Epidemiology of allergic rhinitis

Histological Characteristics of Chronic Allergic Rhinitis Versus Non-allergy: Is There a Difference in the Remodeling?

Demonstrate the histological remodeling changes in the turbinates, identify the frequency of the two forms of rhinitis in the samples studied and determine the remodeling differences found in the two variants. Patients attended an otolaryngology service at the Social Security Hospital of city Sangolqui-Ecuador from February 2016 to June 2017. The allergic variant was determined when eosinophils were found by higher magnification field and non-allergic when they were not found in the submucosal segment. Epithelial, inflammatory, and stromal markers were analyzed. One hundred twenty histopathological samples were analyzed, 75% presented allergic rhinitis, the age averaged 36.2 years. When we compared between the allergic and non-allergic variants: epithelial and stromal markers we had significant differences, as well as between each of its components; except fibrosis. In relation to the inflammatory pattern, there were significant differences between the number of mast cells and stromal markers with eosinophils > 10 by field. The allergic type corresponded to 75% of patients with persistent severe rhinitis who underwent turbinectomy. Regarding remodeling, there was a statistically significant difference in favor of the allergic variant. Eosinophilia greater than 10 was directly related to mastocytosis and subepithelial edema.

Association between occupational clusters and allergic rhinitis in the Korean population: analysis of the Korean National Health and Nutrition Examination Survey data

OBJECTIVES

This study aimed to investigate the association between occupational clusters and allergic rhinitis (AR).

METHODS

The study was based on data from the Korean National Health and Nutrition Examination Survey (KNHANES: 2007-2015). This study included 46,965 individuals: 20,491 men and 26,474 women. AR was defined as having been diagnosed by a physician. Occupations were classified according to occupational characteristics and skill levels into white (chief executives, senior officials, legislators, managers, professionals, and technicians), pink (clerks, clerical support workers, services and sales workers), blue (craft and related trades workers, drivers, plant and machine operators, assemblers, elementary occupation workers), and green (skilled agricultural, forestry, and fishery workers) categories. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) of AR according to the occupational clusters by using the chi-squared test and logistic regression.

RESULTS

In the study population, 10.7% of the men and 13.5% of the women had AR. The prevalence of AR was highest among white-collar workers, followed by pink, blue, and green-collar workers. Compared to green-collar workers, among men the adjusted ORs of the blue, pink, and white-collar workers were 2.00 (95% CI 1.58-2.53), 2.46 (95% CI 1.91-3.15), and 2.78 (95% CI 2.20-3.51), respectively; and among women were 2.45 (95% CI 1.99-3.02), 2.64 (95% CI 2.15-3.25), and 3.63 (95% CI 2.96-4.47), respectively.

CONCLUSIONS

This study suggests that AR prevalence is significantly associated with occupational clusters.

Concealing Emotions at Work Is Associated with Allergic Rhinitis in Korea

Concealing emotions at work can cause considerable psychological stress. While there is extensive research on the adverse health effects of concealing emotions and the association between allergic diseases and stress, research has not yet investigated whether concealing emotions at work is associated with allergic rhinitis. Allergic rhinitis is a common disease in many industrialized countries, and its prevalence is increasing. Thus, our aim was to determine the strength of this association using data from three years (2007-2009) of the 4th Korean National Health and Nutrition Examination Survey. Participants (aged 20-64) were 8,345 individuals who were economically active and who had completed the questionnaire items on concealing emotions at work. Odds ratio (OR) and 95% confidence intervals (95% CIs) were calculated for allergic rhinitis using logistic regression models. Among all participants, 3,140 subjects (37.6%) reported concealing their emotions at work: 1,661 men and 1,479 women. The OR (95% CIs) for allergic rhinitis among those who concealed emotions at work versus those who did not was 1.318 (1.148-1.512). Stratified by sex, the OR (95% CIs) was 1.307 (1.078-1.585) among men and 1.346 (1.105-1.639) among women. Thus, individuals who concealed their emotions at work were significantly more likely to have a diagnosis of AR in comparison to those who did not. Because concealing emotions at work has adverse health effects, labor policies that aim to reduce this practice are needed.

