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Li Q, Wang Y, Wang J, Zhao C. Improving drug repositioning accuracy using non-negative matrix tri-factorization. Sci Rep 2025; 15:7840. [PMID: 40050702 PMCID: PMC11885831 DOI: 10.1038/s41598-025-91757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 02/24/2025] [Indexed: 03/09/2025] Open
Abstract
Drug repositioning is a transformative approach in drug discovery, offering a pathway to repurpose existing drugs for new therapeutic uses. In this study, we introduce the IDDNMTF model designed to predict drug repositioning opportunities with greater precision. The IDDNMTF model integrates multiple datasets, allowing for a more comprehensive analysis of drug-disease associations. We evaluated the IDDNMTF model using various combinations of datasets and found that its performance, as measured by AUC, AUPR, and F1 scores, improved with the inclusion of more data. This trend underscores the importance of data diversity in strengthening predictive capabilities. Comparatively, the IDDNMTF model demonstrated superior performance against the NMF model, solidifying its potential in drug repositioning. In summary, the IDDNMTF model offers a promising tool for identifying new therapeutic uses for existing drugs. Its predictive accuracy and interpretability are poised to accelerate the transition from bench to bedside, contributing to personalized medicine and the development of targeted treatments.
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Affiliation(s)
- Qingmei Li
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Yangyang Wang
- School of Electronics and Information, Northwestern Polytechnical University, Xi'an, 710129, China
| | - Jihan Wang
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Congzhe Zhao
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
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Tameeris E, Bohnen AM, Bindels PJE, Elshout G. The effect of allergic rhinitis treatment on asthma control: a systematic review. NPJ Prim Care Respir Med 2025; 35:4. [PMID: 39824842 PMCID: PMC11748716 DOI: 10.1038/s41533-024-00408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 12/09/2024] [Indexed: 01/20/2025] Open
Abstract
Asthma and allergic rhinitis (AR) are common disorders of the respiratory tract that often coincide. Control of AR symptoms can improve asthma outcomes in patients with co-existing diseases. Our aim is to produce a systematic review of the effectiveness of conventional anti-AR medication for asthma outcomes in patients with both diseases. The Embase, Medline and Cochrane databases were searched for publications up to October 2024. Randomised controlled trials (RCTs) that reported objective (OAO) or subjective asthma outcomes (SAO) and compared the efficacy of anti-AR medication to placebo or conventional asthma medication were included. Included medication interventions were antihistamines (AH), corticosteroids and leukotriene receptor antagonists (LRA). We included thirty-three RCTs. Six had an exclusively paediatric study population, 17 a partially paediatric study population. No clinically relevant improvements were seen in SAO. Quality of life (QoL) showed a significant and clinically relevant improvement in five studies. A significant and clinically relevant improvement of OAO was seen in four studies. LRAs did not show significant improvements from baseline. When compared, corticosteroids performed significantly better than LRAs. Significant improvements in both OAO and SAO were seen more often in studies with AHs than with corticosteroids. Anti-allergic initiated AHs and corticosteroids seemed to have a positive effect on asthma outcomes, with AHs having the tendency to elicit more changes in outcomes than the other studied medication groups. LRAs do not seem to influence asthma outcomes. Most significant improvements were seen in QoL and OAO. SAO did not show clinically relevant improvements.
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Affiliation(s)
- Ellen Tameeris
- Erasmus MC, Department of General Practice, Rotterdam, The Netherlands.
| | - Arthur M Bohnen
- Erasmus MC, Department of General Practice, Rotterdam, The Netherlands
| | | | - Gijs Elshout
- Erasmus MC, Department of General Practice, Rotterdam, The Netherlands
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A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:773-796. [PMID: 36894277 DOI: 10.1016/j.jaip.2023.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/09/2023]
Abstract
An updated edition of the International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has recently been published. This consensus document, which included the participation of 87 primary authors and 40 additional consultant authors, who critically appraised evidence on 144 individual topics concerning allergic rhinitis, provides guidance for health care providers using the evidence-based review with recommendations (EBRR) methodology. This synopsis highlights topical areas including pathophysiology, epidemiology, disease burden, risk and protective factors, evaluation and diagnosis, aeroallergen avoidance and environmental controls, single and combination pharmacotherapy options, allergen immunotherapy (subcutaneous, sublingual, rush, cluster), pediatric considerations, alternative and emerging therapies, and unmet needs. Based on the EBRR methodology, ICAR:AR includes strong recommendations for the treatment of allergic rhinitis: (1) for the use of newer generation antihistamines compared with first-generation alternatives, intranasal corticosteroid, intranasal saline, combination therapy with intranasal corticosteroid plus intranasal antihistamine for patients not responding to monotherapy, and subcutaneous immunotherapy and sublingual tablet immunotherapy in properly selected patients; (2) against the use of oral decongestant monotherapy and routine use of oral corticosteroids.
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Tiotiu A, Novakova P, Guillermo G, Correira de Sousa J, Braido F. Management of adult asthma and chronic rhinitis as one airway disease. Expert Rev Respir Med 2021; 15:1135-1147. [PMID: 34030569 DOI: 10.1080/17476348.2021.1932470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Chronic rhinitis is defined as nasal inflammation with the presence of minimum two symptoms such as nasal obstruction, rhinorrhea, sneezing and/or itching one hour daily for a minimum of 12 weeks/year. According their etiology, four groups of rhinitis are described: allergic, infectious, non-allergic non-infectious and mixed.Chronic rhinitis is frequently associated with asthma, shares similar mechanisms of the pathogenesis and has a negative impact of its outcomes sustaining the concept of unified airways disease.Areas covered: The present review summarizes the complex relationship between chronic rhinitis and asthma on the basis of recent epidemiological data, clinical characteristics, diagnosis and therapeutic management. All four groups are discussed with the impact of their specific treatment on asthma outcomes. Some medications are common for chronic rhinitis and asthma while others are more specific but able to treat the associated comorbidity.Expert opinion: The systematic assessment of chronic rhinitis in patients with asthma and its specific treatment improves both disease outcomes. Conversely, several therapies of asthma demonstrated beneficial effects on chronic rhinitis. Treating both diseases at the same time by only one medication is an interesting option to explore in the future in order to limit drugs administration, related costs and side effects.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, France; 9 Rue Du Morvan, Vandoeuvre-lès-Nancy, France.,Development, Adaptation and Disadvantage. Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, - Vandoeuvre-lès-Nancy, France
| | - Plamena Novakova
- ;department of Allergology, Medical University of Sofia, University Hospital "Alexandrovska"; 1, Sofia, Bulgaria
| | - Guidos Guillermo
- Department of Immunology, School of Medicine, Instituto Politecnico Nacional, Gustavo A. Madero, Ciudad De México, CDMX, Mexico
| | - Jaime Correira de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Campus De, Braga, Portugal
| | - Fulvio Braido
- Allergy and Respiratory Diseases Department, University of Genoa, Genova GE, Italy
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Gao X, Yin M, Yang P, Li X, Di L, Wang W, Cui H, Yan X, Liu J. Effect of Exposure to Cats and Dogs on the Risk of Asthma and Allergic Rhinitis: A Systematic Review and Meta-analysis. Am J Rhinol Allergy 2020; 34:703-714. [PMID: 32564683 DOI: 10.1177/1945892420932487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Controversies persist regarding whether exposure to cat or dog increases the risk of asthma and allergic rhinitis. OBJECTIVE This meta-analysis aimed to assess the associations between exposure to cats or dogs and the development of asthma and allergic rhinitis. METHODS A systematic review was performed to identify case-control and cohort studies before May 2019, evaluating the association between exposure to cats and dogs and the risk of asthma and rhinitis. The risk of bias was assessed using the Newcastle-Ottawa Scale. The odds ratios (ORs) and risk ratios (RRs) were pooled for case-control and cohort studies, respectively. Subgroup analyses were performed on prespecified study-level characteristics. RESULTS The meta-analysis of 34 cohort studies showed a protective role of exposure to cats [RR: 0.88, 95% confidence interval (CI): 0.77-0.99] or dogs (RR: 0.85, 95% CI: 0.73-0.97) in the development of asthma. The subgroup analysis of birth cohort (RR: 0.74, 95% CI: 0.56-0.93) and children population (RR: 0.83, 95% CI: 0.70-0.96) also suggested a favorable role of exposure to dogs in the development of asthma. Pooled evidence from 13 case-control studies indicated no significant impact of cats (OR: 1.66, 95% CI: 0.39-2.94) and dogs (OR: 1.22, 95% CI: 0.92-1.52) on the development of asthma. A pooled analysis of five cohort studies showed a favorable effect of exposure to cats (RR: 0.60, 95% CI: 0.33-0.86) or dogs (RR: 0.68, 95% CI 0.44-0.90) on the development of allergic rhinitis. CONCLUSION The findings indicated a protective effect of exposure to cats and dogs, especially ownership, on the development of asthma and allergic rhinitis.
