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Goniotakis I, Perikleous E, Fouzas S, Steiropoulos P, Paraskakis E. A Clinical Approach of Allergic Rhinitis in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1571. [PMID: 37761533 PMCID: PMC10528841 DOI: 10.3390/children10091571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Allergic rhinitis is an important disease with a global footprint and a growing prevalence, affecting children and adults. Although it is commonly under-diagnosed and under-treated, it causes important social and economic effects (diminished quality of life, poor academic performance, escalated medical visits, heightened medication usage, and effects in other chronic conditions, e.g., asthma). It is characterized by distinctive, easily identifiable symptoms (sneezing, nasal discharge, nasal congestion, nasal-eye-palatal itching) and indirect accompanying indicators (fatigue and decreased school performance). The classification of allergic rhinitis hinges upon its nature and chronic distribution (seasonal or perennial) and its intensity, which spans from mild to moderate and severe. The diagnostic process primarily relies upon recognizing key clinical indicators, evaluating historical records, and considering risk factors. It is supported by abnormal laboratory findings, like in vitro allergen-specific IgE tests (enzyme immunoassay-EIA, chemiluminense immunoassay-CLIA) or in vivo skin prick tests for specific allergens. In the differential diagnosis, other chronic diseases manifesting with chronic rhinitis should be excluded (e.g., rhinosinusitis, chronic non-allergic rhinitis, rhinitis triggered by medications). The treatment of allergic rhinitis in children is mainly chronic and is focused on allergen exposure prevention, drug therapy, and immunotherapy in severe cases. Locally administered intranasal corticosteroids are the cornerstone of therapy. They are safe, effective, and have a favorable safety profile even during long-term use. Choosing a suitable intranasal corticosteroid drug with low systemic bioavailability makes long-term treatment even safer. Combinations of intranasal corticosteroids and H1 antihistamines are available in several countries and are widely used in more severe cases and the presence of year-round symptoms. Adding newer-generation oral H1-antihistamines broadens the available therapeutic inventory without significant effects compared to using previous-generation, once widely available, H1-antihistamines. Treatment of allergic rhinitis is complex and multi-dimensional, requiring an effective approach by a specialized group of specialized pediatricians, and is severely affected by the concurrent presence or development of other diseases in the spectrum of allergic diseases (conjunctivitis, asthma).
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Affiliation(s)
- Ioannis Goniotakis
- Pediatric Respiratory Unit, Pediatric Department, University of Crete, 70013 Heraklion, Greece; (I.G.); (E.P.)
| | - Evanthia Perikleous
- Pediatric Emergency Department, General Hospital of Nicosia, 2031 Nicosia, Cyprus;
| | - Sotirios Fouzas
- Pediatric Respiratory Unit, University Hospital of Patras, 26504 Patras, Greece;
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Emmanouil Paraskakis
- Pediatric Respiratory Unit, Pediatric Department, University of Crete, 70013 Heraklion, Greece; (I.G.); (E.P.)
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Rafiqul Islam A, Ferdousi J, Shahinozzaman M. Previously published ethno-pharmacological reports reveal the potentiality of plants and plant-derived products used as traditional home remedies by Bangladeshi COVID-19 patients to combat SARS-CoV-2. Saudi J Biol Sci 2021; 28:6653-6673. [PMID: 34305428 PMCID: PMC8285211 DOI: 10.1016/j.sjbs.2021.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 01/08/2023] Open
Abstract
Several plants have traditionally been used since antiquity to treat various gastroenteritis and respiratory symptoms similar to COVID-19 outcomes. The common symptoms of COVID-19 include fever or chills, cold, cough, flu, headache, diarrhoea, tiredness/fatigue, sore throat, loss of taste or smell, asthma, shortness of breath, or difficulty breathing, etc. This study aims to find out the plants and plant-derived products which are being used by the COVID-19 infected patients in Bangladesh and how those plants are being used for the management of COVID-19 symptoms. In this study, online and partially in-person survey interviews were carried out among Bangladeshi respondents. We selected Bangladeshi COVID-19 patients who were detected Coronavirus positive (+) by RT-PCR nucleic acid test and later recovered. Furthermore, identified plant species from the surveys were thoroughly investigated for safety and efficacy based on the previous ethnomedicinal usage reports. Based on the published data, they were also reviewed for their significant potentialities as antiviral, anti-inflammatory, and immunomodulatory agents. We explored comprehensive information about a total of 26 plant species, belonging to 23 genera and 17 different botanical families, used in COVID-19 treatment as home remedies by the respondents. Most of the plants and plant-derived products were collected directly from the local marketplace. According to our survey results, greatly top 5 cited plant species measured as per the highest RFC value are Camellia sinensis (1.0) > Allium sativum (0.984) > Azadirachta indica (0.966) > Zingiber officinale (0.966) > Syzygium aromaticum (0.943). Previously published ethnomedicinal usage reports, antiviral, anti-inflammatory, and immunomodulatory activity of the concerned plant species also support our results. Thus, the survey and review analysis simultaneously reveals that these reported plants and plant-derived products might be promising candidates for the treatment of COVID-19. Moreover, this study clarifies the reported plants for their safety during COVID-19 management and thereby supporting them to include in any future pre-clinical and clinical investigation for developing herbal COVID-19 therapeutics.
