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Yonekura S, Okamoto Y, Yamaide F, Nakano T, Hirano K, Funakoshi U, Hamasaki S, Iinuma T, Hanazawa T, Shimojo N. Factors contributing to the diagnosis and onset prediction of perennial allergic rhinitis in high-risk children: A sub-analysis of the CHIBA study. Allergol Int 2024:S1323-8930(24)00013-3. [PMID: 38350815 DOI: 10.1016/j.alit.2024.01.012] [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: 09/18/2023] [Revised: 12/21/2023] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This study aimed to clarify the diagnostic and predictive factors for perennial allergic rhinitis (PAR) onset in children by analyzing the results of the Chiba High-risk Birth Cohort for Allergy study, which examined newborns with a family history of allergies. METHODS Overall, 306 pregnant women were recruited. Their newborns were examined by otolaryngologists and pediatric allergists at 1, 2, and 5 years of age. Participants with clinical and laboratory data available at all consultation points were considered eligible. RESULTS Among 187 eligible participants, the prevalence rates of PAR were 2.1%, 4.3%, and 24.1% at 1, 2, and 5 years of age, respectively. AR-specific nasal local findings and eosinophils in nasal smear were observed in a substantial number of patients with PAR at 1 and 2 years of age. Factors present up to 2 years of age that were associated with PAR onset at 5 years of age, in descending order, were as follows: sensitization to house dust mites (HDM), nasal eosinophilia, and sensitization to cat dander. In 44 cases with HDM sensitization, nasal eosinophilia up to 2 years of age achieved a sensitivity of 76.0% and a specificity of 73.7% for predicting PAR onset at 5 years. CONCLUSIONS Rhinitis findings and nasal eosinophilia are useful auxiliary diagnostic items for pediatric PAR. Sensitization to HDM and nasal eosinophilia were the most influential factors associated with future PAR onset. A combination of these factors may facilitate the prediction of PAR onset.
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Affiliation(s)
- Syuji Yonekura
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Otolaryngology, Chiba Rosai Hospital, Chiba, Japan
| | - Fumiya Yamaide
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pediatrics, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Taiji Nakano
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kiyomi Hirano
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Urara Funakoshi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sawako Hamasaki
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohisa Iinuma
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toyoyuki Hanazawa
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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Jaladat AM, Ranjbar K, Shahriarirad R, Salehi Z. Successful use of Ma'oljobon, a Persian medicine whey product, in a patient with severe chronic cough: A case report. ADVANCES IN INTEGRATIVE MEDICINE 2022. [DOI: 10.1016/j.aimed.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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Bousquet J, Caimmi DP, Bedbrook A, Bewick M, Hellings PW, Devillier P, Arnavielhe S, Bachert C, Bergmann KC, Canonica GW, Chavannes N, Cruz AA, Dahl R, Demoly P, De Vries G, Mathieu-Dupas E, Finkwagner A, Fonseca J, Guldemond N, Haahtela T, Hellqvist-Dahl B, Just J, Keil T, Klimek L, Kowalski ML, Kuitunen M, Kuna P, Kvedariene V, Laune D, Pereira AM, Carreiro-Martins P, Melén E, Morais-Almeida M, Mullol J, Muraro A, Murray R, Nogueira-Silva L, Papadopoulos NG, Passalacqua G, Portejoie F, Price D, Ryan D, Samolinski B, Sheikh A, Siroux V, Spranger O, Todo Bom A, Tomazic PV, Valero A, Valovirta E, Valiulis A, VandenPlas O, van der Meulen S, van Eerd M, Wickman M, Zuberbier T. Pilot study of mobile phone technology in allergic rhinitis in European countries: the MASK-rhinitis study. Allergy 2017; 72:857-865. [PMID: 28072463 DOI: 10.1111/all.13125] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The use of Apps running on smartphones and tablets profoundly affects medicine. The MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) App (Allergy Diary) assesses allergic rhinitis symptoms, disease control and impact on patients' lives. It is freely available in 20 countries (iOS and Android platforms). AIMS To assess in a pilot study whether (i) Allergy Diary users were able to properly provide baseline characteristics (ii) simple phenotypic characteristics based upon data captured by the Allergy Diary could be identified and (iii) information gathered by this study could suggest novel research questions. METHODS The Allergy Diary users were classified into six groups according to the baseline data that they entered into the App: (i) asymptomatic; (ii) nasal symptoms excluding rhinorrhea; (iii) rhinorrhea; (iv) rhinorrhea plus 1-2 nasal/ocular symptoms; (v) rhinorrhea plus ≥3 nasal/ocular symptoms; and (vi) rhinorrhea plus all nasal/ocular symptoms. RESULTS By 1 June 2016, 3260 users had registered with the Allergy Diary and 2710 had completed the baseline questionnaire. Troublesome symptoms were found mainly in the users with the most symptoms. Around 50% of users with troublesome rhinitis and/or ocular symptoms suffered work impairment. Sleep was impaired by troublesome symptoms and nasal obstruction. CONCLUSIONS This is the first App (iOS and Android) to have tested for allergic rhinitis and conjunctivitis. A simple questionnaire administered by cell phones enables the identification of phenotypic differences between a priori defined rhinitis groups. The results suggest novel concepts and research questions in allergic rhinitis that may not be identified using classical methods.
