Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence

Indolepropionic acid modulates the immune response in allergic rhinitis through the AKT/CEBPB/IL‑10 signaling pathway

Allergic rhinitis (AR) is a common inflammatory disorder of the nasal mucosa, usually triggered by environmental allergens. Indolepropionic acid (IPA) can influence immune responses; however, the specific mechanisms underlying the effects of IPA on immune regulation in AR remain largely unexplored. In the present study, an experimental mouse model of AR was established by sensitizing and exposing the mice to allergens, followed by the administration of IPA via gavage. Nasal symptoms were assessed through behavioral scoring, histological examinations were conducted to evaluate changes in nasal mucosa, and cytokine levels were quantified using ELISA. The expression of key signaling molecules was analyzed by immunohistochemistry, reverse transcription‑quantitative PCR and western blotting. Additionally, the effects of IPA combined with an AKT inhibitor (HY‑10355) on signaling pathway‑related proteins in human nasal epithelial cells were evaluated using cellular immunofluorescence and western blotting. The results revealed that IPA treatment significantly reduced nasal inflammation, as indicated by decreased sneezing and mucus secretion. Histological analysis showed reduced inflammatory cell infiltration and epithelial damage in IPA‑treated mice compared to controls. Furthermore, cytokine analysis revealed reduced levels of the pro‑inflammatory cytokines IL‑4, IL‑5, IL‑13 and immunoglobulin E, along with increased levels of the anti‑inflammatory cytokine IL‑10. Molecular investigations demonstrated that IPA can activate the AKT/CCAAT enhancer binding protein β pathway, leading to increased IL‑10 expression and reduced inflammation. In conclusion, these findings suggested that IPA may serve as a promising therapeutic strategy for managing AR, pending further clinical validation.

Inflammatory and oxidative stress markers in serum, urine and exhaled breath condensate: Relationship between asthma and obesity in children

BACKGROUND

Systemic inflammation and oxidative stress are known to exacerbate airway inflammation in asthma. Obesity contributes to this pathophysiology.

OBJECTIVE

To determine the relationship between obesity, disease severity, disease control, and oxidative stress in asthma with multiple oxidative stress markers.

METHODS

The study included 65 obese-asthma (OA), 25 non-obese asthma (A), and 30 healthy non-obese controls (C). Skin prick tests, lung functions, and 8-isoprostane levels in urine samples were measured. Exhaled breath condensate (EBC) was tested for 8-isoprostane, glutathione peroxidase, and malondialdehyde (MDA). Serum samples were taken for adiponectin and leptin.

RESULTS

OA leptin levels were higher than those of the A and C groups (p < 0.001). Glutathione peroxidase levels in EBC were found to be different between groups (p = 0.016), while there was no difference in two-group comparisons. MDA levels were significant (p < 0.001) between groups, with the A group's lower levels contributing to this significance. 8-isoprostane levels were greater in the OA group than in other groups (p = 0.005). This significance came from the difference between the OA and A groups (p = 0.005). Urine 8-isoprostane levels were different between groups (p = 0.001), and the OA group had lower levels than the A group (p = 0.003). In EBC, there were positive correlations between BMI and MDA (p < 0.001, r = 0.484) and 8-isoprostane (p < 0.001, r = 0.471). Patients with uncontrolled/partially-controlled asthma had greater levels of MDA and 8-isoprostane than those with well-controlled asthma (p = 0.036 and p = 0.011).

CONCLUSION

Elevated levels of MDAand 8-isoprostane in EBC in obese asthma support that obesity increases oxidative stress markers. This relationship indicate that antioxidant therapies may be beneficial in OA patients. EBC is a reliable and noninvasive technique for measuring oxidative inflammation.

Association between gut microbiota and allergic rhinitis: a systematic review and meta-analysis

Background

Many studies have shown that allergic rhinitis (AR) is closely related to intestinal flora, and probiotics are effective in treatment. However, the results of human observational studies on the correlation between intestinal flora and AR have been contradictory. The aim of this study was to determine the relationship between gut microbiota and allergic rhinitis and to provide a clinical reference.

Methods

PubMed, Web of Science, Medline, Embase, Cochrane Library, and Cinahl databases were searched, and the literature on the correlation between allergic rhinitis and the gut microbiota reported from database establishment to December 2023 was included. Literature meeting the inclusion criteria was screened, and meta-analysis of the included literature was performed using R software (4.3.3). Literature quality underwent assessment utilizing the Newcastle-Ottawa Quality Assessment Scale. Hedge's g standardized mean difference (SMD), confidence intervals (CIs), and heterogeneity (I2 ) for alpha diversity were calculated. Median interquartile range (IQR) were calculated as effect statistics for the abundance of bacteria. The Egger test determined publication bias in the literature.

Results

A total of 10 observational studies in humans were conducted, identifying 550 patients with AR and 385 healthy individuals. No statistically significant differences were observed in alpha diversity between two groups, including Shannon index (SMD = -0.3938, 95% CI [-0.9847-0.1972], I2 = 94%), Simpson index (SMD = -0.16, 95% CI [-1.12-0.80], I2 = 96%) and Chao1 index (SMD = -0.00, 95% CI [-1.32-1.32], I2 = 97%). We performed a meta-analysis for the following four phyla, but found no significant differences: Firmicutes (95% CI [-0.10-0.19], I2 = 75%), Bacteroidetes (95% CI [-0.42-0.19], I2 = 95%), Proteobacteria (95% CI [-0.06-0.03], I2 = 92%), Actinobacteria (95% CI [-0.09-0.03], I2 = 83%).

Conclusions

The currently available evidence does not suggest that patients with allergic rhinitis may have similar intestinal flora imbalances. Nevertheless, further corroboration is required with larger samples and higher-quality studies.

Seasonal Proteomic Variations and Biomarkers in Seasonal Allergic Rhinitis: Insights from Olink Inflammation Profiling

Purpose

Seasonal allergic rhinitis (SAR) is a prevalent inflammatory condition, yet its molecular mechanisms and reliable biomarkers remain incompletely understood. This study aimed to identify key inflammation-related proteins and pathways associated with SAR by investigating seasonal proteomic profile variations and their correlations with SAR symptoms.

Patients and Methods

Serum samples were collected from nineteen SAR patients during both allergy (in-season, IS) and non-allergy (out-of-season, OS) periods. Differentially expressed proteins (DEPs) were identified using the Olink Target 96 Inflammation panel, which were further analyzed through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Spearman correlation analysis was conducted to explore associations between DEPs and SAR symptoms, including sneezing, rhinorrhea, nasal blockage, itchy nose, and itchy eye.

Results

A total of 36 inflammation-related DEPs were identified, all significantly upregulated in the allergy season. Notable proteins such as glial cell line-derived neurotrophic factor (GDNF), interleukin-18 receptor 1 (IL-18R1), and interleukin-15 receptor alpha (IL-15RA) showed strong correlations with SAR symptoms. Sneezing was associated with IL-2 receptor beta (IL-2RB) (r = 0.415, p = 0.013), rhinorrhea with FMS-related tyrosine kinase 3 ligand (Flt3L) (r = 0.455, p = 0.004), and nasal blockage with osteoprotegerin (OPG) (r = 0.493, p = 0.002). GO analysis revealed enrichments in Ras signaling and small GTPase pathways, while KEGG analysis highlighted immune-related pathways, including PI3K-Akt signaling and cytokine-cytokine receptor interactions.

Conclusion

This study identified key inflammation-related proteins and pathways that vary seasonally in SAR, offering insights into potential biomarkers and therapeutic targets for SAR management. Further studies are recommended to validate these findings in larger and more diverse populations.

Wheezing on admission: a marker for bronchiolitis severity and asthma development

BACKGROUND

Supervised clustering of bronchiolitis patients, according to their clinical characteristics at hospital admission, helps predict short-term hospital outcomes and the risk of developing childhood respiratory illness. Thus, we evaluated the use of wheezing status for stratifying bronchiolitis patients.

METHODS

A prospective cohort study was conducted involving 668 previously healthy, full-term Chilean infants ( < 2 years old) hospitalized with bronchiolitis. Patients categorized based on their wheezing status at hospital admission were monitored during hospitalization and followed for 4 years after discharge.

RESULTS

Wheezing children presented a more severe illness requiring more oxygen during their hospital stay. Upon discharge, they were more likely to develop preschool wheezing at 12 months and asthma at 4 years of age. Among the non-wheezing, those with RSV had more severe disease. Risk factors exclusively associated with persistent asthma development for the wheezing were clinical bacterial coinfection, parental asthma history, and having had a severe bronchiolitis episode. Risk factors exclusive for non-wheezing were maternal smoking during pregnancy and severe retractions.

CONCLUSION

Bronchiolitis patients can be categorized based on their wheezing status at hospital admission, helping predict short-term clinical outcomes and identify infants at risk of developing severe short- and long-term respiratory illnesses.

IMPACT

Stratifying viral bronchiolitis patients using a simple bedside strategy based on their wheezing status at hospitalization can help improve individual-based clinical decisions during hospitalization and enable early identification of infants with a higher risk of developing severe respiratory illnesses and long-term associated diseases. Viral bronchiolitis patients can be stratified based on their hospitalized wheezing status. Wheezing patients exhibited similar clinical patterns during hospitalization and long-term clinical outcomes upon discharge. Wheezing infants were more likely to develop preschool wheezing and asthma.

Bibliometric perspectives on inflammatory and immunological research in pediatric asthma

OBJECTIVE

Pediatric bronchial asthma, a prevalent chronic inflammatory respiratory disease, significantly affects children globally. However, bibliometric analyses focused on its inflammatory and immunological aspects are limited. This study aims to provide an overview of the field, identify key focus areas, and predict emerging trends.

