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Czech EJ, Overholser A, Schultz P. Allergic Rhinitis. Med Clin North Am 2024; 108:609-628. [PMID: 38816106 DOI: 10.1016/j.mcna.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Allergic rhinitis is a common ailment in primary and acute care settings. Diagnosis is clinical, by means of history and physical examination. Referral to an allergist is considered when symptoms are difficult to manage and/or confirmation by means of further testing is desired. Management of allergic rhinitis should not be considered trivial, as multiple secondary effects can present as the course progresses. Several treatment modalities exist but should begin with glucocorticoid nasal sprays and systemic second- or third-generation antihistamines.
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Affiliation(s)
- Eric J Czech
- Division of Physician Assistant Studies, Department of Family Medicine, The University of Toledo College of Medicine and Life Sciences, 3333 Glendale Avenue, Toledo, OH 43614, USA; Department of Family Medicine, The University of Toledo College of Medicine and Life Sciences, 3333 Glendale Avenue, Toledo, OH 43614, USA.
| | - Andrew Overholser
- Division of Physician Assistant Studies, Department of Family Medicine, The University of Toledo College of Medicine and Life Sciences, 3333 Glendale Avenue, Toledo, OH 43614, USA; Department of Family Medicine, The University of Toledo College of Medicine and Life Sciences, 3333 Glendale Avenue, Toledo, OH 43614, USA
| | - Paul Schultz
- Department of Family Medicine, The University of Toledo College of Medicine and Life Sciences, 3333 Glendale Avenue, Toledo, OH 43614, USA
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Wang K, Zhang Y, Wan L, Li J, Wang C, Zhang L. Comparison of clinical traits for seasonal and perennial allergic rhinitis during allergen exposure. Allergy Asthma Proc 2024; 45:173-179. [PMID: 38755782 DOI: 10.2500/aap.2024.45.240009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background: Allergic rhinitis (AR) is traditionally subdivided into seasonal AR (SAR) and perennial AR (PAR) according to the type of allergen and the occurrence of symptoms during the year. There are currently no reports on the comparison of trait profiles for SAR and PAR during the allergen exposure. Purpose: The purpose of this study was to analyze the clinical characteristics of SAR and PAR during respective allergen exposure periods to provide valuable information for the development of treatment strategies. Methods: This study was performed between August 1, 2021, and January 31, 2022, in the Department of Allergy, Beijing Tongren Hospital. We continuously included diagnosed SAR and PAR outpatients who volunteered to participate in the survey. A questionnaire with regard to medical history, severity of symptoms, and diagnosis and treatment status was collected. Results: A total of 296 patients with SAR and 448 with PAR were finally recruited. Patients with SAR had more severe rhinorrhea compared with patients with PAR (p < 0.001), whereas there was no statistically significant difference in the severity of itching, sneezing, and congestion between the two entities (p ≥ 0.05). Both the gritty and watery eyes of patients with SAR were noticeably more severe than those of patients with PAR (PTotal Ocular Symptom Score [PTOSS] < 0.001). AR symptom severity is mainly associated with the comorbid allergic conjunctivitis (odds ratio 1.94 [95% confidence interval, 1.21-3.09]). SAR patients and PAR patients show no statistically significant differences in terms of their frequency of visits, annual expenditure, and choice of medication treatment for AR (p > 0.05). The overall control under standard medication of both patients with PAR and those with SAR is not ideal, especially in SAR. Conclusion: The current cross-sectional study demonstrated that the patients with SAR exhibited more severe overall clinical symptoms than those with PAR, especially nasal rhinorrhea and gritty and watery eyes. Both of the two disease entities have poor control under standardized medication treatment, especially in SAR. Further multicenter longitudinal studies that involve larger and more diverse populations should be conducted to provide a more accurate and comprehensive understanding of the condition.
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Affiliation(s)
- Kunpeng Wang
- From the Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- From the Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lianqi Wan
- From the Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingyun Li
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China, and
| | - Chengshuo Wang
- From the Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- From the Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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3
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Ebrahimi P, Taheri H, Mousavinejad SA, Nazari P. Hypokalemic paralysis following intramuscular betamethasone injection: A case report and review of literature. Clin Case Rep 2024; 12:e8923. [PMID: 38770411 PMCID: PMC11103555 DOI: 10.1002/ccr3.8923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/02/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
Acute neuromuscular paralysis is a relatively common condition in emergency rooms (ERs). They can be caused by several reasons, including adverse drug reactions. Betamethasone is a glucocorticoid commonly used for various conditions, such as allergic conditions. One of the rare but known side effects of glucocorticoids is hypokalemia. Rare cases of hypokalemia following high- and low-dose glucocorticoid injections have been reported. This study presents the history of a young, healthy male without significant past medical history who presented with an inability to stand and walk due to four-limb paralysis (more prominent in the lower limbs) following an intramuscular injection of a 4 mg betamethasone, which was prescribed for the treatment of allergic rhinitis. The patient was stabilized with an intravascular injection of potassium chloride diluted in 1000 mL of normal saline and monitored for 24 h, ruling out any other endocrine condition. Hypokalemia and its severe form are defined as the serum level of lower than 3.5 and 2.5 mEq/Lit, respectively. One of the etiologies of drug-induced hypokalemic paralysis is systemic glucocorticoid administration. In severe cases, it can cause quadriplegia and other neuromuscular, respiratory, and cardiac complications. Therefore, it is an urgent condition that should be managed carefully. Pregnant women who are receiving these medications are a specific group at risk of hypokalemic paralysis. There are several safer treatments for seasonal allergic rhinitis compared to systemic glucocorticoids, which should be considered by physicians. Moreover, paralysis in patients receiving these medications should be approached attentively since it might be caused by hypokalemia, which can be life threatening if not treated. It is advisable that the blood level of electrolytes, especially potassium, be checked for patients who present with paralysis or weakness after glucocorticoid injections.
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Affiliation(s)
- Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Homa Taheri
- Cedars‐Sinai Cardiology DepartmentLos AngelesCaliforniaUSA
| | | | - Pedram Nazari
- Cancer Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
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Gurgel RK, Baroody FM, Damask CC, Mims JW, Ishman SL, Baker DP, Contrera KJ, Farid FS, Fornadley JA, Gardner DD, Henry LR, Kim J, Levy JM, Reger CM, Ritz HJ, Stachler RJ, Valdez TA, Reyes J, Dhepyasuwan N. Clinical Practice Guideline: Immunotherapy for Inhalant Allergy. Otolaryngol Head Neck Surg 2024; 170 Suppl 1:S1-S42. [PMID: 38408152 DOI: 10.1002/ohn.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care. PURPOSE The purpose of this clinical practice guideline (CPG) is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce the risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The GDG made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitizations, (2) reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre- and co-seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions (LRs) to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The GDG offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta-blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.
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Affiliation(s)
| | - Fuad M Baroody
- The University of Chicago Medicine, Chicago, Illinois, USA
| | | | - James Whit Mims
- Wake Forest Baptist Health, Winston Salem, North Carolina, USA
| | | | - Dole P Baker
- Anderson ENT & Facial Plastics, Anderson, South Carolina, USA
| | | | | | - John A Fornadley
- Associated Otolaryngologists of PA, Inc, Hershey, Pennsylvania, USA
| | | | | | - Jean Kim
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua M Levy
- National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland, USA
| | - Christine M Reger
- Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Gurgel RK, Baroody FM, Damask CC, Mims JW, Gardner DD, Reger CM, Reyes J, Dhepyasuwan N. Plain Language Summary: Immunotherapy for Inhalant Allergy. Otolaryngol Head Neck Surg 2024; 170:668-674. [PMID: 38408155 DOI: 10.1002/ohn.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
The plain language summary explains allergen immunotherapy to patients, families, and caregivers. The summary is for patients aged 5 years and older who are experiencing symptoms from inhalant allergies and are considering immunotherapy as a treatment option. It is based on the 2024 "Clinical Practice Guideline: Immunotherapy for Inhalant Allergy." This plain language summary is a companion publication to the full guideline, which provides greater detail for health care providers. Guidelines and their recommendations may not apply to every patient, but they can be used to find best practices and quality improvement opportunities.
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Affiliation(s)
| | - Fuad M Baroody
- The University of Chicago Medicine, Chicago, Illinois, USA
| | | | - James Whit Mims
- Wake Forest Baptist Health, Winston Salem, North Carolina, USA
| | | | - Christine M Reger
- University of Pennsylvania, Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Joe Reyes
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Starchenka S, Oluwayi K, Heath M, Armfield O, Shamji M, Layhadi J, Lis K, Cadavez L, Rusyn O, Skinner M, De Kam PJ. Peripheral blood mononuclear cell transcriptome profile in a clinical trial with subcutaneous, grass pollen allergoid immunotherapy. Clin Exp Allergy 2024; 54:130-142. [PMID: 38169056 DOI: 10.1111/cea.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Allergen-specific immunotherapy (AIT) is the only disease-modifying treatment in allergic airway diseases. Underlying immunological mechanisms and candidate biomarkers, which may be translated into predictive/surrogate measures of clinical efficacy, remain an active area of research. The aim of this study was to evaluate Pollinex Quattro (PQ) Grass AIT induced immunomodulatory mechanisms, based on transcriptome profiling of peripheral blood mononuclear cells. METHODS 119 subjects with grass pollen induced seasonal allergic rhinitis (SAR) were randomized in a 2:2:1:1 ratio to receive a cumulative dose of PQ Grass as a conventional or extended pre-seasonal regimen, placebo, or placebo with MicroCrystalline Tyrosine. Gene expression analysis was an exploratory endpoint evaluated in a subgroup of 30 subjects randomly selected from the four treatment arms. Samples were collected at three time points: screening (baseline), before the start of the grass pollen season and at the end of the season. This study was funded by the manufacturer of PQ. RESULTS Transcriptome analysis demonstrated that the most significant changes in gene expression, for both treatment regimens, were at the end of the grass pollen season, with the main Th1 candidate molecules (IL-12A, IFNγ) upregulated and Th2 signature cytokines downregulated (IL-4, IL-13, IL-9) (p < .05). Canonical pathways analysis demonstrated Th1, Th2, Th17 and IL-17 as the most significantly enriched pathways based on absolute value of activation z-score (IzI score ≥ 2, p < .05). Upstream regulator analysis showed pronounced inhibition of pro-inflammatory allergic molecules IgE, IL-17A, IL-17F, IL-25 (IL-17E) (IzI score ≥ 2, FDR < 0.05) and activation of pro-tolerogenic molecules IL-12A, IL-27, IL-35 (EBI3) at the end of the grass pollen season. CONCLUSION Peripheral blood mononuclear cells transcriptome profile showed an inhibition of Th2, Th17 pro-inflammatory allergic responses and immune deviation towards Th1 responses. PQ Grass extended regimen exhibited a superior mechanistic efficacy profile in comparison with PQ conventional regimen.
