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Wang C, Cheng L, Li H, Liu Z, Lou H, Shi J, Sun Y, Wang D, Yang Q, Yu H, Zhao C, Zhu D, Cheng F, Li Y, Liao B, Lu M, Meng C, Shen S, Sun Y, Zheng R, Zhang L. Chinese expert recommendation on transnasal corticosteroid nebulization for the treatment of chronic rhinosinusitis 2021. J Thorac Dis 2022; 13:6217-6229. [PMID: 34992802 PMCID: PMC8662474 DOI: 10.21037/jtd-21-1142] [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: 07/10/2021] [Accepted: 11/16/2021] [Indexed: 12/02/2022]
Abstract
Corticosteroids are efficacious in treating chronic rhinosinusitis (CRS), but concerns on the potential side effects remain, especially for long-term usage of systemic corticosteroids. Accumulated evidence shows that transnasal nebulization may be a reasonable solution in balancing both efficacy and safety. However, no consensus or guideline has been formulated on the use of steroid transnasal nebulization in treating CRS. The consensus is achieved through literature review and exchange of Chinese experts in Group of Otorhinolaryngology and Ophthalmology, Chinese Society of Allergy (CSA). This document covers the development, equipment, pharmacological mechanism, and evidence-based efficacy and safety, as well as the special concern of the application of steroid transnasal nebulization during the coronavirus disease (COVID-19) pandemic. The expert consensus clarifies the application of steroid transnasal nebulization in treating CRS and common comorbidities during the perioperative and postoperative periods.
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Affiliation(s)
- Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Huabin Li
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Sun
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Dehui Wang
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Allergy, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongmeng Yu
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China.,Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor, Chinese Academy of Medical Sciences, Shanghai, China
| | - Changqing Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Fengli Cheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Liao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meiping Lu
- Department of Otorhinolaryngology & Clinical Allergy Center, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Cuida Meng
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shen Shen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yueqi Sun
- Department of Otolaryngology, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Rui Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Allergy, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Leceta A, Sologuren A, Valiente R, Campo C, Labeaga L. Bilastine in allergic rhinoconjunctivitis and urticaria: a practical approach to treatment decisions based on queries received by the medical information department. Drugs Context 2017; 6:212500. [PMID: 28210286 PMCID: PMC5299972 DOI: 10.7573/dic.212500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bilastine is a safe and effective commonly prescribed non-sedating H1-antihistamine approved for symptomatic treatment in patients with allergic disorders such as rhinoconjunctivitis and urticaria. It was evaluated in many patients throughout the clinical development required for its approval, but clinical trials generally exclude many patients who will benefit in everyday clinical practice (especially those with coexisting diseases and/or being treated with concomitant drugs). Following its introduction into clinical practice, the Medical Information Specialists at Faes Farma have received many practical queries regarding the optimal use of bilastine in different circumstances. DATA SOURCES AND METHODS Queries received by the Medical Information Department and the responses provided to senders of these queries. RESULTS The most frequent questions received by the Medical Information Department included the potential for drug-drug interactions with bilastine and commonly used agents such as anticoagulants (including the novel oral anticoagulants), antiretrovirals, antituberculosis regimens, corticosteroids, digoxin, oral contraceptives, and proton pump inhibitors. Most of these medicines are not usually allowed in clinical trials, and so advice needs to be based upon the pharmacological profiles of the drugs involved and expert opinion. The pharmacokinetic profile of bilastine appears favourable since it undergoes negligible metabolism and is almost exclusively eliminated via renal excretion, and it neither induces nor inhibits the activity of several isoenzymes from the CYP 450 system. Consequently, bilastine does not interact with cytochrome metabolic pathways. Other queries involved specific patient groups such as subjects with renal impairment, women who are breastfeeding or who are trying to become pregnant, and patients with other concomitant diseases. Interestingly, several questions related to topics that are well covered in the Summary of Product Characteristics (SmPC), which suggests that this resource is not being well used. CONCLUSIONS Overall, this analysis highlights gaps in our knowledge regarding the optimal use of bilastine. Expert opinion based upon an understanding of the science can help in the decision-making, but more research is needed to provide evidence-based answers in certain circumstances.
