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Spoto G, Accetta AS, Grella M, Di Modica I, Nicotera AG, Di Rosa G. Respiratory Comorbidities and Complications of Cerebral Palsy. Dev Neurorehabil 2024; 27:194-203. [PMID: 38992903 DOI: 10.1080/17518423.2024.2374959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 04/29/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Respiratory complications are the most frequent cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP) and represent the leading cause of hospitalizations. Several factors negatively influence the respiratory status of these children: lung parenchymal alterations and factors modifying the pulmonary pump function of chest and respiratory muscles, as well as concomitant pathologies that indirectly affect the respiratory function, such as sleep disorder, malnutrition, epilepsy, and pharmacological treatments. Early management of respiratory complications can improve the global health of children with CP and enhance quality of life for them and their caregivers.
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Mei M, Dai D, Guo Z, Zhang C, Liu J, Qi Y, Wang X, Wang L, Qian L. Underlying causes and outcomes of recurrent pneumonia in hospitalized children. Pediatr Pulmonol 2023; 58:1674-1682. [PMID: 36919525 DOI: 10.1002/ppul.26374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To describe the clinical characteristics and underlying causes of recurrent pneumonia (RP) among hospitalized children, and to identify risk factors associated with adverse outcomes. METHODS We reviewed the medical records of hospitalized children diagnosed with RP at the Children's Hospital of Fudan University from January 2016 to January 2021 and then described clinical characteristics and underlying causes. The associations between factors and adverse outcomes were assessed using logistic regression. RESULTS Of 551 children with RP, 483 (87.7%) manifested underlying causes, with recurrent aspiration (127, 23.0%), primary immunodeficiency (PID) (91, 16.5%), and congenital heart diseases (63, 11.4%) being the most common. Genetic defects were identified in about a quarter (158, 28.7%) of the patients. PID odds ratio (OR, 7.9; 95% confidence interval [CI], 2.8-22.8), primary ciliary dyskinesia (OR, 12.9; 95% CI, 3.0-54.8), bronchiolitis obliterans (OR, 7.0; 95% CI, 1.7-28.5), and a diagnosis of RP at an age of >3 years (OR, 3.4; 95% CI, 1.3-9.0) were risk factors for severe outcomes. Aspiration (OR, 2.9; 95% CI, 1.3-6.3) and an abnormal family history (OR, 3.3; 95% CI, 1.3-8.2) were risk factors for rehospitalization. CONCLUSIONS The majority (87.7%) of hospitalized children with RP exhibited underlying causes, and genetic defects were common.
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Affiliation(s)
- Mei Mei
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Dan Dai
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Zhuoyao Guo
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Congcong Zhang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Jing Liu
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanyuan Qi
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaochuan Wang
- Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai, China
| | - Libo Wang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Liling Qian
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
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A Brief Review of Local Bacteriotherapy for Preventing Respiratory Infections. ALLERGIES 2022. [DOI: 10.3390/allergies2040013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Recurrent respiratory infections (RRIs) account for relevant economic and social implications and significantly affect family life. Local Bacteriotherapy (LB) represents an innovative option in preventing RRIs. Local bacteriotherapy consists of administering “good” and safe bacteria (probiotics) by nasal or oral route. In particular, two strains (Streptococcus salivarius 24SMB and Streptococcus oralis 89a) are commonly used. The present article presents and discusses the literature concerning LB. Infections of airways include the upper and lower respiratory tract. A series of clinical trials investigated the preventive role of LB in preventing upper and lower RIs. These studies demonstrated that LB safely reduced the prevalence and severity of RIs, the use of antibiotics, and absences from school. Therefore, Local Bacteriotherapy may be considered an interesting therapeutic option in RRI prevention.
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Torretta S, Rosazza C, Baselli L, Berti C, Bosi P, Dellepiane RM, Folino F, Milani GP, Marchisio P. Immunological profiles of children with recurrent otitis media with or without spontaneous tympanic membrane perforation and of children with recurrent respiratory infections. Int J Pediatr Otorhinolaryngol 2022; 160:111219. [PMID: 35835031 DOI: 10.1016/j.ijporl.2022.111219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/15/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The primary aim of this study was to compare the immunological profiles of children affected by recurrent acute otitis media (rAOM) with and without spontaneous tympanic membrane perforation (STMP). The secondary aim was to compare immunological features of children without parameters outside the normal range and affected by either rAOM or recurrent respiratory tract infections (rRTI). METHODS In this study, otherwise healthy children (<10 years of age) with rAOM or rRTI were included. Data on perinatal history, vaccination status, presence of risk factors for rAOM or rRTI (including personal or family history of allergy) and number of infectious episodes in the previous 12 months were retrospectively obtained. Furthermore, data on immunological profile (blood cell count, circulating IgA, IgG, IgM and total IgE, IgG subclasses and lymphocyte subpopulations) were collected. The immune profile of children affected by rAOM with and without STMP were compared. Among children with parameters within normal range, we compared the levels of the immunological parameters of children affected by rAOM (with and without STMP) and rRTI. RESULTS The study involved a total of 751 children: 566 (75.3%) with rAOM and 185 (24.7%) with rRTI. Among the 566 children with rAOM, 39.7% had uncomplicated rAOM and 60.3% had rAOM with STMP. The mean age of the study population was 34.9 (SD 20.5) months. The frequency of children with parameters outside the normal range was similar among children with rAOM with (4.9%) and without STMP (6.1%). Among subjects without parameters outside the normal range, children with uncomplicated rAOM had significantly lower serum IgG, lymphocyte CD8+ and CD19+ and significantly higher IgG2 levels than children affected by rAOM with STMP. Finally, children with rAOM had lower levels of IgA, IgM and IgG2 and higher levels of IgG, lymphocyte CD19+ and CD16/56+ compared to children with rRTI. CONCLUSIONS A low (<6.5%) percentage of children with rAOM with or without STMP present parameters outside the normal range. Among subjects without parameters outside the normal range, children with uncomplicated rAOM have a different immune profile as compared to those with STMP and rRTI. New prospective studies are needed to further explore the immune features of children affected by rAOM with and without STMP.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Chiara Rosazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, Milan, Italy
| | - Lucia Baselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Intensive Care Unit, Milan, Italy
| | - Cristiana Berti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Intensive Care Unit, Milan, Italy
| | | | - Rosa Maria Dellepiane
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Intensive Care Unit, Milan, Italy
| | - Francesco Folino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Gregorio Paolo Milani
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatri Unit, Milan, Italy.
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, Milan, Italy; University of Milan, Milan, Department of Pathophysiology and Transplantation, Italy
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Berber A, Del-Río-Navarro BE, Reyes-Noriega N, Sienra-Monge JJL. Immunostimulants for preventing respiratory tract infection in children: A systematic review and meta-analysis. World Allergy Organ J 2022; 15:100684. [PMID: 36185547 PMCID: PMC9483654 DOI: 10.1016/j.waojou.2022.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Childhood acute respiratory tract infections (ARTIs) are a significant cause of morbidity and mortality, so, immunostimulants have been used as a preventative measure. Despite this, there is no updated evidence regarding the safety and efficacy of immunostimulant drugs for this purpose. This study aimed to determine the effectiveness and safety of immunostimulants in preventing ARTIs in children based on the most recent scientific evidence. Data sources such as PubMed, Cochrane Central Register of Controlled Trials, Embase, Google Scholar, and Scopus were searched from 1965 to 10 January 2022 to identify randomized controlled trials (RCTs) comparing immunostimulants administered by any method, with placebo to prevent ARTIs on children under 18 years of age without immunodeficiencies, anatomical, genetic, or allergic conditions. In order to analyze data from the studies, we used Review Manager 5.4 (The Cochrane Collaboration, 2020), assessed the certainty of the evidence with Grading of Recommendations, Assessment, Development and Evaluations (GRADE), and assessed the quality and risk of bias of the studies using the RoB tool 1.0. Further, outcomes were combined and analyzed using meta-analysis, subgroup analysis, and sensitivity analysis. Throughout the review, we included 72 placebo-controlled clinical trials involving 12,229 children. The meta-analyses, however, included only 38 studies (52.8%) with 4643 children (38% of the total) with data on mean number of ARTIs. These studies demonstrated a reduction in the ARTIs (MD –1.12 [95%CI –1.39 to −0.85]) and ratio of means of ARTIs (0.61 [95%CI 0.54–0.69]), corresponding to a percentage reduction of 39% (95%CI, 46%–31%) with moderate-quality data. Nevertheless, since there was considerable to substantial heterogeneity and bias was unclear in all domains in 32 out of 72 trials, the quality of the evidence for efficacy was deemed low. Only 14 trials reported adverse events. The review indicates that immunostimulants reduce the incidence of ARTIs by 40% on average in susceptible children, despite low-quality evidence, heterogeneity, and the possibility of publication bias. However, further studies are needed to establish immunostimulants' safety and efficacy profiles. This review was conducted without the support of any funding and has no registered number.
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Affiliation(s)
- Arturo Berber
- External Collaborator of the Hospital Infantil de México Federico Gómez, Mexico
| | | | - Nayely Reyes-Noriega
- Allergy and Immunology Department of the Hospital Infantil de México Federico Gómez, Mexico
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Abdelkader A, Wahba AA, El-tonsy M, Zewail AA, Shams Eldin M. Recurrent respiratory infections and vitamin A levels: a link? It is cross-sectional. Medicine (Baltimore) 2022; 101:e30108. [PMID: 35984160 PMCID: PMC9388016 DOI: 10.1097/md.0000000000030108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Respiratory tract infections are common illnesses in children, causing significant morbidity and negatively affecting their health. Vitamin A protects against infections and maintains epithelial integrity. The goal of this study was to determine the correlation between vitamin A deficiency and recurrent respiratory tract infections (RRTIs). Participants in this cross-sectional study were divided into 3 groups: RRTIs (including patients with history of RRTIs presenting with respiratory tract infection symptoms), RTI (including patients without history of RRTIs presenting with respiratory tract infection symptoms), and control (including children who came for a routine health checkup without a history of RRTIs or respiratory tract infection symptoms). The vitamin A assay was performed using high-performance liquid chromatography. The study included 550 children aged 6.64 ± 2.61 years. The RRTIs group included 150 children (27.3%), the RTI group included 300 children (54.5%), and the control group included 100 children (18.2%). Subclinical vitamin A deficiency and vitamin A deficiency affected 3.1% and 1.3% of subjects, respectively. Subclinical vitamin A deficiency and vitamin A deficiency were higher in children with RRTIs than in those with RTI (8% vs 1.3%, P = .001 and 4% vs 0.3%, P = .006). Additionally, children with RRTIs had significantly higher rates of subclinical vitamin A deficiency and vitamin A deficiency than those in the control group, which had 1% subclinical vitamin A deficiency (P = .017) and no cases of vitamin A deficiency (P = .043). The RRTIs group had higher rates of otitis media (27.3%), sinusitis (20%), and pneumonia (4.7%) than the RTI group (P = .002). Vitamin A insufficiency was associated with RRTIs in children.
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Affiliation(s)
- Ashraf Abdelkader
- Department of Pediatrics, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt
- Scientific Research and Continuous Medical Education Unit, Al Ansari Specialist Hospital, Yanbu, Saudi Arabia
- *Correspondence: Ashraf Abdelkader, Faculty of Medicine for Boys, Al-Azhar University, Al mokhaym Aldaem street, Nasr City, Cairo 11751, Egypt (E-mail: )
| | - Ashraf A. Wahba
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed El-tonsy
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | | | - Mohamed Shams Eldin
- Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Zama D, Totaro C, Biscardi L, Rocca A, Turroni S, Brigidi P, Lanari M. The Relationship between Gut Microbiota and Respiratory Tract Infections in Childhood: A Narrative Review. Nutrients 2022; 14:nu14142992. [PMID: 35889952 PMCID: PMC9323999 DOI: 10.3390/nu14142992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
Respiratory tract infections (RTIs) are common in childhood and represent one of the main causes of hospitalization in this population. In recent years, many studies have described the association between gut microbiota (GM) composition and RTIs in animal models. In particular, the “inter-talk” between GM and the immune system has recently been unveiled. However, the role of GM in human, and especially infantile, RTIs has not yet been fully established. In this narrative review we provide an up-to-date overview of the physiological pathways that explain how the GM shapes the immune system, potentially influencing the response to common childhood respiratory viral infections and compare studies analysing the relationship between GM composition and RTIs in children. Most studies provide evidence of GM dysbiosis, but it is not yet possible to identify a distinct bacterial signature associated with RTI predisposition. A better understanding of GM involvement in RTIs could lead to innovative integrated GM-based strategies for the prevention and treatment of RTIs in the paediatric population.