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Affiliation(s)
| | | | | | | | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - Janice Layhadi
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
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Guo BC, Wu KH, Chen CY, Lin WY, Chang YJ, Lin MJ, Wu HP. Advancements in Allergen Immunotherapy for the Treatment of Atopic Dermatitis. Int J Mol Sci 2024; 25:1316. [PMID: 38279315 PMCID: PMC10816003 DOI: 10.3390/ijms25021316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects individuals of all age groups, manifesting as a spectrum of symptoms varying from mild to severe. Allergen immunotherapy (AIT) involves the administration of allergen extracts and has emerged as a potential treatment strategy for modifying immune responses. Its pathogenesis involves epidermal barrier dysfunction, microbiome imbalance, immune dysregulation, and environmental factors. Existing treatment strategies encompass topical steroids to systemic agents, while AIT is under investigation as a potential immune-modifying alternative. Several studies have shown reductions in the severity scoring of atopic dermatitis (SCORAD) scores, daily rescue medication use, and visual analog scale (VAS) scores following AIT. Biomarker changes include increased IgG4 levels and decreased eosinophil counts. This review provides valuable insights for future research and clinical practice, exploring AIT as a viable option for the management of AD.
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Affiliation(s)
- Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs’ Taichung Metro Harbor Hospital, Taichung 43503, Taiwan;
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Wen-Ya Lin
- Department of Pediatrics, Taichung Veteran General Hospital, Taichung 43503, Taiwan;
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Shen Z, Zhang P, Kang W, Chen X, Li H, Shao Y, Liu L, Quan F. Clinical efficacy in one-year treatment with Artemisia annua-SLIT drops in monosensitized and polysensitized individuals. Am J Otolaryngol 2023; 44:104002. [PMID: 37478537 DOI: 10.1016/j.amjoto.2023.104002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Seasonal allergic rhinoconjunctivitis (SARC) caused by Artemisia seriously affects patients' quality of life in northern China. This study aimed to estimate further the efficacy and safety of a one-year course of Artemisia annua-sublingual immunotherapy (SLIT) on SARC patients. MATERIALS AND METHODS This was an open-label, randomized, controlled, single-centre study involving 150 SARC patients induced by Artemisia, randomized to SLIT group (n = 75, SLIT along with pharmacotherapy) or control group (n = 75, pharmacotherapy only). According to the skin prick test (SPT) results, the SLIT group was divided into monosensitized and polysensitized groups to analyze the influence of sensitization status on the efficacy of Artemisia annua-SLIT. The clinical indicators of this study were total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), combined scores of medication and rhinoconjunctivitis symptom (CSMRS), and score of visual analog scale (VAS). Safety was evaluated by the occurrence of adverse events (AEs). Daily administration of the drops was recorded in diaries by the patients. RESULTS After nearly one year of treatment and follow-ups, there was a significant decline in TRSS, TMS, CSMRS, and VAS from the baseline scores in the SLIT group (p < 0.001). However, as pollen counts increased in 2022, indicators above in the control group increased significantly during the peak pollen phase (PPP) in 2022 grass pollen season (GPS) compared to the baseline. Meanwhile, we found no significant difference in TRSS, TMS, CSMRS, and VAS between the monosensitized and polysensitized groups (p > 0.05). Moreover, the result indicated that the clinical improvement in TRSS, TMS, CSMRS, and VAS was still observed in polysensitized patients who were allergic to Artemisia pollen and sensitized to house dust mite (HDM) (n = 15) in PPP of 2022, compared to the baseline value (p < 0.001). CONCLUSION Artemisia annua-SLIT was proven effective, tolerable and safe in patients with SARC after nearly one year of treatment, whether monosensitization or polysensitization.
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Affiliation(s)
- Zhen Shen
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Pengfei Zhang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wei Kang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xin Chen
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huajing Li
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuan Shao
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lifeng Liu
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fang Quan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Masuda S, Deguchi S, Ogata F, Yoshitomi J, Otake H, Kanai K, Kawasaki N, Nagai N. Nasal Absorption Enhancement of Mometasone Furoate Nanocrystal Dispersions. Int J Nanomedicine 2023; 18:5685-5699. [PMID: 37841023 PMCID: PMC10573391 DOI: 10.2147/ijn.s430952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose We designed a 0.05% mometasone furoate (MF) nanocrystal dispersion and investigated whether the application of MF nanocrystals in nasal formulations enhanced local absorption compared to traditional nasal MF formulations (CA-MF). Methods MF nanocrystal dispersions (MF-NPs) were prepared by bead milling MF microcrystal dispersions (MF-MPs) consisting of MF, 2-hydroxypropyl-β-cyclodextrin, methylcellulose, and purified water. Pluronic F-127 combined with methylcellulose, Pluronic F-68, or carbopol was used as a base for in situ gelation (thickener). MF concentrations were measured using high-performance liquid chromatography, and nasal absorption of MF was evaluated in 6 week-old male Institute of Cancer Research (ICR) mice. Results The particle size range of MF prepared with the bead mill treatment was 80-200 nm, and the nanoparticles increased the local absorption of MF, which was higher than that of CA-MF and MF-MPs. In addition, unlike the results obtained in the small intestine and corneal tissue, the high absorption of nanocrystalline MF in the nasal mucosa was related to a pathway that was not derived from energy-dependent endocytosis. Moreover, the application of the in situ gelling system attenuated the local absorption of MF-NPs, owing to a decrease in drug diffusion in the dispersions. Conclusion We found that nanoparticulation of MF enhances local intranasal absorption, and nasal bioavailability is higher than that of CA-MF. In addition, we demonstrate that viscosity regulation is an important factor in the design of nasal formulations based on MF nanocrystals. These findings provide insights for the design of novel nanomedicines with enhanced nasal bioavailability.
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Affiliation(s)
- Shuya Masuda
- Faculty of Pharmacy, Kindai University, Osaka, Japan
| | - Saori Deguchi
- Faculty of Pharmacy, Kindai University, Osaka, Japan
| | | | | | - Hiroko Otake
- Faculty of Pharmacy, Kindai University, Osaka, Japan
| | - Kazutaka Kanai
- Department of Small Animal Internal Medicine, School of Veterinary Medicine, University of Kitasato, Aomori, Japan
| | | | - Noriaki Nagai
- Faculty of Pharmacy, Kindai University, Osaka, Japan
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10
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de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy. Allergy 2023; 78:2756-2766. [PMID: 37366581 DOI: 10.1111/all.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial. METHODS In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response. RESULTS The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated. CONCLUSIONS This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.
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Affiliation(s)
| | - S Zielen
- Children and Adolescents Department, Allergology, Pulmonology & Cystic Fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center, LLC, Cincinnati, Ohio, USA
| | - U Berger
- Aerobiology and Pollen Research Unit, Department of Oto-Rhino-Laryngology, Medical University Vienna, Vienna, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research- Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc, White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean Township, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center, S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, DC, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
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11
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Thangaraj P, Varadharajan R. Assessment of Olfactory Dysfunction Using ODOFIN Sniffin' Sticks: A Prospective Comparative Study. Indian J Otolaryngol Head Neck Surg 2023; 75:1078-1083. [PMID: 37206763 PMCID: PMC10188811 DOI: 10.1007/s12070-023-03622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023] Open
Abstract
Olfactory loss can impair the ability to detect harmful warning smells like smoke or gas leaks, significantly affect the quality of life and increase the morbidity. This study was done using Sniffin stick test kit with an objective to compare the effect of Steroid Nasal Spray with Normal Saline Nasal Spray in improving the olfactory dysfunction seen in cases of chronic nasal obstruction. This Prospective comparative study was conducted on patients presenting to the ENT OPD with olfactory dysfunction due to various nasal pathologies. The olfaction was assessed qualitatively using ODOFIN Sniffin' sticks before and 2 weeks after the use of either a steroid [Group A] or Saline Nasal Spray [Group B] and the results documented and analysed. Total 162 eligible patients were selected. Majority of the study participants were males and the major symptom was Hyposmia. In group A, the initial Sniffin stick test showed Anosmia in 26 and Hyposmia in 55 patients and after 2 weeks, only 2 and 26 patients had Anosmia and Hyposmia respectively. Wherein group B, there was no significant improvement in the olfaction even after 2 weeks of treatment. The improvement in the olfaction was significant between the groups. (p = < 0.001). Our study using ODOFIN Sniffin' sticks for assessing olfactory dysfunction in various nasal pathologies showed that Steroid Nasal Spray is an effective and safe treatment option in managing olfactory dysfunction.
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Affiliation(s)
- Priyanka Thangaraj
- Department of Otorhinolaryngology, Aarupadai Veedu Medical College, Vinayaka Missions Research Foundation, Puducherry, India
| | - Ramesh Varadharajan
- Department of Otorhinolaryngology, Aarupadai Veedu Medical College, Vinayaka Missions Research Foundation, Puducherry, India
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12
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Allergic Rhinitis. Prim Care 2023; 50:159-178. [PMID: 37105599 DOI: 10.1016/j.pop.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Allergic rhinitis is a common ailment in primary and acute care settings. Diagnosis is clinical, by means of history and physical examination. Referral to an allergist is considered when symptoms are difficult to manage and/or confirmation by means of further testing is desired. Management of allergic rhinitis should not be considered trivial, as multiple secondary effects can present as the course progresses. Several treatment modalities exist but should begin with glucocorticoid nasal sprays and systemic second- or third-generation antihistamines.
