Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial.

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.

Leukotriene B4 and 8-isoprostane in exhaled breath condensate of children with episodic and persistent asthma.

BACKGROUND: Leukotrienes and isoprostanes are biomarkers of airway inflammation and oxidative stress that can be detected in exhaled breath condensate (EBC). The aim of this study was to evaluate leukotriene B4 (LTB4) and 8-isoprostane levels in EBC of healthy and asthmatic children with episodic and moderate persistent asthma. METHODS: EBC was collected from 62 children aged 6 to 14 years: 22 healthy children, 30 patients with episodic asthma, and 10 patients with moderate persistent asthma, without preventive treatment at the time of enrolment. RESULTS: LTB concentrations were higher in children with asthma than in healthy controls (50.7 pg/mL vs. 13.68 pg/mL, P < .011). The same was true for children with moderate persistent asthma compared to children with episodic asthma (146.9 pg/mL vs. 18.85 pg/mL, P < .0001), children with moderate persistent asthma compared to healthy controls (146.9 pg/mL vs. 13.68 pg/mL, P < .0001), and children with episodic asthma compared to healthy controls (P, nonsignificant). EBC concentrations of 8-isoprostane were higher in asthmatic than in healthy children (18.3 pg/mL vs. 6.59 pg/mL, P < .026). They were also increased in children with moderate persistent asthma compared to those with episodic asthma (36.25 pg/mL and 12.28 pg/mL, P < .012), and in children with moderate persistent asthma and episodic asthma compared to healthy controls (36.25 pg/mL vs. 6.59 pg/mL [P < .0001] and 12.28 pg/mL versus 6.59 pg/mL [P < .0001], respectively). CONCLUSION: LTB4 and 8-isoprostane concentrations were increased in asthmatic children compared to healthy individuals, with differences detected for 2 degrees of asthma severity. Our findings suggest that EBC is a noninvasive method for airway inflammation and oxidative stress assessment.

Epidemiologic, clinical and socioeconomic factors of atopic dermatitis in Spain: Alergológica-2005.

OBJECTIVE: To analyze the clinical and epidemiologic characteristics of the population with atopic dermatitis (AD) consulting in Allergology services in Spain. MATERIALS AND METHODS: The study was a multi-center, observational, descriptive, cross-sectional epidemiologic study with prospective collection of data on patients consulting for the first time in Allergology services in Spain. By means of a data collection record, personal and specific variables were collected during the calendar year 2005 from a total of 4991 patients with AD. RESULTS: AD was diagnosed in 171 patients (3.4% of patients seen in Allergology services), which represented no significant change with regard to the Alergológica-1992 study. In 72% of cases, AD was associated with other allergic disorders. The mean age of the onset of clinical manifestations of AD was 1 year and 4 months. During the first consultations, the suspected diagnosis of AD was established in 83% of cases. In 58% of cases the cause was considered idiopathic and 42% were associated with sensitization to allergens. In 10% of patients with AD the triggering allergens were foods and in 26% aeroallergens. Most patients (94%) received hydrating skin and drug treatment (anti-histamines 73%, topical corticoids 49%, calcineurin inhibitors 31%). Only 10% of patients followed an exclusion diet. CONCLUSIONS: No significant increase in the demand for AD consultations was observed in comparison with Alergológica-1992. AD was frequently associated with other allergic disorders. In few cases was food involved in the etiology of the disease. In most cases nothing more than topical drug treatment was indicated.

Allergy to sea fishing baits.

We report a new case of rhinitis and asthma caused by sea fishing baits. The results showed exposure to Sipunculus nudus (Phylum Sipuncula; order Sipunculida: Sipunculidae) to be the main cause of the allergic symptoms. The intervention of IgE was demonstrated, with the presence of cross-reactions with allergenic extracts from other worm species used as baits, belonging to different orders of Annelida.

Omalizumab. A review of the new treatment of allergic asthma and seasonal allergic rhinitis.

The causal role of immunoglobulin E (IgE) in triggering the cascade of biochemical events leading to allergic disease is well established. Treatments that selectively inhibit IgE activity are a logical approach in managing the allergic response. Omalizumab is a recombinant humanised monoclonal antibody which specifically binds to the Cε3 domain of immunoglobulin (Ig) E, the site of high-affinity IgE receptor binding. The clinical benefit and steroid-sparing effect of treatment with the anti-immunoglobulin-E (IgE) antibody, Omalizumab, was assessed in patients with moderate-to-severe allergic asthma and seasonal allergic rhinitis. Intravenous and subcutaneous administration of anti-IgE mAb reduces circulating levels of IgE in atopic patients to low levels commonly seen in non-atopic individuals. Anti-IgE therapy offers protection against allergen-induced bronchoconstriction, reduces the need for short acting inhaled beta 2-agonist and corticosteroids among asthmatic patients and reduces severity of symptoms of allergic rhinitis. Adverse events were infrequent in clinical trials of omalizumab, and not significantly different from placebo. The most frequent drug-related event was mild to moderate urticaria. They do not induce anaphylaxis and the occurrence of antibodies against anti-IgE mAb is sporadic. The results of cited studies suggest that humanized anti-IgE monoclonal antibodies may have important immunotherapeutic benefit for treatment of allergic disorders.

Oral rush desensitization to cow milk. Following of desensitized patients during three years.

We report the induction of tolerance in four patients with severe IgE-mediated cow's milk allergy, with an oral rush desensitization by introducing increasing daily doses of cow's milk (CM) for 5 days under clinical conditions in order to enable the patients to tolerate 200 ml of CM daily. Our results indicate that we can induce clinical tolerance in CM allergy by oral administration of progressive doses of milk. After three years of following, the four patients are taking CM with good tolerance. Specific IgE levels of casein have decreased progressively during these three years until being not detectable in three of the four patients and also a reduction has been observed in the cutaneous skin prick test reactions to CM.

Pressurised metered-dose inhalers (MDIs) versus dry powder inhalers devices (DPIs) to rapid-acting inhaled b2-agonists for asthma in children.

OBJECTIVE: To compare the clinical effectiveness of pressurized metered-dose inhalers (MDIs) with that of dry powder inhalers (DPIs) in delivering short-acting b2-agonists in children with asthma. METHODS: Searches were performed in Medline (1997-March 2002), the Cochrane Library Database and the Embase reference lists of review articles and clinical trials. In addition, the international headquarters of b2-agonist manufacturers were contacted. We performed a review of randomized controlled trials. RESULTS: Ten randomized controlled trials were included. No differences in clinical effectiveness were found between MDIs and PDIs. Two studies reported that fewer adverse events occurred when the Turbuhaler was used. Two long-term studies in children found that children preferred the MDI to the Rotohaler. CONCLUSIONS: 1) In stable asthma, short-acting b2 bronchodilators in standard MDIs are as effective as dry powder inhalers. 2) Pooling of results was limited by the small number of studies and therefore no overall conclusions could be drawn. 3) From the limited data available, we found little or no evidence for an additional clinical benefit of DPI devices over standard MDIs in children with asthma.