METHODS

We collected and analyzed relevant literature published from January 1, 2000, to May 31, 2024, from the Web of Science Core Collection. Collaborative network analysis was conducted using CiteSpace 5.8.R3, VOSviewer 1.6.20, and Bibliometrix.

RESULTS

A total of 911 papers were retrieved, showing growth in research output since 2006, with the United States leading in publications. The University of Western Australia ranks first in publication count, while the University of Wisconsin-Madison has the highest average citations per paper. Among 5,059 authors, 146 core authors contributed to 592 articles, accounting for 64.98% of total publications, with Anne M. Fitzpatrick as the leading author. The journal "Allergy, Asthma & Immunology Reviews" is the most influential, and "asthma" is the most cited keyword. Co-citation analysis reveals 20 keyword clusters, with hotspots including "efficacy" and "allergic rhinitis." The most cited paper is by D. P. Strachan in the "British Medical Journal."

CONCLUSION

This study reveals a significant increase in pediatric asthma research from 2000 to 2024, with the U.S. leading in scholarly contributions. Key findings highlight allergic airway inflammation and type 2 inflammation as primary mechanisms underlying the disease. Inhaled corticosteroids and biologics are identified as effective treatments. These insights emphasize the importance of global collaboration and ongoing research efforts to advance understanding of pathogenic mechanisms and clinical management in pediatric asthma patients.

Allergic rhinitis and urticaria burden and antihistamine treatment options in Thailand: A modified Delphi study

Background

Allergic rhinitis (AR) and chronic urticaria impose significant socioeconomic burdens on lower-income countries. Despite the availability of evidence-based guidelines, their implementation varies, and comprehensive data on these allergic conditions are notably lacking in Thailand.

Objectives

We sought to describe current management strategies for AR and urticaria in Thailand.

Methods

The Allergy, Asthma, and Immunology Association of Thailand used a modified Delphi method to explore consensus on management strategies for AR and urticaria. Clinicians with expertise in these conditions provided input through a web-based questionnaire. The survey assessed disease burden in Thailand, its impact on quality of life, and the use of H1-antihistimine treatment options.

Results

In total, 105 experts, mainly in allergy and immunology, with 70% having more than 10 years of clinical practice, provided input. Consensus was achieved on 22 (88%) of the 25 statements. Second-generation antihistamines were preferred as initial treatment for AR and urticaria because of their reduced sedation and lack of anticholinergic effects. Almost all participants (98.1%) recommended these antihistamines for acute and chronic urticaria. Additionally, 87.6% of the respondents favored up-dosing a single antihistamine agent for managing chronic urticaria. The benefits of orally disintegrating antihistamines were particularly noted for their ease of administration and patient compliance.

Conclusion

Results indicate a knowledge gap in evidence-based practices among Thai clinicians. Addressing this gap through enhancing clinical guideline adherence and encouraging pharmacist involvement in patient care can improve access to medication and better disease management, ultimately improving patient outcomes while reducing the socioeconomic burden of AR and urticaria.

Turbinate Injection of Botulinum Toxin in the Treatment of the Chronic Rhinitis

OBJECTIVES

This systemic review with meta-analysis evaluated the effect of intranasal BTX-A turbinate injection on chronic rhinitis-related symptoms.

DATA SOURCES

PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases.

REVIEW METHODS

We reviewed studies retrieved from databases up to Aug 2024. The studies evaluating the degree of change of rhinitis-related symptom scores and quality of life before and after BTX-A injection were analyzed. Standard mean differences were used to calculate effect sizes.

RESULTS

A total of 269 patients from 7 studies were analyzed. BTX-A injection showed a significant improvement in rhinitis-related symptoms (congestion: 2.5416, 95% CI 1.0927-3.9905, I2 = 94.4%, itching: 1.2553, 95% CI 0.6660-1.8446; I2 = 70.8%, rhinorrhea: 1.8451, 95% CI 1.0468-2.6435, I2 = 89.7%, and sneezing: 1.3580, 95% CI 0.5194-2.1967; I2 = 90.7%), total nasal symptom score (2.4020, 95% CI 1.4161-3.3879, I2 = 86.1%), and quality of life (1.5256, 95% CI 1.0760-1.9752; I2 = 0.0%) throughout the follow-up period (4 months). However, 3 months after injection, although symptom improvement remained, there was no statistical significance. Allergic rhinitis (AR) patients showed a significant improvement in rhinitis-related symptoms compared with nonallergic rhinitis (NAR) patients.

CONCLUSIONS

Nasal symptoms and quality of life scores related to rhinitis were decreased after BTX-A injection. In particular, this treatment showed better efficacy in AR and could be more beneficial for the symptoms of nasal congestion and rhinorrhea at the early periods of treatment. However, the effects lasted for a relatively short period of only 2-3 months. Laryngoscope, 135:1545-1552, 2025.

Guidance for type 2 inflammatory biomarkers

Type 2 inflammation in the airways and lungs is inflammation induced by type 2 cytokines such as IL-4, IL-5, and IL-13, produced primarily by type 2 helper T cells and type 2 innate lymphoid cells, and causes changes in the physiology and structure of the airways. Type 2 inflammation is currently in the spotlight because of its direct link to the treatment of several airway and lung diseases. Abundant evidences have accumulated that inflammatory biomarkers such as blood eosinophils, fractional exhaled nitric oxide, and IgE are essential clinical tools in the diagnosis and management of asthma and COPD. It is well known that asthma and COPD have diverse inflammatory phenotypes even when clinical features are similar, and it has been demonstrated that assessment of airway inflammation with biomarkers can improve diagnostic accuracy, determine safer and more effective treatment strategies, and predict future risks such as exacerbations and lung function decline. The Japanese Respiratory Society has published clinical practice guidelines for the evaluation of type 2 inflammation in the airways and lungs. In addition to asthma and COPD, the guide covers a wide range of airway and lung diseases, including interstitial lung disease, allergic bronchopulmonary mycosis, allergic rhinitis, and eosinophilic chronic rhinosinusitis. It also provides comprehensive guidelines covering a variety of clinical biomarkers. The purpose of this guidance is to provide evidences for the interpretation of type 2 inflammation measurements and to promote the widespread use of inflammation assessment to further improve the efficiency of airway and respiratory disease management.

Rhinoconjunctivitis symptoms in children and adolescents with asthma: Longitudinal clustering analysis

BACKGROUND

Rhinoconjunctivitis phenotypes are conventionally described on the basis of symptom severity, duration and seasonality, and aeroallergen sensitization. It is not known whether these phenotypes fully reflect the patterns of symptoms seen at a population level.

OBJECTIVE

We sought to identify phenotypes of rhinoconjunctivitis on the basis of symptom intensity and seasonality using an unbiased approach and to compare their characteristics.

METHODS

A cohort of children with asthma in low-income urban environments was prospectively followed with a rhinoconjunctivitis activity questionnaire, and their upper and lower airway disease was managed for 12 months with every 2-month visit based on standardized algorithms. We identified individual rhinoconjunctivitis symptom trajectories and clusters of those trajectories and compared the clusters focusing on atopic characteristics.

RESULTS

Data obtained from 619 children yielded 5 symptom clusters: 2 had high symptoms (22.5%) but differed in seasonal pattern, 1 had medium symptoms (13.6%), 1 had medium nasal congestion only (20.4%), and 1 had low symptoms (43.6%). The latter was further split into 2 subgroups if nasal corticosteroids were frequently prescribed (23.6%) or not (20.0%). Seasonal variation was absent in the low symptom clusters. The number of allergic sensitizations and family history of allergic airway disease were higher in the high symptom clusters, but allergic sensitization did not explain differences in seasonality.

CONCLUSIONS

This study identified rhinoconjunctivitis phenotypes that have not been previously reported and were not differentiated by demographics or by measures of atopy and type 2 inflammation. Factors beyond allergy need to be investigated to better understand the pathobiology of rhinoconjunctivitis.

The efficiency of azelastine hydrochloride and fluticasone propionate nasal spray to improve PAP adherence in patients with obstructive sleep apnea

Patients with obstructive sleep apnea (OSA) often struggle with CPAP therapy adherence. The intranasal corticosteroids (INS) alone have not significantly improved CPAP adherence but the combination drugs that faster relieved symptoms were not well studied. This study aimed to assess the combined effectiveness of INS (fluticasone propionate) and intranasal antihistamines (azelastine hydrochloride) in enhancing CPAP adherence and mitigating CPAP-induced rhinitis symptoms in OSA patients. A double-blind, randomized controlled trial with stratified random sampling was conducted at Thammasat University Hospital from March 2022 to March 2023. Participants included OSA patients undergoing CPAP treatment. The patients completed questionnaires and interviews at the baseline, the second week, and one month after starting CPAP therapy, with CPAP usage electronic data collected. Among 116 enrolled patients, most had severe OSA (78.9%), with a majority being male (56.9%). The intervention group did not significantly differ from the placebo group in terms of CPAP usage, nasal symptoms, quality of life, or side effects. Subgroup analysis showed improved CPAP adherence in the treatment group when using pressure below 15 cm H2O (7.8% increase in CPAP usage days, P = 0.04). This study marks the first evaluation of combination drugs for enhancing CPAP therapy adherence in OSA patients. Although these drugs did not significantly enhance overall CPAP adherence, there was a trend toward increasing CPAP adherence in patients using lower pressure levels. Thus, combining fluticasone and azelastine may benefit certain OSA patients. Further research is essential to comprehend and validate these benefits fully.Clinicaltrials.in.th number TCTR20220308003 (08/03/2022).

