Pub Date : 2024-05-07DOI: 10.1007/s40629-024-00294-9
Julia Hurraß, Gerhard A. Wiesmüller
The AWMF S2k guideline “Medical clinical diagnostics for indoor mold exposure” was introduced in 2016. The guideline is based on a standardized procedure of the AWMF including a systematic literature search involving several medical disciplines. The expert group has updated this guideline in accordance with AWMF specifications. For this purpose, a new Medline search was carried out for the current version of the guideline up to June 2022 with additional search terms. The search results were evaluated and further narrowed down by means of abstract screening and, where applicable, evidence-based evaluation of the full texts. Medical guidelines on related topics were also taken into account. The updated guideline is available since October 2023. This is intended to close the existing knowledge gap for rational and efficient medical diagnostics for indoor mold contamination and provides 26 core statements and recommendations, which are presented in detail.
{"title":"The German guideline on medical clinical diagnostics for indoor mold exposure: key messages","authors":"Julia Hurraß, Gerhard A. Wiesmüller","doi":"10.1007/s40629-024-00294-9","DOIUrl":"10.1007/s40629-024-00294-9","url":null,"abstract":"<div><p>The AWMF S2k guideline “Medical clinical diagnostics for indoor mold exposure” was introduced in 2016. The guideline is based on a standardized procedure of the AWMF including a systematic literature search involving several medical disciplines. The expert group has updated this guideline in accordance with AWMF specifications. For this purpose, a new Medline search was carried out for the current version of the guideline up to June 2022 with additional search terms. The search results were evaluated and further narrowed down by means of abstract screening and, where applicable, evidence-based evaluation of the full texts. Medical guidelines on related topics were also taken into account. The updated guideline is available since October 2023. This is intended to close the existing knowledge gap for rational and efficient medical diagnostics for indoor mold contamination and provides 26 core statements and recommendations, which are presented in detail.</p></div>","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40629-024-00294-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141002328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1007/s40629-024-00295-8
Julia Hurraß, Rabea Teubel, Guido Fischer, Birger Heinzow, Gerhard A. Wiesmüller
The AWMF (Association of the Scientific Medical Societies) mold guideline “Medical clinical diagnostics for indoor mold exposure”—Update 2023 [44] concludes that there is limited or presumed evidence of a link between indoor dampness/mold exposure and health problems. However, there is inadequate or insufficient evidence for an association between indoor dampness/mold exposure and the environmental medical syndromes sick building syndrome (SBS), multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS). Newly coined terms, such as biotoxicosis and mold and vapor hypersensitivity syndrome (MDHS) or volatoxins, suggest a nosological specificity of a pathophysiological connection for which, however, there is no evidence to date. The background to this assessment is presented in this paper.
{"title":"What effect do mycotoxins, cell wall components, enzymes and other mold components and metabolites have on our health?","authors":"Julia Hurraß, Rabea Teubel, Guido Fischer, Birger Heinzow, Gerhard A. Wiesmüller","doi":"10.1007/s40629-024-00295-8","DOIUrl":"10.1007/s40629-024-00295-8","url":null,"abstract":"<div><p>The AWMF (Association of the Scientific Medical Societies) mold guideline “Medical clinical diagnostics for indoor mold exposure”—Update 2023 [44] concludes that there is limited or presumed evidence of a link between indoor dampness/mold exposure and health problems. However, there is inadequate or insufficient evidence for an association between indoor dampness/mold exposure and the environmental medical syndromes sick building syndrome (SBS), multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS). Newly coined terms, such as biotoxicosis and mold and vapor hypersensitivity syndrome (MDHS) or volatoxins, suggest a nosological specificity of a pathophysiological connection for which, however, there is no evidence to date. The background to this assessment is presented in this paper.</p></div>","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40629-024-00295-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1007/s40629-024-00293-w
Randolf Brehler, Uta Rabe
Molds are ubiquitous in our environment and are considered by the population to be the most important indoor pollutant problem [1]. The current 2023 update to the AWMF mold guideline [1] is intended to allay or channel fears and provide assistance for a sensible diagnosis and treatment decision.
