Bibliographic updates

The Monthly choice
Claude MOLINA* and Jacques GAYRAUD**

1. Nasal filters for the treatment of Allergic Rhinitis
2. New data on Occupational Asthma
3. A new life for Tiotropium
4. Reduction of inhaled corticosteroids and risk of asthma exacerbations
5. Common variable Immunodeficiency: Clinical Picture and treatment of 2212 European patients

1. Nasal filters for the treatment of Allergic Rhinitis

Item: ENT Allergy
Key words: Seasonal rhinitis – Nasal filter

In a randomized, short clinical trial , P.Kenney et al (Aarhus Denmark JACI March 2014 in press) demonstrates that Rhinix ®, a new nasal filter, was significantly more effective than placebo in alleviating nasal symptoms in 24 adults with seasonal allergic rhinitis (SAR), primarily through its effect on nasal itching, sneezing, and nasal discharge. It is well tolerated and safe to use.

2. New data on Occupational Asthma

Item: Occupational asthma
Key words: Asthma – Irritant products

S.M Tarlo and C.Lemierre (NEJM 2014 370 Feb 640-649) review the classical sensitizer agents (High Molecular Weight such animals and Low MW such di-isocyanates) and focus on new agents (manufacture of cytotoxic drugs for example) but draw mainly attention to irritant induced asthma such airways dysfunction to persons exposed to very high levels of alkaline dust from the dramatic collapse of World Trade Center in New-York (Only 36% of subjects recovered after 9 years of follow-up). Work exposure may cause or exacerbate asthma. Primary and secondary prevention in most cases minimize the risk of long term impairment. However symptoms and airway hyper responsiveness persist in 70% of patients, even several years after exposure avoidance.

3. A new life for Tiotropium

Item: Respiratory Allergy
Key words: Tiotropium – Cough – Capsaïcine

(M.A.Birrell et al JACI 2014 3 133 679-687 London)
Recent studies have suggested that the Long Acting Muscarinic receptor Antagonist: Tiotropium, a drug widely prescribed for its bronchodilator activity in patients with COPD and asthma, improves symptoms and attenuates capsaicine induced cough in pre clinical and clinical challenge studies. The authors demonstrate for the first time, that Tiotropium inhibits TRPV1-mediated effects on sensory afferents through a mechanism unrelated to its anticholinergic activity, and account for possible other clinical benefits associated with taking Tiotropium.

4. Reduction of inhaled corticosteroids (ICS) and risk of asthma exacerbations.

Item: Asthma
Key words: Controlled asthma - Inhaled Corticosteroids

(J.B Hagan Mayo Clinic Rochester Allergy 2014 69 4 510-516).
Systematic review and meta-analysis of 206 randomized controlled trials confirm that decreasing by 50% the dose of ICS among stable asthmatics after a period of 4 weeks or more (according to international guidelines ) and comparing statistically to those who maintain a stable dose, do not affect the risk of asthma exacerbations after a mean follow-up of 22 weeks. This work supports the current European and American guidelines.

5. Common variable Immunodeficiency: Clinical Picture and treatment of 2212 European patients

Item: Clinical Immunology
Key words: Common variable Immunodeficiency - Hypogamma globulinemia

(B.Gathman JACI Feb 2014 in press) Data from 28 medical centers analyze retrospectively the clinical presentation, diagnostic and treatment of this entity, (also called hypogamma globulinemia) the common denominator of which, being a profound antibody deficiency caused by intrinsic defect of B cells and lack of T cell co-stimulation. The main features include respiratory tract infections (this infection- only type results in better quality of life), an early onset disease (≤ 10 years) male subjects (39,8%) ; splenomegaly enteropathy, auto-immunity, granulomas (not bronchectasis) form a set of interrelated symptoms. Immunoglobulin replacement, very different between centers, include doses ranging from 130 to 750mg/Kg/month, (patients with levels of less than 4g/L have poor clinical outcome), whereas higher levels reduce frequency of serious bacterial infections. A common electronic European registry of such patients, to synthesize diagnostic and treatment protocols, is strongly recommended.

Cl. Molina

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Last updated 31 October 2014