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Affiliation(s)
- J. Bousquet
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Montpellier France
- INSERM; VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches; U1168 Paris, and UVSQ, UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Yvelines France
| | - D. P. Caimmi
- CHRU de Montpellier; UPMC Paris 06, UMR-S 1136; IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
- Department of Respiratory Diseases; Montpellier University Hospital; Montpellier France
| | - A. Bedbrook
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Montpellier France
| | | | - P. W. Hellings
- Department of Microbiology and Immunology; Laboratory of Clinical Immunology; KU Leuven; Leuven Belgium
| | - P. Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220; Pôle des Maladies Respiratoires; Hôpital Foch; Suresnes Université Versailles Saint-Quentin; Versailles France
| | | | - C. Bachert
- ENT Department; Upper Airways Research Laboratory; Ghent University Hospital; Ghent Belgium
| | - K. C. Bergmann
- Department of Dermatology and Allergy; Comprehensive Allergy-Centre-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Global Allergy and Asthma European Network (GA LEN); Berlin Germany
| | - G. W. Canonica
- Allergy and Respiratory Diseases Clinic; DIMI; University of Genoa; IRCCS AOU San Martino-IST; Genoa Italy
| | - N.H. Chavannes
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden The Netherlands
| | - A. A. Cruz
- ProAR - Nucleo de Excelencia em Asma; Federal University of Bahia; Salvador Brasil
- GARD Executive Committee; Geneva Switzerland
| | - R. Dahl
- ProAR - Nucleo de Excelencia em Asma; Federal University of Bahia; Salvador Brasil
- GARD Executive Committee; Geneva Switzerland
| | - P. Demoly
- CHRU de Montpellier; UPMC Paris 06, UMR-S 1136; IPLESP, Equipe EPAR; Sorbonne Universités; Paris France
- Department of Respiratory Diseases; Montpellier University Hospital; Montpellier France
| | | | | | - A. Finkwagner
- Global Allergy and Asthma Platform GAAPP; Vienna Austria
| | - J. Fonseca
- Center for Health Technology and Services Research - CINTESIS; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
| | - N. Guldemond
- Institute of Health Policy and Management iBMG - Erasmus Universit; Rotterdam The Netherlands
| | - T. Haahtela
- Skin and Allergy Hospital; Helsinki University Hospital; Helsinki Finland
| | - B. Hellqvist-Dahl
- Department of Respiratory Diseases; Odense University Hospital; Odense Denmark
| | - J. Just
- Allergology Department; Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand-Trousseau (APHP); UPMC Univ Paris 06; UMR_S 1136; Institut Pierre Louis d'Epidémiologie et de Santé Publique; Equipe EPAR; Sorbonne Universités; Paris France
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité -Universitätsmedizin Berlin; Berlin Germany
- Institute for Clinical Epidemiology and Biometry; University of Wuerzburg; Wuerzburg Germany
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Healthy Ageing Reseach Centre (HARC); Medical University of Lodz; Lodz Poland
| | - M. Kuitunen
- Children's Hospital; University of Helsinki and University Hospital of Helsinki; Helsinki Finland
| | - P. Kuna
- Division of Internal Medicine, Asthma and Allergy; Barlicki University Hospital; Medical University of Lodz; Lodz Poland
| | - V. Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology; Vilnius University; Vilnius Lithuania
| | | | - A. M. Pereira
- Center for Health Technology and Services Research - CINTESIS; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- Allergy Unit; CUF Porto Instituto & Hospital; Porto Portugal
| | - P. Carreiro-Martins
- CEDOC; Respiratory Research Group; Nova Medical School; Campo dos Martires da Patria; Lisbon Portugal
- Serviço de Imunoalergologia; Hospital de Dona Estefânia; Centro Hospitalar de Lisboa Central, EPE; Lisbon Portugal
| | - E. Melén
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - M. Morais-Almeida
- Allergy and Clinical Immunology Department; Hospital CUF-Descobertas; Lisboa Portugal
| | - J. Mullol
- ENT Department; Hospital Clinic; Clinical & Experimental Respiratory Immunoallergy; IDIBAPS; CIBERES; Universitat de Barcelona; Barcelona Catalonia Spain
| | - A. Muraro
