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Altaş U, Altaş ZM, Öz F, Özkars MY. Evaluation of Neuropsychiatric Effects of Montelukast-Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1301. [PMID: 37628300 PMCID: PMC10453715 DOI: 10.3390/children10081301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Drug-induced neuropsychiatric effects are important for disease management. We aim to evaluate the neuropsychiatric effects of montelukast-levocetirizine combination therapy in children. This descriptive study was conducted with children aged 2-5 years, diagnosed with asthma and allergic rhinitis, who began to receive montelukast and levocetirizine combination therapy. The respiratory and asthma control test for children (TRACK), Rhino Conjunctivitis Scoring System (RCSS), and common neuropsychiatric effects (irritable behavior, hallucinations, headaches, nightmares, sleep disorders, behavioral and mood disorder, restlessness, depression) were ascertained by the questionnaire applied before and 4 weeks after the treatment. Parents answered on behalf of their children. The most common finding before and after treatment was irritable behavior. While irritable behavior was observed in 82.4% (n = 56) of children before the treatment, this percentage was 63.2% (n = 43) after the treatment (p = 0.004). The percentage of children who developed at least one neuropsychiatric symptom after treatment was 22.1% (n = 15). There was no significant effect of age, gender, RCSS, TRACK, or allergy test positivity on the development of neuropsychiatric symptoms (p > 0.05). According to the results, at least one neuropsychiatric finding developed in approximately one in five children. Identifying risk factors will enable more careful treatment or consideration of alternative treatments for children at higher risk in the clinical follow-up period.
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Affiliation(s)
- Uğur Altaş
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ümraniye Training and Research Hospital, Ümraniye, 34764 Istanbul, Türkiye;
| | - Zeynep Meva Altaş
- Ümraniye District Health Directorate, Ümraniye, 34764 Istanbul, Türkiye;
| | - Fırat Öz
- Department of Child and Adolescent Psychiatry, Siirt Training and Research Hospital, 56000 Siirt, Türkiye;
| | - Mehmet Yaşar Özkars
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ümraniye Training and Research Hospital, Ümraniye, 34764 Istanbul, Türkiye;
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Abstract
INTRODUCTION The numerous links between allergic rhinitis and asthma have been extensively explored in the last two decades, gaining great concern within the scientific community. These two conditions frequently coexist in the same patient and share numerous pathogenetic and pathophysiological mechanisms. AREAS COVERED We reviewed major pathophysiological, epidemiological, and clinical links between allergic rhinitis and asthma. We also provided a comprehensive discussion of allergic rhinitis treatment according to current guidelines, with a particular focus on the relevance of allergic rhinitis therapies in patients with comorbid asthma. EXPERT OPINION We believe that there are several unmet needs for our patients, however, there are promising advances forecasted for the future. Although allergic rhinitis is a recognized risk factor for asthma, a proper asthma detection and prevention plan in allergic rhinitis patients is not available. Allergen immunotherapy (AIT) represents a promising preventive strategy and may deserve an earlier positioning in allergic rhinitis management. A multidisciplinary approach should characterize the journey of patients with respiratory allergies, with an adequate referral to specialized Allergy/Asthma centers. Molecular Allergy Diagnosis may provide support for optimal AIT use. Finally, a possible evolution of biological treatment can be envisaged, mainly if biosimilars decrease such therapies' costs.
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Tiotiu A, Novakova P, Guillermo G, Correira de Sousa J, Braido F. Management of adult asthma and chronic rhinitis as one airway disease. Expert Rev Respir Med 2021; 15:1135-1147. [PMID: 34030569 DOI: 10.1080/17476348.2021.1932470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Chronic rhinitis is defined as nasal inflammation with the presence of minimum two symptoms such as nasal obstruction, rhinorrhea, sneezing and/or itching one hour daily for a minimum of 12 weeks/year. According their etiology, four groups of rhinitis are described: allergic, infectious, non-allergic non-infectious and mixed.Chronic rhinitis is frequently associated with asthma, shares similar mechanisms of the pathogenesis and has a negative impact of its outcomes sustaining the concept of unified airways disease.Areas covered: The present review summarizes the complex relationship between chronic rhinitis and asthma on the basis of recent epidemiological data, clinical characteristics, diagnosis and therapeutic management. All four groups are discussed with the impact of their specific treatment on asthma outcomes. Some medications are common for chronic rhinitis and asthma while others are more specific but able to treat the associated comorbidity.Expert opinion: The systematic assessment of chronic rhinitis in patients with asthma and its specific treatment improves both disease outcomes. Conversely, several therapies of asthma demonstrated beneficial effects on chronic rhinitis. Treating both diseases at the same time by only one medication is an interesting option to explore in the future in order to limit drugs administration, related costs and side effects.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, France; 9 Rue Du Morvan, Vandoeuvre-lès-Nancy, France.,Development, Adaptation and Disadvantage. Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, - Vandoeuvre-lès-Nancy, France
| | - Plamena Novakova
- ;department of Allergology, Medical University of Sofia, University Hospital "Alexandrovska"; 1, Sofia, Bulgaria
| | - Guidos Guillermo
- Department of Immunology, School of Medicine, Instituto Politecnico Nacional, Gustavo A. Madero, Ciudad De México, CDMX, Mexico
| | - Jaime Correira de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Campus De, Braga, Portugal
| | - Fulvio Braido
- Allergy and Respiratory Diseases Department, University of Genoa, Genova GE, Italy
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Peerzada MN, Hamel E, Bai R, Supuran CT, Azam A. Deciphering the key heterocyclic scaffolds in targeting microtubules, kinases and carbonic anhydrases for cancer drug development. Pharmacol Ther 2021; 225:107860. [PMID: 33895188 DOI: 10.1016/j.pharmthera.2021.107860] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022]
Abstract
Heterocyclic scaffolds are widely utilized for drug design by taking into account the molecular structure of therapeutic targets that are related to a broad spectrum of ailments, including tumors. Such compounds display various covalent and non-covalent interactions with the specific residues of the target proteins while causing their inhibition. There is a substantial number of heterocyclic compounds approved for cancer treatment, and these compounds function by interacting with different therapeutic targets involved in tumorogenesis. In this review, we trace and emphasize the privileged heterocyclic pharmacophores that have immense potency against several essential chemotherapeutic tumor targets: microtubules, kinases and carbonic anhydrases. Potent compounds currently undergoing pre-clinical and clinical studies have also been assessed for ascertaining the effective class of chemical scaffolds that have significant therapeutic potential against multiple malignancies. In addition, we also describe briefly the role of heterocyclic compounds in various chemotherapy regimens. The optimized molecular hybridization of delineated motifs may result in the discovery of more active anticancer therapeutics and circumvent the development of resistance by specific targets in the future.
