Treatment Of Respiratory Allergy Research Articles

Probiotics for allergic respiratory diseases – Putting it into perspective

Respiratory allergies include allergic rhinitis, sinusitis and asthma. Increasing attention on pathogenesis of allergic airway diseases has given rise to "atopic march" hypothesis i.e. clinical features of atopic eczema occur first and precede the development of asthma and allergic rhinitis. The "hygiene hypothesis" proposes that the increase in allergic diseases reflects a decrease in infections during childhood. Clinical trials also suggest that the exposure to microbes through the gastrointestinal tract powerfully shapes immune function. Probiotics are live organisms which exert a beneficial effect in the prevention as well as treatment of allergic diseases through modification of immune system of host via gut ecosystem. Intestinal microbiota differs in infants who later develop allergic diseases, and feeding probiotics to infants at risk has been shown to reduce their rate of developing eczema. This has prompted studies of feeding probiotics in prevention as well as treatment of respiratory allergy. We hereby discuss the status of probiotics in respiratory allergy.

Quoi de neuf en allergologie pédiatrique en 2007–2008 ? Partie 2 : allergie oculaire et respiratoire (une revue de la littérature internationale de septembre 2007–octobre 2008)

Numerous studies on pathophysiology, epidemiology, (early) diagnosis, prevention and treatment of respiratory allergy in children have been published since October 2007. Parental atopy and/or asthma and bronchial hyperreactivity, gynecological and obstetrical problems during pregnancy, prematurity, maternal exposure to domestic pollutants during pregnancy, passive smoking in utero and during early life, early exposure to high levels of mites and molds, respiratory infections and a personal history of atopy (atopic dermatitis, food allergy, sensitizations detected by means of prick-tests and/or specific IgE determination) are associated with an increased risk of wheezing and asthma. However, these risk factors are dependent on complex interactions with numerous genes and interactions between genes themselves. In wheezing infants, bronchial and blood eosinophilia, bronchial hyperreactivity and severity of bronchiolitis are significant risk factors for asthma in childhood. Ribavirin treatment of respiratory syncytial virus bronchiolitis in infants significantly reduces the risk of asthma in children. The control of asthma exacerbations is better in children treated with inhaled corticosteroids than in children treated with leukotriene receptor antagonists. However, these drugs may be more effective than inhaled corticosteroids in the control of the bronchial eosinophilic inflammation. Sublingual immunotherapy may be as effective as subcutaneous immunotherapy in the prevention of neosensitizations in children sensitized to one or a low number of allergens. However, adherence to sublingual immunotherapy is far from excellent and a new case of severe anaphylactic reaction to sublingual immunotherapy has been reported recently.

Antiprotozoal drugs in the treatment of respiratory allergy: a side that should be explored

Antiprotozoal drugs in the treatment of respiratory allergy: a side that should be explored

The evidence on the efficacy of Specific Immunotherapy in the treatment of respiratory allergy: A randomized controlled trials database

The evidence on the efficacy of Specific Immunotherapy in the treatment of respiratory allergy: A randomized controlled trials database

Corticosteroids (inhaled and/or intranasal) in the treatment of respiratory allergy in children: safety vs. efficacy

Background Topical administration of Corticosteroids (CS) can reduce the total dose of CS required to treat the patient and minimize side effects. Topical CS is extremely effective and has an excellent safety profile. Nonetheless, care must be taken when multiple sites such as lungs, nose and skin are being treated. CS mechanisms of action on the inflammatory process are complex. The aim of this study is to review such mechanisms and the adverse events secondary to it. Methods Review English database (Embase, Pub-Med, Scielo) searching words: CS, adverse events, inhaled CS, intranasal CS, and children. Results There is a classic mechanism involving a genomic effect of CS and a non-genomic effect, independently of gene transcription process. This mechanism acts by reducing mucosal blood flow in the asthmatic airways. Second-generation topical CS is the treatment of choice in allergic diseases control because of their good anti-inflammatory activity, poor absorption and first-pass hepatic metabolism. When comparing different CS, it is important to compare therapeutically equivalent doses. Although topical CS reduces systemic side effects, local and even systemic side effects can occur. Many factors affect the amount of drug that reaches the lung, including inhaler technique and inhaler type, fine particle dose and particle distribution. Conclusion Most patients with allergic diseases respond to CS treatment, but there is a small subset of them whose response is unsatisfactory even with high doses of CS. They are classified as corticosteroid-resistant asthmatics. Pro-inflammatory cytokines appear to up regulate the expression of GRβ that has been associated with CS resistance.