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Affiliation(s)
- Daniele Zama
- Paediatric Emergency Unit, IRCCS Ospedale Maggiore Policlinico Sant’Orsola, Department of Medicine and Surgery, University of Bologna, 40138 Bologna, Italy; (D.Z.); (A.R.); (M.L.)
| | - Camilla Totaro
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
| | - Lorenzo Biscardi
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-2144231
| | - Alessandro Rocca
- Paediatric Emergency Unit, IRCCS Ospedale Maggiore Policlinico Sant’Orsola, Department of Medicine and Surgery, University of Bologna, 40138 Bologna, Italy; (D.Z.); (A.R.); (M.L.)
| | - Silvia Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.T.); (P.B.)
| | - Patrizia Brigidi
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (S.T.); (P.B.)
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS Ospedale Maggiore Policlinico Sant’Orsola, Department of Medicine and Surgery, University of Bologna, 40138 Bologna, Italy; (D.Z.); (A.R.); (M.L.)
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8
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Inchingolo AD, Malcangi G, Semjonova A, Inchingolo AM, Patano A, Coloccia G, Ceci S, Marinelli G, Di Pede C, Ciocia AM, Mancini A, Palmieri G, Barile G, Settanni V, De Leonardis N, Rapone B, Piras F, Viapiano F, Cardarelli F, Nucci L, Bordea IR, Scarano A, Lorusso F, Palermo A, Costa S, Tartaglia GM, Corriero A, Brienza N, Di Venere D, Inchingolo F, Dipalma G. Oralbiotica/Oralbiotics: The Impact of Oral Microbiota on Dental Health and Demineralization: A Systematic Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1014. [PMID: 35883998 PMCID: PMC9323959 DOI: 10.3390/children9071014] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 12/17/2022]
Abstract
The oral microbiota plays a vital role in the human microbiome and oral health. Imbalances between microbes and their hosts can lead to oral and systemic disorders such as diabetes or cardiovascular disease. The purpose of this review is to investigate the literature evidence of oral microbiota dysbiosis on oral health and discuss current knowledge and emerging mechanisms governing oral polymicrobial synergy and dysbiosis; both have enhanced our understanding of pathogenic mechanisms and aided the design of innovative therapeutic approaches as ORALBIOTICA for oral diseases such as demineralization. PubMed, Web of Science, Google Scholar, Scopus, Cochrane Library, EMBEDDED, Dentistry & Oral Sciences Source via EBSCO, APA PsycINFO, APA PsyArticles, and DRUGS@FDA were searched for publications that matched our topic from January 2017 to 22 April 2022, with an English language constraint using the following Boolean keywords: ("microbio*" and "demineralization*") AND ("oral microbiota" and "demineralization"). Twenty-two studies were included for qualitative analysis. As seen by the studies included in this review, the balance of the microbiota is unstable and influenced by oral hygiene, the presence of orthodontic devices in the oral cavity and poor eating habits that can modify its composition and behavior in both positive and negative ways, increasing the development of demineralization, caries processes, and periodontal disease. Under conditions of dysbiosis, favored by an acidic environment, the reproduction of specific bacterial strains increases, favoring cariogenic ones such as Bifidobacterium dentium, Bifidobacterium longum, and S. mutans, than S. salivarius and A. viscosus, and increasing of Firmicutes strains to the disadvantage of Bacteroidetes. Microbial balance can be restored by using probiotics and prebiotics to manage and treat oral diseases, as evidenced by mouthwashes or dietary modifications that can influence microbiota balance and prevent or slow disease progression.
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Affiliation(s)
- Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Alexandra Semjonova
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giovanni Coloccia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Sabino Ceci
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Chiara Di Pede
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Anna Maria Ciocia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giulia Palmieri
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giuseppe Barile
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Vito Settanni
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Nicole De Leonardis
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Biagio Rapone
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Fabio Viapiano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Filippo Cardarelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 6, 80138 Naples, Italy;
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy; (A.S.); (F.L.)
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy; (A.S.); (F.L.)
| | - Andrea Palermo
- Implant Dentistry College of Medicine and Dentistry Birmingham, University of Birmingham, Birmingham B46BN, UK;
| | - Stefania Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, 98125 Messina, Italy;
| | - Gianluca Martino Tartaglia
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy;
- Department of Orthodontics, Faculty of Medicine, University of Milan, 20100 Milan, Italy
| | - Alberto Corriero
- Unit of Anesthesia and Resuscitation, Department of Emergencies and Organ Transplantations, Aldo Moro University, 70124 Bari, Italy; (A.C.); (N.B.)
| | - Nicola Brienza
- Unit of Anesthesia and Resuscitation, Department of Emergencies and Organ Transplantations, Aldo Moro University, 70124 Bari, Italy; (A.C.); (N.B.)
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
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9
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Xu B, Li X, Hu S, Bao Y, Chen F, Chen Z, Du Y, Liu E, Liu Y, Mou Q, Su B, Wang B, Xu J, Xu G, Yang Q, Gao L, Liu X, Li L, Ma R, Shen K. Safety and efficacy of Yupingfeng granules in children with recurrent respiratory tract infection: A randomized clinical trial. Pediatr Investig 2022; 6:75-84. [PMID: 35774519 PMCID: PMC9218971 DOI: 10.1002/ped4.12326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
Importance Recurrent respiratory tract infection (RRTI) is common in children. Inappropriate RRTI treatment will lead to asthma and other diseases, thereby seriously affecting the growth and physical health of children. Immune function modulation can prevent and alleviate childhood RRTI. Yupingfeng (YPF), a patented traditional Chinese medicine (TCM), has immunomodulatory effects and is widely used in China to treat children with RRTI. Objective To evaluate the safety and efficacy of YPF monotherapy in treating children with RRTI. Methods This multicenter, randomized, double-blind, double-simulation, noninferiority clinical trial was conducted from January 2015 to August 2017, with an 8-week treatment period and 52-week follow-up after the drug withdrawal. Children aged 2-6 years with RRTI meeting the inclusion and exclusion criteria were enrolled in 13 hospitals in China and divided randomly into three groups (2:2:1 ratio) to receive YPF, pidotimod, or placebo. The primary outcome was the proportion of RRTI returning to normal standard level during the follow-up. The secondary outcomes were reduction in the number of RRTI recurrences, effect on clinical symptoms (in accord with TCM practice), effect per symptom, and safety. The trial was registered at the Chinese Clinical Trials Registry (www.chictr.org.cn) under the unique identifier ChiCTR-IPR-15006847. Results Three hundred and fifty-one children were enrolled and randomly assigned to 3 groups; 124, 125, and 61 children in the YPF, pidotimod, and placebo groups, respectively, had completed the trial. During the follow-up, the proportion of RRTI returning to normal standard level was 73.13%, 67.15%, and 38.81% with YPF, pidotimod, and placebo, respectively (P < 0.0001). The proportion of cases who returned to normal standard level in the YPF group was 34.32% higher than that in the placebo group. The safety profile did not significantly differ among the groups. Interpretation YPF granules were noninferior to the active control drug pidotimod oral solution for the treatment of RRTI in children, and were superior to placebo, with a high safety profile.
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Affiliation(s)
- Baoping Xu
- China National Clinical Research Center of Respiratory DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Xinmin Li
- The First Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Siyuan Hu
- The First Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Yixiao Bao
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Fengmei Chen
- Guangdong Women and Children Hospital and Health InstituteGuangzhouGuangdongChina
| | - Zhimin Chen
- Children's Hospital of Zhejiang University School of MedicineZhejiangChina
| | - Yonggang Du
- Changzhi People's HospitalChangzhiShanxiChina
| | - Enmei Liu
- Children's Hospital of Chongqing Medical UniversityChongqingChina
| | - Yufeng Liu
- The Fourth Affiliated Hospital of Liaoning University of Traditional Chinese MedicineShenyangLiaoningChina
| | - Qinghui Mou
- Qilu Children's Hospital of Shandong UniversityJinanShandongChina
| | - Baoling Su
- Heji Hospital Affiliated to Changzhi Medical CollegeChangzhiShanxiChina
| | - Bo Wang
- Guangdong Women and Children Hospital and Health InstituteGuangzhouGuangdongChina
| | - Jianwen Xu
- The Third Affiliated Hospital of Xinxiang Medical CollegeXinxiangHenanChina
| | - Guiping Xu
- Huizhou Traditional Chinese Medicine HospitalGuangdongChina
| | | | - Liwei Gao
- China National Clinical Research Center of Respiratory DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Xiaohui Liu
- Beijing Children's Hospital, Capital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Lei Li
- Drug Research and Evaluation Technology CenterChinese Association of Traditional Chinese MedicineBeijingChina
| | - Rong Ma
- The First Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Kunling Shen
- China National Clinical Research Center of Respiratory DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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10
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Rennerova Z, Picó Sirvent L, Carvajal Roca E, Paśnik J, Logar M, Milošević K, Majtan J, Jesenak M. Beta-(1,3/1,6)-D-glucan from Pleurotus ostreatus in the prevention of recurrent respiratory tract infections: An international, multicentre, open-label, prospective study. Front Pediatr 2022; 10:999701. [PMID: 36324817 PMCID: PMC9619242 DOI: 10.3389/fped.2022.999701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Preschool children are particularly susceptible to recurrent upper and lower respiratory tract infections due to their immune immaturity and other contributing factors. Preventing and/or treating children suffering from recurrent respiratory tract infections (RRTIs) is challenging, and it is important to provide more clinical evidence about the safety and efficacy of natural immunomodulating preparations, including β-glucans. The aim of the present study was to assess the incidence of respiratory tract infections (RTIs) in children with a history of RRTIs for a period of 6 months (3 months of pleuran supplementation and 3 months of follow-up) compared with the same period from October to March of the previous year prior to enrolment in the study. A total of 1,030 children with a mean age of 3.49 ± 1.91 years from seven countries were included in this study. The total number of RTIs observed during the study period was significantly lower compared to the same period of the previous year (7.07 ± 2.89 vs. 3.87 ± 3.19; p < 0.001). Analysis of each type of RTI revealed significant reductions in the mean number and duration of infections for all RTI subtypes compared to the previous year. This study also confirmed the beneficial safety profile of pleuran supplementation. In conclusion, pleuran supplementation represents an interesting and prospective supplement in preventing respiratory infections and reveals new strategies for supporting immune functions in the paediatric population.
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Affiliation(s)
- Zuzana Rennerova
- Department of Paediatric Pulmonology and Phthisiology, Faculty of Medicine, Slovak Medical University, National Children Institute of Health, Bratislava, Slovakia
| | - Leandro Picó Sirvent
- Paediatrics Department, Hospital de la Salud, Valencia, Spain.,Faculty of Medicine and Health Sciences, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | - Eva Carvajal Roca
- Paediatrics Department, Hospital de la Salud, Valencia, Spain.,Faculty of Medicine and Health Sciences, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
| | | | - Mateja Logar
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.,Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Milošević
- Department of Pulmonology and Allergology, University Children's Hospital, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Juraj Majtan
- Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia.,Department of Microbiology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Milos Jesenak
- Department of Paediatrics, Jessenius Faculty of Medicine, University Teaching Hospital in Martin, Comenius University in Bratislava, Martin, Slovakia.,Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovakia
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11
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Wang X, Li X, Jin C, Bai X, Qi X, Wang J, Zhang L, Li N, Jin N, Song W, Gao H, Gao B, Zhang Y, Wang L. Association Between Serum Vitamin A Levels and Recurrent Respiratory Tract Infections in Children. Front Pediatr 2021; 9:756217. [PMID: 35004539 PMCID: PMC8740126 DOI: 10.3389/fped.2021.756217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
To evaluate the association between serum vitamin A levels and the prevalence of recurrent respiratory tract infections (RRTIs) in children and adolescents and to provide evidence that would help decrease the prevalence of respiratory tract infections (RTIs) in children. This cross-sectional study included 8034 children and adolescents in Beijing aged 6 months to 17 years. RRTI and RTI symptoms were diagnosed according to the Clinical Concept and Management of Recurrent Respiratory Tract Infections in Children. Multivariate logistic regression models were used to evaluate the association between serum vitamin A levels and RRTIs after adjusting for potential confounders. Among the included children, 721 (8.97%) were diagnosed with vitamin A deficiency, whereas 3,073 (38.25%) were diagnosed with subclinical vitamin A deficiency. Only 28.8% (208/721) of children with vitamin A deficiency and 53.1% (1,631/3,073) of children with subclinical vitamin A deficiency had no RRTI and RTI symptoms, respectively. Compared with children with normal vitamin A levels, those with vitamin A deficiency and subclinical vitamin A deficiency had a greater risk for RRTIs, with an odds ratio (OR) of 6.924 [95% confidence interval (CI): 5.433-8.824] and 2.140 (95% CI: 1.825-2.510), respectively]. Vitamin A levels were also positively associated with RTI symptoms, with those having vitamin A deficiency and subclinical vitamin A deficiency showing an OR of 1.126 (95% CI: 0.773-1.640) and 1.216 (95% CI: 1.036-1.427), respectively. The present cross-sectional study found that low serum vitamin A levels were significantly associated with RRTI or RTI prevalence in children and adolescents.