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Affiliation(s)
- Amalia Leceta
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Ander Sologuren
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Román Valiente
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Cristina Campo
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Luis Labeaga
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
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Ridolo E, Caminati M, Martignago I, Melli V, Salvottini C, Rossi O, Dama A, Schiappoli M, Bovo C, Incorvaia C, Senna G. Allergic rhinitis: pharmacotherapy in pregnancy and old age. Expert Rev Clin Pharmacol 2016; 9:1081-9. [PMID: 27177184 DOI: 10.1080/17512433.2016.1189324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) affects 20-30% of women in reproductive age and may worsen during pregnancy. About 10% of the elderly suffer from AR, and it could be under-diagnosed in these patients. Many drugs are currently available, however AR treatment during pregnancy and old age represents a challenging issue. AREAS COVERED A review of the literature on the topic has been performed. Expert commentary: In pregnancy, drug avoidance should be carefully balanced with the need for AR optimal control. Topical drugs are suggested as a first approach. The safety and tolerability profile of second-generation antihistamines is well supported. If allergen immunotherapy (AIT) is ongoing and well tolerated, there is no reason for stopping it. AIT initiation in pregnancy is not recommended. For elderly patients, no specific concerns have been highlighted regarding topical treatments, except from nasal decongestionants. Second generation antihistamines are generally well tolerated. Old age should not preclude AIT.
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Affiliation(s)
- E Ridolo
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - M Caminati
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - I Martignago
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - V Melli
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - C Salvottini
- c Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | - O Rossi
- d Allergy Unit , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy
| | - A Dama
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - M Schiappoli
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - C Bovo
- e Medical Direction , Verona University Hospital , Verona , Italy
| | - C Incorvaia
- f Allergy/Pulmonary Rehabilitation , ICP Hospital , Milano , Italy
| | - G Senna
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
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Lim A, Stewart K, König K, George J. Systematic review of the safety of regular preventive asthma medications during pregnancy. Ann Pharmacother 2011; 45:931-45. [PMID: 21712513 DOI: 10.1345/aph.1p764] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To review the safety of regular preventive asthma medications during pregnancy. DATA SOURCES The following databases were searched from inception to February 2011: Ovid MEDLINE, PubMed, Cochrane Library, EMBASE and CINAHL Plus. STUDY SELECTION AND DATA EXTRACTION The search was limited to human studies published in the English language. Titles of all articles were screened for relevance. Abstracts of relevant articles were scrutinized to confirm relevance before obtaining full text. DATA SYNTHESIS Selected articles were read by 2 authors and the accuracy of the data extracted was confirmed. RESULTS Thirty-three articles were included in the final review. Small sample size, missing data, inadequate control for confounding factors, and poor documentation of dosage range were common limitations of the studies reviewed. The use of inhaled corticosteroids, cromolyns, and long-acting β(2) agonists during pregnancy was not associated with any particular adverse event, although the fluticasone/salmeterol combination has been associated with poor outcomes in postmarketing studies. Congenital malformations have been reported with leukotriene receptor antagonist exposure during pregnancy, but those women also had exposure to other medications, including oral corticosteroids. CONCLUSIONS Some negative outcomes of preventive asthma medications have been reported, although their direct link with medication use is inconclusive. Selection of preventive medications for asthma management during pregnancy should be based on an assessment of the risks and benefits of medication use versus the risks of poorly controlled asthma.
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Affiliation(s)
- Angelina Lim
- Pharmacy Department, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesth Analg 2010; 111:895-8. [PMID: 20237046 DOI: 10.1213/ane.0b013e3181c8a5a2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sore throat is a common complication after surgery. Postoperative cough and hoarseness can also be distressing to patients. We sought to determine the effect of an inhaler steroid on sore throat, cough, and hoarseness during the first 24 hours of the postoperative period. METHODS We enrolled 120 women with ASA physical status I or II and term singleton pregnancy who were scheduled for elective cesarean delivery under general anesthesia. Patients were randomized into 2 groups: in the sitting position, group F patients received 500 μg inhaled fluticasone propionate via a spacer device during 2 deep inspirations, after arrival in the operating room, and group C had no treatment. The patients were interviewed by a blinded investigator for postoperative sore throat, cough, and hoarseness at 1 and 24 hours after surgery. RESULTS There were no significant differences in age, height, weight, body mass index, duration of surgery, intubation, and grade of laryngeal exposure between the 2 groups. The incidence of sore throat, cough, and hoarseness was significantly lower in group F (3.33%, 3.33%, and 3.33%) compared with the control group (36.67%, 18.33%, and 35%) (P < 0.05 for all comparisons), not only in the first postoperative hour but also 24 hours after surgery (13.33%, 13.33%, and 25% in group F vs 40%, 41.67%, and 50% in the control group). The incidence of moderate and severe hoarseness in group F at the first hour was significantly less than the control group (P < 0.05). CONCLUSIONS Inhaled fluticasone propionate decreases the incidence and severity of postoperative sore throat, cough, and hoarseness in patients undergoing cesarean delivery under general anesthesia.
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