The role of house dust mite immunotherapy in Indonesian children with chronic rhinosinusitis allergy: A randomized control trial

The Influence of Family Crisis Coping Strategies on Family Quality of Life in the Assessment of Patients with Idiopathic Scoliosis

The aim of the study was to assess the impact of the strategies of coping with the family crisis in children and adolescents with idiopathic scoliosis on the level of their family's quality of life (FQOL). The study group consisted of 100 adolescents (girls 83%, boys 17% of the entire main group) with an average age of 14 (13.83 ± 1.92). The control group consisted of the same number of people as the study group (girls 78%, boys 22% of the entire control group) with an average age of 14 (14.09 ± 2.16). The FQOL scale was used to assess the family's quality of life, and the F-COPES scale was used to assess the problem-solving strategies used by the family (individual members) in a difficult life situation. Statistical analysis showed significant differences between the two compared groups. While dealing with a crisis situation in their families, adolescents treated for idiopathic scoliosis were using the spiritual support strategy (M ± SD 5.12 ± 2.07) significantly more often, while their healthy peers much more willingly and more often benefited from other possible strategies (F-COPES). Additionally, statistically significant differences were observed in the assessment of children and adolescents from both groups that the usage of different strategies available on the F-COPES scale correlated and affected the areas of the FQOL level of their families. Gaining spiritual support had a negative impact on the area of physical and financial well-being of FQOL, as assessed by juveniles with SI (R = -0.254, p = 0.011). However, in the opinion of healthy peers, the strategy of gaining social support (F-COPES) resulted in a higher level of FQOL in the area of disability problems (p = 0.005). A long process of SI treatment can cause crisis situations for patients and their families and affect both the physical and mental health of patients by changing the FQOL level of their families.

Safety Profile and Issues of Subcutaneous Immunotherapy in the Treatment of Children with Allergic Rhinitis

This study aims to evaluate safety issues of house dust mite subcutaneous immunotherapy (SCIT) among allergic rhinitis (AR) children. A retrospective cohort study was done between 2015 and 2020 to investigate the side effects of SCIT among AR children caused by a house dust mite allergy. Among 1098 patients who received house dust mite subcutaneous immunotherapy injections, 284 patients (25.87%) had side effects (SE). SE were found to be 699 times higher or in 2.27% of the 30,744 subcutaneous immunotherapy injections. A total of 17.9% of the patients had local SE during SCIT administration. Systemic side effects occurred in 8.38% of children receiving SCIT and in 0.53% of the total population who received SCIT injections. Only 2/92 (2.18%) of patients suffered an allergic reaction within 30 minutes of injection and these patients responded well to antiallergic medication. Severe anaphylaxis occurred in 0.091% of the 1098 patients in the SCIT group and in 0.0033% of the 30,774 SCIT injections. Systemic SE after SCIT occurred in 8.38% of patients receiving SCIT or 0.53% of the total number of SCIT injections. Anaphylactic episodes occurred in 16 patients (1.46%) and 15 patients (1.37%) who had first and second episodes. One severe attack was found and it was resolved with adrenaline. This study demonstrates that in pediatric patients with AR who received HDM SCIT for 18 months with high adherence, some experienced significant local SE and systemic SE caused by SCIT, but this did not interfere with the course of AR treatment or the effectiveness of SCIT.

Indonesia-Based Study of the Clinical and Cost-Saving Benefits of Subcutaneous Allergen Immunotherapy for Children with Allergic Rhinitis in Private Practice

BACKGROUND

Until now, the cost of allergy treatment in the insured public health care system and the non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy.

OBJECTIVE

To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in a non-insured self-financing private health care system.

METHODS

A retrospective cohort study conducted from 2015 until 2020 that compared the clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1098 subjects.

RESULTS

A decrease in sp-HDM-IgE level (kU/mL) from 20.5 + 8.75 kU/mL to 12.1 + 3.07 kU/mL was observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT, it costs IDR 21,753,062.7 per child, and for non-SCIT, it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT, it costs IDR 17,024,138.8, while with non-SCIT, it costs IDR 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT, it costs IDR 9,550,126.6, while with non-SCIT, it costs IDR 52,073,938.9.

CONCLUSIONS

In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.