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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Allergic rhinitis in children is often complicated by bacterial sinusitis, which can lead to chronic illness and dysfunction. Sinus disease manifests differently in children than in adults, with cough, rhinorrhea, and middle ear disease being common and pain, headache, and fever being uncommon. Sinusitis may exacerbate asthma, and as many as 70% of children with allergy and chronic rhinitis have abnormal findings on sinus x-ray studies. Nasal cytologic specimens showing large numbers of polymorphonuclear cells with intracellular bacteria are also evidence of sinusitis. Obstruction of the nasal airways by allergic rhinitis or enlarged adenoids can lead to deviations in facial growth, specifically increased facial length. With the removal of the obstruction and a return to nasal breathing, facial length may become more normal. Sinusitis in children is treated with antibiotics, usually for 3 to 4 weeks, to eliminate the infection. Adjunctive therapy with antihistamines, decongestants, cromolyn, and corticosteroids may also be helpful. Topical steroids, such as flunisolide and beclomethasone, can be very useful in pediatric patients. These steroids decrease edema and prevent the release of allergic mediators that may be responsible for an environment favoring the bacterial infection causing sinusitis.
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PMID:The role of nasal airway obstruction in sinus disease and facial development. 305 46

The correlation of Waters view radiographs and A-mode ultrasound for diagnosing sinusitis was evaluated in 75 subjects with allergic rhinitis who presented with signs and symptoms suggesting sinus disease. All patients had Waters view radiographs, which were read by a radiologist (E. G.) who was not provided with historical information. Ultrasound tracings were obtained by registered nurses who were trained to perform this procedure. Tracings were interpreted by two representatives of American Electromedics Corporation, the manufacturer of the Echosine ultrasound machine used in this study. Most common symptoms among the patients were cough and rhinorrhea. The complaint of headache correlated negatively (p = 0.001) with an abnormal radiograph, whereas physical findings of copious and purulent rhinorrhea correlated positively (p = 0.05 and 0.001, respectively). Middle ear abnormalities on examination and tympanometry were more common in those with abnormal radiographs, p less than 0.05 and p less than 0.01, respectively. If the radiograph is considered to be a "gold standard," sensitivity of ultrasound varied from 44% to 58% and specificity from 55% to 61%, dependent on which criteria are applied to the radiograph to consider it normal. A-mode ultrasound is not sufficiently comparable to radiography to be used as its substitute for diagnosing sinus disease.
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PMID:Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. 351 Nov 25

The aim of this study was to compare the efficacy and side effects of budesonide and disodium cromoglycate (DSCG) in seasonal allergic rhinitis. In a double-blind, double-dummy comparative study, 43 patients with seasonal allergic rhinitis were either treated with budesonide (200 micrograms b.d.) or DSCG (5.2 mg 5 times daily). After a 1 week run-in period treatment was given for 3 weeks. The patient scorings for nasal secretion, nasal itching, sneezing bouts and total nasal symptoms were significantly different between the treatment groups during the whole treatment period. The scorings for nasal blockage were significantly different during the last 2 weeks of treatment. All differences were in favour of budesonide treatment. The patients' assessment of the treatment favoured budesonide (P less than 0.02). Side effects were few and mild, but one patient from the budesonide group stopped treatment because of headache.
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PMID:Treatment of seasonal allergic rhinitis with budesonide and disodium cromoglycate. A double-blind clinical comparison between budesonide and disodium cromoglycate. 391 4

Loratadine is a long-acting antihistamine agent, exhibiting partial selectivity for peripheral histamine H1-receptors. To date, loratadine has been evaluated in allergic rhinitis, urticaria and, to a limited extent, in asthma. In several large controlled comparative clinical studies, loratadine was superior to placebo, faster acting than astemizole and as effective as azatadine, cetirizine, chlorpheniramine (chlorphenamine), clemastine, hydroxyzine, mequitazine and terfenadine in patients with allergic rhinitis and chronic urticaria. The clinical effectiveness of loratadine in asthma is at present unclear. Loratadine is well tolerated. At dosages of 10 mg daily, commonly reported adverse events were somnolence, fatigue and headache. Sedation occurred less frequently with loratadine than with azatadine, cetirizine, chlorpheniramine, clemastine and mequitazine. Serious ventricular arrhythmias, as reported with some other second generation histamine H1-receptor antagonists, have not been observed with loratadine to date. Thus, loratadine, with its attributes of once daily administration, fast onset of action and essentially nonsedating properties, would appear to be an appropriate first-line agent for the treatment of allergic rhinitis or urticaria.
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PMID:Loratadine. A reappraisal of its pharmacological properties and therapeutic use in allergic disorders. 752 33

