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Davis GE, Ow RA, Yen DM, O'Malley EM, Del Signore AG. Clinical Outcomes After Innovative Multipoint Impedance-Controlled Radiofrequency Ablation of the Posterior Nasal Nerve for Treatment of Chronic Rhinitis. EAR, NOSE & THROAT JOURNAL 2024:1455613241285134. [PMID: 39315465 DOI: 10.1177/01455613241285134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Objective: Chronic rhinitis substantially impacts a person's quality of life. We evaluated a novel, multipoint, impedance-controlled, radiofrequency ablation device for the treatment of chronic rhinitis. Methods: This was a prospective, multicenter, single-arm clinical study of posterior nasal nerve ablation in adults with chronic rhinitis. The primary efficacy endpoint was the change in reflective Total Nasal Symptom Score (rTNSS) at 6-month follow-up. Additional assessments included the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), Nasal Obstruction Symptom Evaluation (NOSE), and mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ). The primary safety endpoint was the incidence of related serious adverse events. Results: Seventy-nine of 80 enrolled participants completed 6-month follow-up. Statistically significant improvements were observed for mean change in rTNSS (-4.2), ETDQ-7 (-1.2), NOSE (-33.5), and mini-RQLQ (-1.8; P < .0001 for all). Allergic and nonallergic rhinitis subgroups demonstrated significant improvement in all assessments (P < .0001) with no significant differences between subgroups. Higher baseline rTNSS was associated with greater improvements at follow-up. One serious adverse event of epistaxis was reported. Conclusions: The results of this study demonstrate the efficacy and safety of a multipoint, impedance-controlled, radiofrequency ablation device for the treatment of chronic rhinitis. Significant improvements were observed in rTNSS, ETDQ-7, NOSE, and mini-RQLQ assessments.Study registration: www.clinicaltrials.gov. Unique identifier NCT05591989.
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Affiliation(s)
- Greg E Davis
- Proliance Surgeons, Seattle and Puyallup, WA, USA
| | - Randall A Ow
- Sacramento Ear, Nose, and Throat, Roseville, CA, USA
| | - David M Yen
- Specialty Physician Associates, Bethlehem, PA, USA
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Wong QYA, Lim JJ, Ng JY, Malipeddi P, Lim YYE, Sio YY, Chew FT. The burden of allergic rhinitis is undermanaged in a large proportion of Chinese young adults from Singapore. World Allergy Organ J 2024; 17:100954. [PMID: 39228765 PMCID: PMC11367507 DOI: 10.1016/j.waojou.2024.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2024] [Accepted: 08/01/2024] [Indexed: 09/05/2024] Open
Abstract
Background Allergic rhinitis (AR) is a nasal disorder characterized by the simultaneous manifestation of at least 2 out of 4 possible symptoms: rhinorrhea, nasal itching, nasal pruritus, and sneezing. Presently, among Chinese young adults from Singapore, we characterised AR phenotypes, established Total Nasal Symptom Score (TNSS) baselines, and examined the management of AR. Methods Participants completed an investigator-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and underwent a skin prick test (SPT). Individuals exhibiting sensitization during the SPT while having at least 2 rhinitis symptoms were identified as AR cases, then categorized into Allergic Rhinitis in Asthma (ARIA) classifications. Results There were 9323 subjects analyzed. AR prevalence was estimated at 35.4%. Rhinorrhea was perceived as the most severe (mean Nasal Symptom Score (mNSS) ± SD: 1.42 ± 0.74), while nasal pruritus was the least severe (mNSS ± SD: 1.24 ± 0.68). Among moderate-severe AR (68.1%), most were affected by either troublesome symptoms (27.7%) or sleep disturbances (18.4%). By ARIA classes, 26.6% were mild intermittent, 5.4% were mild persistent, 50.3% were moderate-severe intermittent, and 17.6% were moderate-severe persistent. The mean TNSS (mTNSS) of AR cases was 4.43 (SD = 2.49) and between AR classifications, the mTNSS was significantly different. Notably, a large proportion of AR cases remained undiagnosed (85.2%), untreated (72.5%), or both (65.4%); 19.8% self-medicated for AR. Conclusions There was a significant difference in TNSS of the AR phenotypes, and among phenotypes with a higher mTNSS, a large proportion remained untreated, undiagnosed, or both. The evidence indicates an existing burden of AR among Chinese young adults in Singapore which is notably undermanaged.
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Affiliation(s)
- Qi Yi Ambrose Wong
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Jun Jie Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Jun Yan Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Praneeth Malipeddi
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Yi Ying Eliza Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Yang Yie Sio
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
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Takashima M, Stolovitzky JP, Ow RA, Silvers SL, McDuffie CM, Dean M, Sedaghat AR, Tajudeen BA. Temperature-controlled radiofrequency ablation for the treatment of chronic rhinitis: Two-year outcomes from a prospective multicenter trial. Int Forum Allergy Rhinol 2024; 14:1182-1194. [PMID: 38266636 DOI: 10.1002/alr.23315] [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: 09/24/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Minimally invasive temperature-controlled radiofrequency (TCRF) ablation of the posterior nasal nerve (PNN) demonstrated a significant larger treatment effect on the symptom burden of chronic rhinitis patients than a sham control (no energy delivery) at the 3-month primary endpoint of this trial. METHODS Two-year posttreatment outcomes for patients treated in a prospective, multicenter, patient-blinded randomized controlled trial were determined by combining the index active treatment-arm and index control-arm crossover patients into a single group (after the primary endpoint) to evaluate the treatment effect durability and long-term effects on concomitant chronic rhinitis medication usage. RESULTS The mean baseline reflective total nasal symptom score (rTNSS) was 8.2 (95% confidence interval [CI], 7.9-8.6; N = 104). At 2 years (N = 79), the mean change in rTNSS was -5.3 (95% CI, -5.8 to -4.8; p < 0.001; 64.6% improvement). The 2-year responder rate (≥30% improvement in rTNSS) was 87.3% (95% CI, 78.0-93.8). All four components of the rTNSS (rhinorrhea, congestion, sneezing, and nasal itching) showed significant improvement over baseline, with rhinorrhea and congestion showing the most improvement. Postnasal drip and cough symptoms were also significantly improved. At 2 years, 81.0% (95% CI, 70.6-89.0) reported a minimal clinically important difference of ≥0.4-point improvement in the mini-rhinoconjunctivitis quality of life questionnaire score. Of 56 patients using chronic rhinitis medications at baseline, 25 of 56 (44.6%) either stopped all medication use (7/56 [12.5%]) or stopped/decreased (18/56 [32.1%]) use of ≥1 medication class at 2 years. No serious adverse events related to the device/procedure were reported over 2 years. To determine the potential effect of patients who left the trial over 2 years on the responder rate, the responder statuses of the 14 patients with follow-up data who were lost to follow-up/withdrew/died were imputed by the last observation carried forward and the responder statuses of all nine patients who had an additional nasal procedure were imputed to nonresponder, resulting in a 2-year responder rate of 79.4% (95% CI, 70.3-86.8). CONCLUSION TCRF ablation of the PNN is safe and resulted in a significant and sustained reduction in chronic rhinitis symptom burden through 2 years and a substantial reduction in concomitant medication burden.
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Affiliation(s)
- Masayoshi Takashima
- The Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - J Pablo Stolovitzky
- The Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California, USA
| | | | - Chad M McDuffie
- Ear, Nose, and Throat Associates of Texas, McKinney, Texas, USA
| | - Marc Dean
- Ear & Sinus Institute, Fort Worth, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech Health Science Center, Lubbock, Texas, USA
- Otorhinologic Research Institute, Dallas, Texas, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Reh DD, Lay K, Davis G, Dubin MG, Yen DM, O'Malley EM, Sillers M. Long-term outcomes following impedance-controlled radiofrequency ablation for the treatment of chronic rhinitis. Laryngoscope Investig Otolaryngol 2024; 9:e1286. [PMID: 38835333 PMCID: PMC11149760 DOI: 10.1002/lio2.1286] [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: 02/22/2024] [Revised: 04/12/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
Objective To assess long-term safety and effectiveness of a multipoint, impedance-controlled, RF ablation device for treatment of chronic rhinitis through 12-month follow-up. Methods A prospective, multicenter study. Bilateral posterior nasal nerve (PNN) ablation was performed on all participants. Assessments at 6-, 9-, and 12-month visits included Visual Analog Scale Nasal Symptom Score (VAS NSS), reflective Total Nasal Symptom Score (rTNSS), mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini RQLQ), and adverse events. Results Thirty-six participants were enrolled and 35 completed the 12-month follow-up. All 5 VAS NSS items demonstrated statistically significant improvement (p < .0001) over baseline at all 3 time points. The total rTNSS improved from 7.9 ± 1.8 at baseline to 4.3 ± 2.1 at 6-months, 3.8 ± 2.4 at 9-months, and 4.0 ± 2.1 at 12-months (all p < .0001). At 12-months, 91% (31/35) of participants had achieved the minimum clinically important difference (MCID) of a reduction from baseline of ≥1 point and 80% (28/35) of the participants met the responder criteria of ≥30% reduction from baseline. The total mean mini RQLQ was reduced from 3.0 ± 1.0 at baseline to 1.4 ± 0.8 at 6-months, 1.4 ± 1.0 at 9-months, and 1.3 ± 0.8 at 12-months (all p < .0001). At 12-months, 86% (30/35) of participants achieved the MCID of a reduction from baseline of ≥0.4 points for the mini RQLQ. No related serious adverse events occurred during the study. Conclusions Impedance-controlled RF ablation of the PNN is safe and resulted in durable, significant improvement in rhinitis symptoms and quality of life through 12-month follow-up. Trial Registration The study is registered at www.clinicaltrials.gov with the unique identifier of NCT05324397. Level of Evidence 4.
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Affiliation(s)
- Douglas D Reh
- Centers for Advanced ENT Care Baltimore Maryland USA
| | | | - Greg Davis
- ENT and Allergy Associates Seattle and Puyallup Washington USA
| | - Marc G Dubin
- Centers for Advanced ENT Care Baltimore Maryland USA
| | - David M Yen
- Specialty Physician Associates Bethlehem Pennsylvania USA
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Kim DH, Kang YJ, Kim SW, Kim SW, Basurrah MA, Hwang SH. Effectiveness of the Posterior Nasal Nerve Cryoablation in Allergic and Non-Allergic Rhinitis. Laryngoscope 2024; 134:2502-2512. [PMID: 37991147 DOI: 10.1002/lary.31163] [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: 06/30/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES This study assessed the impact of cryoablation of the posterior nasal nerve on symptoms of rhinitis in individuals with allergic rhinitis (AR) and non-allergic rhinitis (NAR). DATA SOURCES PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases for studies published up to June 2023. REVIEW METHODS Studies that evaluated the quality of life and rhinitis-related symptom scores before and after cryotherapy treatment, as well as sham-controlled studies, were included. RESULTS In total, 368 patients from seven studies were analyzed. Patients who underwent cryoablation showed a significant improvement in rhinitis-related symptoms in both NAR and AR. In particular, the most significant improvement was observed in symptoms of rhinorrhea and congestion. Furthermore, cryoablation improved the disease-specific quality of life evaluated using the Rhinoconjunctivitis Quality of Life Questionnaire. The rate of clinical improvement in the total nasal symptom score (total nasal symptom score [TNSS]; >30% reduction from baseline) after cryotherapy was 74%. The change in TNSS score significantly increased over time in NAR patients (p = 0.0041). Therefore, changes in the TNSS score after 12 months of cryotherapy treatment were greater in the NAR group than in the AR group (p = 0.0020), indicating that cryoablation is effective for both types of rhinitis and has better long-term efficacy in NAR than in AR. CONCLUSIONS Subjective symptom scores related to rhinitis, particularly for rhinorrhea and congestion, decrease after cryoablation of the posterior nasal nerve. Furthermore, the symptom improvement was greater in NAR than AR. Laryngoscope, 134:2502-2512, 2024.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Luong AU, Yong M, Hwang PH, Lin BY, Gopi P, Mohan V, Ma Y, Johnson J, Yen DM, DeMera RS, Bleier BS. Acoustic resonance therapy is safe and effective for the treatment of nasal congestion in rhinitis: A randomized sham-controlled trial. Int Forum Allergy Rhinol 2024; 14:919-927. [PMID: 37812532 DOI: 10.1002/alr.23284] [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: 07/31/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Acoustic resonance therapy (ART) is a novel vibrational treatment that delivers patient-specific resonant frequency acoustic energy to the sinonasal cavities. In a pilot study, ART was effective for the acute treatment of nasal congestion. We conducted a sham-controlled randomized trial to validate the efficacy of ART when administered daily for 2 weeks. METHODS A total of 52 adult patients were enrolled in a multi-center, randomized, double-blinded, sham-controlled, interventional study evaluating ART administered by a vibrational headband. Patients received either active treatment or a non-therapeutic sham treatment twice daily over 2 weeks. Clinical endpoints were the average change in nasal congestion sub-score of the Total Nasal Symptom Score (TNSS) and the average change in composite TNSS. RESULTS ART resulted in a significantly greater mean change in the nasal congestion sub-score compared to sham (-0.87 [95% confidence interval [CI] -1.11, -0.62] vs. -0.44 [95% CI -0.64, -0.23], p = 0.008). ART also resulted in a significantly greater reduction in the composite TNSS versus sham, (-2.85 [95% CI -3.85, -1.85], vs. -1.32 [95% CI -2.27, -0.36], p = 0.027). The response rate, determined by a nasal congestion sub-score minimal clinically important difference of 0.23, was 80.8% for ART and 46.2% for sham, with an adjusted risk ratio of 1.95 (95% CI 1.26, 3.02, p = 0.003) in favor of ART. Safety endpoints showed no adverse events. CONCLUSION ART is a safe and effective non-pharmacologic alternative for the treatment of nasal congestion.
