Medicine › Immunology and Allergy

Allergic Rhinitis and Sensitization

Works Count: 75523

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This cluster of papers focuses on the impact of allergic rhinitis on asthma, including allergen-specific immunotherapy, immunological mechanisms, and the influence of environmental factors such as pollen allergy and climate change. It also addresses the epidemiology, quality of life, and management strategies for allergic rhinitis and its comorbidity with asthma.

Keywords

Allergen-specific Immunotherapy; Asthma; Pollen Allergy; T Regulatory Cells; Immunological Mechanisms; Sublingual Immunotherapy; House Dust Mite Allergens; Climate Change; Epidemiology; Quality of Life

Advances in H<sub>1</sub>-Antihistamines

2004-11-17

F. Estelle R. Simons

Histamine has an important role as a chemical messenger in physiologic responses, neurotransmission, allergic inflammation, and immunomodulation by way of the H1-receptor. Most H1-antihistamines, which are useful in treating these … Histamine has an important role as a chemical messenger in physiologic responses, neurotransmission, allergic inflammation, and immunomodulation by way of the H1-receptor. Most H1-antihistamines, which are useful in treating these effects, possess similar efficacy in allergic rhinoconjunctivitis and chronic urticaria. However, there are clinically relevant differences among them in their pharmacology and safety profiles.

The diagnosis and management of rhinitis: An updated practice parameter

2008-07-27

Dana Wallace , Mark S. Dykewicz , David I. Bernstein +7 more

Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis

2001-07-01

David P. Skoner

Der p 1 facilitates transepithelial allergen delivery by disruption of tight junctions

1999-07-01

Hong Wan , Helen L. Winton , Christian Soeller +7 more

House dust mite (HDM) allergens are important factors in the increasing prevalence of asthma. The lung epithelium forms a barrier that allergens must cross before they can cause sensitization. However, … House dust mite (HDM) allergens are important factors in the increasing prevalence of asthma. The lung epithelium forms a barrier that allergens must cross before they can cause sensitization. However, the mechanisms involved are unknown. Here we show that the cysteine proteinase allergen Der p 1 from fecal pellets of the HDM Dermatophagoides pteronyssinus causes disruption of intercellular tight junctions (TJs), which are the principal components of the epithelial paracellular permeability barrier. In confluent airway epithelial cells, Der p 1 led to cleavage of the TJ adhesion protein occludin. Cleavage was attenuated by antipain, but not by inhibitors of serine, aspartic, or matrix metalloproteinases. Putative Der p 1 cleavage sites were found in peptides from an extracellular domain of occludin and in the TJ adhesion protein claudin-1. TJ breakdown nonspecifically increased epithelial permeability, allowing Der p 1 to cross the epithelial barrier. Thus, transepithelial movement of Der p 1 to dendritic antigen-presenting cells via the paracellular pathway may be promoted by the allergen's own proteolytic activity. These results suggest that opening of TJs by environmental proteinases may be the initial step in the development of asthma to a variety of allergens.

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REDUCTION OF BRONCHIAL HYPERREACTIVITY DURING PROLONGED ALLERGEN AVOIDANCE

1982-09-01

ThomasA.E. Platts-Mills , E. B. Mitchell , Pauline Nock +3 more

Specific immunotherapy has long‐term preventive effect of seasonal and perennial asthma: 10‐year follow‐up on the PAT study

2007-07-06

Lars Jacobsen , B. Niggemann , Sten Dreborg +7 more

Background: 3‐year subcutaneous specific immunotherapy (SIT) in children with seasonal allergic rhinoconjunctivitis reduced the risk of developing asthma during treatment and 2 years after discontinuation of SIT (5‐year follow‐up) indicating … Background: 3‐year subcutaneous specific immunotherapy (SIT) in children with seasonal allergic rhinoconjunctivitis reduced the risk of developing asthma during treatment and 2 years after discontinuation of SIT (5‐year follow‐up) indicating long‐term preventive effect of SIT. Objective: We evaluated the long‐term clinical effect and the preventive effect of developing asthma 7‐years after termination of SIT. Methods: One hundred and forty‐seven subjects, aged 16–25 years with grass and/or birch pollen allergy was investigated 10 years after initiation of a 3‐year course of SIT with standardized allergen extracts of grass and/or birch or no SIT respectively. Conjunctival provocations were performed outside the season and methacholine bronchial provocations were performed during the season and winter. Asthma was assessed by clinical evaluation. Results: The significant improvements in rhinoconjunctivitis and conjunctival sensitivity persisted at the 10‐year follow‐up. Significantly less actively treated subjects had developed asthma at 10‐year follow‐up as evaluated by clinical symptoms [odds ratio 2.5 (1.1–5.9)]. Patients who developed asthma among controls were 24/53 and in the SIT group 16/64. The longitudinal treatment effect when adjusted for bronchial hyper‐responsiveness and asthma status at baseline including all observations at 3, 5 and 10 years follow‐up (children with or without asthma at baseline, n = 189; 511 observations) was statistically significant ( P = 0.0075). The odds ratio for no‐asthma was 4.6 95% CI (1.5–13.7) in favor of SIT. Conclusion: A 3‐year course of SIT with standardized allergen extracts has shown long‐term clinical effects and the potential of preventing development of asthma in children with allergic rhinoconjunctivitis up to 7 years after treatment. Clinical implication: Specific immunotherapy has long‐term clinical effects and the potential of preventing development of asthma in children with allergic rhino conjunctivitis up to 7 years after treatment termination.

Allergen immunotherapy: A practice parameter third update

2010-12-04

Linda Cox , Harold S. Nelson , Richard F. Lockey +7 more

Allergenic pollen and pollen allergy in Europe

2007-05-23

Gennaro D’Amato , Lorenzo Cecchi , С. Бонини +6 more

The allergenic content of the atmosphere varies according to climate, geography and vegetation. Data on the presence and prevalence of allergenic airborne pollens, obtained from both aerobiological studies and allergological … The allergenic content of the atmosphere varies according to climate, geography and vegetation. Data on the presence and prevalence of allergenic airborne pollens, obtained from both aerobiological studies and allergological investigations, make it possible to design pollen calendars with the approximate flowering period of the plants in the sampling area. In this way, even though pollen production and dispersal from year to year depend on the patterns of preseason weather and on the conditions prevailing at the time of anthesis, it is usually possible to forecast the chances of encountering high atmospheric allergenic pollen concentrations in different areas. Aerobiological and allergological studies show that the pollen map of Europe is changing also as a result of cultural factors (for example, importation of plants such as birch and cypress for urban parklands), greater international travel (e.g. colonization by ragweed in France, northern Italy, Austria, Hungary etc.) and climate change. In this regard, the higher frequency of weather extremes, like thunderstorms, and increasing episodes of long range transport of allergenic pollen represent new challenges for researchers. Furthermore, in the last few years, experimental data on pollen and subpollen-particles structure, the pathogenetic role of pollen and the interaction between pollen and air pollutants, gave new insights into the mechanisms of respiratory allergic diseases.

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Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision

2010-09-01

Jan Brožek , Philippe‐Jean Bousquet , Carlos E. Baena‐Cagnani +7 more

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Allergen immunotherapy: Therapeutic vaccines for allergic diseases A WHO position paper☆☆☆★★★♢

1998-10-01

J Bousquet , R LOCKEY , H.‐J. Malling

Immunological mechanisms of allergen-specific immunotherapy

2006-09-25

Mark Larché , Cezmi A. Akdiş , Rudolf Valenta

Treatment strategies for allergy and asthma

2008-02-15

Stephen T. Holgate , Riccardo Polosa

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Inflammatory Mediators in Late Antigen-Induced Rhinitis

1985-07-11

Robert M. Naclerio , David Proud , Alkis Togias +6 more

To investigate the mechanisms responsible for the late-phase response in patients with allergies, we measured four biochemical mediators (histamine, tosyl-L-arginine methyl ester [TAME]-esterase, kinin, and prostaglandin D2) in nasal secretions … To investigate the mechanisms responsible for the late-phase response in patients with allergies, we measured four biochemical mediators (histamine, tosyl-L-arginine methyl ester [TAME]-esterase, kinin, and prostaglandin D2) in nasal secretions after nasal challenge with pollen antigen in 12 patients with allergy. Nine patients had an immediate response and a recurrence of symptoms 3 to 11 hours after challenge. The clinical symptoms during recurrence were accompanied by a second increase in levels of histamine, TAME--esterase, and kinin over base-line values, although kinin levels were lower than during the immediate response. In contrast, although the levels of prostaglandin D2 were significantly increased during the immediate response, they did not increase above base line during the late response. Rechallenge with allergen 11 hours after the initial provocation, however, was associated with reappearance of all four biochemical mediators, including prostaglandin D2. We conclude that the late response to nasal challenge with allergen is accompanied by a second increase in the concentrations of histamine and TAME--esterase but differs from the immediate response in the lack of prostaglandin D2 production and in the amount of kinin generated. Since histamine is released only by mast cells and basophils and prostaglandin D2 is not produced by basophils, we suggest that these cells are partly responsible for the late-phase response.

STUDIES ON THE MECHANISMS OF HYPERSENSITIVITY PHENOMENA

1964-10-01

Lawrence M. Lichtenstein , Abraham G. Osler

Human leukocytes, isolated from the blood of ragweed-sensitive donors, release histamine upon reaction with a purified protein antigen derived from this pollen. The release process has been studied with washed … Human leukocytes, isolated from the blood of ragweed-sensitive donors, release histamine upon reaction with a purified protein antigen derived from this pollen. The release process has been studied with washed cells suspended in a defined, serum-free medium. Physiologic levels of pH, ionic strength, and temperature, as well as both calcium and magnesium, are required for optimal cellular reactivity. The level of cellular sensitivity of approximately 200 ragweed-sensitive donors has been ascertained, and the kinetics of the release process studied. The rate of histamine release is a function of antigen concentration, but even with a large excess of this reagent it is impossible to abolish a lag phase. Chelation of the divalent cations or a decrease in the reaction temperature may be utilized to stop the reaction. These measures are effective both before and after the initiation of histamine release. Diminished cellular reactivity (desensitization) has been achieved by several procedures. These have in common the addition of antigen to cells in an environment deficient in but a single respect, followed by a restoration of optimal conditions. The significance of these data has been discussed and it has been proposed that immunologically induced histamine release is an active, enzymatically mediated process which occurs as a multistep response of viable cells to a specific antigenic stimulus.

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IL‐10 and TGF‐β cooperate in the regulatory T cell response to mucosal allergens in normal immunity and specific immunotherapy

2003-04-07

Marek Jutel , Mübeccel Akdiş , Ferah Budak +4 more

Abstract The regulation of normal and allergic immune responses to airborne allergens in the mucosa is still poorly understood, and the mechanism of specific immunotherapy (SIT) in normalizing the allergic … Abstract The regulation of normal and allergic immune responses to airborne allergens in the mucosa is still poorly understood, and the mechanism of specific immunotherapy (SIT) in normalizing the allergic response to such allergens is currently not clear. Accordingly, we have investigated the immunoregulatory mechanism of both normal and allergic responses to the major house‐dust mite (HDM) and birch pollen allergens — Dermatophagoides pteroynyssinus (Der p)1 and Bet v 1, respectively — as well as the immunologic basis of SIT to HDM in rhinitis and asthma patients. In normal immunity to HDM and birch pollen, an allergen‐specific peripheral T cell suppression to Der p 1 and Bet v 1 was observed. The deviated immune response was characterized by suppressed proliferative T celland Th1 (IFN‐γ) and Th2 (IL‐5, IL‐13) cytokine responses, and increased IL‐10 and TGF‐β secretion by allergen‐specific T cells. Neutralization of cytokine activity showed that T cell suppression was induced by IL‐10 and TGF‐β during SIT and in normal immunity to the mucosal allergens. In addition, SIT induced an antigen‐specific suppressive activity in CD4 + CD25 + T cells of allergic individuals. Together, these results demonstrate a deviation towards a regulatory/suppressor T cell response during SIT and in normal immunity as a key event for the healthy immune response to mucosal antigens.

Consensus statement * on the treatment of allergic rhinitis

2000-02-01

Paul Van Cauwenberge , Claus Bachert , G. Passalacqua +7 more

Allergen Immunotherapy: Therapeutic Vaccines for Allergic Diseases

1998-11-01

Jean Bousquet , Richard F. Lockey , Hans‐Jørgen Malling +7 more

Results of a Home-Based Environmental Intervention among Urban Children with Asthma

2004-09-08

Wayne J. Morgan , Ellen F. Crain , Rebecca S. Gruchalla +7 more

Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes. Reductions in these triggers of asthma have been … Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes. Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma. The objective of this study was to determine whether an environmental intervention tailored to each child's allergic sensitization and environmental risk factors could improve asthma-related outcomes.We enrolled 937 children with atopic asthma (age, 5 to 11 years) in seven major U.S. cities in a randomized, controlled trial of an environmental intervention that lasted one year (intervention year) and included education and remediation for exposure to both allergens and environmental tobacco smoke. Home environmental exposures were assessed every six months, and asthma-related complications were assessed every two months during the intervention and for one year after the intervention.For every 2-week period, the intervention group had fewer days with symptoms than did the control group both during the intervention year (3.39 vs. 4.20 days, P<0.001) and the year afterward (2.62 vs. 3.21 days, P<0.001), as well as greater declines in the levels of allergens at home, such as Dermatophagoides farinae (Der f1) allergen in the bed (P<0.001) and on the bedroom floor (P=0.004), D. pteronyssinus in the bed (P=0.007), and cockroach allergen on the bedroom floor (P<0.001). Reductions in the levels of cockroach allergen and dust-mite allergen (Der f1) on the bedroom floor were significantly correlated with reduced complications of asthma (P<0.001).Among inner-city children with atopic asthma, an individualized, home-based, comprehensive environmental intervention decreases exposure to indoor allergens, including cockroach and dust-mite allergens, resulting in reduced asthma-associated morbidity.