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Affiliation(s)
- Mudasir Nabi Peerzada
- Medicinal Chemistry Research Laboratory, Department of Chemistry, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Ernest Hamel
- Molecular Pharmacology Branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, Frederick National Laboratory for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD 21702, USA
| | - Ruoli Bai
- Molecular Pharmacology Branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, Frederick National Laboratory for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD 21702, USA
| | - Claudiu T Supuran
- Department of NEUROFARBA, Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, Polo Scientifico, Via U. Schiff 6, 50019 Sesto Fiorentino, Florence, Italy.
| | - Amir Azam
- Medicinal Chemistry Research Laboratory, Department of Chemistry, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India.
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Antihistamine Therapy: Levocetirizine in the Practice of a Family Doctor. Fam Med 2019. [DOI: 10.30841/2307-5112.2.2019.174631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tiotiu A, Plavec D, Novakova S, Mihaicuta S, Novakova P, Labor M, Bikov A. Current opinions for the management of asthma associated with ear, nose and throat comorbidities. Eur Respir Rev 2018; 27:27/150/180056. [PMID: 30463872 DOI: 10.1183/16000617.0056-2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.
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Affiliation(s)
- Angelica Tiotiu
- Pulmonology Dept, University Hospital, Nancy, France .,EA 3450 DevAH, Development, Adaptation, Cardio-Respiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | | | - Silviya Novakova
- Allergy Unit, University Hospital "St. George", Plovdiv, Bulgaria
| | | | - Plamena Novakova
- Dept of Allergology and Asthma, Aleksandrovska Hospital, Sofia, Bulgaria
| | - Marina Labor
- Pulmonology Dept, University Hospital Centre Osijek, Osijek, Croatia
| | - Andras Bikov
- NIHR Clinical Research Facility, Manchester University NHS Foundation Trust, Manchester, UK
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Ai J, Xie Z, Qing X, Li W, Liu H, Wang T, Tan G. Clinical Effect of Endoscopic Vidian Neurectomy on Bronchial Asthma Outcomes in Patients with Coexisting Refractory Allergic Rhinitis and Asthma. Am J Rhinol Allergy 2018; 32:139-146. [PMID: 29649887 DOI: 10.1177/1945892418764964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The prevalence of both allergic rhinitis and bronchial asthma is high throughout the world; their mutual influence on each other has been documented in many studies. However, studies regarding surgical intervention are limited. Objective To evaluate the clinical significance of endoscopic vidian neurectomy on bronchial asthma outcomes in patients with coexisting refractory allergic rhinitis and asthma. Methods A total of 109 patients with moderate to severe persistent intractable allergic rhinitis and mild/moderate asthma were allocated to the bilateral endoscopic vidian neurectomy group (group 1) or conservative medication group (group 2) according to the patients' self-selection. The Rhinoconjunctivitis Quality of Life Questionnaire, Visual Analog Scale, Asthma Quality of Life Questionnaire, Total Asthma Symptom Score, and medication scores were evaluated at six months, one year, and three years after undergoing the initial treatments. Multivariate analysis was performed to determine which triggers of asthma attacks were associated with improved asthma outcomes in patients. Results Ninety-five patients were followed up for at least three years. Postoperative scores of Rhinoconjunctivitis Quality of Life Questionnaire and Visual Analog Scale were significantly lower than preoperative scores during follow-up in group 1 and were significantly lower than those of group 2. Postoperative scores of Asthma Quality of Life Questionnaire at the three follow-up time points were higher than the preoperative scores in group 1. The Total Asthma Symptom Score was not significantly decreased in group 1. The medication scores for allergic rhinitis and asthma were gradually reduced after surgery. At the end of the follow-up, the improvement rates for allergic rhinitis and asthma were 90.6% and 45.3%, respectively. Asthma outcomes were significantly improved by controlling rhinitis symptoms in patients whose asthma attacks were induced by "rhinitis onset" or "weather change." Conclusion Controlling allergic rhinitis symptoms by bilateral endoscopic vidian neurectomy can significantly improve asthma outcomes in patients whose asthma attacks are induced by rhinitis onset and/or cold air.
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Affiliation(s)
- Jingang Ai
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zuozhong Xie
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Qing
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Li
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Honghui Liu
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China.,2 Allergy Clinic, Third Xiangya Hospital, Central South University, Changsha, China
| | - Tiansheng Wang
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China.,2 Allergy Clinic, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guolin Tan
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Drugs 2017; 77:175-186. [DOI: 10.1007/s40265-016-0682-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simultaneous High Performance Liquid Chromatography Assay of Pentoxifylline, Bupivacaine HCl, Levocetirizine HCl, Tranilast, and Fluticasone Propionate in Humco™ Sanare Advanced Scar Base. SEPARATIONS 2016. [DOI: 10.3390/separations3020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Klimek L, Mullol J, Hellings P, Gevaert P, Mösges R, Fokkens W. Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. Expert Opin Pharmacother 2016; 17:657-69. [PMID: 26800187 DOI: 10.1517/14656566.2016.1145661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) has a major negative impact on patients' quality of life (QoL) and carries a high socio economic burden. This is particularly the case for patients who experience symptoms for extended periods of time (i.e. those with perennial (PAR) or persistent AR (PER), depending on the classification system used). This review covers available pharmacological advances and recent developments in the treatment of PAR or PER. AREAS COVERED Pharmacological AR treatment is used to reduce symptom burden and help restore patients' normal daily routine. Traditionally, non-sedating antihistamines and intranasal corticosteroids (INS) were the two drug classes recommended for use first line. These, along with antileukotrienes, decongestants, mast cell stabilizers and anticholinergics, constituted the bulk of the AR treatment arsenal. MP-AzeFlu (Dymista®, Meda, Solna, Sweden) is the most recent addition to that arsenal. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray and has surpassed available therapies in terms of symptom control and treatment response. Other relatively new treatments for PAR or PER include H3 antihistamines, toll-like receptor (TLR) agonists, cellulose powders and micro-emulsions, novel biomolecular formulations and omalizumab. Each of these new additions is reviewed here. EXPERT OPINION A new AR drug class has recently been introduced (i.e. RO1AD58). Currently MP-AzeFlu is the only treatment option within this drug class. It can be estimated that combination treatments like MP-AzeFlu will become the mainstay of PAR and PER therapy since use will result in better compliance, improved efficacy over INS and a faster response together with good levels of tolerability. The challenge is to find other equally, or more effective, combination treatments, as has been the therapeutic standard in bronchial asthma for decades. The potential of biologics, as well as TLR-agonists and other new treatment options needs to be further evaluated.
