human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The present study aim ed to evaluate the efficacy of three-year subcutaneous SQ-st and ardized specific immunotherapy ( SCIT ) in house dust mite (HDM)-allergic children with asthma . Ninety children with allergic asthma to HDMs , with or without allergic rhinitis , were r and omly divided into two groups , the treatment group and the control group . The treatment group received SCIT combined with st and ardized glucocorticoid management and the control group received st and ardized glucocorticoid management alone for a period of three years . The mean daily dose of inhaled corticosteroids ( ICSs ) , a four-week diary recording the symptom scores of asthma , peak expiratory flow ( PEF ) measurements , skin prick test results and serum immunoglobulin E ( IgE ) levels were assessed prior to treatment and following one , two and three years of treatment . The median dose of ICS  was reduced in the treatment group after two and three years of treatment compared with that of the control group . After three years of treatment , the discontinuation percentage of ICS in the treatment group was higher than that in the control group . The treatment group demonstrated significantly reduced daytime and night-time asthmatic symptom scores , increased PEF values and reduced serum IgE levels after two and three years of treatment compared with those in the control group ( P<0.05 ) . In conclusion , three-year SCIT treatment combined with ICS is an effective immunotherapy for children with allergic asthma and result ed in a reduction of the required ICS dose Background Many children with asthma do not have sufficient asthma control , which leads to increased healthcare costs and productivity loss of parents . One of the causative factors are adherence problems . Effective interventions improving medication adherence may therefore improve asthma control and reduce costs . A promising solution is sending real time text-messages via the mobile phone network , when a medicine is about to be forgotten . As the effect of real time text-messages in children with asthma is unknown , the primary aim of this study is to determine the effect of a Real Time Medication Monitoring system ( RTMM ) with text-messages on adherence to inhaled corticosteroids ( ICS ) . The secondary objective is to study the effects of RTMM on asthma control , quality of life and cost-effectiveness of treatment . Methods A multicenter , r and omized controlled trial involving 220 children ( 4–11 years ) using ICS for asthma . All children receive an RTMM-device for one year , which registers time and date of ICS doses . Children in the intervention group also receive tailored text-messages , sent only when a dose is at risk of omission . Primary outcome measure is the proportion of ICS dosages taken within the individually predefined time-interval . Secondary outcome measures include asthma control ( monthly Asthma Control Tests ) , asthma exacerbations , healthcare use ( collected from hospital records , patient reports and pharmacy record data ) , and disease-specific quality of life ( PAQLQ question naire ) . Parental and children ’s acceptance of RTMM is evaluated with online focus groups and patient question naires . An economic evaluation is performed adopting a societal perspective , including relevant healthcare costs and parental productivity loss . Furthermore , a decision-analytic model is developed in which different levels of adherence are associated with clinical and financial outcomes . Also , sensitivity analyses are carried out on different price levels for RTMM . Discussion If RTMM with tailored text-message reminders proves to be effective , this technique can be used in daily practice , which would support children with suboptimal adherence in their asthma (self)management and in achieving better asthma control and better quality of life . Trial registration Netherl and s Trial Register NTR2583 BACKGROUND The efficacy and safety of the 300-index of reactivity ( IR ) dose of 5-grass-pollen sublingual immunotherapy ( SLIT ) tablets ( Stallergènes , Antony , France ) have been demonstrated for the treatment of hay fever in adults . OBJECTIVE We sought to assess the efficacy and safety of this tablet in children and adolescents with grass pollen-related allergic rhinitis . METHODS In this multinational , r and omized , double-blind , placebo-controlled study , 278 children ( 5 - 17 years of age ) with grass pollen-related rhinoconjunctivitis ( confirmed by means of a positive grass pollen skin prick test