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Xu N, Zhang CS, Tan X, Lai Y, Cen Y, Zhou S, Xia J, Li Y, Luo Q. The effectiveness and safety of acupoint herbal patching for allergic rhinitis: protocol for a systematic review and meta-analysis. Syst Rev 2024; 13:172. [PMID: 38971762 PMCID: PMC11227191 DOI: 10.1186/s13643-024-02598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/27/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is a common inflammatory disease of the nasal mucosa that is characterized by symptoms such as sneezing, nasal congestion, nasal itching, and rhinorrhoea. In recent years, acupoint herbal patching (AHP) therapy has gained a growing interest as a potential management option for AR. This systematic review and meta-analysis will evaluate the clinical research evidence on the effectiveness and safety of AHP as a treatment option for AR outside of the Sanfu or Sanjiu days (summer or winter solstice). The results of this review will provide up-to-date evidence-based guidance for healthcare providers and individuals seeking alternative treatments for AR. METHODS A comprehensive search of electronic databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, China National Knowledge Infrastructure (CNKI), CQVIP, Sino-Med, and Wanfang Databases) will be conducted from their inception to June 2023. The inclusion criteria will be limited to randomized controlled trials that evaluate the effectiveness or efficacy of non-Sanfu or non-Sanjiu AHP for AR. The primary outcome measure will be the total nasal symptom score. The methodological quality of included studies will be assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2), and meta-analyses will be performed using RevMan (V.5.3) statistical software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to determine the certainty of evidence. DISCUSSION This systematic review and meta-analysis will provide valuable insights into the effectiveness and safety of non-Sanfu or non-Sanjiu AHP as a treatment option for AR. The study aims to produce a high-quality review by adhering to PRISMA-P guidelines and using clinical guideline recommended outcome measures. The results of this review may offer additional treatment options for AR patients who seek complementary and alternative therapies, and hold significant implications for future research in this field. Overall, this study has the potential to inform clinical practice and improve patient outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022181322.
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Affiliation(s)
- Ningcong Xu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou, China
| | - Claire Shuiqing Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Xi Tan
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Yuexiu District, Dade Road 111, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Yunjie Lai
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Airport Road 12, Baiyun District, Guangzhou, China
- Foshan Hospital of Traditional Chinese Medicine, Chancheng District, Qinren Road 6, Foshan, China
| | - Yanfang Cen
- Community Health Service Center of Dagang Town, Nansha District, Tanzhou Boai Avenue 49, Guangzhou, China
| | - Shiqing Zhou
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Yuexiu District, Dade Road 111, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Jiyan Xia
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Yuexiu District, Dade Road 111, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Yunying Li
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Yuexiu District, Dade Road 111, Guangzhou, China
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Yuexiu District, Guangzhou, China
| | - Qiulan Luo
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Yuexiu District, Dade Road 111, Guangzhou, China.
- Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Yuexiu District, Guangzhou, China.
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Dong B, Li B, Xie L, Li Y. Treatment of Allergic Rhinitis with Acupuncture Based on Pathophysiological. Int J Gen Med 2024; 17:2741-2756. [PMID: 38883703 PMCID: PMC11180464 DOI: 10.2147/ijgm.s470949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
Allergic rhinitis is a prevalent allergic diseases and has a profound impact on physical well-being. In recent years, more and more people have changed to allergic diseases, such as allergic rhinitis, allergic asthma, allergic dermatitis and so on. In the incidence of allergic rhinitis, covering all ages. The common clinical treatment of allergic rhinitis are drugs and immunotherapy, but these therapies have certain limitations. Therefore, an effective and economical treatment for AR is urgently needed. Acupuncture are widely used in the clinical treatment of various diseases, but the effect of acupuncture in the treatment of allergic rhinitis (AR) is significant, and the mechanism of acupuncture in the treatment of AR is also a hot spot. Acupuncture is one of the traditional treatment methods of traditional Chinese medicine, which achieves therapeutic effect by pressing a needle or other means at a specific location on the skin to produce a special sensation. Among them, acupuncture, as a popular treatment method, has attracted more and more attention. In this review, we provide an overview of the current understanding of acupuncture and AR, as well as current studies investigating the efficacy and safety of acupuncture for AR.
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Affiliation(s)
- Boyang Dong
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Bingquan Li
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Liangzhen Xie
- Ear-Nose-Throat Department, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Yan Li
- Ear-Nose-Throat Department, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
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Cruz ÁA, Bousquet J. Rhinitis Phenotypes Based on Multimorbidities. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1487-1489. [PMID: 38641129 DOI: 10.1016/j.jaip.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
Chronic allergic and nonallergic rhinitis are common phenotypes of a highly prevalent disorder of the upper airways, often associated with asthma.1 Clinical data, epidemiologic studies, and mHealth-based and genomic approaches indicate the existence of 2 distinct diseases: rhinitis alone and rhinitis + asthma, which may be allergic or less often nonallergic. Both disease phenotypes need to be further characterized, because allergic conjunctivitis, food allergy, and atopic dermatitis, often present in patients with allergic rhinitis, may be considered as independent multimorbidities. Thus, the concept "multimorbid allergic disease" is more appropriate than "one-airway-one-disease." In a meta-analysis, atopic dermatitis was strongly associated with allergic and nonallergic rhinitis, but not with rhinitis and asthma.2 Asthma alone may also be associated with non-type 2 mechanisms.3 The distinction between rhinitis alone and rhinitis and asthma was found in all the 12 countries studied using an mHealth app (MASK-air) in Europe and Latin America. These data indicate that the distinction between the 2 diseases is independent of allergen exposure.4.
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Affiliation(s)
- Álvaro A Cruz
- Federal University of Bahia, Bahia, Brazil; Fundação ProAR, Salvador, Bahia, Brazil; ARIA Initiative, Montpellier, France.
| | - Jean Bousquet
- ARIA Initiative, Montpellier, France; University Hospital Montpellier, Montpellier, France
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Zhao J, He P, Jiang M, He C, Zhao Y, Zhang Z, Zhang Z, Du G, Sun X. Transdermally delivered tolerogenic nanoparticles induced effective immune tolerance for asthma treatment. J Control Release 2024; 366:637-649. [PMID: 38215983 DOI: 10.1016/j.jconrel.2024.01.018] [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: 07/13/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
Induction of antigen-specific immune tolerance for the treatment of allergic or autoimmune diseases is an attractive strategy. Herein, we investigated the protective effect of a transdermal microneedle patch against allergic asthma by stimulating allergen-specific immune tolerance. We fabricated biodegradable tolerogenic nanoparticles (tNPs) that are loaded with a model allergen ovalbumin (OVA) and an immunomodulator rapamycin, and filled the tNPs into microneedle tips by centrifugation to form sustained-release microneedles. After intradermal immunization, the microneedles successfully delivered the cargos into the skin and sustainedly released them for over 96 h. Importantly, the microneedles induced allergen-specific regulatory T cells (Treg), decreased the levels of pro-inflammatory cytokines and antibodies while increased anti-inflammation cytokines, finally leading to restored immune homeostasis. The lung tissue analysis illustrated that the sustained-release microneedles significantly reduced the infiltration of eosinophils, decreased the accumulation of mucus and collagen, and significantly relived asthma symptoms. Our results suggested that the sustained-release microneedle-based transdermal delivery system can induce antigen-specific immune tolerance with improved compliance and efficacy, providing a new therapeutic strategy for the treatment of allergic and autoimmune diseases.
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Affiliation(s)
- Jiaxuan Zhao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China
| | - Penghui He
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China
| | - Min Jiang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China
| | - Chunting He
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China
| | - Yuanhao Zhao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China
| | - Zhihua Zhang
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Changzhou Institute of Advanced Manufacturing Technology, Changzhou 213164, China
| | - Zhibing Zhang
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Guangsheng Du
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China.
| | - Xun Sun
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China.
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House R, Kritikos V, Cvetkovski B, Rimmer J, Yan K, Cheong L, Bousquet J, Lourenco O, Bosnic-Anticevich S. The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacy. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100340. [PMID: 37869069 PMCID: PMC10585337 DOI: 10.1016/j.rcsop.2023.100340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Background The Allergic Rhinitis Clinical Management Pathway (AR-CMaP) was developed to overcome the challenge of implementing current AR guidelines in the Australian community pharmacy practice and support pharmacists in optimally managing patients' AR. Objectives To evaluate the impact of AR-CMaP on patients' behaviour and pharmacists' needs in managing AR in the pharmacy. Methods This study used a cross-sectional, pre-post study design in which the primary outcome was the appropriateness of medications purchased from community pharmacies in Australia. Patient data were collected before and after the implementation of AR-CMaP. Pharmacist needs were recorded before and after AR-CMaP training. Data were analysed descriptively. Results Six pharmacies, 19 pharmacists and a total of 416 patients were included in the study; 206 pre-AR-CMaP implementation and 210 post-AR-CMaP implementation. Pre-AR-CMaP, 22.4% of patients purchased appropriate AR medication compared with 29.0% post-AR-CMaP implementation. Over half the patient cohort (52%) consulted a pharmacist pre-AR-CMaP and 37% consulted a pharmacist post-AR-CMaP implementation. Post-AR-CMaP, pharmacists reported increased awareness of barriers such as patients' lack of time, patients' perceptions about the pharmacist's role and patient choice to self-manage. Pharmacists also rated an increased desire to interact with other health care providers (HCPs) in caring for patients with AR. Conclusions While there was a non-statistically significant increase in the proportion of patients purchasing optimal AR medication, AR-CMaP did empower patients to self-select their own medication without further detriment. Moreover, following the implementation of AR-CMaP, pharmacists developed a greater awareness of their role in AR management, exemplified by their increased desire to be actively involved in AR management and increased interaction with other HCPs. Future research needs to explore more effective tools to support pharmacists' clinical decision-making and target patients' self-selection of AR medications. This study highlights that there is an ingrained self-reliance of AR decision-making that has become a habit for people living with AR.
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Affiliation(s)
- Rachel House
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
| | - Janet Rimmer
- Macquarie University, Macquarie Park, NSW, Australia
- Thoracic Medicine, St Vincent's Private Hospital, Darlinghurst, Australia
| | - Kwok Yan
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lynn Cheong
- Discipline of Pharmacy, University of Canberra, Canberra, Australia
| | - 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
| | - Olga Lourenco
- Faculty of Health Sciences and CICS—UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
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Zihlif M, Abusara OH, Al-Qerem W, Al-Ibadah M, Mahafza TM, Al-Akhras FM, Mahafza NT. CRHR1 polymorphism at rs242941, rs242940, and rs72834580: association of symptoms improvement with intranasal corticosteroids in allergic rhinitis Jordanian patients. Drug Metab Pers Ther 2023; 38:331-338. [PMID: 37216433 DOI: 10.1515/dmpt-2023-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Rhinitis is classified into several types with allergic rhinitis (AR) being the most common. AR is among the inflammatory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), in which corticosteroids are administered to overcome the decrease in cortisol production. The treatment options available for AR vary with 1st line treatment being intranasal corticosteroids (INCS). The responsiveness to corticosteroids is due to their binding to corticotropin-releasing hormone receptor-1 (CRHR1). Various studies have studied the responsiveness to corticosteroids treatment in patients with asthma and COPD in association with CRHR1 gene single nucleotide polymorphisms (SNPs). METHODS In our study, we investigated the association of three SNPs of CRHR1 gene (rs242941, rs242940, and rs72834580) with symptoms improvement post-treatment in AR patients. Blood samples were collected from 103 patients for DNA extraction and gene sequencing. Those patients started to receive INCS for 8 weeks and their symptoms were assessed, through a questionnaire, before treatment and post-treatment to check for symptoms improvement. RESULTS Our data showed that improvement of eye redness is significantly less following INCS treatment in patients with allele (C) (AOR=0.289, p-value-0.028, 95 % CI=0.096-0.873) and genotype (CC) (AOR=0.048, p-value-0.037, 95 % CI=0.003-0.832) of rs242941 SNP. There was no correlation with other genotypes, alleles, or haplotypes of the investigated SNPs. CONCLUSIONS Our findings show that there is no correlation between CRHR1 gene polymorphism and symptoms improvement following INCS treatment. Further studies are required to evaluate the association of INCS and symptoms improvement post-treatment with larger sample size.
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Affiliation(s)
- Malek Zihlif
- Department of Pharmacology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Osama H Abusara
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Mahmood Al-Ibadah
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Tareq M Mahafza
- Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatima M Al-Akhras
- Molecular Biology Research Laboratory, School of Medicine, The University of Jordan, Amman, Jordan
| | - Naseem T Mahafza
- Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan
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Castillo JA, Plaza V, Rodrigo G, Juliá B, Picado C, Fernández C, Mullol J. Chronic rhinosinusitis with nasal polyps and allergic rhinitis as different multimorbid treatable traits in asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100134. [PMID: 37781668 PMCID: PMC10510007 DOI: 10.1016/j.jacig.2023.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 10/03/2023]
Abstract
Background Respiratory multimorbidities are linked to asthma, such as allergic rhinitis (AR) with early allergic asthma and chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) with late nonallergic asthma. Objective Our aim was to investigate the association of asthma severity and control with specific upper airway phenotypes. Method Patients with asthma were prospectively recruited from 23 pulmonology and ear, nose, and throat clinics. Asthma severity and control, as well as upper airway comorbidities (AR and non-AR [NAR], CRSwNP, and CRS without nasal polyps [CRSsNP]) were assessed according to international consensus guidelines definitions. Results A total of 492 asthmatic patients were included. Half of the asthmatic patients (49.6%) had associated rhinitis (37.0% had AR and 12.6% had NAR) and 36.2% had CRS (16.7% had CRSsNP and 19.5% had CRSwNP), whereas 14.2% had no sinonasal symptoms. Most cases of AR (78%) and NAR (84%) were present in patients with mild-to-moderate asthma, whereas CRSwNP was more frequent in patients with severe asthma (35% [P < .001]), mainly nonatopic asthma (44% [P < .001]). Patients with severe asthma with CRSwNP had worse asthma control, which was correlated (r = 0.249 [P = .034]) with sinus occupancy. Multiple logistic regression analysis showed that late-onset asthma, intolerance of aspirin and/or nonsteroidal anti-inflammatory drugs, and CRSwNP were independently associated with severe asthma. Conclusion Severe asthma is associated with CRSwNP, with sinus occupancy affecting asthma control. This study has identified 2 main different upper airway treatable traits, AR and CRSwNP, which need further evaluation to improve management and control of patients with asthma.
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Affiliation(s)
- José Antonio Castillo
- Pneumology Department, Hospital Universitari Dexeus, Barcelona, Spain
- CIBER of Respiratory Diseases, Spain
- Group of Rhinitis, Rhinosinusitis, and Nasal Polyps, Area of Asthma, SEPAR, Spain
| | - Vicente Plaza
- Pneumology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Gustavo Rodrigo
- Emergency Departament, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | | | - César Picado
- CIBER of Respiratory Diseases, Spain
- Pneumology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Fernández
- Preventive Medicine Department, Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela, Fundación IMAS, Santiago de Compostela, Spain
| | - Joaquim Mullol
- CIBER of Respiratory Diseases, Spain
- Group of Rhinitis, Rhinosinusitis, and Nasal Polyps, Area of Asthma, SEPAR, Spain
- Clinical and Experimental Respiratory Immunoallergy, IDIBAPS & Rhinology Unite and Smell Clinic, ENT Department, Hospital Clínic Barcelona, Universitat de Barcelona, Spain
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Li K, Huang W, Li RJ, Feng XC, Chen Z, Tan SY, Xie MF, Huang JP, Liu RJ, Li YY. Efficacy and safety of self-administered acupressure on symptoms, quality of life and nasal mucosal function in patients with perennial allergic rhinitis: study protocol for a randomized controlled exploratory trial. BMC Complement Med Ther 2023; 23:304. [PMID: 37648989 PMCID: PMC10468903 DOI: 10.1186/s12906-023-04132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Allergic rhinitis is a global health problem that can potentially be managed through acupressure. Our clinical observations have identified Allergic Rhinitis Acupressure Therapeutic (ARAT) as a novel acupressure treatment acting on specific acupoints, which may enhance the effectiveness of acupressure. Therefore, we propose a three-arm randomized controlled trial will be conducted to investigate the efficacy and safety of ARAT for perennial allergic rhinitis (PAR). METHODS/DESIGN In this trial, eligible 111 participants diagnosed with PAR will be randomly assigned to one of three groups: the ARAT group, the non-specific acupoints group, or the blank control group. The primary outcome will be the change in the total nasal symptom score, and the secondary outcomes will include: 1) changes in the scores of the standard version of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQs); 2) acoustic rhinometry and anterior rhinomanometry; 3) changes in the scores of relief medication usage; 4) incidence of adverse events. Additionally, we will measure and compare the changes in cytokine levels (IL-5, IL-13, IFN-γ, and TSLP) in nasal secretions. The RQLQs and primary outcomes will be assessed at the beginning, middle, and end stages of the treatment period, with monthly follow-ups conducted over a total of three months. The secondary outcomes and biomarkers in nasal secretions will be measured at the beginning and end of the treatment period. Any adverse events or need for rescue medication will be carefully noted and recorded. DISCUSSION This study may produce a new acupressure treatment prescription that is easy to learn, more targeted, and adaptable. This trial represents the first clinical investigation comparing ARAT treatment for PAR with the non-specific acupoints group and blank control group. Our data is expected to provide evidence demonstrating the safety and efficacy of ARAT for PAR patients, while also exploring the functional mechanism underlying ARAT treatment, moreover, the results offer valuable insights for healthcare professionals in managing PAR symptoms. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2300072292. Registered on June 08, 2023.
