Challenges in Local Allergic Rhinitis Diagnosis, Management, and Research: Current Concepts and Future Perspectives

eHealth in pediatric respiratory allergy

PURPOSE OF REVIEW

This review explores the relevance of eHealth technologies to address unmet needs in pediatric respiratory allergies, particularly allergic rhinitis (AR) and asthma. Given the increasing burden of these conditions, there is a pressing need for effective solutions to enhance disease surveillance, diagnosis, and management.

RECENT FINDINGS

Recent literature highlights the potential of eHealth tools to transform pediatric respiratory allergy care. The use of digital data for infodemiology, application of machine learning models to improve diagnostic sensitivity, smartphone apps with digital patient reported outcome measure (PROMs) and embedded sensors to monitor disease, healthcare professional dashboards with real-time data monitoring and clinical decision support systems (CDSS) are advances emerging to optimize pediatric respiratory allergy care.

SUMMARY

Integrating eHealth technologies into the pediatric respiratory allergy care pathway is a potential solution for current healthcare challenges to better meet the needs of children with AR and asthma. However, while the potential of eHealth is evident, its widespread implementation in real-world practice requires continued research, collaboration, and efforts to overcome existing barriers.

Epidemiology of Childhood Asthma in the UK

Purpose

Global prevalence of pediatric asthma and associated morbidity and mortality has continuously increased. Asthma is the most common chronic illness in children in the UK; however, recent epidemiology data are lacking. This analysis describes the overall prevalence and burden of illness of asthma in children.

Methods

This was a retrospective, longitudinal, database analysis using the Clinical Practice Research Datalink database. Primary care records of 19,330 patients (6-11 years) between January 1 and December 31, 2017, were analyzed. Asthma prevalence was assessed by severity (as described by Global Initiative for Asthma 2017 guidelines), and symptoms, comorbidities, and treatments were compared between asthma patients and matched non-asthmatic controls. Results are presented descriptively; logistic regression analyses were performed for asthma symptoms.

Results

The estimated prevalence of pediatric asthma was 6.5% (95% CI: 6.4-6.5) in the UK (mild: 74.2%; moderate: 15.0%; severe: 10.8%). All patients with moderate or severe asthma and 72.5% of patients with mild asthma were prescribed drug therapy. Most patients with moderate or severe asthma were prescribed a short-acting β2-agonist (94.9% and 96.0%, respectively), compared with 69.2% of mild asthma patients. Daytime symptoms were reported by 78.1% in those with severe asthma; 34.9% reported night-time symptoms and 30.8% reported an impact on usual activities. Asthma patients had a higher baseline prevalence of comorbidities compared with non-asthmatic controls, notably atopic dermatitis (47.8% in severe asthma versus 20.8% in controls) and allergic rhinitis (13.3% in severe asthma versus 2.0% in controls).

Conclusion

This analysis confirmed that asthma remains a common morbidity among children in the UK. Increasing asthma severity was associated with worsening symptoms, and asthma patients had significantly more comorbidities compared with non-asthmatic controls.

The Association of Nasal and Blood Eosinophils with Serum IgE Level in Allergic Rhinitis and Asthma: A Case-Control Study

Background and Aims

Allergic rhinitis and asthma are two common respiratory diseases with allergic etiology in the world's population. Eosinophils and serum IgE levels have been known as inflammatory allergy markers for many years. This study aimed to evaluate the correlation of nasal and blood eosinophils with serum IgE levels in allergic rhinitis and asthma patients.

Methods

This prospective study was done on patients (n = 78) diagnosed with asthma (n = 20), allergic rhinitis (n = 49), and chronic rhinosinusitis with nasal polyposis (CRSwNP) (n = 9) at our hospital in Ahvaz City, Iran. The age of participants in our study ranged from 3 to 73 years, and all of them were subjected to a complete blood count (CBC) test, nasal smear, and determination of serum IgE levels after their consent.

Results

There was no correlation between serum IgE level and nasal eosinophil count (p = 0.728) or between serum IgE level and blood eosinophil count (p = 0.657); however, a positive correlation was detected between blood and nasal eosinophil levels (p = 0.003).

