Small airways in children with allergic rhinoconjunctivitis: the potential role of a multicomponent nutraceutical

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Salvatore Leonardi
Giuseppe Parisi
Maria Papale
Anna Maria Zicari
Roberta Olcese
Amelia Licari
Gianluigi Marseglia
Giorgio Ciprandi


allergic rhinitis, children, spirometry, asthma, MEF50, nutraceutical


Allergic rhinitis and asthma are closely linked. A progression from rhinitis to overt asthma is common. FEF25-75 is a spirometry parameter that could reflect small airways patency and could reliably predict early bronchial involvement in allergic rhinitis patients. MEF50 very strongly correlates with FEF25-75. The aim of this study was to evaluate possible spirometry change in two groups of children suffering from AR over time. The first group took a course of a nutraceutical (Lertal®) before the observation (active group, AG); a second one was considered as control (control group, CG). The children were visited at baseline, at the end of the nutraceutical course, and after 1 year. FEV1, FVC, and MEF50 were the primary outcomes. After one year, children in AG had significantly higher MEF50 than CG children (p=0.009). In conclusion, the present study showed that a course with a multicomponent nutraceutical could prevent the MEF50 decline in children with allergic rhinoconjunctivitis.


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1) Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN and AllerGen). Allergy 2008;63(Suppl. 86):8-160
2) Deliu M, Belgrave D, Simpson A, Murray CS, Kerry G, Custovic A. Impact of rhinitis on asthma severity in school-age children. Allergy. 2014 Jun 24. doi: 10.1111/all.12467
3) Ciprandi G, Signori A, Tosca MA, Cirillo I. Spirometric abnormalities in patients with allergic rhinitis: indicator of an asthma march? Amer J Rhinol Allergy 2011;32:22-8
4) Ciprandi G, Caimmi D, Miraglia del Giudice M, La Rosa M, Salpietro C, Marseglia GL. Recent developments in united airways disease. Allergy Asthma Immunol Res 2012;4:171-7
5) Ciprandi G, Cirillo I The lower airway pathology of Rhinitis. Update Review J Allergy Clin Immunol 2006; 118:1105-1109
6) Ciprandi G, Cirillo I, Vizzaccaro A, Milanese M, Tosca MA. Nasal obstruction in patients with seasonal allergic rhinitis: relationships between allergic inflammation and nasal airflow. Int Arch Allergy Immunol 2004;134:34-40
7) Ciprandi G, Marseglia GL, Klersy C, Tosca MA. Relationships between allergic inflammation and nasal airflow in children with persistent allergic rhinitis due to mite sensitization. Allergy 2005;60:957-60
8) Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950-958
9) Tay TR, Hew M. Comorbid "treatable traits" in difficult asthma: Current evidence and clinical evaluation. Allergy. 2018;73(7):1369-1382
10) Montella S, Baraldi E, Cazzato S, et al. Severe asthma features in children: a case-control online survey. Ital J Pediatr. 2016;42:9
11) Marseglia GL, Cirillo I, Vizzaccaro A, Klersy C, Tosca MA, La Rosa M, Ciprandi G. Role of FEF25-75 as early marker of small airways impairment in subjects with allergic rhinitis Allergy Asthma Proc 2007;28:74-8
12) Lipworth B. Targeting the small airways asthma phenotype: if we can reach it, should we treat it? Ann Allergy Asthma Immunol 2013;110:233-9
13) Simon MR, Chinchilli VM, Phillips BR, et al. Forced expiratory flow between 25% and 75% of vital capacity and FEV1/forced vital capacity ratio in relation to clinical and physiological parameters in asthmatic children with normal FEV1 values. J Allergy Clin Immunol 2010;126:527-34.
14) Siroux V, Boudier A, Dolgopoloff M, Chanoine S, Bousquet J, Gormand F, et al. Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes. J Allergy Clin Immunol 2016;137:1709-16
15) Bar-Yishay E, Amirav I, Goldberg S. Comparison of maximal midexpiratory flow rate and forced expiratory flow at 50% of vital capacity in children. Chest.2003;123:731-5
16) Guder G, Brenner S, Stork S, Held M, Broekhuizen BDL, Lammers JWJ, et al. Diagnostic and prognostic utility of mid-expiratory flow rate in older community-dwelling persons with respiratory symptoms, but without chronic obstructive pulmonary disease. BMC Pulmonary Med 2015;15:83
17) Valovirta E, Petersen TH, Piotrowska T, Laursen MK, Andersen JS, Sørensen HF, et al. Results from the 5-year SQ grass sublingual immunotherapy tablet asthma prevention (GAP) trial in children with grass pollen allergy. J Allergy Clin Immunol. 2018;141:529-538.e13
18) Marseglia GL, Licari A, Ciprandi G. A polycentric, randomized, double blind, parallel-group, placebo-controlled study on Lertal®, a multicomponent nutraceutical, as add-on treatment in children with allergic rhinoconjunctivitis: Phase I during active treatment. J Biol Reg 2019;33:617-622
19) Marseglia GL, Licari A, Leonardi S, Papale M, Zicari AM, Schiavi L, et al. A polycentric, randomized, parallel-group, study on Lertal®, a multicomponent nutraceutical, as preventive treatment in children with allergic rhinoconjunctivitis: Phase II. Ital J Ped 2019;45:84
20) Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-68
21) Mainardi T, Kapoor S, Bielory L. Complementary and alternative medicine: Herbs, phytochemicals and vitamins and their immunologic effects. J Allergy Clin Immunol 2009;123:283-94
22) Ciprandi G, Cirillo I, Signori A. Impact of allergic rhinitis on bronchi: an 8 year follow up study. Am J Rhinol Allergy 2011;25:72-6
23) Cirillo I, Gallo F, Ciprandi G. Impaired spirometry may predict bronchial hyper-responsiveness. JACI in practice 2018;6:2127-9
Ciprandi G, Silvestri M, Pistorio A, Tosca MA, Cirillo I. Clustering analysis in outpatients with allergic rhinitis in clinical practice. Allergy 2019 ;74:607-10

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