1
|
Baroody FM, Gevaert P, Smith PK, Ziaie N, Bernstein JA. Nonallergic Rhinopathy: A Comprehensive Review of Classification, Diagnosis, and Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1436-1447. [PMID: 38467330 DOI: 10.1016/j.jaip.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
Chronic nonallergic rhinitis syndromes encompass various conditions, of which vasomotor rhinitis is the most common form, representing approximately 80% of patients, also referred to as nonallergic rhinopathy (NAR), nasal hyperreactivity, neurogenic rhinitis, or idiopathic rhinitis. Expert panels have recommended replacing vasomotor rhinitis terminology because it is more descriptive of this condition that is characterized by symptoms triggered by chemical irritants and weather changes through chemosensors, mechanosensors, thermosensors, and/or osmosensors activated through different transient receptor potential calcium ion channels. Elucidating the specific role of transient receptor potential vanilloid 1, triggered by capsaicin, has been an important advancement in better understanding the pathophysiology of NAR because it has now been shown that downregulation of transient receptor potential vanilloid 1 receptors by several therapeutic compounds provides symptomatic relief for this condition. The classification of NAR is further complicated by its association with allergic rhinitis referred to as mixed rhinitis, which involves both immunoglobulin E-mediated and neurogenic mechanistic pathways. Comorbidities associated with NAR, including rhinosinusitis, headaches, asthma, chronic cough, and sleep disturbances, underscore the need for comprehensive management. Treatment options for NAR include environmental interventions, pharmacotherapy, and in refractory cases, surgical options, emphasizing the need for a tailored approach for each patient. Thus, it is extremely important to accurately diagnose NAR because inappropriate therapies lead to poor clinical outcomes and unnecessary health care and economic burdens for these patients. This review provides a comprehensive overview of NAR subtypes, focusing on classification, diagnosis, and treatment approaches for NAR.
Collapse
Affiliation(s)
- Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine, Chicago, Ill
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Peter K Smith
- Department of Surgery-Otolaryngology-Head and Neck, School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Navid Ziaie
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| |
Collapse
|
2
|
Bernstein JA, Bernstein JS, Makol R, Ward S. Allergic Rhinitis: A Review. JAMA 2024; 331:866-877. [PMID: 38470381 DOI: 10.1001/jama.2024.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Importance Allergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches. Observations Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year. Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year. Patients with allergic rhinitis should avoid inciting allergens. In addition, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine), whereas patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine. In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid. Conclusions and Relevance Allergic rhinitis is associated with symptoms of nasal congestion, sneezing, and itching of the eyes, nose, and throat. Patients with allergic rhinitis should be instructed to avoid inciting allergens. Therapies include second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine), intranasal antihistamines (eg, azelastine, olopatadine), and intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) and should be selected based on the severity and frequency of symptoms and patient preference.
Collapse
Affiliation(s)
- Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Joshua S Bernstein
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Richika Makol
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie Ward
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
3
|
Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution. J Clin Med 2019; 8:jcm8112019. [PMID: 31752308 PMCID: PMC6912750 DOI: 10.3390/jcm8112019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). These conditions are more recognizable to an experienced clinician, as they can be more clearly demarcated diagnostically. However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.
Collapse
|
4
|
Kumpitsch C, Koskinen K, Schöpf V, Moissl-Eichinger C. The microbiome of the upper respiratory tract in health and disease. BMC Biol 2019; 17:87. [PMID: 31699101 PMCID: PMC6836414 DOI: 10.1186/s12915-019-0703-z] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 02/08/2023] Open
Abstract
The human upper respiratory tract (URT) offers a variety of niches for microbial colonization. Local microbial communities are shaped by the different characteristics of the specific location within the URT, but also by the interaction with both external and intrinsic factors, such as ageing, diseases, immune responses, olfactory function, and lifestyle habits such as smoking. We summarize here the current knowledge about the URT microbiome in health and disease, discuss methodological issues, and consider the potential of the nasal microbiome to be used for medical diagnostics and as a target for therapy.