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Affiliation(s)
- Ludger Klimek
- a Center for Rhinology and Allergology , Wiesbaden , Germany
| | - Joaquim Mullol
- b Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; Rhinology and Smell Clinic, ENT Department , Hospital Clínic , Barcelona , Spain
| | - Peter Hellings
- c Laboratory of Clinical Immunology , University Hospitals Leuven , Leuven , Belgium
| | - Philippe Gevaert
- d Upper Airways Research Laboratory, Department of Otorhinolaryngology , Ghent University Hospital , Ghent , Belgium
| | - Ralph Mösges
- e Institute of Medical Statistics , Informatics and Epidemiology (IMSIE) , Cologne , Germany
| | - Wytske Fokkens
- f Department of Otorhinolaryngology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
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Abstract
PURPOSE OF REVIEW Allergic rhinitis due its high prevalence and burden needs to be properly treated. The disease's clinical features impose well tolerated drugs usable for long-term treatment. Nowadays, second-generation antihistamines and inhaled steroids represent the milestone of rhinitis therapy. The aim of the present review is to provide an update on allergic rhinitis treatment. A particular attention has been deserved to clinical trials, published in the last year that assess the efficacy and safety of new formulation of available drugs or new molecules. RECENT FINDINGS Available and new drugs under investigation seem able to control rhinitis symptoms without a significant patient's burden. The challenge for the next years will be to improve treatment adherence rather than to introduce new drugs. SUMMARY Allergic Rhinitis and its Impact on Asthma guidelines have brought attention to allergic rhinitis and its impact on asthma, but have also proposed a new classification in terms of symptoms severity and persistence useful for tailoring treatment on patients' phenotypes. Their further dissemination is needed; furthermore, they represent a cornerstone for the scientific community through a continuous update on relevant issues such as rhinitis phenotypes, disease management on the basis of new treatments, clinical trials transferability in real life, and allergic rhinitis management in public health programs.
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Braido F, Baiardini I, Stagi E, Scichilone N, Rossi O, Lombardi C, Ridolo E, Gani F, Balestracci S, Girbino G, Senna GE, Bordo A, Church MK, Canonica GW. RhinAsthma patient perspective: a short daily asthma and rhinitis QoL assessment. Allergy 2012; 67:1443-50. [PMID: 22978345 DOI: 10.1111/all.12014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 01/30/2023]
Abstract
BACKGROUND The present study aimed to develop a short validated patient-completed questionnaire, the RhinAsthma Patient Perspective (RAPP), to assess the health-related quality of life (HRQoL) in patients with asthma and comorbid allergic rhinitis in clinical practice. METHODS A provisional RAPP questionnaire was formed from candidate items identified through retrospective analysis of 333 RHINASTHMA questionnaires. This was then tested on 150 asthma patients with allergic rhinitis. RESULTS Psychometric analyses identified eight items fitting a unidimensional model to form RAPP. Internal consistency (Cronbach's alpha coefficient > 0.8) and agreement with RHINASTHMA (r = -0.31, P = 0.0001) were excellent. Criterion, discriminant, and convergent validity were good. Reliability in 47 stable patients was very good (intra-class and concordance correlation coefficients were 0.90 and 0.89, respectively). Responsiveness in 103 patients with health improvement or deterioration was significantly associated with changes in Global Rating Scale (r = -0.4965, P < 0.01), Rhinitis Visual Analogue Scale (r = 0.5722, P < 0.01) and asthma control test (r = -0.6483, P < 0.01). Minimal clinical difference in the analyzed population was 2. CONCLUSION RhinAsthma Patient Perspective is a simple eight-question questionnaire with good measurement properties and sensitivity to health changes, which will provide a valid, reliable and standardized HRQoL measurement in patients with asthma and comorbid allergic rhinitis in clinical practice.
