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Matricardi PM, Hoffmann T, Dramburg S. The "allergic nose as a pollen detector" concept: e-Diaries to predict pollen trends. Pediatr Allergy Immunol 2023; 34:e13966. [PMID: 37366207 DOI: 10.1111/pai.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023]
Abstract
Hirst pollen traps and operator pollen recognition are worldwide used by aerobiologists, providing essential services for the diagnosis and monitoring of allergic patients. More recently, semiautomated or fully automated detector systems have been developed, which facilitate prediction of pollen exposure and risk for the individual patient. In parallel, smartphone apps consisting of short questionnaires filled in daily by the patient/user provide daily scores, time trajectories, and descriptive reports of the severity of respiratory allergies in patients with pollen allergy. The usual scientific and clinical approach to this matter is to monitor the environment (pollen concentration) in order to predict the risk of symptoms (allergic rhinitis) in a population. We discuss here the opposite, contraintuitive possibility, that is, the use of e-diaries to collect daily information of mono-sensitized pollen-allergic patients in order to predict the clinically efficient airborne exposure to a given pollen, area, and time period. In line with the "Patient as Sensor" concept, proposed in 2013 by Bernd Resch, the "allergic nose" may be used as a pollen detector in addition to existing calibrated hardware sensors, namely the pollen stations, thus contributing with individual measurements, sensations, and symptoms' perception. The target of this review is to present a novel concept of pollen monitoring based on "pollen-detector" patients to inspire future cooperative studies aimed at investigating and hopefully validating our hypothesis.
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Affiliation(s)
- Paolo Maria Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tara Hoffmann
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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2
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Arasi S, Castelli S, Di Fraia M, Villalta D, Tripodi S, Perna S, Dramburg S, Brighetti MA, Conte M, Martelli P, Sfika I, Travaglini A, Verardo PL, Villella V, Matricardi PM. @IT2020: An innovative algorithm for allergen immunotherapy prescription in seasonal allergic rhinitis. Clin Exp Allergy 2021; 51:821-828. [DOI: 10.1111/cea.13867] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Stefania Arasi
- Allergy Unit ‐ Area of Translational Research in Pediatric Specialities Bambino Gesù Children's HospitalIRCCS Rome Italy
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
- Department of Pediatrics Unit of Allergy University of Messina Messina Italy
| | - Sveva Castelli
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | - Marco Di Fraia
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | - Danilo Villalta
- Immunology and Allergy Unit “S. Maria degli Angeli” Hospital Pordenone Italy
| | | | - Serena Perna
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | | | | | - Paola Martelli
- Immunology and Allergy Unit “S. Maria degli Angeli” Hospital Pordenone Italy
| | - Ifigenia Sfika
- Pediatric Allergology Unit Sandro Pertini Hospital Rome Italy
| | | | | | | | - Paolo Maria Matricardi
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
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Sofiev M, Palamarchuk Y, Bédard A, Basagana X, Anto JM, Kouznetsov R, Urzua RD, Bergmann KC, Fonseca JA, De Vries G, Van Erd M, Annesi-Maesano I, Laune D, Pépin JL, Jullian-Desayes I, Zeng S, Czarlewski W, Bousquet J. A demonstration project of Global Alliance against Chronic Respiratory Diseases: Prediction of interactions between air pollution and allergen exposure-the Mobile Airways Sentinel NetworK-Impact of air POLLution on Asthma and Rhinitis approach. Chin Med J (Engl) 2020; 133:1561-1567. [PMID: 32649522 PMCID: PMC7386352 DOI: 10.1097/cm9.0000000000000916] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
This review analyzes the state and recent progress in the field of information support for pollen allergy sufferers. For decades, information available for the patients and allergologists consisted of pollen counts, which are vital but insufficient. New technology paves the way to substantial increase in amount and diversity of the data. This paper reviews old and newly suggested methods to predict pollen and air pollutant concentrations in the air and proposes an allergy risk concept, which combines the pollen and pollution information and transforms it into a qualitative risk index. This new index is available in an app (Mobile Airways Sentinel NetworK-air) that was developed in the frame of the European Union grant Impact of Air POLLution on sleep, Asthma and Rhinitis (a project of European Institute of Innovation and Technology-Health). On-going transformation of the pollen allergy information support is based on new technological solutions for pollen and air quality monitoring and predictions. The new information-technology and artificial-intelligence-based solutions help to convert this information into easy-to-use services for both medical practitioners and allergy sufferers.
