Minimal persistent inflammation is present at mucosal level in patients with asymptomatic rhinitis and mite allergy

Prevalence of ocular symptoms in patients with allergic rhinitis: Korean multicenter study

BACKGROUND

Allergic rhinitis (AR) is often accompanied by multiple ocular symptoms. This study aimed to evaluate the prevalence of ocular symptoms and the impact of ocular symptoms on the quality of life in patients with AR.

METHODS

One thousand one hundred seventy-four patients with AR were enrolled from 24 centers in Korea. They were classified into four groups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline and also classified into perennial AR (PAR) and seasonal AR groups. All patients were asked to complete the questionnaire regarding the presence of ocular symptoms, such as eye itching, watery eyes, and red eyes. The correlation between ocular symptoms and the rest of the quality-of-life areas in the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) was also asked.

RESULTS

Seven hundred nineteen (61.2%) of 1174 patients had ocular symptoms. In detail, the numbers of patients with eye itching, watery eyes, red eyes, and other ocular symptoms were 605 (51.5%), 313 (26.7%), 207 (17.6%), and 66 (5.6%), respectively. Female patients (72.5%) complained of ocular symptoms more commonly than male patients (55.1%). The patients with moderate-severe persistent AR showed the highest prevalence of ocular symptoms. The correlation coefficients between ocular symptoms and the rest of the quality-of-life areas in the Mini-RQLQ were statistically significant (p < 0.05).

CONCLUSION

Sixty-one percent of Korean AR patients experienced ocular symptoms. The patients who were women and had PAR and more severe AR showed higher prevalence of ocular symptoms. The ocular symptoms might have a significant impact on the quality of life in patients with AR.

Standardized quality (SQ) house dust mite sublingual immunotherapy tablet (ALK) reduces inhaled corticosteroid use while maintaining asthma control: a randomized, double-blind, placebo-controlled trial

BACKGROUND

Investigations meeting current standards are limited for the effect of house dust mite (HDM) allergy immunotherapy in asthmatic patients.

OBJECTIVE

This trial investigated the efficacy and safety of a standardized quality (SQ; allergen standardization method proprietary to the trial sponsor) HDM SLIT-tablet (ALK, Hørsholm, Denmark) in adults and adolescents with HDM respiratory allergic disease. This publication reports the results of the endpoints related to asthma.

METHODS

Six hundred four subjects 14 years or older with HDM allergic rhinitis and mild-to-moderate asthma were randomized 1:1:1:1 to double-blind daily treatment with one of 3 active doses (1, 3, or 6 SQ-HDM) or placebo. Their use of inhaled corticosteroid (ICS) was standardized and adjusted at baseline and the end of treatment to the lowest dose providing asthma control. The primary end point was a reduction in ICS dose from the individual subject's baseline dose after 1 year of treatment.

RESULTS

The primary analysis revealed a mean difference between 6 SQ-HDM and placebo in the reduction in daily ICS dose of 81 μg (P = .004). Relative mean and median reductions were 42% and 50% for 6 SQ-HDM and 15% and 25% for placebo, respectively. No statistically significant differences were observed for the other assessed asthma parameters, reflecting the intended controlled status of the trial subjects. The most common adverse events were local reactions in the mouth. The rate and severity of adverse events were higher for 3 and 6 SQ-HDM than for 1 SQ-HDM and placebo.

CONCLUSION

Efficacy in mild-to-moderate asthma of 6 SQ-HDM relative to placebo was demonstrated by a moderate statistically significant reduction in the ICS dose required to maintain asthma control. All active doses were well tolerated.

Seasonal changes in nasal cytology in mite-allergic patients

Background

House dust mites (HDMs) are a major cause of allergic rhinitis (AR) and asthma worldwide. Recent studies suggested that the allergen load presents seasonal modifications, giving rise to seasonal variation in nasal inflammation and symptoms. The aim of this study was to evaluate by nasal cytology whether nasal inflammation in mite-allergic patients changes with the seasons of the year.

Methods

The study included 16 patients (seven males and nine females, mean age 38.1 years) with persistent AR caused by monosensitization to HDMs. Nasal cytology was performed in all patients once monthly for 1 year.

Results

Nasal cytology showed that the cells most commonly detected in the nasal mucosa were neutrophils. During the period from October to April, a peak in the number of neutrophils and also the presence of significant numbers of eosinophils, mast cells, and lymphocytes/plasma cells were found, which shows the occurrence of more intense inflammation during these months.

Conclusion

Nasal cytology provides useful data in detecting nasal inflammation and its association with the clinical stage of AR. The seasonal variations in nasal cytology are likely to be induced by the fluctuations in the HDM allergen that have been uncovered in recent investigations.

Altered microRNA expression of nasal mucosa in long-term asthma and allergic rhinitis

BACKGROUND

Asthma and allergic rhinitis (AR) commonly coexist and can be taken as manifestations of one syndrome. Evidence exists that microRNAs (miRNAs) are important in controlling inflammatory processes and they are considered promising biomarkers. However, little is known about the differences in miRNA expression in patients with chronic allergic airway disease. This study evaluated the inflammatory and miRNA profiles of the nasal mucosa of patients with long-term asthma with and without AR.

METHODS

We analyzed inflammatory cells, cytokines, and miRNAs in nasal biopsies and measured exhaled and nasal nitric oxide levels during the nonpollen season in 117 middle-aged men who had suffered mainly from allergic asthma for approximately 20 years and also in 33 healthy controls.

RESULTS

The differences in the number of nasal eosinophils and cytokine expression levels were modest in nasal biopsies taken from asthmatics. Downregulation of miR-18a, miR-126, let-7e, miR-155, and miR-224 and upregulation of miR-498, miR-187, miR-874, miR-143, and miR-886-3p were observed in asthmatic patients in comparison to controls. The differences in miRNA expression were mainly similar in asthmatics with and without AR. With regard to asthma severity, a trend of increased miRNA expression in persistent asthma was seen, whereas the downregulation of certain miRNAs was most distinct in nonpersistent-asthma patients.

CONCLUSIONS

Differences in miRNA expression in the nasal mucosa of subjects with long-term asthma and AR can be seen also when no markers of Th2-type inflammation are detected. Asthma severity had only a minor impact on miRNA expression.