Collapse
Affiliation(s)
- Christina Kumpitsch
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Kaisa Koskinen
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Veronika Schöpf
- Institute of Psychology, University of Graz, Universitaetsplatz 2, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
- Present address: Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christine Moissl-Eichinger
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
| |
Collapse
|
5
|
Price DB, Smith PK, Harvey RJ, Carney AS, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner D, Carter V, Durieux AM. Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease. Pragmat Obs Res 2018; 9:43-54. [PMID: 30147391 PMCID: PMC6101013 DOI: 10.2147/por.s153266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The aim of the study was to explore rhinitis therapy purchases in different Australian regions for patients with and without additional respiratory disease, using both doctor's prescriptions and over-the-counter (OTC) medications. PATIENTS AND METHODS It was a historical cohort study of pharmacy-related claims that included prescription or OTC rhinitis therapy, with or without asthma/COPD therapy, from January 2013 to December 2014. RESULTS Overall, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over a calendar year; the majority were single-therapy purchases for rhinitis only patients. More multiple-therapy was purchased for rhinitis and asthma/COPD patients (4.4%) than for rhinitis only patients (4.0%), with a greater proportion purchased in VIC, SA and TAS (4.7% of rhinitis only patients and 4.5% of rhinitis and asthma/COPD patients) than in other areas. Dual therapy of oral antihistamine (OAH) and intranasal corticosteroid (INS) were the most frequently purchased multiple-therapy, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%). The most frequently purchased single therapy was OAH (70.1% of rhinitis only patients and 57.3% of rhinitis and asthma/COPD patients). First-line INS therapy was more likely to be purchased for rhinitis and asthma/COPD patients (15.3% by prescription and 11.7% OTC) than for rhinitis only patients (5.0% by prescription and 9.2% OTC); however, geographical differences in the proportion of therapies purchased OTC were noted, with a lower proportion of OTC OAH and INS purchases in Queensland and the Northern Territory for patients with and without comorbid respiratory disease. CONCLUSION Purchases of first-line INS therapy are more likely for patients with comorbid respiratory disease if they have received prescriptions and information/advice from their general practitioner. The study results indicate a need for patient information/education at the point-of-sale of OTC OAHs to enable patients to assess their nasal symptoms and receive treatment support from pharmacists. Greater availability to INSs in pharmacies as well as guidance from current guidelines and instruction in correct intranasal technique may also lead to greater uptake of INSs.
Collapse
Affiliation(s)
- David B Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK,
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Pete K Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - Richard John Harvey
- Rhinology and Skull Base, Applied Medical Research Centre, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - A Simon Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
| | - Sinthia Z Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | | | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Alice Ms Durieux
- Observational and Pragmatic Research Institute, Singapore, Singapore,
| |
Collapse
|
6
|
Ramakrishnan VR, Holt J, Nelson LF, Ir D, Robertson CE, Frank DN. Determinants of the Nasal Microbiome: Pilot Study of Effects of Intranasal Medication Use. ALLERGY & RHINOLOGY 2018; 9:2152656718789519. [PMID: 30128169 PMCID: PMC6088474 DOI: 10.1177/2152656718789519] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction A role for bacteria and other microbes has long been suspected in the chronic
inflammatory sinonasal diseases. Recent studies utilizing
culture-independent, sequence-based identification have demonstrated
aberrant shifts in the sinus microbiota of chronic rhinosinusitis subjects,
compared with ostensibly healthy controls. Examining how such microbiota
shifts occur and the potential for physician-prescribed interventions to
influence microbiota dynamics are the topics of the current article. Methods The nasal cavity microbiota of 5 subjects was serially examined over an
8-week period using pan-bacterial 16S rRNA gene sequencing. Four of the
subjects were administered topical mometasone furoate spray, while 1 subject
underwent a mupirocin decolonization procedure in anticipation of orthopedic
surgery. Results Measures of microbial diversity were unaffected by intranasal treatment in 2
patients and were markedly increased in the remaining 3. The increase in
microbial diversity was related to clearance of Moraxella
spp. and a simultaneous increase in members of the phylum Actinobacteria.
Both effects persisted at least 2 weeks beyond cessation of treatment.
Transient changes in the relative abundance of several bacterial genera,
including Staphylococcus and
Priopionibacteria, were also observed during
treatment. Conclusions The effects of intranasal steroids on the sinonasal microbiome are poorly
understood, despite their widespread use in treating chronic sinonasal
inflammatory disorders. In this longitudinal study, administration of
intranasal mometasone furoate or mupirocin resulted in shifts in microbial
diversity that persisted to some degree following treatment cessation.
Further characterization of these effects as well as elucidation of the
mechanism(s) underlying these changes is needed.