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Affiliation(s)
- Mikhail Sofiev
- Finnish Meteorological Institute (FMI), Helsinki 00560, Finland
| | | | - Annabelle Bédard
- Barcelona Institute for Global Health, Centre for Research in Environmental Epidemiology (CREAL), Barcelona 08003, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER) Epidemiología y Salud Pública (CIBERESP), Barcelona 08003, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
| | - Xavier Basagana
- Barcelona Institute for Global Health, Centre for Research in Environmental Epidemiology (CREAL), Barcelona 08003, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER) Epidemiología y Salud Pública (CIBERESP), Barcelona 08003, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona 08003, Spain
| | - Josep M. Anto
- Barcelona Institute for Global Health, Centre for Research in Environmental Epidemiology (CREAL), Barcelona 08003, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER) Epidemiología y Salud Pública (CIBERESP), Barcelona 08003, Spain
- Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona 08003, Spain
| | | | | | - Karl Christian Bergmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Berlin 10117, Germany
| | - Joao A. Fonseca
- Center for Health Technology and Services Research (CINTESIS), Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto; and Medida, Lda Porto s/n 4200-450, Portugal
| | | | | | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department, Institute Pierre Louis of Epidemiology and Public Health, INSERM and Sorbonne Université, Medical School Saint Antoine, Paris 75571, France
| | | | - Jean Louis Pépin
- Université Grenoble Alpes, Laboratoire HP2, Grenoble, INSERM, U1042 and CHU de Grenoble, Grenoble 38000, France
| | - Ingrid Jullian-Desayes
- Université Grenoble Alpes, Laboratoire HP2, Grenoble, INSERM, U1042 and CHU de Grenoble, Grenoble 38000, France
| | | | | | - Jean Bousquet
- University Hospital Montpellier, Montpellier 34000, France
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon-France, Montpellier, France
- Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin 10117, Germany
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4
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Di Fraia M, Tripodi S, Arasi S, Dramburg S, Castelli S, Villalta D, Buzzulini F, Sfika I, Villella V, Potapova E, Perna S, Brighetti MA, Travaglini A, Verardo P, Pelosi S, Zicari AM, Matricardi PM. Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study. J Med Internet Res 2020; 22:e16642. [PMID: 32175909 PMCID: PMC7105930 DOI: 10.2196/16642] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022] Open
Abstract
Background Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording. Objective The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach. Methods The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season. Results Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P<.001; Pordenone: ρ=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (ρ=–0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone. Conclusions Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts.
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Affiliation(s)
- Marco Di Fraia
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany.,Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Salvatore Tripodi
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy.,Allergology Service, Policlinico Casilino, Rome, Italy.,TPS Production, Rome, Italy
| | - Stefania Arasi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany.,Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | - Sveva Castelli
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | - Danilo Villalta
- Department of Immunology-Allergy, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Francesca Buzzulini
- Department of Immunology-Allergy, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Ifigenia Sfika
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Valeria Villella
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Ekaterina Potapova
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | - Serena Perna
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | | | | | - Pierluigi Verardo
- Center of Aerobiology, Agenzia Regionale per la Protezione Ambientale, Pordenone, Italy
| | | | | | - Paolo Maria Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
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5
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Di Fraia M, Arasi S, Castelli S, Dramburg S, Potapova E, Villalta D, Tripodi S, Sfika I, Zicari AM, Villella V, Perna S, Travaglini A, Verardo PL, Matricardi PM. A new molecular multiplex IgE assay for the diagnosis of pollen allergy in Mediterranean countries: A validation study. Clin Exp Allergy 2018; 49:341-349. [DOI: 10.1111/cea.13264] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/12/2018] [Accepted: 07/14/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Marco Di Fraia
- Department of Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | - Stefania Arasi
- Department of Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
- Department of Pediatrics; University of Messina; Messina Italy
- Division of Allergy; University Department of Pediatrics; Pediatric Hospital Bambino Gesù; Rome Vatican City Italy
| | - Sveva Castelli
- Department of Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | - Stephanie Dramburg
- Department of Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | - Ekaterina Potapova
- Department of Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | - Danilo Villalta
- Department of Allergy and Clinical Immunology; S.Maria degli Angeli Hospital; Messina Italy
| | | | - Ifigenia Sfika
- Pediatric Allergy Unit; Sandro Pertini Hospital; Rome Italy
| | - Anna Maria Zicari
- Department of Pediatrics and Child Neuropsychiatry; Sapienza University; Rome Italy
| | | | - Serena Perna
- Department of Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | | | - Pier Luigi Verardo
- Aerobiology Centre; Agenzia Regionale per la Protezione dell'Ambiente del Friuli Venezia Giulia; Palmanova Italy
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
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6
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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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Stringari G, Tripodi S, Caffarelli C, Dondi A, Asero R, Di Rienzo Businco A, Bianchi A, Candelotti P, Ricci G, Bellini F, Maiello N, Miraglia del Giudice M, Frediani T, Sodano S, Dello Iacono I, Macrì F, Peparini I, Povesi Dascola C, Patria MF, Varin E, Peroni D, Comberiati P, Chini L, Moschese V, Lucarelli S, Bernardini R, Pingitore G, Pelosi U, Tosca M, Cirisano A, Faggian D, Travaglini A, Plebani M, Matricardi PM. The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever. J Allergy Clin Immunol 2014; 134:75-81. [PMID: 24794684 DOI: 10.1016/j.jaci.2014.01.042] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/16/2013] [Accepted: 01/20/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. OBJECTIVES We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. METHODS Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA(2)LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. RESULTS No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. CONCLUSIONS In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.
