Management Of Allergic Conditions Research Articles

The clinical efficacy of desloratadine, a non-sedating antihistamine, in the management of allergic conditions: A review of the evidence

Desloratadine is a relatively new, second-generation, tricyclic antihistamine which came into medical use in 2001. This study aimed to review the available evidence in the literature around the clinical efficacy of desloratadine on a range of allergic conditions. A database search in Medline, PubMed, Embase, and Google Scholar was conducted for the research articles published until July 2020, using the keyword desloratadine. An additional reference lists search and citation tracking were also performed. Research articles in English pertaining to desloratadine and its efficacy were considered for inclusion. Study designs, including randomized controlled trials (RCT), observational/case-control studies, and case series were considered. The collective evidence from the current literature shows superior efficacy of desloratadine compared to placebo and some of the other treatment options in the management of seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR), chronic idiopathic urticaria (CIU), and asthmatic symptoms. There is also evidence for potential new roles introduced for desloratadine such as acne treatment, chronic otitis media, and chronic rhinosinusitis, which warrants further investigation. In most studies, desloratadine’s safety and tolerability were comparable with placebo. Current evidence suggest that desloratadine is an ideal option for most of the allergic conditions due to its efficacy as well as favourable safety and tolerability profile. Further large-scale studies are needed to establish the efficacy and safety profile of desloratadine and to compare its effectiveness against other treatments in the management of allergic conditions.

Conviction on itch

Pruritus or itch is defined as an unpleasant sensation of the skin that provokes the urge to scratch. Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. In 10–50% of adults with persistent pruritus, it can be an important dermatologic clue for the presence of a significant underlying systemic disease such as renal insufficiency, cholestasis, hematologic disorder, or malignancy. Antihistamines are used in the management of allergic conditions. They are useful for treating the itching that results from the release of histamine. Desloratadine and fexofenadine are registered for use in infants six months and older, while loratadine and cetirizine can be used from 12 months of age. A new era of antipruritic drugs targeting specific neural receptors, itchy cytokines, and small molecules is swiftly approaching. Ultraviolet B, broad band or narrow band, Acupuncture, Transcutaneous electrical stimulation are supportive methods.

Comparative aeropalynology of two communities in Lagos State, southwestern Nigeria

Pollen allergy is an abnormal response of the immune system to certain pollen grains and these reactions are gradually on the increase all around the world. The need for consistent and accurate data on aero-pollen density as well as the meteorological conditions under which they are prevalent is imperative for appropriate management of allergic conditions in hypersensitive persons. Therefore, to identify the ‘culprit’ pollen related to allergy cases in Lagos, two locations, Ipaja and Ikeja were sampled. Aero-samplers were harvested weekly from February 2016 to July 2016. Acetolysis was done on the samples collected and meteorological data from Nigerian Meteorological Agency and clinical data from Adefemi Medical Center, Ipaja were assessed against pollen counts. The total pollen count of 2,048 was recorded for Ipaja while Ikeja had 820 with main taxa of Amaranthaceae, Poaceae and Euphorbiaceae. Weekly pollen counts were highest in weeks 8 and 10(April) at Ipaja and Ikeja respectively and lowest in weeks 22 and 24(June) at Ipaja and Ikeja respectively. The pollen counts at Ipaja correlated positively with temperature and from the medical records, there was a positive correlation (p<0.05, r=0.166 and r=0.44) between pollen density at both locations with cold and catarrh. Fungal allergens could have caused the spike in pollinosis in the wetter weeks (12 -19). The quality of the clinical data could also be a suspect which reinforces the need for more accurate and standard recording of clinical conditions across hospitals in Nigeria. This is the first record of weekly aerobiological data in Nigeria.

Risk Communication During COVID-19

During the unprecedented times caused by the novel coronavirus disease 2019, there is rapidly evolving information and guidance. However, a focus must also be on proper and effective risk communication. This is especially the case during pandemics that have high rates of infection, significant morbidity, lack of therapeutic measures, and rapid increases in cases, all of which apply to the current coronavirus disease 2019 pandemic. A consequence of poor risk communication and heightened risk perception is hoarding behavior, which can lead to lack of medications and personal protective equipment. One potential way to ensure appropriate risk communication is using social media channels, and ensuring an ongoing consistent media presence. Another important step is to include all stakeholders including members of the allergy community in broader public health messaging. As we continue to face unprecedented times in the allergy community, an understanding and appreciation of risk communication will be essential as we communicate with, and inform, our patients, and our colleagues, moving forward.

Exercise-Related Allergic Diseases

Allergic diseases are common in sports athletes, as they are in the general population. Any physician who involved in the care of athletes will commonly face the management of allergic conditions. Exercise-aggravated or exercise-induced allergic disorders are significant health problems to competitive athletes, although the majority of these disorders are mild and symptomatically annoying, several allergic diseases carry the risk of anaphylaxis and even sudden death. Meticulous approach in the diagnosis and management of allergic conditions is essential for the sports medicine physicians to afford all athletes can compete safely with their highest physical and mental level.

