The efficacy and safety of 30 mg fexofenadine HCl bid in pediatric patients with allergic rhinitis.

Allergic rhinitis is one of the most common chronic disorders in children. It is also one of the most common causes of absence from school. This study reports on the efficacy and safety of a twice-daily oral dose of fexofenadine HCl 30 mg in Asian children aged 6-11 years diagnosed with seasonal or perennial allergic rhinitis. A total of 100 children with a history of allergic rhinitis for more than one year and a positive prick skin test response to at least one of the common aeroallergens in Thailand were enrolled in this multi-center, open-label, non comparative study. The severity of individual symptoms such as sneezing, rhinitis, etc. and adverse events were recorded in diary cards by the patients in form of scores as well as by the investigator at each visit. The total symptom score (TSS) with or without blocked nose at baseline, week 1 and week 2 was recorded. The TSS was defined as the sum of the individual symptom scores except for the nasal blockage score, as nasal blockage was not expected to respond to antihistamine treatment. Only patients with a total symptom score > or = 6 were included in the study. There was a statistically significant improvement at p < 0.01 for the TSS with or without blocked nose and for each symptom score such as blocked nose, sneezing, rhinorrhea, itchy nose/palate and/or throat, and itchy/watery/red eyes from baseline to week 1 and week 2. Additionally, there was a statistically significant improvement between week 1 and week 2 for itchy nose/palate and/or throat and itchy/watery/red eyes (p < 0.05). The Kappa measure of agreement was statistically significant at p < 0.001 between investigator's and patient's/parent's assessment, indicating the same degree of satisfaction with the overall effectiveness of the treatment. Fexofenadine 30 mg bid is effective in reducing the total symptom score of allergic rhinitis including blocked nose and is generally well tolerated. It is not cardiotoxic and is safe for pediatric patients as young as 6 years of age.

Asthma: an increasing problem in children?

The study of asthma trend, nonhospitalized and hospitalized cases, and factors correlated with asthma admissions were carried out at Queen Sirikit National Institute of Child Health (Children's Hospital) between 1986-1995. Asthma OPD visits had increased significantly (r = 0.9039, p < 0.001). The age distribution of the cases are 0-2, 2-5, 5-10 and > 10 years old group. The number of visits in 0-2 and 2-5 years groups were significantly increased (r = 0.908, p = 0.000, r = 0.904, p = 0.000), while in 5-10 and >10 years old groups were not (r = 0.054, p = 0.137, r = -0.565, p = 0.089). Although the OPD visits were increasing, there was a decreasing trend in the age-adjusted percentage of admissions (r = -0.798, p = 0.006). The percentage of admissions was significantly decreased in 0-2, 2-5, and >10 years old groups (r = -0.881, p = 0.001, r = -0.632, p = 0.05, r = -0.815, p = 0.004, respectively). The correlation with the environment was observed (r = 0.915, p < 0.001). There was no correlation with allergic diseases in the family (r = 0.2825, p = 0.4). The 2,312 admission charts (86.69% of total IPD cases) were reviewed and there were 1,855 cases of true asthma. Almost 70% of cases were in the under-five age group and the male to female ratio was 1.3:1. The increasing trend in steroid use was observed (r = 0.693, p = 0.026), while the use of antibiotics was unchanged (r = 0.068, p = 0.852). The percentage of admissions began to decline in 1989 when the aerosolized beta-2 agonists were introduced in the hospital and declined further in 1991 when increased use of aerosolized therapy and prophylactic drugs was observed. Better patient education and regular follow-up care during the past five years are believed to be one of the major contributions to this reduction in admissions.

Interstitial lung diseases in children: a review.

Interstitial lung diseases (ILD) are disorders of the lower respiratory tract, characterized by chronic inflammation of the lung parenchyma, varying degree of fibrosis, derangement of the alveolar walls and loss of the functional alveolar capillary units. ILD are relatively uncommon in children. Most of the interstitial lung diseases have no known etiology. In children, common diseases associated with ILD include viral respiratory tract infections (RSV, parainfluenza, etc.), gastroesophageal reflux, idiopathic pulmonary fibrosis, pulmonary hemosiderosis, eosinophilic pneumonia, pneumonitis associated with AIDS, etc. Chronic inflammation of the alveoli (alveolitis), the initial injury in ILD, and several mediators released from inflammatory cells (eosinophils, neutrophils and macrophages) can cause fibrosis and derangement of alveolar walls. Dyspnea and a non-productive cough are the cardinal symptoms of ILD. Other findings include chest pain, hemoptysis and weight loss. Clubbing of fingers occur in approximately 50 per cent of cases. Diagnosis is based on a combination of history, clinical findings, radiographic findings, pulmonary function tests and histologic findings. Open lung biopsy has been very helpful in providing information regarding the extent and nature of the damage, prognosis and response to therapy. There are 3 main aspects in the treatment of ILD. The most important step is to identify and eliminate the cause. The second is suppression of the inflammation. The third is supportive and symptomatic treatment. Corticosteroids are the drugs commonly used for suppression of inflammation. Immunosuppressive drugs (azathioprine, cyclophosphamide) have also been tried. Lung transplantation and heart transplantation have been successfully achieved in selected patients. The results of therapy should be regularly monitored by clinical symptoms, chest radiographs and serial pulmonary function studies.