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Affiliation(s)
- F. Braido
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - I. Baiardini
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - E. Stagi
- Epidemiology, Biostatistics and Clinical trials; National Cancer Research Institute; Genoa; Italy
| | - N. Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica; University of Palermo; ‘Villa Sofia-Cervello’ Hospital; Palermo; Italy
| | - O. Rossi
- Operative Immunoallergy Unit; A.O.U. Careggi; Florence; Italy
| | - C. Lombardi
- Pneumoallergology Unit; S. Orsola FBF Hospital; Brescia; Italy
| | - E. Ridolo
- Clinical Sciences; University of Parma; Parma; Italy
| | - F. Gani
- Allergy Unit; Respiratory Diseases Division; A.O.U. San Luigi; Torino; Italy
| | - S. Balestracci
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - G. Girbino
- Respiratory Department; University Hospital; Messina; Italy
| | - G. E. Senna
- Allergy Service; Verona Major Hospital; Verona; Italy
| | - A. Bordo
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy Centre Charité; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | - G. W. Canonica
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
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Bautista AP, Eisenlohr CP, Lanz MJ. Nasal nitric oxide and nasal eosinophils decrease with levocetirizine in subjects with perennial allergic rhinitis. Am J Rhinol Allergy 2012; 25:383-7. [PMID: 22185740 DOI: 10.2500/ajra.2011.25.3668] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic rhinitis is commonly treated with antihistamines. Monitoring improvement of airway inflammation noninvasively using nasal nitric oxide (nNO) would be clinically useful. To determine the anti-inflammatory effect of oral levocetirizine dihydrochloride (LC), we measured nNO and nasal eosinophils (nEos) in perennial allergic rhinitis (PAR) subjects. METHODS A randomized double-blind placebo-controlled crossover design was used. Inclusion criteria consisted of subjects having a PAR history, exam and diary scores consistent with active symptoms, and positive skin testing. Subjects taking allergy medications 1 month before the study were not enrolled. After consenting, 31 subjects (24 female subjects; mean age, 29 years) were randomized to either oral LC (5 mg) or matching placebo for 2 weeks. After 2 week washout, subjects started the other 2-week treatment. At each visit, nNO was measured by aspiration at each nare using a nasal kit from NIOX (Aerocrine, Sweden) in parts per billion; nEos was collected from nasal smears and measured by microscopy using the scoring system (0-4+) and symptoms were self-reported using the allergic Rhinitis Quality of Life Questionnaire (RQLQ). Daily allergy symptom scores (total symptom score [TSS] 4) were collected at each visit. RESULTS During LC, mean baseline nNO was 807 ± 317 parts per billion (ppb; left) and 831 ± 332 ppb (right) and decreased significantly to 688 ± 266 ppb and 702 ± 286 ppb, respectively (p < 0.05). No significance was found during placebo treatment (778 ± 270 ppb, 808 ± 299 ppb to 802 ± 271 ppb, 813 ± 273 ppb). The mean nNO change was also significant compared with placebo (-125 ppb versus +14 ppb; p < 0.05). There was a significant decrease in nEos with LC compared with placebo (3.1-2.5 versus 2.9-2.6; p < 0.05). RQLQ scores were significantly improved with LC only. In TSS-4 scoring, a trend toward improvement during LC and significant worsening during placebo was found. Baseline nNO predicted changes in nasal eosinophils (nEos) and RQLQ. CONCLUSION We showed that oral LC therapy decreased objective markers of rhinitis inflammation, nNO and nEos, in patients with PAR. Improvement in symptom scoring was also found with LC treatment.
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Affiliation(s)
- Angela P Bautista
- Department of Allergy, Asthma, and Rhinosinusitis, AAADRS Clinical Research Center, Coral Gables, Florida 33134, USA
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Ciprandi G, Caimmi D, Miraglia Del Giudice M, La Rosa M, Salpietro C, Marseglia GL. Recent developments in United airways disease. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:171-7. [PMID: 22754709 PMCID: PMC3378922 DOI: 10.4168/aair.2012.4.4.171] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/15/2011] [Indexed: 12/25/2022]
Abstract
The nose and lung are both part of the respiratory tract. Often the diseases affecting the nose and/or the bronchi are treated separately. However, in recent years, numerous studies have highlighted the fact that the respiratory system is a single entity and the concept of "united airway disease" has become more and more important. The unity of the respiratory tract is confirmed both from a morphological and from a functional point of view. Nevertheless, this concept is also confirmed for the respiratory immune system, innervation and vascularization interesting all along the tract, from the nose to the bronchioles. When treating rhinitis, it is often necessary to assess the presence of asthma. Patients with sinusitis should be evaluated for a possible concomitant asthma. Conversely, patients with asthma should always be evaluated for possible nasal disease. The medications that treat nasal diseases appear to be useful in improving control of asthma and in reducing bronchial hyperresponsiveness as well. Physicians should always keep these notions in mind, and evaluate and treat respiratory diseases taking into account the unity of the respiratory tract.
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Ciebiada M, Gorska-Ciebiada M, Barylski M, Kmiecik T, Gorski P. Use of montelukast alone or in combination with desloratadine or levocetirizine in patients with persistent allergic rhinitis. Am J Rhinol Allergy 2011; 25:e1-6. [PMID: 21711959 DOI: 10.2500/ajra.2011.25.3540] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND We assessed the course of treatment in patients with persistent allergic rhinitis (AR) treated with montelukast, levocetirizine, or desloratadine alone or combinations of antihistamine and montelukast. METHODS A 32-week randomized, double-blind, placebo-controlled, crossover, double-armed study in 40 adult patients with history of persistent AR, clinical allergy to house-dust mites, and a total nasal symptom score of at least 5 (congestion of at least 2) has been performed. Patients with asthma, chronic obstructive pulmonary disease, nonallergic rhinitis with clinical allergy associated with seasonal allergens, and other serious diseases were excluded. There were four 6-week treatment periods separated by 2-week washout periods. Twenty patients received either montelukast or antihistamine, a combination of montelukast and antihistamine, or placebo. The sequence of treatment was randomly assigned. Nasal symptoms were assessed using a 4-point scale at baseline, daily during the 1st week and on days 14, 21, 28, 35, and 42 of treatment. RESULTS Montelukast alone, levocetirizine alone, desloratadine alone, and the montelukast/antihistamine combinations significantly improved nasal symptoms during the first 24 hours. Improvement gradually increased during the 6 weeks of treatment, especially in patients receiving montelukast alone or in combination therapy with the antihistamine in both arms. Improvement at 42 days of treatment was significantly greater than that achieved on the 1st day of therapy in patients treated with the combination of montelukast and levocetirizine. CONCLUSION Montelukast alone or in combination with antihistamines gave a gradual increase in nasal symptom improvement within 6 weeks of treatment in patients with persistent AR.
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Affiliation(s)
- Maciej Ciebiada
- Department of Pneumology and Allergy, Medical University of Lodz, Poland.