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Affiliation(s)
- Xiaoping Gao
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Mei Yin
- Department of Respiratory and Critical Care Medicine, the Cardiovascular and Cerebrovascular Disease, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Pei Yang
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xia Li
- Department of Otolaryngology, The Third People's Hospital of Yinchuan, Yinchuan, China
| | - Lingling Di
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hua Cui
- Department of Respiratory and Critical Care Medicine, the Cardiovascular and Cerebrovascular Disease, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaohui Yan
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jing Liu
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
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Byrne AL, Marais BJ, Mitnick CD, Garden FL, Lecca L, Contreras C, Yauri Y, Garcia F, Marks GB. Asthma and atopy prevalence are not reduced among former tuberculosis patients compared with controls in Lima, Peru. BMC Pulm Med 2019; 19:40. [PMID: 30760258 PMCID: PMC6373156 DOI: 10.1186/s12890-019-0804-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/05/2019] [Indexed: 01/25/2023] Open
Abstract
Background Although there are theoretical reasons for believing that asthma and atopy may be negatively correlated with tuberculosis, epidemiological studies have had conflicting findings. Objective To determine if people with confirmed tuberculosis were less likely to be atopic and less likely to have atopic disease including asthma compared to those with no previous tuberculosis. Methods Patients in Lima, Peru with a prior history of tuberculosis were identified from clinic records in this cohort study. A representative sample of individuals without a prior tuberculosis diagnosis was recruited from the same community. Allergen skin prick testing was performed to classify atopic status. Allergic rhinitis was identified by history. Asthma was defined by symptoms and spirometry. Eosinophilic airway inflammation was measured using exhaled nitric oxide levels. Results We evaluated 177 patients with, and 161 individuals without, previous tuberculosis. There was a lower prevalence of atopy among people with prior tuberculosis on univariate analysis (odds ratio 0.57; 95% confidence interval 0.37–0.88) but, after adjustment for potential confounders, this was no longer statistically significant (aOR 0.64, 95% CI 0.41–1.01). The prevalence of allergic rhinitis (aOR 0.76, 95% CI 0.47 to 1.24 and asthma (aOR 1.18, 95% CI 0.69 to 2.00) did not differ significantly between the two groups. We also found no significant difference in the prevalence of elevated exhaled nitric oxide (aOR 1.30, 95% CI 0.78 to 2.17) or a combined index of atopic disease (aOR 0.86, 95% CI 0.54 to 1.36). Conclusion In this urban environment in a middle-income country, prior tuberculosis may be associated with a reduced risk of atopy but does not protect against asthma and atopic disease.
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Affiliation(s)
- Anthony L Byrne
- The University of Sydney, St. Vincent's Hospital Sydney, Heart Lung Clinic, Xavier Building. 390, Victoria Street, 2010, Australia. .,Socios En Salud Sucursal Perú, Partners In Health, Lima, Peru. .,Centre for Research Excellence in Tuberculosis (TB-CRE), Sydney, Australia. .,Blacktown Hospital Clinical School, University of Western Sydney, Sydney, Australia.
| | - Ben J Marais
- The University of Sydney, St. Vincent's Hospital Sydney, Heart Lung Clinic, Xavier Building. 390, Victoria Street, 2010, Australia.,Centre for Research Excellence in Tuberculosis (TB-CRE), Sydney, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
| | - Carole D Mitnick
- Socios En Salud Sucursal Perú, Partners In Health, Lima, Peru.,Harvard Medical School, Boston, MA, USA
| | - Frances L Garden
- The Woolcock Institute of Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Leonid Lecca
- Socios En Salud Sucursal Perú, Partners In Health, Lima, Peru.,Harvard Medical School, Boston, MA, USA
| | | | - Yaninna Yauri
- Ministry of Health, Red de Salud Lima Ciudad, Lima, Peru
| | - Fanny Garcia
- Socios En Salud Sucursal Perú, Partners In Health, Lima, Peru
| | - Guy B Marks
- The University of Sydney, St. Vincent's Hospital Sydney, Heart Lung Clinic, Xavier Building. 390, Victoria Street, 2010, Australia.,Centre for Research Excellence in Tuberculosis (TB-CRE), Sydney, Australia.,The Woolcock Institute of Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute of Applied Medical Research, Sydney, Australia
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Tiotiu A, Plavec D, Novakova S, Mihaicuta S, Novakova P, Labor M, Bikov A. Current opinions for the management of asthma associated with ear, nose and throat comorbidities. Eur Respir Rev 2018; 27:27/150/180056. [PMID: 30463872 DOI: 10.1183/16000617.0056-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.
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Affiliation(s)
- Angelica Tiotiu
- Pulmonology Dept, University Hospital, Nancy, France .,EA 3450 DevAH, Development, Adaptation, Cardio-Respiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | | | - Silviya Novakova
- Allergy Unit, University Hospital "St. George", Plovdiv, Bulgaria
| | | | - Plamena Novakova
- Dept of Allergology and Asthma, Aleksandrovska Hospital, Sofia, Bulgaria
| | - Marina Labor
- Pulmonology Dept, University Hospital Centre Osijek, Osijek, Croatia
| | - Andras Bikov
- NIHR Clinical Research Facility, Manchester University NHS Foundation Trust, Manchester, UK
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8
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Bernstein DI, Bardelas JA, Svanholm Fogh B, Kaur A, Li Z, Nolte H. A practical guide to the sublingual immunotherapy tablet adverse event profile: implications for clinical practice. Postgrad Med 2017; 129:590-597. [PMID: 28326906 DOI: 10.1080/00325481.2017.1302306] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Treatment with allergy immunotherapy improves allergic rhinoconjunctivitis, but can also improve comorbidities associated with allergic rhinitis such as asthma. Sublingual immunotherapy (SLIT)-tablets are a convenient and efficacious method of allergy immunotherapy. They are self-administered after the first tablet has been provided under medical supervision. Therapy may elicit local reactions or, rarely, systemic allergic reactions. The objective of this report is to inform healthcare practitioners about the safety and tolerability profile of SLIT-tablets and use this information to provide practical guidance that may inform patients regarding potential adverse reactions and how to manage them. METHODS Pooled analyses of safety data from completed randomized, multicenter, double-blind, placebo-controlled phase 2 and phase 3 US and EU trials of timothy grass, short ragweed, and SQ house dust mite SLIT-tablets were conducted to characterize safety and tolerability. RESULTS SLIT-tablets are generally well tolerated. No life-threatening events, serious systemic allergic reactions, or events that compromised the airway have been reported. The most common treatment-related adverse events (AEs) are oral site reactions, most of which begin on day 1 of treatment, recur for less than 2 weeks, and resolve after approximately 30-60 minutes. Systemic allergic reactions have been managed with conventional pharmacotherapy. Reactions treated with epinephrine are uncommon, but have been reported. Treatment of AEs, treatment discontinuation considerations, and patient FAQs regarding SLIT-tablet safety/tolerability are discussed. CONCLUSIONS This report gives healthcare providers valuable information to educate patients regarding what to expect in terms of SLIT-tablet safety and tolerability. Practical guidance is also provided to ensure proper treatment of any adverse reactions.
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Affiliation(s)
- David I Bernstein
- a Bernstein Clinical Research Center and Department of Medicine and Environmental Health , University of Cincinnati , Cincinnati , OH , USA
| | - Jose A Bardelas
- b Allergy and Asthma Center of North Carolina , High Point , NC , USA
| | | | | | - Ziliang Li
- d Merck & Co., Inc. , Kenilworth , NJ , USA
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Wang Y, Chen H, Zhu R, Liu G, Huang N, Li W, Yang L, Zhang S, Qi S, Daurès JP, Chiriac AM, Demoly P. Allergic Rhinitis Control Test questionnaire-driven stepwise strategy to improve allergic rhinitis control: a prospective study. Allergy 2016; 71:1612-1619. [PMID: 27332957 DOI: 10.1111/all.12963] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Allergic Rhinitis Control Test (ARCT) has been validated for assessing allergic rhinitis (AR) control and identifying severe AR. The aim of the study was to assess the ARCT questionnaire as a tool for stepwise pharmacotherapy. METHODS A standard pharmacotherapy regimen from Step 1 (oral second-generation H1 antihistamine as needed) to Step 5 (oral corticosteroid) was carried out prospectively in a Chinese AR population. The AR patients were initiated with Allergic Rhinitis and its Impact on Asthma (ARIA) appropriate step treatment and assessed with ARCT every 15 days. If ARCT score was equal or above 20 (controlled AR) and maintained for 15 days, the patient would finish the study; if ARCT score was strictly <20 (uncontrolled AR), the patient would receive higher step treatment according to a predefined open design up to Step 5. The different AR control subgroups were compared. RESULTS A total of 255 patients were enrolled in the study; 5 patients dropped out and 2 (0.8%) were controlled at day 0, 85 (34.0%) at day 15, 177 (70.8%) at day 30, 222 (88.8%) at day 45, 241 (96.4%) at day 60 and 242 (96.8%) at day 75. Only 8 (3.2%) patients remained uncontrolled at the endpoint of the study. Patients with ARIA moderate/severe or persistent symptoms, moderate/severe impaired quality of life, asthma history, rhinorrhea and cough symptoms always needed up to Step 4 (nasal corticosteroid plus antihistamine) and prolonged treatments to achieve disease control. CONCLUSIONS The majority of AR can be controlled with standard stepwise treatment. ARCT offers an objective criterion for the stepwise pharmacotherapy of AR.