A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy

OBJECTIVE

The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy.

METHODS

81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation.

RESULTS

Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02).

CONCLUSIONS

A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME.

Mannitol challenge does not confirm bronchial hyperreactivity in some histamine-responsive asthmatic children

OBJECTIVE

The aim of this study was to compare the usefulness of mannitol provocation test to that of classical histamine challenge in children with PC(20)FEV(1) histamine lower than 4 mg/ml.

METHODS

Twenty-two adolescent patients (mean age of 15.4 ± 4.1 years) with established asthma (PC(20)FEV(1) histamine below 4 mg/ml) were included in this study. Bronchial challenge with mannitol was performed 1-2 days after the test with histamine.

RESULTS

The fraction of positive results of mannitol test was markedly lower when compared with the histamine challenge (72.7% vs. 100%, p = .015). The test was discontinued in one case due to severe coughing after inhalation of 315 mg of mannitol. Coughing during inhalation of dry mannitol powder occurred in most patients, although drinking water after subsequent doses alleviated this symptom in nearly all of them. Of note, triboelectrification of the inhaler and capsules was observed during the administration of consecutive mannitol doses, markedly hindering the delivery of this provoking agent. The relative decrease in FEV(1) resulting from bronchial provocation was significantly lower following mannitol delivery when compared with the histamine test (70.3% vs. 81.6% of resting value, p < .001). Significant correlation was not observed between the values of PC(20)FEV(1) histamine and PD(15)FEV(1) mannitol levels.

CONCLUSIONS

Bronchial challenge with mannitol can be used as a screening test in everyday practice, but one cannot exclude bronchial hyperresponsiveness based on its negative results. Moreover, its usefulness is limited by the influence of static on the delivery of sequential mannitol doses and coughing which can be often associated with mannitol inhalation.

High exhaled nitric oxide levels may predict bronchial reversibility in allergic children with asthma or rhinitis

BACKGROUND

Allergic asthma and rhinitis may be associated. Airway inflammation is shared by both disorders. The measure of the fractional concentration of exhaled nitric oxide (FeNO) may be considered as a surrogate marker for airway inflammation, mainly in allergic patients. Reversibility to bronchodilation (BD) testing is a functional characteristic of asthma.

OBJECTIVE

The aim of this study was to evaluate whether FeNO may predict reversibility to BD in a pediatric cohort of allergic subjects with asthma (180) or rhinitis (150).

METHODS

Lung function (including forced expiratory volume at the first second (FEV(1)), forced volume capacity (FVC), forced expiratory flow at 25-75% of volume capacity (FEF (25-75))), FeNO measurement, and BD testing were performed in all children.

RESULTS

Lung function, FeNO, and sensitization type were significantly different in the two groups. A strong correlation was found between FeNO and ΔFEV(1) after BD. Two main predictors of reversibility were FeNO values >34 ppb [Odds RatioAdj (ORAdj) = 1.9] and sensitization to perennial allergens (ORAdj = 1.7).

CONCLUSIONS

This study provided evidence that FeNO was strongly related with the response to BD testing and could predict bronchial reversibility in children with allergic rhinitis or asthma. Therefore, a simple FeNO measurement could suggest relevant information about bronchial reversibility.

Emerging drugs for perennial allergic rhinitis

INTRODUCTION

Allergic rhinitis (AR) is a high-prevalence disease, sustained by an IgE-triggered reaction with histamine release, followed by an inflammatory response which involves cells, mediators, cytokines and adhesion molecules. According to its duration, AR can be either intermittent or persistent. In the persistent form, the inflammatory component usually predominates.

AREAS COVERED

The current therapeutic strategy is based on antihistamines, antileukotrienes and on corticosteroids (which broadly act on inflammation). Allergen-specific immunotherapy is a biological response modifier that affects the immune response to allergens in a broad sense. The available pharmacotherapy is overall effective in controlling symptoms and inflammation, but safety concerns may be present (especially for prolonged treatments), and a proportion of patients remain uncontrolled. The available therapeutic innovations, as derived from the most recent literature are reviewed herein.

EXPERT OPINION

In the last years there have been very few innovative approaches to optimize the management of AR. These include new histamine receptor antagonists, combination therapy and strategies to selectively block relevant signaling pathways of the allergic reaction. Some more promising advances have been shown for allergen immunotherapy, where a number of new strategies are currently under development.

Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.

Nasal cytology in children: recent advances

Nasal cytology is a very useful diagnostic tool in nasal disorders, being able to detect both the cellular modifications of the nasal epithelium caused by either allergen exposure or irritative stimuli (that may be physical or chemical, acute or chronic), or inflammation. Over these past few years, nasal cytology has allowed to identify new disorders, such as the non-allergic rhinitis with eosinophils (NARES), the non-allergic rhinitis with mast cells (NARMA), the non-allergic rhinitis with neutrophils (NARNE), and the non-allergic rhinitis with eosinophils and mast cells (NARESMA). The rhinocytogram is actually able to distinguish the different forms of allergic rhinitis and to suggest the appropriate treatment, such as antinflammatory drugs or allergen immunotherapy. The technique is easy to perform and nasal cytology is therefore particularly suitable even for children. Such a consideration suggests the utility of a systematic use of nasal cytology in the diagnostic work-up of nasal disorders in children, in order to reach a proper defined diagnosis and to set a rational therapeutic approach: in facts, these two elements are fundamental in order to prevent from complications and to improve the patient’s quality of life.

[Allergic rhinitis. Immunological and neurogenic mechanisms]

Allergic rhinitis is one of the most common diseases to affect humans. It is important to note that it is an immunological disease which is associated with significant changes in the mucous membrane of the respiratory tract. Clinical symptoms of allergic rhinitis include sneezing, rhinorrhea, nasal itching, and nasal congestion. The mechanism underlying the development of symptoms associated with allergic rhinitis are complex, including activation and infiltration of inflammatory cells, edema, increased and altered gland activity, nerve terminal activation, triggering of neurogenic inflammation and morphologically detectable remodelling processes in the mucous membrane. Finally, a systematic activation of immune processes also takes place. Thus, allergic rhinitis is clearly a serious disease requiring prompt and effective treatment; moreover, it has been unjustly trivialized to date, not least because of its high incidence.

