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Zhang Y, Wang J, Zhang Q, Deng L, Miao S, Zhong G. Konjac-mulberry leaf compound powder alleviates OVA-induced allergic rhinitis in BALB/c mice. FOOD SCIENCE AND HUMAN WELLNESS 2023. [DOI: 10.1016/j.fshw.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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2
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Scadding GK, Smith PK, Blaiss M, Roberts G, Hellings PW, Gevaert P, Mc Donald M, Sih T, Halken S, Zieglmayer PU, Schmid-Grendelmeier P, Valovirta E, Pawankar R, Wahn U. Allergic Rhinitis in Childhood and the New EUFOREA Algorithm. FRONTIERS IN ALLERGY 2022; 2:706589. [PMID: 35387065 PMCID: PMC8974858 DOI: 10.3389/falgy.2021.706589] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022] Open
Abstract
Allergic rhinitis in childhood has been often missed, mistreated and misunderstood. It has significant comorbidities, adverse effects upon quality of life and educational performance and can progress to asthma or worsen control of existing asthma. Accurate diagnosis and effective treatment are important. The new EUFOREA algorithm provides a succinct but wide- ranging guide to management at all levels, based on previous guidelines with updated evidence and has been adjusted and approved by experts worldwide.
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Affiliation(s)
- Glenis Kathleen Scadding
- Ear, Nose and Throat Department, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.,Faculty of Medical Sciences, University College London, London, United Kingdom
| | | | - Michael Blaiss
- Department of Paediatrics, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Graham Roberts
- National Institute of Health Research Biomedical Research Centre, Southampton General Hospital, Southampton, United Kingdom.,The David Hide Asthma and Allergy Research Centre, Newport, United Kingdom.,Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Peter William Hellings
- Department of Microbiology and Immunology, Department of Otorhinolaryngology, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, Netherlands
| | - Philippe Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | | | - Tania Sih
- Medical School, University of São Paulo, São Paulo, Brazil
| | - Suzanne Halken
- Paediatric Allergy, University of Southern Denmark, Odense, Denmark
| | - Petra Ursula Zieglmayer
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Vienna Challenge Chamber, Vienna, Austria
| | - Peter Schmid-Grendelmeier
- Allergy Unit, Dermatology Department, University Hospital of Zurich, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Ulrich Wahn
- Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Charite-Berlin, Berlin, Germany
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Miligkos M, Dakoutrou M, Statha E, Theochari NA, Mavroeidi IA, Pankozidou Ι, Papaconstadopoulos I, Papadopoulos NG. Newer-generation antihistamines and the risk of adverse events in children: A systematic review. Pediatr Allergy Immunol 2021; 32:1533-1558. [PMID: 33894089 DOI: 10.1111/pai.13522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND H1-antihistamines (AHs) are widely used for the treatment of allergic diseases, being one of the most commonly prescribed classes of medications in pediatrics. Newer-generation AHs are associated with fewer adverse effects compared with first-generation AHs. However, their relative harms in the pediatric population still need scrutiny. METHODS We performed a systematic review of randomized controlled trials (RCTs), which included comparisons of safety parameters between an orally administered newer-generation AH and another AH (first- or second-generation), montelukast, or placebo in children aged ≤12 years. We searched MEDLINE and CENTRAL, independently extracted data on study population, interventions, adverse events (AEs), and treatment discontinuations, and assessed the methodologic quality of the included RCTs using the Cochrane's risk of bias tool. RESULTS Forty-five RCTs published between 1989 and 2017 met eligibility criteria. The majority of RCTs included school-aged children with allergic rhinitis and had a follow-up period of up to a month. Four RCTs reported serious AEs in patients receiving a newer-generation AH, but only two patients experienced a possibly drug-related serious AE. The occurrence of AEs, drug-related AEs, and treatment discontinuations due to AEs varied between RCTs. Most AEs reported were of mild intensity. Indirect evidence indicates that cetirizine is more sedating than the other newer-generation AHs. CONCLUSION Our findings confirm that newer-generation AHs have a favorable safety and tolerability profile. However, we could not draw firm conclusions regarding the comparative safety profile of the newer-generation AHs due to the paucity of head-to-head RCTs, variation in definitions and reporting of AEs, and short follow-up duration.
