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Savouré M, Bousquet J, Leynaert B, Ribet C, Goldberg M, Zins M, Jacquemin B, Nadif R. Asthma is associated with increased severity and duration of rhinitis: A study with the Allergic Rhinitis and its Impact on Asthma classes in the Constances cohort. Clin Transl Allergy 2023; 13:e12316. [PMID: 38006378 PMCID: PMC10668004 DOI: 10.1002/clt2.12316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Few population-based studies have described allergic rhinitis (AR) according to the Allergic Rhinitis and its Impact on Asthma (ARIA) classification, and none have assessed the impact of asthma on this classification. Our aims were to 1) describe AR according to four ARIA classes and 2) within each of the four ARIA classes, compare participants with AR alone versus those with AR and asthma. METHODS Cross-sectional analyses were performed using data from the 2014 annual follow-up questionnaire of the French adult population-based cohort Constances. Current AR was defined by the report of sneezing, runny, or blocked nose in the last 12 months and the report of nasal allergies. Following ARIA recommendations, rhinitis was classified according to its severity (mild or moderate-severe) and duration (intermittent or persistent). Ever asthma was also defined by a questionnaire. RESULTS Among the 4675 participants with AR (57% women, mean age 50.2 ± 12.7 years), 44% were classified as mild/intermittent, 16% mild/persistent, 25% moderate-severe/intermittent, and 15% moderate-severe/persistent. Within each of the four ARIA classes, compared to participants with rhinitis alone, participants with rhinitis and asthma had significantly more severe symptoms, more conjunctivitis, a higher mean eosinophil count and more treatments with intra-nasal corticosteroids and oral antihistamines co-medication. CONCLUSIONS This is a paradigm shift study as for the first time this large population-based study in adults showed that asthma status has a profound effect on the ARIA classification. Rhinitis alone and rhinitis with asthma represent two distinct phenotypes. These results reinforce the need to include asthma status in the ARIA classification and guidelines.
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Affiliation(s)
- Marine Savouré
- Université Paris‐SaclayUVSQUniv. Paris‐SudInsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance
- French Environment and Energy Management AgencyAngersFrance
| | - Jean Bousquet
- Université Paris‐SaclayUVSQUniv. Paris‐SudInsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance
- CharitéUniversitätsmedizin BerlinHumboldt‐Universität zu BerlinBerlinGermany
- Department of Dermatology and AllergyComprehensive Allergy CenterBerlin Institute of HealthBerlinGermany
- Centre Hospitalier UniversitaireMontpellierFrance
- MASK‐airMontpellierFrance
| | - Bénédicte Leynaert
- Université Paris‐SaclayUVSQUniv. Paris‐SudInsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance
| | - Céline Ribet
- Université Paris‐CitéUniversité Paris‐SaclayUVSQ, InsermUMS 11 Cohortes Epidémiologiques en populationVillejuifFrance
| | - Marcel Goldberg
- Université Paris‐CitéUniversité Paris‐SaclayUVSQ, InsermUMS 11 Cohortes Epidémiologiques en populationVillejuifFrance
| | - Marie Zins
- Université Paris‐CitéUniversité Paris‐SaclayUVSQ, InsermUMS 11 Cohortes Epidémiologiques en populationVillejuifFrance
| | - Bénédicte Jacquemin
- Univ RennesInsermEHESPIrset (Institut de recherche en Santé, environnement et travail) ‐ UMR_S 1085RennesFrance
| | - Rachel Nadif
- Université Paris‐SaclayUVSQUniv. Paris‐SudInsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance
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Xu SY, Lv HQ, Zeng CL, Peng YJ. Prevalence and bidirectional association between rhinitis and urticaria: A systematic review and meta-analysis. Allergy Asthma Proc 2023; 44:402-412. [PMID: 37919842 DOI: 10.2500/aap.2023.44.230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Background: Rhinitis, allergic rhinitis in particular, and urticaria are both common diseases globally. However, there is controversy with regard to the correlation between rhinitis and urticaria. Objective: To examine the accurate association between rhinitis and urticaria. Methods: Three medical literature data bases were searched from data base inception until January 11, 2022. The prevalence and association between rhinitis and urticaria were estimated by meta-analysis. Quality assessment was performed by using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% confidence intervals (CI) and pooled prevalence were calculated by using random-effects models. Results: Urticaria prevalence in patients with rhinitis was 17.6% (95% CI, 13.2%-21.9%). The pooled prevalence of rhinitis was 31.3% (95% CI, 24.2%-38.4%) in patients with urticaria, and rhinitis prevalence in patients with acute urticaria and chronic urticaria was 31.6% (95% CI, 7.4%-55.8%) and 28.7% (95% CI, 20.4%-36.9%), respectively. Rhinitis occurrence was significantly associated with urticaria (OR 2.67 [95% CI, 2.625-2.715]). Urticaria and rhinitis were diagnosed based on different criteria, possibly resulting in a potential error of misclassification. Conclusion: Rhinitis and urticaria were significantly correlated. Physicians should be cognizant with regard to this relationship and address nasal or skin symptoms in patients.
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Matricardi PM, Sousa-Pinto B, Dramburg S, Bousquet J. Beyond ARIA: Will e-diaries replace retrospective questionnaires in measuring the severity of allergic rhinitis in clinical research and daily practice? Clin Exp Allergy 2023; 53:1004-1010. [PMID: 37488953 DOI: 10.1111/cea.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 07/26/2023]
Abstract
Retrospective questionnaires are used since decades to assess the severity and/or control of allergic diseases. Applications on smartphones have recently facilitated the use of prospective clinical diaries, based on questionnaires filled every day by the patient. Once limited to clinical trials, these e-diaries, based on validated disease control scores and visual analogue scales, permit a quantitative day-by-day measure free of recall bias. Given the advantages of this procedure, its use could be extended to the daily clinical practice. E-diaries may facilitate (1) a more precise identification of the culprit allergen in the diagnostic work-up of poly-sensitized patients, (2) the stratification of patients for treatment, (3) the follow-up of the patients under treatment for optimized shared decision-making, and (4) a careful assessment of preventive therapies. While a few apps are being used in scientific studies, consensus on their use in daily practice should be reached and guidelines for specialists should be elaborated by scientific associations.
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Affiliation(s)
- Paolo M Matricardi
- Department of Pediatric Respiratory Care, Immunology, and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Stephanie Dramburg
- Department of Pediatric Respiratory Care, Immunology, and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- University Hospital Montpellier, Montpellier, France
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Moon H, Sim C, Lee J, Oh I, An T, Lee J. A Prospective Study on the Association between Oxidative Stress and Duration of Symptoms in Allergic Rhinitis. J Pers Med 2021; 11:jpm11121290. [PMID: 34945762 PMCID: PMC8708387 DOI: 10.3390/jpm11121290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Oxidative stress has been known to play an important role in inflammatory responses of allergic rhinitis. We investigated the association between degree of oxidative stress and severity of allergic rhinitis. A total 226 allergic rhinitis students were classified by a history of allergic rhinitis into groups according to number and duration of symptoms within the previous year. The total antioxidant status (TAS) and total oxidant status (TOS) levels were compared among groups. Mean TAS level (14.03 ± 9.09 mmol/L) in the group with more than six months of symptoms had a tendency to be higher (p = 0.068) than that of the group with fewer than six months (12.33 ± 8.83 mmol/L). There was no statistically significant difference in mean TAS or TOS level with number of symptoms (nasal congestion, itching, sneezing and watery rhinorrhea). A multivariate logistic regression showed that the adjusted odds ratio of TAS was 1.655 and the adjusted odds ratio of TOS was 0.972 in more than a six-month duration group. The TAS level was significantly associated with a more than six-month symptom duration (p = 0.034). Our results suggest that antioxidant activity increased when allergic rhinitis became chronic and further research will be needed considering the disease severity.
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Affiliation(s)
- Hyun Moon
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea; (H.M.); (T.A.)
| | - Changsun Sim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (C.S.); (J.L.)
- Environmental Health Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
| | - Jiho Lee
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (C.S.); (J.L.)
- Environmental Health Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
| | - Inbo Oh
- Environmental Health Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
| | - Taehoon An
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea; (H.M.); (T.A.)
| | - Jongcheol Lee
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea; (H.M.); (T.A.)
