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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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202
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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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203
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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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204
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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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205
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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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206
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Gusenkov S, Stutz H. Top-down and bottom-up characterization of nitrated birch pollen allergen Bet v 1a with CZE hyphenated to an Orbitrap mass spectrometer. Electrophoresis 2018; 39:1190-1200. [PMID: 29389018 PMCID: PMC6175448 DOI: 10.1002/elps.201700413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/19/2018] [Accepted: 01/19/2018] [Indexed: 11/19/2022]
Abstract
Tyrosine (Tyr) residues of the major pollen allergen of birch Betula verrucosa, Bet v 1a, were nitrated by peroxynitrite. This modification enhances the allergenicity. Modified tyrosines were identified by analyzing intact allergen variants in combination with top‐down and bottom‐up approaches. Therefore, a laboratory‐built sheath‐liquid assisted ESI interface was applied for hyphenation of CE to an Orbitrap mass spectrometer to localize individual nitration sites. The major focus was on identification of primary nitration sites. The top‐down approach unambiguously identified Tyr 5 as the most prominent modification site. Fragments from the allergen core and the C‐terminal part carried up to three potential nitration sites, respectively. Thus, a bottom‐up approach with tryptic digest was used as a complementary strategy which allowed for the unambiguous localization of nitration sites within the respective peptides. Nitration propensity for individual Tyr residues was addressed by comparison of MS signals of nitrated peptides relative to all cognates of homolog primary sequence. Combined data identified surface exposed Tyr 5 and Tyr 66 as major nitration sites followed by less accessible Tyr 158 whereas Tyr 81, 83 and 150 possess a lower nitration tendency and are apparently modified in variants with higher nitration levels.
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Affiliation(s)
- Sergey Gusenkov
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Hanno Stutz
- Department of Biosciences, University of Salzburg, Salzburg, Austria
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Gerth van Wijk R, Eguiluz-Gracia I, Gayraud J, Gutermuth J, Hamelmann E, Heffler E, Popov TA, Schmid-Grendelmeier P, Tomazic PV, Tsilochristou O, Muelleneisen N. The roadmap for allergology in Europe: The subspecialty of allergology as "stop-over" on the way to a full specialty. An EAACI position statement. Allergy 2018; 73:540-548. [PMID: 28960379 DOI: 10.1111/all.13321] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 02/06/2023]
Abstract
The vision of European Academy of Allergy and Clinical Immunology (EAACI) and the Union of European Medical Specialists Section and Board on allergology is to promote and to establish a full specialty of allergology in all European countries. In many European countries, a full specialty does not exist. In those countries, organ-based (sub)specialists or paediatricians and internists with an expertise in allergology may deliver allergy care. There are no generally accepted requirements for the training of subspecialists available. To fill the gap between the need and availability of experienced and accredited physicians who can deliver optimal care to the allergic patients, the EAACI Specialty Committee proposes the minimal requirements for training and certification of subspecialists in allergology. This paper describes the required theoretical knowledge, skills, competences and training facilities (staff and institution). The subspecialist as described in this paper should ideally show the necessary competence in providing good quality care to patients in an environment lacking those full specialists in allergology or tertiary care paediatric subspecialists in allergy.
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Affiliation(s)
- R. Gerth van Wijk
- Section of Allergology; Deparment of Internal Medicine; Erasmus MC; Rotterdam the Netherlands
| | - I. Eguiluz-Gracia
- Allergy Unit and Research Laboratory; Regional University Hospital of Malaga and Biomedical Research Institute of Malaga (IBIMA); Malaga Spain
| | | | - J. Gutermuth
- Department of Dermatology; Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - E. Hamelmann
- Children's Center; Bethel Clinic; Bielefeld Germany
- Allergy Center; Ruhr University Bochum; Bochum Germany
| | - E. Heffler
- Personalized Medicine; Asthma and Allergy Clinic - Department of Biomedical Sciences; Humanitas University and Research Center; Milan Italy
| | - T. A. Popov
- Clinic of Allergy and Asthma; Medical University Sofia; Sofia Bulgaria
| | - P. Schmid-Grendelmeier
- Allergy Unit; Department of Dermatology; University Hospital of Zürich; Zürich Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE; Davos Switzerland
| | - P. V. Tomazic
- Department of General Otorhinolaryngology, H&NS; Medical University of Graz; Graz Austria
| | - O. Tsilochristou
- Division of Asthma, Allergy and Lung Biology; King's College London; London UK
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Adam D, Grabenhenrich L, Ortiz M, Binting S, Reinhold T, Brinkhaus B. Impact of acupuncture on antihistamine use in patients suffering seasonal allergic rhinitis: secondary analysis of results from a randomised controlled trial. Acupunct Med 2018; 36:139-145. [PMID: 29440045 PMCID: PMC6029641 DOI: 10.1136/acupmed-2017-011382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 01/01/2023]
Abstract
Background Seasonal allergic rhinitis (SAR) is a common disease that has detrimental effects on the quality of life (QoL) of affected individuals. Approximately 18% of patients try to alleviate their symptoms through acupuncture. The ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) study (ClinicalTrials.gov registration no. NCT00610584) assessed the impact of acupuncture on SAR, showing significant improvements in rhinitis-specific QoL (RQoL) and in rescue medication (RM) use. Objective A secondary analysis of SAR patients’ use of antihistamine. Methods Patients were randomised into three study groups: acupuncture plus RM, sham acupuncture plus RM, and RM alone. The patients documented their medication use before and during the intervention period (8 weeks). The main outcome was the number of days with antihistamine use. Statistical analyses were conducted using parametric and non-parametric tests. The robustness of the results was tested by sensitivity analyses using non-parametric bootstrapping. Results The data from 414 patients were analysed. The acupuncture group used antihistamines significantly less often compared with the other groups (acupuncture vs sham acupuncture: mean difference −4.49 days, p=0.01; acupuncture vs RM: mean difference −9.15 days, p<0.001). Approximately 38% of the acupuncture group did not use any antihistamine in contrast to only 16% in the RM group. The pre-post comparison suggested that the acupuncture patients did not need to increase the days of antihistamine use to alleviate their symptoms, unlike the other groups. Conclusions Acupuncture appeared to significantly reduce the number of days of antihistamine use while improving RQoL and SAR symptoms; it can therefore be considered a valuable, additional treatment option for patients with SAR. Trial registration number NCT00610584; Post-results.
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Affiliation(s)
- Daniela Adam
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Linus Grabenhenrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Miriam Ortiz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sylvia Binting
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Reinhold
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benno Brinkhaus
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Hoffmans R, Wagemakers A, van Drunen C, Hellings P, Fokkens W. Acute and chronic rhinosinusitis and allergic rhinitis in relation to comorbidity, ethnicity and environment. PLoS One 2018; 13:e0192330. [PMID: 29401486 PMCID: PMC5798836 DOI: 10.1371/journal.pone.0192330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background This study was conducted to assess the effect of comorbidity, ethnicity, occupation, smoking and place of residence on allergic rhinitis (AR), acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS). Methods A GA2LEN (The Global Allergy and Asthma European Network) screening questionnaire was sent to a random sample of the Dutch population (n = 16700) in three different areas of the Netherlands. Results Fifty percent (8347) of the questionnaires sent were returned. A total of 29% respondents (27–31% in different areas) met the criteria for AR, 18% (17–21%) for ARS and 16% (13–18%) for CRS. Risk factors for AR were itchy rash, eczema, adverse response after taking a painkiller, asthma, CRS and ARS. Moreover, the risk of AR was twice as low for full-time housewives/househusbands than for people with jobs. The risk of ARS or CRS was significantly higher in respondents with a doctor’s diagnosis of CRS, AR, itchy rash or smoking. The risk of CRS was also significantly higher in respondents with an adverse response after taking painkillers, active smoking or asthma. Caucasians are generally less likely to have AR or CRS than Latin-Americans, Hindustani and African-Creoles, and more likely to have ARS than Asian, Hindustani, Mediterranean and African-Creoles. Conclusions This study found shared and distinct risk factors for AR, ARS and CRS and therefore provides support for the belief that they have shared symptoms but are different diseases with different aetiologies.
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Affiliation(s)
- Ruth Hoffmans
- Academic Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | | | | | - Peter Hellings
- Academic Medical Centre, Amsterdam, The Netherlands
- UZ Leuven, Leuven, Belgium
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Gani F, Lombardi C, Barrocu L, Landi M, Ridolo E, Bugiani M, Rolla G, Senna G, Passalacqua G. The control of allergic rhinitis in real life: a multicenter cross-sectional Italian study. Clin Mol Allergy 2018; 16:4. [PMID: 29434524 PMCID: PMC5797368 DOI: 10.1186/s12948-018-0082-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/24/2018] [Indexed: 01/16/2023] Open
Abstract
Background Allergic Rhinitis (AR) is a high-prevalence disease. In Europe about 25% of the general population is affected, and in Italy the prevalence is estimated to be 19.8%. The Allergic Rhinitis and its Impact on Asthma (ARIA) international document underlined that the prevalence of severe or refractory or overlapping rhinitis is increasing and represents a non-negligible socio-economic burden. In general, despite the social healthcare costs, allergic rhinitis remains underestimated, not sufficiently controlled and often undertreated. Aim of the study In this multi-center Italian observational and prospective study we assessed the control of AR in patients (> 16 years) without previous asthma diagnosis, referred to Allergy Centers. Methods Patients of both sexes and older than 16 with rhinitis symptoms and without asthma were studied. A Visual Analogue Scale (VAS) and the CARAT (Control of Allergic Rhinitis and Asthma Test) were used as patient reported outcome. The possible causes of poor control of AR, as per protocol, were assessed accordingly. Results We observed 250 patients in a real-life setting: more than 60% of them had an uncontrolled AR, only about 50% used multiple medications, and only a minority were receiving allergen immunotherapy. Conclusion This survey, conducted in a real-life setting, confirmed that AR is overall poorly controlled. The VAS assessment well correlates with the structured CARAT questionnaire and with the relevant symptoms of AR.
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Affiliation(s)
- Federica Gani
- Allergy Service, Azienda Ospedaliera "San Luigi Orbassano", Turin, Italy
| | - Carlo Lombardi
- 2Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Laura Barrocu
- Allergy Service, Azienda Ospedaliera "San Luigi Orbassano", Turin, Italy
| | - Massimo Landi
- Primary Care Pediatrician, National Healthcare System, Turin, Italy
| | - Erminia Ridolo
- 4Experimental and Clinical Medicine, University of Parma, Parma, Italy
| | - Massimo Bugiani
- Consultant Physician of Professional Diseases Observatory, Procura della Repubblica, Turin, Italy
| | - Giovanni Rolla
- 6Allergology and Immunology, University of Turin, AO Mauriziano, Turin, Italy
| | - Gianenrico Senna
- 7Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Giovanni Passalacqua
- 8Allergy and Respiratory Diseases, IRCCS San Martino-IST University of Genoa, Genoa, Italy
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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212
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Fujii R, Hishida A, Wu MC, Kondo T, Hattori Y, Naito M, Endoh K, Nakatochi M, Hamajima N, Kubo M, Kuriki K, Wakai K. Genome-wide association study for pollinosis identified two novel loci in interleukin (IL)-1B in a Japanese population. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:109-120. [PMID: 29581620 PMCID: PMC5857507 DOI: 10.18999/nagjms.80.1.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Abstract
The number of pollinosis patients in Japan has significantly increased over the past 20 years. The majority of genome-wide association studies (GWAS) on pollinosis have been conducted in subjects of European descent, with few studies in Japanese populations. The aim of our GWAS was to identify genetic loci associated with self-reported pollinosis in a Japanese population and to understand its molecular background using a combination of single nucleotide polymorphisms (SNPs) and gene- and pathway-based analyses. A total of 731 and 560 individuals who were recruited as participants of the Japan Multi-Institutional Collaborative Cohort Study participated in the discovery and replication phases, respectively. The phenotype of pollinosis was based on the information from a self-administered questionnaire. In the single-SNP analysis, four SNPs (rs11975199, rs11979076, rs11979422, and rs12669708) reached suggestive significance level (P < 1 × 10-4) and had effects in the same direction in both phases of the study. The pathway-based analysis identified two suggestive pathways (nucleotide-binding oligomerization domain -like receptor and tumor necrosis factor signaling pathways). Both rs1143633 and rs3917368 in the interleukin-1B gene showed associations in the retrace (from pathway to gene and SNP) analysis. We performed single-SNP, gene, and pathway analysis and shed light on the molecular mechanisms underlying pollinosis in a Japanese population.
