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Tan CJW, Leow BHW, Tan BKJ, Tan SFJ, Teo NWY, Charn TC. Association Between Smoking and Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:2513-2524. [PMID: 38112394 DOI: 10.1002/lary.31223] [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: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airway. The impact of smoking on CRS has not been clearly established. We aim to clarify the association between first-hand cigarette smoking and the prevalence and prognoses of CRS. REVIEW METHODS PubMed, Embase, SCOPUS, and Cochrane Library were searched from inception until May 15, 2022. Three blinded reviewers selected relevant studies, extracted data, and evaluated study bias following a PROSPERO-registered protocol (CRD42022345585). We used random-effects meta-analyses to pool the prevalence of smoking in CRS, association between smoking status and CRS, and association of smoking with quality of life (QOL) before and after functional endoscopic sinus surgery (FESS). We also performed descriptive analyses of olfactory function, CT scores, and endoscopy scores before and after FESS. RESULTS We included 23 cross-sectional studies, 19 cohort studies, two case-control studies, and one prospective clinical trial. The pooled prevalence of ever-smokers was 40% (95% CI = 0.30-0.51) and 33% (95% CI = 0.25-0.43) in patients with and without CRS. Compared to never-smokers, active smokers and past smokers had 1.35 (95% CI = 1.18-1.55) and 1.23 (95% CI = 1.17-1.29) higher odds of having CRS. Among patients with CRS, non-smokers reported higher initial QOL than smokers (standardized mean difference [SMD] = 0.23, 95% CI = 0.11-0.35), although post-FESS QOL was similar (SMD = 0.10, 95% CI = -0.30-0.51). Descriptive analysis found no significant correlations between smoking and post-FESS olfactory function and endoscopy scores. CONCLUSIONS Cigarette smoking is associated with higher prevalence and odds of CRS. Clinicians should be aware that smoking predisposes to CRS, but does not negatively impact the rhinologic outcomes of FESS. Laryngoscope, 134:2513-2524, 2024.
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Affiliation(s)
- Claire Jing-Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bryan Hao Wei Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Fong-Jun Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Neville Wei Yang Teo
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Surgery Academic Clinical Program, SingHealth, Singapore, Singapore
| | - Tze Choong Charn
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Departments of Otorhinolaryngology-Head & Neck Surgery, Sengkang General Hospital, Singapore, Singapore
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Xue A, Zhu Z, Wang H, Jiang L, Visscher PM, Zeng J, Yang J. Unravelling the complex causal effects of substance use behaviours on common diseases. COMMUNICATIONS MEDICINE 2024; 4:43. [PMID: 38472333 DOI: 10.1038/s43856-024-00473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Substance use behaviours (SUB) including smoking, alcohol consumption, and coffee intake are associated with many health outcomes. However, whether the health effects of SUB are causal remains controversial, especially for alcohol consumption and coffee intake. METHODS In this study, we assess 11 commonly used Mendelian Randomization (MR) methods by simulation and apply them to investigate the causal relationship between 7 SUB traits and health outcomes. We also combine stratified regression, genetic correlation, and MR analyses to investigate the dosage-dependent effects. RESULTS We show that smoking initiation has widespread risk effects on common diseases such as asthma, type 2 diabetes, and peripheral vascular disease. Alcohol consumption shows risk effects specifically on cardiovascular diseases, dyslipidemia, and hypertensive diseases. We find evidence of dosage-dependent effects of coffee and tea intake on common diseases (e.g., cardiovascular disease and osteoarthritis). We observe that the minor allele effect of rs4410790 (the top signal for tea intake level) is negative on heavy tea intake ( b ̂ G W A S = - 0.091 , s . e . = 0.007 , P = 4.90 × 10 - 35 ) but positive on moderate tea intake ( b ̂ G W A S = 0.034 , s . e . = 0.006 , P = 3.40 × 10 - 8 ) , compared to the non-tea-drinkers. CONCLUSION Our study reveals the complexity of the health effects of SUB and informs design for future studies aiming to dissect the causal relationships between behavioural traits and complex diseases.
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Affiliation(s)
- Angli Xue
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
- Garvan-Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Zhihong Zhu
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
- National Centre for Register-Based Research, Aarhus University, Aarhus V, 8210, Denmark
| | - Huanwei Wang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Longda Jiang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Peter M Visscher
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Jian Zeng
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Jian Yang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia.
- School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China.
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China.
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3
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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Burbank AJ, Hernandez ML, Jefferson A, Perry TT, Phipatanakul W, Poole J, Matsui EC. Environmental justice and allergic disease: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee and the Diversity, Equity and Inclusion Committee. J Allergy Clin Immunol 2023; 151:656-670. [PMID: 36584926 PMCID: PMC9992350 DOI: 10.1016/j.jaci.2022.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
Environmental justice is the concept that all people have the right to live in a healthy environment, to be protected against environmental hazards, and to participate in decisions affecting their communities. Communities of color and low-income populations live, work, and play in environments with disproportionate exposure to hazards associated with allergic disease. This unequal distribution of hazards has contributed to health disparities and is largely the result of systemic racism that promotes segregation of neighborhoods, disinvestment in predominantly racial/ethnic minority neighborhoods, and discriminatory housing, employment, and lending practices. The AAAAI Environmental Exposure and Respiratory Health Committee and Diversity, Equity and Inclusion Committee jointly developed this report to improve allergy/immunology specialists' awareness of environmental injustice, its roots in systemic racism, and its impact on health disparities in allergic disease. We present evidence supporting the relationship between exposure to environmental hazards, particularly at the neighborhood level, and the disproportionately high incidence and poor outcomes from allergic diseases in marginalized populations. Achieving environmental justice requires investment in at-risk communities to increase access to safe housing, clean air and water, employment opportunities, education, nutrition, and health care. Through policies that promote environmental justice, we can achieve greater health equity in allergic disease.
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Affiliation(s)
- Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Children's Research Institute, Chapel Hill, NC.
