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Barata F, Shim J, Wu F, Langer P, Fleisch E. The Bitemporal Lens Model-toward a holistic approach to chronic disease prevention with digital biomarkers. JAMIA Open 2024; 7:ooae027. [PMID: 38596697 PMCID: PMC11000821 DOI: 10.1093/jamiaopen/ooae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/22/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
Objectives We introduce the Bitemporal Lens Model, a comprehensive methodology for chronic disease prevention using digital biomarkers. Materials and Methods The Bitemporal Lens Model integrates the change-point model, focusing on critical disease-specific parameters, and the recurrent-pattern model, emphasizing lifestyle and behavioral patterns, for early risk identification. Results By incorporating both the change-point and recurrent-pattern models, the Bitemporal Lens Model offers a comprehensive approach to preventive healthcare, enabling a more nuanced understanding of individual health trajectories, demonstrated through its application in cardiovascular disease prevention. Discussion We explore the benefits of the Bitemporal Lens Model, highlighting its capacity for personalized risk assessment through the integration of two distinct lenses. We also acknowledge challenges associated with handling intricate data across dual temporal dimensions, maintaining data integrity, and addressing ethical concerns pertaining to privacy and data protection. Conclusion The Bitemporal Lens Model presents a novel approach to enhancing preventive healthcare effectiveness.
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Affiliation(s)
- Filipe Barata
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Jinjoo Shim
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Fan Wu
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Patrick Langer
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, ETH Zurich, Zürich, Zürich, 8092, Switzerland
- Centre for Digital Health Interventions, University of St. Gallen, St. Gallen, St. Gallen, 9000, Switzerland
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Wise SK, Hamzavi-Abedi Y, Hannikainen PA, Anand MP, Pitt T, Savoure M, Toskala E. Rhinitis Disease Burden and the Impact of Social Determinants of Health. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1449-1461.e1. [PMID: 38570070 DOI: 10.1016/j.jaip.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
Social determinants of health (SDHs) have a substantial impact on patient care and outcomes globally, both in low- to middle-income countries and in high-income countries. In the clinic, lack of availability of diagnostic tools, inequities in access to care, and challenges obtaining and adhering to prescribed treatment plans may further compound these issues. This article addresses a case of rhinitis in the context of SDHs and inequities in care that may affect various communities and populations around the world. SDHs may include various aspects of one's financial means, education, access to medical care, environment and living situation, and community factors, each of which could play a role in the rhinitis disease manifestations, diagnosis, and management. Allergic and nonallergic rhinitis are considered from this perspective. Rhinitis epidemiology, disease burden, and risk factors are broadly addressed. Patient evaluation, diagnostic tests, and management options are also reviewed, and issues related to SDHs are noted. Finally, inequities in care, knowledge gaps, and unmet needs are highlighted. It is critical to consider SDHs and care inequities when evaluating and treating patients for rhinitis and other allergic conditions.
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Affiliation(s)
- Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Ga.
| | - Yasmin Hamzavi-Abedi
- Departments of Pediatrics and Medicine, Division of Allergy and Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | | | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research, Mysore, Karnataka, India
| | - Tracy Pitt
- Department of Paediatrics, Humber River Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marine Savoure
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Elina Toskala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pa
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Csonka P, Hamelmann E, Turkalj M, Roberts G, Mack DP. SQ sublingual immunotherapy tablets for children with allergic rhinitis: A review of phase three trials. Acta Paediatr 2024. [PMID: 38529710 DOI: 10.1111/apa.17221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
AIM To provide paediatricians with a summary of efficacy and safety of SQ sublingual immunotherapy (SLIT) tablets from phase three, randomised, double-blind, placebo-controlled trials in children and adolescents with allergic rhinitis or rhinoconjunctivitis, with and without asthma. METHODS PubMed searches were conducted and unpublished data were included if necessary. RESULTS Of the 93 publications, 12 were identified reporting 10 trials. One trial was excluded as paediatric-specific efficacy data were unavailable. The nine eligible trials evaluated grass, house dust mite, ragweed and tree SLIT tablets. Consistent reductions in allergic rhinitis or rhinoconjunctivitis symptoms and medication use were observed with SQ SLIT tablets versus placebo. In a five-year trial, sustained reduction of allergic rhinoconjunctivitis symptoms, asthma symptoms and medication use were observed with SQ grass SLIT tablet versus placebo. The number-needed-to-treat to prevent asthma symptoms and medication use in one additional child during follow-up was lowest in younger children. SQ SLIT tablets were generally well tolerated across trials. CONCLUSION Evidence supports use of SQ SLIT tablets in children and adolescents with allergic rhinitis or rhinoconjunctivitis, with and without asthma. Long-term data demonstrate disease-modifying effects of SQ grass SLIT tablet and suggest the clinical relevance of initiating allergy immunotherapy earlier in the disease course.
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Affiliation(s)
- Péter Csonka
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
- Terveystalo Healthcare Oy, Tampere, Finland
| | - Eckard Hamelmann
- Department of Paediatrics, Children's Center Bethel, University Bielefeld, Bielefeld, Germany
| | - Mirjana Turkalj
- Department of Pulmonology, Allergy and Immunology, Srebrnjak Children's Hospital, Zagreb, Croatia
- Medical School, Catholic University of Croatia, Zagreb, Croatia
- Medical School, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Douglas P Mack
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Bernstein JA, Bernstein JS, Makol R, Ward S. Allergic Rhinitis: A Review. JAMA 2024; 331:866-877. [PMID: 38470381 DOI: 10.1001/jama.2024.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Importance Allergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches. Observations Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year. Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year. Patients with allergic rhinitis should avoid inciting allergens. In addition, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine), whereas patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine. In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid. Conclusions and Relevance Allergic rhinitis is associated with symptoms of nasal congestion, sneezing, and itching of the eyes, nose, and throat. Patients with allergic rhinitis should be instructed to avoid inciting allergens. Therapies include second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine), intranasal antihistamines (eg, azelastine, olopatadine), and intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) and should be selected based on the severity and frequency of symptoms and patient preference.
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Affiliation(s)
- Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Joshua S Bernstein
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Richika Makol
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie Ward
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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House R, Kritikos V, Cvetkovski B, Rimmer J, Yan K, Cheong L, Bousquet J, Lourenco O, Bosnic-Anticevich S. The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacy. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100340. [PMID: 37869069 PMCID: PMC10585337 DOI: 10.1016/j.rcsop.2023.100340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Background The Allergic Rhinitis Clinical Management Pathway (AR-CMaP) was developed to overcome the challenge of implementing current AR guidelines in the Australian community pharmacy practice and support pharmacists in optimally managing patients' AR. Objectives To evaluate the impact of AR-CMaP on patients' behaviour and pharmacists' needs in managing AR in the pharmacy. Methods This study used a cross-sectional, pre-post study design in which the primary outcome was the appropriateness of medications purchased from community pharmacies in Australia. Patient data were collected before and after the implementation of AR-CMaP. Pharmacist needs were recorded before and after AR-CMaP training. Data were analysed descriptively. Results Six pharmacies, 19 pharmacists and a total of 416 patients were included in the study; 206 pre-AR-CMaP implementation and 210 post-AR-CMaP implementation. Pre-AR-CMaP, 22.4% of patients purchased appropriate AR medication compared with 29.0% post-AR-CMaP implementation. Over half the patient cohort (52%) consulted a pharmacist pre-AR-CMaP and 37% consulted a pharmacist post-AR-CMaP implementation. Post-AR-CMaP, pharmacists reported increased awareness of barriers such as patients' lack of time, patients' perceptions about the pharmacist's role and patient choice to self-manage. Pharmacists also rated an increased desire to interact with other health care providers (HCPs) in caring for patients with AR. Conclusions While there was a non-statistically significant increase in the proportion of patients purchasing optimal AR medication, AR-CMaP did empower patients to self-select their own medication without further detriment. Moreover, following the implementation of AR-CMaP, pharmacists developed a greater awareness of their role in AR management, exemplified by their increased desire to be actively involved in AR management and increased interaction with other HCPs. Future research needs to explore more effective tools to support pharmacists' clinical decision-making and target patients' self-selection of AR medications. This study highlights that there is an ingrained self-reliance of AR decision-making that has become a habit for people living with AR.
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Affiliation(s)
- Rachel House
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
| | - Janet Rimmer
- Macquarie University, Macquarie Park, NSW, Australia
- Thoracic Medicine, St Vincent's Private Hospital, Darlinghurst, Australia
| | - Kwok Yan
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lynn Cheong
- Discipline of Pharmacy, University of Canberra, Canberra, Australia
| | - Jean Bousquet
- MACVIA-France, Contre les Maladies Chroniques pour un Vieillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Olga Lourenco
- Faculty of Health Sciences and CICS—UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
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Blaiss M, DuBuske L, Nolte H, Opstrup M, Rance K. A practical guide to prescribing sublingual immunotherapy tablets in North America for pediatric allergic rhinoconjunctivitis: an injection-free allergy immunotherapy option. Front Pediatr 2023; 11:1244146. [PMID: 37859770 PMCID: PMC10582981 DOI: 10.3389/fped.2023.1244146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023] Open
Abstract
Allergic rhinoconjunctivitis (ARC) is a common disease that affects individuals of all ages. Pediatricians may be the first (and only) point of care for children with ARC. Sublingual immunotherapy (SLIT)-tablets are a convenient at-home, injection-free allergy immunotherapy option that can be used for the treatment of ARC. This paper provides a practical guide for pediatricians to aid in prescribing SLIT-tablets to children with ARC in North America. Topics include a summary of the available SLIT-tablets and their efficacy and safety, guidance on when SLIT-tablets are an appropriate option, and how to diagnose ARC and identify culprit allergens. Practical guidance is also provided through a proposed decision tree, a prescribing checklist and prescribing procedures, and suggested follow-up assessments.
