Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Expert Panel Consensus Recommendations for Allergic Rhinitis in Patients with Asthma in India

Allergic rhinitis and asthma are commonly coexisting conditions, significantly impacting patient health and quality of life. Despite their interrelation, diagnosing allergic rhinitis in patients with asthma remains challenging, leading to underdiagnosis and suboptimal management. The expert consensus engaged a modified Delphi method involving 29 experts including pulmonologists, ear, nose, and throat surgeons, and allergologists. Through group discussions, consensus statements were developed regarding the epidemiology, diagnosis, and management of allergic rhinitis and asthma. Final consensus statements were formulated based on the experts' collective clinical judgment and experience. This expert consensus provides updated recommendations tailored to the Indian context, addressing the gaps in existing research and clinical practice. By promoting a systematic and evidence-based approach to diagnosis and management, this consensus aims to support clinicians in effectively identifying and treating allergic rhinitis in patients with asthma, thereby improving overall disease management and patient well-being.

Local allergic rhinitis in Asia: rethinking the allergy landscape

PURPOSE OF REVIEW

Local allergic rhinitis (LAR) is increasingly recognized as a distinct phenotype of chronic rhinitis, yet its prevalence and characteristics in Asia remain underexplored. Given the variability in reported LAR prevalence across regions, this review re-evaluates the allergy landscape in Asia, considering environmental and immunological factors, as well as study methodology that may contribute to differences from Western populations.

RECENT FINDINGS

There were more Asian studies which reported lower prevalence (0-20%), in contrast to higher rates in Europe, particularly Mediterranean countries. Urbanization, air pollution, and high dust mite exposure may be important factors of nonatopic rhinitis in Asia. Diagnostic approaches, including nasal-specific IgE and provocation tests, vary across studies, impacting prevalence estimates.

SUMMARY

The lower reported LAR prevalence in Asia suggests potential differences in underlying mechanisms or diagnostic limitations. Further research is needed to refine diagnostic criteria, explore environmental triggers, and assess the clinical relevance of LAR in Asian populations. A better understanding of LAR in Asia could guide targeted management strategies and improve recognition of this condition in clinical practice.

Nasal allergen provocation test: updated indications and diagnostic accuracy

PURPOSE OF REVIEW

The Nasal Allergen Provocation Test (NAPT) is a valuable diagnostic tool for allergic rhinitis, particularly in cases where conventional tests, such as the skin prick test (SPT) and serum-specific IgE (sIgE), yield inconclusive results. By replicating real-life allergen exposure in a controlled setting, NAPT enables the assessment of allergen-specific nasal reactivity. This article aims to review the current knowledge of NAPT.

RECENT FINDINGS

Recent studies have reinforced NAPT as the gold standard for confirming nasal allergic responses. In the past, test protocols, allergen dosages, and outcome measurements varied widely. However, advancements in allergen standardization, the combination of objective and subjective measurements, and metered nasal allergen application have led to an improved and more reliable test method, with ongoing efforts to establish a universal protocol for clinical testing.

SUMMARY

This review summarizes current knowledge on NAPT, including its clinical applications, indications, methodology, and recent advancements. Additionally, we compare NAPT with SPT and sIgE in terms of diagnostic accuracy. The protocols, allergen types and doses, test methodologies, and outcome measures of these studies were analyzed and compared.

Fish and sea products consumption and allergic rhinitis: A multicenter case-control study

BACKGROUND

The association of allergic diseases with the intake of fish-derived proteins and fatty acids remains unclear, with studies showing divergent results. We aimed to examine the association of those nutrients with the occurrence of allergic rhinitis (AR).

METHODS

A multicenter case-control study was conducted with 411 AR cases and 477 controls. Adjusted odds ratios (OR) of AR and their 95 % confidence intervals (CI) were estimated using multivariate logistic regression models. Stratified analyses by fish type and macronutrient were undertaken.

RESULTS

Blue fish consumption, except tuna, is associated with an important decrease in the odds of AR (1 serving/week: OR = 0.46; 95%CI: 0.27-0.80; 2 servings/week: OR = 0.30; 95%CI: 0.17-0.54; 3-4 servings/week: OR = 0.38; 95%CI: 0.20-0.68). Conversely, compared to no intake, white fish consumption is associated with higher odds of AR (3 servings/week: OR = 5.49; 95%CI: 3.27-9.24). A high n-6/n-3 polyunsaturated fatty acids (PUFAs) ratio is associated with higher odds of AR (OR = 1.79; 95%CI: 1.03-3.13 for the highest intake level compared to the lowest). High intake of n-3 PUFAs is associated with substantially lower odds of AR ranging between 46 % and 58 % (stearidonic acid OR = 0.42; 95%CI: 0.24-0.74; eicosapentaenoic acid OR = 0.45; 95%CI: 0.25-0.80; and docosapentaenoic acid OR = 0.54; 95%CI: 0.31-0.96).

CONCLUSIONS

A high intake of blue fish, except tuna, is associated with lower odds of AR while that of white fish has an opposite association with the disease occurrence.

Associations between airborne pollen, pollen-related allergic rhinitis and blood pressure: A systematic review and meta-analysis

BACKGROUND

Allergic rhinitis (AR) due to pollen affects an estimated 18% of adults globally, but is often trivialized. While there is evidence for an association between high pollen exposure and cardiovascular morbidity and mortality, as well as multiple plausible mechanisms suggesting pathways via blood pressure (BP) elevation, no overview exists to date. This systematic review and meta-analysis aims to investigate whether 1) pollen-related AR and 2) exposure to airborne pollen are associated with BP and/or hypertension. We further evaluated which personal characteristics may modify a potential association and identified research gaps.

METHODS

We searched the PubMed, ScienceDirect, EMBASE, and Web of Science databases and systematically reviewed studies focusing on human populations published between 1 January 1990 and 20 September 2023 that presented data on the association between pollen-related AR or pollen exposure and BP or hypertension. We assessed the risk of bias with a customized version of the Risk of Bias tool by the Office of Health Assessment and Translation of the National Toxicology Program (OHAT), conducted random effects meta-analyses of comparable studies and assessed the certainty of evidence according to OHAT recommendations. We carried out sensitivity analyses, excluding studies with a high bias rating.

RESULTS

We identified 24 studies, ranging in sample size from 41 to 9'548'939 participants. Of these, 23 had a cross-sectional design, and the remaining article included both cross-sectional and longitudinal analyses. Investigated exposures were binary pollen-related AR status (23 studies) and within and outside of pollen season (one study), but no study investigated measured pollen exposure (zero studies). Around half of the studies (13/24) were afflicted with high selection and confounding bias. Data from 22 studies using pollen-related AR status as exposure could be included in meta-analysis, to which eleven studies contributed hypertension data, four studies BP data, and seven studies both. In meta-analysis, we found an adjusted odds ratio of 1.16 (95 % confidence interval (CI): 0.91, 1.47) for hypertension and mean differences of 0.99 (95 % CI: -0.09, 2.07) and 0.40 (95 % CI: -0.41, 1.21) for adjusted systolic and diastolic BP, respectively. Results for crude pooled meta-estimates were similar, and none showed statistically significant differences. We rated the overall certainty in the evidence as very low, mainly due to cross-sectional designs, selection and confounding bias and indirectness of exposure.

DISCUSSION

This review shows that there is insufficient evidence to decide whether pollen-related AR is associated with BP or hypertension to date, and therefore does not support a clear mediating role of BP in the relationship between pollen allergy and cardiovascular events. Studies that 1) investigate BP or hypertension as the main outcome and provide adjusted estimates to avoid selection and confounding bias, 2) define AR as solely triggered by pollen and 3) have longitudinal designs were not identified. The certainty of the evidence is therefore limited by (1) reliance on cross-sectional studies, which prevents conclusions about causality, (2) high risk of selection and confounding biases which could not be adjusted for, (3) heterogeneous and indirect definitions of pollen-related AR, and (4) an exclusively binary exposure assessment (with or without pollen-related AR), which limited the ability to study an exposure gradient. Given these limitations, further cross-sectional studies are unlikely to yield clearer results, whereas repeated measurement designs could offer more valuable insights.

OTHER

This review was primarily funded by the Swiss National Science Foundation (SNSF, grant No. 185864) and the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No. 853568). We pre-published the protocol and search strategy on the PROSPERO website (registration number CRD42022381907).

Bro p 3, an nsLTP1: The first major allergen identified in Broussonetia papyrifera pollen

BACKGROUND

Broussonetia papyrifera pollen is an important cause of allergy worldwide, yet its key allergenic components remain unclear. This study aims to identify and characterize the major allergen of B.papyrifera pollen.

METHODS

Patients with allergic rhinitis (AR) symptoms in B.papyrifera pollen season and positive skin prick test (SPT) to B.papyrifera pollen extract were enrolled. Serum sIgE was measured by ImmunoCAP. The pollen crude extract was immunoblotted with patients' sera. The major allergen was purified and subjected to mass spectrometry analysis. The cDNA of the allergen was cloned from a pollen cDNA library. The antigenicity of recombinant allergen was measured by ELISA. Overlapping peptides spanning the allergen were synthesized. Type 2 T cell epitopes were screened using patients' PBMC by IL-4 ELISpot. Cross-reactivity of the allergen was evaluated.

RESULTS

B. papyrifera-sIgE was confirmed in 194 of 201 patients by ImmunoCAP. Bro p 3 was identified as major allergen by immunoblot. We purified, cloned the cDNA of, and determined the full-protein sequence of Bro p 3, an nsLTP1 with an average mass of 10264 Da. Recombinant Bro p 3 (rBro p 3) exhibited identical antigenicity as natural Bro p 3, with sensitization rates of 74.53 % and 78.89 %, respectively. Peptides Pep 7-21, Pep 10-24 and Pep 13-27 stimulated IL-4 secretion by T cells from 8, 9 and 8 out of 11 patients. Bro p 3-sIgE sensitization was significantly correlated to elevated sIgE of B. papyrifera, Morus alba, Morus. rubra, and Humulus scandens. It was also associated with the concurrence of conjunctivitis and conjunctivitis plus asthma. No IgE binding was found to the other two B.papyrifera nsLTPs. Bro p 3 inhibited the IgE binding to M. alba and H. scandens pollen extracts.

