticaria. Sixty patients were treated with the allergoid sublingual SIT (in tablets) plus drugs on demand, 19 with the subcutaneous SIT (depot, aluminium hydroxide subcutaneous SIT) and 31 with the pharmacological therapy alone, mainly nasal steroids and antihistamines. The treatment efficacy, evaluated after 36 months, by symptoms and drug consumption reduction, was statistically better in the group assigned to the allergoid sublingual SIT than in the other two groups. This was the case also for the tolerability, the patient's compliance and the physicians' and patients' opinion. The present findings, obtained by a non-randomized study, show that the allergoid sublingual SIT was very appreciated by both patients and physicians for the good effectiveness and the high degree of safety guaranteed, in addition to its simplicity of use.