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Liu P, Hu T, Kang C, Liu J, Zhang J, Ran H, Zeng X, Qiu S. Research Advances in the Treatment of Allergic Rhinitis by Probiotics. J Asthma Allergy 2022; 15:1413-1428. [PMID: 36238950 PMCID: PMC9552798 DOI: 10.2147/jaa.s382978] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022] Open
Abstract
Allergic rhinitis (AR) impairs the quality of life of patients and reduces the efficiency of social work, it is an increasingly serious public medical and economic problem in the world. Conventional anti-allergic drugs for the treatment of allergic rhinitis (AR) can cause certain side effects, which limit the quality of life of patients. Therefore, it makes sense to look for other forms of treatment. Several studies in recent years have shown that probiotics have shown anti-allergic effects in various mouse and human studies. For example, the application of certain probiotic strains can effectively relieve the typical nasal and ocular symptoms of allergic rhinitis in children and adults, thereby improving the quality of life and work efficiency. At the same time, previous studies in humans and mice have found that probiotics can produce multiple effects, such as reduction of Th2 cell inflammatory factors and/or increase of Th1 cell inflammatory factors, changes in allergy-related immunoglobulins and cell migration, regulate Th1/Th2 balance or restore intestinal microbiota disturbance. For patients with limited activity or allergic rhinitis with more attacks and longer attack duration, oral probiotics have positive effects. The efficacy of probiotics in the prevention and treatment of allergic rhinitis is remarkable, but its specific mechanism needs further study. This review summarizes the research progress of probiotics in the treatment of allergic rhinitis in recent years.
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Affiliation(s)
- Peng Liu
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zunyi, People’s Republic of China
| | - Tianyong Hu
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Shenzhen, People’s Republic of China
| | - Chenglin Kang
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zunyi, People’s Republic of China
| | - Jiangqi Liu
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Shenzhen, People’s Republic of China
| | - Jin Zhang
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zunyi, People’s Republic of China
| | - Hong Ran
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zunyi, People’s Republic of China
| | - Xianhai Zeng
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Shenzhen, People’s Republic of China
| | - Shuqi Qiu
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Shenzhen, People’s Republic of China
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Su Z, Kang Y. Influences of Bifid Triple Viable Capsules Plus Cetirizine on Gut Microbiota and Immune Function in Children with Eczema. Drug Des Devel Ther 2022; 16:2509-2515. [PMID: 35959421 PMCID: PMC9357560 DOI: 10.2147/dddt.s363702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zhenxing Su
- Dermatology, First Hospital of Shanxi Medical University, Taiyuan City, People’s Republic of China
- Correspondence: Zhenxing Su, Dermatology, First Hospital of Shanxi Medical University, No. 85, Jiefang South Road, Yingze District, Taiyuan City, People’s Republic of China, Email
| | - Yaqin Kang
- Pediatrics, First Hospital of Shanxi Medical University, Taiyuan City, People’s Republic of China
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Votto M, Achilli G, De Filippo M, Licari A, Marseglia A, Moiraghi A, Di Sabatino A, Marseglia GL. Pediatric chronic spontaneous urticaria: a brief clinician's guide. Expert Rev Clin Immunol 2022; 18:889-899. [PMID: 35833360 DOI: 10.1080/1744666x.2022.2101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic urticaria (CU) appears with daily or intermittent/recurrent wheals with/without angioedema for more than six weeks. When no specific eliciting factors are found, chronic urticaria is defined as spontaneous (CSU). Up to 50% of patients with CSU do not respond to therapy, leading to a prolonged disease course and the need for expensive therapies, impacting the quality of life (QoL) and healthcare resources. AREAS COVERED : Diagnosis of CSU is made when other potential causes of chronic urticaria are excluded. CSU therapy aims to achieve complete control of symptoms and normalization of QoL. Current treatment options for urticaria aim to target mast cell mediators such as histamine, or activators, such as autoantibodies. Guidelines recommend starting with second generation antihistamines (sgAHs) and adding omalizumab therapy if symptoms are not controlled. This review aims to provide a practical guide for CSU in the pediatric population. EXPERT OPINION : Treatment options for pediatric CSU are primarily based on adult data that have been extrapolated for children. Current guidelines should be re-evaluated based on pediatric data, new biological treatments, and the COVID-19 pandemic. Future research is needed to investigate strategies to personalize current treatments and identify potential predictive biomarkers.