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Affiliation(s)
- Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Immunology and Autoimmune Diseases, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael Yong
- Pacific Neuroscience Institute, Santa Monica, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Bryant Y Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Vivek Mohan
- Sound Health Systems, Los Altos, California, USA
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jacob Johnson
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA
| | - David M Yen
- Specialty Physician Associates, Bethlehem, Pennsylvania, USA
| | | | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Gorelik D, Ahmad JG, Razmi SE, Takashima M, Yiu Y, Thekdi A, Ramanathan M, Dhanda AK, Yim MT, Ahmed OG. Postnasal drip and chronic cough in patients with chronic rhinitis treated with temperature-controlled radiofrequency neurolysis. Int Forum Allergy Rhinol 2024; 14:621-629. [PMID: 37461130 DOI: 10.1002/alr.23238] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To evaluate the contribution of postnasal drip (PND) and chronic cough (CC) to symptoms of patients with chronic rhinitis treated with temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN), and correlate PND and CC scores with components of the reflective total nasal symptom score (rTNSS). METHODS Pooled data from three prospective studies: two single-arm studies and the index active treatment arm of a randomized controlled trial. Adult patients with baseline rTNSS ≥6 were treated with TCRF neurolysis at nonoverlapping regions of the PNN. PND and CC symptoms were evaluated on a 0 (none) to 3 (severe) scale. RESULTS Data from 228 patients (57.9% women, 42.1% men) were included. The mean baseline rTNSS was 8.1 (95% confidence interval [CI], 7.8-8.3), which decreased to 3.2 (95% CI, 2.9-3.5) at 6 months. At baseline, 97.4% of patients had PND and 80.3% had CC. Median baseline PND and CC symptom scores were 3 (interquartile range [IQR], 2-3) and 2 (IQR, 1-2), respectively. At 6 months, this decreased to 1 (IQR, 0-2) and 0 (IQR, 0-1), respectively, showing significant improvement from baseline (both p < 0.001). Spearman correlation coefficients with components of rTNSS (rhinorrhea, congestion, itching, sneezing) were 0.16 to 0.22 for CC and 0.19 to 0.46 for PND, indicating only a weak to moderate correlation. CONCLUSION PND and CC contribute to the symptomatology of chronic rhinitis and are significantly improved after TCRF neurolysis of the PNN. The inclusion of PND and CC symptoms in a chronic rhinitis assessment instrument could provide important additional information for the characterization of the disease state and outcomes after any therapeutic treatment.
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Affiliation(s)
- Daniel Gorelik
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Jumah G Ahmad
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Samuel E Razmi
- EnMed, Texas A&M College of Medicine, Houston, Texas, USA
| | - Masayoshi Takashima
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Yin Yiu
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Apurva Thekdi
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aatin K Dhanda
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael T Yim
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University in Shreveport, Shreveport, Louisiana, USA
| | - Omar G Ahmed
- Department of Otolaryngology - Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Yu AJ, Tam B, Wrobel B, Hur K. Radiofrequency Neurolysis of the Posterior Nasal Nerve: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:507-516. [PMID: 37515507 DOI: 10.1002/lary.30911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/07/2023] [Accepted: 07/04/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Temperature-controlled radiofrequency neurolysis of the posterior nasal nerve (PNN) has been approved for use since 2020. This review synthesized the published data to assess its efficacy for treatment of chronic rhinitis. DATA SOURCES Pubmed/Medline, Embase, Scopus, Web of Science. REVIEW METHODS A systematic search was conducted with no restrictions on publication years in April 2023. RCTs and prospective investigations that reported the reflective Total Nasal Symptom Score (rTNSS) outcome of radiofrequency neurolysis as a single procedure in chronic rhinitis patients were included. Pooled estimates for change in rTNSS from baseline at 3 months and responder rates (≥30% reduction in baseline rTNSS) at 3 and 6 months were obtained. Other outcomes, such as postnasal drip and cough scores, quality of life (QoL) measures, and adverse events were included for qualitative review. RESULTS Five studies were included in the systematic review, of which four were included in the meta-analysis. A total of 284 participants underwent treatment. The pooled change in rTNSS score at 3 months was -4.28 (95% CI, -5.10 to -3.46). The pooled responder rate at 3 months was 77.11% (95% CI, 68.21%-86.01%) and at 6 months 80.80% (95% CI, 70.85%-90.76%). Postnasal drip and cough scores and QoL also improved significantly at follow up. A total of 36 adverse events were reported in 21 (7.4%) patients. CONCLUSIONS The findings from this review suggest that temperature-controlled radiofrequency neurolysis of the PNN is effective at treating chronic rhinitis symptoms and that it has an overall favorable safety profile. Laryngoscope, 134:507-516, 2024.
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Affiliation(s)
- Alison J Yu
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Benjamin Tam
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Bozena Wrobel
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Kevin Hur
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
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Shao S, Wang Y, Zhang N, Zhao Y, Zhang X, Sima Y, Wang P, Xu Y, Wang T, Bao S, Cao Y, Wang X, Zhang L, Bachert C. A prospective single-arm study on the efficacy and safety of short-course oral corticosteroids followed by topical corticosteroids in patients with severe chronic rhinosinusitis with nasal polyps. Expert Rev Clin Immunol 2023; 19:1029-1039. [PMID: 37119005 DOI: 10.1080/1744666x.2023.2209724] [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: 01/20/2023] [Accepted: 04/28/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Little evidence exists regarding an integrated multidimensional evaluation methodology to analyze the within-patient effects of medical treatment for chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to use an integrated evaluation model to analyze the effects of short-course oral corticosteroid (OCS) followed by intranasal corticosteroid spray (INCS) therapy in patients with severe CRSwNP. METHODS In all, 32 patients with severe CRSwNP received oral methylprednisolone for three weeks followed by intranasal budesonide spray for nine weeks in this prospective single-arm study. An evaluation model integrating the concepts of the core outcome set (COS), clinical control and minimum clinically important difference (MCID) was longitudinally evaluated. RESULTS All uncontrolled patients at baseline showed similar progressive improvements from baseline and more than 1 MCID response across core outcomes during the OCS period, with severe CRSwNP being partly controlled in 31 (96.9%) patients and uncontrolled in 1 (3.1%) patient at 3 weeks. During the subsequent INCS period, 14 (43.8%) patients gradually deteriorated to an uncontrolled status at 12 weeks, whereas 18 (56.2%) exhibited partly controlled CRSwNP until 12 weeks. CONCLUSIONS In more than half of the patients, severe CRSwNP was partly controlled with the initial OCS followed by INCS therapy. An integrated evaluation model was used to facilitate the comprehensive evaluation of within-patient response, especially in patients with different responses to the same treatment. TRIAL REGISTRATION ChiCTR1900024287.
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Affiliation(s)
- Shan Shao
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Yue Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Nan Zhang
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Yan Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Xuelian Zhang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 10073, China
| | - Yutong Sima
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Ping Wang
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Yuan Xu
- Departments of Oncology, Community Health Sciences, and Surgery, Cumming School of Medicine, and The Center for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | - Tie Wang
- MIID Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shiping Bao
- Department of Otolaryngology Head and Neck Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Yu Cao
- Department of Epidemiology research, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Xiangdong Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Luo Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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10
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Reh DD, Lay K, Davis G, Dubin MG, Yen DM, O'Malley EM, Sillers M. Clinical evaluation of a novel multipoint radiofrequency ablation device to treat chronic rhinitis. Laryngoscope Investig Otolaryngol 2023; 8:367-372. [PMID: 37090860 PMCID: PMC10116986 DOI: 10.1002/lio2.1040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Objective Safety and efficacy of the NEUROMARK® system for treating chronic rhinitis. Methods A prospective, single-arm, multicenter study was performed on adults with chronic rhinitis who underwent radiofrequency ablation to the posterior nasal nerves. Primary endpoints were device-related serious adverse events (SAEs) at 1 month and change from baseline in visual analog scale nasal symptom scale (VAS NSS) for rhinorrhea and nasal congestion at 3 months. Total nasal symptom score (rTNSS) and mini Rhinoconjunctivitis Quality of Life Questionnaire (mini RQLQ) score were also evaluated. Results Thirty-six participants were enrolled and completed follow-up at 1 and 3 months. Mean VAS NSS scores for rhinorrhea and nasal congestion demonstrated significant improvement at 3 months (both p < .0001). The mean percent changes from baseline in VAS rhinorrhea and nasal congestion were 53% and 55%, respectively. Total scores and all individual rTNSS items significantly improved (all p < .001) over the measured interval. Percent responder rate (≥30% reduction from baseline in total rTNSS) at 3 months was 78%. The total mean mini RQLQ scores, as well as all subdomains, improved significantly (all p < .0001). At 3 months, 89% of participants reported a minimal clinically important difference of ≥0.4 point improvement in the mini RQLQ score. No SAEs occurred during the study. Conclusions The NEUROMARK System is a novel radiofrequency ablation device that provides safe and effective treatment to the posterior nasal nerves for patients with chronic rhinitis. Study participants experienced statistically significant and clinically meaningful improvement in symptoms and quality of life assessments at 3 months post-procedure. Trial Registration The study is registered at www.clinicaltrials.gov with the unique identifier of NCT05324397. Level of Evidence 4.
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Affiliation(s)
| | | | - Greg Davis
- ENT and Allergy AssociatesSeattle and PuyallupWashingtonUSA
| | | | - David M. Yen
- Specialty Physician AssociatesBethlehemPennsylvaniaUSA
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11
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Lam AC, Liddle LJ, MacLellan CL. The Effect of Upper Cervical Mobilization/Manipulation on Temporomandibular Joint Pain, Maximal Mouth Opening, and Pressure Pain Thresholds: A Systematic Review and Meta-Analysis. Arch Rehabil Res Clin Transl 2023; 5:100242. [PMID: 36968167 PMCID: PMC10036235 DOI: 10.1016/j.arrct.2022.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To evaluate the efficacy of upper cervical joint mobilization and/or manipulation on reducing pain and improving maximal mouth opening (MMO) and pressure pain thresholds (PPTs) in adults with temporomandibular joint (TMJ) dysfunction compared with sham or other intervention. Data Sources MEDLINE, CINAHL, EMBASE, and Cochrane Library from inception to June 3, 2022, were searched. Study Selection Eight randomized controlled trials with 437 participants evaluating manual therapy (MT) vs sham and MT vs other intervention were included. Two reviewers independently extracted data and assessed risk of bias. Data Extraction Two independent reviewers extracted information about origin, number of study participants, eligibility criteria, type of intervention, and outcome measures. Data Synthesis Manual therapy was statistically significant in reducing pain compared with sham (mean difference [MD]: -1.93 points, 95% confidence interval [CI]: -3.61 to -0.24, P=.03), and other intervention (MD: -1.03 points, 95% CI: -1.73 to -0.33, P=.004), improved MMO compared with sham (MD: 2.11 mm, 95% CI: 0.26 to 3.96, P=.03), and other intervention (MD: 2.25 mm, 95% CI: 1.01 to 3.48, P<.001), but not statistically significant in improving PPT of masseter compared with sham (MD: 0.45 kg/cm2, 95% CI: -0.21 to 1.11, P=.18), and other intervention (MD: 0.42 kg/cm2, 95% CI: -0.19 to 1.03, P=.18), or the PPT of temporalis compared with sham (MD: 0.37 kg/cm2, 95% CI: -0.03 to 0.77, P=.07), and other intervention (MD: 0.43 kg/cm2, 95% CI: -0.60 to 1.45, P=.42). Conclusion There appears to be limited benefit of upper cervical spine MT on TMJ dysfunction, but definitive conclusions cannot be made because of heterogeneity and imprecision of treatment effects.
