Immunity‐targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children

Abstract

BackgroundUpper respiratory tract infections (URTIs), including rhinitis, nasopharyngitis, tonsillitis and otitis media (OM), comprise of 88% of total respiratory infections, especially in children. Therefore effective prevention and treatment of RTIs remain a high priority worldwide. Preclinical and clinical data highlight the rationale for the use and effectiveness of immunity‐targeted approaches, including targeted immunisations and non‐specific immunomodulation in the prevention and management of recurrent upper RTIs.Objective of reviewThe idea of this review was to summarise the current evidence and address key questions concerning the use of conservative and immunity‐targeted approaches to recurrent and chronic URTIs, with a focus on the paediatric population.Search strategy/Evaluation methodLiterature searches were conducted in March 2017 and updated in September 2017 using: Academic Search Complete; CENTRAL; Health Source: Nursing/Academic Edition; MEDLINE; clinicaltrials.gov; and Cochrane databases. In total, 84 articles were retrieved and reviewed. Two independent researchers focused on primary and secondary endpoints in systematic reviews, meta‐analyses and randomised, controlled trials, using immunity‐directed strategies as the control group or within a subpopulation of larger studies. Existing guidelines and interventional/observational studies on novel applications were also included.ResultsChildren are particularly susceptible to RTIs due to the relative immaturity of their immune systems, as well as other potential predisposing factors such as day care attendance and/or toxic environmental factors (eg increased pathogenic microbial exposure and air pollutants). Recurrent URTIs can affect otherwise healthy children, leading to clinical sequelae and complications, including the development of chronic conditions or the need for surgery. Available pre‐clinical and clinical data highlight the rationale for the use and effectiveness of immunity‐targeted approaches, including targeted immunisations (flu and pneumococcal vaccines) and non‐specific immunomodulation (bacterial lysates), in the prevention and management of recurrent croup, tonsillitis, otitis media, recurrent acute rhinosinusitis and chronic rhinosinusitis.ConclusionsIn this review, we summarise the current evidence and provide data demonstrating that some immunity‐targeted strategies, including vaccination and immunomodulation, have proved effective in the treatment and prevention of recurrent and chronic URTIs in children.

Paediatric Recurrent Ear, Nose and Throat Infections and Complications: Can We Do More?

“…OM-85 has been recommended as adjunct medication to standard medical treatment in adults with CRS without polyps [48,49] and was mentioned in a recently published consensus paper as an effective product to prevent RTIs in children [50]. A recent systematic review concluded that OM-85 can be considered a promising and additional tool in the limited armamentarium of the ENT physician dealing with paediatric ENT infections and their complications [51].…”

Echinacea can help with Azithromycin in prevention of recurrent tonsillitis in children

“…8 Recent studies recommend more randomized controlled trials with adequate long-term follow-up to clarify the benefits of tonsillectomy versus non-surgical treatment in patients with recurrent tonsillitis. 9 Drugs such as penicillin and Azithromycin (AZT) are widely used to control recurrent tonsillitis.…”

Immunoglobulin concentrations in a pediatric population affected by recurrent respiratory infections in the Mogilev region

“…Дефицит IgG 3 , который может протекать совместно с дефицитом IgG 1 , связывают с рецидивирующими обструктивными заболеваниями легких [2,3]. Рецидивирующие респираторные инфекции бактериальной этиологии (гемофильная палочка, пневмококк) имеют связь с дефицитом IgG 2 в ассоциации с дефицитом IgA [11,12].…”

“…Цель исследования -провести анализ содержания иммуноглобулинов в крови и слюне у детей 2-16 лет и характер их взаимосвязей в зависимости от возраста ребенка и частоты эпизодов ОРВИ. [12,13] у 50% часто болеющих детей повышен уровень общего IgE (160-220 МЕ/мл), что соответствует и нашим данным (48,6%). При ОРВИ в год более 6 раз отмечается сниженный уровень IgA в сыворотке.…”