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Review the molecular mechanisms of action, efficacy, and potential side effects associated with inhaled corticosteroids (ICS) in children with persistent asthma. Articles in English from MEDLINE. The following terms were used: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, and oral candidiasis. Treatment guidelines, review articles, controlled trials, meta-analyses, and systematic reviews evaluating the efficacy and the adverse events of treatment with ICS were selected. In vivo and in vitro studies show that the available ICS have different pharmacokinetic and pharmacodynamic properties that result in different action potentials. ICS also differ as to the systemic and local side effects. The bioavailability of these products is essential in order to determine the incidence of side effects. In general, ICS are capable of controlling asthma, reducing the number of exacerbations, medical consultations, hospitalizations, and the need of oral corticosteroid (applications) bursts. Improvement can also be seen in pulmonary function, especially in patients with recent onset asthma. The most documented adverse effect is transitory decrease of growth rate. ICS are the main anti-inflammatory agent used to treat persistent asthma. When administered in low doses, they seem to be safe and effective. Patient monitoring allows for early detection of possible side effects associated with ICS.

Sublingual immunotherapy: from biological extracts to recombinant allergens

Sublingual vaccines based on biological extracts from various natural allergen sources are effective in the treatment of respiratory allergies. These vaccines comprise a complex mixture of proteins and glycoproteins that require dedicated standardization procedures to ensure batch-to-batch consistency. Because of the lack of correlation between the potency of an allergen extract and the quantity of major allergen content, standardization is achieved predominantly by determining the global IgE binding capacity of the extract in vitro. New proteomic technologies can be used to further characterize the most abundant proteins present in an extract. Second-generation sublingual vaccines based on recombinant allergens are under development. The aim is to produce molecularly defined vaccines that exhibit superior efficacy, while allowing for simplified immunization schedules. In this approach, recombinant DNA technology is used to express highly purified allergens in their native (i.e. wild-type) conformation. The recombinant allergens are then formulated with ad hoc adjuvants and/or mucoadhesive galenic excipients so that they specifically target oral Langerhans cells and induce allergen-specific regulatory T cells.

Sublingual and oral immunotherapy.

Sublingual immunotherapy (SLIT) is a viable alternative to the subcutaneous route for the treatment of respiratory allergy, whereas the pure oral route has been abandoned because of its lack of efficacy. The main distinctive feature of SLIT is its optimal safety profile, which has been demonstrated in adults and children. The indications for SLIT are similar to those for the subcutaneous route. A long-lasting effect has been demonstrated for the sublingual route, but data are needed to determine the optimal dose and the preventive effect in asthma.

Prognostic value of asymptomatic skin sensitization to aeroallergens.

Asymptomatic skin sensitization to aeroallergens is frequently encountered in epidemiological studies and in everyday clinical life. Correct management of the condition is essential to avoid both progression into allergic disease and unnecessary intervention. Understanding immunological mechanisms in asymptomatic skin sensitization might provide new insights into the natural history and treatment of respiratory allergy. Research on asymptomatic skin sensitization is rare, and the present review unites previous studies with recent findings. It is a common condition affecting 8-30% of the population when using a local standard panel of aeroallergens. Clinically, immediate but not late-phase reactions are induced by allergen challenge. Absent eosinophil stimulation and migration and low IL-5 levels appear to be sentinel mechanisms. Prospective studies show that 30-60% become allergic, depending on allergens and follow-up period. No prospective intervention studies have been performed; however, allergen avoidance seems efficacious in reducing allergy development to occupational and domestic allergens. Asymptomatic skin sensitization due to an erroneously positive skin test must be ruled out before allergen avoidance measures are initiated. Surprisingly few papers exist on asymptomatic skin sensitization epidemiology and immunology, despite the intriguing question as to why symptoms do not develop in IgE-sensitized patients. It is a common condition and a risk factor for later development of respiratory allergic disease. Cross-sectional intervention studies suggest that allergy development is reduced by allergen avoidance. Immunologically, control of eosinophil stimulation and migration seems to be pivotal. How this control is maintained remains to be elucidated.