| | - Michelle L Hernandez
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Children's Research Institute, Chapel Hill, NC
| | - Akilah Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
| | - Wanda Phipatanakul
- Division of Asthma, Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Jill Poole
- Department of Internal Medicine, Division of Allergy and Immunology, University of Nebraska Medical Center, Omaha, Neb
| | - Elizabeth C Matsui
- Departments of Population Health and Pediatrics, Dell Medical School at University of Texas at Austin, Austin, Tex
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Avdeeva KS, Fokkens WJ, Segboer CL, Reitsma S. The prevalence of non-allergic rhinitis phenotypes in the general population: A cross-sectional study. Allergy 2022; 77:2163-2174. [PMID: 35038765 PMCID: PMC9306544 DOI: 10.1111/all.15223] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/01/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022]
Abstract
Background Non‐allergic rhinitis (NAR) can be subdivided into several phenotypes: rhinorrhea of the elderly, rhinitis medicamentosa, smokers', occupational, hormonal, drug‐induced, gustatory, and idiopathic rhinitis. There are two pathophysiological endotypes of NAR: inflammatory and neurogenic. Phenotypes may serve as an indicator of an underlying endotype and, therefore, help to guide the treatment. The prevalence of each phenotype in the general population is currently unknown. Methodology/Principal Cross‐sectional questionnaire‐based study in the general population of the Netherlands. Results The prevalence of chronic rhinitis in the general population was 40% (N = 558, of those, 65% had NAR and 28% AR, in 7% allergy status is unknown). Individuals with NAR (N = 363) had significantly more complaints in October–February. Those with AR (N = 159) had significantly more complaints in April–August. The most common NAR phenotypes were idiopathic (39%) and rhinitis medicamentosa (14%), followed by occupational (8%), smokers' (6%), hormonal (4%), gustatory (4%), and rhinorrhea of the elderly (4%). The least prevalent phenotype was drug induced (1%). Nineteen percent of the NAR group could not be classified into any of the phenotypes. Conclusions This is the first study to describe the prevalences of NAR phenotypes in the general population. AR and NAR have a distinct seasonality pattern with NAR being more prevalent in autumn/winter and AR in spring/summer. Our data on the prevalence of phenotypes may help clinicians to anticipate the type of patients at their clinic and help guide a tailored treatment approach. The high prevalence of rhinitis medicamentosa is alarming, since this is a potentially preventable phenotype.
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Affiliation(s)
- Klementina S. Avdeeva
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
| | | | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
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Lu M, Yang H, Wang J, An Z, Li J, Wu Z, Zhao Q, Li H, Zhai D, Liu Y, Wu W, Song J. Acute effects of ambient air pollution on outpatients with chronic rhinitis in Xinxiang, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:9889-9897. [PMID: 33159228 DOI: 10.1007/s11356-020-11534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
Air pollution exposure leads to increased mortality and morbidity rates of respiratory diseases. Most of the evidence was founded on acute diseases such as acute lower respiratory diseases. However, limited studies have been conducted to evaluate the effects of air pollution on chronic respiratory diseases. This time-series study was conducted to examine the acute effects of 6 criteria ambient air pollutants on hospital outpatients with chronic rhinitis (CR) in Xinxiang, China. We retrieved 223,826 outpatient records of patients with respiratory diseases, of which 62,901 were those of patients with CR. Results showed that the current 10-μg/m3 increase in fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) corresponds to 0.67% (95% confidence interval [CI]: 0.15-1.18%), 0.58% (95% CI: 0.24-0.92%), 1.89% (95% CI: 0.52-3.27%), 3.01% (95% CI: 1.66-4.35%), and 0.06% (95% CI: 0.03-0.10%) increments in outpatients with CR, respectively. In addition, the effects in the male were stronger than those in the female. Higher effect estimates were observed in the old (≥ 65 years of age) and younger (< 15 years of age) groups. Our study confirmed the association between air pollution and outpatients with CR in Xinxiang, China. More stringent air pollution control measures must be implemented.
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Affiliation(s)
- Mengxue Lu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Huijuan Yang
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Jingyao Wang
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Zhen An
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Juan Li
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Zhineng Wu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Qian Zhao
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Huijun Li
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Desheng Zhai
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Yue Liu
- Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, 100021, China
| | - Weidong Wu
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China
| | - Jie Song
- Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, Henan Province, China.
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Smoking history is negatively associated with allergen specific immunotherapy efficacy: a retrospective analysis. Postepy Dermatol Alergol 2019; 36:673-676. [PMID: 31997993 PMCID: PMC6986293 DOI: 10.5114/ada.2018.80654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/11/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction Allergen specific immunotherapy (AIT) is the only treatment modifying the course of the disease in patients allergic to airborne allergens. It has been proven to be effective in allergic populations, however individual patients vary in terms of response to the therapy. Aim To assess the factors that might affect the efficacy of AIT. Material and methods Patients treated with AIT for grass pollen or house dust mites were included. The efficacy of AIT was assessed with the use of Allergy Control Score (ACS), performed before and at least 1 year after AIT. The following variables were assessed as potential risk factors for a worse response to AIT: age, gender, type of allergy, type of allergen, type of vaccine, type of AIT and smoking history. Results The study group consisted of 145 subjects.AIT was effective in the entire group; the mean ACS results decreased from 21.14 to 14.41 points (p< 0.0001). No differences in efficacy in terms of assessed risk factors were found, except for smoking history (ACS change in the smoking group was smaller: from 21.8 to 18.1 points; p = 0.09, OR = 0.323; 95% CI: 0.11-0.88; p = 0.02). Conclusions Smoking history may affect AIT outcomes.
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8
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Ferrari M, Piccinno E, Marcon A, Marchetti P, Cazzoletti L, Pirina P, Battaglia S, Grosso A, Squillacioti G, Antonicelli L, Verlato G, Pesce G. Chronic bronchitis without airflow obstruction, asthma and rhinitis are differently associated with cardiovascular risk factors and diseases. PLoS One 2019; 14:e0224999. [PMID: 31697758 PMCID: PMC6837508 DOI: 10.1371/journal.pone.0224999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular and respiratory diseases can frequently coexist. Understanding their link may improve disease management. We aimed at assessing the associations of chronic bronchitis (CB), asthma and rhinitis with cardiovascular diseases and risk factors in the general population. METHODS We used data collected in the Gene Environment Interactions in Respiratory Diseases study, an Italian multicentre, multicase-control study. Among 2463 participants (age 21-86, female 50%) who underwent standardized interviews, skin prick and lung function tests, we identified 254 cases of CB without airflow obstruction, 418 cases of asthma without CB, 959 cases of rhinitis alone, and 832 controls. The associations of respiratory diseases with reported cardiovascular risk factors (lifestyles, hypertension, dyslipidaemia), heart disorders (myocardial infarction, coronary thrombosis, angina, aorta or heart surgery) and intermittent claudication were estimated through relative risk ratios (RRR) by multinomial logistic regression models. RESULTS Compared to controls, CB cases were more likely to be heavy smokers, alcohol consumers, physically inactive, and to suffer from hypertension or dyslipidaemia; rhinitis cases were less obese but more likely to have hypertension. Asthma was significantly associated with current smoking. After adjusting for cardiovascular risk factors, heart disorders were associated with CB (RRR[95%CI]: 1.58[1.12-2.22]) and rhinitis (1.35[0.98-1.85]) and intermittent claudication was associated with CB (3.43[2.52-4.67]), asthma (1.51[1.04-2.21]) and rhinitis (2.03[1.34-3.07]). CONCLUSIONS CB, asthma and rhinitis were associated with cardiovascular risk factors and diseases. In particular, CB shared with cardiovascular diseases almost all risk factors and was strongly associated with a higher risk of heart disorders and intermittent claudication.
