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Background: Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice. Objective: To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management. Materials and methods: Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations. Results: The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients' needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations. Conclusions: This innovative CPG methodology was guided by patients' perspectives, clinical evidence as well as ethical and other rationales. This allowed for the creation of a broad set of recommendations that chart optimal clinical practice and define the conditions required to bring about changes to food allergy care that will be sustainable, equitable and conducive to the well-being of all patients in need. [ABSTRACT FROM AUTHOR]

SUMMARY Objective The objective of this study is to evaluate the economic benefits of immunoglobulin replacement therapy achieved subcutaneously (subcutaneous immunoglobulin, SCIG) by the rapid push method compared to intravenous infusion therapy (intravenous immunoglobulin, IVIG) in primary immune deficiency ( PID) patients from the healthcare system perspective in the context of the adult SCIG home infusion program based at St Paul's Hospital, Vancouver, Canada. Materials and methods SCIG and IVIG options were compared in cost-minimisation and budget impact models (BIMs) over 3 years. Sensitivity analyses were performed for both models to evaluate the impact of varying modality of IVIG treatments and proportion of patients switching from IVIG to SCIG. Results The cost-minimisation model estimated that SCIG treatment reduced cost to the healthcare system per patient of $5736 over 3 years, principally because of less use of hospital personnel. This figure varied between $5035 and $8739 depending on modality of IVIG therapy. Assuming 50% of patients receiving IVIG switched to SCIG, the BIM estimated cost savings for the first 3 years at $1·308 million or 37% of the personnel and supply budget. These figures varied between $1·148 million and $2·454 million (36 and 42%) with varying modalities of IVIG therapy. If 75% of patients switched to SCIG, the reduced costs reached $1·962 million or 56% of total budget. Conclusion This study demonstrated that from the health system perspective, rapid push home-based SCIG was less costly than hospital-based IVIG for immunoglobulin replacement therapy in adult PID patients in the Canadian context. [ABSTRACT FROM AUTHOR]

Butter fat was interesterified in a cosurfactant-free microemulsion system containing nonionic and ionic surfactants, using commercial lipase obtained from Rhizopus niveus, at different concentrations of surfactant mixtures and hydrophilic-lipophilic balance (HLB) values. The results indicated that the interesterification yield (IY) of lipasecatalyzed interesterified butter fat reached its maximum in the microemulsion system prepared with the surfactant mixture of HLB value of 9, followed by that of HLB value of 10. In addition, increasing concentrations of surfactant mixtures, from 3 to 6 mM, resulted by an increase in the IY. The interesterification of butter fat in the microemulsion prepared with 3 mM of surfactant mixture of HLB value of 10 showed a minimum hydrolytic activity. The results showed that the interesterified selected triacylglycerol molecules were enriched with the hypocholesterolemic fatty acid C18:l, originally located on sn-1,3 positions, on their sn-2 positions; this fatty acid was favorably interchanged with the hypercholesterolemic fatty acid C16:0, originally located on sn-2 position. The results also indicated that the use of 6 mM of surfactant mixtures increased the acyl exchange reaction toward the long-chain saturated fatty acid C16:0 on the sn-2 position of triacylglycerol molecules. [ABSTRACT FROM AUTHOR]

The partially purified chlorophyllase, obtained from the alga Phaeodactylum tricornutum, was further purified by preparative native gel electrophoresis. The purification procedure provided the recovery of large amounts of a single purified chlorophyllase fraction. However, the electrophoretic analyses of the purified enzymatic fraction under denaturing conditions demonstrated the presence of two bands with mol wt of 43 ±3 and 46 ±3 kDa. The purification procedure resulted in 2-and 195-fold increases in chlorophyllase activity compared to that of the partially purified and crude enzymatic extracts, respectively. The optimum pH for chlorophyllase hydrolytic activity was found to be 8.0. The optimum incubation time and temperature for the hydrolytic activity of the purified chlorophyllase were found to be 2 h and 31°C, respectively. The optimum concentrations of magnesium chloride and dithiothreitol, used as activators, were 4 and 5 mM, respectively. The addition of individual plant membrane lipids, including phosphatidylcholine, phosphatidylglycerol, and β-carotene, to the reaction media increased the enzyme activity markedly. The purified enzyme fraction displayed preferential specificity toward selective substrates with an order of activity as follows: purified chlorophyll b > purified chlorophyll a > partially purified chlorophyll > crude chlorophyll. Diisopropyl fluorophosphate and phytol, respectively, showed noncompetitive and competitive inhibitory effects on chlorophyllase activity with K, values of 0.78 mM and 3.75 μM, respectively. [ABSTRACT FROM AUTHOR]