1
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Scadding GK, Gray C, Conti DM, McDonald M, Backer V, Scadding G, Bernal-Sprekelsen M, De Corso E, Diamant Z, Hopkins C, Jesenak M, Johansen P, Kappen J, Mullol J, Price D, Quirce S, Reitsma S, Toppila-Salmi S, Senior B, Thyssen JP, Wahn U, Hellings PW. Pre-asthma: a useful concept? A EUFOREA paper. Part 2-late onset eosinophilic asthma. FRONTIERS IN ALLERGY 2024; 5:1404735. [PMID: 38812719 PMCID: PMC11133565 DOI: 10.3389/falgy.2024.1404735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously considered the idea of pre-asthma in relation to allergic asthma and considered that, in addition to the need to improve population health via multiple measures, including reduction of exposure to allergens and pollutants and avoidance of obesity, there are several possible specific means to reduce asthma development in those most at risk (pre- asthma). The most obvious is allergen immunotherapy (AIT), which when given for allergic rhinitis (AR) has reasonable evidence to support asthma prevention in children (2) but also needs further study as primary prevention. In this second paper we explore the possibilities for similar actions in late onset eosinophilic asthma.
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Affiliation(s)
- G. K. Scadding
- Department of Allergy & Rhinology, Royal National ENT Hospital, London, United Kingdom
- Division of Immunity and Infection, University College, London, United Kingdom
| | - C. Gray
- Paediatric Allergist, Red Cross Children's Hospital and University of Cape Town, Cape Town, South Africa
- Kidsallergy Centre, Cape Town, South Africa
| | - D. M. Conti
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
- Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Autónoma de Madrid, Calle Francisco Tomás y Valiente, no 2, Ciudad Universitaria de Cantoblanco, Madrid, Spain
| | - M. McDonald
- The Allergy Clinic, Blairgowrie, Randburg, South Africa
| | - V. Backer
- Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - G. Scadding
- Allergy, Royal Brompton Hospital, London, United Kingdom
| | - M. Bernal-Sprekelsen
- Otolaryngology-Department, Clinic Barcelona, Barcelona, Spain
- Otolaryngology-Department, University of Barcelona, Barcelona, Spain
| | - E. De Corso
- Otolaryngology Head and Neck Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Z. Diamant
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
| | - C. Hopkins
- Department of Rhinology and Skull Base Surgery, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | - M. Jesenak
- Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
| | - P. Johansen
- Department of Dermatology, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - J. Kappen
- Department of Pulmonology, STZ Centre of Excellence for Asthma, COPD and Respiratory Allergy, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - J. Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - D. Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - S. Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - S. Reitsma
- Department of Otorhinolarynogology and Head/Neck Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - S. Toppila-Salmi
- Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
- Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - B. Senior
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - J. P. Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - U. Wahn
- Department for Pediatric Pneumology and Immunology, Charite University Medicine, Berlin, Germany
| | - P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals, Leuven, Belgium
- Laboratory of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
- Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium
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2
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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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3
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Blackley BH, Nett RJ, Cox-Ganser JM, Harvey RR, Virji MA. Eye and airway symptoms in hospital staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid. Am J Ind Med 2023; 66:655-669. [PMID: 37221450 PMCID: PMC10431326 DOI: 10.1002/ajim.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Sporicidal products containing hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are used widely in multiple industries, including healthcare. Despite widespread use in healthcare, few studies have assessed associations between exposures to HP, PAA, and AA, and work-related symptoms in these settings. METHODS In 2018, we performed a health and exposure assessment at a hospital where a sporicidal product consisting of HP, PAA, and AA, was used as the primary cleaner on hospital surfaces. We collected 56 personal and mobile air samples for HP, PAA, and AA on participants while they performed their regular cleaning duties; collected area samples for HP (n = 28), PAA (n = 28), and AA (n = 70) in multiple hospital locations where cleaning was performed; and administered a postshift survey to assess eye, skin, and upper and lower airway symptoms that occurred cross-shift or in the previous 4 weeks. RESULTS Full-shift exposure levels for HP (range: <3-559 ppb), PAA (range: <0.2-8 ppb), and AA (range: <5-915 ppb) were all below US occupational exposure limits. We observed positive associations (p < 0.05) between shift, departmental average, and departmental 95th percentile exposures to HP, PAA, and AA vapors, and work-related acute (cross-shift) and chronic (previous 4 weeks) eye, upper airway, and lower airway symptoms after adjusting for age, gender, smoking status, use of other cleaning products containing sensitizers and irritants, allergic status, and stress. CONCLUSIONS Our observations of work-related upper and lower airway symptoms among hospital workers exposed to vapors from a sporicidal product containing HP, PAA, and AA indicate a need for a combination of engineering, administrative, and PPE controls to reduce exposure. Additionally, alternative nonchemical disinfection technologies should be further investigated as a means to simultaneously reduce healthcare workers' exposure to disinfectants while also minimizing costly healthcare-acquired infections.
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Affiliation(s)
- Brie Hawley Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randall J. Nett
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Fort Collins, Colorado, USA
| | - Jean M. Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Robert Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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4
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Furci F, Allegra A, Tonacci A, Isola S, Senna G, Pioggia G, Gangemi S. Air Pollution and microRNAs: The Role of Association in Airway Inflammation. Life (Basel) 2023; 13:1375. [PMID: 37374157 DOI: 10.3390/life13061375] [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: 05/02/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Air pollution exposure plays a key role in the alteration of gene expression profiles, which can be regulated by microRNAs, inducing the development of various diseases. Moreover, there is also evidence of sensitivity of miRNAs to environmental factors, including tobacco smoke. Various diseases are related to specific microRNA signatures, suggesting their potential role in pathophysiological processes; considering their association with environmental pollutants, they could become novel biomarkers of exposure. Therefore, the aim of the present work is to analyse data reported in the literature on the role of environmental stressors on microRNA alterations and, in particular, to identify specific alterations that might be related to the development of airway diseases so as to propose future preventive, diagnostic, and therapeutic strategies.
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Affiliation(s)
- Fabiana Furci
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, 98124 Messina, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy
| | - Stefania Isola
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
- Department of Medicine, Verona University Hospital, 37134 Verona, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
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5
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 92] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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6
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Li L, Fang Z, Lee YK, Zhao J, Zhang H, Peng H, Zhang Y, Lu W, Chen W. Efficacy and Safety of Lactobacillus reuteri CCFM1040 in Allergic Rhinitis and Asthma: A Randomized, Placebo-Controlled Trial. Front Nutr 2022; 9:862934. [PMID: 35464005 PMCID: PMC9022948 DOI: 10.3389/fnut.2022.862934] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022] Open
Abstract
The coexistence of allergic rhinitis (AR) and asthma reinforces the concept of “one airway, one disease,” which has prompted the exploration for a single intervention to treat both diseases. Lactobacillus reuteri CCFM1040 (CCFM1040) was found to be an inhibitor of the common pathogenesis of AR and asthma in our previous studies. This study presented a randomized, placebo-controlled trial to investigate the clinical effects of CCFM1040 on both diseases. The total symptom score (TSS), the quality of life (QoL), and the modulation in the gut microbiota of patients with AR, the Asthma Control and Test (ACT) of patients with asthma, and the safety of both AR and asthma were measured. In patients with AR, CCFM1040 numerically decreased TSS, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), 3 nasal scores in TSS (nasal congestion, watery eyes, and rhinorrhea), and sleep and significantly improved (P = 0.014) non-nose/eye symptoms. The ACT score was numerically increased in patients with asthma (from partially controlled to well-controlled). Significant microbial (from class level to genus level) and metabolic differences (P < 0.05) were found in patients with AR. No adverse reactions were observed. No effect on the blood and urine routine indexes. CCFM1040 has a potential benefit on both diseases. Further studies based on these findings will help to optimize the management of AR and asthma.