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Affiliation(s)
- Kai Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Wei Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Rui-Jian Li
- Second Affiliated Hospital of Shantou University Medical College, Dongxia Road, Jinping District, Shantou, Guangdong Province, China
| | - Xiao-Cong Feng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Zong Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Shu-Yi Tan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Mei-Feng Xie
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Jian-Peng Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Ru-Jia Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Yun-Ying Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Department of Otorhinolaryngology, Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China.
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Albloushi S, Al-Ahmad M. Exploring the latest understanding on the role of immune mediators, genetic and environmental factors in pathogenesis of allergic rhinitis: a systematic review. FRONTIERS IN ALLERGY 2023; 4:1223427. [PMID: 37692890 PMCID: PMC10485773 DOI: 10.3389/falgy.2023.1223427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Despite well-defined clinical phenotypes of chronic rhinitis, the underlying in-depth pathophysiological mechanism, particularly with reference to the involvement of immune mediators, genetic, and environmental factors, are still not fully understood. Therefore, our aim was to give updated information on the pathogenesis of allergic rhinitis (AR), with an emphasis on the role of cytokines in adults aged 18 years and above. Additionally, we investigated the impact of genetic and environmental factors in the pathogenesis of AR. Results A search in various databases identified 1,178 records, and 18 studies were ultimately selected from January 2018 to April 2023. The total sample size in our studies was 4,317, with 2,186 in the experimental and 2,131 in control groups, respectively. The mean age was 33.4 years, with 43% were male, while 57% were female. According to the selected studies, various factors, including immune mediators, particularly cytokines, genetic, and environmental factors, were identified in the development of AR. Conclusion The selected studies presented findings on different factors and sub-factors in the pathogenesis of AR, making it a challenge for us to compare their results. However, based on our findings, researchers can link our identified factors to potential therapies for AR.
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Affiliation(s)
| | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
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10
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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11
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Russo E, Giombi F, Paoletti G, Heffler E, Canonica GW, Pirola F, Mercante G, Spriano G, Malvezzi L, Keber E, SGCP, Giua C. Use, Abuse, and Misuse of Nasal Medications: Real-Life Survey on Community Pharmacist’s Perceptions. J Pers Med 2023; 13:jpm13040579. [PMID: 37108966 PMCID: PMC10142332 DOI: 10.3390/jpm13040579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/18/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Medication overuse is an increasing global problem, especially for those rhinology diseases whose management requires over-the-counter drugs. This observational community pharmacy-based study aimed to investigate the actual use of the best-selling topical nasal medications and to characterize the clinical issues underlying their query through the pharmacist’s perception. Methods: In the pilot phase, a preliminary survey was developed by a team of researchers and tested on a small sample of practitioners to assess usability and intelligibility. Eventual amendments were made according to the feedback obtained, and the final version was submitted to practitioners working in 376 pharmacies evenly distributed over the Italian territory. Results: Two groups of customers (18–30 years old and 60–75 years old) were the ones who most frequently purchased topical decongestants. The dosage applied for sympathomimetic amines was higher than recommended in up to 44.4% and the duration of use longer than 5 days in up to 31.9% of the cases. Patients’ queries of alpha agonists and topical corticosteroids resulted in significantly higher numbers than practitioners’ prescriptions. Allergic rhinitis was the most common disease affecting patients seeking sympathomimetic amines. Conclusions: The prolonged use of sympathomimetic amines in patients suffering from rhinology diseases is a significant problem that requires greater attention in terms of social education and surveillance.
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12
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Bousquet J, Anto JM, Sousa‐Pinto B, Czarlewski W, Bedbrook A, Haahtela T, Klimek L, Pfaar O, Kuna P, Kupczyk M, Regateiro FS, Samolinski B, Valiulis A, Yorgancioglu A, Arnavielhe S, Basagaña X, Bergmann KC, Bosnic‐Anticevich S, Brussino L, Canonica GW, Cardona V, Cecchi L, Chaves‐Loureiro C, Costa E, Cruz AA, Gemicioglu B, Fokkens WJ, Ivancevich JC, Kraxner H, Kvedariene V, Larenas‐Linnemann DE, Laune D, Louis R, Makris M, Maurer M, Melén E, Micheli Y, Morais‐Almeida M, Mullol J, Niedoszytko M, Okamoto Y, Papadopoulos NG, Patella V, Pham‐Thi N, Rouadi PW, Sastre J, Scichilone N, Sheikh A, Sofiev M, Taborda‐Barata L, Toppila‐Salmi S, Tsiligianni I, Valovirta E, Ventura MT, Vieira RJ, Zidarn M, Amaral R, Ansotegui IJ, Bédard A, Benveniste S, Bewick M, Bindslev‐Jensen C, Blain H, Bonini M, Bourret R, Braido F, Carreiro‐Martins P, Charpin D, Cherrez‐Ojeda I, Chivato T, Chu DK, Cingi C, Del Giacco S, de Blay F, Devillier P, De Vries G, Doulaptsi M, Doyen V, Dray G, Fontaine J, Gomez RM, Hagemann J, Heffler E, Hofmann M, Jassem E, Jutel M, Keil T, Kritikos V, Kull I, Kulus M, Lourenço O, Mathieu‐Dupas E, Menditto E, Mösges R, Murray R, Nadif R, Neffen H, Nicola S, O’Hehir R, Olze H, Palamarchuk Y, Pépin J, Pétré B, Picard R, Pitsios C, Puggioni F, Quirce S, Raciborski F, Reitsma S, Roche N, Rodriguez‐Gonzalez M, Romantowski J, Sá‐Sousa A, Serpa FS, Savouré M, Shamji MH, Sova M, Sperl A, Stellato C, Todo‐Bom A, Tomazic PV, Vandenplas O, Van Eerd M, Vasankari T, Viart F, Waserman S, Fonseca JA, Zuberbier T. Digitally-enabled, patient-centred care in rhinitis and asthma multimorbidity: The ARIA-MASK-air ® approach. Clin Transl Allergy 2023; 13:e12215. [PMID: 36705508 PMCID: PMC9823305 DOI: 10.1002/clt2.12215] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 01/09/2023] Open
Abstract
MASK-air® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.
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Affiliation(s)
- Jean Bousquet
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany,University Hospital MontpellierMontpellierFrance,InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance
| | - Josep M. Anto
- ISGlobalBarcelona Institute for Global HealthBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain,Universitat Pompeu Fabra (UPF)BarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Bernardo Sousa‐Pinto
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | | | | | - Tari Haahtela
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck SurgeryUniversitätsmedizin MainzMainzGermany,Center for Rhinology and AllergologyWiesbadenGermany
| | - Oliver Pfaar
- Section of Rhinology and AllergyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology UnitCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,ICBR, Coimbra Institute for Clinical and Biomedical Research, CIBBFaculty of MedicineUniversity of CoimbraCoimbraPortugal,Institute of ImmunologyFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health SciencesVilniusLithuania,Medical Faculty of Vilnius UniversityVilniusLithuania
| | - Arzu Yorgancioglu
- Department of Pulmonary DiseasesCelal Bayar University, Faculty of MedicineManisaTurkey
| | | | - Xavier Basagaña
- ISGlobalBarcelona Institute for Global HealthBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain,Universitat Pompeu Fabra (UPF)BarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Karl C. Bergmann
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Sinthia Bosnic‐Anticevich
- Quality Use of Respiratory Medicine GroupWoolcock Institute of Medical ResearchThe University of SydneySydneyNSWAustralia,Sydney Local Health DistrictSydneyNSWAustralia
| | - Luisa Brussino
- Department of Medical SciencesAllergy and Clinical Immunology UnitUniversity of TorinoTorinoItaly,Mauriziano HospitalTorinoItaly
| | - G. Walter Canonica
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Victoria Cardona
- Allergy SectionDepartment of Internal MedicineHospital Vall d'HebronBarcelonaSpain,ARADyAL Research NetworkBarcelonaSpain
| | - Lorenzo Cecchi
- SOS Allergology and Clinical ImmunologyUSL Toscana CentroPratoItaly
| | - Claudia Chaves‐Loureiro
- Pneumology UnitHospitais da Universidade de CoimbraCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Elisio Costa
- UCIBIO, REQUINTEFaculty of Pharmacy and Competence Center on Active and Healthy AgeingUniversity of Porto (Porto4Ageing)PortoPortugal
| | - Alvaro A. Cruz
- Fundaçao ProARFederal University of Bahia and GARD/WHO Planning GroupSalvadorBahiaBrazil
| | - Bilun Gemicioglu
- Cerrahpasa Faculty of MedicineDepartment of Pulmonary DiseasesIstanbul University‐CerrahpasaIstanbulTurkey
| | - Wytske J. Fokkens
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, location AMCAmsterdamthe Netherlands
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck SurgerySemmelweis UniversityBudapestHungary
| | - Violeta Kvedariene
- Faculty of MedicineInstitute of Clinical MedicineClinic of Chest Diseases and AllergologyVilnius UniversityVilniusLithuania,Faculty of MedicineDepartment of PathologyInstitute of Biomedical SciencesVilnius UniversityVilniusLithuania
| | | | | | - Renaud Louis
- Department of Pulmonary MedicineCHU LiegeLiègeBelgium,GIGA I3 Research GroupUniversity of LiegeLiègeBelgium
| | - Michael Makris
- Allergy Unit “D Kalogeromitros”2nd Department of Dermatology and VenereologyNational & Kapodistrian University of Athens“Attikon” University HospitalAthensGreece
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Erik Melén
- Sach's Children and Youth HospitalSödersjukhusetStockholmSweden,Department of Clinical Science and EducationSödersjukhusetKarolinska InstitutetStockholmSweden
| | | | | | - Joaquim Mullol
- Rhinology Unit & Smell ClinicENT DepartmentHospital ClínicBarcelonaSpain,Clinical & Experimental Respiratory ImmunoallergyIDIBAPS, CIBERESUniversity of BarcelonaBarcelonaSpain
| | | | | | | | - Vincenzo Patella
- Division of Allergy and Clinical ImmunologyDepartment of Medicine“Santa Maria della Speranza” Hospital, BattipagliaSalernoItaly,Agency of Health ASLSalernoItaly
| | - Nhân Pham‐Thi
- Ecole Polytechnique PalaiseauIRBA (Institut de Recherche Bio‐Médicale des Armées)BretignyFrance
| | - Philip W. Rouadi
- Department of Otolaryngology, Head and Neck SurgeryEye and Ear University HospitalBeirutLebanon,Department of Otorhinolaryngology, Head and Neck SurgeryDar Al Shifa HospitalSalmiyaKuwait
| | - Joaquin Sastre
- Fundacion Jimenez Diaz, CIBERESFaculty of MedicineAutonoma University of MadridMadridSpain
| | | | - Aziz Sheikh
- Usher InstituteThe University of EdinburghEdinburghUK
| | | | - Luis Taborda‐Barata
- Department of ImmunoallergologyCova da Beira University Hospital CentreCovilhãPortugal,UBIAir ‐ Clinical & Experimental Lung Centre and CICS‐UBI Health Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | - Sanna Toppila‐Salmi
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group IPCRGAberdeenScotland,Health Planning UnitFaculty of MedicineDepartment of Social MedicineUniversity of CreteCreteGreece
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical ImmunologyUniversity of TurkuTurkuFinland,Terveystalo Allergy ClinicTurkuFinland
| | | | - Rafael José Vieira
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic DiseasesGolnikSlovenia,Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Rita Amaral
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | | | - Annabelle Bédard
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Samuel Benveniste
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO)Broca HospitalParisFrance,Mines ParisTech CRI ‐ PSL Research UniversityFontainebleauFrance
| | - Michael Bewick
- University of Central Lancashire Medical SchoolPrestonUK
| | - Carsten Bindslev‐Jensen
- Odense Research Center for Anaphylaxis (ORCA)OdenseDenmark,Department of Dermatology and Allergy CentreOdense University HospitalOdenseFinland
| | - Hubert Blain
- Department of GeriatricsMontpellier University Hospital, MUSEMontpellierFrance
| | - Matteo Bonini
- Department of Clinical and Surgical SciencesFondazione Policlinico Universitario A Gemelli IRCCSRomeItaly,National Heart and Lung InstituteRoyal Brompton Hospital & Imperial College LondonLondonUK
| | | | - Fulvio Braido
- Department of Internal Medicine (DiMI)University of GenoaGenovaItaly,IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Pedro Carreiro‐Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC)LisbonPortugal,Serviço de ImunoalergologiaHospital de Dona EstefâniaCentro Hospitalar Universitário de Lisboa CentralLisbonPortugal
| | - Denis Charpin
- Clinique des BronchesAllergie et SommeilHôpital NordMarseilleFrance
| | - Ivan Cherrez‐Ojeda
- Universidad Espíritu SantoSamborondónEcuador,Respiralab Research GroupGuayaquil, GuayasEcuador
| | - Tomas Chivato
- School of MedicineUniversity CEU San PabloMadridSpain
| | - Derek K. Chu
- Department of Health Research Methods, Evidence, and Impact & Department of MedicineMcMaster UniversityHamiltonONCanada
| | - Cemal Cingi
- Medical FacultyENT DepartmentEskisehir Osmangazi UniversityEskisehirTurkey
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical ImmunologyUniversity Hospital “Duilio Casula”University of CagliariCagliariItaly
| | - Frédéric de Blay
- Allergy DivisionChest Disease DepartmentUniversity Hospital of StrasbourgStrasbourgFrance,Federation of Translational MedicineUniversity of StrasbourgStrasbourgFrance
| | - Philippe Devillier
- VIM Suresnes, UMR 0892Pôle des Maladies des Voies RespiratoiresHôpital FochUniversité Paris‐SaclaySuresnesFrance
| | | | - Maria Doulaptsi
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of CreteHeraklion, CreteGreece
| | - Virginie Doyen
- Department of Chest MedicineCentre Hospitalier Universitaire UCL NamurNamurBelgique,Université Catholique de LouvainYvoirBelgium
| | | | | | | | - Jan Hagemann
- Department of Otolaryngology, Head and Neck SurgeryUniversitätsmedizin MainzMainzGermany,Center for Rhinology and AllergologyWiesbadenGermany
| | - Enrico Heffler
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Maja Hofmann
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Berlin Institute of HealthBerlinGermany
| | - Ewa Jassem
- Department of PneumologyMedical University of GdańskGdańskPoland
| | - Marek Jutel
- Department of Clinical ImmunologyWrocław Medical UniversityWrocławPoland,ALL‐MED Medical Research InstituteWroclawPoland
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health EconomicsCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute for Clinical Epidemiology and BiometryUniversity of WuerzburgWuerzburgGermany,State Institute of Health, Bavarian Health and Food Safety AuthorityErlangenGermany
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine GroupWoolcock Institute of Medical ResearchThe University of SydneySydneyNSWAustralia
| | - Inger Kull
- Sach's Children and Youth HospitalSödersjukhusetStockholmSweden,Department of Clinical Science and EducationSödersjukhusetKarolinska InstitutetStockholmSweden
| | - Marek Kulus
- Department of Pediatric Respiratory Diseases and AllergologyMedical University of WarsawWarsawPoland
| | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBIHealth Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | | | - Enrica Menditto
- CIRFFDepartment of PharmacyUniversity of Naples Federico IINaplesItaly
| | - Ralph Mösges
- CRI‐Clinical Research International‐LtdHamburgGermany
| | - Ruth Murray
- Medical Communication ConsultantMedscript Ltd, DundalkIreland and WellingtonNew Zealand,Research FellowOPCCambridgeUK
| | - Rachel Nadif
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Hugo Neffen
- Center of Allergy, Immunology and Respiratory DiseasesSanta FeArgentina
| | - Stefania Nicola
- Department of Medical SciencesAllergy and Clinical Immunology UnitUniversity of TorinoTorinoItaly
| | - Robyn O’Hehir
- Department of Allergy, Immunology and Respiratory MedicineAlfred Hospital and Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Heidi Olze
- Berlin Institute of HealthBerlinGermany,Department of OtorhinolaryngologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | | | - Jean‐Louis Pépin
- Université Grenoble AlpesLaboratoire HP2GrenobleFrance,INSERMU1042VillejuifFrance
| | | | - Robert Picard
- Conseil Général de l'Economie Ministère de l'Economiede l'Industrie et du NumériqueParisFrance
| | | | - Francesca Puggioni
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Santiago Quirce
- Department of AllergyHospital La Paz Institute for Health Research (IdiPAZ)MadridSpain
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Sietze Reitsma
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, AMCAmsterdamthe Netherlands
| | - Nicolas Roche
- PneumologieAP‐HP Centre Université de Paris CitéHôpital CochinParisFrance,UMR 1016Institut CochinParisFrance
| | | | - Jan Romantowski
- Department of AllergologyMedical University of GdańskGdanskPoland
| | - Ana Sá‐Sousa
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Faradiba S. Serpa
- Asthma Reference Center ‐ School of Medicine of Santa Casa de Misericórdia of VitóriaVitoria, Espirito SantoBrazil
| | - Marine Savouré
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Mohamed H. Shamji
- National Heart and Lung InstituteImperial CollegeLondonUK,NIHR Imperial Biomedical Research CentreLondonUK
| | - Milan Sova
- Department of Respiratory Medicine and TuberculosisUniversity HospitalBrnoCzech Republic
| | - Annette Sperl
- Center for Rhinology and AllergologyWiesbadenGermany
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoSalernoItaly
| | - Ana Todo‐Bom
- ImunoalergologiaCentro Hospitalar Universitário de CoimbraFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Peter Valentin Tomazic
- Department of General ORLH&NSMedical University of GrazENT‐University Hospital GrazGrazSteiermarkAustria
| | - Olivier Vandenplas
- Department of Chest MedicineCentre Hospitalier Universitaire UCL NamurNamurBelgique,Université Catholique de LouvainYvoirBelgium
| | | | - Tuula Vasankari
- Fihla, Finnish Lung AssociationHelsinkiFinland,University of TurkuTurkuFinland
| | | | - Susan Waserman
- Department of Medicine, Clinical Immunology and AllergyMcMaster UniversityHamiltonOntarioCanada
| | - Joao A. Fonseca
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Torsten Zuberbier
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
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13
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Kakobo PK, Kalala HK, Kelekele JK, Mutombo PB, Nyembue DT, Hellings PW, Kayembe JMN. Determinants of uncontrolled allergic rhinitis in Kinshasa hospitals. FRONTIERS IN ALLERGY 2023; 4:1138537. [PMID: 37034152 PMCID: PMC10073489 DOI: 10.3389/falgy.2023.1138537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Objective To identify the determinants of uncontrolled allergic rhinitis (UCAR) in a hospital setting in Kinshasa, Democratic Republic of Congo. Methods Hospital-based cross-sectional study of 153 patients with allergic rhinitis (AR). The diagnosis of AR was based on clinical grounds according to the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria. Categorization into controlled AR (CAR) and UCAR was based on the visual analog scale (VAS with cut off point of 5). Binary logistic regression was used to identify factors associated with UCAR. Results Patients with UCAR (60.1%) proportionally outnumbered those with CAR (39.9%). There were significantly more patients younger than 30 years of age among patients with UCAR. Factors significantly associated with UCAR were age below 30 years (OR = 3.31; 95% CI: 1.49-7.36; p = 0.003), low serum vitamin D level (OR = 3.86; 95% CI: 1.72-8.68; p = 0.001), persistent form (OR = 3.11; 95% CI: 1.39-6.98; p = 0.006) and moderate to severe form of AR (OR = 4.31; 95% CI: 1.77-10.49; p = 0.001). Conclusions Factors associated with UCAR in this study population were younger age less than 30 years, low vitamin D level, and persistent as well as moderate to severe AR. Further studies are needed to elucidate the underlying mechanisms favoring the occurrence of these factors.
