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Araújo BCL, de Melo Lima TRC, de Gois-Santos VT, Nascimento GKBO, Martins-Filho PR, de Magalhães Simões S. Comparative analysis of masseter muscle electrical activity by nasal patency in children with rhinitis and asthma: a pilot observational study. Eur Arch Otorhinolaryngol 2024; 281:2733-2738. [PMID: 38418553 DOI: 10.1007/s00405-024-08482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 03/01/2024]
Abstract
PURPOSE This pilot cross-sectional study aimed to evaluate differences in electromyographic activity patterns of the masseter muscle according to the nasal patency in children with rhinitis and asthma. METHODS The study included 43 children aged 5-14 years with rhinitis and/or asthma. Patients underwent peak nasal inspiratory flow (PNIF) measurement to assess nasal patency, and electromyographic evaluation of the right and left masseter muscles during chewing and at rest. Electromyographic activity patterns according to nasal patency were compared using the Mann-Whitney test, and effect sizes were measured using the Glass rank biserial (rb) correlation. A p-value of < 0.05 was considered statistically significant. RESULTS No significant differences in electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing were found between the groups. However, we found that patients with low nasal patency had a median electric activity of the right masseter muscle during maximum contraction of 60.53 (51.74-72.43), while those with adequate nasal patency had a median of 77.40 (56.71-88.45). Although the difference in myoelectric activity between the groups did not reach statistical significance (p = 0.061) at the adopted significance level of 5%, the size of the difference between groups were considered moderate (rb = 0.338) and a potential association between nasal patency and the muscular function of the masseter muscle could be suggested. CONCLUSION The study found no differences in the electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing among children with rhinitis and asthma based on nasal patency. Further research with larger sample sizes is needed to validate these findings and gain a better understanding of the impact of nasal patency on the muscular function of the masseter muscle.
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Affiliation(s)
- Brenda Carla Lima Araújo
- Department of Speech Therapy, Pós-Graduação em Ciências da Saúde, Federal University of Sergipe-UFS, Rua Cláudio Batista, S/N. Bairro Sanatório, Aracaju, Sergipe, 49060-100, Brazil.
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
| | - Thales Rafael Correia de Melo Lima
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Vanessa Tavares de Gois-Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Gerlane Karla Bezerra Oliveira Nascimento
- Department of Speech Therapy, Pós-Graduação em Ciências da Saúde, Federal University of Sergipe-UFS, Rua Cláudio Batista, S/N. Bairro Sanatório, Aracaju, Sergipe, 49060-100, Brazil
| | - Paulo Ricardo Martins-Filho
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Applied Health Sciences Program, Federal University of Sergipe, Lagarto, Brazil
| | - Silvia de Magalhães Simões
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Acevedo-Prado A, Seoane-Pillado T, López-Silvarrey-Varela A, Salgado FJ, Cruz MJ, Faraldo-Garcia A, Nieto-Fontarigo JJ, Pértega-Díaz S, Sanchez-Lastres J, San-José-González MA, Bamonde-Rodríguez L, Garnelo-Suárez L, Pérez-Castro T, Sampedro-Campos M, Gonzalez-Barcala FJ. Association of rhinitis with asthma prevalence and severity. Sci Rep 2022; 12:6389. [PMID: 35430600 PMCID: PMC9013347 DOI: 10.1038/s41598-022-10448-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Asthma and rhinitis often co-exist in the same patient. Although some authors observed a higher prevalence and/or greater severity of asthma in patients with rhinitis, this view is not homogeneous and the debate continues. The aim of our study is to describe the prevalence of rhinitis in children and adolescents and to analyse their relationship with the prevalence of asthma. A multicentre study was conducted using the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC). The target population of the study was all those school children aged 6–7 and 13–14 years from 6 of the main health catchment areas of Galicia (1.9 million inhabitants). The schools required were randomly selected, and all children in the targeted age ranges were included. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) between asthma symptoms of the schoolchildren and rhinitis prevalence. The results were adjusted for parental smoking habits, maternal education level, cat and dog exposure, and obesity. A total of 21,420 valid questionnaires were finally obtained. Rhinitis was associated with a significant increase in the prevalence of asthma in both age groups. The highest OR were 11.375 for exercise induced asthma (EIA) for children with recent rhinoconjunctivitis and 9.807 for children with recent rhinitis in 6–7 years old group. The prevalence OR’s are higher in EIA and severe asthmatics. Rhinitis in children and adolescents is associated with a higher prevalence and severity of asthma.
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Arslan E, Tulaci KG, Canakci H, Arslan S, Yazici H. Evaluation of the intranasal steroid treatment outcomes in adenoid tissue hypertrophy with or without allergic rhinitis. Am J Otolaryngol 2021; 42:102983. [PMID: 33610082 DOI: 10.1016/j.amjoto.2021.102983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the intranasal steroid (INS) treatment outcomes in patients with adenoid tissue hypertrophy (ATH) with or without allergic rhinitis (AR). MATERIALS AND METHODS Medical records of 96 children diagnosed with ATH were retrospectively examined. The pediatric version of the Score for Allergic Rhinitis (SFAR) questionnaire was used to determine the AR status of the patients and classify them. The children were divided into two groups based on the questionnaire: Group 1, low probability of AR (SFAR<9); and Group 2, high probability of AR (SFAR≥9). Intranasal mometasone furoate (100 μg/mL) was used to treat ATH for at least 3 months. The severity of nasal obstruction and snoring was evaluated using the visual analog scale (VAS) score, the adenoid/choana (A/C) ratios before and after treatment were compared, and the rate of patient referral to surgery was recorded among groups. RESULTS The change in the A/C ratio within the group between before and after treatment was significant (both P < 0.001). However, the reduction in the adenoid size was more significant in Group 1 than in Group 2 (P = 0.025). A significant improvement in the VAS scores was observed between before and after treatment in both groups (P < 0.001). Furthermore, the rate of surgical referral of Group 1 was significantly lower than that of Group 2 (P = 0.035). CONCLUSIONS INS treatment was found more successful for reducing A/C ratio in ATH without AR. Related with this, when considering the INS treatment for ATH, AR status should be kept in mind for predicting the treatment success.