The detection of an IgE-mediated allergy implies for allergists Allergen immunotherapy (AIT) as an established treatment option. However, compared to the well-validated AIT with pollen and house dust mites, the decision to use AIT with mold extracts must be weighed more heavily between the benefits and risks.
Spores of Alternaria alternata are found in high concentrations in the outdoor air. Due to the high allergenic potential and the small size of the spores, an Alternaria allergy often leads to bronchial asthma, especially in children. The effectiveness of AIT with Alternaria extracts has been tested in several studies; for other molds, especially those from the indoor environment, the efficacy and applicability is very limited.
In terms of differential diagnosis, it must be borne in mind that molds can not only cause common allergic reactions but can also be responsible for allergic bronchopulmonary mycoses/aspergillosis (ABPA), Aspergillus bronchitis, exogenous allergic alveolitis (EAA), invasive aspergillosis, mycoses and rhinosinusitis. Very high concentrations, which can occur particularly in workplaces, can also result in toxic effects (“organic dust toxic syndrome”); molds are also held responsible for mucous membrane irritation, odor effects and mood disorders [1].
霉菌在我们的环境中无处不在,被人们视为最重要的室内污染物问题[1]。目前,AWMF 于 2023 年更新了霉菌指南[1],旨在消除或疏导人们的恐惧心理,为做出合理的诊断和治疗决定提供帮助。然而,与使用花粉和室内尘螨的有效 AIT 相比,在决定使用霉菌提取物的 AIT 时,必须在利益和风险之间进行更多权衡。交替孢霉的孢子在室外空气中的浓度很高。由于交替孢霉具有很高的致敏性,而且孢子的体积很小,因此对交替孢霉过敏的人往往会引发支气管哮喘,尤其是儿童。有几项研究测试了用 Alternaria 提取物进行 AIT 的有效性;但对于其他霉菌,尤其是来自室内环境的霉菌,其有效性和适用性非常有限。在鉴别诊断方面,必须牢记的是,霉菌不仅会引起常见的过敏反应,还可能导致过敏性支气管肺霉菌病/曲霉菌病(ABPA)、曲霉菌性支气管炎、外源性过敏性肺泡炎(EAA)、侵袭性曲霉菌病、霉菌病和鼻炎。特别是在工作场所,极高浓度的霉菌也会导致中毒效应("有机粉尘中毒综合症");霉菌还可导致粘膜刺激、气味影响和情绪失调[1]。
{"title":"Allergen-specific immunotherapy for mold allergies","authors":"Randolf Brehler, Uta Rabe","doi":"10.1007/s40629-024-00293-w","DOIUrl":"10.1007/s40629-024-00293-w","url":null,"abstract":"<div><p>Molds are ubiquitous in our environment and are considered by the population to be the most important indoor pollutant problem [1]. The current 2023 update to the AWMF mold guideline [1] is intended to allay or channel fears and provide assistance for a sensible diagnosis and treatment decision.</p><p>The detection of an IgE-mediated allergy implies for allergists Allergen immunotherapy (AIT) as an established treatment option. However, compared to the well-validated AIT with pollen and house dust mites, the decision to use AIT with mold extracts must be weighed more heavily between the benefits and risks.</p><p>Spores of <i>Alternaria alternata</i> are found in high concentrations in the outdoor air. Due to the high allergenic potential and the small size of the spores, an Alternaria allergy often leads to bronchial asthma, especially in children. The effectiveness of AIT with Alternaria extracts has been tested in several studies; for other molds, especially those from the indoor environment, the efficacy and applicability is very limited.</p><p>In terms of differential diagnosis, it must be borne in mind that molds can not only cause common allergic reactions but can also be responsible for allergic bronchopulmonary mycoses/aspergillosis (ABPA), Aspergillus bronchitis, exogenous allergic alveolitis (EAA), invasive aspergillosis, mycoses and rhinosinusitis. Very high concentrations, which can occur particularly in workplaces, can also result in toxic effects (“organic dust toxic syndrome”); molds are also held responsible for mucous membrane irritation, odor effects and mood disorders [1].</p></div>","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40629-024-00293-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140669406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1007/s40629-024-00284-x
Emilio Narváez-Fernández, Valeria Herrera-Lasso, Lucía Quintana-Castanedo, Miguel González-Muñoz, Ana Fiandor
{"title":"First report of lymphocyte transformation test positivity in a delayed allergic reaction to ticagrelor","authors":"Emilio Narváez-Fernández, Valeria Herrera-Lasso, Lucía Quintana-Castanedo, Miguel González-Muñoz, Ana Fiandor","doi":"10.1007/s40629-024-00284-x","DOIUrl":"10.1007/s40629-024-00284-x","url":null,"abstract":"","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.1007/s40629-024-00288-7
Karin Weisser