Epidemiology of allergy

Atopic disease represents a spectrum of disorders characterized by abnormal sensitivity mediated by IgE; approximately 20% of Americans suffer from some form of allergic disease. The sequelae of inhalant and food allergies may present in many organ systems. Manifestations of allergic disease in one site are often associated with symptoms from another site. It is important for clinicians to understand the epidemiology of atopic disease and its causes to facilitate implementation of effective treatment and prevention strategies. This review focuses on the epidemiology of inhalant allergies causing allergic rhinitis and asthma and on IgE-mediated food allergies.

Patient characteristics and prescription fill patterns for allergic rhinitis medications, with a focus on montelukast, in a commercially insured population

BACKGROUND

Allergic rhinitis (AR), also known as hay fever, is caused by an overreaction of the immune system to airborne allergens. AR is a substantial cause of widespread morbidity, medical treatment costs, and reduced productivity at work and school.

OBJECTIVE

The goal of this research was to describe patient characteristics and prescription fill patterns for patients with AR and to determine those factors associated with the use of montelukast in a large population of commercially insured patients who sought medical treatment for AR.

METHODS

This was a retrospective cohort study using administrative claims data from a commercially available database. Patients, aged 4 to 64 years, with >or=3 years' continuous enrollment and >or=1 medical claim for AR between January 1, 2004, and December 31, 2006, were included. Patients with a concomitant asthma diagnosis were excluded. Patients' demographic and clinical characteristics, comorbidities, health care resource utilization, AR-related medication use, and AR-related physician office visits were assessed for 12 months before the first AR medication fill (index) in 2006. Stepwise logistic regression was used to identify factors predicting the initiation of montelukast therapy for the treatment of AR in 2006.

RESULTS

The study population consisted of 75,140 children (mean [SD] age, 10.6 [4.0] years) and 226,236 adults (mean age, 43.8 [11.8] years). Slightly more than half (52.4%) of the pediatric population was male compared with 44.7% of the adult population. Fifty percent of patients had no pharmacy fills for an AR medication in 2006. Among patients with AR pharmacy fills (n = 150,751), 78.1% had a single index medication fill (montelukast represented 4.5%) and 21.9% were prescribed multiple index medications. Children with AR were more likely to fill a prescription for montelukast (n = 7513) if they were 4 to 11 years of age; male; diagnosed with cough/wheeze; and had 1 or 2 oral corticosteroid fills, >or=3 antibiotic fills, and AR-related physician office visits in the prior 12 months (all, P < 0.001). Prescription fills for montelukast among adult patients with AR were significantly (P < 0.001) associated with other respiratory/atopic conditions; prior fills for antihistamines, oral corticosteroids, or intranasal corticosteroids; and AR-related physician office visits in the prior 12 months. Children and adults with health plans based in the midwestern or southern region of the United States had greater odds of initiating montelukast than those with plans based in the western region (P < 0.001).

CONCLUSIONS

Half of the patients identified with AR did not fill a prescription for an AR medication. Among those patients with AR-related prescription drug fills, most were prescribed a single index pharmacotherapy and did not receive additional AR medications within 30 days of the index date. The use of montelukast was limited and was more commonly prescribed to children and adults with AR whose condition was not controlled with other AR medications.

Allergic rhinitis induces anxiety-like behavior and altered social interaction in rodents

Epidemiological and clinical studies report higher incidences of anxiety and increased emotional reactivity in individuals suffering from respiratory allergies. To evaluate if respiratory allergies are capable of promoting anxiety-like behavior in rodents, we used models of allergic rhinitis and behavioral evaluations followed by assessment of mRNA for cytokines in relevant brain regions. Mice and rats were sensitized to ovoalbumin or pollen, respectively, following standard sensitization and challenge protocols. After challenge, the animals were evaluated in the open field, elevated plus-maze and resident-intruder tests. Cytokines and corticotropin-releasing factor expression were assessed in several brain regions by real-time RT-PCR and plasma corticosterone concentrations by radioimmunoassay. Mice and rats sensitized and exposed to allergen showed increased anxiety-like behavior and reduced social interaction without any overt behavioral signs of sickness. T-helper type 2 (T(H)2) cytokines were induced in both rats and mice in the olfactory bulbs and prefrontal cortex and remained unchanged in the temporal cortex and hypothalamus. The same results were found for CRF mRNA expression. No differences were observed in corticosterone concentrations 1h after the last behavioral test. These results show that sensitization and challenge with allergens induce anxiety across rodent species and that these effects were paralleled by an increased expression of T(H)2 cytokines and CRF in the prefrontal cortex. These studies provide experimental evidence that sensitized rodents experience neuroimmune-mediated anxiety and reduced social interaction associated with allergic rhinitis.