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Key Words
- BAL, Bronchoalveolar lavage
- BALF, Bronchoalveolar lavage fluid
- Bangladesh
- CHO-K1, Wild-type Chinese hamster ovary CHO-K1 cells
- CIK, Ctenopharyngodon idellus kidney Cell line
- COPD, Chronic obstructive pulmonary disease
- COVID-19
- CRD, Complex chronic respiratory disease
- CRFK, Crandell-Reese feline kidney cells
- EGCG, Epigallocatechin-3-gallate
- EPO, Eosinophil peroxidase
- Ethnobotany
- FRhk-4cells, Fetal rhesus monkey kidney cells
- H1N1, Hemagglutinin Type 1 and Neuraminidase Type 1
- HEK293T, Human embryonic kidney cells
- HEp-2 cells, Epithelial cells of human larynx carcinoma
- HLAC, Human lymphoid aggregate cultures
- HeLa, Human epithelial cervical carcinoma cell lines
- Huh-7, Human hepatocyte-derived carcinoma cell line
- IBD, Inflammatory bowel disease
- ICU, Intensive care unit
- IFN‐γ, Interferon‐gamma
- IL, Interleukin
- IgE, Immunoglobulin E
- MARC-145 cells, African green monkey kidney cell line
- MCP-1, Monocyte chemoattractant protein-1
- MDCK, Madin-Darby Canine Kidney cell lines
- MEF, Mouse embryonic fibroblast cells
- Medicinal plants
- NF-κB, Nuclear factor-kappaB
- PBMCs, Peripheral Blood Mononuclear Cells
- RT-PCR, Reverse transcription polymerase chain reaction
- SARS, Severe acute respiratory syndrome, MERS, Middle East respiratory syndrome
- TNF-β, Tumor necrosis factor‐beta
- TNF‐α, Tumor necrosis factor‐alpha
- Th, T-helper
- Traditional home remedies
- VERO cell lines, African green monkey kidney cell lines
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Affiliation(s)
- A.T.M. Rafiqul Islam
- Department of Botany, Faculty of Bio-Sciences, University of Barishal, Barishal 8200, Bangladesh
| | - Jannatul Ferdousi
- Department of Botany, Faculty of Bio-Sciences, University of Barishal, Barishal 8200, Bangladesh
| | - Md Shahinozzaman
- Department of Botany, University of Rajshahi, Rajshahi 6205, Bangladesh
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Hancı D, Altun H, Çetinkaya EA, Muluk NB, Cengiz BP, Cingi C. Cinnamaldehyde is an effective anti-inflammatory agent for treatment of allergic rhinitis in a rat model. Int J Pediatr Otorhinolaryngol 2016; 84:81-7. [PMID: 27063758 DOI: 10.1016/j.ijporl.2016.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The effect of cinnamaldehyde on the treatment of allergic rhinitis (AR) was investigated in rat model. METHODS Twenty-eight female Wistar albino rats were randomly divided into four groups: Group 1 (control) (C), Group 2 (AR with no treatment) (AR+NoTr), Group 3 (AR+Azelastine HCl) (AR+Aze), and Group 4 (AR+cinnamaldehyde) (AR+Cin). At day 21, AR+Aze rats were given an Azelastine HCl drop, and AR+Cin rats were given cinnamaldehyde intranasally. In all groups, allergic symptoms histopathological results were evaluated. RESULTS The AR+NoTr group showed the worst allergic symptoms, cilia loss and greater inflammation. In the AR+Aze and AR+Cin groups, allergic symptom scores were higher than those in the control group. However, between AR+Aze and AR+Cin groups, there were no significant differences in the allergic symptom scores Histopathological analysis revealed vascular congestion and an increase in goblet cell numbers in the AR+Cin group. However, AR+Cin rat nasal mucosa had less plasma cell infiltration compared with the AR+NoTr group. In rats from the AR+Aze group, analysis of the nasal mucosa revealed less eosinophil infiltration than that seen in the AR+NoTr group. A lower score for mast cell (MC) infiltration was observed in the nasal mucosa of rats treated with Azelastine HCl compared with cinnamaldehyde. CONCLUSIONS In this study we observed that both Azelastine HCl and cinnamaldehyde reduced allergic symptoms in an AR rat model. Cinnamaldehyde decreased vascular congestion as well as plasma cell, eosinophil, and inflammatory cell infiltration into the lamina propria.