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Affiliation(s)
- Patricia K. Kakobo
- Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Correspondence: Patricia K. Kakobo
| | - Hilaire K. Kalala
- Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Joseph K. Kelekele
- Ophthalmology Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Paulin B. Mutombo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné T. Nyembue
- Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Peter W. Hellings
- Department of Otorhinolaryngology-Head and Nose Surgery, University Hospital of Leuven, Leuven, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium
| | - Jean-Marie N. Kayembe
- Department of Pneumology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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14
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Jorde I, Schreiber J, Stegemann-Koniszewski S. The Role of Staphylococcus aureus and Its Toxins in the Pathogenesis of Allergic Asthma. Int J Mol Sci 2022; 24:ijms24010654. [PMID: 36614093 PMCID: PMC9820472 DOI: 10.3390/ijms24010654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023] Open
Abstract
Bronchial asthma is one of the most common chronic diseases worldwide and affects more than 300 million patients. Allergic asthma affects the majority of asthmatic children as well as approximately 50% of adult asthmatics. It is characterized by a Th2-mediated immune response against aeroallergens. Many aspects of the overall pathophysiology are known, while the underlying mechanisms and predisposing factors remain largely elusive today. Over the last decade, respiratory colonization with Staphylococcus aureus (S. aureus), a Gram-positive facultative bacterial pathogen, came into focus as a risk factor for the development of atopic respiratory diseases. More than 30% of the world’s population is constantly colonized with S. aureus in their nasopharynx. This colonization is mostly asymptomatic, but in immunocompromised patients, it can lead to serious complications including pneumonia, sepsis, or even death. S. aureus is known for its ability to produce a wide range of proteins including toxins, serine-protease-like proteins, and protein A. In this review, we provide an overview of the current knowledge about the pathophysiology of allergic asthma and to what extent it can be affected by different toxins produced by S. aureus. Intensifying this knowledge might lead to new preventive strategies for atopic respiratory diseases.
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15
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Bousquet J, Toumi M, Sousa-Pinto B, Anto JM, Bedbrook A, Czarlewski W, Valiulis A, Ansotegui IJ, Bosnic-Anticevich S, Brussino L, Canonica GW, Cecchi L, Cherrez-Ojeda I, Chivato T, Costa EM, Cruz AA, Del Giacco S, Fonseca JA, Gemicioglu B, Haahtela T, Ivancevich JC, Jutel M, Kaidashev I, Klimek L, Kvedariene V, Kuna P, Larenas-Linnemann DE, Lipworth B, Morais-Almeida M, Mullol J, Papadopoulos NG, Patella V, Pham-Thi N, Regateiro FS, Rouadi PW, Samolinski B, Sheikh A, Taborda-Barata L, Ventura MT, Yorgancioglu A, Zidarn M, Zuberbier T. The Allergic Rhinitis and Its Impact on Asthma (ARIA) Approach of Value-Added Medicines: As-Needed Treatment in Allergic Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2878-2888. [PMID: 35934308 DOI: 10.1016/j.jaip.2022.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
Drug repurposing is a major field of value-added medicine. It involves investigating and evaluating existing drugs for new therapeutic purposes that address unmet healthcare needs. Several unmet needs in allergic rhinitis could be improved by drug repurposing. This could be game-changing for disease management. Current medications for allergic rhinitis are centered on continuous long-term treatment, and medication registration is based on randomized controlled trials carried out for a minimum of 14 days with adherence of 70% or greater. A new way of treating allergic rhinitis is to propose as-needed treatment depending on symptoms, rather than classical continuous treatment. This rostrum will discuss existing clinical trials on as-needed treatment for allergic rhinitis and real-world data obtained by the mobile health app MASK-air, which focuses on digitally-enabled, patient-centered care pathways.
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Affiliation(s)
- Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; University Hospital Montpellier, Montpellier, France; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Mondher Toumi
- Public Health, Aix-Marseille University, Marseille, France
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal; RISE-Health Research Network, University of Porto, Porto, Portugal
| | - Josep M Anto
- ISGlobaL, Barcelona Institute for Global Health, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | | | | | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino and Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele and Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmonology, Espiritu Santo University, Samborondón, Ecuador
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Elísio M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula," University of Cagliari, Cagliari, Italy
| | - Joao A Fonseca
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal; RISE-Health Research Network, University of Porto, Porto, Portugal
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Igor Kaidashev
- Poltava State Medical University, Poltava Oblast, Ukraine
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, México
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
| | | | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | | | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
| | - Nhân Pham-Thi
- Ecole Polytechnique Palaiseau, Institut de Recherche Bio-Médicale des Armées, Bretigny, France
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; ENT Department, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology, and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Luis Taborda-Barata
- UBIAir-Clinical and Experimental Lung Centre, University of Beira Interior, Covilhã, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | | | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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16
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Sousa-Pinto B, Sá-Sousa A, Vieira RJ, Amaral R, Klimek L, Czarlewski W, Antó JM, Pfaar O, Bedbrook A, Kvedariene V, Ventura MT, Ansotegui IJ, Bergmann KC, Brussino L, Canonica GW, Cardona V, Carreiro-Martins P, Casale T, Cecchi L, Chivato T, Chu DK, Cingi C, Costa EM, Cruz AA, De Feo G, Devillier P, Fokkens WJ, Gaga M, Gemicioğlu B, Haahtela T, Ivancevich JC, Ispayeva Z, Jutel M, Kuna P, Kaidashev I, Kraxner H, Larenas-Linnemann DE, Laune D, Lipworth B, Louis R, Makris M, Monti R, Morais-Almeida M, Mösges R, Mullol J, Odemyr M, Okamoto Y, Papadopoulos NG, Patella V, Pham-Thi N, Regateiro FS, Reitsma S, Rouadi PW, Samolinski B, Sova M, Todo-Bom A, Taborda-Barata L, Tomazic PV, Toppila-Salmi S, Sastre J, Tsiligianni I, Valiulis A, Vandenplas O, Wallace D, Waserman S, Yorgancioglu A, Zidarn M, Zuberbier T, Fonseca JA, Bousquet J. Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK-air ® real-world data. Allergy 2022; 77:2699-2711. [PMID: 35258105 DOI: 10.1111/all.15275] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. METHODS We analysed 2015-2020 MASK-air® European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. RESULTS We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H1 -antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. CONCLUSIONS Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - Ana Sá-Sousa
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - Rafael José Vieira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - Rita Amaral
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Josep M Antó
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University and Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Karl-Christian Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain
| | - Pedro Carreiro-Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Tomas Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, Florida, USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Tomás Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Derek K Chu
- Department of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - Elísio M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Brazil
| | - Giulia De Feo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Philippe Devillier
- VIM Suresnes, UMR_0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location AMC, Amsterdam, The Netherlands
| | - Mina Gaga
- ERS President 2017-2018, 7th Resp Med Department and Asthma Center, Athens Chest Hospital, Athens, Greece
| | - Bilun Gemicioğlu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Zhanat Ispayeva
- Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.,Department of Clinical Immunology, ALL-MED Medical Research Institute, Wrocław, Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | | | - Brian Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, and GIGA I3 Research Group, Liege, Belgium
| | - Michael Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Riccardo Monti
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | | | - Ralph Mösges
- IMSB, Medical Faculty, University of Cologne, and ClinCompetence Cologne GmbH, Cologne, Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Mikaëla Odemyr
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | | | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
| | - Nhân Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, and Institute of Immunology, Faculty of Medicine, University of Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sietze Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location AMC, Amsterdam, The Netherlands
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon, and ENT Department, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Milan Sova
- Department of Pulmonary medicine and tuberculosis, University Hospital Brno, Brno, Czech Republic
| | - Ana Todo-Bom
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon, and ENT Department, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - Luis Taborda-Barata
- Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilha, Portugal.,Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Peter Valentin Tomazic
- Department of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Graz, Austria
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Joaquin Sastre
- Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece, and International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | | | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnick, and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - João A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.,University Hospital Montpellier, Montpellier, France
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17
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Jackson DJ, Akuthota P, Andradas R, Bredenoord AJ, Cordell A, Gray S, Kullman J, Mathur SK, Pavord I, Roufosse F, Rubio C, Rusek IC, Simon D, Strobel MJ, Winders T. Improving Care in Eosinophil-Associated Diseases: A Charter. Adv Ther 2022; 39:2323-2341. [PMID: 35489014 PMCID: PMC9055373 DOI: 10.1007/s12325-022-02110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
Eosinophil-associated diseases (EADs) are a range of heterogeneous conditions in which eosinophils are believed to play a critical pathological role. EADs include common illnesses such as eosinophilic asthma and chronic rhinosinusitis and rare conditions such as hypereosinophilic syndromes (HES) and eosinophilic gastrointestinal disorders (EGIDs). EADs are associated with substantial burdens for the patient, including chronic, debilitating symptoms, increased financial burden, decreased health-related quality of life, and the need for repeated visits to multiple different healthcare professionals (HCPs), emergency departments, and/or hospitals. Poor EAD recognition by HCPs often contributes to delayed diagnoses, which further delays patient access to appropriate care and effective treatments, contributing to poor health outcomes. The objective of this charter is to outline key patient rights and expectations with respect to the management of their condition(s) and to set forth an ambitious action plan to improve health outcomes for patients with EADs: (1) people with EADs, their caretakers, HCPs, and the public must have greater awareness and education about EADs; (2) people with EADs must receive a timely, accurate diagnosis; (3) all people with EADs must have access to an appropriate multidisciplinary team, when necessary; and (4) people with EADs must have access to safe and effective treatment options without unnecessary regulatory delays. The principles described in this charter demonstrate the core elements of quality care that people with EADs must receive, and they represent clear steps by which to reduce patient and caregiver burden and improve patient outcomes. We urge HCPs, healthcare systems, and policymakers worldwide to swiftly adopt these principles to ensure patients with EADs have an accurate diagnosis in a timely manner and access to high-level care and treatment in an appropriate setting.
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18
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Liva GA, Karatzanis AD, Prokopakis EP. Review of Rhinitis: Classification, Types, Pathophysiology. J Clin Med 2021; 10:jcm10143183. [PMID: 34300349 PMCID: PMC8303640 DOI: 10.3390/jcm10143183] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with considerable morbidity and financial burden on health care systems worldwide. Its economic impact is further emphasized by the fact that it represents a risk factor for other conditions such as sinusitis, asthma, learning disabilities, behavioral changes, and psychological impairment. Rhinitis may be associated with many etiologic triggers such as infections, immediate-type allergic responses, inhaled irritants, medications, hormonal disturbances, and neural system dysfunction. It is basically classified into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). However, this subdivision may be considered as an oversimplification because a combined (mixed) phenotype exists in many individuals and different endotypes of rhinitis subgroups are overlapping. Due to the variety of pathophysiologic mechanisms (endotypes) and clinical symptoms (phenotypes), it is difficult to develop clear guidelines for diagnosis and treatment. This study aims to review the types of allergic and non-allergic rhinitis, providing a thorough analysis of the pathophysiological background, diagnostic approach, and main treatment options.
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19
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Van Bulck P, Cools L, Soumya MS, Nyembue DT, Kabobo P, Zhang L, Scadding GK, Toskala E, Fokkens WJ, Steelant B, Hellings PW. A multicenter real-life study on the multiple reasons for uncontrolled allergic rhinitis. Int Forum Allergy Rhinol 2021; 11:1452-1460. [PMID: 34259380 DOI: 10.1002/alr.22808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent data show uncontrolled disease in 35% of allergic rhinitis (AR) patients on medical treatment. The reasons for uncontrolled disease can arbitrarily be divided into disease-related, diagnosis-related, treatment-related, and patient-related factors. However, the relative importance of these factors in uncontrolled disease remains speculative. This explorative study aimed at determining the factors causing uncontrolled AR on four different continents worldwide, identifying the most common reasons for uncontrolled disease in AR. METHODS Patients with uncontrolled AR (n = 430) were asked to fill out a questionnaire and underwent a clinical examination at the outpatient clinic in five university outpatient clinics (Leuven [Belgium], Beijing [China], Kinshasa [Congo], Bangalore [India], and Philadelphia [US]). Two independent physicians evaluated the reason or multiple reasons for uncontrolled disease. The study was coordinated from the University Hospital of Leuven. RESULTS In uncontrolled AR patients, 76% of patients showed two or more reasons for uncontrolled disease according to the physicians' evaluation. Disease-related factors (64%) were considered most often the reason for uncontrolled disease, followed by treatment- (56%), patient- (54%), and diagnosis-related (47%) factors. There is limited variability in observations across different centers worldwide. CONCLUSION We here define the multiple reasons for uncontrolled AR across different continents, with disease-related factors being most frequently associated with uncontrolled disease. A better understanding of uncontrolled disease will guide us in defining strategies to improve AR care.
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Affiliation(s)
- Pauline Van Bulck
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Leen Cools
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Mysore S Soumya
- Department of ENT, St John's Medical College Hospital, Bangalore, India
| | - Dieudonné T Nyembue
- Department of Otolaryngology, University Hospitals Kinshasa, Kinshasa, Congo
| | - Patricia Kabobo
- Department of Otolaryngology, University Hospitals Kinshasa, Kinshasa, Congo
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Glenis K Scadding
- ENT Department Royal National Ear Nose and Throat Hospital, London, UK
| | - Elina Toskala
- Department of Otolaryngology, Head and Neck Surgery, Temple University School of Medicine, Philadelphia, USA
| | - Wytske J Fokkens
- Department of Otolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Brecht Steelant
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research unit, Leuven, Belgium
| | - Peter W Hellings
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Otolaryngology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
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20
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The Effectiveness of the Bacteria Derived Extremolyte Ectoine for the Treatment of Allergic Rhinitis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5562623. [PMID: 34159193 PMCID: PMC8187048 DOI: 10.1155/2021/5562623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
Nonpharmacological therapies with a good tolerability and safety profile are of interest to many patients with allergic rhinitis, as a relevant proportion of them have reservations about guideline-concordant pharmacological therapies due to their local irritations and side effects. Ectoine is a bacterial-derived extremolyte with an ability to protect proteins and biological membranes against damage caused by extreme conditions of salinity, drought, irradiation, pH, and temperature. Evidence from preclinical and clinical studies attests its effectiveness in the treatment of several inflammatory diseases, including allergic rhinitis. In this review, we analyzed 14 recent clinical trials investigating ectoine nasal spray in patients with allergic rhinitis and/or conjunctivitis, including sensitive patient groups like children or pregnant women. Some studies investigated monotherapy with ectoine; others investigated combination therapy of ectoine and an antihistamine or a corticosteroid. Analysis of the study results demonstrated that patients with mild-to-moderate symptoms of allergic rhinitis can be successfully treated with ectoine-containing nasal spray. When applied as monotherapy, ectoine exerted noninferior effects compared to first-line therapies such as antihistamines and cromoglicic acid. Using ectoine as an add-on therapy to antihistamines or intranasal glucocorticosteroids accelerated symptom relief by days and improved the level of symptom relief. Importantly, concomitant treatment with ectoine was proven beneficial in a group of difficult-to-treat patients suffering from moderate-to-severe rhinitis symptoms. Taken together, the natural substance ectoine represents a viable alternative for allergic rhinitis and conjunctivitis patients who wish to avoid local reactions and side effects associated with pharmacological therapies.