Effect of Albendazole Treatments on the Prevalence of Atopy in Children Living in Communities Endemic for Geohelminth Parasites: A Cluster-Randomized Trial

Cooper PJ, Chico ME, Vaca MG, et al. Lancet. 2006;367:1598–1603 PURPOSE OF THE STUDY. To determine if repeated antihelminthic treatments with albendazole affect the prevalence of atopy and clinical indices of allergy among children who live in parasite-endemic communities. STUDY POPULATION. Children (N = 2373) attending the second to seventh year of primary education at 1 of 68 rural schools in a tropical and subtropical region of Ecuador. METHODS. Children were cluster randomized by school to receive albendazole treatment every 2 months for 12 months or no treatment. The primary outcome was the proportion of children with at least 1 positive skin-test result to an environmental allergen after 12 months; secondary outcomes included the proportion of children with reported allergy symptoms, flexural dermatitis, and exercise-induced bronchospasm. No placebo was used, but the investigators who evaluated the children were blinded to their treatment-group assignment. RESULTS. At baseline, there was an inverse association between geohelminth infection and skin-test reactivity (odds ratio: 0.78; 95% confidence interval: 0.65–0.95). Of children who attended albendazole-allocated schools, 91.5% received all 7 albendazole doses; albendazole treatment by parents was reported for 29.4% of the children allocated to no-treatment schools. After 12 months, the prevalence of geohelminth infection declined from 69.3% to 20.5% in the treatment group and from 74.6% to 65.7% in the no-treatment group. There was no evidence of an increase in the prevalence of atopy among children who received albendazole (17%) compared with those in the no-treatment group (17%; age- and gender-adjusted odds ratio: 0.97; 95% CI: 0.68–1.39). Both groups had similar reported allergy symptoms, flexural dermatitis, and exercise-induced bronchospasm after 12 months. CONCLUSIONS. After 12 months, the prevalence of atopy did not increase among school-aged children who were treated with albendazole, compared with children who were not treated. REVIEWER COMMENTS. Management of allergic conditions has increasingly focused on prevention and reduction of risk factors. Small intervention studies have shown increased atopy associated with regular antihelminthic treatment. Although this study was larger, it had a high dropout rate (31%), and antihelminthic treatment of children in the no-treatment group may have biased the results toward the null. It is important to note that the protective effect of geohelminth exposure against atopy may be greater during the first few years of life than by school age. However, these results suggest that treatment of school-aged children with antihelminthics over 12 months does not put them at greater risk of atopy.

A comparison of diagnostic techniques in the diagnosis and management of allergic conditions

SummaryA comparison of diagnostic techniques was carried out in the management of 59 patients with allergies who received desensitisation with Migen or Pollinex vaccines. Patients were tested with radioallergosorbent test (RAST) as well as skin tests, IgE levels and eosinophil counts.Significant differences were shown in the ability of RAST and skin tests to detect allergy (p<.05), skin tests being more sensitive. Significant clinical improvement was seen in 76 per cent of patients with house dust allergy and 92 per cent with grass pollen allergy.RAST testing was found to be of little diagnostic assistance. Skin testing and clinical evaluation were the most reliable methods of diagnosing allergy and monitoring response to therapy. No patients had any adverse reactions to desensitisation.

DIAGNOSIS AND TREATMENT: USE OF STEROIDS IN ASTHMA IN CHILDREN

ALTHOUGH cortisone and its derivatives have been widely and increasingly used in the management of allergic conditions during the past fifteen years, no final judgment has been reached as to their place in management of asthma, either in adults or in children. The seriousness of unresolved questions is well exemplified in the discussion by Alexander, Samter, Arbesman, and others as to whether mortality in asthma has fallen or risen since corticosteroid drugs became available. Without taking sides we can acknowledge that because these agents are both effective and hazardous, their use poses a dilemma. The therapeutic effects of steroids have not been easily separated from their undesired side effects, particularly in prolonged use. Table I lists the better-known effects of chronic administration. The likelihood of each effect varies with the drug used, the effects on fluid and electrolyte economy having been particularly well separated in some agents from the anti-inflammatory effects. It has not been possible, however, to attain adequate anti-inflammatory effects without some stimulation of protein catabolic processes or without some evidence of increased susceptibility to infection or to adrenal suppression. The subtle nature of symptoms of infection in patients receiving steroid therapy may lead to disastrous delays in diagnosis, and have given rise to the legendary patient receiving steroid therapy who "walks to his place on the autopsy table." Certain side effects are more or less specific features of certain agents, such as the marked stimulation of appetite, the weight gain, and the euphoria associated with dexamethasone, or the anorexia, depression, and toxic myopathy associated with triamcinolone. Sometimes a distressing side effect may be avoided by change in agent; highly soluble prednisolone phosphate appears, for example, less likely than prednisolone to stimulate peptic ulceration.