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Affiliation(s)
- Giovanna Stringari
- Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany; Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | - Carlo Caffarelli
- Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Arianna Dondi
- Pediatric Unit, Department for Mother and Child, Ramazzini Hospital, Carpi, Italy; Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Riccardo Asero
- Allergy Unit, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | | | | | | | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Federica Bellini
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | | | - Simona Sodano
- Pediatric Department, La Sapienza University, Rome, Italy
| | | | | | | | - Carlotta Povesi Dascola
- Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Varin
- Pediatric Clinic 2, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Diego Peroni
- Pediatric Unit, G.B. Rossi Hospital, Verona, Italy
| | | | - Loredana Chini
- Unit of Pediatric Allergy and Immunology, Policlinico of Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Viviana Moschese
- Unit of Pediatric Allergy and Immunology, Policlinico of Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | - Mariangela Tosca
- Pulmonary Disease and Allergy Unit, G. Gaslini Hospital, Genoa, Italy
| | | | - Diego Faggian
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | | | - Mario Plebani
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany.
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8
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Blomme K, Tomassen P, Lapeere H, Huvenne W, Bonny M, Acke F, Bachert C, Gevaert P. Prevalence of allergic sensitization versus allergic rhinitis symptoms in an unselected population. Int Arch Allergy Immunol 2012; 160:200-7. [PMID: 23018768 DOI: 10.1159/000339853] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 05/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common allergic disorder and its prevalence has significantly increased worldwide, nowadays affecting up to 40% of the population in young adults. The objective of the present survey was to evaluate the prevalence of allergic sensitization and the prevalence of clinically diagnosed AR in a sample of the Belgian population, and to estimate the effect of age and gender. METHODS We performed a cross-sectional population-based study at an annual public fair in Ghent. Participants underwent a skin prick test (SPT) to 3 aeroallergens: a mix of trees (hazel, alder, and birch), grass pollen, and house dust mite (HDM). The clinical relevance of sensitization was assessed by relating relevant symptoms of AR to the corresponding SPT. RESULTS A total of 2,320 participants (1,475 females, median age 44.7 years, range 3-86) were included in this study. The standardized prevalence rates of sensitization were 13.2% for tree mix, 25.9% for grass pollen, and 25.9% for HDM. Sensitization to at least one of the allergens was present in 40.3% of the subjects. Symptomatic sensitization related to trees was reported in 9.7% of cases, grass-related AR was 17.6%, and HDM-related AR was 17.1%. The overall prevalence of AR was 30.9%. CONCLUSION In this study we demonstrated a 40.3% prevalence of a positive SPT to one or more common aeroallergens. A clinical diagnosis of AR was present in 30.9% of cases, peaking in the third and fourth decades of life. It is to be expected that in the next decades, when this generation grows older, the general AR prevalence will further increase.
