Allergy medicine p 43
BHMS, Diploma in Dermatology
5 years experience overall
Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect "real-world" everyday practice. Alleryg a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis AR using mobile technology. A mobile phone app Allergy Diary, freely available in Google Play and Apple App stores collects the data of daily visual analog scales VAS for i overall allergic symptoms, ii nasal, ocular, and asthma symptoms, iii work, as well as iv medication use using a medicine scroll list including all medications prescribed and over the counter OTC for rhinitis customized for 15 countries. A total of users filled in medicine days of Allergy in and Allergy were reported for days.
The skin barrier protective dysfunction causes the acceleration of secondary infection overlay and extraneous antigens penetration through damaged corneal layer. For the last twenty years in many countries there have been fixed the increase medicine prevalence of the disease [ 2967 allergy, 86 ], as well as the increase of severe and complicated AD incidence with permanently relapsing course that is resistant allergy basic traditional therapy BT [ 1059777880 ].
Acquiring the chronic course with frequent recurrence the disease keeps its clinical features for many years. Ethiopathogenetic reasons for AD are still the subject of wide discussion. Many patients with AD are sensitized to seasonal and perennial aeroallergens, which can play a key role in activation or retention of the skin disease occurrence.
However, it is rather problematic to obviate the pollen allergens—aeroallergens house dust mite, grass and medicine pollen. Among the most important etiological factors in AD development are allergens of house dust mites and their waste products HDMA.
List of Allergic Rhinitis Medications ( Compared) - xxrn.flypole.ru
At the moment, there have been distinguished 24 HDMA, mwdicine the families: Allergy mainly Dermatophagoides pteronyssinus, D.
Lepidoglyphus destructor, Blomia sp. Tyrophagus putrescentiae, Acarus siro [ allergy8889 ]. Due to high enzymatic activity HDMA are able to penetrate through the damaged epidermal skin barrier medicine patients with AD to get the access to immune cells. HDMA cause allergic response both of immediate and delayed types that leads to worsening of AD [ 13 ]. Gutgesell et al. In the medicine of patients with active treatment, special measures were conducted preventing the penetration of HDMA, but the control group did not receive it.
In addition, weekly on a visual analogue scale the patients themselves rated daily itching and itching, inducing insomnia. Some of the patients in the active treatment group reported the reduction of itching, inducing insomnia, however, the statistically significant differences between the groups were not revealed. In adult patients with Medicine it has been shown that allergy reduction of the Medicine impact during the year improves some clinical symptoms of the disease, but does not influence on the activity of the disease.
At the same time HDMA and other aeroallergens are successfully being used as potential preventive and therapeutic variant for AIT in treatment of patients with AD [ 51113262746545760 ]. Deep insight of immunological disorders contributing to the AD pathogenesis has caused the increase of interest in applying of AIT according to this disease.
AIT applying in case of AD requires thorough discussion and analysis of available clinical data to determine with certainty its positive or negative effect on the disease course. AIT in case of AD is still a subject of debates that take place in sessions of many scientific forums where scientists and clinicians express their opinions, discuss and provide evidences of the efficacy of this method or argue to restrict its use.
First encouraging randomized studies on applying SCIT for treatment of children and adults with AD were published in s. InWarner et al. In —90s results of double blind placebo-controlled studies were published where Ring [ 71 ] and Allergy et al. Thus, the allergy was carried out medicine treatment of identical twins suffering from atopic eczema with spring medicine summer exacerbationsone of whom got SCIT with grass pollen allergens and another—got placebo.
Patient who got immunotherapy showed significant improvement of clinical features and reduction of serum IgE levels Ring [ 82 ]. Glover et al. That demonstrated the necessity of carrying out such treatment for a long time to medicine the clinical effect.
And already in Silny et al. The level of allergy specific IgE in the SCIT group had a tendency to decrease, while in the placebo group it had a tendency to increase. Other series of studies not blind, placebo-controlled aolergy made by Silny et al. By the end of the treatment course there was determined clear reliable medicinee in the values of the studied immunological parameters between experimental and control group concentration of general and specific IgE, ECP, SIL-2R, IL-4, IL Of note, conducting randomized research in children is very difficult.
Good results were obtained in all studies that allowed the authors to consider SCIT to be quite prospective method of skin inflammation treatment and really effective and safe alternative method of treatment for patients with AD having Medicine allergy to aeroallergens. Allergy experience of using SCIT in children 5—18 years old with moderate and severe AD and sensitization to HDMA also has showed the positive results [ medicine — 3134357778808283 ].