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Affiliation(s)
- Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Giovanna Achilli
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Maria De Filippo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Alice Moiraghi
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Klain A, Indolfi C, Dinardo G, Decimo F, Tosca MA, Miraglia Del Giudice M, Ciprandi G. Comparing available treatments for pollen-induced allergic rhinitis in children. Expert Rev Clin Immunol 2022; 18:835-843. [PMID: 35726790 DOI: 10.1080/1744666x.2022.2093188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pollen-induced allergic rhinitis (PIAR) is a widespread disease in children, and its prevalence is rapidly evolving. In addition, it may be associated with other atopic diseases, in particular asthma. In most cases, PIAR can be treated effectively by avoiding exposure to responsible allergens and using symptomatic treatments, including intranasal/oral antihistamines or/and nasal corticosteroids, according to ARIA guidelines. In recent decades, new medicines have been studied and developed: allergen-specific immunotherapy (AIT), anti-IgE antibodies, and probiotics. In addition, nutraceuticals have also been used as add-on treatments. This review aims to discuss and compare the old and new therapeutic strategies for PIAR in children. AREAS COVERED Allergic rhinitis is a type 2 inflammatory disease. The management of patients with PIAR entails medications, AIT, and ancillary therapies. In addition, children with PIAR and associated severe asthma may be inclusively treated with biologics. Namely, subjects with allergic comorbidities could benefit from biological agents. However, AIT presently remains the unique causal treatment for PIAR. EXPERT OPINION New strategies may include combined treatments, mainly concerning fixed associations with antihistamines and corticosteroids, nutraceutical products, and new AIT formulations.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giorgio Ciprandi
- Department of Outpatients, Casa Di Cura Villa Serena, Genoa, Italy
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Zhou P, Jia Q, Wang Z, Zhao R, Zhou W. Cetirizine for the treatment of allergic diseases in children: A systematic review and meta-analysis. Front Pediatr 2022; 10:940213. [PMID: 36090559 PMCID: PMC9452751 DOI: 10.3389/fped.2022.940213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The global prevalence of allergic diseases has led to a negative and extensive impact on the health and lives of a large population of children. This study investigates the efficacy, acceptability, and safety of cetirizine (CTZ) for treating allergic diseases in children and provides evidence-based assertions for decision-making. METHODS PubMed, Embase, the Cochrane Library, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the European Union Clinical Trials Register were systematically searched from inception to April 21, 2022. Randomized controlled trials (RCTs) or quasi-RCTs of children with allergic diseases receiving CTZ compared with those receiving placebo or other drugs were included without language limitations. Two investigators independently identified articles, extracted data, conducted meta-analyses, assessed the Cochrane risk of bias of individual studies, and evaluated the evidence certainty using the Grading of Recommendations Assessment, Development, and Evaluation approach; any discrepancies were resolved by consulting with a third investigator. Primary outcomes included scales that evaluated the recovery of allergic conditions in AR, such as the total symptom score (TSS). Secondary outcomes included laboratory test changes, safety (adverse events, AEs), and quality of life (QOL). Data were pooled using the Cochrane Review Manager 5.4, and a fixed-effects model was used if heterogeneity was evaluated as low (I 2 < 50%); otherwise, a random-effects model was adopted. RESULTS A total of 22 studies (5,867 patients) were ultimately included [eight with perennial AR, six with seasonal AR, four with atopic dermatitis (AD), and four with other allergic diseases], most of which had a low or unclear risk of bias. Moderate certainty evidence showed that CTZ was found to benefit allergic symptom control [mean difference (MD) of TSS at 1 week: MD, -0.32 (-0.52, -0.12); at 2 weeks: MD, -0.25 (-0.35, -0.14); at 4 weeks: MD, -4.07 (-4.71, -3.43); at 8 weeks: MD, -4.22 (-4.73, -3.72); at 12 weeks: MD, -5.63 (-6.14, -5.13); all P-values were less than 0.05] and QOL [at 12 weeks: MD, -23.16 (-26.92, -19.39); P < 0.00001] in children with AR. It had similar efficacy compared with other antihistamines (AHs) or montelukast, without showing better control of AD severity in children. Moderate-to-low certainty evidence demonstrated that CTZ was well tolerated and did not increase the risk of severe and overall AEs, cardiotoxicity, damage to the central nervous and digestive systems, or other systems in children, except for the risk of somnolence [risk ratio, 1.62 (1.02, 2.57); P = 0.04, compared with placebo]. CONCLUSION Moderate-to-low certainty evidence revealed that CTZ could improve clinical improvement and QOL in children with AR and have comparable efficacy with other AHs. CTZ is well tolerated in the pediatric population, except for an increased risk of somnolence. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021262767].