- Department of Women and Child Health; Food Allergy Referral Centre Veneto Region; Padua General University Hospital; Padua Italy
| | - R. Murray
- Medical Communications Consultant; MedScript Ltd; Dundalk Co Louth Ireland
| | - L. Nogueira-Silva
- Center for Health Technology and Services Research - CINTESIS; Porto Portugal
- Department of Internal Medicine; Centro Hospitalar Sao Joao; Porto Portugal
| | - N. G. Papadopoulos
- Center for Pediatrics and Child Health; Institute of Human Development; Royal Manchester Children's Hospital; University of Manchester; Manchester UK
- Allergy Department; 2nd Pediatric Clinic; Athens General Children's Hospital “P&A Kyriakou”; University of Athens; Athens Greece
| | - G. Passalacqua
- Allergy and Respiratory Diseases Clinic; DIMI; University of Genoa; IRCCS AOU San Martino-IST; Genoa Italy
| | - F. Portejoie
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Montpellier France
| | - D. Price
- Observational and Pragmatic Research Institute; Singapore and Academic Centre of Primary Care; University of Aberdeen; Aberdeen UK
| | - D. Ryan
- Honorary Clinical Research Fellow; Allergy and Respiratory Research Group; The University of Edinburgh; Edinburgh UK
| | - B. Samolinski
- Department of Prevention of Environmental Hazards and Allergology; Medical University of Warsaw; Warsaw Poland
| | - A. Sheikh
- Centre of Medical Informatics; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
| | - V. Siroux
- INSERM; Université Grenoble Alpes; IAB, U 1209; Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health; Université Joseph Fourier; Grenoble France
| | - O. Spranger
- Global Allergy and Asthma Platform GAAPP; Vienna Austria
| | - A. Todo Bom
- Imunoalergologia; Centro Hospitalar Universitario de Coimbra and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - P. V. Tomazic
- Medical University of Graz; ENT University Hospital Graz; Graz Austria
| | - A. Valero
- Pneumology and Allergy Department; CIBERES and Clinical & Experimental Respiratory Immunoallergy; IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - E. Valovirta
- Department of Lung Diseases and Clinical Allergology; University of Turku; Turku Finland
- Department of Allergy Clinic; Terveystalo; Turku Finland
| | - A. Valiulis
- Vilnius University Clinic of Children's Diseases and Public Health Institute; Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS-SP); Brussels Belgium
| | - O. VandenPlas
- Department of Chest Medicine; Centre Hospitalier Universitaire UCL Namur; Université Catholique de Louvain; Yvoir Belgium
| | - S. van der Meulen
- Attorney at law; Axon Lawyers; the Netherlands. Role: provision of legal services
| | | | - M. Wickman
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - T. Zuberbier
- Department of Dermatology and Allergy; Comprehensive Allergy-Centre-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Global Allergy and Asthma European Network (GA LEN); Berlin Germany
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[Local allergic rhinitis to Alternaria alternata : Evidence for local IgE production exclusively in the nasal mucosa]. HNO 2016; 63:364-72. [PMID: 25929891 DOI: 10.1007/s00106-015-0005-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In a subgroup of patients with symptoms of allergic rhinitis (AR), no systemic sensitization can be detected in skin tests or serum. These patients are considered to be afflicted with so-called "local allergic rhinitis" (LAR) with IgE-production exclusively at the site of the nasal mucosa. Patients without any positive allergy test results but seasonal (intermittent) or perennial (persistent) allergic symptoms were often misdiagnosed as having "non-allergic rhinitis" (NAR) in the past.However, there is evidence for a specific IgE-production in the nasal mucosa in these patients without systemic sensitization. The diagnosis of LAR is confirmed by clinical symptoms, the detection of specific IgE production in the nasal mucosa and/or nasal provocation tests.We report on two cases of LAR to Alternaria alternata with symptoms of persistent allergic rhinitis that have been diagnosed by positive allergenspecific nasal challenge tests and specific IgE determinations in nasal secretions.According to an actual literature research, this is the second report published on LAR caused by Alternaria alternata.