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Affiliation(s)
- Alan C. Lam
- Department of Physical Therapy, St. John's University, Queens, NY
| | - Lane J. Liddle
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Crystal L. MacLellan
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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12
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Takashima M, Stolovitzky JP, Ow RA, Silvers SL, Bikhazi NB, Johnson CD. Temperature-controlled radiofrequency neurolysis for treatment of chronic rhinitis: 12-month outcomes after treatment in a randomized controlled trial. Int Forum Allergy Rhinol 2023; 13:107-115. [PMID: 35714267 PMCID: PMC10083967 DOI: 10.1002/alr.23047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN) area for the treatment of chronic rhinitis was previously reported as superior to a sham-control procedure at 3 months postprocedure in a randomized controlled trial (RCT). The primary endpoint was a responder rate of ≥30% improvement (decrease) for 24-hour reflective total nasal symptom score (rTNSS) compared with baseline. Herein, 12-month outcomes after active treatment are reported. METHODS In this prospective, multicenter, patient-blinded RCT, patients in the index active treatment arm were unblinded at 3 months and followed through 12 months. At 3 months, eligible patients from the sham-control arm of the study were invited to crossover to active treatment. Eligibility criteria included rTNSS ≥6, with moderate-severe rhinorrhea and mild-severe congestion. The TCRF stylus was applied bilaterally to nonoverlapping areas in the region of the PNN. RESULTS Patients in the index active treatment arm (n = 77) had a mean baseline rTNSS of 8.3 (95% confidence interval [CI], 7.9-8.7). At 12 months, the responder rate was 80.6% (n = 67) (95% CI, 69.1%-89.2%). At 12 months, the mean change in rTNSS was -4.8 (95% CI, -5.5 to -4.1; p < 0.001), a 57.8% improvement. The available initial rTNSS-based outcomes in the crossover active treatment arm (n = 27) were following the same course as the index treatment arm. No serious adverse events and 8 adverse events related to the device/procedure were reported in the trial to date. CONCLUSION TCRF neurolysis of the PNN area is safe and the symptom burden improvement that was superior to a sham procedure at 3 months was sustained through 12 months.
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Affiliation(s)
- Masayoshi Takashima
- Department of Otolaryngology-Head & Neck Surgery, Houston Methodist Hospital, Houston, TX
| | | | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, CA
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13
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Young K, Bulosan H, Kejriwal S, Liang J, Wu AW, Tang DM, Birkeland AC, Steele TO. Efficacy of Cryoablation on Chronic Rhinitis Management: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2023:19458924231152331. [PMID: 36691694 DOI: 10.1177/19458924231152331] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis. OBJECTIVE The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS). METHODS A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be -3.48 points (95% CI: -3.73 to -3.23, I2 = 0.13). and -3.50 (95% CI: -3.71 to -3.29, I2 = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be -1.53 (95% CI: -1.74 to -1.31, I2 = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%). CONCLUSIONS The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
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Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Sameer Kejriwal
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Northern California, Oakland, California, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
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Kim M, Ryu G, Kang SY, Kim MA, Yang SI, Lee IH, Choi GS, Kim HJ, Lee SM, Kim DK, Choi JH, Yang HJ, Kim SW. Intranasal antihistamine and corticosteroid to treat allergic rhinitis: A systematic review and meta-analysis. Allergy 2022; 77:3436-3440. [PMID: 35716356 DOI: 10.1111/all.15415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Minji Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Yoon Kang
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Il Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Gil-Soon Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Jeong Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Validation of the Spanish language version of the control of allergic rhinitis and asthma test. NPJ Prim Care Respir Med 2022; 32:47. [PMID: 36309520 PMCID: PMC9617860 DOI: 10.1038/s41533-022-00313-8] [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: 03/13/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022] Open
Abstract
Allergic rhinitis and asthma are common diseases that frequently coexist, referred to as unified airway disease. There is currently no validated scale in Spanish, which allows simultaneous evaluation of both conditions. A translation from Portuguese to Spanish was therefore performed. It was administered to 120 patients aged between 18 and 70 years whose native language was Spanish and presented a diagnosis of allergic rhinitis and asthma. The reliability, validity and sensitivity to instrument change validations were carried out, as well as the values of minimally relevant clinical differences. Reliability was evaluated using Cronbach´s alpha test on CARAT-global: 0.83 [IC 95% 0.79–0.88]; test and retest evaluation was done with Pearson´s correlation coefficient: 0.6 [IC 95% 0.32–0.77] and the standard error of measurement 3.5 (p < 0.005). A confirmatory factor analysis was performed corroborating two factors. Correlation coefficients were not high in the longitudinal validation. Concurrent validity showed an acceptable correlation between CARAT10 asthma ACQ5 and low between allergic rhinitis-VAS. There was a milestone of the controlled disease in the discriminant validity of CARAT10 rhinitis ≥ 8 mean an adequate control, CARAT10-asthma > 16 In this case, CARAT10-asthma value < 16 are interpreted as an inadequate or partial control and values ≥ 16 mean an adequate control and CARAT10-global ≥ 18, patients evaluated with CARAT10 with a result ≥ 18, which would be a patient with both conditions controlled. The minimally relevant clinically important average difference found in the CARAT10 scale was 3.25 (SD 3.77). The CARAT10 scale in Spanish is a standardised, reliable and valid evaluation method on patients with unified airway disease.
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16
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Tataurshchikova NS, Berezhanskiy PV, Rusanova AS. [Effective intranasal GCS application strategy of mono and combines forms in treating patients, suffering from allergic rhinitis. Evidence-based medicine to help a practitioner]. Vestn Otorinolaringol 2022; 87:39-45. [PMID: 35274891 DOI: 10.17116/otorino20228701139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize effective intranasal glucocorticosteroids (GCS) application strategies in treatment of patients, suffering from allergic rhinitis (depending on disease type), based on actual research results. Current study determines the place of fixed intranasal GCS and topic antihistamine medication combination, specifically azelastine and mometasone furoate, as a first line of choice therapy in treatment of patients, suffering from allergic rhinitis. Effective application of stage therapy allows us establish control over allergic inflammation and significantly decrease pharmaceutical load in cases of patients, suffering from allergic rhinitis.
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Affiliation(s)
| | | | - A S Rusanova
- Peoples' Friendship University of Russia, Moscow, Russia
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17
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Ehmer D, McDuffie CM, McIntyre JB, Davis BM, Mehendale NH, Willis JH, Watkins JP, Kakarlapudi VV. Long-term Outcomes Following Temperature-Controlled Radiofrequency Neurolysis for the Treatment of Chronic Rhinitis. ALLERGY & RHINOLOGY (PROVIDENCE, R.I.) 2022; 13:21526575221096045. [PMID: 35663498 PMCID: PMC9158436 DOI: 10.1177/21526575221096045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Temperature-controlled radiofrequency neurolysis of the posterior nasal nerve has been shown to reduce the symptom burden of patients with chronic rhinitis. Objectives To evaluate the long-term safety and effectiveness of temperature-controlled radiofrequency neurolysis of the posterior nasal nerve for the treatment of chronic rhinitis. Methods A prospective extension of a 12-month single-arm study, where reflective total nasal symptom score (rTNSS) and the responses to a study-specific quality of life questionnaire and patient satisfaction survey were collected at 24 months. Results Forty-seven patients completed initial 12-month follow-up after treatment with the study device, of which 34 patients were reconsented and completed 24-month follow-up. The mean rTNSS of the long-term follow-up patients improved from 8.4 (95% confidence interval (CI), 7.7 to 9.0) at baseline to 2.9 (95% CI, 2.1 to 3.6), P < .001 at 24 months, a 65.5% improvement. On a 6-point scale (0-5), postnasal drip improved from a mean of 4.1 (95% CI, 3.6 to 4.6) to 2.1 (95% CI, 1.7 to 2.5) and chronic cough improved from 3.2 (95% CI, 2.7 to 3.6) to 0.9 (95% CI, 0.5 to 1.3) from baseline through 24 months; P < .001 for both measures. The proportion of patients achieving a minimal clinically important difference of 30% improvement from baseline at 24 months was 88.2% (95% CI, 73.4%-95.3%). At 24 months, 24% of patients were taking overall fewer and 15% taking overall more rhinitis medication classes than at baseline. Patients reported a higher quality of life in terms of sleep, well-being, and lower oral medication/nasal spray use at 24 months. There were no serious adverse events considered related to the procedure in the 12-24-month period. Conclusion Temperature-controlled radiofrequency neurolysis results in a significant and durable reduction in the symptom burden of chronic rhinitis and patients reported improved quality of life through 24 months postprocedure.
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Affiliation(s)
- Dale Ehmer
- Ear, Nose, and Throat Associates of Texas, McKinney, Texas, USA
| | | | | | - Bryan M. Davis
- Colorado ENT and Allergy, Colorado Springs, Colorado, USA
| | | | - John H. Willis
- Piedmont Ear, Nose, and Throat Associates, Winston-Salem, North Carolina, USA
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18
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Israel L, Rotter G, Förster-Ruhrmann U, Hummelsberger J, Nögel R, Michalsen A, Tissen-Diabaté T, Binting S, Reinhold T, Ortiz M, Brinkhaus B. Acupressure in patients with seasonal allergic rhinitis: a randomized controlled exploratory trial. Chin Med 2021; 16:137. [PMID: 34922567 PMCID: PMC8684198 DOI: 10.1186/s13020-021-00536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Acupuncture has shown beneficial effects for seasonal allergic rhinitis (SAR); however, it is time and cost intensive. We investigated feasibility and effects of self-administered body acupressure as a self-care technique that stimulates acupuncture points with manual pressure in SAR patients. METHODS We conducted a two-armed randomized controlled exploratory trial to compare effects of self-administered acupressure over 4 weeks at five acupuncture points plus rescue medication (RM) with cetirizine compared to RM alone in SAR patients. Among other outcome parameters, we assessed disease-related quality of life (Rhinitis Quality of Life Questionnaire [RQLQ]), overall SAR symptoms by a visual analogue scale (VAS) and a rescue medication score (RMS) after 4 and 8 weeks. RESULTS Forty-one SAR patients (mean age 38.5 ± 10.0 years, n = 21, 51.2% women) were randomized. Compared to RM alone (n = 21), acupressure plus RM (n = 20) was associated with relevant improvements after 4 weeks, shown by the difference between groups in adjusted means of RQLQ: - 0.9 points (95% CI - 1.6 to - 0.2; p = 0.011) and VAS overall SAR symptoms: - 21.6 mm (95% CI - 36.3 to - 6.8; p = 0.005). The RMS was lower in the acupressure group than in the control group: 1.9 points (95% CI - 3.8 to - 0.1; p = 0.120). Group differences decreased slightly until week 8. The acupressure was feasible and safe. CONCLUSION Results of this exploratory study indicate that self-applied acupressure is feasible, may improve disease-specific quality of life and reduce disease-related symptoms as well as anti-allergic medication intake in SAR patients. High-quality confirmatory studies including a sham-control group are needed in the future. Trial registration DRKS-ID: DRKS00014310. Date of registration in DRKS: 2018/04/24. Investigator sponsored/initiated trial (IST/IIT): yes. Ethics approval/approval of the ethics committee: Approved (leading) Ethics Committee No. EA1/033/18, Ethik-Kommission der Charité -Universitätsmedizin Berlin. URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014310.