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7
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Identification of gene biomarkers with expression profiles in patients with allergic rhinitis. Allergy Asthma Clin Immunol 2022; 18:20. [PMID: 35246242 PMCID: PMC8897927 DOI: 10.1186/s13223-022-00656-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/03/2022] [Indexed: 01/01/2023] Open
Abstract
Background Allergic rhinitis (AR) is an upper respiratory tract inflammation disease caused by IgE-mediated reactions against inhaled allergens. The incidence of AR is significantly increasing throughout the world. Hence, more specific, and sensitive gene biomarkers and understanding the underlying pathways are necessary to further explore the AR pathogenesis. Objective To identify gene biomarkers in nasal mucosa and in blood from AR patients which could be used in AR diagnosis. Methods The gene expression profiles of GSE43523 from nasal epithelial cells and GSE75011 from Th2-enriched CD4+ T cells in blood were downloaded from the Gene Expression Omnibus database. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses and protein–protein interaction (PPI) network analysis were conducted to investigate the functional changes of genes. The receiver operating characteristic (ROC) curves were used to assess the diagnostic values of the hub genes. Real-time quantitative PCR (RT-qPCR) was performed to validate the hub genes. Results Significant differentially enriched gene signatures in AR patients were identified in nasal epithelial cells (n-DEGs) and in blood (t-DEGs). Signatures associated with axoneme, extracellular matrix, collagen fibril organization, cell motility, calcium ion binding, and so on were more enriched in n-DEGs, whereas signatures associated with TNF signaling pathway, detoxification of inorganic compound, and cellular response to corticotropin-releasing hormone stimulus were enriched in t-DEGs. In addition, we identified 8 hub genes and 14 hub genes from n-DEGs and t-DEGs, respectively. The combination of POSTN in nasal mucosa and PENK and CDC25A in blood was constructed with a good AR predicting performance. The area under the curve (AUC) of the ROC curve of 3 hub genes’ combination was 0.98 for AR diagnosis. Conclusion This study utilized gene expression profiles and RT-qPCR validation on nasal mucosa and blood from AR patients to investigate the potential biomarkers for AR diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00656-4.
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8
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Grigorieva IN, Manina IV, Sergeev AY, Popadyuk VI. [Etiopathophysiological mechanism of systemic and local allergic sensitization in the development of chronic rhinitis and chronic rhinosinusitis]. Vestn Otorinolaringol 2022; 87:85-91. [PMID: 35818951 DOI: 10.17116/otorino20228703185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The persistence, development and exacerbation of chronic rhinitis and chronic rhinosinusitis all involve sensitization to respiratory allergens. The allergic response in question is the IgE-mediated mechanism of rhinitis, which often leads to a complex of etiopathophysiological malfunctions in various organs and systems. For clinical classification and further management of patients, it is important not to miss the detection of both systemic allergic sensitization to aeroallergens (which is achieved by conducting skin prick test or detecting the allergen-specific immunoglobulin E in the blood) and local sensitization (which can be confirmed by conducting nasal provocation test or detecting the nasal-specific immunoglobulin E in nasal mucosa). Before a full examination is conducted and both systemic and local sensitization are ruled out, the diagnosis of non-allergic rhinitis and the management of a patient with non-allergic nasal inflammation may be premature.
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Affiliation(s)
- I N Grigorieva
- Institute of Allergology and Clinical Immunology, Moscow, Russia
| | - I V Manina
- Institute of Allergology and Clinical Immunology, Moscow, Russia
| | - A Yu Sergeev
- Institute of Allergology and Clinical Immunology, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V I Popadyuk
- Peoples' Friendship University of Russia, Moscow, Russia
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9
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The Role of IgE in Upper and Lower Airway Disease: More Than Just Allergy! Clin Rev Allergy Immunol 2021; 62:200-215. [PMID: 34536215 PMCID: PMC8818003 DOI: 10.1007/s12016-021-08901-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/25/2022]
Abstract
Immunoglobulin E (IgE) is a well-known key factor in allergic airway disease; however, its central role in non-allergic airway inflammation is often underestimated. In some airway diseases, IgE is produced as a result of allergic sensitization. However, in others, IgE production occurs despite the lack of a specific allergen. Although multiple pathways contribute to the production of IgE in airway disease, it is its activity in mediating the inflammatory response that is associated with disease. Therefore, an understanding of IgE as the unifying component of upper and lower airway diseases has important implications for both diagnosis and treatment. Understanding the role of IgE in each upper and lower airway disease highlights its potential utility as a diagnostic marker and therapeutic target. Further classification of these diseases by whether they are IgE mediated or non–IgE mediated, rather than by the existence of an underlying allergic component, accounts for both systemic and localized IgE activity. Improvements in diagnostic methodologies and standardization of clinical practices with this classification in mind can help identify patients with IgE-mediated diseases. In doing so, this group of patients can receive optimal care through targeted anti-IgE therapeutics, which have already demonstrated efficacy across numerous IgE-mediated upper and lower airway diseases.
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10
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Prieto A, Rondón C, Eguiluz-Gracia I, Muñoz C, Testera-Montes A, Bogas G, Nuñez Cuadros E, Campo P, Torres MJ. Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents. Pediatr Allergy Immunol 2021; 32:953-962. [PMID: 33598969 DOI: 10.1111/pai.13474] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Three allergic phenotypes of rhinitis have been described in adults: allergic rhinitis (AR), local allergic rhinitis (LAR), and dual allergic rhinitis (DAR, coexistence of AR and LAR). Nevertheless, most centers follow a diagnostic approach only based on skin prick test and serum allergen-specific IgE (collectively called atopy tests, AT). This approach prevents the recognition of LAR and DAR, the diagnosis of which requires a nasal allergen challenge (NAC). Here, we investigate the existence of LAR and DAR phenotypes in children and adolescents, and the misdiagnosis rate associated with a work-up exclusively based on AT. METHODS Clinical data were obtained during physician-conducted interviews, and AT and NAC were systematically performed in 5- to 18-year-old patients with chronic rhinitis. The misdiagnosis rate was defined as the proportion of cases where AT and NAC results were discordant. RESULTS A total of 173 patients (mean age 15.1 years, 39.9% male) completed the study. AR (positive AT and NAC), LAR (negative AT and positive NAC), DAR (positive AT and NAC for some allergens and negative AT and positive NAC for other allergens), and non-allergic rhinitis (negative NAC) were diagnosed in 45.7%, 24.9%, 11.6%, and 17.9% of individuals, respectively. The clinical profile was comparable among allergic phenotypes, but allergic patients had a significantly earlier rhinitis onset, higher conjunctivitis prevalence, and more severe disease than NAR individuals. A diagnostic work-up exclusively based on AT misclassified 37.6% of patients. CONCLUSIONS LAR and DAR represent relevant differential diagnosis in pediatric rhinitis. NAC increases the diagnostic accuracy of clinical algorithms for rhinitis in children and adolescents.
