No one wants to have shots, but they're especially problematic in children. Welcome then was the news a few years back that a simple tablet placed under the tongue could induce enough tolerance that many children with allergies might forgo allergy shots altogether. Alas, as Rick and I discuss on PodMed this week, it appears the early results haven't been borne out, at least according to a meta-analysis in JAMA Internal Medicine.
Data was pooled from over 4500 patients in whom sublingual immunotherapy utilizing tablets took place in a randomized controlled trial. Outcome measures were symptom management and use of medications to control symptoms. A very modest benefit of sublingual immunotherapy was seen in terms of reduction in symptoms or medication use, while over 60% of study subjects reported adverse events, compared with about 21% of the control population. Well. Rather disappointing, as I've already opined, but also calls into question the basis upon which the FDA approved sublingual immunotherapy in 2014. At the very least calls for re-examination of the issue and perhaps a comparison with standard issue allergy shots.
Other topics this week include extended use of anticoagulation in folks who've had pulmonary embolism without a discernible cause, and continued cognitive decline after stroke, both in JAMA, as well as rates of healthcare workers coming to work while ill, in JAMA Pediatrics. Until next week, y'all live well.