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21
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Huang Y, Wang C, Zhang Y, Zhang L. Developing nomograms for identifying allergic rhinitis among chronic rhinitis: A real-world study. World Allergy Organ J 2021; 14:100534. [PMID: 33912321 PMCID: PMC8054181 DOI: 10.1016/j.waojou.2021.100534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/10/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background It is difficult to discriminate allergic rhinitis (AR) and nonallergic rhinitis (NAR) in clinical practice due to the similar clinical manifestations. The study was to assess both the demographical and clinical features of AR and NAR in the real-world data of outpatients in China. Methods It was a cross-sectional real-world study. AR and NAR were defined based on both subjective symptoms and objective specific serum IgE test. General demographic characteristics as well as clinical information were documented. Patients were further classified according the seasons of initial visiting hospital (during pollen seasons or not). A scoring system presented as nomograms for presence of AR was performed. Results In the pollen season group, age distribution, the duration of rhinitis, comorbidity of asthma, food allergies, and score of coughing were found significantly associated with AR. Additionally, in the non-pollen season group, we found that ethnicity, age distributions, duration of rhinitis, comorbidity of asthma, food allergies, and family history of allergy, together with scores of gritty eyes were associated factors of AR. Based on multivariate logistic model, we built two nomograms which included previously identified significant risk factors that could be acquired easily during clinical practice with predictive variables to assess their roles in predicting the risk of AR among outpatients with rhinitis. Conclusions The characteristics of patients with different phenotypes of chronic rhinitis are distinctive in different seasons and the developed nomogram in this study might be beneficial for clinical practice.
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Affiliation(s)
- Yanran Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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22
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Vlastos I, Mullol J, Hox V, Doulaptsi M, Seys S, Hellings P, Prokopakis E. Multidisciplinary Care for Severe or Uncontrolled Chronic Upper Airway Diseases. Curr Allergy Asthma Rep 2021; 21:27. [PMID: 33791881 DOI: 10.1007/s11882-021-01004-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW A multidisciplinary approach is regarded as the best practice for many chronic diseases, such as cancer and asthma, with well-documented value. There is also evidence that it may be beneficial to patients with chronic rhinosinusitis (CRS) and/or allergic airway disease presenting to tertiary referral centres. We discuss here whether and how organizing this kind of healthcare transition into a more integrated care pathway would benefit severe chronic upper airways disease (SCUAD) management. RECENT FINDINGS Based on a recent related EUFOREA panel discussion, literature search, and review of the best overseas practices, an appropriate implementation strategy of multidisciplinary care and its potential results are presented. Organizational principles, hurdles, and challenges of the process, as well as envisaged solutions and results, are being reported. The efficiency of care and the quality control assessment are concepts that are currently gaining importance. At the same time, novel treatment options based on molecular and precision medicine advancements, such as biologics, are being increasingly prescribed. Appropriately organized multidisciplinary care teams can adapt to new demands, data, and discoveries to assure maximum benefit for both patients and healthcare professionals.
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Affiliation(s)
- Ioannis Vlastos
- Department of Otorhinolaryngology, University of Crete School of Medicine, Crete, Greece
- Department of Otorhinolaryngology, Aghia Sophia Children's Hospital, Athens, Greece
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Universitat de Barcelona; Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; and CIBERES, Barcelona, Catalonia, Spain
| | - Valerie Hox
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Maria Doulaptsi
- Department of Otorhinolaryngology, University of Crete School of Medicine, Crete, Greece
| | - Sven Seys
- Allergy & Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Peter Hellings
- Allergy & Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
- Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Crete, Greece.
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23
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Bilstein A, Heinrich A, Rybachuk A, Mösges R. Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8885032. [PMID: 33628826 PMCID: PMC7889333 DOI: 10.1155/2021/8885032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
The ocular surface is facing various unspecific stress factors resulting in irritation and inflammation of the epithelia, causing discomfort to the patients. Ectoine is a bacteria-derived extremolyte with the ability to protect proteins and biological membranes from damage caused by extreme environmental conditions like heat, UV-light, high osmolarity, or dryness. Evidence from preclinical and clinical studies attest its effectiveness in treating several epithelium-associated inflammatory diseases, including the eye surface. In this review, we analysed 16 recent clinical trials investigating ectoine eye drops in patients with allergic conjunctivitis or with other unspecific ocular inflammations caused by e.g. ophthalmic surgery. Findings from these studies were reviewed in context with other published work on ectoine. In summary, patients with irritations and unspecific inflammations of the ocular surface have been treated successfully with ectoine-containing eye drops. In these patients, significant improvement was observed in ocular symptoms of allergic rhinoconjunctivitis, postoperative secondary dry eye syndrome, or ocular reepithelisation after surgery. Using ectoine as an add-on therapy to antihistamines, in allergy patients accelerated symptom relief by days, and its use as an add-on to antibiotics resulted in faster wound closure. Ectoine is a natural substance with an excellent tolerability and safety profile thus representing a helpful alternative for patients with inflammatory irritation of the ocular surface, who wish to avoid local reactions and side effects associated with pharmacological therapies or wish to increase the efficacy of standard treatment regimen.
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Affiliation(s)
| | | | - Anna Rybachuk
- Bogomolets National Medical University, Department of Oral and Maxillofacial Surgery, Tarasa Shevchenko Blvd, 13, Kiev, Ukraine 01601
- State Institution “O.S. Kolomiychenko Institute of Otolaryngology of the National Academy of Medical Sciences of Ukraine”, Zoolohichna St, 3, Kiev, Ukraine 03057
| | - Ralph Mösges
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- CRI Ltd., Genter Str. 7, 50672 Cologne, Germany
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24
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Bogdan MS, Slavic DO, Babovic SS, Zvezdin BS, Kolarov VP, Kljajic VL. Olfactory Perception and Different Decongestive Response of the Nasal Mucosa During Menstrual Cycle. Am J Rhinol Allergy 2021; 35:693-699. [PMID: 33496600 DOI: 10.1177/1945892421990308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sex hormones are known to have some influence on nasal functions, but their effect on the decongestive response of the nasal mucosa during menstrual cycle is still undetermined. OBJECTIVES The aim of this study was to examine the nasal physiology, the interconnectedness of olfactory and respiratory nasal function and the decongestive response of the nasal mucosa during menstrual cycle. METHODS This study included 101 healthy women aged 23.26 ± 4.81 years with a regular menstrual cycle. The nasal respiratory function and the decongestive response of the nasal mucosa were examined by rhinomanometry. Subjective sense of nasal obstruction and the subjective odor intensity were assessed by standardized questionnaires. The odor identification ability was assessed by Sniffin' Sticks test. RESULTS Statistically significant higher values of nasal resistance (0.311 ± 0.107 Pa/cm3/s) and NOSE score (11.893 ± 13.83) were observed in the ovulatory phase compared to the luteal (0.281 ± 0.084 Pa/cm3/s and 9.029 ± 11.12). An odor identification test score was significantly higher in luteal phase (12.476 ± 1.48) compared to the ovulatory phase (11.971 ± 1.51), opposite of odor intensity. The difference of nasal resistance before and after decongestion was significantly higher in ovulatory phase (0.105 ± 0.097 Pa/cm3/s) compared to the luteal (0.084 ± 0.079 Pa/cm3/s). Correlation between subjective and objective parameters of the examinated nasal functions was not statistically significant in any menstrual phase. CONCLUSION In the population of women studied, total nasal resistance and NOSE score were significantly lower in the luteal phase of the menstrual cycle. Odor identification was significantly higher in the luteal phase but odor intensity significantly higher in the ovulatory phase. The decongestive response of nasal mucosa was better in the ovulatory phase of the menstrual cycle.
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Affiliation(s)
- Maja S Bogdan
- The Clinic for Obstructive Pulmonary Diseases and Acute Pneumopathies, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | | | - Biljana S Zvezdin
- The Clinic for Obstructive Pulmonary Diseases and Acute Pneumopathies, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Violeta P Kolarov
- The Clinic for Obstructive Pulmonary Diseases and Acute Pneumopathies, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir L Kljajic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Clinical Centre of Vojvodina, Clinic for Otorhinolaryngology and Head and Neck Surgery, Novi Sad, Serbia
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25
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Woo SD, Lee SH, Ye YM, Kim SC, Lee Y, Shin YS, Park HS. A Prospective Study to Compare Clinical Outcomes of Allergic Rhinitis Between Older and Younger Adults: A Potential Effect of Depression in Older Patients. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:339-346. [PMID: 33474866 PMCID: PMC7840878 DOI: 10.4168/aair.2021.13.2.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/02/2022]
Abstract
Although younger patients with allergic rhinitis (AR) have been successfully treated with pharmacotherapy, there are no definitive data on treatment outcomes in older patients with AR. We performed a prospective study of 51 older adults with AR (aged over 65 years) and 101 younger AR patients (aged from 19 to 40 years) to compare clinical outcomes between the 2 groups and to evaluate the impact of depressed mood on treatment outcomes in older AR patients. Changes in total symptom scores (TSS), rhinitis-specific quality of life questionnaire (RQLQ) results, rhinitis control assessment test (RCAT) results and visual analog scale (VAS) scores were evaluated after 4-week treatment according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guideline, and the severity of depressed mood was assessed by using the geriatric depression scale. After 4-week treatment, younger AR patients had greater improvements in clinical scores compared with older adults; differences in least squares mean changes from baseline in older patients vs. younger patients were 1.71 (P = 0.004) for TSS, 10.84 (P < 0.001) for RQLQ, 0.80 (P = 0.275) for RCAT, and 8.60 for VAS score (P = 0.061). Multiple logistic regression analysis showed that the severity of depressed mood was independently associated with severe chronic upper airway disease (adjusted odds ratio, 1.385; P = 0.004). Our results suggest that older AR patients are less responsive to standard treatment compared with younger AR patients and that depressed mood is strongly associated with the increased risk of uncontrolled AR in older AR patients.
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Affiliation(s)
- Seong Dae Woo
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - So Hee Lee
- 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
| | - Su Chin Kim
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Youngsoo Lee
- 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
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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26
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Scadding GK. Grand Challenges in Rhinology. FRONTIERS IN ALLERGY 2020; 1:584518. [PMID: 35386931 PMCID: PMC8974793 DOI: 10.3389/falgy.2020.584518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Glenis K. Scadding
- University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
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27
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Pokharel M, Shrestha BL, Karn D, Dhakal A, Kc AK, Shrestha KS, Shakya S. Prevalence of Aeroallergens in Allergic Rhinitis in a Tertiary Care Hospital. JNMA J Nepal Med Assoc 2020; 58:866-870. [PMID: 34506424 PMCID: PMC7775014 DOI: 10.31729/jnma.5218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The prevalence of allergic rhinitis has increased significantly globally over the last two decades. Detection of sensitizing aeroallergens plays a crucial role in the diagnosis and management of this troublesome disease. This study aims to investigate the spectrum of aeroallergens sensitization in patients with allergic rhinitis in a tertiary care hospital. METHODS A descriptive cross-sectional study conducted in the Department of Otorhinolaryngology of our hospital between January 2016 to December 2019. Ethical approval was taken from the Institutional Review Committee (No: 210/19). Patients diagnosed with allergic rhinitis were enrolled using the convenience sampling technique. Data entry and analysis was done using IBM Statistical Package for Social Sciences version 20.0. RESULTS Among 170 patients, altogether 103 (60.6%) patients yielded positive responses on the skin prick test. The most prevalent aeroallergens were Lepidoglyphus 86 (50.60%), Dermatophagoides pteronyssinus 85 (50%), Dermatophagoides farina 82 (48.20%), Thyrophagus 50 (29.40%), Blomia 46 (27.10%), Acarus 43 (25.30%), cat dander 26 (15.30%), dog dander 24 (14.10%), cow and buffalo dander 20 (11.8%), ragweed 20 (11.8%), grass pollen 18 (10.60%) and mugwort 17 (10%). CONCLUSIONS This study highlights that the frequency of aeroallergens based on skin prick test in patients presenting to a tertiary care hospital which showed the dominance of house dust mites, dog and cat hair, pollen, and grasses. Reduced exposure and training of patients about protection against these agents will possibly help in controlling the severity of allergic rhinitis in this region.
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Affiliation(s)
- Monika Pokharel
- Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University School of Medical Sciences Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Bikash Lal Shrestha
- Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University School of Medical Sciences Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Dharmendra Karn
- Department of Dermatology, Kathmandu University School of Medical Sciences Dhulikhel Hospital, Dhulikhel, Kavre, Nepal.
| | - Ashish Dhakal
- Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University School of Medical Sciences Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Abha Kiran Kc
- Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University School of Medical Sciences Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Krishna Sundar Shrestha
- Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University School of Medical Sciences Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Sushan Shakya
- Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University School of Medical Sciences Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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Pfaar O, Gerth van Wijk R, Klimek L, Bousquet J, Creticos PS. Clinical trials in allergen immunotherapy in the age group of children and adolescents: current concepts and future needs. Clin Transl Allergy 2020; 10:11. [PMID: 32346471 PMCID: PMC7181492 DOI: 10.1186/s13601-020-00314-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
Allergen immunotherapy (AIT) is the only treatment option available for allergic patients with disease-modifying intention. Both efficacy and safety has been demonstrated for multiple trials in children, adolescents and adults. Though regulatory requirements for marketing authorization have been clearly outlined and an increasing number of high quality trials has been initiated, multiple concepts and details in study design may be further elaborated, harmonized and improved. An international group of experts in the field of AIT has thoroughly reviewed and discussed current concepts and provided an outlook on further improvement especially in the age group of children and adolescents. Emphasis of the group's discussion as a basis for this article was put on (i) the regulatory background of marketing authorization of AIT products including the 'Pediatric Investigational Plan', (ii) patient reported outcomes and endpoints in AIT trials, (iii) considerations regarding the 'minimal clinically important difference', (iv) the role of placebo effects in AIT clinical trials and clinical routine and (v) the potential of mobile Health for future development of AIT. Current concepts in AIT have been optimized throughout the recent decades, but there remains room for improvement e.g., in the topics outlined in this article.
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Affiliation(s)
- O Pfaar
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - R Gerth van Wijk
- 2Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - J 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.,5INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France, Universite Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - P S Creticos
- 6Division of Allergy & Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, MD 21224 USA.,Creticos Research Group, Crownsville, MD 21032 USA
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Feleszko W, Rossi GA, Krenke R, Canonica GW, Van Gerven L, Kalyuzhin O. Immunoactive preparations and regulatory responses in the respiratory tract: potential for clinical application in chronic inflammatory airway diseases. Expert Rev Respir Med 2020; 14:603-619. [PMID: 32250709 DOI: 10.1080/17476348.2020.1744436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The prevalence of chronic inflammatory airway diseases is rising. Their treatment with corticosteroids increases infection risk, while overuse of antimicrobial agents may increase morbidity and antimicrobial resistance. Nonspecific immunomodulatory compounds alter immune responses to both infectious and atopic challenges. These compounds may offer an alternative approach for symptom reduction and prophylaxis against both infections and exacerbations in chronic inflammatory airway disease.Areas covered: We assessed the available data on the efficacy of nonspecific immunomodulators including bacterial lysates, synthetic compounds, and vaccines in chronic rhinosinusitis (CRS); allergic and non-allergic rhinitis; chronic obstructive pulmonary disease (COPD), and asthma. A search of PubMed was carried out using the 'Clinical Trials' filter for each condition and immunomodulatory product detailed below, where available, data from meta-analyses were reported.Expert opinion: Pre-clinical data has revealed a coherent mechanistic path of action for oral immunomodulators on the respiratory immune system, principally via the gut-lung immune axis. In patients with asthma, allergic rhinitis, CRS, and COPD immunomodulatory therapy reduces symptoms, exacerbations, hospitalizations, and drug consumption. However, data are heterogeneous, and study quality remains limited. A lack of high-quality recent trials remains the major unmet research need in the field.
