Symbiofilm Trial in Allergic Kids (SYMBIOFILM-TAK)

Study Overview
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Brief Summary
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Healsea® Children is a seawater-based nasal spray supplemented with a natural Symbiofilm® extract (0.02%) isolated from marine bacteria. Symbiofilm has antibiofilm activity against various bacterial pathogens involved in respiratory tract infections.Healsea® Children is indicated in the cleaning and moistening of nasal mucosa during common cold and rhinitis for children above 6 years. This non interventional post-market clinical investigation aimed to confirm the benefit of Healsea® Children in real life setting in children with perennial allergy who are more prone to common cold.

Detailed Description
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Healsea® Children is a seawater-based nasal spray supplemented with a natural Symbiofilm® extract (0.02%) isolated from marine bacteria. Symbiofilm® is an exopolymeric composition with emulsifying properties, in vitro antibiofilm activity and detachment properties against various bacterial pathogens involved in respiratory tract infections. Symbiofilm® has no bacteriostatic nor bactericidal activities. Healsea® Children is indicated in the cleaning and moistening of nasal mucosa during common cold and rhinitis. The common cold is an acute viral infection of the upper respiratory tract, involving, to variable degrees, sneezing, nasal congestion and discharge (rhinorrhea), sore throat, cough, low-grade fever, headache, and malaise (1). It can be caused by members of several families of viruses; the most common are rhinoviruses. Acute viral rhinitis is generally self-limiting. In children where the illness is not self-limiting and extends beyond 7-10 days, many agree that a bacterial infection is likely (1). Bacterial over infections and progression to a chronic state are favoured by the formation of biofilms, which facilitate bacterial growth and persistence as well as reducing antibiotic efficacy (2-3). Allergic diseases may play a particular role in promoting the respiratory infection recurrences (4). The physiological immune response is impaired in allergic subjects and allergic inflammation favours predisposition to respiratory infections. Subjects with allergic disorders may have functional defect of type 1 immune response that is relevant in fighting infections (5-6). Allergic rhinitis (AR) may affect up to 40% of the paediatric population. Nasal symptoms are caused by exposure to an allergen to which a patient is sensitized. AR is characterized by typical nasal symptoms and immunoglobulin E (IgE) -mediated inflammation. The allergic inflammatory process releases many cytokines and other proinflammatory proteins. Inflammation caused by nasal allergy leads to obstruction, fluid accumulation and acute disease. If these diseases are unsuccessfully treated, a chronic state of inflammation, obstruction, and infection develops that can cause mucosal damage and, ultimately, chronic disease (7). For these reasons, the paediatric IgE-dependent allergic population that is more prone to common cold represents a suitable target for Healsea® Children (8-9). During this prospective post-market clinical investigation, IgE-dependent allergic children with early symptoms of infectious rhinitis will be followed, children being treated with Healsea® Children on top of common cold conventional therapies or with conventional therapies only (excluded nasal irrigation). Conventional therapies for non-complicated infectious rhinitis are symptomatic but are not without side effects. For example, decongestant use can increase blood pressure, antihistamine intake is associated with drowsiness. Healsea® Children represents an interesting alternative that can not only improve acute infectious rhinitis symptomatology but could also limit the complication and progression to chronic state. This non interventional post-market clinical investigation aimed to confirm the benefit of Healsea® Children in a real life setting in children with perennial allergy.

