THE RATIONALE FOR DRUG THERAPY IN CHILDREN
WITH UPPER RESPIRATORY TRACT INFECTIONS
EASINESS INDUCED BY STRESS
By Renato COCCHI MD, neurologist and
medical psychologist
Key words: Stress, GABA, URTI easiness, cell-mediated immunity,
drug therapy, glutamine, BDZ, rationale.
Since the pioneering
clinical study in depressed children (Cocchi, 1981) normal and Down children
with easiness to upper respiratory tract infections were successfully treated
by Gabaergic drugs (1998).
Research showed that even
psychological stress undermines host resistance to infections through
neurendocrine mediated changes in immune competence ( Boyce et al., 1995). It
is the same for every kind of stress of external or internal origin or both.
The adrenergic blockade improves cellular immune responses otherwise depressed
by the so called mental stress in humans as one type of internal stresses
(Bachen et al., 1995).
Because the
immune-suppressive action of stress via the GABA impairment (Horger and Roth,
1995) and subsequent cortisol hyper-incretion or hyper-activity (Dhabhar et
al., 1996; Haessig et al., 1996; Dantzer, 1997; Friedman and Irwin, 1997), the
rationale to counteract this easiness by drugs can be explained as it follows.
This treatment uses
Gabaergic drugs like l-glutamine as the precursor of GABA via l-glutamic acid
(Laake et al., 1995; Shupliakov et al., 1997); pyridoxine as the cofactor of
all decarboxylases, GAD inclusive (Baxter,1976); a benzodiazepine as the
sensitizer of type A Gabaergic receptors (Bruni et al., 1980; Viukari, 1983;
Schoch et al., 1985).
Daily doses of 1-14 years
children can be so prescribed: glutamine: 125-500 mg daily (not later than 2
PM); pyridoxine 75-150mg daily; diazepam 1-3mg daily in the evening (in small
children better: oxazepam 5-8mg daily, always in the evening).
This 3-drugs' prescription
works in a synergistical way and can restore the glutamic-GABA pathway impaired
by the stress itself. The use of a benzodiazepine aims to re-sensitize type A
Gabaergic receptors, the first metabolic point where stress applies itself.
Without doing it we can
induce only the increasing of glutamate the cytotoxic effects are now
well-known. But this evening use of a benzodiazepine is the best way to restore
sleep ( Viukari, 1983) often impaired by excess adrenergic stimulation and to
avoid side-effects like daily drowsiness and muscle relaxation.
On the other hand
l-glutamine is directly involved in the nucleogenesis of rapid proliferating
cells (Gismondo et al., 1998) and by this way it contributes to a better
production of leukocytes (Heberer et al., 1996; Newsholm & Calder 1997; Yoo
S.S., et al., 1997).
References
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Boyce W.T. et al.: Psychobiological
reactivity to stress and childhood respiratory illnesses: Result of two prospective
studies. Psychosom. Med. 1995, 57: 411-422.
Bruni G., Dal Pra P., Dotti M.T., Segre G.:
Plasma ACTH and cortisol levels in benzodiazepine treated rats. Pharmacol. Res.
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respiratory diseases in depressed children. Epidemiological survey of 126
subjects, Clinical-therapeutic report of 61 cases. Acta psychiat. Belg. 1981,
81: 350-365.
Cocchi R.: Drug therapy of upper respiratory
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Impair. 1998, 11: 9-17.
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871-881.
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of glutamine in some cells of the immune system and speculative consequences
for the whole animal. Nutrition 1997, 13: 728-730.
Schoch P., Richard J.G., Haering P., Takacs
B., Staehli C., Staehelin T., Haefely W., Moehler H.: Co-localisation of of
GABA A receptors and benzodiazepine receptors in the brain shown by monoclonal
antibodies. Nature 1985, 314: 168-171
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glutamine pools at glutamergic synapses with distinct properties. Neuroscience
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Raven New York, 1983: 279-286.
Yoo S.S., Field C.J., McBurney M.I.:
Glutamine supplementation maintains intramuscular glutamine concentrations and
normalizes lymphocyte function in infected early weaned pigs. J. Nutr. 1997,
127: 2253-2259..
Presented at the 2nd World Congress on Stress, Melbourne October 25-29,
1998.
Author address. Dr Renato COCCHI, via
Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
Immunity
2nd World Congress on Stress
Drugss
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