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RESULTS
OF ALLERGY Dr. Bob Lanier M.D.
IN Professor:
Pediatrics / Immunology
University of North Texas
CHILDREN Health Science Center
Fort Worth, Texas
Consequences of Allergy
1. > 20%
2. > 30%
3. > 40%
Allergic Rhinitis: Increasing
Prevalence in Children
In England, Wales, and Scotland
Th2
Th0 Parasites
Hygiene
Hypothesis
Th1
Bacteria
Not enough
IFN-γ
food IL-12
Virus
Physical Consequences of allergy
• Dental hypothesis
Circles beneath eye
• Chronic allergic inflammation of the upper airway causes
lymphoid hypertrophy with prominence of adenoidal and
tonsillar tissue. This may be associated with poor
appetite, poor growth, obstructive sleep apnea, mouth
breathing, pharyngeal irritation and dental abnormalities.
Antihistamines
Allergy Immunization
Cessation of exposure
Avoidance
You can prevent the progression of allergy
using regular antihistamines?
• 1. TRUE
• 2. FALSE
Atopic March
THE ETAC TRIAL
LONG-TERM TREATMENT WITH CETIRIZINE OF INFANTS WITH
ATOPIC DERMATITIS: A MULTI-COUNTRY, DOUBLE-BLIND,
RANDOMIZED, PLACEBO-CONTROLLED TRIAL OVER 18 MONTHS
• 1.TRUE
• 2. FALSE
Prophylactic management of children at risk
for recurrent upper respiratory infections: the
Preventia I Study.
Grimfeld A, Holgate ST, Canonica GW, Bonini S, Borres MP, Adam D, Canseco Gonzalez C, Lobaton P, Patel
P, Szczeklik A, Danzig MR, Roman I, Bismut H, Czarlewski W.
BACKGROUND: Given the morbidity and mortality of asthma and the recent dramatic increase in its prevalence,
pharmacologic prophylaxis of this disease in children at risk would represent a major medical advance.
OBJECTIVES: The Preventia I Study was designed to evaluate the efficacy and long-term safety of loratadine in
reducing the number of respiratory infections in children at 24 months. A secondary objective was to investigate the
benefit of loratadine treatment in preventing the onset of respiratory exacerbations. METHODS: Preventia I was a
randomized placebo-controlled study involving 22 countries worldwide. The children were 12-30 months of age at
enrollment and had experienced at least five episodes of ENT infections, and no more than two episodes of
wheezing during the previous 12 months. Phase I was a 12-month double-blind period during which the children
were treated with loratadine 5 mg/day (2.5 mg/day for children</=24 months of age) or placebo. Phase II was a
double-blind follow-up period without study medication. RESULTS: Of the 412 children enrolled, 342 and 310
completed Phase I and Phase II, respectively. The results showed a significant decrease in the number of infections
in the whole population of children. However, no difference was observed between the loratadine and placebo
loratadine was shown to reduce the number of respiratory
group. When considering secondary end-points, loratadine was shown to reduce the number of respiratory
exacerbations during the treatment phase
exacerbations during the treatment phase. None of the 204 children who received loratadine discontinued the
study because of drug-related events. Loratadine treatment was not more sedative . than placebo and was not
associated with cardiovascular events. CONCLUSION: The strong decrease in the rate of infections in the children
at risk of recurrent infections, while not being influenced by loratadine treatment, should encourage future reflection
in terms of prophylactic management. This study also confirms the long-term safety of loratadine and its metabolites
in young children.
Allergy can affect sleep and learning ?
• 1. TRUE
• 2. FALSE
Symptoms
Lack G. J Allergy Clin Immunol. 2001;108(suppl):S9-S15. 2McColley SA, et al. Chest. 1997;111:170-173.
1
Emotional and educational effects of ALLERGY
• Slowed thinking
• Sleep problems
• Antihistamines
• Inhaled corticosteroids
• Anti-leukotrienes
• Cromolyn
• Allergen immunotherapy
Avoidance is always the best
treatment for allergy
• TRUE
• FALSE
Allergen avoidance in the secondary and
tertiary prevention of allergic diseases: does
it work? Marinho S, Simpson A, Custovic A
Although allergen avoidance is widely
recommended as part of a secondary and tertiary
prevention strategy for allergic diseases, a clear-
cut demonstration of its effectiveness is still
lacking... current evidence suggests that
interventions in children may be associated with
some beneficial effect on asthma control, but no
conclusive evidence exists regarding rhinitis or
eczema. Prim Care Respir J. 2006 Jun;15(3):152-8. Epub 2006 Mar 29.
IS EXPOSURE TO CATS HARMFUL OR
HELPFUL TO INFANTS?
• 1.HARMFUL
• 2. HELPFUL
+ =
Th1 Th2
Th2
Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based
cross-sectional study . Platts-Mills T Vaughan J, Squillace S, Woodfolk J, Sporik R .
Lancet. 2001 Mar 10;357(9258
Which are the best medications ?
• Antihistamines
Lymphocyte
Preformed mediators Nasal steroids
Histamine
Inflammation
Allergic Rhinitis Treatment
With Antihistamines:
Impaired Learning Performance
50
*
*
45
40
Diphen- Placebo Loratadine Non-allergic
hydramine (n=21)
60 (n=16)
56
(n=25)
30 28
(n=25)
20
20
10 (n=20)
5
(n=20)
0
0
Fall 1996 Fall 1998 Fall 1996 Fall 1998
Age Range 23 to 50 Years Age Range 24 to 50 Years
Adapted from Marshall PS, et al. Ann Allergy Asthma Immunol. 2000;84:403-410.
Antihistamines help asthma
• 1. True
• 2. False
The role of antihistamines in asthma management.
• It’s proven
7 Placebo (n=49)
from baseline (cm)
6
5
4
3
2
*
1
0
1 2 3 4 5 6 7 8 9 10 11 12
Months
*P<0.05
Schenkel et al. Pediatrics. 2000;105:E22.
Summary
GINA guidelines
Preventia Trials
Abstracts and references for
these lectures
BobLanierMD@askdrbob.com