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Abstract
Allergic rhinitis is a common pediatric problem with significant comorbidities and potential complications. This article is an overview of the epidemiology, pathophysiology, and current therapeutic strategies. Allergic rhinitis management in a specific child is age dependent and influenced by the severity and frequency of the symptoms and the presence of any concurrent conditions. Current strategies permit symptomatic control and improved quality of life for most patients.
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Klimek L, von Bernus L, Pfaar O. [Local (exclusive) IgE production in the nasal mucosa. Evidence for local allergic rhinitis]. HNO 2013; 61:217-23. [PMID: 23241861 DOI: 10.1007/s00106-012-2584-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND IgE production at the site of the nasal mucosa without systemic allergic sensitization in skin tests or in serum represents so-called "local allergic rhinitis (LAR)" as a subgroup of patients with symptoms of allergic rhinitis (AR). Formerly, in case of negative allergological test results, seasonal (intermittent) or perennial (persistent) allergic symptoms have been diagnosed as "non-allergic rhinitis" (NAR). However, there is evidence for specific Th2 cytokine, tryptase, and ECP (eosinophil catonic protein) production in the nasal secretion after allergen exposure in these patients without systemic sensitization. DIAGNOSIS Taking this into account, we recommend performing an allergen-specific nasal challenge and measuring the (local) nasal IgE-levels in addition to standard allergy tests in clinical routine in this subgroup of patients. These tests should be perfomed while or shortly after allergen exposure. In addition, an update of the allergy testing should be performed after a time interval since it has been demonstrated that patients formerly diagnosed with NAR may develop LAR or AR, or patients with LAR may develop AR in the future. TREATMENT The pharmacological therapeutic options in LAR are in line with the treatment of AR. If and to what extent this subgroup of AR patients benefit from allergen-specific immunotherapy (SIT) is currently being evaluated in clinical trials.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany.
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Tatar EC, Sürenoğlu UA, Saylam G, Işık E, Ozdek A, Korkmaz H. Is there any correlation between the results of skin-prick test and the severity of symptoms in allergic rhinitis? Am J Rhinol Allergy 2012; 26:e37-9. [PMID: 22391080 DOI: 10.2500/ajra.2012.26.3750] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study was designed to determine whether there is any correlation between results of the skin-prick test and the severity of symptoms in allergic rhinitis. METHODS We retrospectively evaluated 150 patients with persistent or intermittent allergic rhinitis confirmed by positive skin tests and scaled from 1 to 4 according to the size of the wheal. The symptoms including sneezing, nasal obstruction, rhinorrhea, and nasal itching were ranked according to their severity (0 for no symptoms, 1 for mild, 2 for moderate, and 3 for severe). We investigated the correlation between the skin tests' positivity and symptoms score, rhinoconjunctivitis quality-of-life questionnaire (RQLQ), and visual analog scale (VAS) scores. RESULTS Of the 150 patients, 98 had persistent and 52 had intermittent allergic rhinitis. Some patients had multiple allergen sensitivity. Each skin test group was compared with respect to symptom scores, RQLQ, or VAS scores. There was no statistically significant correlation between the size of the wheal and symptoms score, RQLQ, or VAS scores. There was also no correlation between the type of allergen and symptoms score. CONCLUSION The skin-prick test can be applied to support the diagnosis of allergic rhinitis, but one can not predict the severity of illness by stratifying the size of the skin-prick test result.
