Biomedical subjects

Piotr Kuna

Publications and source records attributed to Piotr Kuna.

At least 37 records · Page 2Linked to original sources

PubMed2004

Aspirin intolerance and allergy to house dust mites: important factors associated with development of severe asthma.

BACKGROUND: Although the occurrence of bronchial asthma is still increasing, the possible factors associated with the development of severe asthma have not been completely determined. OBJECTIVE: To measure the incidence of severe asthma and its determinants in outpatients. Aspirin intolerance, house dust mite (HDM) allergy, male sex, age older than 65 years, and duration of asthma exceeding 10 years were investigated as factors potentially related to the severity of asthma. METHODS: The study population included 598 women and 408 men, mean age of 44.59 years (SD +/- 16.45 years), randomly chosen from patients with asthma under follow-up surveillance in an outpatient clinic. Their medical histories were reviewed; spirometry and skin prick tests were performed. RESULTS: The asthma was diagnosed as intermittent in 35.39%, persistently mild in 33.40%, moderate in 23.76%, and severe in 7.45% of the study cohort. In the patients with atopy, HDM allergy was a significant factor associated with the development of severe asthma [odds ratio (OR) = 5.65]. Of the 1,006 patients, 341 (33.90%) had had asthma for at least 10 years, which was a significant factor in the overall study group (OR = 3.64). We found 95 cases (9.44% of the study group) of aspirin intolerance, including 23 of the 75 patients with severe asthma (30.67%; OR = 5.44). Logistic regression analysis showed that aspirin intolerance was most closely associated with severe asthma (beta = 5.79; P < .001). CONCLUSIONS: The data from this study show that aspirin intolerance, HDM allergy, and asthma duration exceeding 10 years are major factors associated with severe asthma in outpatients.

Adolescent↗

PubMed2004

The ECP/Eo count ratio in children with asthma.

We hypothesized that the serum eosinophil eationic protein (ECP) concentration to peripheral blood eosinophil count ratio (ECP/Eo ratio), reflecting active eosinophils, could better correlate with asthma severity in asthmatic patients, than each of these parameters alone. One hundred twenty children with mild to moderate persistent stable asthma were included into the study. At the first visit, previous asthma medications were withheld and patients were administered beta-2 agonists "as needed." At the second visit peripheral blood eosinophil count, serum ECP, sIL-2R, and sICAM-1 were measured, and spirometry and histamine challenge tests were performed. During the study, patients filled daily diary cards to assess symptoms score. One hundred seventeen patients completed the study. The univariate logistic regression analysis showed that asthma severity is related to PC20H, ECP, ECP/Eo ratio, sIL-2R, and sICAM-1. In general, patients with higher level of ECP, ECP/Eo ratio, sIL-2R, sICAM-1 and with lower PC20H exhibited the higher risk of moderate asthma. Multivariate regression analysis showed that only PC20H and ECP/Eo ratio were the best predictors of asthma severity; higher PC20H (1 mg/mL change) slightly decrease (OR = 0.656; 95% CI: 0.44-0.99) and higher ECP/Eo ratio (0.1 pg/cell change) increase (OR = 1.84; 95% CI: 1.02-3.34) a risk of moderate asthma. These data show that the ECP/Eo ratio is a better and more useful marker than ECP or peripheral blood eosinophil count separately in assessing asthma in children.

Adolescent↗

PubMed2004

Comparative effect of triamcinolone, nedocromil and montelukast on asthma control in children: A randomized pragmatic study.

Asthma severity can be judged by measurements of symptoms, lung function, and medication requirements. The objective was to compare the effect of a 4-wk monotherapy with low-dose triamcinolone, montelukast and nedocromil on asthma control, lung function, eosinophil blood count, and bronchial hyper-reactivity in children with mild to moderate asthma allergic to dust mite. Two hundred fifty-six children, aged 6-18 yr, with mild to moderate asthma, participated in an 8-wk study. This was a three-arm, randomized no blinding or placebo pragmatic trial comparing the effect of triamcinolone acetonide (400 microg/day), inhaled nedocromil and montelukast sodium on clinical parameters of asthma [score, forced expiratory volume in 1 s (FEV(1))], PC20H, and eosinophil blood count. Two hundred forty-six children completed the study. After 4 wk of treatment with triamcinolone and montelukast, FEV(1) and PC20H significantly increased, and mean total symptoms score and mean number of eosinophil count in serum significantly decreased. Triamcinolone had a stronger effect on PC20H than montelukast. Nedocromil improved total asthma symptoms score and lung function. There was a reduction in the daytime and night-time symptom scores after treatment with all three drugs. Triamcinolone and montelukast had a stronger effect on asthma symptoms than nedocromil. There were statistically significant differences in reduction of nocturnal asthma symptoms between the triamcinolone and nedocromil groups (p < 0.001) and between montelukast and nedocromil (p = 0.001) groups, but not between the triamcinolone and montelukast groups. There was a reduction in beta-agonists use after treatment with all three drugs, with the strongest effect of triamcinolone. The study showed the strongest effect of low-dose inhaled steroids on clinical symptoms, lung function, bronchial hyper-reactivity and eosinophil blood count when compared to other asthma medications.