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Bachert C, Maspero J. Efficacy of Second-Generation Antihistamines in Patients with Allergic Rhinitis and Comorbid Asthma. J Asthma 2011; 48:965-73. [DOI: 10.3109/02770903.2011.616616] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Baiardini I, Braido F, Ferraioli G, Menoni S, Bruzzone M, Conte ME, Gani F, Ridolo E, Scordamaglia A, Canonica GW. Pitfalls in respiratory allergy management: alexithymia and its impact on patient-reported outcomes. J Asthma 2010; 48:25-32. [PMID: 21121763 DOI: 10.3109/02770903.2010.535883] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Alexithymia is a personality trait characterized by a limited ability to identify and express emotions and it represents a possible risk factor for disease development and management. The objective of the study is to evaluate alexithymia in patients with persistent asthma and comorbid rhinitis and its relation with patient-reported outcomes (PROs). METHODS Alexithymia, quality of life, illness perception, and stress were assessed, as well as rhinitis symptoms and asthma control in out-patients classified according to GINA and ARIA guidelines. RESULTS Out of 115 patients, 19% turned out to be alexithymic (TAS-20 ≥ 61). Concerning alexithymia level, no difference was detected between males and females (χ(2) = 0.317) and among GINA levels (χ(2) = 0.22). Alexithymics had significantly lower Asthma Control Test scores when compared with non-alexithymics (15.86 vs. 19; p = .02). Alexithymics had a worse quality of life (p< .001) and, concerning illness perception, they ascribed to respiratory allergy symptoms that are not strictly disease related and referred to asthma and rhinitis more serious negative consequences (p < .001) and emotional representations (p < .035). Moreover, they had lower illness coherence (p < .001) and lived their disease as a cyclical rather than a chronic disorder (p < .035). As regards stress, alexithymics reported less energy (p < .001), higher levels of tension (p < .001), depression (p < .001), confusion (p > .001), and inertia (p < .001). CONCLUSION Alexithymia is present in a relevant percentage of subjects and, as it can modulate illness perception, quality of life, and stress, it should be considered in disease management.
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Affiliation(s)
- Ilaria Baiardini
- Allergy and Respiratory Disease Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy.
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Compalati E, Ridolo E, Passalacqua G, Braido F, Villa E, Canonica GW. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol 2010; 6:413-23. [PMID: 20441427 DOI: 10.1586/eci.10.15] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rhinitis and asthma are often associated and the two disorders interact at various levels. Rhinitis typically precedes the development of asthma and can contribute to unsatisfactory asthma control. The presence and type of asthma is influenced by sensitization, and the duration and severity of allergic rhinitis. Nasal symptoms, airflow and markers of inflammation directly correlate with lower airway involvement. Local tissue factors, such as microbial stimuli and systemic inflammatory mechanisms, play a role in the clinical expression of the allergic airway syndrome. There is increasing evidence that suggests a major involvement of airway epithelial cells in the pathogenesis of both asthma and allergic rhinitis. Even in patients with rhinitis who do not have asthma, subclinical changes in the lower airways and inflammatory mediators can be detected. The pathogenic role of paranasal sinus infections in respiratory allergy has been better elucidated but there remains a need for further research. Treatment of established rhinitis may affect asthma control and could have some impact on airway obstruction, but a direct effect of rhinitis therapy on lower airway inflammation remains to be clearly established.
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Affiliation(s)
- Enrico Compalati
- Allergy & Respiratory Diseases Clinic, Dept of Internal Medicine, University of Genova, Italy.
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Walsh GM. The anti-inflammatory effects of levocetirizine--are they clinically relevant or just an interesting additional effect? Allergy Asthma Clin Immunol 2009; 5:14. [PMID: 20066054 PMCID: PMC2804563 DOI: 10.1186/1710-1492-5-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 12/17/2009] [Indexed: 12/11/2022] Open
Abstract
Levocetirizine, the R-enantiomer of cetirizine dihydrochloride has pharmacodynamically and pharmacokinetically favourable characteristics, including rapid onset of action, high bioavailability, high affinity for and occupancy of the H1-receptor, limited distribution, minimal hepatic metabolism together with minimal untoward effects. Several well conducted randomised clinical trials have demonstrated the effectiveness of levocetirizine for the treatment of allergic rhinitis and chronic idiopathic urticaria in adults and children. In addition to the treatment for the immediate short-term manifestations of allergic disease, there appears to be a growing trend for the use of levocetirizine as long-term therapy. In addition to its being a potent antihistamine, levocetirizine has several documented anti-inflammatory effects that are observed at clinically relevant concentrations that may enhance its therapeutic benefit. This review will consider the potential or otherwise of the reported anti-inflammatory effects of levocetirizine to enhance its effectiveness in the treatment of allergic disease.
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Affiliation(s)
- Garry M Walsh
- School of Medicine, University of Aberdeen, Aberdeen, UK.
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Canonica GW, Compalati E. Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies. Clin Exp Immunol 2009; 158:260-71. [PMID: 19765020 PMCID: PMC2792821 DOI: 10.1111/j.1365-2249.2009.04017.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2009] [Indexed: 12/21/2022] Open
Abstract
Patients with allergic rhinitis have traditionally been placed into 'seasonal' and 'perennial' categories, which do not account for the subclinical inflammatory state that exists in many patients. In subjects with seasonal and perennial allergic rhinitis, even subthreshold doses of allergen have been found to cause inflammatory cell infiltration in the nasal mucosa, including increases in expression of cellular adhesion molecules, nasal and conjunctival eosinophilia, and other markers of inflammation, which do not result in overt allergy symptoms. This state - which has been termed 'minimal persistent inflammation'- may contribute to hyperreactivity and increased susceptibility to development of clinical symptoms as well as common co-morbidities of allergic rhinitis, such as asthma. Treating overt allergy symptoms as well as this underlying inflammatory state requires agents that have well-established clinical efficacy, convenient administration, potent anti-inflammatory effects and proven long-term safety, so that long-term continuous administration is feasible. Of the three major classes of commonly used allergic rhinitis medications - intranasal corticosteroids, anti-histamines, and anti-leukotrienes - intranasal corticosteroids appear to represent the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.
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MESH Headings
- Administration, Intranasal
- Allergens/immunology
- Asthma/etiology
- Chronic Disease
- Glucocorticoids/therapeutic use
- Histamine H1 Antagonists/therapeutic use
- Humans
- Intercellular Adhesion Molecule-1/immunology
- Leukotriene Antagonists/therapeutic use
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
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Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases, Clinic Dipartmento di Medicina Interna e Specialita Mediche (DIMI), University of Genova, Genova, Italy.
