Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

A study of specific immunoglobulin G4 expression in allergic rhinitis and its value in assessing efficacy and in predicting prognosis of sublingual immunotherapy

Allergic rhinitis (AR) is a widespread health issue with a rising global prevalence, and sublingual immunotherapy (SLIT) has shown efficacy in AR treatment. We examined specific immunoglobulin G4 (sIgG4) expression in AR and its role in evaluating SLIT efficacy and predicting patient prognosis. We compared total nasal symptom score (TNSS), total medication score (TMS), visual analogue scale (VAS) score, inflammatory cytokines, and immune function markers in AR patients before and after SLIT. SLIT reduced TNSS, TMS, VAS scores, IL-4, IL-17, eosinophilia percentage (EOS%), and specific immunoglobulin E (sIgE) levels, while increasing INF-γ, IL-10, and sIgG4. The sIgG4 level at pre-treatment and 12 months post-treatment was negatively correlated with TNSS, TMS, VAS score, IL-4, IL-17, EOS%, and sIgE, and positively correlated with IFN-γ and IL-10. Most patients showed symptomatic improvement. After 12 months, sIgG4 level demonstrated an area under the curve (AUC) of 0.867 for assessing SLIT as effective. Pre-treatment sIgG4 level showed an AUC of 0.869 for predicting SLIT as effective. Collectively, sIgG4 has strong potential assessing SLIT efficacy and prognosis in AR patients, with correlations to TNSS, TMS, VAS score, and IL-4, IL-10, IL-17, INF-γ, EOS% and sIgE levels.

V Brazilian Consensus on Rhinitis - 2024

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Evaluating utility of allergy testing in management of nasal obstruction following inferior turbinate reduction

INTRODUCTION

Allergic rhinitis (AR) within the pediatric population affects more patients than any other chronic disease. Inferior turbinate hypertrophy (ITH) is a common cause of nasal obstruction in children and is strongly associated with AR. Inferior turbinate reduction (ITR) surgery is used in patients with ITH who have failed medical management. While surgery is curative for most, there remains a subset of patients who continue to have symptoms of nasal obstruction despite ITR, which can cause discomfort and significant impacts on quality of life. Additionally, some patients with persistent disease go on to require revision surgery. The objectives in this study were to assess the impact of allergy testing results in patients undergoing ITR and evaluate if they predict long-term durability of surgical outcome.

METHODS

A retrospective chart review of patients undergoing ITR between January and December of 2015 was performed. Data pertaining to demographics, allergy testing results, surgical technique, and medical management was collected. Patients who underwent concomitant procedures at the time of ITR were excluded. Data analysis included descriptive statistics, chi-squared tests, and t-test analyses.

RESULTS

297 patients who underwent ITR were included for data analysis. Overall, 20.9 % of patients had recurrent nasal obstruction after ITR and 5.4 % required revision surgery. Among all included patients, 37.7 % underwent allergy testing of which 53 (47.3 %) tested positive and 54 (48.2 %) tested negative; results were unknown for 5 (4.5 %) patients. In patients with positive allergy tests, 36 % had recurrent nasal obstruction and 11 % required revision surgery. In patients with negative allergy tests, 41 % had recurrent nasal obstruction and 13 % required revision surgery. There were no significant associations among those with positive and negative allergy tests and recurrence of nasal obstruction or need for revision surgery. Patients with a documented clinical diagnosis of AR were more likely to have recurrence of nasal obstruction after surgery than those without (28 % vs 12 %, p = 0.001) and were more likely to require revision surgery (9 % vs 1 %, p = 0.001).

CONCLUSIONS

ITR is a reasonable choice for the treatment of nasal obstruction in children. However, there remains a subset of patients who have recurrent nasal obstruction following initial surgery. Allergy testing results do not appear to impact the rate of recurrent nasal obstruction or the need for revision surgery. Therefore, the utility of allergy testing may have a limited benefit in the management of nasal obstruction in children. However, a clinical diagnosis of allergic rhinitis does appear to be a prognostic factor for experiencing post-operative recurrent nasal obstruction and requiring revision surgery.

Allergic Rhinitis and Its Associated Co-Morbidities Among Patients Attending the ENT Department at Kilimanjaro Christian Medical Center in Northern Tanzania: Cross-Sectional Study

INTRODUCTION

Allergic rhinitis is the specific inflammation against allergen by immune defense cells on the nasal mucosa, which can lead to chronic nasal symptoms such as sneezing, itching, runny nose, and nasal congestion. It is associated with high morbidity including sinusitis, asthma, otitis media, hypertrophied inferior turbinate, and nasal polyps. Despite its complications, it remains poorly recognized and tracked.

METHODS

A cross-sectional hospital-based study was done, a total of 221 patients received Ear, Nose And Throat services at Kilimanjaro Christian Medical Center during the study period all patients with a clinical diagnosis of allergic rhinitis were captured; Data was collected using a pre-tested coded questionnaire (Score For Allergic Rhinitis). The data was then analyzed using SPSS version 22.

RESULTS

A total of 221 patients with a clinical diagnosis of allergic rhinitis were approached in a 6 months study period, 111 (50.2%) were females, and 140 (63.4%) were residing in urban areas. The prevalence of allergic rhinitis was 23.9%. Factors such as age OR 0.12, 95% CI (0.03; 0.40), education OR 0.13, 95% CI (0.04; 0.44), occupation OR 3.75, 95% CI (1.36; 10.32), adenotonsillar hypertrophy OR 4.66, 95% CI (2.21; 9.80), and OME OR 4.11, 95% CI (1.32; 12.83) (p = 0.009) were found to be significantly associated with allergic rhinitis. 60.4%, Inferior turbinate hypertrophy is the leading co-morbidity of allergic rhinitis which accounts for 64.7%.

CONCLUSION

Allergic rhinitis is among the common health problems affecting Tanzanians. It is a commonly seen disorder in younger age ( < 15 years) which is in correlation with other studies done in Africa and worldwide.

Administration Strategy-Dependent Mechanisms and Effects of Human Adipose Tissue Stem Cell Extracellular Vesicles in Mouse Allergic Rhinitis Treatment

We previously found that intravenous injection of extracellular vesicles (EVs) from human adipose tissue-derived stem cells (hADSC) could ameliorate allergic rhinitis (AR) in mice through immunomodulatory effects. In clinical trials, nasal delivery has been an attractive treatment for AR. We sought to determine whether there are differences in the therapeutic effects between caudal injection and their combination. We treated AR mice with ADSC-EVs via caudal vein, nasal cavity, or both. After treatment, the mice were re-sensitized and the indices of behavior, nasal mucosa morphology, and cytokine secretion of the mice under different modes of administration were calculated. The resultes show that tail vein, nasal, and combined administration could effectively relieve the inflammatory infiltration of the nasal mucosa of mice, reduce the secretion of IgE, IL-4, and other inflammatory factors, and alleviate the Th1/Th2 imbalance. Injection and nasal delivery, as well as their combination, effectively alleviated the symptoms of rhinitis in mice. Nasal administration has a better therapeutic effect when the inflammatory response is mild. It could be speculated that ADSC-EVs have excellent properties in the treatment of AR, and modes of administration can be selected for different stages of treatment in clinical therapy.

Association between allergen-specific immunoglobulin E sensitization, allergic rhinitis symptoms, and quality of life in school-aged children

This study aimed to investigate the relationship between allergen-specific immunoglobulin E (IgE) sensitization and allergic rhinitis (AR) symptoms in school-aged children in Japan and to understand the current severity of AR symptoms and the quality of life (QOL) among children with AR. We analyzed data from 8-year-old children who participated in the Yamanashi Adjunct Study of the Japan Environment and Children's Study, focusing on those with complete information on specific IgE levels and AR (1229 for perennial AR [PAR] and 1196 for seasonal AR [SAR]). Sensitization was determined when allergen-specific IgE levels were class 2 (0.70 U/mL) or higher. A total of 656 children (53.4%) were identified as sensitized to house dust mite-specific IgE, comprising 362 (60.6%) boys and 294 (46.5%) girls. For Japanese cedar pollen (JCP)-specific IgE, 820 (68.6%) children were sensitized, with 430 (73.1%) boys and 390 (64.1%) girls. Among children with AR, 40.2% of those with PAR and 78.4% of those with SAR experienced moderate to severe nasal symptoms. This study highlighted the high prevalence of JCP-specific IgE sensitization among school-aged children in Japan and provided insights into the severity of AR symptoms and the impact on QOL in these children.

Histopathological, Cytological and Radiological Correlations in Allergy and Public Health Concerns: A Comprehensive Review

Allergies represent a significant and growing public health concern, affecting millions worldwide and burdening healthcare systems substantially. Accurate diagnosis and understanding of allergy is crucial for effective management and treatment. This review aims to explore the historical evolution, current advances, and prospects of histopathological and cytological techniques in allergy diagnosis, highlighting their crucial role in modern medicine. Major biomedical, public health, and imaging databases such as PubMed, Scopus, Web of Science, and EMBASE were used. The search strategy used include specific keywords and Medical Subject Headings (MeSH) terms related to histopathology, cytology, radiology, allergic diseases, and public health. Histopathological and cytological studies play a pivotal role in elucidating the underlying mechanisms of allergies, offering insights into the cellular and tissue-level changes associated with allergic responses. Histopathology reveals characteristic features such as inflammation, tissue remodeling, and the presence of specific immune cells like eosinophils and mast cells. Cytological analysis can detect cellular changes and abnormalities at a finer scale, providing a complementary perspective to histopathological findings. The correlation between histopathological and cytological findings is critical for achieving accurate and reliable diagnoses. Combined histopathological and cytological studies can reveal the extent of airway inflammation, epithelial damage, and immune cell infiltration, providing a robust basis for clinical decision-making. Recent advancements in diagnostic techniques have further revolutionized the field of allergy diagnosis. These technologies offer increased accuracy, speed, and reproducibility, making them invaluable in both clinical and research settings. Despite these advancements, several challenges and limitations persist. By integrating tissue-level and cellular-level analyses, clinicians can achieve more accurate diagnoses, tailor treatments to individual patients, and ultimately improve the quality of care for those suffering from allergies. In conclusion, histopathological and cytological correlation in allergy diagnosis provides a comprehensive framework for understanding and managing allergic conditions.

