Results of an allergy educational needs questionnaire for primary care.

It is well recognized that knowledge of allergic conditions is suboptimal in primary care. The Primary Care Interest Group of the European Academy of Allergy and Clinical Immunology undertook an educational needs survey to better understand what they were and how best to meet them, in the primary care environment. An electronic questionnaire was devised and distributed as widely as possible. A total of 2226 people from 63 countries opened the e-questionnaire of which 692 provided evaluable responses. In total, 81% were medical doctors with 299 possessing additional qualifications. Self-declared gaps in knowledge were expressed for most manifestations of allergy with a correspondingly high self-expressed educational need. The preferred learning modalities were online guidelines (69.6%) and courses (68.8%) followed closely by workshops (68%), structured online modules (63.9%) and small local working groups (59.75%). Podcasts and webinars scored poorly with only 25% expressing these as preferred learning modes although there was an age gradient. The preferred electronic platform was the personal computer (82.6%). A better understanding of the needs of primary care should help guide the design of educational initiatives to meet those needs.

Google Trends terms reporting rhinitis and related topics differ in European countries.

Google Trends (GT) searches trends of specific queries in Google and reflects the real-life epidemiology of allergic rhinitis. We compared Google Trends terms related to allergy and rhinitis in all European Union countries, Norway and Switzerland from 1 January 2011 to 20 December 2016. The aim was to assess whether the same terms could be used to report the seasonal variations of allergic diseases. Using the Google Trend 5-year graph, an annual and clear seasonality of queries was found in all countries apart from Cyprus, Estonia, Latvia, Lithuania and Malta. Different terms were found to demonstrate seasonality depending on the country - namely 'hay fever', 'allergy' and 'pollen' - showing cultural differences. A single set of terms cannot be used across all European countries, but allergy seasonality can be compared across Europe providing the above three terms are used. Using longitudinal data in different countries and multiple terms, we identified an awareness-related spike of searches (December 2016).

Gastrointestinal safety of amtolmetin guacyl in comparison with celecoxib in patients with rheumatoid arthritis.

OBJECTIVE: Selective inhibitors of cyclo-oxygenase-2 (COX-2) appear to be safer than conventional NSAIDs on the gastrointestinal (GI) tract. Amtolmetin guacyl (AMG), a NSAID that inhibits both COX-1 and COX-2, has an anti-inflammatory effect comparable to that of traditional NSAIDs, with a better GI safety profile. The primary end-point of this study was to evaluate the gastrointestinal safety of amtolmetin guacyl in comparison with celecoxib in patients affected with rheumatoid arthritis. The assessment of efficacy was the secondary end-point. METHODS: This study was a 24-week, randomized, parallel group, double-blind, double dummy, multicentre trial; 235 patients were enrolled and 180 patients (85 in the AMG group and 95 in the celecoxib group) completed the study. Each patient received twice daily amtolmetin guacyl 600 mg or celecoxib 200 mg. Assessment of safety was performed by upper GI endoscopy, gastrointestinal symptoms evaluation, electrocardiography, blood and urine laboratory tests, adverse events recording. Assessment of efficacy was performed by using the American College of Rheumatology (ACR-20) responder index. RESULTS: Neither amtolmetin guacyl nor celecoxib determined a worsening of baseline gastro-duodenal endoscopy findings. The percentage of patients with normal findings did not significantly change after treatment with both drugs, being virtually identical with AMG (i.e. 75.29%) and increasing from 75.79% to 77.66% with celecoxib. Moreover an evaluation of the other safety parameters did not reveal any difference between the two treatment groups. Therapeutic efficacy was equivalent in both groups, with no statistical difference between the two drugs at all time intervals. CONCLUSIONS: In patients affected with rheumatoid arthritis, AMG and celecoxib proved to be equivalent, showing comparable gastrointestinal safety and therapeutic efficacy of treatment.

Comparison of the efficacy of beclometasone dipropionate and fluticasone propionate suspensions for nebulization in adult patients with persistent asthma.

