New AHRQ Review Finds Allergen-Specific Immunotherapy Safe and Effective for Treating Nasal Allergies and Mild Asthma

Electronic Newsletter, Issue 374

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

April 1, 2013

AHRQ Stats

Millions of U.S. women ages 18 to 39 sought medical care in 2009 for the following conditions: mental disorders (6.4 million), asthma and chronic obstructive pulmonary disease (5.5 million), bronchitis and upper respiratory infection (5.3 million), and normal pregnancy and childbirth (5 million). (Source: Agency for Healthcare Research and Quality, MEPS Statistical Brief #403, Health Care Expenditures for the Most Commonly Treated Conditions of Women Ages 18 to 39, 2009.)

Today's Headlines

  1. New AHRQ Review Finds Allergen-Specific Immunotherapy Safe and Effective for Treating Nasal Allergies and Mild Asthma.
  2. Study Finds Indication-Based Prescribing Prevents Errors, Keeps Problem Lists Current.
  3. New AHRQ Research on Cerebral Palsy Evaluates Feeding and Nutrition Interventions.
  4. AHRQ’s Health Care Innovations Exchange Focuses on School-Based Health Programs for At-Risk Youth.
  5. Combined Oral Contraceptives Effective in Treating Abnormal Uterine Bleeding, New AHRQ Research Finds.
  6. New AHRQ Research Finds Some Interventions May Help Prevent Weight Gain.
  7. Register Now for April 15 Webinar on Advanced Methods in Delivery System Improvement Research.
  8. Register Now for Quality Improvement Conference April 25-26.
  9. AHRQ in the professional literature.

 1. New AHRQ Review Finds Allergen-Specific Immunotherapy Safe and Effective for Treating Nasal Allergies and Mild Asthma

At least a moderate level of evidence exists to support the use of allergen-specific immunotherapy as a safe and effective treatment for nasal allergies and mild asthma in adults and children, according to a new AHRQ research review. The review’s findings also appeared in the March 27 issue of the Journal of the American Medical Association (JAMA). The immunotherapy was either injected under the skin (subcutaneous) or placed under the tongue (sublingual). The review found a high strength of evidence that subcutaneous allergen-specific immunotherapy reduced asthma, nasal, and conjunctivitis symptoms, lowered the use of asthma medications, and improved quality of life. A moderate strength of evidence was found to support the use of subcutaneous immunotherapy for reducing the need for rhinoconjunctivitis medication. Strong evidence was found for sublingual immunotherapy to reduce asthma symptoms; moderate evidence was shown for reduced nasal and conjunctivitis symptoms and medication usage and improved allergy-specific quality of life. Currently, no FDA-approved sublingual forms of immunotherapy are available, although researchers and physicians are exploring the off-label use of subcutaneous aqueous allergens for sublingual desensitization. Evidence to support the use of allergen-specific immunotherapy in children is somewhat weaker than evidence supporting its use in adults. Select to access the AHRQ research review, Allergen-Specific Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and/or Asthma. Select to access the JAMA study abstract on PubMed®.

 2. Study Finds Indication-Based Prescribing Prevents Errors, Keeps Problem Lists Current

Requiring a clinician to link medication orders to patients’ health problems prevents wrong orders and keeps problem lists up to date, according to a study supported by AHRQ. Researchers at the University of Illinois implemented a computerized provider order entry system that required the clinician placing the order to link the medicine to an indication in the patient’s problem list. The purpose of this requirement was to help ensure that orders were being placed for the correct patient by cross-referencing the main reasons that a medication is normally prescribed with the patient’s identified health problems. If no matching problem was found in the medical record, the prescriber saw an alert and was prompted to enter the condition. Over a 6-year period, researchers found an interception rate of one wrong-patient order per 4,000 electronic alerts. In 59 percent of the intercepted errors, the prescriber had more than one chart open when they started the medication order. The study, "Indication-Based Prescribing Prevents Wrong Patient Medication Errors in Computerized Provider Order Entry," appeared in the March issue of the Journal of the American Medical Informatics Association. Select to access the abstract on PubMed®.

 3. New AHRQ Research on Cerebral Palsy Evaluates Feeding and Nutrition Interventions

Despite a range of potential feeding and nutrition interventions for patients with cerebral palsy (CP), consensus is lacking about the interventions’ efficacy, safety and applicability, a new AHRQ research review finds. Multiple interventions are often used in combination to treat feeding difficulties in adolescents with CP, making it difficult to know the individual effects of each intervention. Although all of the studies that were reviewed demonstrate significant weight gain with gastrostomy (tube feeding directly into the stomach), results for other growth measures are mixed, and there are potential risks of harms such as overfeeding, infection, stomach ulcers, and reflux. Also, there is not sufficient evidence to determine how well behavioral and surgical interventions can reduce feeding difficulties in adolescents with CP. Select to access the full review, Interventions for Feeding and Nutrition in Cerebral Palsy.

 4. AHRQ’s Health Care Innovations Exchange Focuses on School-Based Health Programs for At-Risk Youth

The March 27 issue of AHRQ’s Health Care Innovations Exchange features three school-based programs that enhance access, especially among minorities, to information, preventive care, and clinical services. One of the featured profiles describes Connecticut’s 78 school-based health centers, which offer a broad array of confidential mental health services to elementary, middle, and high school students. Each center has a licensed therapist with a master’s degree and a background in child and adolescent health who offers individual, group, and family counseling; crisis management services; and mental health education. The therapists treat the whole spectrum of mental health and learning disorders, ranging from episodic problems to long-term issues such as autism, attention deficit hyperactivity disorder, and bipolar disorder. Between 2006 and 2009, 16,700 adolescents visited a center at least once, with the average user visiting nearly five times per year. And 1,130 Hispanic or African-American adolescents received mental health services at a school-based center, with each visiting an average of 14 times during this time period. Select to read more innovation profiles about school-based health programs for at-risk youth on the Innovations Exchange Web site, which contains more than 750 searchable innovations and 1,500 Quality Tools.