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Affiliation(s)
- Wojciech Feleszko
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Giovanni A Rossi
- Chief Emeritus, Pediatric Pulmonology and Allergy Units, Cystic Fibrosis Regional Centre, IRCCS G. Gaslini, Genoa, Italy
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases & Allergy, Medical University of Warsaw, Warsaw, Poland
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy, Clinic-Humanitas University & Research Hospital, Milan, Italy
| | - Laura Van Gerven
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Oleg Kalyuzhin
- Professor of Department of Clinical Immunology and Allergy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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30
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Bousquet J, Anto JM, Bachert C, Bosnic-Anticevich S, Erhola M, Haahtela T, Hellings PW, Kuna P, Pfaar O, Samolinski B, Schünemann HJ, Sheikh A, Wallace D. From ARIA guidelines to the digital transformation of health in rhinitis and asthma multimorbidity. Eur Respir J 2019; 54:54/6/1901023. [PMID: 31801821 DOI: 10.1183/13993003.01023-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Jean Bousquet
- University Hospital Montpellier, Montpellier, France .,MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France.,INSERM U 1168, VIMA: Ageing and chronic diseases, Epidemiological and public health approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France.,Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Dept of Dermatology and Allergy, Berlin, Germany
| | - Josep M Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Woolcock Emphysema Centre and Sydney Local Health District, Glebe, Australia
| | - Marina Erhola
- National Insitute for Health and Welfare, Helsinki, Finland
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Peter W Hellings
- Dept of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Oliver Pfaar
- Dept of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Marburg, Germany
| | - Boleslaw Samolinski
- Dept of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Holger J Schünemann
- Dept of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, FL, USA
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31
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Bousquet J, Pfaar O, Togias A, Schünemann HJ, Ansotegui I, Papadopoulos NG, Tsiligianni I, Agache I, Anto JM, Bachert C, Bedbrook A, Bergmann K, Bosnic‐Anticevich S, Bosse I, Brozek J, Calderon MA, Canonica GW, Caraballo L, Cardona V, Casale T, Cecchi L, Chu D, Costa E, Cruz AA, Czarlewski W, Durham SR, Du Toit G, Dykewicz M, Ebisawa M, Fauquert JL, Fernandez‐Rivas M, Fokkens WJ, Fonseca J, Fontaine J, Gerth van Wijk R, Haahtela T, Halken S, Hellings PW, Ierodiakonou D, Iinuma T, Ivancevich JC, Jacobsen L, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kleine Tebbe J, Klimek L, Kowalski ML, Kuna P, Kvedariene V, La Grutta S, Larenas‐Linemann D, Lau S, Laune D, Le L, Lodrup Carlsen K, Lourenço O, Malling H, Marien G, Menditto E, Mercier G, Mullol J, Muraro A, O’Hehir R, Okamoto Y, Pajno GB, Park H, Panzner P, Passalacqua G, Pham‐Thi N, Roberts G, Pawankar R, Rolland C, Rosario N, Ryan D, Samolinski B, Sanchez‐Borges M, Scadding G, Shamji MH, Sheikh A, Sturm GJ, Todo Bom A, Toppila‐Salmi S, Valentin‐Rostan M, Valiulis A, Valovirta E, Ventura M, Wahn U, Walker S, Wallace D, Waserman S, Yorgancioglu A, Zuberbier T. 2019 ARIA Care pathways for allergen immunotherapy. Allergy 2019; 74:2087-2102. [PMID: 30955224 DOI: 10.1111/all.13805] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 01/02/2023]
Abstract
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
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Affiliation(s)
- Jean Bousquet
- MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
- INSERM U 1168, VIMA : Ageing and Chronic Diseases Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- Euforea Brussels Belgium
- Charité‐Universitätsmedizin Berlin, Humboldt‐Universität zu Berlin Berlin Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation (DAIT) National Institute of Allergy and Infectious Diseases, NIH Bethesda Maryland
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | | | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, 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
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
| | - Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Josep M. Anto
- Centre for Research in Environmental Epidemiology (CREAL) ISGlobAL Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Claus Bachert
- ENT Department, Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium
| | - Anna Bedbrook
- MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
| | - Karl‐Christian Bergmann
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GALEN, Humboldt‐Uniersität zu Berlin Berlin Germany
| | - Sinthia Bosnic‐Anticevich
- Woolcock Institute of Medical Research, Woolcock Emphysema Centre and Local Health District University of Sydney Glebe New South Wales Australia
| | | | - Jan Brozek
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Moises A. Calderon
- Imperial College London ‐ National Heart and Lung Institute Royal Brompton Hospital NHS London UK
| | - Giorgio W. Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Research Hospital Humanitas University Milan Italy
| | - Luigi Caraballo
- Institute for Immunological Research University of Cartagena, Campus de Zaragocilla Cartagena Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb) Cartagena Colombia
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona Spain
| | - Thomas Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy
| | - Derek Chu
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Elisio Costa
- UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Salvador Brazil
- WHO GARD Planning Group Salvador Brazil
| | | | - Stephen R. Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute Imperial College London London UK
| | - George Du Toit
- Guy's and st Thomas' NHS Trust, Kings College London London UK
| | - Mark Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
| | - Jean Luc Fauquert
- Unité de pneumo‐allergologie de l'enfant, pôle pédiatrique CHU de Clermont‐Ferrand‐Estaing Clermont‐Ferrand France
| | | | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centres Amsterdam The Netherlands
| | - João Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
- Medida, Lda Porto Portugal
| | | | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology Erasmus MC Rotterdam The Netherlands
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark
| | - Peter W. Hellings
- Department of Otorhinolaryngology University Hospitals Leuven Leuven Belgium
- Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
| | - Tomohisa Iinuma
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | | | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy Poltava Ukraine
| | - Musa Khaitov
- Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology National Research Center Moscow Russian Federation
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey
| | | | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek L. Kowalski
- Department of Immunology and Allergy, Healthy Ageing Research Center Medical University of Lodz Lodz Poland
- Sach's Children and Youth Hospital, Södersjukhuset Stockholm Sweden
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital Medical University of Lodz Lodz Poland
| | - Violeta Kvedariene
- Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences Vilnius University Vilnius Lithuania
- Faculty of Medicine, Institute of Clinical medicine, Clinic of Chest diseases and Allergology Vilnius University Vilnius Lithuania
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology (IBIM) National Research Council (CNR) Palermo Italy
| | - Désirée Larenas‐Linemann
- Center of Excellence in Asthma and Allergy Médica Sur Clinical Foundation and Hospital México City Mexico
| | - Susanne Lau
- Department of Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany
| | | | - Lan Le
- University of Medicine and Pharmacy Hochiminh City Vietnam
| | - Karin Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBI, Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | | | | | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics University of Naples Federico II Naples Italy
| | - Gregoire Mercier
- Département de l’Information Médicale, Unité Médico‐Economie University Hospital Montpellier France
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department Hospital Clínic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy IDIBAPS, CIBERES, University of Barcelona Barcelona Spain
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health Padua General University Hospital Padua Italy
| | - Robyn O’Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Giovanni B. Pajno
- Department of Pediatrics, Allergy Unit University of Messina Messina Italy
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Petr Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino ‐University of Genoa Genoa Italy
| | | | - Graham Roberts
- David Hide Centre, St Mary's Hospital Isle of Wight and University of Southampton Southampton UK
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | | | | | - Dermot Ryan
- Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
| | - Bolesław Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico‐Docente La Trinidad Caracas Venezuela
| | - Glenis Scadding
- The Royal National TNE Hospital University College London London UK
| | - Mohamed H. Shamji
- Immunomodulation and Tolerance Group Imperial College London London UK
- Allergy and Clinical Immunology Imperial College London London UK
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - Gunter J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
- Outpatient Allergy Clinic Reumannplatz Vienna Austria
| | - Ana Todo Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
| | | | - Arunas Valiulis
- Clinic of Children's Diseases Vilnius University Institute of Clinical Medicine Vilnius Lithuania
- Department of Public Health Institute of Health Sciences Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic University of Turku Turku Finland
| | - Maria‐Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Ulrich Wahn
- Pediatric Department Charité, Berlin Germany
| | | | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Faculty of Medicine Celal Bayar University Manisa Turkey
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GALEN, Humboldt‐Uniersität zu Berlin Berlin Germany
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Bousquet J, Schünemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, Klimek L, Pfaar O, Wallace D, Ansotegui I, Agache I, Bedbrook A, Bergmann KC, Bewick M, Bonniaud P, Bosnic-Anticevich S, Bossé I, Bouchard J, Boulet LP, Brozek J, Brusselle G, Calderon MA, Canonica WG, Caraballo L, Cardona V, Casale T, Cecchi L, Chu DK, Costa EM, Cruz AA, Czarlewski W, D'Amato G, Devillier P, Dykewicz M, Ebisawa M, Fauquert JL, Fokkens WJ, Fonseca JA, Fontaine JF, Gemicioglu B, van Wijk RG, Haahtela T, Halken S, Ierodiakonou D, Iinuma T, Ivancevich JC, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kleine Tebbe J, Kowalski ML, Kuna P, Kvedariene V, La Grutta S, Larenas-Linnemann D, Lau S, Laune D, Le L, Lieberman P, Lodrup Carlsen KC, Lourenço O, Marien G, Carreiro-Martins P, Melén E, Menditto E, Neffen H, Mercier G, Mosgues R, Mullol J, Muraro A, Namazova L, Novellino E, O'Hehir R, Okamoto Y, Ohta K, Park HS, Panzner P, Passalacqua G, Pham-Thi N, Price D, Roberts G, Roche N, Rolland C, Rosario N, Ryan D, Samolinski B, Sanchez-Borges M, Scadding GK, Shamji MH, Sheikh A, Bom AMT, Toppila-Salmi S, Tsiligianni I, Valentin-Rostan M, Valiulis A, Valovirta E, Ventura MT, Walker S, Waserman S, Yorgancioglu A, Zuberbier T. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol 2019; 145:70-80.e3. [PMID: 31627910 DOI: 10.1016/j.jaci.2019.06.049] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/07/2019] [Accepted: 06/12/2019] [Indexed: 01/16/2023]
Abstract
The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on many factors. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines have considerably improved the treatment of allergic rhinitis. However, there is an increasing trend toward use of real-world evidence to inform clinical practice, especially because randomized controlled trials are often limited with regard to the applicability of results. The Contre les Maladies Chroniques pour un Vieillissement Actif (MACVIA) algorithm has proposed an allergic rhinitis treatment by a consensus group. This simple algorithm can be used to step up or step down allergic rhinitis treatment. Next-generation guidelines for the pharmacologic treatment of allergic rhinitis were developed by using existing GRADE-based guidelines for the disease, real-world evidence provided by mobile technology, and additive studies (allergen chamber studies) to refine the MACVIA algorithm.
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Affiliation(s)
- Jean Bousquet
- MACVIA-France, Fondation Partenariale FMC VIA-LR, Montpellier, France; VIMA, INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, France, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, Euforea, Brussels, Belgium and Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany.
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Akdis Togias
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - Martina Erhola
- National Institute for Health and Welfare, Helsinki, Finland
| | - Peter W Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, and Academic Medical Center, University of Amsterdam, The Netherlands, and Euforea, Brussels, Belgium
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Fla
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Anna Bedbrook
- MACVIA-France, Fondation Partenariale FMC VIA-LR, Montpellier, France
| | - Karl-Christian Bergmann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, member of GA(2)LEN, Berlin, Germany
| | | | | | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Woolcock Emphysema Centre and Sydney Local Health District, Glebe, Australia
| | | | | | | | - Jan Brozek
- Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Moises A Calderon
- Imperial College London-National Heart and Lung Institute, Royal Brompton Hospital NHS, London, United Kingdom
| | - Walter G Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer Piso, and the Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
| | - Vicky Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL research network, Barcelona, Spain
| | - Thomas Casale
- the Division of Allergy/Immunology, University of South Florida, Tampa, Fla
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Elisio M Costa
- UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork), University of Porto, Porto, Portugal
| | - Alvaro A Cruz
- ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, and the WHO GARD Planning Group, Bahia, Brazil
| | | | - Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Hospital "A Cardarelli", University of Naples Federico II, Naples, Italy
| | - Philippe Devillier
- UPRES EA220, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France; Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mark Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, St Louis, Mo
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - Jean-Louis Fauquert
- Unité de pneumo-allergologie de l'enfant, pôle pédiatrique Pr-Labbé, CHU de Clermont-Ferrand-Estaing, Clermont-Ferrand, France
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Joao A Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, and Medida, Porto, Portugal
| | | | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Roy Gerth van Wijk
- Department of Internal Medicine, section of Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete and International Primary Care Respiratory Group, Crete, Greece
| | - Tomohisa Iinuma
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | | | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland
| | - Igor Kaidashev
- Ukrainina Medical Stomatological Academy, Poltava, Ukraine
| | - Musa Khaitov
- National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology, Moscow, Russia
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - Jorg Kleine Tebbe
- Allergy & Asthma Center Westend, Outpatient & Clinical Research Center, Berlin, Germany
| | - Marek L Kowalski
- Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Lodz, Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University and Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
| | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, Mexico City, Mexico
| | - Susanne Lau
- Department of Paediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin, Berlin, Germany
| | | | - Lan Le
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Philipp Lieberman
- Departments of Internal Medicine and Pediatrics (Divisions of Allergy and Immunology), University of Tennessee College of Medicine, Germantown, Tenn
| | - Karin C Lodrup Carlsen
- Oslo University Hospital, Department of Paediatrics, Oslo, and University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Olga Lourenço
- Faculty of Health Sciences and CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - Pedro Carreiro-Martins
- Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, and Nova Medical School, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisbon, Portugal
| | - Erik Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
| | - Hugo Neffen
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, and the Center for Allergy and Immunology, Santa Fe, Argentina
| | - Gregoire Mercier
- Unité Médico-Economie, Département de l'Information Médicale, University Hospital, Montpellier, France
| | - Ralph Mosgues
- Institute of Medical Statistics, and Computational Biology, Medical Faculty, University of Cologne, and Clinical Research International, Hamburg, Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, and Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Leyla Namazova
- Scientific Centre of Children's Health under the MoH, Moscow, and Russian National Research Medical University named Pirogov, Moscow, Russia
| | - Ettore Novellino
- Department of Pharmacy of University of Naples Federico II, Naples, Italy
| | - Robyn O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, and the Department of Immunology, Monash University, Melbourne, Australia
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Petr Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, Ospedale Policlino San Martino-University of Genoa, Genoa, Italy
| | - Nhan Pham-Thi
- Allergy Department, Pasteur Institute, Paris, France
| | - David Price
- Observational and Pragmatic Research Institute, Singapore
| | - Graham Roberts
- David Hide Centre, St Mary's Hospital, Isle of Wight, and University of Southampton, Southampton, United Kingdom
| | - Nicolas Roche
- Pneumologie et Soins Intensifs Respiratoires, Hôpitaux Universitaires Paris, and Hôpital Cochin, Paris, France
| | | | - Nelson Rosario
- Hospital de Clinicas, University of Parana, Parana, Brazil
| | - Dermot Ryan
- Allergy and Respiratory Research Group, University of Edinburgh, Edinburgh, United Kingdom
| | - Boleslaw Samolinski
- Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela
| | - Glenis K Scadding
- Royal National TNE Hospital, University College London, London, United Kingdom
| | - Mohamed H Shamji
- Immunomodulation and Tolerance Group and Allergy and Clinical Immunology, Imperial College London, London, United Kingdom
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Ana-Maria Todo Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ioana Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete and International Primary Care Respiratory Group, Crete, Greece
| | | | - Arunas Valiulis
- Vilnius University Institute of Clinical Medicine, Clinic of Children's Diseases, and Institute of Health Sciences, Department of Public Health, Vilnius, Mexico, and the European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | - Maria-Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | | | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, member of GA(2)LEN, Berlin, Germany
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33
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Bosnic‐Anticevich S, Costa E, Menditto E, Lourenço O, Novellino E, Bialek S, Briedis V, Buonaiuto R, Chrystyn H, Cvetkovski B, Di Capua S, Kritikos V, Mair A, Orlando V, Paulino E, Salimäki J, Söderlund R, Tan R, Williams DM, Wroczynski P, Agache I, Ansotegui IJ, Anto JM, Bedbrook A, Bachert C, Bewick M, Bindslev‐Jensen C, Brozek JL, Canonica GW, Cardona V, Carr W, Casale TB, Chavannes NH, Correia de Sousa J, Cruz AA, Czarlewski W, De Carlo G, Demoly P, Devillier P, Dykewicz MS, Gaga M, El‐Gamal Y, Fonseca J, Fokkens WJ, Guzmán MA, Haahtela T, Hellings PW, Illario M, Ivancevich JC, Just J, Kaidashev I, Khaitov M, Khaltaev N, Keil T, Klimek L, Kowalski ML, Kuna P, Kvedariene V, Larenas‐Linnemann DE, Laune D, Le LTT, Lodrup Carlsen KC, Mahboub B, Maier D, Malva J, Manning PJ, Morais‐Almeida M, Mösges R, Mullol J, Münter L, Murray R, Naclerio R, Namazova‐Baranova L, Nekam K, Nyembue TD, Okubo K, O'Hehir RE, Ohta K, Okamoto Y, Onorato GL, Palkonen S, Panzner P, Papadopoulos NG, Park H, Pawankar R, Pfaar O, Phillips J, Plavec D, Popov TA, Potter PC, Prokopakis EP, Roller‐Wirnsberger RE, Rottem M, Ryan D, Samolinski B, Sanchez‐Borges M, Schunemann HJ, Sheikh A, Sisul JC, Somekh D, Stellato C, To T, Todo‐Bom AM, Tomazic PV, Toppila‐Salmi S, Valero A, Valiulis A, Valovirta E, Ventura MT, Wagenmann M, Wallace D, Waserman S, Wickman M, Yiallouros PK, Yorgancioglu A, Yusuf OM, Zar HJ, Zernotti ME, Zhang L, Zidarn M, Zuberbier T, Bousquet J. ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project. Allergy 2019; 74:1219-1236. [PMID: 30565275 DOI: 10.1111/all.13701] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/22/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Abstract
Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
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Affiliation(s)
- Sinthia Bosnic‐Anticevich
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Elisio Costa
- UCIBIO REQUIMTE Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
| | | | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | - Ettore Novellino
- Department of Pharmacy of University of Naples Federico II Naples Italy
| | - Slawomir Bialek
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | - Vitalis Briedis
- Department of Clinical Pharmacy of Lithuanian University of Health Sciences Kaunas Lithuania
| | | | | | - Biljana Cvetkovski
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | | | - Vicky Kritikos
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Alpana Mair
- DG for Health and Social Care Scottish Government Edinburgh UK
| | | | | | | | - Rojin Söderlund
- Department of Nephrology and Endocrinology Karolinska University Hospital Stockholm Sweden
| | - Rachel Tan
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Dennis M. Williams
- Eshelman School of Pharmacy University of North Carolina Chapel Hill North Carolina
| | - Piotr Wroczynski
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | | | | | - Josep M. Anto
- ISGlobAL Centre for Research in Environmental Epidemiology (CREAL) Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - Anna Bedbrook
