The development of asthma in patients with allergic rhinitis

Assessment of tumor growth factor-β1 neutralizing antibody in the treatment of allergic rhinitis and asthma

To identify a novel and effective therapy for allergic rhinitis and asthma (ARA), the present study focused on treatment with tumor growth factor (TGF)-β1 neutralizing antibody. In the present study, four medications were administered to mice with ovalbumin-induced allergic inflammation. Allergic symptoms in the lungs and nasal mucosa were evaluated by detecting the secretion of cytokines from helper T cells (Th) in the peripheral blood, nasal lavage fluid and bronchoalveolar lavage fluid using ELISA. Defects in regulatory T (Treg) cells in peripheral blood mononuclear cells were also detected using flow cytometry. Furthermore, the expression of TGF-β1 and activation of Smad2/3 pathways were assessed using immunohistochemical staining, reverse transcription-quantitative polymerase chain reaction, and western blotting. It was observed that TGF-β1 neutralizing antibody inhibited symptoms of inflammation in the upper and lower airways. TGF-β1 neutralizing antibody also restored the Th1/Th2 balance and ameliorated Treg cell defects induced by ARA. Furthermore, the therapeutic effects of TGF-β1 neutralizing antibody were related to its inhibitory effects on TGF-β1 expression and Smad2/3 signaling in nasal and lung tissues. Therefore, TGF-β1 neutralizing antibody may be an effective medicine for the treatment of ARA.

Age-related off-label use of nasal corticosteroids for allergies is relatively common in Finnish children with asthma

AIM

Allergies can worsen asthma symptoms and we used national data to identify allergy medication prescribed for Finnish children and adolescents who used asthma medication.

METHODS

Register data were available for 13 435 Finnish children aged 0-17 who were entitled to special reimbursement for asthma medication during 2006-2009. Allergy medication purchases were individually analysed 2 years before and 2 years after the entitlement for asthma medication reimbursement was granted.

RESULTS

Two-thirds (66.5%) of the children had used at least one allergy medication during the 4-year follow-up, with an average of five purchases. Most (91%) of the allergy medication purchased was systemic antihistamines and half (50%) was nasal corticosteroids. In all, 8% of the allergy medication and 22% of the nasal corticosteroids were classified as off-label purchases based on the child's age. Paediatric allergologists and paediatricians prescribed 59% of the allergy medication and 76% of the off-label nasal corticoids.

CONCLUSION

Most asthmatic children and adolescents used allergy medication. Nasal corticosteroids were the commonly prescribed off-label item and the prescribers were mainly specialists in paediatric allergology or paediatrics. Official dosage instructions and more specific clinical guidelines are needed to support appropriate prescribing of nasal corticosteroids for young children.

Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study

Environmental factors, pesticides, alcohol and smoking are linked to asthma in children. The association of toxic substances exposure with asthma has not been evaluated. Our objective is to assess such associations among children aged less than 16 years old. This is a cross-sectional study, conducted between January and May 2015, using a sample of Lebanese students from private schools in Beirut and Mount Lebanon. Out of 700 distributed questionnaires, 527 (75.2%) were returned to us. Verbal informed consent was also obtained from all parents prior to participating in the study. A significant association was found between waterpipe smoking and diagnosed asthma (p = 0.003; OR_a = 13.25; 95% CI 2.472–71.026). Alcohol during pregnancy, waterpipe smoking during pregnancy and parents respiratory problems significantly increased the risk of respiratory problems by approximately 5 times, 6 times and 2 times respectively (p = 0.016; OR_a = 4.889; 95% CI 1.339–17.844, p = 0.021; OR_a = 6.083; 95% CI 1.314–28.172, p = 0.004; OR_a = 1.748; 95% CI 1.197–2.554 respectively). Waterpipe smoking, alcohol during pregnancy, recurrent otitis and humidity at home seem to be significantly correlated with asthma in children. Spreading awareness by health care professionals is needed to permit a reduction of the prevalence of these allergic diseases, especially asthma, in children.

Effect of the potent and selective DP1 receptor antagonist, asapiprant (S-555739), in animal models of allergic rhinitis and allergic asthma

Prostaglandin (PG) D2 elicits responses through either the DP1 and/or DP2 receptor. Experimental evidence suggests that stimulation of the DP1 receptor contributes to allergic responses, such that antagonists are considered to be directed therapies for allergic diseases. In this study, we demonstrate the activity of a novel synthetic DP1 receptor antagonist termed asapiprant (S-555739) for the DP1 receptor and other receptors in vitro, and assess the efficacy of asapiprant in several animal models of allergic diseases. We determined the affinity and selectivity of asapiprant for the DP1 receptor in binding assays. In the animal models of allergic rhinitis, changes in nasal resistance, nasal secretion, and cell infiltration in nasal mucosa were assessed after antigen challenge with and without asapiprant. Similarly, in the animal models of asthma, the effect of antigen challenge with and without asapiprant on antigen-induced bronchoconstriction, airway hyper-responsiveness, mucin production, and cell infiltration in lung were assessed. In binding studies, asapiprant exhibited high affinity and selectivity for the DP1 receptor. Significant suppression of antigen-induced nasal resistance, nasal secretion, and cell infiltration in nasal mucosa was observed with asapiprant treatment. In addition, treatment with asapiprant suppressed antigen-induced asthmatic responses, airway hyper-responsiveness, and cell infiltration and mucin production in lung. These results show that asapiprant is a potent and selective DP1 receptor antagonist, and exerts suppressive effects in the animal models of allergic diseases. Thus, asapiprant has potential as a novel therapy for allergic airway diseases.