The use of nebulization for the administration of inhaled steroids plays an important role in asthma patients who are unable to use pressurized aerosol or dry-powder inhalers effectively. Moreover, the type of nebulizer used may affect how much drug is delivered to the lungs. The objective of this multinational, multicentre, randomized, active-controlled, parallel-group study was to compare the efficacy and safety of nebulized corticosteroids in adult patients with chronic asthma. Following a 1-week placebo run-in period, 205 patients, aged 18-65 years, with moderate persistent asthma were randomized to one of two treatment groups for 12 weeks: beclometasone dipropionate (BDP) suspension for nebulization 2,400 microg day(-1) b.i.d. (n = 103), or fluticasone propionate (FP) suspension for nebulization 2,000 microg day(-1) b.i.d. (n = 102), both administered by a jet nebulizer Comparable efficacy in controlling asthma was demonstrated by the two treatments at study end, as evident when evaluating various efficacy parameters (pulmonary function tests, asthma exacerbations and symptoms, and the use of rescue salbutamol). The primary efficacy endpoint was the variation in the pulmonary expiratory flow (PEF) at treatment end over the baseline visit. For the intent-to-treat population, in the BDP group mean PEF values increased statistically significantly from 5.2 +/- 1.31 s(-1) to 5.7 +/- 1.61 s(-1), while in the FP group the increase was from 5.2 +/- 1.21 s(-1) to 5.8 +/- 1.81 s(-1). Mean PEF values as per cent of predicted also increased in a statistically significant way, from 71% to 77.1 % in the BDP group, and from 70.1% to 76.9% in the FP group. The two treatments were equally well tolerated.A total of 23 and 32 patients in the BDP and FP groups, respectively, reported adverse events during the treatment period, and these were generally mild. In conclusion, the results of this study demonstrate that BDP 2,400 microg day(-1) and FP 2,000 microg day(-1), both suspensions for nebulization administered via a jet nebulizer, are equally effective, with an acceptable safety and tolerability profile, when used in adult patients with moderate persistent asthma.

In vivo effect of free radical scavenger hepatoprotective agents on superoxide dismutase (SOD) activity in patients.

The in vivo effects of two hepatoprotective antioxidants (silymarin, and 4-amino-5-imidazole-carboxamide-phosphate) on the expression and activity of superoxide dismutase (SOD) enzyme were studied in erythrocytes from patients with alcoholic cirrhosis. In vivo treatment with any of the drugs markedly increased the SOD expression of lymphocytes as measured by flow-cytofluorimetry following staining with monoclonal anti-Cu, Zn-SOD-antibody and FITC-conjugated anti-mouse Ig, as well as erythrocyte and lymphocyte SOD activities. The data indirectly suggest that antioxidant activity might be one of the important factors in the hepatoprotective action of these agents.

Free radicals in tissue damage in liver diseases and therapeutic approach.

In vitro and in vivo effects of four hepatoprotective agents: silymarin (LegalonR), (+)-cyanidanol-3 (CatergenR), 6,6-methylene-bis(2,2,4-trimethyl-1, 2-dihydroquinoline) (MTDQ), and 4,5-amino-imidazole-carboxamide-phosphate (Aica-P) on the expression and activity of superoxide dismutase enzyme and on certain cellular immune reactions were studied in lymphocytes (and erythrocytes) from cirrhotic patients and from healthy control subjects. In vitro incubation with these drugs inhibited lectin-induced lymphocyte transformation and some of them decreased the antibody-dependent, spontaneous, and lectin-induced lymphocytotoxicity. MTDQ, silymarin and Aica-P enhanced the superoxide dismutase activity of erythrocytes and lymphocytes and the two latter and (+)-cyanidanol-3 increased the superoxide expression of lymphocytes as measured by flow cytofluorometry. In vivo treatment with Aica-P restored the originally low lymphocyte transformation values of patients' lymphocytes. Our results indirectly suggest that both antioxidant and immunomodulatory activities might be important factors in the hepatoprotective action of these drugs.