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Affiliation(s)
- Ana Prieto
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Carmen Rondón
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Candelaria Muñoz
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain
| | - Gador Bogas
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | | | - Paloma Campo
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Maria J Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain.,Laboratory for Nanostructures for the Diagnosis and Treatment of Allergic Diseases, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
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11
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Hurst DS, Gordon BR, McDaniel AB, Poe DS. Intradermal Testing Doubles Identification of Allergy among 110 Immunotherapy-Responsive Patients with Eustachian Tube Dysfunction. Diagnostics (Basel) 2021; 11:763. [PMID: 33923133 PMCID: PMC8146738 DOI: 10.3390/diagnostics11050763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to determine whether the sensitivity advantage of intradermal dilutional testing (IDT) is clinically relevant in patients with obstructive Eustachian tube dysfunction (ETD) or otitis media with effusion (OME). This retrospective, private-practice cohort study compared the sensitivity of skin prick tests (SPT) vs. IDT in 110 adults and children with suspected allergy and OME. Primary outcome measure was symptom resolution from allergy immunotherapy (AIT). IDT identified 57% more patients as being allergic, and 8.6 times more reactive allergens than would have been diagnosed using only SPT. Patients diagnosed by IDT had the same degree of symptom improvement from immunotherapy, independent of allergen sensitivity (66% by SPT vs. 63% by IDT; p = 0.69, not different). Low-sensitivity allergy tests, which may fail to identify allergy in over two thirds of children aged 3 to 15 as being atopic, or among 60% of patients with ETD, may explain why many physicians do not consider allergy as a treatable etiology for their patient's OME/ETD. IDT offers superior sensitivity over SPT for detecting allergens clinically relevant to treating OME/ETD. These data strongly support increased utilization of intradermal testing and invite additional clinical outcome studies.
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Affiliation(s)
- David S. Hurst
- Department of Otolaryngology, Tufts University, Boston 02111, MA, USA
| | - Bruce R. Gordon
- Department of Laryngology & Otology, Harvard University, Boston, MA 02114, USA;
| | - Alan B. McDaniel
- Department of Otolaryngology, University of Louisville, Louisville, KY 40202, USA;
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12
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Eguiluz-Gracia I, Palomares F, Salas M, Testera-Montes A, Ariza A, Davila I, Bartra J, Mayorga C, Torres MJ, Rondon C. Precision Medicine in House Dust Mite-Driven Allergic Asthma. J Clin Med 2020; 9:E3827. [PMID: 33255966 PMCID: PMC7761474 DOI: 10.3390/jcm9123827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
House dust mites (HDMs) are the allergenic sources most frequently involved in airway allergy. Nevertheless, not every sensitized patient develops respiratory symptoms upon exposure to HDM, and there is a clinical need to differentiate allergic asthmatics (AAs) from atopic non-allergic asthmatics with HDM sensitization. This differentiation sometimes requires in vivo provocations like the bronchial allergen challenge (BAC). Interestingly, recent data demonstrate that non-atopic patients with asthma can also develop positive BAC results. This novel phenotype has been termed local allergic asthma (LAA). The interest in identifying the allergic triggers of asthma resides in the possibility of administering allergen immunotherapy (AIT). AIT is a disease-modifying intervention, the clinical benefit of which persists after therapy discontinuation. Recently, new modalities of sublingual tablets of HDM immunotherapy registered as pharmaceutical products (HDM-SLIT tablets) have become commercially available. HDM-SLIT tablets have demonstrated a robust effect over critical asthma parameters (dose of inhaled corticosteroids, exacerbations, and safety), thus being recommended by international guidelines for patients with HDM-driven AA. In this review, we will summarize the current knowledge on the phenotype and endotype of HDM-driven AA, and LAA, address the difficulties for BAC implementation in the clinic, and discuss the effects of AIT in AA and LAA.
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Affiliation(s)
- Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, 29009 Malaga, Spain; (I.E.-G.); (M.S.); (A.T.-M.); (C.M.); (M.J.T.)
- Allergy Research Group, Instituto de Investigación Biomedica de Malaga-IBIMA and ARADyAL, 29009 Malaga, Spain; (F.P.); (A.A.)
| | - Francisca Palomares
- Allergy Research Group, Instituto de Investigación Biomedica de Malaga-IBIMA and ARADyAL, 29009 Malaga, Spain; (F.P.); (A.A.)
| | - Maria Salas
- Allergy Unit, Hospital Regional Universitario de Malaga, 29009 Malaga, Spain; (I.E.-G.); (M.S.); (A.T.-M.); (C.M.); (M.J.T.)
- Allergy Research Group, Instituto de Investigación Biomedica de Malaga-IBIMA and ARADyAL, 29009 Malaga, Spain; (F.P.); (A.A.)
| | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, 29009 Malaga, Spain; (I.E.-G.); (M.S.); (A.T.-M.); (C.M.); (M.J.T.)
- Department of Medicine and Dermatology, Universidad de Malaga, 29016 Malaga, Spain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomedica de Malaga-IBIMA and ARADyAL, 29009 Malaga, Spain; (F.P.); (A.A.)
| | - Ignacio Davila
- Allergy Department, University Hospital of Salamanca, 37007 Salamanca, Spain;
- Allergy Research Group, Institute for Biomedical Research of Salamanca (IBSAL) and ARADyAL, 37007 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Joan Bartra
- Allergy Section, Pulmonology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain;
- Clinical & Experimental Respiratory Immunoallergy (IRCE), Instituto de Investigaciones Biomedicas Pi I Sunyer (IDIBAPS)-ARADyAL, 08036 Barcelona, Spain
| | - Cristobalina Mayorga
- Allergy Unit, Hospital Regional Universitario de Malaga, 29009 Malaga, Spain; (I.E.-G.); (M.S.); (A.T.-M.); (C.M.); (M.J.T.)
- Allergy Research Group, Instituto de Investigación Biomedica de Malaga-IBIMA and ARADyAL, 29009 Malaga, Spain; (F.P.); (A.A.)
- Laboratory for Nanostructures for the Diagnosis and Treatment of Allergic Diseases, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), 29590 Malaga, Spain
| | - Maria Jose Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, 29009 Malaga, Spain; (I.E.-G.); (M.S.); (A.T.-M.); (C.M.); (M.J.T.)
- Allergy Research Group, Instituto de Investigación Biomedica de Malaga-IBIMA and ARADyAL, 29009 Malaga, Spain; (F.P.); (A.A.)
- Department of Medicine and Dermatology, Universidad de Malaga, 29016 Malaga, Spain
- Laboratory for Nanostructures for the Diagnosis and Treatment of Allergic Diseases, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), 29590 Malaga, Spain
| | - Carmen Rondon
- Allergy Unit, Hospital Regional Universitario de Malaga, 29009 Malaga, Spain; (I.E.-G.); (M.S.); (A.T.-M.); (C.M.); (M.J.T.)
- Allergy Research Group, Instituto de Investigación Biomedica de Malaga-IBIMA and ARADyAL, 29009 Malaga, Spain; (F.P.); (A.A.)
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13
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Eguiluz‐Gracia I, Mathioudakis AG, Bartel S, Vijverberg SJH, Fuertes E, Comberiati P, Cai YS, Tomazic PV, Diamant Z, Vestbo J, Galan C, Hoffmann B. The need for clean air: The way air pollution and climate change affect allergic rhinitis and asthma. Allergy 2020; 75:2170-2184. [PMID: 31916265 DOI: 10.1111/all.14177] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
Air pollution and climate change have a significant impact on human health and well-being and contribute to the onset and aggravation of allergic rhinitis and asthma among other chronic respiratory diseases. In Westernized countries, households have experienced a process of increasing insulation and individuals tend to spend most of their time indoors. These sequelae implicate a high exposure to indoor allergens (house dust mites, pets, molds, etc), tobacco smoke, and other pollutants, which have an impact on respiratory health. Outdoor air pollution derived from traffic and other human activities not only has a direct negative effect on human health but also enhances the allergenicity of some plants and contributes to global warming. Climate change modifies the availability and distribution of plant- and fungal-derived allergens and increases the frequency of extreme climate events. This review summarizes the effects of indoor air pollution, outdoor air pollution, and subsequent climate change on asthma and allergic rhinitis in children and adults and addresses the policy adjustments and lifestyle changes required to mitigate their deleterious effects.
