Efficacy of Pidotimod use in treating allergic rhinitis in a pediatric population

Abstract

Background: Allergic rhinitis (AR) and adenoidal hypertrophy (AH) are the most frequent causative disorders of nasal obstruction in children, leading to recurrent respiratory infections. Both nasal cavities are colonized by a stable microbial community susceptible to environmental changes and Staphylococcus aureus seems to play the major role. Furthermore, nasal microbiota holds a large number and variety of viruses with upper respiratory tract infections. This local microbiota deserves attention because its modification could induce a virtuous cross-talking with the immune system, with a better clearance of pathogens. Although AR and AH present a different etiopathogenesis, they have in common a minimal chronic inflammation surrounding nasal obstruction; hence it would be challenging to evaluate the effect of an immunomodulator on this minimal chronic inflammation with possible clinical and microbiological effects. The aim of this study is therefore to evaluate the efficacy of an immunomoldulator (Pidotimod) on nasal obstruction in children with AR and/or AH and whether its action involves a variation of nasal microbiota. Methods: We enrolled 76 children: those with allergic rhinitis (AR) sensitized to dust mites entered the AR group, those with adenoidal hypertrophy (AH) the AH group, those with both conditions the AR/AH group and those without AR ± AH as controls (CTRL). At the first visit they performed: skin prick tests, nasal fiberoptic endoscopy, anterior rhinomanometry, nasal swabs. Children with. AR ± AH started treatment with Pidotimod. After 1 month they were re-evaluated performing the same procedures. The primary outcome was the evaluation of nasal obstruction after treatment and the secondary outcome was the improvement of symptoms and the changes in nasal microflora. Results: All patients improved their mean nasal flow (mNF) in respect to the baseline. In AR children mNF reached that one of CTRL. In AH children±AR the mNF was lower in respect to CTRL and AR group. We did not find any differences among all the groups at the two different time points in nasal microflora. Conclusions: Pidotimod is able to give an improvement in nasal obstruction, especially in AR children but this effect seems to be not mediated by changes in nasal microbiota.

Microbiome profiling of nasal extracellular vesicles in patients with allergic rhinitis

“…11 Moreover, there is a stable microbial community in the nasal cavity of AR, and this microbiota can induce crosstalk with the immune system and eliminate pathogens. 12 Choi et al 13 reported a significant increase in microbial species and bacterial diversity in the nasal tracts of patients with AR. Gan et al 14 also indicated that nasal microbiota may exert pivotal effects on the pathogenesis of heterogeneous nasal mucosal inflammation.…”

Interferons alpha and gamma, pidotimod, and tilorone in the treatment of acute respiratory infections in patients with allergic rhinitis: a prospective, cohort clinical and immunological study

“…Тем не менее факт высокой эффективности пидотимода интересен, потому что он по основным механизмам фармакологического действия существенно дальше от классических противовирусных средств, чем другие Бюллетень сибирской медицины. 2022; 21 (2): 48-59 [31], астмы [22], а также в профилактике ОРИ [19] была доказана ранее, в рамках настоящего исследования оказывал выраженный терапевтический эффект в острую фазу респираторной инфекции у аллергиков. Вероятно, применение системно действующего иммуностимулятора, сдвигающего баланс преобладающего иммунного ответа в направлении Т2→T1, была важнее в плане ускорения купирования симптомов ОРИ для больных с сопутствующим аллергическим ринитом, чем использование препаратов с более выраженным противовирусным действием.…”

Causes and treatments of nasal obstruction in children and adolescents: a systematic literature review

“…Allergic rhinitis (AR) and adenoidal hypertrophy (AH) are frequent causative disorders of nasal obstruction in children, leading to recurrent respiratory infections. Brindisi [31] conducted a clinical study to evaluate the efficacy of an immunomodulator (Pidotimod) on nasal obstruction in children with AR or AH. The authors enrolled 76 children and grouped them into AR and AH groups.…”