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Affiliation(s)
- Marcello Ferrari
- Department of Medicine, Unit of Respiratory Medicine, University of Verona, Verona, Italy
| | - Elia Piccinno
- Department of Medicine, Unit of Respiratory Medicine, University of Verona, Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- * E-mail:
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Pietro Pirina
- Unità Operativa di Pneumologia, Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy
| | - Salvatore Battaglia
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro"(PROMISE), Università di Palermo, Palermo, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Leonardo Antonicelli
- Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giancarlo Pesce
- Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM UMR-S 1136, Paris, France
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9
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Nakamura S, Tsunoda S, Sakaida H, Masuda S, Said AS, Takeuchi K. Analysis of factors associated with cedar pollen sensitization and development of pollinosis in a young Japanese adult population. Allergol Int 2019; 68:39-45. [PMID: 29908674 DOI: 10.1016/j.alit.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/02/2018] [Accepted: 05/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Genetic and environmental factors are proposed to be involved in cedar pollen allergy sensitization and onset. The impact of these factors will provide key information for the prevention of cedar pollen sensitization and allergy onset, which we investigated in this cross-sectional study. METHODS Subjects were 382 young adult volunteers who completed a self-administered questionnaire on self-reported subjective symptoms of pollinosis, physician-diagnosed pollinosis, and background factors. We also measured their serum IgE antibody titers specific for cedar, cypress, and mites. Factors associated with subjective symptoms, physician diagnosis, and the three specific antigens were determined using both univariate and multivariate analyses. RESULTS Sensitization to cedar, cypress, and mites, defined as specific IgE levels of class 1 or above, was found in 78.8%, 64.4%, and 56.0% of subjects, respectively. The prevalence of cedar pollinosis was 41.2% based on subjective symptoms and 22.2% based on physician diagnosis. Factors associated with increased cedar pollen sensitization were mite sensitization, comorbid allergic rhinitis, and family history of cedar pollinosis. Risk-reducing factors for cedar pollen sensitization were keeping a cat, number of common colds, and hours of sleep. Risk-increasing factors for both subjective pollinosis symptoms and physician-diagnosed pollinosis were comorbid allergic rhinitis and family history of cedar pollinosis. CONCLUSIONS Sensitization to cedar pollen in this population was extremely high. Both common and distinct factors were associated with sensitization to pollen and with the development of pollinosis. The distinct factors were associated with sensitization to cedar and cypress antigens.
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10
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Terada T, Kawata R. Early Intervention is Important to Prevent Sensitization to New Allergens. Med Sci (Basel) 2018; 6:E114. [PMID: 30545018 PMCID: PMC6313720 DOI: 10.3390/medsci6040114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022] Open
Abstract
We review current management for allergic rhinitis and possible new treatments for this condition. Management of allergic rhinitis includes promotion of protective factors, avoidance of allergens, and possibly immunotherapy. In recent years, the incidence of allergic rhinitis has increased in many countries. Early intervention at different stages is an important part of management. Allergic disease in infants has been described as the allergic march, commencing with atopic dermatitis accompanied by infantile asthma and progressing to perennial allergic rhinitis induced by house dust mite allergy. In order to prevent polysensitization, allergen-specific immunotherapy should probably be initiated at an earlier age, especially in children with rhinitis who show monosensitization to house dust mite antigens.
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Affiliation(s)
- Tetsuya Terada
- Department of Otolaryngology, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan.
| | - Ryo Kawata
- Department of Otolaryngology, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka 569-8686, Japan.
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11
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Yii ACA, Tay T, Choo XN, Koh MSY, Tee AKH, Wang D. Precision medicine in united airways disease: A "treatable traits" approach. Allergy 2018; 73:1964-1978. [PMID: 29869791 DOI: 10.1111/all.13496] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.
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Affiliation(s)
- A. C. A. Yii
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - T.‐R. Tay
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - X. N. Choo
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - M. S. Y. Koh
- Department of Respiratory and Critical Care Medicine Singapore General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - A. K. H. Tee
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - D.‐Y. Wang
- Department of Otolaryngology National University of Singapore Singapore
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12
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Calabrese C, Costigliola A, Maffei M, Simeon V, Perna F, Tremante E, Merola E, Leone CA, Bianco A. Clinical impact of nasal budesonide treatment on COPD patients with coexistent rhinitis. Int J Chron Obstruct Pulmon Dis 2018; 13:2025-2032. [PMID: 29988687 PMCID: PMC6029594 DOI: 10.2147/copd.s165857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background A high percentage of patients with COPD report chronic nasal symptoms. The study aims to evaluate the clinical impact of a 2-month treatment with inhaled nasal budesonide (100 µg per nostril twice daily) in patients affected by COPD with chronic rhinitis comorbidity. Patients and methods Fifty-three stable COPD patients in therapy according to the Global initiative for chronic Obstructive Lung Disease recommendations were enrolled; 49 completed the study. At enrollment (visit 0), patients underwent skin prick test and rhinoscopy. At visit 0 and after 1 month (visit 1) and 2 months (visit 2) of therapy with nasal budesonide, patients underwent spirometry, and COPD assessment test (CAT), Sinonasal Outcome Test (SNOT 22), and modified Medical Research Council dyspnea scale were administered. Differences in continuous variables, after 2 months of treatment with nasal budesonide, were evaluated using a paired t-test or Wilcoxon matched-pairs signed-ranks test. Results Two months of treatment with nasal budesonide showed a significant statistical improvement in the total scores of CAT, SNOT 22, and modified Medical Research Council (p<0.001). A significant relationship between CAT and SNOT 22 total scores at baseline and after treatment was observed. Conclusion The results of the present study indicate the importance of careful evaluation of the presence of chronic nasal symptoms in all COPD patients and suggest beneficial clinical effect from treatment with nasal budesonide in terms of COPD symptoms and quality of life.
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Affiliation(s)
- Cecilia Calabrese
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
| | - Adriano Costigliola
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
| | - Marianna Maffei
- Ear Nose and Throat Unit and Neck Surgery, Monaldi Hospital, Naples, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Perna
- Department of Clinical Medicine and Surgery, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Eugenio Tremante
- Ear Nose and Throat Unit and Neck Surgery, Monaldi Hospital, Naples, Italy
| | - Elena Merola
- Bronchoscopic Unit, Public Hospital, Eboli, Italy
| | | | - Andrea Bianco
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
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13
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Abstract
PURPOSE OF REVIEW The article reviews the most recent literature on the association between secondhand tobacco smoke exposure and rhinitis. The discussion will focus on the biologic links between tobacco exposure and rhinitis symptoms, evaluating this relationship in different populations. RECENT FINDINGS Significant associations between tobacco smoke exposure and rhinitis symptoms have been identified in US children and adults. This association is not just a US public health concern, as similar analyses have also recently been performed in other populations. Although pediatric data show a significant trend to greater prevalence of rhinitis with greater levels of secondhand smoke exposure, the adult data on secondhand smoke exposure are less consistent. The exact biological mechanism for these associations is likely multifactorial, but does not appear to be driven by an allergic, IgE-mediated reaction. SUMMARY The associations between secondhand tobacco smoke exposure and various upper respiratory inflammatory conditions, including rhinitis, have been observed. The causative biologic mechanisms, however, remain elusive and are a likely target for future research. At this point, evidence points toward nonallergic inflammation as the most likely mechanism. Clearly, further research is necessary before this mechanism is fully established.
