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Allergic Rhinosinusitis
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Pharmacotherapy usually starts with a systemic or intranasal antihistamine, preferably a non-sedating one such as cetirazine or desloratadine. INCSs give very good symptom control. A spray is usually better tolerated than ‘drops’ and, while inevitably there is some systemic absorption, this is least with the low bioavailability preparations (e.g. mometasone and fluticasone). Leukotriene receptor antagonists tend to be reserved for more severe disease, and a short course of oral glucocorticoids may be considered for extreme exacerbation of symptoms, for example, if the child needs symptom control during school examinations. Despite the low bio-availability of modern INCSs, there is a concern regarding systemic absorption, and it is important to bear in mind that some INCSs can now be bought without prescription, so parents and children may ‘self-medicate’.
Risk factors – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
The evidence base to guide treatment decisions for smokers with asthma is limited because of their exclusion from many clinical trials. The overall assessment is that approved medications for nonsmokers with asthma are also effective for smokers with asthma. However, because of reduced corticosteroid sensitivity, it may be necessary to use higher doses of ICS in treating asthmatics who smoke. Montelukast, a leukotriene receptor antagonist is also effective in these patients. Low-dose theophylline and biologics, such as omalizumab, mepolizumab and dupilumab, may improve clinical outcomes in smokers with asthma, although never tested due to tobacco often is an exclusion criteria in RCT studies.
Allergic Rhinitis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
AR is the most prevalent allergic disease in children and may have significant effects on their quality of life. The treatment algorithm for children is broadly similar to that for adults. Avoidance measures then, if necessary, and an oral non-sedating antihistamine are the first-line therapies, but a trial of a leukotriene receptor antagonist may be considered in children who are already using an inhaled steroid for asthma, or if a topical steroid is not tolerated. Fluticasone (licensed from age 4 years) or mometasone (licensed from 6 years) have low systemic bioavailability and are the topical corticosteroids of choice.
Disease burden and treatment adherence among children and adolescent patients with asthma
Published in Journal of Asthma, 2022
Carlyne M. Averell, François Laliberté, Guillaume Germain, David J. Slade, Mei S. Duh, Joseph Spahn
The asthma cohort included 186,868 patients (112,689 children [aged 5–11 years] and 74,179 adolescents [aged 12–17 years]). Baseline characteristics are shown in Table 1 (additional information, Table 1, supplementary material). The mean age was 10.5 years and 40.4% of patients were female (children: 7.9 years and 37.8% were female; adolescents: 14.3 years and 44.3% were female). At baseline, 25.7% of patients used ICS (29.6% children; 19.7% adolescents), 8.8% used ICS/LABA (children: 6.4%; adolescents: 12.4%), 24.0% used OCS (defined as at least one dispensing of OCS during the baseline period; children: 26.6%; adolescents: 19.9%), 19.6% used leukotriene receptor antagonists (LTRA; children: 20.0%; adolescents: 19.0%), and 44.2% used short-acting beta2 agonists (SABA; children: 44.1%; adolescents: 44.4%).
Ragweed allergy immunotherapy tablet MK-3641 (Ragwitek®) for the treatment of allergic rhinitis
Published in Expert Review of Clinical Immunology, 2018
To assess the efficacy of medication approved in the United States for treatment of allergic rhinitis, a systematic review was conducted of randomized, controlled trials through November 2008[16]. A total of 54 articles, including more than 14,000 adults and 1,580 children with AR met the criteria for review. Of these, 29 included oral antihistamines (OAH), 7 included nasal antihistamines (INAH), and 17 included intranasal corticosteroids (INCS). Thirty-eight studies were conducted in patients with seasonal allergic rhinitis (SAR) compared with 12 studies in patients with perennial allergic rhinitis (PAR). The mean improvements from baseline in total nasal symptom score in the SAR studies were: INAHs −22.2%, OAHs −23.5%, INCSs −40.7%, and placebo −15%[15]. Another systematic review assessed the effectiveness of leukotriene receptor antagonists (LRAs) in allergic rhinitis[17]. Eleven studies on SAR were used in the analysis. LRAs reduced the mean daily rhinitis symptom scores 5% more than placebo compared to 7% for OAHs and 17% for INCSs.
Benralizumab for the add-on maintenance treatment of patients with severe asthma aged 12 years and older with an eosinophilic phenotype
Published in Expert Review of Clinical Pharmacology, 2018
Khalid Al Efraij, J. Mark FitzGerald
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by a history of respiratory symptoms (e.g. cough, wheezing, chest tightness, and shortness of breath) that vary over time and in intensity, together with variable expiratory airflow limitation [1]. Most patients with asthma have mild-to-moderate disease that can be well controlled with standard treatment, including inhaled corticosteroids (ICS), and if the disease is more symptomatic, the addition of a long-acting beta agonist (LABA). The addition of a leukotriene receptor antagonist or tiotropium bromide may also improve asthma control and reduce the risk of an exacerbation. Despite these therapies, 5–10% of patients with asthma remain refractory [2]. These patients contribute to approximately 50% of the economic costs associated with asthma due to hospital admissions, use of emergency services, and unscheduled physician visits [3].