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Affiliation(s)
- Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta, GA, United States
| | - Lawrence DuBuske
- Department of Medicine, The George Washington University Hospital, Washington, DC, United States
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Feng Y, Cao Y, Liu Y, Wang Q, He C, Hao J, Zhang K, HuangFu H. Clinical efficacy and safety of coseasonal initiation of Artemisia annua sublingual immunotherapy on patients with Artemisia-induced rhinoconjunctivitis. Am J Otolaryngol 2023; 44:103942. [PMID: 37352680 DOI: 10.1016/j.amjoto.2023.103942] [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: 03/10/2023] [Revised: 05/11/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Patients with seasonal allergic rhinoconjunctivitis (SARC) might seek evaluation and treatment when symptoms appear during the pollen season. It is unclear whether coseasonal-initiated sublingual immunotherapy (SLIT) would be effective and safe for SARC. This study aims to identify the feasibility of initiating Artemisia annua SLIT during the pollen season. MATERIALS AND METHODS Sixty patients with Artemisia-induced SARC were equally recruited into the SLIT and control groups during the pollen season in 2021. The SLIT group was treated with standardized Artemisia annua SLIT drops using a modified dosing schedule combined with pharmacotherapy, while the control group only received pharmacotherapy. Diary cards for clinical symptoms, rescue medication use, and adverse events (AEs) were recorded during the pollen seasons. Objective measures, including average daily combined scores of medication and rhinoconjunctivitis symptoms (CSMRS), total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), and the score of visual analog scale (VAS) were calculated to evaluate the efficacy of SLIT. Safety was assessed through the occurrence and severity of AEs. RESULTS In total, 80.0 % (24/30) patients in the SLIT group and 86.67 % (26/30) patients in the control group completed the study. The severity of SARC, which was assessed by objective measures including CSMRS, TRSS, TMS, and VAS of the SLIT group and the control group, was generally at the same level during the 2021 pollen season, except for the medical consumption, which the score of TMS was slightly higher in the SLIT group. After one year of treatment, the scores of CSMRS, TRSS, and VAS in the SLIT group were significantly improved compared with the control group (all P < 0.001), and the difference in the TMS between the two groups disappeared (P > 0.05). Moreover, clinical improvement of the four objective measures was also observed in the SLIT group compared with the baseline value (P < 0.001). Overall, 9/24 patients in the SLIT group experienced mild local AEs, and two patients experienced mild systemic AEs during the SLIT period. CONCLUSIONS This controlled preliminary study identified that coseasonal-initiated Artemisia annua SLIT treatment for one year was generally safe and effective in improving the symptoms of SARC patients induced by Artemisia annua pollen.
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Affiliation(s)
- Yan Feng
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Yingzi Cao
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Ying Liu
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Qian Wang
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Chan He
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Jianli Hao
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China
| | - Kejun Zhang
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China.
| | - Hui HuangFu
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, Shanxi Medical University, Taiyuan, China.
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Ponda P, Carr T, Rank MA, Bousquet J. Nonallergic Rhinitis, Allergic Rhinitis, and Immunotherapy: Advances in the Last Decade. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:35-42. [PMID: 36152989 DOI: 10.1016/j.jaip.2022.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
Chronic rhinitis encompassing both allergic and nonallergic rhinitis affects a significant portion of the population worldwide, having a great impact on patient quality of life, and associated comorbid conditions, with an important societal economic burden. Allergists are often the first to evaluate and treat allergic and nonallergic rhinitis, addressing the individual triggers of the disease as well as the patient-specific responses to these triggers. This review focuses on the advances that have been made in the diagnosis, management, and treatment of nonallergic and allergic rhinitis over the past 10 years, including specific allergen immunotherapy, care pathways, and digital health.
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Affiliation(s)
- Punita Ponda
- Division of Allergy & Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY; Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Northwell Health System, Manhasset, NY; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY.
| | - Tara Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz; Section of Allergy & Immunology, Department of Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Phoenix and Scottsdale, Ariz; Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Ariz
| | - Jean Bousquet
- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; University Hospital, Montpellier, France
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Wang Y, Tan LX, Xu ZQ, Jiao YX, Zhu DX, Yang YS, Wei JF, Sun JL, Tian M. Identification and characterization of natural PR-1 protein as major allergen from Humulus japonicus pollen. Mol Immunol 2023; 153:170-180. [PMID: 36525884 DOI: 10.1016/j.molimm.2022.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Humulus japonicus pollen is one of the most common allergenic pollens in China. However, little is unveiled regarding the allergenic components in Humulus japonicus pollen. Our study aimed to purify and identify the pathogenesis-related 1 (PR-1) protein from Humulus japonicus pollen, and to characterize the molecular and immunochemical properties of this novel allergen. METHODS The natural PR-1 protein (named as Hum j PR-1) was purified from Humulus japonicus pollen extracts with a combined strategy of chromatography, and identified by mass spectrometry. The coding sequence of Hum j PR-1 was confirmed by cDNA cloning. The recombinant Hum j PR-1 was expressed and purified from Escherichia coli. The allergenicity was assessed by immunoblot, enzyme-linked immunosorbent assay (ELISA), inhibition ELISA, and basophil activation test using Humulus japonicus allergic patients' whole blood. The physicochemical properties and 3-dimensional structure of it were comprehensively characterized by in silico methods. RESULTS The allergenicity analysis revealed that 76.6 % (23/30) of the Humulus japonicus pollen allergic patients displayed specific IgE recognition of the natural Hum j PR-1. The cDNA sequence of Hum j PR-1 had a 516-bp open reading frame encoding 171 amino acids. Physicochemical analysis indicated that Hum j PR-1 was a stable and relatively thermostable protein. Hum j PR-1 shared a similar 3-dimensional folding pattern with other homologous allergens, which was a unique αβα sandwich structure containing 4 α-helices and 6 antiparallel β-sheets, encompassing 4 conserved CAP domain. CONCLUSION The natural PR-1 was firstly purified and characterized as a major allergenic allergen in Humulus japonicus pollen. These findings would contribute to developing diagnostic and therapeutic strategies for Humulus japonicus pollinosis.
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Affiliation(s)
- Ye Wang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ling-Xiao Tan
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhi-Qiang Xu
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yong-Xin Jiao
- Department of Pharmacy, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Dan-Xuan Zhu
- Clinical Allergy Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yong-Shi Yang
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Fu Wei
- Department of Pharmacy, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China; Clinical Allergy Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Jin-Lyu Sun
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Man Tian
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China.
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10
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Tang R, Lei S, Zhu L, Lv Y, Li H. Prevention of omalizumab for seasonal allergic rhinoconjunctivitis: a retrospective cohort study. Front Immunol 2022; 13:913424. [PMID: 35967427 PMCID: PMC9366907 DOI: 10.3389/fimmu.2022.913424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Allergic rhinoconjunctivitis (ARC) is an allergic disease that is characterized by conjunctival and nasal symptoms such as edema and congestion of conjunctiva, rhinorrhea, sneezing, and blocked nose. Seasonal ARC (SARC) is usually induced by seasonal allergens and often occurs at specific times during the year. Traditional treatments of SARC include nasal corticosteroids, antihistamines, and mast cell membrane stabilizers. Biological agents such as omalizumab have also been proved effective in the treatment of SARC. Objectives We aim to certify the preventative efficacy of omalizumab for SARC and explore its influence factors. Methods Medical records of 64 SARC patients were retrospectively analyzed, and generalized linear models were used to analyze influence factors of efficacy of omalizumab. Results Compared with forepassed pollen season without omalizumab treatment, the combined symptom and medication score (CSMS) of ARC with pre-seasonal omalizumab was significantly lower (with omalizumab: 0.67[0.00,1.83], without omalizumab: 4.00[2.83,4.96], p<0.001, max score=6). Subgroup analysis was conducted to explore the influence factor of preventative efficacy of omalizumab. The CSMS with omalizumab treatment were not significantly different among different age, gender, dosage, number of injections, and injection date subgroups (p>0.05). Conclusion Pre-seasonal omalizumab treatment could significantly relieve SARC related symptoms and reduce medication use. This preventative efficacy would not be influenced by the dosage and number of injections of omalizumab. A single dose of 150mg omalizumab could achieve a satisfactory outcome.
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Affiliation(s)
- Rui Tang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID), Beijing, China
| | - Shubin Lei
- Eight-year program of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liping Zhu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuzhen Lv
- Pneumology Department, Yangquan Coal Industry (Group) General Hospital, Shanxi, China
| | - Hong Li
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID), Beijing, China
- *Correspondence: Hong Li,
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Effects of Surgical Treatment for Allergic Rhinitis on Sleep and Mental Health in Adolescents. SURGERIES 2022. [DOI: 10.3390/surgeries3010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Allergic rhinitis (AR) is a common chronic condition that is usually treated medically. Adolescents form a unique population in which AR-associated symptoms are greater than those in adults or children, and are closely related to sleep and mental disorders. In the current study, a retrospective analysis was performed to illustrate the surgical effects of AR symptoms on sleep and mental disorders in adolescents. In 81 adolescents with AR symptoms refractory to medical management, the severity of the AR symptoms was correlated with that of sleep or mental disorders. As a standard surgical procedure, submucosal bony resection of inferior turbinates with posterior nasal neurectomy was performed and half of the subjects underwent septoplasty due to severe deviation of the nasal septum. The degree of improvement in AR-associated symptoms by surgical treatment was correlated with that of mental disorders in adolescent patients who had sleep and mental disorders preoperatively. Considering the impact of AR symptoms on the quality of life of adolescents, surgical treatment can be a potent option for the treatment of AR refractory to medical management in this population.
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Bazuhair M, Salawati E, Alsabban H, Alsabban K, Alzahrani K, Alattas A, Khinkar A. Knowledge and awareness of ocular allergy among Jeddah population. J Family Med Prim Care 2022; 11:1502-1507. [PMID: 35516723 PMCID: PMC9067185 DOI: 10.4103/jfmpc.jfmpc_1591_21] [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: 08/07/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Ocular allergy is one of the common conditions that affects patients from different age groups. Public awareness about the disease is crucial for reducing the incidence of ocular allergy. Aim: The present study aims to evaluate the knowledge level of the general population in Jeddah, Saudi Arabia toward ocular allergy. Methodology: This is a cross-sectional study that included the distribution of an online survey to the public living in Jeddah. The survey included questions to identify common demographics, knowledge, and awareness about ocular allergy signs and symptoms, prevention and treatment, and sources of information. Statistical analysis included descriptive and comparative analysis using Chi-square test and one-way ANOVA test. SPSS version 26 was used for data analysis. Results: In total, 1207 responded to this survey and were included in the analysis. Among them, 71% were females, 36.8% were in the age group of 15–25 years, 74.9% had a bachelor’s degree, 60.4% were non-medical specialists, 13.2% were from the faculty of medicine. More than half of the participants were aware that ocular allergy affects millions of people globally every year. It is one of the most common eye conditions, itching is the primary source of discomfort, 15%–20% of the world population have ocular allergy, the disease causes discomfort and pain within the eye caused by frequent rubbing of the eye, and that symptoms of ocular allergy include redness, itching, tearing, discharge, blurred vision, and photophobia. Further, 64.9% thought that avoiding the source of triggers can help prevent ocular allergy. Social media was the most common source of information among 19.3%. The average score was 15.6 ± 6.1 out of 27 points; 42.6% of the responders had fair knowledge (50%–75%) about ocular allergy. The age group of 15–25 years (P < 0.001), bachelor’s degree holders (P = 0.013), and individuals with a medical background (P = 0.003) were associated with significantly higher mean scores. Males (P = 0.003), age group of 15–25 years (P = 0.024), individuals with a medical background (P < 0.001) had significantly good knowledge about ocular allergy. Conclusion: The knowledge level of the general population about ocular allergy in Jeddah, Saudi Arabia is fair and requires improvement.
