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Moustafa Y, El Nady HG, Saber MM, Dabbous OA, Kamel TB, Abel-Wahhab KG, Sallam SF, Zaki DA. Assessment of Allergic Rhinitis among Children after Low-Level Laser Therapy. Open Access Maced J Med Sci 2019; 7:1968-1973. [PMID: 31406538 PMCID: PMC6684433 DOI: 10.3889/oamjms.2019.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) represents one of the most common global health problems with seriously increasing incidence over the last decades. The goal of the treatment of rhinitis is to prevent or reduce the symptoms caused by the inflammation of affected tissues. Intranasal steroids and oral antihistamines are recommended as first lines of treatment. Acupuncture had reported a significant improvement in daily symptoms and an increase of symptom-free days in many studies enrolling adults' patients. AIM This study aimed to evaluate the laser acupuncture effect on the treatment of children AR in comparison to the effect of the medication and to assess the anti-inflammatory effect of laser acupuncture through measurement of serum inflammatory marker (hs-CRP). METHODS Sixty patients with allergic rhinitis their age group ranged from 4 to 18 years were divided randomly into two groups. Group 1 enrolled 30 patient that received AR in the form of intranasal steroids, antihistaminic, leukotriene antagonists while group2 thirty patients received 12 laser acupuncture sessions (2 sessions a \ week) on specific traditional Chinese acupuncture points. RESULTS There was a significant improvement in the severity score symptoms in both groups through and by the end of the study. High Significant improvement in the levels of the inflammatory marker in both groups, especially in the group which receive laser acupuncture sessions. CONCLUSION Laser acupuncture is a reliable, painless and non-invasive successful technique, which may be used as a complementary treatment for pediatric allergic rhinitis.
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Affiliation(s)
- Yousry Moustafa
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
| | - Hala G. El Nady
- Child Health Department, National Research Centre, Cairo, Egypt
| | - Maha M. Saber
- Complementary Medicine Department, National Research Centre, Cairo, Egypt
| | - Ola A. Dabbous
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
| | | | | | - Sara F. Sallam
- Child Health Department, National Research Centre, Cairo, Egypt
| | - Dina A. Zaki
- Child Health Department, National Research Centre, Cairo, Egypt
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152
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Identification of rare variants of allergic rhinitis based on whole genome sequencing and gene expression profiling: A preliminary investigation in four families. World Allergy Organ J 2019; 12:100038. [PMID: 31236190 PMCID: PMC6581771 DOI: 10.1016/j.waojou.2019.100038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/02/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Despite the success of genome-wide association studies for allergic rhinitis (AR), no definitive causal variants have been identified, and a substantial portion of the heritability of the disease is yet to be discovered. Methods Four families, each with at least 1 parent and one child suffering from dust mite (DM) AR, were recruited, and whole-genome sequencing was performed on samples from 9 eligible individuals from these families. Conjoint analysis was performed for existing gene expression profiling data in the literature and the whole genome sequencing data obtained for these individuals; for presence of family-specific variants segregating with AR and the pathways involved. Similar analyses were also performed with data obtained for 96 sporadic house dust mite (HDM) AR patients and 96 healthy controls. Results Three rare variants in three genes (FLT1_c.603A > T; VEGFB_c.322A > C; and ITGA2_c.502+1G > A), which are involved in Focal Adhesion pathway, were identified in affected, but not unaffected, subjects in two families. VEGFB_c.322A > C and/or ITGA2_c.502+1G > A were further detected in all DM AR patients but not in any healthy individuals in 1 family; which was further investigated for members. The 3 identified variants were not found in any of the sporadic DM AR patients or healthy controls. Conclusion Despite the relatively small sample size, this study has identified several potentially functional rare variants in AR candidate genes, and it provides a platform for future work in larger numbers of families and sporadic individuals for a better understanding of the genetic basis of AR.
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153
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Kelly K, Ratliff S, Mezuk B. Allergies, asthma, and psychopathology in a nationally-representative US sample. J Affect Disord 2019; 251:130-135. [PMID: 30921596 PMCID: PMC7671678 DOI: 10.1016/j.jad.2019.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptoms of depressed mood and anxiety have been associated with immune dysregulation and atopic disorders, however it is unclear whether this relationship spans other forms of psychopathology. The objective of this study was to use a large, population-based sample to examine the association between several common psychiatric conditions and two atopic disorders: seasonal allergies and asthma. This study also examined whether comorbidity between psychiatric disorders confounded the relationship between atopy and each psychiatric disorder. METHODS Data come from the Comprehensive Psychiatric Epidemiology Surveys, a nationally-representative sample of US adults (N = 10,309). Lifetime history of major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), and post-traumatic stress disorder (PTSD) was assessed using the Composite International Diagnostic Inventory. History of seasonal allergies and asthma were assessed by self-report. Weighted logistic regression was used to evaluate the association between allergies and asthma and psychopathology. Psychiatric comorbidities were also examined as potential confounders. RESULTS Approximately 36.6% had a history of allergies and 11.5% a history of asthma. Seasonal allergies were positively associated with odds of MDD (Odds ratio (OR): 1.24, 95% Confidence Interval (CI): 1.06-1.46), GAD (OR: 1.54 (1.28-1.84)), PD (OR: 1.54 (1.24-1.91)), and PTSD (OR: 1.32 (1.09-1.59)). Asthma was not significantly associated with any psychiatric disorder. All significant associations persisted after adjustment for psychiatric comorbidities. LIMITATIONS Limitations include self-reporting of atopic disorder status and of all disorder ages of onset. CONCLUSIONS This study confirms the association between MDD and PD and seasonal allergies, and extends this relationship to GAD and PTSD.
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Affiliation(s)
- Kristen Kelly
- Department of Epidemiology, School of Public Health, University of Michigan, United States.
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154
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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155
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Brennan GL, Potter C, de Vere N, Griffith GW, Skjøth CA, Osborne NJ, Wheeler BW, McInnes RN, Clewlow Y, Barber A, Hanlon HM, Hegarty M, Jones L, Kurganskiy A, Rowney FM, Armitage C, Adams-Groom B, Ford CR, Petch GM, Creer S. Temperate airborne grass pollen defined by spatio-temporal shifts in community composition. Nat Ecol Evol 2019; 3:750-754. [DOI: 10.1038/s41559-019-0849-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/18/2019] [Indexed: 11/09/2022]
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156
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Grzella AN, Schleicher S, Shah-Hosseini K, Astvatsatourov A, Raskopf E, Allekotte S, Mösges R. Liposomal Eye Spray Is as Effective as Antihistamine Eye Drops in Patients with Allergic Rhinoconjunctivitis Induced by Conjunctival Provocation Testing. Int Arch Allergy Immunol 2019; 179:123-131. [PMID: 30909275 DOI: 10.1159/000496938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Liposomal eye spray (LS) has been introduced for the treatment of dry eye. Whether LS can also relieve symptoms due to allergic rhinoconjunctivitis (ARC) has not yet been sufficiently investigated. OBJECTIVES The aim of this study was to assess the onset of action, the reduction of allergy symptoms, and the safety of LS - a nonpharmacological treatment option - compared with those of antihistamine eye drops (AD). METHODS In this open, prospective, controlled, monocenter noninterventional study, adults with ARC received either LS or AD for the relief of eye irritation after a positive conjunctival provocation test (CPT). All patients completed a questionnaire before and after the CPT. Eye irritation was rated on a visual analogue scale (VAS) at 6 time points. Conjunctival redness was analyzed using objective digital analysis based on images taken during the study visit. RESULTS Data were collected from 40 patients (20 per group). In both groups, 80% of patients perceived an onset of action within 0-2 min after application of LS or AD following the CPT. Relief of eye irritation (as determined by VAS) increased throughout the visit for both groups. In the digital analysis, the mean proportion of redness of the eye decreased from 10.3 to 7.0% for LS and from 10.4 to 6.5% for AD, with the largest difference observed 10 min after application (LS: 8.9%; AD: 6.0%; p = 0.094). CONCLUSIONS LS is a nonpharmacological treatment option for ARC, showing no significant difference or relevant numerical inferiority to AD in any parameter studied. It was generally safe and well tolerated.
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Affiliation(s)
- Anne-Nele Grzella
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany.,CRI - Clinical Research International Ltd., Cologne, Germany
| | - Sabine Schleicher
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anatoli Astvatsatourov
- Clinical Trials Center Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Esther Raskopf
- CRI - Clinical Research International Ltd., Cologne, Germany
| | - Silke Allekotte
- CRI - Clinical Research International Ltd., Cologne, Germany
| | - Ralph Mösges
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany, .,CRI - Clinical Research International Ltd., Cologne, Germany,
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157
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Sharif H, Singh I, Kouser L, Mösges R, Bonny MA, Karamani A, Parkin RV, Bovy N, Kishore U, Robb A, Katotomichelakis M, Holtappels G, Derycke L, Corazza F, von Frenckell R, Wathelet N, Duchateau J, Legon T, Pirotton S, Durham SR, Bachert C, Shamji MH. Immunologic mechanisms of a short-course of Lolium perenne peptide immunotherapy: A randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol 2019; 144:738-749. [PMID: 30844425 DOI: 10.1016/j.jaci.2019.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND A 3-week short-course of adjuvant-free hydrolysates of Lolium perenne peptide (LPP) immunotherapy for rhinoconjunctivitis with or without asthma over 4 physician visits is safe, well tolerated, and effective. OBJECTIVE We sought to investigate immunologic mechanisms of LPP immunotherapy in a subset of patients who participated in a phase III, multicenter, randomized, double-blind, placebo-controlled trial (clinical.govNCT02560948). METHODS Participants were randomized to receive LPP (n = 21) or placebo (n = 11) for 3 weeks over 4 visits. Grass pollen-induced basophil, T-cell, and B-cell responses were evaluated before treatment (visit [V] 2), at the end of treatment (V6), and after the pollen season (V8). RESULTS Combined symptom and rescue medication scores (CSMS) were lower during the peak pollen season (-35.1%, P = .03) and throughout the pollen season (-53.7%, P = .03) in the LPP-treated group compared with those in the placebo-treated group. Proportions of CD63+ and CD203cbrightCRTH2+ basophils were decreased following LPP treatment at V6 (10 ng/mL, P < .0001) and V8 (10 ng/mL, P < .001) compared to V2. No change in the placebo-treated group was observed. Blunting of seasonal increases in levels of grass pollen-specific IgE was observed in LPP-treated but not placebo-treated group. LPP immunotherapy, but not placebo, was associated with a reduction in proportions of IL-4+ TH2 (V6, P = .02), IL-4+ (V6, P = .003; V8, P = .004), and IL-21+ (V6, P = .003; V8, P = .002) follicular helper T cells. Induction of FoxP3+, follicular regulatory T, and IL-10+ regulatory B cells were observed at V6 (all P < .05) and V8 (all P < .05) in LPP-treated group. Induction of regulatory B cells was associated with allergen-neutralizing IgG4-blocking antibodies. CONCLUSION For the first time, we demonstrate that the immunologic mechanisms of LPP immunotherapy are underscored by immune modulation in the T- and B-cell compartments, which is necessary for its effect.
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Affiliation(s)
- Hanisah Sharif
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Iesha Singh
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Lubna Kouser
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Ralph Mösges
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), Cologne, Germany
| | | | - Angeliki Karamani
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Rebecca V Parkin
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | | | | | - Abigail Robb
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | | | | | - Lara Derycke
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
| | - Francis Corazza
- Laboratory of Clinical Biology, CHU Brugmann, Brussels, Belgium
| | | | | | | | | | | | - Stephen R Durham
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
| | - Mohamed H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom.