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Affiliation(s)
- Michael Miligkos
- Society of Junior Doctors, Athens, Greece.,First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dakoutrou
- Society of Junior Doctors, Athens, Greece.,First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - Irene Papaconstadopoulos
- Department of Pediatrics, Unterberg Children's Hospital at Monmouth Medical Center, Long Branch, NJ, USA
| | - Nikolaos G Papadopoulos
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
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Bertrand V, Massy N, Vegas N, Gras V, Chalouhi C, Tavolacci MP, Abadie V. Safety of Cyproheptadine, an Orexigenic Drug. Analysis of the French National Pharmacovigilance Data-Base and Systematic Review. Front Pediatr 2021; 9:712413. [PMID: 34676184 PMCID: PMC8525494 DOI: 10.3389/fped.2021.712413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: Cyproheptadine is a first-generation H1-antihistamine drug first that was distributed in the 1960s. While its orexigenic effect was observed early, cyproheptadine is not yet authorized for this indication in all countries today. There is an increasing medical interest and demand for the orexigenic effect of cyproheptadine, especially in children with poor appetite. As cyproheptadine might be evaluated in future clinical trials, we wanted to assess its safety profile. Methods: Using the French national pharmacovigilance database, we retrospectively analyzed all pediatric and adult reports of adverse effects of cyproheptadine recorded since its first distribution in France. Next, we performed a systematic review of the literature of cyproheptadine adverse effects. Results: Since 1985, 93 adverse effects were reported in the French pharmacovigilance database (adults 81.7%, children 18.3%); these were mainly neurological symptoms (n = 38, adults 71%, children 28.9%), and hepatic complications (n = 15, adults 86.7%, children 13.3%). In the literature, the most frequent adverse effect reported was drowsiness in adults or children, and five case reports noted liver complications in adults. We estimated the frequency of hepatic adverse effects at 0.27 to 1.4/1000, regardless of age. Conclusion: Cyproheptadine can be considered a safe drug. Mild neurological effects appear to be frequent, and hepatotoxicity is uncommon to rare. Randomized controlled trials are needed to evaluate the safety and efficacy of cyproheptadine before authorization for appetite stimulation, especially in young children as studies at this age are lacking. Possible hepatic complications should be monitored, as very rare cases of liver failure have been reported.
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Affiliation(s)
| | - Nathalie Massy
- Regional Center of Pharmacovigilance, Rouen University Hospital, Rouen, France
| | - Nancy Vegas
- General Pediatrics Unit, Necker University Hospital, Paris, France.,Refferal Center for Rare Disease ≪ Pierre Robin Sequence and Sucking and Swallowing Congenital Disorders ≫, Necker University Hospital, Paris, France
| | - Valérie Gras
- Regional Center of Pharmacovigilance, Amiens University Hospital, Amiens, France
| | - Christel Chalouhi
- General Pediatrics Unit, Necker University Hospital, Paris, France.,Refferal Center for Rare Disease ≪ Pierre Robin Sequence and Sucking and Swallowing Congenital Disorders ≫, Necker University Hospital, Paris, France
| | | | - Véronique Abadie
- General Pediatrics Unit, Necker University Hospital, Paris, France.,Refferal Center for Rare Disease ≪ Pierre Robin Sequence and Sucking and Swallowing Congenital Disorders ≫, Necker University Hospital, Paris, France.,Paris University, Paris, France
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Abstract
BACKGROUND The clinical benefit of newer antihistamines (AHs) versus other active treatments has not been assessed in pediatric patients with allergic rhinitis. METHODS A systematic literature search was performed in MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials from inception through August 2020. Randomized controlled trials (RCTs) comparing newer with older AHs, corticosteroids, or montelukast were included. The Cochrane Risk of Bias Tool was used for quality assessment. RESULTS Out of 10,656 citations, 16 RCTs (N = 1653) with a duration from 10 days to 3 months were included. When compared with older-generation AHs, the administration of newer AHs did not confer significant benefit and appeared less effective compared with intranasal corticosteroids. However, newer AHs were more potent in achieving symptom control compared with montelukast. Data regarding quality of life were generally missing. The incidence of adverse events was low in all treatment groups. The included RCTs were characterized by moderate risk of bias. CONCLUSIONS Newer AHs are effective in symptom control and well tolerated in the pediatric population. However, inadequate reporting, variation in outcome measures, and a paucity of sufficient randomized comparisons precluded us from quantifying the relative efficacy of newer AHs compared with other treatment options.