Collapse
Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Justin Holt
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado.,Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | - Leah F Nelson
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Diana Ir
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Charles E Robertson
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel N Frank
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
7
|
Singh U, Wangia-Anderson V, Bernstein JA. Chronic Rhinitis Is a High-Risk Comorbidity for 30-Day Hospital Readmission of Patients with Asthma and Chronic Obstructive Pulmonary Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:279-285.e6. [PMID: 30053594 DOI: 10.1016/j.jaip.2018.06.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early hospital readmissions for asthma and chronic obstructive pulmonary disease (COPD), measured as hospital readmission within 30 days from the last discharge, is a major economic burden to our health care system. The association of this measure with comorbid chronic rhinitis (CR) has not been investigated before despite significant clinical association between CR and asthma or COPD. OBJECTIVE To investigate the association of CR with the risk of asthma or COPD-related early hospital readmission rates. METHODS This retrospective cohort study was performed using the asthma- and COPD-related hospital encounter and patient comorbidity data between June 15, 2012, and July 19, 2017, from a large hospital care system in Cincinnati, Ohio. Patients (any sex, race or socioeconomic status, and of all ages) with a primary discharge diagnosis of asthma (n = 4754 patients, 10,111 encounters) and COPD (n = 2176 patients, 4748 encounters) based on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were included. Relevant comorbidities, including comorbid allergic rhinitis (AR) or nonallergic rhinitis (NAR), in such patients were identified using ICD-10-CM codes. The association between 30-day asthma or COPD-related hospital readmission (1670 such encounters for asthma and 736 for COPD) and comorbid CR in the affected patients were determined using Cox proportional hazards models. Multivariate-adjusted hazard ratios (HRs), adjusted for relevant patient comorbidities, compared 30-day asthma- and COPD-related readmissions of patients with CR with those patients without a CR diagnosis. RESULTS Analysis was performed on 4754 patients with asthma and 2176 patients with COPD. The median follow-up period (+interquartile range) for asthma was 980 (+760) days and for COPD was 553 (+827) days. The HRs for 30-day asthma- or COPD-related readmission rates were significantly higher in patients with AR (HR = 4.4 [3.9, 5.0] and 2.4 [1.7, 3.2], respectively) or NAR (HR = 3.7 [2.9, 4.9] and 2.6 [1.8, 3.7], respectively) compared with patients without rhinitis. For asthma, both AR and NAR had higher HRs compared with all other comorbidities analyzed. For COPD, both AR and NAR had HRs to the magnitude as obesity and hypertension. CONCLUSIONS Comorbid CR is significantly associated with 30-day asthma- and COPD-related readmissions. These findings are useful for guiding health care professionals to focus on outpatient management of both the upper and lower respiratory tracts to reduce early readmission of patients with asthma and COPD.
Collapse
Affiliation(s)
- Umesh Singh
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Victoria Wangia-Anderson
- Clin & Health Info Sci, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| |
Collapse
|
8
|
Van Gerven L, Steelant B, Alpizar YA, Talavera K, Hellings PW. Therapeutic effect of capsaicin nasal treatment in patients with mixed rhinitis unresponsive to intranasal steroids. Allergy 2018; 73:248-250. [PMID: 28712109 DOI: 10.1111/all.13245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 01/13/2023]
Abstract
Literature is convincing regarding the efficacy of capsaicin nasal treatment in idiopathic rhinitis (IR). However, up to 50% of IR patients do not meet the strict inclusion criteria of the trials conducted so far. As a consequence, the efficacy of capsaicin is unknown in a significant number of IR patients that do not meet the strict inclusion/exclusion criteria (J Allergy Clin Immunol. 2014;133:1332, J Allergy Clin Immunol. 2017; [Epub ahead of print]). "Mixed rhinitis" (MR) patients have more than one major etiologic factor involved in the mucosal pathology. We have no idea about the efficacy of capsaicin nasal spray in these patients nor about the time interval to seek a second application. We report here that capsaicin nasal spray is effective in a broader group of IR than the purely selected ones described before, that subjective nasal hyper-reactivity is a good predictor of positive outcome, and that the time interval for seeking a second treatment is likely to be shorter in MR patients than in the strictly selected IR patients.
Collapse
Affiliation(s)
- L. Van Gerven
- Clinical division of Otorhinolaryngology Head & Neck Surgery University Hospitals Leuven Leuven Belgium
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - B. Steelant
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - Y. A. Alpizar
- Laboratory for Ion Channel Research Department of Molecular Cell Biology KU Leuven Leuven Belgium
| | - K. Talavera
- Laboratory for Ion Channel Research Department of Molecular Cell Biology KU Leuven Leuven Belgium
| | - P. W. Hellings
- Clinical division of Otorhinolaryngology Head & Neck Surgery University Hospitals Leuven Leuven Belgium
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
- Department of Otorhinolaryngology Academic Medical Center Amsterdam The Netherlands
| |
Collapse
|
9
|
Smith P, Price D, Harvey R, Carney AS, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner D, Carter V, Durieux AMS. Medication-related costs of rhinitis in Australia: a NostraData cross-sectional study of pharmacy purchases. J Asthma Allergy 2017; 10:153-161. [PMID: 28533689 PMCID: PMC5431691 DOI: 10.2147/jaa.s128431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose There is a relative paucity of research regarding medication expenditure associated with multiple-therapy use for rhinitis in Australia. To describe 1) the nature and extent of multiple-therapy use for rhinitis in Australia using data on therapies purchased with prescription or over-the-counter (OTC) and 2) additional costs incurred by multiple-therapy use compared with intranasal corticosteroid (INCS) therapy alone. Patients and methods A retrospective observational study was carried out using a database containing anonymous pharmacy transaction data available from 20% of pharmacies in Australia that links doctor prescriptions and OTC purchase information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment, with or without additional asthma/chronic obstructive pulmonary disease (COPD) therapy, by patients during 2013 and 2014 were assessed. Results In total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 24 months. The majority of rhinitis therapy transactions were single-therapy purchases without additional asthma/COPD therapy. Of the single therapies purchased, 73% were oral antihistamines (OAHs) and 15% were INCS therapy. Dual-therapy purchases of INCSs and OAHs accounted for 40% of multiple-therapy purchases. Patients frequently purchased OAHs, nonsteroidal nasal sprays, and eye drops for allergic conjunctivitis alongside INCSs, resulting in higher financial costs (up to AU$21 per treatment episode) compared with INCS monotherapy. Conclusion This study highlighted the significant burden posed on community pharmacy to address the needs of people with rhinitis symptoms, and the failure to translate the evidence that INCSs are the most effective monotherapy for moderate to severe and/or persistent rhinitis into clinical practice in light of the lack of evidence supporting combination of INCS and OAH therapy. Health care professional engagement, especially at the pharmacy level, will be extremely important if we wish to ensure that the purchase of rhinitis treatment is in accordance with guidelines and that their use is optimal.