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Ellis AK, Gagnon R, Bernstein DI, Nolte H. Randomized controlled trial of ragweed sublingual immunotherapy tablet in the subpopulation of Canadian children and adolescents with allergic rhinoconjunctivitis. Allergy Asthma Clin Immunol 2021; 17:127. [PMID: 34886880 PMCID: PMC8656080 DOI: 10.1186/s13223-021-00626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Post hoc analyses of randomized placebo-controlled trials have demonstrated efficacy and tolerability of the ragweed sublingual immunotherapy (SLIT)-tablet in Canadian adults with ragweed pollen-induced allergic rhinitis/conjunctivitis (AR/C). This post hoc analysis evaluated the efficacy and tolerability of the ragweed SLIT-tablet in the subpopulation of Canadian children and adolescents with AR/C in a previously described randomized, double-blind, placebo-controlled trial.
Methods
The trial (NCT02478398) was conducted in North American and European children/adolescents ages 5–17 years with ragweed pollen-induced AR/C with or without asthma (FEV1 ≥ 80% predicted). Participants were randomized to daily ragweed SLIT-tablet (12 Amb a 1-U) or placebo for up to 28 weeks. The primary endpoint was the average total combined score (TCS; sum of rhinoconjunctivitis daily symptom score [DSS] and daily medication score [DMS]) during peak ragweed pollen season (RPS). Key secondary endpoints were TCS during the entire RPS, and DSS and DMS during peak RPS. Post hoc analyses of the primary and key secondary endpoints were conducted in the subpopulation of Canadian participants.
Results
Of the 1025 randomized participants, 246 (SLIT-tablet, n = 116; placebo, n = 130) were in the Canadian subpopulation. In the total study population, relative TCS (95% CI) improvement with ragweed SLIT-tablet versus placebo was − 38.3% (− 46.0%, − 29.7%; least square [LS] mean difference, − 2.73; P < 0.001) during peak RPS. In the Canadian subpopulation, relative TCS improvements with ragweed SLIT-tablet versus placebo were − 40.8% (− 54.5%, − 20.2%; LS mean difference, − 1.59; P = 0.001) during peak RPS and − 36.6% (− 50.2%, − 16.5%; LS mean difference, − 1.36; P = 0.002) during the entire RPS. DSS and DMS during peak RPS in the Canadian subpopulation improved with SLIT-tablet versus placebo by − 30.6% (− 45.2%, − 7.7%; LS mean difference, − 0.94; P = 0.010) and − 77.2% (− 97.5%, − 44.2%; LS mean difference, − 0.66; P = 0.003), respectively. No events of anaphylaxis, airway compromise, intramuscular epinephrine administration, eosinophilic esophagitis, or severe treatment-related systemic allergic reactions were reported in the overall population or Canadian subpopulation.
Conclusion
Efficacy and safety of the ragweed SLIT-tablet in Canadian children/adolescents with ragweed pollen-induced AR/C was consistent with the total study population. The ragweed SLIT-tablet resulted in clinically meaningful improvement in symptoms, decreased symptom-relieving medication use, and was well tolerated in Canadian children/adolescents.
Trial registration: clinicaltrials.gov, NCT02478398. Registered June 23, 2015, https://clinicaltrials.gov/ct2/show/NCT02478398?term=NCT02478398&draw=2&rank=1
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Meltzer EO, Rosario NA, Van Bever H, Lucio L. Fexofenadine: review of safety, efficacy and unmet needs in children with allergic rhinitis. Allergy Asthma Clin Immunol 2021; 17:113. [PMID: 34727966 PMCID: PMC8561980 DOI: 10.1186/s13223-021-00614-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
Allergic rhinitis (AR) is the most common undiagnosed chronic condition in children. Moderate/severe AR symptoms significantly impair quality of life, and cause sleep disruption, absenteeism and decreased productivity. Additionally, untreated AR predisposes children to asthma and other chronic conditions. Although intranasal corticosteroids are the most effective pharmacologic treatment for AR, oral antihistamines are often preferred. First-generation antihistamines may be chosen to relieve AR symptoms as they are inexpensive and widely available; however, they cause sedative and cardiovascular negative effects due to poor receptor selectivity. Therefore, second-generation antihistamines were developed to reduce adverse effects while retaining efficacy. There are fewer clinical trials in children than adults, therefore, efficacy and safety data is limited, particularly in children under 6 years, highlighting the need to generate these data in young children with AR. Fexofenadine, a highly selective second-generation antihistamine, effectively alleviates symptoms of AR, is non-sedating due to decreased blood-brain barrier permeability, and is devoid of cardiovascular side effects. Importantly, fexofenadine relieves the ocular symptoms of allergic conjunctivitis, which occur concomitantly with AR, improving quality of life. Overall, fexofenadine displays a favorable safety profile and results in greater treatment satisfaction in children compared with other second-generation antihistamines. This review aimed to evaluate and compare the safety and efficacy of fexofenadine with other available first- and second-generation antihistamines in children with AR.
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Affiliation(s)
- Eli O. Meltzer
- grid.266100.30000 0001 2107 4242Department of Pediatrics, Division of Allergy and Immunology, University of California, La Jolla, San Diego, CA USA
| | - Nelson Augusto Rosario
- grid.20736.300000 0001 1941 472XDepartamento de Pediatria, Universidade Federal Do Parana, Curitiba, PR Brazil
| | - Hugo Van Bever
- grid.4280.e0000 0001 2180 6431Department of Pediatrics, Division of Rheumatology, Immunology, Allergy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Luiz Lucio
- Medical Department, Sanofi Consumer Healthcare, AI, Traira 456, Santana de Parnaiba-SP, Brazil, São Paulo, 06540 365 Brazil
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Abstract
PURPOSE OF REVIEW Allergic rhinoconjunctivitis is one of the most common ocular surface allergic inflammatory conditions seen in primary care that impacts patient's quality of life. Allergic conjunctivitis is increasingly being recognized as its own symptom complex that negatively impacts patient's quality of life separate from allergic rhinitis. This article reviews the psychosocial impact of ocular surface allergic inflammatory disorders (namely seasonal allergic conjunctivitis, ocular allergy, perennial allergic conjunctivitis, and atopic keratoconjunctivitis) on adult and pediatric populations. RECENT FINDINGS Despite the perception that allergic conjunctivitis is a trivial condition, it imposes a burden on numerous psychosocial aspects of life for adolescents and adults. Several questionnaires specific to rhinoconjunctivitis have been found to be effective tools at gauging quality of life (QoL) and communicating impairments in specific behavioral domains for adult and pediatric populations. An emerging focus on the role of hormone fluctuations and age on ocular surface allergic inflammation underscores the importance of nuancing the physiologic effects on ocular allergy and QoL at every decade of life. SUMMARY Further exploration and research of symptoms by age would greatly improve our understanding of age's impact on QoL in these patients and contribute to improved management of allergic conjunctivitis.
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Ma T, Chen Y, Pang Y, Wang X, Dai D, Zhuang Y, Shi H, Zheng M, Zhang R, Jin W, Yang X, Wang Y, Shan G, Yan Y, Wang D, Wang X, Wei Q, Yin J, Wang X, Zhang L. Prevalence and risk factors of allergic rhinitis and asthma in the southern edge of the plateau grassland region of northern China: A cross-sectional study. World Allergy Organ J 2021; 14:100537. [PMID: 34429814 PMCID: PMC8356121 DOI: 10.1016/j.waojou.2021.100537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence rates of allergic rhinitis (AR) and asthma in the border region of China may be different from those in the central region of plateau grasslands. A survey was performed to investigate the prevalence and risk factors for AR, asthma, and AR combined with asthma among adults (age ≥ 20 years) residing in the southern border of plateau grasslands in northern China. Methods From May to August 2018, a cross-sectional survey was completed by subjects that were selected using a cluster random sampling method. The subjects completed a questionnaire and were administered skin prick tests (SPTs). Risk factors for AR, asthma, and AR combined with asthma were examined by multivariate logistic regression analyses. Results A total of 1815 adult subjects in the selected region completed study. The prevalence rates of physician-diagnosed AR, asthma, and AR combined with asthma were 13.9% (253), 9.8% (177), and 2.9% (52), respectively. Among the patients with AR, 20.6% were found to have concurrent asthma; among the patients with asthma, 29.4% were found to have concurrent AR. Artemisia and Humulus pollen were the most common sensitizing pollen types. Approximately 70% of subjects with AR and <30% of asthma patients were sensitized to Artemisia and Humulus pollen. Symptoms of AR and asthma mainly appeared during August. A multivariable logistic regression analysis identified sensitization pollen as an independent risk factor for both AR and AR combined with asthma (AR: OR = 16.23, 95% CI: 10.15–25.96; AR combined with asthma: OR = 6.16, 95% CI: 1.28–29.66). An age >40 years old, family history of asthma, moderate-to-severe AR, adverse food reactions, and mold allergies were independent risk factors for AR combined with asthma. Conclusions This study identified the prevalence rates of AR and asthma in the southern borders of the plateau grassland in northern China (>1500 m above sea level). Sensitization pollen is an independent risk factor for AR and AR combined with asthma.
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Key Words
- AI, Alternaria
- AR, allergic rhinitis
- ARIA, Allergic Rhinitis and its Impact on Asthma
- Allergic rhinitis
- Ar, Artemisia
- Asthma
- BHR, Bronchial hyper-responsiveness
- Df, Dermatophagoides farinae
- Dp, Dermatophagoides pteronyssinus
- Hu, Humulus scandens
- IQR, Interquartile range
- Pollen
- Prevalence
- Risk factors
- SPTs, Skin prick tests
- Sa, Salix
- UI, Ulmus pumila
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Affiliation(s)
- Tingting Ma
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yanlei Chen
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yaojun Pang
- Department of Allergy, Zhangbei Hospital, Hebei Province, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Deqing Dai
- Department of Allergy, Zhangbei Hospital, Hebei Province, China
| | - Yan Zhuang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Haiyun Shi
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ming Zheng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Ruijuan Zhang
- Department of Allergy, Zhangbei Hospital, Hebei Province, China
| | - Weiting Jin
- Department of Allergy, Zhangbei Hospital, Hebei Province, China
| | - Xiaomei Yang
- Department of Allergy, Zhangbei Hospital, Hebei Province, China
| | - Ye Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yong Yan
- Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Deyun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiaoyan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qingyu Wei
- Department of Allergy, General Hospital of Northern Theater Command, Shenyang, Liao Ning Province, China
| | - Jinshu Yin
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xueyan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
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Kawai J, Andoh T, Mori K. Suppression of leukotriene B4 production is involved in the anti-pruritic action of Grifola frondosa in pollen allergy-induced ocular itching in mice. FOOD AGR IMMUNOL 2021. [DOI: 10.1080/09540105.2021.1934418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Junya Kawai
- Mushroom Research Laboratory, Hokuto Corporation, Nagano, Japan
| | - Tsugunobu Andoh
- Department of Applied Pharmacology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- Department of Pharmacology and Pathophysiology, College of Pharmacy, Kinjo Gakuin University, Nagoya, Japan
| | - Koichiro Mori
- Mushroom Research Laboratory, Hokuto Corporation, Nagano, Japan
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Comparative nasal airflow with loratadine-pseudoephedrine and fluticasone nasal spray for allergic rhinitis. Ann Allergy Asthma Immunol 2021; 127:342-348.e2. [PMID: 34000435 DOI: 10.1016/j.anai.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although it is known that oral antihistamine-pseudoephedrine combination tablets have a faster onset than intranasal corticosteroid sprays in the treatment of allergic rhinitis after the first dose, the magnitude of change has not been measured in a comparative manner. Furthermore, the sensation of sprayed liquid in the nose may lead patients to mistakenly believe that intranasal steroid sprays work instantly. OBJECTIVE To evaluate, numerically, nasal airflow changes provided by a single dose of loratadine-pseudoephedrine tablet (LP) and fluticasone propionate nasal spray (FP) in participants experiencing allergic rhinitis symptoms, including nasal congestion. METHODS This single-center, double-blinded, placebo-controlled, crossover study evaluated objective nasal airflow changes in patients with a documented sensitivity to ragweed pollen. Participants were randomized to receive 1 of 4 treatment sequences, and their peak nasal inspiratory flow (PNIF) was measured in a span of 4 hours after pollen exposure in an environmental exposure unit. RESULTS Average change in PNIF was 31% with LP in the course of the study, significantly greater than with placebo and FP (12% and 15%, respectively; P < .001). Nevertheless, FP did not produce a significant change compared with its placebo. At hour one post-dose, LP had a clinically significant 31% increase in PNIF, whereas FP only yielded an 8.6% increase (P < .001). Measurable nasal airflow improvements are associated with the opening of nasal passages, allowing congested patients to breathe more freely. CONCLUSION A single dose of LP quickly and significantly (P < .001) improved nasal airflow after ragweed pollen challenge in an environmental exposure unit. Comparatively, FP did not display this same benefit. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03443843.
