Treatment of allergic rhinoconjunctivitis: a review of the role of topical levocabastine

Lcocabastine is an extremely potent and highly selective H1-receptor antagonist which has been specifically developed as eye drops and nasal spray for the treatment of allergic rhinoconjunctivitis. Clinical experience to date suggests that this topical antihistamine is at least as effective as other current first-line therapeutic approaches for the treatment of this condition, including oral H1-receptor antagonists and sodium cromoglycate. Onset of action is rapid, with clinical effects apparent within minutes of instillation. Moreover, duration of action is sufficiently long to permit a convenient twice-daily dosing regimen. Topical levocabastine is well tolerated with an adverse-effect profile comparable with that of placebo and sodium cromoglycate. As might be expected from the route of drug administration, application site reactions are the most frequent adverse effect associated with levocabastine eye drops and nasal spray with an incidence comparable with that seen in placebotreated controls. The availability of effective and well-tolerated topical antihistamines, such as levocabastine, is an important advance which broadens the range of therapeutic approaches available for the clinical management of allergic rhinoconjunctivitis. Levocabastine appears to be an attractive alternative to oral antihistamines as a first-line therapeutic option for the treatment of this atopic condition

Schuivende panelen

Schuivende panelen was de titel van een partijprogramma uit de jaren tachtig. Deze rede is echter geen politiek manifest. Hoewel een wetenschapper in staat moet zijn om politiek te bedrijven en de Allergologie als discipline sinds haar oprichting speelbal geweest is van politieke krachten gaat deze lezing vooral over verschuivingen en ontwikkelingen in het vakgebied. rede In verkorte vorm uitgesproken ter gelegenheid van het aanvaarden van het ambt van bijzonder hoogleraar met als leeropdracht Allergologie aan het Erasmus MC, faculteit van de Erasmus Universiteit Rotterdam, op 20 april 200

Positive and negative AIT trials: What makes the difference?

Background: Allergen immunotherapy has proven to be efficacious in allergic rhinitis and asthma. However, results from randomised clinical trials may vary substantially. Clinical trials may unexpectedly fail. The purpose of this review is to discuss the possible factors that may contribute to a successful or unsuccessful study. Methods: Descriptive review exploring the possible causes of negative outcomes in allergen immunotherapy trials. Results: A series of factors may lead to negative results. Among of these are underpowering of the study, low allergen content in tested extracts, insufficient allergen exposure during monitoring and recruitment of inappropriate patients. In addition, the choice of the primary endpoint may be critical. Discussion: A clinical trial aims to evaluate the efficacy of an agent. However, studies with potential effective compounds may fail because of methodical issues. Sometimes, they are the cause of discrepancies between successful phase II and unsuccessful phase III trials. To understand more about failure of studies, investigators and editors should be encouraged to publish negative trials

Comparison of nasal responsiveness to histamine, methacholine and phentolamine in allergic rhinitis patients and controls

In a selected group of rhinitis patients with an IgE‐mediated allergy to house dust mites the nasal response to insufflation of histamine chloride, methacholine and phentolamine was demonstrated to be higher than in a control group. With the methods used histamine chloride was better at discriminating between healthy subjects and patients than methacholine or phentolamine. This discrimination was shown by assessing the severity of reflex‐mediated symptoms such as the number of sneezes and the amount of secretion, and not by differences in nasal airway resistance. Copyrigh