Allergic rhinitis

Allergic rhinitis (AR) is a common disorder that is strongly linked to asthma and conjunctivitis. Classic symptoms include nasal congestion, nasal itch, rhinorrhea and sneezing. A thorough history, physical examination and assessment of allergen sensitization are important for establishing the diagnosis of AR. Intranasal corticosteroids and second-generation antihistamines are the mainstay of treatment. Allergen immunotherapy is an effective immune-modulating treatment for use in addition to or as an alternative to pharmacologic therapy. This article provides an overview on the pathophysiology, diagnosis, and appropriate management of AR.

Chronic urticaria treatment challenges in children

OBJECTIVE

This paper aims to review the efficacy and safety of current chronic urticaria (CU) treatment in children and the existing patient-reported outcome measures (PROMs) used in this age group.

DATA SOURCE

Since there are few studies of CU in children, the authors performed a non-systematic review of published articles in English, Spanish, and Portuguese in the PubMed database in the last decade. Keywords used were (antihistamines OR omalizumab OR cyclosporine OR treatment) AND (chronic urticaria) AND (children OR adolescents).

DATA SYNTHESIS

According to the current guideline's algorithm, the treatment of CU involves using high doses of antihistamines when there is no response with the licensed dosage. The effectiveness of this increase in children has been demonstrated with control rates ranging from 35% to 92%, with few studies addressing safety profiles. Omalizumab is approved for children over 12 years of age as a second step in the algorithm. Although more studies with children are needed to assess its effectiveness and safety, some data show complete control of symptoms in more than 80% of pediatric cases with no adverse effects, including in children under 12 years. When monitored closely, cyclosporine showed a good response rate in pediatric CU with few adverse events. Also, PROMs validated for this age can be helpful in clinical decisions, such as Urticaria Activity Score summed over 7 days, Urticaria Control Test, and Chronic Urticaria Quality of Life Questionnaire.

CONCLUSIONS

Collaborative studies are necessary to generate stronger evidence to support the guideline recommendations for children. The existing data indicate that these drugs are safe and effective for treatment when dose adjustments are made.

Anatomically-detailed segmented representative adult and pediatric nasal models for assessing regional drug delivery and bioequivalence with suspension nasal sprays

In vitro nasal models can potentially facilitate development and approval of nasal drug products. This study aims to evaluate the potential for using regional deposition measurements from in vitro nasal models to evaluate nasal spray performance across several products. To accomplish this, the posterior regions of six anatomically realistic nasal airway models of adult and pediatric subjects, representing Low (L), Mean (M) and High (H) posterior drug deposition (PD) for each of the two age groups, were segmented with high anatomical precision into five regions of interest. These models were previously developed with the goal of quantifying the range of intersubject variability of PD following administration of inhaled corticosteroids. The in vitro regional drug deposition values were measured for the reference listed drug (RLD) product for triamcinolone acetonide and two corresponding generic (test) nasal spray products, as well as an RLD product for fluticasone furoate nasal spray. In general, the pediatric models mostly demonstrated higher PD compared to the adult models. The majority (>85 %) of PD was confined to the front and the inferior meatus regions. Subsequent population bioequivalence (PBE) analyses of the regional nasal deposition suggested that the anatomical differences among subjects may impact the nasal spray performance across different nasal products.

Upper airway comorbidities of asthma

Asthma, characterized as a chronic heterogeneous airway disease, often presents with common comorbid conditions. The concept of "one airway, one disease" was coined more than 20 years ago, emphasizing the connection between asthma and upper airway comorbidities (UACs) such as allergic or nonallergic rhinitis, chronic rhinosinusitis with or without nasal polyps, and aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease. Since then, numerous studies have demonstrated that UACs are closely related and affect asthma phenotypes. Recognizing these UACs and managing them are crucial aspects of comprehensive asthma care. Addressing these conditions as part of asthma treatment can lead to better control of symptoms, improved lung function, and better quality of life. Moreover, it is important to explore the field of respiratory biologics, which represents the latest advancements in medical treatment options for patients with asthma and UACs.

A Novel Technique for the Topical Application of Botulinum Neurotoxin A to the Nasal Mucosa in Reducing Rhinitis Symptoms

INTRODUCTION

To date, no investigations have been published regarding the concentration, dose, and technique for a mucosal spray application of botulinum toxin A (BTA) to alleviate hypersecretory symptoms of rhinitis in humans. It is a promising option for reducing common symptoms of seasonal allergic rhinitis (AR) and idiopathic non-AR. It is safer and less painful than intranasal injections, with high reported satisfaction in reducing clinical symptoms.

MATERIALS AND METHODS

Seventeen patients with idiopathic rhinitis who presented to a private clinic in Australia were given 25 units of BTA (Letybo®, Hugel, South Korea) at a concentration of 50 U/mL in normal saline in each nostril via a mucosal atomizer device. At 4 and 12 weeks, a survey of symptom relief, satisfaction with treatment, and willingness to get a repeat treatment was collected.

RESULTS

Patients were otherwise healthy, and the mean age was 40.1 ± 19.4 years. The majority (15 of 17) of subjects at 4 and 12 weeks reported significant symptom relief and high satisfaction, and were willing to get a repeat treatment. No adverse effects were reported.

CONCLUSION

Topical application of BTA on the nasal mucosa can be considered an effective therapeutic option in patients with persistent AR and idiopathic rhinitis. In comparison with injection techniques, BTA mucosal spray is effective at reducing persistent symptoms while minimizing the risk of pain and inadvertent systemic injection, and is able to promote contact with a wider mucosal area. Furthermore, it is easy to perform and is more tolerable for the patient. The authors present recommended concentrations, doses, and techniques.

Perceptions of the impact of individual allergic rhinitis symptoms: A survey of ARIA clinical experts

BACKGROUND

Allergic rhinitis (AR) is a highly prevalent disease. We aimed to assess the symptoms that physicians who see patients with AR perceive as the most bothersome in their patients.

METHODS

We performed a cross-sectional study based on an online questionnaire sent to all members of the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative. The survey included questions on the physicians' perceptions of patients' AR symptoms as well as of their own AR symptoms.

RESULTS

Among 401 respondents, 155 (38.7%) reported having AR. ARIA members reported nasal symptoms to be the most frequent (89.7%) and bothersome (80.0%) symptoms experienced by themselves. Likewise, nasal symptoms were reported by ARIA members as the most frequent (94.8% in members with AR vs 96.0% in members without AR) and bothersome (57.0% in members with AR vs 67.9% in members without AR) in their patients. We found a significant association (p = 0.001) between physicians' own symptoms and those perceived as the most bothersome in their patients.

CONCLUSION

Physicians perceive nasal symptoms to be the most frequent and the most bothersome symptoms in AR patients. The physicians' personal experiences with AR may influence their perception of patients' symptoms.

A Study to Evaluate the Role of Probiotics in Allergic Rhinitis

To compare treatment outcomes in allergic rhinitis patients with and without probiotics. The present study was conducted in the Out Patient Department of ENT in a Tertiary Care Hospital w.e.f. April 2023 till March 2024. Total 106 patients of allergic rhinits were included in the study and were divided randomly into 2 groups with 53 in each group. Group A was given probiotics along with standard treatment of antihistaminics and topical steroids and group B was given antihistaminics and topical steroids only. Total Nasal Symptoms Score (TNSS) of all patients was calculated at the time of enrollment and after 8 weeks post treatment. Based on the pre-treatment and post-treatment TNSS, an analysis was made whether probiotics could be an add-on therapy along with the standard treatment given for allergic rhinitis from past so many years. We conducted our study on 106 patients with mean age of 28.1 ± 8.91 years.44% were male and 56% were female. In group A pre-treatment TNSS was 8.057 + 2.307 and post treatment TNSS was 0.887 + 0.776. In group B pre-treatment TNSS was 9.45 + 0.514 and post treatment was 1.89 + 0.776. The mean post-treatment TNSS in group A was lower than the group B. This difference was statistically significant with p value of < 0.05. Based on the study we can suggest that probiotics could be a potential add-on strategy in the management of allergic rhinitis. Probiotic supplement action seems to be effective in ameliorating allergic rhinitis symptoms and improving the quality of life. However further clinical and molecular studies are required to improve our knowledge about interactions among candidate probiotics and host microbiome, cells and immune defenses, in order to create efficacious interventions.

Clinical Efficacy of Probiotics for Allergic Rhinitis: Results of an Exploratory Randomized Controlled Trial

Background: Allergic Rhinitis (AR) is an atopic disease affecting the upper airways of predisposed subjects exposed to aeroallergens. This study evaluates the effects of a mix of specific probiotics (L. acidophilus PBS066, L. rhamnosus LRH020, B. breve BB077, and B. longum subsp. longum BLG240) on symptoms and fecal microbiota modulation in subjects with AR. Methods: Probiotic effects were evaluated at the beginning (T0), at four and eight weeks of treatment (T1 and T2, respectively), and after four weeks of follow-up from the end of treatment (T3) (n = 19) compared to the placebo group (n = 22). AR symptoms and quality of life were evaluated by the mini rhinitis quality of life questionnaire (MiniRQLQ) at each time point. Allergic immune response and fecal microbiota compositions were assessed at T0, T2, and T3. The study was registered on Clinical-Trial.gov (NCT05344352). Results: The probiotic group showed significant improvement in the MiniRQLQ score at T1, T2, and T3 vs. T0 (p < 0.01, p < 0.05, p < 0.01, respectively). At T2, the probiotic group showed an increase in Dorea, which can be negatively associated with allergic diseases, and Fusicatenibacter, an intestinal bacterial genus with anti-inflammatory properties (p-value FDR-corrected = 0.0074 and 0.013, respectively). Conversely, at T3 the placebo group showed an increase in Bacteroides and Ruminococcaceae unassigned, (p-value FDR-corrected = 0.033 and 0.023, respectively) which can be associated with allergies, while the probiotic group showed a significative increase in the Prevotella/Bacteroides ratio (p-value FDR-corrected = 0.023). Conclusions: This probiotic formulation improves symptoms and quality of life in subjects with AR, promoting a shift towards anti-inflammatory and anti-allergic bacterial species in the intestinal microbiota.