response and serum-specific IgE measurement ) received once-daily SLIT tablets or placebo . Treatment was initiated 4 months before the estimated pollen season and continued throughout the season . The primary outcome was the rhinoconjunctivitis total symptom score ( RTSS ) , a sum of 6 individual symptom scores : sneezing , runny nose , itchy nose , nasal congestion , watery eyes , and itchy eyes . Secondary end points included rescue medication intake , individual scores , and safety . RESULTS The intent-to-treat population included 266 children ( mean age , 10.9 + /- 3.22 years ) . The RTSS for the 300-IR group was highly significantly different from that of the placebo group ( P = .001 ) . The 300-IR group showed a mean improvement for the RTSS of 28.0 % over that seen with placebo and a median improvement of 39.3 % . Significant differences between the 300-IR and placebo groups were also observed regarding rescue medication score and proportion of days using rescue medication during the pollen season ( P = .0064 and P = .0146 , respectively ) . Adverse events were generally mild or moderate in intensity and expected . No serious side effects were reported . CONCLUSION Five-grass-pollen SLIT tablets ( 300 IR ) reduce both symptom scores and rescue medication use in children and adolescents with grass pollen-related rhinoconjunctivitis Background Asthma and allergic rhinitis are the two most common chronic disorders in childhood and adolescence . To date , no study has examined the impact of comorbid allergic rhinitis on asthma control in children . Objective To examine the prevalence of allergic rhinitis in children with asthma , and the impact of the disease and its treatment on asthma control . Methods A cross-sectional survey in 203 children with asthma ( 5–18 years ) using vali date d question naires on rhinitis symptoms ( stuffy or runny nose outside a cold ) and its treatment , and the  paediatric Asthma Control Question naire  ( ACQ  ) . Fraction of nitric oxide in exhaled air ( FeNO ) was measured with a Niox Mino analyser ;  total and specific IgE levels were assessed by the Immunocap system . Results 157 children ( 76.2 % ) had symptoms of allergic rhinitis but only 88 of these ( 56.1 % ) had been diagnosed with the condition by a physician  . ACQ scores were worse in children with allergic rhinitis than in those without the condition ( p=0.012 ) . An ACQ score ≥1.0 ( incomplete asthma control ) was significantly more likely in children with allergic rhinitis than in those without ( OR 2.74 , 95 % CI 1.28 to 5.91 , p=0.0081 ) , also after adjustment for FeNO levels and total serum IgE. After adjustment for nasal corticosteroid therapy , allergic rhinitis was no longer associated with incomplete asthma control ( OR 0.72 , 95 % CI 0.47 to 1.12 , p=0.150 ) . Conclusion Allergic rhinitis is common in children with asthma , and has a major impact on asthma control . The authors hypothesise that recognition and treatment of this condition with nasal corticosteroids may improve asthma control in children , but r and omised clinical trials are needed to test this hypothesis BACKGROUND Subcutaneous allergen-specific immunotherapy ( SIT ) has an early onset of action , whereas repeated injections and safety concerns have limited its use in the pediatric age group . Meanwhile , the improved safety profile of the sublingual route has been accepted as an alternative despite its relatively late onset of action . OBJECTIVE We sought to improve the efficacy and safety of SIT with a combination of the subcutaneous route in the build-up phase and sublingual maintenance in comparison with the sublingual or subcutaneous routes alone . METHODS Fifty-one house dust mite-sensitized children with mild-to-moderate asthma were r and omized into one of 4 groups to receive either ( 1 ) subcutaneous immunotherapy ( SCIT ) , ( 2 ) sublingual immunotherapy ( SLIT ) , ( 3 ) SCIT plus SLIT , or ( 4 ) pharmacotherapy . Clinical parameters were evaluated at baseline and months 1 , 4 , 12 , and 18 . Allergen-specific immunoglobulin levels and allergen-induced IL-5 , IL-10 , IL-13 , IL-17 , TGF-β , and IFN-γ levels were evaluated as well . RESULTS In the SCIT and SCIT plus SLIT groups , the number of asthma attacks and inhaled corticosteroid dosage decreased compared with baseline values at the months 4 , 12 , and 18 but only at month 12 in the SLIT group . The improvement in visual analog scores for rhinitis was significant only in the SCIT plus SLIT group . Increases in the levels of regulatory and T(H)1 cytokines were observed both in the SCIT