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Affiliation(s)
- Ibon Eguiluz‐Gracia
- Allergy Unit IBIMA‐Hospital Regional Universitario de Malaga‐UMA Malaga Spain
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine School of Biological Sciences The University of Manchester Manchester Academic Health Science Centre UK
- North West Lung Centre Wythenshawe Hospital Manchester University NHS Foundation Trust Southmoor Road Manchester UK
| | - Sabine Bartel
- Early Life Origins of Chronic Lung Disease, Research Center Borstel Leibniz Lung Center Member of the German Research Center for Lung Research (DZL) Borstel Germany
- Department of Pathology and Medical Biology University Medical Center Groningen GRIAC Research Institute University of Groningen Groningen The Netherlands
| | - Susanne J. H. Vijverberg
- Department of Respiratory Medicine Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Elaine Fuertes
- National Heart and Lung Institute Imperial College London London UK
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology Sechenov University Moscow Russia
| | - Yutong Samuel Cai
- Department of Epidemiology and Biostatistics MRC Centre for Environment and Health School of Public Health Imperial College London London UK
- The George Institute for Global Health University of Oxford Oxford UK
| | - Peter Valentin Tomazic
- Department of General ORL, Head and Neck Surgery Medical University of Graz Graz Austria
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden
- Department of Respiratory Medicine First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine School of Biological Sciences The University of Manchester Manchester Academic Health Science Centre UK
- North West Lung Centre Wythenshawe Hospital Manchester University NHS Foundation Trust Southmoor Road Manchester UK
| | - Carmen Galan
- Department of Botany, Ecology and Plant Physiology International Campus of Excellence on Agrifood (ceiA3) University of Córdoba Córdoba Spain
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine Medical Faculty University of Düsseldorf Düsseldorf Germany
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14
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Eguiluz-Gracia I, Fernandez-Santamaria R, Testera-Montes A, Ariza A, Campo P, Prieto A, Perez-Sanchez N, Salas M, Mayorga C, Torres MJ, Rondon C. Coexistence of nasal reactivity to allergens with and without IgE sensitization in patients with allergic rhinitis. Allergy 2020; 75:1689-1698. [PMID: 31995231 DOI: 10.1111/all.14206] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) and local allergic rhinitis (LAR) are defined by nasal reactivity to aeroallergens with and without positive skin prick test (SPT), respectively. In this study, we aimed to investigate whether both types of allergen-specific reactivity can coexist in the same individual. METHODS Forty-eight patients with perennial rhinitis symptoms and positive SPT with seasonal allergens only (discrepant group) were subjected to consecutive nasal allergen challenges (NAC) with seasonal (NAC-S) and perennial allergens (NAC-P). A nasal lavage was collected before and after the NACs to measure eosinophil cationic protein (ECP). A basophil activation test (BAT) with seasonal and/or perennial allergens was performed in ten patients from the discrepant group and in six seasonal allergic rhinitis (SAR), eight perennial local allergic rhinitis (LAR), six nonallergic rhinitis (NAR), and six healthy control (HC) individuals. RESULTS All patients in the discrepant group tested positive in the NAC-S, and 41 of them (85.4%), also in the NAC-P (group A). Conversely, seven patients tested negative in the NAC-P (group B). ECP in the nasal lavage increased after the NAC-P in the group A (P = .004), but not in the group B. The BAT with seasonal allergens was positive in 100% of SAR and group A cases, whereas the BAT with perennial allergens was positive in 37.5% and 60% of LAR and group A cases, respectively. All NAR and HC subjects tested negative for the BAT. CONCLUSION This study shows that nasal reactivity to aeroallergens with and without positive SPT can coexist in the same patient. We propose the term dual allergic rhinitis for this rhinitis phenotype.
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Affiliation(s)
- Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | | | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain.,Universidad de Málaga-UMA, Málaga, Spain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Paloma Campo
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Ana Prieto
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Málaga, Spain
| | - Natalia Perez-Sanchez
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Maria Salas
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Maria Jose Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain.,Universidad de Málaga-UMA, Málaga, Spain
| | - Carmen Rondon
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
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15
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Meng Y, Yan B, Wang Y, Wu D, Zhang L, Wang C. Diagnosis and management of nonallergic rhinitis with eosinophilia syndrome using cystatin SN together with symptoms. World Allergy Organ J 2020; 13:100134. [PMID: 32577150 PMCID: PMC7301177 DOI: 10.1016/j.waojou.2020.100134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 10/25/2022] Open
Abstract
Background The diagnosis and treatment of nonallergic rhinitis with eosinophilia syndrome (NARES) remain controversial. The aim of this study was to evaluate whether Cystatin SN together with symptoms can be used to diagnose NARES and to measure the efficiency of medical treatment. Methods Seventy-five patients with chronic rhinitis (CR) and 18 control subjects were enrolled. Their clinical characteristics were reviewed and laboratory parameters were evaluated. The concentration of Cystatin SN in nasal secretions was determined using the enzyme-linked immunosorbent assay. The histological assessment of Cystatin SN in the nasal mucosa was conducted by hematoxylin and eosin staining. The logistic regression and receiver operating characteristic curves were used to assess the predictive value of parameters for NARES. Results Nasal obstruction, sneezing, loss of smell, and total visual analogue scale (VAS) score were significantly different among the patients with CR. In particular, olfaction score was higher in patients with NARES than in those without NARES (AR, LAR, or IR). Similarly, the Cystatin SN level was significantly different between the control subjects and patients with CR. After treatment for 2 weeks, the Cystatin SN level and VAS score were significantly decreased in the NARES group. The accuracy of Cystatin SN together with local sIgE and loss of smell to diagnose NARES was up to 0.987 (sensitivity, 100%; specificity, 93.1%). Conclusions Cystatin SN with local sIgE and loss of smell may serve as one of the reliable and alternative biomarkers for the diagnosis of NARES and be used to evaluate disease severity and NARES treatment efficacy.
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Key Words
- AR, allergic rhinitis
- AUC, area under curve
- CR, chronic rhinitis
- Cystatin SN
- Diagnosis
- ECRSwNP, eosinophilic chronic rhinosinusitis with nasal polyps
- GICA, gold immunochromatographic assay
- GINA, Global Initiative for Asthma guidelines
- INS, intranasal corticosteroid
- IR, idiopathic rhinitis
- IgE, immunoglobulin E
- LAR, local allergic rhinitis
- LE, local eosinophils
- NAR, nonallergic rhinitis
- NARES, nonallergic rhinitis with eosinophilia syndrome
- Nonallergic rhinitis with eosinophilia syndrome (NARES)
- ROC, receiver operating characteristic
- SIgE, specific IgE
- Treatment efficacy
- VAS, visual analogue scale
- VIF, variance inflation factor
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Affiliation(s)
- Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Bing Yan
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Yang Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Di Wu
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
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16
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Eguiluz-Gracia I, Ariza A, Testera-Montes A, Rondón C, Campo P. Allergen Immunotherapy for Local Respiratory Allergy. Curr Allergy Asthma Rep 2020; 20:23. [PMID: 32430550 DOI: 10.1007/s11882-020-00920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIESW Local respiratory allergy (LRA) is an eosinophilic phenotype of chronic airway disease. Three entities have been described within the LRA spectrum: local allergic rhinitis (LAR) and local allergic asthma (LAA) in non-atopic patients, and dual allergic rhinitis (DAR) in atopic patients (coexistence of LAR and allergic rhinitis). In this article, we aim to review the current evidence on the therapeutic options for LRA. RECENT FINDINGS No controlled study has assessed the effect of standard therapy (oral antihistamines, intranasal or inhaled corticosteroids, bronchodilators) in LRA subjects. Three randomized clinical trials and one observational study demonstrated that allergen immunotherapy (AIT) is able to control nasal and ocular symptoms, decrease the need for rescue medication, and improve quality of life in LAR individuals. Nasal or inhaled steroids can be expected to improve eosinophilic inflammation in LRA patients but cannot change the natural course of the disease. Moreover, the long-term and disease-modifying effects of AIT in LRA subjects need to be investigated.