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Affiliation(s)
- Lukas Israel
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Gabriele Rotter
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Ulrike Förster-Ruhrmann
- Department for Otolaryngology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Josef Hummelsberger
- Societas Medicinae Sinensis (SMS) e.V. - International Society for Chinese Medicine, Franz-Joseph-Straße 38, 80801, Munich, Germany
| | - Rainer Nögel
- Societas Medicinae Sinensis (SMS) e.V. - International Society for Chinese Medicine, Franz-Joseph-Straße 38, 80801, Munich, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Tatjana Tissen-Diabaté
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Sylvia Binting
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Miriam Ortiz
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany.
| | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
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19
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Zhang K, Li AR, Miglani A, Nguyen SA, Schlosser RJ. Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2021; 36:269-280. [PMID: 34546814 DOI: 10.1177/19458924211041438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow. OBJECTIVE To provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow. METHODS A systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis. RESULTS Twenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [P = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36; P < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65; P < .001], with a trend toward improvement in TNSS. CONCLUSION Overall, INCS resulted in a clinically and statistically meaningful improvement in symptom scores and physiologic measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their impacts upon nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly for mild AR. Future studies should assess the effect of treatment for each of these patient-reported measures.
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Affiliation(s)
- Kathy Zhang
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Andraia R Li
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Amar Miglani
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- 2345Medical University of South Carolina, Charleston, SC, USA
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Li AR, Zhang K, Reddy PD, Nguyen SA, Miglani A, Fried J, Nguyen MI, Schlosser RJ. Systematic review of measures of disease severity in rhinitis. Int Forum Allergy Rhinol 2021; 11:1367-1377. [PMID: 33773058 DOI: 10.1002/alr.22794] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rhinologists often encounter a broad spectrum of allergic rhinitis (AR) and nonallergic rhinitis (NAR) patients, who can be variably classified based upon timing and severity of disease. Our understanding of the varied quality of life (QOL) impact in different classifications of rhinitis is limited. Thus a more comprehensive understanding of the impact of rhinitis upon our patients, as measured by both patient reported outcome measures (PROMs) and clinical physiologic measures, as well as unique factors associated with disease severity is needed. METHODS A systematic search of databases was performed to identify AR and NAR studies reporting Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), total nasal symptom score (TNSS), or visual analogue scale (VAS) scores, and physiologic measures including peak nasal inspiratory flow (PNIF) and nasal airflow. Relationships between PROMs, physiologic measures, and associated factors (e.g., allergic status, disease duration) were assessed by weighted correlations and meta-regressions. RESULTS A total of 171 studies reporting on 33,843 patients were included. Symptoms were more severe in AR than NAR on VAS (p < 0.001). Classification based upon Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines demonstrated differences in PROM severity. There was no significant correlation between PROMs and demographic factors, comorbidities, or physiologic measures. Meta-regression identified a correlation between worse RQLQ scores and shorter disease duration (r = -0.4, p < 0.001). CONCLUSION Rhinitic patients have more severe impact upon QOL in the presence of allergy with variable impact upon specific symptom subdomains. PROMs do not correlate with common demographic factors, comorbidities, or physiologic measures of nasal airflow.
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Affiliation(s)
- Andraia R Li
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Priyanka D Reddy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amar Miglani
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jacob Fried
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mariam I Nguyen
- Charleston County School of the Arts, North Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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21
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Ehmer D, McDuffie CM, Scurry WC, McIntyre JB, Mehendale NH, Willis JH, Shealy RB, Watkins JP, Kakarlapudi VV. Temperature-Controlled Radiofrequency Neurolysis for the Treatment of Rhinitis. Am J Rhinol Allergy 2021; 36:149-156. [PMID: 34382444 PMCID: PMC8652359 DOI: 10.1177/19458924211033400] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Chronic rhinitis is a prevalent condition with a significant impact on quality of life. Posterior nasal nerve and vidian neurectomy are surgical options for treating the symptoms of chronic rhinitis but are invasive procedures. Objective To determine the outcomes of patients diagnosed with refractory chronic rhinitis and treated with temperature-controlled radiofrequency neurolysis of the posterior nasal nerve area in a minimally invasive procedure. Methods A prospective, single-arm multicenter study with follow-up through 52 weeks. Eligible adult patients had chronic rhinitis symptoms of at least 6 months duration with inadequate response to at least 4 weeks usage of intranasal steroids and an overall 12-h reflective total nasal symptom score (rTNSS) ≥ 6 with subscores 2 to 3 for rhinorrhea, 1 to 3 for nasal congestion, and 0 to 3 for each of nasal itching and sneezing. Temperature-controlled radiofrequency energy was delivered to the nasal cavity mucosa overlying the posterior nasal nerve region with a novel single-use, disposable, handheld device. Results A total of 50 patients were treated (42.0% male; mean age 57.9 ± 11.9 years), and 47 completed the study through 52 weeks. Mean rTNSS significantly improved from 8.5 (95% CI 8.0, 9.0) at baseline to 3.6 (95% CI 3.0, 4.3) at 52 weeks (P < .001), a 57.6% improvement. Similar trends in improvement were noted for rTNSS subscores (rhinorrhea, nasal congestion, itching, sneezing), postnasal drip scores, and chronic cough scores. Subgroup analysis demonstrated the treatment was effective regardless of rhinitis classification (allergic or nonallergic). No serious adverse events with a relationship to the device/procedure occurred. Conclusions Temperature-controlled radiofrequency neurolysis of the posterior nasal nerve area for the treatment of chronic rhinitis is safe and resulted in a durable improvement in the symptoms of chronic rhinitis through a 52-week follow-up. Data suggest that this novel device could be considered a minimally invasive option in the otolaryngologist's armamentarium for the treatment of chronic rhinitis.
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Affiliation(s)
- Dale Ehmer
- Ear, Nose, and Throat Associates of Texas, McKinney, TX, USA
| | - Chad M McDuffie
- Ear, Nose, and Throat Associates of Texas, McKinney, TX, USA
| | - W Cooper Scurry
- 161032Piedmont Ear, Nose, and Throat Associates, Winston-Salem, NC, USA
| | | | | | - John H Willis
- 161032Piedmont Ear, Nose, and Throat Associates, Winston-Salem, NC, USA
| | - Ronald B Shealy
- 161032Piedmont Ear, Nose, and Throat Associates, Winston-Salem, NC, USA
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Del Signore AG, Greene JB, Russell JL, Yen DM, O'Malley EM, Schlosser RJ. Cryotherapy for treatment of chronic rhinitis: 3-month outcomes of a randomized, sham-controlled trial. Int Forum Allergy Rhinol 2021; 12:51-61. [PMID: 34355872 PMCID: PMC9291981 DOI: 10.1002/alr.22868] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022]
Abstract
Background The purpose of this study was to test whether cryotherapy is superior to a sham procedure for reducing symptoms of chronic rhinitis. Methods This study was a prospective, multicenter, 1:1 randomized, sham‐controlled, patient‐blinded trial. The predetermined sample size was 61 participants per arm. Adults with moderate/severe symptoms of chronic rhinitis who were candidates for cryotherapy under local anesthesia were enrolled. Participants were required to have minimum reflective Total Nasal Symptom Scores (rTNSSs) of 4 for total, 2 for rhinorrhea, and 1 for nasal congestion. Follow‐up visits occurred at 30 and 90 days postprocedure. Patient‐reported outcome measures included the rTNSS, standardized Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ(S)], and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires. Adverse events were also recorded. The primary endpoint was the comparison between the treatment and sham arms for the percentage of responders at 90 days. Responders were defined as participants with a 30% or greater reduction in rTNSS relative to baseline. Results Twelve US investigational centers enrolled 133 participants. The primary endpoint analysis included 127 participants (64 active, 63 sham) with 90‐day results. The treatment arm was superior at the 90‐day follow‐up with 73.4% (47 of 64) responders compared with 36.5% (23 of 63) in the sham arm (p < 0.001). There were greater improvements in the rTNSS, RQLQ(S), and NOSE scores for the active arm over the sham arm at the 90‐day follow‐up (p < 0.001). One serious procedure‐related adverse event of anxiety/panic attack was reported. Conclusion Cryotherapy is superior to a sham procedure for improving chronic rhinitis symptoms and patient quality of life.
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Affiliation(s)
| | | | | | - David M Yen
- Specialty Physician Associates, Bethlehem, PA
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23
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Khanwalkar A, Johnson J, Zhu W, Johnson E, Lin B, Hwang PH. Resonant vibration of the sinonasal cavities for the treatment of nasal congestion. Int Forum Allergy Rhinol 2021; 12:120-123. [PMID: 34355851 DOI: 10.1002/alr.22877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jacob Johnson
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Wendy Zhu
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA
| | - Ezekiel Johnson
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA
| | - Bryant Lin
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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Ellis AK, Murrieta-Aguttes M, Furey S, Picard P, Carlsten C. Effect of fexofenadine hydrochloride on allergic rhinitis aggravated by air pollutants. ERJ Open Res 2021; 7:00806-2020. [PMID: 33834054 PMCID: PMC8021806 DOI: 10.1183/23120541.00806-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 11/27/2022] Open
Abstract
In recent decades, seasonal allergic rhinitis (SAR) prevalence has increased and recent studies have shown that air pollutants, such as diesel exhaust particles (DEP), can increase inflammatory and allergic biomarkers. The aim of this study was to investigate the effects of DEP on SAR symptoms induced by ragweed and to evaluate the efficacy and safety of fexofenadine HCl 180 mg versus placebo. This phase 3, single-centre, sequential, parallel-group, double-blind, randomised study (NCT03664882) was conducted in an environmental exposure unit (EEU) during sequential exposures: Period 1 (ragweed pollen alone), Period 2 (ragweed pollen+DEP), and Period 3 (ragweed pollen+DEP+single-dose fexofenadine HCl 180 mg or placebo). Efficacy and safety were evaluated in Period 3. Primary endpoints were the area under the curve (AUC) of total nasal symptom score (TNSS) from baseline to hour 12 (AUC0–12) during Period 1 and Period 2; and the AUC of the TNSS from hour 2 to 12 (AUC2–12) during Period 3. 251 out of 257 evaluable subjects were included in the modified intent-to-treat population. Least squares mean difference (95% CI) for TNSS Log AUC0−12 in Period 2 versus Period 1 was 0.13 (0.081–0.182; p<0.0001). Least squares mean difference in TNSS Log AUC2−12 for fexofenadine HCl versus placebo during Period 3 was −0.24 (−0.425–−0.047; p=0.0148). One fexofenadine HCl-related adverse event was observed. SAR symptoms evoked by ragweed were aggravated by DEP. Fexofenadine HCl 180 mg was effective in relieving pollen-induced, air pollution-aggravated allergic rhinitis symptoms. This is the first randomised, double-blind, large study to demonstrate the beneficial effect of a histamine H1-receptor antagonist by reducing ragweed pollen-induced seasonal allergic rhinitis symptoms aggravated by controlled exposure to air pollutantshttps://bit.ly/3oauMFu
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Affiliation(s)
- Anne K Ellis
- Division of Allergy and Immunology, Dept of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Sandy Furey
- Sanofi Consumer Health Care, Bridgewater, MA, USA
| | | | - Christopher Carlsten
- Air Pollution Exposure Laboratory, University of British Columbia, Vancouver, BC, Canada
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Peric A, Gacesa D, Barac A, Peric A. A Herbal Formula in the Therapy of Acute Postviral Rhinosinusitis. Turk Arch Otorhinolaryngol 2021; 59:33-42. [PMID: 33912859 PMCID: PMC8054925 DOI: 10.4274/tao.2020.6098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/12/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To assess the effects and adverse events of preparation Sinulan forte® containing extracts of five medicinal plants in comparison to mometasone furoate nasal spray (MFNS) in therapy of acute postviral rhinosinusitis (APRS). Methods We included 46 APRS patients in this prospective investigation and randomized to two groups. The patients in group 1 (n=23) received MFNS 200 μg two times/day for ten days, and patients in group 2 (n=23) received Sinulan forte®, tablets 225 mg per os, two times/day also for ten days. We evaluated the total symptom score (TSS), the separate scores for individual symptoms (nasal congestion, rhinorrhea, postnasal discharge, facial pain, impaired sense of smell), the quality-of-life outcome, and the findings from nasal endoscopy (edema of the nasal mucosa, nasal secretion) prior and after the therapy. Results Significantly lower absolute post-treatment scores and better relative improvement were identified for TSS, nasal congestion, facial pain, loss of the sense of smell, edema of the mucosa and nasal secretion in patients receiving herbal preparation (group 2). However, lower absolute post-treatment score and better relative improvement were found for rhinorrhea and postnasal drip in group 1. Clinically important differences were found regarding the TSS and endoscopic findings, with no adverse effects in group 2, but in group 1 two patients had mild nasal bleeding and two had sensation of dryness in the nasal mucosa. Conclusion Herbal product Sinulan forte® can be a safe and effective treatment for APRS. Our results suggest no adverse events of this herbal preparation in comparison to intranasal corticosteroid spray therapy.