 5. Combined Oral Contraceptives Effective in Treating Abnormal Uterine Bleeding, New AHRQ Research Finds

Strong evidence shows that the use of combined oral contraceptives can improve menstrual regularity and reduce menstrual blood loss for women with abnormal uterine bleeding, according to a new AHRQ research review. The review focuses on evaluation of nonsurgical options to treat abnormal bleeding, with an emphasis on interventions that are accessible to and within the scope of usual practice for primary care practitioners in any clinical care setting. The review found that effective treatment options (both contraceptive and noncontraceptive) are available in the primary care setting for women who have problematic, irregular, or heavy cyclic menstrual bleeding. In addition to combined oral contraceptives, metformin, a drug commonly used to treat diabetes, also improves cycle regularity. Other treatments, such as progestogens and non-steroidal anti-inflammatory drugs, also have varying levels of effectiveness in women with irregular bleeding patterns. While this review finds strong evidence for the use of combined oral contraceptives, additional studies are needed to examine both biological and patient-reported outcomes over longer periods of time. Select to access the full research review, Primary Care Management of Abnormal Uterine Bleeding.

 6. New AHRQ Research Finds Some Interventions May Help Prevent Weight Gain

Limited evidence shows certain interventions and approaches may help prevent weight gain among adults, according to a new AHRQ research review. Potentially effective strategies include minor behavioral change, such as eating more meals prepared at home, or major changes, including endurance exercise training three times per week. Obesity is a risk factor for chronic conditions, including cardiovascular disease, type 2 diabetes, arthritis, and certain types of cancer. Although evidence is limited to support certain strategies, the rationale for preventing weight gain is sound given the strong evidence that links obesity to poor health, high costs, and other negative consequences. Select to access the full research review, Strategies to Prevent Weight Gain Among Adults.

 7. Register Now for April 15 Webinar on Advanced Methods in Delivery System Improvement Research

AHRQ is sponsoring a webinar on the concept of fuzzy set analysis on April 15 from 1:00 to 2:00 p.m. EDT. Fuzzy set analysis is a mode of analyzing data using set membership and configurational analysis. The mode allows researchers to calibrate partial membership in sets using values in the interval between 0 (non-membership) and 1 (full membership), without abandoning core set theoretic principles. The presenters are Marcus Thygeson, M.D., associate medical director, Health Partners, and Jodi Holtrop, associate professor, Department of Family Medicine, Michigan State University. The moderator is Michael Harrison, Ph.D., senior social scientist, AHRQ. Four other webinars will be held on May 14, June 4, July 15, and a yet to-be-determined date in December. The webinars will focus on planning, executing, analyzing, and reporting research on delivery system improvement. Select to register for the webinar.  

 8. Register Now for Quality Improvement Conference April 25-26

Registration is now open for the Academy for Healthcare Improvement’s second annual research methods conference, "Doing Research at the Front Line of Improving Health Care," on April 25-26 in Arlington, VA. This AHRQ-funded meeting is an international, interprofessional forum, especially for providers of care, who are interested in the best methods for quality improvement research. Select for more information and to register for the conference.  

 9. AHRQ in the Professional Literature

Kronman MP, Zaoutis TE, Haynes K, et al. Antibiotic exposure and IBD development among children: a population-based cohort study. Pediatrics 2012 Oct; 130(4):e794-e803. Select to access the abstract on PubMed®.

Yu H, Greenberg MD, Haviland AM, et al. Multiple patient safety events within a single hospitalization: a national profile in US hospitals. Am J Med Qual 2012 Nov-Dec; 27(6):472-479. Select to access the abstract on PubMed®.

Paddison CA, Elliott MN, Haviland AM, Farley DO, et al. Experiences of care among Medicare beneficiaries with ESRD: Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results. Am J Kidney Dis 2012 Nov 21. Select to access the abstract on PubMed®.

Schiltz NK, Koroukian SM, Lhatoo SD, et al. Temporal trends in pre-surgical evaluations and epilepsy surgery in the U.S. from 1998 to 2009. Epilepsy Res 2012 Aug 1. Select to access the abstract on PubMed®.

Thomas KS, Hyer K, Castle NG, et al. Patient safety culture and the association with safe resident care in nursing homes. Gerontologist 2012 Dec; 52(6):802-811. Select to access the abstract on PubMed®.

Sarfaty M, Myers RE, Harris DM, et al. Variation in colorectal cancer screening steps in primary care: basis for practice improvement. Am J Med Qual 2012 Nov-Dec; 27(6):458-66. Select to access the abstract on PubMed®.

Edwards DR, Aldridge T, Baird DD, et al. Periconceptional over-the-counter nonsteroidal anti-inflammatory drug exposure and risk for spontaneous abortion. Obstet Gynecol 2012 Jul; 120(1):113-22. Select to access the abstract on PubMed®.

Wakefield DS, Kruse RL, Wakefield BJ, et al. Consistency of patient preferences about a secure Internet-based patient communications portal: contemplating, enrolling, and using. Am J Med Qual 2012 Nov-Dec; 27(6):494-502. Select to access the abstract on PubMed®.

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Page last reviewed April 2013
Internet Citation: New AHRQ Review Finds Allergen-Specific Immunotherapy Safe and Effective for Treating Nasal Allergies and Mild Asthma: Electronic Newsletter, Issue 374. April 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/374.html