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14
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Hoffmans R, Wagemakers A, van Drunen C, Hellings P, Fokkens W. Acute and chronic rhinosinusitis and allergic rhinitis in relation to comorbidity, ethnicity and environment. PLoS One 2018; 13:e0192330. [PMID: 29401486 PMCID: PMC5798836 DOI: 10.1371/journal.pone.0192330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background This study was conducted to assess the effect of comorbidity, ethnicity, occupation, smoking and place of residence on allergic rhinitis (AR), acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS). Methods A GA2LEN (The Global Allergy and Asthma European Network) screening questionnaire was sent to a random sample of the Dutch population (n = 16700) in three different areas of the Netherlands. Results Fifty percent (8347) of the questionnaires sent were returned. A total of 29% respondents (27–31% in different areas) met the criteria for AR, 18% (17–21%) for ARS and 16% (13–18%) for CRS. Risk factors for AR were itchy rash, eczema, adverse response after taking a painkiller, asthma, CRS and ARS. Moreover, the risk of AR was twice as low for full-time housewives/househusbands than for people with jobs. The risk of ARS or CRS was significantly higher in respondents with a doctor’s diagnosis of CRS, AR, itchy rash or smoking. The risk of CRS was also significantly higher in respondents with an adverse response after taking painkillers, active smoking or asthma. Caucasians are generally less likely to have AR or CRS than Latin-Americans, Hindustani and African-Creoles, and more likely to have ARS than Asian, Hindustani, Mediterranean and African-Creoles. Conclusions This study found shared and distinct risk factors for AR, ARS and CRS and therefore provides support for the belief that they have shared symptoms but are different diseases with different aetiologies.
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Affiliation(s)
- Ruth Hoffmans
- Academic Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | | | | | - Peter Hellings
- Academic Medical Centre, Amsterdam, The Netherlands
- UZ Leuven, Leuven, Belgium
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15
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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16
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Hellings PW, Klimek L, Cingi C, Agache I, Akdis C, Bachert C, Bousquet J, Demoly P, Gevaert P, Hox V, Hupin C, Kalogjera L, Manole F, Mösges R, Mullol J, Muluk NB, Muraro A, Papadopoulos N, Pawankar R, Rondon C, Rudenko M, Seys SF, Toskala E, Van Gerven L, Zhang L, Zhang N, Fokkens WJ. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2017; 72:1657-1665. [PMID: 28474799 DOI: 10.1111/all.13200] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 12/11/2022]
Abstract
This EAACI position paper aims at providing a state-of-the-art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug-induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called "entopy" or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research.
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Affiliation(s)
- P. W. Hellings
- Clinical division of Otorhinolaryngology Head & Neck Surgery University Hospitals Leuven Leuven Belgium
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - L. Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - C. Cingi
- Department of Otorhinolaryngology Head and Neck Surgery University of Eskisehir Osmangazi Eskisehir Turkey
| | - I. Agache
- Department of Allergy and Clinical Immunology Transylvania University Brasov Romania
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research Christine Kuhne-Center for Allergy Research and Education University of Zurich Davos Switzerland
| | - C. Bachert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - J. Bousquet
- Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
| | - P. Demoly
- Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
| | - P. Gevaert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - V. Hox
- Service d'ORL Cliniques Universitaires St-Luc Brussels Belgium
| | - C. Hupin
- Service d'ORL Cliniques Universitaires St-Luc Brussels Belgium
- Institut de Recherche Expérimentale et Clinique (IREC) Pole de Pneumologie, ORL & Dermatologie Université catholique de Louvain (UCL) Brussels Belgium
| | - L. Kalogjera
- Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Sestre milosrdnice Zagreb Croatia
| | - F. Manole
- ENT Department Faculty of Medicine University of Oradea Oradea Romania
| | - R. Mösges
- Institute of Medical Statistics, Informatics, and Epidemiology Medical Faculty University of Köln Cologne Germany
| | - J. Mullol
- Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia Hospital Clínic Barcelona Catalonia Spain
| | - N. B. Muluk
- ENT Department Faculty of Medicine Kirikkale University Kirikkale Turkey
| | - A. Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region Department of Mother and Child Health University of Padua Padua Italy
| | - N. Papadopoulos
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
- University of Manchestter Manchester UK
| | | | - C. Rondon
- Allergy Service Carlos Haya Hospital Malaga Spain
| | - M. Rudenko
- London Allergyology and Immunology Center London UK
| | - S. F. Seys
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - E. Toskala
- Department of Otorhinolaryngology-Head and Neck Surgery Temple University Philadelphia USA
| | - L. Van Gerven
- Clinical division of Otorhinolaryngology Head & Neck Surgery University Hospitals Leuven Leuven Belgium
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - L. Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing Tongren Hospital Capital Medical University Beijing China
| | - N. Zhang
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology Head & Neck Surgery Academic Medical Centre (AMC) Amsterdam The Netherlands
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Thomson NC. Asthma and smoking-induced airway disease without spirometric COPD. Eur Respir J 2017; 49:49/5/1602061. [PMID: 28461294 DOI: 10.1183/13993003.02061-2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
Abstract
Due to the high prevalence rates of cigarette smoking and asthma, current and ex-smokers frequently develop chronic airway disease without spirometric evidence of chronic obstructive pulmonary disease (COPD), either alone or associated with asthma. This review considers the classification, clinical outcomes, inflammatory and imaging variables, phenotypes, and management of current and ex-smokers with airway disease without COPD, focusing on overlaps in those with and without asthma. These individuals have more respiratory symptoms, worse quality of life, increased exacerbation rates, reduced lung function and more comorbidities than never-smokers with asthma or healthy never-smokers. As well as clinical features, airway inflammatory and structural changes in smoking-induced airway disease without COPD overlap with those found in smokers with asthma. Cigarette smoking is associated with worse clinical outcomes in some phenotypes of asthma. Management involves public health measures to control exposure to tobacco smoke, personal advice on smoking cessation and the use of appropriate targeted therapies, although evidence is limited on their effectiveness. Understanding the mechanisms, natural history and management of current and ex-smokers with asthma and smoking-induced airway disease without COPD is a priority for future research.