CONCLUSIONS

We demonstrated that Bro p 3 is the major allergen of B. papyrifera pollen and the first allergen from this species with its full sequence determined. The I7-R27 peptides of Bro p 3 represent its immunodominant type 2 T cell epitopes. Bro p 3 sensitization is relevant to clinical phenotypes and the cross-reactivity between M. alba, H. scandens and B.papyrifera pollen.

Association of grass pollen concentration and physical symptoms as well as impairments in day-to-day life in pollen allergy patients

Allergic diseases are a major global public health issue, profoundly impacting the daily lives of millions of people worldwide. The aim of this study is to investigate the association between daily grass pollen concentration and daily physical symptoms as well as impairments in day-to-day life in pollen allergy patients in Bavaria, Germany over a period of three-months. Pollen data of the pollen season 2022 were obtained from the electronic pollen information network of Bavaria. We used an app-based questionnaire and developed an index to measure physical symptoms-regarding eyes and nose as well as impairments in day-to-day life including performance, sleep quality and daily activities. For our analyses we used data from 53 patients. The associations were analysed using linear mixed models (LMM). We found a statistically significant association between the level of grass pollen concentration and both the index physical symptoms (β = 0.002; p < 0.001) and the index impairments in day-to-day life (β = 0.00064; p < 0.048). It is important that patients are well informed about the pollen count as well as their physical symptoms and daily life impairments so that they can manage their allergies effectively and appropriately.

Single-cell RNA sequencing reveals immunological link between house dust mite allergy and childhood asthma

Allergic asthma in children is typically associated with house dust mites (HDM) as the key allergen. Nevertheless, the diagnostic rate remains below 60% due to the absence of specific symptoms and diagnostic markers, which hinders the implementation of targeted personalized therapies. This study investigates immunological features of asthma with house dust mite (HDM) sensitisation in children, aiming to uncover diagnostic markers at single-cell resolution. The cohort comprised 8 children with physician-diagnosed asthma (age range: 4-11 years), stratified into groups based on HDM sensitization status. Single-cell RNA sequencing of peripheral blood mononuclear cells (PBMCs) was conducted, employing Seurat for cell identification and differential gene expression analysis. Enrichment analyses and LASSO regression identified signature genes related to cellular origin, with protein-protein interaction networks elucidating cellular communication differences between groups. A total of 11 distinct cell types were identified, with classical monocytes and monocytes being the predominant cell types that differentiated the two groups. Among these, 12 genes were up-regulated, and 40 down-regulated, mainly involving MHC-II complex and antigen presentation pathways, as validated by Gene Ontology and Gene Set Enrichment Analysis. The machine learning model accurately predicted cellular groupings, evidenced by an area under the curve of 0.83. Enhanced communication signals in HDM allergy cases involved monocytes, contrasting with reduced interactions in naive CD8 + cells. HLA-DR and HLA-DP were identified as the primary hallmark receptors, and the innate immunity differences with non-dust mite allergic asthma were characterized by 18 genes including top candidates MT-ND4 and RPS3A. Individuals with HDM-sensitized asthma exhibited altered expression of MHC-II complex genes in their PBMCs and distinct gene expression patterns in antigen-presenting cells, highlighting the critical role of HLA-DR and HLA-DP in the HDM allergen presentation.

Recent Studies and Prospects of Biologics in Allergic Rhinitis Treatment

Allergic rhinitis (AR) is a common and increasingly prevalent chronic inflammatory disorder of the nasal mucosa that severely impacts patients' quality of life, causing symptoms like nasal congestion, sneezing, and itching. AR is primarily mediated by immunoglobulin E (IgE) when allergens are present, making it challenging to manage despite available therapies like pharmacotherapy, immunotherapy, and surgery. Recently, research has focused on biologics as an emerging therapeutic option for AR. Biologics target specific immune pathways in type 2 inflammation, which underlies many allergic diseases including AR. Biologics offer a targeted and potentially more effective alternative to traditional therapies, addressing the underlying immune mechanisms rather than simply alleviating symptoms. Based on key clinical trial evidence, this paper tentatively proposes a multidimensional strategy for selecting biologics in AR, integrating serum IgE levels, disease phenotypes (seasonal/persistent), and comorbid characteristics to guide individualized treatment. However, the long-term cost-effectiveness, optimal dosing regimens, and patient adherence to biologics require further validation through real-world data. Despite these challenges, recent advancements in biologics represent a promising step forward in AR management. With ongoing research and clinical trials, biologics may soon provide more effective and lasting relief for patients suffering from allergic rhinitis.

Dietary advanced glycation end products may increase the incidence of allergic rhinitis depending on genetic susceptibility: a prospective cohort study

Background: Limited evidence exists for the relationship between dietary advanced glycation end product (AGE) intake and allergic rhinitis (AR). Herein, the association between dietary AGEs and the risk of developing AR and whether genetic susceptibility influences the effects of dietary AGEs on AR were explored. Methods: In total, 125 276 participants without AR at baseline and having completed at least two 24-hour dietary recalls from the UK Biobank (2006-2010) were included. Dietary AGEs, specifically Nε-(1-carboxyethyl)-L-lysine (CEL), Nε-(carboxymethyl) lysine (CML), and Nδ-(5-hydro-5-methyl-4-imidazolone-2-yl) ornithine (MG-H1), were quantified by coupling 24-hour food assessments with a validated dietary AGE database. The incidence of allergic rhinitis was determined through hospital admissions. Multivariate Cox regression models were used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) of the association between dietary AGE intake and the risk of AR. Results: During a median follow-up period of 12.4 years, 1171 individuals developed AR. In the fully adjusted model, higher dietary AGEs (HR: 1.27; 95% CI: 1.07, 1.50; P-trend = 0.006) and MG-H1 intake (HR: 1.19; 95% CI: 1.01, 1.41; P-trend = 0.046), especially the dietary AGEs derived from baked foods (HR: 1.23; 95% CI: 1.03, 1.46; P-trend = 0.020) and from nuts and legumes (HR: 1.24; 95% CI: 1.05, 1.47; P-trend = 0.013) were associated with an increased risk of AR. Among participants with a low genetic risk of AR, the HRs (95% CI) of AR were 1.32 (1.01, 1.73) and 1.37 (1.05, 1.79) for dietary AGE and MG-H1 intake, respectively. Conclusions: Dietary AGE intake was associated with an increased risk of AR, which was modified through genetic predisposition.

Innovative surgical approaches for chronic rhinitis: nasal neurectomy mechanisms, techniques, and clinical outcomes

INTRODUCTION

Chronic rhinitis (CR) represents a prevalent, persistent inflammatory condition of the nasal mucosa, substantially impacting patients' quality of life. Despite standard pharmacotherapy, many patients with refractory symptoms do not achieve adequate relief, highlighting the need for alternative interventions such as nasal neurectomy.

AREAS COVERED

Literature was reviewed on the PubMed, EMBASE, and Web of Science databases published from March 1961 to April 2025. Our review discusses the underlying mechanisms, surgical techniques, and clinical outcomes of different nasal neurectomy approaches, including vidian neurectomy, vidian-branch neurectomy, and anterior ethmoidal neurectomy, as well as recent advancements in endoscopic and minimally invasive methods.

EXPERT OPINION

Nasal neurectomy presents a promising alternative for managing refractory CR by directly targeting the neuro-immune pathways that drive symptoms. Understanding the mechanisms, techniques, and clinical outcomes in nasal neurectomy will not only advance our insight into CR pathophysiology but also guide the development of refined, patient-specific surgical strategies for optimal outcomes.

Impact of Vitamin D3 Supplementation on Symptom Severity & IgE in Persistent Allergic Rhinitis

The potential for vitamin D₃ supplementation as adjunctive therapy in allergic rhinitis (AR) management remains a topic of considerable interest. Studies have investigated the relationship between serum vitamin D levels and AR severity, with conflicting results. To evaluate the impact of vitamin D₃ supplementation on symptom severity and IgE levels in patients with persistent allergic rhinitis (AR), and to assess the role of sustained supplementation in achieving long-term benefits. A randomized, double-blind, prospective interventional study was conducted at a teaching institute in India with 600 AR patients randomized into three groups: Group A (intranasal corticosteroids and placebo), Group B (intranasal corticosteroids and vitamin D₃ supplementation with maintenance doses), and Group C (intranasal corticosteroids and vitamin D₃ without maintenance doses). A control group of 200 healthy individuals was also included. Vitamin D₃, IgE levels, and Total Nasal Symptom Score (TNSS) were measured at baseline, 2 months, and 6 months. At baseline, 81.66% of AR patients had suboptimal vitamin D₃ levels compared to 65% in the control group. Group B showed the most significant improvement in vitamin D₃ levels, with 80% achieving normal levels by 6 months. TNSS and IgE levels also improved significantly in Group B, with sustained reductions compared to Groups A and C (p < 0.001). Group C showed a rebound in symptoms and IgE levels after discontinuation of supplementation. Sustained vitamin D₃ supplementation significantly improves symptom severity and IgE levels in patients with persistent AR. These findings suggest vitamin D₃ as a promising adjunct to standard AR treatment.

Allergic rhinitis and urticaria burden and antihistamine treatment options in Thailand: A modified Delphi study

Background

Allergic rhinitis (AR) and chronic urticaria impose significant socioeconomic burdens on lower-income countries. Despite the availability of evidence-based guidelines, their implementation varies, and comprehensive data on these allergic conditions are notably lacking in Thailand.

Objectives

We sought to describe current management strategies for AR and urticaria in Thailand.

Methods

The Allergy, Asthma, and Immunology Association of Thailand used a modified Delphi method to explore consensus on management strategies for AR and urticaria. Clinicians with expertise in these conditions provided input through a web-based questionnaire. The survey assessed disease burden in Thailand, its impact on quality of life, and the use of H1-antihistimine treatment options.

Results

In total, 105 experts, mainly in allergy and immunology, with 70% having more than 10 years of clinical practice, provided input. Consensus was achieved on 22 (88%) of the 25 statements. Second-generation antihistamines were preferred as initial treatment for AR and urticaria because of their reduced sedation and lack of anticholinergic effects. Almost all participants (98.1%) recommended these antihistamines for acute and chronic urticaria. Additionally, 87.6% of the respondents favored up-dosing a single antihistamine agent for managing chronic urticaria. The benefits of orally disintegrating antihistamines were particularly noted for their ease of administration and patient compliance.