The Allergy Crossroads of Subtropical Regions: Mites, Crustaceans, and the Rise of Edible Insects

Background: Edible insects (EIs) are increasingly recognized as a sustainable protein source, yet concerns persist regarding allergic reactions, even in individuals without prior known consumption. This study examines the immune response profile in patients from a subtropical area to improve understanding of mite-related cross-reactivity and emerging food sensitizations. Methods: To assess sensitization to edible insects, we analyzed 634 patients from a tertiary care allergy institution with high perennial exposure to house dust mites and storage mites. Sensitization patterns were assessed using the ALEX²® MacroArray platform, a multiplex IgE diagnostic tool covering 282 allergens, including Locusta migratoria (Lm), Acheta domesticus (Ad), and T. molitor (Tm). Patients with IgE levels ≥0.3 kU/L were evaluated for cross-reactivity to both mite allergens and pan-allergens. Results: Of the 634 patients, 138 (21.76%) exhibited IgE sensitization to at least one EI extract. Tropomyosin was the most prevalent pan-allergen (63.76%), followed by troponin-C (28.98%) and arginine kinase (26.81%). Notably, 95.66% of EI-sensitized individuals also reacted to mite allergens. However, 23.18% lacked reactivity to common pan-allergens, suggesting alternative sensitization mechanisms. Conclusions: This investigation can highlight regional variations in EI sensitization, where high mite exposure in subtropical climates appears to influence IgE responses to insect proteins. The findings suggest that EI sensitization is not merely incidental but represents a distinct immunological phenomenon shaped by environmental factors and allergen cross-reactivity. Since the presence of food-specific IgE does not reliably indicate clinical allergy, and the lack of food challenge data constrains diagnostic certainty, acknowledging EI sensitization as a potential risk factor remains essential for ensuring food safety and protecting public health.

HFD-induced LPS translocation and elevated blood lipids exacerbated the inflammatory response in allergic rhinitis

Allergic rhinitis (AR) is one of the most prevalent chronic diseases, with studies indicating that a high-fat diet (HFD) may heighten susceptibility to AR. This study aims to investigate the impact of HFD on ovalbumin (OVA)-induced AR using both an OVA-sensitized rat model and a macrophage model treated with palmitic acid (PA). The systemic effects of HFD were explored with respect to intestinal barrier integrity, serum lipids and lipopolysaccharide (LPS) levels, and inflammatory response. In AR rats fed with HFD, there was a reduction in the expression of tight junction proteins in colon tissues, increased serum levels of lipids and LPS, and elevated inflammatory responses in both nasal lavage fluid (NLF) and serum. Additionally, there was enhanced NF-κB and NLRP3 inflammasome activity observed in both nasal and colon tissues. In vitro experiments demonstrated that PA and LPS synergistically amplified inflammatory responses in THP-1-derived macrophages, paralleling the systemic findings. These results suggest that HFD-induced intestinal barrier dysfunction facilitates the translocation of LPS into the bloodstream. Elevated serum LPS level, together with increased blood lipids levels, may exacerbate the inflammatory response in AR through the activation of NF-κB and NLRP3 inflammasome.

Future of allergy and immunology: Is artificial intelligence the key in the digital era?

Artificial intelligence (AI) is reshaping allergy and immunology by integrating cutting-edge technology to enhance patient outcomes and redefine clinical practices and research. This review evaluates AI's evolving role, emphasizing its impact on diagnostic accuracy, personalized treatments, and innovative research methodologies. AI has advanced diagnostic tools, such as models predicting allergen sensitivity, and enhanced immunotherapy strategies. Its ability to process extensive data sets has enabled deeper understanding of allergic diseases and immune system responses, leading to more accurate, effective, and tailored treatments. Furthermore, AI is facilitating personalized care through AI-driven allergen mapping, automated patient monitoring, and targeted immunotherapy. The integration of AI into clinical practice promises a future in which allergy and immunology are characterized by precisely customized health care solutions. This review adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses flowchart, with a comprehensive analysis of databases, including Scopus, Web of Science, PubMed, and preprint platforms using keywords related to AI and allergy and immunology. From an initial pool of 192 studies, 20 documents were selected based on inclusion criteria. Our findings highlight how AI is transforming allergy and immunology by enhancing patient care, research methodologies, and clinical innovation, offering a glimpse into the near future of technology-driven health care in these fields.

Vocal biomarkers correlate with FEV1 variations during methacholine challenge

BACKGROUND

Mobile health applications are increasingly valued for their role in asthma management and the opportunity for large dataset collection. Our study aimed to investigate the feasibility of applying signal-processing and machine-learning technologies to detect alterations in the lower airway caliber and develop a machine-learning algorithm to identify changes in vocal biomarkers and detect bronchoconstriction in patients with airway hyperreactivity.

METHODS

This is an explorative observational prospective longitudinal study focused on vocal biomarkers and their association with bronchial constriction and respiratory function. Non-smoker adults with clinical suspicion of asthma were consecutively enrolled from May 2023 to September 2023. At each step of a Methacholine Challenge Test (MCT) performed on these patients, the respiratory sounds were recorded via a smartphone through an app specifically developed. Several biomarkers were extracted and their relationship with the change in Forced Expiratory Volume in the first second (FEV1) was measured.

RESULTS

Forty-two subjects were enrolled. The highest correlation with FEV1 came from exhalation vocal events. No single feature exhibited robust behavior across different subjects, while each subject showed "personal" highly correlated features. All values were strongly statistically significant irrespectively of the result of MCT.

CONCLUSION

The app's algorithm is sensitive in correlating specific vocal biomarkers to FEV1 variations during MCT. This feature may assist physicians in diagnosing asthma and its exacerbation and in assessing therapy response and adherence. The socio-economic implications might be significant, and the simplicity of use makes it an ideal tool for research.

A Content Analysis of YouTube Videos on Allergic Rhinitis Management

Introduction

This study evaluates the quality, reliability, and usability of YouTube videos on allergic rhinitis (AR) management using validated assessment tools to determine their alignment with evidence-based practices and their potential impact on patient understanding.

Methods

A cross-sectional analysis was conducted on 50 YouTube videos identified using predefined keywords. Videos were assessed using DISCERN, JAMA, and PEMAT tools for quality, authorship, and usability, respectively. Engagement metrics such as views, likes, and comments were recorded. Videos were categorized by source (medical professionals, influencers, pharmaceutical companies, and alternative therapists) and format (testimonial, educational, promotional). Statistical analyses, including Spearman's correlation and chi-square tests, were performed to explore relationships between video quality and engagement.

Results

The mean DISCERN, JAMA, and PEMAT scores across all videos were 3.1/5, 2.7/4, and 72%, respectively. Videos by medical professionals scored the highest in quality but had lower engagement, while influencer videos attracted the highest views (mean: 40,000) but scored poorly on quality metrics. Evidence-based treatments were discussed in 72% of videos, yet only 20% mentioned immunotherapy. Misinformation was identified in 36% of videos, with exaggerated claims about "natural cures" being the most common theme. A negative correlation was found between DISCERN scores and views (r = -0.42, p = 0.03), indicating that higher-quality videos received fewer views.

Conclusions

YouTube videos on AR management exhibit significant variability in quality and engagement, highlighting a trade-off between reliability and popularity. Enhancing the accessibility and visibility of evidence-based content requires collaboration between medical professionals and content creators. Addressing misinformation and improving patient education through digital platforms is essential for optimizing health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-025-05396-6.

Rhinitis in the Geriatric Population: Epidemiological and Cytological Aspects

Allergic rhinitis (AR), traditionally considered as a childhood condition, is increasingly recognized among older adults, driven by rising life expectancy and environmental factors. Although allergic sensitization declines with age, AR prevalence in the elderly is underestimated, with 3-12% of geriatric patients affected. Diagnosis is challenging due to nonspecific symptoms and overlapping conditions, leading to underdiagnosis and inadequate treatment. AR significantly impacts the quality of life (QoL), often exacerbating respiratory comorbidities like asthma and COPD. Presbynasalis, encompassing age-related sinonasal changes, includes reduced allergic responses, increased chronic rhinosinusitis, altered nasal structure, and impaired mucociliary clearance. Non-allergic rhinitis, atrophic rhinitis, and overlapping rhinitis further complicate AR diagnosis in the elderly. Effective management involves personalized pharmacotherapy, allergen-specific immunotherapy (AIT), and addressing comorbidities and polypharmacy risks. Despite safety concerns, recent studies demonstrate AIT efficacy in elderly patients, reducing symptoms and medication use. Given AR's impact on cognitive and respiratory health, accurate diagnosis and treatment can enhance QoL and mitigate health decline. Greater awareness and further research are essential to understand AR prevalence and improve outcomes for geriatric patients.

Determination of the Bioavailability of 3 Intranasal Formulations of Azelastine Hydrochloride in Healthy Male Volunteers

The primary objective of the study was to determine the bioavailability of 2 new formulations of azelastine (AZE) hydrochloride (0.10% and 0.15% AZE) containing sorbitol and sucralose compared with the commercially available 0.10% AZE. This study was performed in healthy volunteers based on the pharmacokinetic parameters maximum plasma concentration and area under the plasma concentration-time curve from time zero to the last measurable concentration. This was a Phase 1, open-label, single-center, randomized, parallel-group study. Subjects were randomized to 1 of 3 treatment groups: (1) 0.10% AZE (treatment A), (2) 0.15% AZE (treatment B) (Groups 1 and 2 both containing sorbitol and sucralose), and (3) the commercially available 0.10% AZE (treatment C). A total of 54 subjects were randomized and received treatment A, B, or C. Maximum plasma concentration and area under the plasma concentration-time curve were similar when compared in treatments A and C (0.1%) for AZE and its metabolite, desmethylazelastine. The most frequently reported adverse events were rhinorrhea (5.6%) and sneezing (5.6%).

