Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

Tsilochristou, Olympia; Douladiris, Nikolaos; Makris, Michael; Papadopoulos, Nikolaos G.

doi:10.1007/s40272-013-0043-3

Cited by 34 publications

(23 citation statements)

References 108 publications

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Section: Abstract: 5-grass-pollen Tablet • Allergic Rhinitis • Allergsupporting

confidence: 71%

“…In a recent study, allergic conjunctivitis was identified in 53.5% of patients with AR, a finding comparable to those from other studies [15]. More than one-third of patients with AR have asthma [2]; AR frequently precedes the development of asthma and has been proposed as an independent risk factor for it [16].Both US and EU guidance recommend that management of AR combines patient education with specific allergen avoidance, symptomatic pharmacotherapy and allergen-specific immunotherapy (AIT) [1,2,4]. It is typically not possible to eliminate exposure to pollen; therefore, drug treatment is often necessary to provide symptomatic relief.…”

supporting

confidence: 71%

See 1 more Smart Citation

Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience

Didier

Wahn

Horak

et al. 2014

Expert Review of Clinical Immunology

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OralairÒ (OA) (Stallergenes, Antony, France) is a unique pre-and co-seasonal 5-grass-pollen sublingual immunotherapy tablet launched in 2008, and now approved in 31 countries worldwide for the treatment of grass-pollen allergic rhinitis and rhinoconjunctivitis. OA is the first oral treatment with a consistent, well-balanced allergen extract that mimics natural exposure and sensitization. A wealth of data exists from over 5 years of clinical and realworld experience demonstrating the efficacy and safety of OA for grass-pollen-allergy treatment. OA is highly effective from the first pollen season in all patient subgroups, including children and those with comorbid mild asthma, irrespective of sensitization status and symptom severity. OA also has sustained long-term benefits for symptom control and quality of life. This article provides an overview of the pharmacodynamics and pharmacology of OA; its efficacy, safety, tolerability and cost-effectiveness for the treatment of allergic rhinitis and rhinoconjunctivitis and its role in clinical practice. Allergic rhinitis (AR) is a common chronic inflammatory illness, characterized by rhinorrhea, nasal congestion, sneezing, nasal and ocular pruritis and watery eyes [1]. Inhalation of allergens by sensitized individuals triggers the IgE-mediated release of inflammatory mediators and cytokines, leading to a rapid appearance of symptoms [2]. AR has historically been classified as 'seasonal' or 'perennial' depending on whether symptoms occur with seasonal exposure to aeroallergens or are present throughout the year. Seasonal AR is most commonly attributed to plant pollen and other outdoor allergens, while perennial AR is associated with indoor allergens, such as dust mites, mold, cockroaches and pet dander, although it can also be associated with pollen in areas where this is prevalent year-round [3,4].In 2001, the WHO-sponsored Allergic Rhinitis and its Impact on Asthma meeting produced guidelines proposing an alternative classification of the condition into 'intermittent' or 'persistent' AR, and grading symptoms as 'mild' or 'moderate/severe' [5]. Globally, the prevalence of seasonal ('hay fever') and perennial AR ranges from 7 to 42 and 1 to 13%, respectively, with the former being more common in children than adults [6]. The length of exposure to seasonal allergens is dependent on geographic location and climatic conditions [4]; in Europe, the main pollen season typically occurs from March to July, with slight variations according to latitude [7].Approximately 500 million people worldwide [6], including an estimated 30-60 million in the USA [4] 1309Drug Profile suffer from AR, and its prevalence is increasing in most countries [2]. It is estimated that from 10 to 30% of adults and up to 40% of the pediatric population have AR [3,9]. While AR does not directly lead to mortality, it places a considerable burden on affected individuals, who often have a reduced quality of life (QoL), compared with non-sufferers [10]. The physical symptoms of AR can cause sleep disturbance...