Conclusion

There is no significant relationship between serum IgE level and eosinophil count in the blood and nasal secretions. Serum IgE level and blood or nasal eosinophil count are both useful biomarkers for monitoring allergic rhinitis and asthma individually, but no diagnostic conclusion can be drawn from their correlation.

Diagnostic Workup in IgE-Mediated Allergy to Asteraceae Weed Pollen and Herbal Medicine Products in Europe

Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may also suffer hypersensitivity reactions to herbal medicines obtained from certain cross-reactive plants in the Compositae family, such as chamomile, marigold, and purple coneflower. General physicians, ear, nose, and throat (ENT) specialists, and pulmonologists need to be familiar with the diagnostic tests used by allergists in clinical practice to support accurate diagnosis in such patients. Allergists must also be aware of the suggestions of the European Medicines Agency (EMA)'s Herbal Medicinal Products Committee and the broad spectrum of herbal therapies to educate their patients about potential risks.

[Immunoglobulin E in nasal secretions]

Diagnosis of allergic disease is primarily verified by IgE blood serum analysis. Determination in nasal secretions is technically more difficult, particularly due to a low specimen volume and the method of sample collection. Nasal secretions are frequently collected by lavage, which allows qualitative diagnostics, whereas swabs with defined amounts of mucus enable quantitative analyses. In the case of negative skin and serum tests, detection of IgE in nasal mucus combined with nasal provocation testing aids differentiation between local allergic and nonallergic rhinitis.

Local Allergic Rhinitis-A Challenge for Allergology and Otorhinolaryngology Cooperation (Scoping Review)

Local allergic rhinitis (LAR) represents a medical provocation for allergists and otorhinolaryngologists. LAR is considered to be a subtype of allergic rhinitis (AR) that affects a great percentage of patients who were, for decades, diagnosed as having chronic non-allergic rhinitis. The clinical picture is represented by rhinorrhea, sneezing, and nasal itching correlated with specific pollen season or dust, mold, or pet interior exposure. Usual assessment of AR (skin prick testing and serum IgE assessment) produces negative results. Specialized centers in allergology and ENT around the globe use a nasal allergen challenge, assessment of local IgE, basophil activation test (BAT), and nasal cytology in the diagnostic approach to the disease, taking into account their current limitations. The impact of LAR on quality-of-life indicators is the same as in AR. Treatment for LAR is similar to that for AR and is the same as for AR: allergen exposure avoidance, drug therapy, and allergen immunotherapy. This scoping review gathers the current up-to-date open access evidence available on PubMed on the subject of LAR.

Allergic Rhinitis: A Review

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.

The Impact of Cytokines on Health-Related Quality of Life in Adolescents with Allergic Rhinitis

BACKGROUND

Frequent episodes of nasal symptoms are the usual clinical manifestations (CM) of allergic rhinitis (AR) and have a significant negative impact on health-related quality of life (HRQoL) in adolescents. The purpose of this cross-sectional study was to test the hypothesis that cytokines in nasal mucus may be associated with HRQoL in adolescents with AR.

METHODS

European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), "The Adolescent Rhinoconjunctivitis Quality of Life Questionnaire" (AdolRQLQ) and the Total 4 Symptom Score (T4SS) scoring system were administered to 113 adolescents with AR, nonallergic rhinitis (NAR) and to healthy control subjects. Nasal secretions were sampled and tested for 13 cytokines using a multiplex flow cytometric bead assay.

RESULTS

The AR group had significantly lower EQ-5D-3L (0.661 ± 0.267 vs. 0.943 ± 0.088; p < 0.001) and higher AdolRQLQ total scores (2.76 ± 1.01 vs. 1.02 ± 0.10; p < 0.001) compared to the control group. The AR group had higher concentrations of IL-1β (p = 0.002), IL-6 (p = 0.031), IL-8 (p < 0.001), IL17-A (p = 0.013) and IL-18 (p = 0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as severe CM, were identified as significant predictors of lower HRQoL in adolescents with AR.

CONCLUSIONS

This study identified IL-1β, IL-6, as well as severe CM, as predictors of lower HRQoL in adolescents with AR. However, these results should only serve as a starting point for additional confirmation research.