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Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology

1998-11-01

Mark S. Dykewicz , Stanley M. Fìneman , David P. Skoner +7 more

Exposure to House-Dust Mite Allergen (<i>Der p</i>I) and the Development of Asthma in Childhood

1990-08-23

Richard Sporik , Stephen T. Holgate , Thomas A.E. Platts‐Mills +1 more

Children with asthma commonly have positive skin tests for inhaled allergens, and in the United Kingdom the majority of older children with asthma are sensitized to the house-dust mite. In … Children with asthma commonly have positive skin tests for inhaled allergens, and in the United Kingdom the majority of older children with asthma are sensitized to the house-dust mite. In a cohort of British children at risk for allergic disease because of family history, we investigated prospectively from 1978 to 1989 the relation between exposure to the house-dust mite allergen (Der p I) and the development of sensitization and asthma.

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Allergic Rhinitis and Its Impact on Asthma

2001-11-01

Jean Bousquet , Paul Van Cauwenberge , Nikolaï Khaltaev

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Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003

2004-05-01

S. G. O. Johansson , Thomas Bieber , Ronald Dahl +7 more

Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma

2012-09-27

Philippe Gevaert , Lien Calus , Thibaut Van Zele +7 more

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A mechanism for the initiation of allergen-induced T helper type 2 responses

2007-12-21

Caroline L. Sokol , Gregory M. Barton , Andrew G. Farr +1 more

Indoor allergens and asthma:Report of the Third International Workshop

1997-12-01

Thomas A.E. Platts‐Mills , D. Vervloët , W Thomas +2 more

Prevalence and rate of diagnosis of allergic rhinitis in Europe

2004-10-31

Vincent Bauchau , Stephen R. Durham

To measure the prevalence of allergic rhinitis among European adults and the proportion of undiagnosed subjects, a two-step, cross-sectional, population-based survey in Belgium, France, Germany, Italy, Spain, and the UK … To measure the prevalence of allergic rhinitis among European adults and the proportion of undiagnosed subjects, a two-step, cross-sectional, population-based survey in Belgium, France, Germany, Italy, Spain, and the UK was undertaken. Step one of the study involved screening for allergic rhinitis by telephone interview, based on history of symptoms and/or self-awareness of the condition. Step two undertook confirmation of allergic rhinitis in a subset of the subjects screened positive; this was performed by a clinical diagnosis conducted in three to five clinical centres per country, including specific immunoglobulin E tests and a disease-specific questionnaire. A total of 9,646 telephone interviews were conducted between February and April 2001. Self-awareness of allergic rhinitis was reported by 19% of the subjects. Physician-based diagnosis of allergic rhinitis was reported by 13% of the subjects. In step two, 725 clinical assessments were conducted between May and August 2001. A total of 411 of patients, who underwent step two, had investigator-confirmed allergic rhinitis. Among patients with investigator-confirmed allergic rhinitis, 45% had not reported a previous diagnosis by a physician. Prevalence of subjects with clinically confirmable allergic rhinitis estimated by combining step one and step two data ranged from 17% in Italy to 29% in Belgium with an overall value of 23%. This large-scale study confirms that allergic rhinitis has a high prevalence in western Europe and is frequently undiagnosed.

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Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys

2006-08-01

M. Innes Asher , Stephen Montefort , Bengt Björkstén +4 more

Exposure to Dogs and Cats in the First Year of Life and Risk of Allergic Sensitization at 6 to 7 Years of Age

2002-08-28

Dennis R. Ownby , Christine Johnson , Edward L. Peterson

OF asthma in the United States and other developed countries over the last few decades has been a cause for concern. 1,24][5][6] Many studies have attempted to elucidate relationships between … OF asthma in the United States and other developed countries over the last few decades has been a cause for concern. 1,24][5][6] Many studies have attempted to elucidate relationships between environmental exposures, especially during infancy, and the risk of allergic sensitization in later life. 7,8These studies are based on the theory that an individual's genetic predisposition to allergic disease is activated or enhanced by early allergen exposure. 4,7,9The outcome of interactions between genetic influences and allergen exposures may be influenced by other environmental exposures, such as passive exposure to environmental tobacco smoke. 7,9If these relationships were better understood it might become possible to reduce the prevalence of allergic sensitization and perhaps asthma in children.Exposure to dogs and cats during infancy has been thought to increase the

The skin prick test – European standards

2013-01-01

Lucie Heinzerling , Adriano Mari , Karl‐Christian Bergmann +7 more

Skin prick testing is an essential test procedure to confirm sensitization in IgE-mediated allergic disease in subjects with rhinoconjunctivitis, asthma, urticaria, anapylaxis, atopic eczema and food and drug allergy. This … Skin prick testing is an essential test procedure to confirm sensitization in IgE-mediated allergic disease in subjects with rhinoconjunctivitis, asthma, urticaria, anapylaxis, atopic eczema and food and drug allergy. This manuscript reviews the available evidence including Medline and Embase searches, abstracts of international allergy meetings and position papers from the world allergy literature. The recommended method of prick testing includes the appropriate use of specific allergen extracts, positive and negative controls, interpretation of the tests after 15 - 20 minutes of application, with a positive result defined as a wheal ≥3 mm diameter. A standard prick test panel for Europe for inhalants is proposed and includes hazel (Corylus avellana), alder (Alnus incana), birch (Betula alba), plane (Platanus vulgaris), cypress (Cupressus sempervirens), grass mix (Poa pratensis, Dactilis glomerata, Lolium perenne, Phleum pratense, Festuca pratensis, Helictotrichon pretense), Olive (Olea europaea), mugwort (Artemisia vulgaris), ragweed (Ambrosia artemisiifolia), Alternaria alternata (tenuis), Cladosporium herbarum, Aspergillus fumigatus, Parietaria, cat, dog, Dermatophagoides pteronyssinus, Dermatophagoides farinae, and cockroach (Blatella germanica). Standardization of the skin test procedures and standard panels for different geographic locations are encouraged worldwide to permit better comparisons for diagnostic, clinical and research purposes.

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Sublingual immunotherapy for allergic rhinitis: systematic review and meta‐analysis*

2004-12-03

D R Wilson , Marcia Torres Lima , Stephen R. Durham

Allergic rhinitis is a common condition which, at its most severe, can significantly impair quality of life despite optimal treatment with antihistamines and topical nasal corticosteroids. Allergen injection immunotherapy significantly … Allergic rhinitis is a common condition which, at its most severe, can significantly impair quality of life despite optimal treatment with antihistamines and topical nasal corticosteroids. Allergen injection immunotherapy significantly reduces symptoms and medication requirements in allergic rhinitis but its use is limited by the possibility of severe systemic reactions. There has therefore been considerable interest in alternative routes for delivery of allergen immunotherapy, particularly the sublingual route. The objective was to evaluate the efficacy of sublingual immunotherapy (SLIT), compared with placebo, for reductions in symptoms and medication requirements. The Cochrane Controlled Clinical Trials Register, MEDLINE (1966–2002), EMBASE (1974–2002) and Scisearch were searched, up to September 2002, using the terms (Rhin* OR hay fever) AND (immunotherap* OR desensiti*ation) AND (sublingual). All studies identified by the searches were assessed by the reviewers to identify Randomized Controlled Trials involving participants with symptoms of allergic rhinitis and proven allergen sensitivity, treated with SLIT or corresponding placebo. Data from identified studies was abstracted onto a standard extraction sheet and subsequently entered into RevMan 4.1. Analysis was performed by the method of standardized mean differences (SMD) using a random effects model. P ‐values < 0.05 were considered statistically significant. Subgroup analyses were performed according to the type of allergen administered, the age of participants and the duration of treatment. Twenty‐two trials involving 979 patients, were included. There were six trials of SLIT for house dust mite allergy, five for grass pollen, five for parietaria, two for olive and one each for, ragweed, cat, tree and cupressus. Five studies enrolled exclusively children. Seventeen studies administered the allergen by sublingual drops subsequently swallowed, three by drops subsequently spat out and two by sublingual tablets. Eight studies involved treatment for less than 6 months, 10 studies for 6–12 months and four studies for greater than 12 months. All included studies were double‐blind placebo‐controlled trials of parallell group design. Concealment of treatment allocation was considered adequate in all studies and the use of identical placebo preparations was almost universal. There was significant heterogeneity, most likely due to widely differing scoring systems between studies, for most comparisons. Overall there was a significant reduction in both symptoms (SMD −0.42, 95% confidence interval −0.69 to −0.15; P = 0.002) and medication requirements [SMD −0.43 (−0.63, −0.23); P = 0.00003] following immunotherapy. Subgroup analyses failed to identify a disproportionate benefit of treatment according to the allergen administered. There was no significant reduction in symptoms and medication scores in those studies involving only children but total numbers of participants was too small to make this a reliable conclusion. Increasing duration of treatment does not clearly increase efficacy. The total dose of allergen administered may be important but insufficient data was available to analyse this factor.

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Allergic Rhinitis and its Impact on Asthma (ARIA)

2003-02-01

Jean Bousquet

Summary Allergic rhinitis is a worldwide health problem and prevalence of the disease is increasing, with economic and social consequences. An initiative from ARIA (Allergic Rhinitis and its Impact on … Summary Allergic rhinitis is a worldwide health problem and prevalence of the disease is increasing, with economic and social consequences. An initiative from ARIA (Allergic Rhinitis and its Impact on Asthma), an NGO working with the World Health Organization, has forwarded three main developments in the management of allergic rhinitis. Firstly, ARIA has provided new evidence‐based guidelines for the treatment of rhinitis that can be used worldwide, including in developing countries. The guidelines were designed to be used by the specialist as well as by the primary caregiver. Secondly, ARIA proposes a new subdivision of allergic rhinitis and suggests evidence‐based management of the disease using a stepwise approach. Thirdly, ARIA notes that asthma and rhinitis are common comorbidities and proposes that allergic patients are treated globally to combine treatment of upper and lower airway disease.

Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC

1998-04-01

Richard Beasley

Mechanisms of allergen-specific immunotherapy

2011-01-01

Cezmi A. Akdiş , Mübeccel Akdis

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Allergen injection immunotherapy for seasonal allergic rhinitis

2007-01-24

Moisés A. Calderón , Bernadette Alves , Mikila R. Jacobson +3 more

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Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis

1991-01-01

Elizabeth F. Juniper , Gordon Guyatt

Summary The objective of this study was to develop and test a health‐related quality of life questionnaire for clinical trials in rhinoconjunctivitis. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was … Summary The objective of this study was to develop and test a health‐related quality of life questionnaire for clinical trials in rhinoconjunctivitis. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was developed by asking patients to identify areas of their lives affected by rhinoconjunctivitis. The resultant RQLQ was tested for reproducibility, responsiveness and validity in a randomized, double‐blind trial of regular versus ‘as required’ aqueous beclomethasone dipropionate (BDP) nasal spray in ragweed pollen‐induced rhinoconjunctivitis. Eighty‐five patients from previous rhinoconjunctivitis studies participated in the developmental survey. Sixty ragweed‐sensitive patients, from previous trials and media notices, were enrolled in the clinical trial. Aqueous BDP (800 μg) nasal spray was administered regularly or ‘as required’ throughout the ragweed pollen season. The survey revealed that, in addition to local symptoms of rhinoconjunctivitis, patients experienced impairment of quality of life through systemic symptoms, sleep disturbance, practical problems, activity limitations and emotional problems. The RQLQ includes 28 questions related to these dimensions. Repeated administration of the RQLQ demonstrated good reproducibility. During the clinical trial, the RQLQ proved responsive in its ability to distinguish between regular and ‘as required’ medication use. Validity was shown by moderate to strong relations between changes in symptom diary scores and changes in RQLQ scores. In conclusion the RQLQ is likely to prove useful as a measure of health‐related quality of life in clinical trials in both rhinoconjunctivitis and rhinitis.

Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study)

2002-02-01

Christian Möller , Sten Dreborg , Hosne Ara Ferdousi +7 more

Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study

2001-03-01

Thomas A.E. Platts‐Mills , John W. Vaughan , Susan Pollart Squillace +2 more

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

2008-03-07

Jean Bousquet , N. Khaltaev , Álvaro A. Cruz +7 more

Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an immunoglobulin E (IgE)-mediated inflammation of the membranes lining the nose (1). It was defined in … Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an immunoglobulin E (IgE)-mediated inflammation of the membranes lining the nose (1). It was defined in 1929 (2): ‘The three cardinal symptoms in nasal reactions occurring in allergy are sneezing, nasal obstruction and mucous discharge’. Allergic rhinitis is a global health problem that causes major illness and disability worldwide. Patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work. The economic impact of allergic rhinitis is often underestimated because the disease does not induce elevated direct costs. However, the indirect costs are substantial (1). Both allergic rhinitis and asthma are systemic inflammatory conditions and are often co-morbidities. Although asthma and other forms of allergic disease have been described in antiquity, ‘hay fever’ is surprisingly modern. Very rare descriptions can be traced back to Islamic texts of the 9th century and European texts of the 16th century. It was only in the early 19th century that the disease was carefully described, and at that time it was regarded as most unusual (3). In the 19th century, the disease followed the industrialization of westernized countries (4). By the end of the 19th century it had become commonplace in both Europe and North America. However, the prevalence of allergic rhinitis was still low and has considerably increased during the past 50 years. In some countries, over 50% of adolescents are reporting symptoms of allergic rhinitis (5). Using a conservative estimate, allergic rhinitis occurs in over 500 million people around the world. The prevalence of allergic rhinitis is increasing in most countries of the world, and particularly in areas with low or medium levels of prevalence. However, it may be plateauing or even decreasing in the highest prevalence areas. Rhinitis and allergic diseases are now taken seriously and the European Union (6) or countries such as Canada have specific programs to better understand, manage and prevent allergic diseases. Risk factors for allergic rhinitis are well identified. In the middle of the 19th century, the cause of hay fever was ascribed to pollens (7, 8). Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations. The diagnosis of allergic rhinitis is often easy, but in some cases it may cause problems and many patients are still underdiagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work. The management of allergic rhinitis is well established and many guidelines have been issued although the first ones were not evidence based (9–11). In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) World Health Organization (WHO) workshop, the suggestions were made by a panel of experts and based on evidence using an extensive review of the literature available up to December 1999 (1). The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. (12). The second important achievement of ARIA was to propose a new classification for allergic rhinitis which was subdivided into ‘intermittent’ (IAR) or ‘persistent’ (PER) disease (1). Moreover, it is now recognized that allergic rhinitis comprises more than the classical symptoms of sneezing, rhinorrhoea and nasal obstruction. It is associated with impairments in how patients function in day-to-day life. The severity of allergic rhinitis was therefore classified as ‘mild’ or ‘moderate/severe’ depending on symptoms but also on quality of life (QOL; 1). Another important aspect of the ARIA guidelines was to consider co-morbidities of allergic rhinitis. Eye involvement in allergic rhinitis has been described for a long time (13). The nasal airways and their closely-associated paranasal sinuses are an integral part of the respiratory tract (1, 14–16). In the second century, Claudius Galenus, one of the fathers of modern respiratory physiology, defined the nose as a ‘respiratory instrument’ in his work De usu partium [on the usefulness of the (body) parts (17)]. The co-morbidities between the upper and lower airways were described with the clinical description of allergic rhinitis (3, 8). The nasal and bronchial mucosa present similarities, and one of the most important concepts regarding nose–lung interactions is the functional complementarity (14). Interactions between the lower and the upper airways are well known and have been extensively studied since 1990. Over 80% of asthmatics have rhinitis and 10–40% of patients with rhinitis have asthma (1). Most patients with asthma have rhinitis (18) suggesting the concept of ‘one airway one disease’ although there are differences between rhinitis and asthma (19, 20). The ARIA document was intended to be a state-of-the-art for the specialist as well as for the general practitioner and other healthcare professionals: to update their knowledge of allergic rhinitis; to highlight the impact of allergic rhinitis on asthma; to provide an evidence-based documented revision on diagnostic methods; to provide an evidence-based revision on treatments and to propose a stepwise approach to management. The ARIA document was not intended to be a standard-of-care document for individual countries. It was provided as a basis for doctors, healthcare professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients. The ARIA workshop held at the WHO headquarters proposed the recommendations shown in Table 1. An update of the ARIA guidelines was needed because: a large number of papers have been published over the past 7 years extending our knowledge on the epidemiology, diagnosis, management and co-morbidities of allergic rhinitis. Other guidelines have been produced since 1999 (21), but these did not review the ongoing literature extensively using an evidence-based model; the ARIA recommendations were proposed by an expert group and needed to be validated in terms of classification and management; new evidence-based systems are currently available to guide recommendations and include safety and costs as well as efficacy of treatments (22, 23); there were gaps in our knowledge in the first ARIA document. In particular: some aspects of treatment like complementary and alternative medicine were not appropriately discussed; the links between the upper and lower airways in developing countries and deprived areas were not sufficiently developed even though, in the original ARIA document, a section was written on this subject in collaboration with the UNION (formerly IUATLD); sport and rhinitis in athletes and rhinitis and its links with asthma in preschool children. The ARIA update commenced in 2004. Several chapters of ARIA were extensively reviewed in an evidence-based model, and papers were published (or submitted) in peer-reviewed journals: tertiary prevention of allergy, complementary and alternative medicine, pharmacotherapy and anti-IgE treatment, allergen-specific immunotherapy, links between rhinitis and asthma and mechanisms of rhinitis (24–28). There was then a need for a global document based on the published papers to highlight the interactions between the upper and the lower airways and to: develop an evidence-based global document on a key problem of respiratory medicine including diagnosis, epidemiology, common risk factors, management and prevention; propose educational materials for healthcare professionals and patients; meet the objectives of the WHO Global Alliance against Chronic Respiratory Diseases (GARD; 29) in order to help coordinate the efforts of the different GARD organizations towards a better prevention and management of chronic respiratory diseases (CRD), to increase CRD awareness and also to fill some of the gaps in knowledge; focus on the prevention of chronic respiratory and allergic diseases; highlight gaps in knowledge, particularly in developing countries and deprived areas; prepare an executive summary and pocket guide for doctors, patients and healthcare professionals. Rhinitis is defined as an inflammation of the lining of the nose and is characterized by nasal symptoms including anterior or posterior rhinorrhoea, sneezing, nasal blockage and/or itching of the nose. These symptoms occur during two or more consecutive days for more than 1 h on most days (9). Allergic rhinitis is the most common form of noninfectious rhinitis and is associated with an IgE-mediated immune response against allergens. It is often associated with ocular symptoms. Several nonallergic conditions can cause similar symptoms: infections, hormonal imbalance, physical agents, anatomical anomalies and the use of certain drugs (30). Rhinitis is therefore classified as shown in Table 2 (1). The differential diagnosis of rhinitis is presented in Table 3 (1). Since the nasal mucosa is continuous with that of the paranasal sinuses, congestion of the ostia may result in sinusitis which does not exist without rhinitis. The term ‘rhinosinusitis’ should replace ‘sinusitis’ (31). Vasomotor rhinitis is a term which is not used in this document, as vasomotor symptoms can be caused by allergic and nonallergic rhinitis. Definition and classification of allergic rhinitis Allergic rhinitis is clinically defined as a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation. Allergic rhinitis is subdivided into IAR or PER disease. The severity of allergic rhinitis can be classified as ‘mild’ or ‘moderate/severe’. Allergic rhinitis impairs QOL, sleep, school and work. Many nonallergic triggers induce nasal symptoms which mimic allergic rhinitis. They include drugs (aspirin and other nonsteroidal anti-inflammatory agents), occupational agents, foods, physical, emotional and chemical factors and viral infections. 2.2.1.1. Clinical definition. Symptoms of allergic rhinitis include rhinorrhoea, nasal obstruction (32), nasal itching and sneezing which are reversible spontaneously or with treatment (2, 33–36). Postnasal drip mainly occurs either with profuse anterior rhinorrhoea in allergic rhinitis (37) or without significant anterior rhinorrhoea in chronic rhinosinusitis (CRS; 38, 39). Preschool children may just have nasal obstruction. However, when nasal obstruction is the only symptom, it is very rarely associated with allergy. Patients with nonallergic rhinitis may have similar symptoms (40). Allergic rhinitis is subdivided into ‘IAR’ or ‘PER’ disease. The severity of allergic rhinitis can be classified as ‘mild’ or ‘moderate/severe’ (1). 2.2.1.2. Definition for epidemiologic studies. The clinical definition of rhinitis is difficult to use in the epidemiologic settings of large populations where it is impossible to visit everybody individually or to obtain the laboratory evidence of each immune response. However, the standardization of the definition of rhinitis in epidemiologic studies is of crucial importance, especially when comparing the prevalence between studies. Initial epidemiologic studies have assessed allergic rhinitis on the basis of simple ‘working definitions’. Various standardized questionnaires have been used for this effect (41, 42). The first questionnaires assessing seasonal allergic rhinitis dealt with ‘nasal catarrh’ (British Medical Research Council, 1960; 43) and ‘runny nose during spring’ (British Medical Research Council, 1962; 44). Questions introducing the diagnostic term of ‘seasonal allergic rhinitis’ were successively used: ‘Have you ever had seasonal allergic rhinitis?’ or ‘Has a doctor ever told you that you suffer from seasonal allergic rhinitis?’ In the European Community Respiratory Health Survey (ECRHS) full-length questionnaire, the question asked on rhinitis was: ‘Do you have any nasal allergies including “seasonal allergic rhinitis”?’ (45). To identify the responsible allergen, the ECRHS study has included potential triggers of the symptoms. However, this question is not sensitive enough and some patients with nonallergic rhinitis answer ‘yes’. There are however problems with questionnaires. Many patients poorly perceive nasal symptoms of allergic rhinitis: some exaggerate symptoms, whereas many others tend to dismiss the disease (46). Moreover, a large proportion of rhinitis symptoms are not of allergic origin (47). In the Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA), the prevalence of current seasonal allergic rhinitis varied between 9.1% (questionnaire answer and a positive skin prick test to at least one pollen) and 14.2% (questionnaire answer only). Diagnostic criteria affect the reported prevalence rates of rhinitis (48–50). A score considering most of the features of allergic rhinitis (clinical symptoms, season of the year, triggers, parental history, individual medical history and perceived allergy) has recently been proposed (51). Using the doctor’s diagnosis (based on questionnaire, examination and skin tests to common aeroallergens) as a gold standard, these scores had good positive and negative predictive values (84% and 74%, respectively) in the identification of patients suffering from allergic rhinitis. Symptoms of perennial rhinitis have been defined as frequent, nonseasonal, nasal or ocular (‘rhinoconjunctivitis’). In one study, the length of the disease was also taken into consideration to differentiate perennial allergic rhinitis from the ‘common cold’ (viral upper respiratory infections; 52). Objective tests for the diagnosis of IgE-mediated allergy (skin prick test and serum-specific IgE) can also be used (53–55). The diagnostic efficiency of IgE, skin prick tests and Phadiatop® was estimated in 8 329 randomized adults from the SAPALDIA. The skin prick test had the best positive predictive value (48.7%) for the epidemiologic diagnosis of allergic rhinitis compared to the Phadiatop® (43.5%) or total serum IgE (31.6%) (56). Future working definitions may encompass not only clinical symptoms and immune response tests, but also nasal function and eventually specific nasal challenge (57). 2.2.2. Intermittent (IAR) and persistent allergic rhinitis (PER). Previously, allergic rhinitis was subdivided, based on the time of exposure, into seasonal, perennial and occupational (9, 10, 58, 59). Perennial allergic rhinitis is most frequently caused by indoor allergens such as dust mites, molds, insects (cockroaches) and animal danders. Seasonal allergic rhinitis is related to a wide variety of outdoor allergens such as pollens or molds. However, this classification is not entirely satisfactory as: in certain areas, pollens and molds are perennial allergens [e.g. grass pollen allergy in Southern California and Florida (60) or Parietaria pollen allergy in the Mediterranean area (61)]; symptoms of perennial allergy may not always be present all year round. This is particularly the case for a large number of patients allergic to house dust mites (HDM) suffering only from mild or moderate/severe IAR (62–65). This is also the case in the Mediterranean area where levels of HDM allergen are low in the summer (66); the majority of patients are sensitized to many different allergens and therefore exposed throughout the year (33, 62, 67–69). In many patients, perennial symptoms are often present and patients experience seasonal exacerbations when exposed to pollens or molds. It appears therefore that this classification is not adherent to real life; climatic changes modify the time and duration of the pollen season which may make predictions difficult; allergic patients travel and may be exposed to the sensitizing allergens in different times of the year; some patients allergic to pollen are also allergic to molds and it is difficult to clearly define the pollen season (70); some patients sensitized only to a single pollen species have perennial symptoms (71); due to the priming effect on the nasal mucosa induced by low levels of pollen allergens (72–77) and minimal PER inflammation of the nose in patients with symptom-free rhinitis (64, 78, 79), symptoms do not necessarily occur strictly in conjunction with the allergen season and nonspecific irritants such as air pollution may aggravate symptoms in symptomatic patients and induce symptoms in asymptomatic patients with nasal inflammation (80). Thus, a major change in the subdivision of allergic rhinitis was proposed in the ARIA document with the terms ‘IAR’ and ‘PER’ (1). It was shown that the classic types of seasonal and perennial rhinitis cannot be used interchangeably with the new classification of IAR/PER, as they do not represent the same stratum of disease. Thus, ‘IAR’ and ‘PER’ are not synonymous with ‘seasonal’ and ‘perennial’ (36, 62, 67, 81–83). In the original ARIA document, the number of consecutive days used to classify patients with PER was more than four per week (1). However, it appears that patients with PER usually suffer almost every day (84). Whereas the majority of patients have symptoms unrelated to seasons, it is possible to discriminate pollen seasons in some patients. In this case, patients experience symptoms during defined times of the year or have mild PER during most months of the year and more severe symptoms when exposed to high concentrations of allergens during pollen seasons. As most patients are polysensitized, it appears that the ARIA classification is closer to the patients’ needs than the previous one (85). Moreover, PER does not necessarily result from allergic origin (86). 2.2.3.1. Classical symptoms and signs. Allergic rhinitis is characterized by subjective symptoms which may be difficult to quantify due to the fact that they depend largely on the patient’s perception. 2.2.3.2. Symptoms associated with social life, work and school. It is now recognized that allergic rhinitis comprises more than the classical symptoms of sneezing, rhinorrhoea and nasal obstruction. It is associated with impairments in how patients function in day-to-day life. Impairment of QOL is seen in adults (10, 87, 88) and in children (89–92). Patients may also suffer from sleep disorders and emotional problems, as well as from impairment in activities and social functioning (93). Poorly-controlled symptoms of allergic rhinitis may contribute to sleep loss or disturbance (94–104). Moreover, H1-antihistamines with sedative properties can increase sedation in patients with allergic rhinitis (105, 106). Although sleep apnoea syndrome has been associated with nasal disturbances (107–109), it is unclear as to whether allergic rhinitis is associated with sleep apnoea (100, 107, 110). It has been shown that patients with moderate/severe symptoms of IAR or PER have an impaired sleep pattern by comparison to normal subjects and patients with mild rhinitis (111). It is also commonly accepted that allergic rhinitis impairs work (10, 84, 112, 113) and school performance (114–116). In several studies, the severity of allergic rhinitis, assessed using QOL measures, work productivity questionnaires or sleep questionnaires, was found to be somewhat independent of duration (67, 84, 111, 117). 2.2.3.3. Objective measures of severity. Objective measures of the severity of allergic rhinitis include: symptom scores; visual analogue scales (VAS ; 118, 119 ; Fig. 1) ; measurements of nasal obstruction, such as peak inspiratory flow measurements, acoustic rhinometry and rhinomanometry (120–122); measurements of inflammation such as nitric oxide (NO) measurements, cells and mediators in nasal lavages, cytology and nasal biopsy (121, 123); reactivity measurements such as provocation with histamine, methacholine, allergen, hypertonic saline, capsaicin or cold dry air (124) and measurements of the sense of smell (125). Mean mast cells, toludine blue staining, IgE+ and eosinophil cell counts/mm2 nasal biopsy tissues collected from patients with perennial allergic (PAR) and idiopathic (ID) rhinitis, and normal nonrhinitic subjects (N). (Horizontal bar + median counts; St1 = counts in epithelium; St2 = counts in superficial submucosa; St3 = counts in deep submucosa.) (Modified from Powe et al. 2001 (15) and reprinted with kind permission.) Measurements of VAS, nasal obstruction and smell are used in clinical practice. The other measurements are primarily used in research. 2.2.3.4. ARIA classification of allergic rhinitis. In the ARIA classification, allergic rhinitis can be classified as ‘mild’ or ‘moderate/severe’ depending on the severity of the symptoms and their impact on social life, school and work (Table 4). It has also been proposed to classify the severity as ‘mild’, ‘moderate’ or ‘severe’ (36, 126, 127). However, it seems that this proposal makes it more complex for the practicing doctor and does not provide any significant improvement to the patient, this more complex classification failing to translate to a difference in therapeutic options. The severity of allergic rhinitis is independent of its treatment. In asthma, the control level is also independent of asthma medications (128–132). Although such an independent relationship was suspected in a study on allergic rhinitis (67), this very important finding was confirmed in a recent study in which it was found that the severity of rhinitis is independent of its treatment (119). Thus, as for asthma, one of the problems to consider is to replace ‘severity’ by ‘control’, but sufficient data are not yet available. 2.3.1. Infectious rhinitis. For infectious rhinitis, the term rhinosinusitis is usually used. Rhinosinusitis is an inflammatory process involving the mucosa of the nose and one or more sinuses. The mucosa of the nose and sinuses form a continuum and thus, more often than not, the mucous membranes of the sinuses are involved in diseases which are primarily caused by an inflammation of the nasal mucosa. For this reason, infectious rhinitis is discussed under Rhinosinusitis. 2.3.2. Work-related rhinitis. Occupational rhinitis arises in response to an airborne agent present in the workplace and may be due to an allergic reaction or an irritant response (133). Causes include laboratory animals (rats, mice, guinea-pigs, etc.; 134), wood dust, particularly hard woods (Mahogany, Western Red Cedar, etc.; 135), mites (136), latex (137), enzymes (138), grains (bakers and agricultural workers; 139, 140) and chemicals such as acid anhydrides, platinum salts (141), glues and solvents (142). Occupational rhinitis is frequently underdiagnosed due to under-reporting and/or a lack of doctor awareness (133, 143). Diagnosis is suspected when symptoms occur in relation to work. Differentiating between immunologic sensitization and irritation may be difficult. Given the high prevalence of rhinitis in the general population, whatever the cause, then objective tests confirming the occupational origin are essential (144). Measures of inflammatory parameters via nasal lavage and the objective assessment of nasal congestion both offer practical means of monitoring responses (133). Growing experience with acoustic rhinometry and peak nasal inspiratory flow (PNIF) suggests that these methods may have a role in monitoring and diagnosing (145). The surveillance of sensitized workers may enable an early detection of occupational asthma. 2.3.3. Drug-induced rhinitis. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) commonly induce rhinitis and asthma (Table 5). The disease has recently been defined as aspirin-exacerbated respiratory disease (146). In a population-based random sample, aspirin hypersensitivity was more frequent among subjects with allergic rhinitis than among those without (2.6%vs 0.3%; 147). In about 10% of adult patients with asthma, aspirin and other NSAIDs that inhibit cyclo-oxygenase (COX) enzymes (COX-1 and COX-2) precipitate asthma attacks and naso-ocular reactions (148). This distinct clinical syndrome, called aspirin-induced asthma, is characterized by a typical sequence of symptoms: an intense eosinophilic inflammation of the nasal and bronchial tissues combined with an overproduction of cysteinyl leukotrienes (CysLT; 149) and other prostanoids (150, 151). After the ingestion of aspirin or other NSAIDs, an acute asthma attack occurs within 3 hours, usually accompanied by profuse rhinorrhoea, conjunctival injection, periorbital edema and sometimes a scarlet flushing of the head and neck. Aggressive nasal polyposis and asthma run a protracted course, despite the avoidance of aspirin and cross-reacting drugs (152). Blood eosinophil counts are raised and eosinophils are present in nasal mucosa and bronchial airways. Specific anti-COX-2 enzymes are usually well tolerated in aspirin-sensitive patients (149) but many are no longer marketed. A range of other medications is known to cause nasal symptoms. These include: reserpine (154); guanethidine (155); phentolamine (156); methyldopa (155); ACE inhibitors (157); α-adrenoceptor antagonists; intraocular or oral ophthalmic preparations of β-blockers (158); chlorpromazine and oral contraceptives. The term rhinitis medicamentosa (159–161) applies to the rebound nasal obstruction which develops in patients who use intranasal vasoconstrictors chronically. The pathophysiology of the condition is unclear; however, vasodilatation and intravascular edema have both been implicated. The management of rhinitis medicamentosa requires the withdrawal of topical decongestants to allow the nasal mucosa to recover, followed by treatment of the underlying nasal disease (162). Cocaine sniffing is often associated with frequent sniffing, rhinorrhoea, diminished olfaction and septal perforation (163, 164). Amongst the multiuse aqueous nasal, ophthalmic and otic products, benzalkonium chloride is the most common preservative. Intranasal products containing this preservative appear to be safe and well tolerated for both long- and short-term clinical use (165). 2.3.4. Hormonal rhinitis. Changes in the nose are known to occur during the menstrual cycle (166), puberty, pregnancy (167, 168) and in specific endocrine disorders such as hypothyroidism (169) and acromegaly (170). Hormonal imbalance may also be responsible for the atrophic nasal change in postmenopausal women. A hormonal PER or rhinosinusitis may develop in the last trimester of pregnancy in otherwise healthy women. Its severity parallels the blood estrogen level (171). Symptoms disappear at delivery. In a woman with perennial rhinitis, symptoms may improve or deteriorate during pregnancy (172). 2.3.5. Nasal symptoms related to physical and chemical factors. Physical and chemical factors can induce nasal symptoms which may mimic rhinitis in subjects with sensitive mucous membranes and even in normal subjects if the concentration of chemical triggers is high enough (173, 174). Sudden changes in temperature can induce nasal symptoms in patients with allergic rhinitis (175). Chronic effects of cold dry air are important. Skier’s nose (cold, dry air; 176) has been described as a distinct entity. However, the distinction between a normal physiologic response and a disease is not clear and all rhinitis patients may exhibit an exaggerated response to unspecific physical or chemical stimuli. Little information is available on the acute or chronic effects of air pollutants on the nasal mucosa (177). The alterations of physiologic nasal respiration is of importance for any athlete. The impact of exercise on rhinitis and the effect of rhinitis on exercise received considerable attention before the 1984 Olympics, where evidence indicated that chronic rhinitis frequently occurs and deserves specific management in athletes (178). Athletes suffering from symptoms of rhinitis were shown to have impaired performances (179). Many active athletes suffer from allergic rhinitis during the pollen season (180, 181) and most of these receive treatment for their nasal symptoms. On the other hand, some conditions induce nasal symptoms. This is the case of the skier’s nose, a model of cold-induced rhinitis (176, 182–184), or rhinitis in competitive swimmers who inhale large quantities of chlorine gas or hypochlorite liquid (185–187). In runners, nasal resistance falls to about half of its resting values. Decongestion begins immediately after starting running and persists for around 30 min after (27). In multiple chemical sensitivities, nasal symptoms such as impaired odor perception may be present (188). 2.3.6. Rhinitis in smokers. In smokers, eye irritation and odor perception are more common than in nonsmokers (189). Tobacco smoke can alter the mucociliary clearance (190) and can cause an eosinophilic and ‘allergic’-like inflammation in the nasal mucosa of nonatopic children (191). Some smokers report a sensitivity to tobacco smoke including headache, nose irritation (rhinorrhoea, nasal congestion, postnasal drip and sneezing) and nasal obstruction (192). However, in normal subjects, smoking was not found to impair nasal QOL (193). Nonallergic rhinitis with eosinophilia syndrome (NARES) might be caused by passive smoking inducing an ‘allergy-like’ inflammatory response (194). 2.3.7. Food-induced rhinitis. Food allergy is a very rare cause of isolated rhinitis (195). However, nasal symptoms are common among the many symptoms of food-induced anaphylaxis (195). On the other hand, foods and alcoholic beverages in particular may induce symptoms by unknown nonallergic mechanisms. Gustatory rhinitis (hot, spicy food such as hot red pepper; 196) can induce rhinorrhoea, probably because it contains capsaicin. This is able to stimulate