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Association between nasal patency and orofacial myofunctional changes in patients with asthma and rhinitis. Eur Arch Otorhinolaryngol 2021; 278:2371-2377. [PMID: 33389007 DOI: 10.1007/s00405-020-06518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To verify the association between orofacial myofunctional changes and nasal patency. METHOD Observational study of 43 children and adolescents with asthma and/or rhinitis, aged between 5 and 14 years, from May 2017 to September 2019. Patients underwent peak nasal inspiratory flow (PNIF) for nasal patency assessment and orofacial myofunctional assessment. Clinical data were obtained from an interview on the day of the patients' medical evaluation. The relationship between orofacial myofunctional changes and PNIF was analyzed using a logistic regression model. Estimates were reported as odds ratio (OR) and 95% confidence interval (95%CI). We evaluated multicollinearity using the variance inflation factor and analyzed the adjusted fit with the Akaike information criterion and McFadden's R2 metric; p value < 0.05 was considered statistically significant. RESULTS Inadequate positioning of the mandible (OR = 11.22; 95%CI 1.83-69; p = 0.009) and the presence of tension in the facial muscles during the swallowing of liquid (OR = 4.61; 95%CI 1.31-16.20; p = 0.017) were associated with altered PNIF in children and adolescents with asthma and rhinitis. CONCLUSION Children and adolescents with asthma and rhinitis along with reduced nasal patency presented orofacial myofunctional changes, such as inadequate positioning of the jaw and the presence of tension in the facial muscles during swallowing of liquid.
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Loo EXL, Liew TM, Yap GC, Wong LSY, Shek LPC, Goh A, Van Bever HPS, Teoh OH, Yap F, Tan KH, Thomas B, Ramamurthy MB, Goh DYT, Eriksson JG, Chong YS, Godfrey KM, Lee BW, Tham EH. Trajectories of early-onset rhinitis in the Singapore GUSTO mother-offspring cohort. Clin Exp Allergy 2020; 51:419-429. [PMID: 33278848 DOI: 10.1111/cea.13803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/11/2020] [Accepted: 11/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The natural history of childhood rhinitis is not well described. OBJECTIVE This study aimed to identify different rhinitis trajectories in early childhood and their predictors and allergic associations. METHODS Rhinitis symptoms were ascertained prospectively from birth until 6 years using standardized questionnaires in 772 participants. Rhinitis was defined as one or more episodes of sneezing, runny and/or blocked nose >2 weeks duration. Latent trajectories were identified using group-based modelling, and their predictive risk factors and allergic associations were examined. RESULTS Three rhinitis trajectory groups were identified: 7.6% (n = 59) were termed early transient rhinitis, 8.6% (n = 66) late transient rhinitis, and 6.6% (n = 51) persistent rhinitis. The remaining 77.2% (n = 596) were classified as non-rhinitis/reference group. Early transient rhinitis subjects were more likely of Indian ethnicity, had siblings, reported childcare attendance, early wheezing and eczema in the first 3 years of life. Late transient rhinitis was associated with antenatal exposure to smoking, higher maternal education levels, and wheezing at age 36-72 months. Persistent rhinitis was associated with male gender, paternal and maternal history of atopy, eczema, and house dust mite sensitization. CONCLUSIONS & CLINICAL RELEVANCE Risk factors for early transient rhinitis involve a combination of genetic and early environmental exposures, whereas late transient rhinitis may relate to maternal factors and early respiratory infections independent of atopy. In contrast, persistent rhinitis is strongly associated with atopic risk and likely represents the typical trajectory associated with allergic disorders. Allergic rhinitis symptoms may commence as early as the first year of life and may inform development of early interventive strategies.