Conclusion

Results indicate a knowledge gap in evidence-based practices among Thai clinicians. Addressing this gap through enhancing clinical guideline adherence and encouraging pharmacist involvement in patient care can improve access to medication and better disease management, ultimately improving patient outcomes while reducing the socioeconomic burden of AR and urticaria.

Metabolomic profiles in allergic rhinitis: A systematic review and meta-analysis

BACKGROUND

Allergic rhinitis (AR) is a prevalent chronic inflammatory condition that significantly affects patient quality of life and poses a substantial public health burden. Recent advancements in metabolomics have facilitated a deeper understanding of the metabolic pathways involved in AR, offering potential for new biomarkers and therapeutic targets.

OBJECTIVE

To conduct a systematic review and meta-analysis of clinical studies summarizing the metabolomic profiles of AR to gain deeper insights into the metabolic changes and pathologic processes underlying AR.

METHODS

A comprehensive literature search was conducted across PubMed, Embase, Scopus, and Web of Science databases up to October 2024. A qualitative review of the screened studies was performed, followed by meta-analyses of metabolites reported in at least 2 studies. High-impact targets, pathways, and their associations were identified using bioinformatic analyses.

RESULTS

A total of 21 studies, encompassing 84 metabolites associated with AR, met the inclusion criteria. There were 7 metabolites that consistently exhibited up-regulation in AR across multiple studies and were included in the meta-analysis. Pathway enrichment analyses revealed significant involvement of pathways such as "valine, leucine, and isoleucine biosynthesis" and "linoleic acid metabolism" in AR pathogenesis. The metabolite-pathway-gene network analysis highlighted key functional connections between metabolites, pathways, and immune response genes.

CONCLUSION

This comprehensive analysis indicates that differential metabolites may play pivotal roles in AR pathogenesis, offering potential biomarkers and therapeutic targets. Further studies are necessary to validate these findings and elucidate the complex metabolic pathways involved in AR.

Restoration of IFN-γ-Producing MAIT Cell Correlates to Beneficial Allergen Immunotherapy in Allergic Rhinitis Patients

BACKGROUND

Mucosal-associated invariant T cells (MAIT) are emerging as important regulators at mucosal surfaces. While these cells have been linked to a Th1-biased immune response and support for B cells, their roles in allergic diseases characterised by type 2 inflammation remain elusive. The study seeks to characterise MAIT cells in house dust mite (HDM)-induced allergic rhinitis (AR) and subsequent allergen immunotherapy (AIT), aiming to elucidate their clinical significance in AR and potential to enhance AIT effectiveness.

METHODS

MAIT cells were assessed in patients with AR and individuals undergoing AIT. The ratio and cytokine-producing capacity of these cells were analysed to explore their correlations with AR progression and their responsiveness to HDM extracts and MAIT cell-specific agonists.

RESULTS

In AR patients, there was an increase in the ratios of circulating MAIT cells and tonsil follicular T helper-like MAIT cells, alongside a decrease in the IFN-γ-producing MAIT cells. AIT restored their IFN-γ producing capacity, which was further boosted by T cell receptor (TCR) activation using MAIT cell-specific agonist-loaded artificial antigen-presenting cells (aAPCs). Synergistic effects of aAPCs and HDM enhance MAIT cell activation and IFN-γ production while reducing HDM-induced IgE levels in PBMC cocultures. Moreover, higher ratios of MAIT cells and IFN-γ-producing MAIT cells correlated with decreased IgE and increased IgG4 and improved clinical outcomes during AIT.

CONCLUSIONS

These findings underscore the compromised IFN-γ-producing MAIT cells in AR and their restoration following AIT and TCR stimulation, highlighting the cell's therapeutic potential and predictive value for clinical outcomes in AR and AIT.

Clinical efficacy of sublingual immunotherapy for allergic rhinitis and atopic cough: 5-year real-world surveillance

PURPOSE

Atopic cough (AC) is a prevalent allergic condition, frequently observed in children with allergic rhinitis (AR) seeking treatment at our clinical department. Hence, the primary objective of this study was to assess the effectiveness and safety of house dust mite (HDM)-sublingual immunotherapy (SLIT) in managing AC, offering a novel therapeutic strategy for its treatment.

MATERIALS AND METHODS

This retrospective study enrolled 103 children diagnosed with AR and AC. Among them, 55 children underwent a 3-year course of SLIT (SLIT group), while 48 children received only symptomatic drug therapy (control group). Treatment initiation for both groups was in 2019, with annual on-site follow-up visits conducted until 2024 to evaluate treatment efficacy and safety. The comparison of efficacy evaluation indicators between the SLIT group and the control group encompassed the total nasal symptoms score (TNSS), daytime cough symptom score (daytime CSS), nighttime cough symptom score (nighttime CSS), cough evaluation test (CET) score, the total medication score (TMS), and visual analogue scale (VAS) score. Furthermore, the long-term efficacy of a 3-year SLIT treatment was evaluated. Safety was assessed based on adverse events (AEs).

RESULTS

All efficacy indicators exhibited no significant differences at baseline (all p > 0.05). The TNSS in the SLIT group demonstrated a significant reduction compared to baseline across the study period (2019-2024) (all p < 0.001). In contrast, the decrease in TNSS in the control group was less pronounced than in the SLIT group, with a noticeable rebound in 2024. Regarding AC assessment, the daytime/nighttime CSS in the SLIT group remained consistently lower both during the SLIT treatment phase and post-SLIT discontinuation, while the control group displayed a rebounding trend, albeit without statistical significance (p > 0.05). Furthermore, CET score in the SLIT group remained consistently low from the initiation of SLIT treatment until 2024, whereas the control group experienced a significant rebound (p < 0.001), indicating deteriorating cough symptoms. In the comprehensive evaluation of treatment efficacy, a significant decrease in TMS and VAS score was observed in the SLIT group throughout the study duration (all p < 0.001), whereas the control group exhibited varying degrees of rebound in TMS and VAS score in 2023 and 2024.

CONCLUSION

Compared to treatment with symptomatic medication alone, a 3-year course of HDM-SLIT exhibited superior efficacy in managing AC, both during the treatment period and following treatment discontinuation.

Interactions among Cupressaceae pollen, air pollutants and meteorology in the urban and suburban areas of Beijing, China

Atmospheric pollutants alter the physicochemical properties of pollen allergens, and raise a high risk of co-exposure to more aeroallergens in the allergic population. It is necessary to reveal the relationships between them and the impacts of meteorology on them both. Herein, synchronous data of aerobiology, pollution and meteorology at the same location are used to investigate the correlation between Cupressaceae pollen (major allergen in Norther China) and atmospheric pollutants, and their association with meteorological factors at different timescales in the urban and suburban areas of Beijing, China. In this research, the correlation between allergenic pollen, air pollutants and meteorological factors may display distinct patterns at daily and hourly timescales. Daily concentration of Cupressaceae pollen was positively correlated with PM2.5 and O3. Hourly pollen concentration exhibited positive correlation with NOx and PM2.5 during high-pollen episodes. Increasing temperature and decreasing relative humidity after sunrise facilitate pollination, causing hourly pollen peak. Temperature exhibited a strong positive correlation with daily and hourly O3 concentrations. Highly humid conditions largely decreased allergenic pollen and O3 concentrations but increased NOx and PM2.5 concentrations. In the urban area, local winds considerably impacting on hourly pollen peaks were associated with high levels of NOx and PM2.5. Concentration weighted trajectory (CWT) results indicated that allergenic pollen and O3 may have some common potential source areas. This research will help us to get a better understanding of the linkage between allergenic pollen and air pollutants, and their dynamics under varying meteorological conditions, and provide effective support on addressing respiratory allergies on the risk of co-exposure for allergenic pollen and air pollutants in the urban and suburban areas of Beijing city.

Eosinophils and pleural macrophages counter regulate IL-33-elicited airway inflammation via the 12/15-lipoxygenase pathway

Introduction

Fatty acid metabolism plays a crucial role in regulating airway inflammation through the synthesis of lipid mediators. We have previously demonstrated that a 12/15-lipoxygenase (12/15-LOX or Alox15)-derived mediator attenuates IL-33-induced eosinophilic airway inflammation in mice. However, the cellular sources of these mediators remain unclear.

Methods

To identify the cellular sources, we used several cell type-specific conditional 12/15-LOX-deficient mice.

Results

We found that eosinophils and pleural macrophages were the major 12/15-LOX-expressing cell types responsible for attenuating airway inflammation. Eosinophils were the major population of 12/15-LOX-expressing cells found in inflamed lung tissue. In addition, pleural macrophages were the major population of 12/15-LOX-expressing cells in the thoracic cavity and were found to translocate into inflamed lung tissue in response to airway inflammation.

Discussion

This study suggests that eosinophils and pleural macrophages cooperatively regulate eosinophilic airway inflammation via 12/15-LOX expression. Targeting 12/15-LOX metabolism in these cells may offer new therapeutic strategies for severe asthma.

The Effect of Environmental Factors, Health Behaviors, and Psychosocial Aspects on Allergic Diseases in Korean Adolescents

Background and Objectives: Adolescence is a critical period of physical and mental development, yet allergic diseases are often poorly managed. Factors such as sleep deprivation, obesity, smoking, and mental stress can worsen allergic conditions and complicate treatment. This study examines the environmental, behavioral, and psychosocial factors influencing allergic diseases in Korean adolescents using data from the Korean National Health and Nutrition Examination Survey (KNHNES). Materials and Methods: From the 25,534 participants in the Fifth KNHNES, 1630 adolescents (aged 13-18 years) were selected. We analyzed demographic and lifestyle factors, including gender, age, housing type, family size, economic status, obesity, tobacco and alcohol use, sleep duration, and physical activity. Psychosocial factors such as stress perception, suicidal ideation, depressive symptoms, mental health counseling, and self-rated health were also examined. Results: The prevalence rates of allergic diseases were 23% for allergic rhinitis (AR), 11% for atopic dermatitis (AD), and 9.8% for asthma (AS), with 35.8% of adolescents having at least one allergic condition. Smoking was significantly associated with AS (odds ratio [OR] 1.753, p = 0.006), while shorter sleep durations increased AR risk (p = 0.000). Male adolescents had a lower risk of AD (OR 0.706, p = 0.046), and high economic status was inversely correlated with AD (OR 0.445, p = 0.006). Positive self-rated health was linked to lower AS risk (OR 0.447, p = 0.000). AR was significantly associated with male gender (OR 1.391, p = 0.045), high economic status (OR 1.784, p = 0.026), and high stress perception (OR 1.479, p = 0.013). Conclusions: Low self-rated health and high stress perception have been identified as risk factors for allergic diseases during adolescence. Integrating psychosocial counseling with medical treatment may improve management and outcomes.

