Allergic Rhinitis in Children - New Therapeutic Options
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 14, Issue 5
Abstract
Allergic rhinitis (AR) is an inflammatory process of the nasal mucosa, most often IgE dependent, caused by environmental allergens. Typical symptoms of the disease are: an aqueous secretion from the nose, nasal congestion, itching of the nose and sneezing, which disappear spontaneously or under the influence of treatment. AR is the most common allergic disease in the world, affecting 5-40% of the pediatric population [1]. Due to the time of exposure to the agent causing allergic rhinitis, it can be divided into seasonal (SAR) and perennial (PAR). Currently, there are four ways of dealing with patients with AR: education of patients and their parents, eliminating allergens, pharmacotherapy (nasal glucocorticoids, nasal and oral antihistamines, alpha-mimetics, anticholinergics, anti-leukotrienes, cromones, anti-IgE therapy), and allergen immunotherapy (subcutaneous and sublingual) [1-3]. Due to the high incidence of AR, the negative impact of the disease on the quality of life, and incomplete effectiveness of previously available therapeutic methods, new methods of treatment are being developed [4]. Literature sources and the authors’ own experiences indicate the possibility of using bacterial lysates, probiotics and vitamin D in AR therapy for children. Polyvalent Bacterial Lysates (PBL) Polyvalent bacterial lysates (PBL) are a mixture of antigens obtained from inactivated bacteria which are the most common etiologic agents of infections of the respiratory system. PBL have been used for many years to prevent respiratory infections in children and adults. In addition, they shorten the duration of respiratory infections and reduce the frequency of antibiotic therapy. We can divide PBL according to the method of obtaining them into chemical (PCBL) and mechanical lysates (PMBL). It is postulated that mechanical lysates show a higher immunogenic potential compared to chemical lysates [5]. Recent research highlights the immunoregulatory potential of PBL, indicating the possibility of their future use in the prevention and treatment of other diseases, including atopic dermatitis, AR, and asthma [6- 13]. In Banche, we find evidence of the effectiveness of bacterial lysates in SAR therapy. The authors of the study found a clinically significant improvement in the severity of SAR symptoms in 61.5% of patients receiving PMBL, while in the remaining patients of this group (38.5%) they did not observe improvement or worsening of the disease vs. the placebo group, in which SAR deterioration occurred in 53.4% of subjects [9]. In the 2017 grass pollen season, the authors of this article conducted a randomized, open-label study, assessing the effect of PMBL on the clinical course of SAR. The study was performed on a group of 38 children aged 5-17 years suffering from SAR caused by grass pollen. Patients were randomly divided into two groups. One group received additional PMBL during the grass pollen season, and the remaining patients used only standard AR therapy. In patients treated with additional PMBL, the severity of SAR decreased vs. the group not taking PMBL in the second half of the grass pollen season [14]. The obtained results prompted the authors to re-conduct the study in the following season of grass pollination (2018). This was a multi-centre, prospective randomized, double-blind, placebo-controlled study in parallel groups (PMBL vs. placebo), whose strongly positive results will be presented at the EAACI 2019 congress in Lisbon. Introduction Allergic rhinitis (AR) is an inflammatory process of the nasal mucosa, most often IgE dependent, caused by environmental allergens. Typical symptoms of the disease are: an aqueous secretion from the nose, nasal congestion, itching of the nose and sneezing, which disappear spontaneously or under the influence of treatment. AR is the most common allergic disease in the world, affecting 5-40% of the pediatric population [1]. Due to the time of exposure to the agent causing allergic rhinitis, it can be divided into seasonal (SAR) and perennial (PAR). Currently, there are four ways of dealing with patients with AR: education of patients and their parents, eliminating allergens, pharmacotherapy (nasal glucocorticoids, nasal and oral antihistamines, alpha-mimetics, anticholinergics, anti-leukotrienes, cromones, anti-IgE therapy), and allergen immunotherapy (subcutaneous and sublingual) [1-3]. Due to the high incidence of AR, the negative impact of the disease on the quality of life, and incomplete effectiveness of previously available therapeutic methods, new methods of treatment are being developed [4]. Literature sources and the authors’ own experiences