Paraoxonase-1 Is a Pivotal Regulator Responsible for Suppressing Allergic Airway Inflammation Through Adipose Stem Cell-Derived Extracellular Vesicles

Although adipose stem cell (ASC)-derived extracellular vesicles (EVs) are as effective as ASCs in the suppression of Th2 cell-mediated eosinophilic inflammation, the role of identified pulmonary genes has not been well documented. Thus, we assessed the immunomodulatory effects of paraoxonase-1 (PON1) on allergic airway inflammation in a mouse model of asthma. Five-week-old female C57BL/6 mice were sensitized to ovalbumin (OVA) by intraperitoneal injection and challenged intranasally with OVA. To evaluate the effect of PON1 on allergic airway inflammation, the intranasal and intraperitoneal injections of recombinant mouse serum PON1 (5 μg/50 μL) were performed before the OVA challenge. We evaluated airway hyperresponsiveness (AHR), total inflammatory cells, and eosinophils in the bronchoalveolar lavage fluid (BALF), lung histology, serum immunoglobulin (Ig), cytokine profiles of BALF and lung draining lymph nodes (LLNs), the expression of interleukin (IL)-25 and transforming growth factor (TGF)-β in mouse lung epithelial cell (MLE-12 cell), and dendritic cell (DC) differentiation. The intraperitoneal and intranasal administration of PON1 significantly decreased AHR, total inflammatory cells and eosinophils in BALF, eosinophilic airway inflammation, serum total, and OVA-specific IgE. PON1 treatment, which marked reduced IL-4, IL-5, and IL-13 in the BALF and LLN but significantly increased interferon-γ and TGF-β. Furthermore, PON1 treatment significantly decreased the expression of IL-25 and increased TGF-β in MLE-12 cells. The expressions of CD40, CD80, and CD86 in immature DCs were significantly increased by PON1 treatment. The administration of PON1 ameliorated allergic airway inflammation and improved AHR through the downregulation of IL-4, IL-5, and IL-13 and upregulation of TGF-β in asthmatic mice. Furthermore, PON1 treatment decreased Th2-mediated inflammation induced by Aspergillus protease antigen by decreasing IL-25 and increasing TGF-β.

A cross-sectional study on occupational hygiene in biowaste plants

Recycling demands are increasing and new biowaste plants are established. The aim of this study is to obtain knowledge about occupational hygiene in biowaste pretreatment plants. At 6 plants, bioaerosol exposure, hand hygiene, and bioaerosol concentrations in work areas were investigated repeatedly. The total inflammatory potential (TIP) of exposures was measured using the human HL-60 cell line. Exposure to airborne bacteria, bacteria able to grow anaerobic, fungi(37°C), endotoxin, and TIP differed between plants and was lowest in a plant transporting waste in closed pipes compared to plants where waste was delivered on the receiving hall floor. Conversely, high exposures were measured in a plant that also processes compost. All microbial components had an impact on TIP of workers' exposure with main effects of fungi and endotoxin. Seasonality was found for several exposures and TIP, and they were lowest in the winter. Concentrations of bacteria and fungi on workers' hands at the end of the workday were 15 times higher for production than for nonproduction workers. In work areas, the concentrations of airborne fungi were highest in the waste-receiving area. Bacteria (3.2 µm) and anaerobic bacteria (4.0 µm) were present as larger airborne particles than fungi (2.8 µm), and bacteria were largest in the waste-receiving area. The microbial community compositions of exposures and work areas differed between plants and work areas. In conclusion, measures to reduce exposure should focus on the waste-receiving area and on the production workers. Differences in exposures and community compositions were found between seasons, work areas, work groups, and plants.

Association of asthma and bronchiectasis: Mendelian randomization analyses and observational study

BACKGROUND

Previous studies have demonstrated that asthma is closely associated with bronchiectasis, however, the causal relationship between asthma and bronchiectasis has not been investigated in depth. Therefore, this study aims to explore the causal relationship and to identify potential factors that mediate between these two diseases.

METHOD

All the necessary summarized information were obtained from publicly available genome-wide association study (GWAS). Two-sample Mendelian randomization (two-sample MR) was employed to explore the causal relationship between asthma and bronchiectasis, with an additional dataset used for validation. Heterogeneity and pleiotropy analyses were utilized to verify the robustness of the results. Subsequently, mediation MR analyses were performed to identify potential mediating factors. Lastly, a retrospective observational study was conducted to validate the findings.

RESULT

Preliminary inverse-variance weighted (IVW) results indicated there was a causal effect of asthma on bronchiectasis (odds ratio [OR] = 1.228, 95% confidence interval [CI]: 1.077-1.400, P = 0.002). Repetition validation yielded a consistent result. Mediation MR analysis demonstrated that the presence of nasal polyps (OR = 1.063, 95% CI: 1.015-1.113, mediation ratio = 30.492%, P = 0.009), acute sinusitis (OR = 1.062, 95% CI: 1.009-1.118, mediation ratio = 30.157%, P = 0.018), chronic sinusitis (OR = 1.085, 95% CI: 1.024-1.150, mediation ratio = 40.677%, P = 0.005), and peripheral eosinophil counts (OR = 1.013, 95% CI: 1.000-1.026, mediation ratio = 6.514%, P = 0.042) served as significant mediators in the occurrence and development of bronchiectasis induced by asthma. Furthermore, a retrospective observational study observed that bronchiectasis patients with asthma had a higher prevalence of sinusitis (5.043% vs 2.971%, P < 0.001), nasal polyps (0.536% vs 0.152%, P < 0.001), and rhinitis (13.197% vs 1.860%, P < 0.001). The ratio (1.950 (0.500, 5.600) vs 1.500 (0.500, 2.600), P = 0.006) and counts (0.125 (0.040, 0.363) vs 0.090 (0.030, 0.160), P < 0.001) of peripheral blood eosinophils were also elevated in bronchiectasis patients with asthma.

CONCLUSION

The MR analysis uncovered a notable genetic association between asthma and bronchiectasis, which was partially mediated by sinusitis, nasal polyps, and eosinophils. A subsequent retrospective study provided further evidence by demonstrating that bronchiectasis patients with asthma had a higher prevalence of sinusitis, nasal polyps, an elevated proportion of eosinophils, and higher eosinophil counts.

Investigation and Analysis of Inhalant Allergens in Patients with Allergic Rhinitis in Yinchuan, China

INTRODUCTION

This study aimed to analyze the types and distribution characteristics of major inhalant allergens in patients with allergic rhinitis (AR) in Yinchuan, China.

METHODS

In this cross-sectional study, 2,000 outpatients suspected of having AR were included from 2022 to 2023 at the Department of Otolaryngology-Head and Neck Surgery, General Hospital of Ningxia Medical University. Skin prick tests were performed on the included individuals using 13 common inhalant allergens: house dust mites, dust mites, tropical mites, Artemisia, dog hair, ragweed, cat hair, grass pollen, tree pollen, mold group I, mold group IV, German cockroach (Blattella germanica), and American cockroach (Periplaneta americana). The results of the skin prick tests were summarized, and patients with positive results were grouped by ethnicity, gender, and age to compare the differences in the positive rates of various inhalant allergens between the groups. The number of patients visiting each month was recorded to analyze the temporal variation in the incidence rate and compare the differences in the main inhalant sensitizers among patients in each quarter.

RESULTS

Among the 2,000 included patients, there were 1,060 males and 940 females, with an average age of 18.7 years. Among the 2,000 outpatients who underwent allergen skin prick tests, 1,346 cases (67.30%) had positive results. The inhalant allergens were ranked in descending order of positive rates as follows: Artemisia (53.25%), dust mites (51.10%), house dust mites (49.10%), ragweed (45.70%), tropical mites (43.15%), dog hair (19.20%), cat hair (16.05%), American cockroach (12.10%), German cockroach (11.25%), grass pollen (9.15%), tree pollen (7.10%), mold group I (6.10%), and mold group IV (5.05%). There were no statistically significant differences in positive rates between different ethnicities or genders (all p > 0.05). Compared to patients aged 18 years and above, patients under 18 years old had statistically significant differences in positive rates for dust mites, Artemisia, ragweed, mold group I, and German cockroach (all p < 0.05). The seasonal distribution indicated that autumn had the highest number of patient visits in a year (579 cases, 58.95%).

CONCLUSION

Artemisia and dust mites were the major inhalant allergens in patients with suspected AR in Yinchuan, China. The positive rate of inhalant allergen skin prick tests was not correlated with the ethnicity or gender of the local population. Autumn was the season with the highest frequency of visits by patients with suspected AR.