Besides Allergy was pharmaco-economic efficiency. SLIT treatment is well tolerated, adverse reactions are local; mostly mrdicine reactions are in mouth cavity or gastrointestinal tract.
System reactions medicine to skin, respiratory tract or anaphylaxis 34 extremely rare [ 37 ]. SLIT is significant step forward and is particularly suitable for pediatric patients. However, to assess the clinical effectiveness there was made medicine number of clinical studies, including randomized, placebo-controlled. In Galli et al. A group of children with AD was divided into 2 parts: one of which was a control group and was given placebo. Two other groups got active treatment.
In Pajno G. A allergy result of this therapy was noticed only in the patients with mild, moderate AD, but not with severe form of AD.
Allergyy authors made a conclusion that SLIT can be an additional therapeutic tool for the treatment of allergic AD in properly selected, for such method, children. In an open, uncontrolled, non-randomized pilot study Cadario et al. Analysis of the result of tests carried out on adults and children showed that with a high degree of certainty it can be proven that high doses of SLIT, in its daily conduct, reduce both ADs symptoms and amount of drugs required for treatment.
Low doses allergy SLIT reduce the development of new sensibilizations and allergy mild allergy moderate form of AD course decrease the symptoms of the disease. In general, despite the dichotomous results presented in the studies, the meta-analysis provided moderate quality evidence allergy AIT efficacy in AD. However, these conclusions were based on analysis of a small number of randomized controlled studies with significant heterogeneity in research, which did not allow to make final conclusion about the efficacy of AIT in AD.
Pleskovic N. In Di Rienzo et al. Arkwright allergy al. Choi et al. The condition of the affected skin which was resistant to traditional therapy improved significantly. Based on that data the authors make a conclusion that SLIT with long-term use can be a safe alternative treatment of recurrent allergic AD.
By the evidences of SLIT efficacy in treatment of different AD were already allergy on the results of 77 clinical studies and 7 meta-analyses [ 62 ]. Medicine the fact that there is a great progress in introduction of Alleegy there are still a lot of questions that remain unanswered [ 2448 ].
One of them is the use of AIT in AD especially in children that causes wide discussions in the scientific circles [ 48 ]. Usually AIT in medicinee with AD is not used as a medicinr line therapy, so for infants and babies with positive family anamnesis of AD, AIT should be considered as an option for the secondary prevention from atopic diseases [ 17 ]. If children have AD on the background allergy AR or BA with sensitization to aeroallergens, AIT can be considered as a therapeutic agent to reduce the progression of concomitant respiratory pathology as well as to prevent the sensitization to unrelated allergens SCIT -[ 25387492 ]; SLIT — [ 365152 ].
However, the strength of immune response may vary and depends on individual characteristics of a child. At the moment it can be stated that AIT, in compliance with all necessary conditions for its implementation, medicine be really effective and safe treatment option for a specific group of patients with IgE-mediated AD with sensitization to aeroallergens in particular, to HDMA, grass and plants pollen allergens or in severe uncontrolled form of AD when the benefits of using AIT exceed the risk of adverse effects occurrence.
Also, there are the questions mentioned that still remain unanswered. For the AIT conduction there should be a strict selection of patients with prior research in the area to confirm the diagnosis of IgE-mediated disease. The preliminary diagnostics of immunopathogenetic phenotype of AD and pathophysiological disorders, including immune, will allow a doctor to develop the appropriate algorithm of complex treatment of AD in children, aimed at their correction.
Nowadays there is a lot of documents regulating the conduct of AIT in patients with respiratory medicije, including children, however there are still no clear recommendations regarding AD. All guidelines mark AD as a disease that requires further careful research. In AD, however, there is no clearly defined methodological base where all the guiding principles of AIT conduct could be registered, where could be taken into account the optimal medicine and schemes, safety of methods and possible allergy effects, the rules of first aid, indications and contraindications, impact on life quality, pharmaco-economic aspects, etc.
The new interpretation of Alletgy method has proved to be the most promising, as it has included the abilities of both immunotherapy methods: SCIT has quickly activated the tolerogenic to cause-significant allergens at the initial stage of treatment, and SLIT later has provided the safety in long-term use.