Improvement and prevention of asthma with concomitant treatment of allergic rhinitis and allergen-specific therapy

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.

Childhood mouth-breathing consequences at adult age: ventilatory function and quality of life

Introduction Mouth breathing can affect the functions of the respiratory systems and quality of life. For this reason, children who grow up with this stimulus may have implications on physical and psychological aspects at adult age.Objective To evaluate childhood mouth-breathing consequences for the ventilatory function and quality of life at adult age.Materials and methods Prospective, observational and cross-sectional study with 24 adults, between 18 and 30 years old, mouth breathers during childhood, comprised the childhood mouth-breathing group (CMB). The childhood nasal-breathing (CNB) group was composed of 20 adults of the same age, without history of respiratory disease during all their lives. Measurements of maximal respiratory pressures, peak expiratory flow and 6-minute walk test were assessed. In addition, all the volunteers answered the Short Form-36 questionnaire (SF-36).Results The maximal inspiratory (p = 0.001) and expiratory (p = 0.000) pressures as well as the distance in the walk test (p = 0.003) were lower in the COB. The COB also presented lower score in the General Health domain of the SF-36 Questionnaire (p = 0.002).Conclusion Childhood mouth-breathing yields consequences for the ventilatory function at adult age, with lower respiratory muscle strength and functional exercise capacity. Conversely, the quality of life was little affected by the mouth breathing in this study.

Qu Feng Xuan Bi Formula attenuates anaphylactic rhinitis-asthma symptoms via reducing EOS count and regulating T cell function in rat ARA models

ETHNOPHARMACOLOGICAL RELEVANCE

Aqueous extract of Qu Feng Xuan Bi Formula (QFXBF, a Chinese herb formula) which composed of Radix Glycyrrhizae, Radix Glycyrrhizae Preparata, Paeonia sterniana Fletcher in Journ, Pheretima, Allium macrostemon Bunge, Astragalus membranaceus (Fisch) Bunge and Divaricate Saposhnikovia Root has been used in treatment of allergic rhinitis and asthma (ARA) as an approved hospital prescription for many years in Jiangsu Province Hospital of Traditional Chinese Medicine, China. The present study was designed to investigate the effect of the aqueous extract of QFXBF in the gene expression of Toll-like receptor 9 (TLR9) and the manners of immune modulation of T cell-associated interleukin (IL-4 and IL-13) in rat ARA models.

MATERIALS AND METHODS

Fifty SD male rats were divided into five groups: not treated group, OVA only group (treated only with OVA), dexamethasone (DXM) group, low dose QFXBF group and high dose QFXBF group randomly (n=10 per group). Rat allergic rhinitis and asthma model was developed by ovalbumin (OVA) sensitization and nose infusion. Pathological changes of nasal tissue and lungs were examined by H&E staining. Gene expressions of TLR9, Stat 3, Jak-1 and C-Jun in nasal tissue were assayed by real-time polymerase chain reaction (RT-PCR). The serum and broncho-alveolar lavage fluid (BALF) levels of T cell-associated interleukin (IL-4 and IL-13) were determined by enzyme-linked immunosorbent assay (ELISA).

RESULT

The ARA model was successfully established. Marked EOS count was observed in BALF from ARA models. The aqueous extract of QFXBF could reduce EOS levels and increase TLR9 expression, but did not affect the gene expression of Stat-3 and Jak-1 and C-Jun. The reduction of IL-13 concentration in serum from high dose QFXBF group was observed in BALF, albeit not significantly. Despite the not treated group, serum levels of IL-4 had significantly increased in other four groups (P<0.001, n=4-6) but made higher in low dose QFXBF group and DXM group (P<0.05, n=4-6).

CONCLUSION

This study originally provides the evidence that the aqueous extract of Qu Feng Xuan Bi Formula alone is effective in the treatment of anaphylactic rhinitis-asthma symptoms. The extract of Qu Feng Xuan Bi Formula was effective to reduce the eosophil recruitment to the lung. In addition it increased the IL-4 concentration in the BALF and expression of TLR9 in the nasal tissue. No alteration was observed in the IL-13 concentration in the BALF and expression of STAT-3, JAK-1 and C-Jun in nasal tissue. The results thereby scientifically provided mechanism of these aqueous extract of QFXBF in improvement of ARA and supported its clinical use.

Tobacco intervention teachable moments for pediatric otolaryngologists: atopy and second hand smoke exposure among children

OBJECTIVES

Pediatric otolaryngology clinics have tremendous access to children with allergic conditions, yet no research has evaluated in this setting environmental tobacco smoke and the occurrence of atopic diseases.

