Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?: a meta-analysis of published RCTs.

OBJECTIVE: To determine whether specific oral tolerance induction (SOTI) is more effective than avoidance in inducing tolerance in children aged 0-18 years who have immunoglobulin E (IgE)-mediated food allergy. DATA SOURCES: MEDLINE (1950 to July 2009), EMBASE (1980 to July 2009) and all EBM Reviews: Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database (from start date to November 2008). The online table of contents (November 2003 to July 2009) of the Journal of Allergy and Clinical Immunology, Pediatric Allergy and Immunology and Allergy were also searched, and reference lists of retrieved articles were scrutinised for relevant studies. STUDY SELECTION: Randomised controlled trials (RCT) were included providing they enrolled children with IgE-mediated food allergy diagnosed using the criterion standard tool (double-blind placebo-controlled food challenge) before randomisation and also compared posttreatment tolerance between groups using the criterion standard measures. RESULTS: Three studies met the inclusion criteria, and two proved a statistically significant reduction in endpoint allergy (determined by oral food challenge) after SOTI compared with the control. The meta-analysis of the included studies found a lower RR of allergy after SOTI, but this did not meet statistical significance (0.606783; 95% CI 0.317733 to 1.158791). CONCLUSIONS: SOTI cannot yet be recommended in routine practice as a means to induce tolerance in children with IgE-mediated food allergy. Further research is needed using large, high-quality RCT that investigate a variety of food allergens and assesses the long-term efficacy, safety and cost-effectiveness of SOTI.

The needs of parents with chronically sick children: a literature review.

AIMS: This paper aims to provide health care professionals with an enhanced knowledge of the needs of parents with chronically sick children. DESIGN: The article takes the form of a critical literature review and examines eight research studies that were carried out from 1987 to 1997, written in the English language and analysing solely the needs or experiences of both parents with at least one chronically sick child. FINDINGS: Appropriately all eight studies were carried out from the naturalistic paradigm and yielded rich data. The synthesis of the results of the papers found three main themes emerging: the need for normality and certainty, the need for information, and the need for partnership. CONCLUSION: The results of the review serve to emphasize and reiterate the burden of the demands made on these parents, and act as a reminder of the need for empathetic care delivery.

Grading of biopsies of laryngeal carcinomas by multiple criteria.

The system of tumor grading of Jakobsson et al was applied in a study of the malignancy grade of biopsy tissue compared with the grade of the corresponding tissue obtained at definitive surgery. The results suggest that at biopsy tumors are rated lower grade than they exhibit in the final tumor tissue. Some observations are made on the application of this system of point rating multiple features to determine histologic grade.

Verrucous carcinoma of the larynx. - A study of its pathologic anatomy.

In the 10 years between 1964 and 1974, 276 patients with infiltrating carcinoma of the larynx included 31 cases of varrucous carcinoma (11 per cent of the series). This tumor is characterized by the pushing invasion of well differentiated squamous epithelium growing in a vertically folded invasive pattern. The tumor appears most frequently in the two decades between 50 and 69 years of age. The ratio of male to female patients was 3.4:1. Verrucous carcinoma has a predilection for the supraglottic regions of the larynx. Cut surface of the tumor shows clefting and sharp margins. Lymph node metastasis occurred in five cases. The marked inflammatory host reaction can cause misleading cervical lymphadenopathy. Problems in diagnosis are discussed.