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13
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Siewert J, Teut M, Gaertner K, Binting S, Eberhardt C, Ortiz M, Grabowska W, Reinhold T, Roll S, Stoeckigt B, Willich SN, Cramer H, Brinkhaus B. Homeopathy for seasonal allergic rhinitis: rationale, design and methods of the three-armed randomized controlled HOMEOSAR trial. BMC Complement Med Ther 2022; 22:338. [PMID: 36550537 PMCID: PMC9773622 DOI: 10.1186/s12906-022-03820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with seasonal allergic rhinitis (SAR) frequently use homeopathic therapy. Although there is some evidence that homeopathy may be effective in treating symptoms of SAR, there is a lack of high-quality clinical trials. Therefore, the aim of the homeopathy for SAR (HOMEOSAR) trial is to determine the efficacy of individualized or standardized homeopathic drug treatment compared to placebo regarding rhinitis-related quality of life in patients with SAR. METHODS This randomized, placebo-controlled, double-blind, three-armed intervention study will be conducted at two university hospital outpatient clinics for complementary and integrative medicine in Berlin and in 12 office-based practices specializing in homeopathic treatment in Germany. A total of 270 patients with clinical symptoms of SAR and positive allergy test to birch and grass pollen will receive homeopathic anamnesis and subsequently be randomized into (a) standardized homeopathic drug treatment with Galphimia Glauca (potency D6), (b) individualized homeopathic drug treatment (D6), or (c) placebo. All three groups can receive on-demand rescue medication as needed. Treatment will consist of two consultations and daily intake of the study medication for 4 weeks during the pollen season. The primary outcome is the mean overall score of the Rhinitis Quality of Life Questionnaire (RQLQ) in weeks 3 and 4, analyzed using analysis of covariance (adjusted for baseline RQLQ overall score and study center). A closed testing procedure will be used to control the overall type I error comparing the 3 treatment groups. Secondary outcomes include the overall RQLQ and its seven domain scores, responder status (decrease in RQLQ overall score of at least 0.5 points compared to the baseline value), use of rescue medication, intensity of total and individual SAR symptoms based on visual analog scale, generic health-related quality of life, safety, utilization of health care resources and associated costs. In addition, a qualitative data analysis is planned. CONCLUSION The results of our study will contribute to clarifying the possible therapeutic effects of homeopathic drug treatment for patients with SAR. TRIAL REGISTRATION This study has been registered in the German Clinical Trial Registry with trial ID DRKS00018081 on June 09, 2020.
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Affiliation(s)
- J. Siewert
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - M. Teut
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - K. Gaertner
- grid.412581.b0000 0000 9024 6397Institute for Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany
| | - S. Binting
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - C. Eberhardt
- grid.7468.d0000 0001 2248 7639Pharmacy Department, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - M. Ortiz
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - W. Grabowska
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - T. Reinhold
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. Roll
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B. Stoeckigt
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. N. Willich
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - H. Cramer
- grid.5718.b0000 0001 2187 5445Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - B. Brinkhaus
- grid.6363.00000 0001 2218 4662Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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14
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Elgormus Y. Biomarkers and their Clinical Applications in Pediatrics. Biomark Med 2022. [DOI: 10.2174/9789815040463122010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Biomarker studies are becoming increasingly interesting for many fields of
medicine. The use of biomarkers in medicine is involved in detecting diseases and
supporting diagnosis and treatment decisions. New research and new discoveries on the
molecular basis of the disease show that there may be a number of promising new
biomarkers for use in daily clinical practice. Clinical trials in children lag behind adult
research both in quality and quantity. The number of biomarkers validated to optimize
pediatric patient management is limited. In the pathogenesis of many diseases, it should
not be extrapolated to the pediatric clinical setting, taking into account that biomarkers
that are effective in adults are clearly different in children and that ontogeny directly
affects disease development and therapeutic response in children. The search for ideal
biomarkers or markers that can make an early and definitive diagnosis in neonatal
sepsis is still ongoing. The ideal biomarker for pediatric diseases should be costeffective,
noninvasive, applicable to pediatric specific diseases, and its results should
correspond to age-related physiological changes. Lactate, troponin and B-type
natriuretic peptide are valuable biomarkers in the evaluation and management of
critically ill children with cardiac disease. Tumor markers in children are biochemical
substances used in the clinical treatment of pediatric tumors and to detect the presence
of cancer (regression or progression). In this chapter, current and brief information
about biomarkers and their clinical applications used in the diagnosis and monitoring of
pediatric diseases is presented.;
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Affiliation(s)
- Yusuf Elgormus
- Medicine Hospital,Department of Pediatric Health and Diseases,Department of Pediatric Health and Diseases, Medicine Hospital, Istanbul, Turkey,Istanbul,Turkey
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15
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Wang X, Liu LJ, Li LF, Shi XD, Shen YW. Clinical Features of Urticaria: Results From a Hospital-Based Multicenter Study in China. Front Med (Lausanne) 2022; 9:899857. [PMID: 35755046 PMCID: PMC9220089 DOI: 10.3389/fmed.2022.899857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background The clinical features of urticaria have not been fully illustrated. Objectives To demonstrate clinical features of urticaria in different areas of southern and northern China. Methods In this hospital-based multicenter study, outpatients with urticaria filled in a questionnaire during the initial visit and follow-up (once per week, lasting for a month). Results Overall, 1,715 outpatients with urticaria with a mean age of 37.86 ± 16.08 years (range = 0.5–87 years) were recruited. The median disease duration was 1.94 ± 4.31 years (range = 0–58 years). More itching was observed in the northern areas higher than that in the southern areas (99.5 vs 94.1%, P < 0.001). The incidence of pain, arthralgia, and family history in southern areas was higher than that in northern areas (5.1 vs 1.1%, 9.6 vs 0, 10.6% vs 3.2%, P < 0.001). The leading subtypes of specified urticaria were chronic spontaneous urticaria (81.4%) and symptomatic dermographism (35.9%). The incidence of symptomatic dermographism and cold urticaria in the southern areas was lower than that in the northern areas (31.8 vs. 50.3%, 4 vs. 8.5%, P < 0.001). Allergic diseases were the most common concomitant disorders of urticaria. More than half of the patients had to avoid certain food, such as fish-prawn-crab (30.7%) and alcohol (20%). Ebastine (41.1%) was the most commonly prescribed drug. The disease duration negatively correlated with the severity of itching and number of wheals (>50/24H) (Spearman’s rank correlation test, p < 0.001). Conclusion This study provides a profile of clinical characteristics of urticaria in China and filled the gap in the field of regional comparative studies on urticaria.
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Affiliation(s)
- Xin Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li-Juan Liu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin-Feng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dong Shi
- AI Research and Development Center, China Telecom Research Institute, Beijing, China
| | - Yi-Wei Shen
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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16
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Zhang Y, Shan C, Liu W, Han Y, Shi G, Ma Y, Wagner K, Tian X, Zhang L, Larona AJ, Sacavage S, Franklin K, Wang C, Zhang L. Intranasal budesonide for rhinitis during a high airborne pollution period: a randomized controlled trial. Allergy Asthma Clin Immunol 2022; 18:56. [PMID: 35725523 PMCID: PMC9207822 DOI: 10.1186/s13223-022-00686-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Air pollution may induce or reinforce nasal inflammation regardless of allergy status. There is limited direct clinical evidence informing the treatment of airborne pollution-related rhinitis. Objective To assess the effectiveness of intranasal budesonide in adults with self-reported rhinitis symptoms triggered/worsened by airborne pollution. Methods Adults in northern China with self-reported rhinitis symptoms triggered or worsened by airborne pollution were randomized to budesonide 256 µg/day or placebo for 10 days in pollution season (October 2019 to February 2020). The primary endpoint was the mean change from baseline in 24-h reflective total nasal symptom score (rTNSS) averaged over 10 days. The secondary endpoints were subject-assessed Global Impression of Change (SGIC), mean change from baseline in individual nasal symptom severity, and mean change from baseline in individual non-nasal symptoms of cough and postnasal drip severity. One-sided P < 0.0125 was considered statistically significant. Results After an interruption by COVID-19, an interim analysis showed that the study could be ended for efficacy with n = 206 participants (103/group) since the primary efficacy endpoint demonstrated significant results. The final efficacy results showed that the 10-day-averaged rTNSS change in the budesonide group was greater than with placebo (− 2.20 vs − 1.72, P = 0.0107). Budesonide also significantly improved 10-day-averaged itching/sneezing change (− 0.75 vs − 0.51, P = 0.0009). Results for SGIC and all other individual symptoms did not show significant differences between the two groups. Conclusions Intranasal budesonide 256 µg once daily improved the total nasal symptoms and itching/sneezing over 10 days in adults with rhinitis triggered/worsened by airborne pollution. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00686-y.
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Affiliation(s)
- Yuan Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China.,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chunguang Shan
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital to Hebei Medical University, Shijiazhuang, Hebei, China
| | - Weiwei Liu
- Department of Otolaryngology Head and Neck Surgery, Cangzhou Center Hospital, Cangzhou, Hebei, China
| | - Yaozhong Han
- Department of Otolaryngology Head and Neck Surgery, The No.2 Hospital of Baoding, Baoding, Hebei, China
| | - Guanggang Shi
- Department of Otolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Yongjian Ma
- Department of Otolaryngology Head and Neck Surgery, The No.2 People's Hospital of Weifang, Weifang, Shandong, China
| | - Kerstin Wagner
- Johnson & Johnson Consumer Inc, Fort Washington, PA, USA
| | - Xiaoyan Tian
- Johnson & Johnson Consumer China Ltd, Shanghai, China
| | - Lili Zhang
- Johnson & Johnson Consumer China Ltd, Shanghai, China
| | - Allan Joseph Larona
- Johnson & Johnson Consumer Regional Office Asia Pacific, Singapore, Singapore
| | | | | | - Chengshuo Wang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China. .,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China. .,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
| | - Luo Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China. .,Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China. .,Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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17
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Allergic rhinitis, allergic contact dermatitis and disease comorbidity belong to separate entities with distinct composition of T-cell subsets, cytokines, immunoglobulins and autoantibodies. Allergy Asthma Clin Immunol 2022; 18:10. [PMID: 35148790 PMCID: PMC8840545 DOI: 10.1186/s13223-022-00646-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Allergic rhinitis (AR) and allergic contact dermatitis (ACD) are prevalent allergic diseases and have significant impacts on patients’ daily life. Despite many studies on AR or ACD have been conducted separately, little is known about the immune responses in patients of AR combined with ACD and the interplay between AR and ACD. Our study compared various aspects of immune elements in patients with AR or/and ACD, aiming to characterize the immune responses in AR, ACD, and AR combined with ACD. Methods A total of 57 patients diagnosed with AR or/and ACD and 28 healthy volunteers were included. AR patients were further divided into seasonal AR (SAR) and perennial AR (PAR). All subjects’ blood samples were taken to assess the concentration of immunoglobulins, complement C3, C4, autoantibodies and cytokines in serum by immunoturbidimetry, ELISA or Luminex200 platform. Peripheral blood mononuclear cells (PBMCs) were subjected to the analysis of lymphocyte subpopulations by flow cytometry. Results It indicated that AR disease caused elevated levels of IgE, IgA, IgG, IgG4, as well as IL-4, IL-15, IL-8 and IL-6 in serum. AR patients possessed a decreased CD4/CD8 ratio and an increased proportion of memory CD4 + T-cell subset, with a skewed Th2 response and an enhanced CD8 + T-cell activation. Compared with patients with sole AR or ACD condition, AR + ACD patients presented with a significantly increased proportion of memory CD8 + T-cell subset and were prone to autoimmune disorders as indicated by the increased autoantibodies. The immune elements in patients with ACD only were least affected compared with those in other conditions. Additionally, seasonal or perennial AR patients exhibited different cytokine profiles and proportions of memory T-cell subsets. Conclusions In this study, we illuminated the respective characteristics of immune responses in AR, ACD, and AR combined with ACD. Meanwhile, we discovered that the PAR and SAR patients possessed different cytokine profiles and T-cell compartments. It suggested that these allergic conditions belong to different disease entities. Characterizing the detailed immune changes in these allergic diseases would help to develop proper treatments targeting particular immune elements in different allergic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00646-6.
