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Häussler D, Sommer JU, Nastev A, Aderhold C, Wenzel A, Kramer B, Stuck BA, Birk R. Influence of MP 29-02 on ciliary beat frequency in human epithelial cells in vitro. Eur Arch Otorhinolaryngol 2018; 275:1483-1490. [PMID: 29675754 DOI: 10.1007/s00405-018-4979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/16/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE MP 29-02, which contains fluticasone propionate and azelastine hydrochloride, is used as a topical nasal application for the treatment of seasonal and perennial allergic rhinitis. Although a multitude of data is available on the clinical symptom reduction and treatment safety of MP 29-02, the effect of MP 29-02 on ciliary beat frequency (CBF) has not been evaluated thus far. METHODS MP 29-02-containing solution was applied at concentrations of 2.5, 5, 10, and 20% to 14 healthy subjects, and nasal ciliated epithelial cells were then visualized using a phase-contrast microscope. CBF was measured after the application of MP 29-02. For a comparison, fluticasone propionate was used. CBF measurements were then performed for 15 min at 22 °C. Ringer's solution was applied as a negative control. RESULTS MP 29-02 significantly reduced CBF at all the tested concentrations compared with that of the control group within the observation time. At a 2.5% concentration, MP 29-02 significantly reduced CBF from 6.81 Hz (SD ± 1.35 Hz) at baseline to 4.88 Hz (SD ± 1.52 Hz, p < 0.001) after 15 min. In contrast, for fluticasone propionate, a significant reduction was observed only with the 20% concentration after 5, 10, and 15 min. CONCLUSIONS MP 29-09 significantly reduced CB, with an almost linear relationship between the MP 29-09 concentration and reduction in CBF. For fluticasone propionate, a significant reduction of CBF was observed only at the highest analyzed concentration. The findings have implications for the long-term use of the MP 29-02. Yet, further clinical studies are needed to confirm these results in vivo, especially in patients with seasonal or perennial allergic rhinits.
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Affiliation(s)
- D Häussler
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.
| | - J U Sommer
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.
| | - A Nastev
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - C Aderhold
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - A Wenzel
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - B Kramer
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - B A Stuck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
- Philipps-Universität Marburg, Marburg, Germany
| | - R Birk
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
- Philipps-Universität Marburg, Marburg, Germany
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Berger W, Sher E, Gawchik S, Fineman S. Safety of a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in children: A randomized clinical trial. Allergy Asthma Proc 2018; 39:110-116. [PMID: 29490769 DOI: 10.2500/aap.2018.39.4116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The safety of a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) has been established in adults and adolescents with allergic rhinitis but not in children <12 years old. OBJECTIVE To evaluate the safety and tolerability of an intranasal formulation of AZE and FP in children ages 4-11 years with allergic rhinitis. METHODS The study was a randomized, 3-month, parallel-group, open-label design. Qualified patients were randomized in a 3:1 ratio to AZE/FP (n = 304) or fluticasone propionate (FP) (n = 101), one spray per nostril twice daily, and to one of three age groups: ≥4 to <6 years, ≥6 to <9 years, and ≥9 to <12 years. Safety was assessed by child- or caregiver-reported adverse events, nasal examinations, vital signs, and laboratory assessments. RESULTS The incidence of treatment-related adverse events (TRAEs) was low in both the AZE/FP (16%) and FP-only (12%) groups after 90 days' continuous use. Epistaxis was the most frequently reported TRAE in both groups (AZE/FP, 9%; FP, 9%), followed by headache (AZE/FP, 3%; FP, 1%). All other TRAEs in the AZE/FP group were reported by ≤1% of the children. The majority of TRAEs were of mild intensity and resolved spontaneously. Results of nasal examinations showed an improvement over time in both groups, with no cases of mucosal ulceration or nasal septal perforation. There were no unusual or unexpected changes in laboratory parameters or vital signs. CONCLUSION The intranasal formulation of AZE and FP was safe and well tolerated after 3 months' continuous use in children with allergic rhinitis.The study was registered on <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://ClinicalTrials.gov">ClinicalTrials.gov</ext-link> (NCT01794741).
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Affiliation(s)
- William Berger
- From the Allergy and Asthma Associates of Southern California, Mission Viejo, California, USA
| | - Ellen Sher
- Atlantic Allergy, Asthma and Immunology Associates of New Jersey, Ocean, New Jersey, USA
| | - Sandra Gawchik
- Asthma Allergy Associates, Glen Mills, Pennsylvania, USA
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Sakano E, Sarinho ESC, Cruz AA, Pastorino AC, Tamashiro E, Kuschnir F, Castro FFM, Romano FR, Wandalsen GF, Chong-Neto HJ, Mello JFD, Silva LR, Rizzo MC, Miyake MAM, Rosário Filho NA, Rubini NDPM, Mion O, Camargos PA, Roithmann R, Godinho RN, Pignatari SSN, Sih T, Anselmo-Lima WT, Solé D. IV Brazilian Consensus on Rhinitis - an update on allergic rhinitis. Braz J Otorhinolaryngol 2017; 84:S1808-8694(17)30187-8. [PMID: 29254864 PMCID: PMC9442845 DOI: 10.1016/j.bjorl.2017.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. OBJECTIVE To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. METHODS We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. RESULTS The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. CONCLUSION A flowchart for allergic rhinitis treatment has been proposed.