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Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis

2016-02-02

Claus Bachert , Leda Mannent , Robert M. Naclerio +7 more

IMPORTANCEDupilumab has demonstrated efficacy in patients with asthma and atopic dermatitis, which are both type 2 helper T-cell-mediated diseases.OBJECTIVE To assess inhibition of interleukins 4 and 13 with dupilumab in … IMPORTANCEDupilumab has demonstrated efficacy in patients with asthma and atopic dermatitis, which are both type 2 helper T-cell-mediated diseases.OBJECTIVE To assess inhibition of interleukins 4 and 13 with dupilumab in patients with chronic sinusitis and nasal polyposis. DESIGN, SETTING, AND PARTICIPANTSA randomized, double-blind, placebo-controlled parallel-group study conducted at 13 sites in the United States and Europe between August 2013 and August 2014 in 60 adults with chronic sinusitis and nasal polyposis refractory to intranasal corticosteroids with 16 weeks of follow-up.INTERVENTIONS Subcutaneous dupilumab (a 600 mg loading dose followed by 300 mg weekly; n = 30) or placebo (n = 30) plus mometasone furoate nasal spray for 16 weeks. MAIN OUTCOMES AND MEASURESChange in endoscopic nasal polyp score (range, 0-8; higher scores indicate worse status) at 16 weeks (primary end point).Secondary end points included Lund-Mackay computed tomography (CT) score (range, 0-24; higher scores indicate worse status), 22-item SinoNasal Outcome Test score (range, 0-110; higher scores indicating worse quality of life; minimal clinically important difference Ն8.90), sense of smell assessed using the University of Pennsylvania Smell Identification Test (UPSIT) score (range, 0-40; higher scores indicate better status), symptoms, and safety.RESULTS Among the 60 patients who were randomized (mean [SD] age, 48.4 years [9.4 years]; 34 men [56.7%]; 35 with comorbid asthma), 51 completed the study.The least squares (LS) mean change in nasal polyp score was -0.3 (95% CI, -1.0 to 0.4) with placebo and -1.9 (95% CI, -2.5 to -1.2) with dupilumab (LS mean difference, -1.6 [95% CI, -2.4 to -0.7]; P < .001).The LS mean difference between the 2 groups for the Lund-Mackay CT total score was -8.8 (95% CI, -11.1 to -6.6; P < .001).Significant improvements with dupilumab were also observed for the 22-item SinoNasal Outcome Test (LS mean difference between groups, -18.1 [95% CI, -25.6 to -10.6]; P < .001)and sense of smell assessed by UPSIT (LS mean difference, 14.8 [95% CI, 10.9 to 18.7]; P < .001).The most common adverse events were nasopharyngitis (33% in the placebo group vs 47% in the dupilumab group), injection site reactions (7% vs 40%, respectively), and headache (17% vs 20%).CONCLUSIONS AND RELEVANCE Among adults with symptomatic chronic sinusitis and nasal polyposis refractory to intranasal corticosteroids, the addition of subcutaneous dupilumab to mometasone furoate nasal spray compared with mometasone alone reduced endoscopic nasal polyp burden after 16 weeks.Further studies are needed to assess longer treatment duration, larger samples, and direct comparison with other medications.

Tablets with spores used in absolute pollen analysis

1971-01-01

Jens Stockmarr

Long-Term Clinical Efficacy of Grass-Pollen Immunotherapy

1999-08-12

Stephen R. Durham , Samantha Walker , Eva‐Maria Varga +6 more

Pollen immunotherapy is effective in selected patients with IgE-mediated seasonal allergic rhinitis, although it is questionable whether there is long-term benefit after the discontinuation of treatment. Pollen immunotherapy is effective in selected patients with IgE-mediated seasonal allergic rhinitis, although it is questionable whether there is long-term benefit after the discontinuation of treatment.

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Malignant Melanoma in Patients Treated for Psoriasis with Methoxsalen (Psoralen) and Ultraviolet A Radiation (PUVA)

1997-04-10

Robert S. Stern , Khanh T. Nichols , Liisa Väkevä

Photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA) is an effective treatment for psoriasis. However, PUVA is mutagenic, increases the risk of squamous-cell skin cancer, and can cause … Photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA) is an effective treatment for psoriasis. However, PUVA is mutagenic, increases the risk of squamous-cell skin cancer, and can cause irregular, pigmented skin lesions. We studied the occurrence of melanoma among patients treated with PUVA.We prospectively identified cases of melanoma and documented the extent of exposure to PUVA among 1380 patients with psoriasis who were first treated with PUVA in 1975 or 1976. Using incidence data, we calculated the expected incidence of melanoma in this cohort and compared it with the observed incidence. Using regression models, we assessed the risks of melanoma associated with a long time (> or = 15 years) since the first treatment and with a large number of PUVA treatments (> or = 250).From 1975 through 1990, we detected four malignant melanomas, about the number expected in the overall population (relative risk, 1.1). From 1991 through 1996, we detected seven malignant melanomas (relative risk, 5.4; 95 percent confidence interval, 2.2 to 11.1). The risk of melanoma was higher in the later period than in the earlier one (incidence-rate ratio, 3.8) and higher among patients who received at least 250 PUVA treatments than among those who received fewer treatments (incidence-rate ratio, 3.1).About 15 years after the first treatment with PUVA, the risk of malignant melanoma increases, especially among patients who receive 250 treatments or more.