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Affiliation(s)
- Xiaoyan Wang
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Xingming Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Chunhua Jin
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Xinyuan Bai
- School of Public Health, Capital Medical University, Beijing, China
| | - Xinran Qi
- School of Public Health, Capital Medical University, Beijing, China
| | - Jianhong Wang
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Lili Zhang
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Na Li
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Na Jin
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Wenhong Song
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Haitao Gao
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Baojun Gao
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Yue Zhang
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Lin Wang
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
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12
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Chiappini E, Santamaria F, Marseglia GL, Marchisio P, Galli L, Cutrera R, de Martino M, Antonini S, Becherucci P, Biasci P, Bortone B, Bottero S, Caldarelli V, Cardinale F, Gattinara GC, Ciarcià M, Ciofi D, D'Elios S, Di Mauro G, Doria M, Indinnimeo L, Lo Vecchio A, Macrì F, Mattina R, Miniello VL, Del Giudice MM, Morbin G, Motisi MA, Novelli A, Palamara AT, Panatta ML, Pasinato A, Peroni D, Perruccio K, Piacentini G, Pifferi M, Pignataro L, Sitzia E, Tersigni C, Torretta S, Trambusti I, Trippella G, Valentini D, Valentini S, Varricchio A, Verga MC, Vicini C, Zecca M, Villani A. Prevention of recurrent respiratory infections : Inter-society Consensus. Ital J Pediatr 2021; 47:211. [PMID: 34696778 PMCID: PMC8543868 DOI: 10.1186/s13052-021-01150-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
Recurrent respiratory infections (RRIs) are a common clinical condition in children, in fact about 25% of children under 1 year and 6% of children during the first 6 years of life have RRIs. In most cases, infections occur with mild clinical manifestations and the frequency of episodes tends to decrease over time with a complete resolution by 12 years of age. However, RRIs significantly reduce child and family quality of life and lead to significant medical and social costs.Despite the importance of this condition, there is currently no agreed definition of the term RRIs in the literature, especially concerning the frequency and type of infectious episodes to be considered. The aim of this consensus document is to propose an updated definition and provide recommendations with the intent of guiding the physician in the complex process of diagnosis, management and prevention of RRIs.
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Affiliation(s)
- Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy.
| | - Francesca Santamaria
- Departement of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, University of Pavia IRCCS San Matteo foundation, Pavia, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Renato Cutrera
- Respiratory Unit, Academic Pediatric Department, Pediatric Hospital Bambino Gesù IRCCS, Rome, Italy
| | - Maurizio de Martino
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sara Antonini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Paolo Becherucci
- Family Pediatrician, Local Health Unit, Lastra a Signa, Florence, Italy
| | - Paolo Biasci
- Family Pediatrician, Local Health Unit, Livorno, Italy
| | - Barbara Bortone
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sergio Bottero
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valeria Caldarelli
- Department of Obstetrics Gynaecology and Pediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy
| | | | - Martina Ciarcià
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Daniele Ciofi
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Mattia Doria
- Family Pediatrician, Local Health Unit, Chioggia, Venice, Italy
| | - Luciana Indinnimeo
- Pediatric Department "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Andrea Lo Vecchio
- Departement of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Macrì
- Department of Pediatrics "Sapienza", University of Rome, Rome, Italy
| | - Roberto Mattina
- Department of Biomedical, Surgical, and Odontoiatric Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Guido Morbin
- Family Pediatrician, Local Health Unit, Trento, Italy
| | - Marco Antonio Motisi
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Andrea Novelli
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Anna Teresa Palamara
- Department of Public Health and Infectious Diseases, Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Maria Laura Panatta
- Department of Otorhinolaryngology, IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Angela Pasinato
- Family Pediatrician, Local Health Unit, Torri di Quartesolo, Vicenza, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Katia Perruccio
- Pediatric Oncology Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Massimo Pifferi
- Department of Pediatrics Pulmonology and Allergology Section University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Sitzia
- Department of Otorhinolaryngology, IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Chiara Tersigni
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Trambusti
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Giulia Trippella
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Diletta Valentini
- Department of Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sandro Valentini
- Family Pediatrician, Local Health Unit, Colle Val d'Elsa, Siena, Italy
| | | | - Maria Carmen Verga
- Family Pediatrician, Local Health Unit Salerno, Vietri sul Mare, Salerno, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Marco Zecca
- Pediatric Hematology-Oncology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Villani
- Department of Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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13
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Zhou B, Niu W, Liu F, Yuan Y, Wang K, Zhang J, Wang Y, Zhang Z. Risk factors for recurrent respiratory tract infection in preschool-aged children. Pediatr Res 2021; 90:223-231. [PMID: 33173178 DOI: 10.1038/s41390-020-01233-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/12/2020] [Accepted: 10/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to identify potential risk factors for recurrent respiratory tract infection among Chinese preschool-aged children, and further to construct a nomogram prediction model. METHODS This is a cross-sectional survey conducted in Beijing. Utilizing a stratified cluster random sampling strategy, a total of 7222 children from 20 kindergartens were enrolled. Data are analyzed by STATA software and R language. RESULTS Five independent factors were identified to be significantly associated with recurrent respiratory tract infection risk overall and by pathogenic sites. The significant odds of recurrent respiratory tract infection was 8.31 (95% confidence interval [CI]: 5.69-12.12, P < 0.001), 2.31 (2.06-2.58, P < 0.001), 1.72 (1.48-1.99, P < 0.001), 1.24 (1.08-1.43, P = 0.002), and 1.19 (1.09-1.31, P < 0.001) for asthma, allergy, initial use of antibiotics <6 months, breastfeeding duration <6 months, and maternal body mass index, respectively. Besides the leading role played by asthma, allergy, initial use of antibiotics, and breastfeeding might exert a graded, dose-dependent effect on recurrent respiratory tract infection susceptibility. CONCLUSIONS We have identified five potential risk factors for the risk of recurrent respiratory tract infection from 7222 preschool-aged Chinese children. Notably, asthma plays a leading role, and allergy, initial use of antibiotics, and breastfeeding might exert a graded, dose-dependent effect on recurrent respiratory tract infection susceptibility. IMPACT This is the first report of examining the joint contribution of multiple potential risk factors to recurrent respiratory tract infection among Chinese preschool-aged children. We have identified five potential risk factors for the risk of recurrent respiratory tract infection via analyzing survey data from 7222 preschool-aged Chinese children. Asthma plays a leading role, and allergy, initial use of antibiotics, and breastfeeding might exert a graded, dose-dependent effect on recurrent respiratory tract infection susceptibility.
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Affiliation(s)
- Bo Zhou
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,International Medical Services, China-Japan Friendship Hospital, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Fangyu Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yuan Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,International Medical Services, China-Japan Friendship Hospital, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Kundi Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Yunfeng Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Zhixin Zhang
- International Medical Services, China-Japan Friendship Hospital, Beijing, China. .,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
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14
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Kwon CY, Lee B, Chang GT. Acupoint Herbal Patching for Long-Term Immune Function in Children with Recurrent Respiratory-Tract Infections: A Systematic Review of Real-World Data. Med Acupunct 2021; 33:124-136. [PMID: 33912269 DOI: 10.1089/acu.2020.1444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Acupoint herbal patching (AHP) has been used for the prevention and treatment of recurrent respiratory-tract infections (RRTIs) in children. some studies have suggested relevance to immune function as AHP's mechanism. This study was conducted to evaluate the long-term effects of AHP on immune function in pediatric patients with RRTIs based on real-world data from more than 1-year of follow-up. Materials and Methods: Eleven English-, Korean-, and Chinese-language databases were searched comprehensively up to January 2020. Real-world clinical data assessing AHP for children with RRTI and reporting long-term immune function-related biomarkers as outcomes were included. Descriptive analyses of the details of the participants, interventions, and outcomes were conducted. The risk of bias was assessed, using the ROBINS-I [Risk of Bias in Non-randomized Studies-of Interventions] tool. Results: Four observational studies with 399 pediatric participants were included. Two studies reported salivary secretory immunoglobulin (Ig) A (sIgA) as an immune function-related biomarker and 2 reported serum levels of IgA, IgG, and IgM. sIgA levels showed inconsistent results at 1 year after AHP. However, IgA, IgG, and IgM levels were increased significantly at both 1 and 2 years after AHP. The frequency and duration of respiratory infections were also reduced significantly after AHP. Most studies had high risks of bias, especially lack of consideration of confounding factors. Conclusions: Current evidence suggested that AHP might be connected to immune function-related biomarker levels and symptoms in pediatric patients with RRTIs in the long-term. Further well-designed, large-size, long-term registries are needed to investigate the effects of AHP on immune function in pediatric patients with RRTIs.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, Republic of Korea
| | - Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Gyu Tae Chang
- Department of Pediatrics of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
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Zhamankulov A, Rozenson R, Morenko M, Shnayder K, Akhmetova U, Tyo A. COVID-19 and recurrent respiratory infections in children of Kazakhstan. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The study goal was to investigate the COVID-19 clinical course in children with recurrent respiratory infections (RRI) in Nur-Sultan, Kazakhstan.
Material and Methods — we conducted the retrospective analysis of 94 children with RRI, diagnosed with COVID-19, in Nur-Sultan, Kazakhstan. The study involved 53 males and 41 females. The inclusion criterion for the study was the frequency of RRI at least six times per year. In the course of our study, we split the patients among three groups and identified two phenotypes. These groups included children with RRI and atopic phenotype (Group 1), with D-deficiency phenotype (Group 2), and control group (Group 3) encompassing children with RRI lacking these phenotypes.
Results — The most common symptoms of 94 pediatric patients were dry cough (94.7%), fever (81.9%), along with a loss of appetite and fatigue (76.6%). Malaise was observed in 74.5% cases, rhinorrhea was noted in 71.2% of patients, sore throat was detected in 64.9 % of children, and dyspnea was established in 45.7% of cases. We observed no statistical differences in clinical manifestations of COVID-19 among three groups of children. However, duration of hospitalization period, of fever, and of the catarrhal period differed significantly among the groups (р<0.001).
Conclusion — In children with RRI and vitamin D deficiency, who were diagnosed with COVID-19, the course of the infection was unfavorable (which was confirmed by a longer hospital stay and catarrhal period), and a more severe intoxication syndrome was observed. In the group of children with atopic phenotype, a prolonged residual cough was detected.
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Menzella F, Ferrari E, Ferrucci SM, Lombardi E, Alfano S, Bonavita O, Morini P, Rizzi A, Matucci A. Self-administration of omalizumab: why not? A literature review and expert opinion. Expert Opin Biol Ther 2021; 21:499-507. [PMID: 33504237 DOI: 10.1080/14712598.2021.1882990] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Omalizumab is used to treat severe uncontrolled allergic asthma and chronic spontaneous urticaria (CSU), and is approved for self-administration in prefilled syringes. It is thus important to understand the advantages, critical issues, and indications for home administration.Areas covered: The present review summarizes the available evidence on home administration of omalizumab in asthma and CSU to illustrate the advantages derived from self-administration of patients in this setting.Expert opinion: The available data suggest that patients can safely administer biologics at home with suitable training, and that home administration is time saving and cost-effective. The majority of patients with severe asthma or CSU treated with omalizumab are likely to be suitable candidates for self-administration, which can be proposed to anyone that the clinician deems suitable. In addition to clinicians, pharmacists can also play a key role in managing patients who are prescribed home administration. A practical flow chart is proposed on selection of patients and their management during home administration. Self-administration of biologics can be considered as a valid alternative to traditional injections in a clinical setting, and the evidence has shown that no major issues need to be overcome in terms of safety or efficacy.
