Management Of Respiratory Allergy Research Articles

Factors Associated with Non-adherence to Specific Allergen Immunotherapy in Management of Respiratory Allergy

Non-adherence to specific allergen immunotherapy is a major hurdle faced by the allergist, contributing to poor clinical outcomes. To assess the independent association of various factors with non-adherence to specific allergen immunotherapy. Fifty consecutive (non-adherent) and control (adherent) subjects receiving specific allergen immunotherapy were included in the study and various factors related to non-adherence including socio-demographic, clinical and immunotherapy related variables were compared between the two groups by univariate and multivariate analysis. On univariate analysis, gender, allergic conjunctivitis, family history, progression of disease, perception of immunotherapy, medicine requirement, and the pattern of missed doses greater than two in the last 10, 20 and 30 doses were found to be significantly associated with non-adherence. On multivariate analysis, independent association was observed with allergic conjunctivitis, family history, perception of immunotherapy, missed doses greater than two in the last 10 doses of immunotherapy and medicine requirement. The independent factors associated with non-adherence may vary between different settings and countries. There is a need for developing individual case holding programmes to improve clinical outcomes in patients receiving specific allergen immunotherapy.

Prevention of Allergic Asthma with Allergen Avoidance Measures and the Role of Exposome.

It is well known that combination of sensitization and exposure to inhaled environmental allergens is related to both the development and elicitation of symptoms of asthma and that avoidance of allergens would exert beneficial effects in the prevention and control of the disease. Other important factors include the relevance of other allergens, exposure to sensitizing agents also outside patient's home, exposure to irritants (like chemical air pollutants), and the involvement of the patient with a correct education. It is also likely that clinical phase of allergic airway disease and the degree of airways remodeling represent relevant factors for the clinical outcome of allergen avoidance procedure. We reviewed existing evidence on prevention of asthma through allergen avoidance. The management of respiratory allergy is a complex strategy (including prevention, drugs, immunological, and educational interventions). In addition, it is difficult in real life to distinguish the efficacy of single interventions. However, a combined strategy is likely to produce clinical results. A combined strategy is likely to produce satisfactory management of asthma. Allergens are an important trigger factor for the development of symptoms of respiratory allergy, and avoidance measures are able to reduce allergen levels. It is likely that clinical phase of allergic airway disease and the degree of airways remodeling represents relevant factors for the clinical outcome of allergen avoidance procedures. Considering the management of respiratory allergy is a complex strategy; it is difficult in real life to distinguish the efficacy of single interventions. However, further studies better quantifying the effects of allergens are needed.

One Century of Allergen-Specific Immunotherapy for Respiratory Allergy

Among the treatments available for respiratory allergy, which include allergen avoidance and pharmacotherapy, specific immunotherapy (SIT) is the only treatment able to not only act on the symptoms of allergy but also act on the causes. SIT is the practice of administering gradually increasing doses of the specific causative allergen to reduce the clinical reactivity of allergic subjects and was introduced one century ago. SIT remained an empirical treatment for more than 40 years, but the first controlled trial in 1954 paved the way for the scientific era. At present, SIT may be administered in two forms: subcutaneous (SCIT) and sublingual immunotherapy (SLIT). A large number of trials, globally analyzed in several meta-analyses, evaluated the efficacy and safety of SCIT and SLIT in allergic rhinitis and asthma. Current available data give solid evidence to the clinical efficacy of both SCIT and SLIT in allergic rhinitis and asthma. Providing the recommended doses and administration schedules are adhered to, the safety and tolerability are very good; however, adverse systemic reactions remain a drawback for SCIT. After one century of use, accumulating evidence surrounds SIT and the central role in the management of respiratory allergy.