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Affiliation(s)
- Ryosuke Fujii
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michael C Wu
- Biostatistics and Biomathematics Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, United States
| | - Takaaki Kondo
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuta Hattori
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Labour Force Statistics Office, Statistics Bureau, Ministry of Internal Affairs and Communications, Tokyo, Japan
| | - Mariko Naito
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kaori Endoh
- Laboratory of Public Health, Graduate School of Integrated Pharmaceutical and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan
| | - Masahiro Nakatochi
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Health Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, Center of Genomic Medicine, RIKEN, Yokohama, Japan
| | - Kiyonori Kuriki
- Laboratory of Public Health, Graduate School of Integrated Pharmaceutical and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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213
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Nilsen AH, Helvik AS, Thorstensen WM, Bugten V. A comparison of symptoms and quality of life before and after nasal septoplasty and radiofrequency therapy of the inferior turbinate. BMC EAR, NOSE, AND THROAT DISORDERS 2018; 18:2. [PMID: 29422774 PMCID: PMC5787231 DOI: 10.1186/s12901-017-0050-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023]
Abstract
Background The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty combined with radiofrequency therapy of inferior turbinates (RFIT) (group-2) and 58 patients who underwent RFIT alone (group-3). The secondary goal is to investigate if the change in symptoms and HQOL differed between these three patient groups after surgery. Methods All patients reported symptoms on a visual analogue scale (VAS) and HQOL on Sino-Nasal-Outcome-Test-20 (SNOT-20) and Short-Form-Health-Survey-36 (SF-36) before and 6 months after surgery. The pre- and postoperative scores and improvement were compared within and between the three patient groups. Results Preoperatively the three patient groups had a fairly similar symptom burden and HQOL, except for group-1 which reported more symptoms of oral breathing than group-3 (p < 0.01) and group-3 which reported more problems in the ear/facial--subset of SNOT-20 and in the general-mental-health-domain of SF-36 than group-1 (p < 0.01). Postoperatively all patient groups reported improved symptom scores of nasal obstruction, nasal discharge, snoring, oral breathing and reduced general health (p < 0.01), and better HQOL (p < 0.05). Patients in group-2 had less symptoms of nasal obstruction than group-3 (p < 0.05). Postoperative symptom score for nasal obstruction was 29.1 (SD67.6) in group-1, 27.5 (SD22.5) in group-2 and 37.2 (SD24.8) in group-3. Revision cases reported more nasal obstruction postoperatively; 41.3 (SD27) than non revision cases; 28.6 (SD24) (p < 0.01). The HQOL after surgery was about the same in all three patient groups, but we found that patients with comorbidities as sleep apnea and asthma reported worse HQOL than other patients (p < 0.01). Conclusion Surgical treatment of nasal obstruction led to less symptoms and better HQOL for all three patient groups. Comparing the postoperative scores between the patient groups we find that all groups reached the same level of HQOL. Regarding symptoms, the patients who underwent septoplasty combined with RFIT reported postoperatively less nasal obstruction than patients who underwent RFIT alone which may indicate that a combined procedure of septoplasty and RFIT is better than RFIT alone to treat nasal obstruction. Furthermore, revision cases, patients with sleep apnea and asthma patients seem to have poorer outcome after surgery than other patients. Both disease specific and general QOL instruments add valuable information for identifying factors influencing outcome. Electronic supplementary material The online version of this article (10.1186/s12901-017-0050-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann Helen Nilsen
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway
| | - Anne-Sofie Helvik
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway.,2Institute of Public Health and General Practice, Norwegian University of Science and Technology, 7006 Trondheim, Norway
| | - Wenche Moe Thorstensen
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway.,3Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7006 Trondheim, Norway
| | - Vegard Bugten
- 1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway.,3Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7006 Trondheim, Norway
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214
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Lee JH, Kim SC, Choi H, Jung CG, Ban GY, Shin YS, Nahm DH, Park HS, Ye YM. A Retrospective Study of Clinical Response Predictors in Subcutaneous Allergen Immunotherapy With House Dust Mites for Allergic Rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:18-24. [PMID: 29178674 PMCID: PMC5705479 DOI: 10.4168/aair.2018.10.1.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/12/2017] [Accepted: 07/25/2017] [Indexed: 12/27/2022]
Abstract
Purpose House dust mites (HDM) are major allergens that cause allergic rhinitis (AR). Allergen-specific subcutaneous immunotherapy (SCIT) has been shown to be clinically beneficial in many clinical trials. Such trials, however, are not reflective of all patient populations. The aim of this study was to describe the efficacy and safety of SCIT in routine clinical practice in Korean adults with AR sensitized to HDM. Methods We reviewed medical records of 304 patients with AR treated at an allergy clinic of a tertiary hospital using SCIT with aluminum hydroxide-adsorbed allergen extract targeting HDM alone or with pollens for at least 1 year from 2000 to 2012. Patients with asthma were excluded. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Specific immunoglobulin E (IgE) levels to HDM were categorized into 6 classes. Results The mean time until achieving remission was 4.9±0.1 years, and the cumulative incidence of remission from AR was 76.6%. Severe AR (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.23-0.69; P=0.001), specific IgE levels to HDM ≥17.5 kU/L (OR, 1.85; 95% CI, 1.01-3.37; P=0.045), and duration of immunotherapy ≥3 years (OR, 7.37; 95% CI, 3.50-15.51; P<0.001) were identified as significant predictors of clinical remission during SCIT for patients with AR sensitized to HDM. Overall, 73 patients (24.0%) experienced adverse reactions to SCIT, and only 1 case of anaphylaxis (0.3%) developed. Conclusions SCIT with HDM was found to be effective and safe for patients with AR. Specific IgE levels to HDM and a duration of SCIT ≥3 years may be predictors of clinical responses to SCIT in AR patients.
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Affiliation(s)
- Ji Ho Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Su Chin Kim
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Hyunna Choi
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Chang Gyu Jung
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ga Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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215
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McInnes RN, Hemming D, Burgess P, Lyndsay D, Osborne NJ, Skjøth CA, Thomas S, Vardoulakis S. Mapping allergenic pollen vegetation in UK to study environmental exposure and human health. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 599-600:483-499. [PMID: 28482306 PMCID: PMC5593151 DOI: 10.1016/j.scitotenv.2017.04.136] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 05/14/2023]
Abstract
Allergenic pollen is produced by the flowers of a number of trees, grasses and weeds found throughout the UK. Exposure to such pollen grains can exacerbate pollen-related asthma and allergenic conditions such as allergic rhinitis (hay fever). Maps showing the location of these allergenic taxa have many applications: they can be used to provide advice on risk assessments; combined with health data to inform research on health impacts such as respiratory hospital admissions; combined with weather data to improve pollen forecasting systems; or as inputs to pollen emission models. In this study we present 1km resolution maps of 12 taxa of trees, grass and weeds found in the UK. We have selected the main species recorded by the UK pollen network. The taxa mapped in this study were: Alnus (alder), Fraxinus (ash), Betula (birch), Corylus (hazel), Quercus (oak), Pinus (pine) and Salix (willow), Poaceae (grass), Artemisia (mugwort), Plantago (plantain), Rumex (dock, sorrels) and Urtica (nettle). We also focus on one high population centre and present maps showing local level detail around the city of London. Our results show the different geographical distributions of the 12 taxa of trees, weeds and grass, which can be used to study plants in the UK associated with allergy and allergic asthma. These maps have been produced in order to study environmental exposure and human health, although there are many possible applications. This novel method not only provides maps of many different plant types, but also at high resolution across regions of the UK, and we uniquely present 12 key plant taxa using a consistent methodology. To consider the impact on human health due to exposure of the pollen grains, it is important to consider the timing of pollen release, and its dispersal, as well as the effect on air quality, which is also discussed here.
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Affiliation(s)
- Rachel N McInnes
- Met Office Hadley Centre, FitzRoy Road, Exeter, EX1 3PB, UK; European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK.
| | - Deborah Hemming
- Met Office Hadley Centre, FitzRoy Road, Exeter, EX1 3PB, UK; Birmingham Institute of Forest Research, School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Peter Burgess
- Devon Wildlife Trust, Cricklepit Mill, Commercial Road, Exeter, EX2 4AB, UK
| | - Donna Lyndsay
- Bluesky International Limited, Unit 3, Jackson Street, Coalville, Leicestershire LE67 3NR, UK
| | - Nicholas J Osborne
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia; European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK
| | - Carsten Ambelas Skjøth
- National Pollen and Aerobiological Research Unit, Institute of Science and the Environment, University of Worcester, WR2 6AJ, UK
| | - Sam Thomas
- Institute of Biological, Environmental & Rural Sciences (IBERS), Aberystwyth University, Penglais, Aberystwyth, Ceredigion SY23 3DA, UK
| | - Sotiris Vardoulakis
- Environmental Change Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ,UK; European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK
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216
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Fasunla AJ, Ijitola JO, Nwaorgu OG. Tympanometric Patterns of Children with Allergic Rhinitis Treated at a Tertiary Health Institution. OTO Open 2017; 1:2473974X17742648. [PMID: 30480199 PMCID: PMC6239153 DOI: 10.1177/2473974x17742648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives To determine the prevalence of otitis media with effusion (OME) and compare
patterns of tympanogram between children with and without allergic rhinitis
in Ibadan, Nigeria. Study Design A case-control study of children (2-7 years) with AR from May 2015 to March
2016. Setting Tertiary hospital. Subjects and Methods Consecutive 86 children with AR and 86 healthy controls (nonallergic)
participated in the study. A structured questionnaire was administered to
parents or caregivers of the participants to obtain relevant
sociodemographic and clinical information. Diagnosis of AR was by
symptomatology and nasal cytology. Both groups had ear, nose, and throat
examination and tympanometric evaluation. OME was diagnosed according to
Jerger’s tympanometric patterns. Results The mean ± SD ages of cases and controls were 3.80 ± 1.72 and 3.78 ± 1.71
years, respectively. All cases presented with watery nasal discharge, bouts
of sneezing, and nasal itching. The duration of AR symptoms was 18 ± 13
months. Among cases and controls, Jerger’s type A tympanogram was the most
common pattern, while type C was the least common. Thirty-nine (45.3%)
children with AR had OME, as compared with 8 (9.3%) controls, and the
difference was statistically significant (P < .001; odds
ratio = 8.090; 95% CI = 3.48-18.79). Conclusion Prevalence of OME was significantly high among children with AR. Jerger’s
type B and C tympanograms were more common among children with AR than the
healthy pediatric population. This background information supports the need
for routine tympanometric evaluation of children with AR.
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Affiliation(s)
- Ayotunde James Fasunla
- Department of Otorhinolaryngology, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Julius Olowo Ijitola
- Department of Otorhinolaryngology, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Onyekwere George Nwaorgu
- Department of Otorhinolaryngology, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria
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217
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Bao Y, Chen J, Cheng L, Guo Y, Hong S, Kong W, Lai H, Li H, Li H, Li J, Li T, Lin X, Liu S, Liu Z, Lou H, Meng J, Qiu Q, Shen K, Tang W, Tao Z, Wang C, Wang X, Wei Q, Xiang L, Xie H, Xu Y, Zhang G, Zhang Y, Zheng Y, Zhi Y, Chen D, Hong H, Li Q, Liu L, Meng Y, Wang N, Wang Y, Zhou Y, Zhang L. Chinese Guideline on allergen immunotherapy for allergic rhinitis. J Thorac Dis 2017; 9:4607-4650. [PMID: 29268533 DOI: 10.21037/jtd.2017.10.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present document is based on a consensus reached by a panel of experts from Chinese Society of Allergy (CSA) and Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G). Allergen immunotherapy (AIT), has increasingly been used as a treatment for allergic rhinitis (AR) globally, as it has been shown to provide a long-term effect in improving nasal and ocular symptoms, reducing medication need, and improving quality of life. AIT is currently the only curative intervention that can potentially modify the immune system in individuals suffering from AR and prevent the development of new sensitization and the progression of disease from AR to asthma. Although the use of AIT is becoming more acceptable in China, to date no AR immunotherapy guideline from China is available for use by the international community. This document has thus been produced and covers the main aspects of AIT undertaken in China; including selection of patients for AIT, the allergen extracts available on the Chinese market, schedules and doses of allergen employed in different routes of AIT, assessment of effect and safety, patients' administration and follow-up, and management of adverse reactions. The Chinese guideline for AR immunotherapy will thus serve as a reference point by doctors, healthcare professionals and organizations involved in the AIT of AR in China. Moreover, this guideline will serve as a source of information for the international community on AIT treatment strategies employed in China.