METHODS

Caregivers or parents of 201 consecutive patients in a Hungarian pediatric otolaryngology clinic were queried on otolaryngologic conditions; self-reported diagnoses of atopic diseases; and tobacco smoke exposure.

RESULTS

A history of asthma was reported in 10.3% of children; 38.7% had at least one parent who smoked. Fifteen out of the 20 children with asthma (75.0%) had at least one parent who smoked. Having a diagnosis of hay fever and having a parent who smoked greatly increased the odds of having a diagnosis of asthma.

CONCLUSIONS

Second hand smoke exposure among children in an otolaryngology clinic was common, and was associated with co-existing atopic conditions. Pediatric otolaryngologists have an important opportunity to address parental smoking as part their care of children.

Variance of melatonin and cortisol rhythm in patients with allergic rhinitis

OBJECTIVE

Allergic rhinitis is an IgE-mediated inflammatory disease which effects 10%-50% of the normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in allergic rhinitis have not been investigated.

STUDY DESIGN

Salivary levels of melatonin and cortisol were measured by radioimmunoassay in 35 newly diagnosed allergic rhinitis patients and in 23 control subjects matched for age and gender.

RESULTS

In the study group; amplitude, baseline and peak levels of salivary melatonin were significantly decreased compared with healty controls (p<0.001). No differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p>0.05). In the study subjects, the circadian rhythm of cortisol was flattened when compared with the control group. The amplitude and the 24h mean levels of salivary cortisol in the study group were significantly lower than in the control group and the acrophase was delayed in patients compared with control subjects (p<0.001).

CONCLUSION

The circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with allergic rhinitis. These results may also be contributive data to explain the pathogenesis of allergic rhinitis and also they can be applicable as adjunctive therapeutic tools in the future and melatonin drugs might be an alternative in the therapy of resistant allergic rhinitis patients or allergic rhinitis patients who cannot use cortisol drugs.

Fractional exhaled nitric oxide and impulse oscillometry in children with allergic rhinitis

Purpose

Airway inflammation, bronchial hyper-responsiveness (BHR), and bronchodilator response (BDR) are representative characteristics of asthma. Because allergic rhinitis (AR) is a risk factor for asthma development, we evaluated these 3 characteristics in AR using measurement of fractional exhaled nitric oxide (FeNO), a methacholine challenge test (MCT), and impulse oscillometry (IOS).

Methods

This study included 112 children with asthma (asthma group), 196 children with AR (AR group), and 32 control subjects (control group). We compared pulmonary function parameters and FeNO levels among the 3 groups. The AR group was subdivided into 2 categories: the AR group with BHR and the AR group without, and again pulmonary function and FeNO levels were compared between the 2 subgroups.

Results

FeNO levels were more increased in the AR and asthma groups than in the control group; within the AR group, FeNO was higher in the AR group with BHR than in the AR group without. The BDR was more increased in the AR group than in the control group when percent changes in reactance at 5 Hz (Δ X5) and reactance area (Δ AX) were compared. In the AR group, however, there was no difference in Δ X5 and Δ AX between the AR group with BHR and the AR group without.

Conclusions

Reversible airway obstruction on IOS and elevated FeNO levels were observed in children with AR. Because elevated FeNO levels can indicate airway inflammation and because chronic inflammation may lead to BHR, FeNO levels may be associated with BHR in AR. IOS can be a useful tool for detecting lower airway involvement of AR independent of BHR assessed in the MCT.

Ocorrência de rinite, respiração oral e alterações orofaciais em adolescentes asmáticos

OBJETIVO: determinar a ocorrência de rinite, respiração oral e alterações orofaciais em adolescentes asmáticos. MÉTODO: estudo do tipo transversal, realizado com 155 adolescentes asmáticos de 12 a 15 anos e de ambos os sexos, atendidos no Instituto Materno Infantil Professor Fernando Figueira. O levantamento de dados consistiu de duas etapas: a primeira para análise dos prontuários dos pacientes e da realização de dois testes para avaliação adicional da função respiratória. Sendo um com o auxílio do espelho de Glatzel e o outro com a contagem do tempo de permanência da água na boca. A segunda por meio de exame clínico para identificação das alterações orofaciais. RESULTADOS: a frequência de rinite alérgica foi elevada (80,6%), não existindo diferença significante entre o sexo feminino (80,9%) e o masculino (80,5%). Quanto ao padrão de respiração 32,9% dos asmáticos apresentaram respiração oronasal. As alterações faciais mais frequentes para o sexo masculino foram: olheiras (93,1%), palato ogival (82,8%), lábios ressecados (70,1%), selamento labial inadequado (77,0%), olhos caídos (62,1%) e face alongada (57,5%). O sexo feminino apresentou as maiores frequências para as seguintes características: olheiras (91,2%), palato ogival (85,3%), selamento labial inadequado (67,6%), lábios ressecados (63,2%) face alongada (66,2%) e lábio superior estreito (57,4%). CONCLUSÃO: em adolescentes asmáticos a frequência de rinite alérgica foi alta, bem como a ocorrência de respiração oral e de alterações faciais.

Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building

Mold exposure in damp buildings is associated with both nasal symptoms and asthma development, but the progression of building-related (BR) rhinosinusitis symptoms to asthma is unstudied. We examined the risk of developing BR-asthma symptoms in relation to prior BR-rhinosinusitis symptoms and microbial exposure among occupants of a damp building. We conducted four cross-sectional health and environmental surveys among occupants of a 20-story water-damaged office building. We defined BR-rhinosinusitis symptom (N=131) and comparison (N=361) groups from participants' first questionnaire responses. We compared the odds for the development of BR-asthma symptoms between these two groups over the subsequent surveys, using logistic regression models adjusted for demographics, smoking, building tenure, and first-survey exposures to fungi, endotoxin, and ergosterol. The BR-rhinosinusitis symptom group had higher odds for developing BR-asthma symptoms [odds ratio (OR)=2.2; 95% confidence interval (CI)=1.3-3.6] in any subsequent survey compared to those without BR-rhinosinusitis symptoms. The BR-rhinosinusitis symptom group with higher fungal exposure within the building had an OR of 7.4 (95% CI=2.8-19.9) for developing BR-asthma symptoms, compared to the lower fungal exposure group without BR-rhinosinusitis symptoms. Our findings suggest that rhinosinusitis associated with occupancy of water-damaged buildings may be a sentinel for increased risk for asthma onset in such buildings.

PRACTICAL IMPLICATIONS

Exposure to mold is associated with the development of asthma in damp building occupants, and rhinitis is known to be a risk factor for asthma. However, there is little information about the degree of risk for the progression of rhinosinusitis to asthma owing to mold exposures in damp buildings. Our study of damp building occupants demonstrates that building-related (BR) rhinosinusitis symptoms were a risk factor for the development of BR asthma symptoms and that exposure to mold (fungi) or other dampness-related agents augments risk for the development of BR asthma symptoms among those with BR rhinosinusitis symptoms. Our findings suggest that occurrence of BR upper respiratory illness in water-damaged buildings may presage future endemic asthma.

The role of inhaled and/or nasal corticosteroids on the bronchodilator response

PURPOSE

To compare the profiles of the bronchodilator response (BDR) among children with asthma and/or allergic rhinitis (AR) and to determine whether BDR in these children is reduced by treatment with inhaled and/or nasal corticosteroid.

METHODS

Sixty-eight children with asthma (mean age, 10.9 years), 45 children with comorbid asthma and AR (mean age, 10.5 years), and 44 children with AR alone (mean age, 10.2 years) were investigated. After a 2-week baseline period, all children were treated with inhaled fluticasone propionate (either 100 or 250 µg b.i.d., tailored to asthma severity) or nasal fluticasone propionate (one spray b.i.d. in each nostril) or both, according to the condition. Before and 2 weeks after starting treatment, all children were evaluated with spirometry and bronchodilator testing. BDR was calculated as a percent change from the forced expiratory volume in 1 second (FEV(1)) at baseline.

RESULTS

The mean BDR was 10.3% [95% confidence interval (CI) 8.3-12.4%] in children with asthma, 9.0% (95% CI 7.3-10.9%) in subjects with asthma and AR, and 5.0% (95% CI 4.1-5.9%) in children with AR alone (P<0.001). After treatment, the mean BDR was reduced to 5.2% (95% CI 4.2-6.3%) (P<0.001) in children with asthma and to 4.5% (95% CI 3.5-5.5%) (P<0.001) in children with asthma and AR. However, children with rhinitis showed no significant change in BDR after treatment, with the mean value being 4.7% (95% CI 3.7-5.8%) (P=0.597).

CONCLUSION

The findings of this study imply that an elevated BDR in children with AR cannot be attributed to nasal inflammation alone and highlights the close relationship between the upper and lower airways.

Intranasal Mometasone Furoate for Treatment of Allergic Rhinitis

Allergic rhinitis (AR) is a chronic nasal disease that affects the upper respiratory tract. This disorder is characterized by inflammation of the mucous membranes and it manifests with several nasal symptoms accompanied sometimes by non-nasal symptoms. Best therapy aims to prevent and improve the AR-clinical picture. Steroids have an important role in the treatment of AR. The development of steroids administrated directly on nasal mucosa has much reduced the systemic adverse affects associated with oral steroids therapy. Mometasone furoate aqueous nasal spray is a synthetic steroid assessed for intranasal use in the therapy of adults and children affected by AR. Such topical nasal steroid is an effective molecule improving clinical picture of AR and it is also approved as prophylactic therapy. In this article, apart from a careful description of its successful clinical use the authors review pharmacokinetic/pharmacodynamic profile, mechanism of action, safety, and efficacy of such steroid molecule.

Allergy from infancy to adolescence. A population-based 18-year follow-up cohort

BACKGROUND

Anxious parents have many concerns about the future health of their atopic infants. Paediatricians and primary care practitioners need to seek knowledge on long-term outcomes in order to cope with the increasing caseload of suspected allergy and the concerns of parents. The aim of the study was to assess suspected and diagnosed allergy in infancy as predictors of allergy and asthma in adolescence.