Allergen-specific immunotherapy provides immediate, long-term and preventive clinical effects in children and adults: the effects of immunotherapy can be categorised by level of benefit -the centenary of allergen specific subcutaneous immunotherapy

Allergen Specific Immunotherapy (SIT) for respiratory allergic diseases is able to significantly improve symptoms as well as reduce the need for symptomatic medication, but SIT also has the capacity for long-term clinical effects and plays a protective role against the development of further allergies and symptoms. The treatment acts on basic immunological mechanisms, and has the potential to change the pathological allergic immune response. In this paper we discuss some of the most important achievements in the documentation of the benefits of immunotherapy, over the last 2 decades, which have marked a period of extensive research on the clinical effects and immunological background of the mechanisms involved. The outcome of immunotherapy is described as different levels of benefit from early reduction in symptoms over progressive clinical effects during treatment to long-term effects after discontinuation of the treatment and prevention of asthma. The efficacy of SIT increases the longer it is continued and immunological changes lead to potential long-term benefits. SIT alone and not the symptomatic treatment nor other avoidance measures has so far been documented as the therapy with long-term or preventive potential. The allergic condition is driven by a subset of T-helper lymphocytes (Th2), which are characterised by the production of cytokines like IL-4, and IL-5. Immunological changes following SIT lead to potential curative effects. One mechanism whereby immunotherapy suppresses the allergic response is through increased production of IgG4 antibodies. Induction of specific IgG4 is able to influence the allergic response in different ways and is related to immunological effector mechanisms, also responsible for the reduced late phase hyperreactivity and ongoing allergic inflammation. SIT is the only treatment which interferes with the basic pathophysiological mechanisms of the allergic disease, thereby creating the potential for changes in the long-term prognosis of respiratory allergy. SIT should not only be recognised as first-line therapeutic treatment for allergic rhinoconjunctivitis but also as secondary preventive treatment for respiratory allergic diseases.

Allergenic immunotherapy and seasonal changes in nitric oxide concentration in exhaled air in seasonal rhinitis patients

BACKGROUND

Concentration of nitric oxide in exhaled air (FeNO) was revealed to decrease as a result of immunotherapy. However, individuals who are exposed to environmental allergens are characterized by elevated values of FeNO. The aim of this study was to analyze the effects of subcutaneous immunotherapy (SCIT) on the dynamics of FeNO determined during consecutive pollination seasons.

METHODS

This study, performed between 2005 and 2008, included 41 patients with confirmed sensitivity to grass pollens and predominating symptoms of seasonal allergic rhinitis, randomly assigned to desensitization by preseasonal or maintenance SCIT. FeNO was measured prior to and during each pollen season (November-January and May-July, respectively). The results were conferred to data on grass pollination intensity in 2006-2008 (air concentration of grass pollen grains, seasonal number of days when air concentration of grass pollen reached at least 50 grains per 1 m(3)).

RESULTS

Median content of FeNO in exhaled air was significantly higher in 2007 compared to 2006 and 2008 pollen seasons. During 2007 and 2008 pollen seasons, significant increase in FeNO was observed compared to the respective preseasonal values. Median number of days with air concentration of grass pollen ≥ 50 grains per 1 m(3) of air during 4 weeks preceding seasonal FeNO measurement was significantly higher in 2007, corresponding to higher FeNO value recorded during this pollen season. However, no significant correlation was observed between seasonal number of days with ≥ 50 grass pollen grains per 1 m(3) of air and FeNO in exhaled air (r=0.09, p=0.362).

CONCLUSIONS

Most seasonal allergic rhinitis patients show physiological levels of FeNO prior to the pollen seasons and a marked increase in this parameter, probably proportional to pollination intensity, is observed within the seasons. ISRCTN Registry: ISRCTN86562422.

Allergic rhinitis

Allergic rhinitis is a very common disorder that affects people of all ages, peaking in the teenage years. It is frequently ignored, underdiagnosed, misdiagnosed, and mistreated, which not only is detrimental to health but also has societal costs. Although allergic rhinitis is not a serious illness, it is clinically relevant because it underlies many complications, is a major risk factor for poor asthma control, and affects quality of life and productivity at work or school. Management of allergic rhinitis is best when directed by guidelines. A diagnostic trial of a pharmacotherapeutic agent could be started in people with clinically identified allergic rhinitis; however, to confirm the diagnosis, specific IgE reactivity needs to be recorded. Documented IgE reactivity has the added benefit of guiding implementation of environmental controls, which could substantially ameliorate symptoms of allergic rhinitis and might prevent development of asthma, especially in an occupational setting. Many classes of drug are available, effective, and safe. In meta-analyses, intranasal corticosteroids are superior to other treatments, have a good safety profile, and treat all symptoms of allergic rhinitis effectively. First-generation antihistamines are associated with sedation, psychomotor retardation, and reduced academic performance. Only immunotherapy with individually targeted allergens has the potential to alter the natural history of allergic rhinitis. Patients' education is a vital component of treatment. Even with the best pharmacotherapy, one in five affected individuals remains highly symptomatic, and further research is needed in this area.

Monosensitization and polysensitization in allergic rhinitis

BACKGROUND

Polysensitization is common in patients with allergic rhinitis (AR) and may affect clinical feature. However, there are patients who remain monosensitized.

OBJECTIVE

This cross-sectional study aimed at evaluating a large cohort of AR patients to define the percentage and the features of mono- and poly-sensitized subjects.

METHODS

This observational cross-sectional study included a large group of AR patients: 2415 subjects (1958 males, mean age 24.6 ± 5 years) were consecutively evaluated. Symptom severity, type and number of sensitizations, and AR duration were considered.

RESULTS

621 patients (25.7%) were monosensitized: 377 to Parietaria, 194 to house dust mites, 19 to birch, 17 to grasses, 12 to molds, 2 to olive, and 1 to cypress. There was no difference between mono- and polysensitized patients concerning the duration of rhinitis (6 ± 2.14 years vs 6 ± 3.7). Severity of symptoms was higher in polysensitized patients than in monosensitized (p<0.05); in addition, there was a difference among monosensitized patients: Parietaria-allergy induces the most severe symptoms.

