Fexofenadine is Efficacious and Safe in Children (Aged 6-11 Years) with Seasonal Allergic Rhinitis

Background: This is the first prospective, randomized, doubleblind, placebo-controlled study showing statistical improvement of an H1-antihistamine in children with seasonal allergic rhinitis in all symptoms throughout the entire treatment period. Objective: This randomized, placebo-controlled, parallelgroup,double-blind study was performed to assess the efficacy and safety of fexofenadine in children with seasonal allergic rhinitis. Methods: This study was conducted at 148 centers in 15 countries. Nine hundred thirty-five children (aged 6-11 years) were randomized and treated with either fexofenadine HCl 30 mg (n = 464) or placebo (n = 471) tablets twice a day for 14 days. Individual symptoms (sneezing; rhinorrhea; itchy nose, mouth, throat, and/or ears; itchy, watery, and/or red eyes; and nasal congestion) were assessed at baseline and then daily at 7:00 AM and 7:00 PM (±1 hour) during the double-blind treatment period. Each total symptom score was the sum of all symptoms, excluding nasal congestion. The primary efficacy variable was the change from baseline in the average of the daily 12-hour evening reflective total symptom scores throughout the double-blind treatment. Safety was evaluated from adverse-event reporting, vital signs, physical examinations, and clinical laboratory data at screening and study end point

Mometasone and desloratadine additive effect on eosinophil survival and cytokine secretion from epithelial cells

Although antihistamines and topical corticosteroids are used in combination to treat allergic rhinitis, their additive effect has not been yet demonstrated. The aim was investigate the antiinflammatory additive effect of mometasone and desloratadine on cytokine and sICAM-1 secretion by epithelial cells, and on eosinophil survival stimulated by human epithelial cells secretions from nasal mucosa and polyps. Methods Epithelial cells obtained from nasal mucosa or polyps were stimulated with 10% fetal bovine serum in presence of mometasone (10-11M-10-5M) with/without desloratadine (10-5M). Cytokine and sICAM-1 concentrations in supernatants were measured by ELISA. Peripheral blood eosinophils were incubated during 4 days with epithelial cell secretions with (10-11M-10-5M) and/or desloratadine (10-5M) and survival assessed by Trypan blue. Results are expressed as percentage (mean ± SEM) compared to control. Results Fetal bovine serum stimulated IL-6, IL-8, GM-CSF and sICAM-1 secretion. In mucosa and polyp epithelial cells, mometasone inhibited this induced secretion while desloratadine inhibited IL-6 and IL-8. The combination of 10-5M desloratadine and 10-9M mometasone reduced IL-6 secretion (48 ± 11%, p < 0.05) greater extent than mometasone alone (68 ± 10%) compared to control (100%). Epithelial cell secretions induced eosinophil survival from day 1 to 4, this effect being inhibited by mometasone. At day 4, the combination of mometasone (10-11M) and desloratadine (10-5M) provoked an increased inhibition of eosinophil survival induced by cell secretions (27 ± 5%, p < 0.01) than mometasone (44 ± 7%) or desloratadine (46 ± 7%) alone. Conclusions These results suggest that the combination of desloratadine and mometasone furoate have a greater antinflammatory effect in an in vitro model of eosinophil inflammation than those drugs administered alone

Asthma in the elderly: what we know and what we have yet to know

In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients

Trefoil factor 2 rapidly induces interleukin 33 to promote type 2 immunity during allergic asthma and hookworm infection

The molecular mechanisms that drive mucosal T helper type 2 (T[subscript H]2) responses against parasitic helminths and allergens remain unclear. In this study, we demonstrate in mice that TFF2 (trefoil factor 2), an epithelial cell–derived repair molecule, is needed for the control of lung injury caused by the hookworm parasite Nippostrongylus brasiliensis and for type 2 immunity after infection. TFF2 is also necessary for the rapid production of IL-33, a T[subscript H]2-promoting cytokine, by lung epithelia, alveolar macrophages, and inflammatory dendritic cells in infected mice. TFF2 also increases the severity of allergic lung disease caused by house dust mite antigens or IL-13. Moreover, TFF2 messenger RNA expression is significantly increased in nasal mucosal brushings during asthma exacerbations in children. These experiments extend the biological functions of TFF2 from tissue repair to the initiation and maintenance of mucosal T[subscript H]2 responses

