Off-label prescribing for allergic diseases in pre-school children.

BACKGROUND: Several studies have demonstrated that medication is commonly used off-label in children with allergic diseases. The aim of this study was to characterise off-label use of prescriptions for allergic diseases in pre-school children from an allergology outpatient unit. METHODS: The clinical files of children aged ≤ 6 years seen in a reference allergology consultation with asthma, allergic rhinitis, and/or atopic eczema were reviewed. A total of 500 patients were consecutively observed from January to June 2012. The data collected included gender, age, diagnosis, and prescriptions with the respective daily dosage. RESULTS: A total of 1224 prescriptions were registered. The most prescribed medications were oral antihistamines (34.6%), antileukotrienes (22.6%), topical nasal corticosteroids (20.3%), and inhaled corticosteroids (17.7%). From all prescriptions, 422 (34.5%) were considered off-label for age (62.6%), dosage (31.7%), or clinical indication (5.7%). Off-label use was more frequent in children aged <2 years, with 73.5% prescribed for children of this age. CONCLUSIONS: Off-label use of drugs for the treatment of paediatric allergic diseases is high. However, these prescriptions are not necessarily wrong, and are recommended in many guidelines. Randomised controlled studies are limited by methodological difficulties creating the need for more observational studies in order to further evaluate the safety and efficacy of drugs used in children.

Maintaining the health-for-all momentum.

The efficiency and effectiveness of the health-for-all strategy have been judged largely by the results achieved in the developing countries. Assessments of progress have, for the most part, failed to take account of the slowness of advances previously made in the developed countries, and to allow for the fact that health services develop in parallel with teaching institutions and other bodies. In most African countries the whole process has been hindered by worsening economic, social and legal conditions. In considering how the momentum of the health-for-all strategy may be maintained, this article argues against undue bias towards the profit motive, which could lead to many people having access to only second-class services.