Stapokibart for moderate-to-severe seasonal allergic rhinitis: a randomized phase 3 trial

Seasonal allergic rhinitis (SAR) places a significant socioeconomic burden, particularly on individuals with poorly managed recurrent and severe symptoms despite standard-of-care treatment. Stapokibart, a humanized monoclonal antibody that targets the interleukin (IL)-4 receptor subunit alpha, inhibits its interaction with both IL-4 and IL-13 in type 2 inflammation. Here we aim to assess the efficacy and safety of stapokibart as an add-on therapy in adults with moderate-to-severe SAR. The study was a phase 3 multicenter, randomized, double-blind, placebo-controlled clinical trial with 108 patients diagnosed with moderate-to-severe SAR and having baseline blood eosinophil counts ≥300 cells μl-1. Participants were randomized (1:1) to receive 600 mg (loading dose) to 300 mg stapokibart subcutaneously or a placebo every 2 weeks for 4 weeks. The primary endpoint was mean change from baseline in daily reflective total nasal symptom score (rTNSS) over the first 2 weeks. Multiplicity-tested secondary endpoints included changes in rTNSS over 4 weeks, reflective total ocular symptom score and Rhinoconjunctivitis Quality of Life Questionnaire score over 2 weeks and 4 weeks. Compared with the placebo, stapokibart led to a significant improvement in the mean change from baseline in daily rTNSS during the 2-week (least-squares mean difference, -1.3; 95% confidence interval, -2.0 to -0.6; P = 0.0008) and 4-week (least-squares mean difference, -1.7; 95% confidence interval, -2.5 to -0.8; P = 0.0002) treatments. Stapokibart significantly improved the multiplicity-tested secondary endpoints. Treatment-emergent adverse events were comparable between the groups. Pharmacodynamics and exploratory analyses indicated that the observed improvements in outcomes during pollen season may be attributed to the reduction of type 2 inflammation in response to stapokibart treatment. The results of this trial show that pollen seasonal administration of stapokibart improved both nasal and ocular symptoms and quality of life in patients with moderate-to-severe SAR. ClinicalTrials.gov registration: NCT05908032 .

LPCAT1 reduces inflammatory response, apoptosis and barrier damage of nasal mucosal epithelial cells caused by allergic rhinitis through endoplasmic reticulum stress

Allergic rhinitis (AR), common in children and adolescents, involves Lysophosphatidylcholine acyltransferase 1 (LPCAT1) catalyzing surfactant lipid biosynthesis and suppressing endoplasmic reticulum expression. However, the precise mechanism underlying the impact of LPCAT1 on epithelial cell damage in AR remains elusive. Hence, the present investigation elucidated the potential effect of LPCAT1 on epithelial cell damage in AR by inhibiting endoplasmic reticulum stress. To assess cell viability, CCK8 assay was employed. Additionally, western blotting was utilized to evaluate the expression of endoplasmic reticulum stress-associated proteins ATF6, CHOP, p-eIF2α, p-IRE1, and LPCAT1. Subsequently, an interference plasmid targeting LPCAT1 was constructed, and western blot analysis was conducted to determine interference level of LPCAT1. An ELISA assay was employed to quantify the concentrations of TNFα, IL-1β, IL-6, GM-CSF, and eotaxin. Additionally, flow cytometry and western blotting techniques were utilized to evaluate cellular apoptosis, whereas immunofluorescence staining was applied to detect the expression levels of ZO-1. Our findings indicated that IL-13 stimulation resulted in an elevated expression of ER stress proteins and LPCAT1 in nasal mucosal epithelial cells. Furthermore, LPCAT1 interference diminished the expression of inflammatory mediators, apoptosis markers, barrier disruption indicators, and ER stress proteins in IL-13-stimulated nasal mucosal epithelial cells. Further, by inhibiting ER stress, LPCAT1 interference diminished the expression of inflammatory factors, apoptosis, and barrier damage in nasal mucosal epithelial cells stimulated by IL-13. Concisely, LPCAT1 ameliorates AR-induced inflammation, apoptosis, and barrier impairment in nasal mucosal epithelial cells by modulating ER stress, implying its potential as a novel therapeutic target for AR.

A Streamlined Treatment Algorithm for Allergic Rhinitis in the Arab Region: Expert Panel Opinion

Allergic rhinitis (AR) is a prevalent atopic condition that is frequently misdiagnosed, mistreated, or overlooked, despite its high prevalence and significant economic burden. Pharmacotherapy effectively controls symptoms in the majority of cases; however, the current local guidelines and recommendations are ambiguous regarding the initiation and cessation of combined antihistamines and intranasal corticosteroids treatment. Additionally, guidelines do not specify the duration of AR therapy or identify cases eligible for combination therapy. In contrast, the current era emphasizes personalized medicine, which considers genetic variants that may clinically alter the tolerance and intended outcome of specific drugs. Moreover, there has been a noticeable surge in the number of individuals affected by AR in the Arab region. A systematic treatment algorithm tailored to the Arab region's population is urgently needed. This consensus outlines the recommendations of experts from three scientific meetings that gathered specialists in otolaryngology, pediatrics, and immuno-allergology from Egypt, Tunisia, the Kingdom of Saudi Arabia, and the United Arab Emirates. The expert panel opinion encompassed pre-meeting surveys followed by discussions about diversified topics related to AR management in the Arab region, including AR diagnosis and disease characteristics, patient profiling, and conventional and advanced treatment options. The experts developed a streamlined algorithm to enhance decision-making for AR treatment in Arab countries, based on discussions and a comprehensive literature review. To our knowledge, this manuscript presents the first region-specific, consensus-based management algorithm tailored to the Arab region, addressing unique local considerations.

Safety and onset time of modified Yupingfeng nasal spray versus mometasone furoate nasal spray on house dust mites-induced moderate to severe allergic rhinitis: A prospective, multicenter, randomized, open-label, parallel-group clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

House dust mite (HDM)-induced allergic rhinitis (AR) is a significant global health issue, leading to considerable illness and disability worldwide. In traditional Chinese medicine, Modified Yupingfeng Nasal Spray (MYN) is believed to support defense systems, and regulate immune defense systems.

AIM OF THE STUDY

Previous research has shown that both MYN and mometasone furoate nasal spray (MFN) can alleviate symptoms of HDM-induced AR. However, the safety and onset time of MYN compared to MFN for treating HDM-induced AR remain unclear. This study aimed to explore the onset time, safety, and potential mechanisms of MYN and MFN in the treatment of HDM-induced AR.

METHODS

In a multicenter, randomized, open-label, parallel-arm trial, 207 patients with AR who tested positive for HDMs allergens (≥2+) were randomly assigned to receive either MYN or MFN treatment. The primary endpoint was the onset time of AR remission. Additionally, 9 patients were randomly selected from each group to investigate potential mechanisms.

RESULTS

Compared to MFN (12.05 ± 1.07 days), MYN (21.56 ± 1.92 days) had a slower onset time in controlling AR symptoms. However, there was no significant difference in cumulative remission of AR between MYN and MFN after 77 days of treatment. At the end of the study, no significant difference in disease control rates was observed between MYN (89.00%) and MFN (96.04%) (P > 0.05). MYN treatment significantly increased PTEN mRNA levels in nasal mucosal epithelial cells and serum IL-10, while reducing NF-κΒ and TSLP levels in nasal lavage fluid, as well as serum IL-6 and TNF-α (P < 0.05).

CONCLUSIONS

Both MYN and MFN effectively reduce AR symptoms; however, MFN acts more quickly than MYN in relieving these symptoms, while MYN is associated with fewer side effects. The therapeutic effects of MYN may be linked to the regulation of the PTEN/NF-κB/TSLP signaling pathway.

Hotspots and Trends in Allergic Rhinitis Nasal Mucosa Studies: A Bibliometric Analysis (2010-2024)

Purpose

This study aims to conduct a bibliometric and visual analysis of the research on the nasal mucosa in allergic rhinitis (AR) and to explore its emerging trends, hotspots, and future development.

Methods

We comprehensively searched the Web of Science Core Collection (WoSCC) for literature related to the nasal mucosa in AR published between 2010 and 2024. Bibliometric and visual analyses were performed using CiteSpace, VOSviewer, and the R language.

Results

A total of 1124 relevant articles were included in this study, and the analysis showed that the number of articles in this field has been increasing year by year. China dominated the article output, followed by South Korea and Japan. American Journal of Rhinology & Allergy (69 articles) topped the list of publications; keyword analysis showed that "immune response", "inflammatory response", "autophagy", "NLRP3 inflammasome", and "miRNAs" are hotspots in this field.

Conclusion

Over the past decade, research related to the nasal mucosa in AR have gained growing interest. This study is the first to use visualization software and data mining information to conduct a bibliometric analysis in this particular field, thereby providing fresh perspectives on the research terrain.

Climate Change and Allergens: Current and Future Impacts

Climate change will continue to impact allergic diseases in direct and indirect ways. Rising global temperatures are contributing to increased duration of pollen seasons, altered aeroallergen production and potency of allergens, and changes in the geographic distribution of allergenic plants that drive increased human exposure to aeroallergens and increased allergic disease morbidity. Climate change is inextricably linked with air pollution, the latter of which was shown to act as an adjuvant for allergic inflammatory processes promoting allergic sensitization. Pollutant exposure is also linked with higher prevalence of childhood asthma and exacerbation of existing asthma and allergic disease. Increased exposure, or co-exposure, to aeroallergens and air pollution as a result of climate change will result in higher rates of sensitization, and incident allergic disease remains uncertain. Vulnerable populations, including children, the elderly, and marginalized groups, are likely to be disproportionately affected. This review summarizes the current knowledge of the effects of climate change on aeroallergens, and by extension, allergic disease. Addressing these health challenges requires a comprehensive understanding of the interaction between climate change, allergens, pollution and public health, alongside proactive measures to mitigate these effects.