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Affiliation(s)
- Y. Wang
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Allergy Division; Pulmonology Department; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier Cedex 5 France
- Laboratory of Biostatistics, Epidemiology and Public Health (EA2415); University of Montpellier; Montpellier Cedex 5 France
| | - H. Chen
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - R. Zhu
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - G. Liu
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - N. Huang
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - W. Li
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - L. Yang
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - S. Zhang
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - S. Qi
- Department of Allergy; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - J.-P. Daurès
- Laboratory of Biostatistics, Epidemiology and Public Health (EA2415); University of Montpellier; Montpellier Cedex 5 France
| | - A. M. Chiriac
- Allergy Division; Pulmonology Department; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier Cedex 5 France
- UPMC Paris 06; UMR-S 1136 INSERM; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - P. Demoly
- Allergy Division; Pulmonology Department; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier Cedex 5 France
- UPMC Paris 06; UMR-S 1136 INSERM; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
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11
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Montaño-Velázquez BB, Flores-Rojas EB, García-Vázquez FJ, Jurado-Hernandez S, Venancio Hernández MA, Alanis Flores AK, Jáuregui-Renaud K. Effect of cigarette smoke on counts of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa in young patients with perennial allergic rhinitis. Braz J Otorhinolaryngol 2016; 83:420-425. [PMID: 27287302 PMCID: PMC9442755 DOI: 10.1016/j.bjorl.2016.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/13/2016] [Accepted: 04/27/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods In a cross-sectional study, forty-four patients were evaluated (aged 7–19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.
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Affiliation(s)
| | - Eulalia Beatriz Flores-Rojas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Service of Otorhinolaryngology, Mexico City, Mexico
| | | | - Silvio Jurado-Hernandez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Service of Otorhinolaryngology, Mexico City, Mexico
| | - Marco Antonio Venancio Hernández
- Instituto Mexicano del Seguro Social, CMN La Raza, Hospital de Especialidades, Service of Immunology and Allergy, Mexico City, Mexico
| | - Angélica Kathya Alanis Flores
- Instituto Mexicano del Seguro Social, CMN La Raza, Hospital de Especialidades, Service of Immunology and Allergy, Mexico City, Mexico
| | - Kathrine Jáuregui-Renaud
- Instituto Mexicano del Seguro Social, Centro Médico Nacional sXXI, P.B. Edificio C Salud en el Trabajo, Medical Research Unit in Otoneurology, Mexico City, Mexico.
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12
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Mener DJ, Lin SY. Improvement and prevention of asthma with concomitant treatment of allergic rhinitis and allergen-specific therapy. Int Forum Allergy Rhinol 2015; 5 Suppl 1:S45-50. [PMID: 26072703 DOI: 10.1002/alr.21569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Asthma and allergic rhinitis are 2 of the most prevalent chronic medical diseases. Asthma is estimated to affect 8% of adults and 9% of children, with nearly 300 million people affected worldwide. Poorly controlled allergic rhinitis may be associated with worsening asthma symptoms over time. Various treatments have been proposed in the improvement and prevention of asthma in children and adults with allergic symptoms, which have included pharmacotherapy with antihistamines and topical intranasal corticosteroids, as well as allergen-specific immunotherapy. METHODS Articles were selected through PubMed and personal knowledge of the authors based on a comprehensive literature review examining whether treatment of allergic rhinitis improves and/or prevents concomitant symptoms of asthma. The largest and highest-quality studies were included in the literature review. The search selection was not standardized. Articles written in a language other than English were excluded. RESULTS Clinical trials have showed improvement in asthma symptoms with concomitant treatment of allergic rhinitis with antihistamines and topical intranasal corticosteroids, though improvement in objective pulmonary function parameters has not been uniformly demonstrated with antihistamine use alone. There is very strong evidence to suggest that subcutaneous and sublingual immunotherapy may in addition prevent the progression of asthma in high-risk atopic patients by inducing immunological tolerance. CONCLUSION Traditional pharmacotherapy with antihistamines and topical intranasal steroids has been shown to improve allergic rhinitis symptoms with concomitant allergic asthma; however, only allergen-specific immunotherapy offers long-term control in improving asthma symptoms, exacerbations, and likely ultimate prevention in developing asthma.
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Affiliation(s)
- David J Mener
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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13
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Abstract
A 35-year-old woman has a history of nasal congestion on most days of the year, dating back to her late teens. She has chronic nasal drainage, which is clear and thick. Her congestion is worst in the late summer and early fall and again in the early spring; at these times, she also has sneezing, nasal itching, and cough. Five years ago, she had an episode of shortness of breath with wheezing on a day when her nasal symptoms were severe, but this episode resolved spontaneously and has not recurred. Her eyes do not bother her. Over-the-counter oral antihistamines help her symptoms a little, as do nasal decongestants, which she uses occasionally. Her 6-year-old son has similar symptoms. How should this case be managed?
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14
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Han S. Clinical Pharmacology Review for Primary Health Care Providers: I. Antihistamines. Transl Clin Pharmacol 2014. [DOI: 10.12793/tcp.2014.22.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Seunghoon Han
- Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137-701, Korea
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15
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Tsilochristou OA, Douladiris N, Makris M, Papadopoulos NG. Pediatric allergic rhinitis and asthma: can the march be halted? Paediatr Drugs 2013; 15:431-40. [PMID: 23955538 DOI: 10.1007/s40272-013-0043-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The strong epidemiologic and pathophysiologic link between allergic rhinitis (AR) and asthma has led to the concept of 'united airways disease' or 'respiratory allergy', implying that allergy, in its widest sense, underlies this clinical syndrome. Progression from AR to asthma is frequent and part of the 'atopic march'. Since pediatric immune responses are more adaptable and therefore may be more amenable to treatment, interventions at early childhood are characterized by a higher chance to affect the natural history of respiratory allergy. Although current treatments are quite effective in alleviating respiratory allergy symptoms, it has proven much more difficult to confirm any influence on the progression of the disease. Much more promising is the field of specific allergen immunotherapy, where current evidence, although not yet of ideal robustness, points towards a disease-modifying effect. In addition, newer or emerging, possibly more effective or more targeted interventions are promising in the preventive sense.
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Affiliation(s)
- Olympia A Tsilochristou
- Allergy Unit "D. Kalogeromitros," Medical School, "Attikon" University Hospital, 1, Rimini str, 124 62, Chaidari, Athens, Greece,
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16
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Ramachandran G, Muthu S, Renuga S. Quantum mechanical study of the structure and spectroscopic (FT-IR, FT-Raman), first-order hyperpolarizability, NBO and HOMO-LUMO analysis of S-S-2 methylamino-1-phenyl propan-1-ol. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2013; 107:386-398. [PMID: 23485937 DOI: 10.1016/j.saa.2013.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/27/2012] [Accepted: 01/10/2013] [Indexed: 06/01/2023]
Abstract
The experimental and theoretical vibrational spectra of S-S-2 methylamino-1-phenyl propan-1-ol (SSMPL). Fourier transform infrared (FTIR) and FT Raman spectra of SSMPL in the solid phase were recorded and analyzed. The molecular geometry, vibrational frequencies, infrared intensities, Raman activities and atomic charges were calculated using density functional theory calculation (B3LYP) with standard 6-31G(d,p) and high level 6-311++G(d,p) basis sets. Complete vibrational assignment and analysis of the fundamental modes of the compound were carried out using the observed FTIR and FT Raman data. The thermodynamic functions of the title compound were also performed by B3LYP with two basis sets 6-31G(d,p) and 6-311++G(d,p). Stability of the molecule arising from hyper conjugative interactions, charge delocalization has been analyzed using natural bond orbital (NBO) analysis. The calculated HOMO and LUMO energies show that charge transfer occurs within the molecule. Using the method B3LYP, the dipole moment (μ), polarizability (α) and the hyperpolarizability (β) values of the investigated molecule has been computed. Total energy distribution (TED) was used for the assignment of Unambiguous vibrational fundamental modes. Finally, Simulated FTIR and FT Raman spectra of SSMPL showed good agreement with the observed spectra.