Acetates↗

PubMed2004

[Current recommendation for asthma treatment].

Asthma is a chronic inflammatory disease, characterized chronic inflammation of respiratory tract, reversible bronchial obturation and non-specific bronchial hyperresponsiveness. Typical symptoms of asthma are cough, wheezing and dyspnea. Diagnosis should be based on positive reversibility test with beta2-agonist. In the management of asthma patient education, allergen avoidance and anti-inflammatory treatment should be always implemented. Recently fast and long acting beta2-agonist was introduced with great success. Combination treatment with long acting beta2-agonists and topical glucocorticosteroids for patients with moderate and severe chronic asthma is recommended. We can also consider antileukotrienes and long acting theophylline as an option in patients not fully controlled by inhaled steroids. Patient with asthma should be always examined closely for chronic rhinitis and treated accordingly with antihistaminic drugs. Atopic asthma can be also treated with immunotherapy. With new drugs for asthma we can achieve full control of disease symptoms without unwanted side effects.

Adrenal Cortex Hormones↗

PubMed2003

A randomized, double-blind, double-dummy, parallel-group, multicenter, dose-reduction trial of the minimal effective doses of budesonide and fluticasone dry-powder inhalers in adults with mild to moderate asthma.

BACKGROUND: Inhaled corticosteroids are established first-line anti-inflammatory treatment for asthma. Clinical trials comparing inhaled corticosteroids must take into consideration that because of their excellent effect at low doses, they typically induce a near-maximal response in asthma patients. OBJECTIVE: The aim of the present dose-response study was to estimate the minimal effective doses (MEDs) of budesonide and of fluticasone propionate via dry-powder inhaler in adults with mild to moderate asthma. METHODS: This was a randomized, double-blind, double-dummy, parallel-group, multicenter, dose-reduction trial performed in adults to compare these 2 inhaled corticosteroids. After a 4- to 6-week run-in period with beclomethasone dipropionate 2000 pg/d, patients fulfilling defined criteria for asthma control were randomly allocated to treatment with budesonide or fluticasone, both administered BID at a total of 800 pg/d. At 5-week intervals, the dose was reduced to 400 and then 200 pg/d (200 and 100 pg BID) if asthma control was maintained according to further defined criteria. The MED was defined as the last dose level before deterioration of asthma control. RESULTS: Subjects were 197 asthmatic patients with a mean age of 40.6 years in the budesonide group and 41.5 years in the fluticasone group. In both groups, baseline mean forced expiratory volume in 1 second (FEV(1)) was 79.4% of the predicted normal volume and baseline mean FEV(1) reversibility was 22.3%. The median MED for both groups was 400 microg/d, with no detectable difference in dis-tributions. The budesonide-to-fluticasone ratio for the geometric mean MED was 123% (95% CI, 99-153 [not significant]). No statistically significant differences regarding lung function, symptom scores, or rescue medication usage were found between the treatment groups during the first treatment period. Adverse-event profiles were similar in both groups, and no unexpected adverse events were considered to be caused by the study drugs. CONCLUSION: This effect-controlled study did not detect a statistically significant difference between the MEDs for budesonide and fluticasone via dry-powder inhaler in adults with mild to moderate asthma.

Administration, Inhalation↗

PubMed2003

[Epidemics of allergic diseases: a new health problem in the modern world].

A large number of epidemiological studies have demonstrated that over the past 20-30 years a dramatic increase occurred in the prevalence of allergic diseases throughout the developed world. Allergy has become one of the major public health problems. This article presents the impact of allergy on health state.

