Rhinology. Supplement最新文献

This paper reviews all clinical studies involving the use of astemizole in children. The indications of seasonal allergic rhinitis, perennial rhinitis and various allergic disorders were considered in a total of 21 studies (1,008 patients). Reference compounds were placebo and other antihistamines, such as chlorpheniramine and terfenadine. Astemizole and other antihistamines were effective in the treatment of these disorders with a more favourable result for those treated with astemizole. Astemizole appeared very satisfactory as regards laboratory data and absence of side effects.

There are no studies available in the literature on the effects of classical antihistamines on the central nervous system (CNS) in children. Clinical studies indicate that somnolence occurs more often with classical antihistamines than with placebo. There is no difference in inducing somnolence in children between placebo and astemizole or terfenadine, two new antihistamines that have thoroughly been shown to have no sedative effect greater than placebo in adults. A double-blind, cross-over trial investigating the CNS-effects of astemizole and chlorpheniramine in schoolchildren failed to show a negative effect of either of these drugs on performance.

The one-year-prevalence rate of bronchial asthma in children varies from 1-3%, when investigated in general practice, to 5-7% in population studies. The prevalence rate is highest in young boys. Eighty percent of the asthmatic children are allergic, house-dust-mite allergy being the most common allergy. The one-year-prevalence rate of rhinitis is 5-10% in general practice, and 10-12% in population studies. Again, the prevalence rate is highest in young boys. About 90% of children with rhinitis symptoms are allergic, with pollen allergy as the most common allergy. Risk factors for developing allergic diseases are many. The predisposition is probably the most prevailing risk factor. Period of birth, sex, race, diet, the presence of other allergic diseases, tobacco smoking, pollution, and allergens in the environment, all these factors alone or in combination almost double the risk. There is no doubt that both asthma and hay-fever prevalences have steadily increased within the last 50 years. Also, admissions to hospitals for childhood asthma have continued to increase, while the mortality of asthma in children has not risen statistically. This increase is in contrast to the effective medication available for both asthma and allergic rhinitis, and to the number of preventive factors known to us today. The time has come to try to change it at all costs. The outcome of allergic rhinitis and asthma shows that only 10% are cured, 50% ameliorate, 30% remain unchanged, and 10% deteriorate. Factors determining the outcome are age, immunotherapy, sex, mother's age at childbirth, infections, other allergic diseases, and signs and symptoms of food allergy.(ABSTRACT TRUNCATED AT 250 WORDS)

Levocabastine is a novel H1-receptor antagonist for topical use, which is being investigated in allergic rhinitis (nasal spray) and conjunctivitis (eye drops). Its anti-allergic effects have been demonstrated in nasal and ocular provocation tests. Clinical studies have been performed in 1,363 patients with allergic rhinitis and 1,218 patients with allergic conjunctivitis, comparing levocabastine mainly to placebo and cromoglycate. Levocabastine was effective when used at a dose of 2 sprays per nostril or 1 drop per eye twice daily, which if necessary can be increased up to four times daily. Levocabastine was superior to placebo in alleviating symptoms such as sneezing, itchy nose, runny nose, itchy eyes, red eyes and lacrimation. In global evaluations some 60% of patients had good to excellent results with the nasal spray and some 75% with the eye drops. Levocabastine was shown to be as good or even slightly better than cromoglycate. Onset of action was fast, with 73% of patients reporting symptom relief within 30 min after administration of levocabastine nasal spray. Adverse experiences were similar in type and incidence with levocabastine, cromoglycate and placebo, for nasal spray as well as eye drops. The most frequent complaints were nasal and ocular irritation, respectively, with a similar incidence for the three drugs. Limited data are available in children so far, but they indicate response rate and adverse-experience profile to be similar to what was observed in adults. Levocabastine, thus, is an interesting new antihistamine available for topical use in allergic rhinoconjunctivitis. It has been extensively evaluated in adults, and preliminary data indicate that it can also be useful in allergic children.

Allergic rhinitis (AR) is a very common disease in children, often underdiagnosed and with underestimated complications. Its prevalence has increased during the last years, due to changes in environmental factors. The therapeutic strategy will include prevention by identification and eviction of the main allergens, associated to pharmacological therapy. Among antirhinitic drugs, the new generation of non-sedative specific antihistamines represent the main choice. We report our own experience with astemizole, one of these new antihistamines which confirms that astemizole is an effective and safe drug for the management of AR in children.

A brief overview has been given about types, diagnostics and therapy of midfacial fractures. The ENT-surgeon should play an important and active role in the treatment. In extended cases interdisciplinary cooperation will give better results.