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Affiliation(s)
- Neil C Thomson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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18
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Roth-Walter F, Bergmayr C, Meitz S, Buchleitner S, Stremnitzer C, Fazekas J, Moskovskich A, Müller MA, Roth GA, Manzano-Szalai K, Dvorak Z, Neunkirchner A, Jensen-Jarolim E. Janus-faced Acrolein prevents allergy but accelerates tumor growth by promoting immunoregulatory Foxp3+ cells: Mouse model for passive respiratory exposure. Sci Rep 2017; 7:45067. [PMID: 28332605 PMCID: PMC5362909 DOI: 10.1038/srep45067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/20/2017] [Indexed: 12/30/2022] Open
Abstract
Acrolein, a highly reactive unsaturated aldehyde, is generated in large amounts during smoking and is best known for its genotoxic capacity. Here, we aimed to assess whether acrolein at concentrations relevant for smokers may also exert immunomodulatory effects that could be relevant in allergy or cancer. In a BALB/c allergy model repeated nasal exposure to acrolein abrogated allergen-specific antibody and cytokine formation, and led to a relative accumulation of regulatory T cells in the lungs. Only the acrolein-treated mice were protected from bronchial hyperreactivity as well as from anaphylactic reactions upon challenge with the specific allergen. Moreover, grafted D2F2 tumor cells grew faster and intratumoral Foxp3+ cell accumulation was observed in these mice compared to sham-treated controls. Results from reporter cell lines suggested that acrolein acts via the aryl-hydrocarbon receptor which could be inhibited by resveratrol and 3′-methoxy-4′-nitroflavone Acrolein- stimulation of human PBMCs increased Foxp3+ expression by T cells which could be antagonized by resveratrol. Our mouse and human data thus revealed that acrolein exerts systemic immunosuppression by promoting Foxp3+ regulatory cells. This provides a novel explanation why smokers have a lower allergy, but higher cancer risk.
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Affiliation(s)
- Franziska Roth-Walter
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Cornelia Bergmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Sarah Meitz
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Stefan Buchleitner
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Caroline Stremnitzer
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Judit Fazekas
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Anna Moskovskich
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Mario A Müller
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Georg A Roth
- Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Austria
| | - Krisztina Manzano-Szalai
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Zdenek Dvorak
- Department of Cell Biology and Genetics, Palacky University, Olomouc, Czech Republic
| | - Alina Neunkirchner
- Christian Doppler Laboratory for Immunomodulation, Medical University of Vienna, Vienna, Austria
| | - Erika Jensen-Jarolim
- Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria.,Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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UK prescribing practices as proxy markers of unmet need in allergic rhinitis: a retrospective observational study. NPJ Prim Care Respir Med 2016; 26:16033. [PMID: 27334893 PMCID: PMC4918055 DOI: 10.1038/npjpcrm.2016.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/22/2016] [Indexed: 01/31/2023] Open
Abstract
Little data on UK prescribing patterns and treatment effectiveness for allergic rhinitis (AR) are available. We quantified unmet pharmacologic needs in AR by assessing AR treatment effectiveness based on the prescribing behaviour of UK general practitioners (GP) during two consecutive pollen seasons (2009 and 2010). We conducted a retrospective observational study with the data from the Optimum Patient Care Research Database. We assessed diagnoses and prescription data for patients with a recorded diagnosis of rhinitis who took rhinitis medication during the study period. We assessed the data from 25,069 patients in 2009 and 22,381 patients in 2010. Monotherapy was the initial prescription of the season for 67% of patients with seasonal AR (SAR) and 77% of patients with nonseasonal upper airways disease (NSUAD), for both years. Initial oral antihistamine (OAH) or intranasal corticosteroid (INS) monotherapy proved insufficient for >20% of SAR and >37% of NSUAD patients. Multiple therapy was the initial prescription for 33% of SAR and 23% of NSUAD in both years, rising to 45% and >50% by season end, respectively. For NSUAD, dual-therapy prescriptions doubled and triple-therapy prescriptions almost tripled during both seasons. Many patients revisited their GP regardless of initial prescription. Initial OAH or INS monotherapy provides insufficient symptom control for many AR patients. GPs often prescribe multiple therapies at the start of the season, with co-prescription becoming more common as the season progresses. However, patients prescribed multiple therapies frequently revisit their GP, presumably to adjust treatment. These data suggest the need for more effective AR treatment and management strategies.
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Abramson MJ, Schindler C, Schikowski T, Bircher AJ, Burdet L, Gerbase MW, Imboden M, Rochat T, Schmid-Grendelmeier P, Turk AJ, Zemp E, Künzli N, Probst-Hensch N. Rhinitis in Swiss adults is associated with asthma and early life factors, but not second hand tobacco smoke or obesity. Allergol Int 2016; 65:192-198. [PMID: 26724835 DOI: 10.1016/j.alit.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Second hand tobacco smoke (SHS) and overweight/obesity are risk factors for asthma and lower airway respiratory symptoms. We investigated whether SHS or overweight/obesity were also associated with allergic or non-allergic rhinitis. METHODS Cross-sectional data were obtained during the second SAPALDIA Study. Interviewer administered questionnaires were completed by 8047 participants from 8 communities in Switzerland. Blood was collected from 5841 participants and tested for allergen specific IgE. Allergic rhinitis was defined as nasal symptoms with detectable IgE. Data were analysed by multinomial logistic regression with four outcome categories defined according to the presence or absence of rhinitis and/or atopy. RESULTS The prevalence of allergic rhinitis was 885 (15.2%) and non-allergic rhinitis 323 (5.5%). The risk of allergic rhinitis was increased in subjects with physician diagnosed asthma (Relative Risk Ratio 6.81; 95%CI 5.39, 8.6), maternal atopy (1.56; 1.27, 1.92) and paternal atopy (1.41; 1.11, 1.79). Older subjects were at lower risk (0.96; 0.95,0.97 per year), as were those raised on a farm (0.64; 0.49,0.84), with older siblings (0.92; 0.86,0.97 per sib) or from rural areas. The risk of non-allergic rhinitis was also increased in subjects with physician diagnosed asthma (4.02; 2.86, 5.67), reduced in males (0.59; 0.46, 0.77), but not associated with upbringing on a farm or older siblings. There were no significant associations of SHS or overweight/obesity with either form of rhinitis. CONCLUSIONS Allergic and non-allergic rhinitis have different risk factors apart from asthma. There are significant regional variations within Switzerland, which are not explained by the factors examined.