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Scordamaglia F, Compalati E, Baiardini I, Scordamaglia A, Canonica GW. Levocetirizine in the treatment of allergic diseases. Expert Opin Pharmacother 2009; 10:2367-77. [PMID: 19663743 DOI: 10.1517/14656560903193086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Levocetirizine, the R-enantiomer of cetirizine dihydrochloride, is a new molecule with a potent and selective antihistamine activity. OBJECTIVE To investigate the evidence that levocetirizine is an effective therapy for allergic disease. METHODS Evaluation of published articles in English, or having an English abstract. RESULTS Clinical trials indicate that levocetirizine is safe and effective for the treatment of allergic rhinitis and chronic idiopathic urticaria. The compound shows a rapid onset of action, high bioavailability and affinity for the H1 receptor. Moreover, this molecule demonstrates many anti-inflammatory effects that enhance the clinical therapeutic benefit not only in short-term but also in long-term treatments, as reported in recent trials utilizing levocetirizine for several months. CONCLUSION Levocetirizine confirms its safe effective activity for treatment of allergic disease in both adults and children.
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Affiliation(s)
- Francesca Scordamaglia
- Genoa University, Department of Internal Medicine, Allergy and Respiratory Diseases, Genoa, Italy
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Abstract
Allergic rhinitis (AR) and asthma are disorders of the airway characterized by inflammation of the respiratory mucosa. The presence of one disorder increases the likelihood that the other will also occur. As they are mechanistically intertwined, one can exacerbate the other when both conditions are present. In addition, comorbid AR and asthma have an additive impact on patients' health-related quality of life. The Allergic Rhinitis and its Impact on Asthma (ARIA) recommendations suggest that asthma patients should be evaluated for AR, and all AR patients should undergo tests for asthma. They also suggest that ideally, a combined strategy should be used to treat the upper and lower airway diseases. While treatment for AR includes antihistamines, intranasal glucocorticosteroids, antileukotrienes, and specific immunotherapy, data suggest that these treatment approaches may also improve asthma outcomes. This article reviews current clinical approaches to the diagnosis and management of patients with comorbid AR and asthma.
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Lu S, Liu N, Dass SB, Reiss TF. A randomized study comparing the effect of loratadine added to montelukast with montelukast, loratadine, and beclomethasone monotherapies in patients with chronic asthma. J Asthma 2009; 46:465-9. [PMID: 19544166 DOI: 10.1080/02770900902846323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Loratadine added to montelukast has been suggested to improve endpoints of asthma. OBJECTIVE This study investigated the additive effects of concomitant montelukast and loratadine when compared with montelukast, loratadine, and inhaled beclomethasone monotherapies in asthma. Methods. Patients (N = 406) were 15 to 65 years of age with a forced expiratory volume in 1 second (FEV(1))-predicted of 50% to 85%, FEV(1) reversibility > or = 15%, and a minimal level of daytime symptoms and beta -agonist use. This three-part 2X2 crossover-study consisted of two double-blind 6-week treatment periods where patients were administered once daily oral montelukast 10 mg, loratadine 10 mg, montelukast 10 mg + loratadine 10 mg, or twice daily inhaled beclomethasone 200 mu g. A subsequent 48-week extension study compared montelukast + loratadine with beclomethasone. The primary endpoint was the percentage change from baseline in FEV(1). RESULTS Over 6 weeks of double-blind treatment, significant improvements (p < 0.05) in the primary endpoint of FEV(1) were seen for montelukast + loratadine versus loratadine (least-square mean percentage-point difference of 5.8%), beclomethasone versus montelukast + loratadine (2.35%), montelukast versus loratadine (5.94%), and beclomethasone versus montelukast (4.65%); a numerical improvement (p = 0.054) was seen for montelukast + loratadine versus montelukast (1.60%). Significant improvements for montelukast + loratadine versus montelukast were seen in some secondary endpoints (evening peak expiratory flow, nocturnal asthma symptom score, nocturnal awakenings, and asthma-specific quality of life) but not others. Significant improvements in most endpoints except daytime asthma symptoms score were seen for montelukast + loratadine versus loratadine. In the extension study, both montelukast + loratadine and beclomethasone improved several endpoints. All treatments were generally comparable in the percentage of patients with clinical and laboratory adverse experiences. CONCLUSION In this study, the addition of loratadine to montelukast produced a small numerical, but not statistically significant, improvement in FEV(1) and, in general, no consistent improvement in other asthma endpoints. No improvement of montelukast + loratadine versus beclomethasone was seen in any endpoint.
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Affiliation(s)
- Susan Lu
- Merck Research Laboratories, Rahway, New Jersey 07065, USA
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25
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Update on prescription and over-the-counter histamine inverse agonists in rhinitis therapy. Curr Allergy Asthma Rep 2009; 9:140-8. [PMID: 19210904 DOI: 10.1007/s11882-009-0021-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Allergic rhinitis (AR) is associated with histamine-mediated physiologic events. The currently used histamine antagonists are all inverse agonists that bind and inactivate histamine H1 receptors. Second-generation antihistamines are much more H1-receptor selective with less central nervous system penetration than first-generation agents. Antihistamines typically are more effective in seasonal than perennial AR and do not demonstrate significant relief of nasal congestion. The recent availability of some second-generation antihistamines as over-the-counter products clearly places them as the preferred first-line treatment for mild to moderate AR based on safety when compared with first-generation over-the-counter antihistamines. The remaining prescription-only second-generation antihistamines, fexofenadine, desloratadine, and levocetirizine, all have unique attributes. Antihistamines in oral, intranasal, or intraocular formulations will likely remain among the mainstays of allergy therapeutics.