Bioinformatics analysis and identification of underlying biomarkers potentially linking allergic rhinitis and autophagy

Allergic rhinitis (AR) resulted in impairing human health and quality of life seriously. There is currently no definitive remedy for AR. Recent studies have shown that autophagy may regulate airway inflammation. Our comprehension of autophagy and its molecular mechanism in the field of AR condition remains incomplete. Our research endeavors to bridge this knowledge deficit by investigating the correlation between AR and autophagy. The AR-related gene expression profile GSE50223 was screened and downloaded. The "limma" package of R software was utilized to identify differentially expressed genes associated with autophagy. GO, KEGG, and Gene set enrichment analyses were conducted. A PPI network of differentially expressed autophagy-related genes were established and further identified through the CytoHubba algorithm. A receiver operating characteristic curve analysis was employed to evaluate the diagnostic effectiveness of the hub genes and to examine the relationship between autophagy-related genes and AR. Finally, qRT-PCR was carried out to confirm the chosen autophagy-related genes using clinical samples. 21 autophagy-related genes in allergic rhinitis were identified. BECN1, PIK3C3, GABARAPL2, ULK2, and UVRAG were considered as significant differentially expressed autophagy-related genes. However, additional molecular biological experiments will be necessary to elucidate the underlying mechanism connecting autophagy and AR.

Group 2 Innate Lymphoid Cells in Allergic Rhinitis

Allergic rhinitis (AR), which presents symptoms like sneezing and a runny nose, is categorized as an upper respiratory condition of type 2. Recent progress in comprehending AR has revealed the significant role played by type 2 cytokines, specifically interleukin (IL)-13, IL-4, and IL-5. These cytokines are released by helper T cells 2 (Th2) and innate lymphoid cells (ILC2s). ILC2s have the ability to interact with various immune cells and are essential in promoting both type 2 immune response and tissue repair, contributing to normal homeostatic functions within the body. This article presents a summary of the latest advancements in comprehending the activity of ILC2s, with particular emphasis on their potential role involvement in AR. It explores how they collaborate with Th2 cells to exacerbate nasal inflammation and interact with regulatory T cells (Tregs) to counteract the suppressive role mediated by Tregs during allergic inflammation. The significance of ILC2s in allergen-specific therapy is highlighted. A comprehensive understanding of ILC2s biology establishes a robust foundation for unraveling the pathogenesis of AR and devising innovative therapeutic approaches for its management.

Impact of the COVID-19 pandemic and lockdown measures on clinical visits and subjective symptoms in childhood allergic rhinitis induced by house dust mites in Shanghai

BACKGROUND

Establishing the interaction between aeroallergens and air pollution in children with house dust mite induced allergic rhinitis (HDM-AR) remains challenging, especially in urban areas. The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown measures provided a valuable opportunity.

METHODS

We analyzed the clinical data of HDM-AR children between March and August in 2018-2020, and classified the children according to the type and the degree of HDM sensitization. The records of patients' hospital visits, allergic rhinitis symptoms assessments, and air pollution measurements in Shanghai were used to assess the differences before (2018-2019) and during the pandemic (2020), as well as during lockdown (March-June) and unlockdown (July-August) period in 2020.

RESULTS

The study included 1570 HDM-AR children aged 2 to 8 years old, 815 (51.9%) were monosensitized to HDM (mono-HDM-AR), and 755 (48.1%) were polysensitized to HDM (poly-HDM-AR). There was a significant increase in the rate of clinical visits among children with HDM-AR during the COVID-19 pandemic compared to pre-pandemic (P < 0.001), particularly among older children aged 7-8 years (P = 0.01). During the unlockdown period, there was a notable decrease in clinical visits for children with poly-HDM-AR (P < 0.001). Children with high levels of HDM sensitization exhibited significant symptom improvement in unlockdown period (P < 0.001). Although the air pollutants concentration had improved during the study, there was no effect on the improvement of HDM-AR children as expected.

CONCLUSIONS

The COVID-19 pandemic and its associated lockdown measures provided a unique context to observe the dynamics of management in children with HDM-AR. The findings underscore the complexity of managing allergic conditions in pediatric populations, highlighting the influence of environmental and lifestyle changes on disease presentation and the need for tailored approaches to treatment during periods of societal disruption.

Association Between Frequency of Away-From-Home Meals and Prevalence of Inflammatory Sinonasal Diseases: A Population-Based Cross-Sectional Study

At the beginning of the COVID-19 pandemic, people had to stay at home due to quarantine, and the food delivery industry grew significantly. Concerns have been raised regarding the popularity of away-from-home (AFH) meals and their impact on health. In this study, we evaluated the association between the frequency of AFH meals and the prevalence of allergic rhinitis (AR) and chronic rhinosinusitis (CRS). In this cross-sectional study, the Korean National Health and Nutrition Examination Survey was reviewed from 2010 to 2019. The frequency of AFH meals was assessed as how often the respondents ate AFH meals in an average week. Those who ate AFH meals less than once per week were designated as group 1, one to four times as group 2, and five times or more as group 3. The diagnoses of AR and CRS were evaluated, and symptoms, endoscopic findings, and serum immunoglobulin E (IgE) levels were assessed. Logistic regression analyses were performed. A total of 48,515 participants were eligible. In multivariate logistic regression analysis for AR, when compared to group 1, the odds ratios (ORs) for AR in participants of group 2 (OR = 1.226, 95% confidence interval [CI] = 1.136-1.324) and group 3 (OR = 1.227, 95% CI = 1.126-1.337) were significantly higher (p < 0.0001). For CRS, group 2 (OR = 1.139, 95% CI = 1.029-1.260) and group 3 (OR = 1.210, 95% CI = 1.078-1.358) showed a significantly higher risk than group 1 (p = 0.0044). Individuals who consume AFH meals frequently might suffer less from AR or CRS if they change their dietary habits and prepare meals more often at home.

Efficacy and perceived satisfaction of 3-year SLIT in children with allergic rhinitis and asthma: a pilot study

BACKGROUND

Despite the presence of robust evidence, there is very limited data on the efficacy of allergen immunotherapy (AIT) for selected patients. Accordingly, we aimed to evaluate the efficacy and perceived satisfaction of a 3-year course of sublingual immunotherapy (SLIT) in a paediatric population with allergic rhinitis and/or asthma.

METHODS

A pilot, monocentre, retrospective cohort study was performed. One hundred fifty-three children who fulfilled the criteria for allergic rhinitis and asthma and were either mono- or poly-sensitized were enrolled. A standardized questionnaire assessing perceived efficacy, use of rescue medication, disease control, number of exacerbations, quality of life, and perceived satisfaction was administered to each patient.

RESULTS

Seventy patients (49 males, 21 females; mean age, 14.3±1.9 years) were included in the final analysis. All 70 patients received SLIT for up to 3 years, with 100% adherence to the treatment throughout the study. Significant improvements in symptoms and quality of life were reported (p<0.01). There was also a significant decrease in disease severity, use of rescue medication, and sleep disturbances (p<0.01). Additionally, a significant improvement in school performance was also recorded (p<0.01). Of the enrolled patients, 60 out of 70 (85.7%) reported being very satisfied, 6 out of 70 (8.57%) were much satisfied, and 4 out of 60 (5.71%) were satisfied.

CONCLUSIONS

We were the first to demonstrate the efficacy and perceived satisfaction of a 3-year SLIT in a paediatric population, with 100% treatment adherence throughout the study.

Efficacy and Safety of Montelukast+Levocetirizine Combination Therapy Compared to Montelukast Monotherapy for Allergic Rhinitis in Children

PURPOSE

The combination therapy of leukotriene receptor antagonists and antihistamines may alleviate allergic rhinitis (AR) symptoms better than monotherapy. This study aimed to investigate the safety and efficacy of Monterizine®, a fixed-dose combination of montelukast and levocetirizine, compared to montelukast monotherapy in pediatric patients with AR.

METHODS

One hundred seventy-six children aged 6 to 14 years with perennial AR symptoms were recruited. One hundred forty-seven subjects were randomized into 1 of 2 groups: the mont+levo group (fixed-dose combination of montelukast [5 mg] + levocetirizine [5 mg]) or the mont group (montelukast single agent [5 mg]). Study subjects took the treatment every evening for 4 weeks and recorded their daytime nasal symptom score (DNSS) and nighttime nasal symptom score (NNSS) in a diary every day. Adverse events (AEs) were also recorded, and patients were surveyed as to their overall satisfaction with the therapeutic product they received.

RESULTS

When DNSS and NNSS were assessed individually, daytime nasal congestion symptom scores decreased more in the mont+levo group during the 4-week treatment period than in the mont group (P = 0.0341). The daytime rhinorrhea symptom scores also decreased more in the mont+levo group (P = 0.0469). The nighttime nasal congestion score (severity when awake) decreased more in the mont+levo group than in the mont group (P = 0.0381). Study subjects in the mont+levo group experienced a greater improvement in quality of life than subjects in the mont group (P < 0.0001).

CONCLUSIONS

The combination therapy of montelukast and levocetirizine was more effective in reducing both daytime nasal symptoms (nasal congestion and rhinorrhea) and nighttime nasal symptoms (severity of nasal congestion when awake). With fewer AEs and higher overall satisfaction, combination therapy is recommended for pediatric patients with perennial AR.

The Evaluation Value of the Modified Lund-Kennedy Nasal Endoscopy Score on the Efficacy of Sublingual Immunotherapy for Allergic Rhinitis

OBJECTIVE

Allergic rhinitis (AR) is a growing public health problem worldwide. Respecting the significance of the modified Lund-Kennedy (MLK) score in rhinitis assessment, we delved into its evaluation value on the sublingual immunotherapy (SLIT) efficacy in AR patients.

METHODS

Totally 100 AR patients were enrolled, with pre- and post-SLIT MLK score, total nasal symptoms score (TNSS), total medication score (TMS), visual analogue scale (VAS), inflammatory cytokines, and immune function-related parameters compared. The correlations of MLK score with TNSS/TMS/VAS, as well as with IL-4/INF-γ/eosinophil (EOS)/percentage/specific immunoglobulin (sIgE)/sIgG were assessed by Spearman correlation analysis. The value of MLK score on assessing SLIT efficacy in AR patients was analyzed.