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Affiliation(s)
- Francesco Menzella
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, Italy
| | - Emanuele Ferrari
- Hospital Pharmacy, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Silvia Mariel Ferrucci
- Servizio di Dermatologia Allergologica e Professionale, U.O.C. Dermatologia. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, "Meyer" Pediatric University Hospital, Florence, Italy
| | | | | | | | | | - Andrea Matucci
- Immunoallergology Unit, University Hospital Careggi, Florence, Italy
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Distinct Antiviral Properties of Two Different Bacterial Lysates. Can Respir J 2021; 2021:8826645. [PMID: 33613792 PMCID: PMC7878088 DOI: 10.1155/2021/8826645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
Oral bacterial lysates (OBLs) can reduce the frequency and severity of recurrent respiratory tract infections in children from viral and bacterial origins. OBL-induced early innate immune reaction was already shown, but the specific features of different OBLs have never been studied and compared. A study was conducted to assess in vitro the protective effects on rhinovirus- (RV-) infected human bronchial epithelial cells (BECs) of two slightly different OBLs: OM-85 and Pulmonarom. Furthermore, since immune cells represent the key arm for antiviral defence, the capacity of these OBLs to induce selected cytokine production in mouse bone marrow-derived DCs (BMDCs) was also evaluated. Although different OBLs may share some mechanisms to protect host cells from virus infection, some product-specific antimicrobial activities were observed on RV-infected human BECs and mouse BMDCs. These results are consistent with a product-specific response possibly triggered by different pathogen-associated molecular patterns (PAMPs) contained in OBLs.
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Esposito S, Jones MH, Feleszko W, Martell JAO, Falup-Pecurariu O, Geppe N, Martinón-Torres F, Shen KL, Roth M, Principi N. Prevention of New Respiratory Episodes in Children with Recurrent Respiratory Infections: An Expert Consensus Statement. Microorganisms 2020; 8:E1810. [PMID: 33213053 PMCID: PMC7698530 DOI: 10.3390/microorganisms8111810] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/01/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, 43126 Parma, Italy
| | - Marcus Herbert Jones
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre (RS) 90619-900, Brazil;
| | - Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy, The Medical University of Warsaw, 00-927 Warsaw, Poland;
| | - José A. Ortega Martell
- Department of Immunology, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo 42082, Mexico;
| | - Oana Falup-Pecurariu
- Faculty of Medicine, Transilvania University, Children’s Clinic Hospital, 500036 Brasov, Romania;
| | - Natalia Geppe
- Department of Paediatrics, Sechenov First Moscow State Medical University, 115093 Moscow, Russia;
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | - Kun-Ling Shen
- China National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
| | - Michael Roth
- Pulmonary Cell Research and Pneumology, Department of Biomedicine and Internal Medicine, University Hospital Basel, 4002 Basel, Switzerland;
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Gelardi M, Giancaspro R, Fiore V, Fortunato F, Cassano M. COVID-19: Effects of lockdown on adenotonsillar hypertrophy and related diseases in children. Int J Pediatr Otorhinolaryngol 2020; 138:110284. [PMID: 32861977 PMCID: PMC7415340 DOI: 10.1016/j.ijporl.2020.110284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND In response to the coronavirus pandemic 2019 (COVID-19), Italy established the national school closings from March 5, 2020. It has been shown that during school closures, there are significant decreases in the diagnoses of the respiratory infections. This has brought as well to a reduction in all those symptoms related to adenotonsillar hypertrophy. METHODS The study included 162 children, aged between 3 and 13 years, waiting for adenoidectomy and/or tonsillectomy, eventually combined with tympanocentesis or tube insertion. Parents have been called to answer a telephone interview aimed at detecting how the symptoms related to adenotonsillar hypertrophy were changing during lockdown. RESULTS There was an improvement in the overall symptomatology of children during the lockdown period. The value attributed by parents to the children's general assessment during the lockdown period decreased significatively during the quarantine (p = 0,0000). CONCLUSIONS The present study demonstrates that lockdown can have a positive impact on those specific diseases derived from precocious socialization and that it results to be particularly effective for the most vulnerable children. Indeed, lockdown has resulted to be so efficient that it has caused a modification in a medical and surgical therapeutic indication.
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Affiliation(s)
- M. Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - R. Giancaspro
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - V. Fiore
- Unit of Otolaryngology, University of Foggia, Foggia, Italy,Corresponding author. Unit of Otolaryngology, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - F. Fortunato
- Section of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - M. Cassano
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
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Ji J, Ren L, Liu Y, Zheng M, Fang H, Xu H, He H, Zhang M, Wang X, Shan J, Hou Y. Elevated monocytic myeloid-derived suppressor cells positively correlate with infection frequency in children with RRTIs. Eur J Immunol 2020; 51:2687-2690. [PMID: 33111310 DOI: 10.1002/eji.202048629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/28/2020] [Accepted: 10/26/2020] [Indexed: 11/06/2022]
Abstract
In children with recurrent respiratory tract infections (RRTIs), the percentages and numbers of monocytic myeloid-derived suppressor cells (MDSCs) were elevated. The elevated MDSCs positively correlate with respiratory tract infection frequency in RRTIs children. The elevated MDSCs can inhibit CD8+ T-cells proliferation in RRTIs children.
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Affiliation(s)
- Jianjian Ji
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lishun Ren
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuling Liu
- Institute of Pediatrics, Nanjing Pukou Hospital of TCM, Nanjing, China
| | - Min Zheng
- Department of Pediatric, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Huazhong Fang
- Institute of Pediatrics, Nanjing Pukou Hospital of TCM, Nanjing, China
| | - Hui Xu
- Institute of Pediatrics, Nanjing Pukou Hospital of TCM, Nanjing, China
| | - Huizhen He
- Institute of Pediatrics, Nanjing Pukou Hospital of TCM, Nanjing, China
| | - Min Zhang
- Institute of Pediatrics, Nanjing Pukou Hospital of TCM, Nanjing, China
| | - Xianzheng Wang
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinjun Shan
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yayi Hou
- The State Key Laboratory of Pharmaceutical Biotechnology, Division of Immunology, Medical School, Nanjing University, Nanjing, China
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Ciprandi G, La Mantia I, Damiani V, Passali D. Local Bacteriotherapy - a promising preventive tool in recurrent respiratory infections. Expert Rev Clin Immunol 2020; 16:1047-1052. [PMID: 33022191 DOI: 10.1080/1744666x.2021.1833720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Children with recurrent respiratory infections (RRI) represent a social issue for the economic burden and the negative family impact. Local Bacteriotherapy is an attractive therapeutic strategy that could be potentially effective in preventing infections. The current article remarks on the existing evidence of preventing RRI by Local Bacteriotherapy. AREAS COVERED The literature search methodology was based on the articles cited by PubMed from 1980 to 2020. Respiratory infections include rhino-pharyngitis, otitis media, rhinosinusitis, pharyngo-tracheitis, bronchitis, and pneumonia. Several studies were performed to investigate the effects of Local Bacteriotherapy in children with RRI. Both intranasal and oral Local Bacteriotherapy were evaluated. The findings showed that Local Bacteriotherapy significantly reduced the number of RI episodes, their severity, the use of antibiotics, and school absences. EXPERT OPINION Local Bacteriotherapy is a promising approach to RRI prevention and could be a profitable strategy to contrast infections in the future.
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Affiliation(s)
| | | | - Valerio Damiani
- Medical Department, Drugs Minerals and Generics , Pomezia, Italy
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Lee B, Kwon CY, Chang GT. Acupoint herbal patching for children with recurrent respiratory tract infection: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 40:101209. [PMID: 32891285 DOI: 10.1016/j.ctcp.2020.101209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Acupoint herbal patching (AHP) has been used for recurrent respiratory tract infection (RRTI) in children. This systematic review aimed to analyze the safety and efficacy of AHP in pediatric RRTI. METHODS Eleven databases were comprehensively searched up to January 2020. Randomized controlled trials (RCTs) using AHP as a monotherapy or adjunctive therapy in pediatric patients with RRTI were included. RESULTS Twenty-two RCTs with 3579 participants were included. Meta-analyses showed that outbreaks and disease duration of respiratory tract infection (RTI) per year significantly decreased in the AHP group compared with the placebo group, when follow-up was conducted after 1, 2, or 3 years. Moreover, AHP as a monotherapy or adjunctive therapy significantly decreased outbreaks and disease duration of RTI without serious adverse events. CONCLUSION This review provides promising evidence that AHP may reduce the frequency and duration of RTI and improve immune function in pediatric patients with RRTI.
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Affiliation(s)
- Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, 34054, Republic of Korea.
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, 62 Yangjeong-ro, Busanjin-gu, Busan, 47227, Republic of Korea.
| | - Gyu Tae Chang
- Department of Pediatrics of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea.
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Cardinale F, Lombardi E, Rossi O, Bagnasco D, Bellocchi A, Menzella F. Epithelial dysfunction, respiratory infections and asthma: the importance of immunomodulation. A focus on OM-85. Expert Rev Respir Med 2020; 14:1019-1026. [PMID: 32635771 DOI: 10.1080/17476348.2020.1793673] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Damage to the respiratory epithelium, is often a multifactorial phenomenon. The risk for developing a damage in respiratory epithelium and recurrent respiratory infections may vary among individuals. Preventive measures are based on strengthening the immune function, thus increasing the natural response to pathogens. Immunomodulatory agents are: i. synthetic molecules; ii. Probiotics, prebiotics, symbiotics; iii. Lysates, bacterial extracts immunomodulators: OM-85, RU 41740, D53; iv. Trace elements, vitamins. OM-85 is used for the prevention of recurrent respiratory tract infections and/or exacerbations both in adults and children, showing a good efficacy and safety profile. Its active principle, an extract of bacterial lysates isolated from 21 known respiratory pathogenic strains, shows protection against airway infections of bacterial and viral origin. AREAS COVERED This non-systematic review focuses on bacterial lysates and in particular on OM-85 and its effects on respiratory epithelium function and activity in asthma respiratory infections. Studies were selected by PubMed search of "bacterial lysate" or "OM-85" and "respiratory epithelium" or "respiratory infections", from 1993 to 2019. EXPERT OPINION Results highlight the ability of OM-85 to trigger immunomodulatory and protective immune responses against different pathogens in vivo, including influenza and respiratory syncytial virus as well bacterial superinfection following influenza.
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Affiliation(s)
- Fabio Cardinale
- University of Bari, Azienda Ospedaliero-Universitaria 'Policlinico-Giovanni XXIII', UOC di Pediatria e Pronto Soccorso , Bari, Italy
| | - Enrico Lombardi
- 'Meyer' Pediatric University Hospital, Pediatric Pumonary Unit , Firenze, Italy
| | - Oliviero Rossi
- Azienda Ospedaliero-Universitaria Careggi, UOC di Immunoallergologia , Firenze, Italy
| | - Diego Bagnasco
- Casa di Cura Villa Montallegro, Unità di Malattie Dell'apparato Respiratorio , Genova, Italy
| | - Aldo Bellocchi
- ASL ROMA 4/Dist.4, Pediatrician- Family Doctor , Roma, Italy
| | - Francesco Menzella
- Azienda USL di Reggio Emilia-IRCSS, Department of Medical Specialties, Santa Maria Nuova Hospital, Pneumology Unit , Reggio Emilia, Italy
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Rossi GA, Pohunek P, Feleszko W, Ballarini S, Colin AA. Viral infections and wheezing-asthma inception in childhood: is there a role for immunomodulation by oral bacterial lysates? Clin Transl Allergy 2020; 10:17. [PMID: 32509272 PMCID: PMC7255835 DOI: 10.1186/s13601-020-00322-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022] Open
Abstract
Severe and recurrent infections of the respiratory tract in early childhood constitute major risk factors for the development of bronchial hyper-responsiveness and obstructive respiratory diseases in later life. In the first years of life, the vast majority of respiratory tract infections (RTI) leading to wheezing and asthma are of a viral origin and severity and recurrence are the consequence of a greater exposure to infectious agents in a period when the immune system is still relatively immature. Therefore, boosting the efficiency of the host immune response against viral infections seems to be a rational preventative approach. In the last decades it has been demonstrated that living in farm environments, i.e. early-life exposure to microbes, may reduce the risk of allergic and infectious disorders, increasing the immune response efficacy. These findings have suggested that treatment with bacterial lysates could promote a nonspecific immunomodulation useful in the prevention of recurrent RTIs and of wheezing inception and persistence. Experimental and clinical studies showing the reduction of RTI frequency and severity in childhood and elucidating the involved mechanisms can support this hypothesis.