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Ear Acupressure for Allergic Rhinitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6699749. [PMID: 34007299 PMCID: PMC8110385 DOI: 10.1155/2021/6699749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/27/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
Background The treatment effects and safety of ear acupressure (EAP) for patients with allergic rhinitis (AR) have yet to be clarified. Objective To evaluate the effects and safety of EAP in AR patients. Design Systematic review of published studies. Methods A total of 24 English and Chinese databases (PubMed, EMBASE (Excerpta Medical Database), Cochrane Central Register of Controlled Trials, CINAHL, Informit, ScienceDirect, LILACS (Latin American and Caribbean Health Sciences), ProQuest, AMED, Blackwell Synergy, PsycINFO, Panteleimon, AcuBriefs, KoreaMed, IndMed, Ingenta, mRCT, ISI Web of Knowledge, ERIC, VIP Information (http://www.cqvip.com), China National Knowledge Infrastructure (http://www.cnki.net), Cochrane Library, Chinese Cochrane Centre Controlled Trials Register Platform, and Wanfang Chinese Digital Periodical and Conference Database) were searched from their respective inceptions to August 2020 to collect randomized controlled trials of ear acupressure for allergic rhinitis. We performed literature inclusion, data extraction, and trial quality evaluations. Methodological quality was assessed according to the Cochrane Handbook. Revman5.3 was used for all analyses. Results A total of 203 trials were identified and eleven studies involved 1094 participants aged 3–70 years. EAP was better than control group interventions in terms of effectiveness (risk ratio (RR): 0.51; 95% confidence interval (CI): 0.36–0.70; P < 0.0001). EAP was superior to sham EAP in terms of improvement of the total nasal symptom score (RR: −0.50; 95% CI: −0.96–0.05; P = 0.03), sneezing score (RR: −0.36; 95% CI: −0.59–0.12; P = 0.003), global QoL score (RR: 0.42; 95% CI: 0.04–0.08; P = 0.03), and eye symptom score (RR: −0.36; 95% CI: −0.67–0.05; P = 0.02). Conclusions Despite the positive results, it is premature to confirm the efficacy of EAP for treating AR. More high-quality studies are needed to confirm safety and efficacy.
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Abstract
Allergic conjunctivitis is a disease of increasing prevalence that affects both children and adults and causes significant deterioration of their quality of life and sometimes irreversible visual damage. There are various forms of the disease, some are allergen-induced such as seasonal and perennial allergic conjunctivitis, giant papillary conjunctivitis, and contact allergic blepharoconjunctivitis, whereas others are not always explained by allergen exposure, such as vernal keratoconjunctivitis and atopic keratoconjunctivitis. We review their clinical course, characteristics, and differential diagnosis, and highlight recent advances in their pathophysiology and treatment.
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Affiliation(s)
| | - Jose Manuel Benitez-Del-Castillo
- Hospital Clinico San Carlos de Madrid Department of Ophthalmology, Madrid, Spain.,Universidad Complutense de Madrid, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Madrid, Spain.,Clínica Rementería, Madrid, Spain
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21
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Al-Dairi W, Al Saeed AA, Al Sowayigh OM. Impact of Quarantine During COVID-19 Pandemic on the Quality of Life of Patients with Allergic Conjunctivitis. Cureus 2020; 12:e12240. [PMID: 33505811 PMCID: PMC7822578 DOI: 10.7759/cureus.12240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The conjunctiva is one of the most frequently damaged targets for inflammatory responses induced by allergic immunological hypersensitivity reactions. Allergic conjunctivitis (AC) typically manifests as a spectrum of potential severity, ranging from mild symptoms to severe troublesome symptoms that might interfere significantly with daily activities and overall quality of life. Aim This study aimed to evaluate impact of the quarantine during the COVID-19 pandemic on the quality of life of allergic conjunctivitis patients. Methodology This is a cross-sectional study conducted among confirmed patients with allergic conjunctivitis in Saudi Arabia from the period of July 2020 to September 2020. An electronic validated structured-questionnaire explored the participants' demography, symptoms, known allergen and risk factors, and patient psychological and functional domains of life using Eye Allergy Patient Impact Questionnaire (EAPIQ). Data were gathered in MS Excel and all statistical analyses were performed using SPSS version 21. Results The most common symptoms of AC was itching (79.9%) and redness of the eye (38.8%), while the most common causes was dust (46.9%) and pollens (46.9%). With regards to the assessment of EAPIQ, the mean score was higher in the impact of eye allergy symptoms domain (mean 12.6 ± 4.84 SD.), while it was lower in the impact of AC on the psychological and emotional domain (mean 10.7 ± 5.62 SD.). Statistical analysis revealed that previous history of AC and a visit to healthcare provider were the significant factors associated with the increased risk of eye allergy symptoms, troubled daily activities and bothered psychological and emotional life. Conclusion This study demonstrated that a patients' eye allergy symptoms affect many aspects of patients' daily activities. In addition to affecting functionality, these symptoms also affect patients' emotional state. Although the impact of daily activities and emotions due to eye allergy were minimal, the impact of eye allergy symptoms during quarantine period was still found to be moderate. We found the severity of AC & its impact over a patients' quality of life was moderate which suggests there was no major effect found on AC severity during the COVID-19 pandemic quarantine period. Further studies with detailed analysis of triggering factors might lead to a better understanding of the disease and its relation to the patients' activities & lifestyle which can directly affect the AC management & quality of life.
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Affiliation(s)
| | - Ali A Al Saeed
- College of Medicine, King Faisal University, Al Ahsa, SAU
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22
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Muzalyova A, Brunner JO. Determinants of the utilization of allergy management measures among hay fever sufferers: a theory-based cross-sectional study. BMC Public Health 2020; 20:1876. [PMID: 33287774 PMCID: PMC7720499 DOI: 10.1186/s12889-020-09959-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The quality of life of chronically ill individuals, such as hay fever sufferers, is significantly dependent on their health behavior. This survey aimed to explain the health-related behavior of allergic individuals using the protection motivation theory (PMT) and the transtheoretical model (TTM). Methods The influencing variables stated by PMT were operationalized based on data from semistructured pilot interviews and a pretest with 12 individuals from the target population. The final questionnaire inquired perceived seriousness and severity of hay fever, response efficacy, response costs, self-efficacy, and the use of various hay fever management measures in relation to the TTM stages. Multivariate logistic regression was performed to investigate the relationships between the PMT constructs and the examined health behavior. Results A total of 569 allergic individuals completed the online questionnaire. Only 33.26% of allergic individuals were in the maintenance stage for treatment under medical supervision, and almost 60% preferred hay fever self-management. A total of 67.56% had a well-established habit of taking anti-allergic medication, but only 25.31% had undergone specific immunotherapy. The likelihood of seeking medical supervision was positively influenced by perceived severity (OR = 1.35, 95% CI: 1.02–1.81), perceived seriousness (OR = 2.12, 95% CI: 1.56–2.89), and self-efficacy (OR = 4.52, 95% CI: 3.11–6.65). The perceived severity of symptoms predicted the practice of hay fever self-management (OR = 1.60, 95% CI: 1.21–2.11), as well as anti-allergic medication intake (OR = 1.65, 95% CI: 1.16–2.35). The latter measure was also positively influenced by self-efficacy (OR = 1.52, 95% CI: 1.01–2.28) and hay fever self-management (OR = 4.76, 95% CI: 2.67–7.49). Undergoing specific immunotherapy was significantly predicted only by medical supervision (OR = 9.80, 95% CI: 8.16–13.80). Allergen avoidance was a strategy used by allergic individuals who preferred hay fever self-management (OR = 2.56, 95% CI: 1.87–3.52) and experienced notable symptom severity (OR = 2.12, 95% CI: 1.60–2.81). Conclusion Educational interventions that increase the awareness of health risks associated with inadequate hay fever management and measures to increase self-efficacy might be beneficial for the promotion of appropriate hay fever management among allergic individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09959-w.
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Affiliation(s)
- Anna Muzalyova
- Chair of Health Care Operations/ Health Information Management, UNIKA-T, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany.
| | - Jens O Brunner
- Chair of Health Care Operations/ Health Information Management, UNIKA-T, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany
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Bosnic-Anticevich S, Smith P, Abramson M, Hespe CM, Johnson M, Stosic R, Price DB. Impact of allergic rhinitis on the day-to-day lives of children: insights from an Australian cross-sectional study. BMJ Open 2020; 10:e038870. [PMID: 33234631 PMCID: PMC7689068 DOI: 10.1136/bmjopen-2020-038870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
STUDY DESIGN AND OBJECTIVE Cross-sectional, observational survey to describe the impact of allergic rhinitis (AR) on Australian children (2 to 15 years). METHODS Participants (n=1541), parents of children aged 2 to 15 years, provided information on behalf of themselves and one eligible child in their household using a custom-built online questionnaire. Children were allocated to case (AR) or control (No AR) analysis groups based on a validated screening questionnaire. STATISTICAL METHODS The study sample was stratified on age: primary analysis population (6 to 15 years, n=1111; AR=797, No AR=314); exploratory population (2 to 5 years). The primary endpoint, parent-perceived burden, was quantified using a validated measure of health status and analysed via comparison of means. RESULTS The majority of AR cases were treated (730/797; 90.3%) and classified as having moderate-severe, intermittent AR (549/797; 68.9%). Half reported adequate symptom control in the prior 2 weeks (389/797; 48.8%; OR=4.04; 95% CI (CI) 2.24 to 7.31). Having AR was associated with worse overall health status (7.4 vs 8.4, mean difference (least squares mean difference (LSMD))=-0.99; 95% CI -1.18 to -0.79), fewer days being happy (22.2 vs 25.9, LSMD=-3.68; 95% CI -4.82 to -2.54) and more days of poor physical (2.82 vs 0.78, LSMD=2.04; 95% CI 1.61 to 2.47) and emotional (2.14 vs 0.67, LSMD=1.47; 95% CI 1.02 to -1.92) health compared with not having AR. All of these outcomes were significantly (p<0.05) worse in children who reported inadequate symptom control. Having AR negatively impacted on schoolwork, sleep and other activities, and increased the likelihood of having comorbidities. CONCLUSION The parent-perceived burden of AR in Australian children is high and it impacts many areas of day-to-day living. Inadequate symptom control is a key driver of the extent of this impact. Opportunities to optimise the management of AR in children include the adoption of self-assessment tools to gauge and monitor adequacy of symptom control.
