Background: The incidence of allergic diseases is increasing in industrialized countries and the immunological mechanisms leading to tolerance or allergy are poorly understood. Cytokines with suppressive abilities and CD4+CD25+ regulatory T cells have been suggested to play a central role in allergen-specific responses. The aim was to determine whether major grass allergens induce production of suppressive cytokines in allergic and healthy subjects and to examine the inhibitory effect of these cytokines on allergic responses. Methods: Peripheral blood mononuclear cells (PBMCs) were isolated from healthy and grass-allergic donors and stimulated with the major grass allergens Phl p 1 or Phl p 5. The effects of endogenous IL-10 and/or TGF-β on proliferation and cytokine production were determined by use of blocking antibodies. In addition, the number of CD4+CD25+ T cells and their expression of chemokine receptors were investigated by flow cytometry. Results: Phl p 1 and Phl p 5 induced IL-10 production, which down-regulated proliferation and cytokine production, in PBMC cultures from atopic but not from non-atopic donors. Comparable frequencies of CD4+CD25+ T cells were present in PBMCs in the two groups, but fewer cells from atopic donors were CD4+CD25+CCR4+ and more cells were CD4+CD25+CLA+ compared to healthy donors. Conclusion:Allergen-specific responses of grass allergic patients but not in non-atopic subjects are influenced by regulatory cytokines produced in response to the important allergens. Differences in CD4+CD25+ T cell expression of chemokine receptors in allergic compared to non-atopic donors could suggest that the homing of CD4+CD25+ T cells is important for the regulation of allergen-specific responses.
PurposeAllergic rhinitis and asthma symptoms are detrimental to health-related quality of life (HRQoL). Health technology appraisal agencies often require cost–utility analysis when assessing new interventions. Appropriate utility estimates, which quantify the value of different conditions in cost–utility analyses, are scarce for allergic rhinitis and asthma health states. This study aimed to generate utilities for allergic rhinitis and asthma health states from a European general population sample of adults and children.MethodsHealth state descriptions incorporating symptoms, impact of symptoms on daily life and symptom treatment were developed using clinical guidelines. Descriptions were amended with clinician and patient input, and incorporated into a survey in which each health state was followed by a standard gamble (adults) or visual analogue scale (children) item. The survey was distributed to samples of adults and children aged 8 to 11 from four European countries that were stratified to represent the general population within that country.Results1454 adults and 1082 children completed the survey. Mean health utilities ranged from 0.635 to 0.880 and those elicited in children were lower (0.635 to 0.705) than those elicited in adults (0.812 to 0.880). Disutilities assessing the impact of increased allergic rhinitis severity and comorbidities were also greater in children than in adults.ConclusionsSymptoms of allergic rhinitis and asthma were valued as having a clinically meaningful impact on HRQoL. Children valued health states as poorer than adults, and further research should investigate whether this reflects true preferential differences or results from methodological and/or comprehension differences between the two groups.Electronic supplementary materialThe online version of this article (10.1007/s11136-018-1910-8) contains supplementary material, which is available to authorized users.
BackgroundThe Grazax Asthma Prevention (GAP) trial has recently demonstrated significant reductions in the odds of asthma symptoms or medication use in patients treated with SQ® grass SLIT-tablet relative to placebo, both in combination with allergy and asthma pharmacotherapy. The objective of the present analysis was to evaluate the cost-effectiveness of SQ grass SLIT-tablet relative to placebo in children with AR from the perspective of a German healthcare payer.MethodsA cost-utility model was developed in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) to evaluate the cost-utility of SQ grass SLIT-tablet in combination with pharmacotherapy versus pharmacotherapy alone in patients with AR. Transition probabilities were derived from the GAP trial, and costs were taken from a real-world insurance database analysis. Future costs and effects were discounted at 3% per annum, and extensive deterministic and probabilistic sensitivity analyses were performed.ResultsOver a 10-year time horizon, the base case analysis showed an increase in overall treatment costs of €897 per child being treated with SQ grass SLIT-tablet relative to pharmacotherapy alone. The increased treatment costs were accompanied by an improvement in patient quality of life of 0.10 quality-adjusted life years (QALYs) yielding an ICER of €8978 per QALY gained, falling well below a willingness-to-pay threshold of €17,800 per QALY gained. The base case results were insensitive to changes in all individual model parameters.DiscussionImprovements in quality of life with the SQ grass SLIT-tablet would be accompanied by only a modest increase in costs over a 10-year time horizon, with the SQ grass SLIT-tablet therefore representing excellent value for money from the German healthcare payer perspective.
The effectiveness of TCM seemed to be related to the health-care system structure in which it was implemented. Most studies on TCM were conducted in US-American Health Maintenance Organizations. Thus, it is unclear to what extent these results can be transferred to the German health system. However, in the light of the promising results of these studies it seems to be worthwhile to test TCM also under conditions of the German health-care system.
Background. Heterogeneity in the design and quality of trials evaluating allergy immunotherapies (AITs) limits their comparability, making it difficult for physicians, patients, and payers to select the best treatment option. Methods. This systematic review evaluated the quality of randomised controlled trials (RCTs) of registered grass AITs using the National Institute of Health and Care Excellence checklist.
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