Collapse
Affiliation(s)
- Pete Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - David Price
- Observational and Pragmatic Research Institute, Singapore.,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Richard Harvey
- Applied Medical Research Center, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Andrew Simon Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sinthia Z Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | | | | | | |
Collapse
|
10
|
Greiwe JC, Bernstein JA. Combination therapy in allergic rhinitis: What works and what does not work. Am J Rhinol Allergy 2017; 30:391-396. [PMID: 28124648 DOI: 10.2500/ajra.2016.30.4391] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allergic rhinitis and other rhinitis subtypes are increasingly becoming some of the most prevalent and expensive medical conditions that affect the U.S. POPULATION Both direct health care costs and indirect costs significantly impact the health care system due to delays in diagnosis, lack of treatment, ineffective treatment, poor medication adherence, and associated comorbidities. Many patients who have AR turn to over-the-counter medications for relief but often find themselves dissatisfied with the results. Determining the correct diagnosis, followed by initiation of the most-effective treatment(s), is essential to provide patients with better symptomatic management and quality of life. Although there are many options, currently available combination therapies, e.g., azelastine with fluticasone and intranasal corticosteroids with nasal decongestants, offer distinct advantages for the management of complex rhinitis phenotypes. Further research is required to investigate the pathomechanisms and biomarkers for mixed rhinitis and nonallergic vasomotor rhinitis subtypes that will lead to novel targeted therapies for these conditions.
Collapse
Affiliation(s)
- Justin C Greiwe
- Bernstein Allergy Group, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | | |
Collapse
|
11
|
Gupta J, Johansson E, Bernstein JA, Chakraborty R, Khurana Hershey GK, Rothenberg ME, Mersha TB. Resolving the etiology of atopic disorders by using genetic analysis of racial ancestry. J Allergy Clin Immunol 2016; 138:676-699. [PMID: 27297995 PMCID: PMC5014679 DOI: 10.1016/j.jaci.2016.02.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 02/09/2016] [Accepted: 02/25/2016] [Indexed: 12/23/2022]
Abstract
Atopic dermatitis (AD), food allergy, allergic rhinitis, and asthma are common atopic disorders of complex etiology. The frequently observed atopic march from early AD to asthma, allergic rhinitis, or both later in life and the extensive comorbidity of atopic disorders suggest common causal mechanisms in addition to distinct ones. Indeed, both disease-specific and shared genomic regions exist for atopic disorders. Their prevalence also varies among races; for example, AD and asthma have a higher prevalence in African Americans when compared with European Americans. Whether this disparity stems from true genetic or race-specific environmental risk factors or both is unknown. Thus far, the majority of the genetic studies on atopic diseases have used populations of European ancestry, limiting their generalizability. Large-cohort initiatives and new analytic methods, such as admixture mapping, are currently being used to address this knowledge gap. Here we discuss the unique and shared genetic risk factors for atopic disorders in the context of ancestry variations and the promise of high-throughput "-omics"-based systems biology approach in providing greater insight to deconstruct their genetic and nongenetic etiologies. Future research will also focus on deep phenotyping and genotyping of diverse racial ancestry, gene-environment, and gene-gene interactions.