A Delphi consensus on diagnosis, management, and treatment with allergen immunotherapy of polysensitized children in Spain: CAPP study, Part 1

BACKGROUND

The study aimed to evaluate the level of agreement between specialists in pediatric allergology regarding the diagnosis and indications for pollen allergen immunotherapy (AIT) of polysensitized children in Spain.

MATERIALS AND METHODS

A Delphi study was performed using an online survey designed by a committee of pediatric AIT experts: 46 and 44 panelists participated in rounds 1 and 2, respectively. In round 1, 204 statements on 8 dimensions were evaluated (Diagnosis; Therapeutic management; Pollens - Part I; Mites; Moulds; Animals; Hymenoptera venom; and Mixtures - Part II). A total of 148 statements were finally accepted after round 2. Panel members rated their level of agreement with assessments on a 9-point Likert scale based on acceptance by ≥ 66.7% of them.

RESULTS

According to the results, the polysensitization determination in allergic patients is confirmed by clinical history, skin prick test, total and specific IgE, and molecular diagnostics. Clinical assessments are recommended for the AIT effectiveness evaluation. Follow-ups should be performed 6 months after AIT initiation. According to experts, pollens are the most representative allergens in allergic rhinitis but AIT is more effective in bronchial asthma treatment. The IgE levels are positively related to the intensity of the symptomatology and the efficacy of Grass AIT. In pollen mixtures, a maximum mixture of three AIT allergens is established between Grass, Olive, and Cupressaceae. Mixing pollen from Platanus acerifolia and Parietaria is not recommended.

CONCLUSIONS

This study provides, where evidence is lacking, current expert-based opinions on clinical decision-making for managing pollen AIT in polysensitized children.

Correlation between peripheral blood iNKT cell levels and exhaled NO in patients with allergic rhinitis

OBJECTIVES

This study aimed to investigate the relationship between the frequency of CD3 + TCRVα24 + iNKT cells, the proportions of iNKT CD4+, iNKT CD8 + and iNKT CD4-CD8- (DN) subgroups in peripheral blood, and nasal exhaled nitric oxide (NO) levels in patients with allergic rhinitis (AR).

METHODS

Peripheral blood samples were collected from 40 AR patients and 40 patients with nasal septal deviation (DNS). The frequencies of the iNKT cell subgroups were analyzed, and nasal exhaled NO levels were measured. Correlation analyses were conducted to assess the associations between these parameters..

RESULTS

The frequency of CD3 + TCRVα24 + iNKT cells was significantly higher in the AR group (0.4863 % ± 0.0874 %) compared to the DNS group (0.4451 % ± 0.0603 %) (p < 0.05). The proportions of iNKT CD4+, iNKT CD8+, and iNKT CD4-CD8- (DN) cells in the AR group were 76.32 % ± 10.24 %, 12.71 % ± 4.34 %, and 11.08 % ± 6.29 %, respectively, while in the DNS group, they were 60.79 % ± 9.04 %, 13.81 % ± 5.56 %, and 25.56 % ± 6.45 %. Significant differences were observed in the proportions of iNKT CD4+ and iNKT CD4-CD8- (DN) cells between the two groups (p < 0.01). Nasal exhaled NO levels were significantly elevated in the AR group (842.33 ± 237.88 ppb) compared to the DNS group (527.37 ± 163.57 ppb, p < 0.01). In the AR group, nasal exhaled NO levels showed a strong positive correlation with the frequency of iNKT cells (r = 0.9, p < 0.01), the iNKT CD4+ subgroup (r = 0.93, p < 0.01), and a negative correlation with the iNKT CD4-CD8- (DN) subgroup (r = -0.877, p < 0.01). These findings suggest that elevated iNKT cells, particularly the iNKT CD4+ subgroup resembling T helper 2 (Th2) cells, may contribute to AR pathogenesis.

CONCLUSIONS

The significant correlations between iNKT cell subgroups and nasal exhaled NO levels highlight the role of iNKT cell variations in NO-mediated AR pathogenesis. These findings also suggest the potential diagnostic value of analyzing iNKT cell profiles in AR patients.

Determination of the Bioavailability of 3 Intranasal Formulations of Azelastine Hydrochloride in Healthy Male Volunteers

The primary objective of the study was to determine the bioavailability of 2 new formulations of azelastine (AZE) hydrochloride (0.10% and 0.15% AZE) containing sorbitol and sucralose compared with the commercially available 0.10% AZE. This study was performed in healthy volunteers based on the pharmacokinetic parameters maximum plasma concentration and area under the plasma concentration-time curve from time zero to the last measurable concentration. This was a Phase 1, open-label, single-center, randomized, parallel-group study. Subjects were randomized to 1 of 3 treatment groups: (1) 0.10% AZE (treatment A), (2) 0.15% AZE (treatment B) (Groups 1 and 2 both containing sorbitol and sucralose), and (3) the commercially available 0.10% AZE (treatment C). A total of 54 subjects were randomized and received treatment A, B, or C. Maximum plasma concentration and area under the plasma concentration-time curve were similar when compared in treatments A and C (0.1%) for AZE and its metabolite, desmethylazelastine. The most frequently reported adverse events were rhinorrhea (5.6%) and sneezing (5.6%).

Stapokibart (CM310) in patients with uncontrolled seasonal allergic rhinitis (PHECDA): Rationale and design of a multicentre, randomized, double-blind, placebo-controlled study

Background

Seasonal allergic rhinitis (SAR) is a global health issue, and the current standard of care (SoC) has limited effectiveness in controlling the disease. There is a need for innovative treatments to better manage uncontrolled SAR and advance beyond the uniform SoC, and biologics targeting type 2 inflammation driving allergic rhinitis is promising.

Objective

To evaluate the efficacy and safety of Stapokibart, a humanized monoclonal antibody targeting interleukin-4 receptor subunit alpha, as an add-on therapy in patients with uncontrolled SAR.

Methods

The PHECDA is a multicenter, randomized, double-blind, placebo-controlled, phase 3 clinical study designed to evaluate the efficacy and safety of Stapokibart in treating uncontrolled SAR in adults. Conducted across 18 centers in China during the pollen season, the study plans to recruit 108 adult patients with moderate to severe nasal symptoms despite receiving SoC during the previous seasonal pollen period, along with a 1-week run-in period and a baseline blood eosinophil count of at least 300 cells·μL-1. The study consists of a screening/run-in period (1 week), treatment period (4 weeks), and follow-up period (8 weeks). In addition to SoC, which includes mometasone furoate nasal spray and loratadine, participants are randomly assigned using a centralized interactive-web-response-system to receive either subcutaneous Stapokibart 600 (loading dose)-300 mg or a placebo every 2 weeks for 4 weeks. The primary endpoint of the study is the mean change from baseline in the daily reflective total nasal symptom score over the first 2 weeks of treatment. Subjects who have been administered at least 1 dose of the investigational drug will be included in the assessments of both efficacy and safety.

Results

This article outlines the methodology utilized in a multicenter trial studying Stapokibar for seasonal allergic rhinitis, with expectations to discuss its significant effects in subsequent analyses based on trial outcomes.

Conclusion

The PHECDA study is for the first time to provide insight into the efficacy and safety of a seasonal add-on Stapokibart for patients with uncontrolled SAR during pollen exposure.

Trial registration

NCT05908032.

Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) Written Allergic Rhinitis Questionnaire for phone survey in children aged 6‒7 years

OBJECTIVE

To validate and assess the reproducibility of the ISAAC Written Allergic Rhinitis Questionnaire (WARQ) for children aged between 6 and 7 years by telephone contact.

METHODS

Observational study through interviews with guardians of children aged 6-7 years using the ISAAC Allergic Rhinitis (AR) module questionnaire in three different phases separated by 2 weeks each: telephone interviews in the first and third contacts and face-to-face interviews, with the same guardian of telephone interviews, in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients.

RESULTS

Data from 94 children (48 from the allergic rhinitis Control Group ‒ CG) were analyzed. Reproducibility showed perfect agreement (100%) for the question number 1 - Which refers to the symptoms of AR, ever: "Has your child ever had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?" and for the question number 2 - Which refers to current symptoms of AR: "In the past 12 months, has your child had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?" A strong agreement was also observed for the question number 3 (κ = 0.871) - it defines the presence of comorbidity of allergic rhinoconjuntivitis "In the past 12 months, has this nose problem been accompanied by itchy-watery eyes?" The validation showed high specificity (≥76.7%) and sensitivity (≥98%) for all questions, except for the ones related to seasonality and intensity of symptoms.

CONCLUSIONS

Our results showed that the ISAAC AR module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of AR. It may be an appropriate alternative tool in epidemiological studies of childhood AR, especially in periods of social isolation, such as Coronavirus pandemic.

LEVEL OF EVIDENCE

Cohort Study.

LEVEL IV

Short-course subcutaneous treatment with birch pollen allergoids greatly improves symptom and medication scores in birch allergy

BACKGROUND

Subcutaneous immunotherapy has emerged as an effective option for treating allergic diseases. Here, we assessed the clinical impact of the mannan-conjugated birch pollen polymerized allergoid T502 in birch pollen-induced allergic rhinoconjunctivitis.

METHODS

In this prospective, randomized, double-blind placebo-controlled phase III trial, 298 birch pollen-allergic adult patients were treated across 28 trial sites in Germany. Patients received either placebo or 23,000 mTU T502 subcutaneously over five pre-seasonal visits. Efficacy was assessed by comparing the combined symptom and medication score (CSMS) between placebo and T502 during the peak birch pollen season 2022. Safety, tolerability and immunologic effects were also analyzed.

RESULTS

During the peak birch pollen season, the median CSMS of the T502 group was reduced by 33% (p = 0.002) compared to placebo. The median daily symptom score and daily medication score were reduced by 30.4% (p < 0.001) and 56.3% (p = 0.045), respectively. Health related quality of life improved as reflected by reduction of RQLQ values by 31.5% (p < 0.0001). Production of Bet v 1 sIgG4 and Bet v 1 sIgG increased up to 6.2-fold and 3-fold respectively in the T502 group (p < 0.0001). The sIgE/sIgG4 ratio was strongly reduced in the T502 group at V7 (-62.9%, p < 0.0001). No fatalities nor serious adverse events were reported. In total, 16 systemic allergic reactions occurred (Grade I/II).