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Affiliation(s)
- Sinthia Bosnic-Anticevich
- Department Lead, Quality Use of Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Smith
- Professor of Clinical Medicine, Griffith University, Southport, Queensland, Australia
| | - Michael Abramson
- Professor of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University and Honorary Medical Officer in Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Charlotte Mary Hespe
- General Practitioner & Head of Primary Care Research, University of Notre Dame, Australia (Sydney School of Medicine), Sydney & Director Asthma Foundation, Sydney, New South Wales, Australia
| | - Menai Johnson
- Head of Central Medical Operations, Real World Clinical Evidence, Sanofi Australia/New Zealand, Sydney, New South Wales, Australia
| | - Rodney Stosic
- Formerly Head of Medical Affairs, Sanofi Consumer Healthcare, Sydney, New South Wales, Australia
| | - David B Price
- Managing Director, Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Olopatadine/mometasone combination nasal spray in allergic rhinitis: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tan R, Kritikos V, Cvetkovski B, Rimmer J, Yan K, Cheong L, Bousquet J, Bosnic-Anticevich S. Study protocol: Development, implementation, evaluation and refinement of a translational allergic rhinitis clinical management pathway (AR-CMaP) for community pharmacies. Res Social Adm Pharm 2020; 17:S1551-7411(20)30991-8. [PMID: 34756364 DOI: 10.1016/j.sapharm.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic Rhinitis (AR) is a highly burdened chronic respiratory disease1-4, which affects about 40% of the world's population5. Research shows that only 15% of people with AR, in the community pharmacy setting are using optimal AR medication6. There is a clear need to better implement AR management guidelines so that more effective medication selection and an evidence-based approach to the management of AR is implemented. OBJECTIVE This paper describes the methods that will be used to develop, implement, evaluate and refine an evidence-based, guideline informed allergic rhinitis clinical management pathway, Allergic Rhinitis Clinical Management Pathway (AR-CMaP) for community pharmacy. METHODS AR-CMaP was developed based on the latest AR management guidelines for pharmacy7 and empirical evidence associated with patient self-management behaviours in community pharmacy15, utilising the Promoting Action on Research Implementation in Health Services implementation framework (Phase 1). AR-CMaP was then implemented in six pharmacies in the Australian Capital Territory (ACT), Australia (Phase 2). The impact of AR-CMaP on AR management in the pharmacy (AR medication management and pharmacy practice) will be evaluated in a pre-post intervention study design (Phase 3). Phase 4 will involve the refinement of AR-CMaP to ensure its generalisability and scalability; readiness for large-scale dissemination across different pharmacy locations (e.g. rural, remote, metropolitan) and different pharmacy business models. CONCLUSIONS There is an urgent need to develop a translational AR clinical pathway, to address the wide-spread challenge of suboptimal AR management and burden of AR on individuals and society. This protocol paper describes the methods underpinning the development, implementation, evaluation and refinement of an evidence-based AR clinical pathway for community pharmacy setting, which is in line with current clinical evidence and feasible for effective implementation into the community pharmacy setting.
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Affiliation(s)
- Rachel Tan
- Woolcock Institute of Medical Research, Glebe, NSW, Australia; The University of Sydney, Camperdown, NSW, Australia.
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, Glebe, NSW, Australia; The University of Sydney, Camperdown, NSW, Australia
| | - Biljana Cvetkovski
- Woolcock Institute of Medical Research, Glebe, NSW, Australia; The University of Sydney, Camperdown, NSW, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, Glebe, NSW, Australia; Thoracic Medicine, St Vincent's Private Hospital, Darlinghurst, Australia
| | - Kwok Yan
- Woolcock Institute of Medical Research, Glebe, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lynn Cheong
- Discipline of Pharmacy, University of Canberra, Canberra, Australia
| | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques Pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Glebe, NSW, Australia; The University of Sydney, Camperdown, NSW, Australia; Sydney Local Health District, Sydney, NSW, Australia
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The Role of Th17 Cells and IL-17 in Th2 Immune Responses of Allergic Conjunctivitis. J Ophthalmol 2020; 2020:6917185. [PMID: 32566265 PMCID: PMC7267877 DOI: 10.1155/2020/6917185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022] Open
Abstract
Allergic conjunctivitis (AC) is a common allergic disease that is often associated with the onset of rhinitis or asthma. The incidence of AC has increased significantly in recent years possibly due to air pollution and climate warming. AC seriously affects patients' quality of life and work efficiency. Th (T-helper) 2 immune responses and type I hypersensitivity reactions are generally considered the basis of occurrence of AC. It has been found that new subpopulations of T-helper cells, Th17 cells that produce interleukin-17 (IL-17), play an important role in the Th2-mediated pathogenesis of conjunctivitis. Studies have shown that Th17 cells are involved in a variety of immune inflammation, including psoriasis, rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and asthma. However, the role of Th17 and IL-17 in AC is unclear. This paper will focus on how T-helper 17 cells and interleukin-17 are activated in the Th2 immune response of allergic conjunctivitis and how they promote the Th2 immune response of AC.
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Ellis AK, Boursiquot J, Carr S, Graham F, Masse MS. Patient and physician perceptions of seasonal allergic rhinitis and allergen immunotherapy: a parallel physician patient survey. Allergy Asthma Clin Immunol 2020; 16:15. [PMID: 32123533 PMCID: PMC7035743 DOI: 10.1186/s13223-020-0412-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/06/2020] [Indexed: 12/04/2022] Open
Abstract
Background The Allergy Patient Identification for Immunotherapy (AsPIRe) program was a parallel physician and patient survey. The objectives were to examine physician and patient perceptions of seasonal allergy symptoms and their impact on patients, and to examine patient and physician attitudes to allergen immunotherapy (AIT) for seasonal allergies. AsPIRe was led by a steering committee and received research ethics board clearance from Queen’s University. Methods Allergists (17) from across Canada enrolled in the AsPIRe program and completed an on-line survey to collect demographic information and baseline perceptions. Allergists then recruited patients and completed paper-based parallel physician and patient questionnaires. Patients received an AIT informational booklet with their questionnaire. Patients who were AIT-naïve with no contraindication to AIT and 12 years of age and older met the inclusion criteria. Results The survey was in field from February 2018 to June 2018. A total of 141 allergist surveys and 136 patient surveys were completed. Mean age of patients was 30 years old (range 12–70). Fifty-seven percent of patients reported prior knowledge of AIT. Seventy-two percent of patients reported seasonal allergies of longer than 5 years duration and in this subset of patients, 46% were at their first allergist visit. Seventy-three percent of all patients indicated they would be likely or very likely to try sublingual immunotherapy (SLIT), if recommended by their allergist compared to 36% for subcutaneous immunotherapy (SCIT). Conversely, 10% of patients reported they would be unlikely or very unlikely to try SLIT compared to 46% of patients who would be unlikely or very unlikely to try SCIT if recommended by their allergist. Conclusions In this particular study cohort, there was a gap in perception between allergists and their patients as to the impact of allergy symptoms on daily life. Patients reported being more frequently impacted vs. their physician’s assessment. When asked about preference for AIT options, Canadian patients reported they were more likely to follow their allergists’ recommendation for initiation of SLIT compared to SCIT.
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Affiliation(s)
- Anne K Ellis
- 1Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON Canada
| | - Jean Boursiquot
- 2Division of Allergy and Clinical Immunology, Centre hospitalier universitaire de Québec, Laval University, Quebec City, QC Canada
| | - Stuart Carr
- 3Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - François Graham
- 4Division of Allergy and Immunology, Department of Medicine, Université de Montréal, Quebec, Canada
| | - Marie-Soleil Masse
- 4Division of Allergy and Immunology, Department of Medicine, Université de Montréal, Quebec, Canada
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Alqurashi KA, Bamahfouz AY, Almasoudi BM. Prevalence and causative agents of allergic conjunctivitis and its determinants in adult citizens of Western Saudi Arabia: A survey. Oman J Ophthalmol 2020; 13:29-33. [PMID: 32174737 PMCID: PMC7050458 DOI: 10.4103/ojo.ojo_31_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/22/2019] [Accepted: 11/19/2019] [Indexed: 12/03/2022] Open
Abstract
PURPOSE: To estimate the prevalence of allergic conjunctivitis (AC) and its related allergic ailments among Saudi adults in the western region. METHODS: Adult population of Taif, Makkah, and Jeddah cities was surveyed from 2017 to June 2018. Subjective questionnaire was used to collect the response. Participants were asked about symptoms (redness, itching, watering, based diagnosis and details of AC, treatment taken in the pasts, and associated conditions, such as allergic asthma and rhinitis). The age-sex-adjusted prevalence, its determinants, and associations to other ailments were assessed. RESULTS: We surveyed 2187 participants (mean age 26.0 ± 9.1 years). The age-sex-adjusted prevalence of AC was 70.5% (95% confidence interval [CI] 68.6–72.4). There could be 2.1 million AC patients among 3.1 million adult populations in Western KSA. It was significantly higher in females compared to males (odds ratio [OR] = 1.7 [95% CI 1.4–2.2]). The risk of AC did not vary by age group (χ2 = 2.5, df = 3, P = 0.1). The variation of AC in three provinces was not significant (χ2 = 0.3, df = 3, P = 0.6). Dust (42.6%) and unknown (24.8%) allergens were the main causative agents of AC. AC was significantly associated to asthma (OR = 2.8) and allergic rhinitis (OR = 2.2). CONCLUSION: AC affects seven in ten adults in Western Saudi Arabia. AC is positively associated to allergic rhinitis and bronchial asthma. Public health policies at primary eye-care level should focus on early detection and care of persons with AC.
