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[Effect of 2 therapeutic protocols in minor forms of respiratory allergy]
Insights
Specific immunotherapy significantly improved minor allergic respiratory diseases (MARD) in children compared to other treatments. This approach also reduced the progression to asthma in atopic children.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Immunotherapy
Background:
- Minor allergic respiratory diseases (MARD) are common in children and may be linked to inhalant allergens.
- Identifying the role of allergens and effective treatments for MARD is crucial for preventing disease progression.
Purpose of the Study:
- To investigate if MARD in children are caused by inhalant allergens.
- To evaluate the efficacy of two therapeutic protocols for MARD: specific immunotherapy vs. non-specific immunotherapy with adjunctive treatments.
Main Methods:
- A prospective study involving 261 children diagnosed with MARD.
- Allergen testing included PRIST, prick tests, and RAST for common inhalant allergens.
- Children were randomized into three groups: specific immunotherapy (n=64), non-specific immunotherapy (n=103), and a control group (n=67).
- Follow-up ranged from 1 to 4 years, monitoring disease improvement and progression to asthma.
Main Results:
- Specific immunotherapy demonstrated significantly higher improvement rates (83.6%) compared to non-specific immunotherapy (52.4%) and the control group (16.4%).
- Children receiving specific immunotherapy had a lower incidence of progressing to asthma (6%) compared to the non-specific group (23.3%) and control group (37.3%).
- Allergen testing revealed positive results in 56.5% of the children.
Conclusions:
- Specific immunotherapy is highly effective for atopic MARD in children.
- Non-specific immunotherapy with ketotifen and bacterial vaccines showed satisfactory results in non-atopic MARD.
- Regular monitoring of IgE levels and allergen testing is recommended for children with MARD, especially non-atopic cases.
Abstract:
The purpose of this prospective study was to determine in 261 children whether the "minor" allergic respiratory diseases (MARD) (chronic cough, bronchitis asthmatic, rhinopharyngitis, recurrent otitis media, croup) are due to inhalants allergens and, if so, whether they can be treated with two therapeutic protocols. First protocol (B) included nonspecific immunotherapy with bacterial vaccines aerosols + Fusafungin sprays and Ketotifen were employed in 103 children; and the second protocol (C) included specific immunotherapy with D. Pteronyssinus, in 64 children. This two formula were compared with a control group (67 children). The children were previous tested by PRIST, prick test with house dust, mite, pollens, moulds and by RAST to house dust and mite allergens (56.5% positive results). The follow up study was conducted over 1 to 4 years periods (mean = 1.95 years). Each child's behaviour was monitored regularly by parents and doctor. 54 children drop out this study. Specific hyposensitized children (C) had significant higher improvement (83.6% - p less than 0.01) than B protocol (52.4%) and than control group (16.4%) in overall population. During this study, 51 children with previous MARD go on to more serious obstructive lung disease - asthma: 37.3% in the control group, 23.3% in B group and 6% in hyposensitized group. The results suggest that it is important in children with MARD to monitor the levels of the total and specific Ig E and cutaneous reactions with prick test to common allergens; specific immunotherapy is highly indicated in atopic MARD; in non-atopic MARD children, ketotifen and nonspecific immunotherapy have satisfactory results. Total and specific Ig E levels and prick test must be repeated once a year in this non-atopic children in order to find the specific allergens.