- Correspondence: ; Tel.: +82-33-610-4372; Fax: +82-33-642-3189
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Rhinitis Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1492-1503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
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Potapova E, Bauersachs D, Villella V, Meneguzzi G, Scala E, Sfika I, Tripodi S, Panetta V, Dramburg S, Skevaki C, Matricardi PM. Validation study of a new chemiluminescent singleplex IgE assay in a set of Italian allergic rhinitis patients. Clin Exp Allergy 2020; 51:604-613. [DOI: 10.1111/cea.13785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/04/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Ekaterina Potapova
- Division of Pneumonology, Immunology and Intensive Medicine Department of Pediatrics Charité – Universitätsmedizin Berlin Germany
| | - Daniel Bauersachs
- Institute of Laboratory Medicine Universities of Giessen and Marburg Lung Center (UGMLC) German Center for Lung Research (DZL) Philipps University Marburg Marburg Germany
| | | | - Giorgia Meneguzzi
- Allergy Unit Istituto dermopatico dell'Immacolata (IDI)‐IRCCS Roma Italy
| | - Enrico Scala
- Allergy Unit Istituto dermopatico dell'Immacolata (IDI)‐IRCCS Roma Italy
| | - Ifigenia Sfika
- Pediatric Allergy Unit Sandro Pertini Hospital Rome Italy
| | | | | | - Stephanie Dramburg
- Division of Pneumonology, Immunology and Intensive Medicine Department of Pediatrics Charité – Universitätsmedizin Berlin Germany
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine Universities of Giessen and Marburg Lung Center (UGMLC) German Center for Lung Research (DZL) Philipps University Marburg Marburg Germany
| | - Paolo Maria Matricardi
- Division of Pneumonology, Immunology and Intensive Medicine Department of Pediatrics Charité – Universitätsmedizin Berlin Germany
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Nieto A, Nieto M, Mazón Á. The clinical evidence of second-generation H1-antihistamines in the treatment of allergic rhinitis and urticaria in children over 2 years with a special focus on rupatadine. Expert Opin Pharmacother 2020; 22:511-519. [PMID: 33198523 DOI: 10.1080/14656566.2020.1830970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Many obstacles limit the development of pharmacologic studies in children, in particular ethical and practical issues. Therefore, although second-generation H1-antihistamines (sgAH) are recommended by international guidelines as first-line therapy in childhood allergies, most data on the efficacy of antihistamines in children has been extrapolated from studies in adult patients. AREAS COVERED The current review focuses on rupatadine, a well-studied modern sgAH that has dual affinity for histamine H1-receptors and PAF receptors. In recent years, clinical efficacy and safety controlled-clinical trials on rupatadine were conducted in children and were based on latest current guidelines using validated tools of allergic rhinitis and urticaria. EXPERT OPINION Children are not little adults since they present specific physiologic, metabolic, and developmental differences that should be evaluated in specific trials. The clinical evidence with rupatadine in children is the most recent and validated in accordance with current recommendations, with extensive direct data on efficacy and safety in pediatric populations over 2 years old.
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Affiliation(s)
- Antonio Nieto
- Pediatric Pulmonology & Allergy Unit, Children's Hospital La Fe, Valencia, Spain
| | - María Nieto
- Allergy Service, Hospital De La Plana, Villarreal, Castellón, Spain
| | - Ángel Mazón
- Pediatric Pulmonology & Allergy Unit, Children's Hospital La Fe, Valencia, Spain
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Valero A, del Cuvillo A, Navarro AM, Colás C, Sastre J, Mullol J. Validation of the ARIA items to assess allergic rhinitis control (ARIA-C). Allergy 2020; 75:2964-2966. [PMID: 32452064 DOI: 10.1111/all.14418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Valero
- CIBERESInstituto de Salud Carlos III Madrid Spain
- Department of Pneumology and Allergy Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | - Alfonso del Cuvillo
- Rhinology & Asthma Unit Department of Otorhinolaryngology Hospital Universitario de Jerez Jerez Spain
| | - Ana M. Navarro
- Department of Allergy Hospital El Tomillar Dos Hermanas Sevilla Spain
| | - Carlos Colás
- Department of Allergy Hospital Clínico Lozano Blesa Instituto de Investigación Sanitaria de Aragón Zaragoza Spain
| | - Joaquín Sastre
- CIBERESInstituto de Salud Carlos III Madrid Spain
- Department of Allergy Fundación Jiménez Díaz Madrid Spain
- Department of Medicine Universidad Autónoma de Madrid Madrid Spain
| | - Joaquim Mullol
- CIBERESInstituto de Salud Carlos III Madrid Spain
- Rhinology Unit & Smell Clinic Department of Otorhinolaryngology Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
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Yuan T, Xiong J, Yang J, Wang X, Jiang Y, Zhou X, Liao K, Xu L. The Effectiveness and Safety of Thunder Fire Moxibustion for Treating Allergic Rhinitis: A PRISMA Compliant Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:6760436. [PMID: 33029169 PMCID: PMC7532423 DOI: 10.1155/2020/6760436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is a noninfectious inflammatory disease caused by allergic individuals exposed to allergens. Western medicine therapy for treating AR causes obvious adverse events, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Therefore, we conducted this meta-analysis to evaluate the effectiveness and safety of TFM for treating AR. METHODS PubMed, Web of Science, Embase, the Cochrane Library, CNKI, WanFang, VIP, and CBM from inception to April 5, 2020, were searched without any language restriction. Reviewers identified studies, extracted data, and assessed the quality, independently. The primary outcomes were the total effective rate and the TNSS. The secondary outcomes included TNNSS, RQLQ, VAS, serum IgE, IgA, or IgG level, and adverse events. Randomized controlled trials (RCTs) were collected; methodological quality was evaluated using the Cochrane risk of bias assessment tool (RoB), and the level of evidence was rated using the GRADE approach. Meta-analysis was performed using the RevMan5.3.0 software. RESULTS A total of 18 RCTs were included, including 1600 patients. The results of this meta-analysis showed a statistically significant effect in a total effective rate of T = TFM (RR = 1.07; 95% CI [1.03, 1.12]; P = 0.45; I 2 = 0%) and T = TFM + other treatments (RR = 1.18; 95% CI [1.11, 1.25]; P = 0.03; I 2 = 53%). In addition, TFM intervention also showed significant difference in total symptom score (T = TFM + other treatments) (MD = -1.42; 95% CI [-1.55, -1.29]; P = 0.03; I 2 = 60%) in patients with AR. CONCLUSION Existing evidence shows that TFM is safe and effective for AR. Due to the universal low quality of the eligible trials and low evidence level, we should draw our conclusions with caution. Therefore, clinical researchers should carry out more large-sample, multicentre, high-quality randomized controlled clinical trials in the future to verify the clinical efficacy of TFM in treating AR.
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Affiliation(s)
- Ting Yuan
- Institute of Acupuncture, Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Jun Xiong
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of TCM, Nanchang, Jiangxi, China
| | - Jun Yang
- Institute of Acupuncture, Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Xue Wang
- Institute of Acupuncture, Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Yunfeng Jiang
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of TCM, Nanchang, Jiangxi, China
| | - Xiaohong Zhou
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of TCM, Nanchang, Jiangxi, China
| | - Kai Liao
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of TCM, Nanchang, Jiangxi, China
| | - Lingling Xu
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Jiangxi University of TCM, Nanchang, Jiangxi, China
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Efficacy of Chinese Medicine Acupoint Application Combined with Montelukast on Children with Perennial Allergic Rhinitis: A Randomized Controlled Trial. Chin J Integr Med 2020; 26:845-852. [PMID: 32870478 DOI: 10.1007/s11655-020-3099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of Chinese medicine acupoint application (CMAA) combined with Western medicine for perennial allergic rhinitis (PAR) in children. METHODS In this prospective, parallel, randomized, placebo-controlled and single-blind trial from August to September, 2017, 180 children with PAR were randomly assigned to an integrative group (CMAA and Montelukast), CMAA group (CMAA and placebo tablet), or Montelukast group (placebo CMAA and Montelukast). Participants were applied with CMAA for 6 sessions over 2 weeks, and/or Montelukast Chewable Tablet orally once daily for 12 weeks. The changes in severity of symptoms were measured by Visual Analog Scale (VAS) and rhinitis control assessment test (RCAT) at 0, 2, 4 and 12 weeks of treatment. Blood samples were collected for serum interleukin-4, interferon gamma γ and T helper type 1 (Th1)/Th2 flow cytometric analysis at the time points of 0, 4 and 12 weeks. RESULTS Eight cases dropped out from the trial, 3 in the integrative group, 2 in the CMAA group and 3 in the Montelukast group. The VAS scores decreased significantly while the RCAT scores increased significantly in all three groups at 4 and 12 weeks compared with baseline (P<0.01 or P<0.05). The VAS scores were significantly lower while the RCAT scores were significantly higher in the integrative and CMAA groups than the Montelukast group at 2 and 4 weeks (P<0.01 or P<0.05). At 2, 4 and 12 weeks, the scores of nasal congestion, sneezing, sleep problem, and rhinitis symptom control in the integrative and CMAA groups increased significantly compared with baseline (P<0.01 or P<0.05). The least percentages of Th2 and the most alleviated Th2 shift (highest Th1/Th2) were observed in the integrative group at 12 weeks compared with the other two groups (P<0.05). CONCLUSION The combination of CMAA with Montelukast might be more effective and appropriate than either option alone for children with PAR. (Registered at Chinese Clinical Trial Register, registration No. ChiCTR-IOR-17012434).