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Affiliation(s)
- Aleksandar Peric
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
| | - Dejan Gacesa
- Ear Nose and Throat Hospital "Doctor Zutic", Belgrade, Serbia
| | - Aleksandra Barac
- Department of Infectious and Tropical Diseases, Belgrade University School of Medicine, Belgrade, Serbia
| | - Aneta Peric
- Institute of Pharmacy, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
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Elevated Levels of Activated and Pathogenic Eosinophils Characterize Moderate-Severe House Dust Mite Allergic Rhinitis. J Immunol Res 2020; 2020:8085615. [PMID: 32855977 PMCID: PMC7443015 DOI: 10.1155/2020/8085615] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 01/14/2023] Open
Abstract
Eosinophils play a critical role in the pathogenesis of allergic airway inflammation. However, the relative importance of eosinophil activation and pathogenicity in driving the progression of disease severity of allergic rhinitis (AR) remains to be defined. We aimed to assess the relation of activated and pathogenic eosinophils with disease severity of patients with AR. Peripheral blood and nasal samples were collected from patients with mild (n = 10) and moderate-severe (n = 21) house dust mite AR and healthy control subjects (n = 10) recruited prospectively. Expressions of activation and pathogenic markers on eosinophils in the blood and nose were analyzed by flow cytometry. The eosinophilic cation protein- (ECP-) releasing potential and the pro-Th2 function of blood eosinophils were compared between the mild and moderate-severe patients and healthy controls. Our results showed that the numbers of activated (CD44+ and CD69+) and pathogenic (CD101+CD274+) eosinophils in the blood and nose as well as blood eosinophil progenitors were increased in moderate-severe AR compared with the mild patients and healthy controls. In addition, the levels of activated and pathogenic eosinophils in the blood were positively correlated with the total nasal symptom score and serum ECP and eosinophil peroxidase (EPX) levels in patients with AR. Furthermore, the blood eosinophils obtained from the moderate-severe patients exhibited a higher potential of releasing ECP and EPX induced by CCL11 and of promoting Th2 responses than those from the mild patients and healthy controls. In conclusion, patients with moderate-severe AR are characterized by elevated levels of activated and pathogenic eosinophils, which are associated with higher production of ECP, EPX, and IL-4 in the peripheral blood.
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27
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Kang J, Lee G, Kim J, Kim Y, Park S, Lee D. Effects and safety of intranasal phototherapy for allergic rhinitis: Study protocol for a single-center, randomized, double-blind, parallel, placebo-controlled, investigator-initiated, pilot study. Medicine (Baltimore) 2020; 99:e20835. [PMID: 32791671 PMCID: PMC7387024 DOI: 10.1097/md.0000000000020835] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) is an immunoglobulin E (Ig E)-mediated inflammatory disease. Intranasal phototherapy is a promising treatment modality because it has a profound immunosuppressive effect, but the available evidence of its use for AR is insufficient. Therefore, rigorously designed randomized controlled trials (RCTs) are needed. Our objective is to describe the protocol for a feasibility trial to assess the effects and safety of intranasal phototherapy for the treatment of AR. METHODS AND ANALYSIS This is a study protocol for a single-center, randomized, double-blind, parallel, placebo-controlled, investigator-initiated pilot study. A total of 40 patients with AR will be randomly assigned to the medical device or sham device group in a 1:1 ratio. The participants will receive intranasal phototherapy with a medical or sham device for 20 min 5 times a week for 2 weeks. The primary outcome will be the mean change in the Total Nasal Symptom Score (TNSS) from baseline to 2 weeks. The secondary outcomes will include the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, Nasal Endoscopy Index, total serum Ig E level, and eosinophil count. DISCUSSION The findings of this study will provide the basis for subsequent large-scale definitive RCTs to confirm the effects and safety of intranasal phototherapy for the treatment of nasal symptoms in patients with AR who do not respond well to conventional therapy. This study may assist in the development of noninvasive treatment for patients with AR. TRIAL REGISTRATION This study was registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0003253).
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Affiliation(s)
- Jeongin Kang
- Department of Ophthalmology, Otolaryngology, and Dermatology, College of Korean Medicine, Woo-Suk University, Jeonju
| | - Goeun Lee
- Department of Oriental Rehabilitation, National Rehabilitation Center, Seoul
| | - Jeonghun Kim
- Evidence-Based Healthcare Research Collaborating Center, Woo-Suk University, Jeonju
| | - Youngeun Kim
- Future Medicine Division, Korea Institute of Oriental Medicine
| | - Sunju Park
- Department of Preventive Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea
| | - Donghyo Lee
- Department of Ophthalmology, Otolaryngology, and Dermatology, College of Korean Medicine, Woo-Suk University, Jeonju
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Du K, Qing H, Zheng M, Wang X, Zhang L. Intranasal antihistamine is superior to oral H 1 antihistamine as an add-on therapy to intranasal corticosteroid for treating allergic rhinitis. Ann Allergy Asthma Immunol 2020; 125:589-596.e3. [PMID: 32650045 DOI: 10.1016/j.anai.2020.06.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Currently, a combination of intranasal corticosteroid (INCS) plus oral H1 antihistamine (OAH) or intranasal H1 antihistamine (INAH) therapy is frequently used in the treatment of allergic rhinitis (AR). The superiority of the 2 combined treatments needs to be further examined. OBJECTIVE To identify the better of the 2 therapeutic strategies for treating AR. METHODS A literature review was performed on MEDLINE, Cochrane Library, and EMBASE databases. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, meta-analyses of the total nasal symptom scores and individual nasal symptom scores were pooled based on studies that compared concomitant H1 antihistamines plus INCS with INCS alone in the treatment of AR. The pooled results were expressed as weighted mean differences between the treatments. For each selected study, we calculated the relative clinical impact based on the total nasal symptom scores as follows: 100 × (ScoreMonotherapy - ScoreCombined therapy) / ScoreMonotherapy. RESULTS A total of 13 publications met our selection criteria, with 5066 patients. The pooled results revealed no significant weighted mean difference on the total nasal symptom scores between concomitant OAH plus INCS and INCS alone. As for the individual symptoms, the most common symptom that revealed remission was rhinorrhea, which was after OAH in combination with INCS. The combination therapy of INAH and INCS was superior to INCS alone. In an indirect comparison, the weighted mean relative clinical impact of INAH plus INCS was significantly higher than that of OAH plus INCS. CONCLUSION Intranasal H1 antihistamines have an add-on effect on intranasal corticosteroids, and the combination of intranasal H1 antihistamines plus intranasal corticosteroid is superior to that of oral H1 antihistamines plus intranasal corticosteroid in improving nasal symptoms for patients with AR.
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Affiliation(s)
- Kun Du
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China
| | - Hui Qing
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China
| | - Xiangdong Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China.
| | - Luo Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China; Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China.
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Yorgancıoğlu AA, Gemicioğlu B, Cingi C, Kalaycı Ö, Kalyoncu AF, Bachert C, Hellings P, Pfaar O, Schünemann HJ, Wallace D, Bedbrook A, Czarlewski W, Bousquet J. ARIA 2019, Allerjik Rinite Tedavi Yaklaşımı-Türkiye. Turk Thorac J 2020; 21:122-133. [PMID: 32203003 DOI: 10.5152/turkthoracj.2019.19084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
Abstract
Gerçek yaşamda, çevresel maruziyetlerin de etkilediği rinit ve astım mültimorbidite durumlarında, dijitalleşmiş ve kişiye odaklanan tedaviler için bütünleştirilmiş tedavi yollarının değerlendirilmesi önerilmektedir. Gerçek yaşamdaki bu durum mültisipliner bir yaklaşımla basamaklandırılıp, rehberilerinde ülkelerdeki gereksinimlere göre değiştilmesini gerektirebilir. Allerjik rinitte hem farmakoterapi hem immünoterapi açısından acil yeni yaklaşımlara ihtiyaç olduğu görülmüştür. 3. Aralık 2018'de Paris'te bir toplantı yapılmış ve iki ayrı belge hazırlanmıştır. Bu yayında bunlara ait bir özet sunulup, ülkeye ve sağlık sistemine uygun kullanımın çerçevesi oluşturulmak istenmiştir.
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Affiliation(s)
| | - Bilun Gemicioğlu
- Department of Chest Diseases, İstanbul University-Cerrahpaşa, Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Cemal Cingi
- Department of Ear Nose Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ömer Kalaycı
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
| | - Peter Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Belgium, and Academic Medical Center, University of Amsterdam, The Netherlands and Euforea, Brussels, Belgium
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Anna Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | | | - Jean Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
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30
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Soler ZM, Nguyen SA, Salvador C, Lackland T, Desiato VM, Storck K, Schlosser RJ. A novel device combining acoustic vibration with oscillating expiratory pressure for the treatment of nasal congestion. Int Forum Allergy Rhinol 2020; 10:610-618. [PMID: 32104962 PMCID: PMC7317541 DOI: 10.1002/alr.22537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic nasal congestion affects 20% of the population with significant impact on quality of life. This study investigated the simultaneous administration of nasal acoustic vibration and oscillating expiratory pressure for the treatment of nasal congestion. METHODS Patients with chronic nasal congestion but without fixed anatomic obstruction participated in a prospective clinical study applying simultaneous acoustic vibrations and positive expiratory pressure to the nasal cavity twice daily over 5 weeks. Safety was assessed by rhinoscopy and patient questionnaires. Efficacy was assessed using peak nasal inspiratory flow (PNIF), visual analogue scale (VAS) of nasal symptoms, Total Nasal Symptom Score (TNSS), Nasal Obstruction and Septoplasty Effectiveness (NOSE) score, and the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS Forty patients (mean age 39 years, 65% female) completed the study with no adverse effects. At the 2 week follow-up, PNIF improved by 25.0 L/min (31% increase from baseline, p < 0.001). At the 5 week follow-up, nasal congestion VAS improved from mean ± SD of 5.8 ± 2.4 to 2.6 ± 2.3, TNSS improved from 7.2 ± 3.5 to 3.5 ± 3.1, NOSE improved from 50.4 ± 19.9 to 23.3 ± 17.2, and SNOT-22 improved from 31.7 ± 20.3 to 14.2 ± 12.7, all p < 0.001. Eighty percent of patients would use the device again and 87.5% would recommend to others. CONCLUSION Simultaneous administration of acoustic vibration and oscillating expiratory pressure appears to be a safe treatment for chronic nasal congestion. Results from this initial study are promising with regard to efficacy but will require further study.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Craig Salvador
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Thomas Lackland
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Vincent M Desiato
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kristina Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergol Select 2019; 3:22-50. [PMID: 32176226 PMCID: PMC7066682 DOI: 10.5414/alx02120e] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods: ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results: The present ICP (integrated care pathway) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion: A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.