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Wu AC, Gregory M, Kymes S, Lambert D, Edler J, Stwalley D, Fuhlbrigge AL. Modeling asthma exacerbations through lung function in children. J Allergy Clin Immunol 2012; 130:1065-70. [PMID: 23021884 DOI: 10.1016/j.jaci.2012.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 08/03/2012] [Accepted: 08/06/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Formal economic evaluation using a model-based approach is playing an increasingly important role in health care decision making. OBJECTIVE To develop a model by using an objective measure of lung function-- prebronchodilator FEV(1) as a percent of predicted (FEV(1)% predicted)--as the primary independent factor to predict the frequency of adverse events related to the exacerbation of asthma on a population level. METHODS We developed a Markov simulation model of childhood asthma by using data from the Childhood Asthma Management Program. The primary outcomes were the result of asthma exacerbations defined as hospitalizations, emergency department (ED) visits, and the need for oral corticosteroid therapy. Predicted monthly frequencies for each acute event were based on negative binomial regression equations estimated from the placebo arm of the Childhood Asthma Management Program with covariates of age, prebronchodilator FEV(1)% predicted, time in study, prior hospitalizations, and prior nocturnal awakenings. RESULTS Simulated versus observed mean number of acute events were similar within the placebo and treatment groups. While the trial demonstrated treatment effects of 48% reduction in hospitalizations, 46% reduction in ED visits, and 44% reduction in the need for oral corticosteroid therapy at 48 months, the model simulated similar reductions of 49% in hospitalizations, 41% in ED visits, and 46% in the need for oral corticosteroid therapy. CONCLUSIONS Our findings suggest that longitudinal intervention effects may be modeled through FEV(1)% predicted to estimate hospitalizations, ED visits, and need for oral corticosteroid therapy in childhood asthma for planning and evaluation purposes.
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Affiliation(s)
- Ann Chen Wu
- Department of Population Medicine, Center for Child Health Care Studies, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
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18
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Feng CH, Miller MD, Simon RA. The united allergic airway: connections between allergic rhinitis, asthma, and chronic sinusitis. Am J Rhinol Allergy 2012; 26:187-90. [PMID: 22643942 PMCID: PMC3906509 DOI: 10.2500/ajra.2012.26.3762] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The united allergic airway is a theory that connects allergic rhinitis (AR), chronic rhinosinusitis, and asthma, in which seemingly disparate diseases, instead of being thought of separately, are instead viewed as arising from a common atopic entity. OBJECTIVE This article describes patients with such diseases; explores ideas suggesting a unified pathogenesis; elucidates the various treatment modalities available, emphasizing nasal corticosteroids and antihistamines; and provides an update of the literature. METHODS A literature review was conducted. CONCLUSION The aggregation of research suggests that AR, asthma, and chronic rhinosinusitis are linked by the united allergic airway, a notion that encompasses commonalities in pathophysiology, epidemiology, and treatment.
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Affiliation(s)
- Charles H Feng
- Department of Internal Medicine, Scripps Green Hospital, La Jolla, California, USA.
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19
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Montaño-Velázquez BB, Navarrete RC, Mogica Martínez MD, Becerril-Ángeles M, Jáuregui-Renaud K. Rhinomanometry in young patients with perennial allergic rhinitis with/without recent exposure to tobacco smoke. Clin Otolaryngol 2012; 36:320-4. [PMID: 21696554 DOI: 10.1111/j.1749-4486.2011.02360.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the influence of environmental exposure to tobacco smoke on the nasal symptoms and nasal resistance of young patients with perennial allergic rhinitis. DESIGN Cross-sectional study. SETTING Tertiary referral centre. PARTICIPANTS Fifty patients were evaluated (aged 10-19 years old): 25 patients with and 25 patients without recent exposure to tobacco smoke (confirmed by cotinine/creatinine ratio). MAIN OUTCOMES MEASURES After a clinical evaluation, all the patients replied to a validated questionnaire of the severity of the nasal symptoms. Then total nasal airway resistance was recorded by active anterior rhinomanometry. RESULTS Patients with exposure to tobacco smoke had a larger total resistance than patients without exposure (t-test, P < 0.01). No significant correlation was observed between the total score of the questionnaire of nasal symptoms and the nasal resistance. CONCLUSIONS In young patients with perennial allergic rhinitis, exposure to tobacco smoke can be related to increased nasal resistance, which may not be recognised by the report of nasal symptoms.
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20
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Compalati E, Ridolo E, Passalacqua G, Braido F, Villa E, Canonica GW. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol 2010; 6:413-23. [PMID: 20441427 DOI: 10.1586/eci.10.15] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rhinitis and asthma are often associated and the two disorders interact at various levels. Rhinitis typically precedes the development of asthma and can contribute to unsatisfactory asthma control. The presence and type of asthma is influenced by sensitization, and the duration and severity of allergic rhinitis. Nasal symptoms, airflow and markers of inflammation directly correlate with lower airway involvement. Local tissue factors, such as microbial stimuli and systemic inflammatory mechanisms, play a role in the clinical expression of the allergic airway syndrome. There is increasing evidence that suggests a major involvement of airway epithelial cells in the pathogenesis of both asthma and allergic rhinitis. Even in patients with rhinitis who do not have asthma, subclinical changes in the lower airways and inflammatory mediators can be detected. The pathogenic role of paranasal sinus infections in respiratory allergy has been better elucidated but there remains a need for further research. Treatment of established rhinitis may affect asthma control and could have some impact on airway obstruction, but a direct effect of rhinitis therapy on lower airway inflammation remains to be clearly established.
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Affiliation(s)
- Enrico Compalati
- Allergy & Respiratory Diseases Clinic, Dept of Internal Medicine, University of Genova, Italy.
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21
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Dunford PJ, Holgate ST. The role of histamine in asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 709:53-66. [PMID: 21618887 DOI: 10.1007/978-1-4419-8056-4_6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Histamine is a ubiquitous inflammatory mediator intimately associated with the pathology of allergy. Traditional antihistamines, targeting the histamine H1 receptor, have failed to demonstrate a significant role for histamine in asthma. Novel immunomodulatory roles for histamine and the discovery of a novel histamine receptor, the histamine H4 receptor, have resulted in a reassessment of its importance in asthma.
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Affiliation(s)
- Paul J Dunford
- Department of Immunology, Johnson & Johnson Pharmaceutical Research & Development, LLC, San Diego, California 92121, USA.
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22
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Jutel M, Akdis M, Akdis CA. Histamine, histamine receptors and their role in immune pathology. Clin Exp Allergy 2009; 39:1786-800. [DOI: 10.1111/j.1365-2222.2009.03374.x] [Citation(s) in RCA: 242] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Allergic rhinitis (AR) and asthma are disorders of the airway characterized by inflammation of the respiratory mucosa. The presence of one disorder increases the likelihood that the other will also occur. As they are mechanistically intertwined, one can exacerbate the other when both conditions are present. In addition, comorbid AR and asthma have an additive impact on patients' health-related quality of life. The Allergic Rhinitis and its Impact on Asthma (ARIA) recommendations suggest that asthma patients should be evaluated for AR, and all AR patients should undergo tests for asthma. They also suggest that ideally, a combined strategy should be used to treat the upper and lower airway diseases. While treatment for AR includes antihistamines, intranasal glucocorticosteroids, antileukotrienes, and specific immunotherapy, data suggest that these treatment approaches may also improve asthma outcomes. This article reviews current clinical approaches to the diagnosis and management of patients with comorbid AR and asthma.
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24
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Tsai JJ, Liao EC, Tsai FH, Hsieh CC, Lee MF. The effect of local nasal immunotherapy in allergic rhinitis: using strips of the allergen dermatophagoides pteronyssinus. J Asthma 2009; 46:165-70. [PMID: 19253124 DOI: 10.1080/02770900802553110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Local nasal immunotherapy (LNIT) has been reported to be effective for mite-induced allergic rhinitis. However, its compliance is poor due to persistent nasal reactions and difficult application. The main objective of this study was to develop a Dermatophagoides pteronyssinus (Der p)-coated strip for self-application and to evaluate its clinical efficacy. Randomized, double-blind, placebo-controlled trials were carried out to evaluate the efficacy and compliance of LNIT. A total of 35 patients with allergic rhinitis from the allergy clinic were recruited to receive four months of LNIT. Clinical efficacy was evaluated by the symptoms of sneezing, rhinorrhea and nasal stuffiness. Local and systemic effects were evaluated by measuring histamine and eosinophil cationic protein (ECP) in nasal discharge and allergen-specific IgG1, IgG4 and IgE in sera. LNIT with Der p-coated strips could reduce nasal symptoms and modulate the serum levels of Der p-specific IgG1, IgG4 and IgE. The secretion of both histamine and ECP was reduced within four months after treatment. When the symptomatic and immunological changes were compared between active treatment and placebo groups, the improvements were greater in the active treatment groups for all three symptom scores. There were no severe adverse events except nasal response persisting within the first month in some cases. LNIT with a steady dose of Der p-coated strips can be self-administered at home without any systemic reactions. Both local and systemic immune responses were observed after LNIT. This therapeutic modality may serve as a good alternative treatment for allergic rhinitis.