CONCLUSION

This study conducted in a large AR population might suggest that monosensitized and polysensitized AR patients could constitute two different categories. In addition, the specific type of allergy may condition the clinical feature.

Spirometric abnormalities in patients with allergic rhinitis: Indicator of an "asthma march"?

BACKGROUND

Allergic rhinitis (AR) may precede and promote the onset of asthma. However, few studies addressed this issue mainly concerning bronchial physiological parameters. The aim of this study was to assess forced expiratory flow at 25-75% (FEF(25-75)), forced expiratory volume at 1 second (FEV(1)), and response to bronchodilation test in a large group of AR patients.

METHODS

Sixteen hundred five adult AR patients were evaluated. Clinical examination, assessment of nasal obstruction perception by visual analog scale, spirometry, and bronchodilation test were performed in all patients.

RESULTS

There were 8.4% of patients with abnormal FEV(1) values, 24.7% had impaired FEF(25-75), and 66.1% had reversibility with bronchodilation. A trend of spirometric impairment seems to exist in these patients. Age, gender, and duration of rhinitis may be risk factors for these findings. Different grades of bronchial impairment seem to exist.

CONCLUSION

This study highlights the close link between upper and lower airways and suggests the possible existence of a progression from AR toward asthma, such as an "asthma march." Therefore, asthma should be suspected and carefully investigated in AR patients.

Relationship between bronchial hyperreactivity and bronchodilation in patients with allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) may be considered a risk factor for the onset of asthma. Recently, it has been reported that forced expiratory flow between 25% and 75% of vital capacity (FEF(25%-75%)) may predict a positive response to bronchodilation test in asthmatic children. Moreover, bronchial hyperreactivity (BHR) is frequently detected in AR patients.

OBJECTIVE

To evaluate the possible relationship between the response to bronchodilation test and methacholine challenge, also considering the FEF(25%-75%) values in a large group of patients with persistent allergic rhinitis.

METHODS

Three hundred sixty-five consecutive AR patients were evaluated. Clinical examination, spirometry, methacholine bronchial challenge, and bronchodilation test were performed in all patients.

RESULTS

Two hundred forty-one patients (66%) had "positive" results for bronchodilation test; FEF(25%-75%) was abnormal in 78 patients (21.4%), and 76 patients (20.8%) had severe BHR. An FEF(25%-75%) cutoff value of less than 58.5% of predicted may optimally (AUC 0.97) discriminate patients with both severe BHR and reversibility.

CONCLUSION

This study confirms previous studies and increases the strength of the role of FEF(25%-75%) as a marker of early bronchial involvement in patients suffering from persistent allergic rhinitis. Moreover, an FEF(25%-75%) value less than 58.5% of predicted may suggest the co-existence of severe BHR and reversibility.

Bronchodilation test in patients with allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) may be considered a risk factor for the onset of asthma. Recently, it has been reported that forced expiratory flow between 25% and 75% of vital capacity (FEF₂₅₋₇₅) may predict a positive response to bronchodilation test in asthmatic children. The aim of this study was to evaluate a large group of adult AR patients to investigate the frequency of response to bronchodilation test and FEF₂₅₋₇₅ values.

METHODS

One thousand four hundred and sixty-nine consecutive patients suffering from persistent AR were evaluated. Clinical examination, spirometry, and bronchodilation test were performed in all patients.

RESULTS

In this study, 62.9% of patients had reversibility to bronchodilation test and 17.8% had impaired FEF₂₅₋₇₅ values (≤ 65% of predicted). Impaired FEF₂₅₋₇₅ values associated with longer rhinitis duration may predict reversibility to bronchodilation test (OR = 11.3; P < 0.001). In addition, a FEF₂₅₋₇₅ cutoff value ≤ 71% of predicted may already discriminate patients with reversibility.

CONCLUSIONS

This study highlights that about two-thirds of patients with persistent AR may be considered at risk of becoming asthmatic. This finding should be adequately considered as a precocious spirometry may allow the early detection of patients prone to develop asthma and consequently to treat them.

Ocular symptoms in nonspecific conjunctival hyperreactivity

BACKGROUND

Ocular symptoms can be triggered by nonspecific environmental factors, characterizing conjunctival hyperreactivity (CHR).

OBJECTIVE

To examine CHR in subjects with ocular symptoms by means of a hyperosmolar conjunctival provocation test (HCPT).

METHODS

Sixty-three subjects with ocular complaints (itching, redness, or tearing) were tested for allergy to a common panel of inhalant allergens (Alk Abelló-FDA Allergenic, Brazil). They were considered allergic if tests were positive to at least 1 allergen. HCPT with serial diluted glucose concentrations was positive if it produced conjunctival hyperemia up to a 50% solution. Digital images were analyzed by 2 observers who marked redness in the challenged eyes in red (GIMP 2.6.5 software). The number of red dots of the affected eye was compared with the number of blue dots of the control eye.

RESULTS

HCPT was positive in 6 of 7 grass pollen-sensitive subjects, in 17 of 20 dust mite-sensitive subjects, and in 10 of 11 subjects who were sensitive to both allergens. HCPT was positive in 33 of 38 allergic subjects (87%) and in 4 of 25 (16%) non-allergic subjects; sensitivity was 87%, and specificity was 84%. Significant correlation (r = 0.96 Pearson; P < .0001) was seen between the number of red dots in 23 digitalized images marked by observers.

CONCLUSION

HCPT indentified CHR in allergic as well as in non-allergic subjects. Allergic subjects exhibited more CHR than did non-allergic subjects. Conjunctival hyperreactivity was present in allergic subjects even when they were asymptomatic. Digital images may be useful for objective evaluation of ocular hyperemia in HCPT.

Impact of allergic rhinitis on bronchi: an 8-year follow-up study

BACKGROUND

Allergic rhinitis is considered a strong risk factor for the onset of asthma. However, few studies addressed this issue from a functional point of view. The aim of this study was to follow up a group of patients with allergic rhinitis to investigate the onset of possible spirometric abnormalities and/or bronchial hyperreactivity (BHR).

METHODS

Eighty-nine patients with moderate-severe persistent allergic rhinitis were prospectively and consecutively evaluated; 940 controls were also included in the study. Clinical examination, skin-prick test, spirometry, and methacholine challenge were performed in all patients every 2 years for 8 years.