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Affiliation(s)
- Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Qiong Jia
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Zhenhuan Wang
- Department of Pharmacy, First Hospital of Tsinghua University, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Wei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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Jawad Hashim M. Common Allergic Disorders. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Parisi GF, Manti S, Papale M, Amato M, Licari A, Marseglia GL, Leonardi S. Nasal Nitric Oxide and Nasal Cytology as Predictive Markers of Short-Term Sublingual Allergen-Specific Immunotherapy Efficacy in Children with Allergic Rhinitis. Am J Rhinol Allergy 2021; 36:323-329. [PMID: 34866408 DOI: 10.1177/19458924211060592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few studies have been conducted on the short-term response to sublingual immunotherapy (SLIT). OBJECTIVE The purpose of our experimental trial was to evaluate if two markers such as nasal nitric oxide (nNO) and nasal cytology could be useful to identify a precocious clinical efficacy of SLIT treatment. METHODS We enrolled 34 children aged 6 to 14 years old with diagnosis of allergic rhinitis (AR) and documented sensitization towards house dust mites. We started allergoid-monomeric tablets immunotherapy along with any conventional therapy for AR and we evaluated at baseline (T0), after one (T1), two (T2), three (T3), and six months (T6) the effects of the treatment through the study of: i) a visual analogue scale (VAS 1-10); ii) measurement of nNO; iii) measurement of FeNO; iv) nasal cytology; v) spirometry; and vi) evaluation of any conventional therapy. RESULTS We observed an improvement in symptoms evaluated by global VAS (T0 vs. T6: 47.13 vs. 17.57; p < .05) and a statistically significant reduction of nNO (1035.2 ± 956.08 vs. 139.2 ± 59.01; p < .05). In this case, significance was reached when the patients completed the 6 months of treatment. Cytological evaluation revealed significant reduction in nasal eosinophils (T0 vs. T6: 87% vs. 16%; p < .01). Moreover, at T0, 56% of patients had also neutrophils that were reduced up to the 8% at T6 (p < .05). CONCLUSIONS Our data confirm the effectiveness of SLIT treatment from a clinical perspective and identifies two biomarkers, such as nNO and nasal cytology, as predictive of treatment efficacy in the short term.
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Manti S, Tosca MA, Licari A, Brambilla I, Foiadelli T, Ciprandi G, Marseglia GL. Cough Remedies for Children and Adolescents: Current and Future Perspectives. Paediatr Drugs 2020; 22:617-634. [PMID: 32929686 DOI: 10.1007/s40272-020-00420-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cough is a widespread symptom in children and adolescents. Despite advances in scientific knowledge about the neurophysiological mechanisms underlying the cough reflex, the best therapeutic approaches for children and adolescents who cough remain unclear, and many needs are still unmet. Many remedies for cough are self-prescribed, reflecting strong demand, but significant evidence of their efficacy and safety is missing in pediatric populations. Moreover, as most coughs are part of self-limited illnesses, treatment could be considered unnecessary in some patients. Drug therapy to relieve cough and other symptoms is an essential part of treating a child with cough. However, unfortunately, the number of studies in each category of cough medications is minimal, and dosing and treatment duration varies significantly among studies. Some treatments have been shown to be no more effective than placebo. Lack of clear indications for dosing and treatment duration, the number of available drugs, the numerous active ingredients in products, and multiple caregivers administering medication to children have been considered contributors to an increased risk of inappropriate prescribing, accidental overdosing, and adverse events. This review presents the most recent evidence on the safety and efficacy of available cough remedies, focusing on the pediatric age group, and includes H1 receptor antagonists, mucolytics and expectorants, drugs acting peripherally on the cough reflex, drugs acting centrally on the cough reflex, drugs acting both peripherally and centrally on the cough reflex, and other compounds, including menthol, glycerol, honey, and medical devices composed of complex natural substances. Future perspectives on new therapeutic targets are also discussed.
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Affiliation(s)
- Sara Manti
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Amelia Licari
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Ilaria Brambilla
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giorgio Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Via P. Boselli 5, 16146, Genoa, Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
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Nutzen und Risiken sorgsam abwägen. DER DEUTSCHE DERMATOLOGE 2020. [PMCID: PMC7653979 DOI: 10.1007/s15011-020-3341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Tomazic PV, Lang-Loidolt D. Current and emerging pharmacotherapy for pediatric allergic rhinitis. Expert Opin Pharmacother 2020; 22:849-855. [PMID: 32808819 DOI: 10.1080/14656566.2020.1808622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) is a global health problem in adults as well as the younger population, continuously increasing and posing a significant problem for patients, health care systems and economies. For the younger population, some aspects differ from treatment of adults, namely, prevention, compliance and adherence. AREAS COVERED This narrative review summarizes all the pharmacotherapeutic options with special focus on the pediatric population. Moreover, it elucidates prevention strategies as well as future developments of AR treatment. Currently, symptomatic therapy in the form of steroids and antihistamines is applied topically and systemically where steroids need to be administered with caution and for a very short term. The only disease-modifying and causal treatment is allergen immunotherapy administered sublingually and subcutaneously. Future and current novel therapeutic options are human monoclonal antibodies. EXPERT OPINION The greatest potential for future developments currently lie in allergen immunotherapy and here in different routes of administration and modification of (recombinant) allergens as well as immune-modulating adjuvants and nanoparticles. Secondly, monoclonal antibodies are promising molecules blocking and/or interfering with up- and downstream immune mechanisms. Another important aspect lies in prevention of allergic sensitization and disease progression through both AIT and biologics which is particularly true for the pediatric population.
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Affiliation(s)
- Peter Valentin Tomazic
- Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Doris Lang-Loidolt
- Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
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Common Allergic Disorders. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_38-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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