Bioequivalence Study of 2 Formulations of Fluticasone Nasal Spray in Healthy Chinese Volunteers

This study aimed to evaluate the pharmacokinetic characteristics, safety, and bioequivalence of 2 formulations of fluticasone nasal spray in healthy Chinese subjects. A single-center, randomized, open-label, single-dose, 2-formulation, 2-sequence, 2-period crossover bioequivalence study was conducted under fasting conditions. A total of 120 healthy male and female subjects were enrolled, of which 119 subjects completed the entire study. The main pharmacokinetic parameters of the parent drug, fluticasone propionate (FP), in plasma were as follows: For the test formulation, maximum plasma concentration (Cmax) was 10.3 pg/mL, area under the plasma concentration-time curve from time zero to the last quantifiable concentration (AUC0-t) was 65.6 pg•h/mL, and area under the plasma concentration-time curve from time zero to infinity (AUC0-∞) was 86.4 pg•h/mL. For the reference formulation: Cmax was 8.80 pg/mL, AUC0-t was 58.2 pg•h/mL, and AUC0-∞ was 75.2 pg•h/mL. The 90% confidence intervals of the geometric means for AUC0-t, AUC0-∞, and Cmax between the 2 formulations were 105%-120%, 103%-120%, and 112%-124%, respectively. The results show that the test and reference formulations were well tolerated, with no serious adverse events reported. According to the criteria for bioequivalence, the FP nasal spray (test formulation) is bioequivalent to the reference formulation.

Stapokibart (CM310) in patients with uncontrolled seasonal allergic rhinitis (PHECDA): Rationale and design of a multicentre, randomized, double-blind, placebo-controlled study

Background

Seasonal allergic rhinitis (SAR) is a global health issue, and the current standard of care (SoC) has limited effectiveness in controlling the disease. There is a need for innovative treatments to better manage uncontrolled SAR and advance beyond the uniform SoC, and biologics targeting type 2 inflammation driving allergic rhinitis is promising.

Objective

To evaluate the efficacy and safety of Stapokibart, a humanized monoclonal antibody targeting interleukin-4 receptor subunit alpha, as an add-on therapy in patients with uncontrolled SAR.

Methods

The PHECDA is a multicenter, randomized, double-blind, placebo-controlled, phase 3 clinical study designed to evaluate the efficacy and safety of Stapokibart in treating uncontrolled SAR in adults. Conducted across 18 centers in China during the pollen season, the study plans to recruit 108 adult patients with moderate to severe nasal symptoms despite receiving SoC during the previous seasonal pollen period, along with a 1-week run-in period and a baseline blood eosinophil count of at least 300 cells·μL-1. The study consists of a screening/run-in period (1 week), treatment period (4 weeks), and follow-up period (8 weeks). In addition to SoC, which includes mometasone furoate nasal spray and loratadine, participants are randomly assigned using a centralized interactive-web-response-system to receive either subcutaneous Stapokibart 600 (loading dose)-300 mg or a placebo every 2 weeks for 4 weeks. The primary endpoint of the study is the mean change from baseline in the daily reflective total nasal symptom score over the first 2 weeks of treatment. Subjects who have been administered at least 1 dose of the investigational drug will be included in the assessments of both efficacy and safety.

Results

This article outlines the methodology utilized in a multicenter trial studying Stapokibar for seasonal allergic rhinitis, with expectations to discuss its significant effects in subsequent analyses based on trial outcomes.

Conclusion

The PHECDA study is for the first time to provide insight into the efficacy and safety of a seasonal add-on Stapokibart for patients with uncontrolled SAR during pollen exposure.

Trial registration

NCT05908032.

Efficacy and safety of azelastine hydrochloride and fluticasone propionate nasal spray in treating allergic rhinitis: A randomized controlled trial

Background

MP-AzeFlu (Dymista; Meda Pharma GmbH & Co., KG), a formulation combining azelastine hydrochloride and fluticasone propionate in a single spray, is superior to fluticasone propionate alone in relieving symptoms and improving the quality of life of patients with allergic rhinitis.

Objectives

In this study, we evaluated whether the effect of AzeFlu, a generic drug manufactured from China, is equivalent to that of MP-AzeFlu.

Methods

In total, 679 patients were recruited for a multicentre, randomized, double-blind, original drug-controlled, and parallel-group clinical trial. Overall, 339 and 340 patients were administered with AzeFlu and MP-AzeFlu, respectively. Efficacy was assessed by changes in the reflective total nasal symptom score, the area under the curve of reflective total nasal symptom score changes over time, changes from baseline in individual nasal symptom scores, and the Rhinoconjunctivitis Quality of Life Questionnaire. In addition, a safety evaluation was simultaneously performed.

Results

AzeFlu and MP-AzeFlu reduced the reflective total nasal symptom score from baseline (AzeFlu -6.7 [standard deviation, 2.59]; MP-AzeFlu -6.7 [standard deviation, 2.76]; P = 0.905) and improved nasal symptoms and quality of life (AzeFlu -62.3 [standard deviation, 33.59]; MP-AzeFlu -64.7 [standard deviation, 33.73]; P = 0.394) in patients with allergic rhinitis. Significant differences were not observed between groups.

Conclusion

AzeFlu showed effects equivalent to those of MP-AzeFlu in this clinical trial and may benefit Chinese patients with allergic rhinitis.Registration number: CTR20190189 (chinadrugtrials.org.cn/index.html).

Analysis of miRNA Expression in Patients With NSAID-Exacerbated Respiratory Disease

PURPOSE

Non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is a phenotype of bronchial asthma that is characterized by a severe course and the presence of chronic rhinosinusitis (CRS) with nasal polyps. MicroRNAs (miRNAs) belong to a family of small, non-coding RNAs whose primary function is to regulate gene transcription. The aim of this study was to determine the miRNA profile and to validate selected miRNAs in biological material from the upper respiratory tract collected with a minimally-invasive method in patients with N-ERD.

METHODS

The miRNA profile was assessed in subjects with N-ERD, CRS, and allergic asthma (AA), as well as healthy controls (HCs), using microarray technique. Following this, 6 miRNAs were validated using reverse transcription polymerase chain reaction in 77 subjects.

RESULTS

The profiling identified 23 miRNAs whose expression significantly differed between patients with N-ERD and HCs. Based on these results, 6 miRNAs were selected for further validation. It was found that patients with N-ERD had significantly different expressions of miR-34a-5p and miR-22-5p compared to those with AA. In the whole study group, significant correlations were found between miR-7d-3p/miR-34a-5p/miR-22-5p and the presence of blood eosinophilia (r = 0.25, r = 0.28 and r = 0.26, for all P < 0.05). Forced expiratory volume in 1 second/forced vital capacity was correlated with miR-149a-5p expression (r = 0.27, P < 0.05).

CONCLUSIONS

The results indicate that the miRNA profile in nasal mucosal lining fluid of patients with N-ERD differs from patients with AA, CRS, and compared to HCs. Some of the miRNAs selected on the basis of profiling may be involved in the regulation of eosinophilic inflammation in the respiratory tract. Our findings suggest that specific miRNAs may be considered as potential biomarkers of N-ERD.

Polymerized Molecular Allergoid Alt a1: Effective SCIT in Pediatric Asthma Patients

Background: Allergy to Alternaria alternata (Alt a), although often underdiagnosed, is a significant global health issue. In the allergen immunotherapy (AIT) field, novel therapeutic strategies are emerging, particularly with the advent of polymerized allergoids. This study aims to evaluate the efficacy of subcutaneous immunotherapy (SCIT) based on these innovative molecules in children with respiratory allergies, assessing clinical and functional parameters. Methods: We enrolled 42 patients aged between 6 and 16 years, all of whom had allergic rhinitis (AR) and concomitant asthma and all of whom were monosensitized to Alt a. Between December 2020 and December 2021, 17 patients initiated SCIT with Modigoid® for Alt a1, while 25 patients continued with standard therapy. At the initial visit (T0), all the patients underwent nasal and bronchial evaluation, including exhaled nitric oxide (eFeNO) measurement and spirometry. The Asthma Control Test (ACT) was used to evaluate the control of asthma symptoms. Patients were followed up every 6 months, with a comprehensive re-evaluation at 24 months (T1) replicating the initial assessments. Results: After 24 months of SCIT with the new polymerized molecular allergoid Alt a1 (Modigoid®), children showed a statistically significant reduction in eFeNO levels, improved FEV1 values, and enhanced ACT scores. Conclusions: SCIT with the new molecular allergoid Alt a1 significantly improves functional parameters (FEV1 and eFeNO) and subjective asthma symptoms (ACT scores) in children with AR and objective asthma signs. This treatment represents an effective preventive strategy that can be used to halt the progression of the classic atopic march from AR to asthma and potentially reverse the atopic march.

EUFOREA meeting on defining disease states in allergic rhinitis: towards a unified language in AR

Allergic rhinitis (AR), the most prevalent immunological disease, affects approximately 400 million individuals globally and can significantly impact quality of life (QoL). Despite nearly 25 years of guidelines, AR remains largely under- diagnosed, suboptimally treated and poorly controlled. In the light of new knowledge and treatment options, there is a necessity to update or revise fundamental AR definitions to facilitate communication across diverse specialties engaged in its treatment and to improve patient care. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) convened a meeting of experts and patient representatives to deliberate the optimal methodology for measuring AR treatment responses and establishing novel treatment goals. This paper presents a consensus on revised AR definitions, including control, severe allergic rhinoconjunctivitis (SARC), refractory severe allergic rhinoconjunctivitis (R-SARC), remission, resolution, improvement, exacerbation, treatable traits (TTs), treat to target, relapse, progression, disease modification, and prevention.