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Affiliation(s)
- Jaw-Ji Tsai
- Department of Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan.
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25
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Abstract
PURPOSE OF REVIEW Although great improvement has been obtained in quality of life and mastering of illness by asthmatic children over recent decades, controversies still exist related to asthma treatment. The objective of the present article is to discuss such controversies. RECENT FINDINGS Results from recent publications related to childhood asthma treatment question existing dogmas. Important for prescribing correct treatment to children is correct diagnosis. Phenotypes of childhood asthma related to treatment decisions are discussed. Early use of inhaled steroids in young children is still debated as well as the preference of inhaled long-acting beta2-agonists versus leukotriene receptor antagonists as add on to inhaled steroids. When present, both allergic rhinitis and asthma should be treated to obtain improved control. Also as regards the treatment of exercise-induced asthma in children, new results concerning use of leukotriene receptor antagonists is discussed as well as the acute treatment in infants with bronchial obstruction. SUMMARY There are still several controversies regarding treatment of the asthmatic child. New studies designed specifically for children are needed to solve these questions. One cannot rely on studies performed in adults for treatment in children. New studies designed for childhood asthma are needed to solve these controversies.
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26
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Ramanathan R, Reyderman L, Su AD, Alvarez N, Chowdhury SK, Alton KB, Wirth MA, Clement RP, Statkevich P, Patrick JE. Disposition of desloratadine in healthy volunteers. Xenobiotica 2008; 37:770-87. [PMID: 17620222 DOI: 10.1080/00498250701463325] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The absorption, metabolism and excretion of desloratadine (DL, Clarinex) were characterized in six healthy male volunteers. Subjects received a single oral 10-mg dose of [(14)C]DL ( approximately 104 microCi). Blood, urine and feces were collected over 240 h. DL was well absorbed; drug-derived radioactivity was excreted in both urine (41%) and feces (47%). With the exception of a single subject, DL was extensively metabolized; the major biotransformation pathway consisted of hydroxylation at the 3 position of the pyridine ring and subsequent glucuronidation (3-OH-DL-glucuronide or M13). In five of the six subjects, DL was slowly eliminated (mean t((1/2)) = 19.5 h) and persisted in the plasma for 48-120 h post-dose. This is in contrast to a t((1/2)) of approximately 110 h and quantifiable plasma DL concentrations for the entire 240-h sampling period in one subject, who was identified phenotypically as a poor metabolizer of DL. This subject also exhibited correspondingly lower amounts of M13 in urine and 3-OH-DL (M40) in feces. Disposition of DL in this subject was characterized by slow absorption, slow metabolism and prolonged elimination. Further clinical studies confirmed the lack of safety issues associated with polymorphism of DL metabolism (Prenner et al. 2006, Expert Opinion on Drug Safety, 5: 211-223).
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Affiliation(s)
- R Ramanathan
- Schering-Plough Research Institute, Kenilworth, NJ 07033, USA.
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27
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Ichimaru Y, Kanazawa H, Kamoi H, Kyoh S, Tochino Y, Kodama T, Hirata K. Correlations of health-related quality of life questionnaire results in asthma and allergic rhinitis: effects of a leukotriene receptor antagonist. J Int Med Res 2008; 36:559-66. [PMID: 18534139 DOI: 10.1177/147323000803600322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Bronchial asthma and allergic rhinitis frequently coexist. This study investigated correlations of health-related quality of life (QOL) questionnaires for these diseases, assessing whether the selective leukotriene receptor antagonist (LTRA), pranlukast, had additional benefits to overall asthma control when there was concomitant allergic rhinitis. Patients with asthma-associated allergic rhinitis were randomly allocated to either LTRA(+) (n = 21, treated for 3 months with pranlukast), or LTRA(-) (n = 8, no pranlukast). At study start and at 3 months, pulmonary function was evaluated and QOL assessments were made using the Asthma Health Questionnaire-Japan (AHQ-Japan) and the Japan Rhino-conjunctivitis Quality of Life Questionnaire (JRQLQ). Total scores were significantly correlated both before and after therapy. After 3 months' therapy, pulmonary function and total AHQ-Japan and JRQLQ scores significantly improved in the LTRA(+) group, but not in the LTRA(-) group. A significant correlation between change at 3 months in the AHQ-Japan and JRQLQ scores from baseline values was seen in the LTRA(+) group. LTRA therapy improved allergic rhinitis symptoms, asthma symptoms and pulmonary function.
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Affiliation(s)
- Y Ichimaru
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abenoku, Osaka, Japan.
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28
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Walsh GM. The anti‐inflammatory effects of the second‐generation antihistamines. Dermatol Ther 2008. [DOI: 10.1111/j.1529-8019.2000.00042.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Garry M. Walsh
- University of Aberdeen Medical School, Aberdeen, Scotland
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29
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Ferreira J, Silveira P, Marques JA. Estudo nacional de qualidade de vida na asma – Aplicação do Asthma Quality of Life Questionnaire de Marks (AQLQ-M) na população portuguesa. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008. [DOI: 10.1016/s0873-2159(15)30253-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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30
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Abstract
A relationship between allergic rhinitis and acute and chronic rhinosinusitis has been postulated for many years. Epidemiologic evidence suggests that such a relationship is likely. In addition, evidence of a common pathophysiologic mechanism linking these diseases is compelling and continues to evolve. Although a clear and definitive causal relationship remains to be elucidated, an increasing number of studies support the plausibility of this link. The current paradigm of the "unified airway" and evidence to support this model further strengthen this link. This article reviews the literature relating allergic rhinitis and acute and chronic rhinosinusitis.
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Affiliation(s)
- Nadir Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1313 21st Avenue South, Room 602, Nashville, TN 37232-4480, USA
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3138] [Impact Index Per Article: 184.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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32
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Thurmond RL, Gelfand EW, Dunford PJ. The role of histamine H1 and H4 receptors in allergic inflammation: the search for new antihistamines. Nat Rev Drug Discov 2008; 7:41-53. [PMID: 18172439 DOI: 10.1038/nrd2465] [Citation(s) in RCA: 395] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Histamine has a key role in allergic inflammatory conditions. The inflammatory responses resulting from the liberation of histamine have long been thought to be mediated by the histamine H1 receptor, and H1-receptor antagonists--commonly known as antihistamines--have been used to treat allergies for many years. However, the importance of histamine in the pathology of conditions such as asthma and chronic pruritus may have been underestimated. Here, we review accumulating evidence suggesting that histamine indeed has roles in inflammation and immune function modulation in such diseases. In particular, the discovery of a fourth histamine receptor (H4) and its expression on numerous immune and inflammatory cells has prompted a re-evaluation of the actions of histamine, suggesting a new potential for H4-receptor antagonists and a possible synergy between H1 and H4-receptor antagonists in targeting various inflammatory conditions.
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Affiliation(s)
- Robin L Thurmond
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C. San Diego, California 92121, USA.
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33
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Kessel A, Halloun H, Bamberger E, Kugelman A, Toubi E. Abnormal spirometry in children with persistent allergic rhinitis due to mite sensitization: the benefit of nasal corticosteroids. Pediatr Allergy Immunol 2008; 19:61-6. [PMID: 17651381 DOI: 10.1111/j.1399-3038.2007.00588.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inflammatory processes affecting nasal and bronchial mucosa are similar in nature. The purpose of this study was to examine whether children with perennial allergic rhinitis, without underlying asthma, have impaired pulmonary function. We also investigated whether nasal corticosteroids and loratidine would improve the pulmonary function tests of those children with impaired lung function. Fifty subjects with moderate/severe persistent allergic rhinitis due to exclusively dust mite sensitization and no past medical history suggestive of asthma were assessed. The control group consisted of 26 matched healthy subjects. Subjects with airway obstruction, as detected by forced expiratory volume/1 s (FEV1) or forced expiratory flow from 25/% to 75% (FEF(25-75)) values <80% of those predicted, were treated with loratidine, once a day for 10 days, and daily nasal budesonide for 3 months. We found that 11 of 50 patients (22%) with perennial allergic rhinitis had impaired pulmonary function (FEF(25-75) values <80%), compared to 1/26 (3.8%) of the control group (p < or = 0.05). Reversibility was observed in 9/11 (81.8%), mean 24.7% +/- 10.3%. Within 3 months of treatment, 7/10 had FEF(25-75) > 80% of their predicted values as well as significant improvements in their FEV1 (p = 0.04), and FEV1/FVC (p = 0.04). We conclude that a substantial proportion of children with perennial allergic rhinitis have diminished FEF (25-75) values and reversible airway obstruction. Nasal corticosteroids improve the pulmonary function tests of these children with impaired lung function.