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Exposure to an Aeroallergen as a Possible Precipitating Factor in Respiratory Arrest in Young Patients with Asthma

1991-02-07

Mark T. O’Hollaren , John W. Yunginger , Kenneth P. Offord +4 more

Exposure to airborne spores of the common mold Alternaria alternata has been implicated in asthma attacks. Such exposure is particularly frequent in the Midwest during the summer and fall months. … Exposure to airborne spores of the common mold Alternaria alternata has been implicated in asthma attacks. Such exposure is particularly frequent in the Midwest during the summer and fall months. To determine the role of A. alternata in triggering severe asthma attacks, we investigated the cases of 11 patients with asthma who had sudden respiratory arrest and determined the frequency of sensitivity to this allergen in these patients.

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Association of Asthma with Serum IgE Levels and Skin-Test Reactivity to Allergens

1989-02-02

B BURROWS , Fernando D. Martínez , Marilyn Halonen +2 more

We investigated the association of self-reported asthma or allergic rhinitis with serum IgE levels and skin-test reactivity to allergens in 2657 subjects in a general-population study. Regardless of the subjects' … We investigated the association of self-reported asthma or allergic rhinitis with serum IgE levels and skin-test reactivity to allergens in 2657 subjects in a general-population study. Regardless of the subjects' status with respect to atopy or their age group, the prevalence of asthma was closely related to the serum IgE level standardized for age and sex (P less than 0.0001), and no asthma was present in the 177 subjects with the lowest IgE levels for their age and sex (greater than 1.46 SD below the mean). The log odds ratio increased linearly with the serum IgE level after we controlled for possible confounders and the degree of reactivity to skin tests. In contrast, allergic rhinitis appeared to be associated primarily with skin-test reactions to common aeroallergens, independently of the serum IgE level. We conclude that asthma is almost always associated with some type of IgE-related reaction and therefore has an allergic basis, although not all the allergic stimuli that cause asthma appear to have been included in the battery of common aeroallergens we used to assess atopic status. These findings challenge the concept that there are basic differences between so-called allergic ("extrinsic") and nonallergic ("intrinsic") forms of asthma.

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

2017-09-23

Graham Roberts , Oliver Pfaar , Cezmi A. Akdiş +7 more

Abstract Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance … Abstract Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side‐effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease‐modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project “EAACI Guidelines on Allergen Immunotherapy.” It aims to provide evidence‐based clinical recommendations and has been informed by a formal systematic review and meta‐analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product‐specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short‐term benefit. The strongest evidence for long‐term benefit is documented for grass AIT (especially for the grass tablets) where long‐term benefit is seen. To achieve long‐term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long‐term benefit and use in children.

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Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines—2016 revision

2017-06-08

Jan Brożek , Jean Bousquet , Ioana Agache +7 more

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Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials

2019-09-19

Claus Bachert , Joseph K. Han , Martin Desrosiers +7 more

Allergic rhinitis

2011-07-25

Alexander N. Greiner , Peter W. Hellings , Guiseppina Rotiroti +1 more

On the Cover

2025-06-26

| AJN American Journal of Nursing

A real-world retrospective study to evaluate the effectiveness and safety of montelukast and fexofenadine fixed-dose combination in the management of patients with allergic rhinitis

2025-06-25

Anand Pendakur , Arjun Muralidharan , Bharat Anil Toshniwal +7 more | Indian Journal of Allergy Asthma and Immunology

Abstract: BACKGROUND: Allergic rhinitis (AR) is on the rise in India. The disease has a negative impact on the patient’s quality of life and their daily activity. The addition of … Abstract: BACKGROUND: Allergic rhinitis (AR) is on the rise in India. The disease has a negative impact on the patient’s quality of life and their daily activity. The addition of an antihistamine to montelukast as a combination therapy offers an enhancing and complementary effect, thereby reducing the symptoms of AR effectively. METHODS: A retrospective open-label, single-arm, multicenter, real-world observational study was designed to understand the effectiveness and tolerability of the fixed-dose combination of montelukast/fexofenadine (FDC-M/F [10 mg + 120 mg]) in patients with AR. Patients fulfilling the inclusion criteria aged more than 15 years, having either symptoms suggesting AR (mild-intermittent, mild-persistent, or moderate intermittent) or Total Nasal Symptom Score (TNSS) of 5 or more as per the Allergic Rhinitis and its Impact on Asthma (ARIA) classification (if recorded), with no antihistamine in the previous week and have not received either montelukast plus fexofenadine for at least 4 weeks during the previous 6 months were included in this study. Patients with AR having a history of severe attacks of acute asthma within the span of the past 3 months, comorbidities such as severe hepatic/renal impairment, autoimmune, cardiovascular, or neurological diseases, and pregnant/lactating women were excluded from the study. Medical records were collected from the database of 12 sites across India from June 2022 to June 2023. The primary variables assessed were changes in the TNSS and Total Ocular Symptom Score (TOSS), changes in the Physicians Global Assessment (PGA) scale, Patients Global Assessment Scale (PGAS) from baseline to 4–6 weeks. RESULTS: A total of 329 medical records fulfilled the criteria for the enrolment. A statistically significant improvement was observed in both the TNSS and TOSS with FDC M/F at the end of the study period of 4–6 weeks; mean TNSS at baseline 6.66 (standard deviation [SD] 2.32; 95% confidence interval [CI], P < 0.001) reduced to 0.95 (SD 1.33 95% CI, P < 0.001), a mean difference of 5.71; Mean TOSS at baseline 1.54 (SD 2.32; 95% CI, P < 0.001), reduced to 0.23 (SD 0.73 95% CI, P < 0.001), a mean difference of 1.31 after 4–6 weeks. The combination was well-tolerated, and most of the patients were satisfied with the treatment. CONCLUSION: The FDC M/F led to a significant decrease in TNSS and TOSS compared to baseline. Thus, it may be an attractive treatment option for mild-intermittent, mild-persistent AR for reducing nasal and ocular symptoms.

Sensitisation patterns and burden of uncontrolled respiratory allergy symptoms in military personnel

2025-06-25

Senne Gorris , I Baron , Jolijn Brouwer +6 more | BMJ Military Health

Introduction Military personnel is often deployed in environmentally distinct areas across the globe and thereby exposed to a multitude of new plants, weeds or trees. Sensitisation to inhalant allergens occurs … Introduction Military personnel is often deployed in environmentally distinct areas across the globe and thereby exposed to a multitude of new plants, weeds or trees. Sensitisation to inhalant allergens occurs upon exposure in predisposed individuals. This causes frequent problems that may affect the readiness of the personnel. Methods Study participants were recruited among the military personnel of the Belgian Army and invited to receive an allergy test by the skin prick automated test (SPAT) device for a panel of 22 inhalant allergens. A questionnaire was completed to retrieve information on demographics, lifestyle, history of allergy, rhinitis and asthma symptoms, as well as treatment and history of deployment. Results In total, 160 subjects were included with varying histories of deployment to the Middle East (n=68), Western Africa (n=53), Eastern Europe (n=50), Central Africa (n=47), the USA (n=20) or no international deployment (n=31). A majority of military personnel (79.9%) did not take allergy medication. Applying Allergic Rhinitis and its Impact on Asthma criteria, 26% and 27.9% of untreated soldiers were identified with, respectively, uncontrolled and partly controlled rhinoconjunctivitis. Sensitisation to house dust mite ( Dermatophagoides farinae : 29.5%, Dermatophagoides pteronyssinus : 27.5%), timothy grass (28.8%), birch (20.9%), hazel (17.9%) and cat (16.3%) was commonly detected. Also, sensitisation to allergens that are less common in Belgium were detected: Cynodon dactylon (13.1%), Chenopodium alba (6.9%), Phoenix dactylifera (6.2%), Blattella germanica (3.9%), Blomia tropicalis (3.1%) and Salsola kali (1.5%). Conclusions Over one-quarter of military personnel not treated with allergy medication were identified with uncontrolled rhinoconjunctivitis. Timely allergy diagnosis and treatment are crucial for optimal performance of military personnel during international deployment and avoid an ‘unfit-for-duty’. Allergy testing of an extended allergen panel by SPAT can be efficiently implemented in medical screening programmes for military candidates. Trial registration number NCT05807958 .

Greenness and pollution exposure predict corticosterone concentration in an urban songbird

2025-06-25

Mikus Āboliņš-Ābols , Ray Yeager , Jay Turner +2 more | Frontiers in Physiology

Air pollution is known to negatively affect avian health, and some air pollutants have been suggested to drive changes in bird population size at a regional level. Although several studies … Air pollution is known to negatively affect avian health, and some air pollutants have been suggested to drive changes in bird population size at a regional level. Although several studies have investigated the effect of air pollution on bird health, how air pollution exposure is associated with avian physiology at a local scale is not known. Moreover, the extent to which avian health may be affected by vegetation, which modulates pollutant deposition and dispersion, has not been assessed. Here we combine high-resolution mapping of major air pollutants (NO 2 and ultrafine particles) and vegetation types with dense spatial sampling of American robins, an urban exploiter, to ask how air pollution exposure, vegetation, and their interaction predict baseline corticosterone and bird condition. The relationships between environmental variables and physiological metrics were assessed at various distances from the capture location. We found that elevated air NO 2 concentration is associated with higher baseline corticosterone levels within 500 m of the capture location. Vegetation did not modulate the relationship between corticosterone and NO 2 . We found sex-dependent relationships between greenness, corticosterone, and body weight. Within 20 m from the capture locations female corticosterone showed negative relationship with leaf area index, while female body weight was positivity related to the overall greenness. These relationships were absent in males. Collectively, the results of this study show that variations in air pollution and vegetation at a local intra-neighborhood scale predict fitness- and stress-related markers in an urban songbird.

The Allergy Trigger Atlas: Spatial and Biological drivers of plant sensitization in China

2025-06-24

Xianli Lv , H. L. Dai , Hu Zou +5 more | Ethnobotany Research and Applications

Engineered Iontophoresis Patch for Epicutaneous Allergen‐specific Immunotherapy

2025-06-24

Zhi‐Ting Cao , Jianye Ren , Ying Huang +5 more | Advanced Functional Materials

Abstract Epidermal immunotherapy represents an emerging treatment method for allergic diseases. Nevertheless, an unformidable obstacle for epidermal drug delivery is the dense stratum corneum of the skin. Here, iontophoresis technology … Abstract Epidermal immunotherapy represents an emerging treatment method for allergic diseases. Nevertheless, an unformidable obstacle for epidermal drug delivery is the dense stratum corneum of the skin. Here, iontophoresis technology is utilized for epidermal delivery of allergen protein. Briefly, an iontophoresis patch consists of conductive nanofiber polypyrrole (PPy) and polyvinyl alcohol (PVA) by electrospinning technology, onto which cationic lipid dioctadecyl–dimethylammonium bromide vesicles containing ovalbumin (DDA@OVA) are loaded via electrospraying technology, forming a stable in situ composite structure. Compared with DDA@OVA/PVA, DDA@OVA/PPy‐PVA demonstrated a significant increase in both allergen release and penetration into the epidermis. Ultimately, a high‐level activation of antigen‐presenting cells is facilitated. Importantly, DDA@OVA/PPy‐PVA induces a significant increase in the levels of helper T cell 1 (Th1)‐related cytokines such as IFN‐γ and IL‐12, inhibits the differentiation of T cells into Th2 cells, and further affects the secretion of OVA‐specific IgE and promotes the production of protective antibody IgG. The lung tissue analysis illustrates that DDA@OVA/PPy‐PVA treatment achieves regular alveolar structures in the lumen and significantly relieved asthma symptoms. The findings indicate that iontophoresis patches provide multiple benefits, including drug‐responsive release, efficient penetration, and advanced therapeutic efficacy. These attributes make iontophoresis patches a promising treatment option for allergic diseases.

Extended Endoscopic Posterior Nasal Neurectomy

2025-06-23

Curtis F. Mack , John R. Craig | The Laryngoscope

A surgical technique for extended endoscopic posterior nasal neurectomy (EPNN) is described, which includes transection of both posterior nasal and posterolateral nasal nerves to treat medically refractory chronic rhinitis. This … A surgical technique for extended endoscopic posterior nasal neurectomy (EPNN) is described, which includes transection of both posterior nasal and posterolateral nasal nerves to treat medically refractory chronic rhinitis. This approach targets a broader range of autonomic and sensory fibers than a traditional EPNN. A case example demonstrates complete symptom resolution at 6-month follow-up.