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ARIA-Leitlinie 2019: Behandlung der allergischen Rhinitis im deutschen Gesundheitssystem. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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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Mullol J, Izquierdo I, Okubo K, Canonica GW, Bousquet J, Valero A. Clinically relevant effect of rupatadine 20 mg and 10 mg in seasonal allergic rhinitis: a pooled responder analysis. Clin Transl Allergy 2019; 9:50. [PMID: 31624533 PMCID: PMC6784348 DOI: 10.1186/s13601-019-0293-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background Different clinical trials showed the superior efficacy of rupatadine compared to placebo at improving seasonal allergic rhinitis (SAR) symptoms, but no study has assessed if the response promoted is clinically meaningful. Methods This study is a pooled analysis of data of seven randomized, double-blind, placebo-controlled SAR studies comparing responder proportions upon treatment with rupatadine (10 or 20 mg) or placebo. We evaluated the following symptom scores at baseline (Visit 1) and over 14 days of treatment: Total 4 Nasal Symptom Score (T4NSS), Total 2 Ocular Symptom Score (T2OSS) and Total 6 Symptom Score (T6SS). The proportion of responders (50% and 75% response) and the time to response were compared between groups on days 7 (Visit 2) and 14 (Visit 3). Responder rates were compared between groups on days 7 and 14 for the complete/near-to-complete response for T4NSS (TN4SS score ≤ 2 and each symptom score ≤ 1) and T6SS (T6SS score ≤ 3 and each symptom score ≤ 1). Results Data from 1470 patients were analyzed: 332 treated with placebo, 662 with rupatadine 10 mg and 476 with rupatadine 20 mg. The reduction in T4NSS, T2OSS and T6SS over 14 days of treatment relative to baseline was statistically higher in rupatadine groups vs the placebo group, with greater improvements in the 20 mg group. A statistically higher proportion of patients reached the 50% and 75% response for T4NSS, T2OSS and T6SS in rupatadine groups compared to the placebo group across the visits. Among rupatadine-treated patients, those receiving 20 mg compared favourably for both cut-off responses. The time to achieve a proportion of responders was shorter in the rupatadine 20 mg group than in the rupatadine 10 mg and placebo groups for all the symptom scores. The number of patients who achieved a complete/near-to-complete response for both symptom scores was higher in rupatadine groups than in the placebo group, with higher proportions in the 20 mg group. Conclusions This responder analysis confirms the superior efficacy of rupatadine vs placebo to treat SAR. Rupatadine promoted higher proportions of responders according to stringent response criteria and in a dose-dependent manner, with faster and higher response rates in the 20 mg group.
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Affiliation(s)
- Joaquim Mullol
- 1Unitat de Rinologia, & Clínica de l'Olfacte, ENT Department, Hospital Clínic de Barcelona, C/Villarroel, 170, 08036 Barcelona, Catalonia Spain.,2Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,3Universitat de Barcelona, Barcelona, Spain.,4CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia Spain
| | - Iñaki Izquierdo
- Department of Clinical Development & Medical Adviser, Biohorm, Grupo Uriach, Avinguda Camí Reial, 51-57, 08184 Barcelona, Catalonia Spain
| | - Kimihiro Okubo
- 6Department of Otolaryngology-Head and Neck Surgery, Nippon Medical School, Tokyo, Japan
| | - Giorgio Walter Canonica
- 7Personalized Medicine Clinic Asthma & Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - 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
| | - Antonio Valero
- 2Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,4CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia Spain.,9Allergy Section, Pneumology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Chang MT, Song S, Hwang PH. Cryosurgical ablation for treatment of rhinitis: A prospective multicenter study. Laryngoscope 2019; 130:1877-1884. [PMID: 31566744 PMCID: PMC7384004 DOI: 10.1002/lary.28301] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/08/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022]
Abstract
Objective To assess the efficacy and safety of cryoablation of the posterior nasal nerve (PNN) for treatment of chronic rhinitis. Methods This was a prospective single‐arm trial of 98 adult patients at six U.S. centers with chronic allergic and nonallergic rhinitis. PNN cryoablation was performed in‐office under local anesthesia using a handheld device. Patients discontinued use of intranasal ipratropium 3 days prior to treatment and throughout the study period. Reflective Total Nasal Symptom Score (rTNSS) was measured at pretreatment baseline and posttreatment at 1 month, 3 months, 6 months, and 9 months. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was completed at pretreatment and 3 months posttreatment. Adverse effects and postprocedure medication usage were recorded. Results Ninety‐eight procedures (100%) were successfully completed. rTNSS significantly improved over pretreatment baseline (6.1 ± 1.9) at 1 month (2.9 ± 1.9, P < 0.001), 3 months (3.0 ± 2.3, P < 0.001), 6 months (3.0 ± 2.1, P < 0.001), and 9 months (3.0 ± 2.4, P < 0.001) postprocedure. Nasal congestion and rhinorrhea subscores improved significantly at all time points (P < 0.001). Both allergic and nonallergic rhinitis subcohorts showed improvement (P < 0.001), with a comparable degree of improvement between groups. RQLQ significantly improved over pretreatment baseline (3.0 ± 1.0) at 3 months (1.5 ± 1.0, P < 0.001), and all RQLQ subdomains demonstrated improvement. Of 54 patients using intranasal medication at baseline, 19 (35.2%) were able to discontinue use. Twenty‐nine adverse effects were reported, including headache, epistaxis, and sinusitis. Conclusion Cryoablation of the PNN for chronic rhinitis is safe and can result in relief of nasal symptoms and improvements in quality of life. Level of Evidence 4 Laryngoscope, 130: 1877–1884, 2020
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Affiliation(s)
- Michael T Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Sunhee Song
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, Daegu Veterans Hospital, Daegu, Republic of Korea
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Kang T, Sung CM, Yang HC. Radiofrequency ablation of turbinates after septoplasty has no effect on allergic rhinitis symptoms other than nasal obstruction. Int Forum Allergy Rhinol 2019; 9:1257-1262. [PMID: 31449735 DOI: 10.1002/alr.22420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In this study we evaluated the effects of inferior turbinate radiofrequency ablation (RFA), performed after septoplasty, on patients with allergic rhinitis (AR) symptoms. METHODS This was a prospective, randomized, controlled study involving 60 patients with both a deviated nasal septum (DNS) and AR. Those who underwent septoplasty/sham surgery constituted the Septo-Sham group and those who underwent septoplasty/RFA formed the Septo-RFA group. Demographic factors, pre- and postoperative symptom scores for allergic rhinitis (SFARs), and Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) scores were calculated. We subdivided the total SFAR (tSFAR) scores into scores for nasal obstruction (SFAR-NO) and scores for symptoms other than nasal obstruction (SFAR-SONO); the latter included rhinorrhea, itching, and sneezing. RESULTS The baseline characteristics were similar between the groups. The 2 types of surgery improved both the NOSE and SFAR scores. In subgroup analysis according to the type of symptoms, both types of surgery showed improvement in SFAR-NO and SFAR-SONO scores. However, the extent of improvement did not differ between the groups, regardless of the type of symptoms. CONCLUSION For patients with both DNS and AR, both types of surgery afford postoperative symptomatic improvement. Both types of surgery yielded improvement in both nasal obstruction and symptoms other than nasal obstruction. However, performing RFA after septoplasty did not afford further short-term symptomatic improvements. Thus, septoplasty without RFA may be optimal for patients with both DNS and AR.
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Affiliation(s)
- Taegu Kang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Chung Man Sung
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
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Kandathil CK, Saltychev M, Abdelwahab M, Spataro EA, Moubayed SP, Most SP. Minimal Clinically Important Difference of the Standardized Cosmesis and Health Nasal Outcomes Survey. Aesthet Surg J 2019; 39:837-840. [PMID: 30873533 DOI: 10.1093/asj/sjz070] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The minimal clinically important difference (MCID) for the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) has not been determined. OBJECTIVES The authors sought to define the MCID for both domains of the SCHNOS questionnaire. METHODS This prospective cohort study included patients who underwent functional, cosmetic, or combined rhinoplasty operation from June 2017 to June 2018 at a tertiary referral center. The average preoperative, postoperative, and change in scores were calculated for the nasal obstruction symptom evaluation scale (NOSE) and SCHNOS. Anchor-based MCIDs were estimated for both SCHNOS subscales to define change in obstruction and cosmesis perceived after the rhinoplasty. RESULTS Eighty-seven patients (69% women, 31% males) with a mean age (standard deviation [SD]) of 38 years (14.7) at the time of surgery were included. The mean postoperative follow-up period (SD) was 145 days (117). The mean preoperative score (SD) for the NOSE was 52 (32), SCHNOS for nasal obstruction (SCHNOS-O) score was 55 (33), and SCHNOS for nasal cosmesis (SCHNOS-C) score was 50 (26) points. Postoperatively, the NOSE score was 23 (22), SCHNOS-O score was 24 (23), and SCHNOS-C score was 13 (18) points. The mean change in scores (SD) for NOSE, SCHNOS-O, and SCHNOS-C was -29 (37), -31 (38), and -37 (28), respectively. The calculated MCID for SCHNOS-O was 26 (16) and for SCHNOS-C was 22 (15) points. The MCID for NOSE was 24 (13) points. A sensitivity test for the patients with a follow-up ≥3 months showed only slightly different MCID estimates: 28 (17) for SCHNOS-O, 18 (13) for SCHNOS-C, and 24 (15) points for NOSE. CONCLUSIONS For the obstruction domain SCHNOS-O, the MCID was 28 points. For the cosmetic domain SCHNOS-C, the MCID was 18 points.
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Affiliation(s)
| | - Mikhail Saltychev
- Adjunct Professor, Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Mohamed Abdelwahab
- Assistant Lecturer, Department of Otolaryngology-Head and Neck Surgery, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Emily A Spataro
- Assistant Professor, Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Sami P Moubayed
- Assistant Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Sam P Most
- Professor and Division Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
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Mobile technology offers novel insights into the control and treatment of allergic rhinitis: The MASK study. J Allergy Clin Immunol 2019; 144:135-143.e6. [PMID: 30951790 DOI: 10.1016/j.jaci.2019.01.053] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/05/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mobile health can be used to generate innovative insights into optimizing treatment to improve allergic rhinitis (AR) control. OBJECTIVES A cross-sectional real-world observational study was undertaken in 22 countries to complement a pilot study and provide novel information on medication use, disease control, and work productivity in the everyday life of patients with AR. METHODS A mobile phone app (Allergy Diary, which is freely available on Google Play and Apple stores) was used to collect the data of daily visual analogue scale (VAS) scores for (1) overall allergic symptoms; (2) nasal, ocular, and asthma symptoms; (3) work; and (4) medication use by using a treatment scroll list including all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral H1-antihistamines were studied. RESULTS Nine thousand one hundred twenty-two users filled in 112,054 days of VASs in 2016 and 2017. Assessment of days was informative. Control of days with rhinitis differed between no (best control), single (good control for intranasal corticosteroid-treated days), or multiple (worst control) treatments. Users with the worst control increased the range of treatments being used. The same trend was found for asthma, eye symptoms, and work productivity. Differences between oral H1-antihistamines were found. CONCLUSIONS This study confirms the usefulness of the Allergy Diary in accessing and assessing behavior in patients with AR. This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible.
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Calderón MA, Casale TB, Demoly P. Validation of Patient-Reported Outcomes for Clinical Trials in Allergic Rhinitis: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1450-1461.e6. [PMID: 30797777 DOI: 10.1016/j.jaip.2019.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 01/07/2023]
Abstract
Although regulatory authorities have recently recommended the use of a combined symptom-medication score as a primary efficacy end point, none has been psychometrically validated. Here, we sought to determine to what extent allergic rhinitis (AR)-related patient-reported outcomes (symptom scores, medication scores, disease control scores, and satisfaction or quality-of-life scales) have been assessed for construct, content, and/or criterion validity, reliability, responsiveness, and the minimal clinically important difference. We searched the PubMed database from January 1997 to June 2018 with logical combinations of key words related to validation, AR, and patient-rated outcomes and scales. From a total of 1705 potentially relevant publications, 55 were reviewed. Despite the current emphasis on a combined symptom-medication score for evaluating the efficacy of allergen immunotherapy in AR, symptom scores have not been extensively validated, and we did not find any publications describing the validation of a medication score. Disease control scales (mainly the Rhinitis Control Assessment Test, the Control of Allergic Rhinitis and Asthma Test, and the Allergic Rhinitis Control Test) and health-related quality-of-life scales (mainly the Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] and the mini-RQLQ) have been extensively validated in AR but have some practical disadvantages as primary efficacy criteria in clinical trials.