and SLIT groups , with some differences in dynamics . Antigen-specific IgG(4 ) levels increased in the SCIT and SCIT plus SLIT groups but not in the SLIT group . Clinical symptom scores were correlated positively with IL-5 levels and negatively with antigen-specific IgG(4 ) , IFN-γ , and TGF-β levels . CONCLUSION Our novel regimen of immunotherapy , SCIT plus SLIT , appeared promising in that it successfully combined the advantages of the 2 alternatives : rapid onset and potency in SCIT and safety and avoidance of injections in SLIT Continuing study for a second year and further analysis of a double‐blind placebo controlled trial , already briefly reported , of injections of tyrosine‐adsorbed , glutaraldehyde‐modified Dermatophagoides pteronyssinus antigen in fifty‐one children with perennial asthma and positive bronchial challenge to the antigen , confirms that the patients receiving the treatment reduced their symptomatic medication more than controls , without deterioration of symptoms . Some became symptom‐free , when off all treatment Asthma is the most common chronic disease of childhood . Specific immunotherapy is widely used in several countries for managing allergic asthma . Many clinical trials and a meta- analysis of several studies support its efficacy to reduce the symptoms and medical requirements . The purpose of this study was to clarify the efficacy of subcutaneous immunotherapy ( SCIT ) in improving the symptoms and reducing medication requirements in primary school children with asthma in comparison with pharmacotherapy . A single-blind , drug-controlled clinical trial was performed . A total of 242 primary school children with allergic asthma were included in the study . The patients were recruited from subjects attending the Allergic Center in Mosul City . Their age range was 7 - 12 years with mean age of 10 + /- 2 years . From the total only 197 children ( 81 % ) completed the study and were eligible for analysis , of those , 85 children were managed with SCIT and 112 children were managed with pharmacotherapies only . The follow-up after 1 year indicated that the children treated with SCIT show a marked reduction in the clinical symptoms , medication requirements , and the level of serum-specific IgE when compared with children treated with conventional drugs . SCIT was effective treatment and can prevent or decrease the onset of new sensitization to the offending allergen and maintain its beneficial effect for years after discontinuation Hyposensitisation with Dermatophagoides pteronyssinus tyrosine absorbate in asthmatic children with bronchial sensitivity to D. pteronyssinus  was effective in a 12-month double-blind controlled clinical trial . Compared with controls , treated children used a smaller quantity of drugs while maintaining clinical and lung function improvements . In most children who improved there was no change in immediate response to D. pteronyssinus on bronchial provocation test , but the late reaction was lost in half the patients and these showed the greatest improvement in symptoms UNLABELLED SAFETY and efficacy of sublingual ( sublingual-swallow ) immunotherapy ( IT ) with house dust mite extract were evaluated in 30 children ( 6 - 15 2/3 years of age ) over the first 12 months of an ongoing study . The cumulative dose was 570 micrograms Der p I ( five times that administered with subcutaneous therapy ) . SAFETY One patient on active treatment dropped out after 8 weeks because of a subjective feeling of severe weakness , question ably induced by the therapy . Five patients on active therapy and one patient on placebo reported minor local side effects . EFFICACY Pulmonary symptoms were reduced after 12 months in actively treated asthmatics , but this was not consistent with the lack of improvement in bronchial reactivity , skin sensitivity and specific IgG and IgG4 against D.pt . in this group . In patients with rhinitis  nasal sensitivity was reduced in the placebo group without concomitant improvement in the nasal symptom score . Specific IgE ( D.pt . and D.f . ) increased significantly more in the active treatment group after 3 and 12 months . We conclude that sublingual IT over 12 months with the fivefold Der p 1 dose of subcutaneous IT was well tolerated , but there was no consistent clinical or immunological benefit compared to placebo Background : Especially in childhood , sublingual immunotherapy ( SLIT ) could offer advantages over subcutaneous therapy . However , limited data on its efficacy is available Sublingual immunotherapy has been suggested for the treatment 