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Department Ghent University Hospital Ghent Belgium
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Research Center for Anaphylaxis (ORCA) Odense Denmark
| | - Jan L. Brozek
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Giorgio Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy Humanitas Research Hospital Humanitas University Rozzano, Milan Italy
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall ‘dHebron & ARADyAL Research Network Barcelona Spain
| | - Warner Carr
- Allergy and Asthma Associates of Southern California Mission Viejo California
| | - Thomas B. Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida
| | - Niels H. Chavannes
- Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Braga Portugal
- ICVS/3B's PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Bahia Brazil
- WHO GARD Planning Group Brasilia Brazil
| | | | - Giuseppe De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Pascal Demoly
- Department of Respiratory Diseases Montpellier University Hospital Montpellier France
- Epidemiology of Allergic and Respiratory Diseases Department Institute Pierre Louis of Epidemiology and Public Health Medical School Saint Antoine INSERM and UPMC Sorbonne Université Paris France
| | - Philippe Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220 Hôpital Foch Suresnes Université Versailles Saint‐Quentin Université Paris Saclay Saclay France
| | - Mark S. Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
| | - Mina Gaga
- ERS President 2017‐2018 Athens Chest Hospital 7th Resp Med Department and Asthma Center Athens Greece
| | - Yehia El‐Gamal
- Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt
| | - João Fonseca
- CINTESIS Center for Research in Health Technologies and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
- MEDIDA, Lda Porto Portugal
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centre Amsterdam The Netherlands
| | | | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Peter W. Hellings
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - Maddalena Illario
- Division for Health Innovation Campania Region and Federico II University Hospital Naples (R&D and DISMET) Naples Italy
| | | | - Jocelyne Just
- Allergology Department Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand‐Trousseau (APHP) Sorbonne Universités UPMC Univ Paris 06 UMR_S 1136 Institut Pierre Louis d'Epidémiologie et de Santé Publique Equipe EPAR Paris France
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy Poltava Ukraine
| | - Musa Khaitov
- National Research Center Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular immunology Moscow Russian Federation
| | | | - Thomas 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
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek L. Kowalski
- Department of Immunology and Allergy Healthy Ageing Research Center Medical University of Lodz Lodz Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | | | | | | | - Lan T. T. Le
- University of Medicine and Pharmacy Hochiminh City Vietnam
| | - Karin C. Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical MedicineUniversity of Oslo Oslo Norway
| | - Bassam Mahboub
- Department of Pulmonary Medicine Rashid Hospital Dubai UAE
| | | | - Joao Malva
- Faculty of Medicine Coimbra Institute for Clinical and Biomedical Research (iCBR) University of Coimbra Coimbra Portugal
- Ageing@Coimbra EIP‐AHA Reference Site Coimbra Portugal
| | - Patrick J. Manning
- Department of Medicine (RCSI) Bon Secours Hospital Glasnevin, Dublin Ireland
| | | | - Ralph Mösges
- Institute of Medical Statistics, and Computational Biology Medical Faculty University of Cologne Cologne Germany
- CRI‐Clinical Research International‐Ltd Hamburg Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain
| | - Lars Münter
- Danish Committee for Health Education Copenhagen East Denmark
| | | | | | - Leyla Namazova‐Baranova
- Scientific Centre of Children's Health under the MoH, Russia, Russian National Research Medical University named Pirogov Moscow Russia
| | - Kristof Nekam
- Hospital of the Hospitaller Brothers in Buda Budapest Hungary
| | | | - Kimi Okubo
- Department of Otolaryngology Nippon Medical School Tokyo Japan
| | - Robyn E. O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
- Department of Immunology Monash University Melbourne Victoria Australia
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital Tokyo Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | - Susanna Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine 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
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section for Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Jim Phillips
- Centre for Empowering Patients and Communities Faulkland, Somerset UK
| | - Davor Plavec
- Children's Hospital Srebrnjak Zagreb, School of Medicine University J.J. Strossmayer Osijek Croatia
| | | | - Paul C. Potter
- Allergy Diagnostic and Clinical Research Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Emmanuel P. Prokopakis
- Department of Otorhinolaryngology University of Crete School of Medicine Heraklion Greece
| | | | - Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology Emek Medical Center Afula Israel
| | - Dermot Ryan
- Honorary Clinical Research Fellow Allergy and Respiratory Research Group The University of Edinburgh Past President SLAAI FACAAI Edinburgh UK
| | - Bolesław Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Médico‐Docente la Trinidad Caracas Trinidad
- Clínica El Avila Altamira, Caracas Venezuela
| | - Holger J. Schunemann
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | | | - David Somekh
- European Health Futures Forum (EHFF) Isle of Wright UK
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Salerno Italy
| | - Teresa To
- The Hospital for Sick Children Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Ana Maria Todo‐Bom
- Imunoalergologia Centro Hospitalar Universitário de Coimbra Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | | | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Antonio Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy IDIBAPS University of Barcelona Barcelona Spain
| | - Arunas Valiulis
- Clinic of Children's Diseases and Institute of Health Sciences Department of Public Health Vilnius University Institute of Clinical Medicine Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Errka Valovirta
- Department of Lung Diseases and Clinical Immunology University of Turku and Terveystalo allergy clinic Turku Finland
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Martin Wagenmann
- Department of Otorhinolaryngology Universitätsklinikum Düsseldorf Dusseldorf Germany
| | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Magnus Wickman
- Centre for Clinical Research Sörmland Uppsala University Eskilstuna Sweden
| | - Panayiotis K. Yiallouros
- Cyprus International Institute for Environmenta & Public Health in Association with Harvard School of Public Health Cyprus University of Technology Limassol Cyprus
- Department of Pediatrics Hospital “Archbishop Makarios III” Nicosia Cyprus
| | | | | | - Heather J. Zar
- Department of Paediatrics and Child Health Red Cross Children's, Hospital, and MRC Unit on Child & Adolescent Health University of Cape Town Cape Town South Africa
| | | | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Beijing Institute of Otolaryngology Beijing China
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases Golnik Slovenia
| | - Torsten Zuberbier
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
| | - Jean Bousquet
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
- University Hospital Montpellier France
- INSERM U 1168 VIMA: Ageing and chronic diseases Epidemiological and public health approaches Villejuif France
- Université Versailles St‐Quentin‐en‐Yvelines UMR‐S 1168 Montigny le Bretonneux France
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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35
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Bjermer L, Westman M, Holmström M, Wickman MC. The complex pathophysiology of allergic rhinitis: scientific rationale for the development of an alternative treatment option. Allergy Asthma Clin Immunol 2019; 15:24. [PMID: 31015846 PMCID: PMC6469109 DOI: 10.1186/s13223-018-0314-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/20/2018] [Indexed: 01/27/2023] Open
Abstract
Allergic rhinitis (AR) poses a global health problem and can be challenging to treat. Many of the current symptomatic treatments for AR have been available for decades, yet there has been little improvement in patient quality of life or symptom burden over the years. In this review, we ask why this might be and explore the pathophysiological gaps that exist within the various AR treatment classes. We focus on the benefits and drawbacks of different treatment options and delivery routes for AR treatments and consider how, given what is known about AR pathophysiology and symptomatology, patients may be offered more effective treatment options for rapid, effective, and sustained AR control. In particular, we consider how a new AR preparation, MP-AzeFlu (Dymista®, Meda, Sweden), comprising a formulation of an intranasal antihistamine (azelastine hydrochloride), an intranasal corticosteroid (fluticasone propionate), and excipients delivered in a single spray, may offer benefits over and above single and multiple AR therapy options. We review the evidence in support of this treatment across the spectrum of AR disease. The concept of AR control is also reviewed within the context of new European Union and Contre les Maladies Chroniques pour un VIeillissement Actif-Allergic Rhinitis and its Impact on Asthma initiatives.
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Affiliation(s)
- Leif Bjermer
- 1Department of Respiratory Medicine & Allergology, Skane University Hospital, 22185, Lund, Sweden
| | - Marit Westman
- 2Dept. of ENT-diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden.,3Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mats Holmström
- 4Dept. of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus C Wickman
- 5Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.,Sach's Children's Hospital, 118 83 Stockholm, Sweden
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36
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Bousquet J, Bedbrook A, Czarlewski W, Onorato GL, Arnavielhe S, Laune D, Mathieu-Dupas E, Fonseca J, Costa E, Lourenço O, Morais-Almeida M, Todo-Bom A, Illario M, Menditto E, Canonica GW, Cecchi L, Monti R, Napoli L, Ventura MT, De Feo G, Fokkens WJ, Chavannes NH, Reitsma S, Cruz AA, da Silva J, Serpa FS, Larenas-Linnemann D, Fuentes Perez JM, Huerta-Villalobos YR, Rivero-Yeverino D, Rodriguez-Zagal E, Valiulis A, Dubakiene R, Emuzyte R, Kvedariene V, Annesi-Maesano I, Blain H, Bonniaud P, Bosse I, Dauvilliers Y, Devillier P, Fontaine JF, Pépin JL, Pham-Thi N, Portejoie F, Picard R, Roche N, Rolland C, Schmidt-Grendelmeier P, Kuna P, Samolinski B, Anto JM, Cardona V, Mullol J, Pinnock H, Ryan D, Sheikh A, Walker S, Williams S, Becker S, Klimek L, Pfaar O, Bergmann KC, Mösges R, Zuberbier T, Roller-Wirnsberger RE, Tomazic PV, Haahtela T, Salimäki J, Toppila-Salmi S, Valovirta E, Vasankari T, Gemicioğlu B, Yorgancioglu A, Papadopoulos NG, Prokopakis EP, Tsiligianni IG, Bosnic-Anticevich S, O'Hehir R, Ivancevich JC, Neffen H, Zernotti ME, Kull I, Melén E, Wickman M, Bachert C, Hellings PW, Brusselle G, Palkonen S, Bindslev-Jensen C, Eller E, Waserman S, Boulet LP, Bouchard J, Chu DK, Schünemann HJ, Sova M, De Vries G, van Eerd M, Agache I, Ansotegui IJ, Bewick M, Casale T, Dykewick M, Ebisawa M, Murray R, Naclerio R, Okamoto Y, Wallace DV. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma. Clin Transl Allergy 2019; 9:16. [PMID: 30911372 PMCID: PMC6413444 DOI: 10.1186/s13601-019-0252-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/04/2019] [Indexed: 01/02/2023] Open
Abstract
Aims Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases. Methods MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients. Stakeholders Include patients, health care professionals (pharmacists and physicians), authorities, patient’s associations, private and public sectors. Results MASK is deployed in 23 countries and 17 languages. 26,000 users have registered. EU grants (2018) MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour). Lessons learnt (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.
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Affiliation(s)
- J Bousquet
- 1MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny Le Bretonneux, France.,Euforea, Brussels, Belgium.,4Humboldt-Universität zu Berlin, Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - A Bedbrook
- 1MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France
| | - G L Onorato
- 1MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | | | - D Laune
- KYomed INNOV, Montpellier, France
| | | | - J Fonseca
- Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Medida, Lda Porto, Portugal
| | - E Costa
- 8UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto (Porto4Ageing), Porto, Portugal
| | - O Lourenço
- 9Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - A Todo-Bom
- 11Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - E Menditto
- 13CIRFF, Federico II University, Naples, Italy
| | - G W Canonica
- 14Personalized Medicine Clinic Asthma and Allergy, Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - R Monti
- 16Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Turin, Italy
| | - L Napoli
- Consortium of Pharmacies and Services COSAFER, Salerno, Italy
| | - M T Ventura
- 18Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - G De Feo
- 19Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centre (AMC), Amsterdam, The Netherlands
| | - N H Chavannes
- 21Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centre (AMC), Amsterdam, The Netherlands
| | - A A Cruz
- 22ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Vitória da Conquista, Brazil
| | - J da Silva
- WHO GARD Planning Group, Salvador, Brazil
| | - F S Serpa
- 24Department of Internal Medicine and Allergic Clinic of Professor Polydoro Ernani de Sao, Thiago University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,25Asthma Reference Center, Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria, Vitória, Esperito Santo Brazil
| | - D Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, Mexico City, Mexico
| | - J M Fuentes Perez
- 27Hospital General Regional 1 "Dr Carlos Mc Gregor Sanchez Navarro" IMSS, Mexico City, Mexico
| | - Y R Huerta-Villalobos
- 27Hospital General Regional 1 "Dr Carlos Mc Gregor Sanchez Navarro" IMSS, Mexico City, Mexico
| | | | | | - A Valiulis
- 29Clinic of Children's Diseases, and Institute of Health Sciences Department of Public Health, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania.,European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - R Dubakiene
- 31Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | - R Emuzyte
- 32Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - V Kvedariene
- 33Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - I Annesi-Maesano
- 34Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM, Sorbonne Université, Medical School Saint Antoine, Paris, France
| | - H Blain
- 35Department of Geriatrics, Montpellier University Hospital, Montpellier, France.,36EA 2991, Euromov, University Montpellier, Montpellier, France
| | | | - I Bosse
- Allergist, La Rochelle, France
| | - Y Dauvilliers
- 39Sleep Unit, Department of Neurology, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - P Devillier
- 41UPRES EA220, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | | | - J L Pépin
- 43Laboratoire HP2, Grenoble, INSERM, U1042, Université Grenoble Alpes, Grenoble, France.,44CHU de Grenoble, Grenoble, France
| | - N Pham-Thi
- 45Allergy Department, Pasteur Institute, Paris, France
| | - F Portejoie
- 1MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - R Picard
- Conseil Général de l'Economie Ministère de l'Economie, de l'Industrie et du Numérique, Paris, France
| | - N Roche
- 47Pneumologie et Soins Intensifs Respiratoires, Hôpitaux Universitaires Paris, Centre Hôpital Cochin, Paris, France
| | - C Rolland
- Association Asthme et Allergie, Paris, France
| | - P Schmidt-Grendelmeier
- 49Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - P Kuna
- 50Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - B Samolinski
- 51Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - J M Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,53IMIM (Hospital del Mar Research Institute), Barcelona, Spain.,54CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,55Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - V Cardona
- 56Allergy Section, Department of Internal Medicine, Hospital Vall 'dHebron & ARADyAL Research Network, Barcelona, Spain
| | - J Mullol
- 57Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.,58Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - H Pinnock
- 59Asthma UK Centre for Applied Research, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - D Ryan
- 60Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
| | - A Sheikh
- 61The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - S Walker
- 62Asthma UK, Mansell Street, London, UK
| | - S Williams
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland, UK
| | - S Becker
- 64Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Mainz, Germany
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - O Pfaar
- 66Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Marburg, Germany
| | - K C Bergmann
- 67Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany
| | - R Mösges
- 69Institute of Medical Statistics, and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany.,CRI-Clinical Research International-Ltd, Hamburg, Germany
| | - T Zuberbier
- 67Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany
| | | | - P V Tomazic
- 72Department of ENT, Medical University of Graz, Graz, Austria
| | - T Haahtela
- 73Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - J Salimäki
- Association of Finnish Pharmacies, Helsinki, Finland
| | - S Toppila-Salmi
- 73Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - E Valovirta
- 75Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic, University of Turku, Turku, Finland
| | - T Vasankari
- FILHA, Finnish Lung Association, Helsinki, Finland
| | - B Gemicioğlu
- 77Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istambul, Turkey
| | - A Yorgancioglu
- 78Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - N G Papadopoulos
- 79Division of Infection, Immunity and Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.,80Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - E P Prokopakis
- 81Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece
| | - I G Tsiligianni
- 61The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.,82Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - S Bosnic-Anticevich
- 83University of Sydney and Woolcock Emphysema Centre and Local Health District, Woolcock Institute of Medical Research, Glebe, NSW Australia
| | - R O'Hehir
- 84Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia.,85Department of Immunology, Monash University, Melbourne, VIC Australia
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - H Neffen
- Director of Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina Center for Allergy and Immunology, Santa Fe, Argentina
| | - M E Zernotti
- 88Universidad Católica de Córdoba, Córdoba, Argentina
| | - I Kull
- 89Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,90Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Melén
- 90Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Wickman
- 91Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - C Bachert
- 92Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
| | - P W Hellings
- Euforea, Brussels, Belgium.,93Department of Otorhinolaryngology, Univ Hospitals Leuven, Louvain, Belgium.,94Academic Medical Center, Univ of Amsterdam, Amsterdam, The Netherlands
| | - G Brusselle
- 95Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - S Palkonen
- 96EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
| | - E Eller
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
| | - S Waserman
- 98Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON Canada
| | - L P Boulet
- 99Quebec Heart and Lung Institute, Laval University, Québec City, QC Canada
| | - J Bouchard
- Clinical Medecine, Laval's University, Quebec City, Canada
| | - D K Chu
- Medecine Department, Hôpital de la Malbaie, Quebec, Canada
| | - H J Schünemann
- Medecine Department, Hôpital de la Malbaie, Quebec, Canada
| | - M Sova
- 102Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON Canada
| | - G De Vries
- 103Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic.,Peercode BV, Geldermalsen, The Netherlands
| | - M van Eerd
- 103Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic.,Peercode BV, Geldermalsen, The Netherlands
| | - I Agache
- 105Faculty of Medicine, Transylvania University, Brasov, Romania
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - M Bewick
- iQ4U Consultants Ltd, London, UK
| | - T Casale
- 108Division of Allergy/Immunology, University of South Florida, Tampa, USA
| | - M Dykewick
- 109Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - M Ebisawa
- 110Clinical Reserch Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - R Murray
- Medical Communications Consultant, MedScript Ltd (Ireland & New Zealand), Dundalk, Ireland.,Honorary Research Fellow, OPC, Cambridge, UK
| | - R Naclerio
- 113Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Y Okamoto
- 114Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - D V Wallace
- 115Nova Southeastern University, Fort Lauderdale, FL USA
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Vlastos I, Gkouskou K, Doulaptsi M, Karatzanis A, Prokopakis EP. Precision Medicine in Rhinosinusitis. Curr Allergy Asthma Rep 2019; 19:12. [PMID: 30793224 DOI: 10.1007/s11882-019-0850-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Our scope is the presentation of research and clinical progresses in relation to precision medicine that are expected to alter our clinical practice in relation to chronic rhinosinusitis (CRS). Current knowledge on phenotypes and endotypes, biomarkers, and clinical markers for diagnosis, medical and surgical therapy, and prognosis is presented as well as the role of precision medicine in United Airway Disease and SCUAD (severe-uncontrolled chronic upper airway inflammation). RECENT FINDINGS Current technological progresses, mostly in relation to molecular biology and information technology, have permitted more detailed pathophysiological assessments and multidimensional approaches in airways diseases. Based on the concept of united airways diseases, new classification schemes, called endotypes, have been proposed for CRS. In addition, novel biological treatments that have been introduced for the treatment of asthma show great promise as well for severe uncontrolled cases of CRS with nasal polyps. Central to this approach are new biomarkers that are being examined in relation to complex bio-clinical traits of CRS. As this narrative review of the aforementioned precision medicine initiatives in relation to CRS advances, a modification of current practice is expected not only for severe chronic upper airways diseases in tertiary centers but also for milder and more common cases that are being encountered in the community.