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Chen YT, Ying YH, Chang K, Hsieh YH. Study of Patients' Willingness to Pay for a Cure of Chronic Obstructive Pulmonary Disease in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13030273. [PMID: 26938547 PMCID: PMC4808936 DOI: 10.3390/ijerph13030273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/29/2016] [Accepted: 02/17/2016] [Indexed: 01/30/2023]
Abstract
Objectives: Chronic Obstructive Pulmonary Disease (COPD) is one of the fastest growing causes of death worldwide. However, few studies, if any, have been conducted that have investigated patient profiles in Asia. This paper analyzes patient willingness to pay (WTP) as a function of patient disease severity, health-related quality of life (HRQL), and smoking behavior in Taiwan. Study Design: A cross-sectional survey was conducted using in-person interviews with COPD patients. A hypothetical scenario was designed and presented to ascertain each subject’s willingness to pay (WTP) for a cure for COPD. Methods: A survey of subjects with COPD was performed in Taiwan. The contingent valuation method (CVM) was employed to measure patient financial burden, which was analyzed along with covariates that included various types of health-related quality of life (HRQL), severity level, and demographic background. Multivariate regression and simulation methods were employed for analysis. Results: A total of 142 subjects were interviewed, with an average annual WTP of approximately $1422 USD (or 42,662.37 NTD, New Taiwan Dollars). The annual WTP for patients 55 years of age or younger, $5709.06, was the highest and equivalent to approximately one-third of Taiwan average annual personal income or quadruple the spending amount of the Taiwan National Bureau of Health Insurance (NBHI) for each COPD patient. Current cigarette smokers were willing to pay a substantially higher amount than former smokers and nonsmokers, which reflects a psychological desire for redemption in COPD patients. Conclusions: The results of this study provide directions for the relevant authorities regarding the alleviation of suffering as a result of COPD. Appropriate health promotion measures, such as measures to reduce tobacco usage, early diagnosis, and active treatment, may be necessary to contain the escalating costs related to COPD and to prevent this epidemic from worsening.
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Affiliation(s)
- Yi-Ting Chen
- Hualien Buddhist Tzu-Chi General Hospital, Hualien City 970, Taiwan.
| | - Yung-Hsiang Ying
- Department of Business Administration, National Taiwan Normal University, Taipei City 106, Taiwan.
| | - Koyin Chang
- Department of Healthcare Information and Management, Ming Chuan University; Taipei City 111, Taiwan.
| | - Ya-Hui Hsieh
- Department of Healthcare Information and Management, Ming Chuan University; Taipei City 111, Taiwan.
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Ng CL, Wang DY. Latest developments in allergic rhinitis in Allergy for clinicians and researchers. Allergy 2015; 70:1521-30. [PMID: 26443244 DOI: 10.1111/all.12782] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 02/06/2023]
Abstract
Research efforts in allergic rhinitis have always been intense. Over the past 3 years, numerous breakthroughs in basic science and clinical research have been made, augmenting our understanding of this condition that afflicts a significant proportion of the global population. New epidemiological findings, novel insights into the molecular and cellular mechanisms of allergy, enhancement of current developmental theories, new concepts of the goals and endpoints of management, and latest therapeutic modalities that includes the harnessing of information technology and big data are some areas where important advances were made. We attempt to bring you a summary of the key research advances made in the field of allergic rhinitis from 2013 to 2015.
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Affiliation(s)
- C. L. Ng
- Department of Otolaryngology; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore City Singapore
| | - D. Y. Wang
- Department of Otolaryngology; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore City Singapore
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Khazaei HA, Khazaei B, Dashtizadeh GA, Mohammadi M. Cigarette Smoking and Skin Prick Test in Patients With Allergic Rhinitis. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2015; 4:e23483. [PMID: 26495257 PMCID: PMC4609504 DOI: 10.5812/ijhrba.23483v2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 02/15/2015] [Accepted: 04/25/2015] [Indexed: 12/16/2022]
Abstract
Background: Allergic Rhinitis (AR) is the most common allergic disease, affecting 30% of population around the world. The disease is predominantly associated with exposure to some aeroallergens like cigarette smoking. Skin Prick Test (SPT) is a method of detecting immediate allergic reactions and is applied for controlling disease and therapeutic modality. Objectives: This study was designed to investigate the effect of cigarette smoking on SPT results among male and female individuals with AR disease. Patients and Methods: A total of 478 patients with AR admitted to the 2 main hospitals of Zahedan City from 2005 to 2012, were recruited in this analytic-descriptive study. Categories of smokers and never smokers were used based on patient’s statements and their history of smoking. SPT was performed with panel of some allergens and results were recorded and analyzed statistically. Odds ratio and confidence interval method were calculated using univariate logistic regression. Results: The results of this study indicated that 41.4% of patients with allergic rhinitis was smoker with ages ranged from 15 to 70 years. The result of this study also showed that smoking has no effect on SPT results of pollen and weeds aeroallergens conducted on male and female AR patients. However, male were significantly more sensitive than female in terms of sensitivity to the aspergillus, cladosporium, house dust mite, grasses, wheat, cockroach, and feather allergens. Conclusions: Our findings did not support the effect of cigarette smoking on SPT reactivity to pollen and weeds aeroallergens. However, male were significantly more sensitive than female in terms of sensitivity to some allergens.
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Affiliation(s)
- Hossein Ali Khazaei
- Department of Immunology and Hematology, Research Center for Clinical Immunology, Ali Ebne Abi Taleb Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Bahman Khazaei
- Ali Ebne Abi Taleb Hospital, Zahedan University of Medical Sciences, Chabahar Branch, Zahedan, IR Iran
- Corresponding author: Bahman Khazaei, Ali Ebne Abi Taleb Hospital, Zahedan University of Medical Sciences, Chabahar Branch, Zahedan, IR Iran. Tel: +98-5433224122, Fax: +98-5433295563, E-mail:
| | - Gholam Ali Dashtizadeh
- Department of ENT, Faculty of Medicine, Ali Ebne Abi Taleb Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mahdi Mohammadi
- Department of Biostatistics and Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
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Lee WH, Hong SN, Kim HJ, Ahn S, Rhee CS, Lee CH, Kim JW. Effects of cigarette smoking on rhinologic diseases: Korean National Health and Nutrition Examination Survey 2008-2011. Int Forum Allergy Rhinol 2015; 5:937-43. [PMID: 26034006 DOI: 10.1002/alr.21553] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several studies have shown a relationship between cigarette smoking and general diseases of the nose in a large Asian population. The current study was conducted to better understand the effect of cigarette smoke exposure on rhinologic diseases in Koreans. METHODS Data were obtained from the 2008-2011 Korea National Health and Nutrition Examination Survey, a cross-sectional survey of the noninstitutionalized population in Korea. Of the 37,753 people surveyed, 11,589 adult participants had completed questionnaires on rhinologic symptoms and smoking behaviors, had undergone nasal endoscopy, and had provided urine collection were enrolled. Rhinologic diseases investigated in this study included subjective olfactory dysfunction, rhinitis symptoms, chronic rhinosinusitis (CRS), and nasal septal deviation with obstructive symptoms. The relationship between disease and cigarette smoking was evaluated using multivariate regression analyses. RESULTS In South Korea, the weighted prevalence of subjective olfactory dysfunction, rhinitis symptoms, CRS, and nasal septal deviation with obstructive symptoms was 4.6%, 27.2%, 6.2%, and 4.0%, respectively. The only disease significantly associated with active smoking was CRS in participants 40 years of age and older after adjusting for age, sex, residency, house income, education, and occupation (adjusted odds ratio = 1.427, 95% confidence interval = 1.050 to 1.938). For each year of active smoking, CRS prevalence increased by 1.5%. None of the rhinologic diseases examined were associated with passive smoking. CONCLUSION Our study showed that CRS seems to be associated with active smoking in older participants. Considering the relatively high prevalence of CRS in Korea, further longitudinal researches for their association and prevention are required.