Association of Abnormal Body Weight and Allergic Rhinitis-A Systematic Review and Meta-Analysis

OBJECTIVE

Allergic rhinitis (AR) is a prevalent inflammatory condition of the nasal mucosa, with significant burden worldwide. While studies have demonstrated a relationship between body mass index (BMI) and other atopic diseases, its association with AR is uncertain. This study aims to clarify the association between non-normal BMI and AR.

DESIGN

According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, independent authors screened studies for eligibility, extracted data and assessed bias of included studies using the Newcastle-Ottawa scale and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. A random-effects meta-analysis was used to pool maximally covariate-adjusted estimates. Additional subgroup and bias analyses were performed.

DATA SOURCES

PubMed, Embase, Cochrane Library, SCOPUS and CINAHL were searched from inception to 14 January, 2024.

ELIGIBILITY CRITERIA

Observational studies investigating the association between non-normal BMI and AR in both children and adults.

RESULTS

We included 32 articles comprising 2,008,835 participants. The risk of bias was low (N = 20) or moderate (N = 12) and GRADE certainty of evidence was very low to low. Pooled cross-sectional analyses indicated that obese children (OR = 0.99, 95% CI = 0.96-1.03, I2 = 0%), obese adults (OR = 1.11, 95% CI = 0.92-1.33, I2 = 73%), overweight children (OR = 1.02, 95% CI = 0.98-1.06, I2 = 35%), and overweight adults (OR = 1.13, 95% CI = 0.90-1.40, I2 = 0%) showed similar odds of AR compared to controls. Additionally, longitudinal analyses did not identify any evidence for an association between overweight (OR = 1.03, 95% CI = 0.85-1.24, I2 = 29%) or underweight (OR = 1.09, 95% CI = 0.77-1.54, I2 = 72%) children and AR risk. These results remained largely robust across various subgroups and sensitivity assessments.

CONCLUSION

Abnormal BMI may not be associated with AR. This study adds to the expanding literature on the association between non-normal BMI and atopic diseases. Further prospective studies are needed to explore the longitudinal relationship between BMI and AR and the effect of weight loss interventions on AR, given the limits of existing literature.

TRIAL REGISTRATION

PROSPERO CRD42024503589.

Efficacy of vidian neurectomy in treating chronic rhinosinusitis with nasal polyps combined with allergic rhinitis: A systematic review and meta-analysis

OBJECTIVE

To evaluate the impact of additional vidian neurectomy or posterior nasal neurectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and allergic rhinitis (AR), compared to the outcomes of conventional endoscopic sinus surgery alone.

METHODS

Up to May 2024, six databases were systematically searched. We evaluated studies that compared the clinical improvement of chronic sinusitis-related symptoms and endoscopic findings between the neurectomy group (endoscopic sinus surgery plus vidian neurectomy or posterior nasal neurectomy) and the control group (endoscopic sinus surgery only).

RESULTS

The neurectomy group showed a significant reduction in the Lund-Kennedy endoscopic score (SMD = -1.3163 [-1.6519; -0.9807]; I² = 53.3 %). However, this treatment did not have a significant effect on the Quality-of-life score (SMD = -0.1222 [-0.3427; 0.0983]; I² = 27.5 %) or patient-reported nasal symptom-related VAS scores (SMD = -1.6690 [-3.7062; 0.3682]; I² = 96.3 %). In the subgroup analyses of these results according to time points of measurement, the Lund-Kennedy endoscopic score was statistically lower in the treatment group during treatment periods (postop 6months, 12months, and 24months). However, there were no statistically significant differences in Quality-of-life score and VAS between the treatment and control groups during all treatment periods. There was no significant difference in the recurrent rate of CRS during the following up periods (odds ratio=0.5263 [0.1518; 1.8254], I2 = NA) between two groups. Regarding the adverse effect of neurectomy, this additional procedure did not induce the postoperative bleeding (odds ratio=0.8886 [0.3411; 2.3150]; I2 = 0.0 %) and dry eye related discomfort (odds ratio=65.3560 [0.1044; 40,908.1619]; I2 = 88.9 %) significantly compared to control group.

CONCLUSIONS

Additional neurectomy shows better efficacy in improving endoscopic findings and is safer in patients with CRSwNP combined with AR; however, more clinical studies are needed to evaluate its long-term symptomatic effects and disease recurrence.

The use of metagenomic and untargeted metabolomics in the analysis of the effects of the Lycium barbarum glycopeptide on allergic airway inflammation induced by Artemesia annua pollen

ETHNOPHARMACOLOGICAL RELEVANCE

The prevalence of allergic airway inflammation (AAI) worldwide is high. Artemisia annua L. pollen is spread worldwide, and allergic diseases caused by its plant polysaccharides, which are closely related to the intestinal microbiota, have anti-inflammatory effects. Further isolation and purification of Lycium barbarum L. yielded its most effective component Lycium barbarum L. glycopeptide (LbGP), which can inhibit inflammation in animal models. However, its therapeutic effect on AAI and its mechanism of regulating the intestinal flora have not been fully investigated.

AIM OF THE STUDY

To explore LbGP in APE-induced immunological mechanisms of AAI and the interaction mechanism of the intestinal flora and metabolites.

METHODS

A mouse model of AAI generated from Artemisia annua pollen was constructed, and immunological indices related to the disease were examined. A combination of macrogenomic and metabolomic analyses was used to investigate the effects of LbGP on the gut microbial and metabolite profiles of mice with airway inflammation.

RESULTS

LbGP effectively alleviated Artemisia. annua pollen extract (APE)-induced AAI, corrected Th1/Th2 immune dysregulation, decreased Th17 cells, increased Treg cells, and altered the composition and function of the intestinal microbiota. LbGP treatment increased the number of OdoribacterandDuncaniella in the intestines of the mice, but the numble of Alistipes and Ruminococcus decreased. Metabolite pathway enrichment analysis were used to determine the effects of taurine and hypotaurine metabolism, bile acid secretion, and pyrimidine metabolism pathways on disease.

CONCLUSION

Our results revealed significant changes in the macrogenome and metabolome following APE and LbGP intervention, revealed potential correlations between gut microbial species and metabolites, and highlighted the beneficial effects of LbGP on AAI through the modulation of the gut microbiome and host metabolism.

Chitooligosaccharides suppress airway inflammation, fibrosis, and mucus hypersecretion in a house dust mite-induced allergy model

Background

Respiratory allergy is a serious respiratory disorder characterized by inflammation, mucus hypersecretion, and airway tissue sclerosis. Disruption of the T helper 1 (Th1) and T helper 2 (Th2) immune systems by stimuli induced by house dust mites (HDM) and fine particulate matter leads to the secretion of various inflammatory cytokines, resulting in immune respiratory diseases characterized by airway inflammation. Chitooligosaccharides (COS) are known for their antioxidant and anti-inflammatory properties.

Methods

Human airway epithelial cells (BEAS-2B) were cultured in DMEM/F12 medium containing COS at concentrations of 25-100 µg/ml for 24 h. No intracellular toxicity was observed up to 1,000 µg/ml. Cell experiments were conducted at COS concentrations below 100 µg/ml, while animal experiments were performed at concentrations below 100 mg/kg body weight for 4 weeks. Samples of right lung tissue obtained from the experimental animals were used for gene and protein expression analysis, whereas samples of contralateral lung tissue were used for immunohistochemical analysis.

Results

COS regulated Th1 immunity by inhibiting major cytokines, including inflammatory tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6), in BEAS-2B cells. In the HDM-induced allergic respiratory model, COS suppressed the infiltration of inflammatory cells around the airways and inhibited the mRNA expression of Th1 immune cytokines in lung tissues, while also reducing the expression of nuclear factor kappa B (NF-κB)-related proteins. Furthermore, the results confirmed the suppression of the levels of immunoglobulin E (IgE) in the blood secreted by mast cells activated by HDM, which led to a reduction in allergic mucus hypersecretion and airway sclerosis.

Conclusion

In summary, COS are thought to improve airway resistance by alleviating inflammatory allergic respiratory diseases caused by HDM and are regarded as substances that regulate the balance of the Th1 and Th2 immune systems in epithelial cells affected by mucus hypersecretion.

16S rRNA sequencing-based evaluation of the protective effects of key gut microbiota on inhaled allergen-induced allergic rhinitis

Introduction

Allergic rhinitis (AR) is a common respiratory disorder influenced by various factors in its pathogenesis. Recent studies have begun to emphasize the significant role of gut microbiota in immune modulation and its potential association with the development of AR. This research aims to characterize the gut microbiota of patients with AR who are sensitized via inhalation, utilizing 16S rRNA sequencing to shed light on the pathogenesis of AR and identify potential therapeutic targets.

Methods

To achieve the study's objectives, we compared the microbiota profiles between patients with AR and healthy controls. Microbial diversity was assessed using alpha and beta diversity indices, and differential microbiota populations were identified through Linear discriminant analysis Effect Size (LEfSe) analysis. A Least Absolute Shrinkage and Selection Operator (LASSO) regression model was employed to pinpoint key species. Additionally, PICRUSt2 was utilized to predict the functional pathways associated with these identified species.

Results

The analysis identified a total of 1,122 common species, along with 1,803 species associated with AR and 1,739 species associated with healthy controls. LEfSe analysis revealed 20 significant discrepancies at the genus level. The LASSO regression model identified 8 key genera, including Prevotellaceae UCG-004 and Rhodococcus, which exhibited AUC values exceeding 0.7, indicating strong diagnostic potential. Furthermore, functional pathway analysis suggested that these pivotal species are involved in pathways such as L-lysine biosynthesis and photorespiration, potentially contributing to the pathogenesis of AR.