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18
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Intranasal low-level laser therapy versus acupuncture treatment for allergic rhinitis: A randomized, noninferiority trial. Explore (NY) 2022; 18:676-682. [DOI: 10.1016/j.explore.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022]
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19
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Zhang K, Li AR, Miglani A, Nguyen SA, Schlosser RJ. Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2021; 36:269-280. [PMID: 34546814 DOI: 10.1177/19458924211041438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow. OBJECTIVE To provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow. METHODS A systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis. RESULTS Twenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [P = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36; P < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65; P < .001], with a trend toward improvement in TNSS. CONCLUSION Overall, INCS resulted in a clinically and statistically meaningful improvement in symptom scores and physiologic measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their impacts upon nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly for mild AR. Future studies should assess the effect of treatment for each of these patient-reported measures.
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Affiliation(s)
- Kathy Zhang
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Andraia R Li
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Amar Miglani
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- 2345Medical University of South Carolina, Charleston, SC, USA
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Solarz K, Obuchowicz A, Asman M, Nowak W, Witecka J, Pietrzak J, Marek M, Łonak A, Stadnicka I, Hajduga-Staśko B. Abundance of domestic mites in dwellings of children and adolescents with asthma in relation to environmental factors and allergy symptoms. Sci Rep 2021; 11:18453. [PMID: 34531458 PMCID: PMC8446054 DOI: 10.1038/s41598-021-97936-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
Exposure to house dust allergens, mainly from domestic mites, is an important cause of allergic reactions in sensitized asthmatic patients. A total of 63 dust samples were collected from 16 flats in Bytom (south Poland); in each flat a person (age 4-17 years) suffering from bronchial asthma lived with his/her family. Mite density was calculated as the number of specimens per g of dust. The results were compared with household features and the data were statistically analyzed. In total 566 mite specimens were isolated, including 526 members of the family Pyroglyphidae (93%). The dominant species were Dermatophagoides pteronyssinus (60% of the total count) and Dermatophagoides farinae (32%). Pyroglyphids were found in all mite positive samples (68%) of which 35% also contained non-pyroglyphids, including glycyphagids, cheyletids and gamasids. The results suggest associations between the density of some mite taxa (per g of dust) and the following indoor environmental factors: presence of pets, number of inhabitants, coal-stoves as a type of heating, cleaning frequency, higher relative humidity, presence of flowers and PVC windows. The severity of asthma seems to be associated with the numbers of D. farinae, total domestic mites and live mites per g of dust.
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Affiliation(s)
- Krzysztof Solarz
- Department of Parasitology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
| | - Anna Obuchowicz
- Department of Pediatrics in Bytom, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marek Asman
- Department of Parasitology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland.
| | - Wacław Nowak
- Department of Pediatrics in Bytom, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Joanna Witecka
- Department of Parasitology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
| | - Jolanta Pietrzak
- Department of Pediatrics in Bytom, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marta Marek
- Department of Pediatrics in Bytom, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Aldona Łonak
- Department of Parasitology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
| | - Izabela Stadnicka
- Department of Molecular Biology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
| | - Bernadeta Hajduga-Staśko
- Department of Parasitology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Katowice, Poland
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Tang H, Han X, Li T, Feng Y, Sun J. Protective effect of miR-138-5p inhibition modified human mesenchymal stem cell on ovalbumin-induced allergic rhinitis and asthma syndrome. J Cell Mol Med 2021; 25:5038-5049. [PMID: 33973707 PMCID: PMC8178307 DOI: 10.1111/jcmm.16473] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/09/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
The objective of the study is to evaluate the protective effects of human mesenchymal stem cells (hMSCs) modified with miR‐138‐5p inhibitor against the allergic rhinitis and asthma syndrome (ARAS). MiR‐138‐5p or negative control was transfected into hMSCs, and fluorescence‐activated cell sorting was used to evaluate hMSC surface markers. Quantitative real‐time PCR (qRT‐PCR) was used to evaluate miR‐138‐5p, SIRT1, caspase‐3, IL‐6, IL‐1β and TNF‐α levels after TNF‐α and IL‐6 stimulations. hMSCs with or without miR‐138‐5p inhibition was intranasally administered into ARAS mice (n = 10 each group), followed by monitoring sneezing and nasal rubbing events to evaluate the allergic symptoms. Histamine, ovalbumin‐specific IgE, IgG2a, IgG1 and LTC4 release were monitored in the serum and nasal lavage fluid using enzyme‐linked immunosorbent assay. Expression of SIRT1 and HMGB1/TLR4 pathway in nasal mucosa was assessed. After miR‐138‐5p inhibitor transfection, the hMSC lineage was preserved. Binding between SIRT1 and miR‐138‐4p was observed, and miR‐138‐5p inhibition led to upregulation of SIRT1. Inhibition of miR‐138‐5p led to attenuated inflammatory responses of hMSCs upon TNF‐α and IL‐6 stimulation, and allergic symptoms in mice, as well as histamine and ovalbumin‐specific IgG release. hMSCs with miR‐138‐5p inhibition showed characteristics of activated SIRT1 and inhibited HMGB1/TLR4 pathway. Inhibition of miR‐138‐5p in hMSCs enhanced its effects in attenuating inflammatory responses and allergic reaction in the ARAS model, which is presumably regulated by SIRT1 and the HMGB1/TLR4 pathway.
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Affiliation(s)
- Huaping Tang
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xiaolei Han
- Health Office, Qingdao Municipal Hospital, Qingdao, China
| | - Tingtian Li
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Yan Feng
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Jie Sun
- Department of International Clinic, Qingdao Municipal Hospital, Qingdao, China
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22
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Thongngarm T, Wongsa C, Phinyo P, Assanasen P, Tantilipikorn P, Sompornrattanaphan M. As-Needed Versus Regular Use of Fluticasone Furoate Nasal Spray in Patients with Moderate to Severe, Persistent, Perennial Allergic Rhinitis: A Randomized Controlled Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1365-1373.e6. [DOI: 10.1016/j.jaip.2020.09.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 01/20/2023]
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23
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Cingi C, Bayar Muluk N, Mitsias DI, Papadopoulos NG, Klimek L, Laulajainen-Hongisto A, Hytönen M, Toppila-Salmi SK, Scadding GK. The Nose as a Route for Therapy: Part 1. Pharmacotherapy. FRONTIERS IN ALLERGY 2021; 2:638136. [PMID: 35387039 PMCID: PMC8974766 DOI: 10.3389/falgy.2021.638136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/08/2021] [Indexed: 12/30/2022] Open
Abstract
This article reviews nasal structure and function in the light of intranasal pharmacotherapy. The nose provides an accessible, fast route for local treatment of nose and sinus diseases, with lower doses than are necessary systemically and few adverse effects. It can also be used for other medications as it has sufficient surface area protected from local damage by mucociliary clearance, absence of digestive enzymes, responsive blood flow, and provides a rapid route to the central nervous system.
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Affiliation(s)
- Cemal Cingi
- Department of Otolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Nuray Bayar Muluk
- Department of Otolaryngology, Kirikkale University, Kirikkale, Turkey
| | - Dimitrios I Mitsias
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Ludger Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Anu Laulajainen-Hongisto
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sanna Katriina Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.,Faculty of Medicine, The Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Glenis Kathleen Scadding
- University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Royal National Throat Nose and Ear Hospital, London, United Kingdom
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24
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Du K, Qing H, Zheng M, Wang X, Zhang L. Intranasal antihistamine is superior to oral H 1 antihistamine as an add-on therapy to intranasal corticosteroid for treating allergic rhinitis. Ann Allergy Asthma Immunol 2020; 125:589-596.e3. [PMID: 32650045 DOI: 10.1016/j.anai.2020.06.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Currently, a combination of intranasal corticosteroid (INCS) plus oral H1 antihistamine (OAH) or intranasal H1 antihistamine (INAH) therapy is frequently used in the treatment of allergic rhinitis (AR). The superiority of the 2 combined treatments needs to be further examined. OBJECTIVE To identify the better of the 2 therapeutic strategies for treating AR. METHODS A literature review was performed on MEDLINE, Cochrane Library, and EMBASE databases. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, meta-analyses of the total nasal symptom scores and individual nasal symptom scores were pooled based on studies that compared concomitant H1 antihistamines plus INCS with INCS alone in the treatment of AR. The pooled results were expressed as weighted mean differences between the treatments. For each selected study, we calculated the relative clinical impact based on the total nasal symptom scores as follows: 100 × (ScoreMonotherapy - ScoreCombined therapy) / ScoreMonotherapy. RESULTS A total of 13 publications met our selection criteria, with 5066 patients. The pooled results revealed no significant weighted mean difference on the total nasal symptom scores between concomitant OAH plus INCS and INCS alone. As for the individual symptoms, the most common symptom that revealed remission was rhinorrhea, which was after OAH in combination with INCS. The combination therapy of INAH and INCS was superior to INCS alone. In an indirect comparison, the weighted mean relative clinical impact of INAH plus INCS was significantly higher than that of OAH plus INCS. CONCLUSION Intranasal H1 antihistamines have an add-on effect on intranasal corticosteroids, and the combination of intranasal H1 antihistamines plus intranasal corticosteroid is superior to that of oral H1 antihistamines plus intranasal corticosteroid in improving nasal symptoms for patients with AR.
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Affiliation(s)
- Kun Du
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China
| | - Hui Qing
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China
| | - Xiangdong Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China.
| | - Luo Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, People's Republic of China; Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China.