RESULTS

SLIT treatment reduced MLK/TNSS/TMS/VAS scores, abated IL-4 level/EOS percentage/sIgE, and elevated INF-γ/sIgG levels. MLK score was positively correlated with pre- and post-SLIT TNSS score (rpre-treatment = 0.592, rpost-treatment = 0.756), TMS score (rpre-treatment = 0.385, rpost-treatment = 0.718), VAS score (rpre-treatment = 0.369, rpost-treatment = 0.704), IL-4 (rpre-treatment = 0.553, rpost-treatment = 0.639), EOS percentage (rpre-treatment = 0.511, rpost-treatment = 0.632), and sIgE (rpre-treatment = 0.472, rpost-treatment = 0.524), and negatively with INF-γ (rpre-treatment = -0.418, rpost-treatment = -0.578) and sIgG4 (rpre-treatment = -0.460, rpost-treatment = -0.613). The MLK score had an area under curve of 0.846 (77.01% sensitivity, 76.92% specificity, 4 cut-off value) and 0.944 (91.67% sensitivity, 92.11% specificity, 2 cut-off value) for assessing SLIT treatment as effective and markedly effective for the patients, respectively.

CONCLUSION

The MLK score had good evaluation value on the efficacy of SLIT treatment in AR patients.

Nasal allergen challenge with Blomia tropicalis in children and adolescents

BACKGROUND

Local allergic rhinitis (LAR) is a well-defined phenotype in adults, but still there is little data available on children. This scarcity of data can be partly attributed to the lack of standardized protocols for Nasal Allergen Challenges (NAC) in this demographic.

METHODS

20 controls (control group) and 24 patients (rhinitis group) with allergic rhinitis diagnosis sensitized to Blomia tropicalis (Bt) underwent the NAC with Bt. The acoustic rhinometry was performed after instillation of increasing concentrations of Bt (5,000 BU/mL).

RESULTS

The median reduction in the volume of the nasal cavity in its first five centimeters (V5) by the conclusion of the NAC in the rhinitis group was markedly higher than that observed in the control group, at -22.9% (range: -21.1% to -26.2%) compared to -7.7% (ranging: -4.8% to +12.8%).

CONCLUSIONS

Our research demonstrates the efficacy and safety of the NAC protocol utilizing Bt in distinguishing allergic from non-allergic children.

Individualized sublingual immunotherapy with dynamic maintenance dose ascending for house dust mite-induced allergic rhinitis

BACKGROUND

Precision dosing in sublingual immunotherapy (SLIT) has become a hotspot gradually, yet no standardized dose adjustment pattern for house dust mite (HDM)-SLIT. This study aims to investigate the clinical feasibility of the dynamic maintenance dose ascending regimen for individualized SLIT.

METHODS

A total of 258 allergic rhinitis (AR) patients treated with HDM-SLIT were included in this retrospective study. Patients were divided into the regular dose (RD) group (n = 101) and the high dose (HD) group (n = 157) according to different maintenance dosages of SLIT. In the RD group, patients received the fixed dose recommended by the manufacturer. In the HD group, patients received a maximum tolerance dose determined by dynamic dose ascending. The clinical efficacy was evaluated by combined symptom and medication score (CSMS) and visual analogue scale score (VAS) at the baseline, 0.5-year, 1-year, and 2-year. The safety was evaluated by adverse events (AEs).

RESULTS

Significant reductions of CSMS and VAS at 0.5-year, 1-year, and 2-year were observed in both the RD group and the HD group compared to the baseline (P < 0.05). In addition, greater improvements in these clinical parameters from 0.5- to 2-year were found in the HD group compared to the RD group (P < 0.05). For subgroup analysis in the HD group, no significant differences in CSMS and VAS were observed among subgroups of patients <14 years old and patients ≥14 years old (P > 0.05). No serious AEs in the two groups and no significant differences were observed between the AE incidence rate of the RD group and HD group during the incremental and maintenance phases.

CONCLUSIONS

The 2-year HDM-SLIT with dynamic maintenance dose ascending regimen offers an "optimal" treatment for AR patients while maintaining safety. This study introduced a pattern for individualized dose adjustment in clinical practice, offering potential benefits for AR patients.

Impact of Allergic Rhinitis Control on Work Productivity and Costs: A Real-World Data MASK-air Study

BACKGROUND

Allergic rhinitis (AR) has a substantial socioeconomic impact associated with impaired work productivity.

OBJECTIVE

To study the impact of AR on work productivity and estimate the corresponding indirect costs for 40 countries.

METHODS

We conducted a cross-sectional study using direct patient data from the MASK-air app on users with self-reported AR. We used the Work Productivity and Activity Impairment Questionnaire: Allergy Specific to measure the impact of AR on work productivity (presenteeism and absenteeism). Weekly indirect costs were estimated per country for each level of rhinitis control. Patients with and without asthma were considered.

RESULTS

We assessed data from 677 weeks (364 patients), 280 of which were reported by patients with asthma. Regarding presenteeism, the median impact of AR in weeks of poor disease control was 60.7% (percentiles 25-75 [P25-P75] 24.9%-74.2%), whereas partial and good disease control were, respectively, associated with an impact of 25.0% (P25-P75 12.1%-42.4%) and 4.4% (P25-P75 0.8%-12.9%). In poorly controlled weeks, presenteeism was associated with indirect costs ranging from 65.7 US$ purchase power parities (PPPs) (P25-P75 29.2-143.2) in Brazil to 693.6 US$ PPP (P25-P75 405.2-1,094.9) in Iceland. Median absenteeism per week was of 0% for all levels of rhinitis control. Patients with AR + asthma showed higher overall work impairment than patients with AR alone, particularly in poorly controlled weeks (median work impairment in AR alone 39.1% [P25-P75 12.5%-71.9%]; median work impairment in AR + asthma 68.4% [P25-P75 54.6%-80.2%]).

CONCLUSIONS

Poor AR control was associated with decreased work productivity and increased indirect costs, particularly in patients with AR + asthma. The estimates from this study underpin the economic burden of AR.

Clinical Effect Analysis of Fire-needle Acupuncture at Neiyingxiang Treating Persistent Allergic Rhinitis

OBJECTIVES

We conducted the first trial to evaluate the effect that fire-needle acupuncture at Neiyingxiang (ExHN 9) in patients with moderate to severe persistent AR.

METHODS

This was a randomized, single-center, sham, and placebo-controlled rial. Patients were kept blinded to their group assignment. All participants were equally assigned to the fire-needle acupuncture (FA) treatment group, sham fire-needle acupuncture (SFA) group, or loratadine group. The trial was designed with an acupuncture intervention once a week for 4 weeks and follow-up 4 weeks. The Total Nasal Symptom Scores (TNSS), Total Non-Nasal Symptom Scores (TNNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Allergic Rhinitis Control Test (ARCT), and total nasal resistance of 150 Pa were evaluated as outcome measures.

RESULTS

A total of 180 participants were enrolled, and 175 participants completed the trials. At 2 and 4 weeks, the TNSS, TNNSS, and RQLQ scores of the FA and loratadine groups were significantly lower than those of the SFA group. At 8 weeks, the scores of loratadine group increased compared with the FA group (Cohen's d >0.80, p < 0.01). The ACRT score of the FA treatment group rose gradually. After treatment, the total nasal resistance of the FA group was significantly decreased and was lower than that of the other two groups (Cohen's d >0.80, p < 0.01).

CONCLUSION

Fire-needle acupuncture at Neiyingxiang (ExHN 9) is effective for improving nasal allergy symptoms and quality of life in patients with moderate and severe persistent AR, and the duration of its effects is long.

LEVEL OF EVIDENCE

2 Laryngoscope, 134:4471-4479, 2024.

Investigation of the Effectiveness of Nasal Sprays in Allergic Rhinitis

Objectives: We investigated the effectiveness of different types of nasal irrigation sprays in adult allergic rhinitis (AR) patients. Methods: A total of 1700 patients with AR (866 males and 834 females) were assigned to: Group 1: Hypertonic nasal spray group (n = 600) (Sinomarin® hypertonic nasal spray); Group 2: Algae-containing hypertonic nasal spray group (n = 600) (Sinomarin Plus Algae ENT); and Group 3: Isotonic saline nasal spray group (n = 500). All patients underwent an otolaryngological examination, continued their standard AR treatment, and received the assigned nasal spray additionally (1 spray to each nostril, 3 times a day, for 3 weeks). Allergic symptom scores, turbinate examination, total symptom scores, and quality of life (QoL) scores were evaluated during pre- and post-treatment periods. Results: In groups 1 and 2, symptom scores and turbinate color and edema, total symptom scores, and QoL scores increased after treatment (P < .05). In the saline group, there were no significant differences in symptom scores and total symptom scores after treatment; however, improvement was detected in turbinate color and edema values after treatment. QoL scores increased after treatment. When comparing the 3 groups, the total symptom scores of groups 1 and 2 were significantly lower, and the QoL scores of groups 1 and 2 were considerably higher than those of the saline group. There were no significant differences between groups 1 and 2. Conclusion: Algae-containing and hypertonic nasal spray may be added to the standard AR treatment to increase QoL and decrease total symptom scores.

Artificial Intelligence-Supported Development of Health Guideline Questions

BACKGROUND

Guideline questions are typically proposed by experts.

OBJECTIVE

To assess how large language models (LLMs) can support the development of guideline questions, providing insights on approaches and lessons learned.

DESIGN

Two approaches for guideline question generation were assessed: 1) identification of questions conveyed by online search queries and 2) direct generation of guideline questions by LLMs. For the former, the researchers retrieved popular queries on allergic rhinitis using Google Trends (GT) and identified those conveying questions using both manual and LLM-based methods. They then manually structured as guideline questions the queries that conveyed relevant questions. For the second approach, they tasked an LLM with proposing guideline questions, assuming the role of either a patient or a clinician.

SETTING

Allergic Rhinitis and its Impact on Asthma (ARIA) 2024 guidelines.

PARTICIPANTS

None.