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Lin B, Cai B, Wang H. Honeysuckle extract relieves ovalbumin-induced allergic rhinitis by inhibiting AR-induced inflammation and autoimmunity. Biosci Rep 2019; 39:BSR20190673. [PMID: 31308153 PMCID: PMC6663992 DOI: 10.1042/bsr20190673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 02/05/2023] Open
Abstract
Honeysuckle has antiviral, antioxidative and anti-inflammatory properties. Allergic rhinitis (AR) is induced by immunoglobulin E (IgE)-mediated inflammatory reaction. Our study investigates whether honeysuckle extract (HE) has therapeutic effect on AR. An AR model of mice was established by ovalbumin (OVA). Hematoxylin-Eosin staining was used to assess nasal mucosa damage. Enzyme-linked immunosorbent assay (ELISA) was performed to determine serum histamine, IgE and interleukin (IL)-2, IL-4, IL-17 and interferon-γ (IFN-γ) from nasal lavage fluid. Western blot was carried out to analyze the protein level from nasal mucosa tissue. We found that HE not only decreased nasal rubbing and sneezing in AR mice, but also reduced AR-induced damage to nasal mucosa. Moreover, HE lowered the levels of serum IgE and histamine and inhibited IL-4 and IL-17 levels from AR mice but raised IL-2 and IFN-γ levels in AR-induced nasal lavage fluid. Our results also showed that HE elevated the protein levels of forkhead box P3 (Foxp3) and T-box transcription factor (T-bet) in AR-induced nasal mucosa tissue, whereas it inhibited signal transducer and activator of transcription (STAT) 3 and GATA binding protein 3 (GATA-3) protein levels. By regulating AR-induced inflammatory reaction and autoimmune response, HE also relieved OVA-induced AR. Thus, HE could be used as a potential drug to treat AR.
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Affiliation(s)
- Bin Lin
- ENT Department, Guangzhou Hospital of Integrated Traditional and West Medicine, No. 87 Yingbin Road, Huadu District, Guangzhou 510800, Guangdong Province, China
| | - Bijuan Cai
- ENT Department, Guangzhou Hospital of Integrated Traditional and West Medicine, No. 87 Yingbin Road, Huadu District, Guangzhou 510800, Guangdong Province, China
| | - Huige Wang
- ENT Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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7
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Histamine, histamine receptors, and anti-histamines in the context of allergic responses. LYMPHOSIGN JOURNAL 2019. [DOI: 10.14785/lymphosign-2018-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Histamine is a bioactive amine which is considered a key player in the allergic response. Thus, histamine receptor blockers (antihistamines) play an important role in the treatment of a number atopic diseases such as allergic rhinitis, conjunctivitis, and acute and chronic forms of urticaria. Histamine is produced by immune cells but also by bacteria in the gut. Beyond its role in the acute allergic response, histamine exerts numerous effects by binding to its 4 pleiotropic G-protein coupled histamine receptors. Here, we describe the roles of these histamine receptors and antihistamines in the human system, clinical applications, side effects, and novel concepts for the usage of antihistamines with different specificity based on guidelines and recommendations. Statement of novelty: This review provides an overview of histamine receptors and links it to clinical relevance of antagonizing their action in clinical routine.
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De Bruyne P, Christiaens T, Boussery K, Mehuys E, Van Winckel M. Are antihistamines effective in children? A review of the evidence. Arch Dis Child 2017; 102:56-60. [PMID: 27335428 DOI: 10.1136/archdischild-2015-310416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS During the last decades, much attention has been paid to off-label and unlicensed prescriptions in paediatrics. However, on-label prescribing can also cause health issues. In this paper, the case of first-generation H1-antihistamines is investigated, notably the range of indications for which products are licensed in different European countries and the evidence base (or lack thereof) for each indication, as well as reported adverse drug reactions. METHODS Review of the Summary of Product Characteristics of first-generation H1-antihistamines with a focus on paediatric use. This is plotted against the evidence available in the literature. RESULTS This investigation shows a large variability in labelled indications and licensing ages when compared in five different European countries. Moreover, most of the indications are not based on clinical trials evaluating efficacy and safety of these drugs in children. CONCLUSIONS Many of the licensed indications of first-generation antihistamines do not appear to be evidence based.
