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Farraia M, Paciência I, Castro Mendes F, Cavaleiro Rufo J, Delgado L, Moreira A. Cost-effectiveness analysis of grass pollen specific immunotherapy in children with allergic rhinitis compared to the standard of care symptomatic treatment in Portugal. Eur Ann Allergy Clin Immunol 2023; 55:212-228. [PMID: 34927406 DOI: 10.23822/eurannaci.1764-1489.240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Background. Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are scarce. We aim to compare the cost-effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) against standard-of-care (SOC) treatment in children with grass pollen allergic rhinitis. Methods. We created a Markov model to compare the three strategies over a 10-year horizon. SOC was the reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis were used to assess models' uncertainty. Results. We obtained an ICER of € 12,605 and € 6,318 for SLIT and SCIT, respectively. In sensitivity analysis, SCIT was more cost-effective than SLIT. Conclusions. AIT is cost-effective in children with grass pollen allergic rhinitis, especially for the subcutaneous route.
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Affiliation(s)
- M Farraia
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - I Paciência
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - F Castro Mendes
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - J Cavaleiro Rufo
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Portugal
| | - A Moreira
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
- São João University Hospital Center, Porto, Portugal
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Paciência I, Cavaleiro Rufo J, Ribeiro AI, Mendes FC, Farraia M, Silva D, Delgado L, Moreira A. Association between the density and type of trees around urban schools and exhaled nitric oxide levels in schoolchildren. Eur Ann Allergy Clin Immunol 2021; 53:29-36. [PMID: 32729315 DOI: 10.23822/eurannaci.1764-1489.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Greenspaces in school's neighbourhood represent an important environment to promote healthy development. The aim of this study was to assess the association between the density and type of trees around schools and exhaled Nitric Oxide (NO) levels in schoolchildren. Data on 845 children from 20 primary schools in Porto was analysed. Airway inflammation was assessed by measuring exhaled NO level. The density and type of trees were quantified within a 500 m buffer around schools. Associations were estimated using mixed-effect models. A significant association was observed between non-tree covered areas around schools and exhaled NO levels in schoolchildren (β = - 1.42, 95% CI - 2.84, - 0.001). Our results suggested that the presence of trees in school neighbourhoods may play a role in the biological mechanisms underlying the complex links between environment and airway inflammation.
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Affiliation(s)
- I Paciência
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - A I Ribeiro
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, School of Medicine, University of Porto, Porto, Portugal
| | - F C Mendes
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - M Farraia
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - D Silva
- Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - L Delgado
- Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - A Moreira
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal.,Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal
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Leal M, Paciência I, Farraia M, Cavaleiro Rufo J, Castro Mendes F, Delgado L, Viegas C, Moreira A. Airborne food and aeroallergens levels in healthcare settings. An unaccounted but potentially relevant source of exposure? J Investig Allergol Clin Immunol 2020; 31:426-432. [PMID: 32500857 DOI: 10.18176/jiaci.0623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Exposure to airborne allergens of biological origin associates with the development and exacerbation of allergic asthma and rhinitis. Assessment of allergens exposure in healthcare facilities may contribute to monitor hygiene and survey specific allergens which may cause symptoms in sensitized subjects. Objective: To assess concentration of indoor and airborne food allergens across different healthcare settings. METHODS Dust was vacuumed from primary health care centers in Lisbon; and emergency unit, day hospital, internal medicine ward, operating room and the outpatient clinic of a university central hospital in Porto. Samples were sieved, weighed, extracted and concentrations of Nbos d 5, Cor a 9, Gal d 2, Ara h 3, Ara h 6, Der p 1, Fel d 1, Can f 1, Bla g 2, Alt a 1 and Phl p 5 were determined using a multiplex array for allergens (MARIA™). RESULTS All airborne food and aeroallergens were found at least in one sampled area, except for Alt a 1. Levels of Der p 1 and Fel d 1 ranged from 13.0 µg/g to 971.0 µg/g and from 7.0 µg/g to 4618.8 µg/g, respectively. The emergency unit revealed the higher levels of food allergens, namely Nbos d 5 (16034.0 µg/g) and Cor a 9 (10649.5 µg/g). CONCLUSIONS With the exception of the operating room, exposure levels of dust mite, cat and dog allergens in healthcare facilities were above the values associated with sensitization and occurrence of allergic asthma or rhinitis symptoms in sensitized subjects.
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Affiliation(s)
- M Leal
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - I Paciência
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - M Farraia
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - F Castro Mendes
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - L Delgado
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Portugal
| | - A Moreira
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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Farraia M, Cavaleiro Rufo J, Paciência I, Castro Mendes F, Delgado L, Laerte Boechat J, Moreira A. Metabolic interactions in asthma. Eur Ann Allergy Clin Immunol 2019; 51:196-205. [PMID: 31287260 DOI: 10.23822/eurannaci.1764-1489.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Metabolomics can be used to explore altered metabolic pathways in asthma, giving insights into its pathophysiology. We aimed to review how metabolomics has been used to understand asthma by describing metabolic pathways under research and discussing clinical implications. The search was performed in PubMed, and studies published since 2000 using a metabolomics approach, were included. A total of 32 studies were analysed. Pathways related with cellular energy homeostasis, lipid metabolism and oxidative stress, immune and inflammatory processes and others were altered. Initial studies focused on biomarker discovery. But, metabolomics can be used to evaluate drug effects on specific pathways, to highlight pathways that can further develop in new targeted treatments and to identify differences according to asthma severity and phenotypes.
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Affiliation(s)
- M Farraia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - I Paciência
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal and Centro Hospitalar Universitário de S. João EPE, Porto, Portugal.,Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal
| | - F Castro Mendes
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal and Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
| | - L Delgado
- Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Departamento de Imunoalergologia, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
| | - J Laerte Boechat
- Disciplina de Imunologia Clínica, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brasil
| | - A Moreira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal and Centro Hospitalar Universitário de S. João EPE, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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