Role of immunmodulators in allergen-specific immunotherapy

Allergen-specific immunotherapy (SIT) is the only causal treatment of allergic disorders and therefore a cornerstone in the management of respiratory allergy. SIT is effective in patients with allergic rhinitis and mild-to-moderate allergic asthma. Successful treatment is associated with decrease in allergic symptoms of the upper and lower airways. The most relevant limitation in the daily routine is the restricted use of SIT in patients with moderate-to-severe allergic asthma. A strategy to overcome this limitation is to combine SIT with immunmodulators. One example of a recently developed immunmodulator is Omalizumab, a humanized, monoclonal anti-IgE antibody that binds to circulating IgE molecules, thus interrupting the allergic cascade downstream the IgE production of B cells. Up to now, four clinical trials have been performed, which all showed that the combination of Omalizumab and SIT is safe and clinically more effective than SIT alone. Moreover, administration of Omalizumab prior to SIT reduces the risk of SIT-related systemic reactions. Omalizumab and SIT are also effective in patients with mild-moderate allergic asthma. In conclusion, the use of Omalizumab as an additive immunmodulator improves safety and efficacy and might be a useful approach to broaden the indication of specific immunotherapy in allergic patients.

Emerging sublingual immunotherapy drugs

Importance of the field: There is epidemiological evidence that respiratory allergy has reached epidemic proportions; owing to the related socio-economic impact, this topic deserves particular attention. An integrated approach involving pharmacotherapy and the immunomodulatory effect of immunotherapy is expected to optimize the management of respiratory allergy, reducing its clinical and economic burdens. Sublingual immunotherapy (SLIT) has gained increasing interest for its efficacy comparable to traditional subcutaneous immunotherapy and its good safety profile.Areas covered in this review: A review of the up-to-date state of the art concerning the key aspects of SLIT is provided; the critical issues are discussed in the light of the comprehensive revision of the recent World Allergy Organization position paper and the subsequent literature, paying particular attention to efficacy, safety, additional effects, adherence and clinical developments.What the reader will gain: The overview of current certainties and concerns, related to the use of SLIT, allows the reader's insight into the future directions of research and clinical applications of SLIT, aimed at covering current unmet needs.Take home message: A large amount of experimental evidence sustains the use of SLIT, though some aspects still need to be clarified to provide clear, evidence-based recommendations. Unmet needs represent the basis for future research, while clinical hypotheses would open the search for new indications and modalities.

Sublingual Immunotherapy

Allergen-specific immunotherapy, together with drug therapy and allergen avoidance, is a cornerstone in the management of respiratory allergy in both adults and children. Since the introduction of sublingual administration of immunotherapy (SLIT), it was regarded as the most promising approach, especially because of its optimal safety profile. After 15 years of clinical trials, the WHO officially accepted SLIT as a routine clinical option in both adults and children. This paper reviews the up-to-date aspects about clinical efficacy, safety and pharmacokinetics of sublingual immunotherapy.

Non-Injection Routes for Allergen Immunotherapy: Focus on Sublingual Immunotherapy

Allergen specific immunotherapy, together with drugs and allergen avoidance, is a cornerstone in the management of respiratory allergy. The non-injection or local routes were developed with the main goal of improving the safety and minimizing the risk of those side effects, which can accompany the injection route. The pure oral route and the bronchial route showed, in the clinical trials, only a marginal efficacy with not negligible side effects. Therefore, these routes are no longer recommended for clinical use. The nasal route proved effective and safe, but its efficacy is strictly limited to the nose. Moreover, the practical problems with administration have made the use of nasal immunotherapy progressively declining. The efficacy of the sublingual route is confirmed by numerous controlled trials, and a meta analysis (in allergic rhinitis). The safety profile, as derived from clinical trials and post marketing surveillance studies, is satisfactory, with mild gastrointestinal complaints being the more frequent side effect reported. Recent studies have also demonstrated that SLIT has a long-lasting effect and a preventive effect on the onset of new skin sensitizations, and interesting data on adherence and mechanisms of action have become recently available. Based on these experimental data, SLIT is now officially accepted as a viable alternative to the subcutaneous route in adults and children. Several points still need to be elucidated, including: mechanisms of action, optimal dosages, and indications in pediatric patients.

Sublingual immunotherapy: what lessons can we draw from recent studies?

