We have essentially two ways of managing. One is to say, ‘I’m going to biopsy and treat everything.’ The other is to say, ‘I’m going to biopsy and treat only those that look concerning to me. —Dinesh Chhetri, MD
Explore This IssueMarch 2021
Is sublingual immunotherapy (SLIT) effective for allergic rhinitis?
Andrew Lane, MD, director of the Johns Hopkins Sinus Center in Maryland, said that yes, SLIT is an effective treatment in adults and children who have severe allergic rhinitis symptoms that aren’t responsive to traditional pharmacotherapy, reducing symptoms and improving quality of life. It also helps reduce the use of anti-allergic medications and is self-administered easily, Dr. Lane said. Studies show that results from SLIT therapy are best when the treatment is given for at least 12 months, but he cautioned that the clinical effect size might be small.
One of the highest quality data sources mentioned by Dr. Lane was a meta-analysis of 49 randomized, double-blind, placebo-controlled clinical trials of the therapy for allergic rhinitis (Allergy. 2011;66:740-752). Patients treated with SLIT showed significantly improved symptom and medication scores when compared to patients receiving a placebo, with a trend toward more reduction if SLIT was given for more than 12 months. All doses and preparations of SLIT were equally effective.
Dr. Lane noted that more study is needed to determine the most effective starting point and the optimal dosing for SLIT. Researchers should also report sensitization status uniformly so that the therapy can be assessed across patients who are mono- and poly-sensitized, he said.
Should patients receive five days of antibiotics following clean-contaminated head and neck surgery?
Peri-operative antibiotics are given for many common clean-contaminated procedures in head and neck surgery, but the length of time they should be given has remained a question. Samir Khariwala, MD, MS, professor and vice chair of otolaryngology–head and neck surgery at the University of Minnesota, presented data showing that a 24- to 48-hour course appears to do just as well as a longer course.
In one of the studies he cited—a 2016 retrospective review—147 patients undergoing free flap reconstruction received an antibiotic course of two days or fewer, or a long course of more than two days (Surg Infect (Larchmt). 2016;17:100-105). Surgical site infection, flap dehiscence, flap loss, and length of stay were no different for the two groups.
Some evidence, though limited, suggests that a 48-hour course of ampicillin/sulbactam is superior to just 24 hours.
Ampicillin sulbactam should be the preferred antibiotic, according to the data, said Dr. Khariwala. Some evidence, though limited, suggests that a 48-hour course of ampicillin/sulbactam is superior to just 24 hours, however. And clindamycin, which consistently results in higher rates of infections in clean-contaminated surgery, should probably be avoided.