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158
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Wahn U, Bachert C, Heinrich J, Richter H, Zielen S. Real-world benefits of allergen immunotherapy for birch pollen-associated allergic rhinitis and asthma. Allergy 2019; 74:594-604. [PMID: 30183091 PMCID: PMC6585786 DOI: 10.1111/all.13598] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Real-world evidence is sparse on the benefits of allergen immunotherapy [AIT; subcutaneous/sublingual immunotherapy (SCIT/SLIT)], the only disease-modifying intervention for allergic rhinitis (AR) with long-term efficacy. This real-life study evaluated the effect of six AITs (native pollen SLIT/SCIT, four allergoid SCITs) vs symptomatic medication use, on AR symptoms and asthma symptoms/onset, in patients with birch pollen-associated AR and/or asthma. METHODS In this retrospective cohort analysis of a German longitudinal prescription database, AIT patients received ≥2 successive seasonal treatment cycles; non-AIT patients had ≥3 AR prescriptions in three seasons or previous month. Patients were matched for: index year, age, gender, main indication at index, number of seasonal cycles within treatment period, baseline AR/asthma treatment prescriptions. Multiple regression analysis compared prescription data in AIT and non-AIT groups as proxy for clinical status/disease progression. RESULTS Up to 6 years of follow-up, significantly more AIT (65.4%) vs non-AIT (47.4%) patients were AR medication-free; odds ratio (OR) [95% confidence interval (CI)]: 0.51 [(0.48-0.54); P < 0.001] (28.6% covariate-adjusted reduction vs non-AIT; P < 0.001), and significantly more AIT (49.1%) vs non-AIT (35.1%) patients were asthma medication-free [OR (95% CI): 0.59 (0.55-0.65); P < 0.001] (32% reduction vs non-AIT; P < 0.001), or reduced existing asthma medication use (32% covariate-adjusted reduction vs non-AIT; P < 0.001). During treatment, new-onset asthma risk was significantly reduced in the AIT vs non-AIT group (OR: 0.83; P = 0.001). CONCLUSIONS Birch pollen AIT demonstrated real-world benefits up to 6 years post-treatment cessation through significantly reduced AR and asthma medication intake, and significantly decreased risk of new-onset asthma medication use on-treatment.
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Affiliation(s)
- Ulrich Wahn
- Department of Paediatric Pneumology and ImmunologyCharité Medical UniversityBerlinGermany
| | - Claus Bachert
- Upper Airways Research LaboratoryGhent UniversityGhentBelgium
| | - Joachim Heinrich
- Institute of EpidemiologyHelmholtz Zentrum MunichGerman Research Centre for Environmental Health GmbHNeuherbergGermany
| | | | - Stefan Zielen
- Division of Allergology, Pulmonology and Cystic FibrosisDepartment of PaediatricsGoethe University HospitalFrankfurtGermany
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159
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Castillo Vizuete JA, Sastre J, del Cuvillo Bernal A, Picado C, Martínez Moragón E, Ignacio García JM, Cisneros Serrano C, Álvarez Gutiérrez FJ, Mullol Miret J. Asthma, Rhinitis, and Nasal Polyp Multimorbidities. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.arbr.2018.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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160
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Katz DSW, Dzul A, Kendel A, Batterman SA. Effect of intra-urban temperature variation on tree flowering phenology, airborne pollen, and measurement error in epidemiological studies of allergenic pollen. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 653:1213-1222. [PMID: 30759561 PMCID: PMC6402594 DOI: 10.1016/j.scitotenv.2018.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 05/23/2023]
Abstract
Temperature gradients in cities can cause inter-neighborhood differences in the timing of pollen release. However, most epidemiological studies examining allergenic pollen utilize daily measurements from a single pollen monitoring station with the implicit assumption that the measured time series of airborne pollen concentrations applies across the study areas, and that the temporal mismatch between concentrations at the counting station and elsewhere in the study area is negligible. This assumption is tested by quantifying temperature using satellite imagery, observing flowering times of oak (Quercus) and mulberry (Morus) trees at multiple sites, and collecting airborne pollen. Epidemiological studies of allergenic pollen are reviewed and temperatures within their study areas are quantified. In this one-year study, peak oak flowering time was well explained by average February nighttime temperature (R2 = 0.94), which varied by 6 °C across Detroit. This relationship was used to predict flowering phenology across the study region. Peak flowering ranged from April 20-May 13 and predicted a substantial portion of relative airborne oak pollen concentrations in Detroit (R2 = 0.46) and at the regional pollen monitoring station (R2 = 0.61). The regional pollen monitoring station was located in a cooler outlying area where peak flowering occurred around May 12 and peak pollen concentrations were measured on May 15. This provides evidence that the timing of pollen release varies substantially within a metropolitan area and challenges the assumption that pollen measurements at a single location are representative of an entire city. Across the epidemiological studies, 50% of study areas were not within 1 °C (equal to a lag or lead of 4 days in flowering time) of temperatures at the pollen measurement location. Epidemiological studies using a single pollen station as a proxy for pollen concentrations are prone to significant measurement error if the study area is climatically variable.
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Affiliation(s)
- Daniel S W Katz
- School of Public Health, University of Michigan- Ann Arbor, Ann Arbor, MI, USA.
| | - Andrew Dzul
- Lakeshore Ear, Nose, and Throat, Saint Claire Shores, MI, USA
| | - Amber Kendel
- Lakeshore Ear, Nose, and Throat, Saint Claire Shores, MI, USA
| | - Stuart A Batterman
- School of Public Health, University of Michigan- Ann Arbor, Ann Arbor, MI, USA
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161
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Chaaban MR, Mansi A, Tripple JW, Wise SK. SCIT Versus SLIT: Which One Do You Recommend, Doc? Am J Med Sci 2019; 357:442-447. [PMID: 31010469 DOI: 10.1016/j.amjms.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/21/2019] [Accepted: 02/06/2019] [Indexed: 12/27/2022]
Abstract
Allergic rhinitis is a prevalent condition that has a significant impact on the quality of life of many patients. When initial therapy fails to control the symptoms, allergen immunotherapy (AIT) has been suggested as an option by the Joint Task Force on Practice Parameters. The 2 main forms of AIT are via subcutaneous and sublingual routes, called subcutaneous immunotherapy and sublingual immunotherapy, respectively. There is debate about which is the better option for patients with each method offering its own pros and cons. We present 2 patients with allergic rhinitisAR that were deemed good candidates for AIT and explore current evidence for both subcutaneous immunotherapy and sublingual immunotherapy. The advantages and disadvantages of each method are discussed with the goal of providing a framework for the physician when deciding on AIT for their patients. In addition, we explore the use of AIT in patients with asthma and atopic dermatitis as potential patient populations that may benefit from the treatment. We use the discussion to provide recommendations regarding which method of AIT is best suited for both our patients.
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Affiliation(s)
| | | | - Julia W Tripple
- Department of Internal Medicince, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Sarah K Wise
- Department of Otolaryngology, Emory University, Atlanta, Georgia
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162
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Hellings PW, Pugin B, Mariën G, Bachert C, Breynaert C, Bullens DM, Ceuppens JL, Clement G, Cox T, Ebo D, Gevaert P, Halewyck S, Hox V, Ladha K, Jacobs R, Rombaux P, Schrijvers R, Speleman K, Van der Brempt X, Van Gerven L, Vanderveken O, Verhaeghe B, Vierstraete K, Vlaminck S, Watelet JB, Bousquet J, Seys SF. Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement. Clin Transl Allergy 2019; 9:1. [PMID: 30740211 PMCID: PMC6360767 DOI: 10.1186/s13601-019-0243-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022] Open
Abstract
Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.
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Affiliation(s)
- P W Hellings
- 1ENT Clinical Department, University Hospital Leuven, Kapucijnenvoer 33, 3000 Louvain, Belgium.,2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - B Pugin
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | - G Mariën
- European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium
| | - C Bachert
- 4ENT Clinical Department, University Hospital Ghent, Ghent, Belgium.,5Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium
| | - C Breynaert
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,6Internal Medicine Clinical Department, UZ Leuven, Louvain, Belgium
| | - D M Bullens
- 7Pediatrics Clinical Department, UZ Leuven, Louvain, Belgium
| | - J L Ceuppens
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,6Internal Medicine Clinical Department, UZ Leuven, Louvain, Belgium
| | - G Clement
- 8ENT Clinical Department, AZ Damiaan, Ostend, Belgium
| | - T Cox
- 9ENT Clinical Department, Jessa Hospital, Hasselt, Belgium
| | - D Ebo
- 10Immunology-Allergology-Rheumatology, University Hospital Antwerp, Antwerp, Belgium
| | - P Gevaert
- 4ENT Clinical Department, University Hospital Ghent, Ghent, Belgium.,5Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium
| | - S Halewyck
- 11ENT Clinical Department, UZ Brussel, Brussels, Belgium.,ENT Clinical Department, ASZ Aalst, Aalst, Belgium
| | - V Hox
- 13ENT Clinical Department, Clinique Universitaires Saint-Luc, Brussels, Belgium
| | - K Ladha
- 14Pediatrics Clinical Department, CHU Charleroi, Charleroi, Belgium
| | - R Jacobs
- 15ENT Clinical Department, AZ Sint-Blasius, Dendermonde, Belgium
| | - P Rombaux
- 13ENT Clinical Department, Clinique Universitaires Saint-Luc, Brussels, Belgium
| | - R Schrijvers
- 2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium.,6Internal Medicine Clinical Department, UZ Leuven, Louvain, Belgium
| | - K Speleman
- 16ENT Clinical Department, AZ Sint-Jan, Brugge, Belgium
| | | | - L Van Gerven
- 1ENT Clinical Department, University Hospital Leuven, Kapucijnenvoer 33, 3000 Louvain, Belgium
| | - O Vanderveken
- 18ENT Clinical Department, University Hospital Antwerp, Antwerp, Belgium
| | - B Verhaeghe
- ENT Clinical Department, St-Andries ziekenhuis, Tielt, Belgium
| | - K Vierstraete
- 20ENT Clinical Department, AZ Groeninge, Kortrijk, Belgium
| | - S Vlaminck
- 21ENT Clinical Department, AZ Delta Roeselare, Roeselare, Belgium
| | - J-B Watelet
- 4ENT Clinical Department, University Hospital Ghent, Ghent, Belgium
| | - J Bousquet
- 22Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France
| | - S F Seys
- 1ENT Clinical Department, University Hospital Leuven, Kapucijnenvoer 33, 3000 Louvain, Belgium.,2Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
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163
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Fyhrquist N, Werfel T, Bilò MB, Mülleneisen N, Gerth van Wijk R. The roadmap for the Allergology specialty and allergy care in Europe and adjacent countries. An EAACI position paper. Clin Transl Allergy 2019; 9:3. [PMID: 30697418 PMCID: PMC6345018 DOI: 10.1186/s13601-019-0245-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/04/2019] [Indexed: 01/27/2023] Open
Abstract
The high prevalence of allergic diseases warrants for sufficient health care provisions available to patients with allergic diseases. Allergy care should be delivered by well-trained specialists. However, the current status of allergy care is not well documented. For this reason a survey among European and a few non-European countries was launched by the National Allergy Society Committee from the European Academy of Allergy and Clinical Immunology and the Union Européenne des Médecins Spécialistes section and board of Allergology. The survey shows that in the vast majority of countries allergy care services are available. However, a substantial heterogeneity is reported regarding recognition of the full specialty, the number of practicing specialists or subspecialists, and training aspects. Growth but also decline of specialty and subspecialties is reported. In addition, the survey gives insight in strengths, weaknesses, opportunities and threats in this field. It appears that the recognition of the full specialty determines strength as well as weakness. Aging of specialists combined with a decline in the number of trainees form a major threat. Opportunities are seen in creating awareness for allergy, focus on attracting young physicians. The conclusion is that harmonization of allergy services across Europe is needed. Investment in young doctors, creating new opportunities and lobbying for the full specialty is required.