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Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Li Y, Chen J, Rui X, Li N, Jiang F, Shen J. The association between sixteen genome-wide association studies-related allergic diseases loci and childhood allergic rhinitis in a Chinese Han population. Cytokine 2018; 111:162-170. [PMID: 30170133 DOI: 10.1016/j.cyto.2018.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/21/2018] [Accepted: 08/20/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is one of the most common respiratory diseases in children. It is caused by a combination of genetic and environmental factors. Moderate-to-severe AR decreases the quality of life and social performance in children. OBJECTIVE To investigate whether polymorphisms in previously published genome-wide association studies (GWAS) allergic disease loci are associated with childhood AR and the severity of AR symptoms in a Chinese Han population. METHODS A case-control study was conducted in 503 pediatric patients with AR and 393 control Chinese school-aged subjects. AR severity was classified as mild or moderate-to-severe according to the AR and its Impact on Asthma (ARIA) guidelines. Overall, 16 tagged single-nucleotide polymorphisms (tSNPs) of published GWAS associations with allergic diseases were selected. All subjects were genotyped and analyzed for the 16 selected tSNPs using the improved multiplex ligation detection reaction (iMLDR) technique. RESULTS Both rs7130588_AG and rs7927894_CT genotypes in EMSY region were associated with a significantly increased risk of AR (1.75-fold and 1.50-fold) compared to the AA and CC genotypes, respectively, specific to moderate-to-severe AR. The difference of rs7130588 genotypes in cases vs. controls was still statistically significant under the additive model after multiple test correction to adjust the false discovery rate (FDR) with an adjusted odds ratio of 1.818 and 95% confidence interval (CI) of 1.240-2.664 (PFDR = 0.0349). The rs7130588_G allele was only associated with a high risk of moderate-to-severe AR (1.85-fold, Page and gender_adjustment = 0.003). The rs2227284_TG genotype at the IL4 locus was significantly associated with a 0.65-fold decreased risk of AR compared to the TT genotype. The protective effect of the rs2227284_G allele was also found in different severity of AR. Haplotype analysis showed a significantly increased AR risk associated with the haplotype G-T-T (rs7130588-rs2155219-rs7927894) and a protective effect with the haplotype C-G-C (rs2243250-rs2227284-s2243290). CONCLUSIONS The loci in EMSY and IL4 can be considered as a hereditary marker for childhood AR. The rs7130588_G allele seems to predispose only to moderate-to-severe AR, though other mechanisms are also likely to be involved.
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Affiliation(s)
- Youjin Li
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
| | - Jie Chen
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Xiaoqing Rui
- Department of Otorhinolaryngology-Head & Neck Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Niu Li
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Fan Jiang
- Department of Child Development and Behavior, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China; MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200127, China
| | - Jun Shen
- Department of Pathology, Laboratory for Molecular Medicine, Partners Personalized Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02115, MA, USA.
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14
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Sterner T, Uldahl A, Svensson Å, Björk J, Svedman C, Nielsen C, Tunsäter A, Bruze M, Kiotseridis H. The Southern Sweden Adolescent Allergy-Cohort: Prevalence of allergic diseases and cross-sectional associations with individual and social factors. J Asthma 2018; 56:227-235. [PMID: 29621411 DOI: 10.1080/02770903.2018.1452033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Asthma and allergic diseases are the most frequent chronic diseases in childhood worldwide, and considered a burden for the affected children and their families. The diseases impose an economic burden on society if not diagnosed and treated properly and management of and these diseases are challenging for healthcare professionals. The aim of the present investigation was to assess the prevalence of allergic diseases in an unselected cohort of adolescents in southern Sweden. Additionally, associations with sociodemographic factors were investigated, as well as impact on daily life. METHODS This cross-sectional study was based on a cohort of n = 1 530 school children, aged 13 to 14, from 13 municipalities in southern Sweden. Data were collected through web-based questionnaires. RESULTS Of all children 32% reported at least one allergic disease. 67% reported one allergic disease and 33% reported more than one. No allergy-related disease were reported by 68%. Current asthma was reported by 9.8% and current rhino-conjunctivitis was reported by 13%. The prevalence of food hypersensitivity was 12% and the prevalence of eczema was 11%. One to three wheezing attacks were reported from 55% and 40% reported more than four attacks of wheezing in the preceding year. The self-reported allergic diseases were diagnosed by a doctor in; 36% (food hypersensitivity) to 69% (rhinoconjunctivitis) of the cases. CONCLUSIONS A high number of affected children were identified. Some children being undiagnosed and some not receiving satisfactory treatment. These results suggest that additional studies to evaluate treatment procedures in order to improve healthcare for allergic children are warranted.
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Affiliation(s)
- Therese Sterner
- a Department of Clinical Sciences , Lunds Universitet , Malmö , Lund , Sweden.,b Department of Dermatology , Skåne University Hospital , Malmö , Sweden.,c Skåne Regional Council , Competence Center of Allergy, Asthma and COPD , Lund , Sweden
| | - Ada Uldahl
- a Department of Clinical Sciences , Lunds Universitet , Malmö , Lund , Sweden.,b Department of Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Åke Svensson
- b Department of Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Jonas Björk
- d Department of Occupational and Environmental Medicine , Lunds Universitet , Lund , Sweden
| | - Cecilia Svedman
- e Department of Occupational and Environmental Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Christel Nielsen
- d Department of Occupational and Environmental Medicine , Lunds Universitet , Lund , Sweden
| | - Alf Tunsäter
- f Respiratory Medicine and Allergology , Medical Sciences, Lunds university , Sweden
| | - Magnus Bruze
- e Department of Occupational and Environmental Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Hampus Kiotseridis
- c Skåne Regional Council , Competence Center of Allergy, Asthma and COPD , Lund , Sweden
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15
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Cipriani F, Mastrorilli C, Tripodi S, Ricci G, Perna S, Panetta V, Asero R, Dondi A, Bianchi A, Maiello N, Miraglia del Giudice M, Frediani T, Macrì F, Lucarelli S, Dello Iacono I, Patria MF, Varin E, Peroni D, Chini L, Moschese V, Bernardini R, Pingitore G, Pelosi U, Tosca M, Paravati F, Sfika I, Businco ADR, Povesi Dascola C, Comberiati P, Frediani S, Lambiase C, Verga MC, Faggian D, Plebani M, Calvani M, Caffarelli C, Matricardi PM. Diagnostic relevance of IgE sensitization profiles to eight recombinant Phleum pratense molecules. Allergy 2018; 73:673-682. [PMID: 29055045 DOI: 10.1111/all.13338] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Grass pollen-related seasonal allergic rhinoconjunctivitis (SARg) is clinically heterogeneous in severity, comorbidities, and response to treatment. The component-resolved diagnostics disclosed also a high heterogeneity at molecular level. Our study aimed at analyzing the characteristics of the IgE sensitization to Phleum pratense molecules and investigating the diagnostic relevance of such molecules in childhood. METHODS We examined 1120 children (age 4-18 years) with SARg. Standardized questionnaires on atopy were acquired through informatics platform (AllergyCARD™). Skin prick tests were performed with pollen extracts. Serum IgE to airborne allergens and eight P. pratense molecules (rPhl p 1, rPhl p 2, rPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11, rPhl p 12) were tested by ImmunoCAP FEIA. RESULTS The analysis of IgE responses against eight P. pratense molecules showed 87 profiles. According to the number of molecules recognized by IgE, the more complex profiles were characterized by higher serum total IgE, higher grass-specific serum IgE, and higher number and degree of sensitization to pollens. The most frequent IgE sensitization profile was the monomolecular Phl p 1. Sensitization to Phl p 7 was a reliable biomarker of asthma, whereas Phl p 12 of oral allergy syndrome. Sensitization to Phl p 7 was associated with a higher severity of SARg, and complex profiles were associated with longer disease duration. CONCLUSIONS In a large pediatric population, the complexity of IgE sensitization profiles against P. pratense molecules is related to high atopic features although useless for predicting the clinical severity. The detection of serum IgE to Phl p 1, Phl p 7, and Phl p 12 can be used as clinical biomarkers of SARg and comorbidities. Further studies in different areas are required to test the impact of different IgE molecular profiles on AIT response.