{"title":"Toxicokinetics of aluminium—novel insights in an old adjuvant","authors":"Karin Weisser","doi":"10.1007/s40629-024-00288-7","DOIUrl":"https://doi.org/10.1007/s40629-024-00288-7","url":null,"abstract":"","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-04DOI: 10.1007/s40629-024-00287-8
Monika Raulf, Sabine Kespohl
The prevalence of sensitization to molds is low in healthy people, but significant in asthmatics. As it has not yet been possible to establish a cause-and-effect relationship between the presence of mold allergens and the occurrence of allergic symptoms, there is a great deal of uncertainty. The update of the S2k guideline “Medical–clinical diagnostics for indoor mold exposure” should help to objectify the topic. Based on the recommendations listed there for the diagnosis of suspected IgE-mediated mold allergy, this article presents the possibilities of skin tests, IgE determinations, and other in vitro test options, but also their limitations in clarifying the cause. Potential possibilities include component-resolved allergy diagnostics, while the limitations include the difficult standardization of test allergen extracts due to the complex allergen source and the insufficient commercial availability of the test extracts. A diagnostic algorithm is presented as a tool for a systematic approach to patients with suspected mold-associated respiratory allergy.
{"title":"Skin tests, serological IgE detection, basophil test—what is available, useful and helps to clarify a mold allergy?","authors":"Monika Raulf, Sabine Kespohl","doi":"10.1007/s40629-024-00287-8","DOIUrl":"10.1007/s40629-024-00287-8","url":null,"abstract":"<div><p>The prevalence of sensitization to molds is low in healthy people, but significant in asthmatics. As it has not yet been possible to establish a cause-and-effect relationship between the presence of mold allergens and the occurrence of allergic symptoms, there is a great deal of uncertainty. The update of the S2k guideline “Medical–clinical diagnostics for indoor mold exposure” should help to objectify the topic. Based on the recommendations listed there for the diagnosis of suspected IgE-mediated mold allergy, this article presents the possibilities of skin tests, IgE determinations, and other in vitro test options, but also their limitations in clarifying the cause. Potential possibilities include component-resolved allergy diagnostics, while the limitations include the difficult standardization of test allergen extracts due to the complex allergen source and the insufficient commercial availability of the test extracts. A diagnostic algorithm is presented as a tool for a systematic approach to patients with suspected mold-associated respiratory allergy.</p></div>","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40629-024-00287-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1007/s40629-024-00286-9
Jannik Stemler, Julia A. Nacov, Rosanne Sprute, Oliver A. Cornely, Marcus Joest, Sven Becker, Ludger Klimek
Aspergillus-associated diseases are rare and pose challenges for practitioners. Diagnosis is complex and requires rational, targeted, and multidisciplinary collaboration, as well as a high degree of expertise and an individualized approach. For the infectious diseases physician, the focus is on the question of infection or colonization. In severely immunocompromised patients, invasive aspergillosis occurs, which most frequently affects the lungs (IPA) and is characterized by invasive, destructive growth. This acute clinical picture is associated with a high mortality rate. Chronic pulmonary aspergillosis (CPA) develops on the basis of pre-existing changes in lung structure caused by other pulmonary diseases and often requires surgical treatment. Another chronic form is allergic bronchopulmonary aspergillosis (ABPA). It is often associated with bronchiectasis in patients with bronchial asthma or cystic fibrosis. Sinus mycoses are divided into non-invasive and invasive forms, which can occur in immunocompromised patients and most commonly affect the maxillary sinus. Here, local surgical measures are an obligatory part of treatment, whereas the non-invasive form usually has an allergic component. In addition, drug-based antifungal and/or anti-inflammatory therapy is used for all entities.