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Affiliation(s)
- I Eguiluz-Gracia
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - A Ariza
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA and ARADyAL, Málaga, Spain
| | - A Testera-Montes
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - C Rondón
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain.
| | - P Campo
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
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17
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The Roadmap From Allergic Rhinitis to Asthma. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Harvey RR, Fechter-Leggett ED, Bailey RL, Edwards NT, Fedan KB, Virji MA, Nett RJ, Cox-Ganser JM, Cummings KJ. The Burden of Respiratory Abnormalities Among Workers at Coffee Roasting and Packaging Facilities. Front Public Health 2020; 8:5. [PMID: 32083049 PMCID: PMC7003510 DOI: 10.3389/fpubh.2020.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/08/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Respiratory hazards in the coffee roasting and packaging industry can include asthmagens such as green coffee bean and other dust and alpha-diketones such as diacetyl and 2,3-pentanedione that can occur naturally from roasting coffee or artificially from addition of flavoring to coffee. We sought to describe the burden of respiratory abnormalities among workers at 17 coffee roasting and packaging facilities. Methods: We completed medical surveys at 17 coffee roasting and packaging facilities that included interviewer-administered questionnaires and pulmonary function testing. We summarized work-related symptoms, diagnoses, and spirometry testing results among all participants. We compared health outcomes between participants who worked near flavoring and who did not. Results: Participants most commonly reported nose and eye symptoms, and wheeze, with a work-related pattern for some. Symptoms and pulmonary function tests were consistent with work-related asthma in some participants. About 5% of workers had abnormal spirometry and most improved after bronchodilator. Health outcomes were similar between employees who worked near flavoring and who did not, except employees who worked near flavoring reported more chronic bronchitis and ever receiving a diagnosis of asthma than those who did not work near flavoring. Conclusion: The symptoms and patterns likely represent overlapping health effects of different respiratory hazards, including green coffee bean and other dust that can contribute to work-related asthma, and diacetyl and 2,3-pentanedione that can contribute to obliterative bronchiolitis. Healthcare providers and occupational health and safety practitioners should be aware that workers at coffee roasting and packaging facilities are potentially at risk for occupational lung diseases.
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Affiliation(s)
- R. Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
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19
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Crespo-Lessmann A, Curto E, Mateus E, Soto L, García-Moral A, Torrejón M, Belda A, Giner J, Ramos-Barbón D, Plaza V. Total and specific immunoglobulin E in induced sputum in allergic and non-allergic asthma. PLoS One 2020; 15:e0228045. [PMID: 31995587 PMCID: PMC6988954 DOI: 10.1371/journal.pone.0228045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022] Open
Abstract
Background Most patients with nonallergic asthma have normal serum immunoglobulin E (IgE) levels. Recent reports suggest that total and aeroallergen-specific IgE levels in induced sputum may be higher in nonallergic asthmatics than in healthy controls. Our objective is to compare total and dust-mite specific (Der p 1) IgE levels in induced sputum in allergic and nonallergic asthmatics and healthy controls. Methods Total and Der p 1-specific IgE were measured in induced sputum (ImmunoCAP immunoassay) from 56 age- and sex-matched asthmatics (21 allergic, 35 nonallergic) and 9 healthy controls. Allergic asthma was defined as asthma with a positive prick test and/or clinically-significant Der p 1-specific serum IgE levels. Results Patients with allergic asthma presented significantly higher total and Der p 1-specific serum IgE levels. There were no significant between-group differences in total sputum IgE. However, Der p 1-specific sputum IgE levels were significantly higher (p = 0.000) in the allergic asthmatics, but without differences between the controls and nonallergic asthmatics. Serum and sputum IgE levels were significantly correlated, both for total IgE (rho = 0.498; p = 0.000) and Der p 1-specific IgE (rho, 0.621; p = 0001). Conclusions Total IgE levels measured in serum and induced sputum are significantly correlated. No significant differences were found between the differents groups in total sputum IgE. Nevertheless, the levels of Der p 1-specific sputum IgE levels were significantly higher in the allergic asthmatics, but without differences between the controls and nonallergic asthmatics. Probably due to the lack of sensitivity of the test used, but with the growing evidence for local allergic reactions better methods are need to explore its presence. The Clinical Trials Identifier for this project is NCT03640936.
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Affiliation(s)
- Astrid Crespo-Lessmann
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
- * E-mail:
| | - Elena Curto
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Eder Mateus
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Lorena Soto
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Alba García-Moral
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Montserrat Torrejón
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Alicia Belda
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Jordi Giner
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - David Ramos-Barbón
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine and Allergology, Hospital de la Santa Creu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Department of Medicine of Universitat Autònoma de Barcelona (UAB), CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain
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20
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Breiteneder H, Diamant Z, Eiwegger T, Fokkens WJ, Traidl‐Hoffmann C, Nadeau K, O’Hehir RE, O’Mahony L, Pfaar O, Torres MJ, Wang DY, Zhang L, Akdis CA. Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care. Allergy 2019; 74:2293-2311. [PMID: 31056763 PMCID: PMC6973012 DOI: 10.1111/all.13851] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/28/2019] [Accepted: 04/12/2019] [Indexed: 12/16/2022]
Abstract
The specialties of allergy and clinical immunology have entered the era of precision medicine with the stratification of diseases into distinct disease subsets, specific diagnoses, and targeted treatment options, including biologicals and small molecules. This article reviews recent developments in research and patient care and future trends in the discipline. The section on basic mechanisms of allergic diseases summarizes the current status and defines research needs in structural biology, type 2 inflammation, immune tolerance, neuroimmune mechanisms, role of the microbiome and diet, environmental factors, and respiratory viral infections. In the section on diagnostic challenges, clinical trials, precision medicine and immune monitoring of allergic diseases, asthma, allergic and nonallergic rhinitis, and new approaches to the diagnosis and treatment of drug hypersensitivity reactions are discussed in further detail. In the third section, unmet needs and future research areas for the treatment of allergic diseases are highlighted with topics on food allergy, biologics, small molecules, and novel therapeutic concepts in allergen‐specific immunotherapy for airway disease. Unknowns and future research needs are discussed at the end of each subsection.
