Clinical and therapeutic aspects of sinusitis in children with bronchial asthma.

Eighty children between 4 and 14 years of age suffering from bronchial asthma were investigated. Fifty-five of them showed clinical and radiological findings of sinusitis. Of these, 13 patients with purulent postnasal drip were treated with ampicillin, phenylephrine and triprolidine (therapy A) and for the other 42 ampicillin was replaced by beclomethasone (therapy B). Thirty-four of 55 children showed improvement in sinus X-rays; 20 children had a considerable decrease in the severity of asthma and many symptoms cleared up after the therapy for sinusitis (P less than 0.001). In conclusion, owing to the high prevalence of sinusitis in children with bronchial asthma, all asthmatic children should be investigated to check for a sinus disease.

Seven hereditary syndromes with pigmentary retinopathy. A review and differential diagnosis.

This article reviews several autosomal recessive syndromes characterized by pigmentary retinopathy and, in many, combined with deafness, hypogonadism, and/or mental retardation. These syndromes are manifested in infancy and childhood. Although no specific treatment is available, an early diagnosis can be the first step in initiating symptomative management and preventive measures for the patient and family.

A double-blind group comparative study of nedocromil sodium in the treatment of seasonal allergic rhinitis.

Thirty-eight patients with seasonal rhinitis due to grass pollen allergy took part in this double-blind study comparing 1% nedocromil sodium and placebo. Treatment was allocated by randomised coding sheet and consisted of 1% nedocromil sodium nasal spray or placebo given four times daily for four weeks during the peak pollen season. Highly significant (p less than 0.001) differences in favour of nedocromil sodium were seen for all signs and symptoms recorded at clinical assessments, and for diary card assessments of symptoms. In addition, time to effect and patient and clinician opinions of treatment significantly (p less than 0.001) favoured nedocromil sodium. Laboratory data on blood and urine samples taken before and after treatment showed no significant effects, and both treatments were well tolerated. Nedocromil sodium 1% nasal spray taken four times daily was shown to be an effective treatment for grass pollen rhinitis.

Comparison of mizolastine with loratadine in the treatment of perennial allergic rhinitis.

Mizolastine is a new, non-sedating antihistamine providing satisfactory symptomatic relief in seasonal allergic rhinitis. The purpose of this study has been to compare mizolastine to loratadine in perennial allergic rhinitis. This multicentre, double-blind study has involved 68 patients, randomly allocated, after a one-week placebo run-in, to 10 mg mizolastine or 10 mg loratadine, both given on a once-daily basis, for four weeks. Comparable symptom relief occurs in both groups resulting, respectively for mizolastine and loratadine, in a 66.6% and a 61.3% decrease in total nasal score, to a 74.8% and a 76.4% decrease in total ocular score, and to a 69.0% and a 64.8% decrease in global total score. Safety is satisfactory in both groups. Mizolastine is at least as effective as loratadine in relieving perennial allergic rhinitis symptoms and its safety profile allows its use in the treatment of this disease.

[Recent advances concerning etiopathogenesis of nasal polyposis]. / Nuove acquisizioni sull'eziopatogenesi della poliposi nasale.

The way nasal polyps arise and why they tend to recur is still unknown. Quite frequently they are found in association with asthma, rhinitis and ASA-intolerance, thus suggesting a multifactorial etiopathogenesis. The incidence of atopy in patients affected with nasal polyposis is quite low (16.8%). Recent studies stress the involvement of mast cell mediators due to various degranulating stimuli other than those mediated by IgE. The finding of the interleukin-2 receptor (IL2-R) on murine mast cells and on human peripheral blood basophils, together with the possibility of inducing basophil degranulation through IL2 stimulation, have led the authors to seek IL2R on human nasal polyp mast cells and to study subpopulations of nasal polyp lymphoid infiltrates. Nasal polyps obtained from 4 patients, admitted to the E.N.T. Department of the Catholic University of Rome in 1988, were snap frozen soon after their surgical removal through transmaxillary ethmoidectomy. In this study the following monoclonal antibodies (MoAb) were used: Leu-2a (CD8), Leu-3a/3b (CD4), Leu-4 (CD3), anti-HLA-DR and anti-IL2-R (CD25), OKM1 (CD11), OKB2 (CD24) and 1HT4-4H3 (CD 25). In no patient was there evidence of atopy, asthma or ASA-intolerance. Several mast cells (MC) were observed, chiefly in the connective axis and perivascular areas. These cells were characterized by a large number of cytoplasmatic monomorphic granules. The MC displayed the IL2-R and they were very often close to T-lymphocytes. T-cell subpopulations were predominantly composed of CD4-positive cells (about 75% of all lymphocytes) often associated in clusters and located both in the submucosa and in the connective axis. CD8-positive cells (10-15% of the lymphoid cells) were located most often just under the epithelium. They were hardly ever scattered within the CD4-positive cell clusters. Almost all T cells were activated, above all those surrounding the MC. These results would appear to suggest the presence of a cell-mediated immune response in nasal polyp pathogenesis where MC degranulation, determined by activated T-cell cytokines, plays an important role.