Effect of once-daily fluticasone furoate nasal spray on nasal symptoms in adults and adolescents with perennial allergic rhinitis

BACKGROUND

Intranasal corticosteroids are recommended as first-line therapy for the treatment of allergic rhinitis. Fluticasone furoate is a novel enhanced-affinity glucocorticoid for the treatment of allergic rhinitis.

OBJECTIVE

To compare the efficacy and safety of intranasal fluticasone furoate with those of vehicle placebo nasal spray in adult and adolescent patients with perennial allergic rhinitis (PAR).

METHODS

After screening (7-14 days), patients 12 years and older with confirmed PAR were randomized to receive fluticasone furoate, 110 microg once daily, or placebo once daily intranasally for 4 weeks in this double-blind, multicenter study. The primary end point was mean change from baseline during the entire treatment period in daily reflective total nasal symptom score (rTNSS), recorded on diary cards by patients, using a 4-point categorical scale.

RESULTS

The mean reduction from baseline during the treatment period in daily rTNSS was significantly greater in fluticasone furoate recipients than in placebo recipients (P = .005). This finding was supported by significantly greater mean reductions in morning rTNSS and evening rTNSS (P = .004 and P = .011, respectively). A significantly greater mean reduction in instantaneous morning predose TNSS with fluticasone furoate compared with placebo (P = .006) confirmed the efficacy of once-daily administration. Fluticasone furoate was also significantly more effective than placebo in overall response to therapy (P = .005).

CONCLUSIONS

Fluticasone furoate nasal spray, 110 microg once daily, effectively relieved nasal symptoms of PAR in adults and adolescents 12 years and older.

Physician-diagnosed asthma and allergic rhinitis in Manitoba: 1985-1998

BACKGROUND

A worldwide increase has been noted in the prevalence of asthma, but the data for other allergic disorders are less consistent.

OBJECTIVE

To study 14-year trends in utilization of physician resources for asthma and compare them to trends for allergic rhinitis.

METHODS

We studied visits to physicians by Manitoba residents for asthma (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 493) and allergic rhinitis (ICD-9 code 477) between 1985 and 1998. Prevalence and incidence of physician resources utilization were calculated annually for the total population and by age groups. Aggregate statistics and frequency of physician resources utilization were also analyzed.

RESULTS

The prevalence and incidence of physician resources utilization for asthma increased more than for allergic rhinitis; differences were most striking in the youngest age groups. In adults, the differences were smaller and changed little with time. Most of the increase in asthma care occurred in children and in people without allergic rhinitis. Overall, 17% of Manitobans were diagnosed as having asthma, and the average asthmatic patient made 6 visits. Approximately 14% had an allergic rhinitis diagnosis, each person being seen twice on average. Coexistence of asthma and allergic rhinitis led to increased physician resources utilization for each of the conditions.

CONCLUSIONS

Trends in utilization of physician resources for allergic rhinitis differed strikingly from trends for asthma, particularly in the youngest age group. Asthma and allergic rhinitis affected comparable proportions of the population, but a diagnosis of asthma resulted in much higher utilization of physician resources. The relationship of physician-diagnosed asthma and atopy, as indicated by the diagnosis of allergic rhinitis, appears to have weakened with time in children but not in adults.