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Affiliation(s)
- Yixiao Bao
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lei Cheng
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing 210029, China
| | - Yinshi Guo
- Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Suling Hong
- Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - He Lai
- Department of Allergy, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Houyong Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Huabin Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, Allergy and Clinical Immunology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Tianying Li
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoping Lin
- The PLA Center of respiratory and allergic disease diagnosing and management, Shenyang 110016, China
| | - Shixi Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zheng Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Juan Meng
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qianhui Qiu
- Department of Otorhinolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Kunling Shen
- Department of Pediatric Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wei Tang
- Department of Pulmonary and Critical Care Medicine, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Zezhang Tao
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Qingyu Wei
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Hua Xie
- Department of Respiratory Medicine, the General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yu Xu
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Yiwu Zheng
- Scientific Affairs, ALK, Guangzhou 510300, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100720, China
| | - Dehua Chen
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Haiyu Hong
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Quansheng Li
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Lin Liu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Nan Wang
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yihui Wang
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yue Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China
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Matsuoka T, Bernstein DI, Masuyama K, Nolte H, Okamiya K, Seitzberg D, Nelson HS. Pooled efficacy and safety data for house dust mite sublingual immunotherapy tablets in adolescents. Pediatr Allergy Immunol 2017; 28:661-667. [PMID: 28660739 DOI: 10.1111/pai.12747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND House dust mite (HDM) respiratory allergy is a common and burdensome disease in children and adolescents. There are few HDM allergy immunotherapy trials in children with perennial allergic rhinitis. This post hoc analysis used pooled data to evaluate efficacy and safety of the SQ HDM sublingual immunotherapy (SLIT) tablet in adolescents (12-17 years). METHODS In two double-blind, placebo-controlled trials conducted in North America and Japan, respectively, subjects aged 12+ years with HDM allergic rhinitis were randomized to up to 1 year of treatment. The primary end-point in both trials was the average total combined rhinitis score (TCRS) during the last 8 weeks of treatment in the active group compared with placebo. Data from subjects aged 12-17 years were pooled (N=395). RESULTS In the pooled adolescent subpopulation, average TCRS improved 22% with 12 SQ HDM vs placebo (absolute treatment difference of 1.04; P<.01). Rhinitis daily symptom score (DSS), conjunctivitis DSS and rhinitis daily medication score (DMS) were also significantly improved vs placebo in the pooled adolescent subpopulation (all P<.05). There were no new safety signals for adolescents. The frequency of adverse events was similar in adolescents and adults with the majority being mild application site-related events. CONCLUSIONS Treatment with 12 SQ HDM appears to be effective and well tolerated in adolescents with HDM allergic rhinitis.
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Affiliation(s)
- Tomokazu Matsuoka
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | - David I Bernstein
- Bernstein Clinical Research Center and Division of Allergy and Immunology, University of Cincinnati, Cincinnati, OH, USA
| | - Keisuke Masuyama
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | | | - Kazuhiro Okamiya
- Clinical Development Department, Torii Pharmaceutical Co. Ltd., Tokyo, Japan
| | | | - Harold S Nelson
- Division of Allergy/Immunology, Department of Medicine National Jewish Health, Denver, CO, USA
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219
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Katotomichelakis M, Iliou T, Karvelis I, Giotakis E, Daniilides G, Erkotidou E, Lazaridis C, Anastassopoulos GK. Symptomatology Patterns in Children with Allergic Rhinitis. Med Sci Monit 2017; 23:4939-4946. [PMID: 29033449 PMCID: PMC5654957 DOI: 10.12659/msm.903136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Although allergic rhinitis (AR) is recognized as a growing global health disease with considerable importance for patients’ lives, especially among children and adolescents, there is a lack of population studies concerning symptomatology patterns of the disease. The present study aimed to explore symptoms prevalence among school-aged children, to detect any correlation between allergen sensitivities with symptomatology patterns, and, finally, to evaluate the association of the sensitivity grade score with symptoms severity or seasonality. Material/Methods This was a cross-sectional, observational study in a childhood population. The first stage included recruitment of children and parental-completed questionnaires. The second stage included skin-prick tests for the most common allergens. Severity of symptoms was self-evaluated using a scale that ranged from “0” (no symptoms), “1” (mild), and “2” (moderate-to-severe). AR was classified as seasonal (SAR) or perennial (PAR). Results The most frequent symptoms were reported for nasal obstruction, sneezing, and rhinorrhea. All nasal symptoms were significantly more profound among children with HDM sensitivity. However, more symptoms, not only nasal, but also ocular and general ones, were detected among patients with grass pollen sensitivity. Patients with PAR reported more severe symptoms. SAR was associated with mild disease. Finally, the sensitivity grade score was significantly correlated with symptom severity. Conclusions Our results suggest that allergen sensitivity may be correlated with symptomatology patterns among children who have allergic rhinitis.
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Affiliation(s)
- Michael Katotomichelakis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece
| | - Theodoros Iliou
- Laboratory of Informatics, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece
| | - Ioannis Karvelis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece
| | - Evangelos Giotakis
- Department of Otorhinolaryngology, Facial Plastic and Reconstructive Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Gerasimos Daniilides
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece
| | - Eleni Erkotidou
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece
| | - Christos Lazaridis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece
| | - George K Anastassopoulos
- Laboratory of Informatics, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece
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Vandenplas O, Vinnikov D, Blanc PD, Agache I, Bachert C, Bewick M, Cardell LO, Cullinan P, Demoly P, Descatha A, Fonseca J, Haahtela T, Hellings PW, Jamart J, Jantunen J, Kalayci Ö, Price D, Samolinski B, Sastre J, Tian L, Valero AL, Zhang X, Bousquet J. Impact of Rhinitis on Work Productivity: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:1274-1286.e9. [PMID: 29017832 DOI: 10.1016/j.jaip.2017.09.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/02/2017] [Accepted: 09/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is increasingly acknowledged as having a substantial socioeconomic impact associated with impaired work productivity, although available information remains fragmented. OBJECTIVE This systematic review summarizes recently available information to provide a quantitative estimate of the burden of AR on work productivity including lost work time (ie, absenteeism) and reduced performance while working (ie, presenteeism). METHODS A Medline search retrieved original studies from 2005 to 2015 pertaining to the impact of AR on work productivity. A pooled analysis of results was carried out with studies reporting data collected through the validated Work Productivity and Activity Impairment (WPAI) questionnaire. RESULTS The search identified 19 observational surveys and 9 interventional studies. Six studies reported economic evaluations. Pooled analysis of WPAI-based studies found an estimated 3.6% (95% confidence interval [CI], 2.4; 4.8%) missed work time and 35.9% (95% CI, 29.7; 42.1%) had impairment in at-work performance due to AR. Economic evaluations indicated that indirect costs associated with lost work productivity are the principal contributor to the total AR costs and result mainly from impaired presenteeism. The severity of AR symptoms was the most consistent disease-related factor associated with a greater impact of AR on work productivity, although ocular symptoms and sleep disturbances may independently affect work productivity. Overall, the pharmacologic treatment of AR showed a beneficial effect on work productivity. CONCLUSIONS This systematic review provides summary estimates of the magnitude of work productivity impairment due to AR and identifies its main determinant factors. This information may help guide both clinicians and health policy makers.
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Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Denis Vinnikov
- Department of Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | | | - Lars-Olaf Cardell
- Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, UK
| | - Pascal Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - Alexis Descatha
- AP-HP, Occupational Health Department, Unité de pathologie professionnelle, University Hospital of West Suburb of Paris, Poincaré, Garches, and Versailles St-Quentin University, INSERM, Villejuif, France
| | - Joao Fonseca
- Center for Health Technology and Services Research-CINTESIS, Faculdade de Medicina, Universidade do Porto; and Allergy Unit, CUF Porto Instituto & Hospital, Porto, Portugal
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Peter W Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Jacques Jamart
- Scientific Support Unit, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Juha Jantunen
- South Karelia Allergy and Environment Institute, Imatra, Finland
| | - Ömer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, UK; Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Joaquin Sastre
- Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid, Spain
| | - Longxiu Tian
- Ross School of Business, University of Michigan, Ann Arbor, Mich
| | - Antonio L Valero
- Pneumology and Allergy Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | | | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France; INSERM, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, U1168, Paris, France; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France
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Kang KT, Yeh TH, Hsu WC, Lee CH. In response to Letter regarding “Revision adenoidectomy in children: a population-based cohort study in Taiwan”. Eur Arch Otorhinolaryngol 2017; 274:3823-3824. [DOI: 10.1007/s00405-017-4703-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/05/2017] [Indexed: 11/29/2022]
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Demoly P, Kleine-Tebbe J, Rehm D. Clinical benefits of treatment with SQ house dust mite sublingual tablet in house dust mite allergic rhinitis. Allergy 2017; 72:1576-1578. [PMID: 28273339 DOI: 10.1111/all.13155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/27/2022]
Abstract
Treatment with SQ (standardised quality) house dust mite sublingual tablet for 1 year resulted in a decreased probability of having an allergic rhinitis (AR) exacerbation day (from 11% [placebo] to 5% [SQ house dust mite sublingual tablet]) and an increased probability of having a mild AR day (from 16% [placebo] to 34% [SQ house dust mite sublingual tablet]).
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Affiliation(s)
- P. Demoly
- Division of Allergy; Department of Pulmonology; Hopital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136 INSERM; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - J. Kleine-Tebbe
- Allergy & Asthma Center Westend; Outpatient Clinic & Research Center Hanf; Ackermann & Kleine-Tebbe; Berlin Germany
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223
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Emminger W, Hernández MD, Cardona V, Smeenk F, Fogh BS, Calderon MA, de Blay F, Backer V. The SQ House Dust Mite SLIT-Tablet Is Well Tolerated in Patients with House Dust Mite Respiratory Allergic Disease. Int Arch Allergy Immunol 2017; 174:35-44. [PMID: 28950268 DOI: 10.1159/000478699] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/13/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The SQ house dust mite (HDM) SLIT-tablet (ALK, Denmark) addresses the underlying cause of HDM respiratory allergic disease, and a clinical effect has been demonstrated for both HDM allergic rhinitis and allergic asthma. Here, we present pooled safety data from an adult population with HDM respiratory allergy, with particular focus on the impact of asthma on the SQ HDM SLIT-tablet tolerability profile. METHODS Safety data from 2 randomised double-blind, placebo-controlled clinical trials were included: MT-04: 834 adults with HDM allergic asthma not well controlled by inhaled corticosteroids and with HDM allergic rhinitis, and MT-06: 992 adults with moderate-to-severe HDM allergic rhinitis despite the use of allergy pharmacotherapy and with or without asthma. RESULTS The proportion of subjects experiencing adverse events (AEs) was greater in the active treatment group (12 SQ-HDM; 73% of subjects) compared to placebo (53%). The most common treatment-related AEs were local allergic reactions. No AEs were reported as systemic allergic reactions. Regardless of asthma status, most AEs were mild or moderate (>97% of AEs) and the frequency of serious AEs was low. Subgroup analysis revealed no statistically significant difference in the risk of experiencing moderate or severe treatment-related AEs for subjects with asthma compared to subjects without asthma (p = 0.88). In addition, subjects with partly controlled or uncontrolled asthma were no more likely to experience moderate or severe treatment-related AEs than subjects with controlled asthma (p = 0.42). CONCLUSION The SQ HDM SLIT-tablet is well tolerated, and the safety profile was comparable for subjects with HDM respiratory allergic disease irrespective of asthma status.