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Affiliation(s)
- Giovanni A. Rossi
- Department of Pediatrics, Pulmonary and Allergy Disease Unit and Cystic Fibrosis Center, G. Gaslini University Hospital, Largo G. Gaslini, 4, 16148 Genoa, Italy
| | - Petr Pohunek
- Dept of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Stefania Ballarini
- Medical Affairs Lead, Infectious Diseases, OM Pharma, a Vifor Pharma Company, Meyrin, Geneva, Switzerland
| | - Andrew A. Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL USA
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Identification and Quantification of “Quality Markers” in Tongkang Tablet on Recurrent Respiratory Tract Infections (RRTIs) by UFLC-IT-TOF–MS/MS and HPLC–DAD. Chromatographia 2020. [DOI: 10.1007/s10337-020-03881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Manti S, Parisi GF, Papale M, Licari A, Salpietro C, Miraglia Del Giudice M, Marseglia GL, Leonardi S. Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray for treatment of upper respiratory tract infections in children: a pilot study on short-term efficacy. Ital J Pediatr 2020; 46:42. [PMID: 32245500 PMCID: PMC7126168 DOI: 10.1186/s13052-020-0798-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Recurrent respiratory infections (RRIs) are defined by the presence of at least one of the following criteria: (i) > 6 annual respiratory infections (RIs); (ii) > 1 monthly RIs involving the upper airways from September to April; (iii) > 3 annual RIs involving the lower airways represent a very common health problem in the first years of life. We conducted a multi-centre, prospective, single-open study to assess the efficacy and the safety of Streptococcus salivarius 24SMBc and Streptococcus oralis 89a in the prevention of upper respiratory tract infections (URTIs) in children. Methods Ninety-one children (M:F = 47:44, mean age 7.4 ± 2.3 years) with RRIs were enrolled in the study between September and November 2018. At baseline, children received Streptococcus salivarius 24SMBc and Streptococcus oralis 89a as 2 puffs for nostril twice/day for 7 days/months. The treatment lasted for 3 consecutive months. Efficacy was expressed in terms of absence or presence of fever, cough, bronchospasm, rhinorrhea and otalgia, at 1 month (T1), and 3 (T3) months. Safety and tolerability of the probiotic were evaluated on the basis of the number and type of adverse events (AEs) recorded during the treatment. Results Children treated with Streptococcus salivarius 24SMBc and Streptococcus oralis 89a showed a significant decrease of symptoms including episodes of fever, cough, bronchospasm, rhinorrhea, and otalgia (p < 0.001) compared to baseline. The treatment significantly reduced the number of episodes of fever, cough, bronchospasm, rhinorrhea, otalgia, and cough also in patients with positive familial history for atopy and in atopic children (p < 0.05). No significant differences in symptoms among children with negative familial history for atopy and children with positive familial history for atopy subgroups, not atopic and atopic children subgroups, and smoke-exposed and not smoke-exposed subgroups were observed (p > 0.05). Conducting a subgroup analysis according to the age, it has been reported that children aged 1–3 years old showed an improvement in all symptoms, however, they become statistically significant only at the end of the 3 months of treatment (p < 0.05). Conversely, in children aged 3–6 and 6–12 years old, the therapeutic efficacy was progressive and significant already from the first month of therapy (p < 0.05). None of the children were withdrawn from the study because of AEs, although 9 children experienced burning nose leading to interruption of therapy. Conclusions Our findings suggest that Streptococcus salivarius 24SMBc and Streptococcus oralis 89a treatment is safe and seems to be effective on short-term in the treatment of RRIs. Studies involving a longer observation period are necessary to establish the real efficacy of the product for the treatment of pediatric patients affected by RRIs.
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Affiliation(s)
- Sara Manti
- Department of Pediatrics, Unit of Pediatric Genetics and Immunology, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Maria Papale
- Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Amelia Licari
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Via Camillo Golgi 17, 27100, Pavia, Italy
| | - Carmelo Salpietro
- Department of Pediatrics, Unit of Pediatric Genetics and Immunology, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli.", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Via Camillo Golgi 17, 27100, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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Valentini D, Di Camillo C, Mirante N, Marcellini V, Carsetti R, Villani A. Effects of Pidotimod on recurrent respiratory infections in children with Down syndrome: a retrospective Italian study. Ital J Pediatr 2020; 46:31. [PMID: 32164747 PMCID: PMC7068926 DOI: 10.1186/s13052-020-0797-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Down syndrome (DS) show a high susceptibility to recurrent infections (RI), caused by immune defects and abnormalities of the airways. Our goal was to investigate the effects of Pidotimod on RI prevention in children with DS, comparing immune and clinical parameters before (T0) and after (T1) the treatment with Pidotimod. METHODS The study was conducted at the Down syndrome outpatient Center of Bambino Gesù Children's Hospital, in Rome. We reviewed the medical records of all children with a positive history for RI and who received oral prophylaxis of Pidotimod from September 2016 to February 2017. RESULTS Thirty-three children met the inclusion criteria (males: 51.5%; average age: 6 years ±SD: 3). We found a significant decrease in the number of children with upper respiratory infections (82% at T0 vs 24% at T1; p = 0,0001) and with lower respiratory infections (36% at T0 vs 9% at T1; p = 0.003) after treatment with Pidotimod. We also demonstrated a significant decrease in the number of children hospitalized for respiratory infections (18% at T0 vs 3% at T1; p = 0.03). We measured T and B cells in the peripheral blood and B cell function in vitro at T0 and T1. We found that the response to CpG improved at T1. A significant increase of B cell frequency (p = 0.0009), B cell proliferation (p = 0.0278) and IgM secretion (p = 0.0478) were observed in children with DS after treatment. CONCLUSIONS Our results provided evidence that Pidotimod may be able to prevent RI in children with Down syndrome.
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Affiliation(s)
- Diletta Valentini
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Chiara Di Camillo
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Nadia Mirante
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Valentina Marcellini
- Immunology Research Area, B-cell development Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Carsetti
- Immunology Research Area, B-cell development Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Immunological Diagnosis Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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Tarantino V, Savaia V, D'Agostino R, Damiani V, Ciprandi G. Oral bacteriotherapy in children with recurrent respiratory infections: a real-life study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:73-76. [PMID: 32073565 PMCID: PMC7947738 DOI: 10.23750/abm.v91i1-s.9230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 11/25/2022]
Abstract
Children with recurrent respiratory infections (RRI) represent a social issue for the economic burden and the familiar negative impact. Bacteriotherapy, such as the administration of “good” bacteria, is a new therapeutic strategy that could be potentially effective in preventing infections. The current study tested the hypothesis of preventing RRI by oral Bacteriotherapy in a real-life setting. This open study was conducted in an outpatient clinic, enrolling 51 children (27 males, mean age 4.8 ± 2.6 years) suffering from RRI. Children were treated with an oral spray, containing Streptococcus salivarius 24SMB and Streptococcus oralis89a (125 x 109 CFU/g), 2 puffs per os once/day for 30 consecutive days; this course was repeated for 3 months. The evaluated parameters were: RI number and school absences reported in the current year; these outcomes were compared with those recorded in the past year. The mean number of RI significantly diminished: from 5.17 (2.30) in the past year to 2.25 (2.43) after the treatment (p<0.0001). The mean number of school absences significantly diminished (from 3.35 to 1.86; p<0.0001). In conclusion, this real-life study suggests that oral Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis89a could efficaciously and safely prevent RRI in children. (www.actabiomedica.it)
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Affiliation(s)
- Vincenzo Tarantino
- Dipartimento Testa-Collo e Neuroscienze - IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Valentina Savaia
- Dipartimento Testa-Collo e Neuroscienze - IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Roberto D'Agostino
- Dipartimento Testa-Collo e Neuroscienze - IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Varricchio A, La Mantia I, Brunese FP, Ciprandi G. Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies. Ital J Pediatr 2020; 46:18. [PMID: 32039733 PMCID: PMC7008537 DOI: 10.1186/s13052-020-0782-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/29/2020] [Indexed: 12/24/2022] Open
Abstract
The upper airways (UA) should be considered as a functional unit. Current functional anatomy divides URT in three, mutually dependent, "junction boxes": i) the ostio-meatal complex (OMC), ii) the spheno-ethmoidal recess (SER), and iii) the rhinopharynx (RP). Correct ventilation and effective mucociliary clearance of these sites significantly affect the healthy physiology of the entire respiratory system. The OMC, SER, and RP obstruction is the first pathogenic step in the inflammatory/infectious cascade of UA disorders. The inflammation of the respiratory mucosa is the main pathogenic factor for airway obstruction. Moreover, bacterial biofilm (a strategy modality of bacterial survival) is an important local cause of systemic antibiotic ineffectiveness, recurrent infections, and antibiotic resistance. Health microbiota guarantees UA wellness; on the contrary, dysbiosis promotes and worsens UA infections. Allergy, namely type 2 inflammation, is a common cause of UA obstruction such as promoting in turn infections. Fiberoptic endoscopy is a mandatory diagnostic tool in clinical practice. Nasal cytology, mainly concerning flow cytometry, allows defining rhinitis phenotypes so allowing a precision medicine approach. Several conventional therapeutic approaches are available, but efficacy and safety should be ever properly considered before the prescription. Also, complementary medicine plays a fruitful role in the management of UA diseases. National and real-world studies are reported and discussed as they may be useful in daily clinical practice.
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Affiliation(s)
- Attilio Varricchio
- UOSD Video-Endoscopia delle VAS, P.O. San Gennaro - ASL Napoli 1-centro, Naples, Italy
| | | | | | - Giorgio Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Via Boselli 5, 16146, Genoa, Italy.
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Esposito S, Bianchini S, Bosis S, Tagliabue C, Coro I, Argentiero A, Principi N. A randomized, placebo-controlled, double-blinded, single-centre, phase IV trial to assess the efficacy and safety of OM-85 in children suffering from recurrent respiratory tract infections. J Transl Med 2019; 17:284. [PMID: 31443716 PMCID: PMC6708164 DOI: 10.1186/s12967-019-2040-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/18/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Over many years, OM-85, a lysate of 21 common bacterial respiratory pathogens, has been demonstrated to prevent respiratory recurrences in children. However, further studies are needed to explore the true importance of OM-85 in the prevention of respiratory tract infections (RTIs) in children. This study was planned to further contribute to the evaluation of the role played by OM-85 in prevention of recurrent RTIs in children. METHODS This study was a randomized (3:3:1), placebo-controlled, double-blind, single-centre, phase IV trial carried out in Italy to assess the efficacy of OM-85 (Broncho-Vaxom®; Vifor Pharma; Meyrin 2/Geneva, Switzerland) in reducing the number of new RTI episodes in 288 children aged 1 to 6 years with a history of recurrent RTIs and to compare the efficacy of the standard 3-month regimen with that of administration of OM-85 for 6 months during a 6-month study period. RESULTS The number of RTIs and of children who experienced at least one RTI were significantly lower among patients receiving OM-85 for 3 months than among those given placebo (33% vs 65.1%, p < 0.0001). Differences were statistically significant for upper RTIs (i.e., common cold/viral pharyngitis and acute otitis media; p < 0.0001 and p = 0.006, respectively). Days of absence from day-care for children and working days lost by parents were significantly lower in the group with children treated with OM-85 for 3 months than in the placebo group (p = 0.007 and p = 0.004, respectively). No difference was seen between children who received OM-85 for 3 and those who received OM-85 for 6 months. The prevalence of atopy as well as the history of recurrent wheezing and age of the study child did not influence the results. Benefit was maximally evident among children with a history of frequent recurrences. OM-85 was well tolerated and safe, even in children who received an influenza vaccination. CONCLUSIONS The use of OM-85 for 3 months in 3 series of 10 consecutive days each time reduces the risk of recurrent RTIs in children, with a favourable safety profile. The greater effect observed in children prone to several respiratory episodes than in non-prone children seems to indicate that this lysate should be administered especially to children with a proven high susceptibility to RTIs.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Coro
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy
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Santamaria F, Montella S, Stocchero M, Pirillo P, Bozzetto S, Giordano G, Poeta M, Baraldi E. Effects of pidotimod and bifidobacteria mixture on clinical symptoms and urinary metabolomic profile of children with recurrent respiratory infections: a randomized placebo-controlled trial. Pulm Pharmacol Ther 2019; 58:101818. [PMID: 31302340 DOI: 10.1016/j.pupt.2019.101818] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/12/2019] [Accepted: 07/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many preschool children develop recurrent respiratory tract infections (RRI). Strategies to prevent RRI include the use of immunomodulators as pidotimod or probiotics, but there is limited evidence of their efficacy on clinical features or on urine metabolic profile. OBJECTIVE To evaluate whether pidotimod and/or bifidobacteria can reduce RRI morbidity and influence the urine metabolic profile in preschool children. MATERIALS AND METHODS Children aged 3-6 years with RRI were enrolled in a four-arm, exploratory, prospective, randomized, double-blinded, placebo-controlled trial. Patients were randomly assigned to receive pidotimod plus bifidobacteria, pidotimod plus placebo, bifidobacteria plus placebo or double placebo for the first 10 days of each month over 4 consecutive months. Respiratory symptoms and infections were recorded with a daily diary by parents during the study. Metabolomic analyses on urine samples collected before and after treatment were performed. RESULTS Compared to placebo, children receiving pidotimod, alone or with bifidobacteria, had more symptom-free days (69 versus 44, p = 0.003; and 65 versus 44, p = 0.02, respectively) and a lower percentage of days with common cold (17% versus 37%, p = 0.005; and 15% versus 37%, p = 0.004, respectively). The metabolomic analysis showed that children treated with Pidotimod (alone or in combination with bifidobacteria) present, respect to children treated with placebo, a biochemical profile characterized by compounds related to the pathway of steroids hormones, hippuric acid and tryptophan. No significant difference in the metabolic profile was found between children receiving bifidobacteria alone and controls. CONCLUSIONS Preschool children with RRI treated with pidotimod have better clinical outcomes and a different urine metabolomic profile than subjects receiving placebo. Further investigations are needed to clarify the connection between pidotimod and gut microbiome.
