Patient Care - Allergy & Immunology - October 2007 - (Page 2)

Research Digest cine. Citing lack of federal and state funding, 10 states changed their policies to restrict access to selected new vaccines for underinsured children. Lee GM, Santoli JM, Hannan C, et al. Gaps in vaccine financing for underinsured children in the United States. JAMA. 2007;298: 638-643. Hemochromatosis fades as threat in liver transplants The survival rates of liver transplant patients who have hemochromatosis have improved dramatically over the past decade and are now almost identical to the average survival rate of all liver trans- Rituximab effective for treating severe pemphigus A single cycle of rituximab can be effective for treating patients with severe pemphigus who are not responding to corticosteroids. However, its use should be limited due to the drug’s potentially life-threatening side effects. Researchers in France treated 21 patients whose severe pemphigus was corticosteroid refractory or corticosteroid dependent or who had contraindications to corticosteroids with 4 weekly infusions of rituximab (375 mg/m2 of body-surface area). After 3 months, 18 patients (86%) had a complete remission, defined as epithelialization of all skin and mucosal lesions. Although 9 patients relapsed after a mean of 18.9 months, 18 patients were disease free after a median follow-up of 34 months. Eight patients were not taking corticosteroids, and the mean prednisone dosage fell in patients taking corticosteroids. One patient developed pyelonephritis and another died from septicemia. The study “supports previous reports that describe the beneficial effects of rituximab in the treatment of pemphigus without the need for infusions of intravenous immune globulins; however, its use must be restricted to a limited number of patients with pemphigus vulgaris or pemphigus foliaceus that is not responsive to conventional therapy . . . or to patients in whom these drugs may be harmful,” states an accompanying editorial. Diaz LA. Rituximab and pemphigus—a therapeutic advance [editorial]. N Engl J Med. 2007;357(6):605-607. Joly P, Mouquet H, Roujeau JC, et al. A single cycle of rituximab for the treatment of severe pemphigus. N Engl J Med. 2007; 357(6):545-552. plant patients. Researchers used data from the United Network for Organ Sharing to compare the survival rates of adults receiving transplants in the United States between 1990 and 1996 (16,286) to the survival rates of those receiving transplants between 1997 and 2006 (34,020). The proportion of patients with hemochromatosis was 1.1% in the earlier group and 0.6% in the later group. Oneyear survival rates for patients with hemochromatosis improved from 79% in the 1990-1996 period to 86% in the 19972006 period. The survival rates were higher for hemochromatosis patients than for those with hepatocellular carcinoma, hepatitis C virus infection, nonalcoholic steatohepatitis-induced or cryptogenic cirrhosis, alcoholic liver disease, or acute hepatic failure. The authors state that “although we speculate that more careful patient selection with regard to cardiac diseases and hepatocellular carcinoma and improved care before and after transplantation are potential reasons for this observed change in survival, future research should attempt to confirm these hypotheses.” Yu L, Ioannou GN. Survival of liver transplant recipients with hemochromatosis in the United States. Gastroenterology. 2007;133(2):489-495. 2 PATIENT CARE ALLERGY & IMMUNOLOGY www.patientcareonline.com http://www.patientcareonline.com

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Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

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