title: Can zinc be an adjuvant therapy for juvenile onset recurrent respiratory papillomatosis?
abstract: OBJECTIVE
  To report a severe case of juvenile onset recurrent respiratory papillomatosis (JORRP) controlled by zinc replacement therapy. To review the contemporary adjuvant therapies used in JORRP.
  
  
  METHODS
  The trial of zinc was described in terms of its effect on the inter-surgical interval, site score and clinical symptoms. Long-term follow-up with dose adjustment was detailed. Articles reporting trials of adjuvant therapies over the past 20 years were reviewed in terms of regimen used, mode of assessment, side effects and final outcome.
  
  
  RESULTS
  Zinc was effective in decreasing the severity of the disease, the rate of relapse and the need for surgery. There was an obvious relation between the dose used and the degree of improvement. Prolonged treatment seems to be needed to sustain the positive effect. No side effects were noticed over a 45-month follow-up period. The literature does support the role of zinc in modulating the immune system. Eight adjuvant therapies were reviewed as published in 40 reports. Interferon was the most used substance. It is definitely effective but often associated with relapse upon discontinuation. The effect of cidofovir was favorable yet not dramatic as initially expected. Other less commonly used therapies showed humble effects. The HspE7 vaccine seems to be promising awaiting further trials.
  
  
  CONCLUSIONS
  Zinc replacement therapy may benefit JORRP patients with zinc deficiency and should be investigated in more cases. Several adjuvant therapies are available for use in JORRP. They are generally beneficial though mostly not curative.
authors.affiliation: Section of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, American University of Beirut and Medical Center, Beirut, Lebanon. mb36@aub.edu.lb
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bitar
authors.forename: Rami
authors.initials: R
authors.lastname: Baz
authors.forename: Nabil
authors.initials: N
authors.lastname: Fuleihan
authors.forename: Musa
authors.initials: M
authors.lastname: Muallem
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002675:Child, Preschool; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use*; D010212:Papilloma / Q000188:drug therapy* / Q000601:surgery; D015032:Zinc / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D015032:Zinc; D000077404:Cidofovir