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Affiliation(s)
- N Fyhrquist
- 1Unit of Systems Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Werfel
- 2Department of Dermatology and Allergy, Hannover Medical University, Hannover, Germany
| | - M B Bilò
- 3Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | - R Gerth van Wijk
- 5Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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164
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Li CL, Lin HC, Lin CY, Hsu TF. Effectiveness of Hypertonic Saline Nasal Irrigation for Alleviating Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:E64. [PMID: 30634447 PMCID: PMC6352276 DOI: 10.3390/jcm8010064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 12/28/2022] Open
Abstract
We aimed to explore the efficacy of hypertonic saline nasal irritation (HSNI) for improving nasal symptoms and quality of life, and for decreasing oral antihistamine consumption in children with allergic rhinitis (AR). We conducted a systematic search of PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Chinese Electronic Periodicals Service, and Cochrane Library of Controlled Trials databases for prospective randomized, controlled trials assessing HSNI effects in children with AR and published before December 2017. Two authors independently assessed each trial's quality and extracted data for a meta-analysis. We included four trails comprising 351 patients. HSNI improved patients' nasal symptom scores (mean difference 1.82 points after treatment; 95% confidence interval (CI), 0.35⁻3.30; I² = 64%; p = 0.02) and a significantly lower rescue antihistamine use rate (risk ratio (RR), 0.68; 95% CI, 0.48⁻0.95; I² = 28%; p = 0.02). Analyses comparing HSNI with isotonic saline nasal irrigation (ISNI) showed better nasal symptom scores (mean difference, 1.22 points; 95% CI, 1.01⁻1.44; I² = 0%; p < 0.001) in patients in the HSNI group, although the antihistamine use (RR, 0.84; 95% CI, 0.64⁻1.10; I² = 0%; p = 0.2) and adverse effect rates were similar between groups. Compared with ISNI, HSNI may be a reasonable adjunctive treatment for children with AR.
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Affiliation(s)
- Chia-Ling Li
- Department of Nursing, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan.
- School of Nursing, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Hsiao-Chuan Lin
- Department of Nursing, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan.
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan.
| | - Teh-Fu Hsu
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei 11221, Taiwan.
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165
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Gani F, Lombardi C, Bonizzoni G, Rolla G, Brussino L, Landi M, Schiappoli M, Senna G, Savi E, Ridolo E, Ventura MT, Gamba P, Patella V, Bugiani M. The Characteristics of Severe Chronic Upper-Airway Disease (SCUAD) in Patients with Allergic Rhinitis: A Real-Life Multicenter Cross-Sectional Italian Study. Int Arch Allergy Immunol 2019; 178:333-337. [PMID: 30605899 DOI: 10.1159/000495305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are few studies regarding severe chronic upper-airway disease (SCUAD) that represents an important socioeconomic problem for the treatment of rhinitis and associated comorbidities, particularly asthma. OBJECTIVES The aim of our study is to evaluate the prevalence of this pathology in patients with allergic rhinitis (AR) in real life, to phenotype allergic patients with SCUAD, and to identify which factors are related to the severity of the disease. METHODS We studied 113 patients with uncontrolled AR despite optimal adherence to therapy according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in a multicenter Italian study, analyzing comorbidity, use of additional drugs, not scheduled visits, and the number of emergency room admissions. RESULTS Our data suggest that polysensitization is the only statistically significant factor correlating with SCUAD. Asthma does not seem to represent a correlating factor. An important finding is the poor use (20%) of allergy immunotherapy (AIT), although patients were suffering from AR and the ARIA guidelines recommend the use of AIT in moderate/severe AR. CONCLUSIONS The SCUAD population seems not to have a specific phenotype; there is a greater presence of SCUAD in polysensibilized patients, perhaps a sign of greater inflammation.
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Affiliation(s)
- Federica Gani
- Allergy Service, AOU San Luigi Gonzaga Hospital, Turin, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology and Respiratory Diseases, Fondazione Poliambulanza Hospital, Brescia, Italy
| | | | - Giovanni Rolla
- Allergology and Immunology, Mauriziano Hospital, University of Turin, Turin, Italy
| | - Luisa Brussino
- Allergology and Immunology, Mauriziano Hospital, University of Turin, Turin, Italy
| | - Massimo Landi
- Primary Care Physician, National Healthcare System, Turin, Italy
| | - Michele Schiappoli
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Eleonora Savi
- Allergy Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Erminia Ridolo
- Experimental and Clinical Medicine, University of Parma, Parma, Italy
| | | | - Paolo Gamba
- ENT Department, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Vincenzo Patella
- Centro aziendale provinciale per la cura delle malattie allergologiche e immunologiche gravi, ASL Salerno, Ospedale Civile, Battipaglia, Italy
| | - Massimo Bugiani
- Consultant Physician of Professional Diseases Observatory, Procura della Repubblica, Turin, Italy
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166
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Management of Respiratory Disorders and the Pharmacist's Role: Cough, Colds, and Sore Throats and Allergies (Including Eyes). ENCYCLOPEDIA OF PHARMACY PRACTICE AND CLINICAL PHARMACY 2019. [PMCID: PMC7173409 DOI: 10.1016/b978-0-12-812735-3.00510-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Complaints pertaining to the upper respiratory tract, such as the common cold and allergies, are a common reason for presentation to community pharmacies. This chapter explores the common cold and influenza and associated symptoms, including cough, congestion, rhinorrhea, sore throat, diarrhea, pain, and fever. This chapter will aid pharmacists in identifying the characteristics and pharmacological and nonpharmacological management of these conditions. Allergies of the nose and eyes are another common ailment encountered in the community pharmacy, and this chapter assists pharmacists in reaching a differential diagnosis and strategies to manage these conditions.
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167
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Ren L, Zhang W, Zhang Y, Zhang L. Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:367-380. [PMID: 30912326 PMCID: PMC6439193 DOI: 10.4168/aair.2019.11.3.367] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Nitric oxide (NO) is an important endogenous mediator in both upper and lower respiratory systems. The purpose of the present study was to extract nasal NO (nNO) normal range of Chinese adults and the internal influencing factors. The differences in nNO levels between rhinitis and asymptomatic atopic subjects, and the diagnostic value of nNO in allergic rhinitis (AR) were further investigated. METHODS One thousand adults were recruited from the general public. Participants were divided into different subgroups according to the questionnaires and skin prick tests. In all of these subjects, nNO, fractional exhaled NO (FeNO) and nasal airflow resistance were measured. The normal ranges of nNO and FeNO, the differences between subgroups, and the correlations between NO (nNO and FeNO) and other internal factors were analyzed. RESULTS Both nNO and FeNO levels were significantly higher in AR patients than in healthy and asymptomatic atopic subjects. The nNO levels were significantly lower in asymptomatic atopic subjects than in normal adults. FeNO levels were significantly higher in non-AR patients than in the healthy and asymptomatic atopic adults. The cutoff value of nNO for the diagnosis of AR was 117.5 ppb (sensitivity, 50.9%; specificity, 63.9%). The nNO levels were correlated with FeNO levels, total nasal resistance measured at 75Pa, nasal volume within 0-7 cm from the anterior nares (V0-7cm) and nasal symptom visual analogue scale (VAS) scores, while the FeNO levels were correlated with age, height, weight, body surface area, nasal volume of V0-7cm and the nasal symptom VAS score. CONCLUSIONS The nNO level can be significantly different between healthy and AR patients and may be significantly correlated with nasal symptoms and nasal patency of rhinitis patients. However, the clinical value of nNO is still in the exploration stage.
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Affiliation(s)
- Lei Ren
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yuan Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Luo Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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168
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Zhang Y, Zhang L. Increasing Prevalence of Allergic Rhinitis in China. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:156-169. [PMID: 30661309 PMCID: PMC6340797 DOI: 10.4168/aair.2019.11.2.156] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/16/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022]
Abstract
Allergic rhinitis (AR) is a critical public health, medical and economic problem in China. AR is also an important risk factor which will cause many diseases or disorders, especially in children. The trend of AR incidence is still on the rise in recent years and has had a significant effect on the general public. This significant increase is alarming, which highlights an urgent need for better understanding of the prevalence status and characteristics, sensitization patterns, and the associated risk factors of AR in order to improve treatment and develop effective prevention strategies.
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Affiliation(s)
- Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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169
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Virus-like particles in der Prophylaxe und Immuntherapie allergischer Erkrankungen. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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170
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Huang Y, Zhang Y, Zhang L. Prevalence of allergic and nonallergic rhinitis in a rural area of northern China based on sensitization to specific aeroallergens. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2018; 14:77. [PMID: 30479630 PMCID: PMC6247523 DOI: 10.1186/s13223-018-0299-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most epidemiologic studies reporting prevalence of allergic rhinitis (AR) and nonallergic rhinitis (NAR) have assessed solely self-reported prevalence, without confirmation by objective measures. Furthermore, reports of prevalence of NAR in Chinese subjects are scarce. Thus, we aimed to explore the prevalence and risk factors of AR and NAR in a Chinese, based on both clinical manifestation and allergic status. METHODS We conducted a population-based cross-sectional survey, involving 1084 local residents from a rural area of Beijing, China. Participants were enrolled using a stratified two-stage cluster sampling method. All adult participants or the guardians of children completed standardized questionnaires to provide relevant demographic and clinical information. Skin prick tests were also performed to determine sensitization to specific aeroallergens. AR/NAR was classified according to Allergic Rhinitis and its Impact on Asthma criteria. RESULTS Prevalence of self-reported AR was 46.80%. Based on SPT results, the confirmed standardized prevalence of AR and NAR were 16.78% and 24.60%, respectively. Severity scores for nasal itching, sneezing, rhinorrhea and congestion were significantly higher in subjects with AR, than subjects with NAR (P < 0.05 for all). The three most common aeroallergens in self-reported AR group were Blattella germanica (16.6%), Dermatophagoides farinae (14.6%), and Dermatophagoides pteronyssinus (13.9%). Family history of AR and atopic dermatitis were significantly associated with AR (adjusted OR: 4.97 and 2.69, respectively), whereas family history of AR and asthma were significantly associated with NAR (adjusted OR: 3.53 and 2.45, respectively). Similarly, comorbid asthma, CRS, and atopic dermatitis were significant risk factors for both AR and NAR. CONCLUSIONS Combination of standardized questionnaires and specific allergen tests may provide more accurate estimates of prevalence of AR and NAR and associated risk factors.
