Safety of celecoxib in patients with cutaneous reactions due to ASA-NSAIDs intolerance

BACKGROUND

Pseudo-allergic reactions against aspirin (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs) are quite frequent.

OBJECTIVE

Our aim was to determine tolerance of Celecoxib, a selective inhibitor of cyclooxygenase-2 (Cox-2), by oral challenge test in patients who showed skin reactions (diffuse erythema or urticaria/angioedema) after taking ASA and/or NSAIDs.

METHODS

The oral challenge test was carried out in single-blind on 86 patients treated with a 200 mg cumulative dose of Celebrex, administered in 3 or 4 visits at 48-72 hours interval.

RESULTS

Only 4 patients showed mild skin reactions. In addition, we observed 37 patients with osteoarthrosis taking a 200-400 mg/day dose of Celebrex 5-6 times a week, over a period of 75 days. At day 36, we observed in a single patient urticarial phenomena appeared on the chest and the back.

CONCLUSIONS

Our study proves therefore Celecoxib safety on a 72-hour observation period.

Symptomatic relief after grass nasal immunotherapy: lasting efficacy after 4-5 years

Twenty-two patients with rhinoconjunctivitis from grass pollen allergy, who were initially recruited for a one-year open clinical trial with local nasal immunotherapy (LNIT), continued the treatment for 2 or 3 more years. Three to four years after the end of treatment, they were reapproached and agreed to complete a questionnaire to evaluate their symptoms and rescue medications during the grass-pollen season. Twelve patients (54.6%) were almost free of symptoms, six patients (27.3%) complained of only minor symptoms, and four (18.1%) still had substantial symptoms. The median score for cumulative symptoms 4-5 years after stopping LNIT (112.5 points) was lower than before LNIT (291.6 points) and after the one-year clinical trial (138.2 points). The present observational study confirms the validity of LNIT as an alternative to conventional subcutaneous immunotherapy.

Local nasal immunotherapy: efficacy and tolerability of two different administration schedules in grass pollen rhinitis

BACKGROUND

Efficacy and safety of local nasal immunotherapy has been demonstrated by many placebo-controlled clinical trials. The treatment schedule consists of an induction phase at increasing dosages followed by a maintenance phase. Aim of present study has been to evaluate a new simplified treatment schedule at constant dosage.

METHODS AND RESULTS

26 grass-allergic rhinitic patients have been treated according to the new constant dosage schedule, while 15 patients in a control group were treated with conventional incremental dosage schedule. A commercial preparation of allergens incorporated into powder (Allerkin). The total cumulative dosage administered with conventional schedule resulted higher than simplified constant schedule (5,025 vs 3,000 AU). To evaluate efficacy, symptom and rescue medication scores were recorded during the spring pollen season, and a subjective overall evaluation was asked to the patients at the end of the season. The analysis of scores showed that the two treatment schedules were equivalent as regards both efficacy and safety, being side effects light and restricted to the administration site (sneezing).

CONCLUSIONS

The use of a constant dosage schedules is suggested for the administration of local nasal immunotherapy, having as advantage a better simplicity. Avoidance of mistakes in dosages is considered important in a therapy which is self-administered by patients.

Clinical efficacy and safety of local nasal immunotherapy

Local nasal immunotherapy represents an alternative route of allergen administration. It was proposed to overcome the risk of systemic reactions rarely reported during the traditional subcutaneous immunotherapy. Some studies carried out in the past generally showed good efficacy but poor tolerability. The aqueous extracts mostly used in these studies carry some drawbacks such as the volume effect, self-digestion and the difficulty of administering reproducible dosages. The recent availability of allergen extracts in powder form has led to better stability and standardization. The studies carried out with these freeze-dried allergens showed clinical efficacy and good tolerability in perennial (mite, cat) and seasonal (grass, birch, Parietaria) allergic rhinitis. According to these findings this new local nasal immunotherapy with extract in powder form represents a suitable alternative to the traditional immunotherapy in the treatment of allergic rhinitis.

