Abnormal spirometry in children with persistent allergic rhinitis due to mite sensitization: The benefit of nasal corticosteroids
ABSTRACT Inflammatory processes affecting nasal and bronchial mucosa are similar in nature. The purpose of this study was to examine whether children with perennial allergic rhinitis, without underlying asthma, have impaired pulmonary function. We also investigated whether nasal corticosteroids and loratidine would improve the pulmonary function tests of those children with impaired lung function. Fifty subjects with moderate/severe persistent allergic rhinitis due to exclusively dust mite sensitization and no past medical history suggestive of asthma were assessed. The control group consisted of 26 matched healthy subjects. Subjects with airway obstruction, as detected by forced expiratory volume/1 s (FEV1) or forced expiratory flow from 25/% to 75% (FEF(25-75)) values <80% of those predicted, were treated with loratidine, once a day for 10 days, and daily nasal budesonide for 3 months. We found that 11 of 50 patients (22%) with perennial allergic rhinitis had impaired pulmonary function (FEF(25-75) values <80%), compared to 1/26 (3.8%) of the control group (p < or = 0.05). Reversibility was observed in 9/11 (81.8%), mean 24.7% +/- 10.3%. Within 3 months of treatment, 7/10 had FEF(25-75) > 80% of their predicted values as well as significant improvements in their FEV1 (p = 0.04), and FEV1/FVC (p = 0.04). We conclude that a substantial proportion of children with perennial allergic rhinitis have diminished FEF (25-75) values and reversible airway obstruction. Nasal corticosteroids improve the pulmonary function tests of these children with impaired lung function.
SourceAvailable from: Erkka Valovirta
Article: Allergy and asthma prevention 2014[Show abstract] [Hide abstract]
ABSTRACT: Asthma and allergic diseases have become one of the epidemics of the 21st century in developed countries. Much of the success of other areas of Medicine, such as infectious diseases, lies on preventive measures. Thus, much effort is also being placed lately in the prevention of asthma and allergy. This manuscript reviews the current evidence, divided in four areas of activity. Interventions modifying environmental exposure to allergens have provided inconsistent results, with multifaceted interventions being more effective in the prevention of asthma. Regarding nutrition, the use of hydrolysed formulas in high risk infants reduces the incidence of atopic dermatitis, while there is for now not enough evidence to recommend other dietary modifications, prebiotics, probiotics, or other microbial products. Pharmacologic agents used until now for prevention have not proved useful, while there is hope that antiviral vaccines could be useful in the future. Allergen-specific immunotherapy is effective for the treatment of allergic patients with symptoms; the study of its value for primary and secondary prevention of asthma and allergy is in its very preliminary phases. The lack of success in the prevention of these disorders lies on their complexity, which involves many genetic, epigenetic and environmental interactions. There is a need to identify target populations, involved mechanisms and interactions, and the best interventions. These must be effective, feasible, implementable and affordable.This article is protected by copyright. All rights reserved.Pediatric Allergy and Immunology 09/2014; 25(6). DOI:10.1111/pai.12272 · 3.86 Impact Factor
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ABSTRACT: Subjects with allergic rhinitis (AR) suffer from impaired lung function, especially decreased FEF25-75% . The purpose of this study was to examine lung function and the long-term response to INCS in AR patients with impaired lung function, and to characterize the phenotype of these children. Two hundred two children with AR underwent an allergy evaluation including a skin prick test and spirometry. Children with impaired lung function were treated with daily nasal corticosteroids spray (INCS) and antihistamine as needed. Fifty-three children out of 202 (26.3%) had impaired lung function: 34 of them (64.2%) had FEF25-75% values under 80% of predicted and normal FEV1 values, and 19 individuals (35.8%), had both FEF25-75% and FEV1 values below 80% of predicted. A positive correlation between FEV1 and FEF25-75% values (r = 0.369, P = 0.007) and a reverse correlation between duration of nasal symptoms and FEF25-75% values (r = -0.364, P = 0.012) were found. Post-ronchodilation FEV1 levels increased from 81.9 ± 8.0 to 87.7 ± 10.4 (P < 0.0001). Thirty-five of the 53 children complied with a continuous INCS treatment regimen over a period of 3-12 months, demonstrated increased FEF25-75% (84.4 ± 13.6 vs. 70.1 ± 7.1, P < 0.001) and FEV1 (92.3 ± 10.9 vs. 84.4 ± 7.8, P < 0.0001) after INCS treatment. However, FEF25-75% values were still significantly lower compared to the group of AR children with normal lung function (84.4 ± 13.6 vs. 95.7 ± 8.8, P < 0.0001). INCS improve FEF25-75% above 80% of predicted values in 2/3 of children with abnormal lung function. However, this improvement does not reach levels of AR children with normal lung function. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.Pediatric Pulmonology 09/2014; 49(9). DOI:10.1002/ppul.22912 · 2.30 Impact Factor
Archivos argentinos de pediatría 08/2013; 111(4):322-327. DOI:10.5546/aap.2013.322 · 0.29 Impact Factor