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Affiliation(s)
- Yanran Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong, DongCheng District, Beijing, 100005 People’s Republic of China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong, DongCheng District, Beijing, 100005 People’s Republic of China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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171
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Al-Digheari A, Mahboub B, Tarraf H, Yucel T, Annesi-Maesano I, Doble A, Lahlou A, Tariq L, Aziz F, El Hasnaoui A. The clinical burden of allergic rhinitis in five Middle Eastern countries: results of the SNAPSHOT program. Allergy Asthma Clin Immunol 2018; 14:63. [PMID: 30473712 PMCID: PMC6240937 DOI: 10.1186/s13223-018-0298-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/06/2018] [Indexed: 01/18/2023] Open
Abstract
Background The SNAPSHOT program provides current data on the allergic rhinitis burden in the adult general population of five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia and the United Arab Emirates, the latter three grouped into a Gulf cluster). Methods A multi-country, cross-sectional, epidemiological program conducted by telephone in a random sample of the adult general population; quotas were defined per country demographics. Subjects were screened for allergic rhinitis using the Score For Allergic Rhinitis questionnaire. Current prevalence (last 12 months) was estimated. Disease severity and control were assessed using the Allergic Rhinitis and its Impact on Asthma classification and Rhinitis Control Assessment Test respectively. Quality of sleep, impact on daily activities and quality of life were measured using the Epworth Sleepiness Scale, Sheehan Disability Scale and EuroQol Five-Dimension questionnaire respectively. Multivariate logistic regression analyses were used to investigate risk factors and co-morbidities. Results 1808 of 33,486 subjects enrolled in the SNAPSHOT program fulfilled the case definition for allergic rhinitis. Prevalence was 3.6% [95% CI 3.2–4.0%] in Egypt, 6.4% [95% CI 5.9–6.9%] in Turkey and 6.4% [95% CI 6.0–6.9%] in the Gulf cluster. Risk factors identified were country, co-morbid asthma and income. Subjects with allergic rhinitis reported a significantly lower quality of life compared to the general population (p < 0.0001). Overall, 55% of allergic rhinitis subjects were moderate/severe and 33% were uncontrolled. Both these groups reported impaired quality of life and quality of sleep and increased impairment of daily activities compared to mild/well-controlled subjects (p < 0.0001). Conclusions Although the observed prevalence of allergic rhinitis in these Middle Eastern countries is low compared to western countries, its burden is considerable. Allergic rhinitis in general, and specifically uncontrolled and severe disease, results in a negative impact on quality of life, quality of sleep and daily activities.
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Affiliation(s)
- Ahmed Al-Digheari
- 1Department of Paediatrics, Allergy And Clinical Immunology, Security Forces Hospital, Ministry of Interior, Riyadh, Saudi Arabia
| | - Bassam Mahboub
- 2College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,3Pulmonary Medicine Department, Rashid Hospital, Dubai, United Arab Emirates
| | | | - Taskin Yucel
- 5Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
| | - Isabella Annesi-Maesano
- 6Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Institut Pierre Louis d'Epidemiologie et de Sante Publique (IPLESP), Sorbonne Universite and INSERM, Medical School Saint-Antoine, Paris, France
| | | | | | - Luqman Tariq
- GlaxoSmithKline, PO Box 50199, Dubai, United Arab Emirates
| | - Fayaz Aziz
- GlaxoSmithKline, PO Box 50199, Dubai, United Arab Emirates
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172
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Asthma, rhinitis, and nasal polyp multimorbidities. Arch Bronconeumol 2018; 55:146-155. [PMID: 30449614 DOI: 10.1016/j.arbres.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022]
Abstract
The aim of this review is to assist pulmonologists in the management of diseases involving both the upper and lower respiratory tract that are linked by a common, interrelated epidemiology, clinical signs and symptoms, and inflammatory mechanism - asthma, in particular. The document discusses the definitions of the various sinonasal phenotypes associated with asthma: allergic and non-allergic rhinitis and chronic rhinosinusitis with or without nasal polyps. Diagnostic criteria and severity levels are also listed. Particular attention has been given to the 2 main syndromes associated with asthma: (i)allergic rhinitis, the most common, and (ii)chronic rhinosinusitis with nasal polyps, the disease most closely associated with severe asthma. To summarize, the upper respiratory tract should always be evaluated in order to achieve a single diagnosis and comprehensive treatment of the "united airway".
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173
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Abstract
Seasonal allergic conjunctivitis (SAC) is a frequent disease, which is often associated with allergic rhinitis and subsequently manifested as allergic rhinoconjunctivitis. In contrast to other types of chronic allergic conjunctivitis, the course of SAC is not sight-threatening. Pathogenetically, the underlying cause of SAC is an immunoglobulin E (IgE) mediated, Th2-driven type 1 hypersensitivity reaction. Clinically it presents with itching, light-red conjunctival injection as well as chemosis that exceeds the extent of conjunctival injection. The goals of treatment are relief of acute signs and symptoms, control of the underlying inflammatory process and utilization of preventive options. Dually effective local therapeutics combine the advantages of rapid action with a relatively long-lasting effect by a two-fold active approach. Specific immunotherapy is useful in selected patients.
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174
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Arsoy G, Varış A, Saloumi LM, Abdi A, Başgut B. Insights on Allergic Rhinitis Management from a Northern Cyprus Perspective and Evaluation of the Impact of Pharmacist-Led Educational Intervention on Patients' Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E83. [PMID: 30405059 PMCID: PMC6262628 DOI: 10.3390/medicina54050083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE the global prevalence of allergic rhinitis (AR) is rising and yet there is scarce information concerning the diagnosis, management and treatment patterns of AR in Northern Cyprus (NC). This study aims to provide a unique perspective on AR management as well as assessing the effectiveness of the pharmacist-led educational intervention for improving care of AR patients. METHODS across-sectional survey was carried out with community pharmacists (n = 70), patients (n = 138) and ear, nose and throat (ENT) specialists (n = 12) in NC. For a controlled interventional trial, trained pharmacists provided a brief education on management of AR and nasal spray technique for patients while other pharmacists provided the usual care. Quality of life (QoL) and other outcome measures on the perceived symptom severity of the two groups were compared after a 6-week period. RESULTS only 33.3% of the ear, nose and throat (ENT) specialists and 15.7% of the community pharmacists are aware of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The majority of patients (63%) self-managed with over-the-counter medications. Nasal congestion (96.4%) is the most bothersome symptom and oral antihistamines are the most commonly purchased medications (51.4%), indicating a pattern of suboptimal management. The pharmacists-led educational intervention has resulted in statistically more significant improvement in regards to nasal congestion and QoL for the intervention group patients (p < 0.05). CONCLUSION the current management of AR has not been in accordance with the ARIA guidelines in NC. An educational intervention of the pharmacists can enhance the symptom management and improve the QoL in patients with AR.
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Affiliation(s)
- Günay Arsoy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Ahmet Varış
- Department of Otolaryngology, Burhan Nalbantoglu State Hospital, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Louai M Saloumi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Abdikarim Abdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Bilgen Başgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
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Faber MA, Van Gasse AL, Decuyper II, Sabato V, Hagendorens MM, Mertens C, Bridts CH, De Clerck LS, Ebo DG. Cross-Reactive Aeroallergens: Which Need to Cross Our Mind in Food Allergy Diagnosis? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:1813-1823. [PMID: 30172018 DOI: 10.1016/j.jaip.2018.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 01/08/2023]
Abstract
Secondary food allergies due to cross-reactivity between inhalant and food allergens are a significant and increasing global health issue. Cross-reactive food allergies predominantly involve plant-derived foods resulting from a prior sensitization to cross-reactive components present in pollen (grass, tree, weeds) and natural rubber latex. Also, primary sensitization to allergens present in fungi, insects, and both nonmammalian and mammalian meat might induce cross-reactive food allergic syndromes. Correct diagnosis of these associated food allergies is not always straightforward and can pose a difficult challenge. As a matter of fact, cross-reactive allergens might hamper food allergy diagnosis, as they can cause clinically irrelevant positive tests to cross-reacting foods that are safely consumed. This review summarizes the most relevant cross-reactivity syndromes between inhalant and food allergens. Particular focus is paid to the potential and limitations of confirmatory testing such as skin testing, specific IgE assays, molecular diagnosis, and basophil activation test.
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Affiliation(s)
- Margaretha A Faber
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Athina L Van Gasse
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Ine I Decuyper
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Christel Mertens
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Chris H Bridts
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Luc S De Clerck
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Didier G Ebo
- Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
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Nelson HS. Ragweed allergy immunotherapy tablet MK-3641 (Ragwitek®) for the treatment of allergic rhinitis. Expert Rev Clin Immunol 2018; 14:1003-1011. [PMID: 30345820 DOI: 10.1080/1744666x.2018.1538788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) is among the most common chronic conditions affecting both children and adults. It is the cause of significant morbidity from the symptoms and interference with sleep. It results in major impairment of performance both at school and at work. In the U.S. and certain parts of Europe, ragweed pollen is a major cause of seasonal AR. In 2014, the U.S. Food and Drug Administration (FDA) approved a sublingual ragweed tablet (MK-3641) for use in adults with ragweed-induced AR. Areas covered: This paper will review the impact of ragweed-induced AR and available treatments including subcutaneous immunotherapy and studies with MK-3641. The principal search method was PubMed. Expert commentary: One dosing finding, two 28-day safety and two 52-week safety and efficacy studies have been conducted with MK-3641. The 12-U (12μg Amb a 1) tablet was the most effective. Local application site reactions were common but usually not serious. Only one, non-serious systemic reaction was reported in four safety studies. MK-3641 is a safe and effective treatment for ragweed-pollen-induced AR when treatment is initiated ≥ 12 weeks prior to the onset of the ragweed pollen season.
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Affiliation(s)
- Harold S Nelson
- a Department of Medicine, Division of Allergy/Immunology , National Jewish Health , Denver , Colorado USA
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177
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The Influence of Age on the Relationship Between Allergic Rhinitis and Otitis Media. Curr Allergy Asthma Rep 2018; 18:68. [PMID: 30343453 DOI: 10.1007/s11882-018-0826-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To examine the relationship between otitis media, allergic rhinitis, and age. RECENT FINDINGS Otitis media and allergic rhinitis are prevalent conditions with a controversial relationship. Some data suggest that these entities are significantly associated, either through allergic rhinitis inducing Eustachian tube dysfunction or through allergic pathophysiology simultaneously occurring intranasally and in the ear. Other studies, however, have refuted this relationship. For example, treatment with antihistamines does not reliably improve OME, making causation and association challenging to establish. Age may have an effect on the nature of the relationship between allergic rhinitis and otitis media, by impacting both the individual conditions and their association. Epidemiological, immunological, and adenoidal studies have suggested that differences occur with age, and this review encapsulates the related data and publications. We begin by evaluating how allergic rhinitis and otitis media each are affected by age, then evaluate the role that age may have in the relationship between the two conditions. Adult and pediatric literature are evaluated so as to include the full impact of age across patients' lifespan. Age induces changes in immunity, patterns of inflammation, and susceptibility to both allergic rhinitis and otitis media with effusion. Age may also be an effect modifier which impacts the nature of the relationship between these two conditions. The influence of age on the association between these highly prevalent conditions remains a topic of active study.