CONCLUSIONS

Treatment with T502 significantly reduced symptoms and medication need in rhinoconjunctivitis patients. The treatment is well tolerated and safe.

WAO - ARIA consensus on chronic cough: Executive summary

Acute cough is a highly prevalent symptom in clinical practice. Chronic cough is a complex disease with significant impact on quality of life. The mechanistic pathways of chronic cough in cough-comorbid clinical phenotypes are elusive. Mounting evidence suggests presence of a hypersensitive cough reflex and implication of transient receptor potential channels and P2X receptors in cough neuronal pathways. Previously, the World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough published updated experimental and clinical data on chronic cough, in addition to a multidisciplinary care pathway approach to its management. The goal of this manuscript is to provide clinicians with a succinct summary of chronic cough pathophysiology, clinical phenotypes, and management strategies in both primary and cough specialty care. This executive summary is a primer for clinicians on chronic cough. Increasing awareness on the topic among primary care physicians will improve the outcome of management of patients with chronic cough.

The SQ tree sublingual immunotherapy tablet is effective and well tolerated in children-A pivotal phase III trial

BACKGROUND

Allergic rhinitis and/or conjunctivitis (AR/C) induced by tree pollen is common and negatively impacts quality of life in children and adolescents. This phase III trial investigated the efficacy and safety of the SQ tree SLIT-tablet in a paediatric population (5-17 years) with moderate-to-severe AR/C induced by pollen from birch and trees in the birch homologous group.

METHODS

Nine hundred and fifty-two subjects were randomized (1:1) to daily treatment with SQ tree SLIT-tablet or placebo for up to 52 weeks and had free access to AR/C symptom-relieving medications. The primary endpoint was the average total combined score (TCS); sum of average daily symptom score (DSS) and average daily medication score (DMS) during the birch pollen season (BPS). Key secondary endpoints included average DSS and DMS during BPS and average TCS, DSS and DMS during tree pollen season (TPS).

RESULTS

SQ tree SLIT-tablet demonstrated a statistically significant and clinically relevant treatment effect compared with placebo for the TCS during BPS with an absolute treatment difference of 1.29 (95% CI: 0.58, 2.00; p = .0004) and a relative reduction of 21.9% (95% CI: 10.6, 31.9). Results were substantiated by reductions in both DSS and DMS versus placebo during the BPS and in DSS, DMS and TCS during the TPS. Treatment was generally well tolerated. Most treatment-related adverse events were mild or moderate local administration site reactions.

CONCLUSION

This is the first paediatric trial to provide robust evidence of efficacy and safety of the SQ tree SLIT-tablet in tree pollen-induced AR/C in a paediatric population (5-17 years).

Efficacy and safety of azelastine hydrochloride and fluticasone propionate nasal spray in treating allergic rhinitis: A randomized controlled trial

Background

MP-AzeFlu (Dymista; Meda Pharma GmbH & Co., KG), a formulation combining azelastine hydrochloride and fluticasone propionate in a single spray, is superior to fluticasone propionate alone in relieving symptoms and improving the quality of life of patients with allergic rhinitis.

Objectives

In this study, we evaluated whether the effect of AzeFlu, a generic drug manufactured from China, is equivalent to that of MP-AzeFlu.

Methods

In total, 679 patients were recruited for a multicentre, randomized, double-blind, original drug-controlled, and parallel-group clinical trial. Overall, 339 and 340 patients were administered with AzeFlu and MP-AzeFlu, respectively. Efficacy was assessed by changes in the reflective total nasal symptom score, the area under the curve of reflective total nasal symptom score changes over time, changes from baseline in individual nasal symptom scores, and the Rhinoconjunctivitis Quality of Life Questionnaire. In addition, a safety evaluation was simultaneously performed.

Results

AzeFlu and MP-AzeFlu reduced the reflective total nasal symptom score from baseline (AzeFlu -6.7 [standard deviation, 2.59]; MP-AzeFlu -6.7 [standard deviation, 2.76]; P = 0.905) and improved nasal symptoms and quality of life (AzeFlu -62.3 [standard deviation, 33.59]; MP-AzeFlu -64.7 [standard deviation, 33.73]; P = 0.394) in patients with allergic rhinitis. Significant differences were not observed between groups.

Conclusion

AzeFlu showed effects equivalent to those of MP-AzeFlu in this clinical trial and may benefit Chinese patients with allergic rhinitis.Registration number: CTR20190189 (chinadrugtrials.org.cn/index.html).

In-silico exploring pathway and mechanism-based therapeutics for allergic rhinitis: Network pharmacology, molecular docking, ADMET, quantum chemistry and machine learning based QSAR approaches

Allergic rhinitis is a devastating health complication that interrupts the quality of daily life and significantly affects around 40 % of the population worldwide. Despite the availability of various treatment options, many patients continue to struggle with persistent symptoms and side effects, highlighting the need for innovative therapeutic approaches. Therefore, identifying pathway and mechanism-based targeted therapies with more effective and fewer side effects could aid current therapeutics and provide novel therapeutic advantages. This study aimed to identify potential drug candidates for allergic rhinitis treatment by employing in-silico approaches, including network pharmacology, molecular docking, ADMET, similarity, pharmacophore modeling, quantum chemistry, and machine learning-based QSAR modeling. From three traditionally used medicinal plants known as allergic rhinitis curing, Xanthium strumarium, Magnolia liliiflora, and Tylophora indica, 241 compounds were obtained, and their favorable ADMET properties were analyzed. Network pharmacology revealed 203 potential therapeutic targets, with 15 hub targets identified through protein-protein interaction network analysis and most of them play key roles in inflammatory and immune pathways confirmed by KEGG pathway analysis. Molecular docking, similarity testing, and pharmacophore modeling studies identified promising compounds Quercetin, Yinyanghuo E, Uralenin, CID:90643991, CID:42607537, CID:76329670, Heracetin, and Fisetin exhibiting strong binding affinities with key regulatory targets, NFKB1, TRAF6, and key cytokines IL5, and IL6 that directly and indirectly involved in allergic reactions. Quantum chemistry calculations revealed favorable electronic properties and reactivities of these compounds. The machine learning-based QSAR model predicted IC50 < 50 nM for almost all compounds, indicating highly potent inhibitors. Hence, this in-silico study identified some novel promising drug candidates for treating allergic rhinitis by targeting crucial inflammatory and immune pathways, offering improved treatment outcomes and reduced side effects, subject to further experimental validation.

A Randomized Comparison of Bencycloquidium Bromide, Mometasone Furoate, and a Combination for Persistent Allergic Rhinitis

BACKGROUND

Moderate to severe persistent allergic rhinitis (AR) poses a substantial socioeconomic burden.

OBJECTIVES

We aimed to establish the superiority of bencycloquidium bromide (BCQB) nasal spray and BCQB combined with mometasone furoate nasal spray (MFNS) over MFNS alone in adults with moderate to severe persistent AR.

METHODS

In this multicenter, randomized, controlled clinical trial (NCT05038202), adults with moderate to severe persistent AR were randomly assigned to receive BCQB, MFNS, or a combination treatment for 4-week periods. Mean changes from baseline in the daily reflective runny nose, nasal congestion, sneezing, nasal itching scores, total nasal symptom score (TNSS) and Rhinoconjunctivitis Quality of Life Questionnaire scores were recorded. We also assessed the exploratory end points and adverse events.

RESULTS

Bencycloquidium bromide led to a significant improvement in the mean change from baseline in daily reflective runny nose during the 4-week treatment, compared with MFNS (least-squares mean difference, -0.27; 95% CI, -0.44 to -0.09; P = .004). The BCQB combined with MFNS significantly improved runny nose, nasal congestion, sneezing, TNSS, and Rhinoconjunctivitis Quality of Life Questionnaire scores compared with MFNS alone, except for nasal itching. Bencycloquidium bromide significantly decreased the percent change in eosinophilic cationic protein, eotaxin, vasoactive intestinal peptide, and IL-6 levels. Treatment-emergent adverse events were similar among the three groups.

CONCLUSIONS

Bencycloquidium bromide was superior to MFNS in reducing daily runny nose symptoms. The combination of BCQB and MFNS was superior to MFNS alone in alleviating TNSS in patients with moderate to severe persistent AR with a predominant symptom of runny nose.

Nanotechnology-Based Therapeutics for Airway Inflammatory Diseases

Under the concept of "one airway, one disease", upper and lower airway inflammatory diseases share similar pathogenic mechanisms and are collectively referred to as airway inflammatory diseases. With industrial development and environmental changes, the incidence of these diseases has gradually increased. Traditional treatments, including glucocorticoids, antihistamines, and bronchodilators, have alleviated much of the discomfort experienced by patients. However, conventional drug delivery routes have inherent flaws, such as significant side effects, irritation of the respiratory mucosa, and issues related to drug deactivation. In recent years, nanomaterials have emerged as excellent carriers for drug delivery and are being increasingly utilized in the treatment of airway inflammatory diseases. These materials not only optimize the delivery of traditional medications but also facilitate the administration of various new drugs that target novel pathways, thereby enhancing the treatment outcomes of inflammatory diseases. This study reviews the latest research on nano-drug delivery systems used in the treatment of airway inflammatory diseases, covering traditional drugs, immunotherapy drugs, antimicrobial drugs, plant-derived drugs, and RNA drugs. The challenges involved in developing nano-delivery systems for these diseases are discussed, along with a future outlook. This review offers new insights that researchers can utilize to advance further research into the clinical application of nano-drug delivery systems for treating airway inflammatory diseases.

Genetic variants in PD-1 and its ligands, gene-gene and gene-environment interactions in allergic rhinitis

BACKGROUND

The etiology of allergic rhinitis (AR), in which genetic and environmental factors are closely intertwined, has not yet been completely clarified. Programmed cell death 1 (PD-1) and its ligands (PD-L1 and PD-L2) regulate the immune and inflammatory responses during the development of immune-related and atopic diseases. To clarify the associations of genetic variants in PD-1, PD-L1 and PD-L2 with susceptibility to AR, gene-gene and gene-environment interactions were investigated.