This multicenter, double-blind, randomized, controlled, parallel-group study compared the safety and efficacy of intranasal triamcinolone acetonide with oral loratadine in relieving symptoms of ragweed-induced seasonal allergic rhinitis. Patients from community-based allergy practices with a history of at least two seasons of seasonal allergic rhinitis verified by a positive skin test received either once-daily treatment with intranasal triacinolone acetonide 220 micrograms plus 1 placebo capsule or oral loratadine 10 mg plus placebo nasal spray. Other medications for rhinitis were prohibited. Changes in rhinitis symptoms were assessed by using patient evaluations, physician global evaluations, and withdrawal rates. Efficacy was evaluated in 274 of 298 patients randomized to treatment (134 to triamcinolone acetonide and 140 to loratadine). Mean total nasal symptom scores for weeks 1, 2, 3, and 4 and the overall score showed greater improvement (P = 0.001) with triamcinolone acetonide than with loratadine. Improvement in all rhinitis symptoms was significantly greater with triamcinolone acetonide than with loratadine; there was a trend for greater improvement in ocular symptoms with triamcinolone acetonide. Physicians' global evaluations indicated triamcinolone acetonide provided moderate-to-complete relief in 78% of patients compared with 58% of loratadine-treated patients (P < or = 0.0001). Both treatments were well tolerated; headache was the most commonly reported adverse event in both groups. Intranasal triamcinolone acetonide was significantly more effective than oral loratadine in relieving the symptoms of seasonal allergic rhinitis.
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PMID:Comparison of intranasal triamcinolone acetonide with oral loratadine for the treatment of patients with seasonal allergic rhinitis. 758 52

This paper analyzed the relationship among the differential diagnosis, treatment, and results for allergic rhinitis using the covariance structural model. The data were collected from 274 patients with suspected allergic rhinitis who visited the Otorlaryngology Department of the Paik Hospital during 1991-1993. After each patient's characteristics was categorized and combined into several common factors, covariance structure analysis was performed to analyze the structural relationships among the differential diagnosis, treatment, and results of treatment using the significant factors obtained from discriminant analysis. The significant characteristics influenced the diagnosis were the results of skin test from mite/animal, and from mugworts, the results from laboratory tests, rhinorrhea and sneezing, and nasal polyps. The significant characteristics that influenced the method of treatment were: nasal polyps, headache/general symptom, family history/medication, and septal deviation. Headache/general symptom was the only significantly influencing factor for the treatment results.
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PMID:Structural modeling of differential diagnosis, treatment, and results for allergic rhinitis. 761 59

A prospective, comparative, random study was conducted with 40 patients treated with ebastine vs. terfenadine. The purpose of the study was to evaluate the efficacy of both as second generation antihistamines used in the treatment of allergic rhinitis. Ten milligrams of ebastine was administered once a day before breakfast (fasting), in 5 and 10 year old children and 20 mg in 11 to 15 year olds. Ebastine was more efficient in the control of symptoms (rhinorrhea, nasal obstruction, sneezing, eye and nose itching) than terfenadine from the seventh day on, (p 0.05). Tolerance to ebastine was good, although a small number of patients (1.5%) suffered collateral symptoms: sleepiness, headaches and nausea. The two doses of ebastine (10 or 20 mg depending on the patients age) had overall efficacy rates better than terfenadine (p 0.05%).
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PMID:[Ebastine vs terfenadine in allergic rhinitis]. 790 44