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25
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Kim JY, Han YJ, Lee JS, Lee JH, Jo SH, Kim SH. Evaluation of a possible association between allergic rhinitis and depression, suicidal ideation, and suicide attempts among adolescents based on a nationwide cross-sectional study. Int J Pediatr Otorhinolaryngol 2020; 134:110070. [PMID: 32387708 DOI: 10.1016/j.ijporl.2020.110070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We assessed associated factors for depression and suicidality among adolescents with allergic rhinitis (AR) by analyzing data from annual Korea Youth Risk Behavior Web-based Surveys (KYRBSs) completed from 2007 to 2017. METHODS Data from the KYRBS were obtained from a stratified, multistage, clustered sample. Using self-reported questionnaires, students provided yes-or-no answers to questions addressing their doctor-diagnosed AR and self-experienced depression, suicidal ideation and suicide attempts. Associated factors for depression and suicidality were identified by logistic regression models after controlling for potential confounding factors. A total of 818,684 adolescents were targeted, and 788,411 adolescents completed the survey. RESULTS An AR diagnosis was reported in 30.8% of respondents. Among respondents with AR, 34.5%, 18.4%, and 4.2% reported depression, suicidal ideation, and suicide attempts, respectively. Adolescents with AR were significantly more likely to have negative mental health status, including suicidality than adolescents without AR. After multiple logistic regression analyses, perception of stress was most strongly associated with depression and suicidal ideation (adjusted odds ratio: 5.16 [95% confidence interval; 5.04-5.28], 4.81 [4.65-4.98], respectively). For suicide attempts, subjective unhappiness was most strongly associated (3.63 [3.47-3.79]) among adolescents with AR. Presence of AR itself was also associated with depression and suicidality (1.10 [1.08-1.11], 1.08 [1.06-1.10], 1.05 [1.01-1.08], respectively). CONCLUSION Adolescents with AR had significantly greater prevalence of depression and suicidality. Multidisciplinary team approaches, including psychological support, may be needed to prevent suicide among adolescents with AR, especially those with identifiable risk factors.
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Affiliation(s)
- Joo Young Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young Joo Han
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jun Hwa Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seon Hui Jo
- Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
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26
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Abstract
PURPOSE OF REVIEW The purpose of this review was to explore mechanisms, causes, and therapies of itchy conditions involving organs beyond the skin including the eyes, ears, nose, and genital region. RECENT FINDINGS Conditions which cause itch in these locations vary from skin diseases that extend to these areas (i.e., atopic dermatitis, seborrheic dermatitis, and psoriasis) to allergic conditions (i.e., allergic rhinitis and conjunctivitis) and to neuropathic conditions that relate to afferent nerve fiber damage (i.e., lumbosacral radiculopathies in genital disease) as well as some psychological components. Similar to the skin, itch in these locations involves a complex interaction between epithelial cells, unmyelinated C nerve fibers, and cytokines. There is also a significant component of neural sensitization phenomena. Mechanisms of itch beyond the skin are currently an understudied topic that affects millions of patients. Future research should be done in order to further understand the pathophysiology of itch in these body sites.
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Affiliation(s)
- Rachel Shireen Golpanian
- Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Peter Smith
- School of Medicine and Griffith Health Institute, Griffith Health, Griffith University, Gold Coast Campus, Southport, QLD, 4215, Australia
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA.
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27
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Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in Practice. PHARMACY 2020; 8:pharmacy8020085. [PMID: 32429362 PMCID: PMC7355936 DOI: 10.3390/pharmacy8020085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 01/30/2023] Open
Abstract
The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines.
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28
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Tani-Ishii N, Muromachi K, Mutoh N, Suzuki J, Shimojima K, Fujimaki R, Kezuka H, Koba T, Ta K. Effect of salivary secretion with mouthguard use on seasonal allergic rhinitis symptom improvement. J Oral Biosci 2020; 62:205-211. [PMID: 32407887 DOI: 10.1016/j.job.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES It was shown that mucosal immunity via salivary IgA may be related to the improvement of seasonal allergic rhinitis (SAR) symptoms, and improvement of SAR symptoms through saliva flow increase has been reported in patients using mouthguard (MG) in dental treatment. The purpose of this study was to analyze the effect of MG use on SAR symptom improvement and to clarify the role of saliva on SAR symptom development. METHODS We recruited patients from the Kanagawa Dental University Hospital including 38 and 8 patients with SAR and non-SAR symptoms during two seasons from March 2017 to April 2018. We analyzed the saliva flow rate pre- and post-MG use and measured the amount of IgA and IgG4 in the saliva. We assessed the correlation between SAR symptoms and MG use. SAR symptoms were examined according to a specific clinical score. RESULTS It was revealed that salivary IgA concentration was significantly lower in SAR patients than in controls. SAR symptoms significantly improved with MG use. The saliva flow rate and IgA levels significantly increased with MG use, although the IgG4 levels did not change. CONCLUSIONS MG use may be beneficial for improving the symptoms of SAR patients by increasing the IgA levels. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR: UMIN000026428) on 6thMarch 2017.
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Affiliation(s)
- Nobuyuki Tani-Ishii
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan.
| | - Koichiro Muromachi
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
| | - Noriko Mutoh
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
| | - Jiro Suzuki
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
| | - Kaori Shimojima
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
| | - Ryuji Fujimaki
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
| | - Hajime Kezuka
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
| | - Taiki Koba
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
| | - Kyo Ta
- Department of Pulp Biology and Endodontics, Graduate School of Kanagawa Dental University, 82 Inaoka, Yokosuka, 2388580, Japan
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29
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Di Fraia M, Tripodi S, Arasi S, Dramburg S, Castelli S, Villalta D, Buzzulini F, Sfika I, Villella V, Potapova E, Perna S, Brighetti MA, Travaglini A, Verardo P, Pelosi S, Zicari AM, Matricardi PM. Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study. J Med Internet Res 2020; 22:e16642. [PMID: 32175909 PMCID: PMC7105930 DOI: 10.2196/16642] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022] Open
Abstract
Background Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording. Objective The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach. Methods The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season. Results Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P<.001; Pordenone: ρ=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (ρ=–0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone. Conclusions Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts.
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Affiliation(s)
- Marco Di Fraia
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany.,Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Salvatore Tripodi
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy.,Allergology Service, Policlinico Casilino, Rome, Italy.,TPS Production, Rome, Italy
| | - Stefania Arasi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany.,Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | - Sveva Castelli
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | - Danilo Villalta
- Department of Immunology-Allergy, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Francesca Buzzulini
- Department of Immunology-Allergy, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Ifigenia Sfika
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Valeria Villella
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Ekaterina Potapova
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | - Serena Perna
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
| | | | | | - Pierluigi Verardo
- Center of Aerobiology, Agenzia Regionale per la Protezione Ambientale, Pordenone, Italy
| | | | | | - Paolo Maria Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
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30
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Starchenka S, Heath MD, Lineberry A, Higenbottam T, Skinner MA. Transcriptome analysis and safety profile of the early-phase clinical response to an adjuvanted grass allergoid immunotherapy. World Allergy Organ J 2019; 12:100087. [PMID: 31768216 PMCID: PMC6872854 DOI: 10.1016/j.waojou.2019.100087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022] Open
Abstract
Background Specific immunotherapy is the only type of disease-modifying treatment, which induces rapid desensitization and long-term sustained unresponsiveness in patients with seasonal allergic rhinoconjunctivitis. The safety and tolerability of a new cumulative dose regimen of 35600 SU Grass MATA MPL for subcutaneous immunotherapy were assessed in pre-seasonal, single-blind, placebo controlled Phase I clinical study. Underlying immunological mechanisms were explored using transcriptome analysis of peripheral blood mononuclear cells. Methods Study subjects with a history of moderate to severe seasonal allergic rhinitis and/or conjunctivitis (SAR) due to grass (Pooideae) pollen exposure were randomized on a 1:1 ratio to receive either six 1.0 mL injections of cumulative dose regimen 35600 SU of Grass MATA MPL or placebo. The study consisted of three periods: screening, randomization and treatment and End of Study period. Blood samples were taken for clinical safety laboratory assessments and for the assessment of gene expression analysis during screening visit and End of Study visit. The safety statistics was calculated using Fisher's exact test. Delta Delta Ct method analysis of RT2 Profiler PCR Array gene expression results was used to calculate changes in gene expression level. Genes with the absolute value of log2 fold change greater than ±1.1 and p-value less than 0.05 were identified as differentially expressed and underwent IPA data analysis. Results The results of the study indicated that the higher cumulative dose regimen of the immunotherapy was well-tolerated. Changes in gene expression profile were associated with early immune responses implicating innate and adaptive immune mechanisms. Pathways and mechanistic network analysis via IPA mapped differentially expressed genes onto canonical pathways related to T cell differentiation, cytokine signalling and Th1/Th2 activation pathways. The transcriptome findings of the study could be further verified in large-scale field studies in order to explore their potential as predictive markers of successful immunotherapy. Conclusions The higher dose cumulative regime 35600 SU of Grass MATA MPL vaccine was well tolerated and safe. Molecular markers IL-27, IL-10, IL-4, TNF, IFNγ, TGFβ and TLR4 were the main predicted molecular drivers of the observed gene expression changes following early stages of SIT with Grass MATA MPL immunotherapy.
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Key Words
- ADRs, adverse drug reactions
- AE, adverse events
- AIT, allergen mmunotherapy
- ARC, adverse reaction complex
- Allergen immunotherapy
- Allergoid
- DC, dendritic cell
- EAACI, European Academy of Allergy and Clinical Immunology
- FEV, forced expiratory volume
- FVC, forced vital capacity
- Grass pollen
- IPA, Ingenuity Pathway Analysis
- MATA, modified allergen tyrosine adsorbate
- MCT, microcrystalline tyrosine
- MPL, monophosphoryl lipid A
- SAEs, serious adverse events
- SAR, seasonal allergic rhinoconjunctivitis
- SD, standard deviation
- SIT, specific immunotherapy
- SU, standardized units
- Safety
- TEAEs, treatment-emergent adverse events
- TLR, toll-like receptor
- TSS, total symptom score
- Transcriptome
- URA, Upstream Regulator Analysis
- mRNA, messenger ribosomal nucleic acid
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Affiliation(s)
- Sviatlana Starchenka
- Corresponding author. Allergy Therapeutics (UK) Ltd, Worthing, BN14 8SA, United Kingdom.
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31
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Hemmati S, Rahimi N, Dabiri S, Alaeddini M, Etemad-Moghadam S, Dehpour AR. Inhibition of ovalbumin-induced allergic rhinitis by sumatriptan through the nitric oxide pathway in mice. Life Sci 2019; 236:116901. [DOI: 10.1016/j.lfs.2019.116901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/08/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
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32
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Zielen S, Kuna P, Aberer W, Lassmann S, Pfaar O, Klimek L, Wade A, Kluehr K, Raab J, Wessiepe D, Lee D, Kramer M, Gunawardena K, Higenbottam T, Heath M, Skinner M, de Kam P. Strong dose response after immunotherapy with PQ grass using conjunctival provocation testing. World Allergy Organ J 2019; 12:100075. [PMID: 31709029 PMCID: PMC6831906 DOI: 10.1016/j.waojou.2019.100075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pollinex Quattro Grass (PQ Grass) is an effective, well-tolerated, short pre-seasonal subcutaneous immunotherapy to treat seasonal allergic rhinoconjunctivitis (SAR) due to grass pollen. In this Phase II study, 4 cumulative doses of PQ Grass and placebo were evaluated to determine its optimal cumulative dose. Methods Patients with grass pollen-induced SAR were randomised to either a cumulative dose of PQ Grass (5100, 14400, 27600 and 35600 SU) or placebo, administered as 6 weekly subcutaneous injections over 31-41 days (EudraCT number 2017-000333-31). Standardized conjunctival provocation tests (CPT) using grass pollen allergen extract were performed at screening, baseline and post-treatment to determine the total symptom score (TSS) assessed approximately 4 weeks after dosing. Three models were pre-defined (Emax, logistic, and linear in log-dose model) to evaluate a dose response relationship. Results In total, 95.5% of the 447 randomized patients received all 6 injections. A highly statistically significant (p < 0.0001), monotonic dose response was observed for all three pre-specified models. All treatment groups showed a statistically significant decrease from baseline in TSS compared to placebo, with the largest decrease observed after 27600 SU (p < 0.0001). The full course of 6 injections was completed by 95.5% of patients. Treatment-emergent adverse events were similar across PQ Grass groups, and mostly mild and transient in nature. Conclusions PQ Grass demonstrated a strong curvilinear dose response in TSS following CPT without compromising its safety profile.