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Affiliation(s)
- Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore, Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gaik Chin Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lydia Su Yin Wong
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Anne Goh
- Department of Paediatric Allergy and Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hugo P S Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Oon Hoe Teoh
- Department of Paediatric Allergy and Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Fabian Yap
- Department of Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal and Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Biju Thomas
- Department of Paediatric Allergy and Respiratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mahesh Babu Ramamurthy
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore, Singapore, Singapore.,Department of Obstetrics & Gynaecology, National University of Singapore, Singapore, Singapore.,University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore, Singapore, Singapore.,Department of Obstetrics & Gynaecology, National University of Singapore, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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Schoettler N, Strek ME. Recent Advances in Severe Asthma: From Phenotypes to Personalized Medicine. Chest 2019; 157:516-528. [PMID: 31678077 DOI: 10.1016/j.chest.2019.10.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/15/2019] [Accepted: 10/18/2019] [Indexed: 12/31/2022] Open
Abstract
This review focuses on recent clinical and translational discoveries in severe and uncontrolled asthma that now enable phenotyping and personalized therapies in these patients. Although asthma is common in both children and adults and typically responds to standard therapies, a subset of individuals with asthma experience severe and/or persistent symptoms despite appropriate therapies. Airflow obstruction leading to frequent symptoms requiring higher levels of controller therapy is the cardinal feature of severe asthma, but the underlying molecular mechanisms, or endotypes, are diverse and variable between individuals. Two major risk factors that contribute to severe asthma are genetics and environmental exposures that modulate immune responses, and although these often interact in complex manners that are not fully understood, certain endotypes converge in severe asthma. A number of studies have evaluated various features of patients with severe asthma and classified patients into phenotypes with clinical relevance. This phenotyping is now incorporated into clinical practice and can be used to guide advanced biological therapies that target specific molecules and inflammatory pathways that contribute to asthma pathogenesis.
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Affiliation(s)
- Nathan Schoettler
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
| | - Mary E Strek
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
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Wadden D, Farrell J, Smith MJ, Twells LK, Gao Z. Maternal history of asthma modifies the risk of childhood persistent asthma associated with maternal age at birth: Results from a large prospective cohort in Canada. J Asthma 2019; 58:38-45. [PMID: 31479289 DOI: 10.1080/02770903.2019.1658207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Asthma is a prevalent disease that affects many Canadians. Persistent asthma can affect quality of life, and has multiple health implications. Maternal age at birth has been associated with many adverse health outcomes in children. Conflicting study results exist regarding maternal age at birth and childhood asthma. The association between maternal age at birth and persistent asthma in children is still unknown. OBJECTIVE To investigate the relationship between maternal age at birth and persistent asthma in children at ten years of age. METHODS This is a prospective cohort study including all children aged 0-2 years who took part in the first cycle of the National Longitudinal Survey of Children and Youths (NLSCY) and were followed every two years until eight to ten years of age in Cycle 5. An interaction term between maternal age at birth and maternal asthma history was introduced in a multivariate model to examine modification effects of maternal asthma history on the association. RESULTS Multivariate logistic regression demonstrated that older maternal age at birth was significantly associated with an increased risk of childhood persistent asthma in mothers with a history of asthma (OR = 1.20, 95% CI: 1.04-1.40, p = .016). No relationship was found in mothers without a history of asthma. CONCLUSION Maternal history of asthma has an impact on the association between maternal age at birth and childhood persistent asthma in children by age ten. The finding may help explain the inconsistent results in the literature regarding the risk of asthma associated with maternal age at birth.
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Affiliation(s)
- Danny Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jamie Farrell
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Mary Jane Smith
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Laurie K Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Araújo BCL, Simões SDM, Moreira MGS, Mendes ALF, Martins-Filho PRS. Evidence of orofacial myofunctional therapy patients with asthma and rhinitis: a systematic review. Codas 2019; 31:e20190009. [PMID: 31483044 DOI: 10.1590/2317-1782/20192019009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE to evaluate the efficacy of orofacial myofunctional therapy in improving orofacial function and nasal breathing in patients with asthma and rhinitis and, consequently, achieve clinical control of these conditions. RESEARCH STRATEGIES We used the elements of the PICOT method (study population, intervention, comparison, outcomes and type of studies) to define the eligibility criteria: (1) Population: patients with asthma and rhinitis; (2) Intervention: orofacial myofunctional therapy to improve chewing, swallowing, and breathing; (3) Comparison: control group without orofacial myofunctional therapy; (4) Predefined outcomes: clinical control of asthma and improvement of orofacial functions and nasal breathing; (5) Study type: clinical trials. The data were collected from PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), OATD, and Open Thesis, in November 2018. SELECTION CRITERIA Randomized controlled trials published in full-text versions without language restriction, no filter was used. DATA ANALYSIS Demographic characteristics of study participants, specific diagnosis of asthma and control medication, type, duration, intensity and follow-up of orofacial myofunctional therapy, and outcome data. The risk of bias was assessed according to the Cochrane guidelines for clinical trials. RESULTS One study met the eligibility criteria: although the study has shown an improvement of functional control and clinical scores of asthma, the evidence is very low. CONCLUSION There is no scientific evidence on the efficacy of orofacial myofunctional therapy in improving clinical control, orofacial function, and nasal breathing in patients with asthma and rhinitis.