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Section: Abstract: 5-grass-pollen Tablet • Allergic Rhinitis • Allergsupporting

confidence: 71%

supporting

confidence: 71%

Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience

Didier

Wahn

Horak

et al. 2014

Expert Review of Clinical Immunology

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“…It is also possible that the relationship between AR and asthma could be, at least in part, causal. 19,34,[45][46][47] This idea is supported by findings of significantly impaired lung function in children with moderate-severe persistent rhinitis, compared to mild intermittent rhinitis, in children without overt asthma symptoms, which was independent of atopic status. 30 Studies showing that provocation of nasal mucosa with allergen in patients with AR caused pulmonary symptoms and decreased airway function, and similarly segmental bronchial provocation triggered nasal inflammation, support the unified airway concept.…”

Section: Allergic Rhinitismentioning

confidence: 75%

“…30 Studies showing that provocation of nasal mucosa with allergen in patients with AR caused pulmonary symptoms and decreased airway function, and similarly segmental bronchial provocation triggered nasal inflammation, support the unified airway concept. 44,46 These mechanisms may underlie the relationship between AR and STRA. 19,34,[45][46][47] This idea is supported by findings of significantly impaired lung function in children with moderate-severe persistent rhinitis, compared to mild intermittent rhinitis, in children without overt asthma symptoms, which was independent of atopic status.…”

Section: Allergic Rhinitismentioning

confidence: 99%

Does allergy explain why some children have severe asthma?

Bonner

Roberts

2018

Clin Experimental Allergy

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Asthma is a common disease in childhood with a minority of affected children having severe therapy-resistant asthma (STRA). Children with STRA can be differentiated from those with mild-moderate disease by greater allergic sensitization, increased eosinophilic airway inflammation, increased airway remodelling and reduced corticosteroid responsiveness. The aetiology of STRA in children is multifactorial but allergy seems to play a key role. Many children with asthma have coexisting allergic disease, and severe rhinitis seems to be an important driver of STRA in children. Allergies to foods, moulds, pollen and pets have also been associated with severe asthma exacerbations. Identifying allergens that are driving asthma symptoms in children with STRA may provide additional strategies for improving their disease control. Avoidance strategies may be possible. Additional monoclonal antibody therapy with Omalizumab or Mepolizumab may be helpful in children with clinically important polysensitization.

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“…The incidence of cedar pollen allergy (a seasonal type of AR) has also been increasing, and its prevalence in 5-9-year-old children was demonstrated to be 13.7%, according to a survey performed in 2008 (5). As both diseases affect the airways and exacerbation of nasal symptoms influences asthma symptoms, these two diseases are increasingly viewed from the perspective of the 'one airway, one disease' paradigm (6). Pranlukast dry syrup is an LTRA that is used as a monotherapy for bronchial asthma or AR (7)(8)(9)(10); however, its use in children with both diseases has not been examined.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a leukotriene receptor antagonist for pediatric cedar pollen allergy complicated by asthma

Yoshihara

Kikuchi

Saitou

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Leukotriene receptor antagonists (LTRAs) are identified as a monotherapy for asthma and allergic rhinitis; however, their use in children for treatment of these diseases has not been examined. Accordingly, the present study investigated the efficacy of pranlukast dry syrup for children with both pollinosis and asthma. The subjects were children receiving treatment for asthma who were also diagnosed with cedar pollen allergy. Patients were divided into a group that received continuous treatment with pranlukast (group A; n=20) and a group that commenced add-on treatment for pollinosis following the onset of symptoms (group B; n=20). Patients in group B were randomly allocated to subgroup B1 (add-on treatment with pranlukast dry syrup) or subgroup B2 (add-on treatment with a second-generation antihistamine). In both groups, nasal and ocular symptoms were evaluated every day and recorded in a diary. Exacerbation of nasal obstruction was demonstrated in group B; however, not in group A. There was a significant difference in symptoms observed between the two groups during the late peak pollen period (P<0.05). The incidence of nasal obstruction (defined as a nasal obstruction score ≥3 or use of a nasal steroid spray) was significantly lower in group A compared with group B (P<0.05). The maximum scores for sneezing and nasal obstruction during the late peak of the pollen season were lowest in group A, followed by subgroup B1 and subgroup B2. The present study demonstrated that long-term administration of LTRA for the management of asthma may improve nasal symptoms of pollinosis during the pollen season in children with pollinosis and asthma.

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Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

Cited by 34 publications

References 108 publications

Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience

Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience

Does allergy explain why some children have severe asthma?

Efficacy of a leukotriene receptor antagonist for pediatric cedar pollen allergy complicated by asthma

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