Collapse
Affiliation(s)
- Jayanta Gupta
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Elisabet Johansson
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Ranajit Chakraborty
- Center for Computational Genomics, Institute of Applied Genetics, Department of Molecular and Medical Genetics, University of North Texas Health Science Center, Fort Worth, Tex
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Tesfaye B Mersha
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
| |
Collapse
|
12
|
Yang Y, Zhou W, Chen A. Efficacy of sublingual immunotherapy for cedar pollinosis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2016; 117:348-353. [PMID: 27566862 DOI: 10.1016/j.anai.2016.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/15/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND The efficacy of immunotherapy for cedar pollinosis using a single cedar antigen extract via the sublingual route is uncertain. OBJECTIVE To assess the efficacy of sublingual immunotherapy (SLIT) for patients with cedar pollinosis by performing a systematic review and meta-analysis. METHODS Randomized clinical trials (RCTs) that compared SLIT with a placebo for patients with cedar pollinosis were searched in the MEDLINE, EMBASE, and Cochrane databases. The primary outcome was the symptom medication score, and secondary outcomes were adverse events, quality of life, and serum IgE and IgG4 levels. RESULTS We analyzed 4 RCTs with a total of 762 patients. Meta-analysis revealed that SLIT significantly decreased symptom medication scores compared with placebo groups (standardized mean difference [SMD], -0.94; 95% confidence interval [CI], -1.75 to -0.14; P = .02; I2 = 93%), and subgroup analysis revealed that SLIT had a significant positive effect on cedar pollinosis when pollen concentration was less (SMD, -2.29; 95% CI, -3.64 to -2.16; P < .001) or more (SMD, -0.36; 95% CI, -0.51 to -0.21; P < .001; I2 = 0%) than 1,200/cm2, and treatment duration was longer than 1 year (SMD, -0.43; 95% CI, -0.59 to -0.26; P < .001; I2 = 0%). Adverse events were reported in 237 of 405 patients (58.5%) receiving SLIT vs 192 of 357 patients (53.8%) receiving the placebo. CONCLUSION This study revealed a statistically significant benefit of SLIT in patients with cedar pollinosis. However, these findings were based on analysis of a small number of RCTs. Additional large-sample and high-quality RCTs are necessary for further study.
Collapse
Affiliation(s)
- Yao Yang
- Department of Dermatology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Weikang Zhou
- Department of Allergy, Chongqing General Hospital, Chongqing, China
| | - Aijun Chen
- Department of Dermatology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
13
|
Abstract
Nonallergic rhinitis (NAR) is one of the most common conditions in medicine, affecting the quality of life of millions of patients throughout the United States. Despite its ubiquitous nature, NAR remains a poorly managed and often difficult to treat condition. NAR is often suboptimally managed by clinicians with poor clinical outcomes. Establishing the correct diagnosis requires a keen understanding of the unique underlying mechanisms involved in NAR, which is still evolving. Ultimately epidemiologic studies that better define NAR prevalence and its economic burden on society are needed to convince funding agencies of the need for research to elucidate mechanisms and specific treatment approaches for this condition.
Collapse
Affiliation(s)
- Justin Greiwe
- Bernstein Allergy Group, 8444 Winton Rd, Cincinnati, OH 45231, USA; Division of Allergy, Immunology and Rheumatology, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Jonathan A Bernstein
- Bernstein Allergy Group, 8444 Winton Rd, Cincinnati, OH 45231, USA; Division of Allergy, Immunology and Rheumatology, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
| |
Collapse
|
14
|
Otsuka H, Takanashi I, Tokunou S, Endo S, Okubo K. Involvement of Staphylococcus aureus and Moraxella catarrhalis in Japanese cedar pollinosis. Am J Rhinol Allergy 2016; 30:99-106. [PMID: 26877537 DOI: 10.2500/ajra.2016.30.4283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE From mid February to the end of March, each year ∼30% of Japanese have Japanese cedar pollinosis. Moreover, 10-50% of patients with this pollinosis exhibit nasal manifestations in the preseason. These patients have a predominance of neutrophils but not eosinophils in nasal swabs and high carriage of Staphylococcus aureus. We hypothesized that S. aureus or other bacteria and associated neutrophilia were involved in preseasonal symptoms. METHODS Cytology and bacterial colony growth were assessed in nasal swabs in the groups of asymptomatic patients in the preseason (PreAsP) (n = 53) and symptomatic patients in the preseason (PreSyP) (n = 60), and in group of symptomatic patients in season (InSyP) (n = 72). RESULTS In the preseason, high neutrophilia was present in only 20% of the PreAsP group but in 47% of the PreSyP group (p < 0.01). Nasal carriage of S. aureus in the PreAsP and PreSyP groups were 79%, 75%, respectively, whereas, for Moraxella catarrhalis, these were 9% versus 25% (PreAsP versus PreSyP group; p < 0.05). In patients with positive results for S. aureus and M. catarrhalis, the degrees of neutrophilia (-, ±, +, 2+, 3+) in the PreSyP group were larger than in the PreAsP groups (p < 0.01). In the PreSyP group, the magnitude of neutrophilia was greater (p < 0.05) in subgroups with more colonies of S. aureus than in subgroups with fewer colonies. CONCLUSION Nasal symptoms in the preseason are associated with neutrophilia and nasal colonization with S. aureus and M. catarrhalis. Patients with symptoms in the preseason had improved symptom scores when given prophylactic treatment early in season but had more-severe symptom scores late in season than asymptomatic patients in the preseason. Neutrophil-associated tissue damage related to bacterial colonization may underlie these associations.