Hepatoprotective and immunological effects of antioxidant drugs.

The hepatoprotective and immunomodulatory effects of silymarin and amino-imidazole-carboxamide-phosphate were studied in 40 patients with alcoholic cirrhosis of the liver in a one-month double-blind clinical trial. Treatment with either of the drugs normalized the elevated levels of aspartate aminotransferase, alanine aminotransferase and serum bilirubin, markedly reduced the high level of gamma-glutamyl transferase, increased lectin-induced lymphoblast transformation, decreased the percentage of OKT8+ cells and suppressed lymphocytotoxicity. None of these changes occurred in the placebo-treated group. Thus, the hepatoprotective effects of silymarin and amino-imidazole-carboxamide-phosphate in alcoholic cirrhosis can partly be attributed to the immunomodulatory activity of the drugs.

[Cross reactivities between food antigens of plant or animal origin]. / Növényi és állati eredetú táplálékok közötti allergiás keresztreakciók.

Knowledge about cross reactivities among food proteins of plant or animal origin is getting more and more important. Cross reaction provoking often clinical symptoms may be based on close taxonomical relations or on the presence of "archaic", ubiquiter protein structures preserved during phylogenesis. The most significant cross reactivities characterized by increasing incidence are between pollens and foods of plant origin and between latex and fruits.

[Effect of silimarin (Legalon) therapy on the antioxidant defense mechanism and lipid peroxidation in alcoholic liver disease (double blind protocol)]. / Silymarin (Legalon) kezelés hatása idült alkoholos májbetegek antioxidáns védörendszerére és a lipid peroxidációra (kettös vak protokoll).

A double blind study. Antioxidant and antiperoxidative effects of the free radical scavenger agent silymarin (Legalon) were investigated in patients with chronic alcoholic liver disease in a double blind clinical trial. Six month treatment (at a daily dose of 420 mg) with silymarin significantly enhanced the originally low superoxide dismutase activity of erythrocytes and lymphocytes and also restored the diminished superoxide dismutase expression on lymphocytes as measured by flow-cytofluorimetry. In addition, silymarin therapy markedly increased the serum level of ree--SH groups and the activity of glutathione peroxidase. In contrast, a considerable fall in serum malondialdehyde concentration was detected in patients having received silymarin. However, in case of placebo-treated patients the above mentioned parameters of antioxidant defense system and lipid peroxidation failed to change significantly. These data indirectly suggest that antioxidant, antiperoxidative effects might be important factors in the mechanism of hepatoprotective action of silymarin.

[Liver-protective action of silymarin therapy in chronic alcoholic liver diseases]. / Silymarin kezelés májvédö hatása idült alkoholos májbetegségben.

The effects of silymarin (Legalon) therapy on liver function tests, serum procollagen III peptide level and liver histology were studied in 36 patients with chronic alcoholic liver disease in a six month double blind clinical trial. During silymarin treatment serum bilirubin, aspartate aminotransferase and alanin-aminotransferase values have been normalized, while gamma-glutamyl transferase activity and procollagen III peptid level decreased. The changes were significant, and there was a significant difference between post-treatment values of the two groups, as well. In the placebo group only gamma-glutamyl transferase values decreased significantly but to a lesser extent than that in the silymarin group. The histological alterations showed an improvement in the silymarin group, while remained unchanged in the placebo group. These results indicate that silymarin exerts hepatoprotective activity and is able to improve liver functions in alcoholic patients.

[Systemic lupus erythematosus and pregnancy (effect of pre-conception hematologic disorders on fetal outcome)]. / Szisztémás lupus erythematosus és terhesség (prekoncepcionális haematológiai rendellenességek hatása a magzati eredményekre).