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Affiliation(s)
- Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Matteo Stocchero
- Women's and Children's Health Department, University of Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy.
| | - Paola Pirillo
- Women's and Children's Health Department, University of Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy; Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Corso Stati Uniti 4, 35129, Padova, Italy.
| | - Sara Bozzetto
- Women's and Children's Health Department, University of Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy.
| | - Giuseppe Giordano
- Women's and Children's Health Department, University of Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy; Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Corso Stati Uniti 4, 35129, Padova, Italy.
| | - Marco Poeta
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy; Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Corso Stati Uniti 4, 35129, Padova, Italy.
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Niu H, Wang R, Jia YT, Cai Y. Pidotimod, an immunostimulant in pediatric recurrent respiratory tract infections: A meta-analysis of randomized controlled trials. Int Immunopharmacol 2018; 67:35-45. [PMID: 30530167 DOI: 10.1016/j.intimp.2018.11.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Recurrent respiratory tract infections (RRTIs) remain a great challenge to pediatricians, because they can increase the risk of various complications and there is no confirmed effective treatment. In the present study, we aimed to assess the effectiveness and safety of pidotimod (PDT), an immunostimulant, in treatment of RRTIs in children aged 14 years and under. METHODS PubMed, EMBASE, Web of Science, Cochrane Library, ClinicalTrials.gov, CBM and CNKI were searched from their inception up to February 2018. All randomized controlled trials (RCTs) using PDT with various treatment durations and enrolling participants <14 years of age were included in the present review. The interventions were PDT plus conventional treatment (e.g. anti-bacterial and antiviral therapy) or PDT alone versus the conventional treatment plus placebo or conventional treatment alone. RESULTS A total of 29 RCTs consisting of 4344 pediatric patients were included in this meta-analysis. Ten RCTs were published from Italy, Russia or Greece, and 19 RCTs were published by Chinese groups. However, appropriate randomization methods were only used in 15 trials. Only one study had explicit allocation concealment. Since only eight RCTs were double-blind and placebo controlled, the evidence was not assessed as high quality. The meta-analysis indicates that treatment with PDT resulted in a significant increase in the proportion of participants who had lower RTIs (RR 1.59; 95% CI 1.45-1.74, p < 0.00001) compared with the conventional treatment. PDT could significantly decrease the duration of cough and fever. The number of patients in using antibiotics was also remarkably decreased in the PDT treatment group. Moreover, PDT administration improved the levels of serum immunoglobulin (IgG, IgA, or IgM) and T-lymphocyte subtypes (CD3+, CD4+). Besides, PDT administration did not increase the risk of adverse events of any cause (RR = 1.05, 95% CI 0.72-1.54, p = 0.80). CONCLUSIONS PDT showed a good efficacy and safety in treatment of pediatric RRTIs. Further high-quality and large-scale RCTs are still required to provide confirmatory evidence. TRIAL REGISTRATION The protocol of this study can be found at PROSPERO with the registration number of CRD42018093541.
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Affiliation(s)
- Hui Niu
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, 28 Fu Xing Road, Beijing 100853, People's Republic of China
| | - Rui Wang
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, 28 Fu Xing Road, Beijing 100853, People's Republic of China
| | - Yu-Ting Jia
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, 28 Fu Xing Road, Beijing 100853, People's Republic of China
| | - Yun Cai
- Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, 28 Fu Xing Road, Beijing 100853, People's Republic of China.
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Jin X, Ji Z, Li X, Liu R, Guan Y. Bioinformatics analysis and verification of key genes associated with recurrent respiratory tract infections. Int J Mol Med 2018; 42:514-524. [PMID: 29693136 DOI: 10.3892/ijmm.2018.3640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/02/2018] [Indexed: 11/05/2022] Open
Abstract
We evaluated the key genes related with recurrent respiratory tract infections (RRTIs), and then elucidated the possible molecular mechanisms of RRTIs. Neutrophil was isolated from peripheral bloods of the recurrent lower respiratory tract infection patients and healthy volunteers, respectively. The next generation sequencing information was obtained after RNA extraction, purification, library construction and sequencing. The sequencing information was preprocessed. Bioinformatics analysis including analysis of differentially expre-ssed genes (DEGs), Gene Ontology (GO) and pathway enrichment analysis, protein-protein interaction (PPI) analysis and transcription factors analysis were performed. The key genes were verified by real-time PCR. In total, 17 significant DEGs were obtained in case group compared with the control group by bioinformatics analysis. Then, 6 of 17 genes were detected by real-time PCR. There was statistical significance between case and control groups for peroxisome proliferator-activated receptor-γ (PPARG), prostaglandin-endoperoxide synthase 2 (PTGS2), transferrin (TF) and interleukin-10 (IL-10) (P<0.05), and there was no statistical significance between case and control groups for TIMP metallopeptidase inhibitor 1 (TIMP1) and matrix metallopeptidase 1 (MMP1). PPARG, PTGS2, TF and IL-10 are key genes associated with the progression of RRTIs. We speculate that TIMP1 and MMP1 may also be involved in the progression of RRTIs, but further studies with large number of samples are needed for verification.
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Affiliation(s)
- Xiang Jin
- Department of Respiratory Medicine, The First Hospital, Jilin University, Changchun, Jilin 130000, P.R. China
| | - Zhiyong Ji
- Department of ICU, The First Hospital, Jilin University, Changchun, Jilin 130000, P.R. China
| | - Xiaodan Li
- Department of Respiratory Medicine, The First Hospital, Jilin University, Changchun, Jilin 130000, P.R. China
| | - Rui Liu
- Department of Respiratory Medicine, The First Hospital, Jilin University, Changchun, Jilin 130000, P.R. China
| | - Yinghui Guan
- Department of Respiratory Medicine, The First Hospital, Jilin University, Changchun, Jilin 130000, P.R. China
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de Oliveira TB, Klering EA, da Veiga ABG. Is recurrent respiratory infection associated with allergic respiratory disease? J Asthma 2018. [PMID: 29533102 DOI: 10.1080/02770903.2018.1445266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Respiratory infections cause high morbidity and mortality worldwide. This study aims to estimate the relationship between allergic respiratory diseases with the occurrence of recurrent respiratory infection (RRI) in children and adolescents. METHODS The International Study of Asthma and Allergies in Childhood questionnaire and a questionnaire that provides data on the history of respiratory infections and the use of antibiotics were used to obtain data from patients. The relationship between the presence of asthma or allergic rhinitis and the occurrence of respiratory infections in childhood was analyzed. RESULTS We interviewed the caregivers of 531 children aged 0 to 15 years. The average age of participants was 7.43 years, with females accounting for 52.2%. This study found significant relationship between: presence of asthma or allergic rhinitis with RRI, with prevalence ratio (PR) of 2.47 (1.51-4.02) and 1.61 (1.34-1.93), respectively; respiratory allergies with use of antibiotics for respiratory problems, with PR of 5.32 (2.17-13.0) for asthma and of 1.64 (1.29-2.09) for allergic rhinitis; asthma and allergic rhinitis with diseases of the lower respiratory airways, with PR of 7.82 (4.63-13.21) and 1.65 (1.38-1.96), respectively. In contrast, no relationship between upper respiratory airway diseases and asthma and allergic rhinitis was observed, with PR of 0.71 (0.35-1.48) and 1.30 (0.87-1.95), respectively. CONCLUSIONS RRI is associated with previous atopic diseases, and these conditions should be considered when treating children.
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Affiliation(s)
- Tiago Bittencourt de Oliveira
- a Departamento Ciências da Saúde , Universidade Regional Integrada do Alto Uruguai e das Missões-URI , Santo Ângelo , Rio Grande do Sul , Brazil.,b Programa de Pós-Graduação em Patologia , Universidade Federal de Ciências da Saúde de Porto Alegre , Porto Alegre , Rio Grande do Sul , Brazil
| | - Everton Andrei Klering
- a Departamento Ciências da Saúde , Universidade Regional Integrada do Alto Uruguai e das Missões-URI , Santo Ângelo , Rio Grande do Sul , Brazil
| | - Ana Beatriz Gorini da Veiga
- b Programa de Pós-Graduação em Patologia , Universidade Federal de Ciências da Saúde de Porto Alegre , Porto Alegre , Rio Grande do Sul , Brazil
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Respiratory Tract Infections and the Role of Biologically Active Polysaccharides in Their Management and Prevention. Nutrients 2017; 9:nu9070779. [PMID: 28726737 PMCID: PMC5537893 DOI: 10.3390/nu9070779] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 12/13/2022] Open
Abstract
Respiratory tract infections (RTIs) are the most common form of infections in every age category. Recurrent respiratory tract infections (RRTIs), a specific form of RTIs, represent a typical and common problem associated with early childhood, causing high indirect and direct costs on the healthcare system. They are usually the consequence of immature immunity in children and high exposure to various respiratory pathogens. Their rational management should aim at excluding other severe chronic diseases associated with increased morbidity (e.g., primary immunodeficiency syndromes, cystic fibrosis, and ciliary dyskinesia) and at supporting maturity of the mucosal immune system. However, RRTIs can also be observed in adults (e.g., during exhausting and stressful periods, chronic inflammatory diseases, secondary immunodeficiencies, or in elite athletes) and require greater attention. Biologically active polysaccharides (e.g., β-glucans) are one of the most studied natural immunomodulators with a pluripotent mode of action and biological activity. According to many studies, they possess immunomodulatory, anti-inflammatory, and anti-infectious activities and therefore could be suggested as an effective part of treating and preventing RTIs. Based on published studies, the application of β-glucans was proven as a possible therapeutic and preventive approach in managing and preventing recurrent respiratory tract infections in children (especially β-glucans from Pleurotus ostreatus), adults (mostly the studies with yeast-derived β-glucans), and in elite athletes (studies with β-glucans from Pleurotus ostreatus or yeast).
