xRead - Olfactory Disorders (September 2023)

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573

PATEL et al.

TABLE IX-17 Evidence for AR-related olfactory loss management with immunotherapy therapy Study Year LOE Study design Study groups Clinical end point

Conclusions

Limited evidence that immunotherapy improves sense of smell baseline there was significant improvement on SS baseline, there was significant improvement in subjective symptom score baseline, there was significant improvement in subjective symptom score baseline, there was significant improvement in subjective symptom score Superior to placebo Compared with Compared with Compared with Compared with

Subjective symptom score SS-TDI

Stuck

2015

1

Systematic review Mixed AR

et al 225

1 RCT and 4 cohort studies

Tansuker et al 1371

2014

4

Case series

MixedAR(n = 12) SCIT

SS-TDI

Mun

2013

4

Case series

MixedAR(n = 153) SLIT

Subjective symptom score

et al 1372

Kataotomichelakis et al 1373

2013

4

Case series

MixedAR(n = 36)

SS-TDI

Chang

2009

4

Case series

MixedAR(n = 142) SLIT

Subjective symptom score

et al 1374

Radcliff

1996

2

RCT

AR(n = 36) SCIT Placebo

Subjective symptom score

et al 1375

AR = allergic rhinosinusitis; LOE = level of evidnce; RCT = randomized controlled trial; SCIT = subcutaneous immunotherapy; SLIT = sublingual immunother apy; SS = Sniffin’ Sticks; SS-TDI = SS-TDI = Sniffin’ Sticks threshold, discrimination, identification combination.

training in patients with OD related to neurodegenerative diseases. Policy level :Option. Intervention : Consider smell training in patients with OD related to neurodegenerative disease given very low risk. Medical therapy for OD in intracranial disease–, neurochemistry/neurotransmitter imbalance–, and neurodegenerative disease–related disease Aggregate grade of evidence : C (Level 2: one study; Level 3: one study; Level 4: two studies). Benefit : One case report notes improvement in sub jective measures of olfaction in patients with dysomias with olanzapine. Two studies with objective data with mixed results. One study notes stabilization of UPSIT R in patients with PD with an aerobic exercise program. Over all, data are limited. Harm : Olanzapine carries a black box warning of increased risk of stroke and death in elderly patients. Cost :

Direct: Moderate monetary cost that varies based on insurance provider. Indirect: Low. Benefits-harm assessment : Unclear given lack of data. Value judgments :None. Policy level : No recommendation. Intervention : No recommendation can be made for patients with postiatrogenic anosmia, PD, olfactory refer ence syndrome, or dysosmias given a lack of clear benefit and risks associated with prescription medicine. Aerobic stationary bicycle exercise can be recommended to patients with PD for many reasons and may slow the decline of smell loss. E Treatment of other underlying systemic disease states One of the less discussed areas of OD is the manage ment of OD because of underlying systemic diseases. In