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Key Words
- ADRs, adverse drug reactions
- AE, adverse events
- AIT, allergen immunotherapy
- ANCOVA, analysis of covariance
- ARC, adverse reaction complexes
- Allergen immunotherapy
- Allergoid
- CIA-CPT, Culture – Independent Assessment of the Conjunctival Provocation Test
- CPT, conjunctival provocation test
- Cumulative dose
- Curvilinear dose response
- EAACI, European Academy of Allergy and Clinical Immunology
- EMA, European Medicine Agency
- FAS, Full Analysis Set
- FEV, forced expiratory volume
- FVC, forced vital capacity
- Grass pollen
- HEP, Histamine Equivalent Potency
- LPS, lipopolysaccharide
- MCP-Mod, Multiple Comparison Procedure and Modelling
- MCT, microcrystalline tyrosine
- MPL, Monophosphoryl Lipid A
- MedDRA, Medical Dictionary for Regulatory Activities
- PPS, Per Protocol Set
- SAEs, serious adverse events
- SAF, safety set
- SAR, seasonal allergic rhinoconjunctivitis
- SD, standard deviation
- SU, standardized units
- TEAEs, treatment-emergent adverse events
- TLR, Toll-like receptor
- TSS, Total Symptom Score
- mFAS, Modified Full Analysis Set
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Affiliation(s)
- S. Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - P. Kuna
- Poradnia Alergologii i Chorób Płuc Lodz, Poland
| | - W. Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S. Lassmann
- Specialist in Otolaryngology, Saalfeld, Germany
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - L. Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - A. Wade
- Allergy Therapeutics Ltd., Worthing, UK
| | - K. Kluehr
- Allergy Therapeutics Ltd., Worthing, UK
| | - J. Raab
- Allergy Therapeutics Ltd., Worthing, UK
| | - D. Wessiepe
- Metronomia Clinical Research GmbH, Munich, Germany
| | - D. Lee
- Allergy Therapeutics Ltd., Worthing, UK
| | | | | | | | | | | | - P.J. de Kam
- Allergy Therapeutics Ltd., Worthing, UK
- Corresponding author. Allergy Therapeutics (UK) Ltd, Dominion Way Worthing, West Sussex BN14 8SA, UK
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Baldrick P, Hutchings JW, Heath MD, Skinner MA. Safety Evaluation of PQ Birch Allergy Immunotherapy to Support Product Development. Regul Toxicol Pharmacol 2019; 108:104441. [PMID: 31425728 DOI: 10.1016/j.yrtph.2019.104441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/24/2022]
Abstract
PQ Birch represents an allergen-specific immunotherapy for the treatment of birch pollinosis. It consists of native birch pollen extract chemically modified with glutaldehyde adsorbed to L-tyrosine in its microcrystalline form with addition of the adjuvant Monophosphoryl Lipid A (MPL®). A nonclinical safety testing strategy was designed based upon interpretation of current legislation and regulatory intelligence and comprised genotoxicity studies (bacterial reverse mutation and Chinese hamster ovary micronucleus assays), a rat repeat dose toxicology study and a rabbit local tolerance study. No safety findings of concern were found. Thus, no evidence of genotoxicity was found. Relatively minor, immunostimulatory effects were seen following repeated subcutaneous dosing (once every 2 weeks for 13 weeks) as reversible increased white cell count (notably neutrophils), increased globulin level (resulting in decreased albumin/globulin [A/G] ratio) and increased fibrinogen, as well as minor dose site reaction in the form of inflammatory cell infiltrate. These findings are likely due to the immunostimulatory nature of MPL® and/or the presence of L-tyrosine within the adjuvanted vaccine. Similar dose site inflammatory changes to the injected formulation were also noted in the rabbit local tolerance study.
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Affiliation(s)
- Paul Baldrick
- Nonclinical Strategic Product Development, Covance Laboratories Ltd, Otley Road, Harrogate, North Yorkshire, HG3 1PY, England, UK.
| | - James W Hutchings
- Allergy Therapeutics (UK) Ltd, Dominion Way, Worthing, West Sussex, BN14 8SA, England, UK.
| | - Matthew D Heath
- Allergy Therapeutics (UK) Ltd, Dominion Way, Worthing, West Sussex, BN14 8SA, England, UK
| | - Murray A Skinner
- Allergy Therapeutics (UK) Ltd, Dominion Way, Worthing, West Sussex, BN14 8SA, England, UK
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Sun M, Yu X, Wang T, Bi S, Liu Y, Chen X. Nasal adaptive chitosan-based nano-vehicles for anti-allergic drug delivery. Int J Biol Macromol 2019; 135:1182-1192. [DOI: 10.1016/j.ijbiomac.2019.05.188] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/16/2019] [Accepted: 05/26/2019] [Indexed: 12/18/2022]
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Salcan İ, Salcan S, Erdem HB, Müderris S. An Investigation of Genetic Polymorphism In The Rs35521 Serotonin Transporter Gene In Allergic Rhinitis. ENT UPDATES 2019. [DOI: 10.32448/entupdates.595445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Jung CY, Cho MJ, Kang HR, Hong SU, Sung WS, Kim EJ. Efficacy and safety of electric heating moxibustion for perennial allergic rhinitis: protocol for a randomized controlled trial. Trials 2019; 20:445. [PMID: 31324214 PMCID: PMC6642592 DOI: 10.1186/s13063-019-3550-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 07/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is an IgE-mediated disease that adversely affects quality of life. Many studies report that moxibustion is an effective treatment for perennial allergic rhinitis (PAR). However, it is difficult to perform moxibustion on the face because of possible burning of the skin and the noxious effects of smoke. Electric heating moxibustion does not have these limitations. The purpose of this clinical trial is to assess the possibility of treating PAR with electric heating moxibustion and to assess the feasibility of conducting a clinical test on a larger scale. METHODS This is a randomized, open-label, assessor-blind, parallel-design pilot clinical study. We will recruit 40 eligible participants and randomly allocate them into an electric heating moxibustion group or an acupuncture group at a 1:1 ratio. Patients in both groups will receive eight treatments over 4 weeks, and the final follow-up will be 4 weeks after the last treatment. Eleven acupuncture points will be used for patients in both groups (EX-HN3 and bilateral EX-HN-8, LI20, LI4, GB20, and ST36). The primary outcome measure is change in the Total Nasal Symptom Score, and the secondary outcome measures are changes in the Rhinoconjunctivitis Quality of Life Questionnaire, nasal endoscopy index for pattern identification, pattern identification questionnaire for AR, total IgE, eosinophil count, and adverse effects. DISCUSSION This clinical trial will examine the effect of electric heating moxibustion on PAR. TRIAL REGISTRATION ClinicalTrials.gov, NCT03342105 . Registered on 14 November 2017.
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Affiliation(s)
- Chan-Yung Jung
- Institute of Oriental Medicine, College of Korean Medicine, Dongguk University, Gyeongju, South Korea
| | - Min-Jin Cho
- College of Korean Medicine, Dongguk University, Gyeonggi-do, South Korea
| | - Ha-Ra Kang
- Department of Acupuncture and Moxibustion, Dongguk University Ilsan Oriental Hospital, Gyeonggi-do, South Korea
| | - Seung-Ug Hong
- Department of Ophthalmology, Otolaryngology and Dermatology, Dongguk University Ilsan Oriental Hospital, Gyeonggi-do, South Korea
| | - Won-Suk Sung
- Department of Acupuncture and Moxibustion, Dongguk University Bundang Oriental Hospital, Gyeonggi-do, South Korea
| | - Eun-Jung Kim
- Department of Acupuncture and Moxibustion, Dongguk University Bundang Oriental Hospital, Gyeonggi-do, South Korea
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New guidelines for the treatment of seasonal allergic rhinitis. Postepy Dermatol Alergol 2019; 36:255-260. [PMID: 31333340 PMCID: PMC6640027 DOI: 10.5114/ada.2018.75749] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/16/2018] [Indexed: 12/20/2022] Open
Abstract
The paper discusses the classification and forms of allergic rhinitis with a special focus on seasonal allergic rhinitis (SAR). The general principles of SAR management are presented, including the role of nasal glucocorticoids, nasal and oral antihistamines, and antileukotrienes. Based on the latest guidelines, the current rules for the selection of drugs in the therapy of SAR are given, paying special attention to the initial treatment. The aim of the paper is to present updated guidelines for the pharmacological management of patients with seasonal allergic rhinitis.