The correlation between airborne pollen and asthma in children: a systematic review and meta-analysis

2025-06-23

Xiaoya Wang , Bo Liu , Yujie Yang +4 more | Frontiers in Pediatrics

Background Childhood asthma is a prevalent chronic respiratory disease globally. Airborne pollen is a known environmental trigger, but the impact of different pollen types on pediatric asthma remains unclear. Seasonal … Background Childhood asthma is a prevalent chronic respiratory disease globally. Airborne pollen is a known environmental trigger, but the impact of different pollen types on pediatric asthma remains unclear. Seasonal and geographic pollen variations, influenced by climate change, may affect asthma patterns. A comprehensive review is needed to clarify these associations and guide prevention strategies. Methods Relevant literature on the association between airborne pollen and asthma in children was retrieved from CNKI, Wanfang Data, VIP, CBM, Web of Science, PubMed, Cochrane and Embase at home and abroad from the establishment of the database to March 1, 2025. EndNote X8 and Excel 2021 were used for data management and screening, while Stata 15 was used for statistical analysis. Results A total of 9 articles were included in this meta-analysis, from 2007 to 2024, with a total sample size of 87,270 children. The pooled analysis showed that airborne pollen exposure was significantly associated with the risk of childhood asthma (OR = 1.23, 95% CI: 1.13–1.33, P &lt; 0.001). Subgroup analysis showed that the combined effect size of tree pollen exposure was OR = 1.56 (95% CI: 0.99–2.12, P &lt; 0.001), and the effect size of grass and weed pollen exposure was OR = 1.06 (95% CI: 1.01–1.12, P &lt; 0.001). The comprehensive effect size of literature considering air pollutants and climatic factors was OR = 1.35 (95% CI: 1.20–1.50, P = 0.034), while literature not considering these factors was OR = 1.08 (95% CI: 1.06–1.10, P = 0.156). Age subgroup analysis showed that the effect size for preschool children was OR = 1.31 (95% CI: 0.53–2.09, P = 0.156), and for school-age children was OR = 1.52 (95% CI: 1.32–1.73, P = 0.298). Sensitivity analysis and Egger's test showed no significant publication bias. Conclusion Airborne pollen is a notable risk factor for childhood asthma, and tree pollen exposure may be more dangerous than grass and weed pollen exposure. When atmospheric pollutants and meteorological conditions are considered, the association between airborne pollen and childhood asthma is more pronounced. The evidence is insufficient to support a significant age-related difference between pollen and asthma.

Characterization of the clinical relevance and hypoallergenic peptides of the newly evidenced major allergen Hum j 1

2025-06-23

Yali Cheng , Qiong Li , Yongshi Yang +4 more | Frontiers in Immunology

Background Humulus japonicus (HJ) pollen is a predominant autumn allergen in northern China. Two decades ago, a 10 kDa protein termed Hum j 1 was proposed as a major allergen, … Background Humulus japonicus (HJ) pollen is a predominant autumn allergen in northern China. Two decades ago, a 10 kDa protein termed Hum j 1 was proposed as a major allergen, but its uncertainty hindered its clinical application. This study aims to investigate the clinical relevance of Hum j 1 and screen hypoallergenic peptides for potential application in molecular diagnosis and immunotherapy. Methods Serum samples from 93 HJ pollen-allergic patients were analyzed for IgE reactivity against recombinant Hum j 1 (rHum j 1). We evaluated correlations between IgE responses to rHum j 1 and HJ pollen crude extracts using Spearman’s rank correlation analysis. The association between clinical symptoms and Hum j 1-IgE positivity was evaluated by group comparisons and multivariable analyses. Allergenicity of Hum j 1 was further investigated by immunoblotting and basophil activation tests. Six KLH-coupled peptides (21–25 amino acids) spanning the complete Hum j 1 sequence were synthesized to assess hypoallergenicity and IgG-mediated inhibitory effects against allergen-specific IgE binding using a murine passive immunization model. Results rHum j 1 demonstrated IgE reactivity in 74.2% (69/93) of the patients and induced significant basophil activation. rHum j 1-specific IgE levels showed a moderate positive correlation with crude extract-specific IgE levels (Spearman’s ρ = 0.529, p &lt; 0.0001). Patients with allergic rhinitis complicated by asthma had significantly higher levels of Hum j 1-sIgE ( p = 0.014). We found a significant association between Hum j 1 sensitization and asthma in the multivariate analysis [odds ratio (OR) = 3.98, 95% confidence interval (CI): 1.2–13.0, p = 0.02], with Hum j 1-sensitized patients showing higher asthma prevalence compared to non-sensitized individuals (46% vs. 17%, p = 0.010). All six peptides showed significantly reduced IgE reactivity ( p &lt; 0.0001) and minimal basophil activation. Immunized mice produced high-titer IgG antibodies that inhibited patient IgE binding to rHum j 1 by 22.09%–64.61%. Conclusions Hum j 1 could enhance the sensitivity of HJ pollen crude extract-based IgE assays. IgE reactivity to Hum j 1 was more frequently associated with allergic asthma. The hypoallergenic linear peptides of Hum j 1 laid the foundation for the development of a molecular vaccine for allergen-specific immunotherapy. These findings would contribute to developing diagnostic and therapeutic strategies for HJ pollinosis.

Patterns and Seasonal Changes of Airborne Pollens in Phitsanulok, Lower Northern Thailand: A 16-Year Aeroallergen Survey

2025-06-23

| Journal of the Medical Association of Thailand

Objective: Airborne pollens are significant triggers of allergic rhinitis, atopic conjunctivitis, and asthma. The present study aimed to examine the patterns, quantities, and dynamic changes of airborne pollens in Phitsanulok, … Objective: Airborne pollens are significant triggers of allergic rhinitis, atopic conjunctivitis, and asthma. The present study aimed to examine the patterns, quantities, and dynamic changes of airborne pollens in Phitsanulok, lower northern Thailand, during three periods, November 2006 to October 2007, August 2013 to July 2014, and August 2022 to July 2023. Materials and Methods: In 2006 to 2007, airborne pollens were collected using a Rotorod sampler positioned 1.5 to 2 meters above ground. In 2013 to 2014 and 2022 to 2023, pollens were collected using a Burkard seven-day volumetric spore trap positioned 15 meters above ground. The exposed rods and slides were stained for microscopic analysis. Meteorological data were also obtained. Results: Monthly airborne pollen counts ranged from 48 to 304 grains/m³ in 2006 to 2007, 28.1 to 110.8 grains/m³ in 2013 to 2014, and 60.7 to 151.7 grains/m³ in 2022 to 2023. Peaks occurred in February, May, and August in 2006 to 2007, December in 2013 to 2014, and February and December in 2022 to 2023. Wild grass and cultivated grass were the most and second most common pollen, respectively, across all three periods, with variations in the pollen types ranked third to tenth. Total annual rainfall from 2013 to 2014 was the lowest among the three periods. The highest temperatures and lowest humidity levels, recorded in April 2013 to 2014 and 2022 to 2023, corresponded to low pollen levels. Conclusion: The average monthly pollen count during 2022 to 2023 was lower than that recorded in 2006 to 2007 but slightly higher than in 2013 to 2014. Wild grass was the predominant pollen type over the 16-year period, with levels considered a high allergic risk.

Exploring the Link between Adenoidal Hypertrophy and Childhood Rhinitis: A Comprehensive Cross Sectional Study

2025-06-23

Srujan Vallur , Sanjay Kumar , Vikasdeep Gupta +1 more | Indian Journal of Otolaryngology and Head & Neck Surgery

Comprehensive Analysis of Allergens Exposure and Symptoms Onset for Allergic Conjunctivitis: A Retrospective Cohort Study

2025-06-23

Rakhi Biswas , D. Anish , Shobha Rani RH +5 more | Ophthalmology Research An International Journal

Aims: This retrospective cohort study aims to assess the demographic characteristics, symptom progression, and allergen triggers in allergic conjunctivitis to provide insights for improved clinical management and preventive strategies. Study … Aims: This retrospective cohort study aims to assess the demographic characteristics, symptom progression, and allergen triggers in allergic conjunctivitis to provide insights for improved clinical management and preventive strategies. Study Design: Rretrospective Cohort Study. Place and Duration of Study: Bengaluru Allergy Center (BAC). Department of Allergy. March 2024 to May 2024. Methodology: Conducted at Bengaluru Allergy Center, the study involved 260 patients (169 patients were men, made up the majority; 91 patients were female) over six months. Data were analyzed for demographics, symptom severity, allergen exposure, and treatment outcomes. Statistical analysis, including Chi-square tests, evaluated the association between allergen types and symptom onset. Results: The prevalence was higher among males (65%) and adults aged 19–59 years (47%). Symptoms persisted throughout the year in 85.3% of cases, with a significant proportion experiencing both eye and nasal discomfort. Eye redness (84%) and itching (88.5%) were the most common symptoms. House dust mites were identified as the most significant allergen trigger, followed by pollens and insects, with a highly significant association between allergen type and symptom onset (p = 0.000073). Conclusion: The findings highlight the persistent nature of allergic conjunctivitis, with house dust mites as a major trigger. Targeted allergen-specific management, early diagnosis, and awareness campaigns are crucial for mitigating the impact of allergic conjunctivitis and improving patient outcomes.

Inhaled Allergy Diagnostics and Treatment in a Polluted Environment

2025-06-21

Marcel Mazur , Ewa Czarnobilska | International Journal of Molecular Sciences

Allergic diseases have been increasing in prevalence over the last years. In a polluted environment, this problem can worsen and become more complex. Long-term exposure to air pollution can lead … Allergic diseases have been increasing in prevalence over the last years. In a polluted environment, this problem can worsen and become more complex. Long-term exposure to air pollution can lead to the aggravation of allergic rhinitis (AR) and even to the development of seasonal asthma. Climate changes can accelerate and extend the pollination season. Research indicates that air pollution may modify the properties of pollen, making it more aggressive. Asymptomatic allergic people disclose their allergies in a polluted environment. A polluted environment complicates the diagnosis of seasonal allergies. The treatment might be more challenging as standard allergy medications may not be enough to control symptoms. The causal treatment of allergic rhinitis is specific allergen immunotherapy (AIT), which may prove less effective in people living in a polluted environment. The problem may lie in the proper evaluation for AIT as well as the assessment of its effectiveness. To date, the best way to confirm an allergy and qualify a patient for AIT seems to be molecular diagnostics. The question arises whether patients exposed to air pollution, which could potentially reduce the effectiveness of AIT, are still eligible for AIT. It is also debatable whether molecular diagnostics remain effective in such cases. Advancing precision medicine alongside environmental management represents a critical pathway toward reducing the growing global burden of allergic diseases.

An Introduction to Allergic Rhinitis & An Introduction and A Comparison Between Levocetirizine and Mometasone Furoate

2025-06-19

Penghan Chen | Theoretical and Natural Science

Allergic rhinitis is an extremely significant disease that bothers billions of people worldwide. Due to its prevalence, its important to know prevention and possible treatments for this disease. Although it … Allergic rhinitis is an extremely significant disease that bothers billions of people worldwide. Due to its prevalence, its important to know prevention and possible treatments for this disease. Although it is extremely hard to cure allergic rhinitis completely, there are still multiple ways to inhibit its symptoms or to prevent it from occurring. This article will introduce the definition of allergy, the organ the disease occurs, its mechanism, causes, common symptoms, common allergens, and three main types of medical treatments for allergic rhinitis; there will also be a discussion and comparison between levocetirizine and mometasone furoate in multiple perspectives including price, mechanism, effectiveness, and seriousness of their side effects. The research is conducted by collecting and compiling abundant information and data from multiple scientific researches and websites and analyzing them from an innovative perspective in order to form an original idea. The conclusion shows that Allergic rhinitis has a significantly high prevalence in China, so its important to pay attention to this disease. Based on the fact that its hard to cure completely now, future studies may focus on developing ways to cure or inhibit the symptoms of allergic rhinitis completely. Both drugs have similar safeness and effeteness, but the price for levocetirizine is significantly lower, so levocetirizine is a more economically friendly choice.

Molecular Diagnosis in Hymenoptera Allergy: Comparison of Euroline DPA-Dx and ImmunoCAP

2025-06-19

L Marqués , Arantza Vega , Federico Roca +7 more | Toxins

The efficacy of Hymenoptera venom immunotherapy is contingent upon the accurate identification of the insect responsible for the allergic reaction. The techniques used to detect specific IgE suffer from difficulties … The efficacy of Hymenoptera venom immunotherapy is contingent upon the accurate identification of the insect responsible for the allergic reaction. The techniques used to detect specific IgE suffer from difficulties due to the cross-reactivity between Hymenoptera venoms (false positives), diagnostic ability, and the limited availability of allergenic components (false negatives). In this study, we analyzed the discrepancies in the results obtained with Euroline® DPA-Dx and ImmunoCAP® in the diagnosis of allergic reactions due to Hymenoptera stings in 151 patients. The results (positive/negative) of ImmunoCAP® and Euroline® agreed in 77/151 (50.99%) cases; with 15/151 (9.93%) cases positive for the same insect, and 61/151 (40.4%) cases positive for multiple insects. When the results were used to decide which venom to use for immunotherapy, there was a statistically significant discrepancy for Polistes dominula (21.8% of cases with ImmunoCAP® compared to only 8.4% with Euroline®). The presence of Polistes venom phospholipase (Pol d 1) in Euroline® did not increase its ability to differentiate double sensitization to wasps. ImmunoCAP® and Euroline® exhibited comparable diagnostic performance in bee venom allergy. For vespid venom allergy-particularly involving Polistes species-ImmunoCAP® appeared to show a slight diagnostic advantage, although this finding should be interpreted with caution.