METHODS

A total of 452 AR patients and 495 controls were enrolled in this hospital-based case-control study. Eight single nucleotide polymorphisms (SNPs) in the PDCD1, PDCD1LG1 and PDCD1LG2 genes were genotyped. The correlations between SNPs and AR incidence, as well as gene-gene and gene-environment interactions were explored. Differentially expressed genes were screened by the Limma package in two Gene Expression Omnibus (GEO) datasets of AR patients. Expression qualitative trait locus (eQTL) analysis was performed via the Genotype-Tissue Expression (GTEx) database.

RESULTS

The rs2297136 (A/G) in PDCD1LG1 was associated with a significantly increased risk of AR, whereas the PDCD1LG2 rs16923189 G allele was associated with a reduced risk of AR. In the subgroups according to AR-related phenotypes, the rs2297136 G allele increased, while the rs16923189 G allele reduced AR risk. Gene-gene interactions and gene-environment interactions (e.g., PDCD1LG1 polymorphisms with factors such as smoke, main road and cooking fumes) were verified in AR patients, but they were not significant after Bonferroni correction.

CONCLUSION

PDCD1LG1 rs2297136 and PDCD1LG2 rs16923189 are associated with susceptibility to AR in this Chinese population. The PD-1/PD-L1 and PD-1/PD-L2 signaling pathways may regulate gene-gene and gene-environment interactions in the pathogenesis of AR.

The Joint Association of Sleep Quality and Outdoor Activity with Asthma and Allergic Rhinitis in Children: A Cross-Sectional Study in Shanghai

Purpose

Aiming to investigate the combined association of sleep quality and outdoor activity with the risk of asthma and allergic rhinitis in children.

Patients and Methods

16,936 children from kindergartens and primary schools in 13 administrative districts of Shanghai, China were involved in the analyses. The Children's Sleep Habits Questionnaire (CSHQ) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire were respectively used to evaluate the sleep quality, allergic rhinitis and asthma. Multivariable logistic regression models were used to analyze the correlation of sleep quality, outdoor activities and their combination with children's asthma and allergic rhinitis.

Results

The overall prevalence of asthma and allergic rhinitis in our sampled children were 10.2% and 17.6%, respectively. Poor sleep quality (asthma: aOR, 1.45; 95% CI: 1.23 to 1.73; allergic rhinitis: aOR, 1.16; 95% CI: 1.03 to 1.31) and low outdoor activity (asthma: aOR, 1.30; 95% CI: 1.14 to 1.49, allergic rhinitis: aOR, 1.18; 95% CI: 1.07 to 1.32) were separately associated with higher risk of asthma and allergic rhinitis, and when the two were superimposed, an additive effect (asthma: aOR, 1.76; 95% CI: 1.30 to 2.39; allergic rhinitis: aOR, 1.46; 95% CI: 1.17 to 1.82) was revealed. These associations were independent of sleep duration, but being stronger in sleep sufficiency group. And after stratification by gender, premature birth and family history of allergy, similar associations were validated in general.

Conclusion

Poor sleep quality and low levels of outdoor activity, when combined, have a stronger association with asthma and allergic rhinitis than each factor independently, and this relationship is not influenced by sleep duration. Our findings highlight the need for public health interventions that simultaneously address multiple lifestyle factors to reduce the risk of allergic diseases.

Validated HPLC method for simultaneous determination of azelastine hydrochloride fluticasone propionate and oxymetazoline in nasal mucosa and nasopharyngeal swabs from real human samples

A combination of three co-administrated drugs, such as azelastine hydrochloride (AZT), fluticasone propionate (FP), and oxymetazoline (OXY), is more effective than single therapy for the treatment of seasonal allergy and COVID-19. We established an efficient methodology for the determination of those analytes in spiked nasal mucosa and nasopharyngeal swabs from real human samples. A simple and quick protein precipitation method was used for sample extraction, using acetonitrile. RP-HPLC/DAD method was performed using an Exsil 100 ODS C18 (250 × 4.6 mm, 5 μm) column with an acetonitrile: water (70:30 v/v) solvent system at a flow rate of 0.7 mL/min. A photodiode array detector was applied at 240 nm. A good separation of the three proposed analytes with a short run time of 10 min was noted. Our method was validated according to FDA guidelines for bioanalytical validation methods. Calibration curves were linear in nasal mucosa samples at concentration ranges of 8-125, 10-100, and 10-125 µg/mL, with average recoveries ± SD of 101.56%±0.39, 102.45%±0.86, and 104.61%±4.52 for AZT, FP, and OXY; respectively. The results of precision and accuracy are within acceptable limits. According to stability assays, the three analytes under investigation were stable throughout sample preparation, storage, and injection. Our method was applied to real nasopharyngeal swabs. It shows that the results of the swabs were not affected by gender or age. Good recoveries with low % RSD were observed: 99.03% ± 0.75, 100.02% ± 0.94, and 100.94% ± 1.98 for both genders, and 100.45% ± 0.96, 100.69% ± 1.08, and 100.32% ± 1.53 for different ages for AZT, FP, and OXY; respectively. Moreover, the amount of those drugs in the nasal mucosa was observed for seven hours, and a constant concentration with a low% RSD was noted for the first four hours. Therefore, this method can be applied to monitor the therapeutic dose in the nasal mucosa for the determination of those analytes.

Clinical and molecular analysis of longitudinal rhinitis phenotypes in an urban birth cohort

BACKGROUND

Chronic rhinitis symptoms cause significant health burden among children and can have a heterogeneous presentation. Defining phenotypes of childhood chronic rhinitis and associated pathobiology may lead to prevention or improved treatments.

OBJECTIVES

We sought to identify longitudinal patterns of rhinitis symptoms in childhood and determine their associations with early life risk factors, allergic comorbidities, and nasal epithelial cell gene expression.

METHODS

Chronic rhinitis symptoms were evaluated from ages 1 through 11 years in 485 urban children at high risk for allergic disease in the URECA (Urban Environment and Childhood Asthma) birth cohort. We identified longitudinal rhinitis phenotypes and their relationships to early life exposures, atopic comorbidities, and patterns of nasal epithelial gene expression at age 11 years.

RESULTS

Chronic rhinitis symptoms started early in many children and were a risk factor for developing aeroallergen sensitization. We identified 4 longitudinal rhinitis phenotypes: low/minimal, persistent, persistent decreasing, and late increasing. Persistent rhinitis was most closely linked to allergic sensitization and asthma. Risk factors for persistent rhinitis included frequent colds (P < .001), antibiotic use (P < .001), and reduced exposure to common indoor aeroallergens (P = .003). Compared to low/minimal rhinitis phenotype, the other rhinitis phenotypes were associated with increased expression of canonical type 2 genes and decreased expression of immune response genes.

CONCLUSIONS

In urban children, rhinitis symptoms often precede aeroallergen sensitization. Rhinitis phenotypes based on symptoms had distinct risk factors and nasal transcriptome. These results suggest that focusing on early life risk factors and distinct immune mechanisms may be a target to preventing chronic rhinitis in childhood.

Coseasonal initiation of Artemisia annua sublingual immunotherapy in children and adult patients with allergic rhinoconjunctivitis

PURPOSE

This study aimed to investigate the efficacy and safety of coseasonal initiation of Artemisia annua sublingual immunotherapy (SLIT) for children and adult patients with allergic rhinoconjunctivitis (ARC).

METHODS

A total of 50 patients (aged 4-60 years) with ARC who visited hospital from July to September 2022 were enrolled and randomly divided into the SLIT (n = 25) and control group (n = 25). Patients in SLIT group received Artemisia annua SLIT and patients in control group only received symptomatic medication. The study continued for 1 year. Four nasal symptom scores, two eye symptom scores, and medication usage of the patients during 2021 (baseline) and 2023 pollen seasons were recorded, as well as adverse events (AEs) during the study.

RESULTS

Finally, 20 patients of SLIT group and 22 patients of control group completed this study. Compared with the baseline, the levels of total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), and combined symptom and medication score for rhinoconjunctivitis (CSMS-RC) experienced significant reductions after 1 year SLIT. Additionally, these outcomes also decreased significantly in SLIT group when compared with the control group during 2023 pollen season. Especially, there were more patients showed symptoms reduction, medication use decrease, and efficacy improvement in the SLIT group. Notably, no severe AEs were observed throughout the treatment course among patients receiving SLIT.

CONCLUSIONS

Coseasonal initiating Artemisia annua SLIT demonstrated clinical efficacy and safety for children and adult patients with ARC.

Changes in and Potential Mechanisms of Circulating IgA+CD27-Class-Switched Memory B Cells in Patients With Allergic Rhinitis

Background

The role of memory B cells and their subgroups in allergic rhinitis (AR) and allergen immunotherapy (AIT) remains unclear. This study aimed to investigate the characteristics of memory B cells in the circulation of patients with AR and those undergoing AIT, as well as their clinical significance.

Methods

This study involved a cohort comprising 32 healthy control subjects, 39 individuals diagnosed with AR, and 31 AR patients who had received AIT for over one year. Visual analog scale (VAS) scores were used for symptom assessment, and the serum concentrations of immunoglobulins and cytokines were quantified. This study evaluated alterations in the proportions of peripheral blood memory B cells and their subpopulations, plasma cells, and various T-cell subsets across the three participant groups.

Results

The proportion of IgA+CD27- class-switched memory B cells in the AR group significantly decreased compared to the control group, but significantly increased following AIT (P < 0.05). In AR patients, circulating IgA+CD27- class-switched memory B cells were significantly positively correlated with Treg cells, IL-10, and IL-4 and significantly negatively correlated with IFN-γ, total IgE, sIgE, and VAS scores (P < 0.05). After AIT, the number of circulating IgA+CD27- class-switched memory B cells in AR patients was significantly positively correlated with the number of Treg cells and IL-10 and significantly negatively correlated with the VAS score (P < 0.05).

Conclusion

The IgA+CD27- class-switched memory cell subset in human peripheral blood may serve as a potential biomarker for evaluating AR symptoms and treatment efficacy. Its mechanism may be associated with interactions between T and B cells.