{"title":"Aspergillus-associated diseases from an infectious diseases and allergological perspective","authors":"Jannik Stemler, Julia A. Nacov, Rosanne Sprute, Oliver A. Cornely, Marcus Joest, Sven Becker, Ludger Klimek","doi":"10.1007/s40629-024-00286-9","DOIUrl":"10.1007/s40629-024-00286-9","url":null,"abstract":"<div><p><i>Aspergillus</i>-associated diseases are rare and pose challenges for practitioners. Diagnosis is complex and requires rational, targeted, and multidisciplinary collaboration, as well as a high degree of expertise and an individualized approach. For the infectious diseases physician, the focus is on the question of infection or colonization. In severely immunocompromised patients, invasive aspergillosis occurs, which most frequently affects the lungs (IPA) and is characterized by invasive, destructive growth. This acute clinical picture is associated with a high mortality rate. Chronic pulmonary aspergillosis (CPA) develops on the basis of pre-existing changes in lung structure caused by other pulmonary diseases and often requires surgical treatment. Another chronic form is allergic bronchopulmonary aspergillosis (ABPA). It is often associated with bronchiectasis in patients with bronchial asthma or cystic fibrosis. Sinus mycoses are divided into non-invasive and invasive forms, which can occur in immunocompromised patients and most commonly affect the maxillary sinus. Here, local surgical measures are an obligatory part of treatment, whereas the non-invasive form usually has an allergic component. In addition, drug-based antifungal and/or anti-inflammatory therapy is used for all entities.</p></div>","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40629-024-00286-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140214422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-06DOI: 10.1007/s40629-024-00285-w
Francisco Vega MD PhD, Azahara Lopez-Raigada MD, M. Victoria Mugica MD PhD, Rodrigo Jimenez-Saiz PhD, Carlos Blanco MD PhD
{"title":"Assessment of a fast challenge test with iodinated contrast media in allergic patients with anaphylaxis","authors":"Francisco Vega MD PhD, Azahara Lopez-Raigada MD, M. Victoria Mugica MD PhD, Rodrigo Jimenez-Saiz PhD, Carlos Blanco MD PhD","doi":"10.1007/s40629-024-00285-w","DOIUrl":"10.1007/s40629-024-00285-w","url":null,"abstract":"","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140263063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-29DOI: 10.1007/s40629-024-00283-y
Lukas Dirr, Katharina Bastl, Maximilian Bastl, Johannes M. Bouchal, Uwe E. Berger, Friðgeir Grímsson
Pollen allergy can have a significant impact on a person’s quality of life. Recently, food supplements have gained in importance for persons suffering from pollen allergy. Still, there is not much research data on the efficacy of food supplements and the experienced relief, especially when choosing study designs that require less effort than randomized controlled trials (RCT).
A food supplement containing an Astragalus membranaceus root extract was administered to 328 voluntary participants during the 2018 birch, grass and ragweed pollen season in Austria. Participants documented their symptoms and medication intake in the online Patients Hay-fever Diary (PHD). All participants were asked to answer a quality-of-life questionnaire at the end of the study. Alongside with the adherence rate the overall symptom load index (SLI) and the nasal symptoms of the participants were monitored and compared to a filtered group of users from the PHD.
The adherence rates range from 32.8% to 77.3%. Additional data like a quality-of-life questionnaire and the mean overall/nasal SLI showed differences between participants and the baseline. However, they were only statistically significant for the ragweed pollen season and the nasal symptoms.
The study design relied on the evaluation of crowd-source symptom data alone by comparing the participants with a baseline. The participant adherence turned out lower than expected; however a trend for reduced symptoms was found and is also supported by the quality-of-life questionnaire.