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16
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Mariño-Sanchez F, Valls-Mateus M, Haag O, Alobid I, Bousquet J, Mullol J. Smell loss is associated with severe and uncontrolled disease in children and adolescents with persistent allergic rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1752-1755.e3. [PMID: 29426750 DOI: 10.1016/j.jaip.2017.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/16/2017] [Accepted: 12/19/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Franklin Mariño-Sanchez
- Rhinology Unit, Otorhinolaryngology Department, University Hospital Ramón y Cajal, Madrid, Spain; Pediatric Otorhinolaryngology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain; Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
| | - Meritxell Valls-Mateus
- Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Rhinology Unit and Smell Clínic, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Oliver Haag
- Pediatric Otorhinolaryngology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Rhinology Unit and Smell Clínic, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jean Bousquet
- INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Joaquim Mullol
- Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Rhinology Unit and Smell Clínic, Hospital Clínic, Barcelona, Catalonia, Spain
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17
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Valls-Mateus M, Marino-Sanchez F, Ruiz-Echevarría K, Cardenas-Escalante P, Jiménez-Feijoo R, Blasco-Lozano J, Giner-Muñoz MT, Haag O, Alobid I, Plaza Martin AM, Mullol J. Nasal obstructive disorders impair health-related quality of life in adolescents with persistent allergic rhinitis: A real-life study. Pediatr Allergy Immunol 2017; 28:438-445. [PMID: 28423474 DOI: 10.1111/pai.12724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously reported a higher prevalence of nasal obstructive disorders (NOD) in pediatric patients with persistent allergic rhinitis (PER) not responding to medical treatment. The aim of this study was to determine the impact of NOD on quality of life (QoL) in this population. METHODS Real-life prospective study including 142 patients (41 children, 6-11 years old and 101 adolescents, 12-17 years old) with moderate and severe PER. After 2 months of medical treatment (intranasal steroids and antihistamines), patients were asked whether their symptoms had improved (yes/no) and classified accordingly in R, responders and NR, non-responders. Nasal symptoms (visual analog scale, VAS), NOD (nasal endoscopy), and QoL (PRQLQ, AdolQRLQ) were also assessed. RESULTS Sixty-nine adolescents and 24 children were included in the NR group. NR presented worse QoL overall scores in adolescents (3.16±1.1 vs 1.63±0.99; P=.00001) and children (2.19±0.82 vs 1.51±0.77, P=.02). Medical treatment failure was associated with worse outcomes in QoL (adolescents OR: 1.6, P<.0001; children OR: 1.04, P=.036). Female adolescents presented worse QoL scores than males (3.19 vs 2.36, P=.001). The presence of obstructive septal deviation (OR: 1.02, P=.005), obstructive turbinate hyperplasia (OR: 1.03, P=.0006), and coexistence of both (OR=2.06, P=.001) was associated with worse QoL in adolescents. A strong and highly significant correlation was found between nasal symptoms VAS and QoL. CONCLUSION The presence of NOD, particularly in adolescents, is associated with poor QoL outcomes. Assessment of NOD in pediatric PER should be considered an essential approach to determine the response to treatment and its impact on patient's QoL.
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Affiliation(s)
- Meritxell Valls-Mateus
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.,Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Franklin Marino-Sanchez
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Paulina Cardenas-Escalante
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Jaime Blasco-Lozano
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - María Teresa Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Oliver Haag
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ana María Plaza Martin
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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18
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Mariño-Sánchez F, Valls-Mateus M, Cardenas-Escalante P, Haag O, Ruiz-Echevarría K, Jiménez-Feijoo R, Lozano-Blasco J, Giner-Muñoz MT, Plaza-Martin AM, Mullol J. Influence of nasal septum deformity on nasal obstruction, disease severity, and medical treatment response among children and adolescents with persistent allergic rhinitis. Int J Pediatr Otorhinolaryngol 2017; 95:145-154. [PMID: 28576524 DOI: 10.1016/j.ijporl.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the impact of different types of nasal septum deformity (NSD) on nasal obstruction, rhinitis severity and response to medical treatment among pediatric persistent allergic rhinitis (PER) patients. METHODS In a prospective, real-life study, 150 children and adolescents (mean age 13 ± 2.8 years, females 32.6%) diagnosed with PER according to ARIA guidelines were assessed by nasal endoscopy for NSD according to Mladina's classification, their response to medical treatment (intranasal steroids and antihistamines or antileucotriens), the presence of comorbidities, rhinitis severity (modified-ARIA criterion) and nasal obstruction visual analog scale score (VAS). RESULTS Most patients (87%) had 1 of the 7 types of septal deformities. There was a high prevalence of bilateral (types 4 and 6; 46%) and anterior unilateral (types 1 and 2; 25%) NSD in patients not responding to medical treatment. Type 4 (OR = 6.4; p = 0.005) or type 6 (OR = 4.4; p = 0.03) NSD increased the risk of lack of improvement with medical treatment. Coexistence of anterior unilateral or bilateral NSD with severe turbinate enlargement increased >20-fold the risk of lack of improvement. Patients with bilateral NSD presented greater rhinitis severity. Non-responder adolescents displayed higher prevalence of bilateral NSD than children (53% vs. 23%; p = 0.02). Nasal obstruction VAS was higher for patients with anterior than posterior NSD, and greater for patients with bilateral NSD than any other type of septal morphology. CONCLUSION Nasal endoscopy shows that bilateral and unilateral anterior nasal septum deformities are strongly associated with a poor response to medical treatment, greater rhinitis severity and higher nasal obstruction VAS. Consequently, nasal endoscopy is necessary in the PER patients to understand the disease severity as well as to plan a specific surgical treatment in order to improve nasal obstruction, disease severity, and patient's quality of life.
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Affiliation(s)
- Franklin Mariño-Sánchez
- Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain; Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
| | - Meritxell Valls-Mateus
- Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Oliver Haag
- Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jaime Lozano-Blasco
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María T Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana M Plaza-Martin
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Joaquim Mullol
- Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain.
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19
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Mariño-Sánchez FS, Valls-Mateus M, Ruiz-Echevarría K, Alobid I, Cardenas-Escalante P, Jiménez-Feijoo R, Lozano-Blasco J, Giner-Muñoz MT, Rodríguez-Jorge J, Haag O, Plaza-Martin AM, Mullol J. Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study). Pediatr Allergy Immunol 2017; 28:176-184. [PMID: 27801958 DOI: 10.1111/pai.12679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). METHODS In a prospective, real-life study, 130 paediatric PER patients (13.1 ± 2.8 years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). RESULTS After 2 months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. CONCLUSIONS In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.
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Affiliation(s)
- Franklin S Mariño-Sánchez
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya)
| | - Meritxell Valls-Mateus
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Paulina Cardenas-Escalante
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Jaime Lozano-Blasco
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - María T Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | | | - Oliver Haag
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana M Plaza-Martin
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
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20
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Dogru M. Investigation of asthma comorbidity in children with different severities of allergic rhinitis. Am J Rhinol Allergy 2017; 30:186-9. [PMID: 27216348 DOI: 10.2500/ajra.2016.30.4315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma comorbidity is widely seen. However, the effects of AR on asthma are more likely to be studied in the literature. OBJECTIVE To investigate the prevalence of asthma in children with AR who are followed-up and to evaluate the effect of asthma on the severity of AR. METHODS A total of 509 children with AR who were followed-up in the pediatric allergy-immunology department between January 2012 and December 2013 were enrolled in the study. Asthma and AR are diagnosed by using the Global Initiative for Asthma and the Allergic Rhinitis and its Impact on Asthma, respectively. The patients were categorized into two groups according to the presence of asthma. The two groups were compared according to sociodemographic characteristics, clinical features, and laboratory findings. Skin-prick test results, serum immunoglobulin E levels, and the percentage of eosinophils of the patients were evaluated. RESULTS A total of 299 of the patients were boys (58.7%) the mean age was 7.2 ± 3.5 years (range, 1.5-18 years). Patients with moderate-severe persistent rhinitis (40.5% of all patients) were the most common rhinitis subgroup. Mild intermittent rhinitis was diagnosed in 17.7%, mild persistent rhinitis in 11.2%, and moderate-severe intermittent rhinitis in 30.6% of the patients. Two hundred seventy-one children with AR (53.2%) also had concomitant asthma. The patients were categorized into two groups: AR-asthma comorbidity group (group I) and AR-only group (group II). There was no significant difference between these two groups when compared with the sex, age, familial atopy, exposure to smoke, and severity of AR (p > 0.05). The duration of illness, immunoglobulin E levels, number of positive sensitivity, sensitivity to house-dust mites, sensitivity to cockroaches, and polysensitization were significantly higher in the AR-asthma comorbidity group (p < 0.05). CONCLUSION This study showed that asthma comorbidity had no effect on the severity of AR. However, it was also shown that the majority of children with AR had asthma comorbidity. For these purposes, the presence of asthma should be investigated in children with AR, independent of severity.
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Affiliation(s)
- Mahmut Dogru
- Department of Pediatrics, Zeynep Kamil Woman and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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21
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Mastrorilli C, Posa D, Cipriani F, Caffarelli C. Asthma and allergic rhinitis in childhood: what's new. Pediatr Allergy Immunol 2016; 27:795-803. [PMID: 27862336 DOI: 10.1111/pai.12681] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/23/2022]
Abstract
Novel approaches are currently offered for the diagnostic workup and therapeutic management of allergic rhinitis and asthma. New predictive biomarkers of allergy and asthma are available. Primary and secondary prevention, earlier intervention, and modification of the natural history of allergic rhinitis and asthma are being intensively investigated. This review highlights advances in the understanding of the etiology, diagnosis, and management of atopic airway diseases in childhood, as well as prenatal and early-life risk factors and strategies for prevention.