METHODS

Families expecting their first baby and making their first visit to a maternity health care clinic in 1986 were selected as the study population in a random sample. There were 1278 eligible study families. The data were provided of the children at the ages of 9 and 18 months and 3, 5, 12, 15 and 18 years by health care professionals, parents, and adolescents (themselves).

RESULTS

At the age of 9 months, the prevalence of allergy suspicions was distinctly higher than that of allergy diagnoses. At the age of five years suspected allergy approaches were nil, and the prevalence of diagnosed allergy was about 9%. During the adolescence, the prevalence of self-reported allergy increases steadily up to the age of 18 years, and that of asthma remains at approximately 5%. Suspected allergy at the age of 9 or 18 months and at the 5 years of age does not predict allergy at adolescence. Compared with non-allergic children, children with definite allergy at the age of 5 were over 8 times more likely to have allergy and nearly 7 times more likely to have asthma in adolescence.

CONCLUSION

An early ascertained diagnosis of allergy, but not suspicions of allergy, predicts prevailing allergy in adolescence. Efforts need to be focused on accurate diagnosis of early childhood allergies.

Ebastine in allergic rhinitis and chronic idiopathic urticaria

Histamine is a key mediator in the development of allergy symptoms, and oral H(1)-antihistamines are among the most widely used treatments for symptomatic relief in conditions such as allergic rhinitis and chronic urticaria. Ebastine is a second-generation antihistamine which has been shown to be an effective treatment for both seasonal and perennial allergic rhinitis. In controlled clinical trials in adult and adolescent patients with allergic rhinitis, ebastine 10 mg once-daily improved symptoms to a significantly greater extent than placebo and to a similar extent as loratadine 10 mg and cetirizine 10 mg (both once-daily), while ebastine 20 mg proved to be more effective than these two comparator antihistamines. In addition, ebastine was significantly more effective than placebo at relieving the symptoms of chronic idiopathic urticaria. Ebastine provides efficacy throughout the 24-h dosing interval with once-daily administration and clinical benefit is seen from the first day of treatment. Small studies have found beneficial effects for ebastine in patients with other disorders, including cold urticaria, dermographic urticaria, atopic asthma, mosquito bites and (in combination with pseudoephedrine) the common cold. In addition to the regular ebastine tablet, a fast-dissolving tablet (FDT) formulation, which disintegrates in the mouth without the aid of a drink, is also available. It has been shown to be bioequivalent to the regular tablet, and to be significantly more effective than desloratadine at reducing histamine-induced cutaneous wheals. A number of patient surveys demonstrated that the majority of individuals who tried the fast-dissolving formulation reported it to be convenient for use, fast-acting and preferred it to their previous antihistamine medication. Perhaps most importantly, a large proportion of patients indicated that they would prefer to use this new formulation in the future. Ebastine has a rapid onset of action and it can be administered once-daily, with or without food. Dose modifications are not needed in elderly patients, or in those with renal or mild to moderate hepatic impairment. Ebastine is generally well-tolerated, and clinical studies showed that at usual therapeutic doses of 10 and 20 mg once-daily, it had no clinically relevant adverse effects on cognitive function and psychomotor performance or on cardiovascular function. In conclusion, ebastine is an effective and generally well-tolerated treatment for allergic rhinitis and chronic idiopathic urticaria. In addition to the regular tablet formulation, ebastine is available as a FDT, providing a treatment option that is particularly convenient for patients.

Risk factors for asthma and allergic diseases in school children across Lebanon

Introduction:

Childhood asthma is one of important diseases of childhood. There is no known prevalence of asthma and allergic diseases in Lebanon. This study was conducted with a secondary objective of finding the odds of exposure to asthma, allergic rhinitis and eczema potential risk factors in Lebanese children.

Material and methods:

It is a cross-sectional study on children in public and private schools. A sample of 22 schools participated, where standardized written core questionnaires were distributed. 5–12 year old students completed the questionnaires at home, while 13–14 year old students filled it in class.

Results:

5522 children were evaluated for asthma, allergic rhinitis and atopic eczema prevalence and their associated factors. These diseases seem to be similarly affected by parental respiratory problems, parental smoking, infancy gastroesophageal reflux, recurrent otitis, and previous pertussis. Humidity on the bedroom walls is associated with both asthma and allergic rhinitis, a spongy pillow with both allergic rhinitis and eczema, animal possession with asthma, and noncotton mattress with atopic eczema. The adjusted odds ratios for significant associations varied between 1.25 and 3 (0.0001 < p-value < 0.01).

Conclusion:

These factors are preventable, thus permitting a possible reduction of the prevalence of these diseases.