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224
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Gonzalez M, Doña I, Palomares F, Campo P, Rodriguez MJ, Rondon C, Gomez F, Fernandez TD, Perkins JR, Escribese MM, Torres MJ, Mayorga C. Dermatophagoides pteronyssinus immunotherapy changes the T-regulatory cell activity. Sci Rep 2017; 7:11949. [PMID: 28931869 PMCID: PMC5607227 DOI: 10.1038/s41598-017-12261-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/05/2017] [Indexed: 01/12/2023] Open
Abstract
Subcutaneous specific immunotherapy (SCIT) has been shown to modify the Dermatophagoides pteronissinus (DP) allergic response, characterized by generation of Treg cells. However, studies have reported no changes in the proportion of Treg cells after immunotherapy, indicating that the effects may be due to modifications in their regulatory activities. We aimed to determine whether Tregs generated by DP-SCIT can switch the allergic response to tolerant and study the involvement of suppressive cytokines on it. Twenty-four DP-allergic rhinitis patients were recruited, 16 treated with DP-SCIT and 8 untreated. Treg and T effector cells were isolated before and after DP-SCIT, and cocultured in different combinations with α-IL-10, α-TGF-β blocking antibodies and nDer p 1. Treg cells after DP-SCIT increased Th1 and decreased Th2 and Th9 proliferation. Similarly, they increased IL-10 and decreased IL-4 and IL-9-producing cells. α-IL-10 affected the activity of Treg cells obtained after DP-SCIT only. Finally, DP-specific IgG4 levels, Treg percentage and IL-10 production were correlated after DP-SCIT. These results demonstrate that DP-SCIT induces Treg cells with different suppressive activities. These changes could be mediated by IL-10 production and appear to play an important role in the induction of the tolerance response leading to a clinical improvement of symptoms.
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Affiliation(s)
- M Gonzalez
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - I Doña
- Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - F Palomares
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - P Campo
- Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M J Rodriguez
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - C Rondon
- Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - F Gomez
- Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - T D Fernandez
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - J R Perkins
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M M Escribese
- Institute for Applied Molecular Medicine (IMMA), School of Medicine, Universidad CEU San Pablo, Madrid, Spain
- Basical Medical Sciences Department, Faculty of Medicine, CEU San Pablo University, Madrid, Spain
| | - M J Torres
- Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - C Mayorga
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain.
- Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain.
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225
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Boelke G, Berger U, Bergmann KC, Bindslev-Jensen C, Bousquet J, Gildemeister J, Jutel M, Pfaar O, Sehlinger T, Zuberbier T. Peak nasal inspiratory flow as outcome for provocation studies in allergen exposure chambers: a GA 2LEN study. Clin Transl Allergy 2017; 7:33. [PMID: 28932387 PMCID: PMC5604509 DOI: 10.1186/s13601-017-0169-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/04/2017] [Indexed: 12/24/2022] Open
Abstract
Background The GA2LEN chamber has been developed as a novel mobile allergen exposure chamber (AEC) allowing standardized multicenter trials in allergy. Hitherto, subjective nasal symptom scores have been the most often used outcome parameter, but in standardized modern trials objective parameters are preferred. Despite its practicability, the objective parameter peak nasal inspiratory flow (PNIF) has been rarely used for allergy trials in the setting of allergen exposure chambers. This study aims to evaluate PNIF as an outcome parameter for provocation studies in AECs. Methods In a randomized controlled blinded setting subjects suffering from allergic rhinitis were exposed to grass pollen, birch pollen, house dust mite and/or placebo in the GA2LEN chamber. Different allergen concentrations were used to evaluate symptom severities. Patients had to perform PNIF before and every 30 min during a challenge using a portable PNIF meter. Results 86 subjects participated in 203 challenges, altogether. House dust mite provocations caused the greatest reduction in PNIF values, followed by grass pollen and birch pollen. Provocations with every allergen or pollen concentration led to a significant decrease (p < 0.05) in PNIF compared to baseline. Furthermore, positive correlations were obtained between PNIF and peak expiratory flow, height and weight, and inverse correlations between PNIF and total nasal symptom score, nasal congestion score and visual analog scale of overall subjective symptoms. Conclusion PNIF is a helpful and feasible tool for conducting provocation trials with allergens, especially grass pollen and house dust mite, in an AEC. Electronic supplementary material The online version of this article (doi:10.1186/s13601-017-0169-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georg Boelke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Center-Charité, Berlin, Germany
| | - Uwe Berger
- Department of Otorhinolaryngology, Aerobiology and Pollen Information Research Unit, Medical University of Vienna, Vienna, Austria
| | - Karl-Christian Bergmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Center-Charité, Berlin, Germany
| | | | - Jean Bousquet
- CHRU, Montpellier University Hospital Center, Montpellier, France
| | | | - Marek Jutel
- ALL-MED Medical Research Institute, Wrocław, Poland.,Department of Clinical Immunology, Wroclaw Medical University, Wrocław, Poland
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Center-Charité, Berlin, Germany
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226
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Valero A, Quirce S, Dávila I, Delgado J, Domínguez-Ortega J. Allergic respiratory disease: Different allergens, different symptoms. Allergy 2017; 72:1306-1316. [PMID: 28208220 DOI: 10.1111/all.13141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Spanish population is rather homogeneous in its genetic and sociocultural characteristics, but allergen sensitization shows wide geographical variations. We aimed at assessing whether sensitization to different allergens in the diverse geographical areas induced different clinical and quality-of-life characteristics in adult patients with a first-time diagnosis of rhinitis and/or asthma. METHODS Two sequential, identically designed studies were carried out to evaluate such associations (PERFILAR I and II). PERFILAR II was an extension of PERFILAR I with additional allergens being included. Both phases were epidemiological, descriptive, cross-sectional, nonintervention multicenter studies. Participants were required to have lived for at least the last 2 years in the geographical zone. Asthma control assessment was based on ACQ-5. Health-related quality of life was evaluated with validated scales for rhinitis (ESPRINT-15) and asthma (Mini-AQLQ). Skin prick tests were used to identify sensitization to involved allergens. RESULTS A total of 301 physicians recruited 2711 patients for PERFILAR I+II. Sensitization to allergens was significantly different in patients with rhinitis with/without asthma. Seasonal allergens were associated with rhinitis, a longer time to asthma development, and more severe and commonly intermittent rhinitis. HDM were associated with more common rhinitis, and Alternaria was associated with asthma. The study confirms an association of geographical areas with relevant allergens and allergic clinical picture. CONCLUSION Different types of aeroallergens and specific sensitization profiles are associated with different allergic clinical pictures (rhinitis with/without asthma), different clinical symptoms, and different levels of severity. This could have implications to predict later clinical course and to select appropriate management approaches.
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Affiliation(s)
- A. Valero
- Pneumology and Allergy Department; Clinical and Experimental Respiratory Immunoallergy; IDIBAPS; CIBERES; Hospital Clinic; Barcelona Spain
| | - S. Quirce
- Department of Allergy; Healthcare Research Institute IdiPAZ; CIBER de Enfermedades Respiratorias; CIBERES; Hospital Universitario La Paz; Madrid Spain
| | - I. Dávila
- Immunoallergy Department; IBSAL-Hospital Universitario de Salamanca; Salamanca Spain
| | - J. Delgado
- Allergy Department; Hospital Virgen Macarena; Sevilla Spain
| | - J. Domínguez-Ortega
- Department of Allergy; Healthcare Research Institute IdiPAZ; CIBER de Enfermedades Respiratorias; CIBERES; Hospital Universitario La Paz; Madrid Spain
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Todkill D, Loveridge P, Elliot AJ, Morbey R, de Lusignan S, Edeghere O, Smith G. Socioeconomic and geographical variation in general practitioner consultations for allergic rhinitis in England, 2003-2014: an observational study. BMJ Open 2017; 7:e017038. [PMID: 28801431 PMCID: PMC5724116 DOI: 10.1136/bmjopen-2017-017038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Allergic rhinitis (AR) is a global health problem, potentially impacting individuals' sleep, work and social life. We aimed to use a surveillance network of general practitioners (GPs) to describe the epidemiology of AR consultations in England. SETTING A large GP surveillance network covering approximately 53% of the English population. METHODS GP consultations for AR across England between 30 December 2002 and 31 December 2014 were analysed. Using more granular data available between 2 April 2012 and 31 December 2014 rates and rate ratios (RR) of AR were further analysed in different age groups, gender, rural-urban classification and index of multiple deprivation score quintile of location of GP. RESULTS The mean weekly rate for AR consultations was 19.8 consultations per 100 000 GP registered patients (range 1.13-207), with a regular peak occurring during June (weeks 24-26), and a smaller peak during April. Between 1 April 2012 and 31 December 2014, the highest mean daily rates of consultations per 1 00 000 were: in age group 5-14 years (rate=8.02, RR 6.65, 95% CI 6.38 to 6.93); females (rate=4.57, RR 1.12 95% CI 1.12 to 1.13); persons registered at a GP in the most socioeconomically deprived quintile local authority (rate=5.69, RR 1.48, 95% CI 1.47 to 1.49) or in an urban area with major conurbation (rate=5.91, RR 1.78, 95% CI 1.69 to 1.87). CONCLUSIONS AR rates were higher in those aged 5-14 years, females and in urban and socioeconomically deprived areas. This needs to be viewed in the context of this study's limitations but should be considered in health promotion and service planning.
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Affiliation(s)
- Daniel Todkill
- Field Epidemiology Service, National Infection Service, Public Health England, Birmingham, UK
- Health Services Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Loveridge
- Real-time Syndromic Surveillance, National Infection Service, Public Health England, Birmingham, UK
| | - Alex James Elliot
- Real-time Syndromic Surveillance, National Infection Service, Public Health England, Birmingham, UK
- NIHR Health Protection Research Unit, Emergency Preparedness and Response, London, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance, National Infection Service, Public Health England, Birmingham, UK
| | - Simon de Lusignan
- Department of Clinical & Experimental Medicine, University of Surrey, Surrey, UK
- Research and Surveillance Centre, Royal College of General Practitioners, London, England
| | - Obaghe Edeghere
- Field Epidemiology Service, National Infection Service, Public Health England, Birmingham, UK
- Real-time Syndromic Surveillance, National Infection Service, Public Health England, Birmingham, UK
| | - Gillian Smith
- Real-time Syndromic Surveillance, National Infection Service, Public Health England, Birmingham, UK
- NIHR Health Protection Research Unit, Emergency Preparedness and Response, London, UK
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Ellis AK, Steacy LM, Joshi A, Bhowmik S, Raut A. Efficacy of the novel nasal steroid S0597 tested in an environmental exposure unit. Ann Allergy Asthma Immunol 2017; 117:310-7. [PMID: 27613466 DOI: 10.1016/j.anai.2016.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND S0597 is a novel glucocorticosteroid that was formulated as an intranasal spray to treat seasonal allergic rhinitis (SAR). In a previous phase 2 study, doses of 100 to 400 μg twice daily were well tolerated and more effective than placebo for improving nasal symptoms induced by grass pollen. OBJECTIVE To assess the clinical efficacy and safety of a once-daily S0597 nasal spray for treatment of SAR induced by ragweed pollen in an environmental exposure unit (EEU). METHODS A single-center, phase 2, randomized, double-blind study in 222 adults with SAR and a positive skin prick test result to short ragweed. Participants underwent ragweed pollen challenge in the EEU at the screening or priming visit and on days 1, 7, and 14 and received 50, 200, or 400 μg of S0597 or placebo in the evening for 13 days. The primary efficacy end point was change in total nasal symptom score (TNSS) from baseline to day 14. RESULTS Improvement in TNSS from baseline to day 14 was statistically significant in all S0597 groups compared with placebo. Least-squares mean differences in change from baseline between active treatment and placebo were 1.18, 1.84, and 1.17 for the 50-, 200-, and 400-μg/d S0597 groups, respectively (P < .05). The 200-μg group demonstrated statistically significant improvements in all TNSS subscales (rhinorrhea, nasal congestion, sneezing, nasal itching) compared with placebo at days 7 and 14. CONCLUSION Treatment with 50 to 400 μg of S0597 once daily was well tolerated and significantly more effective than placebo in relieving nasal symptoms of SAR associated with ragweed pollen. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01940146.
