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      Choosing wisely in Allergology: a Slow Medicine approach to the discipline promoted by the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC)

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          Abstract

          Background

          One of the main problem health care systems are facis is the mis-use and over-use of medical resources (including useless exams, surgical interventions, medical treatments, screening procedures…) which may lead to high health care related costs without increased patients’ benefit and possible harm to the patients themselves. The “Choosing wisely” campaign, in Italy denominated “Doing more does not mean doing better”, tries to educate doctors and citizens at a correct use of medical resources.

          Methods

          the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC) adhered to the “Doing more does not mean doing better” campaing and made a list of the 5 allergological procedures with the highest evidence of inappropriateness.

          Results

          the 5 recommendations were: “Do not perform allergy tests for drugs (including anhestetics) and/or foods when there are neither clinical history nor symptoms suggestive of hypersensitivity reactions”; “Do not perform the so-called “food intolerance tests” (apart from those which are validated for suspect celiac disease or lactose enzymatic intolerance)”; “Do not perform serological allergy tests (i.e.: total IgE, specific IgE, ISAC) as first-line tests or as “screening” assays”; “Do not treat patients sensitized to allergens or aptens if there is not a clear correlation between exposure to that specific allergen/apten and symptoms suggestive of allergic reaction”; “Do not diagnose asthma without having performed lung function tests”.

          Conclusions

          An important role scientific societies should play is to advise on correct diagnostic and therapeutical pathways. For this reason SIAAIC decided to adhere to the Slow Medicine Italy campaign “Doing more does not mean doing better” with the aim of warning the scientific community and the citizens/patients about some allergological procedures, which, when performed in the wrong clinical setting, may be not only useless, but unnecessarily expensive and even harmful for patients’ health.

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          Most cited references37

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          'Choosing Wisely': a growing international campaign.

          Much attention has been paid to the inappropriate underuse of tests and treatments but until recently little attention has focused on the overuse that does not add value for patients and may even cause harm. Choosing Wisely is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments and procedures. The campaign began in the United States in 2012, in Canada in 2014 and now many countries around the world are adapting the campaign and implementing it. This article describes the present status of Choosing Wisely programs in 12 countries. It articulates key elements, a set of five principles, and describes the challenges countries face in the early phases of Choosing Wisely. These countries plan to continue collaboration including developing metrics to measure overuse.
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            General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis

            Objectives To quantify the benefits and harms of general health checks in adults with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes. Design Cochrane systematic review and meta-analysis of randomised trials. For mortality, we analysed the results with random effects meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible. Data sources Medline, EMBASE, Healthstar, Cochrane Library, Cochrane Central Register of Controlled Trials, CINAHL, EPOC register, ClinicalTrials.gov, and WHO ICTRP, supplemented by manual searches of reference lists of included studies, citation tracking (Web of Knowledge), and contacts with trialists. Selection criteria Randomised trials comparing health checks with no health checks in adult populations unselected for disease or risk factors. Health checks defined as screening general populations for more than one disease or risk factor in more than one organ system. We did not include geriatric trials. Data extraction Two observers independently assessed eligibility, extracted data, and assessed the risk of bias. We contacted authors for additional outcomes or trial details when necessary. Results We identified 16 trials, 14 of which had available outcome data (182 880 participants). Nine trials provided data on total mortality (11 940 deaths), and they gave a risk ratio of 0.99 (95% confidence interval 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (4567 deaths), risk ratio 1.03 (0.91 to 1.17), and eight on cancer mortality (3663 deaths), risk ratio 1.01 (0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings. We did not find beneficial effects of general health checks on morbidity, hospitalisation, disability, worry, additional physician visits, or absence from work, but not all trials reported on these outcomes. One trial found that health checks led to a 20% increase in the total number of new diagnoses per participant over six years compared with the control group and an increased number of people with self reported chronic conditions, and one trial found an increased prevalence of hypertension and hypercholesterolaemia. Two out of four trials found an increased use of antihypertensives. Two out of four trials found small beneficial effects on self reported health, which could be due to bias. Conclusions General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although they increased the number of new diagnoses. Important harmful outcomes were often not studied or reported. Systematic review registration Cochrane Library, doi:10.1002/14651858.CD009009.
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              Allergy Diagnostic Testing: An Updated Practice Parameter

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                Author and article information

                Contributors
                +39 095 3781185 , heffler.enrico@gmail.com
                landi@alma.it
                silvana.quadrino@gmail.com
                cristoforo.incorvaia@gmail.com
                pizzimentistefano@gmail.com
                sandra.vernero@ausl.bologna.it
                crimi@unict.it
                grolla@mauriziano.it
                canonica@unige.it
                Journal
                Clin Mol Allergy
                Clin Mol Allergy
                Clinical and Molecular Allergy : CMA
                BioMed Central (London )
                1476-7961
                20 November 2015
                20 November 2015
                2015
                : 13
                : 28
                Affiliations
                [ ]Department of Clinical and Experimental Medicine, Respiratory Medicine and Allergy, University of Catania, Catania, Italy
                [ ]Pediatrician Primary Care, Turin, Italy
                [ ]“Change” Institute, Turin, Italy
                [ ]Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy
                [ ]ASL-TO3, Allergy Outpatients’ Clinic, “Edoardo Agnelli” Hospital, Pinerolo, TO Italy
                [ ]“Slow Medicine Italy”, Turin, Italy
                [ ]Department of Medical Sciences, Allergy and Clinical Immunology, University of Torino, Turin, Italy
                [ ]Allergy and Respiratory Diseases Clinic, DIMI-Department of Internal Medicine, IRCCS AOU S.Martino-IST, Genoa, Italy
                Article
                34
                10.1186/s12948-015-0034-8
                4653937
                6d48741c-37a1-48d2-a4e7-2d387c2bc2bb
                © Heffler et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 29 July 2015
                : 28 September 2015
                Categories
                Research
                Custom metadata
                © The Author(s) 2015

                Immunology
                allergy,slow medicine,chossing wisely,appropriateness,asthma,food allergy
                Immunology
                allergy, slow medicine, chossing wisely, appropriateness, asthma, food allergy

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