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Affiliation(s)
- Emel Cadallı Tatar
- Department of Otolaryngology, Ministry of Health, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
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Boghdadi G, Marei A, Ali A, Lotfy G, Abdulfattah M, Sorour S. Immunological markers in allergic rhinitis patients treated with date palm immunotherapy. Inflamm Res 2012; 61:719-24. [PMID: 22456954 DOI: 10.1007/s00011-012-0464-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 01/25/2012] [Accepted: 03/08/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Allergic rhinitis (AR) is regulated by the local production and release of several cytokines. Allergen specific immunotherapy (IT) has been widely used for many years as a specific treatment of allergic diseases. This study aimed to investigate the changes in clinical and immunological markers before and after Phoenix dactylifera IT in AR patients. MATERIALS AND METHODS Total symptom score and levels of total immunoglobulin E (IgE), albumin, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-10, IL-4, and IL-13 were measured in the serum and nasal samples of thirty non-atopic healthy controls and thirty patients with allergic rhinitis before and after 15 months of IT. RESULTS We found significantly higher concentrations of serum TNF-α and nasal TNF-α and IL-13, and significantly lower concentration of nasal IL-10, in allergic patients than in non-allergic. Moreover, serum and nasal IL-10 increased significantly after IT. However, there was neither a significant reduction in total IgE nor a significant increase in IFN-γ at the end of IT. CONCLUSIONS Our data show a clinical improvement associated with a decline in some inflammation parameters after IT. Moreover, date palm IT induced a significant increase in serum and nasal IL-10 levels.
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Affiliation(s)
- Ghada Boghdadi
- Immunology Research Lab, Faculty of Medicine, Microbiology and Immunology, Zagazig University, Zagazig, Egypt.
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Sogut A, Yilmaz O, Kirmaz C, Ozbilgin K, Onur E, Celik O, Pinar E, Vatansever S, Dinc G, Yuksel H. Regulatory-T, T-helper 1, and T-helper 2 cell differentiation in nasal mucosa of allergic rhinitis with olive pollen sensitivity. Int Arch Allergy Immunol 2011; 157:349-53. [PMID: 22123238 DOI: 10.1159/000329159] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 04/29/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is a disease in which T-helper (Th)2 response is predominant and its pathogenic mechanism is still poorly understood. AIM To evaluate the possible role of Th1, Th2 and regulatory-T (Treg) cells in the pathogenesis of AR. METHODS This case-control study enrolled 41 patients with seasonal AR (10-62 years old), sensitive to olive pollens, and 15 healthy controls (18-60 years old). Nasal biopsy was performed and specimens of nasal lavage fluid were obtained from all participants. The levels of interleukin (IL)-4, IL-10, interferon (IFN)-γ and transforming growth factor-β (TGF-β) were measured in nasal lavage fluid specimens. The expression of FOXP3, GATA-3 and T-bet was measured by immunohistochemical methods in the nasal biopsy specimens. RESULTS The levels of IFN-γ in the group with AR were significantly lower than those in the control group (p = 0.008). The levels of IL-4, IL-10 and TGF-β did not differ between the two groups. The expression of FOXP3 and T-bet in patients with AR was significantly lower than that in the control group (both p = 0.001). Expression of GATA-3 in the nasal mucosa was similar between the groups (p = 0.2). The ratios of T-bet/GATA-3 and FOXP3/GATA-3 in the AR group were significantly lower than those in the control group (p = 0.001). CONCLUSION Insufficient Treg and Th1 cells may be associated with the allergic inflammation that may be attributed to the Th2 immune response in patients suffering from AR who are sensitive to olive pollen.
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Affiliation(s)
- Ayhan Sogut
- Pediatric Allergy and Pulmonology Unit, Celal Bayar University School of Medicine, Manisa, Turkey.