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The present study aim ed to evaluate the efficacy of three-year subcutaneous SQ-st and ardized specific immunotherapy ( SCIT ) in house dust mite (HDM)-allergic children with asthma . Ninety children with allergic asthma to HDMs , with or without allergic rhinitis , were r and omly divided into two groups , the treatment group and the control group . The treatment group received SCIT combined with st and ardized glucocorticoid management and the control group received st and ardized glucocorticoid management alone for a period of three years . The mean daily dose of inhaled corticosteroids ( ICSs ) , a four-week diary recording the symptom scores of asthma , peak expiratory flow ( PEF ) measurements , skin prick test results and serum immunoglobulin E ( IgE ) levels were assessed prior to treatment and following one , two and three years of treatment . The median dose of ICS  was reduced in the treatment group after two and three years of treatment compared with that of the control group . After three years of treatment , the discontinuation percentage of ICS in the treatment group was higher than that in the control group . The treatment group demonstrated significantly reduced daytime and night-time asthmatic symptom scores , increased PEF values and reduced serum IgE levels after two and three years of treatment compared with those in the control group ( P<0.05 ) . In conclusion , three-year SCIT treatment combined with ICS is an effective immunotherapy for children with allergic asthma and result ed in a reduction of the required ICS dose Background Many children with asthma do not have sufficient asthma control , which leads to increased healthcare costs and productivity loss of parents . One of the causative factors are adherence problems . Effective interventions improving medication adherence may therefore improve asthma control and reduce costs . A promising solution is sending real time text-messages via the mobile phone network , when a medicine is about to be forgotten . As the effect of real time text-messages in children with asthma is unknown , the primary aim of this study is to determine the effect of a Real Time Medication Monitoring system ( RTMM ) with text-messages on adherence to inhaled corticosteroids ( ICS ) . The secondary objective is to study the effects of RTMM on asthma control , quality of life and cost-effectiveness of treatment . Methods A multicenter , r and omized controlled trial involving 220 children ( 4–11 years ) using ICS for asthma . All children receive an RTMM-device for one year , which registers time and date of ICS doses . Children in the intervention group also receive tailored text-messages , sent only when a dose is at risk of omission . Primary outcome measure is the proportion of ICS dosages taken within the individually predefined time-interval . Secondary outcome measures include asthma control ( monthly Asthma Control Tests ) , asthma exacerbations , healthcare use ( collected from hospital records , patient reports and pharmacy record data ) , and disease-specific quality of life ( PAQLQ question naire ) . Parental and children ’s acceptance of RTMM is evaluated with online focus groups and patient question naires . An economic evaluation is performed adopting a societal perspective , including relevant healthcare costs and parental productivity loss . Furthermore , a decision-analytic model is developed in which different levels of adherence are associated with clinical and financial outcomes . Also , sensitivity analyses are carried out on different price levels for RTMM . Discussion If RTMM with tailored text-message reminders proves to be effective , this technique can be used in daily practice , which would support children with suboptimal adherence in their asthma (self)management and in achieving better asthma control and better quality of life . Trial registration Netherl and s Trial Register NTR2583 BACKGROUND The efficacy and safety of the 300-index of reactivity ( IR ) dose of 5-grass-pollen sublingual immunotherapy ( SLIT ) tablets ( Stallergènes , Antony , France ) have been demonstrated for the treatment of hay fever in adults . OBJECTIVE We sought to assess the efficacy and safety of this tablet in children and adolescents with grass pollen-related allergic rhinitis . METHODS In this multinational , r and omized , double-blind , placebo-controlled study , 278 children ( 5 - 17 years of age ) with grass pollen-related rhinoconjunctivitis ( confirmed by means of a positive grass pollen skin prick test response