MEASUREMENTS

Frequency of relevant questions generated.

RESULTS

The authors retrieved 3975 unique queries using GT. From these, they identified 37 questions, of which 22 had not been previously posed by guideline panel members and 2 were eventually prioritized by the panel. Direct interactions with LLMs resulted in the generation of 22 unique relevant questions (11 not previously suggested by panel members), and 4 were eventually prioritized by the panel. In total, 6 of 39 final questions prioritized for the 2024 ARIA guidelines were not initially thought of by the panel. The researchers provide a set of practical insights on the implementation of their approaches based on the lessons learned.

LIMITATION

Single case study (ARIA guidelines).

CONCLUSION

Approaches using LLMs can support the development of guideline questions, complementing traditional methods and potentially augmenting questions prioritized by guideline panels.

PRIMARY FUNDING SOURCE

Fraunhofer Cluster of Excellence for Immune-Mediated Diseases.

Intranasal corticosteroid users in The Netherlands: A drug utilization study

Background

To improve (patient-tailored) instructions for intranasal corticosteroid (INC) administration, we need to gain insight into specific characteristics of INC users and comedication use.

Objective

We examined INC prescriptions obtained from the Dutch InterAction Database to gain insight into the prevalence and incidence rates, INC use in previous years, and comedication.

Methods

We retrospectively examined INC prescriptions written between January 1, 2015, and December 31, 2019. Prevalence and incidence rates were stratified by age and sex. The use of INCs in previous years and comedication were analyzed.

Results

In 2019, a total of 172,563 INC prescriptions were written and dispensed to 75,048 individuals. Also in 2019, the prevalence and incidence of INC users were 68.9 and 25.6 per 1000 individuals, respectively. INCs were used by all age groups. More than half of INC users in 2019 did not receive a prescription in 2018, almost a quarter received a prescription in 5 consecutive years, 28% used an INC in combination with an inhaler, 29% used an INC together with a systemic antihistamine, 9% used an INC along with ocular medication, and 1% used an INC with an intranasal antihistamine. Several corticosteroid-containing drugs were being used in combination with INCs by 2% to 16% of those studied.

Conclusion

This study gives insights into opportunities for patient-tailored instructions. INCs are used by various age groups and by new or intermittent users as well as by continuous users. On the bases of these results, patient-tailored instructions can be developed and subsequently studied to determine whether the instructions affect treatment adherence and efficacy. The insights gained about comedication provide opportunities for improved evaluation of the INC administration technique. Taken together, these suggestions might lead to a more patient-tailored approach, which might in turn lead to improved treatment with INCs.

Bimin Kang ameliorates the minimal persistent inflammation in allergic rhinitis by reducing BCL11B expression and regulating ILC2 plasticity

ETHNOPHARMACOLOGICAL RELEVANCE

Minimal persistent inflammation (MPI) is a major contributor to the recurrence of allergic rhinitis (AR). The traditional Chinese herbal medicine known as Bimin Kang Mixture (BMK) have been used in clinics for decades to treat AR, which can relieve AR symptoms, reduce inflammatory response and improve immune function. However, its mechanism in controlling MPI is still unclear.

AIM OF THE STUDY

This study aims to assess the therapeutic effect of BMK on MPI, and elaborate the mechanism involved in BMK intervention in BCL11B regulation of type 2 innate lymphoid cell (ILC2) plasticity in the treatment of MPI.

MATERIAL AND METHODS

The effect of BMK (9.1 ml/kg) and Loratadine (15.15 mg/kg) on MPI was evaluated based on symptoms, pathological staining, and ELISA assays. RT-qPCR and flow cytometry were also employed to assess the expression of BCL11B, IL-12/IL-12Rβ2, and IL-18/IL-18Rα signaling pathways associated with ILC2 plasticity in the airway tissues of MPI mice following BMK intervention.

RESULTS

BMK restored the airway epithelial barrier, and markedly reduced inflammatory cells (eosinophils, neutrophils) infiltration (P < 0.01) and goblet cells hyperplasia (P < 0.05). BCL11B expression positively correlated with the ILC2 proportion in the lungs and nasal mucosa of AR and MPI mice (P < 0.01). BMK downregulated BCL11B expression (P < 0.05) and reduced the proportion of ILC2, ILC3 and ILC3-like ILC2 subsets (P < 0.05). Moreover, BMK promoted the conversion of ILC2 into an ILC1-like phenotype through IL-12/IL-12Rβ2 and IL-18/IL-18Rα signaling pathways in MPI mice.

CONCLUSION

By downregulating BCL11B expression, BMK regulates ILC2 plasticity and decreases the proportion of ILC2, ILC3, and ILC3-like ILC2 subsets, promoting the conversion of ILC2 to ILC1, thus restoring balance of ILC subsets in airway tissues and control MPI.

Effects of probiotics on the prevention and treatment of children with allergic rhinitis: a meta-analysis of randomized controlled trials

Background and aim

Recent studies have demonstrated the anti-allergic effects of probiotics in humans. However, their role in preventing and treating pediatric allergic rhinitis has not been thoroughly investigated. This study aimed to systematically review the efficacy and preventive effects of probiotics on pediatric allergic rhinitis.

Methods

We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science databases for all relevant studies on probiotics and pediatric allergic rhinitis. Studies meeting the inclusion criteria were included, data were extracted, and meta-analyses were performed.

Results

A total of 28 studies with 4,765 participants were included in this study. The pooled results showed that the use of probiotics was associated with a significant improvement in total nose symptom scores (SMD, -2.27; 95% CI, -3.26 to -1.29; P < 0.00001), itchy nose scores (SMD, -0.44; 95% CI, -0.80 to -0.07; P = 0.02), sneezing scores (SMD, -0.47; 95% CI, -0.84 to -0.10; P = 0.01), eye symptoms (SMD, -3.77; 95% CI, -5.47 to -2.07; P < 0.00001), and Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (SMD, -2.52; 95% CI, -4.12 to -0.92; P < 00001). However, the use of probiotics was not associated with the incidence of allergic rhinitis (RR, 0.9; 95% CI, 0.74-1.08; P = 0.26).

Conclusions

The present study demonstrated that probiotics were effective and safe for improving pediatric allergic rhinitis symptoms and quality of life. However, probiotics could not prevent pediatric allergic rhinitis.

The Role of Neuro-Immune Interactions in the Pathology and Pathogenesis of Allergic Rhinitis

BACKGROUND

Allergic rhinitis (AR) is a non-infectious inflammatory disease of the nasal mucosa mediated by IgE and involving a variety of immune cells such as mast cells. In previous studies, AR was considered as an isolated disease of the immune system. However, recent studies have found that the nervous system is closely related to the development of AR. Bidirectional communication between the nervous and immune systems plays an important role in AR.

SUMMARY

The nervous system and immune system depend on the anatomical relationship between nerve fibers and immune cells, as well as various neurotransmitters, cytokines, inflammatory mediators, etc. to produce bidirectional connections, which affect the development of AR.

KEY MESSAGES

This article reviews the impact of neuro-immune interactions in AR on the development of AR, including neuro-immune cell units.

Changes in respiratory tract and gut microbiota in AR mice and their relationship with Th1/Th2/Treg

BACKGROUND

The etiology of allergic rhinitis (AR) is not fully understood. Studies have shown that the maturation of children's immune systems is closely related to microecology. However, few studies have focused simultaneously on changes in respiratory and gut microbiota in AR and their correlation between microecological changes and Th1/Th2/Treg.

OBJECTIVE

The aim is to investigate the pathogenesis of AR based on respiratory microecology, gut microecology, and Th1/Th2/Treg levels by applying microbiome techniques and correlation analysis.

METHODS

Standardized OVA-induced AR mice were established. Serum OVA-sIgE, IL-4, IFN-γ, IL-10 were measured by ELISA, Tregs in lymph nodes were determined by flow cytometry, and the histological characteristics of nasal tissues were evaluated by Hematoxylin & Eosin (H&E). Nasal symptoms were observed to determine the reliability of the AR mouse model. Nasal lavage fluid (NALF) and fecal samples were collected after the last OVA challenge. The composition of respiratory microbiota in NALF and gut microbial in feces samples via 16S rRNA gene sequencing between the two groups, further explored the relationship between microbiota and Th1/Th2/Treg levels.

RESULTS

In the AR group, the incidence of nose rubbing and sneezing in each mouse was significantly increased compared with the control group (all P < 0.001) and the inflammatory cell infiltration of NALF shows a significant increase in eosinophilic and neutrophilic infiltrates upon the AR group; H&E showed that the nasal mucosa of AR mice infiltration of massive eosinophils cells and neutrophils cells. OVA-sIgE and IL-4 in the AR group were increased (P < 0.01, P < 0.05) and IFN-γ, IL-10 were significantly decreased (P < 0.01, P < 0.05). Tregs showed a downward trend in the AR group, but there was no statistical difference. Compared with the control group, the respiratory microbiota of AR mice did not change significantly, while the gut microbiota changed significantly. In gut microbiota, compared to the control group, Shannon index in the AR group revealed a significant decrease at the genus level (P < 0.01), and Simpson index was significantly increased at all levels (all P < 0.05). PCoA also showed significant differences in beta diversity between the two groups (all P < 0.05). Compared to the control group, Deferribacteres at phylum level, Roseburia, Ruminiclostridium, Anaerotruncus at genus level were significantly decreased in the AR group (all P < 0.05). Spearman's rank correlation showed that OVA-sIgE was positively correlated with Bacteroidetes, Muribaculaceae and Erysipelotrichaceae (all P < 0.05); IL-4 was significantly negatively correlated with Epsilonbacteraeota and Deferribacteres (all P < 0.05). Treg was significantly positively correlated with Patescibacteria, Lachnospiraceae, and Saccharimonadaceae in gut microecology.