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Affiliation(s)
- Eulalia Sakano
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil.
| | - Emanuel S C Sarinho
- Universidade Federal de Pernambuco (UFPE), Faculdade de Medicina, Departamento de Pediatria, Recife, PE, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Alvaro A Cruz
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria - Instituto da Criança, Salvador, BA, Brazil; Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil
| | - Antonio C Pastorino
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Department of Pediatrics - Instituto da Criança, São Paulo, SP, Brazil
| | - Edwin Tamashiro
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Fábio Kuschnir
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Medicina, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Fábio F M Castro
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Medicina - Divisão de Imunologia Clínica e Alergia, São Paulo, SP, Brazil
| | - Fabrizio R Romano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Gustavo F Wandalsen
- Universidade Federal de Pernambuco (UFPE), Faculdade de Medicina, Departamento de Pediatria, Recife, PE, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Herberto J Chong-Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Curitiba, PR, Brazil
| | - João F de Mello
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luciana R Silva
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil
| | - Maria Cândida Rizzo
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Cidade de São Paulo (UNICID), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Mônica A M Miyake
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Hospital Sirio-Libanês, Núcleo de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nelson A Rosário Filho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Curitiba, PR, Brazil
| | - Norma de Paula M Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Departamento de Medicina, Divisão de Alergia e Imunologia, Rio de Janeiro, RJ, Brazil
| | - Olavo Mion
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Paulo A Camargos
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal de Minas Gerais (UFMG), Departamento de Pediatria, Divisão de Pneumologia, Belo Horizonte, MG, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade Luterana do Brasil (ULBRA), Departamento de Otorrinolaringologia, Canoas, RS, Brazil
| | - Ricardo N Godinho
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Instituto de Ciências Biológicas e da Saúde, Belo Horizonte, MG, Brazil
| | - Shirley Shizue N Pignatari
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Tania Sih
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, São Paulo, SP, Brazil
| | - Wilma T Anselmo-Lima
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Dirceu Solé
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Pediatria - Divisão de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
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Klimek L, Poletti SC, Sperl A, Spielhaupter M, Bardenhewer C, Mullol J, Hörmann K, Hummel T. Olfaction in patients with allergic rhinitis: an indicator of successful MP-AzeFlu therapy. Int Forum Allergy Rhinol 2016; 7:287-292. [PMID: 27888645 DOI: 10.1002/alr.21877] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the effect of MP-AzeFlu on olfaction and the interaction between severity of allergic rhinitis and olfactory improvement after therapy. METHODS A prospective, multicenter, observational study was performed on 47 patients with persistent allergic rhinitis. Duration and severity of allergic rhinitis was diagnosed and classified using the modified Allergic Rhinitis and its Impact on Asthma (ARIA) criteria and the proof of allergen sensitization from positive skin-prick tests, specific immonoglobulin E (IgE) in serum, and nasal provocation response. Patients were treated with MP-AzeFlu (1 spray/nostril twice daily) over 3 months. Olfactory function was assessed at baseline and at 1 and 3 months of therapy using the "Sniffin' Sticks" test. In addition, a nasal symptom score was recorded on a visual analog scale (VAS) at each given time-point. RESULTS MP-AzeFlu was found to be associated with a significant improvement in TDI score, from 23.7 at baseline to 34.2 at 1 month (p < 0.001) and 37.1 at 3 months (p < 0.001) of treatment. Furthermore, a highly significant improvement of symptoms over time (p < 0.001; VAS at baseline: 84.3; 1 month: 32.4; 3 months: 26.2) could be demonstrated. Most importantly, there was a highly significant interaction between the severity of allergic rhinitis and olfactory function (p < 0.001) and VAS (p < 0.001). CONCLUSION MP-AzeFlu is associated with olfactory improvement in persistent allergic rhinitis patients. Further, the modified ARIA severity classification is an indicator of patients' olfactory function. Moreover, assessment of olfaction seems to be a reliable indicator of the clinical success of antiallergic/antiinflammatory therapy.
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Affiliation(s)
- Ludger Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden, Germany
| | - Sophia C Poletti
- Interdisciplinary Centre "Smell & Taste," Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Annette Sperl
- Zentrum für Rhinologie und Allergologie, Wiesbaden, Germany
| | | | | | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES; Barcelona, Catalonia, Spain
| | - Karl Hörmann
- Department of Otorhinolaryngology, Mannheim University Hospital, Mannheim, Germany
| | - Thomas Hummel
- Interdisciplinary Centre "Smell & Taste," Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
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