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Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol 2010; 10:1-7. [DOI: 10.1097/aci.0b013e328334f5fb] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3008] [Impact Index Per Article: 188.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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Powe DG, Jones NS. Local mucosal immunoglobulin E production: does allergy exist in non-allergic rhinitis? Clin Exp Allergy 2007; 36:1367-72. [PMID: 17083346 DOI: 10.1111/j.1365-2222.2006.02593.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this review, we critically evaluate the evidence for local IgE production in allergic rhinitis mucosa and the concept of local allergy in non-atopic idiopathic rhinitis. Significantly, fewer studies have focused on the disease pathways associated with non-allergic rhinitis compared with their allergic counterparts. Recently, there's been a revival of the hypothesis concerning the existence of local tissue-specific allergic disease confined to the nasal mucosa of some systemically non-atopic rhinitis subjects. Providing the evidence for local mucosal IgE production in allergic rhinitis is a pre-requisite to reviewing its existence in non-allergic rhinitis. In addition, practical and theoretical approaches useful in the detection of allergy in non-allergic rhinitis will be discussed. Furthermore, successful therapeutic regimens used in the treatment of non-allergic rhinitis will be examined as these could provide an insight into the underlying pathophysiology of this common but poorly understood disease.
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Affiliation(s)
- D G Powe
- Division of Pathology, School of Molecular Medical Sciences, Queen's Medical Centre, Nottingham, UK.
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Rondón C, Romero JJ, López S, Antúnez C, Martín-Casañez E, Torres MJ, Mayorga C, R-Pena R, Blanca M. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol 2007; 119:899-905. [PMID: 17337294 DOI: 10.1016/j.jaci.2007.01.006] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 01/03/2007] [Accepted: 01/09/2007] [Indexed: 12/30/2022]
Abstract
BACKGROUND Allergic rhinitis is an IgE-mediated inflammatory disease of the nasal mucosa, which is usually diagnosed by typical symptoms, positive skin tests, and/or serum specific IgE antibodies to allergens. Despite suggestive symptoms of allergic rhinitis, some patients have a negative diagnostic test for atopy. OBJECTIVE To evaluate in the nose the inflammatory response, specific IgE to Dermatophagoides pteronyssinus (DP), and the response to a nasal allergen provocation test with DP (NAPT-DP), in patients with persistent nonallergic rhinitis (PNAR) compared with patients with persistent allergic rhinitis (PAR) and healthy controls. METHODS Fifty patients with PNAR, 30 with PAR to DP, and 30 healthy controls were studied by determining the nasal leukocyte-lymphocyte phenotype by flow cytometry (CD16, CD8, CD4, CD33, CD3, and CD45), nasal eosinophil cationic protein (ECP), albumin, total and specific IgE to DP, and NAPT-DP. RESULTS The PNAR patients showed a similar leukocyte-lymphocyte phenotype in nasal lavage to the PAR patients and was different to the healthy controls. Within the PNAR group, 54% showed a positive NAPT-DP, with 22% of these having nasal specific IgE to DP. CONCLUSION These data support the hypothesis that in persistent nonallergic rhinitis some patients may have local inflammation, nasal IgE production, and a positive response to a nasal allergen provocation test despite no evidence of systemic atopy. Further research is needed to evaluate the influence of other perennial allergens and/or immunologic mechanisms. CLINICAL IMPLICATIONS The local production of IgE antibodies without systemic detection is a condition that should be considered in patients with PNAR.