and serum-specific IgE measurement ) received once-daily SLIT tablets or placebo . Treatment was initiated 4 months before the estimated pollen season and continued throughout the season . The primary outcome was the rhinoconjunctivitis total symptom score ( RTSS ) , a sum of 6 individual symptom scores : sneezing , runny nose , itchy nose , nasal congestion , watery eyes , and itchy eyes . Secondary end points included rescue medication intake , individual scores , and safety . RESULTS The intent-to-treat population included 266 children ( mean age , 10.9 + /- 3.22 years ) . The RTSS for the 300-IR group was highly significantly different from that of the placebo group ( P = .001 ) . The 300-IR group showed a mean improvement for the RTSS of 28.0 % over that seen with placebo and a median improvement of 39.3 % . Significant differences between the 300-IR and placebo groups were also observed regarding rescue medication score and proportion of days using rescue medication during the pollen season ( P = .0064 and P = .0146 , respectively ) . Adverse events were generally mild or moderate in intensity and expected . No serious side effects were reported . CONCLUSION Five-grass-pollen SLIT tablets ( 300 IR ) reduce both symptom scores and rescue medication use in children and adolescents with grass pollen-related rhinoconjunctivitis Background Asthma and allergic rhinitis are the two most common chronic disorders in childhood and adolescence . To date , no study has examined the impact of comorbid allergic rhinitis on asthma control in children . Objective To examine the prevalence of allergic rhinitis in children with asthma , and the impact of the disease and its treatment on asthma control . Methods A cross-sectional survey in 203 children with asthma ( 5–18 years ) using vali date d question naires on rhinitis symptoms ( stuffy or runny nose outside a cold ) and its treatment , and the  paediatric Asthma Control Question naire  ( ACQ  ) . Fraction of nitric oxide in exhaled air ( FeNO ) was measured with a Niox Mino analyser ;  total and specific IgE levels were assessed by the Immunocap system . Results 157 children ( 76.2 % ) had symptoms of allergic rhinitis but only 88 of these ( 56.1 % ) had been diagnosed with the condition by a physician  . ACQ scores were worse in children with allergic rhinitis than in those without the condition ( p=0.012 ) . An ACQ score ≥1.0 ( incomplete asthma control ) was significantly more likely in children with allergic rhinitis than in those without ( OR 2.74 , 95 % CI 1.28 to 5.91 , p=0.0081 ) , also after adjustment for FeNO levels and total serum IgE. After adjustment for nasal corticosteroid therapy , allergic rhinitis was no longer associated with incomplete asthma control ( OR 0.72 , 95 % CI 0.47 to 1.12 , p=0.150 ) . Conclusion Allergic rhinitis is common in children with asthma , and has a major impact on asthma control . The authors hypothesise that recognition and treatment of this condition with nasal corticosteroids may improve asthma control in children , but r and omised clinical trials are needed to test this hypothesis BACKGROUND Subcutaneous allergen-specific immunotherapy ( SIT ) has an early onset of action , whereas repeated injections and safety concerns have limited its use in the pediatric age group . Meanwhile , the improved safety profile of the sublingual route has been accepted as an alternative despite its relatively late onset of action . OBJECTIVE We sought to improve the efficacy and safety of SIT with a combination of the subcutaneous route in the build-up phase and sublingual maintenance in comparison with the sublingual or subcutaneous routes alone . METHODS Fifty-one house dust mite-sensitized children with mild-to-moderate asthma were r and omized into one of 4 groups to receive either ( 1 ) subcutaneous immunotherapy ( SCIT ) , ( 2 ) sublingual immunotherapy ( SLIT ) , ( 3 ) SCIT plus SLIT , or ( 4 ) pharmacotherapy . Clinical parameters were evaluated at baseline and months 1 , 4 , 12 , and 18 . Allergen-specific immunoglobulin levels and allergen-induced IL-5 , IL-10 , IL-13 , IL-17 , TGF-β , and IFN-γ levels were evaluated as well . RESULTS In the SCIT and SCIT plus SLIT groups , the number of asthma attacks and inhaled corticosteroid dosage decreased compared with baseline values at the months 4 , 12 , and 18 but only at month 12 in the SLIT group . The improvement in visual analog scores for rhinitis was significant only in the SCIT plus SLIT group . Increases in the levels of regulatory and T(H)1 cytokines were observed both in the SCIT and SLIT