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178
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Blin P, Demoly P, Drouet M, Falissard B, Lignot-Maleyran S, Maizi H, Lorrain S, Lassalle R, Droz-Perroteau C, Moore N, Molimard M. An observational cohort study of the use of five-grass-pollen extract sublingual immunotherapy during the 2015 pollen season in France. Allergy Asthma Clin Immunol 2018; 14:38. [PMID: 30258465 PMCID: PMC6151918 DOI: 10.1186/s13223-018-0262-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Allergic rhinitis affects around one quarter of the Western European population. Prophylactic allergen immunotherapy may be useful to reduce the risk of acute symptomatic attacks (hayfever). A five-grass pollen extract sublingual immunotherapy (5GPE-SLIT) has been developed for the treatment of allergic rhinitis to grass pollen. The objective of this study was to describe real-world treatment patterns with 5GPE-SLIT in France with respect to the prescribing information. Methods This prospective cohort study was conducted by 90 community and hospital allergists. Adults and children (> 5 years old) starting a first treatment with 5GPE-SLIT prior to the 2015 pollen season were eligible. Data was collected at the inclusion visit and at the end of the pollen season. The primary outcome variable was compatibility of 5GPE-SLIT prescription with the prescribing information. This was determined with respect to four variables: (1) interval between 5GPE-SLIT initiation and onset of the pollen season ≥ 3 months, (2) age of patient ≥ 5 years, (3) intermittent symptoms or mild symptom severity (4) confirmatory diagnostic test. At study end, symptoms reported during the pollen season and any modifications to treatment or adverse events were documented. Results 280 adults and 203 children were enrolled. The prescribing information was respected for 82.5% of adults and 86.7% of children. A skin test was performed for all patients. 5GPE-SLIT was started 3–5 months before the pollen season for 85.3%. Treatment was discontinued before the start of the pollen season in 11.0% of patients overall, generally because of an adverse event (78.8% of discontinuations). The mean duration of treatment was 5.2 months in adults and 5.6 months in children. At the end of follow-up, symptoms during the pollen season were intermittent for 75.0% of adults and 85.7% of children, and severity was mild for 61.8 and 66.0% respectively. During 5GPE-SLIT, the following symptoms reported during the previous year were not reported again in > 50% of patients: nasal congestion, rhinorrhoea, repeated sneezing, conjunctivitis and nasal pruritus. Conclusions 5GPE-SLIT use was generally consistent with prescribing recommendations and was associated with an improvement of AR severity, with resolution of the principal AR symptoms in around half the patients treated. Trial registration EUPAS9358. Registered 13 May 2015. Not prospectively registered. http://www.encepp.eu/encepp/viewResource.htm?id=16229 Electronic supplementary material The online version of this article (10.1186/s13223-018-0262-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick Blin
- 1Bordeaux PharmacoEpi, Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.,CIC Bordeaux, CIC Bordeaux CIC1401, Bordeaux Cedex, France
| | - Pascal Demoly
- 3Allergy Department, CHRU de Montpellier, Montpellier, France
| | | | | | - Séverine Lignot-Maleyran
- 1Bordeaux PharmacoEpi, Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.,CIC Bordeaux, CIC Bordeaux CIC1401, Bordeaux Cedex, France
| | - Hélène Maizi
- 1Bordeaux PharmacoEpi, Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.,CIC Bordeaux, CIC Bordeaux CIC1401, Bordeaux Cedex, France
| | - Simon Lorrain
- 1Bordeaux PharmacoEpi, Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.,CIC Bordeaux, CIC Bordeaux CIC1401, Bordeaux Cedex, France
| | - Régis Lassalle
- 1Bordeaux PharmacoEpi, Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.,CIC Bordeaux, CIC Bordeaux CIC1401, Bordeaux Cedex, France
| | - Cécile Droz-Perroteau
- 1Bordeaux PharmacoEpi, Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.,CIC Bordeaux, CIC Bordeaux CIC1401, Bordeaux Cedex, France
| | - Nicholas Moore
- 1Bordeaux PharmacoEpi, Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.,CIC Bordeaux, CIC Bordeaux CIC1401, Bordeaux Cedex, France.,CHU INSERM U1219, Bordeaux, France
| | - Mathieu Molimard
- CHU INSERM U1219, Bordeaux, France.,7Pharmacology Department, CHU de Bordeaux, Bordeaux, France
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Novak N, Buhl T, Pfaar O. Adherence During Early Allergen Immunotherapy and Strategies to Motivate and Support Patients. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10312545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Allergic rhinitis is one of the most common chronic inflammatory conditions, affecting up to 30% of people in Europe. Allergen immunotherapy (AIT) is the only treatment for allergic rhinitis and asthma that has a disease-modifying effect, and it is recommended in European guidelines for use in conjunction with patient education, specific allergen avoidance, and symptomatic pharmacotherapy. Reported AIT adherence rates vary widely but are often low in real-world settings. Factors known to affect adherence are patient, treatment, or physician-related, and vary between healthcare settings. Misconceptions or a lack of AIT knowledge among patients with regard to efficacy and side effects may contribute to high rates of discontinuation observed during the first year of AIT treatment. Interventions to improve patient adherence are multifaceted and should focus on patient education, particularly the provision of accurate information regarding adverse effects of AIT and when to expect an improvement in symptoms, patient-support programmes, and the use of regular eHealth reminders via a telephone call, text message, or social media. Serum-based biomarkers also have the potential to play a role in evaluating early response to AIT and in monitoring treatment adherence in clinical practice. In this review, the authors explore barriers to continuation with AIT and discuss initiatives to motivate and support patients through the challenging early months of treatment, prior to the onset of clinical effect and when side effects are most common, to encourage long-term adherence to therapy and achieve optimal patient outcomes.
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and Allergy, University of Bonn Medical Center, Bonn, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Georg-August University, Göttingen, Germany; Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen and University of Osnabrück, Osnabrück, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
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Bilgilisoy Filiz M, Filiz S, Baran RT, Çakır T, Koldaş Doğan Ş, Parlak M, Toraman NF. Restless legs syndrome in children with allergic rhinitis: A comparative study on frequency, severity and sleep quality. Turk J Phys Med Rehabil 2018; 64:198-204. [PMID: 31453512 PMCID: PMC6657790 DOI: 10.5606/tftrd.2018.2265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/11/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aims to investigate the frequency and severity of restless legs syndrome (RLS) and its relationship with sleep quality in children with allergic rhinitis (AR) with the hypothesis that comorbid RLS may be an additional causative factor of sleep disturbances in pediatric AR. PATIENTS AND METHODS A total of 143 children with AR (aged 8-18 years) and 144 healthy control subjects (aged 8-18 years) were included. The diagnosis of AR was established on history, clinical examination and skin prick test according to the Allergic Rhinitis and its Impact on Asthma guidelines. Presence of RLS was determined using the International RLS study group (IRLSSG) criteria. The severity of RLS was assessed using the IRLSSG rating scale. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI). RESULTS Thirteen patients (9.1%) in AR group, and six children (4.2%) in control group had RLS (p=0.159). The frequency of RLS in AR group was higher than two folds when compared to the control group; however, the difference was not statistically significant. Restless legs syndrome severity score was significantly higher in AR group than control group (15.00 [11-20] and 11.00 [10-16] respectively, p=0.046). Total PSQI scores were similar between groups. Also, no significant differences were observed in total PSQI scores of AR patients with or without RLS. CONCLUSION Restless legs syndrome was not more common but was more severe in children with AR. There was no evidence that RLS has an obvious effect on sleep quality in children with AR.
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Affiliation(s)
- Meral Bilgilisoy Filiz
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Serkan Filiz
- Department of Pediatric Allergy and Immunology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Rıza Taner Baran
- Department of Department of Pediatric Endocrinology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Tuncay Çakır
- Department of Physical Medicine and Rehabilitation, Private Likya Hospital, Antalya, Turkey
| | - Şebnem Koldaş Doğan
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mesut Parlak
- Department of Department of Pediatric Endocrinology, Medicine Faculty of Akdeniz University, Antalya, Turkey
| | - Naciye Füsun Toraman
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
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181
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Utility of narrow band imaging in the diagnosis of middle turbinate head edema. Am J Otolaryngol 2018; 39:570-574. [PMID: 29961655 DOI: 10.1016/j.amjoto.2018.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Middle turbinate head edema has recently been found to have high specificity for diagnosis of inhalant allergy. However, subtle mucosal edema can be difficult to appreciate under white light endoscopy. Narrow band imaging (NBI) has the potential to demonstrate edema by identifying reduced mucosal vascularity and improve sensitivity for the detection of mucosal edema. Narrow band imaging was assessed to determine its utility in objectifying mucosal edema. MEATERIALS AND METHODS A cross-sectional diagnostic study was performed on patients with edematous mucosa of the middle turbinate head. Under traditional white light endoscopy, areas of edematous mucosa were identified. Using NBI, these areas were compared to areas of normal mucosa on the middle turbinate head. NBI images of these same areas were then converted to grey scale and a vascularity index was created by pixel analysis and brightness in Fiji Image J software (Wisconsin, US). RESULTS Thirty-three middle turbinates were assessed (age 42.4 ± 12.5, 42.4% female). NBI discriminated between areas identified under white light endoscopy as edematous and normal (158.2 ± 48.4 v 96.9 ± 32.7 p < 0.01). Receiver operating curve (ROC) analysis suggested a threshold of 115 brightness units to define endoscopically visible edematous mucosa with sensitivity 70% and specificity 79% (ROC AUC, p = 0.85). CONCLUSIONS NBI can differentiate edematous from normal mucosa. The potential for an objective measure of mucosal edema may assist research efforts and may provide a more sensitive tool for subtle mucosal inflammatory changes.
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Reinhold T, Willich S, Brüggenjürgen B. Subcutaneous specific immunotherapy: Economic implications from the perspective of statutory health insurance - a population based cost-effectiveness estimation. Allergol Select 2018; 2:111-120. [PMID: 31826032 PMCID: PMC6881850 DOI: 10.5414/alx1507e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/23/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Specific immunotherapy is the only potentially curative therapy in patients with allergic rhinitis (AR) and allergic asthma (AA). The present study examined the effects of subcutaneous immunotherapy (SCIT) on the financial situation of the German statutory health insurance systems and measures the impact on AR/AA prevalence during the next decades. A further objective was to identify possible SCIT-treatment strategies in order to reach an efficient SCIT-use. METHODS Taking population projections of the German Statistical Federal Office, the number of expected new cases (AR, AA) was calculated until 2050. Based on assumptions about the proportion of patients who received SCIT in the future, age cohorts run through a model-calculation based on Markov chains. Data on effectiveness were extracted from published literature. For determining the cost situation of SCIT pharmacies we used selling prices for Allergovit®. All future costs are discounted at a mean rate of 2%. The model calculation was supplemented by a Delphi panel. RESULTS Based on the current situation, a total annual economic burden of 540 million Euros is to be expected for care of about yearly 6 million patients with AR and AA in Germany between 2011 and 2050. Several scenarios have shown that the use of SCIT seems to be associated with cost savings from the perspective of statutory health insurances, when SCIT is offered to a larger amount of patients with moderate to severe symptoms. That would result in reduced number of expensive patients who suffer from AA. The best effects on the future number of diseased patients could be achieved, however, if SCIT additionally would be applied to patients in earlier stages of disease. Due to the large number of patients receiving SCIT in such a scenario, the initial costs would not completely compensated by cost savings. Nevertheless, the additional costs of 300 to 350 Euros per additionally healed patient seem to be justifiable. CONCLUSION From the perspective of the SHI, SCIT is a useful strategic option for preventing the progression of allergic diseases. Particularly with increased use in early disease stages, the number of healed patients is high. Potential cost savings may result from increased treatment rates in patients with advanced disease stages.
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Affiliation(s)
- T Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medicine, Berlin, Germany
| | - S Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medicine, Berlin, Germany
| | - B Brüggenjürgen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medicine, Berlin, Germany
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183
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Nasal disease and quality of life in athletes. The Journal of Laryngology & Otology 2018; 132:812-815. [DOI: 10.1017/s0022215118001408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesNasal disease imposes a significant disease burden upon the individual in the general population, but is relatively under studied in athletes. This study sought to define the frequency of nasal symptoms in the active population, and to quantify the impact of these symptoms on quality of life and on the frequency of upper respiratory tract infections.ResultsA total of 296 participants completed the study (246 athletes and 50 sedentary controls). Nasal symptoms were significantly more frequent in the active group than in the sedentary controls (70 per cent vs 52 per cent). Upper respiratory tract infections were significantly more common in athletes with regular nasal symptoms than in athletes without nasal symptoms. Quality-of-life scores, as measured by the 22-item Sino-Nasal Outcome Test, were significantly worse in athletes with regular nasal symptoms.ConclusionThis study suggests that regular exercise is associated with a significant increase in the prevalence of troubling nasal symptoms, and nasal symptoms in athletes are associated with increased susceptibility to upper respiratory tract infections. Quality of life was negatively affected, confirming the importance of nasal health to athlete welfare.