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Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [PMID: 17054180 DOI: 10.1002/14651858.cd003664.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Allergies and food reactions are common and may be associated with foods including adapted cow's milk formula. Formulas containing hydrolysed proteins have been used to treat infants with allergy or food intolerance. However, it is unclear whether hydrolysed formula can be advocated for prevention of allergy and food intolerance in infants without evidence of allergy or food intolerance. OBJECTIVES To determine the effect of feeding hydrolysed formulas on allergy and food intolerance in infants and children compared to adapted cow's milk or human breast milk. If hydrolysed formulas are effective, to determine what type of hydrolysed formula is most effective including extensively and partially hydrolysed formulas. To determine which infants benefit, including infants at low or high risk of allergy and infants receiving early, short term or prolonged formula feeding. SEARCH STRATEGY The standard search strategy of the Cochrane Neonatal Review Group was used. The review was updated with searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966-March 2006), EMBASE (1980-March 2006) and CINAHL (1982-March 2006) and previous reviews including cross references. SELECTION CRITERIA Randomised and quasi-randomised trials that compare the use of a hydrolysed infant formula to human milk or cow's milk formula. Trials with >80% follow up of participants were eligible for inclusion. DATA COLLECTION AND ANALYSIS Eligibility of studies for inclusion, methodological quality and data extraction were assessed independently by each review author. Primary outcomes included clinical allergy, specific allergies and food intolerance. Meta-analysis was conducted using a fixed effects model. MAIN RESULTS Two trials compared early, short term hydrolysed formula to human milk feeding. No significant difference in infant allergy or childhood cow's milk allergy (CMA) were reported. No eligible trial compared prolonged hydrolysed formula to human milk feeding. Two trials compared early, short term hydrolysed formula to cow's milk formula feeding. No significant benefits were reported. One large quasi-random study reported a reduction in infant CMA of borderline significance in low risk infants (RR 0.62, 95% CI 0.38, 1.00). Ten eligible studies compared prolonged feeding with hydrolysed formula versus cow's milk formula in high risk infants. Meta-analysis found a significant reduction in infant allergy (seven studies, 2514 infants; typical RR 0.79, 95% CI 0.66, 0.94), but not in the incidence of childhood allergy (two studies, 950 infants; typical RR 0.85, 95% CI 0.69, 1.05). There was no significant difference in infant eczema (eight studies, 2558 infants, typical RR 0.84, 95% CI 0.68, 1.04), childhood eczema incidence (two studies, 950 infants, typical RR 0.83, 95% CI 0.63, 1.10), childhood eczema prevalence (one study, 872 infants; RR 0.66, 95% CI 0.43, 1.02), or infant or childhood asthma, rhinitis and food allergy. One study reported a significant reduction in infants with CMA with confirmed atopy (RR 0.36, 95% CI 0.15, 0.89). Subgroup analysis of trials blinded to formula found no significant difference in infant allergy (four studies, 2156 infants; typical RR 0.87, 95% CI 0.69, 1.08) or childhood allergy incidence (one study, 872 infants; RR 0.91, 95% CI 0.73, 1.14). No eligible trial examined the effect of prolonged hydrolysed formula feeding on allergy beyond early childhood. There is evidence that preterm or low birthweight infants fed a hydrolysed preterm formula have significantly reduced weight gain, but not in other growth parameters (head circumference or length). Studies in term infants report no adverse effects on growth. Subgroup analysis of trials of partially hydrolysed versus cow's milk formula found a significant reduction in infant allergy (six studies, 1391 infants; typical RR 0.79, 95% CI 0.65, 0.97) but not childhood allergy, or infant or childhood asthma, eczema or rhinitis. Methodological concerns were the same as for the overall analysis. Analysis of trials of extensively hydrolysed formula versus cow's milk formula found no significant differences in allergy or food intolerance. Infants fed extensively hydrolysed formula compared with partially hydrolysed formula had a significant reduction in food allergy (two studies, 341 infants; typical RR 0.43, 95% CI 0.19, 0.99), but there was no significant difference in all allergy or any other specific allergy incidence. Comparing extensively hydrolysed casein containing formula with cow's milk formula, one study (431 infants) reported a significant reduction in childhood allergy incidence (RR 0.72, 95% CI 0.53, 0.97). Meta-analysis found a significant reduction in infant eczema (three studies, 1237 infants; typical RR 0.71, 95% CI 0.51, 0.97). One study reported a significant reduction in childhood eczema incidence (RR 0.66, 95% CI 0.44, 0.98) and prevalence (RR 0.50, 95% CI 0.27, 0.92). AUTHORS' CONCLUSIONS There is no evidence to support feeding with a hydrolysed formula for the prevention of allergy compared to exclusive breast feeding. In high risk infants who are unable to be completely breast fed, there is limited evidence that prolonged feeding with a hydrolysed formula compared to a cow's milk formula reduces infant and childhood allergy and infant CMA. In view of methodological concerns and inconsistency of findings, further large, well designed trials comparing formulas containing partially hydrolysed whey, or extensively hydrolysed casein to cow's milk formulas are needed.
