Results: Sixty-one studies met our inclusion criteria. The majority of the studies (66%) evaluated single-allergen immunotherapy regimens. The literature provides high-grade evidence that SCIT reduces asthma symptoms, asthma medication usage, rhinitis/rhinoconjunctivitis symptoms, conjunctivitis symptoms, and rhinitis/rhinoconjunctivitis disease-specific quality of life in comparison to placebo or usual care. There is moderate evidence that SCIT decreases rhinitis/rhinoconjunctivitis medication usage. Respiratory reactions were the most common systemic reaction. There were few reports of anaphylaxis; no deaths were reported.
Explore this issue:April 2015
Conclusions: Generally moderate to strong evidence supports the effectiveness of SCIT for treatment of allergic rhinitis and asthma, particularly with single-allergen immunotherapy regimens. Adverse reactions to SCIT are common, but no deaths were reported in the included studies (Laryngoscope. 2014;124:616-627).
The Prevalence of Bacterial Infection in Acute Rhinosinusitis: A Systematic Review and Meta-Analysis
Objectives/Hypothesis: To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS).
Methods: Electronic databases were systematically searched for relevant studies published up to June 2012.
Results: Twenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%–59.0%), ranging from 52.5% (CI 46.7%–58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%–68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%–67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%–46.8%).
Conclusions: Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS (Laryngoscope. 2015;125:57-69).