Nimesulide in the treatment of patients intolerant of aspirin and other NSAIDs

Aspirin (acetylsalicylic acid) and other NSAIDs are responsible for many adverse effects. Among them, pseudo-allergic reactions (urticaria/angioedema, asthma, anaphylaxis) affect up to 9% of the population and up to 30% of asthmatic patients. The mechanisms provoking these reactions have not been fully elucidated, but it appears that inhibition of cyclo-oxygenase (COX) plays a central role. The anti-inflammatory action of nimesulide differs from that of other NSAIDs, possibly because of its chemical structure. In particular, nimesulide is selective for COX-2 and displays additional properties in terms of its effects on inflammatory mediator synthesis and release. For these reasons, nimesulide is generally well tolerated by NSAID-intolerant patients and patients with NSAID-induced asthma. The good tolerability of nimesulide as an alternative drug for use in patients with NSAID intolerance has been demonstrated in a large number of clinical studies.

Local nasal immunotherapy with extract in powder form is effective and safe in grass pollen rhinitis: a double-blind study

BACKGROUND

Local nasal immunotherapy has been studied, by means of an extract in powder form, in patients with allergic rhinitis caused by grass pollen.

METHODS

Thirty-two patients allergic to grass were studied for 37 weeks in a double-blind controlled trial. Subjects were selected on the basis of a positive history, skin test result, RAST finding, and result of intranasal challenge to grass pollen. Two 16-patient groups were randomly assigned to active or placebo treatment. The treatment lasted 26 weeks (14 for the build-up phase, 12 for the maintenance period).

RESULTS

No significant differences were observed in nasal symptoms during the treatment. During the pollen season the mean weekly symptom and medication scores were significantly lower in the treated group, compared with the control group, even considering each allergic symptom separately. Moreover, only in the treated group was a significant increase of specific nasal threshold to grass pollen observed after treatment.

CONCLUSIONS

This study indicates that local nasal immunotherapy with allergen in powder form can be a suitable alternative to the traditional subcutaneous immunotherapy in terms of clinical efficacy and safety in grass-allergic rhinitis.

Local nasal immunotherapy for birch allergic rhinitis with extract in powder form

BACKGROUND

Traditional subcutaneous immunotherapy has been proved effective in birch pollenosis. It has, however, some drawbacks as systemic reactions, which are rare but important. Local nasal immunotherapy (LNIT) represents a potential safer route of allergen administration.

OBJECTIVE

To study the clinical efficacy and safety of local nasal immunotherapy by means of an extract in powder form as treatment of birch allergic rhinitis.

METHODS

Thirty birch allergic patients have been selected on the basis of a positive history, skin test, radioallergosorbent test assay (RAST) and specific nasal challenge. Two 15 patient groups were randomly assigned to the active treatment or to the placebo one. Treatment lasted 22 weeks (14 for the build-up phase and eight for maintenance period) and symptoms were recorded during the treatment and the birch pollen season.

RESULTS

The clinical efficacy of LNIT is suggested by a significant reduction of medication score only in the treated group during the pollen season, although the symptom score was significantly lower in the treated group for 1 week only. Moreover, a significant increase of specific nasal threshold dose was observed after treatment only in the active treated group. Mild adverse reaction to LNIT, limited to the upper respiratory tract, were reported during the treatment in the active group, but they did not interfere with LNIT schedule. No asthmatic or systemic reaction were observed.

CONCLUSIONS

This study indicates that LNIT with allergen in powder form has proven clinically effective in the treatment of birch allergic rhinitis. Further studies are needed to establish whether this treatment can be considered a real alternative to the traditional subcutaneous immunotherapy in birch allergic rhinitis.

