title: Children passive smoking jeopardises the efficacy of standard anti-allergic pharmacological therapy, while sublingual immunotherapy withstands.
abstract: BACKGROUND
  The association between genetic predisposition and environmental risk factors such as passive smoke in determining respiratory allergies is still uncertain; even less is known about the role played by passive smoking in influencing the success of therapy for rhinitis and allergic asthma.
  
  
  OBJECTIVE
  The purpose of this prospective, randomised study was to determine whether passive smoking influences the outcome of therapies in paediatric patients with allergic respiratory diseases.
  
  
  METHODS
  The study included 68 children (mean age 11.51 years; range: 5-17) suffering from perennial rhinitis and intermittent asthma monosensitised to Dermatophagoides. Thirty-four subjects were exposed to daily passive smoking in their families, 34 were not. The two groups have been then randomised to receive continuous treatment with cetirizine or SLIT for three years.
  
  
  RESULTS
  There were 3/34 (8.8%) dropouts in the SLIT arm and 4/34 (11.7%) in the cetirizine arm. After three years, the patients exposed to passive smoking showed higher nasal eosinophilia, a worse clinical-symptomatic and pharmacological score with a worsened bronchial reactivity and functional indices of persistent asthma, regardless of how they had been treated. Nevertheless, SLIT prevented the worsening of all the clinical parameters more than the antihistamine alone either among the children exposed to smoking or not.
  
  
  CONCLUSIONS
  Exposure to passive smoking in children suffering from respiratory allergies due to Dermatophagoides decreased the clinical response to both drug therapy and SLIT. Nonetheless, while the children submitted to drug therapy worsened or did not show any significant improvement, the ones treated with SLIT improved.
authors.affiliation: Pneumology Unit, Cuasso al Monte, Macchi Hospital Foundation, Varese, Italy. maurizio marogna@libero.it
authors.forename: M
authors.initials: M
authors.lastname: Marogna
authors.forename: A
authors.initials: A
authors.lastname: Massolo
authors.forename: F
authors.initials: F
authors.lastname: Colombo
authors.forename: P
authors.initials: P
authors.lastname: Isella
authors.forename: M
authors.initials: M
authors.lastname: Bruno
authors.forename: P
authors.initials: P
authors.lastname: Falagiani
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000276:immunology / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017332:Cetirizine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003888:Desensitization, Immunologic; D004802:Eosinophilia; D005260:Female; D006801:Humans; D008297:Male; D039981:Pyroglyphidae / Q000276:immunology; D012221:Rhinitis, Allergic, Perennial / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D039741:Antigens, Dermatophagoides; D014028:Tobacco Smoke Pollution; D017332:Cetirizine