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Affiliation(s)
- Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
| | - Lisa M Steacy
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | | | | | - Atul Raut
- Sun Pharma Advanced Research Company Ltd, Mumbai, India
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Nolte H, Plunkett G, Grosch K, Larsen JN, Lund K, Bollen M. Major allergen content consistency of SQ house dust mite sublingual immunotherapy tablets and relevance across geographic regions. Ann Allergy Asthma Immunol 2017; 117:298-303. [PMID: 27613464 DOI: 10.1016/j.anai.2016.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Consistency in composition and potency, particularly regarding major allergens, is crucial for the quality of extracts for allergen immunotherapy. OBJECTIVE To characterize the major allergen composition of house dust mite (HDM) extracts commercially available in the United States and the SQ HDM sublingual immunotherapy (SLIT) tablet, and to relate the composition to patient sensitization patterns. METHODS Der 1/Der 2 ratios were determined in 10,000- and 30,000-AU/mL HDM extracts from 5 US companies and the SQ HDM SLIT-tablet. Allergen content was analyzed by enzyme-linked immunosorbent assay and compared with an in-house reference. Sensitivity toward Der p 1, Der p 2, and Der p 10 was determined in serum from randomly selected subgroups of 220 individuals from North American and European SQ HDM SLIT-tablet trials. RESULTS Mean Der 1/Der 2 ratios in US HDM extracts ranged from 0.4 to 20.5. For the SQ HDM SLIT-tablet (20 batches), variability did not exceed 12% regarding content of Der f 1 (SD, 11.9%; 95% confidence interval [CI], 0.94-1.06), Der p 1 (SD, 6.1%; 95% CI, 0.97-1.03), and combined Der 2 allergen (SD, 6.4%; 95% CI, 0.97-1.03), indicating a consistent Der 1/Der 2 ratio. High allergen sensitivity frequencies toward Der p 1 and Der p 2 were observed regardless of geographic region. Efficacy of the SQ HDM SLIT-tablet has been demonstrated in 5 clinical trials. CONCLUSION The SQ HDM SLIT-tablet has efficacy potential for a broad range of patients because it includes a consistent 1:1 ratio of the 2 major HDM allergens to which individuals were most frequently sensitized across geographic regions. Efficacy has been demonstrated.
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Mortuaire G, Michel J, Papon JF, Malard O, Ebbo D, Crampette L, Jankowski R, Coste A, Serrano E. Specific immunotherapy in allergic rhinitis. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:253-258. [PMID: 28684084 DOI: 10.1016/j.anorl.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Allergic rhinitis is a common condition, with significant impact on quality of life depending on severity and quality of control. Allergen-specific immunotherapy (allergen-SIT) is the only known treatment able to alter the natural course of allergic rhinitis. Although well known to allergologists, it has yet to be fully adopted by the ENT community. This review, based on the most recent meta-analyses and clinical studies, shows that SIT significantly reduces symptoms and medication requirements (nasal corticosteroids, H1-antihistamines) in allergic rhinitis. It can reduce the risk of progression to asthma and, if initiated early enough, of developing new sensitizations. Immunobiological analysis shows an altered inflammatory profile following SIT, with immune tolerance involving T-regulatory lymphocyte induction and IgG production. Sublingual SIT with drops is as effective as subcutaneous SIT and is simpler to use, with less anaphylactic risk. Standardization of trial protocols in terms of treatment response assessment and side effect grading is recommended to improve comparative studies. Sublingual SIT with tablets has recently been introduced, providing a good opportunity for ENT practitioners to adopt the SIT approach in rhinitis triggered by allergy to pollens and, in the near future, to house dust mites.
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Affiliation(s)
- G Mortuaire
- Inserm U995, service d'ORL et de chirurgie cervicofaciale, Lille Inflammation Research International Center, université de Lille, hôpital Huriez, CHU de Lille, 59000 Lille, France.
| | - J Michel
- Service d'ORL et de chirurgie cervicofaciale, CHU Hôpital La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - J F Papon
- Service d'ORL et de chirurgie cervicofaciale, Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - O Malard
- Service d'ORL et de chirurgie cervicofaciale, CHU de Nantes, 44000 Nantes, France
| | - D Ebbo
- Groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - L Crampette
- Service d'ORL et de chirurgie cervicofaciale, CHU de Montpellier, 34090 Montpellier, France
| | - R Jankowski
- Service d'ORL et de chirurgie cervicofaciale, CHU Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - A Coste
- Service d'ORL et de chirurgie cervicofaciale, CHU de Créteil, 94000 Créteil, France
| | - E Serrano
- Service d'ORL et de chirurgie cervicofaciale, CHU de Toulouse, 31059 Toulouse, France
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Gutiérrez-Cardona N, Sands P, Roberts G, Lucas JS, Walker W, Salib R, Burgess A, Ismail-Koch H. The acceptability and tolerability of nasal douching in children with allergic rhinitis: A systematic review. Int J Pediatr Otorhinolaryngol 2017; 98:126-135. [PMID: 28583489 DOI: 10.1016/j.ijporl.2017.04.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is a significant issue in children. Treatment options include allergen avoidance, pharmacotherapy and immunotherapy. The use of nasal saline douching (NSD) in children has recently gained acceptability. However, there is limited data regarding the acceptability and tolerability of NSD in children with AR. METHODS A search was conducted using Medline and Embase databases from January 1946 until June 2015 on the use of NSD in children aged 4-12 years with AR. All publications identified that assessed the beneficial effects, acceptability and tolerability were included. RESULTS 40 studies were analyzed. Data varied considerably in terms of saline solutions used, modality of application, participant numbers, study design, follow up and outcomes. Factors that appear to influence the acceptability and tolerability of NSD include parental and health professionals' preconceptions, and characteristics of the solution. CONCLUSIONS Nasal saline douching appears to be effective, being accepted and tolerated in the majority of children (78-100%). NSD has a significant positive impact on the quality of life in children with allergic rhinitis. When used as an adjunctive treatment having mainly a cleansing property, NSD potentiates the effects and may reduce the dose required of AR medications. Among the principal factors that influence the acceptability and tolerability of NSD are the child's age, delivery system and method, and tonicity. Nasal saline douching provides an accessible, low cost, low morbidity, easy to use treatment in children with allergic rhinitis.
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Affiliation(s)
- Nelson Gutiérrez-Cardona
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO171BJ, United Kingdom.
| | - Paula Sands
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Graham Roberts
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Jane S Lucas
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Woolf Walker
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Rami Salib
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO171BJ, United Kingdom; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Andrea Burgess
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Hasnaa Ismail-Koch
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO171BJ, United Kingdom; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
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Hoffmann HJ, Valovirta E, Pfaar O, Moingeon P, Schmid JM, Skaarup SH, Cardell LO, Simonsen K, Larché M, Durham SR, Sørensen P. Novel approaches and perspectives in allergen immunotherapy. Allergy 2017; 72:1022-1034. [PMID: 28122129 DOI: 10.1111/all.13135] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 01/01/2023]
Abstract
In this review, we report on relevant current topics in allergen immunotherapy (AIT) which were broadly discussed during the first Aarhus Immunotherapy Symposium (Aarhus, Denmark) in December 2015 by leading clinicians, scientists and industry representatives in the field. The aim of this symposium was to highlight AIT-related aspects of public health, clinical efficacy evaluation, mechanisms, development of new biomarkers and an overview of novel therapeutic approaches. Allergy is a public health issue of high socioeconomic relevance, and development of evidence-based action plans to address allergy as a public health issue ought to be on national and regional agendas. The underlying mechanisms are in the focus of current research that lays the ground for innovative therapies. Standardization and harmonization of clinical endpoints in AIT trials as well as current knowledge about potential biomarkers have substantiated proof of effectiveness of this disease-modifying therapeutic option. Novel treatments such as peptide immunotherapy, intralymphatic immunotherapy and use of recombinant allergens herald a new age in which AIT may address treatment of allergy as a public health issue by reaching a large fraction of patients.
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Affiliation(s)
- H. J. Hoffmann
- Department of Clinical Medicine; HEALTH; Aarhus University; Aarhus Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - E. Valovirta
- Department of Lung Diseases and Clinical Immunology; University of Turku; Turku Finland
- Filha; Finnish Lung Health Association; Helsinki Finland
- Terveystalo Allergy Clinic Turku; Finland
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery; Medical Faculty Mannheim; Universitätsmedizin Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - P. Moingeon
- Research and Development; StallergenesGreer; Antony Cedex France
| | - J. M. Schmid
- Department of Clinical Medicine; HEALTH; Aarhus University; Aarhus Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - S. H. Skaarup
- Department of Clinical Medicine; HEALTH; Aarhus University; Aarhus Denmark
- Department of Respiratory Diseases and Allergy; Aarhus University Hospital; Aarhus Denmark
| | - L.-O. Cardell
- Division of ENT Diseases; Department of Clinical Sciences, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of ENT Diseases; Karolinska University Hospital; Stockholm Sweden
| | - K. Simonsen
- Anergis SA; BioPole III; Epalinges Switzerland
| | - M. Larché
- Clinical Immunology & Allergy and Respirology Divisions; Department of Medicine; McMaster University; Hamilton ON Canada
- Firestone Institute for Respiratory Health; McMaster University; Hamilton ON Canada
| | - S. R. Durham
- Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College London; London UK
| | - P. Sørensen
- Research and Development; StallergenesGreer; Antony Cedex France
- Department of Biomedicine; HEALTH; Aarhus University & Research; Aarhus Denmark
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Different clinical effect of several types of airborne allergens on the severity of bronchial hyperreactivity. Wien Klin Wochenschr 2017; 129:674-679. [PMID: 28593388 DOI: 10.1007/s00508-017-1220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Atopic sensitization belongs to the most common risk factors for bronchial asthma. However, in clinical practice, it is not clear whether sensitization against pollen and perennial allergens is differently associated with the severity of bronchial hyperresponsiveness (BHR). AIM To find out whether patients sensitized to perennial allergens differ in severity of bronchial hyperresponsiveness from patients sensitized to pollen allergens. METHODS The study includes 109 patients. Based on the results of skin prick tests, patients were divided into three groups: sensitivity to pollen allergens - group A; sensitivity to perennial allergens - group B; sensitivity to both pollen and perennial allergens - group C. Based on the histamine bronchoprovocation test, we compared the values of histamine provocative concentration causing a 20% drop in FEV1 (PC20) among particular groups of patients. Mild bronchial hyperresponsiveness was determined if the value of PC20 was >4 mg/ml, while if the value of PC20 was <4 mg/ml, the bronchial hyperresponsiveness was considered as moderate/severe. RESULTS A statistically significant difference was found in the degrees of bronchial hyperresponsiveness between the three groups of patients, namely, group A with the patients sensitized only to the pollen allergens, group B comprising patients sensitized to the perennial allergens only, and group C, involving patients sensitized to the combination of both pollen and perennial allergens. The PC20 values were higher among the patients from the group A (7.46 mg/ml) compared to group B (4.25 mg/ml) and C (4.52 mg/ml). The odds ratio for moderate/severe BHR was 5.21 and 5.04 in group B and group C, respectively. CONCLUSION Severity of bronchial hyperresponsiveness shows differences according to sensitization to particular allergens. Perennial allergens are more often associated with serious forms of bronchial hyperresponsiveness which also have an impact on the severity and prognosis of bronchial asthma.
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235
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Identification of Proteases and Protease Inhibitors in Allergenic and Non-Allergenic Pollen. Int J Mol Sci 2017; 18:ijms18061199. [PMID: 28587253 PMCID: PMC5486022 DOI: 10.3390/ijms18061199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/24/2017] [Accepted: 06/01/2017] [Indexed: 12/15/2022] Open
Abstract
Pollen is one of the most common causes of allergy worldwide, making the study of their molecular composition crucial for the advancement of allergy research. Despite substantial efforts in this field, it is not yet clear why some plant pollens strongly provoke allergies while others do not. However, proteases and protease inhibitors from allergen sources are known to play an important role in the development of pollen allergies. In this study, we aim to uncover differences in the transcriptional pattern of proteases and protease inhibitors in Betula verrucosa and Pinus sylvestris pollen as models for high and low allergenic potential, respectively. We applied RNA sequencing to Betula verrucosa and Pinus sylvestris pollen. After de-novo assembly we derived general functional profiles of the protein coding transcripts. By utilization of domain based functional annotation we identified potential proteases and protease inhibitors and compared their expression in the two types of pollen. Functional profiles are highly similar between Betula verrucosa and Pinus sylvestris pollen. Both pollen contain proteases and inhibitors from 53 and 7 Pfam families, respectively. Some of the members comprised within those families are implicated in facilitating allergen entry, while others are known allergens themselves. Our work revealed several candidate proteins which, with further investigation, represent exciting new leads in elucidating the process behind allergic sensitization.