Discussion

This study identifies critical gut microbiota that could serve as potential biomarkers for allergic rhinitis, providing new insights into its pathogenesis and offering avenues for future therapeutic strategies. Further investigation into these microbiota may lead to enhanced understanding and management of AR.

V Brazilian Consensus on Rhinitis - 2024

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Efficacy and safety of intranasal medications for allergic rhinitis: Network meta-analysis

BACKGROUND

Intranasal antihistamines (INAH), corticosteroids (INCS), and their fixed combinations (INAH+INCS) are one of the cornerstones of the treatment of allergic rhinitis (AR). We performed a systematic review and network-meta-analysis comparing the efficacy and safety of INAH, INCS, and INAH+INCS in patients with AR.

METHODS

We searched four electronic bibliographic databases and three clinical trial databases for randomised controlled trials assessing the use of INAH, INCS, and INAH+INCS in adults with seasonal or perennial AR. We performed a network meta-analysis on the Total Nasal Symptom Score, Total Ocular Symptom Score, Rhinoconjunctivitis Quality-of-Life Questionnaire, development of adverse events, and withdrawals due to adverse events. Certainty of evidence was assessed using GRADE-NMA.

RESULTS

We included 167 primary studies, most of which assessed patients with seasonal AR. Among individual medications, azelastine-fluticasone, and fluticasone furoate were the most frequently highest-ranked interventions for efficacy outcomes, being regularly associated with clinically meaningful larger improvements when compared to other active treatments. Considering drug classes, INAH+INCS were the highest-ranked interventions for all outcomes in which they were assessed, followed in most cases by INCS. In 105 out of 184 comparisons in seasonal AR, and 28 out of 97 comparisons in perennial AR, certainty of evidence was considered "high" or "moderate".

CONCLUSION

Intranasal medications for AR display clinically relevant differences in their efficacy, but all show a good safety profile. To our knowledge, this is the first network meta-analysis comparing INAH, INCS, and INAH+INCS in AR, providing relevant evidence for guideline developers and practising physicians on the most efficacious treatments.

Mepolizumab in chronic rhinosinusitis with nasal polyps: Real life data in a multicentric Sicilian experience

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a type 2 pattern of inflammation. Mepolizumab was approved for the treatment of CRSwNP in 2021. However, there is a lack of real-life studies.

AIM

This work aimed to evaluate the effectiveness and safety profile of Mepolizumab during the first year of treatment in a real-life setting.

METHODS

A multicentric observational cohort study was carried out. A total of 67 patients were enrolled in the Otorhinolaryngology Unit of the three University Hospitals and considered for Mepolizumab therapy. All recorder characteristics were age (at the first Mepolizumab application visit), sex, smoke habits, previous local and systemic corticosteroid therapy, history of endoscopic sinus surgery, number of previous endoscopic sinus surgery, concomitant asthma, history of an allergic condition, immunoglobulin E (IgE), allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), Aspirin Exacerbated Respiratory Disease (AERD), other comorbidities associated, blood eosinophils, nasal polyp score, sinonasal outcome test 22 (SNOT 22), sniffin' stick test, the start date of Mepolizumab therapy and number of doses of Mepolizumab and eventually, Mepolizumab's adverse events related to administration. The Wilcoxon test for dependent samples was performed to compare variables. Statistical significance was assumed for p values < 0.05.

RESULTS

A statistically significant reduction in SNOT-22 and NPS was shown in the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). A statistically significant increase value at the Sniffin' sticks test was shown in the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). At the 12-month follow-up, according to EUFOREA indications, all patients were considered to remain in treatment with Mepolizumab and continued the treatment because of a reduced NPS, improved quality of life, and a reduced need for system corticosteroids.

CONCLUSIONS

This multi-centric real-life study supported the effectiveness of Mepolizumab in patients with severe uncontrolled CRSwNP in the improvement of quality of life, the severity of symptoms, polyp size reduction, and smell function. Our data also support the safety profile of monoclonal therapy with Mepolizumab.

Allergic rhinitis

Allergic rhinitis (AR) is a common disorder that is strongly linked to asthma and conjunctivitis. Classic symptoms include nasal congestion, nasal itch, rhinorrhea and sneezing. A thorough history, physical examination and assessment of allergen sensitization are important for establishing the diagnosis of AR. Intranasal corticosteroids and second-generation antihistamines are the mainstay of treatment. Allergen immunotherapy is an effective immune-modulating treatment for use in addition to or as an alternative to pharmacologic therapy. This article provides an overview on the pathophysiology, diagnosis, and appropriate management of AR.

Molecular Profiles of Sensitization to Non-Specific Lipid Transfer Proteins in Lithuania: Single Center Experience

Non-specific Lipid Transfer proteins (nsLTPs) are relevant allergens of several pollens and plant foods. Sensitization to nsLTPs is not typical in our region. Still, it has become an increasingly common cause of IgE-mediated food allergies and food-induced anaphylaxis in Northern Europe in recent decades. No in-depth studies describe the prevalence of sensitization of molecular components to nsLTPs in Lithuania. This study aimed to determine the sensitization profile of atopic patients at the Immunology and Allergy Department of Kauno Klinikos to the components of nsLTPs, using molecular allergen component analysis. Sixty Lithuanian adults with symptoms of allergic rhinitis and/or allergic asthma and/or food allergies were included into the study. Specific immunoglobulin E (IgE) levels were measured using two in vitro techniques: allergen extract and molecular component analysis. Results showed that 25% of subjects were sensitized to nsLTP-containing allergen sources, mostly to Zea m 14, Mal d 3, Vit v 1, and Art v 3. The median amount of total IgE was higher in nsLTP-sensitized patients than in nsLTP-nonsensitized patients. Based on Cohen's Kappa and McNemar tests, the results of allergen extract and component analysis tests do not always agree, especially when we determine the sensitization to allergen sources containing nsLTPs. Molecular allergen component analysis could be the first choice in determining detailed sensitization to nsLTPs in patients who experienced anaphylaxis of unknown origin.

Deficiency of DEK proto-oncogene alleviates allergic rhinitis by inhibiting RhoA/Ezrin-mediated mitochondrial fission

BACKGROUND

Allergic rhinitis (AR) is a kind of immune disease mediated by IgE. We are intrigued by the potential role of DEK proto-oncogene (DEK) in inflammation-related diseases. We investigated the effects and mechanisms of DEK in treating AR, aiming to identify potential new treatment targets for AR.

METHODS

The AR mouse model was induced by house dust mite (HDM) (1 mg/mL). HNEpCs stimulated by HDM (1 mg/mL) were pretreated for 24 h with or without DEK lentivirus. The effect of DEK knockout or knockdown on AR was evaluated in vitro and in vivo using western blotting, ELISA, flow cytometry, real-time quantitative PCR, immunohistochemistry, HE staining, PAS staining, Diff staining, and immunofluorescence.

RESULTS

After DEK knockdown, the inflammatory response of AR mice was reduced. In addition, DEK deletion mitigated nasal tissue damage and mitochondrial division. Our further studies showed that DEK deletion or inhibition led to the down-regulation of RhoA activity and decreased phosphorylation of Ezrin and Drp1 proteins, and inhibited mitochondrial division. Overall, DEK deficiency mitigated AR by down-regulating RhoA/Ezrin/Drp1 pathway activity.

CONCLUSION

DEK alleviates AR through RhoA/Ezrin/Drp1 signaling pathway, which provides a new perspective for developing improved therapies and understanding the pathogenesis of AR.

Efficacy of dupilumab on chronic rhinosinusitis with nasal polyps and concomitant asthma in biologic-naive and biologic-pretreated patients

OBJECTIVES

Dupilumab, an anti-IL-4 receptor monoclonal antibody (mAb), was recently approved for the treatment of severe chronic rhinosinusitis with nasal polyps (CRSwNP). The main objective of this study was to assess whether previous exposure to biological treatment affected the clinical outcomes in CRSwNP and asthma patients, treated with dupilumab over time. A collateral secondary objective was to analyse the effects over time of dupilumab in patients with and without aeroallergen sensitization.

METHODS

Single-centre retrospective observational study on severe CRSwNP patients treated with dupilumab. Nasal polyp score (NPS), visual analogue scale (VAS) symptom score, sinonasal outcome test (SNOT-22), aeroallergen sensitization, total serum IgE levels, and blood eosinophil counts were assessed at baseline and after 4, 6 and 12 months.

RESULTS

42 patients were included, 40 (95.2%) had asthma. Twenty-one (50%) patients received dupilumab without prior biological treatment (Group A: naive) and 50% switched to dupilumab from previous biological treatment (Group B: pre-treated). NPS, VAS symptoms, SNOT-22 improved significantly after 12 months treatment in both groups of patients (p < 0.001). After 12 months, VAS overall symptom score showed a significant reduction from 6 (IQR, 4.6-8.6) and 6 (IQR, 3.8-7.1) for Group A and Group B patients respectively, to 1.2 (IQR, 0.8-2.7) and 1.2 (IQR, 0.2-2.5); NPS from 6 (IQR, 4.0-7.0) and 5 (IQR, 3.5-6.0), respectively, to 1 (IQR, 0.0-2.0) and 0 (IQR, 0.0-3.0) and SNOT-22 from 64 (IQR, 56-78) and 71 (IQR, 47.5-76.0) respectively, to 5.5 (IQR, 4-21) and 6 (IQR, 4-15). IgE reduced from 57 to 22.1 and from 46.9 to 30.2 in Group A and Group B respectively (p < 0.001).