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Drobyshev VA, Shpagina LA, Karmanovskaya SA, Zaitseva IG. [Innovative technology full volume lavage of the nasal cavity in the treatment of allergic and vasomotor rhinitis]. Vestn Otorinolaringol 2019; 83:59-64. [PMID: 30412178 DOI: 10.17116/otorino20188305159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Viewed 60 men and women (mean age 26.2±2.4 years) with rhinitis, including: 30 people (18 women and 12 men) 20-45 years with verified diagnoses of persistent allergic rhinitis and 30 patients (16 males and 14 females) 18-35 years (mean age 22.5±1.7 years) - neurovegetative form of chronic vasomotor rhinitis in the phase of exacerbation, receiving basic therapy with antihistamines of the II generation, stabilizers of membranes of mast cells and decongestants, divided by random sampling into 4 groups: 1A (20 patients with allergic rhinitis) and 2A (20 patients with vasomotor rhinitis) were received within 30 days in addition to the basic therapy of the nasal cavity washing procedure with the device Dolphin; in the groups 1B (10 patients with allergic rhinitis) and 2B (10 patients with vasomotor rhinitis) only basic treatment was carried out. By the end of the treatment course, the severity of the symptom 'difficulty in nasal breathing' in patients in groups 1A and 2A, decreased 2.6 times and met the criterion of 'minor violation', while in groups 1B-decreased only 1.3 times, and in 2B-changes were not significant and corresponded to 'moderate violation'. Manifestations of rhinorrhea after therapy decreased in the group of 1A 2.0 times, and in the group of 2A 1.7 times, which was regarded as' a slight manifestation of the symptom', whereas in the groups of 1B and 2B only a tendency to improve was revealed. At the end of the follow - up period, the severity of the symptom 'sneezing' decreased in patients in group 1A by 4.0 times, in group 2A-3.3 times and corresponded to 'no disturbance', while in groups 1B and 2B changes were less than 3.0 and 2.7 times respectively. At the end of the treatment course in patients in groups 1A sense of smell was restored in the group 2A -the degree of severity of olfaction decreased 3.0 times, while in the group of 1B-only 1.2 times, and in the group of 2B-has not changed. According to the visual analog scale (VAS), on the background of treatment optimized by nasal lavage with the device Dolphin complex, the greatest decrease in the degree of violations of household activity was revealed in patients with allergic rhinitis - 2.9 times. After treatment, the effect of rhinitis symptoms on sleep disturbance decreased in groups 1A and 2A 1.9 times, while in groups 1B and 2B - only 1.3 times. The use of nasal lavage with device Dolphin complex in the treatment of allergic and vasomotor rhinitis contributed to a decrease in the frequency of use of intranasal vasoconstrictive drugs by the 10th day of observation by 1.8 and 1.6 times, respectively, and by the 15th day-by 2.3 and 2.4 times, respectively. In the groups of standard treatment (1B and 2B) revealed a significant reduction in the frequency of decongestants was observed only after 15 days of treatment. Thus, the inclusion of a full volumetric nasal lavage with the device Dolphin complex in the treatment of patients with persistent allergic and neurovegetative form of chronic vasomotor rhinitis contributes to the reduction of clinical simtomatics, reduces the severity of violations of everyday life and the frequency of decongestants, improves night sleep of patients.
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Affiliation(s)
- V A Drobyshev
- Novosibirsk State Medical University, st. Krasny Prospekt, d. 52, Novosibirsk, Russia, Russia
| | - L A Shpagina
- SBAH NR 'City clinical hospital #2', Novosibirsk, ul. Polzunova, 21, Russia
| | - S A Karmanovskaya
- SBAH NR 'City clinical hospital #2', Novosibirsk, ul. Polzunova, 21, Russia
| | - I G Zaitseva
- SBAH NR 'City clinical hospital #2', Novosibirsk, ul. Polzunova, 21, Russia
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Hsieh MT, Liang SHY, Yang YH, Kuo TY, Lin TY, Wang TN, Chen VCH, Wu MH. Allergic rhinitis increases the risk of incident panic disorder among young individuals: A nationwide population-based cohort study in Taiwan. J Affect Disord 2019; 252:60-67. [PMID: 30981057 DOI: 10.1016/j.jad.2019.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/12/2019] [Accepted: 04/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies have reported an association between allergy and panic disorder. However, few studies have explored the relationship between allergic rhinitis and panic disorder. Previous studies were limited by cross-sectional study designs, self-reported symptoms, absence of matched controls, and lack of consideration of the influence of steroid and comorbidities. This study aimed to explore the longitudinal association between allergic rhinitis and panic disorder in a large population-based cohort of young people. METHODS In this study, 79,917 new cases of allergic rhinitis between 1998 and 2012 in individuals younger than 20 years were identified from Taiwan's National Health Insurance Research Database. One control (nonallergic rhinitis) per case (allergic rhinitis) was randomly selected from the remaining sample, matching for age, sex, residence, and insurance premium. Both groups were followed until the end of 2013 for incidence of panic disorder. Cox regression analysis was performed, adjusting for sex, age, residence, insurance premium, systemic steroids, asthma, atopic dermatitis, allergic conjunctivitis, attention deficit hyperactivity disorder, depression, and Charlson index. RESULTS Allergic rhinitis was associated with a 2-fold increase in risk for panic disorder after adjustment for other variables. Additional independent risk factor of panic disorders were female sex, older age group, and depression. LIMITATIONS Lifestyle, substance use, smoking by the patient or family members, and psychosocial stressors were not evaluated. CONCLUSIONS Allergic rhinitis was associated with increased risk of panic disorder. Assessment and intervention of allergy rhinitis among young people with panic disorder are critical.
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Affiliation(s)
- Men-Ting Hsieh
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sophie Hsin-Yi Liang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang-Gung Memorial Hospital at Taoyuan and Chang Gung University College of Medicine, Taiwan
| | - Yao-Hsu Yang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 542 No.161, Yu-Pin Rd, Caotun Township, Nantou, Taiwan, R.O.C
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, No. 100, Shiquan 1st Road, Kaohsiung City, Taiwan, R.O.C..
| | - Vincent Chin-Hung Chen
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, 613 Chiayi County, Taiwan
| | - Meng-Huan Wu
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 542 No.161, Yu-Pin Rd, Caotun Township, Nantou, Taiwan, R.O.C..
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Deot N, Barr J, Mankowski N, Brunner J, McCoul ED. Effect of Intranasal Corticosteroids on Secondary Sinonasal Symptoms: A Systematic Review of Randomized Trials. Am J Rhinol Allergy 2019; 33:601-607. [PMID: 31035786 DOI: 10.1177/1945892419844397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Intranasal corticosteroid (INCS) sprays are indicated for use in the treatment of seasonal and perennial allergic rhinitis and include aqueous and nonaqueous formulations. Secondary symptoms of rhinitis include postnasal drip, facial pain/pressure, headache, cough, and ear fullness. The effectiveness of INCS on these specific symptoms, as well as the comparative effectiveness of aqueous and nonaqueous formulations, is poorly defined. Objective To evaluate the effectiveness of aqueous versus nonaqueous INCS formulations on less common sinonasal symptoms. Methods A systematic review was conducted of English-language, randomized controlled trials, with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standard. Studies that did not provide quantitative data on relief of postnasal drip, facial pain/pressure, headache, cough, and ear fullness were excluded. An itemized assessment of the risk of bias was conducted for each included study. Results Of the 118 studies identified, 9 met the criteria for qualitative analysis. An effect on postnasal drip was reported in 5 studies, facial pain/pressure in 2 studies, and cough in 2 studies. A reduction in a specific symptom was reported in about half of these studies, with heterogenous outcome measures. Only 1 study reported the effect of a nonaqueous formulation on a specific symptom. No studies reported an effect on aural fullness. Conclusions Limited data are available regarding the effectiveness of aqueous or nonaqueous INCS on secondary symptoms in adult patients with rhinitis. Further study is needed using homogenous outcome measures and direct comparison of INCS formulations.
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Affiliation(s)
- Neal Deot
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jeremy Barr
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Nicholas Mankowski
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jacob Brunner
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Edward D McCoul
- 1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,2 Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,3 Ochsner Clinical School, University of Queensland, New Orleans, Louisiana
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The Relationship Between Long-term Use of Intranasal Corticosteroid and Intraocular Pressure. J Glaucoma 2019; 28:321-324. [DOI: 10.1097/ijg.0000000000001164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Watts AM, Cripps AW, West NP, Cox AJ. Modulation of Allergic Inflammation in the Nasal Mucosa of Allergic Rhinitis Sufferers With Topical Pharmaceutical Agents. Front Pharmacol 2019; 10:294. [PMID: 31001114 PMCID: PMC6455085 DOI: 10.3389/fphar.2019.00294] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/11/2019] [Indexed: 12/14/2022] Open
Abstract
Allergic rhinitis (AR) is a chronic upper respiratory disease estimated to affect between 10 and 40% of the worldwide population. The mechanisms underlying AR are highly complex and involve multiple immune cells, mediators, and cytokines. As such, the development of a single drug to treat allergic inflammation and/or symptoms is confounded by the complexity of the disease pathophysiology. Complete avoidance of allergens that trigger AR symptoms is not possible and without a cure, the available therapeutic options are typically focused on achieving symptomatic relief. Topical therapies offer many advantages over oral therapies, such as delivering greater concentrations of drugs to the receptor sites at the source of the allergic inflammation and the reduced risk of systemic side effects. This review describes the complex pathophysiology of AR and identifies the mechanism(s) of action of topical treatments including antihistamines, steroids, anticholinergics, decongestants and chromones in relation to AR pathophysiology. Following the literature review a discussion on the future therapeutic strategies for AR treatment is provided.
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Affiliation(s)
- Annabelle M. Watts
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, QLD, Australia
| | - Allan W. Cripps
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Southport, QLD, Australia
| | - Nicholas P. West
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, QLD, Australia
| | - Amanda J. Cox
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, QLD, Australia
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Sapkota A, Murtugudde R, Curriero FC, Upperman CR, Ziska L, Jiang C. Associations between alteration in plant phenology and hay fever prevalence among US adults: Implication for changing climate. PLoS One 2019; 14:e0212010. [PMID: 30921361 PMCID: PMC6438449 DOI: 10.1371/journal.pone.0212010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/26/2018] [Indexed: 12/27/2022] Open
Abstract
Plant phenology (e.g. timing of spring green-up, flowering) is among the most sensitive indicator of ecological response to ongoing climate variability and change. While previous studies have documented changes in the timing of spring green-up and flowering across different parts of the world, empirical evidence regarding how such ongoing ecological changes impact allergic disease burden at population level is lacking. Because earlier spring green-up may increase season length for tree pollen, we hypothesized that early onset of spring (negative anomaly in start of season (SOS)) will be associated with increased hay fever burden. To test this, we first calculated a median cardinal date for SOS for each county within the contiguous US for the years 2001–2013 using phenology data from the National Aeronautics and Space Administration’s Moderate Resolution Imaging Spectroradiometer (MODIS). We categorized yearly deviations in SOS for each county from their respective long-term averages as: very early (>3 wks early), early (1–3 wks early), average (within 1 wk), late (1–3 wks late) and very late (> 3 wks late). We linked these data to 2002–2013 National Health Interview Survey data, and investigated the association between changes in SOS and hay fever prevalence using logistic regression. We observed that adults living in counties with a very early onset of SOS had a 14% higher odds of hay fever compared to the reference group, i.e. those living in counties where onset of spring was within the normal range (Odds Ratios (OR): 1.14. 95% Confidence Interval (CI): 1.03–1.27). Likewise, adults living in counties with very late onset of SOS had a 18% higher odds hay fever compared to the reference group (OR: 1.18, CI: 1.05–1.32). Our data provides the first-ever national scale assessment of the impact of changing plant phenology–linked to ongoing climate variability and change–on hay fever prevalence. Our findings are likely tied to changes in pollen dynamics, i.e early onset of spring increases the duration of exposure to tree pollen, while very late onset of spring increases the propensity of exposure because of simultaneous blooming.