RESULTS

The number of patients with forced expiratory flow at 25 and 75% of pulmonary volume of <70% of predicted significantly increased during the observation time. At baseline, no subjects had BHR; whereas 34 patients had BHR after 8 years. Sensitization to mites, birch, and Parietaria as well as rhinitis duration are risk factors for these changes.

CONCLUSION

This study highlights the close link between upper and lower airways and suggests that spirometry should be performed in patients with allergic rhinitis.

Early bronchial involvement in children with allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) may be frequently associated with asthma or precede it. Bronchial involvement in AR is usually detected by spirometry. Forced expiratory volume in 1 second (FEV(1)) is considered a reliable parameter for asthma diagnosis. However, forced expiratory flow at 25-75% (FEF(25-75)) could be considered a possible marker of early bronchial involvement in AR; indeed, it has been proposed that FEF(25-75) values <70% of predicted may predict this evolution. The aim of this study was to evaluate a large cohort of children with AR to define an FEV(1) value corresponding to impaired FEF(25-75) values.

METHODS

Eight hundred fifty AR children (555 boys; median age, 10 years) were studied. Spirometry and skin-prick test were performed in all of them. Descriptive statistic and multivariate analysis were considered.

RESULTS

Three-hundred (35.3%) patients had FEF(25-75) values <70% of predicted. Still, normal FEV(1) values were associated with overt impaired FEF(25-75) values and the cutoff value was 83%.

CONCLUSION

Spirometry should be adequately interpreted in AR patients; indeed, an FEV(1) cutoff value of 83% detects with good efficiency AR children with early bronchial impairment.

Clinical utility and patient adherence with ebastine for allergic rhinitis

Allergic rhinitis (AR) is a high prevalence disease, affecting 10%-20% of the general population. AR is sustained by an IgE-mediated reaction, and by a complex inflammatory network of cells, mediators, and cytokines, becoming chronic when exposure to allergen persists. A Th2-biased immune response is the basis for the allergic inflammation. Histamine plays a relevant role in symptom occurrence. Therefore, antihistamine use represents a cornerstone in AR management. Ebastine, a novel antihistamine, is effective overall in controlling symptoms, and its safety profile is good. Recently, a new formulation has been developed, ie, a fast-dissolving tablet. Several studies have demonstrated its favorable characteristics. In conclusion, ebastine is an effective and well tolerated antihistamine that may be prescribed for the treatment of AR. The fast-dissolving tablet formulation provides a new option which may be particularly convenient for the patient.

Early detection of allergic diseases in otorhinolaryngology

Asthmatic diseases have been reported since the ancient world. Hay fever for instance, was described for the first time in the late 18(th) century, and the term "allergy" was introduced about 100 years ago. Today the incidence of allergies is rising; almost one third of the Western population suffers from its side effects. Allergies are some of the most chronic medical complaints, which results in high health expenditures. Therefore, they have a large health and political relevance.Caused by genetic and environmental factors, the group of IgE mediated allergies is large. It consists of e.g. atopic dermatitis, allergic asthma or allergic rhinitis. This paper aims to emphasize the ways of early diagnosis of allergic rhinitis (AR) as AR represents the most important representative of allergic diseases in ENT.

The link between allergic rhinitis and asthma: the united airways disease

Rhinitis and asthma are often associated and the two disorders interact at various levels. Rhinitis typically precedes the development of asthma and can contribute to unsatisfactory asthma control. The presence and type of asthma is influenced by sensitization, and the duration and severity of allergic rhinitis. Nasal symptoms, airflow and markers of inflammation directly correlate with lower airway involvement. Local tissue factors, such as microbial stimuli and systemic inflammatory mechanisms, play a role in the clinical expression of the allergic airway syndrome. There is increasing evidence that suggests a major involvement of airway epithelial cells in the pathogenesis of both asthma and allergic rhinitis. Even in patients with rhinitis who do not have asthma, subclinical changes in the lower airways and inflammatory mediators can be detected. The pathogenic role of paranasal sinus infections in respiratory allergy has been better elucidated but there remains a need for further research. Treatment of established rhinitis may affect asthma control and could have some impact on airway obstruction, but a direct effect of rhinitis therapy on lower airway inflammation remains to be clearly established.

Effects of minimal persistent inflammation on nasal mucosa of experimental allergic rhinitis

BACKGROUND

Minimal persistent inflammation (MPI) is considered another piece of the complex puzzle of allergic inflammation. Although some studies regarding MPI have been reported, no study has evaluated the effects of MPI on the structure changes at the site of allergic reaction. This study investigates whether long-time MPI during allergic rhinitis (AR) results in some features of tissue remodeling in the nasal mucosa.

METHODS

An animal model of MPI was developed by repeated nasal challenge with low concentration of ovalbumin (OVA) in sensitized guinea pigs. The models were assessed by allergic symptom after antigen challenge, eosinophil infiltration in the nasal mucosa, and intercellular adhesion molecule (ICAM) 1 expression on nasal epithelial cells. The histopathological changes in nasal mucosa were determined by Alcian blue-periodic acid-Schiff and Masson's trichrome staining. The expression of transforming growth factor (TGF) beta(1) and matrix metalloproteinase (MMP) 9 was examined by immunofluorescence under a confocal laser scan microscope.

RESULTS

When sensitized animals were challenged with the low concentration of 0.01% OVA, the symptom of sneezing disappeared, but there were still mild eosinophils infiltration and weak ICAM-1 expression, which indicated the success of MPI models. Moreover, the number of goblet cells and the percentage area of collagen deposition were both mildly increased. The expression of MMP-9 and TGF-beta(1) was also weakly elevated.

CONCLUSION

We have successfully established MPI models and proved long-time MPI may result in mild features of remodeling in the nasal mucosa, which provide new insights into the unexpected potential effects of MPI on the structural changes.

Impact of allergic rhinitis on asthma in children: effects on bronchodilation test

BACKGROUND

Relevant relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma and its reversibility is considered a diagnostic step for asthma diagnosis.

OBJECTIVE

This study aimed at evaluating a large group of children with allergic rhinitis alone for investigating the degree of brochodilation and possible factors related to it.