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Canonica GW, Fumagalli F, Guerra L, Baiardini I, Compalati E, Rogkakou A, Massacane P, Gamalero C, Riccio AM, Scordamaglia A, Passalacqua G. Levocetirizine in persistent allergic rhinitis: continuous or on-demand use? A pilot study. Curr Med Res Opin 2008; 24:2829-39. [PMID: 18761784 DOI: 10.1185/03007990802395927] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Allergic rhinitis is a high-prevalence disease that affects quality of life (QOL), sleep quality and productivity of patients. According to the ARIA initiative, it is classified as intermittent and persistent, the latter being the most troublesome. METHODS The aim of this randomized, open-label, 6-month, pilot study was to determine whether levocetirizine 5 mg administered continuously once daily in the morning was better than levocetirizine 5 mg on-demand in symptomatic subjects with persistent allergic rhinitis. Total and individual symptom scores were recorded in a diary card throughout the study. QOL, quality of sleep, nasal cytology, rate of drug intake, and safety were also assessed at pre-defined time-points. RESULTS In all, adult patients (31 in each group) were enrolled, of whom 22 dropped out. Both treatment regimens considerably decreased the total and individual symptoms scores from baseline and achieved similar levels up to week 14. Continuous treatment was generally better than on-demand from week 15 onwards, reaching statistical significance from weeks 17 to 21 (from week 19 to 21 for nasal pruritus). Both regimens substantially improved QOL and sleep quality. Both treatments were well tolerated, although the on-demand group reported more adverse events. CONCLUSION The present open label study in 62 patients indicates that levocetirizine 5 mg reliably controls persistent rhinitis over a period of 6 months, and shows a trend to be more effective in controlling the symptoms of rhinitis, improving QOL and decreasing nasal inflammation, when administered as long-term continuous therapy rather than as on-demand therapy.
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Affiliation(s)
- Giorgio Walter Canonica
- University of Genoa, Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa, Italy.
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Abstract
Among the 'allergic' conditions involving the lung, asthma is the more frequent and the most extensively investigated, although asthma itself may be caused by different disorders. The triggering event in allergic subjects is the reaction allergen-specific immunoglobulin E (IgE) that activates mast cells and initiates a complex and redundant inflammatory process, where cells, cytokines and adhesion molecules are involved at different stages. In fact, mucosal eosinophilic inflammation is one of the distinctive features of asthma and the particular T helper type 2 (Th2) phenotype of allergic patients favours it. In general, the clinical severity of asthma correlates well with the degree of inflammation. None the less, other phenomena such as non-specific bronchial hyperresponsiveness and remodelling intervene in the pathophysiology of allergic asthma. These phenomena are only partially inflammation-related. In particular, the remodelling of the bronchial wall seems to start very early in life and also seems to be a distinctive histological feature of the asthmatic bronchus. The recent introduction of biological treatments (monoclonal antibodies) has allowed elucidation of some of the pathogenic features of allergic asthma.
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Affiliation(s)
- G Passalacqua
- Allergy and Respiratory Diseases, Department of Internatl Medicine, San Martino Hospital, Padigliano Maragliano, Italy.
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Baiardini I, Braido F, Tarantini F, Porcu A, Bonini S, Bousquet PJ, Zuberbier T, Demoly P, Canonica GW. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN review. Allergy 2008; 63:660-9. [PMID: 18445183 DOI: 10.1111/j.1398-9995.2008.01649.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Allergic diseases constitute a global health problem, as they have an increasing economic and social impact and, especially, they can deeply interfere with the patients' daily life, being a cause of physical and emotional discomfort. This is why the health-related quality-of-life (HRQoL) has become increasingly important in health care research; in fact, the assessment of the impact the disease and its treatment have on patients, provides a more comprehensive approach in outcome evaluation. Numerous validated questionnaires are available and many studies have been performed evaluating HRQoL in people affected by allergic rhinitis (AR), thus testifying a great interest in this topic. The aims of the present review are: to examine the scientific literature of the last 3 years dealing with the impact of AR treatments suggested by allergic rhinitis and its impact on asthma guidelines on patients' QoL, and to identify the unexplored or not-fully-investigated areas concerning this issue.
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Affiliation(s)
- I Baiardini
- Allergy & Respiratory Diseases, DIMI - University of Genoa, Genoa, Italy
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Walsh GM. A review of the role of levocetirizine as an effective therapy for allergic disease. Expert Opin Pharmacother 2008; 9:859-67. [PMID: 18345961 DOI: 10.1517/14656566.9.5.859] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Levocetirizine is the R-enantiomer of cetirizine dihydrochloride with pharmacodynamically and pharmacokinetically favourable characteristics. OBJECTIVE To review the evidence that levocetirizine is an effective therapy for allergic disease. METHODOLOGY Relevant articles in English or with English abstracts were identified from systematic PubMed searches. RESULTS Levocetirizine has high bioavailability, high affinity for and occupancy of the H1 receptor, rapid onset of action, limited distribution and minimal hepatic metabolism. Clinical trials indicate that it is safe and effective for the treatment of allergic rhinitis and chronic idiopathic urticaria in adults and children with a minimal number of untoward effects. It is also becoming clearer that, in addition to its being a potent antihistamine, levocetirizine has several anti-inflammatory effects that are observed at clinically relevant concentrations that may enhance its therapeutic benefit. Furthermore, there appears to be a growing trend for the use of levocetirizine as long-term therapy in addition to it being used as a treatment for the immediate short-term manifestations of allergic disease. CONCLUSION Levocetirizine is an effective and safe treatment for use in adults and children with allergic disease.
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Affiliation(s)
- Garry M Walsh
- University of Aberdeen, School of Medicine, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK.