Adolescent↗

PubMed2003

[Cytokines in allergic inflammation].

Cytokines play a central role in the pathogenesis of allergic diseases and allergic inflammation. Therefore, an understanding of mechanisms which regulate production and function of cytokines is very important and may result in the development of more effective methods of treatment of allergic diseases. Recent studies have demonstrated that the induction of allergic inflammation requires genetic background and environmentak factors. The most important cytokines and chemokines are IL-4, IL-5, IL-3, IL-13, GM-CSF and TNF-alpha. Many other cytokines are responsible for the growth, maturity, migration activation and apoptosis of all cells involved in allergic inflammation, among them are IL-2, IL-5, IL-6, IL-9, MIP-1 alpha, RANTES, IL-8, IL-12, IL-18, IFN-alpha i gamma, TGF-beta, sIL-4, IL-1Ra. Recently it has been proven that IL-10 and other cytokines from the IL-10 family, and TGF-beta have anti-inflammatory properties in allergy.

Cytokines↗

PubMed2003

[Contemporary views on the pathological mechanism of asthma].

Asthma is a chronic inflammatory disease of the airways. Genetic and environmental factors contribute to the development of asthma. Both inflammation and remodelling are essential mechanisms in the development of subepithelial fibrosis and smooth muscle hypertrophy leading to progressing decrease of FEV1. Inflammatory changes in asthma are characterised by cellular infiltration of airway epithelium, bronchial wall and smooth muscle layer. The most important cells participating in asthma include T lymphocytes, mast cells, airway epithelial cells, eosinophils, antigen-presenting cells, neutrophils, fibroblasts, myofibroblasts and macrophages. They produce many cytokines responsible for the development of allergen-specific clones of Th2 lymphocytes, for production of IgE by B-cells, for increased expression of adhesion molecules, for migration of cells, their activation and release of inflammatory mediators. The mediators coming mainly from mast cells and eosinophils that include leukotrienes, prostaglandins, histamine, alkaline proteins and enzymes are responsible for airway obturation that results from bronchospasm, bronchial mucosal oedema and excessive amount of abnormal mucous secretion. An important role in the obturation is played by smooth muscle hypertrophy and deposition of proteins under the basal membranes of respiratory epithelium.

Asthma↗

PubMed2003

[Recent results of clinical studies of synergistic treatment in obstructive respiratory tract diseases].

Asthma is a chronic inflammatory disease of the bronchial tree, characterised by reversible obturation, bronchial mucosal inflammation and bronchial hyperresponsiveness. In the treatment of asthma, most important is avoidance of provoking allergens and regular anti-inflammatory treatment with inhaled glucocorticosteroids. For patients, very important is quick relief from asthma symptoms, this is why they prefer fast and long acting beta 2-agonists as a symptomatic treatment. Optimal control of asthma symptoms can be achieved with combination treatment consisting of inhaled glucocorticosteroid and beta 2-agonist. Budesonide is a corticosteroid that treats the underlying airway inflammation in asthma; formoterol is a fast and long-acting beta 2-agonist that prevents and reverses airway obstruction. Thus budesonide and formoterol have complementary effects, treating two different components of asthma. Clinical studies show that in the treatment of asthma Symbicort is more effective than double dose GCS, due to the budesonide/formoterol synergy. It is at least as effective, well tolerated and safe as its mono-products in corresponding doses given via separate inhalers. More convenient treatment represents an important benefit for patients with asthma. Symbicort is recommended for regular treatment and could also be used "as needed" due to the rapid onset of the bronchodilatory effect of formoterol.

Adrenal Cortex Hormones↗

PubMed2003

[Comparison of injection-related and local immunotherapy].

Allergen-specific immunotherapy is a well-accepted method in the management of respiratory allergic diseases, applied since over 90 years. Traditional immunotherapy is the practice of subcutaneous administering to subjects with allergy, increasing amounts of modified allergen to achieve hyposensitisation. Recently other routes of allergen administration were proposed including bronchial, nasal, oral and sublingual routes. Controlled trials failed to demonstrate the clinical efficacy and the safety of oral and bronchial administration. Nasal immunotherapy is also declining due to limited efficacy and special administration technique. The sublingual route is safe and efficacious. Unfortunately, up to date no well-designed controlled study comparing subcutaneous with sublingual methods of immunotherapy is available. Still several points need to be elucidated, including long lasting efficacy, mechanism of action, optimal dose, adherence to this therapy and cost-effectiveness. However, sublingual immunotherapy is now accepted by WHO as a valid alternative to the subcutaneous route and should be used in all patients who require immunotherapy and do not accept subcutaneous route of allergen administration. One question is presently beyond discussion: it is better to administer sublingual immunotherapy in patients with allergic diseases than not to give immunotherapy at all.