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Affiliation(s)
- Aharon Kessel
- Division of allergy and clinical Immunology, Department of Clinical Microbiology, Faculty of Medicine Technion, Haifa, Israel.
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34
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Hayden ML. Immunoglobulin E-mediated airway inflammation is active in most patients with asthma. ACTA ACUST UNITED AC 2007; 19:439-49. [PMID: 17760568 DOI: 10.1111/j.1745-7599.2007.00251.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the role of immunoglobulin E (IgE)-mediated inflammation in the pathogenesis of asthma, limitations of standard therapies, and IgE as a logical target for therapy with omalizumab aimed at attaining asthma symptom control. DATA SOURCES Review of worldwide scientific literature on the role of IgE-mediated inflammation in patients with asthma, supplemented with a clinical case study. CONCLUSIONS Clinical trials point to an important role for IgE blocker therapy as an add-on to current therapy to reduce exacerbations and corticosteroid use and to improve quality of life in patients with moderate-to-severe asthma. Omalizumab, a monoclonal antibody that binds IgE, has been shown to be an effective, well-tolerated treatment in these patients. IMPLICATIONS FOR PRACTICE A significant number of patients with moderate-to-severe asthma do not achieve asthma symptom control, despite adhering to current guidelines-based standards of therapy, including the use of inhaled corticosteroids, beta-agonists, and leukotriene modifiers. None of these therapies directly addresses IgE-mediated inflammation. Therefore, patients with persistent symptoms of moderate-to-severe asthma should be evaluated and considered for therapy with the IgE blocker omalizumab.
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Affiliation(s)
- Mary Lou Hayden
- School of Nursing, University of Virginia, Richmond, Virginia, USA.
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35
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Marple BF, Fornadley JA, Patel AA, Fineman SM, Fromer L, Krouse JH, Lanier BQ, Penna P. Keys to successful management of patients with allergic rhinitis: focus on patient confidence, compliance, and satisfaction. Otolaryngol Head Neck Surg 2007; 136:S107-24. [PMID: 17512862 DOI: 10.1016/j.otohns.2007.02.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 02/20/2007] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The American Academy of Otolaryngic Allergy (AAOA) convened an expert, multidisciplinary Working Group on Allergic Rhinitis to discuss patients' self-treatment behaviors and how health care providers approach and treat the condition. PROCEDURES AND DATA SOURCES: Co-moderators, who were chosen by the AAOA Board of Directors, were responsible for initial agenda development and selection of presenters and participants, based on their expertise in diagnosis and treatment of allergic rhinitis. Each presenter performed a literature search from which a presentation was developed, portions of which were utilized in developing this review article. SUMMARY OF FINDINGS Allergic rhinitis is a common chronic condition that has a significant negative impact on general health, co-morbid illnesses, productivity, and quality of life. Treatment of allergic rhinitis includes avoidance of allergens, immunotherapy, and/or pharmacotherapy (ie, antihistamines, decongestants, corticosteroids, mast cell stabilizers, anti-leukotriene agents, anticholinergics). Despite abundant treatment options, 60% of all allergic rhinitis patients in an Asthma and Allergy Foundation of America survey responded that they are "very interested" in finding a new medication and 25% are "constantly" trying different medications to find one that "works." Those who were dissatisfied also said their health care provider does not understand their allergy treatment needs and does not take their allergy symptoms seriously. Dissatisfaction leads to decreased compliance and an increased reliance on multiple agents and over-the-counter products. Furthermore, a lack of effective communication between health care provider and patient leads to poor disease control, noncompliance, and unhappiness in a significant portion of patients. CONCLUSIONS Health care providers must gain a greater understanding of patient expectations to increase medication compliance and patient satisfaction and confidence.
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Affiliation(s)
- Bradley F Marple
- University of Texas Southwestern Medical School, Dallas, TX 75390-7208, USA.
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Abstract
Allergic rhinitis is the most common atopic disorder seen in the outpatient clinic setting diagnosed by history, physical exam and objective testing. According to the Allergic Rhinitis and its Impact on Asthma (ARIA) document, it is classified by chronicity (intermittent or persistent), and severity which is based on symptoms and quality of life (mild, or moderate/severe). It has enormous socioeconomic costs and significant reduction in quality of life. Allergen avoidance should be implemented, particularly in children, to reduce level of exposure; unfortunately efforts are often inadequate. Montelukast, a novel medication, is an antagonist to the leukotriene receptor. It is nonsedating, dosed once daily, and has a safety profile similar in adults and children with approval down to 6 months of age. A review of the literature undoubtedly establishes montelukast as a viable alternative for the treatment of seasonal allergic rhinitis. Its benefits are equivalent to antihistamines, when used as monotherapy, but less than intranasal corticosteroids. The addition of an antihistamine to montelukast does appear to have added benefits and at times is reported to be equivalent to intranasal corticosteroids.
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Affiliation(s)
- Jaime A Lagos
- Division of Clinical Immunology and Allergy, University of Mississippi Medical Center Jackson, MS, USA
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Abstract
Allergic disease is an increasing problem worldwide. Allergic rhinitis, an inflammatory response to an allergen, affects an estimated 20-40 million people in the US, while chronic idiopathic urticaria is a dermatoallergic condition that affects 0.1-3% of people in the US and Europe. The primary goals of treatment for allergic rhinitis are to reduce symptoms, which include sneezing, rhinorrhoea and nasal congestion, improve quality of life and prevent the sequelae associated with this disease, while the goal for chronic idiopathic urticaria is the rapid and prolonged control of symptoms. Quantitatively, histamine is the most abundant mediator present during an allergic episode - thus, antihistamines (historically called histamine H(1) receptor antagonists, now called H(1) receptor inverse agonists) are a first-line defense against allergic rhinitis and chronic idiopathic urticaria. Although first-generation antihistamines can cause sedation and cognitive impairment, second-generation antihistamines are relatively non-sedating and free of such adverse events owing to their comparative inability to penetrate the blood-brain barrier. Desloratadine is one such second-generation antihistamine and is indicated for the treatment of allergic diseases, including allergic rhinitis and chronic idiopathic urticaria. It has proven efficacy against the symptoms associated with seasonal and perennial allergic rhinitis, including nasal congestion, and chronic idiopathic urticaria. As a result, it has been shown to improve patients' quality of life. The safety and efficacy profiles of desloratadine are well established, and published postmarketing analyses have assessed >54 000 patients. Although earlier second-generation antihistamines have been associated with cardiovascular adverse effects, desloratadine has been shown to be safe and well tolerated at nine times the recommended dose. In addition, it has been shown to not interact with concomitantly administered drugs and food. Overall, current data indicate that desloratadine is a safe and effective treatment for allergic diseases.
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MESH Headings
- Histamine H1 Antagonists, Non-Sedating/adverse effects
- Histamine H1 Antagonists, Non-Sedating/therapeutic use
- Humans
- Loratadine/adverse effects
- Loratadine/analogs & derivatives
- Loratadine/therapeutic use
- Product Surveillance, Postmarketing
- Randomized Controlled Trials as Topic
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
- Urticaria/drug therapy
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Affiliation(s)
- William E Berger
- Department of Pediatrics, Division of Allergy and Immunology, University of California, Irvine, California, USA.
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Abstract
PURPOSE OF REVIEW The relationship between allergic rhinitis and asthma has intrigued practicing physicians since the turn of the century. Investigations during the past two decades have led to an increased understanding of this relationship. RECENT FINDINGS A growing body of evidence clearly demonstrates that patients with allergic rhinitis, in the absence of asthma, have distinct abnormalities of lower airway function, including alterations in physiology, histology and biochemistry. In addition, epidemiologic surveys have consistently shown allergic rhinitis as an independent risk factor for developing asthma, and that preexisting abnormalities in lung function may predispose to lower airway disease development. Clinical trials show that specific allergen immunotherapy for children and adults with seasonal allergic rhinitis reduces the risk of developing asthma. In patients with established asthma and concomitant allergic rhinitis, several medications have significant effects upon the upper and lower airways, including intranasal corticosteroids, oral antihistamines, and leukotriene receptor antagonists. SUMMARY Our understanding of the natural history of allergic rhinitis could lead to improvements in early intervention, potentially preventing the progression of allergic rhinitis to asthma. Aggressive treatment of rhinitis in patients with concomitant asthma may enhance asthma outcomes and quality of life for all patients with these chronic diseases.