Efficacy of Using Photobiomodulation Therapy in Allergic Rhinitis: A Placebo-Controlled Randomized Clinical Trial

BACKGROUND

Recent studies have extensively explored new non-invasive and side-effect-free therapeutic strategies for the treatment of allergic rhinitis (AR). Photobiomodulation therapy (PBMT) utilizes photons from the red to infrared spectrum to modulate biological processes, exhibiting anti-inflammatory and regenerative properties. The objective of our study was to evaluate the efficacy of PBMT in patients with AR.

METHODS

This study was a randomized, placebo-controlled, double-blind clinical trial involving 62 patients with AR. Participants underwent PBMT twice weekly, totaling eight sessions over the course of 1 month. The control group consisted of 29 patients who received treatment with a non-light-emitting device, while 33 patients in the laser therapy group received a protocol of 6 J of red and infrared light administered intranasally, along with 1 J of infrared light applied externally to the nose. Objective, psychophysical, and subjective assessments of nasal obstruction and olfactory function were conducted both before and after the treatment.

RESULTS

PBMT contributed to significant improvements in various nasal and respiratory parameters. The peak nasal inspiratory flow demonstrated significant improvement (p < 0.001), and the Nasal Obstruction Symptom Evaluation scale indicated notable enhancement in nasal obstruction (p = 0.048). Additionally, the Rhinitis Control Assessment Test reflected significant symptom improvement over the past week (p = 0.035). However, the University of Pennsylvania Smell Identification Test showed no significant change in olfactory function (p = 0.251).

CONCLUSION

Our data suggest that PBMT may serve as a promising therapeutic option for individuals with AR, providing an alternative for those who are unable to tolerate conventional medications. Furthermore, it demonstrates efficacy and safety as a viable treatment alternative.

The effect of allergic rhinitis treatment on asthma control: a systematic review

Asthma and allergic rhinitis (AR) are common disorders of the respiratory tract that often coincide. Control of AR symptoms can improve asthma outcomes in patients with co-existing diseases. Our aim is to produce a systematic review of the effectiveness of conventional anti-AR medication for asthma outcomes in patients with both diseases. The Embase, Medline and Cochrane databases were searched for publications up to October 2024. Randomised controlled trials (RCTs) that reported objective (OAO) or subjective asthma outcomes (SAO) and compared the efficacy of anti-AR medication to placebo or conventional asthma medication were included. Included medication interventions were antihistamines (AH), corticosteroids and leukotriene receptor antagonists (LRA). We included thirty-three RCTs. Six had an exclusively paediatric study population, 17 a partially paediatric study population. No clinically relevant improvements were seen in SAO. Quality of life (QoL) showed a significant and clinically relevant improvement in five studies. A significant and clinically relevant improvement of OAO was seen in four studies. LRAs did not show significant improvements from baseline. When compared, corticosteroids performed significantly better than LRAs. Significant improvements in both OAO and SAO were seen more often in studies with AHs than with corticosteroids. Anti-allergic initiated AHs and corticosteroids seemed to have a positive effect on asthma outcomes, with AHs having the tendency to elicit more changes in outcomes than the other studied medication groups. LRAs do not seem to influence asthma outcomes. Most significant improvements were seen in QoL and OAO. SAO did not show clinically relevant improvements.

Characteristics of Pediatric Allergic Rhinitis With Different Disease Severity

Background: Although numerous studies have focused on diagnostic biomarkers to help identify allergic rhinitis (AR), data on the characteristics of pediatric AR with different severity is limited. We aimed to compare the characteristics of pediatric AR with different severity. Methods: A total of 1054 children with AR were enrolled and classified into mild intermittent AR, mild persistent AR, moderate-to-severe intermittent AR, and moderate-to-severe persistent AR. All children were surveyed using a questionnaire that included detailed demographic information. Blood cell analysis was performed using an automatic hematology analyzer. Results: No significant differences were observed in feeding patterns, dietary habits, outdoor activity time, total IgE, eosinophil count, and eosinophil percentage among the different AR subgroups. However, a higher prevalence of a family history of AR was noted in the moderate-to-severe persistent group. Symptoms were more likely to exacerbate when using air conditioning in children with moderate-to-severe persistent AR. Multivariate regression analysis also showed that symptom exacerbation when using air conditioning was associated with disease severity. Conclusions: This study suggests that exacerbation of symptoms during air conditioning use can be considered a predictive factor for the severity of pediatric AR. Doctors and parents should pay special attention to these children to prevent more severe symptoms and improve the quality of life of these patients as early as possible.

Intratonsillar Immunotherapy: A Convenient and Effective Alternative to Subcutaneous Immunotherapy for Allergic Rhinitis

Allergen-specific immunotherapy (AIT) is the only treatment that addresses the root cause of immunoglobulin E (IgE)-mediated allergies, but conventional methods face challenges with treatment duration, patient compliance, and adverse effects. In this study, we propose intratonsillar immunotherapy (ITIT) as a new effective and safer route for AIT. Prior to clinical trials, we analyzed tonsil samples from human subjects to assess immune responses, measuring interleukin-4 (IL-4), IL-21, total IgE (tIgE), and allergen-specific IgE concentrations using ELISA and BioIC. Our results indicated that tonsils contained higher levels of allergen-specific IgE compared to peripheral blood. In the clinical phase, 120 allergic rhinitis (AR) patients were treated with either 3 intratonsillar allergen injections over 2 months or conventional subcutaneous immunotherapy (SCIT) over 1 year. ITIT demonstrated superior and faster symptom relief, especially in younger patients, while requiring markedly fewer doses and injections than SCIT. Immunological analysis revealed reduced eosinophil counts, increased regulatory T (Treg) and follicular regulatory T (TFR) cell levels, and a favorable shift in cytokine profiles. Adverse events were minimal, and the treatment showed high patient compliance. These findings suggest that ITIT could provide an effective, safer, and more convenient alternative to AIT.

Serum Periostin as a Potential Biomarker in the Evaluation of Allergic Rhinitis: A Pilot Study

Purpose

Although periostin has recently emerged as a new mediator in chronic allergic diseases, particularly in upper airway disease, its significance as a biomarker for allergic rhinitis (AR) is still unclear. Therefore, we aimed to assess the potential of periostin as a novel candidate biomarker for diagnosing and assessing the severity of AR.

Patients and Methods

A total of 40 patients with AR and 22 healthy controls, all aged over 18 years, were recruited for the study. Participants underwent examinations to assess serum levels of total IgE (tIgE), specific IgE (sIgE), periostin, and remodeling-related factors, as well as fractional exhaled nitric oxide (FeNO) and fractional nasal nitric oxide (FnNO). Additionally, clinical characteristics questionnaire and nasal function assessments were completed by AR patients.

Results

The levels of serum periostin were significantly higher in patients with AR compared to healthy controls (Z=-3.605, p<0.001). There was a notable positive correlation between serum periostin and FeNO (r=0.398, p=0.012), FnNO (r=0.379, p=0.017), as well as the visual analogue scale (VAS) score for ocular tearing (r=0.351, p=0.026) in AR patients. Furthermore, the serum periostin levels were higher in moderate-to-severe AR compared to mild AR cases (Z=-2.007, p=0.045). The level of serum periostin in AR patients showed a sequential increase corresponding to shortness of breath scores from 0 to 3 (Z=10.137, p=0.017). The predicted probability of serum periostin demonstrated moderate diagnostic accuracy in detecting AR (AUC=0.773, p<0.001).

Conclusion

Serum periostin shows potential as a candidate biomarker for detecting AR and can serve as a surrogate biomarker for assessing airway inflammation in AR patients.

Efficacy and safety of SQ house dust mite sublingual immunotherapy-tablet (12 SQ-HDM) in children with allergic rhinitis/rhinoconjunctivitis with or without asthma (MT-12): a randomised, double-blind, placebo-controlled, phase III trial

Background

Allergic rhinitis/rhinoconjunctivitis (AR/C) induced by house dust mites (HDM) often begins in childhood and negatively impacts a child's quality of life. The daily burden can be further compounded by comorbid asthma. Allergen immunotherapy is the only available treatment targeting the underlying cause of allergic disease. Efficacy and safety of the SQ HDM sublingual immunotherapy (SLIT)-tablet has been demonstrated in adults and adolescents with HDM AR/C with or without asthma, but data are lacking for younger children.

Methods

Phase III, randomised, double-blind, placebo-controlled trial in younger children (5-11 years) with HDM AR/C with or without asthma. Eligible subjects were randomised 1:1 to SQ HDM SLIT-tablet or placebo for ∼1 year and had free access to AR/C symptom-relieving medications. The primary outcome was the total combined rhinitis score (TCRS) during the final 8 weeks of the treatment period (∼1 year). Secondary outcomes included the rhinitis daily symptom score (DSS) and medication score (DMS), the rhinoconjunctivitis total combined score (TCS), and the Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) score. Efficacy analyses were conducted on the full analysis set (observed cases). Asthma-related outcomes were also explored. The trial was registered on ClinicalTrials.gov: NCT04145219 and EudraCT: 2019-000560-22.

Findings

A total of 1460 subjects were randomised to SQ HDM SLIT-tablet (n = 729) or placebo (n = 731). The primary outcome, TCRS, was statistically significantly different for SQ HDM SLIT-tablet (n = 693) versus placebo (n = 706), with an absolute difference of 1.0 (95% CI: 0.5, 1.4; p < 0.0001) corresponding to a relative reduction of 22.0% (95% CI: 12.0, 31.1). Key secondary outcomes (DSS, DMS, TCS, PRQLQ) showed statistically significant reductions in symptoms and medication use, and improved disease-related quality of life for SQ HDM SLIT-tablet versus placebo. Improvements in asthma symptoms and reduced asthma medication use indicated an additional effect of SQ HDM-SLIT tablet versus placebo. The SQ HDM SLIT-tablet showed a higher event rate for treatment-related adverse events (AEs) than placebo. Most events were of mild or moderate severity and few subjects discontinued due to AEs (2.5%).

Interpretation

The trial confirmed the efficacy and safety of the SQ HDM SLIT-tablet for treating HDM AR/C in younger children (5-11 years) with or without asthma. The safety profile supports daily self-administration of the SQ HDM SLIT-tablet in children.

Funding

ALK-Abellό, Hørsholm, Denmark.