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Affiliation(s)
- Brenda Carla Lima Araújo
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - Aracaju (SE), Brasil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe - UFS - Aracaju (SE), Brasil
| | - Silvia de Magalhães Simões
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe - UFS - Aracaju (SE), Brasil.,Departamento de Medicina, Universidade Federal de Sergipe - UFS - Aracaju (SE), Brasil
| | | | | | - Paulo Ricardo Saquete Martins-Filho
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe - UFS - Aracaju (SE), Brasil.,Laboratório de Patologia Investigativa, Universidade Federal de Sergipe - UFS - Aracaju (SE), Brasil
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Wang Y, Li C, Xu Y, Xu D, Yang G, Liao F, Luo X. Sublingual Immunotherapy Decreases Expression of Interleukin-33 in Children with Allergic Rhinitis. Indian J Pediatr 2018; 85:872-876. [PMID: 29790007 DOI: 10.1007/s12098-018-2703-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/03/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To identify the expression of IL-33 during SLIT (Sublingual immunotherapy) in AR (Allergic rhinitis) children. METHODS Thirty children received house dust mite (HDM) allergen extract for SLIT and thirty children received placebo in this study. Serum and nasal lavage samples of cases and controls were collected at different time points during SLIT. Interleukin (IL)-33 and other cytokines were estimated in these samples by enzyme-linked immuno sorbent assay (ELISA). Peripheral blood mononuclear cells (PBMC) were prepared and stimulated with rhIL-33 (with or without other stimulators) at different time points during SLIT. RESULTS The present results showed that both serum and nasal lavage of IL-33 levels decreased significantly after 12 mo treatment and this trend maintained at least until 24 mo. The decreased nasal IL-33 level was positively correlated to local Th2 cytokines and increased IL-10 expression at 2 y post SLIT treatment. In vitro experiments showed that IL-33 promotes IL-4 and IL-5 and inhibits IL-10 expression by peripheral blood mononuclear cells (PBMCs) in AR. CONCLUSIONS Decreased IL-33 expression during SLIT may contribute to low Th2 response and enhanced Regulatory T cell cytokines expression. Thus, IL-33 maybe an important predictor during SLIT.
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Affiliation(s)
- Yuanming Wang
- Department of Otolaryngology, Dongguan Women and Children's Hospital, No 99. Zhenxing Road, Dongguan, 523120, China
| | - Chuling Li
- Department of Otolaryngology, Dongguan Women and Children's Hospital, No 99. Zhenxing Road, Dongguan, 523120, China.
| | - Yaxiong Xu
- Department of Otolaryngology, Dongguan Women and Children's Hospital, No 99. Zhenxing Road, Dongguan, 523120, China
| | - Deyu Xu
- Department of Otolaryngology, Dongguan Women and Children's Hospital, No 99. Zhenxing Road, Dongguan, 523120, China
| | - Gang Yang
- Department of Otolaryngology, Dongguan Women and Children's Hospital, No 99. Zhenxing Road, Dongguan, 523120, China
| | - Fang Liao
- Department of Otolaryngology, Dongguan Women and Children's Hospital, No 99. Zhenxing Road, Dongguan, 523120, China
| | - Xianglin Luo
- Department of Otolaryngology, Dongguan Women and Children's Hospital, No 99. Zhenxing Road, Dongguan, 523120, China
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Wen Y, Zhou L, Li Y, Li Z, Deng W, Zhang T. Role of leptin in allergic rhinitis during sublingual immunotherapy. Eur Arch Otorhinolaryngol 2018; 275:2733-2738. [PMID: 30218387 DOI: 10.1007/s00405-018-5123-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/08/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Increasing evidence suggests that leptin is upregulated during allergic reactions in the airway and related to the severity of disease in allergic rhinitis (AR). In this study, we aimed to investigate the expression of leptin during sublingual immunotherapy (SLIT) in AR patients. METHODS Forty AR patients without obesity were recruited in this study. Twenty patients received house dust mite (HDM) allergen extract for SLIT and twenty patients received placebo randomly. Protein expression of leptin in serum and nasal lavage was tested by enzyme-linked immuno sorbent assay (ELISA) 1 and 2 years after SLIT treatment, respectively. Peripheral blood mononuclear cells (PBMCs) and human nasal epithelial cell were prepared and stimulated by recombinant leptin after 24 months' SLIT treatment and the induction of Th2 cytokines (IL-4/IL-5/IL-13) were detected by ELISA. RESULTS SLIT treatment decreased the expression of leptin protein in serum and nasal lavage significantly compared with placebo group 1 and 2 years after SLIT treatment. Nasal leptin level was correlated to decreased Th2 response (IL-4/IL-5/IL-13) and enhanced Treg (IL-10/TGF-beat) response after 2 years' SLIT. We also found that SLIT decreased the ability of leptin in promoting Th2 cytokines expression by PBMCs and human nasal epithelial cell after 2 years' SLIT treatment. CONCLUSION Changes of leptin expression in serum and nasal lavage may be correlated with Th2/Treg regulation during SLIT. Our results suggested that leptin served as an important biomarker during SLIT.
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Affiliation(s)
- Yanhui Wen
- Department of Otolaryngology, Guangzhou Overseas Chinese Hospital, Jinan University, No. 613 West Huangpu Avenue, Guangzhou, 610632, China.,Department of Otolaryngology, The Third People's Hospital of Dongguan, Dongguan, China
| | - Lifeng Zhou
- Department of Otolaryngology, Guangzhou Women and Children's Hospital, Guangzhou, China
| | - Yuqiu Li
- Department of Imaging, The Third People's Hospital of Dongguan, Dongguan, China
| | - Zhengmin Li
- Department of Otolaryngology, Boai Hospital of Zhongshan, Zhongshan, China
| | - Weijun Deng
- Department of General Surgery, The Third People's Hospital of Dongguan, Dongguan, China
| | - Tao Zhang
- Department of Otolaryngology, Guangzhou Overseas Chinese Hospital, Jinan University, No. 613 West Huangpu Avenue, Guangzhou, 610632, China.