A 1-year, open-label extension of a 12-week, double-blind clinical trial was conducted to evaluate the long-term safety and efficacy of once-daily therapy with triamcinolone acetonide nasal aerosol (110, 220, or 440 micrograms) in 93 patients with perennial allergic rhinitis. All three doses of triamcinolone acetonide were associated with sustained improvement in allergic rhinitis symptoms over the course of 1 year, as evidenced by physicians' and patients' global evaluations, ratings of the nasal environment (appearance and color of the nasal mucosa, as well as the quality of nasal secretions), nasal eosinophil counts, and requirement for escape medication. Among patients who reported adverse clinical experiences, most were considered unrelated or remotely related to therapy. Few patients experienced nasal irritation or throat discomfort, and no serious adverse experiences were attributed to treatment. Among 6 patients who withdrew from the study because of adverse experiences, a possible drug relationship was cited in 2 individuals (1 with headache and 1 with nasal blood) and a remote relationship in 1 (with acne). No clinically meaningful changes in vital signs, physical examinations, or laboratory values were noted, and mean serum cortisol levels were not suppressed during long-term treatment. These findings demonstrate that both safety and efficacy are maintained during long-term once-daily therapy with triamcinolone acetonide nasal aerosol in patients with perennial allergic rhinitis.
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PMID:Long-term safety of triamcinolone acetonide nasal aerosol for the treatment of perennial allergic rhinitis. 806 20

Twenty-seven patients suffering from perennial non-allergic rhinitis were treated with capsaicin. The drug was applied intranasally seven times during intervals ranging from 4-7 days. The regimen involved application of a 0.5 ml of a 10 micromolar capsaicin solution on the first day of treatment, 0.5 ml of a 30 micromolar solution on the 2nd and 3rd days of treatment and 0.5 ml of a 100 micromolar solution on the 4th to 7th days of treatment. Two patients dropped out, one because he developed an exanthema of both forearms and the other for unknown reasons. Other side-effects observed were epistaxis (1 case) and increased dryness of the nasal mucosa. Twenty-two patients had experienced nasal obstruction, hypersecretion, nasal itching, sneezing, mucosal dryness and headache before and 6 months following capsaicin application and judged the success of therapy 6 months following treatment. Three patients did not take part in the follow-up. Fifteen of 27 patients felt no change had occurred in nasal complaints, while 7/27 scored significant improvement. Additionally, 11/27 subjects would not undergo this treatment a second time because it had been unsuccessful and/or painful. The mean symptom scores for nasal obstruction, hypersecretion, itching, dryness and headache revealed no significant changes before and 6 months following treatment with capsaicin. Blockers did not benefit from capsaicin treatment. The best change to benefit from intranasal capsaicin application involved patients with nasal hypersecretion and sneezing without substantial obstruction.
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PMID:[Treatment of perennial non-allergic rhinopathy with capsaicin]. 822 19

We examined the prevalence of chronic sinusitis among children who presented to allergy clinics with chronic (> or = 3 months) respiratory symptoms. Ninety-one patients, ranging from 2 to 17 years of age with 62% male and 72% white, completed the study. Fifty-nine percent of patients had positive skin test results, and 25.3% had chronic asthma. Paranasal sinuses were examined by coronal sinus computed tomographic scan. Sixty-three percent (58 to 91) had chronic sinusitis, 5.5% (5 of 91) had concha bullosa, 1% (1 of 91) had foreign body, and 19% (19 of 91) had deviated nasal septums. Among symptoms of sneezing, nasal congestion, postnasal drip, coughing, wheezing, rhinorrhea, and headache, no single symptom was an acceptable predictor of abnormality on computed tomographic scan examinations. Combining the symptoms of moderate to severe rhinorrhea and cough with minimum sneezing had a specificity of 95% and a sensitivity of 38% in predicting the presence of chronic sinusitis. Allergic rhinitis (p = 0.27), mild deviated nasal septum (p = 0.11), unobstructive concha bullosa (p = 0.13), and passive exposure to cigarette smoke (p = 0.53) were not risk factors associated with sinus abnormalities. Age (r = 0.30, p = 0.004) in pediatric patients with chronic respiratory symptoms was the single risk factor significantly associated with abnormalities on sinus computed tomographic scan. Seventy-three percent of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 had chronic sinusitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic sinusitis among pediatric patients with chronic respiratory complaints. 825 16


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