{"title":"Crowd-sourced symptom data in pollen allergy: testing a novel study approach for assessing the efficacy of food supplements","authors":"Lukas Dirr, Katharina Bastl, Maximilian Bastl, Johannes M. Bouchal, Uwe E. Berger, Friðgeir Grímsson","doi":"10.1007/s40629-024-00283-y","DOIUrl":"10.1007/s40629-024-00283-y","url":null,"abstract":"<p>Pollen allergy can have a significant impact on a person’s quality of life. Recently, food supplements have gained in importance for persons suffering from pollen allergy. Still, there is not much research data on the efficacy of food supplements and the experienced relief, especially when choosing study designs that require less effort than randomized controlled trials (RCT).</p><p>A food supplement containing an <i>Astragalus membranaceus</i> root extract was administered to 328 voluntary participants during the 2018 birch, grass and ragweed pollen season in Austria. Participants documented their symptoms and medication intake in the online Patients Hay-fever Diary (PHD). All participants were asked to answer a quality-of-life questionnaire at the end of the study. Alongside with the adherence rate the overall symptom load index (SLI) and the nasal symptoms of the participants were monitored and compared to a filtered group of users from the PHD.</p><p>The adherence rates range from 32.8% to 77.3%. Additional data like a quality-of-life questionnaire and the mean overall/nasal SLI showed differences between participants and the baseline. However, they were only statistically significant for the ragweed pollen season and the nasal symptoms.</p><p>The study design relied on the evaluation of crowd-source symptom data alone by comparing the participants with a baseline. The participant adherence turned out lower than expected; however a trend for reduced symptoms was found and is also supported by the quality-of-life questionnaire.</p>","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40629-024-00283-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140489593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-22DOI: 10.1007/s40629-023-00282-5
Ludger Klimek, Felix Klimek, Christoph Bergmann, Jan Hagemann, Mandy Cuevas, Sven Becker MHBA
Introduction
Pharmacotherapy is the main pillar in the treatment of allergic rhinitis. While antihistamines (AH) and intranasal glucocorticosteroids (INCS) have long been part of the therapeutic standard, a pharmacological combination of both active substances in a nasal spray has so far only been implemented and made available in two preparations in Germany. Recently, an intranasal olopatadine hydrochloride-mometasone furoate (Olo-Mom) combination was introduced as a nasal spray for the treatment of seasonal and perennial allergic rhinitis.
Methods
In a literature search, treatment options for allergic rhinitis were analyzed and the available evidence was determined by searching Medline, PubMed, and the national and international study (ClinicalTrials.gov) and guideline registers and the Cochrane Library. Human studies published on the topic in the period up to and including August 2023 were taken into account.
Results
Based on the international literature and previous experience, the results are summarized and recommendations are given. The drugs used in the pharmacotherapy of AR primarily include INCS, intranasal and oral AH, leukotriene antagonists, intranasal cromoglicic acid preparations, intranasal and oral vasoconstrictors, and nasal rinses. For patients with intermittent and persistent allergic rhinitis, INCS are the first-line therapy, but in many patients they do not work sufficiently or quickly enough. The fixed combination Olo-Mom nasal spray showed significant improvements in the Reflective Total Nasal Symptom Score (rTNSS) in two phase II clinical trials with twice-daily and once-daily administration. In phase III studies, Olo-Mom nasal spray administered twice daily showed significant improvements in rTNSS compared to placebo, olopatadine monotherapy, and mometasone monotherapy.
Conclusion
In summary, AH and INCS will remain the main groups of active ingredients in the treatment of allergic rhinitis in the future. In combination preparations such as the new combination nasal spray olopatadine hydrochloride-mometasone furoate, they are highly effective and safe, thus opening up new perspectives, especially for patients with moderate and severe allergic rhinitis from the age of 12 years.