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Affiliation(s)
- Pauline De Bruyne
- Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thierry Christiaens
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Myriam Van Winckel
- Department of Paediatrics and Medical Genetics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Clinically relevant outcome measures for new pharmacotherapy, allergen avoidance and immunotherapy trials in allergic rhinoconjunctivitis. Curr Opin Allergy Clin Immunol 2016; 15:197-203. [PMID: 25899694 DOI: 10.1097/aci.0000000000000164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a current overview on both primary and secondary measures of efficacy of therapeutic interventions for clinical trials in allergic rhinoconjunctivitis (ARC) patients. In particular, this review highlights similarities and differences regarding endpoints in trials involving allergen immunotherapy (AIT), pharmacotherapy and allergen avoidance and addresses unmet needs regarding these measures in the future. RECENT FINDINGS In 2014, the European Academy of Allergy and Clinical Immunology (EAACI) proposed a standard for the definition of the primary endpoint for AIT trials in ARC and, moreover, emphasized the advantages and disadvantages as well as unmet needs considering outcome measures for this treatment. Recently, as an (indirect) comparison of clinical efficacy of different interventions, the relative clinical impact (RCI) has been used to determine the percentage reduction of symptom scores in active versus placebo treatment. SUMMARY Several primary and secondary clinical endpoints of therapeutic interventions for clinical trials in ARC patients such as AIT or pharmacotherapy have been proposed by the U.S. Food and Drug Administration (FDA) as well as by the European Medicines Agency (EMA). Moreover, recommendations for the implication of these endpoints in clinical trials have been promoted by academia such as the World Allergy Organization (WAO) or the European Academy of Allergy and Clinical Immunology (EAACI).However, an urgent need for the future will be a thorough international harmonization regarding the definition of clinical endpoints, timing of assessments of clinical efficacy and determination of the clinically meaningful and relevant magnitude of efficacy of therapeutic interventions for clinical trials in ARC patients.
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Caimmi D, Calderon MA, Bousquet J, Demoly P. Allergen Immunotherapy Outcomes and Unmet Needs. Immunol Allergy Clin North Am 2016; 36:181-9. [DOI: 10.1016/j.iac.2015.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Price D, Smith P, Hellings P, Papadopoulos N, Fokkens W, Muraro A, Murray R, Chisholm A, Demoly P, Scadding G, Mullol J, Lieberman P, Bachert C, Mösges R, Ryan D, Bousquet J. Current controversies and challenges in allergic rhinitis management. Expert Rev Clin Immunol 2015; 11:1205-17. [PMID: 26325631 DOI: 10.1586/1744666x.2015.1081814] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are many obstacles in the path of effective allergy management, in general, and allergic rhinitis (AR) control, in particular. Chief among them are: insufficient symptom relief in some patients provided by some currently considered first-line AR treatments in real life; an over-reliance on randomized controlled trials to direct AR guideline recommendations; the need for a broader interpretation of the AR evidence base (to include randomized controlled trials and real-life studies); poorly designed and interpreted studies; and lack of an AR control concept and common language of control. These controversies are fully reviewed here and challenging solutions have been presented.
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Affiliation(s)
- David Price
- a 1 Research in Real Life, Singapore, Singapore
| | - Pete Smith
- b 2 Department of Clinical Medicine, Griffith University, Southport, Australia
| | - Peter Hellings
- c 3 Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - Nikos Papadopoulos
- d 4 Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Wytske Fokkens
- e 5 Department of Otorhinolaryngology, Academic Medical Center (AMC) Amsterdam, Amsterdam, The Netherlands
| | - Antonella Muraro
- f 6 Food Allergy Referral Centre, Veneto Region, Department of Women and Child Health, Padua University Hospital, Padua, Italy
| | - Ruth Murray
- g 7 Medscript (Scientific & Medical Affairs), Dundalk, Ireland
| | | | - Pascal Demoly
- i 9 Department of Pulmonology - Division of Allergy, University Hospital of Montpellier, Hôpital Arnaud de Villeneuve, France
| | | | - Joaquim Mullol
- k 11 Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Catalonia, Spain
| | - Phil Lieberman
- l 12 University of Tennessee College of Medicine, Memphis, USA
| | - Claus Bachert
- m 13 Upper Airways Research Laboratory (URL), University Hospital Ghent, Ghent, Belgium
| | - Ralph Mösges
- n 14 Institute of Medical Statistics, Informatics, and Epidemiology, Medical Faculty, University of Köln, Cologne, Germany
| | - Dermot Ryan
- o 15 University of Edinburgh, Edinburgh, UK and Optimum Patient Care, Cambridge, UK
| | - Jean Bousquet
- p 16 University Hospital, Montpellier, France.,q 17 MACVIA-LR, Contre les Maladies Chronique spour un Vieillissement Actif en Languedoc Roussilon, European Innovation Partnership on Active and Healthy Ageing Reference Site, France.,r 18 INSERM, VIMA: Ageing and chronic diseases. Epidemiological and public health approaches, U1168, Paris, and UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
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12
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Abstract
The perception of pain in children is easily influenced by environmental factors and psychological comorbidities that are known to play an important role in its origin and response to therapy. Chronic abdominal pain is one of the most commonly treated conditions in modern pediatric gastroenterology and is the hallmark of 'functional' disorders that include irritable bowel syndrome, functional dyspepsia, and functional abdominal pain. The development of pharmacological therapies for these disorders in adults and children has been limited by the lack of understanding of the putative, pathophysiological mechanisms that underlie them. Peripheral and central pain-signaling mechanisms are known to be involved in chronic pain originating from the gastrointestinal tract, but few therapies have been developed to target specific pathways or enhance correction of the underlying pathophysiology. The responses to therapy have been variable, potentially reflecting the heterogeneity of the disorders for which they are used. Only a few small, randomized clinical trials have evaluated the benefit of pain medications for chronic abdominal pain in children and thus, the decision on the most appropriate treatment is often based on adult studies and empirical data. This review discusses the most common, non-narcotic pharmacological treatments for chronic abdominal pain in children and includes a thorough review of the literature to support or refute their use. Because of the dearth of pediatric studies, the focus is on pharmacological and alternative therapies where there is sufficient evidence of benefit in either adults or children with chronic abdominal pain.
