Strategies to reduce corticosteroid-related adverse events in asthma

Purpose of review Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. Recent findings Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). Summary The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents.
Source: Current Opinion in Allergy and Clinical Immunology - Category: Allergy & Immunology Tags: MECHANISMS OF ALLERGY AND ADULT ASTHMA: Edited by J. Andrew Grant and Enrico Heffler Source Type: research

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ConclusionsThe trial demonstrated a favorable safety profile of the SQ HDM SLIT tablet in Japanese adult patients with AA. The treatment appeared to be efficacious in patients requiring rescue medication (ie, short-acting β2-agonist) at baseline in the efficacy assessment using asthma exacerbation during inhaled corticosteroid reduction (JapicCTI number 121847).
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
ConclusionThe trial demonstrated a favorable safety profile of the SQ HDM SLIT-tablet in Japanese adult patients with AA. The treatment appeared to be efficacious in patients requiring rescue medication (i.e., SABA) at baseline in the efficacy assessment using asthma exacerbation during ICS reduction (JapicCTI number 121847).
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Skin prick/puncture testing (SPT) is currently considered the “gold standard” method for epicutaneous allergy testing. There are multiple advantages of SPT compared to in vitro testing. It is less expensive, less invasive, and provides faster, highly specific results, and a better correlation with inhalant allergy symptoms1. However, there are noted disadv antages to the SPT method, largely based on variability factors. These include controllable variables, such as patient medications (antihistamines, psychotropic agents, high dose oral corticosteroids, and immunotherapy), the device used for the SPT, and the t...
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Letters Source Type: research
Discussion: As in other studies, omalizumab has shown favourable clinical benefits in patients with moderate to severe persistent allergic asthma, stabilizing lung function and maintaining diseases control with a good safety profile.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Allergy and immunology Source Type: research
We report atopic dermatitis treated successfully with allergen immunotherapy.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: M503 Source Type: research
AbstractPurpose of ReviewThis review analyzes the growing evidence regarding the standardized quality house dust mite (SQ-HDM) sublingual immunotherapy (SLIT) tablets as a valuable therapeutic option in asthma, as recently included in the treatment algorithm of the Global Initiative for Asthma (GINA) as an add-on treatment for adult patients with allergic asthma not well controlled with inhaled corticosteroids (ICS).Recent FindingsEvidence from well-designed randomized placebo-controlled clinical trials shows that the SQ-HDM SLIT tablet is effective vs. placebo in reducing both asthma symptoms and the need for ICS, as well...
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research
AbstractPurpose of ReviewIn this article, we review the impact and the treatment of sleep disturbance caused by allergic rhinitis (AR) in adult and pediatric patients.Recent FindingsAlthough intranasal corticosteroids (INS) remain the mainstay treatments for AR-induced sleep disturbance, allergen immunotherapy (AIT) has been suggested to be effective in altering the course and progression of moderate-to-severe AR that is refractory to pharmacotherapy. MP-AzeFlu is a recently developed formulation containing azelastine, an intranasal antihistamine (INAH), and fluticasone propionate, an INS. MP-AzeFlu has been reported to ha...
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research
AbstractPurpose of ReviewTo evaluate the impact of allergic rhinitis (AR) on the development of asthma and to update readers on recent literature suggesting that early treatment of allergic subjects with immunotherapy may prevent asthma onset.Recent FindingsAR is frequently associated with asthma, leading to the concept that these two conditions are different aspects of the same disease. There is increasing evidence that AR precedes the onset of asthmatic symptoms and current treatment strategies are beneficial in symptom control with no impact prevention. There is limited knowledge about the risk factors responsible for t...
Source: Current Allergy and Asthma Reports - Category: Allergy & Immunology Source Type: research
Conclusions: Budesonide/formoterol reinforced montelukast in conjunction with allergen-specific immunotherapy proved to be the most successful combination for curing mycosis induced asthma. Fluticasone/salmeterol increases the risk of heart disease.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Allergy and immunology Source Type: research
Conventional immunotherapy is effective for treatment of allergic rhinitis, allergic asthma, and chronic rhinosinusitis. Rapid desensitization (rush immunotherapy) offers advantages of faster efficacy, improved compliance, and cost effectiveness. While premedication with corticosteroids and antihistamines substantially reduce the incidence of systemic reactions, safety remains the primary concern for this procedure.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
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