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Penagos M, Eifan AO, Durham SR, Scadding GW. Duration of Allergen Immunotherapy for Long-Term Efficacy in Allergic Rhinoconjunctivitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2018; 5:275-290. [PMID: 30221122 PMCID: PMC6132438 DOI: 10.1007/s40521-018-0176-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
RATIONALE Subcutaneous and sublingual immunotherapy are effective for allergic rhinitis. An important question is whether allergen immunotherapy provides a sustained clinical effect after treatment cessation. In view of potential side effects, cost and the necessary patient commitment, long-term benefit is an important consideration for the recommendation of immunotherapy over standard pharmacotherapy. PURPOSE OF REVIEW In this review, we analyse the existing evidence for long-term effects of both routes of administration in the context of double-blind, placebo-controlled, randomised clinical trials that included a follow-up phase of at least 1 year after treatment cessation. RECENT FINDINGS Overall, evidence suggests that 3 years of either subcutaneous or sublingual immunotherapy result in clinical benefit and immunological changes consistent with allergen-specific tolerance sustained for at least 2-3 years after treatment cessation. SUMMARY The data presented here support recommendations in international guidelines that both routes of administration should be continued for a minimum of 3 years. Gaps in the evidence remain regarding the long-term efficacy of immunotherapy for perennial rhinitis and studies performed in children.
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Affiliation(s)
- Martin Penagos
- Allergy and Clinical Immunology, Division of Respiratory Science, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Aarif O. Eifan
- Allergy and Clinical Immunology, Division of Respiratory Science, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Stephen R. Durham
- Allergy and Clinical Immunology, Division of Respiratory Science, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital Imperial College London, Dovehouse Street, London, SW3 6LY UK
| | - Guy W. Scadding
- Allergy and Clinical Immunology, Division of Respiratory Science, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital Imperial College London, Dovehouse Street, London, SW3 6LY UK
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Abstract
Allergic rhinitis affects 20 to 30% of adults in both the United States and Europe and perhaps a somewhat higher percentage of children. In addition to nasal and ocular symptoms directly related to the allergic process, interference of these symptoms with sleep leads to daytime sleepiness and impaired quality of life. Patients miss work because of symptoms but an even greater problem is interference with work productivity, or presenteeism, which has been reported to be the biggest contributor to the total economic cost of allergic rhinitis. There has been increasing awareness that many patients with either seasonal or perennial symptoms but negative skin and in vitro tests for allergen sensitivity have local nasal allergy, diagnosable by the presence of allergen-specific IgE in their nasal secretions or a positive nasal allergen challenge or both. The pharmaceutical management of allergic rhinitis rests on symptomatic treatment with antihistamines that perhaps are more effectively administered intranasally than orally and intranasal corticosteroids. Allergen immunotherapy is very effective, even for local allergic rhinitis, and the shortcomings of subcutaneous immunotherapy of inconvenience and safety are reduced by the introduction of sublingual immunotherapy (SLIT). Use of the latter is currently somewhat limited by the lack of appropriate dosing information for SLIT liquids and the limited number of allergens for which SLIT tablets are available.
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Affiliation(s)
- Flavia C. L. Hoyte
- Department of Medicine, Division of Allergy/Immunology, National Jewish Health, Denver, CO, 80206, USA
| | - Harold S. Nelson
- Department of Medicine, Division of Allergy/Immunology, National Jewish Health, Denver, CO, 80206, USA
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186
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Restimulia L, Pawarti DR, Ekorini HM. The Relationship between Serum Vitamin D Levels with Allergic Rhinitis Incidence and Total Nasal Symptom Score in Allergic Rhinitis Patients. Open Access Maced J Med Sci 2018; 6:1405-1409. [PMID: 30159065 PMCID: PMC6108797 DOI: 10.3889/oamjms.2018.247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Allergic diseases and vitamin D deficiency were found to have a relationship. However, there was limited number of studies on the relationship between vitamin D with allergic rhinitis (AR) and total nasal symptom scores (TNSS), particularly in determining the cut-off points of serum vitamin D levels which correlated to AR. AIM As this particular study has never been conducted in Indonesia, the main objective of this study was to investigate this issue. METHODS The research was conducted at Dr Soetomo Hospital, Surabaya in January 2017. A group of 30 subjects were recruited using consecutive sampling. Levels of serum vitamin D were measured using electrochemiluminescence immunoassay (ECLIA) method while the total nasal symptom scores were obtained by accumulating all the nasal symptoms. Data of serum vitamin D levels and TNSS were analysed statistically with the Pearson correlation test. RESULTS It was found that the mean of serum 25(OH) vitamin D levels (9.13 ng/mL) of the AR group was significantly lower than the non-AR group (26.22 ng/mL) (P = 0.000). The vitamin D cut-off points which correlated to AR was about 12.83 ng/mL (sensitivity = 80%; specificity = 100%). A Pearson correlation test found a strong, negative correlation between vitamin D levels and TNSS (P = 0.000; r = -0.800). CONCLUSION There was a strong, negative correlation between serum vitamin D levels with AR and TNSS. The cut-off points of serum vitamin D levels correlated to AR were approximately12.83 ng/mL. Thus, further research needs to be conducted.
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Affiliation(s)
- Lia Restimulia
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Airlangga University, Jl. Prof. Dr Moestopo No. 47, Surabaya 60132, Indonesia
| | - Dwi Reno Pawarti
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Airlangga University, Jl. Prof. Dr Moestopo No. 47, Surabaya 60132, Indonesia
| | - Haris Mayaguyang Ekorini
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Airlangga University, Jl. Prof. Dr Moestopo No. 47, Surabaya 60132, Indonesia
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Kim YE, Son MJ, Jung SY, Kwon O, Lee JH, Lee DH. Socheongryong-tang for improving nasal symptoms associated with allergic rhinitis: A study protocol for a randomized, open-label, cetirizine controlled, clinical trial. Medicine (Baltimore) 2018; 97:e11812. [PMID: 30142767 PMCID: PMC6112955 DOI: 10.1097/md.0000000000011812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Socheongryong-tang (SCRT) is an herbal medicine with anti-inflammatory and anti-allergic properties, commonly used in East Asian countries to reduce rhinitis symptoms. There have been several clinical studies of its effects on allergic rhinitis (AR), but no trials comparing it with conventional treatment. We present the protocol for a feasibility trial to assess the safety and clinical effectiveness of SCRT in AR in comparison with cetirizine. METHODS AND ANALYSIS This is a randomized, open-label, cetirizine-controlled clinical trial. A total of 30 AR patients who have signed informed consent forms will be recruited and randomly assigned to SCRT or cetirizine groups at a 1:1 ratio. The participants will visit the clinical research center every week and receive SCRT granules or cetirizine tablets. SCRT will be taken twice daily, cetirizine will be taken once daily, and treatment medication will be taken for 2 weeks. Data will be collected at baseline, at week 2, and at week 4 after random allocation. The primary outcome will be the mean change in the total nasal symptom score from baseline to week 2. Secondary outcome measures will include the mini Rhinoconjunctivitis Quality of Life Questionnaire and total serum immunoglobulin E. To assess the safety of SCRT, a liver and renal function test will be conducted before and after treatment, and the participants will be asked about any occurrence of adverse events at every visit. The recruitment rate, completion rate, and medication adherence will also be calculated to assess feasibility. DISCUSSION The findings of this study are expected to provide the basis for a full-scale randomized controlled trial to confirm the safety and effectiveness of SCRT for the treatment of nasal symptoms in patients with AR patients not controlled by conventional therapy. TRIAL REGISTRATION This study has been registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0002380).
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Affiliation(s)
- Young-Eun Kim
- Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon
| | - Mi Ju Son
- Department of Korean Preventive Medicine, College of Korean Medicine, Graduate School, Kyung Hee University, Dongdaemun-gu, Seoul
| | - So Young Jung
- Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon
| | - Ojin Kwon
- Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon
| | - Jun-Hwan Lee
- Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon
- Korean Medicine Life Science, University of Science and Technology, Yuseong-gu, Daejeon
| | - Dong-Hyo Lee
- Department of Ophthalmology and Otolaryngology and Dermatology, Woo-Suk University Korean Medicine Hospital, Wansan-gu, Jeonju-si, Jeollabuk-do, Republic of Korea
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Role of IL-35 in sublingual allergen immunotherapy. J Allergy Clin Immunol 2018; 143:1131-1142.e4. [PMID: 30053528 DOI: 10.1016/j.jaci.2018.06.041] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/06/2018] [Accepted: 06/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Grass pollen-specific immunotherapy involves immunomodulation of allergen-specific TH2 responses and induction of IL-10+ and/or TGF-β+CD4+CD25+ regulatory T cells (induced Treg cells). IL-35+CD4+CD25+ forkhead box protein 3-negative T (IL-35-inducible regulatory T [iTR35]) cells have been reported as a novel subset of induced Treg cells with modulatory characteristics. OBJECTIVE We sought to investigate mechanisms underlying the induction and maintenance of immunologic tolerance induced by IL-35 and iTR35 cells. METHODS The biological effects of IL-35 were assessed on group 2 innate lymphoid cells (ILC2s); dendritic cells primed with thymic stromal lymphopoietin, IL-25, and IL-33; and B and TH2 cells by using flow cytometry and quantitative RT-PCR. Grass pollen-driven TH2 cell proliferation and cytokine production were measured by using tritiated thymidine and Luminex MagPix, respectively. iTR35 cells were quantified in patients with grass pollen allergy (seasonal allergic rhinitis [SAR] group, n = 16), sublingual immunotherapy (SLIT)-treated patients (SLIT group, n = 16), and nonatopic control subjects (NACs; NAC group, n = 16). RESULTS The SAR group had increased proportions of ILC2s (P = .002) and IL-5+ cells (P = .042), IL-13+ cells (P = .042), and IL-5+IL-13+ ILC2s (P = .003) compared with NACs. IL-35 inhibited IL-5 and IL-13 production by ILC2s in the presence of IL-25 or IL-33 (P = .031) and allergen-driven TH2 cytokines by effector T cells. IL-35 inhibited CD40 ligand-, IL-4-, and IL-21-mediated IgE production by B cells (P = .015), allergen-driven T-cell proliferation (P = .001), and TH2 cytokine production mediated by primed dendritic cells. iTR35 cells suppressed TH2 cell proliferation and cytokine production. In addition, allergen-driven IL-35 levels and iTR35 cell counts were increased in patients receiving SLIT (all, P < .001) and NACs (all, P < .001) compared with patients with SAR. CONCLUSION IL-35 and iTR35 cells are potential novel immune regulators induced by SLIT. The clinical relevance of SLIT can be underscored by restoration of protective iTR35 cells.
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Treatment history and association between allergic rhinitis symptoms and quality of life. Ir J Med Sci 2018; 188:703-710. [DOI: 10.1007/s11845-018-1866-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
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Association between allergic and nonallergic rhinitis and obstructive sleep apnea. Curr Opin Allergy Clin Immunol 2018; 18:16-25. [PMID: 29135515 DOI: 10.1097/aci.0000000000000414] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions. RECENT FINDINGS In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep-wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea-hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA. SUMMARY Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa.