New visions in specific immunotherapy in children: an iPAC summary and future trends

Specific immunotherapy is indicated for confirmed immunoglobulin E-mediated airway diseases using standardized allergen products with documented clinical efficacy and safety. For decades the subcutaneous route of administration (SCIT) has been the gold standard. Recently, the sublingual immunotherapy (SLIT) has also been investigated in children. SCIT, especially with grass and birch pollens but also house dust mites, is an effective treatment in children with allergic rhinitis and asthma when a significant part of their symptoms are caused by these allergens. A long-term effect up to 12 yr after discontinuation of SCIT with timothy allergen has been shown. Efficacy and safety of SLIT in pollen allergic rhinoconjunctivitis have been demonstrated in adults. The evidence in children is a little less convincing, and more data is needed. The clinical relevance, long-term results and the size of the effect, as well as the dose, the treatment regimen and duration has not been sufficiently elaborated. It is demonstrated that SCIT has the potential for preventing the development of asthma in children with allergic rhinoconjunctivitis. Also one randomized study indicates a preventive effect of SLIT in children on the development of asthma. At present, there are no studies who clearly demonstrates either a long-term effect or a preventive effect on the development of asthma of SLIT in children. The areas with lack of evidence should be addressed in well performed prospective, randomized long-term studies both with SCIT and SLIT. This review was initiated by iPAC (international Pediatric Allergy and Asthma Consortium) and aims to review current knowledge related to specific immunotherapy in childhood, and to identify needs for future research in this field.

A prospective study on the association between hay fever among children and incidence of asthma in East Germany

BACKGROUND

Aim of this study was to examine the effect of hay fever in childhood for asthma onset from childhood to adulthood in a prospective cohort of 3,199 asthma-free children, initially aged 5-13 years, which were followed for up to 12 years in East-Germany.

METHODS

Crude and adjusted incidence rate ratios (IRR) of asthma onset due to hay fever at baseline were calculated by a generalized estimation equation approach accounting for person years at risk, age at study entry, parental asthma, and gender.

RESULTS

Overall 142 incident cases of asthma were observed. Prevalence of hay fever at baseline was 4%. Crude and adjusted IRR were essentially the same and showed overall and in each age group a substantial higher risk of asthma onset due to hay fever. The adjusted IRR was 4 overall and ranged between 3 and 5 within the three age groups. Restricting the analysis to those participants, who were 17-25 years of age at the end of follow-up resulted in similar IRR.

CONCLUSION

Hay fever in childhood is a strong predictor of asthma onset later in life up to adulthood. The preventive potential of early and efficient treatment of allergic rhinitis to avoid asthma development needs to be investigated.

Serum leptin levels and lipid profiles in patients with allergic rhinitis and mild asthma

BACKGROUND

Despite improved understanding of the pathophysiology of allergic rhinitis and asthma, the effect of serum leptin level is still controversial. Only a few studies have been performed to investigate the serum leptin levels in allergic rhinitis and asthma, and contradictory results have been observed.

OBJECTIVE

We aimed to investigate the association between leptin, lipid profiles and allergic rhinitis and mild asthma, and to determine whether inhaled and/or intranasal steroids affect the leptin levels.

PATIENTS AND METHODS

We studied 43 patients with allergic rhinitis (10 of with mild asthma) (mean age 29.81, range 18-45 yr) and 32 volunteers as a control group (mean age 30.53, range 20-45 yr).

RESULTS

Serum leptin levels in patients were 8.49 +/- 10.76 microg/ml, and did not differ from volunteers 5.42 +/- 6.63 microg/ml. (p > 0.05). We found a direct link between increased body mass index (BMI) and serum leptin levels (p = 0.008). No association was seen between leptin and triglyceride, HDL-cholesterol, VLDL-cholesterol, eosinophil, total IgE (p > 0.05); except for total cholesterol and LDL-cholesterol (p < 0.05). Although, no correlation between allergic rhinitis and mild asthma and serum level of leptin was shown, these parameters and age correlations were stronger in female than in male (p = 0.39 for male and p = 0.011 for female), and also found direct link between increased BMI and sex and patients group (p = 0.008 for male and p = 0.0001 for female). We also determined that there was no effect of inhaled and/or intranasal steroids statistically on serum leptin levels.

CONCLUSION

Our data demonstrate that the serum levels of leptin and lipid profiles on allergic rhinitis and mild asthma were not different than those in controls.

Alterações orofaciais em doenças alérgicas de vias aéreas

OBJETIVO: Apontar as possíveis alterações orofaciais decorrentes do sintoma "obstrução nasal" em pacientes portadores de doenças alérgicas de vias aéreas superiores, por meio de revisão de literatura. FONTES DE DADOS: Levantamento bibliográfico utilizando bancos de dados eletrônicos, como Medline, Ovid, SciELO e Lilacs, com as palavras-chave "asthma", "rhinitis" e "mouth breathing", abrangendo os 30 últimos anos. Foram incluídos artigos de revisão, estudos observacionais e ensaios clínicos. SÍNTESE DOS DADOS: A obstrução nasal é encontrada freqüentemente em doenças alérgicas de vias aéreas, como rinite e asma. A respiração bucal decorrente da obstrução nasal pode interferir de maneira direta no desenvolvimento infantil, com alterações no crescimento do crânio e orofacial, na fala, na alimentação, na postura corporal, na qualidade do sono e no desempenho escolar. CONCLUSÕES: Devido à variedade de alterações orofaciais encontradas na criança respiradora bucal decorrente de obstrução nasal por doenças alérgicas de vias aéreas, é necessário realizar diagnóstico e tratamento precoces por uma equipe multidisciplinar, composta por médico, ortodontista e fonoaudiólogo, contemplando a visão de uma via respiratória única, que traz conseqüências ao crescimento e desenvolvimento do sistema motor oral.

