Initial experience using propranolol as the sole treatment for infantile airway hemangiomas

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114-3914, USA.
International journal of pediatric otorhinolaryngology (Impact Factor: 1.19). 03/2010; 74(3):323-5. DOI: 10.1016/j.ijporl.2009.12.008
Source: PubMed


The objective of this study is to describe the initial use of propranolol as the sole treatment for focal infantile airway hemangiomas, and to report on available literature describing the use of propranolol for airway lesions. This retrospective case series was carried out at a tertiary pediatric medical center. We obtained the following results: two children demonstrated significant response to oral propranolol therapy and avoided not only invasive surgical procedures, but also long-term administration of oral corticosteroids. This is the first report of treating infantile airway hemangiomas with only propranolol without additional surgical intervention or corticosteroid use. Review of literature reveals initial case series with similar, successful results using propranolol as an adjuvant treatment along with other medications and surgical interventions. We conclude that the initial use of propranolol as the sole treatment for infantile airway hemangioma is promising. Literature review reveals that propranolol as the sole treatment for most head and neck hemangiomas shows significant promise based on early case reports. Further studies are needed to determine the long-term effectiveness, dosing strategies, and side effect profile of propranolol treatment for hemangiomas.

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    • "Recently, propranolol has been introduced as a novel modality for the treatment of proliferating haemangiomas (Buckmiller, 2009; Maturo and Hartnick, 2010; Zimmermann et al., 2010) and dental anxiety (Heaton et al., 2010). The response of infantile haemangiomas to propranolol reported in the New England Journal of Medicine by Leaute-Labreze et al. (2008) catapulted the use of this therapy to firstline status among physicians managing this disease (Siegfried et al., 2008). "
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    ABSTRACT: To prevent cardiovascular effects of peripherally administered propranolol, the aim of this study was to evaluate the spinal anesthetic effect of propranolol, a Na(±) channel blocker. After rats were injected with drugs intrathecally, the spinal anesthetic effect of propranolol was compared with that of lidocaine, which is known to produce local anesthesia. We also evaluated the effect of the addition of clonidine with propranolol on spinal anesthesia. Our results showed that propranolol produced a dose-dependent spinal blockade in motor, proprioception, and nociception. On a 50% effective dose (ED(50)) basis, the spinal anesthetic effect of propranolol in motor, proprioception, and nociception [1.16 (1.01-1.34), 1.10 (0.92-1.31), 1.05 (0.89-1.24)] was equal to lidocaine [1.03 (0.94-1.13), 0.95 (0.84-1.07), 0.87 (0.79-0.96)], respectively. On an equipotent basis (0.5, 1.0, 2.5 μmol), the sensory/nociceptive block duration caused by propranolol was longer than that caused by lidocaine (P≤0.01). Co-administration of propranolol (1.1 μmol) and clonidine (0.5 μmol) produced greater spinal anesthesia than propranolol (1.1 μmol) or clonidine (0.5 μmol) alone. These preclinical findings demonstrated that propranolol produces similar spinal anesthesia to lidocaine and that α(2)-adrenergic receptors also contribute to improve the quality and duration of the spinal anesthetic effect of propranolol. Propranolol with a more sensory-selective action over motor blockade elicited longer spinal blockade than did lidocaine.
    European journal of pharmacology 09/2011; 667(1-3):208-14. DOI:10.1016/j.ejphar.2011.06.009 · 2.53 Impact Factor
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    • "Rosbe et al. [25] 2010 3 Propranolol 1—2 Truong et al. [19] 2010 6 Propranolol 2 Truong et al. [26] 2010 1 Propranolol 2 Maturo and Hartnick [27] 2010 2 Propranolol 2 Blanchet et al. [17] 2010 3 Acebutolol 8 Canadas et al. [15] 2010 1 Propranolol 2 Leboulanger et al. [14] 2010 14 Propranolol + Acebutolol 2—3 would induce the release of pro-angiogenic factors (VEGF, bFGF, etc.) stimulating the proliferation of an endothelial cell clone and resulting in the formation of an IH. Betablockers appear to act by inhibiting the secretion of these factors, which stops pathological cell proliferation, and also induces forced apoptosis [5,11—13]. "
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    ABSTRACT: Infantile haemangioma (IH) is the most common tumour during early childhood. Although these benign lesions resolve spontaneously, up until recently laryngotracheal sites of IH required invasive management. The dramatic efficacy of β-blockers on IH has radically changed the prognosis. Surgery is now no longer indicated as first-line therapy, but should only be performed for difficult, refractory cases, or in the presence of absolute contraindications to β-blockers. Long-term steroid therapy is also no longer indicated. Propranolol can be used as first-line, single-agent therapy.
    European Annals of Otorhinolaryngology, Head and Neck Diseases 04/2011; 128(5):236-40. DOI:10.1016/j.anorl.2010.11.009 · 0.82 Impact Factor
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    ABSTRACT: Hemangiomas are benign tumors most commonly encountered in infancy and early childhood. While most of them regress spontaneously, some require treatment due to a significant proliferation, which may be complicated by ulceration, deformation aesthetic deformation or worse impairment vital. Among the treatments used corticosteroids is the standard treatment but its use in high doses expose to potential risks. In 2008, the discovery by "chance" of the effectiveness of propranolol in the management of hemangioma revolutionizes the first line treatment. Its mechanism of action is not yet well understood and establishment of such treatment should be done by a hospital paediatrician in the absence of any contraindications. This article proposes focus on effectiveness and tolerance of β-blockers used as treatment of infantile hemangiomas.
    Thérapie 05/2012; 67(3):257-65. DOI:10.2515/therapie/2012033 · 0.51 Impact Factor
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