CONCLUSIONS

Dupilumab improves symptom severity, polyp size, and health-related quality of life, regardless of the presence or absence of comorbid aeroallergen sensitization and previous administration of biologic therapy.

Intranasal Versus Oral Treatments for Allergic Rhinitis: A Systematic Review With Meta-Analysis

BACKGROUND

Treatments for allergic rhinitis include intranasal or oral medications.

OBJECTIVE

To perform a systematic review with meta-analysis comparing the effectiveness of intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists in improving allergic rhinitis symptoms and quality of life.

METHODS

We searched four bibliographic databases and three clinical trial datasets for randomized controlled trials (1) assessing patients aged 12 years and older with seasonal or perennial allergic rhinitis, and (2) comparing intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists. We performed a meta-analysis of the Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), development of adverse events, and withdrawals owing to adverse events. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation.

RESULTS

We included 35 studies, most of which assessed patients with seasonal allergic rhinitis and displayed an unclear risk of bias. Superiority of intranasal treatments was found for all assessed outcomes. Intranasal corticosteroids were more effective than oral antihistamines at improving the TNSS (mean difference [MD], -0.86; 95% CI, -1.21 to -0.51; I2 = 70%), Total Ocular Symptom Score (MD, -0.36; 95% CI, -0.56 to -0.17; I2 = 0%), and RQLQ (MD, -0.88; 95% CI, -1.15 to -0.61; I2 = 0%), which were mostly associated with clinically meaningful improvements. Superiority of intranasal corticosteroids at improving the TNSS was also found against oral leukotriene receptor antagonists (MD, -1.05; 95% CI, -1.33 to -0.77). Intranasal antihistamines were more effective than oral antihistamines at improving the TNSS (MD, -0.47; 95% CI, -0.81 to -0.14; I2 = 0%) and RQLQ (MD, -0.31; 95% CI, -0.56 to -0.06; I2 = 0%).

CONCLUSIONS

Randomized controlled trials suggest that intranasal treatments are more effective than oral treatments at improving symptoms and quality of life in seasonal allergic rhinitis.

The efficacy and safety of radiofrequency ablation for allergic rhinitis: a systematic review and meta-analysis

OBJECTIVE

This systematic review aims to synthesise findings from randomised, controlled trials and assess the efficacy and safety of radiofrequency ablation in treating allergic rhinitis.

METHODS

A thorough search was conducted across PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang, Chinese Scientific Journal, and Chinese Biomedical Literature databases from their inception until October 2023. The primary outcome measure was the total effective rate, with secondary outcomes including adverse events.

RESULTS

This review included 15 randomised, controlled trials involving 1430 patients. The pooled analysis revealed a statistically significant effect on the total effective rate (odds ratio = 3.27, 95 per cent confidence interval = 2.37 to ~4.51). However, no statistical significance was observed in adverse events (odds ratio = 1.18, 95 per cent confidence interval = 0.67 to ~2.08).

CONCLUSIONS

Based on the analytical results, radiofrequency ablation emerges as an efficacious and safe treatment modality for allergic rhinitis. Given the constraints posed by a limited sample size, it is imperative that forthcoming clinical trials adhere rigorously to the gold standard of randomised, controlled trials for the purpose of corroborating these conclusions.

A Modern Approach to Clinical Outcome Assessment in Allergy Management: Advantages of Allergen Exposure Chambers

Allergic diseases triggered by airborne allergens such as allergic rhinitis and conjunctivitis are increasingly prevalent, posing significant challenges for both patients and healthcare systems. Assessing the efficacy of allergen immunotherapy and other anti-allergic treatments requires precise and reproducible methods. Allergen exposure chambers (AECs) have emerged as advanced tools for evaluating clinical outcomes, offering controlled conditions that address many limitations of traditional field-based studies. This review explores the advantages of AECs in allergy management, emphasizing their role in providing standardized allergen exposure for both clinical research and routine assessments. AECs deliver consistent and reproducible data comparable to the nasal allergen challenge and natural allergen exposure, making them a valuable addition to the diagnosis and treatment effectiveness of allergic diseases. Although they are well suited to early-stage clinical trials, further standardization and validation are needed to gain broader acceptance in pivotal phase III studies. Future research should focus on refining AEC protocols and integrating them into regulatory frameworks, ensuring their role in the advancement of therapeutic approaches for allergic diseases.

The Effects of Mepolizumab on CRSwNP: Real-Life Evidence

Background: This study aims to evaluate the efficacy and safety of mepolizumab in the treatment of severe uncontrolled CRSwNP with or without comorbid asthma in a real-life setting over the first six months of therapy. Methods: A total of 45 patients with nasal polyps with or without comorbid asthma were treated with mepolizumab (100 mg q4w) for 6 months. The following outcomes were assessed before therapy (V0), and after 6 months (V1): endoscopic nasal polyp score (NPS), nasal congestion score (NCS), sinonasal outcome test (SNOT-22), visual analog scale (VAS), nasal flow rate (PNIF), olfactory test (SS-I), and asthma control test (ACT). Blood eosinophil count, oral steroid intake, and rescue surgery were also measured. Results: We found a statistically significant improvement in NPS, NCS, SNOT-22, overall VAS, PNIF, SS-I, and ACT. In addition, we observed a decrease in blood eosinophils count. Mepolizumab was well tolerated, and no patients interrupted the treatment during the follow up. Conclusions: Our real-life study confirmed the efficacy and tolerance of mepolizumab prescribed for CRSwNP with or without asthma. The safety profile of mepolizumab was consistent with previous reports.

Appropriate Allergic Rhinitis Medications Can Reduce Systemic Steroid Requirement and Prevent Rhinosinusitis

Background: Allergic rhinitis (AR) is quite common and sometimes it requires systemic steroids and can be accompanied by coronavirus disease-2019 (COVID-19), rhinosinusitis, or asthma. We aimed to determine the comparative effect of different types of AR medications on clinical prognosis in real-world settings. Methods: We used national claims data provided by the National Health Insurance Service in the Republic of Korea. We enrolled 275,895 adult patients who were first diagnosed with AR and started AR medications between 1 January 2018 and 31 December 2018. We classified them into five groups according to the type of AR medication prescribed and analyzed their 3-year follow-up data. Results: The prescription rate of systemic steroids was low in the INCS group (19%), whereas it was 35-40% in other groups. INCS users needed less systemic steroids than other AR medication users (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.452-0.560; p-value < 0.001). The incidence of rhinosinusitis was approximately 11% in the other AR medication group and 6-8% in the other groups. AH (HR, 0.745; 95% CI, 0.616-0.903; p = 0.003), AH-LTRA (HR, 0.667; 95% CI, 0.551-0.808; p < 0.001), and INCS (HR, 0.746, 95% CI, 0.615-0.904; p = 0.003) significantly prevent rhinosinusitis, compared with other AR medication. However, other prognosis factors were not significantly correlated with the type of AR medications. Conclusions: INCS can reduce systemic steroid requirements and AH, AH-LTRA, and INCS prevent rhinosinusitis compared with other AR medications. As choosing an appropriate AR medication can determine the clinical outcomes, clinicians should be careful in prescribing proper AR medications.

Efficacy and Safety of Montelukast+Levocetirizine Combination Therapy Compared to Montelukast Monotherapy for Allergic Rhinitis in Children

PURPOSE

The combination therapy of leukotriene receptor antagonists and antihistamines may alleviate allergic rhinitis (AR) symptoms better than monotherapy. This study aimed to investigate the safety and efficacy of Monterizine®, a fixed-dose combination of montelukast and levocetirizine, compared to montelukast monotherapy in pediatric patients with AR.

METHODS

One hundred seventy-six children aged 6 to 14 years with perennial AR symptoms were recruited. One hundred forty-seven subjects were randomized into 1 of 2 groups: the mont+levo group (fixed-dose combination of montelukast [5 mg] + levocetirizine [5 mg]) or the mont group (montelukast single agent [5 mg]). Study subjects took the treatment every evening for 4 weeks and recorded their daytime nasal symptom score (DNSS) and nighttime nasal symptom score (NNSS) in a diary every day. Adverse events (AEs) were also recorded, and patients were surveyed as to their overall satisfaction with the therapeutic product they received.

RESULTS

When DNSS and NNSS were assessed individually, daytime nasal congestion symptom scores decreased more in the mont+levo group during the 4-week treatment period than in the mont group (P = 0.0341). The daytime rhinorrhea symptom scores also decreased more in the mont+levo group (P = 0.0469). The nighttime nasal congestion score (severity when awake) decreased more in the mont+levo group than in the mont group (P = 0.0381). Study subjects in the mont+levo group experienced a greater improvement in quality of life than subjects in the mont group (P < 0.0001).

CONCLUSIONS

The combination therapy of montelukast and levocetirizine was more effective in reducing both daytime nasal symptoms (nasal congestion and rhinorrhea) and nighttime nasal symptoms (severity of nasal congestion when awake). With fewer AEs and higher overall satisfaction, combination therapy is recommended for pediatric patients with perennial AR.