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Affiliation(s)
- Katrien Blomme
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
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Bousquet J, Schünemann HJ, Bousquet PJ, Bachert C, Canonica GW, Casale TB, Demoly P, Durham S, Carlsen KH, Malling HJ, Passalacqua G, Simons FER, Anto J, Baena-Cagnani CE, Bergmann KC, Bieber T, Briggs AH, Brozek J, Calderon MA, Dahl R, Devillier P, Gerth van Wijk R, Howarth P, Larenas D, Papadopoulos NG, Schmid-Grendelmeier P, Zuberbier T. How to design and evaluate randomized controlled trials in immunotherapy for allergic rhinitis: an ARIA-GA(2) LEN statement. Allergy 2011; 66:765-74. [PMID: 21496059 DOI: 10.1111/j.1398-9995.2011.02590.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Specific immunotherapy (SIT) is one of the treatments for allergic rhinitis. However, for allergists, nonspecialists, regulators, payers, and patients, there remain gaps in understanding the evaluation of randomized controlled trials (RCTs). Although treating the same diseases, RCTs in SIT and pharmacotherapy should be considered separately for several reasons, as developed in this study. These include the severity and persistence of allergic rhinitis in the patients enrolled in the study, the problem of the placebo, allergen exposure (in particular pollen and mite), the analysis and reporting of the study, the level of symptoms of placebo-treated patients, the clinical relevance of the efficacy of SIT, the need for a validated combined symptom-medication score, the differences between children and adults and pharmacoeconomic analyses. This statement reviews issues raised by the interpretation of RCTs in sublingual immunotherapy. It is not possible to directly extrapolate the rules or parameters used in medication RCTs to SIT. It also provides some suggestions for the research that will be needed. Interestingly, some of the research questions can be approached with the available data obtained from large RCTs.
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MESH Headings
- Administration, Sublingual
- Adolescent
- Adult
- Allergens/administration & dosage
- Allergens/immunology
- Animals
- Child
- Child, Preschool
- Desensitization, Immunologic/methods
- Humans
- Injections, Subcutaneous
- Mites/immunology
- Pollen/immunology
- Quality of Life
- Randomized Controlled Trials as Topic/methods
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/physiopathology
- Rhinitis, Allergic, Seasonal/therapy
- Severity of Illness Index
- Treatment Outcome
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Affiliation(s)
- Jean Bousquet
- University Hospital, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Bodtger U, Assing K, Poulsen LK. A Prospective, Clinical Study on Asymptomatic Sensitisation and Development of Allergic Rhinitis: High Negative Predictive Value of Allergological Testing. Int Arch Allergy Immunol 2011; 155:289-96. [DOI: 10.1159/000320758] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 08/18/2010] [Indexed: 11/19/2022] Open
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Abstract
Component resolved diagnostics introduces new possibilities regarding diagnosis of allergic diseases and individualized, allergen-specific treatment. Furthermore, refinement of IgE-based testing may help elucidate the correlation or lack of correlation between allergenic sensitization and allergic disease. Novel tools to predict severe outcomes and to plan for allergen-specific treatment are necessary, and because only a small amount of blood is needed to test for a multitude of allergens and allergenic components, component resolved diagnostics is promising. A drawback is the risk of overdiagnosis and misinterpretation of the complex results of such tests. Also, the practical use and selection of allergenic components need to be evaluated in large studies including well-characterized patients and healthy, sensitized controls and with representation of different geographical regions.
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Canonica GW, Compalati E. Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies. Clin Exp Immunol 2009; 158:260-71. [PMID: 19765020 PMCID: PMC2792821 DOI: 10.1111/j.1365-2249.2009.04017.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2009] [Indexed: 12/21/2022] Open
Abstract
Patients with allergic rhinitis have traditionally been placed into 'seasonal' and 'perennial' categories, which do not account for the subclinical inflammatory state that exists in many patients. In subjects with seasonal and perennial allergic rhinitis, even subthreshold doses of allergen have been found to cause inflammatory cell infiltration in the nasal mucosa, including increases in expression of cellular adhesion molecules, nasal and conjunctival eosinophilia, and other markers of inflammation, which do not result in overt allergy symptoms. This state - which has been termed 'minimal persistent inflammation'- may contribute to hyperreactivity and increased susceptibility to development of clinical symptoms as well as common co-morbidities of allergic rhinitis, such as asthma. Treating overt allergy symptoms as well as this underlying inflammatory state requires agents that have well-established clinical efficacy, convenient administration, potent anti-inflammatory effects and proven long-term safety, so that long-term continuous administration is feasible. Of the three major classes of commonly used allergic rhinitis medications - intranasal corticosteroids, anti-histamines, and anti-leukotrienes - intranasal corticosteroids appear to represent the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.
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MESH Headings
- Administration, Intranasal
- Allergens/immunology
- Asthma/etiology
- Chronic Disease
- Glucocorticoids/therapeutic use
- Histamine H1 Antagonists/therapeutic use
- Humans
- Intercellular Adhesion Molecule-1/immunology
- Leukotriene Antagonists/therapeutic use
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
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Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases, Clinic Dipartmento di Medicina Interna e Specialita Mediche (DIMI), University of Genova, Genova, Italy.
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3059] [Impact Index Per Article: 191.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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