导言药物疗法是治疗过敏性鼻炎的主要支柱。长期以来,抗组胺药(AH)和鼻内糖皮质激素(INCS)一直是治疗标准的一部分,但将这两种活性物质结合在鼻腔喷雾剂中的药理组合迄今为止只在德国实施过,并有两种制剂可供选择。方法在文献检索中,通过检索 Medline、PubMed、国内和国际研究(ClinicalTrials.gov)和指南登记册以及 Cochrane 图书馆,对过敏性鼻炎的治疗方案进行了分析,并确定了可用证据。结果根据国际文献和以往的经验,对结果进行了总结并给出了建议。用于 AR 药物治疗的药物主要包括 INCS、鼻内和口服 AH、白三烯拮抗剂、鼻内色甘酸制剂、鼻内和口服血管收缩剂以及鼻腔冲洗剂。对于间歇性和持续性过敏性鼻炎患者来说,INCS 是一线疗法,但对许多患者来说,INCS 的作用不够充分或不够迅速。固定复方 Olo-Mom 鼻腔喷雾剂在两项 II 期临床试验中显示,通过每天两次和每天一次的用药,鼻部症状总评分(rTNSS)有明显改善。在 III 期研究中,与安慰剂、奥洛帕他定单药治疗和莫美他松单药治疗相比,每天给药两次的 Olo-Mom 鼻腔喷雾剂显示 rTNSS 有明显改善。在盐酸奥洛他定-糠酸莫米松新型复方鼻喷雾剂等复方制剂中,它们具有高效、安全的特点,从而开辟了新的前景,尤其适用于 12 岁以上的中度和重度过敏性鼻炎患者。
{"title":"Efficacy and safety of the combination nasal spray olopatadine hydrochloride-mometasone furoate in the treatment of allergic rhinitis","authors":"Ludger Klimek, Felix Klimek, Christoph Bergmann, Jan Hagemann, Mandy Cuevas, Sven Becker MHBA","doi":"10.1007/s40629-023-00282-5","DOIUrl":"10.1007/s40629-023-00282-5","url":null,"abstract":"<div><h3>Introduction</h3><p>Pharmacotherapy is the main pillar in the treatment of allergic rhinitis. While antihistamines (AH) and intranasal glucocorticosteroids (INCS) have long been part of the therapeutic standard, a pharmacological combination of both active substances in a nasal spray has so far only been implemented and made available in two preparations in Germany. Recently, an intranasal olopatadine hydrochloride-mometasone furoate (Olo-Mom) combination was introduced as a nasal spray for the treatment of seasonal and perennial allergic rhinitis.</p><h3>Methods</h3><p>In a literature search, treatment options for allergic rhinitis were analyzed and the available evidence was determined by searching Medline, PubMed, and the national and international study (ClinicalTrials.gov) and guideline registers and the Cochrane Library. Human studies published on the topic in the period up to and including August 2023 were taken into account.</p><h3>Results</h3><p>Based on the international literature and previous experience, the results are summarized and recommendations are given. The drugs used in the pharmacotherapy of AR primarily include INCS, intranasal and oral AH, leukotriene antagonists, intranasal cromoglicic acid preparations, intranasal and oral vasoconstrictors, and nasal rinses. For patients with intermittent and persistent allergic rhinitis, INCS are the first-line therapy, but in many patients they do not work sufficiently or quickly enough. The fixed combination Olo-Mom nasal spray showed significant improvements in the Reflective Total Nasal Symptom Score (rTNSS) in two phase II clinical trials with twice-daily and once-daily administration. In phase III studies, Olo-Mom nasal spray administered twice daily showed significant improvements in rTNSS compared to placebo, olopatadine monotherapy, and mometasone monotherapy.</p><h3>Conclusion</h3><p>In summary, AH and INCS will remain the main groups of active ingredients in the treatment of allergic rhinitis in the future. In combination preparations such as the new combination nasal spray olopatadine hydrochloride-mometasone furoate, they are highly effective and safe, thus opening up new perspectives, especially for patients with moderate and severe allergic rhinitis from the age of 12 years.</p></div>","PeriodicalId":37457,"journal":{"name":"Allergo Journal International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40629-023-00282-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}