Jorge Mazza

Once daily mometasone furoate aqueous nasal spray is as effective as twice daily beclomethasone dipropionate for treating perennial allergic rhinitis patients

BACKGROUND Perennial allergic rhinitis is chronic and persistent, may lead to a constellation of secondary complaints including sinusitis, mouth-breathing, and some symptoms resembling a permanent cold, and often requires constant medical intervention. Well-tolerated nasal corticosteroids, alone or in combination with antihistamines, have been found to be very effective in treating this condition. OBJECTIVE To compare the effectiveness and tolerability of mometasone furoate aqueous suspension, a new once daily nasal spray, to placebo vehicle and to beclomethasone dipropionate, administered twice daily, in patients with perennial allergic rhinitis. METHODS This was a randomized, double-blind, placebo-controlled, double-dummy, parallel group study, in 427 patients age 12 years and older at 24 centers in Canada and Europe. Patients allergic to at least one perennial allergen, confirmed by medical history, skin testing, and adequate symptomatology were eligible to receive one of the following regimens for 3 months: mometasone furoate, 200 micrograms only daily; beclomethasone dipropionate, 200 micrograms twice daily (400 micrograms total dose); or placebo vehicle control. The primary efficacy variable was the change from baseline in total AM plus PM diary nasal symptom score over the first 15 days of treatment. RESULTS Three hundred eighty-seven patients were valid for efficacy. For the primary efficacy variable, mometasone furoate was significantly (P < or = .01) more effective than placebo and was indistinguishable from beclomethasone dipropionate. Similar trends were seen among individual symptoms, physician symptom evaluations, and therapeutic response. There was no evidence of tachyphylaxis. All treatments were well tolerated. CONCLUSIONS Mometasone furoate nasal spray adequately controls symptoms of perennial allergic rhinitis, offers the advantage of once daily treatment, and is well tolerated.

Tourette's Syndrome in Patients Referred for Allergy Evaluation

BACKGROUND Tourettes syndrome is a relatively common disorder that may present as a spectrum that can include both motor and behavioral features. METHODS We report four patients referred to allergists to rule out atopy as a reason fro their presumed respiratory symptoms who were subsequently found to have Tourettes syndrome. A review of the literature was also performed using Medline. RESULTS The symptoms of Tourettes syndrome may overlap those associated with allergy involving the respiratory tract. There is little published information on the association of Tourettes syndrome with atopy. CONCLUSIONS Allergists should be aware of Tourettes syndrome and the variable clinical spectrum of this disorder as Tourettes syndrome patients may be referred prior to the diagnosis of Tourettes syndrome.

Budesonide aqueous nasal spray and pressurized metered dose inhaler in the treatment of adult patients with seasonal allergic rhinitis.

Budesonide, a topical corticosteroid used in the treatment of seasonal allergic rhinitis, can be administered to the nose as an aerosol via a pressurized metered dose inhaler (pMDI) or as a metered nasal pump spray. Studies have shown that about 64% (256 μg) of a nominal dose of 400 μg budesonide pMDI preparation is delivered to the patient compared with 100% of the nominal dose of the pump spray. The present study was undertaken to assess the efficacy and safety of budesonide delivered via a nasal pMDI twice daily (Rhinocort® pMDI, at 400 μg/day) with an aqueous suspension of budesonide delivered via a metered nasal pump spray once daily (Rhinocort® Aqua, at 256 μg/day or 400 μg/day). The multicenter, double-blind, randomized, placebo-controlled, parallel-group study was conducted in 318 patients (154 men, 164 women; aged 12–67 years) with ragweed-induced seasonal allergic rhinitis. A 1-week baseline period was followed by a 3-week treatment. Nasal symptoms were recorded by the patients, adverse events were noted, an overall evaluation of treatment efficacy was made, and urine cortisol and creatinine levels were measured. Substantial or total control of symptoms was achieved in 83.8% of patients treated with 256 μg of aqueous budesonide, 76.3% with 400 μg of aqueous budesonide, and 80.8% with 400 μg of budesonide pMDI; these were all significantly different (p < 0.001) compared with placebo (23.4% of patients). There were no significant differences in the 24-hour urine cortisol levels between the groups and there were few, infrequent adverse events, similar between the groups and resolved completely on discontinuation of treatment. It was concluded that budesonide, given once daily as 256 μg or 400 μg in an aqueous suspension or twice daily as 400 μg in a pMDI provides good alleviation of the symptoms of seasonal allergic rhinitis with no significant risk of suppression of urine cortisol.

Food allergy and PPI-responsive esophageal eosinophilia

Background Eosinophilic esophagitis (EoE) is considered a chronic condition mediated by immune reaction to food and/or environmental allergens. Though first recognized decades ago, the characterization of EoE is ongoing and an important aspect of this process is the distinction between EoE and other forms of esophageal eosinophilia [1,2]. One group of patients exhibit marked esophageal eosinophilia (>15 eo/HPF), negative esophageal pH-monitoring studies and yet have clinicopathologic response to proton-pump inhibitor (PPI) treatment: this group is categorized as having PPI-responsive esophageal eosinophilia (PPI-REE) [1,3]. It is not certain whether those with PPI-REE are cases of GERD undiagnosed by pH-monitoring, EoE responding to PPI therapy as in-vitro studies suggest [4], or some combination thereof. GERD is orders of magnitudes more prevalent than EoE and thus misdiagnosed cases of GERD could have significant impact on any study of EoE patients [5,6]. Other groups have attempted to distinguish cases of PPI-REE and EoE, but failed to do so using clinicopathologic criteria [7,8]. This retrospective review of patients diagnosed with EoE aimed to differentiate PPI-REE and non-responsive patients, with an emphasis on prevalence of food allergy between the two groups.

Monitoring of peanut-allergic patients with peanut-specific IgE.

Peanut allergy affects approximately 1% of the population. Double-blind placebo-controlled food challenges are gold standard for diagnosis. Serum peanut-specific IgE (PN-IgE) is used in clinical practice as an additional diagnostic and monitoring tool. The purpose of this study was to characterize the clinical features of a peanut-allergic patients cohort and determine the optimum frequency of measuring PN-IgE to predict the outcome of future peanut challenges. Retrospective chart review was performed of peanut-allergic patients followed up and serially tested for PN-IgE with a qualitative antibody fluorescent-enzyme immunoassay performed at the Immunology Laboratory, London Health Sciences Center, from 1997 to 2004. One hundred eighteen patients (median age at first reaction to peanut, 1.5 years; median baseline PN-IgE, 18.75) were reviewed. Younger age at first reaction and first PN-IgE measurement predicted slower decline of PN-IgE values (p < 0.001 and p = 0.044). At 2 and 5 years post-initial measurement, 12.9 and 66%, respectively, of all patients had a significant decrease of PN-IgE values. Twenty percent of the patients experienced elevation of PN-IgE levels during follow-up. For most patients with significant history of reaction to peanuts and positive skin-prick test, it is probably adequate to measure serum PN-IgE levels every 3-5 years to screen for development of tolerance and predict the outcome of future peanut challenges. More frequent measurements might be considered in older patients with lower initial PN-IgE levels.