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Affiliation(s)
- Adrian Miranda
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA,
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13
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Abstract
Because of its burden on patient's lives and its impact on asthma, allergic rhinitis must be treated properly with more effective and safer treatments. According to guidelines by Allergic Rhinitis and Its Impact on Asthma (ARIA), the classification, pathogenesis, and treatment of allergic rhinitis are well defined. Currently, second-generation antihistamines and inhaled steroids are considered the cornerstone of first-line therapy. However, new formulations of available drugs (e.g., loratadine and rupatadine oral solution, ebastine fast-dissolving tablets, and the combination of intranasal fluticasone propionate and azelastine hydrochloride), recently discovered molecules (e.g., ciclesonide, bilastine, and phosphodiesterase-4 inhibitors), immunologic targets (e.g., omalizumab), and unconventional treatments (e.g., homeopathic treatments) are currently under investigation and represent a new frontier in modern medicine and in allergic rhinitis management. The aim of this review is to provide an update on allergic rhinitis treatment, paying particular attention to clinical trials published within the past 20 months that assessed the efficacy and safety of new formulations of available drugs or new molecules.
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14
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Lee CL, Hsu SH, Jong YJ, Hung CH, Suen JL. Inhibition of histamine H1 receptor activity modulates proinflammatory cytokine production of dendritic cells through c-Rel activity. Int Arch Allergy Immunol 2012; 160:265-74. [PMID: 23075496 DOI: 10.1159/000341637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 07/06/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Histamine exerts diverse effects on immune regulation through four types of histamine receptors (HRs). Among them, type 1 receptor (H1R) plays an important role in allergic inflammation. Dendritic cells (DCs), which express at least three types of HRs, are professional antigen-presenting cells controlling the development of allergic inflammation. However, the molecular mechanisms involved in H1R-mediated NF-ĸB signaling of DCs remain poorly defined. METHODS Bone-marrow (BM)-derived DCs (BM-DCs) were treated with H1R inverse agonists to interrupt basal H1R-mediated signaling. The crosstalk of H1R-mediated signaling and the NF-ĸB pathway was examined by NF-ĸB cellular activity using a luciferase reporter assay, NF-ĸB subunit analysis using Western blotting and TNF-α promoter activity using chromatin immunoprecipitation. RESULTS Blockage of H1R signaling by inverse agonists significantly inhibited TNF-α and IL-6 production of BM-DCs. H1R-specific agonists were able to enhance TNF-α production, but this overexpression was significantly inhibited by NF-ĸB inhibitor. The H1R inverse agonist ketotifen also suppressed cellular NF-ĸB activity, suggesting crosstalk between H1R and NF-ĸB signaling in DCs. After comprehensive analysis of NF-ĸB subunits, c-Rel protein expression was significantly down-regulated in ketotifen-treated BM-DCs, which led to inhibition of the promoter activity of TNF-α. Finally, adoptive transfer of the ketotifen-treated BM-DCs did not induce significant allergic airway inflammation compared to that of control cells in vivo. CONCLUSIONS Our results suggest that c-Rel controls H1R-mediated proinflammatory cytokine production in DCs. This study provides a potential mechanism of H1R-mediated signaling and NF-ĸB pathway crosstalk in allergic inflammation.
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Affiliation(s)
- Chin-Lai Lee
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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