Allergens↗

PubMed2002

Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist: a randomized, double-blind, placebo-controlled trial.

Leukotriene antagonists block the proinflammatory actions of leukotrienes (LT) and have been introduced as new treatments for asthma. Conventional therapy with glucocorticosteroids does not inhibit the biosynthesis of leukotrienes. We therefore tested whether addition of the leukotriene receptor antagonist montelukast was of therapeutic benefit in a group of aspirin-intolerant patients with asthma of whom 90% already were treated with moderate to high doses of glucocorticosteroids. Under double-blind conditions, 80 aspirin-intolerant patients with asthma were randomized to receive 4 wk oral treatment of either 10 mg of montelukast or placebo once daily at bedtime. Pulmonary function was measured as forced expiratory volume in 1 s (FEV(1)) once a week in the clinic and daily as morning and evening peak expiratory flow rate (PEFR). Asthma symptoms and use of rescue bronchodilator were also recorded daily. Asthma specific quality of life (QoL) was assessed before and after the treatments. The group receiving montelukast showed a remarkable improvement of their asthma, whereas the group given placebo showed no change. Thus, from equal baseline values, the mean difference between the groups over the 4-wk treatment period was 10.2% for FEV(1) and 28.0 L for morning PEFR (p for both < 0.001). The improved pulmonary function in the group receiving montelukast occurred at the same time as 27% less bronchodilator was used (p < 0.05), and it was associated with fewer asthma symptoms than in the group given placebo, including 1.3 nights more of sleep per week and 54% fewer asthma exacerbations (p < 0.05). There was also an improvement in asthma-specific QoL (p < 0.05). The therapeutic response to montelukast was consistent across patients with different baseline characteristics and did not correlate with baseline urinary LTE(4). Addition of a leukotriene receptor antagonist such as montelukast improves asthma in aspirin-intolerant patients over and above what can be achieved by glucocorticosteroids.

Acetates↗

PubMed2002

A randomized, double-blind trial of the effect of treatment with formoterol on clinical and inflammatory parameters of asthma in children.

BACKGROUND: In addition to their bronchodilating effect, long-acting inhaled beta-agonists have recently been shown to have some anti-inflammatory properties. OBJECTIVE: The purpose of this study was to evaluate the effect of formoterol on inflammatory mediators in children. METHODS: In this double-blind, randomized, placebo-controlled trial, 34 children, aged 6 to 18 years, with moderate atopic asthma, were randomly allocated to receive formoterol or matching placebo for 4 weeks. The primary endpoint of this study was to determine changes in serum levels of inflammatory markers after treatment with formoterol; secondary endpoints included clinical efficacy and bronchial hyperreactivity. The following parameters were measured: symptom score, forced expiratory volume in 1 second (FEV1), provocative concentration of histamine causing a 20% fall in FEV1 (PC20) for histamine and peripheral blood eosinophil count, serum levels of eosinophil cationic protein (ECP), soluble receptor of interleukin-2 (sIL-2R), level of interleukin-4 (IL-4), level of soluble intercellular adhesion molecule-1 (ICAM-1), and immunoglobulin E (IgE) level before and after treatment. RESULTS: Compared with placebo, treatment with formoterol significantly improved lung function. The mean value of FEV1 changed from 74% of predicted value before treatment to 80% of predicted value after treatment (P < 0.001). The mean concentration of eosinophil blood count before and after treatment was 379 and 310 cells/mm3 (P = 0.035); ECP was 93 and 83 mcg/L; and serum IL-4 was 0.13 and 0.11 pg/mL (P = 0.001). There was no significant difference between formoterol and placebo recipients in PC20H, and serum concentration of sIL-2R, sICAM-1, or IgE after treatment. The group that received formoterol showed improvement in pulmonary function as measured by FEV1 (P < 0.001), and PC20H (P = 0.04) after 4 weeks of treatment. These patients also showed improvement of clinical symptoms (P < 0.001). Serum marker measurements in the formoterol group showed decreased concentrations of eosinophil blood count, ECP, and IL-4, but there was no difference in before and after measurements of sIL-2R, sICAM-1, and IgE. CONCLUSIONS: These results indicate that formoterol has measurable anti-inflammatory properties and can diminish asthma symptoms and bronchial hyperreactivity.