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Affiliation(s)
- Woo Hyun Lee
- Department of Otolaryngology, National Police Hospital, Seoul, South Korea
| | - Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hong Joong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chul Hee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Pallasaho P, Kainu A, Juusela M, Meren M, Sovijärvi A. High prevalence of rhinitis symptoms without allergic sensitization in Estonia and Finland. Eur Clin Respir J 2015; 2:25401. [PMID: 26557256 PMCID: PMC4629761 DOI: 10.3402/ecrj.v2.25401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 02/27/2015] [Accepted: 03/05/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Allergic rhinitis and atopy are more common in urban than rural environments. Non-allergic rhinitis has not been studied to a great extent. We aimed to assess the relationship of rhinitis symptoms with different profiles of allergic sensitization, comparing this in rural and urban environments. METHODS The study population consisted of population-based cohorts of adults aged 26-60 from Helsinki, Finland, and rural Saaremaa and urban Tallinn, Estonia. We compared the results of a structured interview and skin prick tests and assessed the risk factors for rhinitis. RESULTS The prevalence of rhinitis symptoms with atopy was 32.7% in Helsinki, 20.8% in Tallinn, and 12.5% in Saaremaa (p<0.001). Rhinitis symptoms without atopy were found in 26.4%, 29.8%, and 29.3% (p=n.s.), respectively. In Helsinki, 87.3% of participants with atopy identified symptoms as allergic, compared to 57.0% in Tallinn and 47.5% in Saaremaa. Childhood in the countryside (OR 0.63), family history of allergic rhinitis (OR 1.89), and polysensitization (OR 15.99) were significantly associated with rhinitis symptoms with atopy in a multivariate logistic regression model. The most common sensitizers were pollens and animals in Helsinki and mites in Estonia. Exposure to environmental tobacco smoke (OR 1.50) and family history of allergic rhinitis (OR 1.70) were associated with rhinitis symptoms without atopy. CONCLUSION Rhinitis symptoms without allergic sensitization were common in both Finland and Estonia and were associated with environmental tobacco smoke. Family history of allergic rhinitis predisposed to rhinitis symptoms irrespective of atopy status.
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Affiliation(s)
| | - Annette Kainu
- HUCH Heart and Lung Center, Peijas Hospital, Helsinki, Finland ; University of Helsinki and Helsinki University Central Hospital, Vantaa, Finland
| | - Maria Juusela
- Division of Clinical Physiology and Nuclear Medicine, Laboratory Department, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
| | - Mari Meren
- Department of Pulmonology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Anssi Sovijärvi
- Department of Clinical Physiology and Nuclear Medicine, HUCH Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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Hox V, Maes T, Huvenne W, Van Drunen C, Vanoirbeek JA, Joos G, Bachert C, Fokkens W, Ceuppens JL, Nemery B, Hellings PW. A chest physician's guide to mechanisms of sinonasal disease. Thorax 2015; 70:353-8. [DOI: 10.1136/thoraxjnl-2014-205520] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Association between Disease-Specific Quality of Life and Complementary Medicine Use in Patients with Rhinitis in Taiwan: A Cross-Sectional Survey Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:958524. [PMID: 25530792 PMCID: PMC4228815 DOI: 10.1155/2014/958524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/28/2014] [Accepted: 08/13/2014] [Indexed: 01/26/2023]
Abstract
Rhinitis is a common medical condition and can seriously impact patients' quality of life. The objective of this study was to investigate the association between disease-specific quality of life and use of complementary and alternative medicine (CAM) modalities among Taiwanese rhinitis patients. A cross-sectional survey was undertaken at the outpatient department of otolaryngology in a medical center in Taiwan. Sociodemographic information, disease-specific quality of life (Chinese version of the 31-item Rhinosinusitis Outcome Measure, CRSOM-31), and previous use of CAM modalities for treatment of rhinitis of the patients were ascertained. Factor analysis was performed to reduce the number of CAM modalities. The resulting factors were analyzed for their association with CRSOM-31 score using linear regression analyses. Results from the multiple linear regression analyses indicated that Factor 1 (traditional Chinese medicine), Factor 2 (mind-body modalities), Factor 3 (manipulative-based modalities), female sex, and smoking were significantly associated with a worse disease-specific quality of life. In conclusion, various CAM modalities, female sex, and smoking were independent predictors of a worse disease-specific quality of life in Taiwanese patients with rhinitis.
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Hemminki K, Försti A, Fallah M, Sundquist J, Sundquist K, Ji J. Risk of cancer in patients with medically diagnosed hay fever or allergic rhinitis. Int J Cancer 2014; 135:2397-403. [DOI: 10.1002/ijc.28873] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology; German Cancer Research Center (DKFZ); Heidelberg Germany
- Center for Primary Health Care Research; Lund University; Malmö Sweden
| | - Asta Försti
- Division of Molecular Genetic Epidemiology; German Cancer Research Center (DKFZ); Heidelberg Germany
- Center for Primary Health Care Research; Lund University; Malmö Sweden
| | - Mahdi Fallah
- Division of Molecular Genetic Epidemiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Jan Sundquist
- Center for Primary Health Care Research; Lund University; Malmö Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine; Stanford CA
| | - Kristina Sundquist
- Center for Primary Health Care Research; Lund University; Malmö Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine; Stanford CA
| | - Jianguang Ji
- Center for Primary Health Care Research; Lund University; Malmö Sweden
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Assanasen P, Choochurn P, Banhiran W, Bunnag C. Radiofrequency inferior turbinate reduction improves smell ability of patients with chronic rhinitis and inferior turbinate hypertrophy. ALLERGY & RHINOLOGY 2014; 5:12-6. [PMID: 24612902 PMCID: PMC4019738 DOI: 10.2500/ar.2014.5.0077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Radiofrequency inferior turbinate reduction (RFITR) of inferior turbinate hypertrophy (ITH) is an effective way to treat patients with intractable nasal mucosal obstruction. The objective of this study was to assess smell ability, nasal symptoms, inferior turbinate grading (ITG), peak nasal inspiratory flow (PNIF) of patients with chronic rhinitis (CR), and ITH before and after RFITR. Patients with CR and ITH, aged 18–60 years, who underwent RFITR, were prospectively recruited. Smell ability (measured by smell detection threshold [SDT]), visual analog scale (VAS) of nasal symptoms, ITG, and PNIF before and 6–10 weeks after RFITR were compared. Forty-eight subjects were included. All nasal symptoms were significantly decreased after RFITR. After surgery, SDT (tested by phenyl ethyl alcohol) was worsened in 7 patients (14.6%), improved in 8 patients (16.7%), and did not change in 33 patients (68.7%). SDT after RFITR of six patients in the worsened SDT group were still within normal range (> −6.5). There was only one patient whose SDT changed from normosmia to mild hyposmia (−7.25 to −5.38). In the improved SDT group, two of eight patients had obviously better SDT after RFITR, which changed from moderate hyposmia to normosmia (−3.65 to −10; −3.73 to −10), whereas six of eight patients had little better SDT after RFITR. RFITR also significantly reduced ITG and improved PNIF. In conclusion, the treatment of patients with CR and ITH with RFITR significantly improved PNIF, ITG, and nasal symptoms assessed by VAS, although SDT after RFITR could be the same or improved or worsened.