Sublingual immunotherapy in pediatric patients: Beyond clinical efficacy

Purpose of review: Sublingual immunotherapy (SLIT) is widely used in several European countries. Many clinical trials and a meta-analysis presently support its efficacy, but limits and indications in pediatric age still need to be clarified. We review here the most recent literature on SLIT, with particular attention paid to the safety of children and to the additional clinical effects. Recent findings: In addition to clinical trials, post-marketing surveillance studies have confirmed the optimal safety profile of SLIT in adults and children, including those below the age of 5 years. The most recent studies have shown that SLIT identically to the subcutaneous route, has the potential to affect the immunological response to allergens. This is testified to by the facts that SLIT can prevent the onset of new sensitizations and maintain its beneficial effect for years after discontinuation. Moreover, it has been shown that SLIT can prevent the onset of asthma in children with rhinitis. Summary: Due to its excellent safety, SLIT would be an optimal candidate for use in pediatric age groups, where the natural history of allergy can be to some extent modified. Nonetheless, formal and rigorous studies are needed to define its exact indication and dosage.Fil: Baena Cagnani, Carlos E. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Passalacqua, Giovanni. Allergy and Respiratory Diseases, DIMI, University of Genoa, ItalyFil: Baena Cagnani, Rodrigo C. Allergy and Respiratory Diseases, DIMI, University of Genoa, ItalyFil: Croce, Víctor Hugo. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Canonica, Giorgio Walter. Allergy and Respiratory Diseases, DIMI, University of Genoa, Ital

Airway remodelling in children: when does it start?

The review characterizes airway remodelling in childhood asthma and describes how early in life it is possible to detect, and possibly cure, the cellular and biochemical changes that characterize this event. This topic is timely and relevant since a variety of clinical and epidemiologic studies strongly suggest that in asthma, remodelling may start very early in life and that current prevention and treatment measures, including early avoidance measures and pharmaceutical interventions, are relatively ineffective in preventing the development of irreversible airway changes or in reverting them, once established. RECENT FINDINGS: Recent findings show that structural changes characterizing remodelling, such as subepithelial basement membrane thickening, epithelial cell disruption, protease/antiprotease imbalance and neoangiogenesis, are detectable in children with asthma and even in children with respiratory symptoms or with atopy, before a clear clinical diagnosis of bronchial asthma is made. SUMMARY: Identification of the early structural changes that may precede the development of asthma and of factors leading to permanent loss of lung function appear central to future asthma management.Fil: Baena Cagnani, Carlos E. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Rossi, Giovanni A. Pulmonary Disease Unit, G Gaslini Institute, Genoa, ItalyFil: Canonica, Giorgio Walter. Allergy and Respiratory Diseases, Department of Internal Medicine, University of Genoa, Genoa, Ital

Biofilms: actualización y revisión de su rol en las vías respiratorias superiores

Los biofilms son estructuras de microorganismos altamente organizadas que crecen unidas irreversiblemente a una superficie cubiertas por una matriz extracelular polisacárida que ellas mismas secretan. Actualmente los biofilms son considerados factores de virulencia que constituyen un modo de crecimiento protegido, que permite la supervivencia en un medio hostil, facilitando la unión de las bacterias a distintas superficies, ayudando al mantenimiento de las bacterias y protegiéndolas de distintos factores, como los cambios en las condiciones ambientales, la posibilidad de ser fagocitadas por células macrofágicas del huésped o por el efecto de los agentes antimicrobianos. Los cuadros clínicos crónicos de la vía aérea superior, pueden tener relación directa con la presencia de microorganismos en forma de biofilms. Las bacterias, protegidas de las defensas del huésped, en forma de biofilms, continúan con su metabolismo y la producción de exotoxinas locales, lo que favorecería la cronicidad de la respuesta inflamatoria evidenciable por los cambios en la mucosa respiratoria y la persistencia de infecciones que no responden a los tratamientos antibióticos.Fil: Zernotti, M. E.. Universidad Católica de Córdoba; ArgentinaFil: Paraje, Maria Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); ArgentinaFil: Baena Cagnani, C. E.. Universidad Católica de Córdoba; Argentin