Evidence-based strategies for treatment of allergic rhinitis

In this review, an evidence-based medicine approach to diagnosis and treatment for allergic rhinitis is reviewed. We performed a search of the medical literature for randomized, placebo-controlled trials of nonsedating antihistamines, intranasal corticosteroids, montelukast, azelastine, allergen immunotherapy, and anti-IgE. The mean numbers needed to treat were: nonsedating antihistamines--15.2; nasal corticosteroids--4.4; montelukast--14.3; azelastine--5.0; allergen immunotherapy--4.6; and anti-IgE--12.4. Treatment thresholds for use were: antihistamines--23%; nasal corticosteroids--8%; azelastine--16%; montelukast--8%; anti-IgE--50%; and immunotherapy--25%. When used appropriately, this information could become very useful for clinicians, particularly if cost, convenience, and other indirect factors can be included.

Atopic diseases of childhood

PURPOSE OF REVIEW

The incidence of atopic diseases, including atopic dermatitis, allergic rhinitis, and asthma, has increased in developed countries over the past several decades. These diseases comprise a large component of general pediatric practice. This review will highlight some of the recent advances in understanding the pathogenesis and natural history of these diseases, as well as the current approaches to the treatment of children with atopic diseases.

RECENT FINDINGS

Recent studies have identified multiple risk factors for the development and progression of atopic diseases. As a result, much research is focused on identifying therapies that can be initiated at a young age to prevent disease progression. New treatment options have become available in recent years, such as topical immunomodulators for atopic dermatitis, leukotriene antagonists for seasonal allergic rhinitis, and alpha-immunoglobulin E therapy for asthma. The importance of viewing allergic rhinitis and asthma as disorders of a single airway has been emphasized. Finally, an update on the national asthma guidelines was recently released in an effort to promote optimal asthma care.

SUMMARY

This review summarizes many of the recent advances in the diagnosis and treatment of atopic diseases in children. Although not intended to be a comprehensive review of this broad field, it provides a framework for appreciating the complexity of these diseases and for effectively managing them.

The development of asthma in patients with allergic rhinitis

PURPOSE OF REVIEW

We will review data supporting the link between allergic rhinitis and asthma, examine recent progress made towards understanding the influence of allergic rhinitis on asthma regarding future development or progression of asthma, and discuss possible mechanisms through which this occurs and potential preventive measures.

RECENT FINDINGS

Several recent reviews have concluded that a close relationship exists between allergic rhinitis and asthma. It has even been proposed that allergic rhinitis and asthma are manifestations of the same disease entity and that they represent a continuum of disease. Allergic rhinitis often precedes the onset of clinical asthma and is a risk factor for the development of asthma. Recognition of this relationship between allergic rhinitis and asthma is highlighted by the recent development of guidelines for the diagnosis and treatment of these disorders by the international Allergic Rhinitis and Its Impact on Asthma workshop. The mechanisms by which allergic rhinitis may be a risk factor for asthma are not entirely understood, although a few recent studies have addressed this question. Some clues in regard to the identification of subjects at risk of developing asthma have been provided by recent studies. Several recent reports support the belief that early introduction of immunotherapy in patients with allergic rhinitis reduces subsequent development of asthma, whereas it remains to be studied whether timely pharmacotherapy for allergic rhinitis may prevent the progression to asthma.

SUMMARY

Because asthma is generally permanent at the time of diagnosis, it would be of great benefit to identify individuals at increased risk of developing asthma in order to provide a window of opportunity in which the progression to asthma could be prevented. As recognition and early treatment of allergic rhinitis could have important consequences in terms of reducing the prevalence and severity of asthma, there is a need to perform further clinical studies that address this issue.

Atopic diseases of childhood

The atopic diseases of childhood consist of the triad of asthma, allergic rhinitis, and atopic dermatitis. All share a common pathogenesis, being mediated by IgE, and are frequently present together in the same individual and family. These disorders and their comorbidities comprise a large component of general pediatric practice and their incidence in developed countries has been increasing over the past few decades. They are a leading reason for clinic and emergency room visits, as well as hospital admissions. They have the potential to interfere with education, physical activity, socialization, and self-esteem. Fortunately, we now have a reasonable armamentarium of maintenance medications available to help control these disorders and improve the quality of life for children suffering from them. In addition, early diagnosis and aggressive management of these disorders seem to offer the possibility of altering their natural history. As such, developing a sensible approach to the diagnosis and treatment of these disorders in an outpatient setting is essential. In this review, I summarize the most current literature and provide a framework for effectively diagnosing and managing these disorders.