Principles of treatment of respiratory allergies in children

The problem of treating allergic diseases of the respiratory organs (respiratory allergosis - RA) remains difficult and far from being solved, as evidenced by their "rejuvenation": the onset of the disease at an early age, an increase in the prevalence and severity of the course, the frequent formation of forms resistant to basic therapy and frequent "fouling complications in the form of side effects of sympathomimetics, corticosteroid hormones, drug allergies, which makes the treatment of children even more difficult. The change in the clinical course of RA is due to many reasons. These are general social factors (environmental imbalance, an increase in the range of allergens that affect, poor nutrition, etc.), and not always adequate therapy for patients. Patients, as a rule, are limited to symptomatic treatment aimed at stopping acute allergic symptoms, which gives a short-term effect and does not prevent their relapse; very rarely, specific therapy with etiologically significant allergens is used. At the same time, respiratory allergies, which in most cases occur in a chronic form, require the use of systematic complex and staged therapy, which ensures a long-term stable remission of the disease.

通年性アレルギー性鼻炎に対する免疫療法 長期施行例に対する臨床効果

Immunotherapy has been widely used to treat allergic respiratory disorders and has been shown to be effective in the treatment of respiratory allergy, in particular allergic rhinitis. Improvement usually occurs in approximately 80 percent of patients with perennial rhinitis during the course of immunotherapy. The purpose of this paper is to elucidate the clinical outcome of immunotherapy for perennial rhinitis, with special emphasis on the clinical improvement of long-term immunotherapy. This study included 77 patients with perennial rhinitis due to house dust mite, Dermatophagoides farinae (D. farinae), treated with long-term immunotherapy (more than 36 months: 3 to 18 years) with D. farinae extracts.The following results were obtained from answers to questionnaire, a survey of clinical records, and patients'daily recordings of nasal symptoms.1. Relief (excellent and moderate improvement) from sneezing attacks, watery hypersecretion, and nasal congestion was noted in 87%, 93.5%, and 84.4%, respectively.2. In the majority of the patients alleviation of sneezing attacks and watery hypersecretion occurred during the early phase of treatment. On the other hand, in the vast majority relief from nasal congestion was not achieved during the first year of treatment.3. Relief from nasal symptoms increased continuously in over 80% of the patients even after 2 years as immunotherapy proceeded, and sustained clinical relief from nasal congestion persisted even 2 years after the course of treatment.4. Moderate or more general improvement was obtained in 88.3% of the patients as judged by the Okuda's criteria, and 84.4% of the patients stated that they were significantly satisfied with longterm immunotherapy. How much each patient was satisfied with immunotherapy depended significantly upon how much his nasal obstruction was improved.5. Of the 77 patients studied, two had severe systemic reactions (anaphylaxis) at some time during the immunotherapy.Evidence from our clinical study supports the conclusion that immunotherapy is not without risk but is very effective in perennial rhinitis and that the control of nasal congestion in the early phase of treatment is a key to successful immunotherapy.

Hydrocortisone insufflation in the treatment of respiratory allergies.

Hydrocortisone insufflation in the treatment of respiratory allergies.

Treatment of respiratory allergy in children by oral administration of dust and pollen extracts

1. 1. An unselected group of 402 children suffering from respiratory allergy was treated orally. Of these, the records on 294 were available for satisfactory evaluation of results. Of these, 221 had no treatment save oral therapy with a single antigen. 2. 2. The method, as described, is simple, easy, and rapid and, when successful, to be preferred to hypodermic therapy. 3. 3. The method was successful in more than one-half of those using it. Hypodermic therapy gave satisfactory relief in a large number of those who failed to get relief by the oral method.