Multicentre evaluation of Capture Assay Radim Liquid Allergen for measurement of specific IgE antibodies

A multicentre trial of Capture Assay Radim Liquid Allergen was performed to define the sensitivity, specificity and clinical reliability of the system in diagnostic allergology. The results of the evaluation were compared with clinical data and in vivo testing. Good agreement was obtained for Dermatophagoides pteronyssinus (D1), Cat's epithelium (E1), Betula verrucosa (T3) and Olea europea (T9), Artemisia vulgaris (W6) and Parietaria officinalis (W19). Some spreading of data was observed for Artemisia absinthium (W5), Cynodon dactylon (G2), and Lolium perenne (G5). We found a high number of negative cases for Alternaria alternata (M6). The advantages offered by the system are the automation, the small quantity of serum requested, the supply of quantitative results in international units of specific IgE, the user-friendly software. The data are sufficiently reliable for the diagnostic system to be introduced into the clinical laboratory allergological routine.

Tolerability of imidazole salycilate in aspirin-sensitive patients

Over the last few years, many studies have been carried out in order to individualize which nonsteroidal anti-inflammatory drug (NSAID) can be tolerated in aspirin sensitivity. Imidazole salicylate (IS) is a new NSAID that inhibits Tromboxane A2 synthesis, without interferring with cyclo-oxygenase pathway, whose inhibition was demonstrated to cause asthma and/or urticaria/angioedema in aspirin-sensitive patients. We enrolled 67 subjects with documented intolerance to aspirin, pyrazolones or NSAIDs, clinically manifested as urticaria/angioedema (68%), asthma, and/or rhinitis (32%). A challenge with IS was carried out in every patient in single-blind fashion, reaching a cumulative dosage of 1000 mg in the fourth session. No appearance of urticaria or bronchospastic reactions was registered in any subject, confirming the safe use of IS in aspirin-sensitive patients.

Pituitary-adrenal function in asthmatic patients treated with high dose of beclomethasone

Ten asthmatic patients receiving long term treatment with high dose of inhaled beclomethasone dipropionate (BDP) (750 to 2,250 micrograms/die, average 1,400 +/- 474 micrograms) underwent evaluation of hypothalamic-pituitary-adrenal (HPA) axis under basal conditions (serum cortisol and ACTH levels at 8.00 AM and 8.00 PM, 24-hours free urinary cortisol) and by means of pharmacological tests (short tetracosactide and Corticotrophin Releasing Factor Tests). Basal ACTH serum levels at 8.00 PM were lower than the normal values in all patients: three patients had reduced 24-hr free urinary cortisol and six subjects showed lower cortisol serum levels at 8.00 PM. A normal response to the short tetracosactide test was observed in all patients, whilst Corticotrophin Releasing Factor (CRF) induced an increase in ACTH and cortisol levels (expressed as delta AUC) that was significantly lower in the BPD treated patients compared with a control group of five healthy subjects (p < 0.05). Thus BPD, in high doses, may cause a partial inhibition of HPA axis. Our results show that determination of basal ACTH level and CRF test are more sensitive than serum cortisol levels and short tetracosactide test to evaluate a suppression of HPA axis in patients receiving long term inhaled high doses of BDP.

Tolerability of nimesulide in aspirin-sensitive patients

In most patients with aspirin and nonsteroidal antiinflammatory drug (NSAID) intolerance, antiinflammatory treatment is a clinical problem. In this study we evaluated the tolerance to a new nonsteroidal antiinflammatory drug, nimesulide (Aulin, Boehringer Mannheim, Italia), in 429 patients presenting with clear histories of intolerance to NSAIDs. Nimesulide has been chosen due to its weak inhibitory action on cyclooxygenase and its peculiar mechanism of action. We carried out a single-blind challenge with cumulative doses of nimesulide administered on three different days, until the therapeutic dose of 200 mg or intolerance symptoms were reached. Nimesulide has been well tolerated in 418 subjects and only 11 patients (3.3%) showed a positive test. Our study demonstrates that nimesulide seems to be a suitable drug in aspirin hypersensitivity.

