Two long-acting ß 2 -adrenergic agonists (LABAs), salmeterol and formoterol, have been demonstrated to be safe and effective agents in children, both in terms of bronchodilation and prevention of exercise-induced bronchospasm. Their onsets of action differ, with formoterol having an onset similar to albuterol (3 minutes), while salmeterol has a slower onset of action (10–20 minutes). Following a single-dose administration, both agents demonstrate durations of action up to 12 hours. Following regular twice-daily administration, bronchodilation remains effective; however, a level of tolerance (or tachyphylaxis) (more…)

Airway remodelling is considered to be of major importance in the pathology of asthma, with subepithelial basement membrane thickening in particular being indicative of early development of the disease and characteristic of its progression. Airway fibroblasts are central cells in the processes of remodelling: increased deposition of fibroblast-derived connective tissue proteins and differentiation of fibroblasts into contractile myofibroblasts are consistent observations in morphological studies of moderate to severe asthmatic airways. The secretory function of fibroblasts is under the control of locally produced growth factors such as vascular endothelial cell growth factor (VEGF, see below) and platelet-derived growth factor (PDGF). (more…)

Current internationally recognized guidelines indicate that symptomatic asthmatics using a low to medium inhaled corticosteroid dose (400–800 µg/day of beclomethasone or equivalent) alone should preferentially be commenced on a long-acting agonist ß2 prior to an leukotriene receptor antagonists LTRA (British guideline on the management of asthma 2003; GINA Workshop Report 2004). However, two recent large trials have performed head to-head comparisons of add-on long-acting ß2 agonist versus LTRA as therapeutic adjuncts to inhaled corticosteroids, using exacerbation frequency (rather than lung function and symptoms) as the primary end point. (more…)

A variety of proinflammatory cells, mediators, and cytokines orchestrate the development of airway hyperresponsiveness, which results in the episodic airflow obstruction characteristic of asthma. As a consequence, modulation of the underlying disease process with antii-nflammatory agents is firmly established as being the cornerstone of successful management. Inhaled corticosteroids are the most potent antiinflammatory agents available and satisfactorily suppress underlying airway inflammation in most individuals. (more…)

Maintenance of asthma control by once-daily inhaled ciclesonide nasal spray in adults with persistent asthma. Ciclesonide is an inhaled corticosteroid that is converted to an active metabolite, desisobutyryl ciclesonide, in the lungs, thereby minimizing effects on endogenous cortisol inflammation. The goal of finding newer, safer corticosteroids for the management of asthma has led to the development of this inhaled corticosteroid.

This 12-week, double-blind, randomized, parallel-group, placebo-controlled study evaluated the efficacy and safety of ciclesonide in adults with persistent asthma. Efficacy was monitored with asthma symptom scores, rescue medication use, morning and evening peak expiratory flow rate (PEF) measurements, spirometry, and the probability of study completion without experiencing lack of efficacy. It was concluded that ciclesonide (160 or 640 µg) once daily in the morning maintains asthma control effectively, does not affect cortisol levels, and has an adverse event profile comparable with that of placebo in adults with primarily mild to moderate asthma.

It has been reported previously that, compared with fluticasone, ciclesonide possesses equivalent anti-inflammatory efficacy, through pulmonary activation, with a significantly improved safety profile. Since it has low bioavailability because it is metabolized by the lung, it is believed to cause minimal systemic adverse effects. It was found that the morning peak expiratory flow rate (PEF) and FEV 1 values from patient diaries decreased significantly in patients switched from their usual inhaled corticosteroids therapy to placebo but remained stable in patients switched to either dose of ciclesonide (160 or 640 µg). Furthermore, in patients switched to placebo there were significant increases in daily asthma symptoms and the use of rescue medication, with no significant changes from baseline in patients switched to either dose of ciclesonide. Mean changes from baseline in serum and urinary cortisol levels were not statistically significant in any of the treatment groups. Adverse effects were mild, with no reported cases of oral candidiasis.

In conclusion, once-daily inhaled ciclesonide nasal spray (160 or 640 µg) was superior to placebo in the maintenance of asthma control in adult patients previously treated with moderate doses of inhaled corticosteroids, without any significant adverse effects.

Allergic rhinitis is a very common problem associated with poor quality of life, reductions in social and work activities and poor interpersonal relationships. The main goal of the management of allergic rhinitis is to improve the quality of life. Immunotherapy is a specific therapy for allergic rhinitis and several reports have documented the safety and efficacy of this treatment . Safety has been a key issue in immunotherapy and various modalities are being investigated to make allergy immunotherapy more tolerable and safe to administer. (more…)

The specific treatment of allergy has previously relied upon allergen avoidance and sublingual immunotherapy. These approaches have been used predominantly in hymenoptera venom and aero-allergen-driven disease when previous food allergy immunotherapy has been unsuccessful. (more…)

Asthma and allergic diseases are common in both children and adults. Their development depends on an interaction between asthma genetic and asthma environmental risk factors. Genetic manipulation in multi factorial diseases such as asthma is not feasible in the foreseeable future. However, theoretically, environmental exposures can be controlled in an attempt to stem the rising prevalence of these diseases (primary prevention). Environmental exposures may also influence the frequency of symptoms and the requirement for medication in those with established disease. (more…)

To prevent the development of allergy, allergen avoidance has to be instituted before sensitization has occurred. The specific type of aero allergens may vary depending on the climatic and economic situation. For example, House Dust Mite is the most important allergen in humid climates and pet allergens assume importance in cold countries, while cockroach allergen is the major sensitizing agent in crowded, inner city areas. Several large prospective studies have instituted House Dust Mites avoidance measures during pregnancy, at birth and later in childhood, and assessed children for asthma and allergic manifestations. (more…)

Definitions of anaphylaxis vary considerably, impeding the comparison of different clinical studies. Different definitions of anaphylaxis have been developed as clinical descriptions of severe allergic reactions, different authors emphasizing different symptoms.

The author aimed to develop a simple clinical grading system and definition for anaphylaxis using clinical data. He retrospectively analyzed 1149 case records (median age 29 years) with systemic allergic reactions (30% venom allergy, 22% iatrogenic allergy, 18% food allergy) from an emergency department in Australia. (more…)