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Affiliation(s)
- Deniz Hancı
- Okmeydanı Training and Research Hospital, ENT Clinics, Istanbul, Turkey
| | - Hüseyin Altun
- Yunus Emre Hospital, ENT Department, Uskudar, Istanbul, Turkey
| | | | - Nuray Bayar Muluk
- Kırıkkale University, Medical Faculty, ENT Department, Kırıkkale, Turkey.
| | | | - Cemal Cingi
- Eskişehir Osmangazi University, Medical Faculty, ENT Department, Eskişehir, Turkey
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Badran HS, Hussein A, Salah M, Lotfi WT. Identification and Prevalence of Allergic, Nonallergic, and Local Allergic Rhinitis Patients in Western Area, Saudi Arabia. Ann Otol Rhinol Laryngol 2016; 125:634-43. [PMID: 27067153 DOI: 10.1177/0003489416642785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the diagnostic yield of skin prick test (SPT) and serum total immunoglobulin E (IgE) antibodies level in patients with allergic rhinitis (AR) and the role of nasal provocation test (NPT) for the determination of local allergic rhinitis (LAR) in patients with nonallergic rhinitis (NAR). METHODOLOGY This multi-center study included 1230 patients with clinical manifestations for ≥2 years. Patients were classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) and scored according to the quantitative Score for Allergic Rhinitis (SFAR). The SPT and total IgE antibody levels were done for all patients. Patients gave negative SPT underwent NPT, and its result was interpreted using Lebel Symptom Score Scale. RESULTS The SPT was positive in 77.8% of patients, mostly for grass pollen and dust mites. All patients were sensitive to multiple allergens. Median serum IgE antibody level for total study population was 162 IU/ml. Forty-two patients (3.4%) with negative SPT showed a weak response to NPT, while 231 patients (18.7%) with negative SPT had a high response to NPT and were considered to have LAR. CONCLUSION The SPT could discriminate between AR and NAR patients. The NPT could identify LAR in 84.6% of patients with rhinitis among those considered as NAR.
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Affiliation(s)
- Hatem S Badran
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Hussein
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Mohamad Salah
- Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
| | - Wassim T Lotfi
- Department of Otorhinolaryngology, Faculty of Medicine, Fayoum University, Egypt
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Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:607-13. [PMID: 25213056 DOI: 10.1016/j.jaip.2014.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS. OBJECTIVE To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy. METHODS This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use. RESULTS Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS. CONCLUSION Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.
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Li L, Vollmer WM, Butler MG, Wu P, Kharbanda EO, Wu AC. A comparison of confounding adjustment methods for assessment of asthma controller medication effectiveness. Am J Epidemiol 2014; 179:648-59. [PMID: 24464909 DOI: 10.1093/aje/kwt323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We compared the impact of 3 confounding adjustment procedures-covariate-adjusted regression, propensity score regression, and high-dimensional propensity score regression-to assess the effects of selected asthma controller medication use (leukotriene antagonists and inhaled corticosteroids) on the following 4 asthma-related adverse outcomes: emergency department visits, hospitalizations, oral corticosteroid use, and the composite outcome of these. We examined a cohort of 24,680 new users who were 4-17 years of age at the incident dispensing from the Population-Based Effectiveness in Asthma and Lung Diseases (PEAL) Network of 5 commercial health plans and TennCare, the Tennessee Medicaid program, during the period January 1, 2004, to December 31, 2010. The 3 methods yielded similar results, indicating that pediatric patients treated with leukotriene antagonists were no more likely than those treated with inhaled corticosteroids to experience adverse outcomes. Children in the TennCare population who had a diagnosis of allergic rhinitis and who then initiated the use of leukotriene antagonists were less likely to experience an asthma-related emergency department visit. A plausible explanation is that our data set is large enough that the 2 advanced propensity score-based analyses do not have advantages over the traditional covariate-adjusted regression approach. We provide important observations on how to correctly apply the methods in observational data analysis and suggest statistical research areas that need more work to guide implementation.
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