Adolescent↗

PubMed2002

The prevalence of mouse allergen in inner-city homes.

Mouse allergen has not been studied in detail in the general population. It is common for patients from inner-city environments to report significant mouse infestation in their homes and neighborhoods. The aim of this study was to determine the prevalence of mouse allergen in the homes of inner-city children with asthma in relation to the demographic features of these children and their specific housing characteristics. Seventy-eight dust samples from 39 inner-city homes of Lodz, Poland, were analyzed for mouse allergen. Skin-prick tests (SPTs) to mouse allergen were performed in all patients. In addition, data regarding the demographics and housing of the subjects were related to the mouse allergen levels. Mouse allergen was detected in 22 of 78 dust samples (28%), and in 18 of 39 homes (46%), including 13 kitchen (33%) and nine bedroom (23%) samples. Mouse allergen levels did not correlate between different rooms in the same home. The levels detected ranged from 0.09 to 2.34 micro g/g of dust. The highest levels were found in kitchens, with median levels of 0.2 micro g/g, 95% confidence interval (CI): 0.12-0.85 (range: 0.1-2.34 microg/g); in bedrooms the mean levels were 0.23 microg/g, 95% CI: 0.1-0.97 (range: 0.09-1.62 microg/g). Eleven of 18 children with detectable mouse allergen in house dust, and three of 21 without detectable mouse allergen in house dust, had a positive SPT to mouse allergen. On home inspection, 18% of the homes had evidence of mice in one or two rooms and had higher levels of mouse allergen (p < 0.01). None of the other subject or housing variables evaluated were associated with higher mouse allergen levels. In Polish children, mouse allergen is an important factor of sensitivity and should be recognized in the diagnosis of allergic diseases as well as in allergen-reduction programmes.

Adolescent↗

PubMed2002

A randomized, double-blind trial of the effect of treatment with montelukast on bronchial hyperresponsiveness and serum eosinophilic cationic protein (ECP), soluble interleukin 2 receptor (sIL-2R), IL-4, and soluble intercellular adhesion molecule 1 (sICAM-1) in children with asthma.

BACKGROUND: Anti-inflammatory properties of leukotriene modifiers and their effect on bronchial hyperresponsiveness have not been studied in children with asthma. OBJECTIVE: The primary objective of this study was to determine the changes in serum levels of inflammatory mediators, clinical efficacy, and bronchial hyperresponsiveness after treatment with montelukast. METHODS: In this double-blind, randomized, placebo-controlled trial, 39 children with mild-to-moderate atopic asthma were randomly allocated to receive montelukast or placebo for 6 weeks. Main outcome measures were changes in serum concentrations of soluble interleukin 2 receptor (sIL-2R), IL-4, and soluble intercellular adhesion molecule 1 (sICAM-1); peripheral blood eosinophil count; and eosinophilic cationic protein (ECP). Asthma severity score, FEV(1), and bronchial hyperreactivity (BHR) for histamine were secondary end points. RESULTS: Compared to placebo, serum concentrations of IL-4, sICAM-1, and ECP and eosinophil blood counts significantly decreased after 6 weeks of treatment with montelukast. Montelukast significantly improved asthma control and FEV(1). Montelukast resulted in within-group significant decrease in levels of serum sIL-2R (611 vs. 483 pg/mL), IL-4 (0.123 vs 0.102 pg/mL), sICAM-1 (280 vs. 244 ng/mL), and ECP (74 vs. 59 microg/mL) and in eosinophil blood counts (349 vs. 310 cells/mm(3)). Mean FEV(1) value changed from 85% of predicted to 95% (P <.001) and for histamine (PC(20)H) from 2.8 mg/mL to 3.8 mg/mL (P <.001) after treatment with montelukast. There was no significant difference between montelukast and placebo recipients in the serum concentrations of sIL-2R and PC(20)H after treatment. CONCLUSION: Montelukast provides clinical benefit to patients with chronic asthma and decreases bronchial hyperresponsiveness. Montelukast caused a statistically significant decrease of serum concentrations in cytokine, ICAM-1, and ECP and peripheral blood eosinophil counts over the 6-week treatment period. This observation raises the possibility that leukotriene receptor antagonists, such as montelukast, may have effects on parameters of asthmatic inflammation.