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Affiliation(s)
- Moises A Calderón
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital NHS, London, United Kingdom
| | - Thomas B Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.
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Bousquet J, Devillier P, Arnavielhe S, Bedbrook A, Alexis-Alexandre G, van Eerd M, Murray R, Canonica GW, Illario M, Menditto E, Passalacqua G, Stellato C, Triggiani M, Carreiro-Martins P, Fonseca J, Morais Almeida M, Nogueira-Silva L, Pereira AM, Todo Bom A, Bosse I, Caimmi D, Demoly P, Fontaine JF, Just J, Onorato GL, Kowalski ML, Kuna P, Samolinski B, Anto JM, Mullol J, Valero A, Tomazic PV, Bergmann KC, Keil T, Klimek L, Mösges R, Shamai S, Zuberbier T, Murphy E, McDowall P, Price D, Ryan D, Sheikh A, Chavannes NH, Fokkens WJ, Kvedariene V, Valiulis A, Bachert C, Hellings PW, Kull I, Melen E, Wickman M, Bindslev-Jensen C, Eller E, Haahtela T, Papadopoulos NG, Annesi-Maesano I, Bewick M, Bosnic-Anticevich S, Cruz AA, De Vries G, Gemicioglu B, Larenas-Linnemann D, Laune D, Mathieu-Dupas E, O'Hehir RE, Pfaar O, Portejoie F, Siroux V, Spranger O, Valovirta E, VandenPlas O, Yorgancioglu A. Treatment of allergic rhinitis using mobile technology with real-world data: The MASK observational pilot study. Allergy 2018; 73:1763-1774. [PMID: 29336067 DOI: 10.1111/all.13406] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect "real-world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis (AR) using mobile technology. METHODS A mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries. RESULTS A total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control). CONCLUSIONS This study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses.
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Affiliation(s)
- J. Bousquet
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
- INSERM U 1168; VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches; Université Versailles St-Quentin-en-Yvelines, UMR-S168; Villejuif, Montigny le Bretonneux France
- Euforea; Brussels Belgium
| | - P. Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220; Pôle des Maladies Respiratoires; Hôpital Foch; Suresnes - Université Versailles Saint-Quentin; Versailles France
| | | | - A. Bedbrook
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
| | | | | | - R. Murray
- Medical Communications Consultant; MedScript Ltd; Dundalk Ireland
| | - G. W. Canonica
- Allergy and Respiratory Diseases; Department of Internal Medicine; IRCCS San Martino-IST-University of Genoa; Genoa Italy
| | - M. Illario
- Division for Health Innovation; Campania Region and Federico II University Hospital Naples (R&D and DISMET); Naples Italy
| | - E. Menditto
- Center of Pharmacoeconomics; CIRFF; University of Naples Federico II; Naples Italy
| | - G. Passalacqua
- Allergy and Respiratory Diseases; Department of Internal Medicine; IRCCS San Martino-IST-University of Genoa; Genoa Italy
| | - C. Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”; University of Salerno; Salerno Italy
| | - M. Triggiani
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”; University of Salerno; Salerno Italy
| | - P. Carreiro-Martins
- Servicio de Imunoalergologia; EPE - Nova Medical School; Respiratory Research Group; CEDOC; Centro Hospitalar de Lisboa Central; Lisbon Portugal
| | - J. Fonseca
- Faculdade de Medicina; Center for Health Technology and Services Research-CINTESIS; Universidade do Porto; Porto Portugal
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
| | - M. Morais Almeida
- Rhinology Unit & Smell Clinic; ENT Department; Hospital Clinic; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES; University of Barcelona; Barcelona Spain
| | - L. Nogueira-Silva
- Department of Internal Medicine; Center for Health Technology and Services Research-CINTESIS; Centro Hospitalar Sao Joao; Porto Portugal
| | - A. M. Pereira
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
- Immunoallergy Department; CUF-Descobertas Hospital; Lisbon Portugal
- Health Information and Decision Sciences Department; Faculty of Medicine of the University of Porto; Porto Portugal
| | - A. Todo Bom
- Imunoalergologia; Centro Hospitalar Universitario de Coimbra; Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | | | - D. Caimmi
- CHU de Montpellier; UPMC, Paris 06; UMR-S 1136, IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
| | - P. Demoly
- CHU de Montpellier; UPMC, Paris 06; UMR-S 1136, IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
| | | | - J. Just
- Allergology Department; Centre de l'Asthme et des Allergies; Hôpital d'Enfants Armand-Trousseau - INSERM; UMRS 1136, UPMC Univ Paris 06 - Institut Pierre Louis d'Epidémiologie et de Santé Publique; Equipe EPAR; Sorbonne Universités; Paris France
| | - G. L. Onorato
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
- HARC; Lodz Poland
| | - P. Kuna
- Division of Internal Medicine; Asthma and Allergy; Barlicki University Hospital; Medical University of Lodz; Lodz Poland
| | - B. Samolinski
- Department of Prevention of Environmental Hazards and Allergology; Medical University of Warsaw; Warsaw Poland
| | - J. M. Anto
- ISGLoBAL; Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- IMIM (Hospital del Mar Research Institute); Barcelona Spain
- CIBER Epidemiologıa y Salud Publica (CIBERESP); Barcelona Spain
- Universitat Pompeu Fabra (UPF); Barcelona Spain
| | - J. Mullol
- Rhinology Unit & Smell Clinic; ENT Department; Hospital Clinic; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES; University of Barcelona; Barcelona Spain
| | - A. Valero
- Pneumology and Allergy Department Hospital Clınic; Clinical & Experimental Respiratory Immunoallergy; IDIBAPS, CIBERES; University of Barcelona; Barcelona Spain
| | - P. V. Tomazic
- Department of ENT; Medical University of Graz; Graz Austria
| | - K. C. Bergmann
- Comprehensive Allergy-Centre-Charité; Department of Dermatology and Allergy; Global Allergy and Asthma European Network (GA LEN); Charité Universitatsmedizin Berlin; Berlin Germany
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité-Universitatsmedizin; Berlin Germany
- Institute for Clinical Epidemiology and Biometry; University of Wuerzburg; Wuerzburg Germany
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - R. Mösges
- Institute of Medical Statistics and Computational Biology; Medical Faculty; University of Cologne; Cologne Germany
- CRI-Clinical Research International-Ltd; Hamburg Germany
| | - S. Shamai
- Institute of Medical Statistics and Computational Biology; Medical Faculty; University of Cologne; Cologne Germany
- CRI-Clinical Research International-Ltd; Hamburg Germany
| | - T. Zuberbier
- Comprehensive Allergy-Centre-Charité; Department of Dermatology and Allergy; Global Allergy and Asthma European Network (GA LEN); Charité Universitatsmedizin Berlin; Berlin Germany
| | - E. Murphy
- Newcastle OHS; The Newcastle upon Tyne NHS Foundation Hospitals Trust; Newcastle upon Tyne UK
| | - P. McDowall
- Newcastle OHS; The Newcastle upon Tyne NHS Foundation Hospitals Trust; Newcastle upon Tyne UK
| | - D. Price
- Observational and Pragmatic Research Institute; Singapore City Singapore
- Optimum Patient Care; Cambridge UK
- Academic Centre of Primary Care; University of Aberdeen; Aberdeen UK
| | - D. Ryan
- Allergy and Respiratory Research Group; Usher Institute of Population Health Sciences and Informatics; University of Edinburgh; Edinburgh UK
| | - A. Sheikh
- Asthma UK Centre for Applied Research; Centre of Medical Informatics; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
| | - N. H. Chavannes
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden The Netherlands
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
| | - V. Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology; Vilnius University; Vilnius Lithuania
| | - A. Valiulis
- Vilnius University Clinic of Children's Diseases and Public Health Institute; Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS-SP); Brussels Belgium
| | - C. Bachert
- ENT Department; Upper Airways Research Laboratory; Ghent University Hospital; Ghent Belgium
| | - P. W. Hellings
- Euforea; Brussels Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - I. Kull
- Department of Clinical Science and Education; Sodersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - E. Melen
- Department of Clinical Science and Education; Sodersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - M. Wickman
- Sodersjukhuset; Sachs' Children and Youth Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - E. Eller
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - T. Haahtela
- Skin and Allergy Hospital; Helsinki University Hospital; Helsinki Finland
| | - N. G. Papadopoulos
- Center for Pediatrics and Child Health; Institute of Human Development; Royal Manchester Children's Hospital; University of Manchester; Manchester UK
- Allergy Department; 2nd Pediatric Clinic; Athens General Children's Hospital “P&A Kyriakou”; University of Athens; Athens Greece
| | - I. Annesi-Maesano
- EPAR U707 INSERM; Paris France
- EPAR UMR-S UPMC; Paris VI; Paris France
| | | | - S. Bosnic-Anticevich
- Woolcock Institute of Medical Research; University of Sydney; Sydney NSW Australia
- Sydney Local Health District; Glebe NSW Australia
| | - A. A. Cruz
- ProAR-Nucleo de Excelencia em Asma; Federal University of Bahia; Salvador Brazil
- GARD Executive Committee; Salvador Brazil
| | | | - B. Gemicioglu
- Department of Pulmonary Diseases; Cerrahpasa Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - D. Larenas-Linnemann
- Center of Excellence in Asthma and Allergy; Hospital Médica Sur; Mexico City Mexico
| | | | | | - R. E. O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine; Alfred Hospital and Central Clinical School; Monash University; Melbourne Vic. Australia
- Department of Immunology; Monash University; Melbourne Vic. Australia
| | - O. Pfaar
- Center for Rhinology and Allergology; Wiesbaden Germany
- Departent of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannhein; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - F. Portejoie
- Contre les MAladies Chroniques Pour un VIeillissement Actif en France; European Innovation Partnership on Active and Healthy Ageing Reference Site; MACVIA-France; Montpellier France
| | - V. Siroux
- INSERM; Universite Grenoble Alpes; IAB; U 1209; Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health; Université Joseph Fourier; Grenoble France
| | - O. Spranger
- Global Allergy and Asthma Platform GAAPP; Vienna Austria
| | - E. Valovirta
- Department of Lung Diseases and Clinical Allergology; Terveystalo; Allergy Clinic; University of Turku; Turku Finland
| | - O. VandenPlas
- Department of Chest Medicine; Centre Hospitalier Universitaire UCL Namur; Université Catholique de Louvain; Yvoir Belgium
| | - A. Yorgancioglu
- Department of Pulmonology; Celal Bayar University; Manisa Turkey
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Price DB, Smith PK, Harvey RJ, Carney AS, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner D, Carter V, Durieux AM. Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease. Pragmat Obs Res 2018; 9:43-54. [PMID: 30147391 PMCID: PMC6101013 DOI: 10.2147/por.s153266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The aim of the study was to explore rhinitis therapy purchases in different Australian regions for patients with and without additional respiratory disease, using both doctor's prescriptions and over-the-counter (OTC) medications. PATIENTS AND METHODS It was a historical cohort study of pharmacy-related claims that included prescription or OTC rhinitis therapy, with or without asthma/COPD therapy, from January 2013 to December 2014. RESULTS Overall, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over a calendar year; the majority were single-therapy purchases for rhinitis only patients. More multiple-therapy was purchased for rhinitis and asthma/COPD patients (4.4%) than for rhinitis only patients (4.0%), with a greater proportion purchased in VIC, SA and TAS (4.7% of rhinitis only patients and 4.5% of rhinitis and asthma/COPD patients) than in other areas. Dual therapy of oral antihistamine (OAH) and intranasal corticosteroid (INS) were the most frequently purchased multiple-therapy, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%). The most frequently purchased single therapy was OAH (70.1% of rhinitis only patients and 57.3% of rhinitis and asthma/COPD patients). First-line INS therapy was more likely to be purchased for rhinitis and asthma/COPD patients (15.3% by prescription and 11.7% OTC) than for rhinitis only patients (5.0% by prescription and 9.2% OTC); however, geographical differences in the proportion of therapies purchased OTC were noted, with a lower proportion of OTC OAH and INS purchases in Queensland and the Northern Territory for patients with and without comorbid respiratory disease. CONCLUSION Purchases of first-line INS therapy are more likely for patients with comorbid respiratory disease if they have received prescriptions and information/advice from their general practitioner. The study results indicate a need for patient information/education at the point-of-sale of OTC OAHs to enable patients to assess their nasal symptoms and receive treatment support from pharmacists. Greater availability to INSs in pharmacies as well as guidance from current guidelines and instruction in correct intranasal technique may also lead to greater uptake of INSs.