From medicnie point of view, this method can be interesting when conducting AIT in children with AD, but for sure it is necessary to carry out the randomized studies to medicine its efficacy. The important advantages medicjne AIT are: specific allergens and patients can be identified by suitable diagnostics; it is disease-modifying; it has long-lasting effect even after discontinuation; is more effective than pharmacotherapy.
However, therapeutic utilization remains at low level due to poor medixine inconvenient dosing; therapy with wild type allergen prone to have side effects. Medciine literature contains very limited evidence regarding the use of AIT in Allergy in children medicine dictates the need for additional large-scale randomized clinical trials with modern allergen and standardized protocols, the results of which will not only help to identify short-term and long-term protection from AD, but also to develop the guidelines and position papers regulating the use of AIT in children considering medicine peculiarities.
Most of the researches using AIT in AD in children are usually conducted in open uncontrolled trials or represent a series of reports on individual cases. These studies are difficult to compare, because there have been used the allergens from different pharmaceutical companies, doses and schemes of which, in this connection, are difficult to compare. Considering the excellent safety profile, the ability to influence on allergic inflammation, SLIT has huge potential to become a candidate for pathogenetic treatment of AD.
AIT, according medicine experts [ 121719 ], has the following main unmet needs:. The Lack of general standard doses of allergens aeroallergens in particular in extracts for AIT standardized extracts. Difficulty in conducting large-scale, double-blind placebo-controlled, blind, randomized clinical trials in children. An allerby of the situation can only be expected from the use of defined recombinant allergens [ 15 ].
However, the latest fundamental achievements in Immunology and Allergology have made a rapid breakthrough in the field of allerby the basic mechanisms of AIT allegry studying allergy major immune and not immune mechanisms of AD development, which are able not only to initiate the disease, but also affect on its duration and severity [ 34354243 medcine, 49578387 ].
In this regard the new strategies of AD treatment should include a comprehensive immunotherapy including the use medicine AIT and other biologically active agents able to interfere with pathophysiological processes [ 1 — 644 ].
Use of the successes of modern molecular allergology, in particular, Molecular-based allergy diagnostics Allergen Chip technology will help to optimize and personalize the process of selecting the necessary allergens to determine the most appropriate vaccines for children considering the results of the allergen component diagnostics. Microchip diagnostics in pediatric Allergy medicine very important for conducting AIT: risk assessment and prognosis, improvement of the accuracy of diagnosis and cross-reactive sensitization in poly-sensitized patients, thereby improving allergy understanding of triggering allergens; identifying patients and triggering allergens for AIT [ 18 ].
Microarray diagnostics in pediatric allergy is the perfect tool for the diagnosis of IgE sensitization and allergic diseases in children.Apr 18, · Debates in allergy medicine: specific immunotherapy efficiency in children with atopic dermatitis Tatiana A. Slavyanakaya, Vladislava V. Derkach, and Revaz I. Sepiashvili People’s Friendship University of Russia, Moscow, Moscow region RussiaCited by: 7. (9)Allergy and Respiratory Diseases, Department of Internal Medicine, IRCCS San Martino-IST-University of Genoa, Genoa, Italy. (10)Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, xxrn.flypole.ru by: Allergy information includes articles on allergies, symptoms, treatment, medications, food allergies, and allergy relief.
The joint efforts of scientists and clinicians will certainly bring the benefits and will help the patients with AD to cope with medocine disease. Tatiana Slavyanskaya is the first author.
Competing interests. All authors read and approved the final manuscript. Medicine A. Slavyanakaya, Email: ur. Vladislava V. Derkach, Email: medicune.
Revaz I. Sepiashvili, Email: moc. National Center for Biotechnology InformationU. World Allergy Organ J. Published online Apr SlavyanakayaVladislava V. Derkachand Revaz I. Mevicine information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Aug 20; Accepted Mar allergy This article has been corrected. See World Allergy Organ J. This article has been cited by other articles in PMC.
Abstract Allergen specific immunotherapy AIT has been the only pathogenetically meficine treatment of IgE-mediated allergic diseases ADs for many years.
Keywords: Allergy specific immunotherapy, Subcutaneous specific immunotherapy, Sublingual specific immunotherapy, Aeroallergen, Atopic dermatitis, Children, Clinical efficacy. Background Atopic dermatitis AD —is a chronic inflammatory allergic disease ADs of the skin with multifactorial pathogenesis. Atopic dermatitis and allergens Ethiopathogenetic reasons for AD are still the subject of wide discussion.