Acetates↗

PubMed2002

[The effect of inhaled heparin on post-leukotriene bronchoconstriction in children with bronchial asthma].

Heparin besides its anticoagulant properties, possesses anti-inflammatory actions. Inhaled heparin has been shown to reduce early and late phase of asthmatic reaction and suppresses allergen induced rise in bronchial hyperreactivity. The exact mechanism of heparin action in bronchial asthma remains obscure. The mechanism involved in the control of bronchial hyperreactivity by heparin has been studied little and is yet poorly understood. The purpose of the present study was to investigate the effect of inhaled heparin on the airway response to leukotriene D4 Fourteen children with typical history of mild atopic asthma participated in this randomized, double-blind, placebo controlled and cross-over study. At the first visit subjects underwent provocation challenge test with leukotriene D4. Patients came back 14 days later to inhale heparin or placebo followed by provocation test with leukotriene. The third study day was 14 days after the second day and provocation test was performed in the same manner except for that patients who inhaled heparin at the second visit, now were administered placebo and opposite. Ten patients completed the study. One patient was withdrawn from the study because of consent withdrawal and three patients were unable to complete the provocation test because of asthma exacerbation. Single dose of inhaled heparin significantly decreased bronchial hyperreactivity to leukotriene in children with mild asthma (p = 0.005). PC20L after heparin inhalation increased in eight patient and decreased in two. It has been shown that histamine, metacholine, and leukotriene play a role in eosinophil recruitment to the airway. Since histamine, metacholine and leukotriene act through receptor binding to protein G, it is possible that heparin (by displacing eosinophil proteins from receptor-protein G binding) restore binding between receptor and G protein and in such mechanism, decrease bronchial hyperreactivity to leukotriene. In our study heparin was inhaled just before leukotriene provocation test and thus the effect of heparin on eosinophil proteins is less likely possible.

Administration, Inhalation↗

PubMed2002

[The effect of triamcinolone acetonide, montelukast, nedocromil sodium, formoterol on levels levels of sICAM-1, sIL-2R in serum and clinical course of asthma in children].

One of the characteristics of asthma is the variability of inflammation. Thus, it is important to monitor inflammation serially in asthma, e.g. by the use of peripheral blood markers. To evaluate the effect of treatment on allergic inflammation, we measured serum levels of sIL-2R, sICAM-1 and clinical parameters before and after 4 weeks treatment with triamcinolon, montelukast, nedocromil and formoterol. It was 8 week, placebo-controlled and randomized, double blind trial of 158 children with moderate atopic asthma. Patients were randomly allocated to received 400 micrograms triamcinolon (n = 28), 5 or 10 mg (according to age) montelukast (n = 27), 16 mg nedocromil (n = 30), 24 micrograms formoterol (n = 29) or placebo (n = 44). 140 children completed the study. After treatment with triamcinolon, montelukast and nedocromil sIL-2R and sICAM-1 serum level significantly decreased, and all clinical parameters improved; treatment with triamcinolon had the strongest effect on most parameters (except of FEV1). Mean sIL-2R before and after treatment with triamcinolon were 724.1 pg/ml and 486.1 pg/ml respectively (p < 0.001); with nedocromil were 760.2 pg/ml and 596.7 pg/ml respectively (p < 0.001); with montelukast were 617.9 pg/ml and 491.2 pg/ml respectively (p < 0.001); with formoterol were 705.4 pg/ml and 698.9 pg/ml respectively (p = 0.8). Mean sICAM-1 serum levels before and after treatment with triamcinolon were 262.4 ng/ml and 210.4 ng/ml respectively (p < 0.001); with nedocromil were 292.9 ng/ml and 258.4 ng/ml respectively (p < 0.001); with montelukast were 277.7 ng/ml and 242.9 ng/ml respectively (p < 0.001); with formoterol were 262.6 ng/ml and 260.0 ng/ml (p = 0.6). We found significant correlation between: sIL-2R and hyperresponsiveness, sICAM-1 and hyper responsiveness, FEV1 and sICAM-1, FEV1 and sIL-2R, sIL-2R and sICAM-1 after treatment. This study shows that triamcinolon, montelukast and nedocromil contribute to inhibition of allergic inflammation by decreasing sIL-2R and sICAM-1 serum levels. The serum level of sIL-2R and sICAM-1 seem to be a good clinical marker of monitoring the disease; their levels decrease after treatment together with improvement in hyperresponsiveness and clinical parameters.

