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Gómez RM, Moreno P, Compalati E, Canonica GW, Ansotegui Zubeldia IJ. Update meta-analysis on the efficacy and safety issues of fexofenadine. World Allergy Organ J 2023; 16:100795. [PMID: 37546236 PMCID: PMC10401337 DOI: 10.1016/j.waojou.2023.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Background Fexofenadine emerged as one of the most representative second generation histamine H1 antagonist drugs since the 1990s, with an outstanding efficacy and appreciable safety for the treatment of allergic patients. While allergic rhino-conjunctivitis represents the most frequent atopic disease globally, an update of fexofenadine efficacy and safety on this entity was proposed as a surrogate of allergic condition. Methods Double blind, placebo controlled, randomized clinical trials investigating the efficacy and safety of fexofenadine for the treatment of Allergic Rhinitis were searched in 5 major global databases. Eligibility criteria and characteristics, risk of bias, and validity assessment, data extraction and heterogeneity evaluation are described. Primary outcome selected corresponded to 12-reflective and instantaneous total symptom scores (TSS), besides morning instantaneous TSS and the frequency of reported adverse events (AEs); analysis was planned on the intention-to-treat population.Standardized mean differences of scoring systems were analyzed, and Cochran's Q statistic test and the I2 test were assessed for heterogeneity. Results From the initial 83 identified records, 12 eligible studies were selected. In the evaluated patients, individuals receiving fexofenadine (1910) showed a significant reduction of TSS compared with those who received placebo (1777), change from baseline: standardized mean difference (SMD) -0.33; 95% CI-0.47 to -0.18, p < 0.0001. Morning instantaneous TSS also demonstrated lower symptoms (change from baseline: SMS -1.42; 95% CI -2.22 to -0.62, p = 0.0005). Heterogeneity was found across selected studies.Frequency of AEs was similar compared to placebo (OR = 1.04; 0.88-1.21), with no detection of heterogeneity across these 12 studies. Conclusions According to this new evidence, fexofenadine maintains its beneficial profile on signs and symptoms of patients with allergic conditions, as well as its attributes as one of the major candidates for an ideal antihistamine medication (including special conditions such as pregnancy and pre-school age), providing support to its over-the-counter condition in several countries.
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Affiliation(s)
- René Maximiliano Gómez
- Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Argentina
- Ayre Foundation, Salta, Argentina
| | - Pablo Moreno
- Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Argentina
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Asthma & Allergy Unit-IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy
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Lee SL, Lau YL, Wong WHS, Tian LW. Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong ISAAC Study from 1995 to 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416503. [PMID: 36554390 PMCID: PMC9779471 DOI: 10.3390/ijerph192416503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The prevalence of allergic diseases has been increasing in developing areas but has reached a plateau in many developed areas. Regular surveys are imperative to assess the disease burden for the prioritization of resource allocation. OBJECTIVES We examined the change in the prevalence of wheezing, allergic rhinitis (AR), and eczema in school-aged children with possible associative factors and possible health effects of school air quality. METHODS This was the third repeated cross-sectional study conducted in 2015-2016 using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Our first and second surveys were conducted in 1994-1995 and 2000-2001, respectively. Regarding the third survey, we recruited 3698 children aged 6-7 from 33 local schools in 18 districts. Air quality, temperature, and humidity were also measured. The changes in prevalence, multiple regression, and GLIMMIX procedure were analyzed. RESULTS From our first survey to our third survey, the increased prevalences for lifetime wheeze, current wheeze, lifetime rhinitis, current rhinitis, current rhinoconjunctivitis, lifetime chronic rash, and current chronic rash were 4.2%, 2.1%, 12.5%, 12.6%, 14.2%, 3.9%, and 4.1%, respectively. Increased prevalence of parental atopy had the strongest association with an increased prevalence of each of these seven health outcomes. There was no significant association between school air pollutant levels and the prevalence of health outcomes. CONCLUSIONS There was an increase in the prevalence of wheezing, allergic rhinitis, and eczema across the surveys. The most important associated risk factor identified was the increased prevalence of a parental history of atopy.
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Affiliation(s)
- So-Lun Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong
- Department of Paediatrics, Duchess of Kent Children’s Hospital, Hong Kong
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Lin-Wei Tian
- School of Public Health, The University of Hong Kong, Hong Kong
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Melén E, Koppelman GH, Vicedo-Cabrera AM, Andersen ZJ, Bunyavanich S. Allergies to food and airborne allergens in children and adolescents: role of epigenetics in a changing environment. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:810-819. [PMID: 35985346 DOI: 10.1016/s2352-4642(22)00215-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Allergic diseases affect millions of children and adolescents worldwide. In this Review, we focus on allergies to food and airborne allergens and provide examples of prevalence trends during a time when climate change is of increasing concern. Profound environmental changes have affected natural systems in terms of biodiversity loss, air pollution, and climate. We discuss the potential links between these changes and allergic diseases in children, and the clinical implications. Several exposures of relevance for allergic disease also correlate with epigenetic changes such as DNA methylation. We propose that epigenetics could be a promising tool by which exposures and hazards related to a changing environment can be captured. Epigenetics might also provide promising biomarkers and help to elucidate the mechanisms related to allergic disease initiation and progress.