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Su G, Chen X, Liu Z, Yang L, Zhang L, Stålsby Lundborg C, Wen Z, Guo X, Qin X, Liang J, Liu X. Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children. Cochrane Database Syst Rev 2016; 12:CD011958. [PMID: 27905672 PMCID: PMC6463872 DOI: 10.1002/14651858.cd011958.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acute respiratory tract infections (ARTIs) are common in children and can involve both upper and lower airways. Many children experience frequent ARTI episodes or recurrent respiratory tract infections (RRTIs) in early life, which creates challenges for paediatricians, primary care physicians, parents and carers of children.In China, Astragalus (Huang qi), alone or in combination with other herbs, is used by Traditional Chinese Medicine (TCM) practitioners in the form of a water extract, to reduce the risk of ARTIs; it is believed to stimulate the immune system. Better understanding of the therapeutic mechanisms of Astragalus may provide insights into ARTI prevention, and consequently reduced antibiotic use. OBJECTIVES To assess the effectiveness and safety of oral Astragalus for preventing frequent episodes of acute respiratory tract infections (ARTIs) in children in community settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 12, 2015), MEDLINE (Ovid) (1946 to 31 December 2015), Embase (Elsevier) (1974 to 31 December 2015), AMED (Ovid) (1985 to 31 December 2015), Chinese National Knowledge Infrastructure (CNKI) (1979 to 31 December 2015) and Chinese Scientific Journals full text database (CQVIP) (1989 to 31 December 2015), China Biology Medicine disc (CBM 1976 to 31 December 2015) and Wanfang Data Knowledge Service Platform (WanFang) (1998 to 31 December 2015). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing oral Astragalus as a sole Chinese herbal preparation with placebo to prevent frequent episodes of ARTIs in children. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures for this review. We assessed search results to identify relevant studies. We planned to extract data using standardised forms. Disagreements were to be resolved through discussion. Risk of bias was to be assessed using the Cochrane 'Risk of bias' tool. We planned to use mean difference (MD) or standardised mean difference (SMD) for continuous data and risk ratio (RR) or odds ratio (OR) to analyse dichotomous data, both with 95% confidence intervals (CIs). MAIN RESULTS We identified 6080 records: 3352 from English language databases, 2724 from Chinese databases, and four from other sources. Following initial screening and deduplication, we obtained 120 full-text papers for assessment. Of these, 21 were not RCTs; 55 did not meet the inclusion criteria because: participants were aged over 14 years; definition was not included for recurrent or frequent episodes;Astragalus preparation was not an intervention; Astragalus preparation was in the formula but was not the sole agent; the Astragalus preparation was not administered orally; or Astragalus was used for treatment rather than prevention of ARTI. A further 44 studies were excluded because they were not placebo-controlled, although other inclusion criteria were fulfilled.No RCTs met our inclusion criteria. AUTHORS' CONCLUSIONS We found insufficient evidence to enable assessment of the effectiveness and safety of oral Astragalus as a sole intervention to prevent frequent ARTIs in children aged up to 14 years.
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Affiliation(s)
- Guobin Su
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
- Karolinska InstitutetGlobal Health ‐ Health Systems and Policy: Medicines, focusing antibiotics, Department of Public Health SciencesTomtebodavägen 18a, Widerströmska HusetStockholmStockholmSweden171 77
| | - Xiankun Chen
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineKey Unit of Methodology in Clinical ResearchGuangzhouGuangdongChina
| | - Zhuangzhu Liu
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
- Guangdong Provincial Hospital of Chinese MedicineEmergency DepartmentNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Lihong Yang
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineEvidence‐Based Medicine and Clinical Research Service GroupNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - La Zhang
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
| | - Cecilia Stålsby Lundborg
- Karolinska InstitutetGlobal Health ‐ Health Systems and Policy: Medicines, focusing antibiotics, Department of Public Health SciencesTomtebodavägen 18a, Widerströmska HusetStockholmStockholmSweden171 77
| | - Zehuai Wen
- Guangdong Provincial Hospital of Chinese MedicineKey Unit of Methodology in Clinical ResearchNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineEvidence‐Based Medicine and Clinical Research Service GroupNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Xindong Qin
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
| | - Jueyao Liang
- Guangzhou University of Chinese MedicineThe Second Clinical CollegeNo 12 Jichang RoadGuangzhouGuangdongChina510120
| | - Xusheng Liu
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
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Bozzetto S, Pirillo P, Carraro S, Berardi M, Cesca L, Stocchero M, Giordano G, Zanconato S, Baraldi E. Metabolomic profile of children with recurrent respiratory infections. Pharmacol Res 2016; 115:162-167. [PMID: 27888158 DOI: 10.1016/j.phrs.2016.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/12/2016] [Indexed: 11/17/2022]
Abstract
Recurrent respiratory infections (RRI) represent a widespread condition which has a severe social and economic impact. Immunostimulants are used for their prevention. It is crucial to better characterize children with RRI to refine their diagnosis and identify effective personalized prevention strategies. Metabolomics is a high-dimensional biological method that can be used for hypothesis-free biomarker profiling, examining a large number of metabolites in a given sample using spectroscopic techniques. Multivariate statistical data analysis then enables us to infer which metabolic information is relevant to the biological characterization of a given physiological or pathological condition. This can lead to the emergence of new, sometimes unexpected metabolites, and hitherto unknown metabolic pathways, enabling the formulation of new pathogenetic hypotheses, and the identification of new therapeutic targets. The aim of our pilot study was to apply mass-spectrometry-based metabolomics to the analysis of urine samples from children with RRI, comparing these children's biochemical metabolic profiles with those of healthy peers. We also compared the RRI children's and healthy controls' metabolomic urinary profiles after the former had received pidotimod treatment for 3 months to see whether this immunostimulant was associated with biochemical changes in the RRI children's metabolic profile. 13 children (age range 3-6 yeas) with RRI and 15 matched per age healthy peers with no history of respiratory diseases or allergies were enrolled. Their metabolomic urine samples were compared before and after the RRI children had been treated with pidotimod for a period of 3 months. Metabolomic analyses on the urine samples were done using mass spectrometry combined with ultra-performance liquid chromatography (UPLC-MS). The resulting spectroscopic data then underwent multivariate statistical analysis and the most relevant variables characterizing the two groups were identified. Data modeling with post-transformation of PLS2-Discriminant Analysis (ptPLS2-DA) generated a robust model capable of discriminating the urine samples from children with RRI from those of healthy controls (R2=0.92,Q2CV7-fold=0.75, p-value<0.001). The dataset included 1502 time per mass variables, and 138 of them characterized the difference between the two groups. Thirty-five of these distinctive 138 variables persisted in the profiles of the children with RRI after pidotimod treatment. Metabolomics can discriminate children with RRI from healthy controls, suggesting that the former have a dysregulated metabolic profile. Among the variables characterizing children with RRI there are metabolites that may reflect the presence of a different microbiome. After pidotimod treatment, the metabolic profile of the children with RRI was no longer very different from that of the healthy controls, except for the persistence of some microbiome-related variables. We surmise that pidotimod partially "restores" the altered metabolic profile of children with RRI, without modifying the metabolites related to the composition of the gut microbiota. In the light of these results, we hypothesize a potential synergic effect of the combined use of immunostimulants and probiotics for the purpose of prevention in children with RRI.
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Affiliation(s)
- Sara Bozzetto
- Women's and Children's Health Department, University of Padova, Italy.
| | - Paola Pirillo
- Mass Spectrometry and Metabolomic Laboratory, Institute of Pediatric Research, Città della Speranza, Italy Women's and Children's Health Department, University of Padova, Italy
| | - Silvia Carraro
- Women's and Children's Health Department, University of Padova, Italy
| | | | - Laura Cesca
- Women's and Children's Health Department, University of Padova, Italy
| | | | - Giuseppe Giordano
- Mass Spectrometry and Metabolomic Laboratory, Institute of Pediatric Research, Città della Speranza, Italy Women's and Children's Health Department, University of Padova, Italy
| | | | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padova, Italy
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Quezada A, Maggi L, Norambuena X, Inostroza J, Quevedo F. Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children. Allergol Immunopathol (Madr) 2016; 44:376-81. [PMID: 27255476 DOI: 10.1016/j.aller.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/11/2016] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND To analyse specific immune response to the 23-valent pneumococcal polysaccharide vaccine by measuring pneumococcal antibodies in children with asthma and with respiratory recurrent infection (RRI) as compared to healthy children. METHODS The study included 60 children, divided into three groups: 20 with asthma, 20 with RRI, and 20 healthy controls. Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) contained in the 23-valent pneumococcal polysaccharide vaccine (PPV) were measured. A specific IgG concentration ≥1.3μg/mL was considered a protective response to the vaccine. For statistical analysis, levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the x(2) test. RESULTS All of the children showed antipneumococcal antibody levels >1.3μg/mL for over 70% of the serotypes, considered within the normal range of response. Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied. CONCLUSION The asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children. Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency (SAD). Because asthma patients are at high risk for invasive pneumococcal infections, it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine, considering the positive response to PPV reported here.
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Affiliation(s)
- A Quezada
- Department of Pediatrics, School of Medicine, University of Chile, Santiago de Chile, Chile.
| | - L Maggi
- Department of Pediatrics, School of Medicine, University of Chile, Santiago de Chile, Chile
| | - X Norambuena
- Children's Hospital, Dr. Exequiel Gonzalez Cortes, Santiago de Chile, Chile
| | - J Inostroza
- Clinical Laboratory, University of La Frontera, Temuco, Chile
| | - F Quevedo
- Public Health School University of Chile, Santiago de Chile, Chile
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Song T, Hou X, Yu X, Wang Z, Wang R, Li Y, Hu D, Wang X, Xiao Z, Sui Y, Zhu C, Wang J. Adjuvant Treatment with Yupingfeng Formula for Recurrent Respiratory Tract Infections in Children: A Meta-analysis of Randomized Controlled Trials. Phytother Res 2016; 30:1095-103. [PMID: 27145435 DOI: 10.1002/ptr.5628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/17/2016] [Accepted: 03/28/2016] [Indexed: 11/10/2022]
Abstract
This meta-analysis aimed to evaluate the immunomodulating function of Yupingfeng Formula (YPFF) in children with recurrent respiratory tract infections (RRTIs). The PubMed, EMBASE, Cochrane Library, CNKI and WanFang databases were searched for randomized controlled trials comparing with and without YPFF for RRTIs in children. Twelve trials with 1236 patients were identified. Adjuvant treatment with YPFF significantly increased serum levels of IgA (weighted mean difference [WMD] 0.33 mg/mL; 95% confidence interval [CI] 0.20 to 0.45), IgG (WMD 1.36 mg/mL; 95% CI 1.06 to 1.65), IgM (WMD 0.16 mg/mL; 95% CI 0.02 to 0.31), and CD3(+) T-lymphocytes (WMD 10.16%; 95% CI 4.62 to 15.69) but not CD4(+) T-lymphocytes (WMD 3.16%; 95% CI -0.27 to 6.59) and CD8(+) T-lymphocytes (WMD -0.84%; 95% CI -2.50 to 0.81). YPFF also reduced the frequency of RRTIs (WMD -3.80 times; 95% CI -4.86 to -2.74) and increased total effective rates of symptom improvement (risk ratio: 1.44; 95% CI 1.19 to 1.75). Adjuvant treatment with YPFF could improve total clinical effective rate and decrease the frequency of respiratory tract infections in children with RRTIs. The beneficial effects of YPFF may be correlated to its immunomodulating action. More well-designed trials with larger sample sizes are needed to evaluate its efficacy and safety. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tao Song
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Xiaoli Hou
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Xiaohui Yu
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Zhen Wang
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Ruiren Wang
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Yanling Li
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Dan Hu
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Xiaohong Wang
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Zhengzheng Xiao
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Yong Sui
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Chunhong Zhu
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Jing Wang
- Department of Pediatrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
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Diagnosis and Management of Recurrent Respiratory Tract Infections in Children: A Practical Guide. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2015. [DOI: 10.5812/pedinfect.31039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Su G, Chen X, Liu Z, Yang L, Zhang L, Stålsby Lundborg C, Wen Z, Guo X, Qin X, Liang J, Liu X. Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mameli C, Pasinato A, Picca M, Bedogni G, Pisanelli S, Zuccotti GV. Pidotimod for the prevention of acute respiratory infections in healthy children entering into daycare: A double blind randomized placebo-controlled study. Pharmacol Res 2015; 97:79-83. [DOI: 10.1016/j.phrs.2015.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/18/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
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Quezada A, Norambuena X, Inostroza J, Rodríguez J. Specific antibody deficiency with normal immunoglobulin concentration in children with recurrent respiratory infections. Allergol Immunopathol (Madr) 2015; 43:292-7. [PMID: 25498324 DOI: 10.1016/j.aller.2014.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/22/2014] [Accepted: 07/31/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Response to polysaccharide antigens is a test to evaluate the immunological competence of children with recurrent respiratory infections (RRI) of unknown cause and no other immune system abnormality. In order to detect specific antibody deficiency (SAD), a group of children with RRI without other immunodeficiency were prospectively studied. METHODS We included 20 children (12 male), age range 3-14 years, with six or more annual episodes of respiratory infections (RI); one or more monthly episodes of RI during the winter months; or three or more annual episodes of lower RI. The children were immunised with 23-valent polysaccharide anti-pneumococcal vaccine, and ELISA was used to measure anti-polysaccharide IgG antibody levels for 10 pneumococcal serotypes at baseline (T0), and 45 days (T1) and one year post-immunisation (T2). Post-immunisation response above 1.3 μg/ml for more than 50% of the serotypes was considered normal for children 2-5 years, and for more than 70% of the serotypes in children older than 5 years. RESULTS At T1 19/20 children showed a normal response for their age, and only one patient showed a deficient response, suggestive of classic moderate SAD. At T2, 8/20 patients showed deficient responses, suggestive of impaired persistence of specific antibodies. There was a noteworthy association between deficient response and asthma and allergic rhinitis. CONCLUSIONS We propose first ruling out local or systemic causes, then performing serum immunoglobulin IgM, IgG, IgA, IgE and IgG subclass levels, and finally measuring response to polysaccharide pneumococcal antigens for detection of SAD.