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Belhassen M, Demoly P, Bloch-Morot E, de Pouvourville G, Ginoux M, Chartier A, Laforest L, Serup-Hansen N, Toussi M, Van Ganse E. Costs of perennial allergic rhinitis and allergic asthma increase with severity and poor disease control. Allergy 2017; 72:948-958. [PMID: 27886386 DOI: 10.1111/all.13098] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perennial allergic rhinitis (PAR) represents a global and public health problem, due to its prevalence, morbidity, and impact on the quality of life. PAR is frequently associated with allergic asthma (AA). Costs of PAR with or without AA are poorly documented. OBJECTIVE Our study aimed to detail medical resource utilization (MRU) and related direct cost for PAR, with or without concomitant AA, in France. METHODS Using Electronic Health Records (EHRs), we identified in 2010 two cohorts of PAR patients, based on General Practitioners' diagnoses and prescribing data, with and without concomitant AA. For each patient, the EHRs were linked to corresponding claims data with MRU and costs during years 2011 to 2013. Predefined subgroup analyses were performed according to severity of PAR and level of AA control. RESULTS The median annual cost reimbursed by social security system for a patient with PAR, and no AA was 159€ in 2013. This varied from 111€ to 188€ depending on PAR severity. For patients with PAR and concomitant AA, the median annual cost varied between 266€ and 375€, and drug treatment accounted for 42-55% of the costs, depending on asthma control. CONCLUSION This study linking diagnoses from EHRs to claims data collected valid information on PAR management, with or without concomitant AA, and on related costs. There was a clear increase in costs with severity of PAR and control of AA.
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Affiliation(s)
- M. Belhassen
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
| | - P. Demoly
- Department of Pulmonology; Division of Allergy; Arnaud de Villeneuve Hospital; University Hospital of Montpellier; Montpellier France
- Sorbonne University; UPMC Paris 06; UMR-S 1136 INSERM; IPLESP; EPAR; Paris France
| | - E. Bloch-Morot
- French Association for Continual Medical Education of Allergists (ANAFORCAL); Reims France
| | | | - M. Ginoux
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
| | | | - L. Laforest
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
| | | | | | - E. Van Ganse
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
- Respiratory Medicine; Croix Rousse University Hospital; Lyon France
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238
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Colás C, Brosa M, Antón E, Montoro J, Navarro A, Dordal MT, Dávila I, Fernández-Parra B, Ibáñez MDP, Lluch-Bernal M, Matheu V, Rondón C, Sánchez MC, Valero A. Estimate of the total costs of allergic rhinitis in specialized care based on real-world data: the FERIN Study. Allergy 2017; 72:959-966. [PMID: 27886391 DOI: 10.1111/all.13099] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the socioeconomic importance of allergic rhinitis (AR), very few prospective studies have been performed under conditions of clinical practice and with a sufficiently long observation period outside the clinical trial scenario. We prospectively estimated the direct and indirect costs of AR in patients attending specialized clinics in Spain. METHODS Patients were recruited at random from allergy outpatient clinics in 101 health centers throughout Spain over 12 months. We performed a multicenter, observational, prospective study under conditions of clinical practice. We analyzed direct costs from a funder perspective (healthcare costs) and from a societal perspective (healthcare and non-healthcare costs). Indirect costs (absenteeism and presenteeism [productivity lost in the workplace]) were also calculated. The cost of treating conjunctivitis was evaluated alongside that of AR. RESULTS The total mean cost of AR per patient-year (n = 498) was €2326.70 (direct, €553.80; indirect, €1772.90). Direct costs were significantly higher in women (€600.34 vs €484.46, P = 0.02). Total costs for intermittent AR were significantly lower than for persistent AR (€1484.98 vs €2655.86, P < 0.001). Total indirect costs reached €1772.90 (presenteeism, €1682.71; absenteeism, €90.19). The direct costs of AR in patients with intermittent asthma (€507.35) were lower than in patients with mild-persistent asthma (€719.07) and moderate-persistent asthma (€798.71) (P = 0.006). CONCLUSIONS The total cost of AR for society is considerable. Greater frequency of symptoms and more severe AR are associated with higher costs. Indirect costs are almost threefold direct costs, especially in presenteeism. A reduction in presenteeism would generate considerable savings for society.
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Affiliation(s)
- C. Colás
- Department of Allergology; Hospital Clínico-Instituto de Investigación Sanitaria de Aragón; Zaragoza Spain
| | - M. Brosa
- Oblikue Consulting; Barcelona Spain
| | - E. Antón
- Department of Allergology; University Hospital Marqués de Valdecilla; Santander Spain
| | - J. Montoro
- Allergy Unit; Hospital Universitario Arnau de Vilanova; Facultad de Medicina; Universidad Católica de Valencia “San Vicente Mártir”; Valencia Spain
| | - A. Navarro
- UGC Intercentros Alergología de Sevilla; Hospital El Tomillar; Sevilla Spain
| | - M. T. Dordal
- Department of Allergology; Hospital Municipal; Badalona Serveis Assistencials; Badalona Spain
- Sant Pere Claver Fundació Sanitària; Barcelona Spain
| | - I. Dávila
- Department of Allergology; University Hospital of Salamanca; Instituto de Investigaciones Biosanitarias de Salamanca; IBSAL; Salamanca Spain
| | | | - M. D. P. Ibáñez
- Department of Allergology; Hospital Infantil Universitario Niño Jesús; IIS Princesa; Madrid Spain
| | | | - V. Matheu
- Department of Allergology; Hospital Universitario de Canarias; Tenerife Spain
| | - C. Rondón
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. C. Sánchez
- UGC Neumología-Alergia; Complejo Hospitalario Universitario de Huelva; Spain
| | - A. Valero
- Allergy Unit; Servei de Pneumologia i Al.lèrgia Respiratòria; Hospital Clínic; Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona; Spain
- Centro de Investigación Biomédica en red en Enfermedades Respiratorias (CIBERES); Barcelona Spain
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Bousquet J, Caimmi DP, Bedbrook A, Bewick M, Hellings PW, Devillier P, Arnavielhe S, Bachert C, Bergmann KC, Canonica GW, Chavannes N, Cruz AA, Dahl R, Demoly P, De Vries G, Mathieu-Dupas E, Finkwagner A, Fonseca J, Guldemond N, Haahtela T, Hellqvist-Dahl B, Just J, Keil T, Klimek L, Kowalski ML, Kuitunen M, Kuna P, Kvedariene V, Laune D, Pereira AM, Carreiro-Martins P, Melén E, Morais-Almeida M, Mullol J, Muraro A, Murray R, Nogueira-Silva L, Papadopoulos NG, Passalacqua G, Portejoie F, Price D, Ryan D, Samolinski B, Sheikh A, Siroux V, Spranger O, Todo Bom A, Tomazic PV, Valero A, Valovirta E, Valiulis A, VandenPlas O, van der Meulen S, van Eerd M, Wickman M, Zuberbier T. Pilot study of mobile phone technology in allergic rhinitis in European countries: the MASK-rhinitis study. Allergy 2017; 72:857-865. [PMID: 28072463 DOI: 10.1111/all.13125] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The use of Apps running on smartphones and tablets profoundly affects medicine. The MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) App (Allergy Diary) assesses allergic rhinitis symptoms, disease control and impact on patients' lives. It is freely available in 20 countries (iOS and Android platforms). AIMS To assess in a pilot study whether (i) Allergy Diary users were able to properly provide baseline characteristics (ii) simple phenotypic characteristics based upon data captured by the Allergy Diary could be identified and (iii) information gathered by this study could suggest novel research questions. METHODS The Allergy Diary users were classified into six groups according to the baseline data that they entered into the App: (i) asymptomatic; (ii) nasal symptoms excluding rhinorrhea; (iii) rhinorrhea; (iv) rhinorrhea plus 1-2 nasal/ocular symptoms; (v) rhinorrhea plus ≥3 nasal/ocular symptoms; and (vi) rhinorrhea plus all nasal/ocular symptoms. RESULTS By 1 June 2016, 3260 users had registered with the Allergy Diary and 2710 had completed the baseline questionnaire. Troublesome symptoms were found mainly in the users with the most symptoms. Around 50% of users with troublesome rhinitis and/or ocular symptoms suffered work impairment. Sleep was impaired by troublesome symptoms and nasal obstruction. CONCLUSIONS This is the first App (iOS and Android) to have tested for allergic rhinitis and conjunctivitis. A simple questionnaire administered by cell phones enables the identification of phenotypic differences between a priori defined rhinitis groups. The results suggest novel concepts and research questions in allergic rhinitis that may not be identified using classical methods.