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Affiliation(s)
- Carla Mastrorilli
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.,Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Daniela Posa
- Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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22
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Langdon C, Guilemany JM, Valls M, Alobid I, Bartra J, Dávila I, Del Cuvillo A, Ferrer M, Jáuregui I, Montoro J, Sastre J, Valero A, Mullol J. Allergic rhinitis causes loss of smell in children: The OLFAPEDRIAL study. Pediatr Allergy Immunol 2016; 27:867-870. [PMID: 27612327 DOI: 10.1111/pai.12655] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of the OLFAPEDRIAL study was to assess the olfactory dysfunction in allergic paediatric population, which has been scarcely studied. METHODS Observational, cross-sectional and multicentre study evaluated the sense of smell in untreated allergic rhinitis (AR) paediatric patients aged 6-12 years. RESULTS Forty-four per cent (551 of 1260) of children with AR reported smell dysfunction, with both loss of smell frequency (52.1%, p < 0.001) and intensity (0.75 ± 0.84, p < 0.0001) being more frequent in patients with persistent than intermittent AR (38.0% and 0.51 ± 0.73, respectively). In addition, both loss of smell frequency and intensity increased according to disease severity (m-ARIA classification) but always being significantly higher in persistent (p < 0.0001) than in intermittent AR. CONCLUSIONS Children with allergic rhinitis present a mild-moderate loss of smell frequency and intensity which is clearly related to the disease duration and severity. The loss of smell can be considered, as in adults, a clinical marker of disease severity.
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Affiliation(s)
- Cristóbal Langdon
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, IDIBAPS, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - José María Guilemany
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, IDIBAPS, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Meritxell Valls
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Isam Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, IDIBAPS, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Joan Bartra
- Unitat d'Al.lèrgia, Servei de Pneumologia i Al.lèrgia Respiratòria, IDIBAPS, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Red de Investigación de Reacciones Adversas a Alergenos y Fármacos (RIRAAF), Barcelona, Spain
| | - Ignacio Dávila
- Servicio de Inmunoalergia, Complejo Asistencial Universitario de Salamanca, IBSAL, Salamanca, Spain
| | | | - Marta Ferrer
- Red de Investigación de Reacciones Adversas a Alergenos y Fármacos (RIRAAF), Barcelona, Spain.,Departamento de Alergología e Inmunología Clínica, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Javier Montoro
- Facultad de Medicina, Hospital Universitario Arnau de Vilanova, Universidad Católica de Valencia 'San Vicente Mártir', Valencia, Spain
| | - Joaquín Sastre
- Servicio de Alergia, Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Valero
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Unitat d'Al.lèrgia, Servei de Pneumologia i Al.lèrgia Respiratòria, IDIBAPS, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, IDIBAPS, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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23
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Saranz R, Lozano A, Valero A, Lozano N, Bovina Martijena M, Agresta F, Ianiero L, Ponzio M. Impact of rhinitis on lung function in children and adolescents without asthma. Allergol Immunopathol (Madr) 2016; 44:556-562. [PMID: 27496783 DOI: 10.1016/j.aller.2016.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/10/2016] [Accepted: 04/01/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Subclinical spirometric abnormalities may be detected in patients with rhinitis without asthma, proportional to the severity established by ARIA (Allergic Rhinitis and Its Impact on Asthma) guidelines. New criteria of rhinitis classification were recently validated according to the ARIA modified (m-ARIA), which allow the discrimination between moderate to severe grades. The impact of rhinitis on lung function according to frequency and severity is unknown. OBJECTIVES To investigate subclinical spirometric impairment in children and adolescents with allergic and non-allergic rhinitis without overt symptoms of asthma, according to the frequency and severity criteria of rhinitis classified by m-ARIA. METHODS An observational cross-sectional study, including children and adolescents aged 5-18 years with allergic and non-allergic rhinitis without asthma. We analysed the functional abnormalities and bronchodilator response with spirometry in relation to the grade of rhinitis established by m-ARIA using an adjusted logistic model. A value of p<0.05 was considered statistically significant. RESULTS We studied 189 patients; 22.2% showed spirometric abnormalities. Patients with persistent rhinitis had greater impairment of lung function compared to intermittent grade (p=0.026). Lung functional impairment was more frequent in severe and moderate rhinitis than mild grade (p=0.005) and was independent of the atopic status to both frequency (p=0.157) and severity (p=0.538). There was no difference in bronchodilator reversibility between groups (p>0.05). CONCLUSIONS Impaired lung function was associated with persistence and severity of rhinitis and there was no significant difference between patients with moderate and severe rhinitis. The spirometric abnormality was demonstrated in patients with allergic and non-allergic rhinitis.
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24
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Klimek L, Mullol J, Hellings P, Gevaert P, Mösges R, Fokkens W. Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. Expert Opin Pharmacother 2016; 17:657-69. [PMID: 26800187 DOI: 10.1517/14656566.2016.1145661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) has a major negative impact on patients' quality of life (QoL) and carries a high socio economic burden. This is particularly the case for patients who experience symptoms for extended periods of time (i.e. those with perennial (PAR) or persistent AR (PER), depending on the classification system used). This review covers available pharmacological advances and recent developments in the treatment of PAR or PER. AREAS COVERED Pharmacological AR treatment is used to reduce symptom burden and help restore patients' normal daily routine. Traditionally, non-sedating antihistamines and intranasal corticosteroids (INS) were the two drug classes recommended for use first line. These, along with antileukotrienes, decongestants, mast cell stabilizers and anticholinergics, constituted the bulk of the AR treatment arsenal. MP-AzeFlu (Dymista®, Meda, Solna, Sweden) is the most recent addition to that arsenal. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray and has surpassed available therapies in terms of symptom control and treatment response. Other relatively new treatments for PAR or PER include H3 antihistamines, toll-like receptor (TLR) agonists, cellulose powders and micro-emulsions, novel biomolecular formulations and omalizumab. Each of these new additions is reviewed here. EXPERT OPINION A new AR drug class has recently been introduced (i.e. RO1AD58). Currently MP-AzeFlu is the only treatment option within this drug class. It can be estimated that combination treatments like MP-AzeFlu will become the mainstay of PAR and PER therapy since use will result in better compliance, improved efficacy over INS and a faster response together with good levels of tolerability. The challenge is to find other equally, or more effective, combination treatments, as has been the therapeutic standard in bronchial asthma for decades. The potential of biologics, as well as TLR-agonists and other new treatment options needs to be further evaluated.
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Affiliation(s)
- Ludger Klimek
- a Center for Rhinology and Allergology , Wiesbaden , Germany
| | - Joaquim Mullol
- b Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; Rhinology and Smell Clinic, ENT Department , Hospital Clínic , Barcelona , Spain
| | - Peter Hellings
- c Laboratory of Clinical Immunology , University Hospitals Leuven , Leuven , Belgium
| | - Philippe Gevaert
- d Upper Airways Research Laboratory, Department of Otorhinolaryngology , Ghent University Hospital , Ghent , Belgium
| | - Ralph Mösges
- e Institute of Medical Statistics , Informatics and Epidemiology (IMSIE) , Cologne , Germany
| | - Wytske Fokkens
- f Department of Otorhinolaryngology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
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25
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Abstract
The term SCUAD (severe chronic upper airway disease) has been previously introduced to describe cases with upper airway disorders and symptoms not adequately controlled despite correct diagnosis and management. It has been so far applied mainly in adults and no specific focus has been given on the pediatric population. When the term SCUAD is considered for children specifically, a series of issues may arise. These issues involve accurate definition, epidemiology, clinical characteristics, pathophysiology, and socioeconomic implications. These issues seem to clearly differentiate adult from pediatric SCUAD. We attempt to shed light on these issues in an effort to provide directions for future guideline development and research. In this context, P-SCUAD (pediatric severe chronic upper airway disease) is hereby introduced.