Digital health tools in the management of allergic rhinitis: a systematic review

2025-06-18

Abdullah D Alotaibi , Abdullah Alqahtani , Mohahmmed Alateeq +2 more | European Archives of Oto-Rhino-Laryngology

Modelling of airborne birch pollen over Central Europe – model evaluation and sensitivity analysis

2025-06-18

Jan Boreczek , Małgorzata Werner , Maciej Kryza +7 more | The Science of The Total Environment

In this study, we applied the EMEP MSC-W chemical transport model, extended to include birch pollen emissions and dispersion, over Central Europe. Simulations were run for five consecutive birch pollen … In this study, we applied the EMEP MSC-W chemical transport model, extended to include birch pollen emissions and dispersion, over Central Europe. Simulations were run for five consecutive birch pollen seasons (2015-2019), covering various concentration regimes (high, low or moderate seasons). Model predictions were compared to observational data from 12 stations located across Poland. The model consistently predicted earlier start and end dates for the pollen season compared to observations, and generally underestimated pollen concentrations and seasonal pollen integrals (SPIn), especially during high-concentration seasons. A sensitivity analysis was conducted for two selected years (2018 and 2019), adjusting key parameters such as total pollen amount, season length in degree-days, and the heat-sum threshold for season onset. Results showed that modifying the total pollen amount proportionally increased concentrations, while extending the season length tended to decrease early season concentrations, and increase late season concentrations, simultaneously delaying the end of the season. Adjusting the heat-sum threshold for the season start delayed the season, impacting its overall characteristics. Modifying these parameters improved model accuracy, particularly in predicting season onset, which was critical for accurately simulating the temporal dynamics of the pollen season.

Current Understanding of Epithelial-Derived Alarmins in Chronic Rhinosinusitis with Nasal Polyps

2025-06-18

Fuying Cheng , Yizhang Wang , Yingqi Gao +7 more | Clinical Reviews in Allergy & Immunology

Development of an experimental rabbit model of rhinitis medicamentosa

2025-06-18

В. М. Свистушкин , К. В. Еремеева , Xi Yang +6 more | Russian Bulletin of Otorhinolaryngology

Background. Rhinitis medicamentosa (RM), resulting from prolonged use of nasal decongestants, represents a significant clinical problem. The pathogenetic mechanisms of RM remain insufficiently studied, and existing methods for assessing the … Background. Rhinitis medicamentosa (RM), resulting from prolonged use of nasal decongestants, represents a significant clinical problem. The pathogenetic mechanisms of RM remain insufficiently studied, and existing methods for assessing the state of the nasal mucosa require improvement. The development of an experimental model of RM is necessary for testing new therapeutic approaches. Objective. To develop an experimental model of RM in rabbits, evaluate morphological changes in the nasal mucosa, and test the photoplethysmography method for non-invasive diagnosis of microcirculatory disorders. Material and methods. The study was conducted on 18 Soviet Chinchilla rabbits. The RM model was induced by intranasal administration of 0.1% xylometazoline solution (200 μl/nostril, 2 times/day, 14 days). The control group received saline. Histological analysis of the mucosa was performed on days 8 and 15. The state of microcirculation was assessed by photoplethysmography using a cold test. Data registration was carried out in vivo with subsequent digital signal processing. Results. Progressive histological changes were revealed: epithelial dystrophy, a decrease in the number of goblet cells, and vascular alterations. The photoplethysmography demonstrated a significant decrease in the ratio of photoplethysmogram amplitudes in the RM group (median 0.76 vs. 1.48 in the control; p<0.01), reflecting impaired microcirculation. Conclusion. An experimental model of RM in rabbits was developed, confirmed by histological and photoplethysmographic data. The photoplethysmography showed high sensitivity for non-invasive assessment of the mucosal state, opening up prospects for its application in clinical practice and further studies of RM therapy.

Correction: Floral traits and density are uneven drivers of heterospecific pollen deposition in a biodiverse tropical highland community

2025-06-18

Nathália Susin Streher , Pedro Joaquim Bergamo , Tia‐Lynn Ashman +2 more | Oecologia

Microfungus Podosphaera fusca and the Fungus-like Organism Peronospora ficariae as Potential Inhalant Allergens in a Mouse Model of Asthma

2025-06-17

Piotr Właź , Katarzyna Socała , Marta Palusińska‐Szysz +4 more | Cells

Allergic conditions have surged to unprecedented levels globally, affecting approximately 30% of the population. Fungi are among the major sources of allergens, accounting for about 6% of respiratory issues. Identifying … Allergic conditions have surged to unprecedented levels globally, affecting approximately 30% of the population. Fungi are among the major sources of allergens, accounting for about 6% of respiratory issues. Identifying the causes of respiratory allergies is not always possible. Our study assessed the capacity of two plant parasites, Podosphaera fusca and Peronospora ficariae, which infect Cucurbita pepo and Ficaria verna, to provoke inflammatory and asthmatic reactions in mouse models of acute and chronic asthma. We performed experiments by sensitizing mice through intranasal challenges with extracts from P. fusca and P. ficariae. Subsequently, we used ELISA tests to measure pro-inflammatory cytokines, including IL-4, IL-5, IL-13, TNF-α, and TGF-β. We evaluated specific IgE production through ELISA and examined histological changes in mouse lungs using hematoxylin-eosin staining. Our research revealed that P. fusca and P. ficariae induced significant production of all tested cytokines, increased specific IgE levels, and caused histological changes characteristic of acute and chronic asthma progression. Although weaker than the reference allergen ovalbumin, P. fusca and P. ficariae possess proinflammatory and asthma-inducing capabilities, indicating the potential to expand the current list of fungal allergens.

Role of sublingual immunotherapy in management of patients with moderate to severe allergic rhinitis: 1-year randomized controlled study

2025-06-17

Yasser Mohammed Elbeltagy , Tamer Youssef , Fatma S. Hafez +3 more | The Egyptian Journal of Otolaryngology

Abstract Objective The aim of this prospective study is to evaluate the efficacy and safety of sublingual immunotherapy (SLIT) in moderate to severe monosensitized and polysensitized allergic rhinitis patients. Methods … Abstract Objective The aim of this prospective study is to evaluate the efficacy and safety of sublingual immunotherapy (SLIT) in moderate to severe monosensitized and polysensitized allergic rhinitis patients. Methods In this study,75 patients with moderate to severe allergic rhinitis were randomized to receive SLIT ( n = 50) or placebo ( n = 25) for 1-year duration. Subjective and objective evaluations were performed at baseline and then at 6 and 12 months of therapy. Allergen-specific IgG and nasal smear for eosinophilic count were studied at baseline and 12 months. Results SLIT demonstrated a significant reduction of total nasal symptom scores (TNSS), Juniper Rhinitis Quality of Life Questionnaire (RQLQ) scores, total medication score (TMS), and visual analogue scale score (VAS) ( P < .001) when compared with placebo. Serum sIgG levels increased in the SLIT group at 12 months compared with placebo group ( P < .001). Nasal smear for eosinophilic count decreased in SLIT group at 12 months. No relevant systemic symptoms were registered. Conclusion SLIT is an effective, safe, and well-tolerated treatment for allergic rhinitis.

Allergic rhinitis in college students at Dongguan: a cross-sectional survey on disease burden, knowledge, and self-management

2025-06-17

Xin Peng , Yan Han , Hansheng Feng +3 more | Frontiers in Allergy

This study examined the prevalence, clinical characteristics, disease knowledge, and quality of life impact of allergic rhinitis (AR) among college students in Dongguan, China. Using a customized questionnaire, we surveyed … This study examined the prevalence, clinical characteristics, disease knowledge, and quality of life impact of allergic rhinitis (AR) among college students in Dongguan, China. Using a customized questionnaire, we surveyed 1,531 participants (response rate: 85.1%) and identified an AR prevalence of 18.68% (95% CI: 16.72–20.63%). The study identified significant gaps in AR management, including underutilization of allergen testing (only 44.21% of AR patients underwent skin prick testing) and limited medication knowledge among 73% of participants. Environmental control measures were often neglected, and health education was inconsistently delivered, with 72.03% of students relying on the internet for AR information. The findings underscore the need for enhanced health education, improved access to diagnostic testing, and patient-centered communication strategies. Digital platforms and peer-led interventions are recommended to address these gaps and improve AR self-management.

Multicenter Investigation of Current Allergic Rhinitis Coexistence in Asthma Patients

2025-06-17

İmran Özdemir , Nuray Bayar Muluk , Mustafa Yazır +6 more | Journal of Craniofacial Surgery

Objectives: The authors investigated whether any of the participants diagnosed with asthma also suffered from allergic rhinitis (AR); the authors also evaluated the coexistence rate. Methods: The study enrolled 1140 … Objectives: The authors investigated whether any of the participants diagnosed with asthma also suffered from allergic rhinitis (AR); the authors also evaluated the coexistence rate. Methods: The study enrolled 1140 asthma patients (760 males, 380 females) from centers in different regions of Turkey. All subjects showed asthma signs, including shortness of breath, wheezing, coughing, and chest tightness. Asthma severity was evaluated according to the GINA guidelines. The patients were also assessed for sinonasal symptoms and allergic rhinitis using the survey. Results: AR positivity is detected in 846 patients (74.2%). In the age group of 20 to 29, 81.4% have AR, and in the age group of 30 to 39, 66.4% have RA. In asthma individuals, the AR positivity rate is higher in those with nasal discharge, sneezing, itching, and nasal obstruction. In asthma individuals, the total nasal symptom scores were higher in patients with a positive AR diagnosis (15.42±3.03) compared with those with a negative diagnosis (14.83±2.53). Postnasal drip, mucopurulent discharge, nasal polyps, and hyposmia were also positive in AR-positive patients. In AR-positive patients, mild and moderate shortness of breath, moderate and severe wheezing, moderate and severe cough, no chest thickness, and moderate chest tightness were detected. Conclusions: AR positivity was detected in 846 patients with asthma (74.2%). Dysfunction of the upper and lower airways frequently coexists. Early identification and optimal management of AR can improve asthma symptoms. Patients with asthma should be evaluated for allergic rhinitis, and treatments should be planned for both diseases.

Metabolomic insights into variable antihistamine responses in allergic rhinitis: unveiling biomarkers for precision treatment

2025-06-17

Xiaohong Lyu , Yi Liu , Hongna Li +7 more | Frontiers in Immunology

Background The clinical response to antihistamine therapy exhibits substantial heterogeneity among individuals with allergic rhinitis (AR). While these medications represent a cornerstone in AR management, the molecular basis underlying differential … Background The clinical response to antihistamine therapy exhibits substantial heterogeneity among individuals with allergic rhinitis (AR). While these medications represent a cornerstone in AR management, the molecular basis underlying differential treatment outcomes remains incompletely understood. This investigation sought to delineate specific metabolomic profiles that distinguish between AR patients who demonstrate favorable responses to antihistamine treatment and those who exhibit therapeutic resistance. Methods This investigation encompassed a cohort of 57 patients diagnosed with AR, stratified into antihistamine-effective (n=49) and antihistamine-ineffective (n=8) groups. The study protocol integrated multiple analytical approaches, including clinical phenotyping, serum vitamin D quantification, mRNA expression, and untargeted metabolomic analysis. Metabolomic profiling was conducted using a state-of-the-art liquid chromatography-mass spectrometry (LC-MS) platform, enabling comprehensive characterization of the serum metabolome. Results While demographic characteristics and vitamin D levels showed no significant differences between two groups, blood H1R mRNA expression was significantly higher in antihistamine-ineffective patients (P=0.046), and nasal TPSB mRNA expression was elevated (P=0.006). Nineteen metabolites showed significant differences (p&lt;0.05, fold change&gt;2.0, VIP&gt;1.0) between groups. ROC curve analysis identified nine metabolites with high diagnostic potential (AUC&gt;0.70), with Methotrexate (AUC=0.862), Pro-Val-Ala-Glu-Val (AUC=0.804), and TyrMe-Ile-OH (AUC=0.791) showing the strongest discriminatory power. Pathway analysis highlighted the involvement of caffeine metabolism and tryptophan metabolism pathways. Conclusions This study identified distinct metabolomic signatures between antihistamine-effective and antihistamine-ineffective AR patients, providing potential biomarkers for predicting treatment response and new insights into the metabolic mechanisms underlying treatment efficacy in AR.

Prevalence and Characteristics of Antibiotic Allergy in Patients Over 65 Years in A Long-Term Care Setting

2025-06-16

Teresa Garriga‐Baraut | Gerontology & Geriatric Medicine

Introduction: Antibiotic allergy is a commonly reported condition, particularly among older adults, and may contribute to inappropriate antibiotic prescribing and adverse health outcomes. This study aimed to evaluate the prevalence … Introduction: Antibiotic allergy is a commonly reported condition, particularly among older adults, and may contribute to inappropriate antibiotic prescribing and adverse health outcomes. This study aimed to evaluate the prevalence and characteristics of suspected antibiotic allergy in patients over 65 years residing in a long-term care facility, Centre Sociosanitari Colisee Dolors Aleu (Barcelona), and to assess whether reported allergies were confirmed through allergological evaluation or based solely on clinical suspicion.

Clinical efficacy on acupuncture for perennial allergic rhinitis: a study protocol for a randomized clinical trial

2025-06-16

Jiaxin Yang , Shuren Ming , Hui Chen +1 more | Frontiers in Allergy

Background Allergic rhinitis (AR) is a prevalent allergic disorder. Acupuncture has been widely utilized to alleviate allergic symptoms, and numerous studies have investigated its therapeutic effects on AR. However, due … Background Allergic rhinitis (AR) is a prevalent allergic disorder. Acupuncture has been widely utilized to alleviate allergic symptoms, and numerous studies have investigated its therapeutic effects on AR. However, due to the challenges associated with establishing appropriate placebo controls, few studies have directly compared acupuncture with sham acupuncture for AR treatment. This trial investigates the comparative effectiveness and tolerability of acupuncture vs. placebo needling for allergic rhinitis patients. Methods This clinical trial features a stratified randomization scheme with 1:1 allocation, single-blind assessment, and a total sample size of 84 participants. After screening for inclusion, qualified subjects with perennial allergic rhinitis will be randomly allocated to treatment group(accepting acupuncture, n = 42) or control group (accepting sham acupuncture, n = 42). The intervention will last over a 4-week period. The main efficacy outcome is the change in main symptom severity assessed by the Visual Analogue Scale (VAS) after each week of treatment. Secondary outcomes include the Total Nasal Symptom Score (TNSS), Efficacy Index (%) after each treatment session, time to onset of effect, Rhinitis Quality of Life Questionnaire (RQLQ) scores after each week of treatment, and the additional use rate of anti-allergic medications. Conclusion The findings of this study aims to evaluate the effectiveness and safety of acupuncture in treating perennial allergic rhinitis through comprehensive assessment of symptom relief, time-effect relationships, quality of life improvements, and reduction in anti-allergic medication use. Trial Registration Chinese Clinical Trial Registry (ChiCTR2400086227).