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Affiliation(s)
- J. Bousquet
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Montpellier France
- INSERM; VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches; U1168 Paris, and UVSQ, UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Yvelines France
| | - D. P. Caimmi
- CHRU de Montpellier; UPMC Paris 06, UMR-S 1136; IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
- Department of Respiratory Diseases; Montpellier University Hospital; Montpellier France
| | - A. Bedbrook
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Montpellier France
| | | | - P. W. Hellings
- Department of Microbiology and Immunology; Laboratory of Clinical Immunology; KU Leuven; Leuven Belgium
| | - P. Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220; Pôle des Maladies Respiratoires; Hôpital Foch; Suresnes Université Versailles Saint-Quentin; Versailles France
| | | | - C. Bachert
- ENT Department; Upper Airways Research Laboratory; Ghent University Hospital; Ghent Belgium
| | - K. C. Bergmann
- Department of Dermatology and Allergy; Comprehensive Allergy-Centre-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Global Allergy and Asthma European Network (GA LEN); Berlin Germany
| | - G. W. Canonica
- Allergy and Respiratory Diseases Clinic; DIMI; University of Genoa; IRCCS AOU San Martino-IST; Genoa Italy
| | - N.H. Chavannes
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden The Netherlands
| | - A. A. Cruz
- ProAR - Nucleo de Excelencia em Asma; Federal University of Bahia; Salvador Brasil
- GARD Executive Committee; Geneva Switzerland
| | - R. Dahl
- ProAR - Nucleo de Excelencia em Asma; Federal University of Bahia; Salvador Brasil
- GARD Executive Committee; Geneva Switzerland
| | - P. Demoly
- CHRU de Montpellier; UPMC Paris 06, UMR-S 1136; IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
- Department of Respiratory Diseases; Montpellier University Hospital; Montpellier France
| | | | | | - A. Finkwagner
- Global Allergy and Asthma Platform GAAPP; Vienna Austria
| | - J. Fonseca
- Center for Health Technology and Services Research - CINTESIS; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
| | - N. Guldemond
- Institute of Health Policy and Management iBMG - Erasmus Universit; Rotterdam The Netherlands
| | - T. Haahtela
- Skin and Allergy Hospital; Helsinki University Hospital; Helsinki Finland
| | - B. Hellqvist-Dahl
- Department of Respiratory Diseases; Odense University Hospital; Odense Denmark
| | - J. Just
- Allergology Department; Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand-Trousseau (APHP); UPMC Univ Paris 06; UMR_S 1136; Institut Pierre Louis d'Epidémiologie et de Santé Publique; Equipe EPAR; Sorbonne Universités; Paris France
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité -Universitätsmedizin Berlin; Berlin Germany
- Institute for Clinical Epidemiology and Biometry; University of Wuerzburg; Wuerzburg Germany
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Healthy Ageing Reseach Centre (HARC); Medical University of Lodz; Lodz Poland
| | - M. Kuitunen
- Children's Hospital; University of Helsinki and University Hospital of Helsinki; Helsinki Finland
| | - P. Kuna
- Division of Internal Medicine, Asthma and Allergy; Barlicki University Hospital; Medical University of Lodz; Lodz Poland
| | - V. Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology; Vilnius University; Vilnius Lithuania
| | | | - A. M. Pereira
- Center for Health Technology and Services Research - CINTESIS; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
| | - P. Carreiro-Martins
- CEDOC; Respiratory Research Group; Nova Medical School; Campo dos Martires da Patria; Lisbon Portugal
- Serviço de Imunoalergologia; Hospital de Dona Estefânia; Centro Hospitalar de Lisboa Central, EPE; Lisbon Portugal
| | - E. Melén
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - M. Morais-Almeida
- Allergy and Clinical Immunology Department; Hospital CUF-Descobertas; Lisboa Portugal
| | - J. Mullol
- ENT Department; Hospital Clinic; Clinical & Experimental Respiratory Immunoallergy; IDIBAPS; CIBERES; Universitat de Barcelona; Barcelona Catalonia Spain
| | - A. Muraro
- Department of Women and Child Health; Food Allergy Referral Centre Veneto Region; Padua General University Hospital; Padua Italy
| | - R. Murray
- Medical Communications Consultant; MedScript Ltd; Dundalk Co Louth Ireland
| | - L. Nogueira-Silva
- Center for Health Technology and Services Research - CINTESIS; Porto Portugal
- Department of Internal Medicine; Centro Hospitalar Sao Joao; Porto Portugal
| | - N. G. Papadopoulos
- Center for Pediatrics and Child Health; Institute of Human Development; Royal Manchester Children's Hospital; University of Manchester; Manchester UK
- Allergy Department; 2nd Pediatric Clinic; Athens General Children's Hospital “P&A Kyriakou”; University of Athens; Athens Greece
| | - G. Passalacqua
- Allergy and Respiratory Diseases Clinic; DIMI; University of Genoa; IRCCS AOU San Martino-IST; Genoa Italy
| | - F. Portejoie
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Montpellier France
| | - D. Price
- Observational and Pragmatic Research Institute; Singapore and Academic Centre of Primary Care; University of Aberdeen; Aberdeen UK
| | - D. Ryan
- Honorary Clinical Research Fellow; Allergy and Respiratory Research Group; The University of Edinburgh; Edinburgh UK
| | - B. Samolinski
- Department of Prevention of Environmental Hazards and Allergology; Medical University of Warsaw; Warsaw Poland
| | - A. Sheikh
- Centre of Medical Informatics; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
| | - V. Siroux
- INSERM; Université Grenoble Alpes; IAB, U 1209; Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health; Université Joseph Fourier; Grenoble France
| | - O. Spranger
- Global Allergy and Asthma Platform GAAPP; Vienna Austria
| | - A. Todo Bom
- Imunoalergologia; Centro Hospitalar Universitario de Coimbra and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - P. V. Tomazic
- Medical University of Graz; ENT University Hospital Graz; Graz Austria
| | - A. Valero
- Pneumology and Allergy Department; CIBERES and Clinical & Experimental Respiratory Immunoallergy; IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - E. Valovirta
- Department of Lung Diseases and Clinical Allergology; University of Turku; Turku Finland
- Department of Allergy Clinic; Terveystalo; Turku Finland
| | - A. Valiulis
- Vilnius University Clinic of Children's Diseases and Public Health Institute; Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS-SP); Brussels Belgium
| | - O. VandenPlas
- Department of Chest Medicine; Centre Hospitalier Universitaire UCL Namur; Université Catholique de Louvain; Yvoir Belgium
| | - S. van der Meulen
- Attorney at law; Axon Lawyers; the Netherlands. Role: provision of legal services
| | | | - M. Wickman
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - T. Zuberbier
- Department of Dermatology and Allergy; Comprehensive Allergy-Centre-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Global Allergy and Asthma European Network (GA LEN); Berlin Germany
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Effects of CPAP in patients with obstructive apnoea: is the presence of allergic rhinitis relevant? Sleep Breath 2017; 21:893-900. [DOI: 10.1007/s11325-017-1510-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 11/24/2022]
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241
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Feng B, Jin H, Xiang H, Li B, Zheng X, Chen R, Shi Y, Chen S, Chen B. Association of Pediatric Allergic Rhinitis with the Ratings of Attention-Deficit/Hyperactivity Disorder. Am J Rhinol Allergy 2017; 31:161-167. [PMID: 28490400 DOI: 10.2500/ajra.2017.31.4439] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Allergic rhinitis (AR) is currently the most prevalent allergic disease in children and adolescents. Objective Surveys conducted by population-based studies of East Asia revealed an increased prevalence of behavioral disorders in patients with AR. Thus, in this study, we explored the prevalence of attention-deficit/hyperactivity disorder (ADHD) in pediatric patients with AR. Methods A total of 333 children (6–12 years of age) with AR and a total of 322 age-matched controls were included in this study. An otorhinolaryngologist diagnosed all AR cases and evaluated the severity of the disease. Skin-prick test results for 18 major allergens, Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), Child Behavior Checklist (CBCL), and Swanson, Nolan, and Pelham version IV (SNAP-IV) scores were recorded. Results In total, 320 age-matched controls and 323 children with AR completed the study. With respect to the Total Nasal Symptom Score and the PRQLQ, the condition of the experimental group was more serious than that of the controls. The scores on the hyperactivity/impulsivity and inattention subscales, which evaluate ADHD symptoms, and those on the CBCL subscales were significantly higher in patients with AR than in the controls (all p values were <0.01). From the results of the Pearson correlation, we deduced that there were significant positive correlations between the AR-related data and each subscale of the CBCL and SNAP-IV in the AR group. Moreover, two basic characteristics (males and environmental exposure to tobacco smoke) present significant positive and age showed a significant negative correlations affect ADHD symptom in both the AR group and the control group. Also, in the “pure AR” group, hierarchical regression analyses were performed to determine the subtests of the PRQLQ, which are significant predictors of SNAP-IV and CBCL. Conclusions Apart from AR per se, the possible comorbidities of impulsivity and inattention are important when managing children with AR. It is essential to evaluate the symptoms of ADHD in children and adolescents with AR.
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Affiliation(s)
- Bohai Feng
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Haiyong Jin
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Haijie Xiang
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Bangliang Li
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Xiuxiu Zheng
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Ruru Chen
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Yunbin Shi
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Si Chen
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
| | - Bobei Chen
- From the Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China This study was supported by the National Key Clinical Opening Program on Pediatric Respiratory of China (523302)
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242
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Arnedo-Pena A, Romeu-Gracia MA, Bellido-Blasco JB, Meseguer-Ferrer N, Silvestre-Silvestre E, Conde F, Fernández-González S, Dubon MA, Ortuño-Forcada M, Fabregat-Puerto J, Fenollosa-Amposta C, Segura-Navas L, Pac-Sa MR, Museros-Recatala L, Vizcaino A, Tosca-Segura R. Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain). Allergol Immunopathol (Madr) 2017; 45:251-257. [PMID: 27863816 DOI: 10.1016/j.aller.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.
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Affiliation(s)
- A Arnedo-Pena
- Epidemiologic Division, Public Health Center, Castellon, Spain(1); CIBER: Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | | | - J B Bellido-Blasco
- Epidemiologic Division, Public Health Center, Castellon, Spain(1); CIBER: Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | | | | | - F Conde
- Public Health Center, Castellon, Spain
| | | | | | | | | | | | | | - Mª R Pac-Sa
- International Health, Sanidad Exterior, Castellon, Spain
| | | | - A Vizcaino
- Epidemiologic Division, Public Health Center, Castellon, Spain(1)
| | - R Tosca-Segura
- Service of Pediatrics, Hospital General, Castellon, Spain
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Scadding G, Price D, El-Shanawany T, Ahmed S, Ray J, Sargur R, Kumar N. Multicentre, non-interventional study to assess the profile of patients with uncontrolled rhinitis prescribed a novel formulation of azelastine hydrochloride and fluticasone propionate in a single spray in routine clinical practice in the UK. BMJ Open 2017; 7:e014777. [PMID: 28442578 PMCID: PMC5775468 DOI: 10.1136/bmjopen-2016-014777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aims of this study were (1) to characterise the type of patient prescribed MP-AzeFlu (Dymista, a novel formulation of azelastine hydrochloride, fluticasone propionate and excipients in a single spray) in real life in the UK and physicians' reasons for prescribing it and (2) to quantify the personal and societal burden of allergic rhinitis (AR) in the UK prior to MP-AzeFlu prescription. DESIGN, SETTING AND PARTICIPANTS This multicentre, non-interventional study enrolled patients (n=193) with moderate-to-severe AR and acute symptoms who were eligible to receive treatment with MP-AzeFlu according to its licensed indications. Information was gathered on patient demographics, AR history and symptom severity, symptomatology and AR treatments in the previous calendar year (prior to MP-AzeFlu prescription). Physicians also recorded the number of previous AR visits, specific reasons for these visits and their reason for prescribing MP-AzeFlu. RESULTS Most patients had seasonal AR either alone (10.4%) or in combination with perennial AR (35.2%), but many had AR of unknown origin (35.8%). Prior to MP-AzeFlu prescription, patients reported troublesome symptoms (78.2%) and sleep disturbance (64.8%), with congestion considered the most bothersome (54.4%) and ocular symptoms reported by 68.4% of patients. The most frequent reason for MP-AzeFlu prescription was that other therapies were not sufficient in the past (78.8%) or not sufficient to treat acute symptoms (16.1%). 79.3% of patients reported using ≥2 AR therapies in the past year. An average of 1.6 (SD 1.9) doctor visits due to AR were reported prior to MP-AzeFlu prescription. CONCLUSIONS In the UK, MP-AzeFlu was prescribed for individuals (≥12 years) with moderate/severe AR irrespective of (1) previous AR treatment (mono or multiple), (2) previous or likely treatment failure, (3) phenotype, (4) number of previous physician visits for AR and (5) for the relief of both acute symptoms and in anticipation of allergen exposure.
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Affiliation(s)
| | - David Price
- University of Aberdeen, Aberdeen, Scotland
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
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Tian HQ, Cheng L. The role of vitamin D in allergic rhinitis. Asia Pac Allergy 2017; 7:65-73. [PMID: 28487837 PMCID: PMC5410413 DOI: 10.5415/apallergy.2017.7.2.65] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/06/2017] [Indexed: 12/23/2022] Open
Abstract
Recent studies suggest that vitamin D is related to allergic rhinitis (AR). In this review, we first discuss the physiology and metabolism of vitamin D, then we review the function of vitamin D in the immune system, and above all, we highlight the current research regarding the role of vitamin D in AR. Finally, we find that there are both experimental and clinical studies showing that vitamin D is associated with AR, although the results are not consistent and even conflicting. Evidences from those clinical studies show a slightly tendency that serum vitamin D level might be inversely associated with the risk of AR. Meanwhile, it seems that gender and age may influence the relationship between vitamin D and AR. However, because of the heterogeneity in defining AR, differences in study design and so on, all these findings need to be confirmed by further studies. Additional clinical studies as well as experimental research are needed to better understand how vitamin D influences AR.
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Affiliation(s)
- Hui-Qin Tian
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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Marchetti P, Pesce G, Villani S, Antonicelli L, Ariano R, Attena F, Bono R, Bellisario V, Fois A, Gibelli N, Nicolis M, Olivieri M, Pirina P, Scopano E, Siniscalco C, Verlato G, Marcon A. Pollen concentrations and prevalence of asthma and allergic rhinitis in Italy: Evidence from the GEIRD study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 584-585:1093-1099. [PMID: 28169023 DOI: 10.1016/j.scitotenv.2017.01.168] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/13/2017] [Accepted: 01/25/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Pollen exposure has acute adverse effects on sensitized individuals. Information on the prevalence of respiratory diseases in areas with different pollen concentrations is scanty. AIM We performed an ecologic analysis to assess whether the prevalence of allergic rhinitis and asthma in young adults varied across areas with different pollen concentrations in Italy. METHODS A questionnaire on respiratory diseases was delivered to random samples of 20-44year-old subjects from six centers in 2005-2010. Data on the daily air concentrations of 7 major allergologic pollens (Poaceae, Urticaceae, Oleaceae, Cupressaceae, Coryloideae, Betula and Ambrosia) were collected for 2007-2008. Center-specific pollen exposure indicators were calculated, including the average number of days per year with pollens above the low or high concentration thresholds defined by the Italian Association of Aerobiology. Associations between pollen exposure and disease prevalence, adjusted for potential confounders, were estimated using logistic regression models with center as a random-intercept. RESULTS Overall, 8834 subjects (56.8%) filled in the questionnaire. Allergic rhinitis was significantly less frequent in the centers with longer periods with high concentrations of at least one (OR per 10days=0.989, 95%CI: 0.979-0.999) or at least two pollens (OR=0.974, 95%CI: 0.951-0.998); associations with the number of days with at least one (OR=0.988, 95%CI: 0.972-1.004) or at least two (OR=0.985, 95%CI: 0.970-1.001) pollens above the low thresholds were borderline significant. Asthma prevalence was not associated with pollen concentrations. CONCLUSIONS Our study does not support that the prevalence of allergic rhinitis and asthma is greater in centers with higher pollen concentrations. It is not clear whether the observed ecologic associations hold at the individual level.