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Adegbiji WA, Olajide GT, Olajuyin AO, Aremu SK, Olusola AG. Pattern of allergic rhinitis among children in Ekiti, Nigeria. Int J Pediatr Otorhinolaryngol 2018; 106:75-79. [PMID: 29447897 DOI: 10.1016/j.ijporl.2018.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Allergic rhinitis is a chronic and recurrent nasal condition. It is often neglected in children with late presentation. This study aimed at determining the prevalence, sociodemographic features, comorbid illnesses, complications and quality of life in children with allergic rhinitis in the study institution. MATERIALS AND METHODS This is a prospective hospital based study of children with allergic rhinitis in Ekiti state university teaching hospital, Ado Ekiti. The study was carried out in ENT department over a period of two years (between June 2015 to May 2017). Informed consent was obtained from the parents/guardian/patients and consented patients were enrolled into the study. Data were obtained by pretested interviewers assisted questionnaire. Details of their history, physical examination and investigations were carried out and findings were documented. All data obtained were descriptively analysed using SPSS version 18.0 and presented in simple tables and charts. Ethical clearance was sought for and obtained from the ethical committee of the hospital. RESULTS A total of 4341 patients were seen out of which 265 were children with allergic rhinitis. Prevalence of allergic rhinitis in children in this study was 6.1%. There were 63.0% males with male to female ratio of 2:1. Allergic rhinitis was peaked at preschool age group (1-5 years) accounted for 47.9%. A total of 42.3% participants were living in urban setting while 57.7% were from rural setting. Majorities (40.4%) of the patients were in nursery and parent's major occupation was mainly farming in 27.2%. There was positive family history of allergy in 54.7% patients. Perennial allergic rhinitis were noted in 63.8% patients while seasonal allergic rhinitis were noted in 36.2% patients. Major form of allergens was inhalant 81.8% and the least form of allergen was ingestant 5.7%. The commonest identified trigger factors among the study population were as follows: dust, cold weather and smoke which were accounted for 59.6%, 37.4% and 18.9% of the study patients respectively. Other noted triggering factors were soap and perfume which accounted for 4.2% and 1.1% respectively. Major associated comorbid illnesses among the patients were tonsils hypertrophy, adenoid hypertrophy and inferior turbinate hypertrophy which accounted for 55.5%, 46.4% and 40.4% respectively. Clinical presentations of allergic rhinitis in this study were mainly 75.8% nasal blockage, 65.3% runny nose and 8.5% recurrent sneezing. Commonest complications of allergic rhinitis were 35.1% pharyngitis, 32.1% otitis media and 28.3% headache. Treatment of allergic rhinitis leads to improvement on the clinical features in 90.1% patients. No significant improvement in clinical features were noticed in 9.8% patients. None of the studied patients reported worse clinical condition after treatment of allergic rhinitis. No mortality was recorded from allergic rhinitis in this study. CONCLUSION Allergic rhinitis affect all paediatric age group and there were delayed presentation in the participants. There were associated comorbid illnesses, complications and affectation of quality of life at presentation in majority of the patients.
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Affiliation(s)
| | - Gabriel Toye Olajide
- ENT Department, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University Ado-Ekiti (ABUAD), Ekiti State, Nigeria.
| | | | - Shuaib Kayode Aremu
- ENT Department, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University Ado-Ekiti (ABUAD), Ekiti State, Nigeria.
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12
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Bao Y, Chen J, Cheng L, Guo Y, Hong S, Kong W, Lai H, Li H, Li H, Li J, Li T, Lin X, Liu S, Liu Z, Lou H, Meng J, Qiu Q, Shen K, Tang W, Tao Z, Wang C, Wang X, Wei Q, Xiang L, Xie H, Xu Y, Zhang G, Zhang Y, Zheng Y, Zhi Y, Chen D, Hong H, Li Q, Liu L, Meng Y, Wang N, Wang Y, Zhou Y, Zhang L. Chinese Guideline on allergen immunotherapy for allergic rhinitis. J Thorac Dis 2017; 9:4607-4650. [PMID: 29268533 DOI: 10.21037/jtd.2017.10.112] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present document is based on a consensus reached by a panel of experts from Chinese Society of Allergy (CSA) and Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G). Allergen immunotherapy (AIT), has increasingly been used as a treatment for allergic rhinitis (AR) globally, as it has been shown to provide a long-term effect in improving nasal and ocular symptoms, reducing medication need, and improving quality of life. AIT is currently the only curative intervention that can potentially modify the immune system in individuals suffering from AR and prevent the development of new sensitization and the progression of disease from AR to asthma. Although the use of AIT is becoming more acceptable in China, to date no AR immunotherapy guideline from China is available for use by the international community. This document has thus been produced and covers the main aspects of AIT undertaken in China; including selection of patients for AIT, the allergen extracts available on the Chinese market, schedules and doses of allergen employed in different routes of AIT, assessment of effect and safety, patients' administration and follow-up, and management of adverse reactions. The Chinese guideline for AR immunotherapy will thus serve as a reference point by doctors, healthcare professionals and organizations involved in the AIT of AR in China. Moreover, this guideline will serve as a source of information for the international community on AIT treatment strategies employed in China.