METHODS

Two hundred patients with allergic rhinitis and 150 normal subjects were consecutively evaluated. Clinical examination, skin prick test, spirometry, and bronchodilation test were performed in all patients.

RESULTS

Rhinitics showed a significant FEV(1) increase after bronchodilation test (P < 0.0001) in comparison both to basal values and to controls' levels. More than 20% of rhinitics had reversibility (> or =12% basal levels). Patients with reversibility had lower FEV(1) levels, longer rhinitis duration, and perennial allergy.

CONCLUSION

This study highlights the close link between upper and lower airways and the relevance of performing bronchodilation test in patients with allergic rhinitis and these characteristics.

Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies

Patients with allergic rhinitis have traditionally been placed into 'seasonal' and 'perennial' categories, which do not account for the subclinical inflammatory state that exists in many patients. In subjects with seasonal and perennial allergic rhinitis, even subthreshold doses of allergen have been found to cause inflammatory cell infiltration in the nasal mucosa, including increases in expression of cellular adhesion molecules, nasal and conjunctival eosinophilia, and other markers of inflammation, which do not result in overt allergy symptoms. This state - which has been termed 'minimal persistent inflammation'- may contribute to hyperreactivity and increased susceptibility to development of clinical symptoms as well as common co-morbidities of allergic rhinitis, such as asthma. Treating overt allergy symptoms as well as this underlying inflammatory state requires agents that have well-established clinical efficacy, convenient administration, potent anti-inflammatory effects and proven long-term safety, so that long-term continuous administration is feasible. Of the three major classes of commonly used allergic rhinitis medications - intranasal corticosteroids, anti-histamines, and anti-leukotrienes - intranasal corticosteroids appear to represent the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.

Levocetirizine in the treatment of allergic diseases

BACKGROUND

Levocetirizine, the R-enantiomer of cetirizine dihydrochloride, is a new molecule with a potent and selective antihistamine activity.

OBJECTIVE

To investigate the evidence that levocetirizine is an effective therapy for allergic disease.

METHODS

Evaluation of published articles in English, or having an English abstract.

RESULTS

Clinical trials indicate that levocetirizine is safe and effective for the treatment of allergic rhinitis and chronic idiopathic urticaria. The compound shows a rapid onset of action, high bioavailability and affinity for the H1 receptor. Moreover, this molecule demonstrates many anti-inflammatory effects that enhance the clinical therapeutic benefit not only in short-term but also in long-term treatments, as reported in recent trials utilizing levocetirizine for several months.

CONCLUSION

Levocetirizine confirms its safe effective activity for treatment of allergic disease in both adults and children.

Serum adipsin levels in patients with seasonal allergic rhinitis: preliminary data

BACKGROUND

Several studies have outlined a possible relationship between adipokines and respiratory allergic diseases. However, there are no data about a role for adipsin in allergic rhinitis.

OBJECTIVE

The aim of the study was to evaluate the serum adipsin levels in patients with seasonal allergic rhinitis (SAR), subdivided into two sub-groups: treated or not treated with sublingual immunotherapy (SLIT), and in a group of healthy controls.

METHODS

The study included 110 subjects; i) 24 SLIT-treated SAR patients, ii) 62 untreated SAR patients, and iii) 24 normal subjects. All subjects were consecutively evaluated. A skin prick test and blood sampling for assessing serum adipsin levels were performed in all subjects.

RESULTS

Serum adipsin was increased in SAR patients, even though significant only in males. There was also a significant positive association between adipsin and adiponectin.

CONCLUSION

This preliminary study reports that adipsin serum levels may be increased in some SAR patients, but further functional studies should be performed.

Relationship between Responses to Bronchodilation Testing and to Nasal Decongestion Testing in Patients with Allergic Rhinitis Alone

A remarkable relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma as well as nasal obstruction of allergic rhinitis (AR). This study aims to evaluate the response to both bronchodilation and decongestion testing and their relationships in a large group of patients with moderate-severe persistent AR alone. Two hundred eleven patients with moderate-severe persistent AR were prospectively and consecutively evaluated. Clinical examination, skin prick test, spirometry, bronchodilation test, rhinomanometry, and decongestion test were performed on all patients. Seventeen subjects (8%) did not respond to any of the tests, 55 subjects (26.1%) were responders only to the decongestion test, 31 (14.7%) only to the bronchodilation test, and 108 subjects (51.2%) responded to both these tests. Longer AR duration was significantly associated with positive response to both tests (p<0.01). In conclusion, this study provides the first evidence that patients with moderate-severe persistent AR may frequently show reversibility to both bronchodilation and decongestion tests.

Adipokines and sublingual immunotherapy: preliminary report

Several studies have outlined a possible relationship between an increased body mass index (BMI) and respiratory allergic diseases, such as asthma and rhinitis. Very recently, it has been demonstrated that serum adipokines, such as leptin and adiponectin, may be increased in patients with allergic rhinitis. The aim of the study was to evaluate the serum leptin and adiponectin levels in a cohort of patients with pollen-induced allergic rhinitis, before and after a single preseasonal course of sublingual immunotherapy (SLIT). A total of 41 patients (22 male and 19 female, median age 39 years) with AR due to pollen allergy, along with 34 normal subjects, were included in the study. Blood sampling for assessing serum adipokines, immunoglobulin E (IgE) levels, and eosinophils were performed in all subjects before and after the SLIT course. An increasing trend of both adipokines was observed after SLIT, albeit without statistical significance and with gender difference. Leptin was significantly related to some clinical parameters and peripheral eosinophil counts. Conversely, adinopectin showed an inverse significant correlation with peripheral eosinophils counts but only for men. In conclusion, the results of this preliminary study show that a single preseasonal SLIT course does not induce significant modifications in serum adipokines levels but induces only a slight increase.

Serum leptin levels depend on allergen exposure in patients with seasonal allergic rhinitis

Several studies have outlined a possible relationship between an increased body mass index (BMI) and respiratory allergic diseases, such as asthma and rhinitis. There are conflicting data about the role for leptin in allergic rhinitis. Therefore, the aim of the study was to evaluate the serum leptin levels in patients with seasonal allergic rhinitis (SAR), enrolled during and outside the pollen season, and in a group of healthy controls. The study included 137 subjects; 62 symptomatic SAR patients evaluated in season, 41 symptomless SAR patients out season, and 34 normal subjects. All subjects were consecutively evaluated. A skin prick test and blood sampling for assessing serum leptin levels were performed in all subjects. After analysing genders separately, symptomatic male patients had significantly higher levels than symptomless and normal subjects (p = 0.0004 and 0.0031 respectively), symptomatic female patients showed significantly higher levels than normal females (p = 0.0002). This study provides the evidence that leptin serum levels depend on allergen exposure in SAR patients.