Collapse
|
15
|
Paraskevopoulos GD, Kalogiros LA. Non-Allergic Rhinitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
Abstract
Sensory nerve endings within the airway epithelial cells and the solitary chemoreceptor cells, synapsing with sensory nerves, respond to airborne irritants. Transient receptor potential (TRP) channels (A1 and V1 subtypes, specifically) on these nerve endings initiate local antidromic reflexes resulting in the release of neuropeptides such as substance P and calcitonin G-related peptides. These neuropeptides dilate epithelial submucosal blood vessels and may therefore increase transudation across these vessels resulting in submucosal edema, congestion, and rhinitis. Altered expression or activity of these TRP channels can therefore influence responsiveness to irritants. Besides these pathogenic mechanisms, additional mechanisms such as dysautonomia resulting in diminished sympathetic activity and comparative parasympathetic overactivity have also been suggested as a probable mechanism. Therapeutic effectiveness for this condition has been demonstrated through desensitization of TRPV1 channels with typical agonists such as capsaicin. Other agents effective in treating nonallergic rhinitis (NAR) such as azelastine have been demonstrated to exhibit TRPV1 channel activity through the modulation of Ca(2+) signaling on sensory neurons and in nasal epithelial cells. Roles of antimuscarinic agents such as tiotropium in NAR have been suggested by associations of muscarinic cholinergic receptors with TRPV1. The associations between these channels have also been suggested as mechanisms of airway hyperreactivity in asthma. The concept of the united airway disease hypothesis suggests a significant association between rhinitis and asthma. This concept is supported by the development of late-onset asthma in about 10-40 % of NAR patients who also exhibit a greater severity in their asthma. The factors and mechanisms associating NAR with nonallergic asthma are currently unknown. Nonetheless, free immunoglobulin light chains and microRNA alteration as mediators of these inflammatory conditions may play key roles in this association.
Collapse
Affiliation(s)
- Jonathan A Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, 3255 Eden Ave., ML#563 Suite 350, Cincinnati, OH, 45267, USA,
| | | |
Collapse
|
17
|
Kirtsreesakul V, Hararuk K, Leelapong J, Ruttanaphol S. Clinical Efficacy of Nasal Steroids on Nonallergic Rhinitis and the Associated Inflammatory Cell Phenotypes. Am J Rhinol Allergy 2015; 29:343-9. [DOI: 10.2500/ajra.2015.29.4234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Although good response to nasal steroid therapy has been documented in allergic rhinitis (AR), the efficacy of this treatment in non-AR, and the associated inflammatory cell phenotypes has not been fully investigated. Objective To compare the response to steroids in non-AR versus AR and to assess the impact of inflammatory cell phenotypes on non-AR treatment outcomes. Methods A total of 149 patients with rhinitis were divided into non-AR and AR groups by using the allergy skin-prick test. Based on nasal cytology, the non-AR group was further divided into inflammatory non-AR (INAR) and noninflammatory non-AR (NINAR) groups, and the INAR groups were further subdivided into four phenotypes according to inflammatory cell type: non-AR with eosinophils (NARES), non-AR with mast cells (NARMA), non-AR with neutrophils (NARNE), and NARES and mast cells (NARESMA). All the patients were treated over 28 days with 220 μg of nasal triamcinolone acetonide once daily. Nasal symptom score, peak inspiratory flow index, and nasal mucociliary clearance time (NMCCT) were used to evaluate treatment outcomes. Results The initial screening found 67 patients with non-AR and 82 patients with AR. At 28 days after nasal steroid treatment, all nasal symptom score, peak inspiratory flow indexes, and NMCCTs were significantly improved within each group; however, the non-AR group recorded significantly lower levels of improvement in blocked nose, rhinorrhea, sneezing, nasal itching, peak flows, and NMCCTs than the AR group. The NINAR group overall indicated lower levels of improvement than the INAR group. Among the INAR subgroups, the NARESMA, NARES, and NARMA phenotypes had similar outcome improvements, all better than the NARNE phenotype. Conclusion Although both patients with non-AR and those with AR had good steroid response, the patients with non-AR had less improvement than the patients with AR. Patients with NINAR had the worst treatment outcome among the non-AR phenotypes.