CONCLUSION

Our results showed that the respiratory microbiota of AR mice was not significantly altered, but the gut microbiota varied significantly and there was a correlation between gut microbiota and Th1/Th2/Treg.

Concepts for the Development of Person-Centered, Digitally Enabled, Artificial Intelligence-Assisted ARIA Care Pathways (ARIA 2024)

The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own lives based on their lived experiences. Improving healthcare safety, quality, and coordination, as well as quality of life, is an important aim in the care of patients with chronic conditions. Person-centered care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (1) digital care pathways for rhinitis and asthma multimorbidity and (2) digitally enabled, person-centered care.1 It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally enabled, patient-centered care. The paper includes (1) Allergic Rhinitis and its Impact on Asthma (ARIA), a 2-decade journey, (2) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (3) mHealth impact on airway diseases, (4) From guidelines to digital care pathways, (5) Embedding Planetary Health, (6) Novel classification of rhinitis and asthma, (7) Embedding real-life data with population-based studies, (8) The ARIA-EAACI (European Academy of Allergy and Clinical Immunology) strategy for the management of airway diseases using digital biomarkers, (9) Artificial intelligence, (10) The development of digitally enabled, ARIA person-centered care, and (11) The political agenda. The ultimate goal is to propose ARIA 2024 guidelines centered around the patient to make them more applicable and sustainable.

Prevalence of Migraine Headache among Patients with Allergic Rhinitis in a Tertiary Care Hospital, Puducherry

Allergic rhinitis is one of the most common and undertreated diseases in the world. In recent times, there has been increased development of non-sinus headaches among patients with allergic rhinitis. Various common endogenous molecules such as nitric oxide, calcitonin gene-related peptide, and histamine have been implicated in the development of migraines, which leads to the development of migraines among allergic rhinitis patients. The study aims to determine the prevalence of migraine among allergic rhinitis patients and to find the association between the various demographic factors and the presence of migraine. This cross-sectional study was conducted in the ENT department of a tertiary care hospital in Puducherry. All patients aged more than 18 years old with the symptoms of allergic rhinitis were included in the study. The study was conducted six months, from July 2023 to December 2023. ARIA classification is used to determine the severity of the allergic rhinitis, and, per International criteria for headache, was used to diagnose migraine. A total of 282 patients with allergic rhinitis participated in the study. The mean age of the patients was found to be 38.89 ± 11.04 years. The prevalence of migraine among allergic rhinitis patients was found to be 69.1%-Economic status (39.4%). About 16.7% of the patients with diabetes were associated with migraine. The study showed a significant association between sex (p-0.006), age (p < 0.001), and socio-economic status (p-0.034) with the presence of migraine. The study also showed a significant association between the severity of allergic rhinitis and the presence of migraine (p-0.034) and the type of migraine (p-0.004). The study concludes that a significant proportion of the patients with allergic rhinitis were associated with migraine. So, clinicians should always screen for the presence of the migraine in all patients with allergic rhinitis to improve the patient's quality of life.

Risk Factors for Acute Asthma Exacerbations in Adults With Mild Asthma

BACKGROUND

Although individuals with mild asthma account for 30% to 40% of acute asthma exacerbations (AAEs), relatively little attention has been paid to risk factors for AAEs in this population.

OBJECTIVE

To identify risk factors associated with AAEs in patients with mild asthma.

METHODS

This was a retrospective cohort study. We used administrative data from a large managed care organization to identify 199,010 adults aged 18 to 85 years who met study criteria for mild asthma between 2013 and 2018. An asthma-coded qualifying visit (index visit) was identified for each patient. We then used information at the index visit or from the year before the index visit to measure potential risk factors for AAEs in the subsequent year. An AAE was defined as either an asthma-coded hospitalization or emergency department visit, or an asthma-related systemic corticosteroid administration (intramuscular or intravenous) or oral corticosteroid dispensing. Poisson regression models with robust SEs were used to estimate the adjusted risk ratios for future AAEs.

RESULTS

In the study cohort, mean age was 44 years and 64% were female; 6.5% had AAEs within 1 year after the index visit. In multivariate models, age, sex, race, ethnicity, smoking status, body mass index, prior acute asthma care, and a variety of comorbidities and other clinical characteristics were significant predictors for future AAE risk.

CONCLUSION

Population-based disease management strategies for asthma should be expanded to include people with mild asthma in addition to those with moderate to severe disease.

Immunocytes do not mediate food intake and the causal relationship with allergic rhinitis: a comprehensive Mendelian randomization

Background

Observational studies indicate a correlation between food intake and allergic rhinitis. The potential interplay between the immune system and allergic rhinitis might contribute causally to both food intake and allergic rhinitis, providing promising therapeutic avenues. However, elucidating the causal relationship and immune-mediated mechanisms between food intake and allergic rhinitis remains a pending task.

Methods

We utilized a two-sample Mendelian randomization (MR) methodology to explore the causal relationship between food intake and allergic rhinitis. Furthermore, we investigated the potential causal relationship of immune cell signals with allergic rhinitis, as well as the potential causal relationship between food intake and immune cell signals. Moreover, employing both two-step Mendelian randomization and multivariable Mendelian randomization, we delved into the mediating role of immune cell signals in the causal relationship between food intake and allergic rhinitis. Leveraging publicly accessible genetic datasets, our analysis encompassed 903 traits, comprising 171 food intake features, 731 immune cell features, and one trait related to allergic rhinitis.

Result

We found causal relationships between seven types of food intake and allergic rhinitis, as well as between 30 immune cell phenotypes and allergic rhinitis. Furthermore, our two-step Mendelian randomization analysis and multivariable Mendelian randomization analysis indicate that immune cells do not mediate the causal relationship between food intake and allergic rhinitis.

Conclusion

To the best of our knowledge, we are the first to incorporate a large-scale dataset integrating immune cell features, food intake features, and allergic rhinitis into Mendelian randomization analysis. Our research findings indicate that there are causal relationships between six types of food intake and allergic rhinitis, as well as between 30 immune cell phenotypes and allergic rhinitis. Additionally, immune cells do not mediate these relationships.

Ayurveda Management of Allergic Rhinitis: Protocol for a Randomized Controlled Trial

BACKGROUND

Allergic rhinitis (AR) is the inflammation of the membranes lining the nose due to allergen exposure and is characterized by sneezing, nasal congestion, itching of the nose, or postnasal discharge. The prevalence varies worldwide, perhaps due to the geographic and aeroallergen differences, with 10% to 30% of the world's population experiencing AR. In this study, Anu Taila Nasya, Naradiya Laxmivilas Rasa, and Shirishadi Kwath will be compared to a fluticasone nasal spray.

OBJECTIVE

The primary aim is to assess the efficacy of Ayurvedic management for AR (or vataja pratishyaya) by comparing it to a conventional control group. The secondary aims are to determine the mean change in the nasal endoscopy index and the mean change in the laboratory tests.

METHODS

This ongoing study is an open-label randomized controlled interventional trial, with a sample size of 90 both in the trial and standard control group (including dropouts, 20%), and will be carried out for 24 months. Participants in the trial group will receive Ayurvedic treatment, that is, Anu Taila Nasya (6 drops in each nostril for 7 days for 3 consecutive weeks), Naradiya Laxmivilas Rasa (250 mg twice per day), and Shirishadi Kwath (40 ml twice per day for 45 days). The participants in the control group will receive a fluticasone propionate nasal spray (2 sprays once per day for 45 days). The primary outcome will include the mean change in the Control of Allergic Rhinitis and Asthma Test score, and the secondary outcomes will include the mean change in the nasal endoscopy index (assessment of nasal membrane color, pale or hyperemia; rhinorrhea, watery or yellow; and inferior turbinate swelling, hypertrophy) and the mean change in the laboratory tests.

RESULTS

As of May 2024, 72 patients have been enrolled in both groups. Data analysis should be completed by February 2025. The study will be reported following standard guidelines for reporting randomized controlled trials. Clinical results will be disseminated through conferences and peer-reviewed publication in a relevant journal.

CONCLUSIONS

The Ayurvedic approach could be an evidence-based therapeutic tactic for the management of AR.

TRIAL REGISTRATION

Clinical Trials Registry India CTRI/2023/06/053395; https://tinyurl.com/564d2zz8.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56063.

Mutual Influence Between Allergic Rhinitis and Sleep: Factors, Mechanisms, and interventions-A Narrative Review

Patients with allergic rhinitis (AR) have a high incidence of sleep disorders, such as insomnia, which can easily exacerbate nasal symptoms. The aggravation of nasal symptoms further promotes the deterioration of sleep disorders, forming a vicious cycle. Severe cases may even trigger psychological and neurological issues, such as anxiety, depression, and cognitive impairment, causing significant distress to patients, making clinical diagnosis and treatment difficult, and increasing costs. Furthermore, satisfactory therapeutics remain lacking. As the pathogenesis of AR-associated sleep disorders is not clear and research is still insufficient, paying attention to and understanding AR-related sleep disorders is crucial in clinical practice. Multiple studies have shown that the most crucial issues in current research on AR and sleep are analyzing the relationship between AR and sleep disorders, searching for the influencing factors, and investigating potential targets for diagnosis and treatment. This review aimed to identify and summarize the results of relevant studies using "AR" and "sleep disorders" as search terms. In addition, we evaluated the correlation between AR and sleep disorders and examined their interaction and potential mechanisms, offering a foundation for additional screening of potential diagnostic biomarkers and therapeutic targets.

New progress in pediatric allergic rhinitis

The prevalence of allergic rhinitis (AR) in children is steadily increasing, and its onset is closely associated with genetic factors, living environment, and exposure to allergens. In recent years, an increasing number of diagnostic methods have been employed to assist in diagnosing AR. In addition to pharmaceutical treatments, personalized approaches such as environmental control and allergen-specific immunotherapy are gradually gaining popularity. In this article, we reviewed recent research on the etiology, diagnostic classification, treatment methods, and health management of AR in children. These insights will benefit the implementation of personalized diagnosis and treatment for children with AR, promoting health management strategies that improve symptoms and quality of life.