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Affiliation(s)
- David B Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK,
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Pete K Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - Richard John Harvey
- Rhinology and Skull Base, Applied Medical Research Centre, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - A Simon Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
| | - Sinthia Z Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | | | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Alice Ms Durieux
- Observational and Pragmatic Research Institute, Singapore, Singapore,
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Pepper AN, Ledford DK. Nasal and ocular challenges. J Allergy Clin Immunol 2018; 141:1570-1577. [PMID: 29501480 DOI: 10.1016/j.jaci.2017.11.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 12/29/2022]
Abstract
Nasal and ocular challenges facilitate the evaluation of subjective and objective responses to defined allergen or irritant exposure. Nasal and ocular allergen challenges are the gold standard to diagnose allergic rhinitis and conjunctivitis, respectively, and aid in the evaluation of novel therapies in clinical trials. Additionally, nasal and ocular allergen challenges might help identify medically relevant allergens in clinical practice. Nonspecific or irritant challenges evaluate mucosal hyperreactivity. Direct mucosal challenges, which can be performed in an office or research setting, expose the participant to higher allergen doses than common in the natural environment. Park studies and environmental chambers, which are most practical in clinical trials, more closely simulate natural allergen exposure. International consensus guidelines for nasal and ocular challenges do not exist. Therefore the positivity criteria, methodologies, and extract or allergen preparations used in challenges vary in the literature. Regardless of these limitations, nasal and ocular challenges are helpful clinical and research tools for nasal and ocular diseases.
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Affiliation(s)
- Amber N Pepper
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Affairs Hospital, Tampa, Fla
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Affairs Hospital, Tampa, Fla.
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Bousquet J, Meltzer EO, Couroux P, Koltun A, Kopietz F, Munzel U, Kuhl HC, Nguyen DT, Salapatek AM, Price D. Onset of Action of the Fixed Combination Intranasal Azelastine-Fluticasone Propionate in an Allergen Exposure Chamber. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1726-1732.e6. [PMID: 29425904 DOI: 10.1016/j.jaip.2018.01.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/14/2018] [Accepted: 01/19/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND A fixed-dose combination of intranasal azelastine hydrochloride and fluticasone propionate (MP-AzeFlu) is the most effective treatment of allergic rhinitis, but its onset of action requires further investigation. OBJECTIVE To compare the onset of action of MP-AzeFlu with the free combination of oral loratadine (LORA) and intranasal fluticasone propionate (INFP). METHODS In this single-center, randomized, placebo-controlled, double-blind, double-dummy, 3-period crossover trial, allergic rhinitis symptoms were induced in asymptomatic patients by ragweed pollen challenge in an allergen environmental exposure chamber. Patients received single-dose MP-AzeFlu, LORA/INFP, or placebo and were monitored for 4 hours. The primary outcome was onset of action measured by total nasal symptom score (TNSS). Secondary measures were total ocular symptom score (TOSS), total score of the 7 nasal and ocular symptoms (T7SS), and the global visual analog scale (VAS). RESULTS The full analysis set included 82 patients, of which 78 completed all treatments. TNSS was significantly reduced versus placebo from 5 minutes for MP-AzeFlu and 150 minutes for LORA/INFP onward (both P < .05) till the end of assessment (0-4 hours). MP-AzeFlu reduced TNSS to a greater extent at each time point from 5 to 90 minutes (P < .05) and over the entire assessment interval (P ≤ .005) versus LORA/INFP or placebo. No statistically significant difference between LORA/INFP and placebo was observed over the assessment interval (P = .182). The onset of action of MP-AzeFlu assessed by TOSS, T7SS, and VAS was 10 minutes, 2 hours earlier than with LORA/INFP. CONCLUSION MP-AzeFlu had a more rapid onset of action (5 minutes) and was more effective than LORA/INFP.
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Affiliation(s)
- Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France; INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines; Euforea, Brussels, Belgium; Charité, Berlin, Germany.
| | - Eli O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | | | | | | | - Ullrich Munzel
- Meda Pharma GmbH & Co. KG (a Mylan Company), Bad Homurg, Germany
| | | | - Duc Tung Nguyen
- Meda Pharma GmbH & Co. KG (a Mylan Company), Bad Homurg, Germany
| | | | - David Price
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care, Cambridge, UK; Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK
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Liu G, Zhou X, Chen J, Liu F. Oral Antihistamines Alone vs in Combination with Leukotriene Receptor Antagonists for Allergic Rhinitis: A Meta-analysis. Otolaryngol Head Neck Surg 2018; 158:450-458. [PMID: 29337654 DOI: 10.1177/0194599817752624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate whether an adjuvant therapy of leukotriene receptor antagonists (LTRAs) based on oral H1-antihistamines (H1) can increase efficacy of allergic rhinitis (AR) treatment. Data Sources The search involved databases of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, from inception up to September 23, 2017. Randomized controlled trials (RCTs) that compared efficacy of LTRAs + H1 vs H1 alone were eligible. Review Methods Pooled comparative effects were measured using weighted mean difference (WMD) and 95% confidence interval (CI). Subgroup analysis comparing seasonal vs perennial AR was prespecified to explore the source of heterogeneity. The evidence quality of each outcome was assessed by the GRADE approach. Results A total of 8 RCTs were included (n = 1886), and all measured outcomes used scaled scores. Compared with H1 alone, H1 + LTRAs were superior to improve overall daytime (WMD, -0.11; 95% CI, -0.19 to -0.03, high quality) and composite (WMD, -0.12; 95% CI, -0.23 to -0.01; low quality) nasal symptoms. Specifically, H1 + LTRAs had better efficacy against composite nasal rhinorrhea, sneezing, and daytime itching but not congestion. The effects were more pronounced in patients with perennial AR compared to those with seasonal AR. There were no significant differences in nighttime nasal symptoms and eye symptoms between the 2 groups. Conclusion The current evidence suggests that LTRAs + H1 can increase the therapeutic efficacy against daytime and composite nasal symptoms, including rhinorrhea, sneezing, and itching; however, it does not affect nighttime nasal symptoms and eye symptoms. The patients with perennial AR may benefit more from the combination therapy.
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Affiliation(s)
- Guo Liu
- 1 Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xu Zhou
- 2 Evidence-based Medicine Research Center, School of Basic Medical Sciences, Jiangxi University of Traditional Chinese Medicine, Jiangxi, China
| | - Jianrong Chen
- 3 Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Feng Liu
- 1 Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
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Dykewicz MS, Wallace DV, Baroody F, Bernstein J, Craig T, Finegold I, Huang F, Larenas-Linnemann D, Meltzer E, Steven G, Bernstein DI, Blessing-Moore J, Dinakar C, Greenhawt M, Horner CC, Khan DA, Lang D, Oppenheimer J, Portnoy JM, Randolph CR, Rank MA, Dykewicz MS, Wallace DV. Treatment of seasonal allergic rhinitis: An evidence-based focused 2017 guideline update. Ann Allergy Asthma Immunol 2017; 119:489-511.e41. [PMID: 29103802 DOI: 10.1016/j.anai.2017.08.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022]
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Carney AS, Price DB, Smith PK, Harvey R, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner DA, Carter V, Durieux AMS. Seasonal patterns of oral antihistamine and intranasal corticosteroid purchases from Australian community pharmacies: a retrospective observational study. Pragmat Obs Res 2017; 8:157-165. [PMID: 28919832 PMCID: PMC5587174 DOI: 10.2147/por.s134266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To explore patterns in the purchase of prescription and over-the-counter (OTC) oral antihistamines (OAHs) and intranasal corticosteroids (INCSs) by patients, from pharmacies in different geographical regions of Australia. PATIENTS AND METHODS Retrospective observational study using a database containing anonymous pharmacy transaction data from 20.0% of the pharmacies in Australia that link doctor prescriptions and OTC information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment during 2013 and 2014 were assessed. RESULTS In total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 12 months. Of treatments purchased, 75.9% were OAHs and 16.6% were INCSs. OTC purchases of both treatments exceeded purchases through prescription. OTC OAHs purchasing patterns were seasonal and almost identical in the Australian Capital Territory, Victoria, Western Australia, South Australia, and New South Wales, and similar seasonal patterns for OTC INCSs were noted in most regions except for South Australia and Tasmania. Prescription purchasing patterns of both OAHs and INCSs remained unchanged throughout the year in most regions. CONCLUSION This large-scale retrospective observational study identified seasonal purchasing patterns of OTC and prescription OAHs and INCSs in a real-world setting. It highlighted that seasonality only affects OTC purchasing patterns of OAHs and INCSs across Australia and that practitioner prescribing remains unchanged, suggesting that it is only for persistent disease.
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Affiliation(s)
- A Simon Carney
- Department of Otolaryngology – Head and Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - David B Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Pete K Smith
- Clinical Medicine, Griffith University, Southport, QLD
| | - Richard Harvey
- Applied Medical Research Centre, University of New South Wales
- Faculty of Medicine and Health Sciences, Macquarie University
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney
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Seasonal Allergic Rhinitis: A focused systematic review and practice parameter update. Curr Opin Allergy Clin Immunol 2017; 17:286-294. [DOI: 10.1097/aci.0000000000000375] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schatz M, Sicherer SH, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice - 2016 Year in Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:218-236. [PMID: 28143692 DOI: 10.1016/j.jaip.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/19/2023]
Abstract
As editors, we concluded that it would be helpful to our readers to write a Year in Review article that highlights the Review, Original, and Clinical Communication articles published in 2016 in The Journal of Allergy and Clinical Immunology: In Practice. We summarized articles on the topics of asthma, rhinitis/rhinosinusitis, food allergy, anaphylaxis, drug allergy, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Diagnostic tools described include history, skin tests, and in vitro tests. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help you, our readers, consolidate and use this extensive and practical knowledge for the benefit of your patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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IMPLICATION OF ALTERNATIVE MINIMAL CLINICALLY IMPORTANT DIFFERENCE THRESHOLD ESTIMATION METHODS ON TECHNOLOGY ASSESSMENT. Int J Technol Assess Health Care 2016; 32:371-375. [PMID: 27919315 DOI: 10.1017/s0266462316000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Various minimal clinically important difference (MCID) threshold estimation techniques have been applied to seasonal allergic rhinitis (SAR). The objectives of this study are to (i) assess the difference in magnitude of alternative SAR MCID threshold estimates and (ii) evaluate the impact of alternative MCID estimates on health technology assessment (HTA). METHODS Data describing change from baseline of the reflective Total Nasal Symptom Score (rTNSS) for four intranasal SAR treatments were obtained from United States Food and Drug Administration-approved prescribing information. Treatment effects were then compared with anchor-based MCID thresholds derived by Barnes et al. and thresholds obtained from an Agency for Healthcare Research and Quality (AHRQ) panel. RESULTS The change in rTNSS score from baseline, represented as the average of the twice-daily recorded scores of the rTNSS, was -2.1 (p < .001) for azelastine hydrochloride 0.10%, 1.35 (p = .014) for ciclesonide, and -1.47 (p < .001) for fluticasone furoate. The change in the rTNSS score from baseline, represented by sum of the AM and PM score, was -2.7 for MP-AzeFlu (p < .001). The rTNSS change from baseline for each product was compared with anchor-based MCID threshold and the AHRQ panel estimates. Comparison of the observed treatment effect to the anchor-based and AHRQ panel MCID thresholds results in different conclusions, with clinically important differences being inferred when anchor-based estimates serve as the reference point. CONCLUSION The AHRQ panel MCID threshold for the rTNSS was twelve times larger than the anchor-based estimates resulting in conflicting recommendations on whether different SAR treatments provide clinically meaningful benefit.
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Bernstein JA, Mauger DT. The Minimally Clinically Important Difference (MCID): What Difference Does It Make? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:689-90. [DOI: 10.1016/j.jaip.2016.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
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