DENVER—A novel P2Y2 receptor agonist has shown promise as a new therapy for allergic rhinitis (AR). This was one of the important findings reported at the 60th Anniversary Meeting of the American Academy of Allergy, Asthma and Immunology, which was held March 7 to 12 in Denver. Other topics presented at the meeting included the use of eye drops to ease nasal allergy symptoms, an intranasal pollen filter to decrease seasonal rhinitis severity, the association between AR and attention-deficit/hyperactivity disorder (ADHD), a comparison of anaphylaxis in adults and children, the safety of antibiotic desensitization for allergic patients, and the use of chest physiotherapy (CPT) for pediatric asthma.

NEW TREATMENT FOR ALLERGIC RHINITIS

INS37217, a P2Y2 receptor agonist that regulates mucosal hydration in respiratory epithelial tissue, may offer new hope to sufferers of AR. Schaberg et al compared the agent with placebo at concentrations of 5, 10, and 40 mg/mL in 59 patients. The drug was administered as two 100-µL sprays in each nostril. The 10-mg/mL dose caused significantly greater reductions in nasal congestion, rhinorrhea, and facial pain than did placebo. The other two doses also lowered patients’ symptoms, but the differences did not reach significance. All concentrations of the drug were well tolerated. INS37217 may become a useful new therapy for AR.

EYE DROPS MAY EASE NASAL ALLERGY SYMPTOMS

AR and allergic conjunctivitis often occur together. Researchers examined the effects of ketotifen fumarate 0.025% ophthalmic solution, an ocular antiallergy agent, on nasal allergy symptoms. Compared with placebo, administration of the eye drops produced a statistically significant attenuation in nasal symptoms, such as runny nose and nasal congestion. The researchers suggest that ketotifen fumarate be used as an adjunct to nasal spray: The drops may reach sites of allergic inflammation inaccessible to nasal spray.

POLLEN FILTER FOR SEASONAL RHINITIS

An intranasal pollen filter may decrease seasonal rhinitis symptoms associated with ragweed and Bermuda and Bahia pollen. O’Meara et al evaluated symptoms in 62 patients who had been randomly assigned to wear either a pollen filter or placebo device for two hours. The pollen filter significantly reduced major and total symptom severity, itchy nose, rhinorrhea, and number of sneezes. There were no significant differences between groups in postnasal drip, itchy ears, or cough. The greatest difference in subjects was seen after 20 minutes of sitting beside a ragweed patch. The pollen filter may be useful in managing allergies during periods of high allergen exposure.

IS THERE AN ASSOCIATION BETWEEN AR AND ADHD?

Both AR and ADHD are associated with learning difficulties and sleep disturbances in many pediatric patients. Brawley et al recently studied AR symptoms and skin test results for common allergens in 20 children with ADHD. The majority of children (75%) reported at least two symptoms of AR, such as nasal congestion or itchy eyes. All children had a family history of atopy, and 40% had asthma or atopic dermatitis. Of children who underwent physical examinations, 23% had classic physical findings of AR (eg, pale boggy turbinates). Furthermore, 69% of participants had one or more positive skin test results. The authors suggest treating the allergy symptoms of children with ADHD to ameliorate the cognitive difficulties associated with both conditions.

ANAPHYLAXIS IN ADULTS AND CHILDREN

Anaphylaxis differs in adult and pediatric patients, according to Friesen et al, who studied 47 children and 48 adults. Seventy percent of the pediatric patients were male, all had skin manifestations, and none had hypotension. In contrast, most of the adult patients were female, 80% had skin manifestations, and 10% had hypotension. The presence of laryngeal, stomach, and respiratory symptoms did not differ between the two groups. Food was the main cause of anaphylaxis in both groups; however, nuts were more likely to affect children, while seafood was more likely to affect adults. Less than half of either group had been given a prescription for epinephrine. The authors emphasize that physicians should be aware of the differences between children and adults who present with anaphylaxis.

ANTIBIOTIC DESENSITIZATION IN ALLERGIC PATIENTS

Patients with an IgE-mediated allergy to antibiotics may safely undergo desensitization if they need antibiotics to treat life-threatening bacterial infections. Turvey et al studied desensitization in 21 patients with a mean age of 23; 19 of them had cystic fibrosis. The majority of desensitizations were successful (75.4%). Of the cases that were terminated because of an allergic reaction, there were no fatalities; the patients were successfully treated with epinephrine, corticosteroids, and antihistamines. In 60% of unsuccessful desensitizations, the allergy was non-IgE related. Thus, desensitization is a safe and effective option when patients must be treated with antibiotics to which they have an IgE-mediated allergy.

CHEST PHYSIOTHERAPY FOR PEDIATRIC ASTHMA

Although NIH guidelines for asthma state that CPT is not beneficial in treating acute exacerbations, the therapy is still widely used. Hwan et al surveyed 200 pediatricians to ascertain their views on the use of CPT in children. Of the 85 pediatricians who responded, 60.2% felt that CPT had a role in the treatment of acute asthma and had used the therapy to manage a patient with an acute asthma exacerbation. Of the physicians who had used CPT, more than half (57.8%) had performed percussion therapy with or without postural drainage. Since so many pediatricians use CPT despite the lack of evidence to support the practice, the authors recommend more clinical studies of CPT to determine its safety and efficacy in treating acute asthma in children.

—Tamara Gibb