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Affiliation(s)
- Ioannis Vlastos
- ENT Private Practice, 29 Voreiou Ipeirou str, Athens, Greece
| | - Kalliopi Gkouskou
- Embiodiagnostics Biology Research Company, Melissinon and Damvergidon str, Heraklion, Crete, Greece
| | - Maria Doulaptsi
- Department of Otorhinolaryngology, University Hospital of Crete, A Building 3rd Floor, University avenue, 71110, Heraklion, Crete, Greece
| | - Alexander Karatzanis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Emmanuel P Prokopakis
- Department of Otorhinolaryngology, University Hospital of Crete, A Building 3rd Floor, University avenue, 71110, Heraklion, Crete, Greece. .,Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece.
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38
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Heffler E, Brussino L, Del Giacco S, Paoletti G, Minciullo PL, Varricchi G, Scadding G, Malvezzi L, De Virgilio A, Spriano G, Puggioni F, Fornero M, Rolla G, Canonica GW. New drugs in early-stage clinical trials for allergic rhinitis. Expert Opin Investig Drugs 2019; 28:267-273. [PMID: 30676119 DOI: 10.1080/13543784.2019.1571581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) is the most common allergic disease, and it has a relevant impact on the quality of life of the patient. Treatment of AR includes a combination of strategies of proven efficacy and effectiveness; however, a relevant proportion of patients remain uncontrolled. AREAS COVERED This review article summarizes emerging therapeutic approaches to AR; these approaches include nasal sprays, oral drugs, alternative allergen immunotherapy administration routes, and biologic agents. EXPERT OPINION The agents discussed require further clinical trials to prove their efficacy in the treatment of AR. Some of these agents, in particular, allergen immunotherapies and biologics, have the potential to form crucial precision medicine approaches to AR. Those that prove their efficacy in clinical trials must also be evaluated from a pharmacoeconomic perspective, possibly in real-life studies; this will define which therapeutic strategies achieve the most convenient and cost-effective ratio, thus yielding a novel opportunity for the most severe and previously treatment-resistant allergic patients.
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Affiliation(s)
- Enrico Heffler
- a Personalized Medicine, Asthma and Allergy , Humanitas Clinical and Research Center - IRCCS , Rozzano , Italy.,b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
| | - Luisa Brussino
- c Department of Medical Science, Allergy and Clinical Immunology , University of Torino & AO Ordine Mauriziano Umberto I , Torino , Italy
| | - Stefano Del Giacco
- d Department of Medical Sciences 'M. Aresu,' Allergy and Clinical Immunology Unit , University of Cagliari , Cagliari , Italy
| | - Giovanni Paoletti
- b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
| | - Paola Lucia Minciullo
- e Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology , University Hospital 'G. Martino' , Messina , Italy
| | - Gilda Varricchi
- f Department of Translational Medical Sciences and Center for Basic and Clinical Immunology , University of Napoli Federico II , Napoli , Italy
| | - Guy Scadding
- g Allergy and Clinical Immunology, Division of Respiratory Science , National Heart and Lung Institute, Imperial College, Royal Brompton Hospital , London , UK
| | - Luca Malvezzi
- h Department of Otorhinolaryngology , Humanitas Research Hospital - IRCCS , Rozzano , Italy
| | - Armando De Virgilio
- h Department of Otorhinolaryngology , Humanitas Research Hospital - IRCCS , Rozzano , Italy
| | - Giuseppe Spriano
- b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy.,h Department of Otorhinolaryngology , Humanitas Research Hospital - IRCCS , Rozzano , Italy
| | - Francesca Puggioni
- a Personalized Medicine, Asthma and Allergy , Humanitas Clinical and Research Center - IRCCS , Rozzano , Italy.,b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
| | - Monica Fornero
- c Department of Medical Science, Allergy and Clinical Immunology , University of Torino & AO Ordine Mauriziano Umberto I , Torino , Italy
| | - Giovanni Rolla
- c Department of Medical Science, Allergy and Clinical Immunology , University of Torino & AO Ordine Mauriziano Umberto I , Torino , Italy
| | - Giorgio Walter Canonica
- a Personalized Medicine, Asthma and Allergy , Humanitas Clinical and Research Center - IRCCS , Rozzano , Italy.,b Department of Biomedical Sciences , Humanitas University , Pieve Emanuele , Italy
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39
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Luo Q, Zhou S, Li X, Chen Q, Lin W, Lu L, Li H, Chen C, Chen W, Li Y. Chinese herbal medicine bi min fang for allergic rhinitis: protocol for a double-blind, double-dummy, randomized controlled trial. Trials 2019; 20:66. [PMID: 30658660 PMCID: PMC6339341 DOI: 10.1186/s13063-018-3151-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with allergic rhinitis (AR) often seek help from Chinese medicine due to dissatisfaction with conventional treatments. Lung-spleen qi deficiency syndrome (LSQDS) is the most common type of AR, and the Chinese herbal medicine formula bi min fang (BMF) is commonly prescribed for AR patients with LSQDS. However, direct evidence supporting its efficacy and safety is not available, and its potential mechanism of action remains unclear. METHODS/DESIGN This paper presents a double-blind, double-dummy, randomized controlled trial. After a 2-week run-in period, 80 AR patients with LSQDS will be recruited and randomly allocated to the BMF group or the control group in a 1:1 ratio. The patients in the BMF group will receive BMF and the placebo for levocetirizine hydrochloride orally, while the control group participants will receive levocetirizine hydrochloride and the placebo for BMF orally. All participants will receive 4 weeks of treatment and 12 weeks of follow-up. The primary outcome is a change in the Total Nasal Symptom Score (TNSS). Secondary outcomes include changes in scores for the standard version of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ(S)), and visual analog scale (VAS); changes in serum levels of the cytokines interleukin-4, interferon-γ, transforming growth factor β-1, and interleukin-17; and changes in the gut microbiota composition in the stool. The TNSS, RQLQ(S), and VAS will be recorded at the beginning of, middle of and after the treatment period and at the end of each month in the 3-month follow-up period. Blood and stool samples will be collected at baseline and the end of the treatment. The aforementioned four cytokines will be detected in the serum using enzyme-linked immunosorbent assays, and the stool gut microbiota will be detected using 16S ribosomal ribonucleic acid sequencing. Any side effects of the treatment will be recorded. DISCUSSION The results of this trial will provide consolidated evidence of the effect of BMF on AR and the potential mechanism by which BMF acts. This study will be the first to explore the mechanism of action of Chinese herbal medicine on the gut microbiota in AR. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IPR-17010970 . Registered on 23 March 2017.
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Affiliation(s)
- Qiulan Luo
- Otorhinolaryngology Department, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China.,Otorhinolaryngology Department, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Shiqing Zhou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Xiaoshan Li
- Otorhinolaryngology Department, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), 16 Nanwu Road, Nanhai District, Foshan, 528200, China.,Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, 16 Nanwu Road, Nanhai District, Foshan, 528200, China
| | - Qubo Chen
- Biological Resource Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Wenmin Lin
- Otorhinolaryngology Department, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China.,Otorhinolaryngology Department, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Hua Li
- Otorhinolaryngology Department, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China.,Otorhinolaryngology Department, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Caifeng Chen
- Otorhinolaryngology Department, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China.,Otorhinolaryngology Department, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Wenyong Chen
- Otorhinolaryngology Department, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China.,Otorhinolaryngology Department, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China
| | - Yunying Li
- Otorhinolaryngology Department, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China. .,Otorhinolaryngology Department, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, Guangdong Province, China.
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40
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Gani F, Lombardi C, Bonizzoni G, Rolla G, Brussino L, Landi M, Schiappoli M, Senna G, Savi E, Ridolo E, Ventura MT, Gamba P, Patella V, Bugiani M. The Characteristics of Severe Chronic Upper-Airway Disease (SCUAD) in Patients with Allergic Rhinitis: A Real-Life Multicenter Cross-Sectional Italian Study. Int Arch Allergy Immunol 2019; 178:333-337. [PMID: 30605899 DOI: 10.1159/000495305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are few studies regarding severe chronic upper-airway disease (SCUAD) that represents an important socioeconomic problem for the treatment of rhinitis and associated comorbidities, particularly asthma. OBJECTIVES The aim of our study is to evaluate the prevalence of this pathology in patients with allergic rhinitis (AR) in real life, to phenotype allergic patients with SCUAD, and to identify which factors are related to the severity of the disease. METHODS We studied 113 patients with uncontrolled AR despite optimal adherence to therapy according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in a multicenter Italian study, analyzing comorbidity, use of additional drugs, not scheduled visits, and the number of emergency room admissions. RESULTS Our data suggest that polysensitization is the only statistically significant factor correlating with SCUAD. Asthma does not seem to represent a correlating factor. An important finding is the poor use (20%) of allergy immunotherapy (AIT), although patients were suffering from AR and the ARIA guidelines recommend the use of AIT in moderate/severe AR. CONCLUSIONS The SCUAD population seems not to have a specific phenotype; there is a greater presence of SCUAD in polysensibilized patients, perhaps a sign of greater inflammation.
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Affiliation(s)
- Federica Gani
- Allergy Service, AOU San Luigi Gonzaga Hospital, Turin, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology and Respiratory Diseases, Fondazione Poliambulanza Hospital, Brescia, Italy
| | | | - Giovanni Rolla
- Allergology and Immunology, Mauriziano Hospital, University of Turin, Turin, Italy
| | - Luisa Brussino
- Allergology and Immunology, Mauriziano Hospital, University of Turin, Turin, Italy
| | - Massimo Landi
- Primary Care Physician, National Healthcare System, Turin, Italy
| | - Michele Schiappoli
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Eleonora Savi
- Allergy Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Erminia Ridolo
- Experimental and Clinical Medicine, University of Parma, Parma, Italy
| | | | - Paolo Gamba
- ENT Department, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Vincenzo Patella
- Centro aziendale provinciale per la cura delle malattie allergologiche e immunologiche gravi, ASL Salerno, Ospedale Civile, Battipaglia, Italy
| | - Massimo Bugiani
- Consultant Physician of Professional Diseases Observatory, Procura della Repubblica, Turin, Italy
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41
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Tiotiu A, Plavec D, Novakova S, Mihaicuta S, Novakova P, Labor M, Bikov A. Current opinions for the management of asthma associated with ear, nose and throat comorbidities. Eur Respir Rev 2018; 27:27/150/180056. [PMID: 30463872 DOI: 10.1183/16000617.0056-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.
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Affiliation(s)
- Angelica Tiotiu
- Pulmonology Dept, University Hospital, Nancy, France .,EA 3450 DevAH, Development, Adaptation, Cardio-Respiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | | | - Silviya Novakova
- Allergy Unit, University Hospital "St. George", Plovdiv, Bulgaria
| | | | - Plamena Novakova
- Dept of Allergology and Asthma, Aleksandrovska Hospital, Sofia, Bulgaria
| | - Marina Labor
- Pulmonology Dept, University Hospital Centre Osijek, Osijek, Croatia
| | - Andras Bikov
- NIHR Clinical Research Facility, Manchester University NHS Foundation Trust, Manchester, UK
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42
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Bousquet J, Arnavielhe S, Bedbrook A, Bewick M, Laune D, Mathieu-Dupas E, Murray R, Onorato GL, Pépin JL, Picard R, Portejoie F, Costa E, Fonseca J, Lourenço O, Morais-Almeida M, Todo-Bom A, Cruz AA, da Silva J, Serpa FS, Illario M, Menditto E, Cecchi L, Monti R, Napoli L, Ventura MT, De Feo G, Larenas-Linnemann D, Fuentes Perez M, Huerta Villabolos YR, Rivero-Yeverino D, Rodriguez-Zagal E, Amat F, Annesi-Maesano I, Bosse I, Demoly P, Devillier P, Fontaine JF, Just J, Kuna TP, Samolinski B, Valiulis A, Emuzyte R, Kvedariene V, Ryan D, Sheikh A, Schmidt-Grendelmeier P, Klimek L, Pfaar O, Bergmann KC, Mösges R, Zuberbier T, Roller-Wirnsberger RE, Tomazic P, Fokkens WJ, Chavannes NH, Reitsma S, Anto JM, Cardona V, Dedeu T, Mullol J, Haahtela T, Salimäki J, Toppila-Salmi S, Valovirta E, Gemicioğlu B, Yorgancioglu A, Papadopoulos N, Prokopakis EP, Bosnic-Anticevich S, O'Hehir R, Ivancevich JC, Neffen H, Zernotti E, Kull I, Melen E, Wickman M, Bachert C, Hellings P, Palkonen S, Bindslev-Jensen C, Eller E, Waserman S, Sova M, De Vries G, van Eerd M, Agache I, Casale T, Dykewickz M, Naclerio RN, Okamoto Y, Wallace DV. MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence. Clin Transl Allergy 2018; 8:45. [PMID: 30386555 PMCID: PMC6201545 DOI: 10.1186/s13601-018-0227-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022] Open
Abstract
mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over-the-counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self-management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self-medicate, are often non-adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary.
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Affiliation(s)
- J Bousquet
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier, France.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France.,Euforea, Brussels, Belgium
| | | | - A Bedbrook
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier, France
| | - M Bewick
- iQ4U Consultants Ltd, London, UK
| | - D Laune
- KYomed-INNOV, Montpellier, France
| | | | - R Murray
- MedScript Ltd, Dundalk, Co Louth Ireland
| | - G L Onorato
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier, France
| | - J L Pépin
- 7Laboratoire HP2, Grenoble, INSERM, U1042, Université Grenoble Alpes, Grenoble, France.,8CHU de Grenoble, Grenoble, France
| | - R Picard
- Conseil Général de l'Economie Ministère de l'Economie, de l'Industrie et du Numérique, Paris, France
| | - F Portejoie
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, Montpellier, France
| | - E Costa
- 10UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto (Porto4Ageing), Porto, Portugal
| | - J Fonseca
- 11Center for Health Technology and Services Research- CINTESIS, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Medida, Lda, Porto, Portugal
| | - O Lourenço
- 13Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - A Todo-Bom
- 15Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A A Cruz
- 16ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Vitória da Conquista, Brazil.,WHO GARD Planning Group, Salvador, Brazil
| | - J da Silva
- 18Allergy Service, University Hospital of Federal University of Santa Catarina (HU-UFSC), Florianópolis, Brazil
| | - F S Serpa
- 19Asthma Reference Center, Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria, Vitória, Esperito Santo Brazil
| | - M Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - E Menditto
- 21CIRFF, Federico II University, Naples, Italy
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - R Monti
- 23Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - L Napoli
- Consortium of Pharmacies and Services COSAFER, Salerno, Italy
| | - M T Ventura
- 25Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - G De Feo
- 26Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - D Larenas-Linnemann
- 27Center of Excellence in Asthma and Allergy, Hospital Médica Sur, México City, Mexico
| | | | | | | | | | - F Amat
- 31Allergology Department, Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand-Trousseau (APHP), Paris, France.,32UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, Equipe EPAR, 75013 Paris, France
| | - I Annesi-Maesano
- 33Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM, UPMC Sorbonne Université, Medical School Saint Antoine, Paris, France
| | | | - P Demoly
- 35Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - P Devillier
- 36UPRES EA220, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | | | - J Just
- 31Allergology Department, Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand-Trousseau (APHP), Paris, France.,32UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, Equipe EPAR, 75013 Paris, France
| | - T P Kuna
- 38Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - B Samolinski
- 39Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - A Valiulis
- 40Clinic of Children's Diseases, and Institute of Health Sciences Department of Public Health, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania.,European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - R Emuzyte
- 42Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - V Kvedariene
- 43Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D Ryan
- Woodbrook Medical Centre, Loughborough, UK.,45Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh, UK
| | - A Sheikh
- 46Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - P Schmidt-Grendelmeier
- 47Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany.,49Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - O Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany.,49Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - K C Bergmann
- 50Comprehensive Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany
| | - R Mösges
- 52Institute of Medical Statistics, and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany.,CRI-Clinical Research International-Ltd, Hamburg, Germany
| | - T Zuberbier
- 50Comprehensive Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany
| | | | - P Tomazic
- 55Department of ENT, Medical University of Graz, Graz, Austria
| | - W J Fokkens
- 56Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - N H Chavannes
- 57Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - S Reitsma
- 56Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J M Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,59IMIM (Hospital del Mar Research Institute), Barcelona, Spain.,60CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,61Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - V Cardona
- 62Allergy Section, Department of Internal Medicine, Hospital Vall 'dHebron & ARADyAL Research Network, Barcelona, Spain
| | - T Dedeu
- 63AQuAS, Barcelona, Spain.,EUREGHA, European Regional and Local Health Association, Brussels, Belgium
| | - J Mullol
- 65Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.,66Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - T Haahtela
- 67Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - J Salimäki
- Association of Finnish Pharmacists, Helsinki, Finland
| | - S Toppila-Salmi
- 67Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - E Valovirta
- 69Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland.,Terveystalo Allergy Clinic, Turku, Finland
| | - B Gemicioğlu
- 71Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Yorgancioglu
- 72Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.,GARD Executive Committee, Manisa, Turkey
| | - N Papadopoulos
- 74Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.,75Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, 11527 Athens, Greece
| | - E P Prokopakis
- 76Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece
| | - S Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW Australia
| | - R O'Hehir
- 78Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia.,79Department of Immunology, Monash University, Melbourne, VIC Australia
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - H Neffen
- Director of Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina Center for Allergy and Immunology, Santa Fe, Argentina
| | - E Zernotti
- 82Universidad Católica de Córdoba, Córdoba, Argentina
| | - I Kull
- 83Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - E Melen
- 84Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,85Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Wickman
- 86Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - C Bachert
- 87Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - P Hellings
- Euforea, Brussels, Belgium.,88Department of Otorhinolaryngology, Univ Hospitals Leuven, Louvain, Belgium.,89Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Palkonen
- 90EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
| | - E Eller
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
| | - S Waserman
- 92Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON Canada
| | - M Sova
- 93University Hospital Olomouc, Olomouc, Czech Republic
| | - G De Vries
- Peercode BV, Geldermalsen, The Netherlands
| | - M van Eerd
- Peercode BV, Geldermalsen, The Netherlands
| | - I Agache
- 95Faculty of Medicine, Transylvania University, Brasov, Romania
| | - T Casale
- 96Division of Allergy/Immunology, University of South Florida, Tampa, USA
| | - M Dykewickz
- 97Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - R N Naclerio
- 98Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Y Okamoto
- 99Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - D V Wallace
- 100Nova Southeastern University, Fort Lauderdale, Florida USA
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Abstract
PURPOSE OF REVIEW The review provides an overview of the results of asthma clinical trials published in peer review journals in the last 18 months that evaluated patient-reported outcomes (PROs). RECENT FINDINGS In the last 10 years, health care moved toward a patient-centered approach, which includes patients' perspectives reflecting the impact of a disease and its treatment. SUMMARY Surprisingly, among the almost 300 clinical trials published in the last one and a half year, PRO evaluation was performed in only 20 studies, and none of them held in a real-life setting. The effort of applying the scientific methods of PRO investigations in asthma clinical trials following a rigorous and systematic approach needs to be highly improved to allow better understanding of patient reported factors. Some recommendations are drawn particularly about PRO assessment in personalized medicine research. The ability of an individual PRO to evaluate choice of treatment and its effectiveness remains to be achieved.