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Affiliation(s)
- Yixiao Bao
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lei Cheng
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing 210029, China
| | - Yinshi Guo
- Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Suling Hong
- Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - He Lai
- Department of Allergy, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Houyong Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Huabin Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, Allergy and Clinical Immunology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Tianying Li
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoping Lin
- The PLA Center of respiratory and allergic disease diagnosing and management, Shenyang 110016, China
| | - Shixi Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zheng Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Juan Meng
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qianhui Qiu
- Department of Otorhinolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Kunling Shen
- Department of Pediatric Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wei Tang
- Department of Pulmonary and Critical Care Medicine, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Zezhang Tao
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Qingyu Wei
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Hua Xie
- Department of Respiratory Medicine, the General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yu Xu
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Yiwu Zheng
- Scientific Affairs, ALK, Guangzhou 510300, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100720, China
| | - Dehua Chen
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Haiyu Hong
- Department of otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Quansheng Li
- Department of Allergy, NO.202 Hospital of PLA, Shenyang 110003, China
| | - Lin Liu
- Department of Otorhinolaryngology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Nan Wang
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yihui Wang
- Department of Pediatric Respiratory Medicine, Pubin Children Hospital, Shanghai Children Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yue Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China
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13
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Sonninen K, Jyrkkä J, Martikainen JE, Malmström K, Mäkelä MJ, Sepponen K. Age-related off-label use of nasal corticosteroids for allergies is relatively common in Finnish children with asthma. Acta Paediatr 2017; 106:1830-1836. [PMID: 28692177 DOI: 10.1111/apa.13985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/06/2017] [Indexed: 12/17/2022]
Abstract
AIM Allergies can worsen asthma symptoms and we used national data to identify allergy medication prescribed for Finnish children and adolescents who used asthma medication. METHODS Register data were available for 13 435 Finnish children aged 0-17 who were entitled to special reimbursement for asthma medication during 2006-2009. Allergy medication purchases were individually analysed 2 years before and 2 years after the entitlement for asthma medication reimbursement was granted. RESULTS Two-thirds (66.5%) of the children had used at least one allergy medication during the 4-year follow-up, with an average of five purchases. Most (91%) of the allergy medication purchased was systemic antihistamines and half (50%) was nasal corticosteroids. In all, 8% of the allergy medication and 22% of the nasal corticosteroids were classified as off-label purchases based on the child's age. Paediatric allergologists and paediatricians prescribed 59% of the allergy medication and 76% of the off-label nasal corticoids. CONCLUSION Most asthmatic children and adolescents used allergy medication. Nasal corticosteroids were the commonly prescribed off-label item and the prescribers were mainly specialists in paediatric allergology or paediatrics. Official dosage instructions and more specific clinical guidelines are needed to support appropriate prescribing of nasal corticosteroids for young children.
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Affiliation(s)
- Katja Sonninen
- School of Pharmacy; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies; Finnish Medicines Agency; Kuopio Finland
| | | | - Kristiina Malmström
- Department of Allergy; Helsinki University Central Hospital; Helsinki Finland
| | - Mika J. Mäkelä
- Department of Allergy; Helsinki University Central Hospital; Helsinki Finland
| | - Kati Sepponen
- School of Pharmacy; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
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14
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Soares AADA, Barros CM, Santos CGC, Dos Santos MRA, Silva JRS, Silva Junior WMD, Simões SDM. Respiratory muscle strength and pulmonary function in children with rhinitis and asthma after a six-minute walk test. J Asthma 2017; 55:259-265. [PMID: 28488885 DOI: 10.1080/02770903.2017.1326133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Rhinitis and asthma decrease quality of life. Few studies have assessed the performance of children with asthma or rhinitis under submaximal exercise. We evaluated maximal respiratory pressures, spirometric parameters, and ability to sustain submaximal exercise in these children before and after the 6-minute walk test (6MWT), compared to healthy children. METHODS This cross-sectional, analytical study included 89 children aged 6-12 years in outpatient follow-up: 27 healthy (H), 31 with rhinitis (R), and 31 with mild asthma under control (A). Pulmonary function parameters and maximal respiratory pressures were measured before and 5, 10, and 30 minutes after the 6MWT. Wilcoxon test was used to compare numerical numerical variables between two groups and analysis of variance or Kruskal-Wallis test for comparison among three groups. RESULTS Total distance traveled in the 6MWT was similar among the three groups. Compared to pre-test values, VEF1 (Forced Expiratory Volume in 1 second), VEF0.75 (Forced Expiratory Volume in 0.75 second), and FEF25-75 (Forced Expiratory Flow 25-75% of the Forced Vital Capacity - CVF - curve) decreased significantly after the 6MWT in group A, and VEF0.75, FEF25-75, and VEF1/CVF decreased significantly in group R. Groups A and R had lower Maximum Inspiratory Pressure values than group H before and after the 6MWT at all time points assessed. CONCLUSIONS The findings suggest that children with rhinitis and mild asthma present with alterations in respiratory muscle strength and pulmonary function not associated with clinical complaints, reinforcing the concept of the united airways.