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Affiliation(s)
- Khaled A Alqurashi
- Department of Ophthalmology, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Ashjan Yousef Bamahfouz
- Department of Ophthalmology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Ophthalmology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Bayan Mutlaq Almasoudi
- Department of Ophthalmology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Dupuis P, Prokopich CL, Hynes A, Kim H. A contemporary look at allergic conjunctivitis. Allergy Asthma Clin Immunol 2020; 16:5. [PMID: 31993069 PMCID: PMC6975089 DOI: 10.1186/s13223-020-0403-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 01/16/2023] Open
Abstract
Allergic eye disease is common, yet often overlooked in North America. In the U.S., up to 40% of the population is deemed to be affected and this number is growing. Symptoms and signs of ocular allergy can lead to decreased productivity and negatively impact quality of life (QoL). Various treatment options exist to achieve symptom control. For allergic conjunctivitis, ophthalmic agents include antihistamines, mast cell stabilizers, dual-activity agents, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and some off-label treatments. Immunotherapy is recommended as a therapeutic option. This review provides a summary of the forms of ocular allergies, with a focus on symptoms and signs, impact on QoL, physical examination, diagnosis and therapeutic options of allergic conjunctivitis. Through multidisciplinary collaborations, a simplified algorithm for the treatment of allergic conjunctivitis is proposed for Canadian clinical practice.
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Affiliation(s)
- Pascale Dupuis
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada
| | - C Lisa Prokopich
- 2School of Optometry & Vision Science, University of Waterloo, 200 Columbia St W., Waterloo, ON N2L 3G1 Canada
| | | | - Harold Kim
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada.,4Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University Health Sciences Centre, 1280 Main St. W., Hamilton, ON L8S 4K1 Canada
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The Explosion of OTC Management of Allergic Rhinitis: Costs and Risks. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dermer H, Theotoka D, Lee CJ, Chhadva P, Hackam AS, Galor A, Kumar N. Total Tear IgE Levels Correlate with Allergenic and Irritating Environmental Exposures in Individuals with Dry Eye. J Clin Med 2019; 8:jcm8101627. [PMID: 31590324 PMCID: PMC6832222 DOI: 10.3390/jcm8101627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022] Open
Abstract
Dry eye (DE) and allergic conjunctivitis may present similarly, and it remains unclear whether some individuals have an underlying allergic component to their DE. To better understand this relationship, we performed a cross-sectional study in 75 individuals with DE symptoms and/or signs. Immunoglobulin E (IgE) levels in tear samples were quantified and home environmental exposures assessed via standardized survey. Tears were collected by Schirmer strip, and total tear IgE levels were quantified using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using descriptive statistics and linear and logistic regressions. The main outcome measures were total tear IgE levels and their association with environmental exposures. The mean age of the subjects was 66.2 ± 7.8 years. Sixty-two individuals had dry eye symptoms (Dry Eye Questionnaire-5 ≥ 6), and 75 had one or more signs of DE. Detectable total tear IgE levels were observed in 76% of subjects, and 17.3% had high levels (>1 ng/mL). Individuals with exposure to pet(s) (odds ratio (OR) 11.5, p = 0.002) and smoke (OR 38.6, p = 0.008) at home were more likely to have high IgE levels compared to those not exposed. Individuals with tears collected during spring or summer were 3.9 times (p = 0.028) more likely to have high IgE compared to those sampled at other times of year. Subjects born in the US were 3.45 times (p = 0.010) more likely to have high IgE compared to individuals born outside the US. To conclude, a majority of individuals with DE symptoms and/or signs had detectable IgE levels in their tears. High tear IgE levels were correlated with allergy season and exposures in the home linked with allergy.
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Affiliation(s)
- Harrison Dermer
- Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| | - Despoina Theotoka
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA.
| | - Charity J Lee
- Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| | - Priyanka Chhadva
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, IL 60612, USA.
| | - Abigail S Hackam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA.
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA.
| | - Naresh Kumar
- Department of Public Health Sciences, University of Miami, Miami, FL, 33136, USA.
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A qualitative investigation of the allergic rhinitis network from the perspective of the patient. NPJ Prim Care Respir Med 2019; 29:35. [PMID: 31537804 PMCID: PMC6753105 DOI: 10.1038/s41533-019-0147-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/15/2019] [Indexed: 12/28/2022] Open
Abstract
Patient self-selection of over-the-counter medicines for the management of allergic rhinitis is suboptimal. The mapping of the allergic rhinitis network demonstrates that patients’ decisions with regards to their allergic rhinitis management can be influenced by up to 11 individuals/resources (alters). This study aimed to identify the role of alters within the allergic rhinitis network and identify the factors that determined their degree of influence as perceived by the patient. This research was a qualitative exploration embedded in an empirical framework and social network theory. People with allergic rhinitis were interviewed about their network and transcripts were analysed deductively and inductively. Transcripts were coded by researchers independently and then discussed until agreement was reached. Forty-one participants described the roles of 17 alters on their allergic rhinitis management. The roles of alters fell within five categories: diagnosis, medication prescription/supply/administration, medication recommendation, information about allergic rhinitis and emotional support. Participant interactions with these alters were often acute and had a long standing effect, with the participants often navigating the long-term management on their own. The significance of the influence of each alter on their allergic rhinitis management was dependent on the level of trust in their relationship, impact of the role made to the participants’ day-to-day management of allergic rhinitis and/or the participant’s beliefs. Allergic rhinitis management was fragmented and had opportunity to be improved by developing strategies, resources and policies to support self-management in collaboration with patients and health-care professionals.
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Exploring the Asthma Network in People with Allergic Rhinitis Utilizing an Egocentric Social Network Analysis. Pulm Ther 2019; 5:235-245. [PMID: 32026406 PMCID: PMC6967048 DOI: 10.1007/s41030-019-0095-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Asthma and allergic rhinitis (AR) are chronic respiratory diseases of a united airway. Poor AR control is a risk factor for uncontrolled asthma. We know that people with AR feel confident in making their own treatment choices with over-the-counter therapies, yet only 16% of purchases were the optimal selection. With the high level of poor asthma control and overuse of over-the-counter, short-acting beta-agonists, we must consider whether poor AR self-management behaviours are extended to asthma management in those with both diseases. This study aims to investigate asthma management from the perspective of the patient with asthma and AR and understand the influences behind their asthma management decisions. Methods This study utilized a mixed methods approach based on the theoretical and analytical framework of social network theory, including mapping of the asthma network and exploring the roles and influence of those that appear within the network. Results Twenty-two people with asthma and allergic rhinitis participated in this study. General practitioners (GPs), pharmacists and respiratory physicians were the most commonly reported influences behind participants’ asthma management decisions. Although non-healthcare professional (HCP) influences appear within the asthma network, they represented a smaller proportion. Conclusion The asthma network of people with AR is dominated by HCP influences. This network is unique and different to other previously published asthma and AR networks. Further research on the impact of AR on asthma management patient behaviour is required. Electronic Supplementary Material The online version of this article (10.1007/s41030-019-0095-9) contains supplementary material, which is available to authorized users.
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Bosnic‐Anticevich S, Costa E, Menditto E, Lourenço O, Novellino E, Bialek S, Briedis V, Buonaiuto R, Chrystyn H, Cvetkovski B, Di Capua S, Kritikos V, Mair A, Orlando V, Paulino E, Salimäki J, Söderlund R, Tan R, Williams DM, Wroczynski P, Agache I, Ansotegui IJ, Anto JM, Bedbrook A, Bachert C, Bewick M, Bindslev‐Jensen C, Brozek JL, Canonica GW, Cardona V, Carr W, Casale TB, Chavannes NH, Correia de Sousa J, Cruz AA, Czarlewski W, De Carlo G, Demoly P, Devillier P, Dykewicz MS, Gaga M, El‐Gamal Y, Fonseca J, Fokkens WJ, Guzmán MA, Haahtela T, Hellings PW, Illario M, Ivancevich JC, Just J, Kaidashev I, Khaitov M, Khaltaev N, Keil T, Klimek L, Kowalski ML, Kuna P, Kvedariene V, Larenas‐Linnemann DE, Laune D, Le LTT, Lodrup Carlsen KC, Mahboub B, Maier D, Malva J, Manning PJ, Morais‐Almeida M, Mösges R, Mullol J, Münter L, Murray R, Naclerio R, Namazova‐Baranova L, Nekam K, Nyembue TD, Okubo K, O'Hehir RE, Ohta K, Okamoto Y, Onorato GL, Palkonen S, Panzner P, Papadopoulos NG, Park H, Pawankar R, Pfaar O, Phillips J, Plavec D, Popov TA, Potter PC, Prokopakis EP, Roller‐Wirnsberger RE, Rottem M, Ryan D, Samolinski B, Sanchez‐Borges M, Schunemann HJ, Sheikh A, Sisul JC, Somekh D, Stellato C, To T, Todo‐Bom AM, Tomazic PV, Toppila‐Salmi S, Valero A, Valiulis A, Valovirta E, Ventura MT, Wagenmann M, Wallace D, Waserman S, Wickman M, Yiallouros PK, Yorgancioglu A, Yusuf OM, Zar HJ, Zernotti ME, Zhang L, Zidarn M, Zuberbier T, Bousquet J. ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project. Allergy 2019; 74:1219-1236. [PMID: 30565275 DOI: 10.1111/all.13701] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/22/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Abstract
Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
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Affiliation(s)
- Sinthia Bosnic‐Anticevich
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Elisio Costa
- UCIBIO REQUIMTE Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
| | | | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | - Ettore Novellino
- Department of Pharmacy of University of Naples Federico II Naples Italy
| | - Slawomir Bialek
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | - Vitalis Briedis
- Department of Clinical Pharmacy of Lithuanian University of Health Sciences Kaunas Lithuania
| | | | | | - Biljana Cvetkovski
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | | | - Vicky Kritikos
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Alpana Mair
- DG for Health and Social Care Scottish Government Edinburgh UK
| | | | | | | | - Rojin Söderlund
- Department of Nephrology and Endocrinology Karolinska University Hospital Stockholm Sweden
| | - Rachel Tan
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Dennis M. Williams
- Eshelman School of Pharmacy University of North Carolina Chapel Hill North Carolina
| | - Piotr Wroczynski
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | | | | | - Josep M. Anto
- ISGlobAL Centre for Research in Environmental Epidemiology (CREAL) Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - Anna Bedbrook
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Department Ghent University Hospital Ghent Belgium
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Research Center for Anaphylaxis (ORCA) Odense Denmark
| | - Jan L. Brozek
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Giorgio Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy Humanitas Research Hospital Humanitas University Rozzano, Milan Italy
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall ‘dHebron & ARADyAL Research Network Barcelona Spain
| | - Warner Carr
- Allergy and Asthma Associates of Southern California Mission Viejo California
| | - Thomas B. Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida
| | - Niels H. Chavannes
- Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Braga Portugal
- ICVS/3B's PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Bahia Brazil