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Affiliation(s)
- Amir Sapkota
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, United States of America
- * E-mail:
| | - Raghu Murtugudde
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, United States of America
| | - Frank C. Curriero
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Crystal R. Upperman
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, United States of America
| | - Lewis Ziska
- Crop Systems and Global Change Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States of America
| | - Chengsheng Jiang
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, United States of America
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Allergic asthma is associated with increased risk of infections requiring antibiotics. Ann Allergy Asthma Immunol 2019; 120:169-176.e1. [PMID: 29413341 DOI: 10.1016/j.anai.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Viral infection and allergy have been identified as major risk factors for exacerbation in asthma, especially in the presence of both. However, whether patients with allergic asthma are more susceptible to respiratory infections requiring antibiotics remains unknown. OBJECTIVE To investigate allergy as a risk factor for respiratory infections requiring antibiotics based on register data from a nationwide population of patients with asthma. METHODS A register-based prospective follow-up study was performed using the Danish prescription database. In the inclusion period from 2010 through 2011, we identified patients with allergic asthma 18 to 44 years old. Patients were investigated during the follow-up period from 2012 through 2013, depending on their prescription drug use of antiallergic medication and antibiotics. Odds ratios were adjusted for age, sex, asthma severity, education, and urban vs rural residence. RESULTS In a nationwide population we identified 60,415 patients with asthma. Based on prescriptions fillings for antiallergic medication, patients were subdivided into (1) nonallergic asthma (n = 35,334, 51.5%) and (2) allergic asthma (n = 25,081, 48.5%). Allergic asthma was associated with an increased risk of filling at least 2 antibiotic prescriptions per year compared with nonallergic asthma (odds ratio 1.28, 95% confidence interval 1.24-1.33, P < .0001). Interestingly, a subgroup analysis showed a protective effect of immunotherapy against the risk of requiring antibiotics (odds ratio 0.76, 95% confidence interval 0.66-0.87, P = .0001). CONCLUSION Patients with allergic asthma have an increased risk of being prescribed antibiotics for respiratory infections compared with those with nonallergic asthma. Treatment with allergen immunotherapy appears to have a protective effect against this risk.
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Semenya SS, Maroyi A. Ethnobotanical study of curative plants used by traditional healers to treat rhinitis in the Limpopo Province, South Africa. Afr Health Sci 2018; 18:1076-1087. [PMID: 30766574 PMCID: PMC6354866 DOI: 10.4314/ahs.v18i4.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Studies focusing on plants used medicinally to heal and manage rhinitis are very scarce in Africa and elsewhere. OBJECTIVES To document plants used by traditional healers (THs) in the treatment and management of rhinitis and related symptoms in the Limpopo Province of South Africa. METHODS Data was gathered using a semi structured interviews with 105 THs in the Limpopo Province, supplemented by field expeditions for plant specimen collection and observation. RESULTS 63 plant species from 59 genera distributed across 40 botanical families, mainly the Asteraceae (7 spp.) and Euphorbiaceae (6 spp.) were therapeutically used by THs. Overall, 77 herbal recipes (87%=mono and 12.9%=poly), mainly prepared from roots (55.5%) and leaves (19%) were recorded. Most of these recipes were processed via pounding (59.7%) and boiling (20.7%). Oral (44.1%) and nasal (33.7%) was the preferred modes of dispensing remedies by THs. Artemisia afra, Clerodendrum ternatum, Cryptocarya transvaalensis, Enicostema axillare, Kalanchoe brachyloba, Lasiosiphon caffer, Lippia javanica, Schkuhria pinnata, Securidaca longepedunculata, Spirostachys africana, Stylochaeton natalensis and Zanthoxylum capense were the most widely used and preferred species for treatment of rhinitis and/or related symptom by all questioned THs. CONCLUSION This study is the first to document plants used traditionally to treat rhinitis in Africa. Therefore, it provides a baseline data on the plants used to heal rhinitis in the Limpopo Province. Finding of this study can be used as apedestal for further investigation in to effective plant-based anti-rhinitis drugs.
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Affiliation(s)
- Sebua Silas Semenya
- Technology Transfer office, Research Administration and Development Department, University of Limpopo, Private Bag X1106, Sovenga 0727, South Africa
- Medicinal Plants and Economic Development (MPED) Research Centre, Department of Botany, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
| | - Alfred Maroyi
- Medicinal Plants and Economic Development (MPED) Research Centre, Department of Botany, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
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Edo Y, Otaki A, Asano K. Quercetin Enhances the Thioredoxin Production of Nasal Epithelial Cells In Vitro and In Vivo. MEDICINES (BASEL, SWITZERLAND) 2018; 5:E124. [PMID: 30469393 PMCID: PMC6313642 DOI: 10.3390/medicines5040124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/18/2018] [Accepted: 11/18/2018] [Indexed: 04/15/2023]
Abstract
Background: Thioredoxin (TRX) acts as both a scavenger of reactive oxygen species (ROS) and an immuno-modulator. Although quercetin has been shown to favorably modify allergic rhinitis (AR) symptoms, its influence on TRX production is not well defined. The present study was designed to examine whether quercetin could favorably modify AR symptoms via the TRX production of nasal epithelial cells in vitro and in vivo. Methods: Human nasal epithelial cells (HNEpCs) were stimulated with H2O2 in the presence of quercetin. TRX levels in 24-h culture supernatants were examined with ELISA. BALB/c male mice were intraperitoneally sensitized to ovalbumin (OVA) and intranasally challenged with OVA every other day, beginning seven days after the final sensitization. The mice were orally administered quercetin once a day for five consecutive days, beginning seven days after the final sensitization. Nasal symptoms were assessed by counting the number of sneezes and nasal rubbing behaviors during a 10-min period immediately after the challenge. TRX levels in nasal lavage fluids obtained 6 h after the challenge were examined by ELISA. Results: Treatment with 1.0 nM quercetin increased H2O2-induced TRX levels. The oral administration of 20.0 mg/kg of quercetin significantly inhibited nasal symptoms after the challenge. The same dose of quercetin significantly increased TRX levels in nasal lavage fluids. Conclusions: Quercetin's ability to increase TRX production may account, at least in part, for its clinical efficacy toward AR.
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Affiliation(s)
- Yukako Edo
- Graduate School of Health Sciences, Showa University Graduate School, Yokohama 226-8555, Japan.
| | - Amane Otaki
- Division of Nursing, Showa University School of Nursing and Rehabilitation Sciences, Yokohama 226-8555, Japan.
| | - Kazuhito Asano
- Division of Physiology, Showa University School of Nursing and Rehabilitation Sciences, Yokohama 226-8555, Japan.
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Arsoy G, Varış A, Saloumi LM, Abdi A, Başgut B. Insights on Allergic Rhinitis Management from a Northern Cyprus Perspective and Evaluation of the Impact of Pharmacist-Led Educational Intervention on Patients' Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E83. [PMID: 30405059 PMCID: PMC6262628 DOI: 10.3390/medicina54050083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE the global prevalence of allergic rhinitis (AR) is rising and yet there is scarce information concerning the diagnosis, management and treatment patterns of AR in Northern Cyprus (NC). This study aims to provide a unique perspective on AR management as well as assessing the effectiveness of the pharmacist-led educational intervention for improving care of AR patients. METHODS across-sectional survey was carried out with community pharmacists (n = 70), patients (n = 138) and ear, nose and throat (ENT) specialists (n = 12) in NC. For a controlled interventional trial, trained pharmacists provided a brief education on management of AR and nasal spray technique for patients while other pharmacists provided the usual care. Quality of life (QoL) and other outcome measures on the perceived symptom severity of the two groups were compared after a 6-week period. RESULTS only 33.3% of the ear, nose and throat (ENT) specialists and 15.7% of the community pharmacists are aware of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The majority of patients (63%) self-managed with over-the-counter medications. Nasal congestion (96.4%) is the most bothersome symptom and oral antihistamines are the most commonly purchased medications (51.4%), indicating a pattern of suboptimal management. The pharmacists-led educational intervention has resulted in statistically more significant improvement in regards to nasal congestion and QoL for the intervention group patients (p < 0.05). CONCLUSION the current management of AR has not been in accordance with the ARIA guidelines in NC. An educational intervention of the pharmacists can enhance the symptom management and improve the QoL in patients with AR.
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Affiliation(s)
- Günay Arsoy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Ahmet Varış
- Department of Otolaryngology, Burhan Nalbantoglu State Hospital, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Louai M Saloumi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Abdikarim Abdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
| | - Bilgen Başgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia, Northern Cyprus, Mersin 10, Turkey.
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Physicians' Perception on Allergic Rhinitis and Its Management: A Questionnaire Based Survey. Indian J Otolaryngol Head Neck Surg 2018; 71:2096-2105. [PMID: 31763301 DOI: 10.1007/s12070-018-1500-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/14/2018] [Indexed: 12/24/2022] Open
Abstract
Despite high prevalence and impact on quality of life, Allergic Rhinitis (AR) is undertreated. Furthermore, existence of a relationship between AR and upper respiratory tract infection (URTI) is less explored. This Pan-India survey intended to assess physicians' perception about AR and URTI, and management practices in Indian setting. This questionnaire-based survey was conducted by telephonically interviewing 300 physicians [Consultant Physicians (CP): 33%; General Physicians (GP): 32%; ENT surgeons: 16%; pediatricians: 11%; allergy specialists: 8%] across India. CPs (33%) and GPs (32%) treated more AR patients in a month, versus other specialties. According to physicians, about 29.6% of patients with AR develop URTI in a month. Majority of the physicians (98%) believed that recurrent URTI can be considered as an indicator of undiagnosed AR. Majority of the physicians (98%) also considered AR to be a predisposing factor for increased risk of URTI. About 62% agreed that prompt diagnosis and treatment of AR can reduce the risk of complications such as URTI. Most preferred first- and second-line of treatment (alone or in combination) in AR management were oral antihistamines (41%) and intranasal corticosteroids (40%), respectively. Similar treatment preferences were observed irrespective of physicians' specialization and years of experience. This survey sheds light on the need to implement clear guidelines for the diagnosis and management of AR.
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Carrillo-Martin I, Gonzalez-Estrada A, Dimov V. Bepotastine besilate for the treatment of perennial allergic rhinitis. Expert Opin Pharmacother 2018; 19:1727-1730. [DOI: 10.1080/14656566.2018.1519020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Alexei Gonzalez-Estrada
- Division of Pulmonary, Allergy and Sleep Medicine Department of Medicine Mayo Clinic, Jacksonville, FL, USA
| | - Ves Dimov
- Department of Allergy and Clinical Immunology Cleveland Clinic Clinical Associate Professor, FAU Charles E, Schmidt College of Medicine, Weston, FL, USA
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