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Affiliation(s)
- Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology and Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, Netherlands
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine and Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | | | - Supinda Bunyavanich
- Division of Allergy and Immunology, Department of Pediatrics, and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Barne M, Singh S, Mangal DK, Singh M, Awasthi S, Mahesh PA, Kabra SK, Mohammed S, Sukumaran TU, Ghoshal AG, Sinha S, Kochar SK, Singh N, Singh U, Patel KK, Sharma AK, Girase B, Madas S, Chauhan A, Sit N, Siddaiah JB, Singh V, Salvi S. Global Asthma Network Phase I, India: Results for allergic rhinitis and eczema in 127,309 children and adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:51-60. [PMID: 37780584 PMCID: PMC10509898 DOI: 10.1016/j.jacig.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 10/03/2023]
Abstract
Background The Global Asthma Network phase I study in India aimed to study the prevalence, time trends, and associated risk factors of allergic rhinitis and eczema among 6-7-year-old, and 13-14-year-old school children and their parents. Objectives: The objective of the study was to understand the current prevalence and associated risk factors of Allergic Rhinitis and Eczema in India among 6-7-year-olds, 13-14-year-olds and in their parents/guardians for newer directions to health care providers, policy makers and academicians. Methods Cross-sectional, multicenter study using self- and parent-administered questionnaire among randomly selected school children aged 6 to 7 years from 8 centers and 13 to 14 years from 9 centers and their respective parents/guardians across India. Results Prevalence of allergic rhinitis (AR) (%, 95% CI) among 20,084 6-7-year-olds (children), 25,887 13-14-year-olds (adolescents), and 81,296 adults/parents was 7.7% (7.4%-8.1%), 23.5% (23.0%-24.1%), and 9.8% (9.55%-9.96%) and that of eczema was 2.5% (2.3%-2.7%), 3.5% (3.27%-3.71%), and 9.9% (9.7%-10.1%), respectively. Among 6-7-year-olds, AR and eczema showed a significantly (P < .001) declining time trend since the International Study of Asthma and Allergies in school children phase III in 2002-2003. Among 13-14-year-olds, AR (P < .01) but not eczema showed a significant temporal decline. Coexisting atopic condition, parental history of atopy, and some environmental factors consistent with previous studies were significant risk factors among children and adolescents. AR or eczema in either parent strongly predicted the same atopic condition among their adolescent offspring. Among adults, coexisting atopic condition was the strongest predictor of either AR or eczema. Conclusions There is a slight declining time trend of AR and eczema in India over 2 decades among children and adolescents. Nearly 10% of Indian adults suffer from AR and eczema. Although genetic factors had the strongest association for AR and eczema among all age groups, certain early-life and environmental exposures need consideration to devise preventative strategies.
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Affiliation(s)
- Monica Barne
- Chest Research Foundation, Pune, India
- Pulmocare Research and Education Foundation, Pune, India
| | - Sheetu Singh
- Department of Pulmonary Medicine, Rajasthan Hospital, Jaipur, India
| | - Daya Krishan Mangal
- Department of Public Health and Epidemiology, IIHMR University, Jaipur, India
| | - Meenu Singh
- Department of Advanced Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shally Awasthi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Padkuduru A. Mahesh
- Department of Pulmonary Medicine, Jagadguru Sri Shivarathreeshwara Medical College, JSSAHER, Mysuru, India
| | - Sushil K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sabir Mohammed
- Department of Medicine, Sardar Patel Medical College, Bikaner, India
| | | | - Aloke G. Ghoshal
- Department of Respiratory Medicine, National Allergy Asthma Bronchitis Institute, Kolkata, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K. Kochar
- Department of Medicine, Sardar Patel Medical College, Bikaner, India
| | - Nishtha Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, India
| | | | | | - Arvind Kumar Sharma
- Department of Community Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Bhushan Girase
- Chest Research Foundation, Pune, India
- PATH India, New Delhi, India
| | - Sapna Madas
- Chest Research Foundation, Pune, India
- Pulmocare Research and Education Foundation, Pune, India
| | - Anil Chauhan
- Department of Public Health and Epidemiology, IIHMR University, Jaipur, India
| | - Niranjan Sit
- Department of Respiratory Medicine, National Allergy Asthma Bronchitis Institute, Kolkata, India
| | | | - Virendra Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, India
| | - Sundeep Salvi
- Chest Research Foundation, Pune, India
- Pulmocare Research and Education Foundation, Pune, India
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