- WHO GARD Planning Group Brasilia Brazil
| | | | - Giuseppe De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Pascal Demoly
- Department of Respiratory Diseases Montpellier University Hospital Montpellier France
- Epidemiology of Allergic and Respiratory Diseases Department Institute Pierre Louis of Epidemiology and Public Health Medical School Saint Antoine INSERM and UPMC Sorbonne Université Paris France
| | - Philippe Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220 Hôpital Foch Suresnes Université Versailles Saint‐Quentin Université Paris Saclay Saclay France
| | - Mark S. Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
| | - Mina Gaga
- ERS President 2017‐2018 Athens Chest Hospital 7th Resp Med Department and Asthma Center Athens Greece
| | - Yehia El‐Gamal
- Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt
| | - João Fonseca
- CINTESIS Center for Research in Health Technologies and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
- MEDIDA, Lda Porto Portugal
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centre Amsterdam The Netherlands
| | | | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Peter W. Hellings
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - Maddalena Illario
- Division for Health Innovation Campania Region and Federico II University Hospital Naples (R&D and DISMET) Naples Italy
| | | | - Jocelyne Just
- Allergology Department Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand‐Trousseau (APHP) Sorbonne Universités UPMC Univ Paris 06 UMR_S 1136 Institut Pierre Louis d'Epidémiologie et de Santé Publique Equipe EPAR Paris France
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy Poltava Ukraine
| | - Musa Khaitov
- National Research Center Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular immunology Moscow Russian Federation
| | | | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute for Clinical Epidemiology and Biometry University of Wuerzburg Wuerzburg Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek L. Kowalski
- Department of Immunology and Allergy Healthy Ageing Research Center Medical University of Lodz Lodz Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | | | | | | | - Lan T. T. Le
- University of Medicine and Pharmacy Hochiminh City Vietnam
| | - Karin C. Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical MedicineUniversity of Oslo Oslo Norway
| | - Bassam Mahboub
- Department of Pulmonary Medicine Rashid Hospital Dubai UAE
| | | | - Joao Malva
- Faculty of Medicine Coimbra Institute for Clinical and Biomedical Research (iCBR) University of Coimbra Coimbra Portugal
- Ageing@Coimbra EIP‐AHA Reference Site Coimbra Portugal
| | - Patrick J. Manning
- Department of Medicine (RCSI) Bon Secours Hospital Glasnevin, Dublin Ireland
| | | | - Ralph Mösges
- Institute of Medical Statistics, and Computational Biology Medical Faculty University of Cologne Cologne Germany
- CRI‐Clinical Research International‐Ltd Hamburg Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain
| | - Lars Münter
- Danish Committee for Health Education Copenhagen East Denmark
| | | | | | - Leyla Namazova‐Baranova
- Scientific Centre of Children's Health under the MoH, Russia, Russian National Research Medical University named Pirogov Moscow Russia
| | - Kristof Nekam
- Hospital of the Hospitaller Brothers in Buda Budapest Hungary
| | | | - Kimi Okubo
- Department of Otolaryngology Nippon Medical School Tokyo Japan
| | - Robyn E. O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
- Department of Immunology Monash University Melbourne Victoria Australia
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital Tokyo Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | - Susanna Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital “P&A Kyriakou” University of Athens Athens Greece
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section for Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Jim Phillips
- Centre for Empowering Patients and Communities Faulkland, Somerset UK
| | - Davor Plavec
- Children's Hospital Srebrnjak Zagreb, School of Medicine University J.J. Strossmayer Osijek Croatia
| | | | - Paul C. Potter
- Allergy Diagnostic and Clinical Research Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Emmanuel P. Prokopakis
- Department of Otorhinolaryngology University of Crete School of Medicine Heraklion Greece
| | | | - Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology Emek Medical Center Afula Israel
| | - Dermot Ryan
- Honorary Clinical Research Fellow Allergy and Respiratory Research Group The University of Edinburgh Past President SLAAI FACAAI Edinburgh UK
| | - Bolesław Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Médico‐Docente la Trinidad Caracas Trinidad
- Clínica El Avila Altamira, Caracas Venezuela
| | - Holger J. Schunemann
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | | | - David Somekh
- European Health Futures Forum (EHFF) Isle of Wright UK
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Salerno Italy
| | - Teresa To
- The Hospital for Sick Children Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Ana Maria Todo‐Bom
- Imunoalergologia Centro Hospitalar Universitário de Coimbra Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | | | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Antonio Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy IDIBAPS University of Barcelona Barcelona Spain
| | - Arunas Valiulis
- Clinic of Children's Diseases and Institute of Health Sciences Department of Public Health Vilnius University Institute of Clinical Medicine Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Errka Valovirta
- Department of Lung Diseases and Clinical Immunology University of Turku and Terveystalo allergy clinic Turku Finland
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Martin Wagenmann
- Department of Otorhinolaryngology Universitätsklinikum Düsseldorf Dusseldorf Germany
| | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Magnus Wickman
- Centre for Clinical Research Sörmland Uppsala University Eskilstuna Sweden
| | - Panayiotis K. Yiallouros
- Cyprus International Institute for Environmenta & Public Health in Association with Harvard School of Public Health Cyprus University of Technology Limassol Cyprus
- Department of Pediatrics Hospital “Archbishop Makarios III” Nicosia Cyprus
| | | | | | - Heather J. Zar
- Department of Paediatrics and Child Health Red Cross Children's, Hospital, and MRC Unit on Child & Adolescent Health University of Cape Town Cape Town South Africa
| | | | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Beijing Institute of Otolaryngology Beijing China
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases Golnik Slovenia
| | - Torsten Zuberbier
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
| | - Jean Bousquet
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
- University Hospital Montpellier France
- INSERM U 1168 VIMA: Ageing and chronic diseases Epidemiological and public health approaches Villejuif France
- Université Versailles St‐Quentin‐en‐Yvelines UMR‐S 1168 Montigny le Bretonneux France
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Cvetkovski B, Tan R, Kritikos V, Yan K, Azzi E, Srour P, Bosnic-Anticevich S. A patient-centric analysis to identify key influences in allergic rhinitis management. NPJ Prim Care Respir Med 2018; 28:34. [PMID: 30213945 PMCID: PMC6137238 DOI: 10.1038/s41533-018-0100-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022] Open
Abstract
Allergic rhinitis (AR) is increasingly becoming a patient self-managed disease. Just under 70% of patients purchasing pharmacotherapy self-select their treatment with no health-care professional intervention often resulting in poor choices, leading to suboptimal management and increased burden of AR on the individual and the community. However, no decision is made without external, influencing forces. This study aims to determine the key influences driving patients’ decision-making around AR management. To accomplish this aim, we utilised a social network theory framework to map the patient’s AR network and identify the strength of the influences within this network. Adults who reported having AR were interviewed and completed an AR network map and AR severity and quality of life questionnaires. Forty one people with AR completed the study. The AR networks of the participants had a range of 1–11 influences (alters), with an average number of 4 and a median of 5. The larger the impact of AR on their quality of life, the greater the number of alters within their network. The three most commonly identified alters were, general practitioners, pharmacists and the participants’ ‘own experience’. The strength of the influence of health-care professionals (HCPs) was varied. The proportion of HCPs within the AR network increased as the impact of AR on their quality of life increased. By mapping the AR network, this study demonstrated that there are multiple influences behind patient’s decisions regarding AR management but the role of the HCP cannot be dismissed. In-depth interviews with allergy sufferers about their treatment decisions highlights a need for healthcare professionals to help optimize allergy management. Allergic rhinitis (AR), a set of conditions including hayfever, is often poorly managed by patients, partly due to the growing availability of over-the-counter medications. However, little is known about what influences patients’ self-management decisions. Biljana Cvetkovski at the University of Sydney, Australia, and co-workers interviewed 41 adults with AR. The participants also completed quality of life questionnaires and created network maps of key influencers. Cvetkovski found that patients followed many different influences when making treatment decisions, including online resources, family, friends and healthcare professionals. Three of the key influencers were general practitioners, pharmacists and patients’ own experience. Those with severe AR had a larger, more diverse network of influences and often reported treatment fatigue.
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Affiliation(s)
- Biljana Cvetkovski
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.
| | - Rachel Tan
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Kwok Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Elizabeth Azzi
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Pamela Srour
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.,Central Sydney Local Area Health District, Level 11, KGV Building, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
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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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Impact and Assessment of Sleep Disturbance in Adults and Children with Allergic Rhinitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Blaiss MS, Hammerby E, Robinson S, Kennedy-Martin T, Buchs S. The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: A literature review. Ann Allergy Asthma Immunol 2018; 121:43-52.e3. [PMID: 29626629 DOI: 10.1016/j.anai.2018.03.028] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/08/2018] [Accepted: 03/25/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (aged 10-19 years). DATA SOURCES Searches were performed in MEDLINE, Embase, Health Technology Assessment Database, and National Health Service Economic Evaluation Database for studies that evaluated concepts of symptoms, quality of life (QOL), daily activities, sleep, examination performance, school absenteeism and presenteeism, and treatment burden in adolescents with AR or ARC. STUDY SELECTIONS English-language journal articles indexed in the last 15 years describing noninterventional, population-based studies. Records were assessed by 2 independent reviewers. RESULTS A total of 27 articles were identified; outcomes evaluated were symptoms (n = 6 studies), QOL (n = 9), daily activities (n = 5), emotional aspects (n = 3), sleep (n = 6), education (n = 7), and treatment burden (n = 2). AR symptoms rated most bothersome were rhinorrhea, nasal congestion, and itchy eyes. QOL was worse in adolescents with AR vs controls regardless of QOL instrument used. Nasal symptoms and nasal obstruction were more likely to be associated with poor QOL in adolescents than in adults or younger children, respectively. Daily functioning and sleep were also negatively affected by AR. In addition, a detrimental effect on absenteeism, school productivity, and academic performance was reported. CONCLUSION Although AR and ARC are sometimes perceived as trivial conditions, this review indicates that their effect on adolescent life is negative and far-reaching. It is critical that clinicians gain a greater understanding of the unique burden of AR and ARC in adolescents to ensure they receive prompt and appropriate care and treatment to improve clinical and academic outcomes.
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Affiliation(s)
- Michael S Blaiss
- Medical College of Georgia at Augusta University, Augusta, Georgia.
