Ketotifen in the treatment of infants and young children with wheezy bronchitis and bronchial asthma.

Ketotifen, an orally-administered anti-anaphylactic and antihistamine compound, was given in a dose of 0.06 mg/kg to 142 infants and young children presenting either with non-infected wheezy bronchitis or bronchial asthma to an allergy out-patient department. Treatment continued for 12 weeks. At the end of this time, ketotifen was considered to be very effective or effective in 70% of the children. The effect was more marked in non-infected wheezy bronchitis (83.55% response) than in bronchial asthma (56.5% response), perhaps because factors such as leukotrienes, prostaglandins and thromboxanes tend to produce a sustained bronchoconstriction in the latter condition. Ketotifen was not associated with any adverse effects and did not cause behavioural problems. Patients found it palatable and acceptable. The main disadvantage was that symptoms recurred within days of stopping treatment. Especially in non-infected wheezy bronchitis, ketotifen should be given for a year or longer to older children (older than 30 months) who have shown an initial good response to the drug.

Treatment of wheezy infants and children with ketotifen.

An open study was carried out in 74 wheezy infants and children, average age 16 months, to assess the efficacy and tolerance of ketotifen given in the form of a syrup at a dosage of 0.02 to 0.03 mg/kg body weight twice daily over a period of 12 weeks. Treatment was assessed as being successful, by both parents and physician, in 62 (84%) of the patients. Wheeze completely disappeared in 42 (57%) patients, cough in 50 (67%) and bronchial hypersecretion in 47 (64%). Patients who developed a superimposed respiratory infection during the treatment period had milder symptoms than usual; these lasted for a shorter time and in most patients it was not necessary to give antibiotics. Forty-one of the 62 patients who had responded successfully to ketotifen suffered a relapse when treatment was withdrawn at the end of the trial period. Ketotifen was well-tolerated by the majority of patients. The side-effect most frequently reported by the parents was dry mouth, which occurred in 21 patients.

Extrinsic allergic bronchiolo-alveolitis in children.

Fifteen children, 6-14 years old, who were heavily exposed to pigeon droppings, presented with cough, chills and breathlessnes on mild exertion. Twelve gave immediate positive skin test reactions to pigeon droppings. Ten of the fifteen also gave a late (Arthus) reaction, and seven gave a positive delayed reaction which was maximal at 24--72 hr. Nine children had precipitins against avian droppings. In ten patients who were tested for lymphocyte transformation, five gave positive responses to both serum and pigeon droppings. Radiological findings of the chest showed parenchymatous infiltrations and diffuse interstitial reticulations, suggestive of extrinsic allergic alveolitis. In a control group of fifteen heavily-exposed children who had no symptoms, immediate and late skin reactions occurred respectively in five and two. One only had a positive precipitin test, and one of five tested had a positive lymphoblastic transformation. In a non-exposed comparable group of children, all tests were negative except for one immediate positive skin response. Children heavily exposed to the inhalation of avian antigens can develop extrinsic allergic bronchiolo-alveolitis.