The burden of allergic rhinitis is undermanaged in a large proportion of Chinese young adults from Singapore

Background

Allergic rhinitis (AR) is a nasal disorder characterized by the simultaneous manifestation of at least 2 out of 4 possible symptoms: rhinorrhea, nasal itching, nasal pruritus, and sneezing. Presently, among Chinese young adults from Singapore, we characterised AR phenotypes, established Total Nasal Symptom Score (TNSS) baselines, and examined the management of AR.

Methods

Participants completed an investigator-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and underwent a skin prick test (SPT). Individuals exhibiting sensitization during the SPT while having at least 2 rhinitis symptoms were identified as AR cases, then categorized into Allergic Rhinitis in Asthma (ARIA) classifications.

Results

There were 9323 subjects analyzed. AR prevalence was estimated at 35.4%. Rhinorrhea was perceived as the most severe (mean Nasal Symptom Score (mNSS) ± SD: 1.42 ± 0.74), while nasal pruritus was the least severe (mNSS ± SD: 1.24 ± 0.68). Among moderate-severe AR (68.1%), most were affected by either troublesome symptoms (27.7%) or sleep disturbances (18.4%). By ARIA classes, 26.6% were mild intermittent, 5.4% were mild persistent, 50.3% were moderate-severe intermittent, and 17.6% were moderate-severe persistent. The mean TNSS (mTNSS) of AR cases was 4.43 (SD = 2.49) and between AR classifications, the mTNSS was significantly different. Notably, a large proportion of AR cases remained undiagnosed (85.2%), untreated (72.5%), or both (65.4%); 19.8% self-medicated for AR.

Conclusions

There was a significant difference in TNSS of the AR phenotypes, and among phenotypes with a higher mTNSS, a large proportion remained untreated, undiagnosed, or both. The evidence indicates an existing burden of AR among Chinese young adults in Singapore which is notably undermanaged.

Ultrasound guided pulsed radiofrequency neuromodulation of sphenopalatine ganglion treatment for allergic rhinitis in childern: A case report

Allergic rhinitis (AR) is a chronic noninfectious inflammation of the nasal mucosa mediated primarily by allergen-specific immunoglobulin E (IgE) in atopic individuals after exposure to allergens, with the involvement of non-IgE-mediated mechanisms and neuroimmune dysregulation. Conservative treatment of AR is ineffective in children who lack compliance, and traditional surgical procedures are risky, making treatment of this community challenging. The sphenopalatine ganglion (SPG), aka pterygopalatine ganglion, is the largest of the four parasympathetic ganglia located within the head region, existing as a bilateral pair. The fibers that arise from the SPG regulate secretomotor functions and provide sensation from various structures, including the lacrimal glands, the mucous membranes of the oropharynx, nasopharynx, nasal cavity, and upper portion of the oral cavity. Previous studies suggest that SPG plays a much crucial role in the neuro-related pathophysiological mechanisms of AR. Pulsed radiofrequency (PRF) is a commonly used technique in pain management to produce neuromodulatory effects without damaging nerve tissue. Previous research suggests that SPG dysfunction is one of the important pathophysiological mechanisms of trigeminal autonomic cephalalgia, and PRF targeting SPG can effectively exert neuromodulatory effects to improve its symptoms. We thus predicted that the application of PRF for neuromodulation of SPG would be beneficial for symptom remission in AR. We report the first case of AR successfully treated with PRF targeting the SPG, symptoms did ameliorate during the 24-week follow-up period, as manifested by the disappearance of nocturnal open-mouth breathing and its murmur and a significant reduction in the frequency and severity of daily episodes of nasal congestion, tearing, and conjunctival congestion, which diversifies clinical interventions for AR.

Reduced atopic march risk in pediatric atopic dermatitis patients prescribed dupilumab versus conventional immunomodulatory therapy: A population-based cohort study

BACKGROUND

Dupilumab effectively treats atopic dermatitis (AD); however, its role in halting the atopic march remains uncertain.

OBJECTIVE

To investigate dupilumab's effect on atopic march in pediatric AD patients versus conventional immunomodulators.

METHODS

This retrospective cohort study utilized data from the TriNetX US Collaborative Network (2011-2024). Pediatric AD patients (≤18 years) were categorized into DUPI-cohort (newly prescribed dupilumab) or CONV-cohort (prescribed conventional immunomodulators without dupilumab). After 1:1 propensity-score matching, we analyzed atopic march progression, defined by the incident asthma or allergic rhinitis (AR). Cumulative incidence was plotted using Kaplan-Meier, with risk assessment via Cox regression.

RESULTS

The study included 2192 patients in each cohort. The 3-year cumulative incidence of atopic march progression was lower in the DUPI-cohort than the CONV-cohort (20.09% vs 27.22%; P < .001). The DUPI-cohort demonstrated significant risk reduction in atopic march progression (hazard ratio [HR] 0.68, 95% CI 0.55-0.83), individual asthma (HR 0.60, 0.45-0.81), and individual AR (HR 0.69, 0.54-0.88). Younger patients on dupilumab exhibited a greater risk reduction for atopic march progression and individual asthma, contrasting with the opposite age-related pattern for individual AR.

LIMITATIONS

Observational study.

CONCLUSION

Among pediatric AD patients, dupilumab was associated with reduced risk of atopic march progression compared with conventional therapies.

Efficacy and safety of various corticosteroids in the treatment of children with allergic rhinitis: A systematic review and network meta-analysis

BACKGROUND

Intranasal corticosteroids were recommended as first-line drugs for the treatment of allergic rhinitis (AR) children. A variety of corticosteroids were available for clinical choice; however, which could relieve the clinical symptoms of patients to the greatest extent was currently unknown. Thus, we performed a network meta-analysis (NMA) to systematically evaluate the effectiveness and safety of different corticosteroids in treating children with AR, which might provide a basis for more rational clinical treatment decisions.

METHODS

Seven electronic databases were searched, and the retrieval time range was the time from their inception to November 2023. The literature screening, data extraction, and assessment of the risk of bias of included studies were completed independently by two reviewers. A frequentist NMA was performed with Stata17.0 software.

RESULTS

A total of 43 RCTs covering 10,897 participants were included. In the improvement of reflective total nasal symptom score (rTNSS) and instantaneous total nasal symptom score (iTNSS), fluticasone furoate nasal spray (FFNS) and beclomethasone dipropionate (BDP) nasal aerosol presented the best efficacy. Regarding the incidence of adverse reactions, mometasone furoate aqueous nasal spray (MFANS) and BDP showed a good safety profile. In terms of the influence of cortisol (urinary free cortisol, plasma cortisol) and growth, no significant difference was observed between the different groups.

CONCLUSION

The results showed that BDP nasal aerosol and FFNS had best efficacy; MFANS and BDP had the best safety profile. However, this conclusion was less convincing because of the limited numbers of patients/controls and study quality.

Functional Polymorphisms Regulate FOXO1 Transcript Expression and Contribute to the Risk and Symptom Severity of HDM-Induced Allergic Rhinitis

INTRODUCTION

FOXO1 plays an important role in regulating immune processes that contribute to allergic inflammation; however, genetic variants influencing FOXO1 expression in AR pathogenesis remains unclear. This study aimed to investigate the functional effect of FOXO1 single nucleotide polymorphisms (SNPs) on AR development by performing genetic association and functional analysis studies.

METHODS

This study belongs to a part of an ongoing Singapore/Malaysia cross-sectional genetics and epidemiological study (SMCSGES). We assessed the associations of FOXO1 transcript expression levels in peripheral blood mononuclear cells (PBMC) with AR phenotype, total nasal symptom score (TNSS), and SNP genotype in a sub-cohort of n = 658 individuals from the SMCSGES population. Associations of FOXO1 SNPs with AR were assessed in a cohort of n = 5,072 individuals from the SMCSGES population. In vitro promoter luciferase assay was used to evaluate the effect of AR-associated SNPs on FOXO1 promoter activity.

RESULTS

FOXO1 transcript expression in PBMC was significantly associated with the risk of AR (p < 0.05) and TNSS among AR patients (p < 0.0001). We identified a significant association between tag-SNPs rs9549246 and FOXO1 transcript expression in PBMC from the SMCSGES sub-cohort and the multiethnic eQTLGen consortium (false discovery rate-adjusted p < 0.05). The minor allele "A" of tag-SNP rs9549246 was significantly associated with a higher risk of AR (p = 0.04422, odds ratio = 1.21, 95% confidence interval = 1.01-1.45) in the SMCSGES genotyping cohort (n = 5,072). In vitro luciferase assay showed the minor allele "A" of rs35594717 (tagged by rs9549246) was significantly associated with a higher FOXO1 promoter activity (p < 0.05).

CONCLUSION

FOXO1 transcript expression in PBMC has a strong association with the risk and symptom severity of AR. Genetic variants tagged by rs9549246 were shown to affect the expression of FOXO1 and contribute to the development of AR in the SMCSGES population.

Early life exposures of childhood asthma and allergies-an epidemiologic perspective

Children around the world are continuing to develop and suffer from chronic lung diseases such as asthma. Childhood asthma commonly presents with recurrent episodes of cough, shortness of breath, and wheezing, all of which can lead to missed school days and hospitalization admissions. The role of environmental pollutants and aeroallergens has been increasingly recognized in relation to asthma etiology. We showcase the impacts of air pollution and pollen exposures in early life on childhood asthma and allergies through an epidemiologic perspective. We also examine the effects of indoor microbial exposures such as endotoxin and glucan on allergic diseases in schoolchildren as many spend most of their time in a household or classroom setting. Findings of this work can assist in the identification of key environmental factors in critical life periods and improve clinicians' diagnoses of asthma during early childhood.