Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
John Cavenagh, PhD, PA-C
OBJECTIVE: The objective of this EBM review is to determine whether the use of intestinal helminths is safe and effective in the treatment of allergic rhinitis.
STUDY DESIGN: Review of three English language, blinded randomized controlled trials from 2009, 2010, and 2010.
DATA SOURCE: Randomized, controlled, blinded trials comparing the use of intestinal helminths versus visually matched placebo as a treatment for allergic rhinitis found using PubMed and Ovid databases.
OUTCOMES MEASURED: Several different systems were used to evaluate the symptoms or occurrence of AR. Bager et al.2010 uses symptom scores of AR scale of 0 to 3. Feary et al.2009 used the Juniper rhinoconjunctivitis quality of life questionnaire. Flohr et al.2010 used the International Study of Asthma and Allergies in Childhood (ISAAC). Mean symptom score and incidence recorded in daily diaries were used for adverse events.
RESULTS: Bager et al.2010 reported a mean difference in symptom scores of AR as 0.0 a t-test produced a p-value of 0.87 with a 95% CI 0.0(-0.5, 0.4). Feary et al.2009 reported no difference between the treatment and control groups (MD 0.33, 95% CI -0.27 to 0.93). No serious adverse events were reported in Bager et al.2010 or Feary et al.2009. There were several gastrointestinal adverse events reported including indigestion, flatus, upper abdominal pain and diarrhea.
Flohr et al.2010 reported a mean difference of 1.39 between experimental and control groups 95% CI (0.89-2.15) with a P-value of 0.1. The relative risk increase of AR was 37% after treatment. Absolute risk increase or AR was 1.8%. The number needed to harm (in this case cause AR after elimination of helminthic infection) was 56 patients.
CONCLUSIONS: The efficacy of intestinal helminths as a treatment for Allergic rhinitis is inconclusive. The P-values comparing the effect of treatment to placebo were not statistically significant. The controlled administration of helminths can be considered safe since there have been no reports of severe adverse events. Mild Gastrointestinal adverse events have been reported. Flohr et al.2010 demonstrates possible protective actions of helminthes but more research is warranted to obtain more conclusive data.
McCalley, Tanner, "Is the Use of Intestinal Helminths Safe and Effective in the Treatment of Allergic Rhinitis?" (2013). PCOM Physician Assistant Studies Student Scholarship. 100.