Continuous antihistamine treatment controls allergic inflammation and reduces respiratory morbidity in children with mite allergy.
BACKGROUND
Allergic reaction is characterized by a complex inflammatory process. Some of the new antihistamines have antiallergic effects and can affect the inflammatory cell recruitment via adhesion molecule downregulation. We aimed to assess in a 12-month study whether continuous treatment with an antihistamine (terfenadine) can reduce respiratory symptoms and local inflammation in children with mite allergy.


METHODS
The study was double-blind and placebo-controlled: it involved two parallel groups of children suffering from rhinoconjunctivitis and/or mild intermittent asthma due to mite allergy. They received either terfenadine (1 mg/kg per body weight per day) or placebo for 1 year. Nasal, conjunctival, and bronchial symptoms were recorded by diary cards; at each of the programmed control visits, a nasal scraping for inflammatory cells and ICAM-1 was performed. Some additional clinical parameters were also recorded: days of school absence, extra visits for acute respiratory symptoms, and days of hospital admission.


RESULTS
Only children treated with terfenadine achieved significant control of symptoms (P<0.05 in 8 out of 12 months) and allergic inflammation, as shown by inflammatory cell infiltrate and ICAM-1 expression at nasal level (P<0.001), and had significantly fewer extra visits and school absences than the placebo group (P<0.03). No side-effects were reported in either group.


CONCLUSIONS
The present study demonstrates that continuous terfenadine treatment (1 mg/kg body weight per day) could decrease respiratory symptoms and allergic inflammation, and it had an additional antiallergic effect in reducing ICAM-1 expression on nasal epithelial cells. Therefore, the present results confirm the efficacy of a long-term therapeutic strategy in controlling allergic inflammation.
Ciprandi
G
G
Department of Internal Medicine, Genoa University, Italy.
Ricca
V
V
Tosca
M
M
Landi
M
M
Passalacqua
G
G
Canonica
G W
GW
D000293:Adolescent; D000818:Animals; D039741:Antigens, Dermatophagoides; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004391:Dust; D006023:Glycoproteins / Q000032:analysis*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007150:Immunohistochemistry; D018836:Inflammation Mediators / Q000097:blood; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D008925:Mites / Q000276:immunology*; D009297:Nasal Mucosa / Q000166:cytology / Q000276:immunology; D012130:Respiratory Hypersensitivity / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D016593:Terfenadine / Q000627:therapeutic use*; D016896:Treatment Outcome
D039741:Antigens, Dermatophagoides; D004391:Dust; D006023:Glycoproteins; D006634:Histamine H1 Antagonists; D018836:Inflammation Mediators; D018799:Intercellular Adhesion Molecule-1; D016593:Terfenadine