[Medical therapy of allergic rhinitis]. / La terapia medica delle riniti allergiche.

In the last few years, owing to new pathophysiological and pharmacological notions, the therapy of allergic rhinitis has achieved some remarkable goals. On the basis of personal experience and of the literature, a close examination of drugs used for aspecific treatment of allergic rhinitis is carried out, mainly regarding the most currently useful and effective.

[Topical intranasal cortisone therapy]. / La terapia cortisonica topica endonasale.

Owing to improvements made during the last 15 years in the pathophysiological and pharmacological research, many new corticosteroids have been successfully experimented. They have high activity on the target organ and they are suitable for long term therapies since they have not any systemic and/or local side effects. Nowadays the topical intranasal corticosteroid therapy is indispensable for allergic rhinitis treatment and it is very useful for many nasal and bronchopulmonary diseases (some chronic rhinitis, nasal polyposis, bronchial asthma, chronic obstructive bronchopulmonary diseases). The authors use their personal experience and carefully review the literature to describe the general aspects (pharmacology, pharmacokinetics, toxicology, side effects and contraindications) and to analyze the single drugs currently used in Italy and abroad. Finally, they compare the efficacy of each topical intranasal glucocorticoid among themselves and with other drugs.

Allergy: a leading role in otitis media with effusion.

We have studied 35 children with seasonal allergic rhinitis confirmed by positive skin tests and RAST to grass pollen. Intranasal antigen provocation was performed to evaluate the function of the eustachian tube (ET) and middle ear pressure (MEP). Tympanometry was used to evaluate the changes in MEP, while Valsava and Toynbee tympanometric tests were employed to study the ET function, and the changes in nasal airway resistance were measured by anterior rhinomanometry. ET dysfunction (ETD) and a decrease in MEP and nasal airway resistance were demonstrated in the children under study as compared with the controls. The results suggest a role for allergy in ETD and for the development of OME.

Serum immunoglobulins and secretory IgA deficiency in tonsillectomized children.

We studied serum immunoglobulin patterns in 65 children aged 2 to 10 years before and 1 to 4 months after tonsillectomy and adenoidectomy, and secretory IgA (sIgA) levels in 46 children aged 3 to 10 years before and 1 month after the same operation. Serum immunoglobulin and sIgA values were normal prior to surgery, and significantly lower afterwards. The data emphasize the importance of palatine tonsils not only in the synthesis of monomeric immunoglobulins but also in the synthesis of dimeric immunoglobulins in secretions. Although more long-term, follow-up studies supporting our results are needed, we suggest that a post-adenotonsillectomy drop in immunoglobulin and sIgA levels may predispose children to a constellation of disorders. We recommend, therefore, that serum immunoglobulins and sIgA levels be determined in all children before and after surgery.

[Therapy of allergic rhinitis in childhood]. / Zur Therapie der allergischen Rhinitis im Kindesalter.

Allergic rhinitis is the most common of all allergic disorders. After summarising the clinical features and diagnostic approach with regard to differential diagnosis, we will discuss the therapeutic modalities. As with all long-term therapy measures, it is essential to persuade both the child and the parents to participate in the treatment and to get their co-operation.

Evaluation of nasal and blood eosinophilia in children suffering from perennial allergic rhinitis treated with beclomethasone dipropionate.

In 16 children suffering from allergic rhinitis, and treated with intranasal Beclomethasone Dipropionate (BDP) for 3 months, therapy significantly diminished the number of nasal eosinophils, while it did not cause any change in blood eosinophilia. This may confirm the local effect of this drug, given at 300 microgram/die. The reduction of nasal eosinophilia during BDP therapy can be explained by the attenuation of the tissue damage characterized by allergic inflammation. The release of mediators, particularly histamine, increases epithelial permeability and promotes penetration of the high molecular weight allergens which thereby gain access to submucosal mast cells. Further release of mediators makes the mucosa more and more permeable to allergen entry. BDP decreases mucous permeability and allergen absorption, so reducing inflammation and consequently the migration of eosinophils to the sites of the allergic reaction.

Immunopathology of nasal polyps: an immunohistochemical approach.

We studied the mast cells and the T-lymphocyte subpopulations of four patients' nasal polyps using immunohistochemical procedures. The data showed that MC displayed IL2-receptor and that they were very often closely related to CD4+ and MHC class II-positive T-lymphocytes. CD8-positive T-cells represented only 10% to 15% of the whole lymphoid population and were not localized near mast cells. These findings suggest a possible role of cell-mediated immune reactions in the pathogenesis of nasal polyps.