indicate the possibility of using bacterial lysates, probiotics and vitamin D in AR therapy for children. Polyvalent Bacterial Lysates (PBL) Polyvalent bacterial lysates (PBL) are a mixture of antigens obtained from inactivated bacteria which are the most common etiologic agents of infections of the respiratory system. PBL have been used for many years to prevent respiratory infections in children and adults. In addition, they shorten the duration of respiratory infections and reduce the frequency of antibiotic therapy. We can divide PBL according to the method of obtaining them into chemical (PCBL) and mechanical lysates (PMBL). It is postulated that mechanical lysates show a higher immunogenic potential compared to chemical lysates [5]. Recent research highlights the immunoregulatory potential of PBL, indicating the possibility of their future use in the prevention and treatment of other diseases, including atopic dermatitis, AR, and asthma [6- 13]. In Banche, we find evidence of the effectiveness of bacterial lysates in SAR therapy. The authors of the study found a clinically significant improvement in the severity of SAR symptoms in 61.5% of patients receiving PMBL, while in the remaining patients of this group (38.5%) they did not observe improvement or worsening of the disease vs. the placebo group, in which SAR deterioration occurred in 53.4% of subjects [9]. In the 2017 grass pollen season, the authors of this article conducted a randomized, open-label study, assessing the effect of PMBL on the clinical course of SAR. The study was performed on a group of 38 children aged 5-17 years suffering from SAR caused by grass pollen. Patients were randomly divided into two groups. One group received additional PMBL during the grass pollen season, and the remaining patients used only standard AR therapy. In patients treated with additional PMBL, the severity of SAR decreased vs. the group not taking PMBL in the second half of the grass pollen season [14]. The obtained results prompted the authors to re-conduct the study in the following season of grass pollination (2018). This was a multi-centre, prospective randomized, double-blind, placebo-controlled study in parallel groups (PMBL vs. placebo), whose strongly positive results will be presented at the EAACI 2019 congress in Lisbon. Probiotics A lot of experimental and clinical data points to the possible benefits of probiotics in the pollen season in children and adults with AR. The results of research in this area carried out up to 2015 were summarized by Zajac et al. [15] and Güvenç et al. [16] in their meta-analyses. The first meta-analysis included 23 studies with 1919 adult and pediatric patients with SAR or PAR treated with 3 weeks to 12 months with probiotic or placebo. Seventeen studies showed a significant clinical benefit from the use of probiotics in at least one outcome measure when compared to placebo, while 6 trials showed no benefit. Meta-analysis demonstrated significant improvement in Rhinitis Quality of Life (RQLQ) global scores compared to placebo (SMD -2.23, p=0.02) and RQLQ nasal symptom score (SMD -1.21, p<0.00001), but no effect was found for Rhinitis Total Symptom Scores, total IgE or allergen-specific IgE levels. To the second meta-analyses 22 randomized, double-blind, placebo-controlled studies were included with 2242 patients aged 2 to 65 years with SAR or PAR. Patients received daily probiotic or placebo for 4 weeks to 12 months as an adjuvant to standard allergy therapies. Seventeen trials showed significant benefit of probiotics clinically, whereas eight trials showed significant improvement in immunologic parameters compared with placebo. All five studies with Lactobacillus paracasei (LP) strains demonstrated clinically significant improvements compared with placebo. Probiotics showed significant reduction in nasal and ocular symptoms score (SMD -1.23, p<0.001; and -1.84, p<0.001; respectively), total, nasal, and ocular Quality of Live (QoL) scores compared with placebo (SMD -1.84, p<0.001; SMD -2.30, p=0.006; and SMD -3.11, p=0.005; respectively). Although heterogeneity was high, in subgroup analysis, SMD for total, nasal and ocular symptoms with patients with SAR and for nasal QoL scores for studies with LP-33 strain were significant and homogenous. Scores of nasal blockage, rhinorrhea, and nasal itching were significantly lower in the probiotic group compared with placebo. The T-helper 1 to T-helper 2 ratio was significantly lower in the probiotic group compared with placebo (SMD -0.78, p=0.045).
Authors and Affiliations
Janeczek K, Emeryk A
Keywords
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- EP ID EP594795
- DOI 10.26717/BJSTR.2019.14.002623
- Views 161
- Downloads 0
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