Evaluation of autologous serum skin test results in patients with chronic idiopathic urticaria, allergic/non-allergic asthma or rhinitis and healthy people

BACKGROUND

Recent data indicate that the autologous serum skin test (ASST) shows a high rate of reactivity not only in chronic idiopathic urticaria (CIU) but also in cases with non-allergic asthma and rhinitis (NAAR), multiple drug allergy syndrome (MDAS) and even in some healthy people. Aim. To evaluate ASST reactivity in patients with CIU, allergic/non-allergic asthma or rhinitis and in healthy controls.

METHODS

We studied 80 patients with CIU, 40 non-atopic patients with NAAR, 57 patients with allergic rhinitis (AR) and allergic bronchial asthma (ABA), and 45 healthy controls. ASST was performed in all patients and controls, and it was considered positive when a serum-induced weal with a diameter 1.5 mm greater than the negative (saline) control, surrounded by erythema, was present.

RESULTS

In total, 42 patients with CIU showed ASST reactivity (52.5%). ASST was found to be positive in 8 of 40 patients with NAAR (20%). The rate was similar (17.5%) in the AR/ABA patient group. However, 25 healthy controls (55.5%) also had positive ASST. The highest rate was in female controls and in individuals in the 18-30-year-old age group.

CONCLUSION

The data indicate that ASST positivity might be a nonspecific phenomenon, influenced by many factors. In the light of the results of this study, we suggest that the significance of ASST reactivity should be re-evaluated in CIU. In addition, the importance of ASST reactivity in patients with AR/ABA and in patients with NAAR remains unclear, and further controlled studies are needed.

Levocetirizine in persistent allergic rhinitis: continuous or on-demand use? A pilot study

BACKGROUND

Allergic rhinitis is a high-prevalence disease that affects quality of life (QOL), sleep quality and productivity of patients. According to the ARIA initiative, it is classified as intermittent and persistent, the latter being the most troublesome.

METHODS

The aim of this randomized, open-label, 6-month, pilot study was to determine whether levocetirizine 5 mg administered continuously once daily in the morning was better than levocetirizine 5 mg on-demand in symptomatic subjects with persistent allergic rhinitis. Total and individual symptom scores were recorded in a diary card throughout the study. QOL, quality of sleep, nasal cytology, rate of drug intake, and safety were also assessed at pre-defined time-points.

RESULTS

In all, adult patients (31 in each group) were enrolled, of whom 22 dropped out. Both treatment regimens considerably decreased the total and individual symptoms scores from baseline and achieved similar levels up to week 14. Continuous treatment was generally better than on-demand from week 15 onwards, reaching statistical significance from weeks 17 to 21 (from week 19 to 21 for nasal pruritus). Both regimens substantially improved QOL and sleep quality. Both treatments were well tolerated, although the on-demand group reported more adverse events.

CONCLUSION

The present open label study in 62 patients indicates that levocetirizine 5 mg reliably controls persistent rhinitis over a period of 6 months, and shows a trend to be more effective in controlling the symptoms of rhinitis, improving QOL and decreasing nasal inflammation, when administered as long-term continuous therapy rather than as on-demand therapy.

Allergy and the nose

Allergic rhinitis (AR) is the most common immunological disorder and is characterized by an immunoglobulin E (IgE)-mediated inflammation induced by the allergen exposure. This review will consider some issues concerning pathophysiological aspects of AR: impact on asthma, response to decongestion, link with infections, response to specific immunotherapy, relationship with adiposity, effects on quality of life (QoL) and allergic inflammation. AR, even though not a serious illness, may be a clinically relevant disorder as it may present numerous complications and affect QoL, as reported in this review. Therefore, the management of AR patients should be rigorously careful and multi-disciplinary.

Consequences of long-lasting persistent allergic rhinitis in adolescents

While it is well known that asthma is characterized by airway remodelling, only few studies have investigated this issue in patients affected by allergic rhinitis (AR). The aim of the present study is to investigate functional and structural consequences of long-lasting persistent AR (PER) in a cohort of adolescents. Eighty patients, forty with short-lasting and forty with long-lasting PER were prospectively and consecutively evaluated both clinically and by performing skin prick test, nasal cytology, and rhinomanometry. Eosinophils were significantly higher in patients presenting with long-lasting PER rather than in those with short-lasting PER (P < 0.0001). The degree of inflammation was significantly associated with impaired nasal airflow (rs = -0.81). This study provides evidence that adolescents with long-lasting PER may show a progressive worsening of nasal function depending on the inflammation.

Impact of allergic rhinitis on asthma: effects on bronchodilation testing

BACKGROUND

A remarkable relationship exists between the upper and lower airways. Bronchial obstruction is a paramount feature of asthma, and its reversibility is considered a main step in asthma diagnosis.

OBJECTIVE

To investigate the degree of bronchodilation and possible risk factors related to it in patients with moderate-severe persistent allergic rhinitis alone.

METHODS

A total of 375 patients with moderate-severe persistent allergic rhinitis and 115 controls were prospectively and consecutively evaluated by means of clinical examination, skin prick testing, spirometry, and bronchodilation testing.

RESULTS

Patients with rhinitis showed a significant increase in forced expiratory volume in 1 second (FEV) after bronchodilation testing compared with basal values and levels in controls (P < .001). Two-thirds of the rhinitic patients had reversibility (> or = 12% basal levels). Patients with reversibility had lower FEV1 levels, longer rhinitis duration, and mite and tree allergies.

CONCLUSIONS

This study highlights the close link between the upper and lower airways and the relevance of performing bronchodilation testing in patients with moderate-severe persistent allergic rhinitis.