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191
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Gunawardana NC, Durham SR. New approaches to allergen immunotherapy. Ann Allergy Asthma Immunol 2018; 121:293-305. [PMID: 30025907 DOI: 10.1016/j.anai.2018.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE New insights into mechanisms should enable strategic improvement of allergen immunotherapy, aiming to make it safer, faster, more effective, and able to induce long-term tolerance. We review novel approaches with potential to translate into clinical use. DATA SOURCES Database searches were conducted in PubMed, Scopus, and Google Scholar. STUDY SELECTIONS Search terms were based on current and novel approaches in immunotherapy. Literature was selected primarily from recent randomized double-blinded placebo-controlled trials and meta-analyses. RESULTS Alum, microcrystalline tyrosine, and calcium phosphate are adjuvants in current use. Toll-like receptor-4 agonists combined with allergen have potential to shorten duration of treatment. Other novel adjuvants, nanoparticles, and virus-like particles in combination with allergen have shown early promise. Omalizumab lessens systemic side effects but does not improve efficacy. Intralymphatic immunotherapy for aeroallergens, epicutaneous immunotherapy for food allergens, and use of modified allergens (allergoids), recombinant allergens (and hypoallergenic variants), and T- and B-cell peptide approaches have shown evidence of efficacy and permitted shortened courses but have only rarely been compared with conventional extracts. CONCLUSION Novel routes of immunotherapy, use of modified allergens, and combination of allergens with immunostimulatory adjuvants or immune modifiers have been developed to augment downregulation of T-helper cell type 2 immunity and/or induce "protective" blocking antibodies. Although these strategies have permitted shortened courses, confirmatory phase 3 trials are required to confirm efficacy and safety and head-to-head trials are required for comparative efficacy. Currently, subcutaneous and sublingual immunotherapies using in-house standardized crude extracts remain the only approaches proved to induce long-term tolerance.
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Affiliation(s)
- Natasha C Gunawardana
- Imperial College London, London, United Kingdom; Royal Brompton and Harefield Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Stephen R Durham
- Imperial College London, London, United Kingdom; Royal Brompton and Harefield Hospitals, NHS Foundation Trust, London, United Kingdom.
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Salem L, Dao VA, Shah-Hosseini K, de Marees M, Mester J, Mösges R, Vent J. Impaired sports performance of athletes suffering from pollen-induced allergic rhinitis: a cross-sectional, observational survey in German athletes. J Sports Med Phys Fitness 2018; 59:686-692. [PMID: 30009588 DOI: 10.23736/s0022-4707.18.08556-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Allergic rhinitis has major impacts on sports performance of athletes. The present study aimed at determining the frequency of seasonal pollen allergy and analyzing the impacts of pollen allergy, the choice of allergy treatments and their benefits for sports performance in a group of professional and recreational athletes. METHODS The study was conducted as a self-reported questionnaire survey. Subjects were recruited from the German Sport University and the Cologne Marathon 2014 during the peak pollen season of 2014. RESULTS Athletes returned 636 completed questionnaires, 42.6% of participants reported suffering from a pollen allergy and 30.2% also suffered from asthma. Performance impairments were reported in more than 80% of allergic subjects. In all, 82.2% of subjects used symptomatic medications, 32.3% alternative therapies, and 47.6% allergen immunotherapy. Subjects who used immunotherapy had fewer impaired training bouts than those who used symptomatic and alternative therapies. The majority of subjects had concerns about allergy treatment such as side effects, negative impacts on sports performance and lack of long-term effects. CONCLUSIONS This study confirmed a high prevalence of pollen allergy among German athletes. The majority of allergic rhinitis athletes were undertreated, and the reason could be their reservations about allergy treatments. Pollen allergy tremendously reduced sports performance of athletes during the pollen season. This impact can be lessened with proper treatment such as immunotherapy. Better understanding of available treatment modalities should be provided to patients and physicians to improve sports performance of athletes suffering from pollen allergy.
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Affiliation(s)
- Laura Salem
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Van-Anh Dao
- Clinical Research International Ltd. (CRI), Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Markus de Marees
- The German Research Center of Elite Sports, German Sports University of Cologne, Cologne, Germany
| | - Joachim Mester
- The German Research Center of Elite Sports, German Sports University of Cologne, Cologne, Germany
| | - Ralph Mösges
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany.,Clinical Research International Ltd. (CRI), Cologne, Germany
| | - Julia Vent
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany - .,Department of Otorhinolaryngology, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne Medical Center (UKK), Cologne, Germany
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193
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Klimek L, Kündig T, Kramer MF, Guethoff S, Jensen-Jarolim E, Schmidt-Weber CB, Palomares O, Mohsen MO, Jakob T, Bachmann M. Virus-like particles (VLP) in prophylaxis and immunotherapy of allergic diseases. ALLERGO JOURNAL INTERNATIONAL 2018; 27:245-255. [PMID: 30546996 PMCID: PMC6267129 DOI: 10.1007/s40629-018-0074-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/17/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Apart from active allergen avoidance, immunotherapy is regarded as the most effective form of treatment available for type I allergies. Such treatments involve the administration of allergen preparations in various forms and by various routes. Virus-like particles (VLPs) offer a very effective platform for immunization with the allergen and are characterized by high immunogenicity, low allergenicity and high clinical efficacy. Formulations that include Toll-like receptor ligands, T cell stimulatory epitopes and/or depot-forming adjuvants appear to enhance activation of the relevant immune cells. Short nucleotide sequences including CpG motifs have also been intensively explored as potent stimulators of dendritic cells and B cells. METHODS The present paper is based on a systematic literature search in PubMed and MEDLINE, and focuses on the pertinent immunological processes and on clinical data relating to use of VLPs and CpG motifs for the treatment of allergic rhinitis (AR). RESULTS Many published studies have reported positive clinical results following administration of VLPs, either alone or in combination with CpG motifs and, in some cases, even in the absence of the allergen-specific allergen. CONCLUSIONS These results indicate that VLPs modulate immune responses in ways which underline their exceptional promise as a platform for the immunotherapy of allergic disorders. However, clinical evaluations remain limited, and further large-scale and longer-term studies will be necessary to substantiate the efficacy and safety of these novel therapies.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology & Allergology, Wiesbaden, Germany
| | - Thomas Kündig
- Department for Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Matthias F. Kramer
- Bencard Allergie GmbH, Munich, Germany
- Allergy Therapeutics plc, Worthing, UK
| | - Sonja Guethoff
- Bencard Allergie GmbH, Munich, Germany
- Allergy Therapeutics plc, Worthing, UK
| | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Inter-University Messerli Science Institute, Veterinary University Vienna, Vienna, Austria
| | - Carsten B. Schmidt-Weber
- Center for Allergy and Environmental Resarch (ZAUM), Technical University and Helmholtz-Center, Munich, Germany
| | - Oskar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | | | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Gießen, Justus-Liebig-University, Gießen, Germany
| | - Martin Bachmann
- Jenner Institute, University of Oxford, Oxford, UK
- Inselspital, University Department for Rheumatology, Immunology and Allergology, Sahlihaus 1, 3010 Bern, Switzerland
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Cheng L, Chen J, Fu Q, He S, Li H, Liu Z, Tan G, Tao Z, Wang D, Wen W, Xu R, Xu Y, Yang Q, Zhang C, Zhang G, Zhang R, Zhang Y, Zhou B, Zhu D, Chen L, Cui X, Deng Y, Guo Z, Huang Z, Huang Z, Li H, Li J, Li W, Li Y, Xi L, Lou H, Lu M, Ouyang Y, Shi W, Tao X, Tian H, Wang C, Wang M, Wang N, Wang X, Xie H, Yu S, Zhao R, Zheng M, Zhou H, Zhu L, Zhang L. Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:300-353. [PMID: 29949830 PMCID: PMC6021586 DOI: 10.4168/aair.2018.10.4.300] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/17/2017] [Accepted: 10/05/2017] [Indexed: 11/20/2022]
Abstract
Allergic rhinitis (AR) is a global health problem that causes major illnesses and disabilities worldwide. Epidemiologic studies have demonstrated that the prevalence of AR has increased progressively over the last few decades in more developed countries and currently affects up to 40% of the population worldwide. Likewise, a rising trend of AR has also been observed over the last 2-3 decades in developing countries including China, with the prevalence of AR varying widely in these countries. A survey of self-reported AR over a 6-year period in the general Chinese adult population reported that the standardized prevalence of adult AR increased from 11.1% in 2005 to 17.6% in 2011. An increasing number of Journal Articles and imporclinical trials on the epidemiology, pathophysiologic mechanisms, diagnosis, management and comorbidities of AR in Chinese subjects have been published in international peer-reviewed journals over the past 2 decades, and substantially added to our understanding of this disease as a global problem. Although guidelines for the diagnosis and treatment of AR in Chinese subjects have also been published, they have not been translated into English and therefore not generally accessible for reference to non-Chinese speaking international medical communities. Moreover, methods for the diagnosis and treatment of AR in China have not been standardized entirely and some patients are still treated according to regional preferences. Thus, the present guidelines have been developed by the Chinese Society of Allergy to be accessible to both national and international medical communities involved in the management of AR patients. These guidelines have been prepared in line with existing international guidelines to provide evidence-based recommendations for the diagnosis and management of AR in China.
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Affiliation(s)
- Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoheng He
- Allergy and Clinical Immunology Research Centre, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Huabin Li
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guolin Tan
- Department of Otolaryngology Head Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zezhang Tao
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Dehui Wang
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Weiping Wen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Xu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Xu
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Qintai Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chonghua Zhang
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruxin Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Yuan Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Bing Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Luquan Chen
- Department of Traditional Chinese Medicine, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Xinyan Cui
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yuqin Deng
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Zhiqiang Guo
- Department of Otorhinolaryngology Head and Neck Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhenxiao Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Zizhen Huang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Houyong Li
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Jingyun Li
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Wenting Li
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanqing Li
- Department of Otolaryngology Head Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Lin Xi
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Meiping Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yuhui Ouyang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Wendan Shi
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Xiaoyao Tao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huiqin Tian
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Min Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Nan Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangdong Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Hui Xie
- Department of Otorhinolaryngology, Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shaoqing Yu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji University, Shanghai, China
| | - Renwu Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Ming Zheng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Han Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Luping Zhu
- Department of Otorhinolaryngology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Luo Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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Retzler J, Grand TS, Domdey A, Smith A, Romano Rodriguez M. Utility elicitation in adults and children for allergic rhinoconjunctivitis and associated health states. Qual Life Res 2018; 27:2383-2391. [PMID: 29948599 PMCID: PMC6132982 DOI: 10.1007/s11136-018-1910-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 12/02/2022]
Abstract
Purpose Allergic rhinitis and asthma symptoms are detrimental to health-related quality of life (HRQoL). Health technology appraisal agencies often require cost–utility analysis when assessing new interventions. Appropriate utility estimates, which quantify the value of different conditions in cost–utility analyses, are scarce for allergic rhinitis and asthma health states. This study aimed to generate utilities for allergic rhinitis and asthma health states from a European general population sample of adults and children. Methods Health state descriptions incorporating symptoms, impact of symptoms on daily life and symptom treatment were developed using clinical guidelines. Descriptions were amended with clinician and patient input, and incorporated into a survey in which each health state was followed by a standard gamble (adults) or visual analogue scale (children) item. The survey was distributed to samples of adults and children aged 8 to 11 from four European countries that were stratified to represent the general population within that country. Results 1454 adults and 1082 children completed the survey. Mean health utilities ranged from 0.635 to 0.880 and those elicited in children were lower (0.635 to 0.705) than those elicited in adults (0.812 to 0.880). Disutilities assessing the impact of increased allergic rhinitis severity and comorbidities were also greater in children than in adults. Conclusions Symptoms of allergic rhinitis and asthma were valued as having a clinically meaningful impact on HRQoL. Children valued health states as poorer than adults, and further research should investigate whether this reflects true preferential differences or results from methodological and/or comprehension differences between the two groups. Electronic supplementary material The online version of this article (10.1007/s11136-018-1910-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenny Retzler
- York Health Economics Consortium, Enterprise House, University of York, Innovation Way, York, YO10 5NQ, UK.