Open in a separate window. AIT for AD the optimism and the issues Despite the fact that there is a great progress in introduction of AIT there are still a lot of questions that remain unanswered [ 2448 ]. Possibly less effective at least first year Possibly more effective at least first year Optimal dosing of SLIT in drops Optimal dosing regimens are defined only for grass, ragweed and HDM tablets The possibility of using mixtures of multiple mediicne allergens Multiple allergen mixes can be less effective.
Conclusion The important advantages of AIT are: specific allergens and patients can be allergy by suitable diagnostics; it is disease-modifying; it has long-lasting effect even after discontinuation; is more effective than pharmacotherapy. Patient Convenience: fewer dose applications Safety: no anaphylaxis potential and no late phase reactions However, the latest fundamental achievements in Immunology and Allergology have made a rapid breakthrough in the field of discovering the basic mechanisms of AIT and studying the major immune and not immune mechanisms of AD development, which are able not only to initiate the disease, but also affect on its duration and severity [ 343542434957medicine87 ].
Footnotes Tatiana Slavyanskaya is the first author. Contributor Medicine Tatiana A. References 1. Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens. Mechanisms of allergen-specific immunotherapy.
J Allergy Clin Immunol. Mechanisms of immune tolerance to allergens: role of IL and Tregs. J Clin Invest. Akdis CA. Therapies for allergic inflammation: refining strategies to induce tolerance.
Nat Med. Akdis M, Akdis CA. Mechanisms of allergen-specific immunotherapy: multiple suppressor factors at work in immune tolerance to allergens. Update in the mechanisms of allergen-specific immunotherapy.
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Allergy Asthma Immunol Res. Atopic dermatitis in children. J Allergy Clin Immunol Pract. Avgerinou G. Atopic dermatitis: new immunologic allergy. Int J Dermatol. Efficacy of allergen-specific immunotherapy for atopic dermatitis: a systematic review and meta-analysis of randomized controlled trials. Boguniewicz M, Leung DY.
Recent insights into atopic dermatitis and implications for management of infectious complications. Bouton C, Ducommun J. Specific immunotherapy design medicine. Rev Med Suisse. Does allergen-specific immunotherapy represent a therapeutic option for patients with atopic dermatitis? Clinical improvement and immunological changes in atopic dermatitis patients undergoing subcutaneous immunotherapy with a house dust mite allergoid: a pilot study.
Clin Exp Allergy.
Debates in allergy medicine: specific immunotherapy efficiency in children with atopic dermatitis
Varying allergen composition and content affects the in vivo allergenic activity of commercial Dermatophagoides pteronyssinus extracts. Int Arch Allergy Immunol. Sublingual immunotherapy efficacy in patients with atopic dermatitis and house dust mites sensitivity: a prospective pilot study.
Curr Med Res Opin.
Pediatr Allergy Immunol. Sublingual immunotherapy: World Allergy Organization position paper update. Recommendations for appropriate sublingual immunotherapy SLIT clinical trials. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis AR using mobile technology.
A mobile phone app Allergy Diary, freely available in Google Play and Apple App stores collects the data of daily visual analog scales VAS for i overall allergic symptoms, ii nasal, ocular, and asthma symptoms, iii work, as well as iv medication use using a treatment scroll list including all medications prescribed and over the counter OTC for rhinitis customized for 15 countries.
A total of users filled in 17 days of VAS in and Medications were reported for days. The assessment of days appeared to be more informative than the course of the treatment as, in real medicine, patients do not medicine use treatment on a daily basis; rather, they appear to allergy treatment use with the loss of symptom control.
The Allergy Diary allowed differentiation between treatments within or between classes intranasal corticosteroid use containing medications and oral H1-antihistamines. The control of days differed between no [best control], single, or multiple treatments worst control.
This study confirms the usefulness of the Allergy Diary in accessing allergy assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment VAS on a mobile phone, shows novel findings, and generates new hypotheses. Published by John Wiley and Sons Ltd.
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Allergen specific immunotherapy AIT has been the only pathogenetically relevant treatment of IgE-mediated allergic diseases ADs for many years. This review presents results of scientific research, system and meta-analyses that confirm the clinical efficacy of AIT for children with AD who has the sensitization to allergens of house dust mite, grass and plant pollen suffering from co-occurring respiratory ADs and with moderate and severe course of allergic AD. There have been analyzed the most advanced achievements in AIT studies as well as there have been specified the unmet needs in AD.