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Affiliation(s)
- Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Giancarlo Pesce
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Leonardo Antonicelli
- Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Renato Ariano
- Allergologia, Azienda Sanitaria Locale 1, Imperiese, (IM), Italy
| | - Francesco Attena
- Department of Experimental Medicine, II University of Naples, Naples, Italy
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Valeria Bellisario
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Alessandro Fois
- Unit of Lung Disease, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Nadia Gibelli
- U.O.C. di Medicina del Lavoro, Sezione di Allergologia, Fondazione Salvatore Maugeri, Pavia, Italy
| | - Morena Nicolis
- Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Pietro Pirina
- Unit of Lung Disease, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Eugenio Scopano
- Air pollution Unit, Agenzia Regionale per la Protezione Ambientale Campania (ARPAC), Caserta, Italy
| | - Consolata Siniscalco
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Kim HK, Kook JH, Kang KR, Oh DJ, Kim TH, Lee SH. Increased expression of the aryl hydrocarbon receptor in allergic nasal mucosa, contributing to chemokine secretion in nasal epithelium. Am J Rhinol Allergy 2017; 30:107-12. [PMID: 27456584 DOI: 10.2500/ajra.2016.30.4311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pollutants produced by industrial and traffic-related activities have been linked to allergic responses. These noxious agents induce their effects through the aryl hydrocarbon receptor (AhR). OBJECTIVE We analyzed the expression and distribution pattern of AhR in normal and allergic nasal mucosa, and cytokine-driven regulation of its expression. The production levels of chemokine in cultured nasal epithelial cells were evaluated after stimulation with AhR ligand. METHODS The expression levels and distribution pattern of AhR in normal, mild, and moderate-severe persistent allergic nasal mucosa were assessed by using real-time polymerase chain reaction, Western blot, and immunohistochemistry. The expression levels of AhR were determined in cultured nasal epithelial cells treated with T-helper 2 cytokines. In cultured epithelial cells stimulated with 2-(10H-indole-30-carbonyl)-thiazole-4-carboxylic acid methyl ester, the expression levels of granulocyte macrophage colony-stimulating factor, thymus and activation regulated chemokine, macrophage inflammatory protein 1 α, monocyte chemotactic protein 1, regulated on activation normal T-cell expressed and secreted, eotaxin, and interleukin 8 were measured with real-time polymerase chain reaction and enzyme-linked immunosorbent assay. RESULTS Expression of AhR was observed in normal and allergic nasal mucosa where it is distributed in the epithelial layer, submucosal glands, endothelial cells, and inflammatory cells. Its expression levels are increased in allergic nasal mucosa and upregulated after stimulation with T-helper 2 cytokines. The stimulation with 2-(10H-indole-30-carbonyl)-thiazole-4-carboxylic acid methyl ester resulted in increased production of chemokines in cultured epithelial cells. CONCLUSION Analysis of the study results indicated that increased expression levels of AhR may play a role in the pathogenesis of allergic rhinitis, which contributes to chemokine production in nasal mucosa.
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Affiliation(s)
- Ha Kyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
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Juel-Berg N, Darling P, Bolvig J, Foss-Skiftesvik MH, Halken S, Winther L, Hansen KS, Askjaer N, Heegaard S, Madsen AR, Opstrup MS. Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy 2017; 31:19-28. [PMID: 28234147 DOI: 10.2500/ajra.2016.30.4397] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intranasal corticosteroids (INS) (corticosteroid nasal sprays) and oral antihistamines (OA) are two of the most common treatments for patients with allergic rhinitis (AR). To our knowledge, there are no systematic reviews on this topic including trials published after 2007. OBJECTIVE To compare INS with nonsedating OAs as treatments for AR. METHODS The systematic review and meta-analysis were based on the Grades of Recommendation, Assessment, Development, and Evaluation principles and the Patient, Intervention, Comparison, and Outcome approach. Primary literature was searched up to January 22, 2015. Criteria for eligibility were randomized controlled trials that compared the efficacy and/or adverse effects of INS and OA in patients with AR. Continuous outcome data were analyzed by using standardized mean differences (SMD) for multiple outcome measures, and mean differences in the case of a single study or outcome. Pooled estimates of effects, 95% confidence interval (CI), were calculated by using random-effects models. RESULTS The meta-analysis included five randomized controlled trials with a total of 990 patients. INS were superior to OAs in improving total nasal symptoms score (SMD -0.70 [95% CI, -0.93 to -0.47]) and in relieving the following: nasal obstruction (SMD -0.56 [95% CI, -0.82 to -0.29]), rhinorrhea (SMD -0.47 [95% CI, -1.00 to 0.05]), nasal itching (SMD -0.42 [95% CI, -0.65 to -0.18]), sneezing (SMD -0.52 [95% CI, -0.73 to -0.32]), and quality of life mean difference -0.90 [95% CI, -1.18 to -0.62]). There was no difference in relief of ocular symptoms (SMD -0.08 [95% CI, -0.23 to 0.08]). In addition, four randomized controlled trials were included in a narrative analysis. The results in the narrative analysis were comparable with those found in the meta-analysis. CONCLUSION INS were superior to OAs in improving nasal symptoms and quality of life in patients with AR.
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Affiliation(s)
- Nanna Juel-Berg
- Department of Dermatology and Allergology, Copenhagen University Hospital, Gentofte, Denmark
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Mahler V, Klein C, Sager A, Zimmermann J. House dust mite-specific immunotherapy with two licensed vaccines: Outcome under clinical routine conditions. IMMUNITY INFLAMMATION AND DISEASE 2017; 5:132-140. [PMID: 28474505 PMCID: PMC5418138 DOI: 10.1002/iid3.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION House dust mite (HDM) allergens are major causes for the development of allergic diseases. A disease modifying effect and clinical benefit of allergen immunotherapy (AIT) has been demonstrated in a number of clinical trials. Clinical trials, however, are carried out in selected populations under specific conditions based on inclusion and exclusion criteria and may not represent the entire patient population from medical practice. Objective of this study conducted in patients with HDM allergy was to systematically collect information about the benefit of AIT under clinical routine conditions. METHODS In this prospective, multi-center non-interventional study, 220 patients (117 adults, 103 children) with HDM allergy receiving subcutaneous AIT with Depigoid® were monitored for 2 years. Organ-specific key symptoms, health-related quality of life (QoL), and the use of concomitant anti-allergic medication were assessed at baseline and after 12 and 24 months. Effectiveness and tolerability of the AIT was assessed by physicians and patients. Occurrence of adverse events (AEs) was continuously monitored. RESULTS Two hundred and nineteen patients (116 adults, 103 children) were evaluated. A major improvement of the total symptom-score was observed after 24 (12) months in 76% (72%) and 80% (79%) of adults and children, respectively, accompanied by a reduction in concomitant anti-allergic medication and a pronounced improvement in QoL. The effectiveness and tolerability of the AIT was estimated as very good/good by 80-90% of physicians and patients. AEs were observed in 4/117 adults (3.4%) and in 7/103 children (6.8%). Serious AEs were reported in three adults and one child: A grade-II anaphylactic reaction (one adult) controlled by oral antihistamines (no hospitalization) classified as "definitely," three others as not (2) or possibly (1) drug-related. CONCLUSIONS The data collected from 220 patients confirm the efficacy, tolerability/safety, and acceptance of AIT with Depigoid® in adults and children with HDM allergy under routine clinical conditions.
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Affiliation(s)
- Vera Mahler
- Hautklinik Universitätsklinikum Erlangen, Erlangen, Germany
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Trikojat K, Buske-Kirschbaum A, Plessow F, Schmitt J, Fischer R. Memory and multitasking performance during acute allergic inflammation in seasonal allergic rhinitis. Clin Exp Allergy 2017; 47:479-487. [PMID: 28122395 DOI: 10.1111/cea.12893] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/14/2016] [Accepted: 01/12/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND In previous research, patients with seasonal allergic rhinitis (SAR) showed poorer school and work performance during periods of acute allergic inflammation, supporting the idea of an impact of SAR on cognitive functions. However, the specific cognitive domains particularly vulnerable to inflammatory processes are unclear. OBJECTIVE In this study, the influence of SAR on memory and multitasking performance, as two potentially vulnerable cognitive domains essential in everyday life functioning, was investigated in patients with SAR. METHODS Non-medicated patients with SAR (n = 41) and healthy non-allergic controls (n = 42) performed a dual-task paradigm and a verbal learning and memory test during and out of symptomatic allergy periods (pollen vs. non-pollen season). Disease-related factors (e.g. symptom severity, duration of symptoms, duration of disease) and allergy-related quality of life were evaluated as potential influences of cognitive performance. RESULTS During the symptomatic allergy period, patients showed (1) poorer performance in word list-based learning (P = 0.028) and (2) a general slowing in processing speed (P < 0.001) and a shift in processing strategy (P < 0.001) in multitasking. Yet, typical parameters indicating specific multitasking costs were not affected. A significant negative association was found between learning performance and duration of disease (r = -0.451, P = 0.004), whereas symptom severity (r = 0.326; P = 0.037) and quality of life (r = 0.379; P = 0.015) were positively associated with multitasking strategy. CONCLUSIONS Our findings suggest that SAR has a differentiated and complex impact on cognitive functions, which should be considered in the management of SAR symptoms. They also call attention to the importance of selecting sensitive measures and carefully interpreting cognitive outcomes.
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Affiliation(s)
- K Trikojat
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - A Buske-Kirschbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - F Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - J Schmitt
- Centre for Evidence-Based Health Care, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - R Fischer
- Department of Psychology, University of Greifswald, Greifswald, Germany
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Green W, Kleine-Tebbe J, Klimek L, Hahn-Pedersen J, Nørgaard Andreasen J, Taylor M. Cost-effectiveness of SQ ® HDM SLIT-tablet in addition to pharmacotherapy for the treatment of house dust mite allergic rhinitis in Germany. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:77-84. [PMID: 28243132 PMCID: PMC5317265 DOI: 10.2147/ceor.s115931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Allergic rhinitis is a global health problem that burdens society due to associated health care costs and its impact on health. Standardized quality (SQ®) house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet is a sublingually administered allergy immunotherapy tablet for patients with persistent moderate to severe HDM allergic rhinitis despite use of allergy pharmacotherapy. Objective To assess the cost-effectiveness of SQ HDM SLIT-tablet in Germany for patients suffering from HDM allergic rhinitis. Methods A pharmacoeconomic analysis, based on data collected in a double-blinded, phase III randomized placebo-controlled trial (n=992), was undertaken to compare SQ HDM SLIT-tablet in addition to allergy pharmacotherapy to placebo plus allergy pharmacotherapy. Quality-adjusted life year (QALY) scores and health care resource use data recorded in the trial were applied to each treatment group and extrapolated over a nine-year time horizon. A series of scenarios were used to investigate the impact of changes on long-term patient health for both treatment groups, which was measured by annual changes in QALY scores. Deterministic and probabilistic sensitivity analyses were also performed. Results In the base case analysis, compared with allergy pharmacotherapy, SQ HDM SLIT-tablet led to a QALY gain of 0.31 at an incremental cost of €2,276 over the nine-year time horizon, equating to an incremental cost-effectiveness ratio of €7,519. The treatment was cost-effective for all scenarios analyzed; however, results were sensitive to changes in individual parameter values during the deterministic sensitivity analysis. Conclusion SQ HDM SLIT-tablet in addition to pharmacotherapy is cost-effective compared with allergy pharmacotherapy plus placebo for the treatment of persistent moderate to severe HDM allergic rhinitis that is not well controlled by allergy pharmacotherapy.
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Affiliation(s)
- William Green
- York Health Economics Consortium, University of York, York, UK
| | | | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Matthew Taylor
- York Health Economics Consortium, University of York, York, UK
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