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Published on: April 6, 2017
Ipratropium nasal spray in children with perennial rhinitis
E O Meltzer1, H A Orgel, R Biondi
1Allergy & Asthma Medical Group & Research Center, APC; San Diego, California, USA.
Insights
Ipratropium nasal spray effectively reduced rhinorrhea in pediatric patients with perennial nonallergic rhinitis. It also improved quality of life, with few side effects in both allergic and nonallergic rhinitis groups.
Area of Science:
- Otolaryngology
- Allergy and Immunology
- Pediatric Pulmonology
Background:
- Perennial rhinitis, characterized by persistent nasal symptoms, significantly impacts children's quality of life.
- Rhinorrhea is a primary complaint in pediatric perennial rhinitis, necessitating effective treatment options.
- Current therapeutic strategies for pediatric rhinitis require further evaluation for efficacy and safety.
Purpose of the Study:
- To assess the efficacy and safety of ipratropium nasal spray compared to placebo in managing rhinorrhea in pediatric patients.
- To evaluate the impact of ipratropium nasal spray on the quality of life for children experiencing perennial rhinitis.
- To determine optimal dosing frequencies for ipratropium nasal spray in different types of perennial rhinitis.
Main Methods:
- A multicenter, double-blind, parallel-group study involving pediatric patients aged 6-18 years.
- Randomized administration of ipratropium nasal spray (42 mcg/nostril) or placebo, twice daily for 4 weeks.
- Evaluation of nasal symptoms, particularly anterior rhinorrhea, and quality of life assessments.
Main Results:
- Ipratropium nasal spray demonstrated significant reduction in rhinorrhea, especially in patients with perennial nonallergic rhinitis (PNAR).
- A modest decrease in rhinorrhea severity was observed in patients with perennial allergic rhinitis (PAR) during the initial 2 weeks.
- Quality of life improvements were noted, particularly in PNAR patients, with comparable adverse event profiles between groups.
Conclusions:
- Ipratropium nasal spray (0.03%, 42 mcg/nostril twice daily) is a safe and effective treatment for anterior rhinorrhea in pediatric PNAR.
- Twice-daily dosing appears adequate for PNAR, while PAR patients might benefit from more frequent administration (e.g., three times daily).
- Further research may explore optimized ipratropium dosing strategies for perennial allergic rhinitis in pediatric populations.
Objective:
To compare the efficacy and safety of ipratropium nasal spray and placebo administered twice each day for 4 weeks in pediatric patients with perennial rhinitis who had rhinorrhea as a major complaint.
Methods:
This was a multicenter, double-blind, parallel group study. Patients aged 6 to 18 years with symptoms of perennial nonallergic (PNAR) or perennial allergic rhinitis (PAR) were randomized to receive ipratropium (42 micrograms per nostril) or placebo nasal spray, double-blind, twice each day for 4 weeks. Efficacy was evaluated by nasal symptoms, especially anterior rhinorrhea, and quality of life. Previous caregivers for rhinitis and medications used in the past were also evaluated.
Results:
A total of 202 patients were empanelled, 162 with PAR, 40 with PNAR; of these 151 with mild-severe rhinorrhea were evaluated for efficacy. Treatment with ipratropium reduced symptoms of rhinorrhea primarily in patients with PNAR. In patients with PAR this response was less pronounced, and was seen as a modest decrease in the severity of rhinorrhea noted in the first 2 weeks of treatment. Quality of life assessments confirmed that rhinorrhea was bothersome to these pediatric patients, and suggested that treatment with ipratropium nasal spray was associated with an improvement, especially in the patients with PNAR. There were few adverse events; these were similar in the two treatment groups.
Conclusions:
Ipratropium nasal spray 0.03% administered at a dose of 42 micrograms/nostril bid is a safe and effective new therapy for control of anterior rhinorrhea in pediatric patients with PNAR. Twice daily administration is adequate for patients with PNAR, but patients with PAR might benefit from more frequent administration (e.g., tid).
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