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Efficacy of Pidotimod use in treating allergic rhinitis in a pediatric population
Giulia Brindisi1, Anna Maria Zicari2, Laura Schiavi2
1Department of Pediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy. giulia.brindisi@gmail.com.
Insights
Pidotimod improved nasal obstruction in children with allergic rhinitis (AR) and adenoidal hypertrophy (AH). However, this immunomodulator did not significantly alter the nasal microbiota composition in these pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Immunology
- Microbiology
Background:
- Allergic rhinitis (AR) and adenoidal hypertrophy (AH) are leading causes of pediatric nasal obstruction, often linked to recurrent respiratory infections.
- Nasal microbiota, including Staphylococcus aureus and viruses, plays a role in respiratory health and immune responses.
- Chronic inflammation in AR and AH presents an opportunity to study immunomodulators' effects on nasal obstruction and microbiota.
Purpose of the Study:
- To assess the efficacy of Pidotimod, an immunomodulator, in improving nasal obstruction in children with AR and/or AH.
- To investigate whether Pidotimod treatment influences the nasal microbiota composition in these children.
Main Methods:
- Seventy-six children were categorized into AR, AH, AR/AH, and control groups.
- Initial assessments included skin prick tests, nasal endoscopy, rhinomanometry, and nasal swabs.
- Children with AR and/or AH received Pidotimod treatment for one month, followed by repeat assessments.
Main Results:
- All patient groups showed improved mean nasal flow (mNF) after Pidotimod treatment.
- AR children's mNF reached levels comparable to controls; AH children (with or without AR) had lower mNF than controls and AR groups.
- No significant changes in nasal microflora were observed across any groups post-treatment.
Conclusions:
- Pidotimod effectively improves nasal obstruction in children, particularly those with AR.
- The therapeutic effect of Pidotimod on nasal obstruction in this study does not appear to be mediated by alterations in the nasal microbiota.
Background:
Allergic rhinitis (AR) and adenoidal hypertrophy (AH) are the most frequent causative disorders of nasal obstruction in children, leading to recurrent respiratory infections. Both nasal cavities are colonized by a stable microbial community susceptible to environmental changes and Staphylococcus aureus seems to play the major role. Furthermore, nasal microbiota holds a large number and variety of viruses with upper respiratory tract infections. This local microbiota deserves attention because its modification could induce a virtuous cross-talking with the immune system, with a better clearance of pathogens. Although AR and AH present a different etiopathogenesis, they have in common a minimal chronic inflammation surrounding nasal obstruction; hence it would be challenging to evaluate the effect of an immunomodulator on this minimal chronic inflammation with possible clinical and microbiological effects. The aim of this study is therefore to evaluate the efficacy of an immunomoldulator (Pidotimod) on nasal obstruction in children with AR and/or AH and whether its action involves a variation of nasal microbiota.
Methods:
We enrolled 76 children: those with allergic rhinitis (AR) sensitized to dust mites entered the AR group, those with adenoidal hypertrophy (AH) the AH group, those with both conditions the AR/AH group and those without AR ± AH as controls (CTRL). At the first visit they performed: skin prick tests, nasal fiberoptic endoscopy, anterior rhinomanometry, nasal swabs. Children with. AR ± AH started treatment with Pidotimod. After 1 month they were re-evaluated performing the same procedures. The primary outcome was the evaluation of nasal obstruction after treatment and the secondary outcome was the improvement of symptoms and the changes in nasal microflora.
Results:
All patients improved their mean nasal flow (mNF) in respect to the baseline. In AR children mNF reached that one of CTRL. In AH children±AR the mNF was lower in respect to CTRL and AR group. We did not find any differences among all the groups at the two different time points in nasal microflora.
Conclusions:
Pidotimod is able to give an improvement in nasal obstruction, especially in AR children but this effect seems to be not mediated by changes in nasal microbiota.
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