Allergen-specific immunotherapy, together with drugs and allergen avoidance, is a cornerstone in the management of respiratory allergy. The traditional subcutaneous route is burdened by the risk of severe adverse events; therefore, safer routes of administration (e.g. local routes) have been developed and are being investigated. Controlled clinical trials have failed to demonstrate the clinical efficacy and the safety of oral or bronchial administration, and these routes have been abandoned. Local nasal immunotherapy proved effective and safe in 17 of 18 controlled trials; thus it could be considered to be a viable route of immunotherapy. Nevertheless, nasal immunotherapy is effective in rhinitis only and requires a particular administration technique; therefore, its use is slowly declining. In contrast, the efficacy of sublingual administration in the treatment of asthma and rhinitis in adults and children is supported by numerous controlled trials. The safety profile, assessed in clinical trials and post-marketing surveillance studies, is satisfactory; the most frequent side effects are gastrointestinal complaints, which can be easily managed by proper adjustment of the dose. The World Health Organization now considers sublingual immunotherapy as a valid alternative to the subcutaneous route, including its use in children. The long-lasting efficacy of treatment via the sublingual route has been documented recently but a number of points still need to be investigated, including mechanisms of action, optimal dosage, cost-effectiveness and patient's adherence.

Common environmental allergens causing respiratory allergy in India.

Respiratory allergy affects all age groups but the children are the worst affected by the respiratory allergy. Bioparticles from different biological sources are the main cause of allergy. Pollen grains, fungal spores, insect and other materials of biological origin form the most important allergen load in the air. For the efficient diagnosis of the allergy and its effective treatment it is very important to know about the prevalence, seasonal and annual variations of aeroallergens of the area. India being the climatically diversed country, there is diversity in the flora and fauna of different parts of the country. Atmospheric surveys carried out in different parts of India reveal that, Alanus nitida, Amarantus spinosus, Argemone mexicana Cocos nucifera, Betula utilis, Borasus flabellifer, Caraica papaya, Cedrus deodara, Cassia fistula, Parthenium, Chenopodium album, Dodonaea viscosa, Malotus phillipensis, Plantago ovata, Prosopis juliflora, Ricinus communis, Holoptelea intergifolia are the allergenically important pollens of the country. Among the fungal aeroallergens, Alternaria, Candida aibieans, Aspergillus versicolor, Aspergillus terreus, Aspergillus japonicus, Cladosporium cladosporoides, Fusarium roseum, Ganoderma lucidum,Neurospora sitophila Helminthosporium, Ustilago trtici, Uromyses are important allergens. Dust mites D. farinae, D.pteronyssinus are also important source of inhalant allergens particularly in the coastal areas of the country. Cockroaches, beetles, weevils, mosquitoes, house flies also contribute towards the aeroallergen load and are allergenically implicated. Avoidance of the indoor and outdoor aeroallergens is recommended for better management of respiratory allergy.

The role of antihistamines in the management of respiratory allergy

The role of antihistamines in the management of respiratory allergy

Management of respiratory allergy by nonallergists. 1. Allergic rhinitis.

Allergic rhinitis and bronchial asthma are the most common respiratory allergies. An attempt to determine the allergenic factor is essential, but should not delay symptomatic treatment. When antihistamines and decongestants fail to control symptoms of allergie rhinitis and adequate avoidance of allergens is impractical, immunotherapy should be given. If rhinitis persists or takes on a perennial pattern in spite of continuous medication, corticosteroids may be indicated.

Management of respiratory allergy by nonallergists. 2. Asthma.

Although most asthmatic patients should be referred to an allergist for evaluation, many return to their primary physician for symptomatic treatment and administration of allergens. Symptomatic treatment is based on drugs that relax smooth muscle, promote expectoration, and suppress tissue edema. Immunotherapy should be used in asthma even if the disease is mild. Steroids also have a place in the treatment of this common form of respiratory allergy.

DIMETHINDENE MALEATE IN THE MANAGEMENT OF RESPIRATORY ALLERGY.

DIMETHINDENE MALEATE IN THE MANAGEMENT OF RESPIRATORY ALLERGY.