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26
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Bousquet J, Schunemann HJ, Fonseca J, Samolinski B, Bachert C, Canonica GW, Casale T, Cruz AA, Demoly P, Hellings P, Valiulis A, Wickman M, Zuberbier T, Bosnic-Anticevitch S, Bedbrook A, Bergmann KC, Caimmi D, Dahl R, Fokkens WJ, Grisle I, Lodrup Carlsen K, Mullol J, Muraro A, Palkonen S, Papadopoulos N, Passalacqua G, Ryan D, Valovirta E, Yorgancioglu A, Aberer W, Agache I, Adachi M, Akdis CA, Akdis M, Annesi-Maesano I, Ansotegui IJ, Anto JM, Arnavielhe S, Arshad H, Baiardini I, Baigenzhin AK, Barbara C, Bateman ED, Beghé B, Bel EH, Ben Kheder A, Bennoor KS, Benson M, Bewick M, Bieber T, Bindslev-Jensen C, Bjermer L, Blain H, Boner AL, Boulet LP, Bonini M, Bonini S, Bosse I, Bourret R, Bousquet PJ, Braido F, Briggs AH, Brightling CE, Brozek J, Buhl R, Burney PG, Bush A, Caballero-Fonseca F, Calderon MA, Camargos PAM, Camuzat T, Carlsen KH, Carr W, Cepeda Sarabia AM, Chavannes NH, Chatzi L, Chen YZ, Chiron R, Chkhartishvili E, Chuchalin AG, Ciprandi G, Cirule I, Correia de Sousa J, Cox L, Crooks G, Costa DJ, Custovic A, Dahlen SE, Darsow U, De Carlo G, De Blay F, Dedeu T, Deleanu D, Denburg JA, Devillier P, Didier A, Dinh-Xuan AT, Dokic D, Douagui H, Dray G, Dubakiene R, Durham SR, Dykewicz MS, El-Gamal Y, Emuzyte R, Fink Wagner A, Fletcher M, Fiocchi A, Forastiere F, Gamkrelidze A, Gemicioğlu B, Gereda JE, González Diaz S, Gotua M, Grouse L, Guzmán MA, Haahtela T, Hellquist-Dahl B, Heinrich J, Horak F, Hourihane JO', Howarth P, Humbert M, Hyland ME, Ivancevich JC, Jares EJ, Johnston SL, Joos G, Jonquet O, Jung KS, Just J, Kaidashev I, Kalayci O, Kalyoncu AF, Keil T, Keith PK, Khaltaev N, Klimek L, Koffi N'Goran B, Kolek V, Koppelman GH, Kowalski ML, Kull I, Kuna P, Kvedariene V, Lambrecht B, Lau S, Larenas-Linnemann D, Laune D, Le LTT, Lieberman P, Lipworth B, Li J, Louis R, Magard Y, Magnan A, Mahboub B, Majer I, Makela MJ, Manning P, De Manuel Keenoy E, Marshall GD, Masjedi MR, Maurer M, Mavale-Manuel S, Melén E, Melo-Gomes E, Meltzer EO, Merk H, Miculinic N, Mihaltan F, Milenkovic B, Mohammad Y, Molimard M, Momas I, Montilla-Santana A, Morais-Almeida M, Mösges R, Namazova-Baranova L, Naclerio R, Neou A, Neffen H, Nekam K, Niggemann B, Nyembue TD, O'Hehir RE, Ohta K, Okamoto Y, Okubo K, Ouedraogo S, Paggiaro P, Pali-Schöll I, Palmer S, Panzner P, Papi A, Park HS, Pavord I, Pawankar R, Pfaar O, Picard R, Pigearias B, Pin I, Plavec D, Pohl W, Popov TA, Portejoie F, Postma D, Potter P, Price D, Rabe KF, Raciborski F, Radier Pontal F, Repka-Ramirez S, Robalo-Cordeiro C, Rolland C, Rosado-Pinto J, Reitamo S, Rodenas F, Roman Rodriguez M, Romano A, Rosario N, Rosenwasser L, Rottem M, Sanchez-Borges M, Scadding GK, Serrano E, Schmid-Grendelmeier P, Sheikh A, Simons FER, Sisul JC, Skrindo I, Smit HA, Solé D, Sooronbaev T, Spranger O, Stelmach R, Strandberg T, Sunyer J, Thijs C, Todo-Bom A, Triggiani M, Valenta R, Valero AL, van Hage M, Vandenplas O, Vezzani G, Vichyanond P, Viegi G, Wagenmann M, Walker S, Wang DY, Wahn U, Williams DM, Wright J, Yawn BP, Yiallouros PK, Yusuf OM, Zar HJ, Zernotti ME, Zhang L, Zhong N, Zidarn M, Mercier J. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation. Allergy 2015; 70:1372-92. [PMID: 26148220 DOI: 10.1111/all.12686] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 12/20/2022]
Abstract
Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.
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Affiliation(s)
- J Bousquet
- University Hospital, Montpellier, France.,MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM, VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, Paris, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Paris, France
| | - H J Schunemann
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - J Fonseca
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal.,Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal.,Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - C Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - G W Canonica
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - T Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL, USA
| | - A A Cruz
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Bahia, Brasil.,GARD Executive Committee, Bahia, Brasil
| | - P Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France.,EPAR U707 INSERM, Paris, France.,EPAR UMR-S UPMC, Paris, France
| | - P Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - A Valiulis
- Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania
| | - M Wickman
- Sachs' Children's Hospital, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Member of the Global Allergy and Asthma European Network (GA2LEN), Oslo, Norway
| | - S Bosnic-Anticevitch
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW, Australia
| | - A Bedbrook
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - K C Bergmann
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Member of the Global Allergy and Asthma European Network (GA2LEN), Oslo, Norway
| | - D Caimmi
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - R Dahl
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - I Grisle
- Latvian Association of Allergists, Center of Tuberculosis and Lung Diseases of Latvia, Riga, Latvia
| | - K Lodrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'ORL, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Catalonia, Spain
| | - A Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - S Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - N Papadopoulos
- Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - D Ryan
- General Practitioner, Woodbrook Medical Centre, Loughborough, UK.,Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
| | - E Valovirta
- Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University, Manisa, Turkey
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - I Agache
- Transylvania University Brasov, Brasov, Romania
| | - M Adachi
- Department of Clinical Research Center, International University of Health and Welfare/Sanno Hospital, Tokyo, Japan
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | | | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - J M Anto
- Centre for Research in Environmental Epidemiology, Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Department of Experimental and Health Sciences, University of Pompeu Fabra, Barcelona, Spain
| | | | - H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - I Baiardini
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | | | - C Barbara
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases, Lisbon, Portugal
| | - E D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - B Beghé
- Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - E H Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A Ben Kheder
- Service de Pneumologie IV, Hôpital Abderrahman Mami, Ariana, Tunisie
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - M Benson
- Centre for Individualized Medicine, Department of Pediatrics, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - M Bewick
- Deputy National Medical Director, NHS England, England, UK
| | - T Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - L Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France.,EA 2991 Movement To Health, Euromov, University Montpellier, Montpellier, France
| | - A L Boner
- Pediatric Department, University of Verona Hospital, Verona, Italy
| | - L P Boulet
- Québec Heart and Lung Institute, Laval University, Québec City, QC, Canada
| | - M Bonini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - S Bonini
- Second University of Naples and Institute of Translational Medicine, Italian National Research Council, Naples, Italy
| | - I Bosse
- Allergist, La Rochelle, France
| | - R Bourret
- Directeur Général Adjoint, Montpellier University Hospital, Montpellier, France
| | - P J Bousquet
- EPAR U707 INSERM, Paris, France.,EPAR UMR-S UPMC, Paris, France
| | - F Braido
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A H Briggs
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - C E Brightling
- Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK.,Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - J Brozek
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
| | - R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - P G Burney
- National Heart and Lung Institute, Imperial College, London, UK.,Wellcome Centre for Global Health, Imperial College, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College, London, UK
| | - A Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | | | - M A Calderon
- Imperial College London - National Heart and Lung Institute, Royal Brompton Hospital NHS, London, UK
| | - P A M Camargos
- Federal University of Minas Gerais, Medical School, Department of Pediatrics, Belo Horizonte, Brazil
| | - T Camuzat
- Assitant Director General, Montpellier, France.,Région Languedoc Roussillon, Roussillon, France
| | - K H Carlsen
- Department of Paediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - W Carr
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA, USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia.,SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Colombia
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - L Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Y Z Chen
- National Cooperative Group of Paediatric Research on Asthma, Asthma Clinic and Education Center of the Capital Institute of Pediatrics, Peking and Center for Asthma Research and Education, Beijing, China
| | - R Chiron
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - E Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - A G Chuchalin
- Pulmonolory Research Institute FMBA, Moscow, Russia.,GARD Executive Committee, Moscow, Russia
| | - G Ciprandi
- Medicine Department, IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - I Cirule
- Latvian Association of Allergists, University Children Hospital of Latvia, Riga, Latvia
| | - J Correia de Sousa
- Life and Health Sciences Research Institute, ICVS, School of Health Sciences, University of Minho, Braga, Portugal
| | - L Cox
- Department of Medicine, Nova Southeastern University, Davie, FL, USA
| | - G Crooks
- European Innovation Partnership on Active and Healthy Ageing, Reference Site, NHS Scotland, Glasgow, UK
| | - D J Costa
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - A Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
| | - S E Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - U Darsow
- Department of Dermatology and Allergy, Technische Universität Mänchen, Munich, Germany.,ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Technische Universität München, Munich, Germany
| | - G De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
| | - T Dedeu
- European Regional and Local Health Association, Brussels, Belgium
| | - D Deleanu
- Allergology and Immunology Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J A Denburg
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - P Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220, Hôpital Foch, Suresnes Université Versailles Saint-Quentin, Versailles Saint-Quentin, France
| | - A Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - A T Dinh-Xuan
- Service de physiologie, Hôpital Cochin, Université Paris-Descartes, Assistance publique-Hôpitaux de Paris, Paris, France
| | - D Dokic
- Medical Faculty Skopje, University Clinic of Pulmology and Allergy, Skopje, R. Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algers, Algeria
| | - G Dray
- Ecole des Mines, Alès, France
| | - R Dubakiene
- Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - S R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - M S Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MI, USA
| | - Y El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - R Emuzyte
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Fink Wagner
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | | | - A Fiocchi
- Allergy Department, The Bambino Gesù Children's Research Hospital Holy see, Rome, Italy
| | - F Forastiere
- Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy
| | - A Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - B Gemicioğlu
- Turkish Thoracic Society Asthma-Allergy Working Group, Kocaeli, Turkey
| | - J E Gereda
- Allergy and Immunology Division, Clinica Ricardo Palma, Lima, Peru
| | - S González Diaz
- Sociedad Latinoamericana de Allergia, Asma e Immunologia, Mexico City, Mexico
| | - M Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia
| | - L Grouse
- Faculty of the Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - M A Guzmán
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - B Hellquist-Dahl
