447 research outputs found
Rhinitis in children: common clinical presentations and differential diagnoses
No full textRhinitis is a common presentation in childhood. Acute virally induced rhinitis is generally self-limiting and usually does not require medical attention. Whilst allergic rhinitis is the focus of the paediatric allergist, the presentation of other diseases or comorbidities that can complicate or mimic allergic rhinitis needs to be considered. Effects on the child's quality of life also need to be addressed. Rhinitis can be associated with asthma and other significant comorbidities: importantly, non-allergic rhinitis can sometimes be a consequence of systemic immune impairment. The diagnosis of rhinitis is based on clinical findings with directed investigations. Nasal nitric oxide measurement is an emerging diagnostic tool and helpful particularly in relation to evaluating the differential diagnosis in more difficult rhinitis. Successfully identifying the cause of rhinitis in childhood and associated comorbidities can ensure that the patient is successfully treated as described in the recently published EAACI Pediatric Rhinitis Position Paper
Dropouts in sublingual allergen immunotherapy trials - a systematic review
No full textParticipant dropouts can reduce the power of allergen immunotherapy clinical tri-als. Evaluation of the dropout rate and reasons for dropout are important not only in the planning of clinical studies but are also relevant for adherence to immunotherapy in daily clinical practice. A systematic review was carried out in order to establish the overall dropout rate among published double-blind, placebo-controlled randomized clinical trials of sublingual immunotherapy for respiratory allergic diseases. Dropouts were analysed in regards to allergen, formulation, treatment schedule, participant age, study size, number of centres and type of allergic disease. Relative dropout rates in placebo and active groups as well as reasons for dropout were also assessed. A total of 81 studies, comprising 9998 patients, were included. Dropout rates in sublingual immunotherapy controlled studies do not appear to be a major problem with a composite drop-out percentage of 14% (95% CI:11.9–16). Furthermore, they are not different for active compared to placebo-treated participants. This lends support to the positive clinical outcomes seen in meta-analyses of these trial
BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007)
No full textThis is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10–15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.</p
The intriguing role of interleukin 13 in the pathophysiology of asthma
No full textApproximately 5-10% of asthmatic patients worldwide suffer from severe asthma. Experimental and clinical studies have demonstrated that IL-13 is an important cytokine in chronic airways inflammation. IL-13 is involved in Th2 inflammation and has been identified as a possible therapeutic target in the treatment of asthma. Two different human monoclonal antibodies (mAbs) anti-IL-13 (tralokinumab and lebrikizumab) block binding and signaling of IL-13 to its receptors, IL-13Rα1 and IL-13Rα2. Several randomized, double-blind, placebo-controlled multicenter studies have evaluated the safety and efficacy of tralokinumab and lebrikizumab in the treatment of adult patients with severe asthma, but all have failed to meet their primary endpoints. No serious adverse events related to the treatment with these anti-IL-13 mAbs have been reported in these studies. These negative clinical results contrast with positive findings from blocking IL-13 signaling in experimental models of asthma, raising doubts about the transferrable value of some models. Interestingly, dupilumab, a mAb which blocks both IL-4 and IL-13 signaling reduces exacerbation rates and improves lung function in severe asthmatics. These results suggest that IL-4 and IL-13 share some, but not all functional activities in airway inflammation. Tralokinumab might show efficacy in a highly selected cohort of asthmatics characterized by overexpression of IL-13
Aspirin desensitisation therapy for aspirin-intolerant chronic rhinosinusitis
No full textThis review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2009, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</p
The need for patient-focused therapy for children and teenagers with allergic rhinitis: a case-based review of current European practice.
No full textAllergic rhinitis is a common problem in childhood and adolescence, with a negative impact on the quality of life of patients and their families. The treatment modalities for allergic rhinitis include allergen avoidance, anti-inflammatory symptomatic treatment and allergen specific immunotherapy. In this review, four cases of children with allergic rhinitis are presented to illustrate how the recently published EAACI Guidelines on Pediatric Allergic Rhinitis can be implemented in clinical practice
Raising the bar in respiratory care by EUFOREA: report of the European Union Parliament Symposium, April 2024
No full textIn April 2024, the European Summit "Raising the bar in respiratory care" was organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) in the European Parliament and hosted by Members of the European Parliament Dorien Rookmaker and Mislav Kolakušić. The aim of the Summit was to respond to the need of European patients suffering from chronic respiratory diseases (CRDs) by joining forces with European and global organisations in the management of the epidemics of CRD, recognising the weaknesses of current care models and focussing on collaboration to improve care and prevention. Participants belonging to International and National Societies and Committees from the European Rhinologic Society (ERS), International Rhinologic Society (IRS), Belgian Respiratory Society (BeRS), Global Initiative for Asthma (GINA), Global Initiative for Chronic Obstructive Lung Disease (GOLD), Global Alliance against Chronic Respiratory Diseases (GARD), and from the European Federation of Allergy and Airways Diseases Patients Associations (EFA) and the EUFOREA's Patient Advisory Board (PAB) described their vision and action plan to work in partnership to raise the bar in respiratory care. This report summarizes the contributions of the representatives of different European stakeholders in the field of CRDs
Health and Disease: What Can Medicine Do for Philosophy?
No full textPhilosophical discussions about health and disease often refer to a
'medical model' of bodily disease, in which diseases are regarded as causes of
illness; diagnosis consists in identifying the disease affecting the patient,
and this determines the appropriate treatment. This view is plausible only
for diseases whose cause is known, though even in such instances the disease
is the effect on the affected person, and must not be confused with its own
cause. But in fact the medical diagnostic process which progresses...towards
knowledge of causation often stops short of this desirable end-point; and at
whatever point it comes to a halt, its result is expressed in terms of
'diseases'...This nominalist analysis of the medical usages of the names of
diseases has consequences for definitions of health and disease, and for some
problems in medical ethics
New drugs in early-stage clinical trials for allergic rhinitis
No full textIntroduction: Allergic rhinitis (AR) is the most common allergic disease, and it has a relevant impact on the quality of life of the patient. Treatment of AR includes a combination of strategies of proven efficacy and effectiveness; however, a relevant proportion of patients remain uncontrolled. Areas covered: This review article summarizes emerging therapeutic approaches to AR; these approaches include nasal sprays, oral drugs, alternative allergen immunotherapy administration routes, and biologic agents. Expert opinion: The agents discussed require further clinical trials to prove their efficacy in the treatment of AR. Some of these agents, in particular, allergen immunotherapies and biologics, have the potential to form crucial precision medicine approaches to AR. Those that prove their efficacy in clinical trials must also be evaluated from a pharmacoeconomic perspective, possibly in real-life studies; this will define which therapeutic strategies achieve the most convenient and cost-effective ratio, thus yielding a novel opportunity for the most severe and previously treatment-resistant allergic patients
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