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Affiliation(s)
- Heimo Breiteneder
- Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital Lund University Lund Sweden
- Department of Respiratory Medicine, First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
| | - Thomas Eiwegger
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Department of Pediatrics The Hospital for Sick Children Toronto Ontario Canada
- Research Institute, The Hospital for Sick Children, Translational Medicine Program Toronto Ontario Canada
- Department of Immunology The University of Toronto Toronto Ontario Canada
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam University Medical Centres, Location AMC Amsterdam The Netherlands
| | - Claudia Traidl‐Hoffmann
- Chair and Institute of Environmental Medicine UNIKA‐T, Technical University of Munich and Helmholtz Zentrum München Augsburg Germany
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
| | - Kari Nadeau
- Sean N. Parker Center for Allergy & Asthma Research Stanford University Stanford California
| | - Robyn E. O’Hehir
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Central Clinical School Monash University Melbourne Victoria Australia
- Allergy, Asthma and Clinical Immunology Service Alfred Health Melbourne Victoria Australia
| | - Liam O’Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland National University of Ireland Cork Ireland
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy University Hospital Marburg, Philipps‐Universität Marburg Marburg Germany
| | - Maria J. Torres
- Allergy Unit Regional University Hospital of MalagaIBIMA‐UMA‐ARADyAL Malaga Spain
| | - De Yun Wang
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery and Department of Allergy Beijing Tongren Hospital Beijing China
| | - Cezmi A. Akdis
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich Davos Switzerland
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21
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Hamizan AW, Azer M, Alvarado R, Earls P, Barham HP, Tattersall J, Rimmer J, Kalish L, Sewell WA, Harvey R. The Distinguishing Clinical Features of Nonallergic Rhinitis Patients. Am J Rhinol Allergy 2019; 33:524-530. [PMID: 31106562 DOI: 10.1177/1945892419850750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Not all rhinitis patients are affected by an immunoglobulin E (IgE)-mediated inflammatory process. Skin and serum allergy assessments are limited in their ability to define local allergic rhinitis (LAR). Thus, patients with negative systemic allergy assessments comprise a mix of those who truly have nonallergic rhinitis (NAR) and patients with LAR. Objective To determine the clinical characteristics of patients with NAR. Methods A cross-sectional study was performed on consecutive adults with rhinitis symptoms who underwent turbinate surgery. NAR patients were defined by excluding allergy using both systemic (serum-specific IgE and/or skin prick test) and local (inferior turbinate tissue-specific IgE) tests. Allergic rhinitis (AR) patients were defined by any positive systemic or local test toward aeroallergens. The clinical characteristics studied included allergic comorbidities (asthma, eczema, allergic conjunctivitis), inhalant allergen triggers (dust, pollen, animal dander), and environmental triggers (Cincinnati Irritant Index [CII]). Results There were 154 participants (41.79 ± 14.78 years, 37.7% female). NAR patients (11.7%) were older (49.33 ± 15.99 vs 40.78 ± 14.38 years, P = .02), had less self-reported asthma (5.6% vs 36.3%, P < .01) and house dust inhalant trigger (38.9 vs 65.2%, P = .03) compared to AR patients. The CII score was similar for NAR and AR (31.06 ± 28.88 vs 35.49 ± 24.70, P = .61). Conclusion Patients who were older, without asthma, and lacked an inhalant allergy trigger were more likely to have true NAR. Environmental triggers are not distinguishing features of NAR. This may be used as a guide to identify rhinitis patients whose symptoms are truly nonallergic etiology compared to those with falsely negative systemic allergy assessment but may still need management for LAR.
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Affiliation(s)
- Aneeza W Hamizan
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,2 Department of Otorhinolaryngology, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mark Azer
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Peter Earls
- 3 Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia
| | - Henry P Barham
- 4 Sinus and Nasal Specialists of Louisiana, Baton Rouge, Louisiana
| | - Jessica Tattersall
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Janet Rimmer
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,5 Upper Airway Research Group, Woolcock Institute, University of Sydney, Sydney, Australia.,6 Faculty of Medicine, Notre Dame University, Sydney, Australia.,7 Sydney Medical School, University of Sydney, Sydney, Australia
| | - Larry Kalish
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,7 Sydney Medical School, University of Sydney, Sydney, Australia.,8 Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
| | - William A Sewell
- 9 St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,10 Immunology Division, Garvan Institute, Sydney, Australia
| | - Richard Harvey
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,11 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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22
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Tsilochristou O, Kyriakakou M, Manolaraki I, Lakoumentas J, Tiligada E, Maragkoudakis P, Douladiris N, Papadopoulos NG. Detection of local allergic rhinitis in children with chronic, difficult-to-treat, non-allergic rhinitis using multiple nasal provocation tests. Pediatr Allergy Immunol 2019; 30:296-304. [PMID: 30685887 DOI: 10.1111/pai.13021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is little evidence on the incidence and characteristics of local allergic rhinitis (LAR) in children. Most studies have included subjects with perennial rhinitis only, and results are based on the investigation of no more than three allergens per study. Our aim was to determine the proportion of children with LAR amongst children with chronic, difficult-to-treat, perennial or seasonal, rhinitis but no evidence of sensitization to aeroallergens, or other alternative diagnosis. METHODS We performed multiple nasal provocation tests (M-NPTs) with four locally relevant aeroallergens (Phleum pratense, Olea europea, Alternaria alternata, and Dermatophagoides pteronyssinus) in children with absence of aeroallergen sensitization, seen during a calendar year in a specialized rhinitis clinic. We additionally performed single NPT to children with allergic rhinitis (AR; positive control group). The result of the NPT was based on symptoms and acoustic rhinometry. Identification of nasal hyper-reactivity (NHR) triggers was through a questionnaire. RESULTS Local allergic rhinitis was confirmed in 29.2% (7/24) of the negative SPT/blood testing population. All but one of the children reacted to one allergen and one to two. All AR children had positive single NPT with results similar to the LAR. There were no differences in age at examination and rhinitis onset, gender distribution, family atopy, and past or current environment of residency, while the prevalence of reported NHR triggers was comparable amongst the three groups. CONCLUSION This is the first pediatric study where the seasonal or perennial rhinitis population was thoroughly tested for LAR against four aeroallergens. LAR is present in a considerable proportion of children with chronic, difficult-to-treat rhinitis and no sensitization to aeroallergens, and therefore, the performance of NPT should be strongly considered in these cases. There were no distinct clinical characteristics between LAR, AR, and non-allergic rhinitis in children.
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Affiliation(s)
- Olympia Tsilochristou
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK.,Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Marialena Kyriakakou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Manolaraki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - John Lakoumentas
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Ekaterini Tiligada
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Maragkoudakis
- Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Douladiris
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
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23
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Rondón C, Eguiluz-Gracia I, Campo P. Is the evidence of local allergic rhinitis growing? Curr Opin Allergy Clin Immunol 2019; 18:342-349. [PMID: 29847361 DOI: 10.1097/aci.0000000000000456] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW To examine the recent advances on epidemiological studies, diagnostic approach and clinical management of local allergic rhinitis (LAR) in adults and children. RECENT FINDINGS Evidence about LAR is growing especially in pediatric and Asian populations. The prevalence of LAR is lower in Asian countries compared with western countries in both children and adults. LAR is considered a chronic condition and an independent rhinitis phenotype that affects up to 26.5% of nonatopic rhinitis patients. The disease rapidly progress toward the clinical worsening with associated onset of asthma and conjunctivitis, which further impairs patient's quality of life. Nasal Allergen Provocation Test is the diagnostic gold standard that can be complemented by basophil activation test and the detection of specific IgE in nasal secretions. Allergen immunotherapy induces a significant and early improvement in both clinical symptoms and quality of life in LAR patients. SUMMARY LAR is a common entity, with different prevalence depending on geographical locations. LAR has to be considered in the process of differential diagnosis in children and adults with rhinitis. Diagnosis of LAR is crucial in order to start an etiologic treatment such as allergen immunotherapy, which has proven to be very effective in these patients.
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Affiliation(s)
- Carmen Rondón
- Allergy Unit, Hospital Regional Universitario de Malaga-IBIMA, ARADyAL, Malaga, Spain
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24
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Castillo Vizuete JA, Sastre J, del Cuvillo Bernal A, Picado C, Martínez Moragón E, Ignacio García JM, Cisneros Serrano C, Álvarez Gutiérrez FJ, Mullol Miret J. Asthma, Rhinitis, and Nasal Polyp Multimorbidities. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.arbr.2018.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Reitsma S, Subramaniam S, Fokkens WWJ, Wang DY. Recent developments and highlights in rhinitis and allergen immunotherapy. Allergy 2018; 73:2306-2313. [PMID: 30260494 DOI: 10.1111/all.13617] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/09/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023]
Abstract
This review paper aims to provide an overview of recent developments in the field of allergic and non-allergic rhinitis, as well as allergen immunotherapy. Recent advances in phenotyping and endotyping various forms of rhinitis have brought us one step closer towards tailoring treatment more appropriately for a given patient. Updates on local allergic rhinitis are also covered. Allergen immunotherapy (AIT) is an area of significant interest, with multiple original papers and recent position papers and guidelines published. Evidence related to the application of AIT in seasonal and perennial allergic rhinitis (AR), local allergic rhinitis and novel and expanded applications is discussed in the publication.