The aim of the study was to determine the fetal and neonatal outcomes of pregnancies conceived during the inactive phase of systemic lupus erythematosus (SLE). Fetal and neonatal outcomes in 75 pregnancies of 33 patients with SLE were analyzed. In 19 patients (57.6%) the SLE also had hematological autoimmune presentations prior to gestation, such as anemia, thrombopenia, garnulocytopenia, and antiphospholipid antibody and/or lupus anticoagulant (APA). Out of 75 pregnancies, 19 elective terminations were carried out because the disease was active or for non-medical reasons. The adverse fetal outcomes of those 56 pregnancies which occurred during the inactive phase were compared with those of the control patients. In SLE, the rates of spontaneous abortions (46.4%) and newborns with low (< 2500 gr) birthweight (36.7%) were found to increase roughly three times that of the controls and the perinatal fetal loss (16.7%) also increased significantly as compared with the control group (28.5 per thousand). APA noted at any time before pregnancy increased the low birthweight rate (75%) six fold and the perinatal loss (33.3%) more than ten fold but did not affect the rate of spontaneous abortions. Any kind of hemocytopenias without APA, noted before pregnancy did not worsen the fetal outcome in SLE. Neonatal lupus was diagnosed in 2 out of the 30 newborns. Our results suggest that among the hematologic manifestations of SLE presenting before pregnancy, APA can predict the high risks of low birthweight and perinatal fetal loss as opposed to hemocytopenias.

[Immunomodulator effect of silymarin therapy in chronic alcoholic liver diseases]. / Silymarin kezelés immunmoduláns hatása krónikus alkoholos májbetegségben.

The effects of the hepatoprotective, antioxidant drug silymarin (Legalon) on some cellular immune parameters of patients with histologically proven chronic alcoholic liver disease were studied in a six month double blind study. The lectin induced proliferative activity of the lymphocytes got enhanced, the originally low T cell percentage and the originally high CD8+ cell percentage have been normalized, the antibody-dependent and natural cytotoxicity of the lymphocytes decreased during silymarin therapy. All these changes were significant, while in the placebo group no significant changes occurred, except for a moderate elevation of the T cell percentage. Thus, the immunomodulatory activity of silymarin might be involved in the hepatoprotective action of the drug and improves the depressed immunoreactivity of the patients.

[Effectiveness and tolerability of the glucocorticoid mometasone furoate given as nasal spray in seasonal allergic rhinitis]. / A glükokortikoid mometazon furoát orrspray formában való adásának hatása szezonális allergiás rhinitisben.

The clinical effect and tolerance of momethasone furoate (MF) glucocorticoid nasal spray (MFNS) were studied in 14-70 year-old patients suffering from seasonal allergic rhinitis. The patients administered daily one (morning) dose, 100 micrograms each, of MF into both nostrils, for a period of 14 days. They did not use other medicines affecting nasal symptoms. Nasal symptoms (nasal discharge, nasal obstruction, nasal itching, sneezing) and non-nasal symptoms (lacrimation, eye itching/burning sensation, palatal itching, ear itching, general itching), scored 0 to 3, and serving as a basis for evaluating the effect, were registered before treatment (day 1) and at visits on 3, 7 and 14th day. Of the 196 patients involved in the open multicentric study, 188 completed the study. The total average nasal symptom scores decreased, already after 3 days of treatment, from 8.7 to 4.1 and to 1.6 by the 14th day. Decrease of non-nasal symptoms was also conspicuous, however, lacrimation persisted in 57 of 188 cases, while eye itching--mainly in moderate and mild form--in 90 cases. The general condition of rhinitis before the treatment was evaluated by the examiners as severe or very severe in 155 cases (82%), as symptom-free (99 cases) on day 14 in, and mild (71 cases), in 170 cases (90%). The therapeutic effect was considered by both, patients and physician, as excellent, in 106 (56%) and 115 (61%) cases, resp. and as good in 63 (34%) and 56 cases (30%). Side-effects were mostly mild and transitory. Treatment was not discontinued due to side-effect in any of the cases. Based on the results, MFNS, administered in a single daily dose of 200 micrograms, has proved to be an effective and safe glucocorticoid preparation, also easy to use locally, in the treatment of allergic rhinitis.