A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1%) were recorded, representing 4.8% of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5% of the administered doses) and occurred in 10 patients (3.8% of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose.

Pinus pollen aerobiology and clinical sensitization in northwest Spain

BACKGROUND

Pinus pollen allergy has been generally considered to be rare and clinically insignificant. In our geographical area, Pinus pollen constitutes one of the most predominant pollen together with Poaceae and Urticaceae pollen. Pinus pinaster and Pinus radiata are the main species.

OBJECTIVE

This work aimed to determine the atmospheric fluctuations and the existence of patients monosensitized to Pinus pollen in our region.

METHODS

Patients attending our outpatient clinic in the last 4 years with positive cutaneous tests to Pinus pollen and with respiratory symptoms were selected. They were skin tested with commercial extracts of a battery of inhalants including Pinus pollen. Serologic specific IgE to Pinus pollen was performed by CAP system (Pharmacia & Upjohn, Uppsala, Sweden). Airborne Pinus pollen counts in our city were obtained for a 5-year period (1995 to 1999).

RESULTS

We present 10 patients with sensitivity to Pinus pollen and with symptomatology coinciding with Pinus pollen season (February to April). Most of these patients were monosensitizated to Pinus pollen and suffered from seasonal rhinoconjunctivitis. Pinus pollen is present in our area in large amounts from February to April with a peak pollen count in March and April.

CONCLUSIONS

Pinus pollen may be an important allergen since by itself can be the only cause of allergic disease. Therefore, we think that it must be taken into account in patients living in areas with high Pinus pollen concentrations and with seasonal respiratory disease.

[Investigation of the efficacy and tolerability of azelastine nasal spray versus ebastine tablets in patients with seasonal allergic rhinitis]

The efficacy and safety of the nasally administered histamine H1 receptor blocking drug Azelastine was investigated in an open, multicenter, randomized comparative trial with Ebastine in seasonal allergic rhinitis. 110 patients in two parallel groups were treated for 14 days and efficacy was assessed by the physician using a rating scale measuring 10 nasal and ocular symptoms of seasonal rhinitis (0 = absent, 1 = mild, 2 = moderate, 3 = severe). Tolerability was measured on the basis of reported adverse events. Both treatment groups had dramatic reductions in the physician's total symptom score following treatment (p < 0.0005). There was no significant difference between the two groups. Changes in individual rhinitis symptoms showed no differences between the two groups. During treatment, 19 patients had at least one adverse event, 13 in Azelastine group and 6 in Ebastine group; all were mild. The most frequent adverse events reported were somnolence (4 cases in Ebastine group) and a bitter taste (4 patients in the Azelastine group). In conclusion, the results of the study on 110 patients suggest that both Azelastine and Ebastine are effective treatments of the symptoms of seasonal allergic rhinitis. Both drugs were well tolerated.

Uncovering the cultural context for quality of family caregiving for elders

This article is part of a symposium exploring issues in developing cross-culturally equivalent conceptualizations and measures for a study of elder family caregiving. This article describes the development of an instrument to measure quality of elder family caregiving among Anglo and Mexican American caregivers. Following a review of typical approaches for evaluating quality of caregiving, a cross-cultural standard for excellence in elder caregiving is described. An instrument consistent with the United Nations Universal Declaration of Human Rights, the QUALCARE Scale, is identified as an appropriate cross-cultural instrument for assessing the quality of elder family caregiving. Refinement of the QUALCARE Scale using Berry's model for cross-cultural research, which necessitated identification of appropriate cross-cultural indicators of quality, is described. Examples of this process of indicator clarification are given for several basic human rights, based on the cross-cultural research team members' experiences with Anglo and Mexican American caregivers.

Toward a cross-cultural perspective of family caregiving

This article is part of a symposium that explores the issues involved in developing cross-culturally equivalent conceptualizations and measures for studying family caregiving. The examples used are from the instrument development phase of an ongoing program of research designed to generate and test a theory that explains the quality of family caregiving for frail elders at home. This article provides the background for the symposium by introducing the symposium's unifying theme: cross-cultural equivalence. The process described is based on the experiences of the cross-cultural research team and Berry's model for developing cross-culturally equivalent research.

Toward a cross-cultural understanding of family caregiving burden

This article is part of a symposium describing the development of cross-culturally relevant instruments to measure familism, caregiver burden, and quality of elder caregiving among Anglo- and Mexican American caregivers. This article explores issues involved in measuring caregiving burden. Caregiving burden is thought to adversely affect family caregiving, but the influence of culture on perceptions of burden has not been explored. Because no research focuses on caregiving burden among Mexican American caregivers, the first step involved reviewing the literature for cultural factors influencing caregiving and using the expertise of the cross-cultural team to identify and compare the meaning of caregiving burden in both groups. Next, two instrumentation studies were done to analyze the items on Poulshock and Deimling's Burden Instrument for comparable meaning and internal consistency within and between groups. The third step involved assessing the validity of Poulshock and Deimling's conceptualization of burden cross-culturally.

The relevance of familism in cross-cultural studies of family caregiving

Although familism has been studied in both Mexican American and Anglo families, there is controversy about whether familism in both groups is the same. Research has shown great within-group variability, and in addition, the kinship structure in the two groups is fundamentally different. This article explores the cross-cultural issues in conceptualizing familism and its relevance to caregiving among Anglo and Mexican American caregivers. Based on data obtained in an ongoing research program, the process of arriving at similarities and differences in the expression of familism is discussed using Berry's criteria for achieving cultural equivalence.

Connection between two peripherical markers in a group of asthmatic patients

We have studied the goniometric value of the tda angle and the alpha 1 antitrypsin phenotypes in a group of thirty atopic patients with the following patterns: 1) they were affected with asthma, atopic dermatitis and rhinitis. 2) they presented positive prick skin tests for pneumo-allergens and had. 3) positive allergic antecedents. There exists a significant statistical value for the lower tda angle in the right hand, in the MZ phenotypes of alpha 1 antitrypsin bearers, with P less than 0.05 significance. In the left hand there are many individual values that are identical (62% of the total test effected) thus the statistical methods cannot be applied satisfactorily, bearing in mind the significant difference as the statistical group recognized. From this and other previous works, we can conclude that an individual whose right hand tda angle reaches values near 75%, and with a MZ phenotype of alpha 1 antitrypsin, has a greater possibility of pertaining to one of the groups of asthma, atopic dermatitis and rhinitis symptomatology.