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Segboer CL, Terreehorst I, Gevorgyan A, Hellings PW, van Drunen CM, Fokkens WJ. Quality of life is significantly impaired in nonallergic rhinitis patients. Allergy 2018; 73:1094-1100. [PMID: 29131364 DOI: 10.1111/all.13356] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND In contrast to the well-known significant impairment of quality of life (QoL) in allergic rhinitis (AR), the degree of impairment in QoL in nonallergic rhinitis (NAR) remained unknown for a long time, due to a lack of a validated questionnaire to assess QoL in the NAR patient group. In this study, a validation of the mini-RQLQ questionnaire in NAR patients was performed, followed by an assessment of QoL in NAR patients compared to AR and healthy controls. Secondly, use of medication and treatment satisfaction in AR and NAR was assessed. METHODS The study was an observational cohort study in 287 AR and 160 NAR patients. Patients with symptoms of rhinitis were recruited from a tertiary care outpatient clinic of the Otorhinolaryngology Department. Allergic rhinitis (AR) was defined as one or more positive results on skin prick testing and clinically relevant symptoms of rhinitis related to their sensitization. Nonallergic rhinitis (NAR) was defined as clinically relevant symptoms of rhinitis but without positive results on skin prick testing. The mini-RQLQ was successfully validated in this study for NAR patients. RESULTS Quality of life (QoL) in NAR patients was equally-and for some aspects even more-impaired compared to AR. More than half of both AR and NAR patients were unsatisfied with treatment. CONCLUSION These results demonstrate a significant impairment in both AR and NAR patients in their QoL combined with a low treatment satisfaction, emphasizing the need for adequate treatment, especially in the NAR patient group.
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Affiliation(s)
- C. L. Segboer
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - I. Terreehorst
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - A. Gevorgyan
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - P. W. Hellings
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - C. M. van Drunen
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
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Liedtke JP, Mandl A, Köther J, Chwieralski J, Shah-Hosseini K, Raskopf E, Pieper-Fürst U, Allekotte S, Mösges R. RCAT reflects symptom control and quality of life in allergic rhinoconjunctivitis patients. Allergy 2018; 73:1101-1109. [PMID: 29159975 DOI: 10.1111/all.13362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Global Allergy and Asthma European Network (GA2 LEN) Taskforce has requested more data on correlations between various patient-reported outcomes (PROs) in clinical trials on allergy. We compared three tools-the Rhinitis Control Assessment Test (RCAT), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Rhinitis Total Symptom Score (RTSS)-to determine whether the RCAT alone is a sufficient primary outcome parameter in clinical trials on allergic rhinoconjunctivitis. METHODS In two double-blind, placebo-controlled immunotherapy studies, 33 patients allergic to grass pollen and 94 to birch pollen completed two questionnaires (RCAT and RQLQ) and kept their own symptom diary from which the RTSS was calculated. RESULTS Upon comparing RCAT and RQLQ results, we found strong correlations of r = -0.871 for grass pollen-allergic patients and r = -0.795 for birch pollen-allergic patients. The comparison between RCAT and RTSS results showed a strong correlation of r = -0.811 (grass pollen-allergic patients) and a moderate correlation of r = -0.539 (birch pollen-allergic patients). In the RCAT, 69.7% of grass pollen-allergic patients and 45.7% of birch pollen-allergic patients receiving guideline-concordant therapy were regarded as having insufficiently controlled symptoms. CONCLUSION The strong correlations suggest that the RCAT alone is equivalent to the RQLQ with respect to patients' symptom control and quality of life. Patients with uncontrolled symptoms can be identified using the RCAT. Hence, the physician can decide whether symptomatic therapy can be intensified or allergy immunotherapy should be administered.
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Affiliation(s)
- J.-P. Liedtke
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - A. Mandl
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - J. Köther
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - J. Chwieralski
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - K. Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - E. Raskopf
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - U. Pieper-Fürst
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - S. Allekotte
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - R. Mösges
- Institute of Medical Statistics, Informatics and Epidemiology; Faculty of Medicine; University of Cologne; Cologne Germany
- CRI - Clinical Research International Limited; Hamburg Germany
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46
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Novakova SM, Novakova PI, Yakovliev PH, Staevska MT, Mateva NG, Dimcheva TD, Peichev JL. A Three-Year Course of House Dust Mite Sublingual Immunotherapy Appears Effective in Controlling the Symptoms of Allergic Rhinitis. Am J Rhinol Allergy 2018; 32:147-152. [PMID: 29649893 DOI: 10.1177/1945892418764966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Allergic rhinitis is the most common allergic disorder. Although the management of the disease is successful in many patients, based on guidelines, some of them remain with symptoms uncontrolled with pharmacotherapy. Presently, there is no substantiated information on the control of allergic rhinitis in patients who underwent sublingual immunotherapy. Objective The purpose of this prospective follow-up study was to assess the control of allergic rhinitis in adults after a three-year course of house dust mite sublingual immunotherapy. Methods This prospective real-life study was designed to include adults with moderate to severe allergic rhinitis sensitized to house dust mite who underwent a three-year course of sublingual immunotherapy. Control of symptoms was assessed by Rhinitis Control Assessment Test (RCAT) after three years of house dust mite sublingual immunotherapy. Additionally, patients assessed their symptoms by utilizing a visual analog scale. Results A total number of 86 consecutively enrolled patients (46 (53.49%) men; mean age 26.10 years (SD = 5.85)) with moderate to severe allergic rhinitis and clinically relevant sensitization to house dust mite were evaluated. When assessed by RCAT on the third year, 74 (86.05%) had well-controlled symptoms and 20 (27.03%) of them were completely controlled. A significant reduction in visual analog scale scores-from 7.52 cm at baseline to 2.31 cm-was established ( P < 0.0001). There was a strong negative correlation between RCAT scores and visual analog scale (r = -0.65; P < 0.01). Conclusion This study provided evidence that a three-year course of house dust mite sublingual immunotherapy appears effective in controlling the symptoms of allergic rhinitis.
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Affiliation(s)
- Silviya M Novakova
- 1 Allergy Unit of Internal Consulting Department, UMHAT "St. George", Plovdiv, Bulgaria
| | - Plamena I Novakova
- 2 Clinic of Allergy and Asthma, Sofia Medical University, Sofia, Bulgaria
| | | | - Maria T Staevska
- 2 Clinic of Allergy and Asthma, Sofia Medical University, Sofia, Bulgaria
| | - Nonka G Mateva
- 4 Department of Medical informatics, Biostatistics and e-Learning, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
| | - Teodora D Dimcheva
- 4 Department of Medical informatics, Biostatistics and e-Learning, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
| | - Jivko L Peichev
- 4 Department of Medical informatics, Biostatistics and e-Learning, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
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47
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Kao ST, Kuo YH, Wang SD, Hong HJ, Lin LJ. Analogous corticosteroids, 9A and EK100, derived from solid-state-cultured mycelium of Antrodia camphorata inhibit proinflammatory cytokine expression in macrophages. Cytokine 2018; 108:136-144. [PMID: 29605763 DOI: 10.1016/j.cyto.2018.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/13/2022]
Abstract
Antrodia camphorata mycelium is used in traditional Chinese medicine in Taiwan. The wild-type mycelium is rare and expensive, so a solid-state-cultured mycelium of A. camphorata (SCMAC) has been developed. Previous studies have found SCMAC to have anti-inflammatory effects. However, the immunomodulatory effects of SCMAC and of its active phytosterol compounds EK100 and 9A on asthma remain unknown. In this study, BALB/c mice were repeatedly exposed to Dermatogoides pteronyssinus (Der p) at 1-week intervals and were orally administered crude SCMAC extract before the Der p challenge. The mice were sacrificed 72 h after the last challenge to examine the airway remodeling, inflammation, and expression profiles of cytokines and various genes. Then, 30-µg/mL Der p-stimulated MH-S cells with 9A or EK100 were collected for real-time PCR analysis, and the effects of 9A and EK100 on macrophages were evaluated. The crude extract reduced Der p-induced airway hyperresponsiveness, total serum immunoglobulin E levels, and recruitment of inflammatory cells to the bronchoalveolar lavage fluid through cytokine downregulation and Th1/Th2/Th17 response modulation. Additionally, 9A and EK100 inhibited IL-1β and IL-6 expression in alveolar macrophages. These results indicate that the pharmacologically active compounds in a crude SCMAC extract exert synergistic effects on multiple targets to relieve asthma symptoms.
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Affiliation(s)
- Shung-Te Kao
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 40402, Taiwan.
| | - Yueh-Hsiung Kuo
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, China Medical University, Taichung 40402, Taiwan; Department of Biotechnology, Asia University, Taichung 41354, Taiwan.
| | - Shulhn-Der Wang
- School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
| | - Hong-Jye Hong
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
| | - Li-Jen Lin
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
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Chaker AM. [Biologics in Rhinology - Forthcoming Personalized Concepts: the Future Starts Today]. Laryngorhinootologie 2018; 97:S142-S184. [PMID: 29905356 PMCID: PMC6541111 DOI: 10.1055/s-0043-123484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sinunasale Erkrankungen zählen mit zu den häufigsten chronischen Erkrankungen und führen zu einer erheblichen Störung der Lebensqualität, ein komorbides Asthma ist häufig. Trotz leitliniengerechter Therapie ist anzunehmen, dass mind. 20% der Patienten ihre Erkrankungssymptome nicht adäquat kontrollieren können. Neben den etablierten chirurgischen und konservativen Therapieoptionen finden sich nun vielversprechende Therapieansätze, die bspw. mittels therapeutischer Antikörper mechanistisch gezielt in die Pathophysiologie der Erkrankungen eingreifen können. Die Auswahl der geeigneten Patienten durch geeignete Biomarker und die richtige Therapie zum richtigen Stadium der Erkrankung anbieten zu können, ist das Ziel stratifizierter Medizin und eine wichtige Perspektive für die HNO.Chronic diseases of the nose and the paranasal sinuses are most common, frequently associated with bronchial asthma, and result in substantial reduction of quality of life. Despite optimal treatment according to guidelines, approx. 20 % of the patients will report inadequate control of symptoms. Apart from well established surgical and conservative approaches in therapy new therapeutic antibodies are available that aim specifically pathophysiological targets. The optimal allocation of effective therapy for patients using appropriate biomarkers at the most suitable timepoint is the hallmark of stratified medicine and an important perspective in ENT.
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Affiliation(s)
- Adam M. Chaker
- Klinik für Hals-Nasen-Ohrenheilkunde und Zentrum für Allergie und Umwelt, Klinikum rechts der Isar, Technische Universität München
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Yang LF, Cai LM, Li M, Liu JT, Wang ZN, Wang WH, Yang QT, Chen ZG. A 10-year retrospective study of alterative aeroallergens sensitization spectrum in urban children with allergic rhinitis. Ther Clin Risk Manag 2018. [PMID: 29520147 PMCID: PMC5834172 DOI: 10.2147/tcrm.s154692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the alterative spectrum and trends of aeroallergens sensitization in children with allergic rhinitis (AR) in Guangzhou, China in the past 10 years. Participants and methods In this retrospective study, 4,111 children with complaints of nasal hyper-reactivity who visited the Pediatric Department and/or Otolaryngology Department from January 2007 to November 2016 were enrolled. Serum specific immunoglobulin E was measured and positive detection was made in 3,328 patients, who were, therefore, diagnosed with AR. Positive rates and trends of different aeroallergens sensitization were assessed. The tendency of positive rates changing over the years, and the difference and trends in positive rate of aeroallergen sensitization that occurred in subgroups of gender, age, and season were determined and analyzed with logistic regression. Results The percentage of detected common aeroallergens in AR children was (from high to low) 81.07%, 34.44%, 14.72%, 11.81%, 6.04%, and 3.70% for house dust mites (HDMs), cat-dog dander, cockroach, mold mixture, tree pollen mixture, and herb pollen mixture, respectively. An ascending trend of aeroallergens sensitization or AR (odds ratio [OR] =1.116, 95% CI: 1.086-1.146) was found. Interestingly, an increasing trend of cat-dog dander and mold sensitization was found in AR children (OR =1.164, 95% CI: 1.133-1.196; OR =1.169, 95% CI: 1.120-1.223) in this retrospective study, while HDMs sensitization held a steady trend (OR =0.983, 95% CI: 0.961-1.007). Conclusion In the increasing trend of aeroallergens sensitization or AR, HDMs sensitization still held the majority. But emphasis should be made on pet allergy for young children with AR in the context of ascending trend of sensitization to cat-dog dander.
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Affiliation(s)
- Li-Fen Yang
- Department of Pediatrics Intensive Care Unit and Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Liang-Ming Cai
- Department of Pediatrics Intensive Care Unit and Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ming Li
- Department of Pulmonary Diseases, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jin-Tao Liu
- Department of Population and Quantitative Health Science, Case Western Reserve University, Cleveland, OH, USA
| | - Zhao-Ni Wang
- Department of Pediatrics Intensive Care Unit and Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wei-Hao Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qin-Tai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhuang-Gui Chen
- Department of Pediatrics Intensive Care Unit and Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Institution of Respiratory Diseases of Sun Yat-sen University, Guangzhou, People's Republic of China
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50
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Sinus Computed Tomographic Findings in Adult Smokers and Nonsmokers with Asthma. Analysis of Clinical Indices and Biomarkers. Ann Am Thorac Soc 2018; 14:332-341. [PMID: 28029801 DOI: 10.1513/annalsats.201606-463oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE When they occur together, sinusitis and asthma are often thought to represent anatomically separate components of the same chronic inflammatory airway disease. Information about the effect of smoking on the interaction between sinusitis and asthma in patients who have both disorders is limited. OBJECTIVES To evaluate the effect of cigarette smoking on the relationship between the presence and severity of sinusitis and selected asthma-related indices in adults who have asthma. METHODS This study included 127 patients with severe asthma and 79 patients with mild to moderate asthma. Clinical data were obtained from all subjects during a 2-day stay at Hokkaido University Hospital (Sapporo, Japan). The Lund-Mackay scoring system was used to assess the anatomic extent and severity of sinusitis as revealed by sinus computed tomographic (CT) images obtained during hospitalization. We examined associations between Lund-Mackay scores and a variety of asthma-related indices and levels of biomarkers in blood and sputum. To clarify the effect of smoking on these associations, we conducted separate analyses for nonsmoking (<10 pack-years; n = 130) and smoking subjects (≥10 pack-years; n = 76). MEASUREMENTS AND MAIN RESULTS In our cohort of adults with asthma, we found significant positive relationships between the presence and severity of sinusitis as assessed by Lund-Mackay score and the severity of asthma as measured by percent predicted FEV1 or FEV1/FVC for nonsmoking subjects (<10 pack-years) but not for cigarette smokers (>10 pack-years). Lund-Mackay scores correlated with blood and sputum eosinophil counts, serum IgE levels, and fractional exhaled nitric oxide, regardless of smoking status. Lund-Mackay scores also showed significant positive associations with serum periostin and chemokine C-C motif ligand 18 levels, regardless of smoking status, whereas a positive association with plasma osteopontin level was seen only for nonsmoking subjects. CONCLUSIONS We found an association between the severity of sinusitis on CT imaging and the severity of concomitant asthma on spirometry for nonsmoking adults but not for smokers. In adults with asthma, CT imaging evidence of severe sinusitis indicates intense Th2-related inflammation, regardless of smoking status.
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