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Affiliation(s)
- Paraya Assanasen
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Backman H, Hedman L, Jansson SA, Lindberg A, Lundbäck B, Rönmark E. Prevalence trends in respiratory symptoms and asthma in relation to smoking - two cross-sectional studies ten years apart among adults in northern Sweden. World Allergy Organ J 2014; 7:1. [PMID: 24383710 PMCID: PMC3929247 DOI: 10.1186/1939-4551-7-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/17/2013] [Indexed: 02/03/2023] Open
Abstract
Background Smoking is considered to be the single most important preventable risk factor for respiratory symptoms. Estimating prevalence of respiratory symptoms is important since they most often precede a diagnosis of an obstructive airway disease, which places a major burden on the society. The aim of this study was to estimate prevalence trends of respiratory symptoms and asthma among Swedish adults, in relation to smoking habits. A further aim was to estimate the proportion of respiratory symptom and asthma prevalence attributable to smoking. Methods Data from two large-scale cross-sectional surveys among adults performed in northern Sweden in 1996 and 2006 were analysed. Identical methods and the same questionnaire were used in both surveys. The association between smoking, respiratory symptoms and asthma was analysed with multiple logistic regression analyses. Changes in prevalence of respiratory symptoms and asthma from 1996 to 2006 were expressed as odds ratios. Additionally, the population attributable risks of smoking were estimated. Results The prevalence of most respiratory symptoms decreased significantly from 1996 to 2006. Longstanding cough decreased from 12.4 to 10.1%, sputum production from 19.0 to 15.0%, chronic productive cough from 7.3 to 6.2%, and recurrent wheeze from 13.4 to 12.0%. Any wheeze and asthmatic wheeze remained unchanged. This parallels to a decrease in smoking from 27.4 to 19.1%. In contrast, physician-diagnosed asthma increased from 9.4 to 11.6%. The patterns were similar after correction for confounders. All respiratory symptoms were highly associated with smoking, and the proportion of respiratory symptoms in the population attributed to smoking (PAR) ranged from 9.8 to 25.5%. In 2006, PAR of smoking was highest for recurrent wheeze (20.6%). Conclusions In conclusion, we found that respiratory symptoms, in particular symptoms common in bronchitis, decreased among adults in northern Sweden, parallel to a decrease in smoking from 1996 to 2006. In contrast, the prevalence of physician-diagnosed asthma increased during the same time-period. Up to one fourth of the respiratory symptom prevalence in the population was attributable to smoking.
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Affiliation(s)
- Helena Backman
- The OLIN Studies, Department of Research and Development, Norrbotten County Council, Luleå, Sweden.
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Caillaud D, Chanez P, Escamilla R, Burgel PR, Court-Fortune I, Nesme-Meyer P, Deslee G, Perez T, Pinet C, Roche N. Association of chronic nasal symptoms with dyspnoea and quality-of-life impairment in chronic obstructive pulmonary disease. Respirology 2013; 19:346-52. [PMID: 24330257 DOI: 10.1111/resp.12224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/25/2013] [Accepted: 10/06/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Previous studies suggested that chronic nasal symptoms (CNS) are frequent in chronic obstructive pulmonary disease (COPD) subjects, but their contribution to dyspnoea and quality-of-life (QoL) impairment is not clearly established. METHODS Data from the French COPD cohort 'Initiatives bronchopneumopathie chronique obstructive' were analyzed to assess the frequency of CNS (rhinorrhea, obstruction, anosmia) in COPD patients and analyze their impact and associated risk factors. Univariate and multivariate analyses were performed to assess the relationship between CNS with sociodemographic and anthropometric characteristics, risk factors, respiratory symptoms, spirometry, QoL (Saint George's respiratory questionnaire (SGRQ)), dyspnoea (modified Medical Research Council (mMRC) scale), mood disorders (Hospital Anxiety and Depression Scale (HADS)), number of exacerbations and comorbid conditions. RESULTS CNS were reported by 115 of 274 COPD subjects (42%). Among them, rhinorrhea and nasal obstruction were reported by 62% and 43%, respectively. In multivariate analysis, COPD patients with CNS had higher SGRQ total scores, corresponding to worse QoL (P = 0.01), while no independent association was found with exacerbations, lung function and HADS. Among SGRQ domains, an independent association was found with the activity score (P = 0.007). When SGRQ score was forced out of the model to avoid redundancy, mMRC score was independently associated with CNS (P = 0.01). Among risk factors, cumulative smoking, hay fever and atopic dermatitis but not occupational exposures were independently associated with CNS. CONCLUSIONS In this group of COPD subjects, CNS were frequently observed and associated with dyspnoea and poorer QoL. CNS should be systematically assessed and could be a potential target in the management of COPD.
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Affiliation(s)
- Denis Caillaud
- Pulmonary Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
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Factors Associated with the Use of Different Treatment Modalities among Patients with Upper Airway Diseases in Taiwan: A Cross-Sectional Survey Study. J Allergy (Cairo) 2013; 2013:720879. [PMID: 24089619 PMCID: PMC3782124 DOI: 10.1155/2013/720879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 11/21/2022] Open
Abstract
Rhinitis is a common upper airway disease and can have great impact on patients' quality of life. Factors associated with the use of common treatment modalities among 279 Taiwanese rhinitis patients from the outpatient department of otolaryngology in a medical center were investigated using a cross-sectional survey study. Results from multiple logistic regression analysis, adjusted for etiologies of rhinitis, revealed that males were associated with surgical intervention (OR = 2.11, P = 0.009). Lower educational level was associated with oral (OR = 2.31, P = 0.024) and topical medications (OR = 2.50, P = 0.005). Poor or fair general health status was associated with topical medications (OR = 4.47, P = 0.001), whereas very good or excellent general health status was inversely associated with surgical intervention (OR = 0.32, P = 0.002). Smoking was associated with the use of nasal irrigation (OR = 2.72, P = 0.003). Worse disease-specific quality of life was associated with oral medications (OR = 2.46, P = 0.010) and traditional Chinese medicine (OR = 5.43, P < 0.001). In conclusion, the use of different treatment modalities for rhinitis was associated with different combinations of independent factors.
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