The impact of comorbid atopic disease on asthma: clinical expression and treatment

Clinically, asthma and allergic rhinitis involve separate regions of the respiratory tract while representing a common underlying inflammatory syndrome. Much evidence supports an epidemiologic association between the diseases, paranasal sinus involvement in both conditions, and parallel relationship in severity and treatment outcomes. Pathophysiologic mechanisms, including immunoglobulin E (IgE)- mediated inflammation, are also shared. Blocking IgE with the recombinant humanized monoclonal antibody omalizumab demonstrated clinical efficacy in patients with upper and lower airway diseases. IgE blockade, leukotriene modulation, and B-cell depletion therapy have all exhibited success in chronic inflammation, reinforcing and expanding the beneficial role of immunomodulation of global mediators.

Occupational upper airway disease

PURPOSE OF REVIEW

This article reviews recent findings concerning occupational upper airway diseases, which, although very frequent, are usually not considered serious. However, the concept of the 'united airway', evoked during recent years, should change our attitude regarding these diseases. Moreover, new agents in the occupational environment must be characterized. Furthermore, exposure to carcinogens has changed over the years, and in most cases risk should be reassessed.

RECENT FINDINGS

Recent findings concerning work-related upper airway diseases caused by allergens and irritants, and their relationship to lower airway diseases, are reviewed. Findings of studies aimed at characterizing occupational allergens of plant and animal origin are presented. Recognition of work-related upper airway diseases both in clinic and in epidemiological studies is discussed. Current evidence on occupational cancer of the upper airways, its risk factors and changes in them over the years resulting from preventative measures are also described.

SUMMARY

There is significant evidence that occupational allergic diseases of the upper airways can pose important health problems because they represent an early stage of allergy throughout the respiratory system. However, how to detect those rhinitic patients who will develop asthma remains unresolved. New occupational health problems due to irritants were recently reported, and both follow-up studies and evaluations of their implications for the lower airways are warranted. Although preventative measures have been effective to some extent, risk for occupational cancer of the upper airways persists and more targeted epidemiological studies in this area are needed.

Rinite, sinusite e asma: indissociáveis?

Este estudo tem como objetivo rever a literatura ressaltando aspectos epidemiológicos e fisiopatológicos relacionados à abordagem unificada de rinossinusite alérgica e da asma, com as respectivas implicações terapêuticas. O levantamento bibliográfico foi realizado a partir das informações disponibilizadas pelas bases de dados Medline, MD Consult, Highwire, Medscape, LILACS e por pesquisa direta, dos últimos trinta anos, utilizando-se os termos allergic rhinitis e asthma. Foram selecionados 55 artigos originais em revisão não sistemática abordando a questão da associação clínica entre rinossinusite alérgica e asma. Verifica-se que nos últimos anos, com o uso de medicamentos tópicos, para as vias aéreas superiores ou para as vias aéreas inferiores, a abordagem terapêutica tem sido distinta. Entretanto, inúmeros inquéritos epidemiológicos, estudos de imunopatologia e clínicos demonstram a inter-relação entre asma e rinossinusite alérgica evidenciados por: i) a rinite alérgica encontra-se associada à asma e constitui-se em fator de risco independente para o seu aparecimento; ii)as características imunopatológicas da rinite alérgica e da asma são semelhantes; iii)a rinite alérgica e a asma são manifestações de uma enfermidade sistêmica; iv)o controle da rinite favorece o controle da asma. A estreita associação entre a rinite alérgica e a asma requer a integração das abordagens diagnóstica, terapêutica e profilática dessas enfermidades. Opções terapêuticas que permitam o controle simultâneo de ambas oferecem vantagens relacionadas ao custo e à tolerabilidade.