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3002] [Impact Index Per Article: 187.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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Frossard N, Strolin-Benedetti M, Purohit A, Pauli G. Inhibition of allergen-induced wheal and flare reactions by levocetirizine and desloratadine. Br J Clin Pharmacol 2007; 65:172-9. [PMID: 17953719 DOI: 10.1111/j.1365-2125.2007.03009.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT The reproducible and standardized histamine-induced wheal and flare model helps identify the objective effectiveness of antihistamines in humans, as well as their differences in onset and duration of action. Some of the newest antihistamines have already been compared in a head-to-head setting using this model. However, their objective action at inhibiting the allergen-induced wheal and flare response has not been reported yet. WHAT THIS STUDY ADDS The time-response study presented here shows the objective activity of two of the newest generation of antihistamines, levocetirizine and desloratadine, at inhibiting the allergen-induced wheal and flare response in a randomized, cross over, placebo-controlled trial. This model is interesting to the clinical setting since allergic subjects are recruited, and the response to allergen involves mast cell degranulation and release of numerous vasoactive and pro-inflammatory mediators additionally to histamine. In addition, this study reports receptor occupancy for both antihistamines at therapeutic dosage, leading to analysis of potential differences in activity. This study clearly shows the potential anti-inflammatory properties of desloratadine and levocetirizine in their skin activity when allergen is the challenging agent as occurs in the clinical situation. AIMS To evaluate the inhibitory activity of the new-generation antihistamines levocetirizine and desloratadine at their therapeutic doses on the allergen-induced wheal and flare reaction at 1.5 h, 4 h, 7 h, 12 h and 24 h postdose, and to measure their plasma and skin concentrations. METHODS A double-blind, randomized, cross-over, placebo-controlled study in 18 allergic subjects was carried out. The time-response of the wheal and flare reaction areas under the curve (AUC) were compared by anova. RESULTS Both antihistamines significantly (P < 0.001) inhibited the allergen-induced wheal and flare reactions compared with placebo. Levocetirizine was significantly more potent than desloratadine. Mean +/- SEM wheal AUC(0-24 h) was 506.4 +/- 81.0 with levocetirizine and 995.5 +/- 81.0 mm(2) h with desloratadine as compared with placebo (1318.5 +/- 361.0 mm(2) h). Flare AUC(0-24 h) was 5927.3 +/- 1686.5 and 15838.2 +/- 1686.5 mm(2) h, respectively [P < 0.001 for both compared with placebo (22508.2 +/- 7437.1 mm(2) h)]. Levocetirizine showed significant inhibition of wheal and flare already at 1.5 h postdose compared with placebo (P <or= 0.001); desloratadine achieved a significant effect only after 4 h. The mean total plasma concentration at 12 h and 24 h after intake was higher for levocetirizine (58.1 +/- 13.4 and 20.0 +/- 8.1 ng ml(-1), respectively) as compared with desloratadine (0.82 +/- 0.24 and 0.45 +/- 0.16 ng ml(-1)). Similarly, higher mean unbound skin concentrations were observed for levocetirizine 24 h after intake (1.80 ng g(-1)) than for desloratadine (0.07 ng g(-1)). This was associated with greater receptor occupancy for levocetirizine (54%) than desloratadine (34%) at 24 h. CONCLUSIONS Levocetirizine suppressed the cutaneous allergic reactions with a higher potency than desloratadine, which correlated with its high receptor occupancy. Receptor occupancy rather than drug affinity or plasma half-life is more representative of antihistamine potency.
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Affiliation(s)
- Nelly Frossard
- Faculty of Pharmacy, University Louis Pasteur-Strasbourg I, Strasbourg, France.
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Bonini S, Gramiccioni C, Bonini M, Bresciani M. Practical approach to diagnosis and treatment of ocular allergy: a 1-year systematic review. Curr Opin Allergy Clin Immunol 2007; 7:446-9. [PMID: 17873587 DOI: 10.1097/aci.0b013e3282ef868b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW A 1-year systematic review in the field of ocular allergy was carried out to select new information which may be useful for a practical approach to allergic conjunctivitis. RECENT FINDINGS Out of the 56 articles listed by PubMed, 27 papers were included in the review following a consensus achieved among the authors who had independently reviewed all abstracts. Selected articles were classified according to their main focus: antihistamines, omalizumab, new treatments for vernal keratoconjunctivitis and inflammatory ocular disorders, and sublingual immunotherapy. SUMMARY The data reviewed are discussed with the aim of underlining unmet needs and making recommendations for future studies on diagnosis and treatment of ocular allergy which may better guide clinical practice in this important area of allergy and clinical immunology.
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MESH Headings
- Administration, Sublingual
- Anti-Allergic Agents/immunology
- Anti-Allergic Agents/therapeutic use
- Antibodies, Anti-Idiotypic
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/drug therapy
- Conjunctivitis, Allergic/immunology
- Conjunctivitis, Allergic/therapy
- Histamine H1 Antagonists/immunology
- Histamine H1 Antagonists/therapeutic use
- Humans
- Immunotherapy
- Keratoconjunctivitis/diagnosis
- Keratoconjunctivitis/drug therapy
- Keratoconjunctivitis/immunology
- Keratoconjunctivitis/therapy
- Omalizumab
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Braido F, Riccio AM, Guerra L, Gamalero C, Zolezzi A, Tarantini F, De Giovanni B, Folli C, Descalzi D, Canonica GW. Clara cell 16 protein in COPD sputum: A marker of small airways damage? Respir Med 2007; 101:2119-24. [PMID: 17624750 DOI: 10.1016/j.rmed.2007.05.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 05/18/2007] [Accepted: 05/20/2007] [Indexed: 12/14/2022]
Abstract
RATIONALE The development of chronic obstructive pulmonary disease (COPD) in smokers and their susceptibility to infections is not fully understood. Recent evidences suggest that Clara cells play a part in host defense, immunomodulatory response and airways remodelling through the production of specific factors such as Clara cell 16 (CC-16). This protein has never been related to patients' lung function tests, blood gases parameters and diseases severity. OBJECTIVES To evaluate a possible correlation between CC-16 expression in sputum, measured by a new methodological approach, and the degree of severity in patients with moderate and severe COPD. We also analyzed possible correlations between CC-16 and cytological sputum population, arterial blood gases and lung function. MAIN FINDINGS We analyzed 20 patients, mean age 72.95, classified on the basis of the global initiative for chronic obstructive lung disease guidelines (GOLD 2006). The samples were processed for cytological analysis and CC-16 levels were assessed by Western blot. We found lower levels of CC-16 in severe COPD compared to moderate ones (p<0.027). No statistically significant differences were found between CC-16 expression and sputum cellularity (except for macrophages), arterial blood gases, and spirometric parameters. Multiple linear regression analysis of CC-16 versus functional and cytological parameters showed no significance. CONCLUSIONS We found a significantly different expression of CC-16 in COPD patients, according to their stage of severity, as defined by the GOLD 2006 guidelines. Considering CC-16 properties in innate immunity, a possible link between protein expression, innate immune system, and COPD infectious exacerbations may be hypothesized but further investigation are needed.
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Affiliation(s)
- Fulvio Braido
- Allergy and Respiratory Diseases, Department of Internal Medicine, University of Genoa, Pad. Maragliano, Largo R. Benzi, 10 16132 Genova, Italy.
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Bibliography. Current world literature. Outcome measures. Curr Opin Allergy Clin Immunol 2007; 7:288-90. [PMID: 17489050 DOI: 10.1097/aci.0b013e3281fbd52a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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