Investigation of the Effectiveness of Nasal Sprays in Allergic Rhinitis

Objectives: We investigated the effectiveness of different types of nasal irrigation sprays in adult allergic rhinitis (AR) patients. Methods: A total of 1700 patients with AR (866 males and 834 females) were assigned to: Group 1: Hypertonic nasal spray group (n = 600) (Sinomarin® hypertonic nasal spray); Group 2: Algae-containing hypertonic nasal spray group (n = 600) (Sinomarin Plus Algae ENT); and Group 3: Isotonic saline nasal spray group (n = 500). All patients underwent an otolaryngological examination, continued their standard AR treatment, and received the assigned nasal spray additionally (1 spray to each nostril, 3 times a day, for 3 weeks). Allergic symptom scores, turbinate examination, total symptom scores, and quality of life (QoL) scores were evaluated during pre- and post-treatment periods. Results: In groups 1 and 2, symptom scores and turbinate color and edema, total symptom scores, and QoL scores increased after treatment (P < .05). In the saline group, there were no significant differences in symptom scores and total symptom scores after treatment; however, improvement was detected in turbinate color and edema values after treatment. QoL scores increased after treatment. When comparing the 3 groups, the total symptom scores of groups 1 and 2 were significantly lower, and the QoL scores of groups 1 and 2 were considerably higher than those of the saline group. There were no significant differences between groups 1 and 2. Conclusion: Algae-containing and hypertonic nasal spray may be added to the standard AR treatment to increase QoL and decrease total symptom scores.

Genetic polymorphisms of BACH2, a key gene regulating Th2 immune response, increasing risk of allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) is an allergic disease characterized by the dominant differentiation of T helper cell 2 (Th2). BACH2 plays a key role in regulating Th2 immune response. This study aimed to explore the association between BACH2 single nucleotide polymorphism (SNPs) and susceptibility to AR.

METHODS

Han population from northern Shaanxi, China was chosen as subjects. After the DNA extraction from the peripheral blood of subjects, genotyping was completed through the Agena MassARRAY platform. Logistic regression analysis was used to assess the association. Multivariate dimensionality reduction (MDR) was used to evaluate the effect of the interaction between 'SNP-SNP' on susceptibility to AR. Using false-positive report probability (FPRP) analysis to test whether the significant results obtained in this study were noteworthy.

RESULTS

BACH2-rs905670 and -rs2134814 were significantly associated with increased risk of AR. The mutant allele 'A' of rs905670 (OR = 1.36, p = 0.018) and mutant allele 'G' of rs2134814 (OR = 1.34, p = 0.027) were risk genetic factors for AR. The above genetic association was further observed in the stratified analysis: BACH2-rs905670 and-rs2134814 were significantly associated with an increased risk of AR in females, aging older than 43 years, and participants working and living in the loess hills (OR > 1, p < 0.05).

CONCLUSION

BACH2-rs905670 and -rs2134814 are significantly associated with increasing AR risk.

Predictive value of Der p 2-specific IgE for subcutaneous immunotherapy in children with allergic rhinitis

Dermatophagoides pteronyssinus (Der p) subcutaneous immunotherapy (SCIT) has demonstrated efficacy in clinical trials of childhood allergic rhinitis (AR). Currently, there is a lack of some generally accepted biomarkers that may predict the clinical response to SCIT to eventually achieve personalized therapy. In this study, 28 children with AR received Der p SCIT for 26-30 months at baseline, and four efficacy endpoints, serum interleukin (IL)-5, periostin, Der p-specific IgE (sIgE), and Der p sIgG4, were measured by ELSIA. Clinical symptoms and characteristics were assessed by questionnaires, and the associations among periostin, Der p 2 sIgE and clinical efficacy were analyzed. The results showed that SCIT demonstrated a significant reduction in Der p 1 sIgE (P < 0.05) and Der p 2 sIgE (P < 0.01), an increase in Der p sIgG4 (P < 0.001) and an improvement in clinical efficacy at the fourth efficacy endpoint compared with that at baseline. A positive linear correlation was found in serum periostin and Der p sIgE (P < 0.05), Der p sIgG4 (P < 0.05), and clinical efficacy. Importantly, the concentration of serum Der p 2 sIgE showed a positive linear correlation with clinical efficacy and serum periostin (P < 0.05). These results suggest that SCIT can result in reduced type 2 cytokines and Der p sIgE and has long-term efficacy in children with AR. Der p 2 sIgE has a positive linear correlation with clinical efficiency and serum periostin and may be a useful biomarker for the prediction of SCIT.

Concepts for the Development of Person-Centered, Digitally Enabled, Artificial Intelligence-Assisted ARIA Care Pathways (ARIA 2024)

The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own lives based on their lived experiences. Improving healthcare safety, quality, and coordination, as well as quality of life, is an important aim in the care of patients with chronic conditions. Person-centered care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (1) digital care pathways for rhinitis and asthma multimorbidity and (2) digitally enabled, person-centered care.1 It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally enabled, patient-centered care. The paper includes (1) Allergic Rhinitis and its Impact on Asthma (ARIA), a 2-decade journey, (2) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (3) mHealth impact on airway diseases, (4) From guidelines to digital care pathways, (5) Embedding Planetary Health, (6) Novel classification of rhinitis and asthma, (7) Embedding real-life data with population-based studies, (8) The ARIA-EAACI (European Academy of Allergy and Clinical Immunology) strategy for the management of airway diseases using digital biomarkers, (9) Artificial intelligence, (10) The development of digitally enabled, ARIA person-centered care, and (11) The political agenda. The ultimate goal is to propose ARIA 2024 guidelines centered around the patient to make them more applicable and sustainable.

Patient-Reported Outcome Measures in Rhinitis and Chronic Rhinosinusitis

Patient-reported outcome measures (PROMs) are valuable in the assessment and management of rhinitis and chronic rhinosinusitis (CRS). They measure outcomes that may include symptoms, disease control, well-being, and health-related quality of life (QOL). PROMs for rhinitis and rhinosinusitis are often used before and after an intervention, for example, medication, therapeutic procedure, or, in allergic rhinitis (AR), allergen immunotherapy. Although widely used in clinical trials for AR and conjunctivitis, symptom score PROMs are less validated than disease control or QOL measures. The best validated PROM for AR is the Rhinitis Quality of Life Questionnaire, but there is no universally accepted criterion standard for symptom and disease control PROMs. For CRS, at least 15 different criteria have been used to assess disease control in clinical studies, but what CRS disease control means and how it should be measured are concepts in evolution. The most used QOL measure for CRS is the 22-item Sinonasal Outcome Test. The use of PROMs to support clinical decisions and for shared decision-making for rhinitis and rhinosinusitis still has many challenges, including the selection of the preferred instrument, when and how to administer, the impact of comorbidities, and questionnaire fatigue for both patient and provider.

Trends and research foci in immunoregulatory mechanisms of allergic rhinitis: a bibliometric analysis (2014-2024)

Background

This study aims to provide a comprehensive bibliometric analysis of research trends, hotspots, and future directions in the immunoregulatory mechanisms of allergic rhinitis (AR) from 2014 to 2024.

Methods

Data were sourced from the Web of Science Core Collection (WoSCC), covering articles and reviews published between April 1, 2014, and March 31, 2024. The search terms included "Allergic Rhinitis," "AR," and related terms along with specific keywords related to immune cells and inflammatory mediators. Bibliometric tools such as CiteSpace, VOSviewer, and SCImago Graphica were used to analyze institutional cooperation networks, keyword co-occurrence, citation bursts, and research topic evolution. Microsoft Excel 2019 was employed to display annual publication trends.

Results

A total of 2200 papers met the inclusion and exclusion criteria. The number of publications showed an upward trend over the past decade, with a significant peak in 2021. China (583 papers) and the United States (454 papers) were the major contributing countries. Imperial College London emerged as the leading institution. Key research frontiers identified include the roles of NF kappa B and air pollution in AR. Keyword burst analysis revealed emerging topics such as respiratory allergy and personalized treatment strategies. Notable limitations include the exclusive use of the WoSCC database and the restriction to English-language publications.

Conclusion

The field of immunoregulatory mechanisms in allergic rhinitis has seen significant growth, with China and the United States leading the research. Future research should focus on developing personalized treatment plans and understanding the comprehensive impact of environmental factors. Continued interdisciplinary collaboration and international cooperation will be essential for advancing therapeutic strategies in AR.

Epidemiological investigation of allergic rhinitis in children aged 6-12 years in Bayannur City, China

Background

Allergic rhinitis (AR) is an inflammatory condition of the nasal mucosa triggered by exposure to non-harmful substances. Over the past decade, the prevalence of AR in Chinese children has been steadily increasing. However, detailed epidemiological data on AR in children from Bayannur City are lacking.

Methods

This study randomly selected six primary schools in Bayannur City. Electronic questionnaires were distributed via the web, and parents and children completed the questionnaires by scanning the two-dimensional code within a designated timeframe. Statistical analysis was performed on the collected data.

Results

A total of 4,754 valid responses were obtained. The self-reported prevalence of AR among children in Bayannur city was 39.79%. Multivariate analysis revealed that male gender, belonging to an ethnic minority, a history of food or drug allergies, frequent antibiotic use (≥3 times per year in the past two years, with each course lasting ≥3 days), and residence in urban or pastoral areas was associated with an increased prevalence of AR in children. The proportion of children experiencing moderate to severe AR hat impacted their studies or daily life was 48.78%. Chronic AR was reported in 56.71% of cases. Among AR patients with other allergic conditions, the incidence rates were as follows: bronchial asthma 35.99%, upper airway cough syndrome (UACS) 64.32%, secretory otitis media (SOM) 22.41%, obstructive sleep apnea hypopnea-syndrome (OSAHS) 49.58%, allergic dermatitis (AD) 48.72%, and allergic conjunctivitis (AC) 85.20%. The prevalence of AR was 50.30% in urban areas, 13.733% in rural areas and 20.90% in pastoral areas. Seasonal effects on AR prevalence were notably significant in urban and pastoral regions.

Conclusions

The prevalence of AR among children in Bayannur city was 39.80%. Of those with AR, 48.72% experienced significant impacts on their learning or daily life, while only 14.80% had no other allergic conditions. There were significant variations in the prevalence and onset of AR among children between urban, agricultural and pastoral areas.