Collapse
Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Kodchakorn Hararuk
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Jitanong Leelapong
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Suwalee Ruttanaphol
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| |
Collapse
|
18
|
Burte E, Bousquet J, Varraso R, Gormand F, Just J, Matran R, Pin I, Siroux V, Jacquemin B, Nadif R. Characterization of Rhinitis According to the Asthma Status in Adults Using an Unsupervised Approach in the EGEA Study. PLoS One 2015; 10:e0136191. [PMID: 26309034 PMCID: PMC4550236 DOI: 10.1371/journal.pone.0136191] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background The classification of rhinitis in adults is missing in epidemiological studies. Objective To identify phenotypes of adult rhinitis using an unsupervised approach (data-driven) compared with a classical hypothesis-driven approach. Methods 983 adults of the French Epidemiological Study on the Genetics and Environment of Asthma (EGEA) were studied. Self-reported symptoms related to rhinitis such as nasal symptoms, hay fever, sinusitis, conjunctivitis, and sensitivities to different triggers (dust, animals, hay/flowers, cold air…) were used. Allergic sensitization was defined by at least one positive skin prick test to 12 aeroallergens. Mixture model was used to cluster participants, independently in those without (Asthma-, n = 582) and with asthma (Asthma+, n = 401). Results Three clusters were identified in both groups: 1) Cluster A (55% in Asthma-, and 22% in Asthma+) mainly characterized by the absence of nasal symptoms, 2) Cluster B (23% in Asthma-, 36% in Asthma+) mainly characterized by nasal symptoms all over the year, sinusitis and a low prevalence of positive skin prick tests, and 3) Cluster C (22% in Asthma-, 42% in Asthma+) mainly characterized by a peak of nasal symptoms during spring, a high prevalence of positive skin prick tests and a high report of hay fever, allergic rhinitis and conjunctivitis. The highest rate of polysensitization (80%) was found in participants with comorbid asthma and allergic rhinitis. Conclusion This cluster analysis highlighted three clusters of rhinitis with similar characteristics than those known by clinicians but differing according to allergic sensitization, and this whatever the asthma status. These clusters could be easily rebuilt using a small number of variables.
Collapse
Affiliation(s)
- Emilie Burte
- INSERM, U1168, VIMA: Aging and chronic diseases, Epidemiological and Public health approaches, F-94807, Villejuif, France
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
- * E-mail:
| | - Jean Bousquet
- INSERM, U1168, VIMA: Aging and chronic diseases, Epidemiological and Public health approaches, F-94807, Villejuif, France
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
- University hospital, Montpellier, France
| | - Raphaëlle Varraso
- INSERM, U1168, VIMA: Aging and chronic diseases, Epidemiological and Public health approaches, F-94807, Villejuif, France
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | | | - Jocelyne Just
- Allergology Department, Centre de l’Asthme et des Allergies, Hôpital Armand-Trousseau (APHP), APHP, Paris, France
- Université Paris 6 Pierre et Marie Curie, Paris, France
| | - Régis Matran
- Univ Lille Nord de France, F-59000, Lille, France
| | - Isabelle Pin
- INSERM, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000 Grenoble, France
- Univ. Grenoble Alpes, F-38000 Grenoble, France
- CHU de Grenoble, F-38000 Grenoble, France
- CHU de Grenoble, Pediatric Department, F-38000, Grenoble, France
| | - Valérie Siroux
- INSERM, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, F-38000 Grenoble, France
- Univ. Grenoble Alpes, F-38000 Grenoble, France
- CHU de Grenoble, F-38000 Grenoble, France
| | - Bénédicte Jacquemin
- INSERM, U1168, VIMA: Aging and chronic diseases, Epidemiological and Public health approaches, F-94807, Villejuif, France
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
- CREAL-Centre for Research in Environmental Epidemiology Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Rachel Nadif
- INSERM, U1168, VIMA: Aging and chronic diseases, Epidemiological and Public health approaches, F-94807, Villejuif, France
- Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| |
Collapse
|
19
|
Barberi S, Ciprandi G, Verduci E, D'Auria E, Poli P, Pietra B, Incorvaia C, Buttafava S, Frati F, Riva E. Effect of high-dose sublingual immunotherapy on respiratory infections in children allergic to house dust mite. Asia Pac Allergy 2015; 5:163-9. [PMID: 26240793 PMCID: PMC4521165 DOI: 10.5415/apallergy.2015.5.3.163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/08/2015] [Indexed: 12/19/2022] Open
Abstract
Background Allergic rhinitis is characterized by eosinophil inflammation. Allergic inflammation may induce susceptibility to respiratory infections (RI). House dust mite (HDM) sensitization is very frequent in childhood. Allergen immunotherapy may cure allergy as it restores a physiologic immune and clinical tolerance to allergen and exerts anti-inflammatory activity. Objective This study investigated whether six-month high-dose, such as 300 IR (index of reactivity), HDM-sublingual immunotherapy (SLIT) could affect RI in allergic children. Methods Globally, 40 HDM allergic children (18 males; mean age, 9.3 years) were subdivided in 2 groups: 20 treated by symptomatic drugs (group 1) and 20 by high-dose HDM-SLIT (group 2), since September 2012 to April 2013. The daily maintenance dose of HDM-SLIT was 4 pressures corresponding to 24, 4.8, and 60 µg, respectively of the major allergens Dermatophagoides pteronyssinus (Der p) 1, Der p 2, and Dermatophagoides farinae (Der f) 1. RI was diagnosed when at least 2 symptoms or signs, and fever were present for at least 48 hours. A family pediatrician provided diagnosis on a clinical ground. Results SLIT-treated children had significantly (p = 0.01) less RI episodes (3.5) than control group (5.45). About secondary outcomes, SLIT-treated children had less episodes of pharyngo-tonsillitis (p < 0.05) and bronchitis (p < 0.005), and snoring (p < 0.05) than control group. In addition, SLIT-treated children had less fever (p < 0.01) and took fewer medications, such as antibiotics (p < 0.05) and fever-reducers (p < 0.01), than control group. Conclusion This preliminary study might suggest that also a short course (6 months) of high-dose SLIT, titrated in µg of major allergens, could reduce RI in allergic children.