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Affiliation(s)
- Jonathan Corren
- Allergy Research Foundation, Los Angeles, California 90025, USA.
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39
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Nathan RA, Finn AF, LaForce C, Ratner P, Chapman D, de Guia EC, Hewlett D, Kramer B. Comparison of cetirizine-pseudoephedrine and placebo in patients with seasonal allergic rhinitis and concomitant mild-to-moderate asthma: randomized, double-blind study. Ann Allergy Asthma Immunol 2006; 97:389-96. [PMID: 17042147 DOI: 10.1016/s1081-1206(10)60806-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma are common concurrent conditions. OBJECTIVES To evaluate the effects of cetirizine hydrochloride (5 mg)-pseudoephedrine hydrochloride (120 mg) (cetirizine-D) twice daily on AR and asthma symptoms, pulmonary function, and asthma-related quality of life in 274 patients with confirmed seasonal AR and concomitant mild-to-moderate asthma. METHODS In this multicenter, randomized, double-blind, placebo-controlled study, after a 1-week screening period, patients took cetirizine-D or placebo for 4 weeks. The primary efficacy variable, AR total symptom severity complex score, was derived from patient daily diary ratings of sneezing, runny nose, itchy nose, postnasal drip, and nasal congestion. Asthma symptom severity total scores were derived from twice-daily diary ratings of wheezing, coughing, shortness of breath, and chest tightness. Pulmonary function was tested at clinic visits and by patients each morning and evening. Patients completed the Asthma Quality of Life Questionnaire at each visit. All tests were 2-sided, with statistical significance at the .05 level. RESULTS Cetirizine-D reduced total symptom severity complex scores by 42.3% overall vs 23.6% with placebo (P < .001). Asthma symptom severity total scores were significantly improved with cetirizine-D at most times vs placebo. Cetirizine-D treatment was also associated with significantly improved Asthma Quality of Life Questionnaire overall scores. Pulmonary function test results were neutral. Cetirizine-D was well tolerated, with discontinuation and adverse event rates similar to placebo. Somnolence occurred in 8 patients (5.8%) taking cetirizine-D and in 1 (0.7%) taking placebo. CONCLUSIONS Treatment with cetirizine-D twice daily significantly reduced rhinitis and asthma symptoms and improved overall asthma quality of life in patients with seasonal AR and concomitant mild-to-moderate asthma.
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Stempel DA, Stanford RH, Carranza Rosenzweig JR, McLaughlin TP. The use of rhinitis medications in children receiving initial controller therapy for asthma. Curr Med Res Opin 2006; 22:2279-85. [PMID: 17076988 DOI: 10.1185/030079906x148409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Due to common features of asthma and allergic rhinitis, a single therapeutic approach to treating both of these conditions has been proposed. OBJECTIVE To compare and contrast the use of rhinitis medications in a group of children initiating various controller therapies for asthma. METHODS A retrospective, observational study using an integrated managed care database of children aged 4-17 years with an initial medical claim for asthma and an initial pharmacy claim for fluticasone propionate (FP) and salmeterol in a single inhaler (FSC), FP alone, montelukast (MON), or combination FP + MON. Outcomes included the percentage of children initiating controller asthma therapy with prescriptions for non-sedating antihistamine (NSA) and intranasal corticosteroids (INCS) and the mean number of prescriptions for NSA and INCS. RESULTS A total of 5247 children were included. The percentage of children who filled prescriptions for NSA or INCS and the mean number of prescriptions dispensed was similar among children treated with FSC, FP, MON, and FP + MON. There were no significant differences in the relative risk of dispensing either a NSA or INCS across cohorts. Observational studies are limited by their use of administrative data and lack of access to patient records. CONCLUSIONS Children started on common asthma controller therapy are frequent users of rhinitis medications. The quantity and frequency of these medications is not different between dispensed asthma regimens.
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Abstract
PURPOSE OF REVIEW Despite our knowledge of asthma pathophysiology and several guidelines, studies have indicated growing morbidity. This review highlights the rationale for the trend in asthma care of separating asthma control from asthma severity. RECENT FINDINGS Recent research has highlighted why asthma morbidity continues to be such a conundrum. This includes the variability of asthma control over time, inability to achieve total asthma control in some patients, disagreement between various measures of asthma control and the lack of an agreed tool for determining asthma control. SUMMARY By dissociating asthma control and severity, the clinician may focus on the level of control during each encounter, independent of asthma medication. One can still build upon the step-up and step-down algorithm, while reinforcing control of asthma as the ultimate goal. Asthma control connotes the status of the disease, highlighting the dynamic nature of this illness both as the response to a trigger as well as therapy. Although more aggressive intervention may be required to achieve adequate control in severe persistent asthma versus mild persistent disease, the goal of appropriate asthma control remains constant in the spectrum of asthma severity.
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Affiliation(s)
- John J Oppenheimer
- New Jersey Medical School, Cedar Knolls, New Jersey 07927, and Mayo Clinic, Rochester, Minnesota, USA.
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42
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Fuhlbrigge AL, Weiss ST, Kuntz KM, Paltiel AD. Forced expiratory volume in 1 second percentage improves the classification of severity among children with asthma. Pediatrics 2006; 118:e347-55. [PMID: 16864642 DOI: 10.1542/peds.2005-2962] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Spirometry is an important component of the National Asthma Education and Prevention Program guidelines for asthma, yet published data show variable associations between forced expiratory volume in 1 second percentage (FEV1%) predicted, symptoms and health care utilization. The objective of this analysis was to examine the association between FEV1% and future risk of exacerbations among a well-characterized population of children with asthma. METHODS Using data that are available from the Childhood Asthma Management Program, we examined the relationship between prebronchodilator FEV1% and important clinical outcomes. Multiple observations of FEV1 were available for each patient; multivariate regression analysis, using a general estimating equation approach, was used to control for the correlation between repeated measurements among individuals and potential confounders. FEV1% was categorized into 4 levels and as a continuous variable. Outcomes of interest included mean symptom score (0-3), episode-free days, and asthma-related events (oral steroid use, emergency department visits, and hospitalizations) during the ensuing 4-month period. Our analysis was limited to the placebo group (N = 417). RESULTS We observed a clear relationship between prebronchodilator FEV1% and important clinical outcomes. In multivariable models that simultaneously controlled for covariates of interest, age at baseline, time, previous event history, and nocturnal awakenings, a significant relationship between FEV1% and asthma symptoms and serious asthma exacerbations (oral steroids, emergency department visits, and hospitalizations) was observed. Compared with children with an FEV1% > or = 100%, children with FEV1% 80% to 99%, 60% to 79%, and < 60% were 1.3, 1.8, and 4.8, respectively, more likely to have a serious asthma exacerbation during the ensuing 4 months. CONCLUSIONS. In children with mild to moderate asthma, FEV1% predicted is independently associated with future asthma symptoms and health care utilization. Previous asthma-related hospitalizations and nocturnal symptoms also were independently associated with risk for future adverse events. FEV1 is an important component of asthma health status and asthma severity classification.
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Affiliation(s)
- Anne L Fuhlbrigge
- Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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43
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Schenkel EJ. Combining desloratadine and pseudoephedrine in the treatment of seasonal allergic rhinitis. Expert Rev Clin Immunol 2006; 2:519-31. [PMID: 20477610 DOI: 10.1586/1744666x.2.4.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nonsedating antihistamines are a first-line therapy in the management of allergic rhinitis. They relieve the majority of the histamine-mediated symptoms of the condition, including rhinorrhea, sneezing, and pruritus. The nonsedating antihistamine desloratadine is effective in alleviating the symptoms of both seasonal and perennial allergic rhinitis. It may also have some decongestant properties, and thus help to alleviate nasal congestion. Administering desloratadine in combination with the decongestant pseudoephedrine may offer allergic rhinitis patients with moderate-to-severe nasal congestion the benefits of desloratadine's effectiveness for alleviating histamine-mediated symptoms plus pseudoephedrine's relief from nasal congestion. This drug profile reviews a combination therapy containing desloratadine and pseudoephedrine, approved in the USA for the relief of the symptoms of seasonal allergic rhinitis, including nasal congestion.
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Affiliation(s)
- Eric J Schenkel
- Valley Clinical Research Center, 3729 Easton-Nazareth Highway, Suite 202, Easton, PA 18045, USA.