Nasal hyperreactivity

The subject of this thesis is nasal hyperreactivity or hyperresponsiveness in allergic and nonallergic rhinitis. Hyperreactivity represents an altered state of the upper or lower airways, resulting in an exaggerated response to non-specific stimuli encountered in the environment. Generally, hyperrea.ctivity is a major feature of the disease leading to recurrent or chronic symptoms. In allergic rhinitis and asthma hyperreactivity will reinforce the response after allergen exposure. Although it is known that patients with allergic and non-allergic rhinitis often react with symptoms to environmental non-specific stimuli, standardized and generally accepted tools for measurement of nasal hyperreactivity are not available. Many investigators demonstrated a relation between hyperreactivity of the lower airways and IgE-mediated allergy, especially with respect to the link between hyperreactivity and late phase allergic reactions. However, in nasal allergy a relative backlog exists regarding insight into interactions between IgE-mediated reactions and nasal hyperreactivityThis thesis focuses on answering two questions: L How to measure nasal hyperreactivity ? 2. What is the role and clinical significance of nasal hyperreactivity, especially in nasal allergy ? After a review of the literature (part I, Chapter 2) the current methods of assessment of nasal hyperreactivity are analysed (part II). To this end, nasal challenges with various non-specific stimuli were performed in allergic and non-allergic rhinitis patients compared to healthy subjects (chapters 3,4 and 5). Subsequently the clinical aspects of hyperreactivity in nasal allergy (part III) have been investigated. The relevance of hyperresponsiveness was analysed with respect to the daily symptoms of the patie

Nasal allergy to avian antigens

This study describes the case of a patient who developed symptoms of rhinoconjunctivitis on exposure to budgerigars and parrots. An IgE‐mediated allergy to budgerigar, parrot and pigeon antigens was demonstrated using both in‐vivo challenge tests (skin and nasal provocation tests) and in‐vitro investigations (radio‐allergo‐sorbent test, histamine release test). The study shows that the development of nasal disease can be associated with allergy to avian antigens. Copyrigh

Skin tests, T cell responses and self-reported symptoms in children with allergic rhinitis and asthma due to house dust mite allergy

Abstract BACKGROUND: In allergic responses, a distinction is made between an early-phase response, several minutes after allergen exposure, and a late-phase response after several hours. During the late phase, eosinophils and T cells infiltrate the mucosa and play an important role in inflammation. OBJECTIVE: The aim of this study was to examine the relationship between allergen-induced late-phase skin responses and in vitro T cel

Nasal hyperreactivity and inflammation in allergic rhinitis

The history of allergic disease goes back to 1819, when Bostock described his own ‘periodical affection of the eyes and chest’, which he called ‘summer catarrh’. Since they thought it was produced by the effluvium of new hay, this condition was also called hay fever. Later, in 1873, Blackley established that pollen played an important role in the causation of hay fever. Nowadays, the definition of allergy is ‘An untoward physiologic event mediated by a variety of different immunologic reactions’. In this review, the term allergy will be restricted to the IgE-dependent reactions. The most important clinical manifestations of IgE-dependent reactions are allergic conjunctivitis, allergic rhinitis, allergic asthma and atopic dermatitis. However, this review will be restricted to allergic rhinitis. The histopathological features of allergic inflammation involve an increase in blood flow and vascular permeability, leading to plasma exudation and the formation of oedema. In addition, a cascade of events occurs which involves a variety of inflammatory cells. These inflammatory cells migrate under the influence of chemotactic agents to the site of injury and induce the process of repair. Several types of inflammatory cells have been implicated in the pathogenesis of allergic rhinitis. After specific or nonspecific stimuli, inflammatory mediators are generated from cells normally found in the nose, such as mast cells, antigen-presenting cells and epithelial cells (primary effector cells) and from cells recruited into the nose, such as basophils, eosinophils, lymphocytes, platelets and neutrophils (secondary effector cells). This review describes the identification of each of the inflammatory cells and their mediators which play a role in the perennial allergic processes in the nose of rhinitis patients

Intranasal cold dry air is superior to histamine challenge in determining the presence and degree of nasal hyperreactivity in nonallergic noninfectious perennial rhinitis

The objective of the study was to compare cold dry air (CDA) and histamine in differentiating patients with nonallergic noninfectious perennial rhinitis (NANIPER) from control subjects. Nasal reactivity (nasal patency, mucus production, and sneezing) in 16 symptomatic nonsmoking patients with NANIPER and seven nonsmoking control subjects was measured with standardized CDA and histamine provocation series in a randomized crossover study. Intranasal CDA resulted in increased mucus production and nasal blockage in a dose-dependent manner in patients with NANIPER but not in control subjects. Sneezing did not occur. The reproducibility of CDA for patency and mucus production was good. Sen