A comparison of the efficacy of cetirizine and terfenadine. A double-blind, controlled study of chronic idiopathic urticaria

In a 20-d, double-blind, randomized, parallel study, the efficacy of cetirizine and terfenadine was compared in 30 patients with chronic idiopathic urticaria. Subjects were randomly divided into two 15-patient groups. The first group was given cetirizine (10 mg once daily); the second terfenadine (60 mg twice daily). Cetirizine proved to be more effective than terfenadine in controlling urticaria symptoms. In fact, the score of the investigators' overall assessment was significantly lower in the cetirizine-treated group than in the terfenadine-treated group. Moreover, patient evaluation by a visual analog scale and symptoms assessed on a 4-point scale showed a better improvement in the cetirizine group. The number and severity of side-effects were similar in both treatment groups.

Immunoblotting study of specific antibody patterns against latex and banana

We evaluated three nurses presenting with hypersensitivity to latex gloves: the first suffered from rhinitis and asthma caused by latex and cutaneous and respiratory symptoms by banana; the second, allergic to grass pollens, had systemic symptoms handling latex gloves but no reactivity against banana; the third, with no history of allergic disease, had contact urticaria caused by latex. Skin prick tests and RAST confirmed the presence of specific IgE to latex in all the patients. By means of immunoblot after SDS-PAGE the pattern of antibody response (IgE/IgG) proved to be characteristic to each subject. Moreover, pre-incubation of patient sera with the banana extract could completely absorb the specific anti-banana IgE of the patient allergic to both latex and banana, but failed to modify the anti-latex IgE pattern of the three patients, even if the anti-latex IgG pattern partially changed. In our opinion immunoblotting techniques could play a role in clarifying a complex individual response to unusual allergens.

Local nasal immunotherapy for Dermatophagoides-induced rhinitis: efficacy of a powder extract

BACKGROUND

Local nasal immunotherapy by means of an extract in "macronized" powder from was studied in allergic rhinitis to Dermatophagoides species.

METHODS

Twenty-four Dermatophagoides-sensitive patients were studied for 12 months in a double-blind controlled trial. Subjects were selected on the basis of a positive history, skin test, radioallergosorbent test, and intranasal challenge to Dermatophagoides antigen. Two 12-patient groups were selected at random; the first group was given active treatment, and the second received placebo.

RESULTS

After 6 months, the mean weekly symptom and medication scores were significantly lower in the treated group than in the control group. The treated group had a significant increase of specific nasal threshold to Dermatophagoides antigen after treatment. Adverse reactions to local nasal immunotherapy, which were limited to the upper respiratory tract, occurred very rarely and did not interfere with dose schedule.

CONCLUSION

Local nasal immunotherapy in powder form may be a suitable alternative to the traditional subcutaneous immunotherapy in terms of clinical efficacy and safety.

Combined treatment of allergic rhinitis with terfenadine and nimesulide, a non-steroidal antiinflammatory drug

Thirty patient with allergic rhinitis sensitized to Parietaria pollen were enrolled in a double-blind clinical trial in order to evaluate whether the addition of nimesulide, a non-steroidal antiinflammatory drug, to standard antihistamine therapy may improve symptom relief. Patients were randomly divided in two groups: one was given terfenadine (120 mg/day) and nimesulide (200 mg/day), the other was given terfenadine (120 mg/day) and placebo. Both treatments lasted 30 days. Clinical efficacy was assessed by physical examination on 1st, 15th, 30th day of treatment, daily self-evaluation of symptom score, and patient's overall judgement at the end of the trial. The group receiving terfenadine + nimesulide reported a significant lower symptom score and gave a better overall evaluation than the group receiving terfenadine + placebo. These results suggest that the addition of nimesulide to antihistamine treatment may be useful to achieve a better relief of symptoms in allergic rhinitis.