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Affiliation(s)
- D A Osborn
- Westmead Hospital, Neonatal Unit, Hawkesbury Road, Westmead, New South Wales, Australia
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Abstract
History, physical examination, and allergy testing may distinguish the syndromes of rhinitis, classified as allergic, infectious, perennial, nonallergic, and miscellaneous. All may be associated with sinusitis, probably on the basis of obstruction of the osteomeatal complex. Although topical nasal steroids are useful in the treatment of all forms of rhinitis, diagnosis of the offending type in a given patient is necessary for optimal management.
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Affiliation(s)
- Richard D deShazo
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Carney AS, Powe DG, Huskisson RS, Jones NS. Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy? Clin Exp Allergy 2002; 32:1436-40. [PMID: 12372122 DOI: 10.1046/j.1365-2745.2002.01465.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that many patients may have a localized form of allergic rhinitis in the absence of other atopic symptoms and markers. This study compares detailed nasal challenge results obtained from patients with idiopathic rhinitis to those of atopic and normal controls. METHODS Patients with idiopathic rhinitis (n = 23), perennial allergic rhinitis (n = 8) and normal controls (n = 8) underwent a normal saline challenge to exclude hyper-reactivity and then bilateral nasal allergen challenges. Nasal patency was assessed by anterior active rhinomanometry. RESULTS All of the patients with atopic rhinitis demonstrated positive bilateral allergen challenges. All normal control subjects had bilateral negative challenges. Two patients in the idiopathic group tested positively to saline and were excluded from further study with 62% of the remainder testing positive to allergens. Of the idiopathic patients testing positive, 85% were sensitive to house dust mite. CONCLUSION A significant proportion of patients with idiopathic rhinitis have positive nasal challenges, the vast majority to house dust mite allergen. These findings add to the weight of evidence that suggests 'localized allergy' may exist in the absence of systemic atopic markers.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinder's Medical Centre, Bedford Park, Adelaide, SA, Australia.
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Annesi-Maesano I, Didier A, Klossek M, Chanal I, Moreau D, Bousquet J. The score for allergic rhinitis (SFAR): a simple and valid assessment method in population studies. Allergy 2002; 57:107-14. [PMID: 11929412 DOI: 10.1034/j.1398-9995.2002.1o3170.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND No validated assessment of allergic rhinitis (AR) is presently available that can be used in population studies in the absence of medical diagnosis and of objective measurements of allergy. To compensate for this lack, a quantitative Score For Allergic Rhinitis (SFAR) ranging between 0 and 16 has been developed by experts. METHODS The SFAR, encompassing eight features of AR, was validated in three different ways: 1) among 269 outpatients taking the specialist's diagnosis of AR and skin prick tests (SPT) positivity as a gold standard (diagnosis validation); 2) using psychometric methods (internal validation); and 3) in a random population-based sample of 3001 individuals by telephone interview (population acceptability). RESULTS A SFAR value > or = 7 allowed satisfactory discrimination between the outpatients with AR from those without (sensitivity = 74% [95% confidence interval CI: 0.69,0.79], specificity = 83% [0.79, 0.87], positive predictive value = 84% [0.80, 0.88], negative predictive value = 74% [0.69, 0.79] and Youden's index = 0.57, respectively). Internal consistency of the score was also high (among others, Cronbach's alpha coefficient = 0.79). On average, it took only 3 min for the individuals interviewed on the phone to complete the questionnaire, the questions of which were well understood. Among these subjects, the prevalence of AR was 21% [95% CI: 19.5%, 22.5%], which is comparable to other determinations in France. CONCLUSIONS The newly a priori proposed Score For Allergic Rhinitis (SFAR) is easy to use and can be useful to estimate prevalence and to study causation of AR in population settings.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- False Positive Reactions
- Female
- France/epidemiology
- Humans
- Male
- Predictive Value of Tests
- ROC Curve
- Random Allocation
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/psychology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/psychology
- Sensitivity and Specificity
- Skin Tests
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