Efficacy and safety of montelukast in adults with asthma and allergic rhinitis

Several clinical studies have confirmed the effectiveness of montelukast 10mg orally in adults with both asthma and allergic rhinitis. The objective of this phase IV study was to investigate the efficacy and safety of montelukast 10mg in adults with both asthma and allergic rhinitis in a real-life setting. Data from 5855 patients (mean age: 42.8+/-15.4 years) were collected and analyzed following treatment for 4-6 weeks. Efficacy was analyzed by comparing baseline values of: general, day- and night-time improvement in asthma symptoms, need for rescue medication or inhaled corticosteroids (ICSs), general and specific improvement in allergic rhinitis symptoms, reduction in rhinitis medication use, and general and specific quality of life (QoL) improvement with values collected at the end of the observation period of 4-6 weeks. Following treatment with 10mg montelukast 86.5% (n=4547) of patients reported a strong or marked improvement in day-time asthma symptoms and 88.5% (n=4367) reported improvement in night-time symptoms. A similarly high proportion of patients had a strong or marked improvement in all symptoms of allergic rhinitis (i.e. sneezing/itching (84%), rhinorrhea (81.7%), nasal congestion (79.3%), watery eyes (78.4%) and red or burning eyes (77.7%). The use of asthma and rhinitis medication was also reduced. 92.3% (n=5685) of all patients intended to continue montelukast therapy. Overall QoL was "very good" or "good" in 85.2% of patients (n=4991) and a "strong" or "marked" improvement in each of the four domains of sleep, work, everyday life and physical activity. Montelukast was well tolerated. Adverse drug reactions occurred in 14 out of 6158 patients. None of the adverse events was serious. Accordingly, montelukast 10mg is a safe and effective treatment for patients with both asthma and allergic rhinitis.

Risk factors for asthma and atopy

PURPOSE OF REVIEW

The aim of this article is to provide information on risk factors associated with the development of atopy and asthma in childhood.

RECENT FINDINGS

Several gene polymorphisms have been associated with susceptibility to asthma and allergy; complex gene-environmental interactions, however, appear to play a key role in the development of the disease. Early life sensitization to aeroallergens, presence of atopic dermatitis or allergic rhinitis, maternal smoking during pregnancy and children's environmental exposure to tobacco smoke, lower respiratory tract infections with respiratory syncytial virus and potentially with other viruses including rhinovirus and metapneumovirus, exposure to air pollutants, several perinatal factors other than maternal smoking, are among factors associated with an increased risk for development of chronic asthma.

SUMMARY

The prevalence of asthma and allergic diseases is increasing progressively. Those who are involved in the care of young children should be prepared to recognize risk factors for development of these diseases and to appreciate the role of gene-environment interactions. Preventive measures established at an early age may modify the natural history of asthma and other allergic diseases.

Asthma and panic in young adults: a 20-year prospective community study

RATIONALE

Psychologic factors are increasingly recognized to influence the onset and course of asthma. Previous cross-sectional community-based studies have provided evidence for a relatively specific association between asthma and panic.

OBJECTIVES

To examine concurrent and longitudinal associations between asthma and panic in young adults.

MEASUREMENTS AND MAIN RESULTS

Prospective community-based cohort study of young adults (n = 591) followed between ages 19 and 40. Information was derived from six subsequent semistructured diagnostic interviews conducted by professionals. Cross-sectionally (over the whole study period), asthma was more strongly associated with panic disorder (odds ratio [OR] = 4.0; 95% confidence interval [CI], 1.7, 9.3) than with any panic, which included panic disorder and panic attacks (OR = 2.1; 95% CI, 1.1, 4.5). Longitudinally, after adjusting for potentially confounding variables, active asthma predicted subsequent panic disorder (OR = 4.5; 95% CI, 1.1, 20.1), and the presence of panic disorder predicted subsequent asthma activity (OR = 6.3; 95% CI, 2.8, 14.0). Asthma predicted any panic (OR = 2.7; 95% CI, 1.1, 7.1), whereas any panic did not predict subsequent asthma activity. Associations were stronger in smokers than in nonsmokers, and stronger in women than in men. Smoking, early-childhood anxiety, and a family history of allergy were important confounders of the asthma-panic association.

CONCLUSIONS

This is the first long-term follow-up study on asthma and panic. It showed dose-response-type relationships between panic and asthma, and bidirectional longitudinal associations between the two conditions. It provided evidence for familial factors and smoking as possible shared etiologic explanations.

Use of mouse models of allergic rhinitis to study the upper and lower airway link

PURPOSE OF REVIEW

Allergic rhinitis and asthma are examples of a continuum of airway diseases with diverse clinical manifestations. This review examines the most recent work in mouse models studying upper and lower airway links and interactions.

RECENT FINDINGS

The concept of united airways has been supported by investigative and epidemiological studies. Studies using mouse models of asthma and models of allergic rhinitis have demonstrated that analogous pathways lead to inflammation and airway hyperresponsiveness. Th2-type T cells and IL-13 play important immunopathologic roles. Recent studies have examined upper airway mucosal immune responses and development of both allergic and tolerant phenotypes. In a model of allergic airways disease, there is evidence of lower airway inflammation and airways hyperresponsiveness following application of allergen only to the nares, suggesting local stimulation can activate distal allergic responses. Immunomodulatory properties of the airway mucosa have also been explored. Allergen-specific tolerance can be induced by appropriate stimulation of airway mucosa and is associated with activation of IL-10-producing T cells. This effect is mediated by antigen presenting cells, especially dendritic cells.

SUMMARY

Immune stimulation of the airway mucosa, both in the upper and lower airways, results in active T-cell-mediated immune responses leading toward tolerance or asthma and allergic rhinitis. Regulation of these T-cell responses is currently under investigation. It is clear from these studies that antigenic stimulation of any part of the respiratory mucosa can have ripple effects along the entire airway and supports the concept of united airways.