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Carsetti R, Valentini D, Marcellini V, Scarsella M, Marasco E, Giustini F, Bartuli A, Villani A, Ugazio AG. Reduced numbers of switched memory B cells with high terminal differentiation potential in Down syndrome. Eur J Immunol 2014; 45:903-14. [PMID: 25472482 PMCID: PMC4674966 DOI: 10.1002/eji.201445049] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/07/2014] [Accepted: 11/28/2014] [Indexed: 01/21/2023]
Abstract
Children with Down syndrome (DS) have increased susceptibility to infections and a high frequency of leukemia and autoimmune disorders, suggesting that immunodeficiency and immune dysfunction are integral parts of the syndrome. A reduction in B-cell numbers has been reported, associated with moderate immunodeficiency and normal immunoglobulin levels. Here, we compared B-cell populations of 19 children with DS with those in healthy age-matched controls. We found that all steps of peripheral B-cell development are altered in DS, with a more severe defect during the later stages of B-cell development. Transitional and mature-naïve B-cell numbers are reduced by 50% whereas switched memory B cells represent 10–15% of the numbers in age-matched controls. Serum IgM levels were slightly reduced, but all other immunoglobulin isotypes were in the normal range. The frequency of switched memory B cells specific for vaccine antigens was significantly lower in affected children than in their equivalently vaccinated siblings. In vitro switched memory B cells of patients with DS have an increased ability to differentiate into antibody-forming cells in response to TLR9 signals. Tailored vaccination schedules increasing the number of switched memory B cells may improve protection and reduce the risk of death from infection in DS.
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Affiliation(s)
- Rita Carsetti
- Immunology Unit, Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Diagnostic Immunology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Namazova-Baranova LS, Alekseeva AA, Kharit SM, Kozhevnikova TN, Taranushenko TE, Tuzankina IA, Scarci F. Efficacy and safety of pidotimod in the prevention of recurrent respiratory infections in children: a multicentre study. Int J Immunopathol Pharmacol 2014; 27:413-9. [PMID: 25280032 DOI: 10.1177/039463201402700311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Acute respiratory infections (ARI) still represent a big challenge for paediatricians, especially in those children defined as "ailed" as they are more susceptible to such kinds of disease. In this paediatric population, the immune system is still under-developed with an evident alteration in cytokine levels. A clinical study was carried out in 5 sites in Russia with the intention to enroll children particularly susceptible to contract respiratory infections (defined as "ailing"), assigning them to a treatment group with pidotimod in comparison with a control group, treating them for 30 days and observing the reduction in the number of ARI episodes throughout the follow-up period (6 months). Moreover, changes in serum immunological markers were evaluated at baseline and 30 days after treatment discontinuation. One hundred and fifty-seven ailing children were enrolled and assigned to two arms: a main pidotimod treatment group or a control group. The percentage of incidence of ARIs in the observation period at three different time points was statistically significant (p < 0.05). At the end of the follow-up period (after 6 months), ARIs had developed in 72 children (92.3%) in the main group and in 79 patients (100%) in the control group. Concerning changes of the immunological markers, the treatment group showed a better profile of normalization compared to the control group. The 30-day pidotimod therapy course led to improvement/reduction in the rate of acute respiratory infection recurrence in ailing children within a 3-month period, with a quick elimination of symptoms and signs of infection and, as a result, a faster recovery. The normalisation of the content of the pro-inflammatory cytokine interleukin-8 confirmed the immune-modulatory effect of the investigational drug, underlying its prophylactic effect.
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Affiliation(s)
- L S Namazova-Baranova
- Scientific Centre of Children's Health under the Russian Academy of Medical Sciences, Moscow, Russia
| | - A A Alekseeva
- Scientific Centre of Children's Health under the Russian Academy of Medical Sciences, Moscow, Russia
| | - S M Kharit
- Department of Prevention of Infectious Diseases, Public Health Committee in Vaccinal Prevention, Saint Petersburg, Russia
| | - T N Kozhevnikova
- Public Healthcare Institution DGB n. 3, Center for Respiratory Pathology of Children, Tula, Russia
| | - T E Taranushenko
- Krasnoyarsk State Medical University of Russia, Krasnoyarsk, Russia
| | - I A Tuzankina
- Institute of Immunology and Physiology, Uralian Department of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - F Scarci
- Scientific Department, Polichem SA, Lugano-Pazzallo, Switzerland
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Nigro A, Nicastro A, Trodella R. Retrospective observational study to investigate Sinerga, a multifactorial nutritional product, and bacterial extracts in the prevention of recurrent respiratory infections in children. Int J Immunopathol Pharmacol 2014; 27:455-60. [PMID: 25280039 DOI: 10.1177/039463201402700318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this retrospective observational clinical study, 167 children, aged 3 to 7 years, of both sexes, with a clinical history of recurrent respiratory infections, administered with bacterial extracts of first and second generation or Sinerga a nutritional product containing palmitoylethanolamide, bovine colostrum, phenylethylamine and the new generation of probiotic kluyveromyces FM B0399, were observed. The goal of the study was to compare the supplementation with Sinerga with the supplementation with bacterial extracts, for the effect on the frequency of episodes of respiratory infection that had resulted in a prescription for antibiotics. The study focused retrospectively on the months from March 2013 to November 2012. The results showed a greater reduction in the frequency of respiratory infections with antibiotic therapy in the group of children supplemented with Sinerga than in the group treated with bacterial extracts. In particular, it was observed that 49.3% of the children supplemented with Sinerga, against 5% of those supplemented with extracts, had no infectious episodes requiring the administration of an antibiotic. 100% of subjects supplemented with Sinerga have had no more than two episodes of respiratory infection, while this condition, in the cohort treated with bacterial extracts, was observed in only 51% of cases.
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Affiliation(s)
- A Nigro
- Private practice, Montella, Avellino, Italy
| | - A Nicastro
- Pediatric Department, San Giuseppe Moscati Hospital, Avellino, Italy
| | - R Trodella
- Pediatric Department, San Giuseppe Moscati Hospital, Avellino, Italy
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Nazzari E, Torretta S, Pignataro L, Marchisio P, Esposito S. Role of biofilm in children with recurrent upper respiratory tract infections. Eur J Clin Microbiol Infect Dis 2014; 34:421-9. [PMID: 25318897 DOI: 10.1007/s10096-014-2261-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/06/2014] [Indexed: 12/30/2022]
Abstract
Recurrent respiratory tract infections (RRTIs) are very common in children and a major challenge for pediatricians. In the last few years, bacterial biofilms have been linked to RRTIs and antibiotic resistance, and have raised serious concerns regarding the therapeutic management of recurrent middle ear diseases, chronic rhinosinusitis, and recurrent pharyngotonsillitis. This paper aims to review the new insights into biofilm-related upper respiratory tract infections in children and possible therapeutic strategies. It focuses on the clinical implications for recurrent disease and on studies in pediatric patients. Analysis of the literature showed that the involvement of bacterial biofilm in recurrent upper airway tract infections is an emerging problem that may lead to serious concerns about infection control. Despite the large amount of research within this field, detailed insight into the complex structure of bacterial biofilms and the ultrastructural and biochemical mechanisms responsible for its evasion of the immune system and resistance to treatments is currently lacking. In the future, additional emphasis should be placed on biofilm management as a component of therapeutic strategies. This goal can be attained by finding feasible methods for detecting biofilms in vivo and identifying effective methods for administering treatments that eradicate preexisting bacterial biofilms or hinder bacterial adhesion to respiratory cells.
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Affiliation(s)
- E Nazzari
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda no. 9, 20122, Milan, Italy
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Abstract
At the end of 1990s, acute respiratory tract infections (ARTIs) were called the 'forgotten pandemic’, with a clear dichotomy between developing and industrialised countries in mortality and morbidity, the main outcomes associated with ARTIs. This definition still applies 20 years later, when the introduction of new and safe antibiotics and vaccines has certainly contributed to controlling the most life-threatening ARTIs, but has not had a major impact on viral ARTIs in paediatric age. One functional approach to preventing and treating ARTIs is non-specifically increasing the immune response or enhancing the children’s innate defence mechanisms. Different kinds of biologically active substances – called immunostimulants – of natural and synthetic origins and with different mechanisms of action have been introduced in some countries for the prevention of ARTIs in children. Recently, research focused on one of these compounds, Pidotimod, has attempted to better clarify and define its mechanisms of action both in vitro and in vivo. In this paper, we critically examine the most recent findings on Pidotimod. Certainly the improvement of research methodology in the last 20 years and the acquired knowledge in various fields of clinical immunology should be the starting point for research on Pidotimod. Preclinical research will be essential to better understand the mechanisms of action of this compound. However, in vivo studies, especially randomised control trials, will be necessary to establish the real efficacy of Pidotimod in the prevention of ARTIs in paediatric age.
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Affiliation(s)
- Gian Vincenzo Zuccotti
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Via GB Grassi 74, 20157, Milan, Italy.
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Jesenak M, Hrubisko M, Majtan J, Rennerova Z, Banovcin P. Anti-allergic Effect of Pleuran (β
-glucan from Pleurotus ostreatus
) in Children with Recurrent Respiratory Tract Infections. Phytother Res 2013; 28:471-4. [DOI: 10.1002/ptr.5020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/01/2013] [Accepted: 05/15/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Milos Jesenak
- Department of Paediatrics, Jessenius Faculty of Medicine; Comenius University in Bratislava; Martin Slovakia
| | - Martin Hrubisko
- Department of Clinical Immunology, St. Elisabeth's Oncology Institute; Bratislava Slovakia
| | - Juraj Majtan
- Department of Microbiology, Faculty of Medicine; Slovak Medical University; Bratislava Slovakia
- Institute of Zoology, Slovak Academy of Sciences; Bratislava Slovakia
| | | | - Peter Banovcin
- Department of Paediatrics, Jessenius Faculty of Medicine; Comenius University in Bratislava; Martin Slovakia
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Patria MF, Esposito S. Recurrent lower respiratory tract infections in children: a practical approach to diagnosis. Paediatr Respir Rev 2013; 14:53-60. [PMID: 23347661 DOI: 10.1016/j.prrv.2011.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/17/2011] [Accepted: 11/02/2011] [Indexed: 12/20/2022]
Abstract
Many children are affected by recurrent lower respiratory tract infections (LRTIs), but the majority of them do not suffer from serious lung or extrapulmonary disease. The challenge for clinicians is to distinguish the recurrent RTIs with self-limiting or minor problems from those with underlying disease. The aim of this review is to describe a practical approach to children with recurrent LRTIs that limits unnecessary, expensive and time-consuming investigations. The children can be divided into three groups on the basis of their personal and family history and clinical findings: 1) otherwise healthy children who do not need further investigations; 2) those with risk factors for respiratory infections for whom a wait-and-see approach can be recommended; and 3) those in whom further investigations are mandatory. However, regardless of the origin of the recurrent LRTIs, it is important to remember that prevention by means of vaccines against respiratory pathogens (i.e. type b Haemophilus influenzae, pertussis, pneumococcal and influenza vaccines) can play a key role.
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Affiliation(s)
- Maria Francesca Patria
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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