Treatment Of Rhinoconjunctivitis Research Articles

Nonpharmacological Treatment of Rhinoconjunctivitis and Rhinosinusitis

Infectious and allergic diseases of the upper airways are among the most common illnesses of all age groups. Numerous guidelines have been issued for the evidence-based treatment of these diseases. Therapy involves local or systemic application of well-characterized pharmacologically active medications such as glucocorticosteroids, antihistamines, leukotriene-receptor antagonists, alpha-adrenergic receptor agonists, mast-cell stabilizers, and a monoclonal antibody targeting specific immunoglobulin E. In spite of the fact that the various therapeutic options have proven their efficacy and effectiveness in a myriad of well-designed clinical trials, many patients express their discontent with current therapies. In several surveys a majority of patients stated that they would prefer nonpharmacological “nonchemical” treatment over what is currently prescribed or recommended by their physicians. This desire stands in clear contrast to a systematic review conducted some years ago proving that there was practically no evidence at that time for the efficacy of alternative forms of treatment of allergic diseases of the upper airways. Ever since, several meta-analyses, systematic reviews, and well-designed clinical trials have been published, bearing witness to the scientific basis of some nonpharmacologic options like nasal irrigation in the treatment of different pathologies of the upper airways, namely, for rhinosinusitis and for allergic rhinoconjunctivitis. In this special issue, we want to highlight some new approaches that until lately have found less public attention in this domain. In their article on the clinical efficacy of a spray containing hyaluronic acid and dexpanthenol after surgery in the nasal cavity, I. Gouteva et al. demonstrate beneficial effects on wound healing for two substances that have a long history of local application in the nose but formerly were used separately. The so-called “extremolyte” ectoine is a substance, which was introduced a few years ago as a “natural” treatment of allergic and inflammatory pathologies of the skin and the mucosal tissues. Five articles in this issue illuminate the mechanism of action and the potential benefits of a nasal spray containing ectoine in diseases of various aetiologies like rhinitis sicca or allergic rhinitis. A form of local treatment of the nasal mucosa that is proximate to ectoine is the nasal spray containing liposomes. Its use in allergic rhinitis has been well established. A. Eitenmuller and coauthors present in their article for the first time data on ectoine in chronic rhinosinusitis. For patients who are sceptical about using any sort of active ingredients in their nasal spray, the application of mere water in the form of thermal water inhalations could be an alternative. S. Keller et al. have conducted a meta-analysis which demonstrates some benefits of this least-invasive local therapy. There has been much controversy over the last decade on the meaningfulness of probiotics in preventing allergies. New forms now come as treatment of chronic diseases of the upper airways. M. F. Kramer and his coauthor M. D. Heath present the latest state of knowledge of this nutritional therapeutic approach. Another much debated therapy in the field of allergic diseases is acupuncture. Most investigations have previously focussed on pollen-allergic patients. It is the merit of Hauswald and coauthors to have conducted a randomized controlled clinical trial using acupuncture as an alternative to treatment with the state-of-the-art antihistamine loratadine in house dust allergic patients. It has been the intention of the editors of this special issue to round up our knowledge on alternative therapies for upper airways diseases beyond the fields of herbal medicine and homeopathy. The number of articles that have been submitted but more so their quality was a positive surprise. We are very grateful to the publishers who have had the courage of disseminating unusual ideas. Ghada Ali and Marie-Josefine Joisten were the driving spirits behind the scenes and without their continuous commitment this special issue would not have seen the light of the day. We are deeply obliged and thankful for their endeavours. Ralph Mosges Carlos E. Baena-Cagnani Desiderio Passali

Perennial is More Effective than Preseasonal Subcutaneous Immunotherapy in the Treatment of Seasonal Allergic Rhinoconjunctivitis

Two different regimens of subcutaneous immunotherapy (IT), perennial or preseasonal, may be used in the treatment of seasonal allergy. The aim of this study was to compare the efficacy and safety of perennial IT (PIT) and preseasonal IT (PSIT) in patients suffering from seasonal rhinoconjunctivitis. The study was planned as a randomized, double-blind, comparative study on the efficacy and safety of PIT and PSIT. The study group comprised 120 patients allergic to grass and rye pollen. After the observational season they were randomized to receive PIT or PSIT for 3 years. The effect of IT was assessed based on symptom severity and medication use recorded in diaries. Ninety-nine patients completed the study. No difference was seen between the groups regarding combined symptom medication score (SMS) in the first season of IT. During the second season, the difference between PIT and PSIT regarding combined SMS was 27.9% (p = 0.063) and reached 42.7% (p = 0.012) in favor of PIT in the third season. Both treatments had a similar safety profile. PIT was more effective than PSIT in the treatment of rhinoconjunctivitis in patients allergic to grass and rye pollens.

Oral lyophilisate and food immunotherapy: from research to clinical practice

Thanks to its excellent safety profile, sublingual immunotherapy has served as a basis for launching two important lines of research in current allergology: sublingual immunotherapy with pharmaceutical registry (oral lyophilizates or tablets), and sublingual immunotherapy with food. At present, clinical trials are being conducted which use rapid dissolution oral lyophilizates. The results of the clinical trials carried out in large patient groups and based on a double-blind methodological design have allowed pharmaceutical registry of this form of treatment, with the therapeutic indications of rhinitis and allergy to grasses. Phleum lyophilizate indicated for the treatment of rhinoconjunctivitis will be marketed in Spain in the coming months. In parallel to development of the sublingual route, advances in our knowledge of pollen allergy and its relationship to plant food allergies have facilitated the conducting of studies involving sublingual immunotherapy for allergy to kiwifruit, hazelnut and peach - thus giving rise to promising future perspectives for affected patients.

Estrategias de tratamiento de la rinoconjuntivitis y el asma durante el embarazo

Background The incidence of asthma is high, especially in young people, a population group that in-cludes women of reproductive age. We reviewed recent publications on asthma control during pregnancy to avoid undesired effects on both the mother and fetus. The prevalence of rhinoconjunctivitis is also high, although this disease is often under-treated by physicians. The use of β 2-agonists, corticoids (systemic/inhaled/nebulized), epinephrine and specific allergen immunotherapy is discussed. Methods We reviewed recent publications on asthma during pregnancy as well as other articles of interest. Articles providing data on drug therapy, overall strategies and patient education were selected. Sufficient drugs are available for the management of this disease and under-treatment cannot be justified Conclusions Pregnancy is not a disease, but constitutesa period when special care must be taken with underlying diseases. The aim of asthma treatment during pregnancy is to prevent fetal complications due to the effects of medication and asthma crises by keeping the mother symptom free and preventing possible exacerbations. Almost all authors agree that asthma crises in pregnant women should be treated no differently from those in non-pregnant women. Treatment of rhinoconjunctivitis should not be stopped during pregnancy since a wide variety of FDA category B drugs is available. Specific allergen immunotherapy should not be suspended during pregnancy as it is not contraindicated. However, this therapy should not be initiated during pregnancy.