A 12-week placebo-controlled study of rupatadine 10 mg once daily compared with cetirizine 10 mg once daily, in the treatment of persistent allergic rhinitis

BACKGROUND

With the current increasing incidence of allergies worldwide, new treatments showing efficacy and long term safety are needed for chronic conditions such as persistent allergic rhinitis (PER). New generation H1-antihistamines have demonstrated anti-allergic properties, which could possibly enhance their effectiveness in long-term periods of treatment.

OBJECTIVE

To investigate the efficacy of rupatadine, in controlling symptoms of PER over a 12-week period.

METHODS

A randomized, double blind, parallel-group, placebo-controlled study was carried out in patients aged older than 12 years with PER. Main inclusion criteria were: instantaneous total symptom score (i6TSS) >or=45, nasal obstruction score <or=12, and overall assessment of PER >or=2 as moderate during the first visit. The primary efficacy endpoint was the 12-week average change from baseline of the patients' i6TSS.

RESULTS

In all, 736 patients were selected. Of them, 543 (73.8%) were randomized in three different groups: placebo (n = 185), cetirizine (n = 175) and rupatadine (n = 183). Rupatadine (P = 0.008) but not cetirizine (P = 0.07) statistically reduced the baseline i6TSS vs placebo (47.8%, 44.7% and 38.8%, respectively), after 12 weeks. Onset of action was observed at the first 24 h for both treatments (rupatadine vs placebo, P = 0.013; cetirizine vs placebo, P = 0.015). Furthermore, instantaneous total nasal symptoms score (iTNSS) (including nasal blockage) mean change from baseline showed a significant reduction with rupatadine 10 mg in comparison with placebo, along all treatment duration of 12 weeks. Study treatments were well tolerated.

CONCLUSION

Rupatadine significantly relieves symptoms of PER, providing a rapid onset of action and maintains its effects over a long period of 12-weeks.

Relationship between rhinitis duration and worsening of nasal function

BACKGROUND

While it is well known that asthma is characterized by airway remodeling, few studies instead have investigated this issue in patients with allergic rhinitis (AR).

OBJECTIVE

The aim of the study was to evaluate nasal function, ie, nasal airflow, in a cohort of patients with persistent AR (PER).

METHODS

One hundred patients, 50 with short-term and 50 with long-term PER, were prospectively and consecutively evaluated, clinically evaluated by visit, skin prick test, and rhinomanometry.

RESULTS

Nasal airflow values were significantly lower (median flow: 348 mL/sec) in patients with long-term rhinitis (median duration nine years) as compared to patients with short-term (median duration one year) rhinitis (median flow: 466 mL/sec) (P < 0.0001).

CONCLUSION

This study provides the first evidence that patients with PER may show a progressive worsening of nasal airflow depending on the duration of the disorder.

Serum adiponectin levels in patients with pollen-induced allergic rhinitis

BACKGROUND

Several studies have outlined a possible relationship between an increased body mass index and respiratory allergic diseases, such as asthma and rhinitis.

OBJECTIVE

The aim of the study was to evaluate the serum adiponectin levels in a cohort of patients with pollen-induced allergic rhinitis, enrolled outside the pollen season, and in a group of healthy controls.

METHODS

The study included 41 patients with moderate-severe persistent allergic rhinitis due to a pollen allergy and 34 normal subjects. All subjects were prospectively and consecutively evaluated. A skin prick test and blood sampling for assessing serum adiponectin levels were performed in all subjects.

RESULTS

The comparison between allergic patients and normal subjects, globally considered without gender distinction, showed slightly higher values in the allergic population. After analysing genders separately, allergic patients show significantly higher levels than normal males (p = 0.0134), whereas the comparison between allergic and normal females was not significant (p = 0.1419). In addition, in normal males adiponectin serum levels are significantly related with age (p = 0.0123).

CONCLUSION

This preliminary study provides the first evidence of significantly higher adiponectin serum levels in male patients with pollen-induced allergic rhinitis as compared to normal male subjects.

Normal variation of bronchial reactivity in nonasthmatics is associated with the level of mite-specific IgE

OBJECTIVE

To investigate association between non-specific bronchial reactivity (NBR) and level of mite specific IgE amongst mite-sensitized non-asthmatic subjects.

METHODS

Subjects attending occupational check-up were assessed for: respiratory symptoms, atopic status (skin prick testing [SPT], total and specific IgE), spirometry and NBR. Individuals without history of respiratory disease (N = 234) were included into analysis.

RESULTS

All subjects had normal spirometry and 99% had normal NBR while 41.8% had detectable specific IgE to mites. Lung function parameters and NBR were significantly lower in mite sensitized subjects. Multiple regression analysis controlling for age, gender, smoking, family history, SPT, IgE, and lung function showed that NBR was significantly associated only with mite specific IgE level (beta = 0.26; 95% CI, 0.05-0.47; p = 0.018).

CONCLUSION

Even in subjects without allergic symptoms, IgE-mediated sensitization does not appear to be all or nothing phenomenon influencing the normal variability of underlying airway reactivity.

How strong is the evidence that immunotherapy in children prevents the progression of allergy and asthma?

PURPOSE OF REVIEW

The purpose of this review is to describe the scientific evidence that specific immunotherapy can prevent the development of asthma in patients suffering from rhinoconjunctivitis as well as reduce the number of new allergies developing.

RECENT FINDINGS

Proposed strategies for the prevention of the development of allergic rhinoconjunctivitis and asthma include allergen avoidance, pharmacological treatment (antihistamines and steroids) and specific immunotherapy. Long-term follow-up on immunotherapy studies demonstrates that specific immunotherapy for 3 years shows persistent long-term effects on clinical symptoms after termination of treatment and long-term, preventive effects on later development of asthma in children with seasonal rhinoconjunctivitis. It is so far the only treatment for allergic diseases that has been shown to be able to prevent worsening of disease and development of asthma. Also, specific immunotherapy seems to reduce the development of new allergic sensitivities as measured by the skin prick test as well as specific IgE measurements.

SUMMARY

Specific immunotherapy is the only treatment that interferes with the basic pathophysiological mechanisms of the allergic disease and thereby carries the potential for changes in the long-term prognosis of respiratory allergy. Specific immunotherapy should be recognized not only as first-line therapeutic treatment for allergic rhinoconjunctivitis, but also as secondary preventive treatment for respiratory allergic diseases.