Official Title
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Impact of Adding Healsea® Isotonic Nasal Spray to Conventional Therapies for the Care of Children With Allergic Rhinitis Presenting With Symptoms of Acute Infectious Rhinitis: an Observational Study

Conditions
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Common Cold, Allergy

Intervention / Treatment
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* Device: Healsea® Children
* Other: Conventional therapies for common cold


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male/Female subjects ≥6 and ≤10-year-old AsIgE (Allergy specific IgE) ≥ class 2 (RAST) or positive prick test for at least one perennial allergen Acute infectious rhinitis/rhinosinusitis for ≤48h before trial entry Patient presenting with fever ≥ 37.5 °C at screening Symptoms of headache, muscle ache, chilliness, sore throat, blocked nose, runny nose, cough, sneezing with a total score ≤9 (according to a physician-rated symptom score; scale: 0 to 3 [0: no symptom to 3: severe intensity]) At least one of these symptoms: sore throat, runny nose or blocked nose (i.e., with a score ≥1) Written consent obtained from parent/legal guardians Written assent obtained from patient Exclusion Criteria: Known hypersensitivity/allergy to any component of the test device Medical history that is considered by the investigator as a reason for non-inclusion, Severe nasal septum deviation or other condition that could cause nasal obstruction such as the presence of nasal polyps History of nasal or sinus surgery that in the opinion of the investigator may influence symptom scores Antibiotic intake within 2 weeks before screening Systemic corticosteroids within 4 weeks before screening Antihistamines intake for allergy when treatment was started from less than 4 weeks Bacterial lysate intake within 6 months before screening Chronic decongestant use Recent (within the previous 2 days) intake of a common cold medicine that in the opinion of the investigator may influence symptom score at screening (NSAID, nasal decongestants, cough medicines)

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Healsea® Children: isotonic seawater based nasal spray supplemented with natural Symbiofilm® extract<br>Children will receive Healsea® Children nasal spray on top of conventional therapies for common cold, as needed. | Device: Healsea® Children<br>* Children will be administered Healsea Children , one puff (1-2 sec) in each nostril twice a day for 10 days on top of conventional therapies, as needed<br>* Other names: Conventional therapies for common cold;Other: Conventional therapies for common cold<br>* Children will receive conventional therapies for common cold, nasal irrigation excluded (antipyretics, mucolytics, decongestants, antitussives, systemic and topical corticosteroids, antibiotics)<br>|
| Conventional therapies<br>Children will receive conventional therapies for common cold as needed, nasal irrigation excluded | Other: Conventional therapies for common cold<br>* Children will receive conventional therapies for common cold, nasal irrigation excluded (antipyretics, mucolytics, decongestants, antitussives, systemic and topical corticosteroids, antibiotics)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| AUC (Area Under Curve) of the Wisconsin Upper Respiratory Symptoms Survey for Kids (WURSS-K) during the 10-day treatment period | The WURSS-K will be assessed once daily, in the evening, considering the symptoms from the morning to the evening, from Day1 to Day10 (treatment period) | Cumulative AUC of the WURSS score assessed from Day 1 to Day 10 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of common cold symptoms during the whole study: items 2 to 7 of WURSS-K | During the treatment period, the WURSS-K will be assessed once daily. After D10, the WURSS-K will be assessed once daily until the subject feels not sick for two consecutive days. Items 2 to 7 will be used to assess the duration of common cold symptoms in both groups. | Number of days with cold symptoms during the intervention period (10-day treatment) and up to 30 days | 
| Respiratory complication requiring antibiotic prescription after the10-day treatment period | The number of subjects who develop respiratory complication requiring antibiotic prescription during a 20-day follow-up period after the treatment period will be assessed in both groups and compared | Number of subjects with respiratory complications during the 20-day follow-up period | 
| Use of concomitant treatments | Frequency and number of days of use of concomitant treatments (conventional therapies) that may affect common cold symptoms (antibiotics, antipyretics, systemic or local mucolytics, decongestants, antitussives, systemic and topical corticosteroids) will be assessed in both groups and compared | During the intervention, up to 30 days | 
| Spread of the common cold | The number of family members in close contact developing common cold symptoms after the patient all over the study period | During the intervention, up to 30 days | 
| Reporting of incidents, undesirable expected side effects and adverse events | Assessment of adverse events, incidents, undesirable expected side effects during the intervention up to 30 in both groups | During the intervention, up to 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Infectious rhinitis, nasal irrigation, perennial allergy