Levels of Immunoglobulin E Sensitization Drive Symptom Thresholds in Allergic Rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to one or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated to clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known.

OBJECTIVE

The aim of this study was to evaluate phenotypical differences between mono- and poly-sensitized patients with AR and to quantify their symptomatic variability.

METHODS

565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. 155 were mono-sensitized and 410 poly-sensitized. Interactions between sensitization levels and reporting of different symptoms of AR and co-morbidities, disease duration and impact, were assessed. Furthermore, patients were stratified into mono- oligo- and poly-sensitized to assess whether the effect of sensitization on phenotype was ranked.

RESULTS

Poly-sensitized patients reported significantly more often itchy eyes (p=0.001) and had higher number of ocular (p=0.005), itch-related (p=0.036) and total symptoms (p=0.007) than mono-sensitized patients. In addition, polysensitized adults and children more often reported wheeze (p=0.015) and throat-clearing (p=0.04), respectively. Polysensitization was associated with more burdensome AR according to VAS (p=0.005). Increasing sensitization level was reflected in more itchy eyes, number of ocular, itch-related and total number of symptoms, as well as disease burden.

CONCLUSION

With increasing number of sensitizations, AR patients experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.

Prenatal antibiotic exposure increases the risk of infant atopic dermatitis: data from a Greek cohort

Summary

Background. The human microbiome is important due to the impact it has on host immunologic development and allergy-associated diseases. This study aimed to investigate the impact of prenatal exposure to antibiotics on the incidence of atopic dermatitis (AD) in children at 18 months of age. Methods. Mothers were interviewed at baseline, in the maternity ward and by phone questionnaire after 18 months. Demographic data, mode of delivery, yoghurt consumption, antibiotic and other drug use during pregnancy, atopic history, diagnosis of AD and history of infections in the offspring were noted. Results. 385 mothers were interviewed at baseline. 231 (60%) mothers with 236 children responded at follow up. Cesarean section was reported in 116 (50.2%) deliveries while antibiotic use during pregnancy in 55/231 (23.8%) women. 43/236 (18.22%) infants were diagnosed with AD. Intravenous antibiotic use was associated with a 7.7 increased risk of AD diagnosis in the offspring (95%CI 1.23-48.27, p = 0.029). An increased odd for AD was recorded for mothers 30-40 years of age (OR 4.50, 95%CI 1.08-18.7, p = 0.039). No significant association between cesarean section and AD (p = 0.70) was recorded. In multivariate analysis, reported food allergy (OR 8.03, 95%CI 2.30-27.97, p = 0.001) and otitis media episodes in children (OR 3.76, 95%CI 1.60-8.83, p = 0.002) were significantly associated with AD diagnosis. Conclusions. An increased risk of AD was recorded only when antibiotics were given prenatally by intravenous route and in women between 30-40 years of age. Children with food allergy had an increased risk for AD. The relatively high percentage of cesarean sections was not a risk factor for AD.

Correlation of blood pressure, obesity, and adherence to the Mediterranean diet with indices of arterial stiffness in children

The aim of the study was to assess the hypothesis that obesity, blood pressure (BP), and dietary habits (adherence to the Mediterranean diet) are related to indices of arterial stiffness (AS) in childhood. Two hundred and seventy-seven children aged 12 years were measured with the R6.5 Pulsecor® monitor, which performs measurements using an upper arm BP cuff held at above systolic pressure for a short time. The augmentation index (AI) in the brachial artery, the peripheral pulse pressure to central pulse pressure (PPP/CPP) ratio, and the reflected wave transit time to height ratio were used as indices of AS. The degree of adherence to the Mediterranean diet was assessed by the KIDMED index which includes 16 questions on specific dietary habits. Forty-three percent of the children were overweight and obese. Overweight and obese children had significantly lower PPP/CPP and KIDMED score in comparison to children with normal body mass index (BMI). In multivariate regression models, indices of AS were related to mean peripheral BP, heart rate, and height, while BMI had an independent correlation to PPP/CPP. The KIDMED index also had a negative correlation with AI independently of obesity.

CONCLUSION

Obesity and adherence to the Mediterranean diet patterns are factors related independently to indices of AS even in 12-year-old children.