[Future perspectives in the therapy of asthma in children].

Minerva Pediatr 60(2):235-47 (2008) PMID 18449140

Asthma therapy recognizes three fundamental key points: primary prevention, secondary prevention, including the control of inflammatory mechanisms and related symptoms, and tertiary prevention, consisting in the treatment of the early phases leading to airway remodelling. As for primary prevention in infants at ''high risk'' exclusive breastfeeding for at least 3-6 months and the prevention of allergen exposure, respiratory infections and tobacco smoking are recommended. Recent findings suggest a possible protective role of diet (i.e. the intake of vegetables and vitamins and the pre-probiotics). About secondary prevention, the efficacy of drugs suggested by international guidelines (GINA or ARIA) such as antihistamines, leukotriene modifiers and inhaled corticosteroids, it is well known; such drugs can be variably used in different associations, in accordance with the clinical features of the single patient. Among the new therapeutic perspectives, a special attention should be paid to anti-IgE monoclonal antibodies and other humanized monoclonal antibodies targeting and neutralizing inflammatory cytokines; chimeric allergens blocking mast cell receptors; recombinant interleukins with ''anti-inflammatory'' or ''anti-allergic'' properties; in vitro expansion of T lymphocytes with regulatory functions (Treg), and their possible therapeutic approach. Moreover, new experimental observations have identified the role of molecules derived from engineering technologies able to control allergic inflammation. As for prevention and treatment of allergic symptoms, specific immunotherapy has a relevant role, moreover in the paediatric area: it finds progressively greater consensus in terms of both efficacy and safety and is finally recognized in the latest GINA and ARIA guidelines. Tertiary prevention, which concerns the so called ''airway remodeling'', includes new therapeutic approaches such as montelukast, which can control fibroblasts proliferation and their transformation in myofibroblasts, and phosphodiesterase inhibitors. Finally, the use of peptide and non-peptide antagonists of Bradykinin B2 receptors seems to be of great interest.