Collapse
Affiliation(s)
| | - Giorgio Ciprandi
- Department of Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino, 16132 Genoa, Italy
| | - Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | - Enza D'Auria
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | - Piercarlo Poli
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | - Benedetta Pietra
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| | | | - Serena Buttafava
- Medical and Scientific Department, Stallergenes Italy, 20155 Milan, Italy
| | - Franco Frati
- Medical and Scientific Department, Stallergenes Italy, 20155 Milan, Italy
| | - Enrica Riva
- Department of Pediatrics, San Paolo Hospital, 20142 Milan, Italy
| |
Collapse
|
20
|
Lacagnina V, Leto-Barone MS, La Piana S, Seidita A, Pingitore G, Di Lorenzo G. Analysis of a database to predict the result of allergy testing in vivo in patients with chronic nasal symptoms. Am J Rhinol Allergy 2015; 28:414-8. [PMID: 25198028 DOI: 10.2500/ajra.2014.28.4078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This article uses the logistic regression model for diagnostic decision making in patients with chronic nasal symptoms. We studied the ability of the logistic regression model, obtained by the evaluation of a database, to detect patients with positive allergy skin-prick test (SPT) and patients with negative SPT. The model developed was validated using the data set obtained from another medical institution. METHODS The analysis was performed using a database obtained from a questionnaire administered to the patients with nasal symptoms containing personal data, clinical data, and results of allergy testing (SPT). All variables found to be significantly different between patients with positive and negative SPT (p < 0.05) were selected for the logistic regression models and were analyzed with backward stepwise logistic regression, evaluated with area under the curve of the receiver operating characteristic curve. A second set of patients from another institution was used to prove the model. RESULTS The accuracy of the model in identifying, over the second set, both patients whose SPT will be positive and negative was high. The model detected 96% of patients with nasal symptoms and positive SPT and classified 94% of those with negative SPT. CONCLUSION This study is preliminary to the creation of a software that could help the primary care doctors in a diagnostic decision making process (need of allergy testing) in patients complaining of chronic nasal symptoms.
Collapse
Affiliation(s)
- Valerio Lacagnina
- Dipartimento di Scienze Economiche, Aziendali e Statistiche, Università degli Studi di Palermo, Italy
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
Background Identifying allergic rhinitis requires allergy testing, but the first-line referral for rhinitis are usually primary care physicians (PCP), who are not familiar with such tests. The availability of easy and simple tests to be used by PCP to suggest allergy should be very useful. Methods The Respiratory Allergy Prediction (RAP) test, based on 9 questions and previously validated by a panel of experts, was evaluated in this study. Results An overall number of 401 patients (48.6% males, age range 14–62 years) with respiratory symptoms was included. Of them, 89 (22.2%) showed negative results to SPT, while 312 (77.8%) had at least one positive result to SPT. Cohen’s kappa coefficient showed that all questions had an almost perfect excellent agreement between pre and post-test. The algorithm of decision-tree growth Chi-squared Automatic Interaction Detector showed that answering yes to the question 4 (Your nasal/ocular complains do usually start or worsen during the spring?), 6 (Did you ever had cough or shortness of breath, even during exercise?) and 8 (Do you use nasal sprays frequently?) gave a probability to have a positive SPT of 85%. Conclusions These findings show that RAP test can be proposed as an useful tool to be used by physician other than allergists when evaluating patients with rhinitis, suggesting the need of allergy testing. Electronic supplementary material The online version of this article (doi:10.1186/s40413-015-0067-y) contains supplementary material, which is available to authorized users.
Collapse
|
22
|
|