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44
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45
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Di Lorenzo G, Pacor ML, Mansueto P, Esposito Pellitteri M, Lo Bianco C, Ditta V, Leto-Barone MS, Napoli N, Di Fede G, Rini GB. Determinants of bronchial hyperresponsiveness in subjects with rhinitis. Int J Immunopathol Pharmacol 2006; 18:715-22. [PMID: 16388720 DOI: 10.1177/039463200501800414] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Subjects with rhinitis but without asthma may have coexisting bronchial hyperresponsiveness, although the reasons for this are uncertain. To evaluate the factors that determine BHR in rhinitis we examined 410 patients with symptomatic rhinitis with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)>or=80% of the predicted value. In all subjects a skin prick test (SPT) was performed, a determination of total serum IgE and an eosinophils count in the blood. Of the 410 subjects we found that 161 (39.3%) exhibited a methacholine PD20 of 800 mg or less (Group A), whereas 249 (60.7%) had a methacholine PD20 more of 800 mg (Group B). Despite the matched mean values for FEV1 and FVC, compared with Group B, Group A had a lower predicted forced expiratory flow between 25% and 75%(FEF25%-75%) (86.7 +/- 12.0 vs. 93.7 +/- 7.3, P < 0.0001). A great portion of the subjects of the Group Ain respect to subjects of the Group B were exposed to passive smoke (37.8% vs. 22.0%, P = 0.0008), reported having mothers with asthma (34.1% vs. 6.0%, P < 0.0001), presented a positive skin prick test (93.7% vs. 67.0%, P < 0.0001), had higher levels of total serum IgE (geometric mean of Log10 2.46 +/- 0.27 kU/L vs. 2.06 +/- 0.38 kU/L, P < 0.0001) and higher blood eosinophil counts (geometric mean of Log10 2.67 +/- 0.07 x 10(-3) mL vs. 2.57 +/- 0.09 x 10(-3) mL, P < 0.0001), and reported increased nasal obstruction (2.0 (95% CI 1.8 to 2.2) vs. 0.6 (95% CI 0.5 to 0.7), P < 0.0001). Logistic regression demonstrates that nasal obstruction (OR 2.19, 95% CI 1.72 to 2.80) and the presence of positive SPT (OR 6.15, 95% CI 2.42 to 15.61) were the most available predictors to discriminate between subjects with BHR and subjects without BHR. In addition, BHR was positively related to blood eosinophil counts (OR= 2.80, 95% CI 1.54 to 5.07), FEF25%-75% values (OR= 2.72, 95% CI 1.23 to 5.99) and familiarity (mother) for asthma (OR = 2.45, 95% CI 1.10 to 5.46). Whereas passive smoke and total serum IgE were not positively related to BHR. Increased nasal obstruction and the presence of positive SPT were the most available predictors to discriminate between subjects with and without BHR. Finally, BHR was positively related to blood eosinophil counts, FEF25%-75% values and to familiarity (mother) for asthma.
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Affiliation(s)
- G Di Lorenzo
- Dipartimento di Medicina Clinica e delle Patologie Emergenti, Universitá degli Studi di Palermo, Italy.
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46
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Affiliation(s)
- C Serrano
- Servicio de Neumología y Alergia Respiratoria, ICPCT, Hospital Clínic, Barcelona, Spain
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47
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Montaño Velázquez BB, Jáuregui-Renaud K, Bañuelos Arias ADC, Ayala JC, Martínez MDM, Campillo Navarrete R, Rosalia ISV, Salazar MDRC, Serrano HAC, Mondragón AO, Perez RL. Vitamin E effects on nasal symptoms and serum specific IgE levels in patients with perennial allergic rhinitis. Ann Allergy Asthma Immunol 2006; 96:45-50. [PMID: 16440532 DOI: 10.1016/s1081-1206(10)61039-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have shown that vitamin E intake may reduce IgE production. OBJECTIVE To evaluate the effects of vitamin E supplementation on the severity of nasal symptoms and the serum levels of specific IgE in patients with perennial allergic rhinitis. METHODS Sixty-three patients (mean +/- SD age, 12 +/- 2.4 years) with a history of perennial allergic rhinitis participated in this study. None of the patients had evidence of acute infectious disease or used tobacco, corticosteroids, antihistamines, or vitamins. Patients were randomized to receive either vitamin E (400 IU/d) or placebo for 4 weeks, with loratadine-pseudoephedrine (0.2/0.5 mg/kg) during the first 2 weeks of treatment. The severity of nasal symptoms was evaluated using a validated questionnaire, which was administered weekly for 4 weeks. The serum concentrations of specific IgE to 5 common inhalant allergens and lipid peroxides were measured before treatment and at the end of the study. RESULTS Before, during, and after treatment, the symptom severity scores were similar in the 2 groups; within each group, a significant decrease was observed after the first week of follow-up (P < .05), with no further changes. Serum levels of specific IgE and lipid peroxides did not show any significant changes related to vitamin E intake within and between groups. CONCLUSIONS In patients with perennial allergic rhinitis, vitamin E supplementation (400 IU/d) did not have any significant effects on nasal symptom severity or on serum concentrations of specific IgE to 5 common allergens.
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Fisher LH, Davies MJ, Craig TJ. Nasal obstruction, the airway, and the athlete. Clin Rev Allergy Immunol 2006; 29:151-8. [PMID: 16251769 DOI: 10.1385/criai:29:2:151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rhinitis is a common condition that affects a significant proportion of the general population, as well as a high proportion of athletes. Nasal congestion is a predominate symptom of the late-phase reaction in allergic rhinitis and can have far-reaching effects that extend through the airway and beyond the nose. Rhinitis is often found in conjunction with asthma and is a risk factor for asthma. Nasal obstruction, which does not permit conditioning of inspired air by the nasal turbinates, may contribute to asthma symptoms and the development of asthma. These adverse conditions may be especially troublesome for the high-performance athlete who has increased nasal airflow turbulence and who competes under extreme conditions that may worsen rhinitis and asthma. Under the theory of the unified airway, an immune response induced in the nose may extend into the lungs via cytokines and other inflammatory mediators. Nasal congestion can significantly contribute to sleep dysfunction, leading to daytime fatigue and decreased performance. Treatment of allergic rhinitis can improve sleep and foster productivity. Control of rhinitis and nasal congestion, which is obtained by various therapies, may reverse lower airway tendency to bronchoconstriction.
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Affiliation(s)
- Laura H Fisher
- Department of Asthma, Allergy, and Immunology, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
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Fardon TC, Lee DKC, Hodge MR, Lipworth BJ. Addition of fexofenadine to inhaled corticosteroid therapy to reduce inflammatory biomarkers in atopic asthma. Ann Allergy Asthma Immunol 2005; 95:259-65. [PMID: 16200817 DOI: 10.1016/s1081-1206(10)61223-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We previously showed that H1-antihistamines may shift the PC20 (provocation concentration that caused a decrease in forced expiratory volume in 1 second of 20%) threshold to adenosine monophosphate (AMP) challenge but may paradoxically prolong recovery. OBJECTIVES To measure AMP recovery using a constant predetermined AMP PC20 and to evaluate whether fexofenadine use confers add-on effects to treatment with either fluticasone propionate alone or combined fluticasone propionate-salmeterol. METHODS Fourteen atopic patients with mild-to-moderate asthma (forced expiratory volume in 1 second of 76%) completed a double-blind, randomized, crossover study consisting of 3-week treatment blocks of either fluticasone propionate-salmeterol, 250 microg twice daily, or fluticasone propionate alone, 250 microg twice daily, in conjunction with either fexofenadine, 180 mg once daily, or matched placebo. Recovery after a predetermined AMP PC20 challenge was measured (primary outcome), along with exhaled nitric oxide levels, plasma eosinophil cationic protein levels, peripheral eosinophil counts, pulmonary function, diary card outcomes, and quality of life (all secondary outcomes). RESULTS There were no differences in any of the primary or secondary outcomes when fexofenadine was added to treatment with either fluticasone propionate-salmeterol or fluticasone propionate alone. The mean AMP recovery time was 25.0 vs 23.4 minutes for fexofenadine and placebo, respectively, as add-on to fluticasone-salmeterol and 22.5 vs 23.9 minutes, respectively, as add-on to fluticasone alone. CONCLUSION Fexofenadine did not affect recovery to a fixed dose of AMP challenge or any other surrogate inflammatory markers when given as add-on therapy to corticosteroid-treatedatopic asthmatic patients.
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Affiliation(s)
- Tom C Fardon
- Asthma and Allergy Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
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Serrano C, Valero A, Picado C. Rinitis y asma: una vía respiratoria, una enfermedad. Arch Bronconeumol 2005. [DOI: 10.1157/13079841] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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