Acetates↗

PubMed2002

[Precision and economy of skin prick tests].

Due to a rise in the number of cases of allergic disease and a need to increase financial resources for the diagnosis of these conditions, the possibility of reducing costs of skin pricks tests (SPT) was very welcome. In an attempt to reduce costs some practitioners use one lancet for several pricks in one patient. The purpose of this study was to determine whether this way of performing SPT influences the results. 52 subjects with (39) and without (13) atopy were tested with histamine, codeine and standard allergen extracts. SPT were applied to the volar surface of a randomly assigned forearm using two methods: one lancet-one prick on one forearm (single test method) and one lancet-multiple pricks ("multiple test" method) on the other. The false positive tests at the placebo site following allergen were recorded only in multiple test method, in 41 out of 72 pricks (p < 0.00001) when all reactions above baseline were considered and in 26 out of 72 (p = 0.00001) when a 3 mm cut-off was considered. The size of the false positive reaction depends on the intensity of the reaction to the preceding allergen (rang Spearman factor R = 0.706, p < 0.000001) and decreases in the second consecutive placebo test. Our data show that one lancet for multiple test method cannot be used to diagnose factors responsible for allergy, particularly in patients qualified for immunotherapy and in scientific studies. For financial reasons multiple test method can be used in screening and epidemiological studies where atopy is studied and there is no need to identify the specific allergen.

Adult↗

PubMed2002

[Effect of triamcinolone acetonide, montelukast, nedocromil sodium and formoterol on eosinophil blood counts, ECP serum levels and clinical progression of asthma in children].

Eosinophil-mediated damage to the respiratory epithelium is a major pathogenetic mechanism in asthma. Glucocorticoids have confirmed antiinflammatory properties and effect of formoterol, montelukast and nedocromil on markers of inflammation has been studied. Eosinophil blood counts and eosinophil cation protein (ECP) serum level are often use as markers of clinical monitoring of the disease activity. To evaluate the effect of treatment on allergic inflammation, we measured eosinophil blood counts and ECP serum level, and clinical parameters before and after 4 weeks treatment with triamcinolon, montelukast, nedocromil, formoterol. It was 8 week, placebo-controlled and randomized, double blind trial of 154 children with moderate atopic asthma. Patients were randomly allocated to receive 400 mg triamcinolon (n = 28), 5 or 10 mg (according to age) montelukast (n = 27), 16 mg nedocromil (n = 26), 24 micrograms formoterol (n = 28) or placebo (n = 45). 140 children completed the study. After treatment with triamcinolon and montelukast eosinophil blood counts significantly decreased, after treatment with triamcinolon, montelukast and nedocromil ECP serum level significantly decreased; all clinical parameters improved after treatment with each drug; treatment with triamcinolon had the strongest effect on most parameters (except of FEV1). Mean eosinophil blood counts before and after treatment with triamcinolon were 277.4 and 187.2 cells/mm3 respectively (p < 0.001); with montelukast were 279.6 and 250.7 cells/mm3 respectively (p = 0.002); with nedocromil were 181.7 and 170.1 cells/mm3 respectively (p < 0.183); with formoterol were 276.4 and 264.1 cells/mm3 respectively (p = 0.2). Mean ECP serum levels before and after treatment with triamcinolon were 94.3 and 63.5 micrograms/l respectively (p < 0.001); with montelukast were 85.1 micrograms/l and 71.2 micrograms/l respectively (p < 0.001); with nedocromil were 92.6 and 80.1 micrograms/l respectively (p < 0.001); with formoterol were 95.9 micrograms/l and 87.8 micrograms/l (p = 0.05). We found significant correlation between ECP and hyperresponsiveness after treatment with triamcinolon, montelukast. This study shows that triamcinolon, montelukast contribute to inhibition of allergic inflammation by decreasing eosinophil blood counts and ECP. The serum level of ECP seems to be a good clinical marker of monitoring the disease.

Acetates↗