Local nasal immunotherapy in allergic rhinitis to Parietaria. A double-blind controlled study

Preseasonal local nasal immunotherapy (LNIT) by means of an extract in macronized powder form has been studied in allergic rhinitis to parietaria. Twenty-four Parietaria-sensitive patients have been studied for 18 weeks in a double-blind controlled trial. Subjects were selected on the basis of a positive skin test, RAST and intranasal challenge to Parietaria antigen. Three eight-patient groups were randomly planned: the first group was given native Parietaria product, the second modified Parietaria product, and the third placebo. During the pollen season no difference was observed in mean weekly symptom score between the three groups, while the mean weekly medication score was significantly lower in the treated groups than the control group. Only the treated groups showed a significant increase in specific nasal threshold to Parietaria after treatment. Adverse reactions to LNIT, limited to the upper respiratory tract, occurred rarely and did not interfere with the dose schedule. This study indicates that LNIT in powder form may be a suitable alternative to the traditional subcutaneous immunotherapy in terms of clinical efficacy and safety.

[Bronchial asthma in women: peculiar aspects]

Some peculiar aspects of bronchial asthma in women are pointed out and critically examined. The course of asthma is considered during the typical endocrine phases in women (i.e. pregnancy, menstrual cycle and menopause). A worsening is often reported between the 29th and 36th week of pregnancy; the clinical status during pregnancy is attributed to the interaction between the positive effect of cortisol and the antagonism of DOCA, progesterone, aldosterone on the cortisol-glucocorticoid pulmonary receptors. Also the increase of hypotalamic concentration of noradrenaline which inhibits the pituitary-adrenal axis is considered among of the causes of the worsening of symptoms; moreover the increase of progesterone enhances the gastroesophageal reflux which acts as a trigger stimulus and causes bronchospasm. The therapeutic aspects are examined. All the pharmacologic principles are considered regarding the possible harm to the pregnant woman or the fetus. The oldest and well established molecules are considered the most reliable. Bronchial asthma is then examined with regard to menstrual cycle; pre-menstrual asthma is critically reviewed. The Authors conclude that there are neither conclusive data nor a specific therapy. Finally the pathogenesis of perimenopausal asthma is discussed. A possible hyperestrogenism with possible modification of the PGF2/PGE2 rate may be the cause of this syndrome.

Skin and serum reactivity to some storage mites in children sensitive to Dermatophagoides pteronyssinus

The incidence of skin test and RAST positivity for Dermatophagoides farinae and storage mites (Glycyphagus privatus, Lepidoglyphus destructor, Tyrophagus putrescentiae, Acarus siro, and Gohieria fusca) have been evaluated in children with bronchial asthma and positive prick test to Dermatophagoides pteronyssinus. The storage mite with highest incidence of skin and RAST positivity was Gohieria fusca, which caused a positive response in more than 50% of the children evaluated. This antigen appears to possess allergenic determinants not present in Dermatophagoides pteronyssinus. The sensitivity to this antigen might be considered in house dust mite-allergic children who do not improve after specific immunotherapy with Dermatophagoides pteronyssinus extracts.

[Migraine and food]

The frequency of migraine has been studied in adult patients with suspected adverse reaction to foods. Migraine was present in 41 out of 300 patients (13.6%). 38 of these 41 subjects have been treated with elimination diet; 25 (65.7%) obtained a significant improvement of migraine and subsequently, performed challenge test. 24 patients were affected by food intolerance and only one by food allergy. The remaining 13 non-responder subjects suffering from migraine have been subsequently submitted to pharmacological treatment.

The efficacy of ketotifen in a controlled double-blind food challenge study in patients with food allergy

The effectiveness of oral ketotifen was compared with that of placebo in 26 patients with food allergy in a randomized, double-blind parallel study. Patients were selected on the basis of food allergy as established by history, clinical improvement after an exclusion diet, and reappearance of the symptoms after a challenge with the food. Thirteen patients were given ketotifen and 13, placebo. Ketotifen or placebo were administered twice daily for 1 month after the first oral provocation test and the last dose was given 12 hours before the second oral provocation test. Ketotifen protected patients (7/13) significantly more than placebo (2/13; P less than .05). The results of this study suggest that ketotifen may be useful for some patients with food allergy.