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
| | - J Heinrich
- Institute of Epidemiology I, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - F Horak
- Vienna Challenge Chamber, Vienna, Austria
| | - J O 'b Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - P Howarth
- University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, UK
| | - M Humbert
- Université Paris-Sud, Le Kremlin Bicêtre, France.,Service de Pneumologie, Hôpital Bicêtre, Inserm UMR_S999, Le Kremlin Bicêtre, France
| | - M E Hyland
- School of Psychology, Plymouth University, Plymouth, UK
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - E J Jares
- Libra Foundation, Buenos Aires, Argentina
| | - S L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, UK.,MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - G Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - O Jonquet
- Medical Commission, Montpellier University Hospital, Montpellier, France
| | - K S Jung
- Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies. Hôpital d'Enfants Armand-Trousseau, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - I Kaidashev
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - O Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - A F Kalyoncu
- School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Hacettepe University, Ankara, Turkey
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - P K Keith
- Department of Medicine, McMaster University, Health Sciences Centre 3V47, Hamilton, ON, Canada
| | | | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - B Koffi N'Goran
- Société de Pneumologie de Langue Française et Espace Francophone de Pneumologie, Paris, France
| | - V Kolek
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic
| | - G H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | - I Kull
- Sachs' Children's Hospital, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, KUNA, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- Pulmonology and Allergology Center, Vilnius University, Vilnius, Lithuania
| | - B Lambrecht
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - S Lau
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - D Larenas-Linnemann
- Clínica de Alergia, Asma y Pediatría, Hospital Médica Sur, México City, México
| | - D Laune
- Digi Health, Montpellier, France
| | - L T T Le
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - P Lieberman
- Departments of Internal Medicine and Pediatrics (Divisions of Allergy and Immunology), University of Tennessee College of Medicine, Germantown, TN, USA
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
| | - Y Magard
- Service de Pneumo-allergologie, Hôpital Saint-Joseph, Paris, France
| | - A Magnan
- Service de Pneumologie, University of Nantes, UMR INSERM, UMR1087/CNR 6291, l'Institut du Thorax, Nantes, France
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - I Majer
- Department of Respiratory Medicine, University Hospital, Bratislava, Slovakia
| | - M J Makela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - P Manning
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | | | - G D Marshall
- Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, MS, USA
| | - M R Masjedi
- Respiratory Disease Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Maurer
- Allergie-Centrum-Charité at the Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Mavale-Manuel
- Department of Paediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - E Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Melo-Gomes
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases, Lisbon, Portugal
| | - E O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, CA, USA
| | - H Merk
- Hautklinik - Klinik für Dermatologie & Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | | | - F Mihaltan
- National Institute of Pneumology M. Nasta, Bucharest, Romania
| | - B Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Association for Asthma and COPD, Belgrade, Serbia
| | - Y Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
| | - M Molimard
- Département de Pharmacologie, CHU de Bordeaux, Université Bordeaux, INSERM U657, Bordeaux Cedex, France
| | - I Momas
- Department of Public Health and Biostatistics, Paris Descartes University, Paris, France.,Paris Municipal Department of Social Action, Childhood and Health, Paris, France
| | | | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal
| | - R Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - L Namazova-Baranova
- Scientific Centre of Children's Health under the Russian Academy of Medical Sciences, Moscow, Russia
| | - R Naclerio
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center and The Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - A Neou
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Member of the Global Allergy and Asthma European Network (GA2LEN), Oslo, Norway
| | - H Neffen
- Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - K Nekam
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - B Niggemann
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T D Nyembue
- ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
| | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Vic., Australia.,Department of Immunology, Monash University, Melbourne, Vic., Australia
| | - K Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Y Okamoto
- Depatment of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - K Okubo
- Depatment of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - P Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - I Pali-Schöll
- Dept. of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University and University Vienna, Vienna, Austria.,Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University and University Vienna, Vienna, Austria
| | - S Palmer
- Centre for Health Economics, University of York, York, UK
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - A Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - I Pavord
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - O Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - R Picard
- Conseil Général de l'Economie. Ministère de l'Economie, de l'Industrie et du Numérique, Paris, France
| | - B Pigearias
- Société de Pneumologie de Langue Française et Espace Francophone de Pneumologie, Paris, France
| | - I Pin
- Département de pédiatrie, CHU de Grenoble, Grenoble cedex 9, France
| | - D Plavec
- Children's Hospital Srebrnjak, Zagreb, School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - W Pohl
- Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Vienna, Austria
| | - T A Popov
- Clinic of Allergy & Asthma, Medical University Sofia, Sofia, Bulgaria
| | - F Portejoie
- MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc - Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - D Postma
- Department of Pulmonary Medicine and Tuberculosis, GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P Potter
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - D Price
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK.,Research in Real-Life, Cambridge, UK
| | - K F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany.,Department of Medicine, Christian Albrechts University, Airway Research Center North, Member of the German Center for Lung Research, Kiel, Germany
| | - F Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - F Radier Pontal
- Conseil Départemental de l'Ordre des Pharmaciens, Maison des Professions Libérales, Montpellier, France
| | | | - C Robalo-Cordeiro
- Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - C Rolland
- Association Asthme et Allergie, Paris, France
| | - J Rosado-Pinto
- Serviço de Imunoalergologia, Hospital da Luz, Lisboa, Portugal
| | - S Reitamo
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - F Rodenas
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - M Roman Rodriguez
- Primary Care Respiratory Research Unit, Institutode Investigación Sanitaria de Palma IdisPa, Palma de Mallorca, Spain
| | - A Romano
- Allergy Unit, Complesso Integrato Columbus, Rome, Italy
| | - N Rosario
- Hospital de Clinicas, University of Parana, Parana, Brazil
| | - L Rosenwasser
- Department of Allergy, Asthma and Immunology, Children's Mercy Hospitals and Clinics and Pediatrics and Medicine University of Misouri-Kansas City School of Medicine, Kansas City, MI, USA
| | - M Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - M Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad, Venezuela.,Clínica El Avila, 6a transversal Urb, Caracas, Venezuela
| | - G K Scadding
- The Royal National TNE Hospital, University College London, London, UK
| | - E Serrano
- Otolaryngology and Head & Neck Surgery, CHU Rangueil-Larrey, Toulouse, France
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
| | - A Sheikh
- Allergy and Respiratory Research Group, Medical School, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - F E R Simons
- Department of Pediatrics & Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J C Sisul
- Sociedad Paraguaya de Alergia Asma e Inmunologıa, Paraguay, Paraguay
| | - I Skrindo
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H A Smit
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - T Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal medicine, Euro-Asian respiratory Society, Bishkek, Kyrgyzstan
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - T Strandberg
- European Union GeriatricMedicine Society, Vienna, Austria
| | - J Sunyer
- Centre for Research in Environmental Epidemiology, Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain.,Department of Experimental and Health Sciences, University of Pompeu Fabra, Barcelona, Spain
| | - C Thijs
- Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - A Todo-Bom
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - A L Valero
- Pneumology and Allergy Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | - M van Hage
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire Dinant-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - G Vezzani
- Pulmonary Unit, Department of Cardiology, Thoracic and Vascular Medicine, Arcispedale S.Maria Nuova/IRCCS, Research Hospital, Reggio Emilia, Italy.,Regional Agency for Health and Social Care, Reggio Emilia, Italy
| | - P Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.,CNR Institute of Biomedicine and Molecular Immunology "A. Monroy", Palermo, Italy
| | - M Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - U Wahn
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - D M Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UJ, USA
| | - B P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN, USA
| | - P K Yiallouros
- Cyprus International Institute for Environmental & 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
| | - O M Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - M E Zernotti
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - L Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - N Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - J Mercier
- Vice President for Research, University Montpellier, Montpellier, France
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27
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Inter- and intra-rater reliability of a nasal endoscopy index for pattern identification in patients with allergic rhinitis. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13596-015-0191-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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28
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Abstract
Because of its burden on patient's lives and its impact on asthma, allergic rhinitis must be treated properly with more effective and safer treatments. According to guidelines by Allergic Rhinitis and Its Impact on Asthma (ARIA), the classification, pathogenesis, and treatment of allergic rhinitis are well defined. Currently, second-generation antihistamines and inhaled steroids are considered the cornerstone of first-line therapy. However, new formulations of available drugs (e.g., loratadine and rupatadine oral solution, ebastine fast-dissolving tablets, and the combination of intranasal fluticasone propionate and azelastine hydrochloride), recently discovered molecules (e.g., ciclesonide, bilastine, and phosphodiesterase-4 inhibitors), immunologic targets (e.g., omalizumab), and unconventional treatments (e.g., homeopathic treatments) are currently under investigation and represent a new frontier in modern medicine and in allergic rhinitis management. The aim of this review is to provide an update on allergic rhinitis treatment, paying particular attention to clinical trials published within the past 20 months that assessed the efficacy and safety of new formulations of available drugs or new molecules.