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Affiliation(s)
- Sietze Reitsma
- Department of Otorhinolaryngology; Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Soma Subramaniam
- Department of Otolaryngology; Ng Teng Fong General Hospital; Singapore Singapore
| | - Wytske W. J. Fokkens
- Department of Otorhinolaryngology; Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - De Yun Wang
- Department of Otolaryngology; National University of Singapore; Singapore Singapore
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26
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Asthma, rhinitis, and nasal polyp multimorbidities. Arch Bronconeumol 2018; 55:146-155. [PMID: 30449614 DOI: 10.1016/j.arbres.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022]
Abstract
The aim of this review is to assist pulmonologists in the management of diseases involving both the upper and lower respiratory tract that are linked by a common, interrelated epidemiology, clinical signs and symptoms, and inflammatory mechanism - asthma, in particular. The document discusses the definitions of the various sinonasal phenotypes associated with asthma: allergic and non-allergic rhinitis and chronic rhinosinusitis with or without nasal polyps. Diagnostic criteria and severity levels are also listed. Particular attention has been given to the 2 main syndromes associated with asthma: (i)allergic rhinitis, the most common, and (ii)chronic rhinosinusitis with nasal polyps, the disease most closely associated with severe asthma. To summarize, the upper respiratory tract should always be evaluated in order to achieve a single diagnosis and comprehensive treatment of the "united airway".
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27
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Yii ACA, Tay T, Choo XN, Koh MSY, Tee AKH, Wang D. Precision medicine in united airways disease: A "treatable traits" approach. Allergy 2018; 73:1964-1978. [PMID: 29869791 DOI: 10.1111/all.13496] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.
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Affiliation(s)
- A. C. A. Yii
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - T.‐R. Tay
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - X. N. Choo
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - M. S. Y. Koh
- Department of Respiratory and Critical Care Medicine Singapore General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - A. K. H. Tee
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - D.‐Y. Wang
- Department of Otolaryngology National University of Singapore Singapore
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Heffler E, Landi M, Caruso C, Fichera S, Gani F, Guida G, Liuzzo MT, Pistorio MP, Pizzimenti S, Riccio AM, Seccia V, Ferrando M, Malvezzi L, Passalacqua G, Gelardi M. Nasal cytology: Methodology with application to clinical practice and research. Clin Exp Allergy 2018; 48:1092-1106. [PMID: 29904978 DOI: 10.1111/cea.13207] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nasal cytology is an easy, cheap, non-invasive and point-of-care method to assess nasal inflammation and disease-specific cellular features. By means of nasal cytology, it is possible to distinguish between different inflammatory patterns that are typically associated with specific diseases (ie, allergic and non-allergic rhinitis). Its use is particularly relevant when other clinical information, such as signs, symptoms, time-course and allergic sensitizations, is not enough to recognize which of the different rhinitis phenotypes is involved; for example, it is only by means of nasal cytology that it is possible to distinguish, among the non-allergic rhinitis, those characterized by eosinophilic (NARES), mast cellular (NARMA), mixed eosinophilic-mast cellular (NARESMA) or neutrophilic (NARNE) inflammation. Despite its clinical usefulness, cheapness, non-invasiveness and easiness, nasal cytology is still underused and this is at least partially due to the fact that, as far as now, there is not a consensus or an official recommendation on its methodological issues. We here review the scientific literature about nasal cytology, giving recommendations on how to perform and interpret nasal cytology.
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Affiliation(s)
- E Heffler
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, Humanitas University, Milano, Italy
| | - M Landi
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Paediatric National Healthcare System, Torino, Italy
| | - C Caruso
- Allergy Unit, Fondazione Policlinico Gemelli, Presidio Columbus, Rome, Italy
| | - S Fichera
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - F Gani
- Respiratory Allergy, A.O.U. San Luigi, Orbassano, Torino, Italy
| | - G Guida
- Allergy and Lung Physiology, AO Santa Croce e Carle, Cuneo, Italy
| | - M T Liuzzo
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - M P Pistorio
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - S Pizzimenti
- Respiratory Medicine Unit, National Health System, ASL Città di Torino, Torino, Italy
| | - A M Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - V Seccia
- 1st Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - M Ferrando
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - L Malvezzi
- Department of Otolaryngology, Humanitas Clinical and Research Center, Milano, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
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Campo P, Eguiluz-Gracia I, Bogas G, Salas M, Plaza Serón C, Pérez N, Mayorga C, Torres MJ, Shamji MH, Rondon C. Local allergic rhinitis: Implications for management. Clin Exp Allergy 2018; 49:6-16. [PMID: 29900607 DOI: 10.1111/cea.13192] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
A significant proportion of rhinitis patients without systemic IgE-sensitisation tested by skin prick test and serum allergen-specific IgE (sIgE) display nasal reactivity upon nasal allergen provocation test (NAPT). This disease phenotype has been termed local allergic rhinitis (LAR). LAR is an underdiagnosed entity affecting children and adults from different parts of the world, with moderate-to-severe symptoms, impairment of quality of life and rapid progression to symptom worsening. LAR is a stable phenotype and not merely an initial state of AR. Allergic rhinitis and LAR share many clinical features including a positive NAPT response, markers of type 2 nasal inflammation including sIgE in nasal secretions and a significant rate of asthma development. LAR should be considered as a differential diagnosis in those subjects of any age with symptoms suggestive of AR but no evidence of systemic atopy. Although LAR pathophysiology is partially unknown, in some patients sIgE can be demonstrated directly in the nasal secretions and/or indirectly via positive responses in basophil activation test (BAT). LAR can coexist with other rhinitis phenotypes, especially AR. The diagnosis currently relies on the positivity of NAPT to a single or multiple allergens. NAPT has high sensitivity, specificity and reproducibility, and it is considered the gold standard. BAT and the measurement of nasal sIgE can also contribute to LAR diagnosis. LAR patients benefit from the same therapeutic strategies than AR individuals, including the avoidance of allergen exposure and the pharmacotherapy. Moreover, several recent studies support the effectiveness and safety of allergen immunotherapy for LAR, which opens a window of treatment opportunity in these patients.
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Affiliation(s)
- P Campo
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - I Eguiluz-Gracia
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - G Bogas
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - M Salas
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - C Plaza Serón
- Research Laboratory-Allergy Unit, Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - N Pérez
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - C Mayorga
- Research Laboratory-Allergy Unit, Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - M J Torres
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair & Development, MRC Asthma UK Centre Imperial College London, London, UK
| | - C Rondon
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, UMA, Málaga, Spain
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Dilemmas associated with local allergic rhinitis. Postepy Dermatol Alergol 2018; 35:243-245. [PMID: 30008640 PMCID: PMC6041707 DOI: 10.5114/ada.2018.76215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/13/2017] [Indexed: 01/31/2023] Open
Abstract
Local allergic rhinitis (LAR) in patients with no systemic markers of atopy is a very interesting phenomenon due to the lack of any definitive explanation for the mechanism of this IgE-dependent reaction. Some of the recent attempts to explain this phenomenon consider LAR to be closely associated with an allergic reaction, some suggest that this phenomenon is a spontaneous process in the nasal mucosa. Future attempts to elucidate the complexity of inflammatory reactions will undoubtedly establish a clear differential diagnostics algorithm for rhinitis.
