Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis

BACKGROUND

Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow.

OBJECTIVE

To provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow.

METHODS

A systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis.

RESULTS

Twenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [P = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36; P < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65; P < .001], with a trend toward improvement in TNSS.

CONCLUSION

Overall, INCS resulted in a clinically and statistically meaningful improvement in symptom scores and physiologic measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their impacts upon nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly for mild AR. Future studies should assess the effect of treatment for each of these patient-reported measures.

Association between Perceived Stress and Rhinitis-Related Quality of Life: A Multicenter, Cross-Sectional Study

Allergic rhinitis (AR), a common chronic disease, impairs patients’ quality of life (QoL). This study aimed to determine the effect of perceived stress on disease-related QoL in AR patients. There were 741 patients from eight medical centers of the Allergic Rhinitis Cohort (ARCO) study. Data on sociodemographics, chronic conditions, AR severity, perceived stress level and Rhinoconjunctivitis QoL Questionnaire (RQLQ) results, and laboratory test findings were collected. The relationship between perceived stress and total RQLQ was analyzed using multiple linear regression. Potential confounding variables were adjusted. A high perceived stress level was associated with a high total RQLQ, which reflected worsening disease-related QoL. The high stress level was associated with an increased total RQLQ of 1.210 (95% confidence interval, 0.831–1.589; p < 0.0001) compared with the very low level. In the final model, the multiple regression-adjusted R² for RQLQ in AR participants was 0.5279, and perceived stress levels contributed 4.08% in additional explanatory power to RQLQ in AR patients. In conclusion, perceived stress is a potentially modifiable risk factor for decreased disease-related QoL in patients with AR, which may be improved with stress management.

Dynamic Changes, Correlation of Basophils, and the Therapeutic Effect in Patients With Allergic Rhinitis During Allergen-specific Immunotherapy

BACKGROUND

The role of basophils in allergic rhinitis (AR) has been studied extensively; however, there are very few reports on changes in basophils after allergen-specific immunotherapy (SIT).

OBJECTIVE

To examine the changes and correlation of peripheral blood basophils and the therapeutic effect in patients with AR during allergen-SIT.

METHODS

A total of 77 patients with AR who were allergic only to house dust mites received allergen-SIT. At 3 time points, patients underwent testing for the percentage and activation rate of basophils in peripheral blood, skin index (SI) measurement, visual analog scale (VAS) assessment, and rhinoconjunctivitis quality of life questionnaire (RQLQ) evaluation. The results were compared to a control group with congenital preauricular fistula.

RESULTS

(1) Before treatment, the percentage and activation rate of basophils in patients with AR were significantly higher than those in controls. There was no significant difference in the percentages and activation rates of basophils at the 3 time points. (2) The SIs, VAS, and RQLQ scores of the patients immediately after treatment and 2 years posttreatment decreased significantly compared to those before treatment; the SI, VAS, and RQLQ scores of the patients 2 years posttreatment increased significantly compared with those immediately after treatment. (3) There was no correlation between the patients' basophil activation rate and percentage and the SI, VAS, and RQLQ scores at all time points.

CONCLUSION

The percentage and activation rate of basophils were higher in patients with AR than in controls. The values did not change significantly after allergen-SIT and showed no correlation with treatment effectiveness. Therefore, the frequency and activation rate of basophils cannot be used as criteria for assessing the effectiveness of allergen-SIT for house dust mites. Allergen-SIT is effective for the management of AR, but the effect declines after the completion of therapy.