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Ciprandi G, Tosca MA, Silvestri M. Measuring the perception of symptom, drug use and allergen immunotherapy efficacy using the Visual Analogue Scale. Expert Rev Clin Immunol 2013; 10:179-82. [PMID: 24345288 DOI: 10.1586/1744666x.2014.872034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The availability of a simple and reliable tool for quantitatively measuring symptom perception is surely very important in the daily practice. Especially, this concept appears to be fundamental in doctor's office and at home, where there are no adequate resources. The Visual Analogue Scale is a very simple and popular tool that could be used by anyone anywhere. The advantage given by the Visual Analogue Scale consists in the translation of a subjective sensation in an objective measure provided by numbers.
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Affiliation(s)
- Giorgio Ciprandi
- Department of Medicine, IRCCS - Azienda Ospedaliera Universitaria San Martino, Viale Benedetto XV 6, 16132 Genoa, Italy
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30
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Ibáñez MD, Valero AL, Montoro J, Jauregui I, Ferrer M, Dávila I, Bartra J, Del Cuvillo A, Mullol J, Sastre J. Analysis of comorbidities and therapeutic approach for allergic rhinitis in a pediatric population in Spain. Pediatr Allergy Immunol 2013; 24:678-84. [PMID: 24028473 DOI: 10.1111/pai.12126] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common chronic disease in children. The main objective of this study was to analyze the comorbidities and therapeutic approaches for AR in a Spanish pediatric population. METHODS Children aged 6 to 12 years with AR were included in an observational, cross-sectional, multicenter study. RESULTS 1,275 children were recruited from 271 centers. AR was intermittent in 59.5% of cases, persistent in 40.5%, seasonal in 60.7%, and perennial in 39.3% of patients. The most frequent comorbidities were conjunctivitis (53.6%), asthma (49.5%), atopic dermatitis (40%), rhinosinusitis(26.1%), otitis media (23.8%), and adenoid hypertrophy (17.3%). Overall, patients with persistent, moderate or severe, AR were more likely to present comobidities, except for food allergy and urticaria. The most common drugs used for treatment of AR were oral antihistamines(76%), nasal corticosteroids(49%) and a combination of both (45%). Antihistamines and nasal corticosteroids were used on demand (<18 days) in 38 and 41% of patients, respectively; for 18-30 days in 22 and 27%; for 1-3 months in 31 and 29%; and for more than 3 months in 8 and 3%, respectively. Eye drops were used in 32% and specific immunotherapy in 21% of patients. CONCLUSION Comorbidities are frequent in children with AR, supporting the notion of allergy as a systemic disease. Severity and duration of AR were significantly associated with presence of most of comorbidities. The most common drugs used for AR treatment were oral antihistamines, followed by nasal corticosteroids and a combination of both used on demand.
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31
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Morais-Almeida M, Santos N, Pereira AM, Branco-Ferreira M, Nunes C, Bousquet J, Fonseca JA. Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study. Allergy 2013; 68:1278-88. [PMID: 24053488 DOI: 10.1111/all.12221] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Information on rhinitis epidemiology in preschool children is scarce. OBJECTIVES To estimate, in children with 3-5 years of age, current rhinitis prevalence, to describe rhinitis symptoms and associated sociodemographic characteristics, and to report allergic rhinitis and its impact on asthma (ARIA) classification. METHODS Cross-sectional, nationwide, population-based study including children aged 3-5 years. A multistep selection strategy was used to obtain a representative sample. Data were collected at kindergartens and parish centers by face-to-face interview to caregivers, using an adapted ISAAC questionnaire. 'Current rhinitis' (CR) was defined as the presence of ≥1 rhinitis symptom (repeated sneezing and/or itchy nose, blocked nose for >1 h, or runny nose without having a cold/flu) in the last year. Rhinitis lasting ≥4 days/week and ≥4 consecutive weeks was classified as persistent. Moderate-severe disease interfered 'a moderate amount' or 'a lot' in daily activities. RESULTS Five thousand and eighteen children were included. CR prevalence was 43.4% [95% CI (42.0-44.8%); n = 2179] and that of physician-diagnosed rhinitis was 11.7% [95% CI (10.8-12.6%); n = 588]. Of children with CR, 67% reported blocked nose, 48% rhinorrhea, and 46% sneezing/itchy nose. Considering ARIA classification, 30% of the population had mild intermittent, 3% mild persistent, 7% moderate-severe intermittent, and 3% moderate-severe persistent rhinitis. Children with CR had more current wheezing, physician-diagnosed asthma, self-reported food allergy, and family history of allergic disease. These characteristics were also associated with persistent and moderate-severe rhinitis. CONCLUSIONS This is the first nationwide population-based study reporting rhinitis prevalence and ARIA classification in preschool children. In this age-group, rhinitis is frequent and underdiagnosed. About 25% children with rhinitis presented moderate-severe disease.
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Affiliation(s)
| | | | | | | | | | - J. Bousquet
- Department of Allergy and Respiratory Diseases; University Hospital and INSERM; Montpellier; France
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Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW, Papadopoulos NG, Rotiroti G, Scadding G, Timmermans F, Valovirta E. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2013; 68:1102-16. [PMID: 23952296 DOI: 10.1111/all.12235] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2013] [Indexed: 12/13/2022]
Abstract
Rhinitis is a common problem in childhood and adolescence and impacts negatively on physical, social and psychological well-being. This position paper, prepared by the European Academy of Allergy and Clinical Immunology Taskforce on Rhinitis in Children, aims to provide evidence-based recommendations for the diagnosis and therapy of paediatric rhinitis. Rhinitis is characterized by at least two nasal symptoms: rhinorrhoea, blockage, sneezing or itching. It is classified as allergic rhinitis, infectious rhinitis and nonallergic, noninfectious rhinitis. Similar symptoms may occur with other conditions such as adenoidal hypertrophy, septal deviation and nasal polyps. Examination by anterior rhinoscopy and allergy tests may help to substantiate a diagnosis of allergic rhinitis. Avoidance of relevant allergens may be helpful for allergic rhinitis (AR). Oral and intranasal antihistamines and nasal corticosteroids are both appropriate for first-line AR treatment although the latter are more effective. Once-daily forms of corticosteroids are preferred given their improved safety profile. Potentially useful add-on therapies for AR include oral leukotriene receptor antagonists, short bursts of a nasal decongestant, saline douches and nasal anticholinergics. Allergen-specific immunotherapy is helpful in IgE-mediated AR and may prevent the progression of allergic disease. There are still a number of areas that need to be clarified in the management of rhinitis in children and adolescents.
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Affiliation(s)
| | - M. Xatzipsalti
- First Department of Pediatrics; P. & A. Kyriakou Children's Hospital; Athens; Greece
| | | | - A. Custovic
- Manchester Academic Health Science Centre; NIHR Respiratory and Allergy Clinical Research Facility; The University of Manchester; University Hospital of South Manchester NHS Foundation Trust; Manchester; UK
| | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense; Denmark
| | - P. W. Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals of Leuven; Catholic University of Leuven; Leuven; Belgium
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens; Greece
| | | | - G. Scadding
- Royal National Throat Nose and Ear; Hospital - Part of UCL Hospitals NHS Foundation Trust; London; UK
| | - F. Timmermans
- Nederlands Anafylaxis Netwerk; Dordrecht; the Netherlands
| | - E. Valovirta
- Terveystalo Turku; Allergy Clinic; University of Turku; Turku; Finland
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Comparative analysis of allergic rhinitis in children and adults. Curr Allergy Asthma Rep 2013; 13:142-51. [PMID: 23250586 DOI: 10.1007/s11882-012-0331-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Allergic rhinitis (AR) is a worldwide health problem that generates a significant healthcare burden in adults, adolescents, and children. Epidemiological studies have indicated that the prevalence of AR has progressively increased over the last three decades in developed and industrialized countries. AR currently affects up to 40 % of the worldwide population, with differences between adults and children and different countries of the World. Although not life-threatening, AR symptoms are frequently bothersome, adversely affecting work and quality of life of the affected patients, and causing a significant burden on both the individual and society. The symptoms have the potential to lead to both physical and mental complications, with sleep-disordered breathing in childhood and adolescence being associated with disorders in learning performance, behavior, and attention. Clinical features and comorbidities are very important for the "allergic march", and in both adults and children there is some evidence of association between AR and asthma. ARIA classifications of both symptom duration (intermittent, persistent) and severity (mild, moderate, severe) have been validated in both adult and pediatric populations. Based on the duration and severity of patient's disease, an appropriate treatment strategy has been issued for both adults and children, which consists of patient's education, allergen avoidance, and pharmacological as well as allergen-specific immunotherapy treatment. The present review will attempt to compare the characteristics of AR between children and adults, either in the epidemiology, clinical features, impact on QOL, and management of the disease.
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