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31
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Segboer CL, Terreehorst I, Gevorgyan A, Hellings PW, van Drunen CM, Fokkens WJ. Quality of life is significantly impaired in nonallergic rhinitis patients. Allergy 2018; 73:1094-1100. [PMID: 29131364 DOI: 10.1111/all.13356] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND In contrast to the well-known significant impairment of quality of life (QoL) in allergic rhinitis (AR), the degree of impairment in QoL in nonallergic rhinitis (NAR) remained unknown for a long time, due to a lack of a validated questionnaire to assess QoL in the NAR patient group. In this study, a validation of the mini-RQLQ questionnaire in NAR patients was performed, followed by an assessment of QoL in NAR patients compared to AR and healthy controls. Secondly, use of medication and treatment satisfaction in AR and NAR was assessed. METHODS The study was an observational cohort study in 287 AR and 160 NAR patients. Patients with symptoms of rhinitis were recruited from a tertiary care outpatient clinic of the Otorhinolaryngology Department. Allergic rhinitis (AR) was defined as one or more positive results on skin prick testing and clinically relevant symptoms of rhinitis related to their sensitization. Nonallergic rhinitis (NAR) was defined as clinically relevant symptoms of rhinitis but without positive results on skin prick testing. The mini-RQLQ was successfully validated in this study for NAR patients. RESULTS Quality of life (QoL) in NAR patients was equally-and for some aspects even more-impaired compared to AR. More than half of both AR and NAR patients were unsatisfied with treatment. CONCLUSION These results demonstrate a significant impairment in both AR and NAR patients in their QoL combined with a low treatment satisfaction, emphasizing the need for adequate treatment, especially in the NAR patient group.
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Affiliation(s)
- C. L. Segboer
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - I. Terreehorst
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - A. Gevorgyan
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - P. W. Hellings
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - C. M. van Drunen
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
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Ciprandi G, Gallo F, Cirillo I. The impact of allergy on asthma in the clinical practice. ALLERGO JOURNAL INTERNATIONAL 2018; 27:66-67. [DOI: 10.1007/s40629-017-0043-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
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Rondon C, Campo P, Eguiluz-Gracia I, Plaza C, Bogas G, Galindo P, Mayorga C, Torres MJ. Local allergic rhinitis is an independent rhinitis phenotype: The results of a 10-year follow-up study. Allergy 2018; 73:470-478. [PMID: 28833265 DOI: 10.1111/all.13272] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The knowledge about the natural history of local allergic rhinitis (LAR) is limited. One unmet question is to demonstrate whether LAR should be considered the first step in the development of allergic rhinitis (AR) or an independent phenotype. The aim of this study was to prospectively evaluate the natural history of a population with LAR, the potential conversion to AR with systemic atopy and the development of asthma during 10 years. METHODS This is the second phase of a 10-year follow-up study of a cohort of 176 patients with LAR of recent onset and 115 age- and sex-matched healthy controls prospectively evaluated from 2005 to 2016. Clinical-demographic questionnaire, spirometry, skin prick test and specific IgE were evaluated yearly. Nasal allergen provocation tests (NAPT) with Dermatophagoides pteronyssinus, Alternaria alternata, Olea europaea and grass pollen were performed at baseline, and after 5 and 10 years. RESULTS After 10-year LAR, patients experienced a significant and clinically relevant worsening of the rhinitis, with increase in emergency assistance, development of asthma, loss of allergen tolerance and impairment of the quality of life. This worsening became significant after 5 years and progressed throughout 10 years. A similar rate of development of AR with systemic atopy was detected in patients and controls (9.7% vs 7.8%, log-rank P=.623). In 5 patients, conversion to systemic atopy occurred >10 years (3%). CONCLUSIONS LAR is a well-differentiated clinical entity with a low rate of development of systemic atopy, a natural evolution towards worsening and a risk factor for suffering asthma.
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Affiliation(s)
- C. Rondon
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - P. Campo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - I. Eguiluz-Gracia
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - C. Plaza
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - G. Bogas
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - P. Galindo
- Allergy Section; General Hospital; Ciudad Real Spain
| | - C. Mayorga
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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De Greve G, Hellings PW, Fokkens WJ, Pugin B, Steelant B, Seys SF. Endotype-driven treatment in chronic upper airway diseases. Clin Transl Allergy 2017; 7:22. [PMID: 28706720 PMCID: PMC5506670 DOI: 10.1186/s13601-017-0157-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/05/2017] [Indexed: 12/31/2022] Open
Abstract
Rhinitis and rhinosinusitis are the two major clinical entities of chronic upper airway disease. Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) affect respectively up to 10 and 30% of the total population, hence being associated with an important socio-economic burden. Different phenotypes of rhinitis and CRS have been described based on symptom severity and duration, atopy status, level of control, comorbidities and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different, and sometimes overlapping, endotypes being recognized. Type 2 inflammation is well characterized in both AR and CRS with nasal polyps (CRSwNP), whereas type 1 inflammation is found in infectious rhinitis and CRS without nasal polyps (CRSsNP). The neurogenic endotype has been demonstrated in some forms of non-allergic rhinitis. Epithelial barrier dysfunction is shown in AR and CRSwNP. Emerging therapies are targeting one specific pathophysiological pathway or endotype. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment. Personalized medicine is addressing the issue of providing targeted treatment for the right patient and should be seen as one aspect of the promising trend towards precision medicine. This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
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Affiliation(s)
- Glynnis De Greve
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Louvain, Belgium
| | - Peter W Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Louvain, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Ghent, Belgium
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Benoit Pugin
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
| | - Brecht Steelant
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
| | - Sven F Seys
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
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Abstract
Local allergic inflammation (LAI) is recognized recently. 'entopy' was used to define LAI, which was positively correlated with allergen provocation testing, local sIgE up-regulation, inflammatory mediator secretion, and a lack of systemic allergy. The study of LAI is in its infancy and focuses mainly on the respiratory system. It is closely related to nasal inflammation and plays important roles in patients with nonallergic rhinitis (NAR), nonallergic chronic sinusitis with nasal polyps (CRSwNP), and nonallergic fungal rhinosinusitis (NAFRS). Based on studies using nasal allergen provocation testing, 40-57% of patients with NAR exhibited positive results and could be diagnosed as local allergic rhinitis. Total IgE and common airborne allergen-sIgE were up-regulated in eosinophilic CRSwNP patients compared to noneosinophilic CRSwNP patients and healthy controls, possibly due to local allergic inflammation. Some researchers also found that the level of local sIgE was increased in patients with NAFRS; they suggested that local allergic inflammation occurs in NAFRS. Studies of LAI will increase our understanding of nasal inflammation and help to establish novel treatments. However, the diagnosis of local allergic inflammation is complex due to the lack of convenient detection methods. The relationship between local allergic inflammation and systemic allergic inflammation is unclear, and an appropriate treatment for local allergic inflammation is required.
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Affiliation(s)
- Ke-Jia Cheng
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Min-Li Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Ying-Ying Xu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China.
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Licari A, Castagnoli R, Denicolò CF, Rossini L, Marseglia A, Marseglia GL. The Nose and the Lung: United Airway Disease? Front Pediatr 2017; 5:44. [PMID: 28316969 PMCID: PMC5334318 DOI: 10.3389/fped.2017.00044] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/16/2017] [Indexed: 12/31/2022] Open
Abstract
Epidemiologic, pathophysiologic, and clinical evidences recently revealed the link between upper and lower airways, changing the global pathogenic view of respiratory allergy. The aim of this review is to highlight the strong interaction between the upper and lower respiratory tract diseases, in particular allergic rhinitis and asthma.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Chiara Francesca Denicolò
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Linda Rossini
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Alessia Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
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