Do Skin Prick Tests Predict Nasal Provocation Test Outcomes in Allergic Rhinitis Patients?

2025-06-16

Yunhyung Lee , Gyu‐Tae Kim , Seo Jun Kang +1 more | International Forum of Allergy & Rhinology

ABSTRACT Background In diagnosing allergic rhinitis (AR), conventional skin prick tests (SPTs) often fail to reflect allergen‐induced nasal symptoms. Conversely, nasal provocation tests (NPTs) provide more definitive assessments but are … ABSTRACT Background In diagnosing allergic rhinitis (AR), conventional skin prick tests (SPTs) often fail to reflect allergen‐induced nasal symptoms. Conversely, nasal provocation tests (NPTs) provide more definitive assessments but are less accessible. Therefore, we aimed to evaluate the correlation between SPT and NPT outcomes to assess SPT's predictive reliability for NPT results. Methods A retrospective review was performed on 106 patients who underwent simultaneous SPT and NPT for suspected perennial AR. The SPT was assessed by measuring the mean wheal diameter of Dermatophagoides pteronyssinus (Dp). The NPT was performed by administering 100 µL of a 1000 AU/mL Dp solution into both nostrils, with responses assessed by changes in the five AR‐related symptoms (total nasal symptom score, TNSS) at 15 min. Correlation and linear regression analyses were conducted to evaluate the relationship between SPT and NPT outcomes. Results TNSS changes at 15 min following intranasal Dp challenge showed a significant, moderately positive correlation with SPT Dp wheal diameter for all 106 subjects ( ρ = 0.640, p < 0.001). In patients positive for both SPT and NPT ( n = 24, ρ = 0.510, p = 0.011) and those with monosensitization ( n = 30, ρ = 0.644, p < 0.001), a stronger and significant correlation was observed compared to the polysensitized group ( n = 35, ρ = 0.372, p = 0.028), while no significant correlation was noted in patients negative for either test. Linear regression confirmed a significant linear relationship ( R 2 = 0.423, Y = 2.65 X – 0.59, p < 0.001) between SPT wheal size and 15‐min TNSS changes in NPT among all the subjects. Conclusion Significant correlations and linear associations between SPT and NPT outcomes support SPT's predictive capability for NPT responses.

Haller Salzsieder

2025-06-16

Gerd Wunder | Schwäbische Heimat

Understanding the combined symptom medication score in the light of contexts and mechanisms

2025-06-16

Anne Møller Lohmann , Anne Poder Petersen , Johannes Martin Schmid +2 more | PLoS ONE

Background In a clinical trial of allergen‐specific immunotherapy for allergic rhinoconjunctivitis, the Combined Symptom Medication Score (CSMS) was utilized as the primary endpoint. This was aligned with the European Academy … Background In a clinical trial of allergen‐specific immunotherapy for allergic rhinoconjunctivitis, the Combined Symptom Medication Score (CSMS) was utilized as the primary endpoint. This was aligned with the European Academy of Allergy and Clinical Immunology recommendation. However, participants wanted to elaborate on how their behaviour affected their score, so voluntary free text boxes were added to the CSMS questionnaire. This study aimed to evaluate the patient-reported outcomes registered in the free text boxes to identify and understand contexts and mechanisms that may affect the CSMS. Methods The realist evaluation methodology was followed in four iterative steps: 1) development of the initial programme theory and context-mechanism-outcome (CMO) configurations, 2) collection of evidence, 3) data analysis, and 4) interpretation and assessment of results. Results Seven CMO configurations were identified, highlighting contexts and mechanisms that may affect the CSMS. These included CMO1 – decision on preventive relief medication dosage, CMO2 – exhibiting symptom-relieving behaviour, CMO3 – being exposed to different levels of grass pollen, CMO4 – mistaking other symptoms for grass pollen-induced symptoms, CMO5 – different exposure to grass pollen when travelling abroad, CMO6 – reporting of relief medication for other allergies in CSMS, and CMO7 – failure to report symptoms not included in CSMS. Conclusion This realist evaluation contributes verified CMO configurations based on patient perspectives to understand how context and mechanisms may affect the CSMS. We recommend further investigation in quantitative studies, as awareness of these CMOs may increase the internal validity of future allergy trials using CSMS as an endpoint. Trial registration ILIT.NU: EudraCT 2020-001060-28.

DATA ON ALLERGIC DISEASES FROM POLLEN IN THE TIRANA REGION, ALBANIA

2025-06-15

Nikoleta Kallajxhiu , Silvana Turku , Gëzim Kapidani +3 more | International Journal of Ecosystems and Ecology Science (IJEES)

Antihistamines: Beyond just allergy treatment

2025-06-15

Hue Thi Hong Bui , Xuan Duc Nguyen | Ministry of Science and Technology Vietnam

Prevalence and aeroallergen sensitization in pediatric Allergic Rhinitis: A population-based study in Jeju, Korea

2025-06-13

Min‐su Oh , Miok Kim , Jung‐Kook Song +1 more | PLoS ONE

Allergic rhinitis (AR) is a prevalent chronic disease among children, influenced by environmental and genetic factors. Understanding regional aeroallergen sensitization patterns is essential for targeted intervention. This study investigates the … Allergic rhinitis (AR) is a prevalent chronic disease among children, influenced by environmental and genetic factors. Understanding regional aeroallergen sensitization patterns is essential for targeted intervention. This study investigates the prevalence of AR and its associated aeroallergen sensitization among schoolchildren in Jeju, Korea. A cross-sectional, population-based study was conducted in 2016 on 1,067 schoolchildren aged 9–16 years. Data were collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and skin prick tests for 18 common aeroallergens. Statistical analysis was performed using multiple logistic regression to determine risk factors for AR. The prevalence of AR was 29.0%, with the highest sensitization rates observed for Dermatophagoides pteronyssinus (76.5%), Dermatophagoides farinae (60.9%), and Japanese cedar pollen (39.1%). Sensitization to multiple aeroallergens (polysensitivity) was significantly associated with increased AR risk (OR 1.58, 95% CI: 1.017–2.455, p = 0.042). Age-related variations in sensitization patterns were noted, with younger children showing higher overall sensitization rates. This study provides evidence of region-specific allergen sensitization patterns in pediatric AR. The high prevalence of Japanese cedar pollen sensitization highlights the need for further investigation into environmental exposure and potential preventive measures.

Is there a bidirectional relationship between allergic rhinitis and irritable bowel syndrome? A meta-analysis

2025-06-13

Yifen Huang , Lun Cai , Jie Liu +4 more | Journal of Global Health

Some studies suggest a link between allergic rhinitis (AR) and irritable bowel syndrome (IBS), but evidence is insufficient. This meta-analysis aimed to explore the relationship between AR and IBS. We … Some studies suggest a link between allergic rhinitis (AR) and irritable bowel syndrome (IBS), but evidence is insufficient. This meta-analysis aimed to explore the relationship between AR and IBS. We searched the relevant literature in six electronic databases. We included a total of nine articles, seven of which took AR as the research object, two of which took IBS as the research object. We performed a meta-analysis using random effects and estimated the resultant odds ratio (OR). A total of 10 627 patients with AR were included in seven studies, including 956 patients diagnosed with AR in the IBS population and 9671 patients diagnosed with AR in the non-IBS population. By heterogeneity test, X2 = 10.12, F-statistic (F) = 6, P = 0.12, I2 = 41%, OR = 2.88, and Z-score (Z) = 21.97 (P < 0.00001), the results were statistically significant. Patients with AR have an increased risk of developing IBS compared to patients without AR. A total of 1099 patients with IBS were included in two studies, including 384 patients with IBS in AR patients and 715 patients with IBS in the healthy population. After the heterogeneity test, X2 = 0.11, F = 1, P = 0.74, I2 = 0%, OR = 2.15, and Z = 11.81 (P < 0.00001), the results were statistically significant. Patients with IBS have an increased risk of developing AR compared to patients without IBS. The bidirectional association between AR and IBS provides a basis for exploring potential new mechanisms between the two. No. INPLASY202440057.

Update on HDM Allergy: Principal Changes over the Years

2025-06-13

Krzysztof Jurkiewicz , Marek Jutel , Sylwia Smolińska | International Journal of Molecular Sciences

House dust mites (HDMs) are a major source of indoor allergens, significantly contributing to allergic rhinitis, asthma and atopic dermatitis. This review examines the epidemiology, microbiological classification and pathophysiology of … House dust mites (HDMs) are a major source of indoor allergens, significantly contributing to allergic rhinitis, asthma and atopic dermatitis. This review examines the epidemiology, microbiological classification and pathophysiology of HDM allergy, highlighting key allergens such as Der p 1, Der p 2 and Der p 23. Furthermore, we discuss the pivotal role of allergen-specific immunotherapy (AIT), the only disease-modifying treatment for immunoglobulin (Ig)-E disease. Recent studies have identified predictive biomarkers for allergen-specific immunotherapy (AIT) efficacy, including the specific IgE to total IgE (sIgE/tIgE) ratio and regulatory follicular T cell profiles, supporting a more personalized approach to therapy. Additionally, emerging immunotherapy strategies, such as recombinant allergens and peptide-based formulations, aim to improve safety and clinical outcomes. As HDM allergy prevalence rises globally, further research into optimizing diagnostics and treatment strategies remains crucial for enhancing patient care.

Alerting residents and health services to thunderstorm-induced asthma: district-level insights on pollen counts and their impact on health services

2025-06-13

Saifur Rahman , Michael Davoren , Anisur Rahman +3 more | Journal of Public Health

Medication Recommendation, Counseling, and Pricing for Nasal Sprays in German Community Pharmacies: A Simulated Patient Investigation

2025-06-13

Bernhard Langer , Christian Kunow , Tim Dethloff +1 more | Advances in respiratory medicine

For the self-medication of nasal congestion following a common cold, decongestant nasal sprays can be recommended according to the medicine guidelines. In Germany, these are only available in community pharmacies … For the self-medication of nasal congestion following a common cold, decongestant nasal sprays can be recommended according to the medicine guidelines. In Germany, these are only available in community pharmacies (CPs) with free pricing. The aim was to analyze the medication recommendation, counseling, and pricing. A covert simulated patient study, internationally recognized as the “gold standard”, was conducted in all CPs of two medium-sized cities in north-eastern Germany. Each CP was visited twice (86 visits) with the identical scenario by one female and one male simulated patient. At the beginning, they asked for a nasal spray and, when asked, stated that they had had nasal congestion for three days. Slightly more than half (54.7%, 47/86) of the recommended nasal sprays were free of preservatives. The median counseling score was 2.0 out of 8 points, with a significantly higher score observed for the female SP (p = 0.004). Information on the maximum intake duration of five days recommended in the German pharmacy guideline was not provided during any visits. The prices varied in total from EUR 1.95 to EUR 6.22. Therefore, measures by the legislator and the chambers of pharmacists are necessary to sustainably improve the medication recommendation, the counseling, and the price transparency.

Subcutaneous House Dust Mite Immunotherapy Effectiveness and Safety in a Paediatric Population: A Prospective Real-Life Study

2025-06-12

Inmaculada Buendía Jiménez , María Matas Ros , Teresa Garriga‐Baraut +6 more | Journal of Clinical Medicine

Background/Objectives: Allergen immunotherapy is the sole therapeutic option capable of modifying the natural course of allergic rhinitis and preventing the development of asthma. Results from paediatric patients are scarce. To … Background/Objectives: Allergen immunotherapy is the sole therapeutic option capable of modifying the natural course of allergic rhinitis and preventing the development of asthma. Results from paediatric patients are scarce. To evaluate the effectiveness and safety of a glutaraldehyde-modified extract of mites (Beltavac®) administered for one year under clinical routine conditions in children between 3 and 11 years old. Methods: This was a multicentre, prospective, 13-month cohort study. Among 97 children diagnosed with immunoglobulin E-mediated house dust mite allergic rhinoconjunctivitis, 87 initiated the subcutaneous immunotherapy. The main outcomes included the Combined Symptoms and Medication Score (CSMS), assessed for 1 month at baseline and after 1, 6, and 12 months, and the number of adverse reactions according to the WAO adverse reaction grading system. The levels of serum-specific immunoglobulins were also assessed. Results: CSMS improved scores throughout therapy (adjusted mean change and 95% confidence interval: 0.55, 0.26–0.84 points; p < 0.001). Improvements occurred in both children with (n = 68) and without asthma (n = 19), as well as in children aged ≥6 years (n = 76) and <6 years (n = 11), although statistical significance was not reached in the smallest subgroups. Eight children (9.2%) developed a total of 15 adverse reactions. Most occurred after the initial dose (five out of eight children), and were local (six out of eight) and minor (five out of eight). Over 90% of patients completed the full regimen. Conclusions: This study supports the effectiveness and safety of allergen immunotherapy administered according to a rush schedule for one year for paediatric allergic rhinitis.

Nasal‐Specific Immunoglobulin E to Total Immunoglobulin E Ratio Mediates the Effect of Natural Pollen Exposure on Symptom Severity in Patients with Seasonal Allergic Rhinitisto Total IgE Ratio Mediates the Effect of Natural Pollen Exposure on Symptom Severity in Patients with Seasonal Allergic Rhinitis

2025-06-12

Dong Geng Liu , Yuan Zhang , Jingyun Li +3 more | International Forum of Allergy & Rhinology

[Practical guideline for the management of allergic rhinitis in Japan].

2013-11-01

Kimihiro Okubo