| | | | | | - Adam Smith
- York Health Economics Consortium, Enterprise House, University of York, Innovation Way, York, YO10 5NQ, UK
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Nilsen AH, Thorstensen WM, Helvik AS, Nordgaard S, Bugten V. Improvement in minimal cross-sectional area and nasal-cavity volume occurs in different areas after septoplasty and radiofrequency therapy of inferior turbinates. Eur Arch Otorhinolaryngol 2018; 275:1995-2003. [PMID: 29869709 DOI: 10.1007/s00405-018-5022-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Septoplasty and radiofrequency therapy for inferior turbinate hypertrophy (RFIT) are common techniques used to improve nasal patency. Our aim was to compare nasal geometry and function using acoustic rhinometry and peak nasal inspiratory flow (PNIF) in three patients groups undergoing surgery for nasal obstruction, and to investigate if the improvement in minimal cross-sectional area (MCA) and nasal-cavity volume (NCV) occurred in different cavity areas in the groups. Finally, we evaluated the correlation between the objective measurements and the patients' assessment of nasal obstruction (SNO). METHODS This prospective, observational study investigated 148 patients pre-operatively and 6 months post-operatively. Fifty patients underwent septoplasty (group 1), 51 underwent septoplasty combined with RFIT (group 2), and 47 underwent RFIT alone (group 3). The MCA and NCV were measured at two distances (MCA/NCV0-3.0 and MCA/NCV3-5.2), in addition to measuring PNIF and SNO. RESULTS Pre-operatively, groups 1 and 2 had narrower MCA0-3.0 on one side than group 3 (0.31 ± 0.14 and 0.31 ± 0.14) versus (0.40 ± 0.16) cm2. Post-operatively, total MCA0-3.0 and MCA/NCV3-5.2 increased in group 1. In group 2, MCA/NCV0-3.0 at the narrow side and total MCA/NCV3-5.2 increased, while total MCA/NCV3-5.2 increased in group 3. PNIF improved from 106 ± 49 to 150 ± 57 l/min post-operatively. We found a correlation between increased MCA and NCV and less SNO in the septoplasty group (p < 0.01). CONCLUSION Surgery produced an improvement in MCA and NCV in all groups. The improvement occurred in different areas of the nasal cavity in the patient groups. Both anterior and posterior areas increased in the septoplasty groups, while only the posterior area increased in the RFIT group. PNIF improved in all three patient groups, indicating that surgery produced an improvement in nasal patency.
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Affiliation(s)
- Ann Helen Nilsen
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway. .,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.
| | - Wenche Moe Thorstensen
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Anne-Sofie Helvik
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Staale Nordgaard
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Vegard Bugten
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
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197
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Tafuro F, Selis L, Goldoni M, Stendardo M, Mozzoni P, Ridolo E, Boschetto P, Corradi M. Biomarkers of respiratory allergy in laboratory animal care workers: an observational study. Int Arch Occup Environ Health 2018; 91:735-744. [PMID: 29858653 DOI: 10.1007/s00420-018-1321-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/22/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Laboratory animal allergy is a highly prevalent occupational disease among exposed workers. The aim of the study was to validate the biomarkers of airway inflammation in laboratory animal (LA) care workers. METHODS All of the participants in this observational study (63 LA care workers and 64 controls) were administered a clinical questionnaire, underwent spirometry and a skin prick or radioallergosorbent test for common and occupational aeroallergens, and the fraction of exhaled nitric oxide (FeNO50), exhaled breath condensate hydrogen peroxide (EBC H2O2) and serum pneumoprotein levels were measured. Multivariate analysis (ANCOVA) was used to assess the interactions of the variables. RESULTS FeNO50 levels correlated with exposure (p = 0.002), sensitisation (p = 0.000) and age (p = 0.001), but there was no interaction between exposure and sensitisation when age was considered in the model (p = 0.146). EBC-H2O2 levels were higher in the sensitised workers than in the sensitised controls [0.14 (0.08-0.29) µM vs 0.07 (0.05-0.12) µM; p < 0.05]. Serum surfactant protein A (SP-A) levels were unaffected by exposure, sensitisation or age, although higher levels were observed in symptomatic workers; however, SP-D levels were influenced by exposure (p = 0.024) and age (p = 0.022), and club cell 16 levels were influenced by sensitisation (p = 0.027) and age (p = 0.019). CONCLUSIONS The presence of the clinical symptoms associated with LA exposure and high FeNO levels should prompt further medical assessments in LA workers. Although EBC-H2O2 levels do not seem to reflect eosinophilic inflammation, serum SP-A levels could be used to monitor progression from rhinitis to asthma.
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Affiliation(s)
- Federica Tafuro
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luisella Selis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Paola Mozzoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Piera Boschetto
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, Parma, Italy. .,Unit of Occupational Medicine, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43123, Parma, Italy.
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198
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Saeed HS, Wright RB, Ghosh SK. Trends in the prescribing of topical nasal agents Using an NHS England data base. Clin Otolaryngol 2018; 43:1296-1302. [PMID: 29770588 DOI: 10.1111/coa.13143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our aim is to present data depicting geographical prescribing trends and expenditure related to topical nasal agent prescriptions across clinical commissioning groups (CCG's) in England. We assess if prescribing trends can act as a surrogate marker for allergic rhinitis (AR) and rhinosinusitis disease burden (RS). DESIGN NHS England primary care prescriptions dispensed for topical drugs used in nasal allergy (BNF chapter 12.2.1) were accessed using OpenPrescribing beta software. Graphical data over a 5-year period was generated to highlight nationwide trends in prescribing and expenditure. Out of 211 CCG districts, the highest and lowest 40 prescribing rate CCG's were subdivided according to rural/urban output and geographical location to highlight specific regional trends. Two sampled, paired and unpaired t tests of unequal variance were performed to determine the significance of observed trends. RESULTS The 5-year trend in prescription rate (mean yearly expenditure £40 725 258) for drugs used in nasal allergy marginally increased. Peak prescription was during months of high environmental pollen. Regardless of pollen season (June 2016 vs November 2015), CCG's of urban districts had significantly lower rates of prescribing (P ≤ .001). Amongst the 40 lowest and 40 highest prescribing rate CCG's, prescription rates fell significantly between months of high and low environmental pollen (P ≤ .0001). Regardless of pollen season, rural eastern and eastern coastal districts of England had persistently high rates of prescription. CONCLUSIONS This study shows marked geographical variation in prescribing for topical nasal agents in England. There is propensity for eastern districts to have higher rates of prescribing in England. Adopting prescribing trends as a surrogate marker for disease burden could allow allergy and endoscopic sinus surgery services to be concentrated to specific regions. This would provide more effective, economical treatment for both AR and RS.
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Affiliation(s)
- H S Saeed
- Stepping Hill Hospital, Stockport, UK
| | - R B Wright
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - S K Ghosh
- Pennine Acute Hospitals NHS Trust, Manchester, UK
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199
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Häussler D, Sommer JU, Nastev A, Aderhold C, Wenzel A, Kramer B, Stuck BA, Birk R. Influence of MP 29-02 on ciliary beat frequency in human epithelial cells in vitro. Eur Arch Otorhinolaryngol 2018; 275:1483-1490. [PMID: 29675754 DOI: 10.1007/s00405-018-4979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/16/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE MP 29-02, which contains fluticasone propionate and azelastine hydrochloride, is used as a topical nasal application for the treatment of seasonal and perennial allergic rhinitis. Although a multitude of data is available on the clinical symptom reduction and treatment safety of MP 29-02, the effect of MP 29-02 on ciliary beat frequency (CBF) has not been evaluated thus far. METHODS MP 29-02-containing solution was applied at concentrations of 2.5, 5, 10, and 20% to 14 healthy subjects, and nasal ciliated epithelial cells were then visualized using a phase-contrast microscope. CBF was measured after the application of MP 29-02. For a comparison, fluticasone propionate was used. CBF measurements were then performed for 15 min at 22 °C. Ringer's solution was applied as a negative control. RESULTS MP 29-02 significantly reduced CBF at all the tested concentrations compared with that of the control group within the observation time. At a 2.5% concentration, MP 29-02 significantly reduced CBF from 6.81 Hz (SD ± 1.35 Hz) at baseline to 4.88 Hz (SD ± 1.52 Hz, p < 0.001) after 15 min. In contrast, for fluticasone propionate, a significant reduction was observed only with the 20% concentration after 5, 10, and 15 min. CONCLUSIONS MP 29-09 significantly reduced CB, with an almost linear relationship between the MP 29-09 concentration and reduction in CBF. For fluticasone propionate, a significant reduction of CBF was observed only at the highest analyzed concentration. The findings have implications for the long-term use of the MP 29-02. Yet, further clinical studies are needed to confirm these results in vivo, especially in patients with seasonal or perennial allergic rhinits.
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Affiliation(s)
- D Häussler
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.
| | - J U Sommer
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.
| | - A Nastev
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - C Aderhold
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - A Wenzel
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - B Kramer
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - B A Stuck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
- Philipps-Universität Marburg, Marburg, Germany
| | - R Birk
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
- Philipps-Universität Marburg, Marburg, Germany
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200
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Tan R, Cvetkovski B, Kritikos V, Price D, Yan K, Smith P, Bosnic-Anticevich S. The Burden of Rhinitis and the Impact of Medication Management within the Community Pharmacy Setting. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1717-1725. [PMID: 29606639 DOI: 10.1016/j.jaip.2018.01.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/18/2017] [Accepted: 01/16/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The burden of rhinitis is high. It is unknown to what extent this burden is related to inappropriate medication use. OBJECTIVE This study aimed to identify the way in which people with rhinitis medicate their condition and to evaluate the appropriateness of this medication management. METHODS Pharmacy customers who visited Sydney metropolitan community pharmacies and purchased medication for nasal symptoms were the sampling frame for this study. To determine the condition for which the participants were seeking medication and the appropriateness of their medication selection, the following data were collected with a researcher-administered questionnaire: participant's demographics, symptoms, medication selected. An expert panel of clinical researcher pharmacists and specialist respiratory physician evaluated the appropriateness of medication selection based on the Allergic Rhinitis and its Impact on Asthma international guidelines. RESULTS Two hundred and ninety-six participants were recruited from 8 pharmacies; 63.2% had a doctor's diagnosis for the symptoms for which they were selecting treatment. Seventy percent of participants self-selected their medications. Seventy-one percent of the participants were identified as having rhinitis. Overall, 16.5% of participants who had rhinitis selected optimal medications. Sixteen percent of participants with allergic rhinitis reported wheezing (6.3% selected optimal medications). CONCLUSIONS The majority of the participants with rhinitis selected suboptimal medications from community pharmacy highlighting the significant burden of rhinitis in community pharmacy and the contribution of medication management. Pharmacists need to take a proactive and evidence-based role in the management of rhinitis supported by clinical pathways when need to be articulated and promoted in all rhinitis guidelines.
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Affiliation(s)
- Rachel Tan
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - David Price
- Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom; Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | - Kwok Yan
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter Smith
- Clinical Medicine, Griffith University, Southport, Queensland, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; Sydney Local Health District, Sydney, New South Wales, Australia
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