Fwd: [AAPPSPA] Antihistamine-Antibiotic Combo Speeds Resolution of Otitis Media

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> Antihistamine-Antibiotic Combo Speeds Resolution of Otitis Media

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> Fran Lowry

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> November 23, 2010 (Phoenix, Arizona)  Adding the nasal antihistamine

olopatadine to oral antibiotic therapy hastens the resolution of serous otitis

media in children, according to a study presented here at the American College

of Asthma, Allergy & Immunology (ACAAI) 2010 Annual Scientific Meeting.

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> " Otitis media with effusion is a very important problem, " Safa M. Nsouli, MD,

director of the Danville Asthma and Allergy Clinic and the Castro Valley Asthma

and Allergy Clinic in Danville, California, told Medscape Medical News. " It is

very frequent, and the reason for the most visits to the paediatrician. We want

to treat these children quickly so that any damage to the middle ear is

lessened. "

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> Chronic inflammation is the histopathologic landmark of otitis media with

effusion, and past observations have led Dr. Nsouli to believe that adding an

antihistamine to antibiotic therapy would be more effective in this setting.

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> " The advantage of olopatidine is that it is a very gentle antihistamine and

does not contain steroids, " he noted. " It is so safe it was used as eye drops,

and the fact that it does not contain steroids is reassuring to parents. "

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> In his study, which was randomized and open labeled, Dr. Nsouli compared the

efficacy of nasal olopatadine (665 μg per nostril twice daily) together with

oral amoxicillin/clavulanate potassium (90 mg/kg daily given in 2 divided doses

every 12 hours) with that of the antibiotic alone in 40 pediatric patients (20

patients in each group) aged 6 to 11 years. The duration of the study was 2

weeks.

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> Efficacy was assessed with pneumatic otoscopy, impedance tympanometry, and

audiometry on day 7 and day 14 of the study.

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> Using impedance tympanometry was the key to assessing the effect of adding the

antihistamine, Dr. Nsouli said. " These are little children, and sometimes they

cannot describe in words very accurately what they are feeling. Tympanometry is

an objective way to measure improvement. "

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> At day 7, the children who were receiving both medications showed a complete

resolution of their otitis media with effusion. In contrast, the group treated

with antibiotics alone showed no improvement until day 14, Dr. Nsouli said.

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> " It is very important to think of the middle ear as a sinus cavity, and to

treat it as such, " he said. " That is why it is logical to combine treatments.

Rather than thinking of the ear as one target, and the sinus as another, we

should be giving a treatment that targets both at once. "

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> Comments: Combination a Novel Idea

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> nne Frieri, MD, PhD, chief of allergy and immunology at Nassau University

Medical Center, East Meadow, New York, commented that adding a nasal

antihistamine along with an antibiotic seems like a good idea.

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> " We know that olopatadine has many effects on various inflammatory cells, so

adding it to an antibiotic sounds like a smart thing to do, " Dr. Frieri, who

comoderated the session, told Medscape Medical News.

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> " I thought this study was very interesting. It is quite novel to add a nasal

antihistamine because of histamine in the ear fluid, to an antibiotic. It makes

the time to treat shorter. It was a wise thing to do, " she said.

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> Dr. Frieri's comoderator, ph A. Bellanti, MD, professor of pediatrics and

microbiology and immunology at town University Medical Center, Washington,

DC, agreed. " The study suggests that the serous otitis media may be due to an

infection, so adding the antibiotic to the histamine makes sense. You get a

double effect. "

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> For his part, Dr. Nsouli added: " We don't want to use too many antibiotics,

and we don't want children to suffer the ill effects of not being able to hear

because this can cause learning difficulties, which can be irreversible. Also,

the ear infection can cause lasting damage. This is a safe treatment that gets

the children better faster. "

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> Drs. Nsouli, Frieri, and Bellanti have disclosed no relevant financial

relationships.

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> American College of Asthma, Allergy & Immunology (ACAAI) 2010 Annual

Scientific Meeting: Abstract 22: Presented November 14, 2010.

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> Medscape Medical News © 2010 WebMD, LLC

> Sent from my Verizon Wireless BlackBerry

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