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Affiliation(s)
| | - Camila Moraes Barros
- a University Hospital, Federal University of Sergipe , Aracaju , Sergipe , Brazil
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15
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Mouse Sensitivity is an Independent Risk Factor for Rhinitis in Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:82-8.e1. [PMID: 26441149 DOI: 10.1016/j.jaip.2015.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although mouse and cockroach allergy is known to be important in urban children with asthma, the independent association of mouse and cockroach sensitization with rhinitis in these children is unknown. OBJECTIVE To determine the association of mouse and cockroach sensitization with rhinitis in urban children with asthma. METHODS As part of the Mouse Allergen and Asthma Intervention Trial, 499 urban children (5-17 years) with persistent asthma underwent spirometry, skin prick testing to 14 common environmental allergens, and serology for mouse-specific IgE. In 269 subjects, cockroach-specific IgE serology was also obtained. Patient/parent-reported rhinitis in the last 2 weeks and the last 1 year was the primary outcome measure. Mouse/cockroach exposure was measured by reported frequency of sightings. Mouse allergen-settled bedroom dust samples were also measured in mouse-sensitized children. RESULTS Rhinitis was reported in 49.9% and 70.2% of the participants within the last 2 weeks and the last 1 year, respectively. Serum mouse IgE level of 0.35 IU/mL or more was associated with rhinitis in the past 2 weeks (adjusted odds ratio, 2.15; 95% CI, 1.02-4.54; P = .04) and the past 1 year (adjusted odds ratio, 2.40; 95% CI, 1.12-5.1; P = .02) after controlling for age, race, sex, the presence of any smokers at home, primary caregiver education level, number of allergen sensitivities, cockroach IgE level of 0.35 IU/mL or more, and study site (Boston or Baltimore). Measures of home mouse exposure were not associated with rhinitis, regardless of mouse sensitivity. Cockroach sensitivity was not associated with rhinitis regardless of sensitization to other allergens. CONCLUSIONS In urban children with asthma, increased mouse IgE, but not cockroach IgE, in the sera (mouse IgE ≥ 0.35 IU/mL) may be associated independently with rhinitis.
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16
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de Groot EP, Kreggemeijer WJ, Brand PLP. Getting the basics right resolves most cases of uncontrolled and problematic asthma. Acta Paediatr 2015; 104:916-21. [PMID: 26033420 DOI: 10.1111/apa.13059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/20/2014] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
AIM The prevalence of true therapy-resistant asthma among children whose asthma remains uncontrolled, despite daily controller therapy, is unknown. The aim of this study was to investigate the underlying causes in children with uncontrolled asthma. METHODS This was a retrospective chart review of 142 children aged from five to 17 years over a five-year period. The patients had uncontrolled asthma and were referred by general practitioners to a hospital-based paediatric asthma clinic. RESULTS An underlying cause for uncontrolled asthma was found in 138 children (97.2%). The causes were poor adherence (n = 53, 37.3%), ongoing exposure to environmental triggers (n = 40, 28.2%), comorbidities (n = 28, 19.7%), incorrect inhaler technique (n = 11, 7.7%) and incorrect diagnosis (n = 6, 4.2%). After properly addressing these basics in asthma management, the asthma was well controlled in all 138 patients and lung function was normal. Only four children (2.8%) fulfilled the criteria for true therapy-resistant asthma. CONCLUSION A remedial cause in the basics of asthma management could be found in 97% of children with uncontrolled asthma referred to a hospital-based asthma clinic. True therapy-resistant asthma was found to be very rare in children.
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Affiliation(s)
- Eric P. de Groot
- Princess Amalia Children's Centre; Isala Hospital; Zwolle The Netherlands
| | | | - Paul L. P. Brand
- Princess Amalia Children's Centre; Isala Hospital; Zwolle The Netherlands
- UMCG Postgraduate School of Medicine; University Medical Centre and University of Groningen; Groningen The Netherlands
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17
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Rotiroti G, Roberts G, Scadding GK. Rhinitis in children: common clinical presentations and differential diagnoses. Pediatr Allergy Immunol 2015; 26:103-10. [PMID: 25616224 DOI: 10.1111/pai.12339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 12/12/2022]
Abstract
Rhinitis is a common presentation in childhood. Acute virally induced rhinitis is generally self-limiting and usually does not require medical attention. Whilst allergic rhinitis is the focus of the paediatric allergist, the presentation of other diseases or comorbidities that can complicate or mimic allergic rhinitis needs to be considered. Effects on the child's quality of life also need to be addressed. Rhinitis can be associated with asthma and other significant comorbidities: importantly, non-allergic rhinitis can sometimes be a consequence of systemic immune impairment. The diagnosis of rhinitis is based on clinical findings with directed investigations. Nasal nitric oxide measurement is an emerging diagnostic tool and helpful particularly in relation to evaluating the differential diagnosis in more difficult rhinitis. Successfully identifying the cause of rhinitis in childhood and associated comorbidities can ensure that the patient is successfully treated as described in the recently published EAACI Pediatric Rhinitis Position Paper.
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Affiliation(s)
- G Rotiroti
- Royal National Throat Nose and Ear Hospital, Part of UCL Hospitals NHS Foundation Trust, London, UK; Royal Free Hospital NHS Foundation Trust, London, UK
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18
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Santos AF, Borrego LM, Rotiroti G, Scadding G, Roberts G. The need for patient-focused therapy for children and teenagers with allergic rhinitis: a case-based review of current European practice. Clin Transl Allergy 2015; 5:2. [PMID: 25657844 PMCID: PMC4318152 DOI: 10.1186/s13601-014-0044-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/30/2014] [Indexed: 12/21/2022] Open
Abstract
Allergic rhinitis is a common problem in childhood and adolescence, with a negative impact on the quality of life of patients and their families. The treatment modalities for allergic rhinitis include allergen avoidance, anti-inflammatory symptomatic treatment and allergen specific immunotherapy. In this review, four cases of children with allergic rhinitis are presented to illustrate how the recently published EAACI Guidelines on Pediatric Allergic Rhinitis can be implemented in clinical practice.