groups , with some differences in dynamics . Antigen-specific IgG(4 ) levels increased in the SCIT and SCIT plus SLIT groups but not in the SLIT group . Clinical symptom scores were correlated positively with IL-5 levels and negatively with antigen-specific IgG(4 ) , IFN-γ , and TGF-β levels . CONCLUSION Our novel regimen of immunotherapy , SCIT plus SLIT , appeared promising in that it successfully combined the advantages of the 2 alternatives : rapid onset and potency in SCIT and safety and avoidance of injections in SLIT Continuing study for a second year and further analysis of a double‐blind placebo controlled trial , already briefly reported , of injections of tyrosine‐adsorbed , glutaraldehyde‐modified Dermatophagoides pteronyssinus antigen in fifty‐one children with perennial asthma and positive bronchial challenge to the antigen , confirms that the patients receiving the treatment reduced their symptomatic medication more than controls , without deterioration of symptoms . Some became symptom‐free , when off all treatment Asthma is the most common chronic disease of childhood . Specific immunotherapy is widely used in several countries for managing allergic asthma . Many clinical trials and a meta- analysis of several studies support its efficacy to reduce the symptoms and medical requirements . The purpose of this study was to clarify the efficacy of subcutaneous immunotherapy ( SCIT ) in improving the symptoms and reducing medication requirements in primary school children with asthma in comparison with pharmacotherapy . A single-blind , drug-controlled clinical trial was performed . A total of 242 primary school children with allergic asthma were included in the study . The patients were recruited from subjects attending the Allergic Center in Mosul City . Their age range was 7 - 12 years with mean age of 10 + /- 2 years . From the total only 197 children ( 81 % ) completed the study and were eligible for analysis , of those , 85 children were managed with SCIT and 112 children were managed with pharmacotherapies only . The follow-up after 1 year indicated that the children treated with SCIT show a marked reduction in the clinical symptoms , medication requirements , and the level of serum-specific IgE when compared with children treated with conventional drugs . SCIT was effective treatment and can prevent or decrease the onset of new sensitization to the offending allergen and maintain its beneficial effect for years after discontinuation Hyposensitisation with Dermatophagoides pteronyssinus tyrosine absorbate in asthmatic children with bronchial sensitivity to D. pteronyssinus  was effective in a 12-month double-blind controlled clinical trial . Compared with controls , treated children used a smaller quantity of drugs while maintaining clinical and lung function improvements . In most children who improved there was no change in immediate response to D. pteronyssinus on bronchial provocation test , but the late reaction was lost in half the patients and these showed the greatest improvement in symptoms UNLABELLED SAFETY and efficacy of sublingual ( sublingual-swallow ) immunotherapy ( IT ) with house dust mite extract were evaluated in 30 children ( 6 - 15 2/3 years of age ) over the first 12 months of an ongoing study . The cumulative dose was 570 micrograms Der p I ( five times that administered with subcutaneous therapy ) . SAFETY One patient on active treatment dropped out after 8 weeks because of a subjective feeling of severe weakness , question ably induced by the therapy . Five patients on active therapy and one patient on placebo reported minor local side effects . EFFICACY Pulmonary symptoms were reduced after 12 months in actively treated asthmatics , but this was not consistent with the lack of improvement in bronchial reactivity , skin sensitivity and specific IgG and IgG4 against D.pt . in this group . In patients with rhinitis  nasal sensitivity was reduced in the placebo group without concomitant improvement in the nasal symptom score . Specific IgE ( D.pt . and D.f . ) increased significantly more in the active treatment group after 3 and 12 months . We conclude that sublingual IT over 12 months with the fivefold Der p 1 dose of subcutaneous IT was well tolerated , but there was no consistent clinical or immunological benefit compared to placebo Background : Especially in childhood , sublingual immunotherapy ( SLIT ) could offer advantages over subcutaneous therapy . However , limited data on its efficacy is available Sublingual immunotherapy has been suggested for the treatment 
    Output:
    