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Schatz M, Sicherer SH, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2017 Year in Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:328-352. [PMID: 29397373 DOI: 10.1016/j.jaip.2017.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 12/29/2022]
Abstract
An impressive number of clinically impactful studies and reviews were published in The Journal of Allergy and Clinical Immunology: In Practice in 2017. As a service to our readers, the editors provide this Year in Review article to highlight and contextualize the advances published over the past year. We include information from articles on asthma, allergic rhinitis, rhinosinusitis, immunotherapy, atopic dermatitis, contact dermatitis, food allergy, anaphylaxis, drug hypersensitivity, 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. 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 readers consolidate and use this extensive and practical knowledge for the benefit of 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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40
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Bousquet J, Onorato GL, Bachert C, Barbolini M, Bedbrook A, Bjermer L, de Sousa JC, Chavannes NH, Cruz AA, De Manuel Keenoy E, Devillier P, Fonseca J, Hun S, Kostka T, Hellings PW, Illario M, Ivancevich JC, Larenas-Linnemann D, Millot-Keurinck J, Ryan D, Samolinski B, Sheikh A, Yorgancioglu A, Agache I, Arnavielhe S, Bewick M, Annesi-Maesano I, Anto JM, Bergmann KC, Bindslev-Jensen C, Bosnic-Anticevich S, Bouchard J, Caimmi DP, Camargos P, Canonica GW, Cardona V, Carriazo AM, Cingi C, Colgan E, Custovic A, Dahl R, Demoly P, De Vries G, Fokkens WJ, Fontaine JF, Gemicioğlu B, Guldemond N, Gutter Z, Haahtela T, Hellqvist-Dahl B, Jares E, Joos G, Just J, Khaltaev N, Keil T, Klimek L, Kowalski ML, Kull I, Kuna P, Kvedariene V, Laune D, Louis R, Magnan A, Malva J, Mathieu-Dupas E, Melén E, Menditto E, Morais-Almeida M, Mösges R, Mullol J, Murray R, Neffen H, O'Hehir R, Palkonen S, Papadopoulos NG, Passalacqua G, Pépin JL, Portejoie F, Price D, Pugin B, Raciborski F, Simons FER, Sova M, Spranger O, Stellato C, Todo Bom A, Tomazic PV, Triggiani M, Valero A, Valovirta E, VandenPlas O, Valiulis A, van Eerd M, Ventura MT, Wickman M, Young I, Zuberbier T, Zurkuhlen A, Senn A. CHRODIS criteria applied to the MASK (MACVIA-ARIA Sentinel NetworK) Good Practice in allergic rhinitis: a SUNFRAIL report. Clin Transl Allergy 2017; 7:37. [PMID: 29075437 PMCID: PMC5654064 DOI: 10.1186/s13601-017-0173-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023] Open
Abstract
A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75% was observed for 14 items (50%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.
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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, Montpellier, France.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France.,CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - G L Onorato
- Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - C Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - M Barbolini
- Regione Emilia Romagna - Agenzia Sanitaria e Sociale, Reference Site of the European Innovation Partnership on Healthy and Active Ageing, Bologna, Italy
| | - A Bedbrook
- Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - L Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - J Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - A A Cruz
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil.,GARD Executive Committee, Salvador, Brazil
| | - E De Manuel Keenoy
- Kronikgune, International Centre of Excellence in Chronicity Research Barakaldo, Bizkaia Bilbao, Spain
| | - P Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220, Pôle des Maladies Respiratoires, Hôpital Foch, Suresnes Université Versailles Saint-Quentin, Versailles, France
| | - J Fonseca
- Center for Health Technology and Services Research- CINTESIS, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Allergy Unit, CUF Porto Instituto and Hospital, Porto, Portugal
| | - S Hun
- Public Health Agency Northern Ireland, Belfast, UK
| | - T Kostka
- Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland
| | - P W Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - M Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - J C Ivancevich
- Allergy and Immunology Department, Santa Isabel, Buenos Aires, Argentina
| | | | - J Millot-Keurinck
- Caisse Assurance Retraite et Santé Au Travail Languedoc-Roussillon (CARSAT-LR), 34000 Montpellier, France
| | - D Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - B Samolinski
- Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - 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
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University, Manisa, Turkey.,GARD Executive Committee, Manisa, Turkey
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | | | - M Bewick
- iQ4U Consultants Ltd, London, UK
| | - I Annesi-Maesano
- EPAR U707 INSERM, Paris and EPAR UMR-S UPMC, Paris VI, Paris, France
| | - J M Anto
- Centre for Research in Environmental Epidemiology (CREAL), ISGLoBAL, Barcelona, Spain.,IMIM (Hospital del Mar Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - K C Bergmann
- Comprehensive Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW Australia.,Personalized Medicine Clinic Asthma and Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan Italy
| | - J Bouchard
- Laval's University, Quebec City, Canada.,Hôpital de la Malbaie, Quebec City, Canada
| | - D P Caimmi
- CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France.,Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - P Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - G W Canonica
- CHRU de Montpellier, Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - V Cardona
- Allergologia, S Medicina Interna, Hospital Vall d'Hebron, Barcelona, Spain
| | - A M Carriazo
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - C Cingi
- ENT Department, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - E Colgan
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland, UK
| | - A Custovic
- Department of Pediatric, Imperial College London, London, UK
| | - R Dahl
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil.,GARD Executive Committee, Salvador, Brazil
| | - P Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - G De Vries
- Peercode DV, Gerdermalsen, The Netherlands
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - B Gemicioğlu
- Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - N Guldemond
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
| | - Z Gutter
- University Hospital Olomouc - National eHealth Centre, Olomouc, Czech Republic
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - B Hellqvist-Dahl
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
| | - E Jares
- Libra Foundation, Buenos Aires, Argentina
| | - G Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand-Trousseau (APHP), Paris, France.,UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Sorbonne Universités, 75013 Paris, France
| | | | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - M L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, and HARC, Lodz, Poland
| | - I Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | | | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
| | - A Magnan
- Service de Pneumologie, UMR INSERM, UMR1087 and CNR 6291, l'institut du thorax, University of Nantes, Nantes, France
| | - J Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | | | - E Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Menditto
- CIRFF, Federico II University, Naples, Italy
| | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisbon, Portugal
| | - R Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - J Mullol
- Clinical and Experimental Respiratory Immunoallergy, ENT Department, Hospital Clínic, IDIBAPS, CIBERES, Universitat de Barcelona, Barcelona, Spain
| | - R Murray
- Medical Communications Consultant, MedScript Ltd, Dundalk, Co Louth Ireland
| | - H Neffen
- Argentina Center for Allergy and Immunology, Alassia Children's Hospital, Santa Fe, Santa Fe, Argentina
| | - R 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
| | - S Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - N G Papadopoulos
- Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, Manchester, M13 9WL UK.,Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou,", University of Athens, Athens, 11527 Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino Hospital, IST-University of Genoa, Genoa, Italy
| | | | - F Portejoie
- Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - D Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Optimum Patient Care, Cambridge, UK.,Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK
| | - B Pugin
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - F Raciborski
- Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - F E R Simons
- Department of Pediatrics and Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
| | - M Sova
- University Hospital Olomouc, Olomouc, Czech Republic
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Altgasse 8-10, 1130 Vienna, Austria
| | - C Stellato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - A Todo Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - P V Tomazic
- Department of ENT, Medical University of Graz, Graz, Austria
| | - M Triggiani
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - A Valero
- Pneumology and Allergy Department Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - E Valovirta
- Pneumology and Allergy Department Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - O VandenPlas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - A Valiulis
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - M van Eerd
- Peercode DV, Gerdermalsen, The Netherlands
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - M Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Young
- Queen's University Belfast, Belfast, Northern Ireland, UK
| | - T Zuberbier
- Comprehensive Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Global Allergy and Asthma European Network (GA2LEN), Berlin, Germany
| | - A Zurkuhlen
- Gesundheitsregion KölnBonn - HRCB Projekt GmbH, Kohln, Germany
| | - A Senn
- EC-CNECT-H2, European Commission, Brussels, Belgium
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41
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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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42
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Casale TB, Onder RF, Berkowitz RB, Korenblat PE. Nasal Carbon Dioxide Used As Needed in the Symptomatic Treatment of Seasonal Allergic Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:183-189. [PMID: 28705451 DOI: 10.1016/j.jaip.2017.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/01/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nasal, noninhaled carbon dioxide (CO2) was shown to be effective for the treatment of symptoms of seasonal allergic rhinitis (SAR) and perennial allergic rhinitis in single application studies. OBJECTIVE To assess the efficacy of as-needed treatment with nasal, noninhaled CO2 in patients with SAR. METHODS Fifty-six ragweed-allergic patients were enrolled at 3 sites in this study. After a 3- to 7-day run-in, 32 eligible patients who had an instantaneous total nasal symptom score of 8 or more out of a maximum of 12 in at least 2 SAR episodes per day were randomized to the CO2 group (n = 19) or to the placebo group (n = 13). A 10-second/nostril application was used as needed for 14 days (maximum 6 times/d). Patients evaluated their symptoms before and 30 minutes after each application. All symptoms were scored on a 0 to 3 scale. RESULTS Analysis of all treated episodes (CO2 = 816, placebo = 516) showed a statistically significant beneficial change in total nasal symptom score from baseline (effect size = -0.51; P < .001). The effect size was larger with more severe baseline symptoms (baseline severities of ≥6 = -0.98; ≥8 = -1.14; and ≥10 = -1.61; all P < .001). CO2 was well tolerated, with transient nasal discomfort as the most common adverse event reported. There were no serious adverse events, serious adverse device effects, or early discontinuations. CONCLUSIONS Nasal, noninhaled CO2 is effective for the as-needed treatment of SAR symptoms. The effect is rapid and the effect size is large. It represents a novel potential option for the as-needed treatment of rhinitis symptoms.
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Affiliation(s)
- Thomas B Casale
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, Fla.
| | | | | | - Phillip E Korenblat
- The Clinical Research Center, Washington University School of Medicine, St Louis, Mo
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43
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Carr WW, Yawn BP. Management of allergic rhinitis in the era of effective over-the-counter treatments. Postgrad Med 2017; 129:572-580. [PMID: 28532204 DOI: 10.1080/00325481.2017.1333384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Allergic rhinitis (AR) may be regarded as a trivial issue unworthy of the doctor's time, and with the availability of many different over-the-counter (OTC) treatments, up to two thirds of patients self-manage AR before seeking medical care. Yet, AR can have a significant impact on health-related quality of life and is associated with a greater detriment to work productivity than other chronic diseases such as diabetes and hypertension. For many patients, the impact on quality of life is greater than suggested by reported symptoms and should also be a focus of treatment. Although many patients can effectively manage AR symptoms independently, a significant percentage will need direction from a physician to obtain optimal results. The availability of several different classes of treatment - including decongestants, sedating and non-sedating antihistamines, and more recently intranasal corticosteroids (INS) - has increased the complexity of self-management, leaving patients confused about the best approach to treatment. Treatment guidelines universally classify INS as the most effective medical agents available for use in the OTC and primary care settings. Many patients are unaware that INS are available OTC and that they are more effective than other therapies. Patients may have negative perceptions about the safety of INS and may have experienced unpleasant taste, scent, and feel with nasal sprays. Unless a patient volunteers the information, healthcare professionals (HCPs) may be unaware that the patient has significant AR and is using one or more OTC AR therapies. To address this gap in communication, HCPs must be proactive in identifying, assessing, and advising patients with AR, including best strategies to assess allergen trigger symptoms, which treatments are appropriate, and when and how to use them. Proper use of delivery devices is especially important. This article reviews the primary care management of AR in the context of the availability of effective OTC medicines.
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Affiliation(s)
- Warner W Carr
- a Physician, Allergy & Asthma Associates of Southern California, A Medical Group , Southern California Research , Mission Viejo , CA , USA
| | - Barbara P Yawn
- b Department of Family and Community Health , University of Minnesota , Minneapolis , MN , USA
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