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Affiliation(s)
- Alexandra F Santos
- Department of Paediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, UK ; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK ; Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Luis Miguel Borrego
- CUF Descobertas Hospital, Lisbon, Portugal ; CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Giuseppina Rotiroti
- The Royal National Throat, Nose and Ear Hospital & University College London Hospitals, London, UK
| | - Glenis Scadding
- The Royal National Throat, Nose and Ear Hospital & University College London Hospitals, London, UK
| | - Graham Roberts
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK ; Human Development and Health and Clinical Experimental Sciences Academic Subunits, University of Southampton Faculty of Medicine, Southampton, UK ; Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK ; Paediatric Allergy and Respiratory Medicine, University Child Health (MP803), University Hospital Southampton NHS Foundation Trust, Southampton, UK
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19
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Liu W, Luo R, Chen Y, Sun C, Wang J, Zhou L, Li Y, Deng L. Interleukin-31 promotes helper T cell type-2 inflammation in children with allergic rhinitis. Pediatr Res 2015; 77:20-8. [PMID: 25285475 DOI: 10.1038/pr.2014.151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 07/22/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Interleukin-31 (IL-31) is a recently described cytokine that is involved in helper T cell type-2 (Th2)-mediated diseases. However, its regulatory effect in the pathogenesis of children allergic rhinitis (AR) needs to be further characterized. This study sought to evaluate the expression and role of IL-31 in children with AR. METHODS Sixty children with AR and 20 normal controls were included. IL-31 and Th2 cytokines production in tissue, serum, and nasal lavage was examined by immunohistochemistry, quantitative polymerase chain reaction (qPCR), and enzyme-linked immunosorbent assay, respectively. Peripheral blood mononuclear cells (PBMCs) were purified for in vitro regulation experiment of IL-31. Nasal epithelial cells (NECs) were cultured and stimulated by recombinant IL-31. RESULTS The IL-31 mRNA and protein levels in both serum and nasal lavage were significantly enhanced in AR compared with normal controls, especially in children with asthma. The nasal IL-31 was associated with enhanced local Th2 cytokines and mucin 5AC (MUC5AC) expression. In vitro study showed that IL-31 promotes Th2 cytokines expression and MUC5AC upregulation and thus amplified Th2 inflammation. CONCLUSION Our results demonstrate that IL-31 expression in AR aggravated and amplified Th2 inflammation as well as mucin production, and provide a possible explanation for IL-31's regulatory role in the pathogenesis of AR.
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Affiliation(s)
- Wenlong Liu
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Renzhong Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Yanqiu Chen
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Changzhi Sun
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Jie Wang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Lifeng Zhou
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Yan Li
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Li Deng
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
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20
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Liu W, Sun C, Luo X, Han M, Zhou L, Li J, Wang J, Li Y, Luo R, Li H. Elevated B cell-activating factor (BAFF) in children with allergic rhinitis. Int J Pediatr Otorhinolaryngol 2014; 78:2156-60. [PMID: 25447952 DOI: 10.1016/j.ijporl.2014.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the possible role of B cell-activating factor (BAFF) in children with allergic rhinitis (AR). METHODS Twenty-four AR children and 20 normal children were enrolled in this study and nasal lavage and serum were collected. The nasal and serum levels of BAFF were measured using enzyme-linked immunosorbent assay (ELISA). The relationship between serum BAFF and immunoglobulin A (IgA) was evaluated in AR children. RESULTS Our results showed that the nasal and serum levels of BAFF were significantly increased in AR children compared with controls (p<0.05). The nasal and serum levels of BAFF in AR children were significantly associated with disease severity (p<0.05). Moreover, the level of serum BAFF was negatively related to serum IgA level (p<0.05). CONCLUSION Our findings show BAFF expression was significantly increased and related to disease severity, indicating BAFF may be implicated in new treatment modalities for AR children.
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Affiliation(s)
- Wenlong Liu
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Changzhi Sun
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Xi Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China; Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Miaomiao Han
- Department of Otolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lifeng Zhou
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Jian Li
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Wang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Yan Li
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China
| | - Renzhong Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou, China.
| | - Huabin Li
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Department of Otolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Kim EH, Lee JS, Lee NR, Baek SY, Kim EJ, Lee SJ, Kim IS. Regulation of constitutive neutrophil apoptosis due to house dust mite allergen in normal and allergic rhinitis subjects. PLoS One 2014; 9:e105814. [PMID: 25243400 PMCID: PMC4171368 DOI: 10.1371/journal.pone.0105814] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/24/2014] [Indexed: 01/01/2023] Open
Abstract
House dust mite (HDM) is a primary allergen in allergic rhinitis (AR) and asthma. Neutrophil apoptosis is associated with allergic diseases and innate immunity to infection. The present study examined how HDM affects constitutive neutrophil apoptosis in normal and AR subjects. Total IgE increased in AR subjects when compared to normal subjects, and patients with AR were HDM-specific IgE positive (+), which is specific IgE to Dermatophagoides pteronissinus and Dermatophagoides farinae. In normal and AR subjects, neutrophil apoptosis was inhibited by extract of Dermatophagoides pteronissinus (DP), but not by extract of Dermatophagoides farina (DF). Aprotinin (serine protease inhibitor) and E64 (cysteine protease inhibitor) have no effect on neutrophil apoptosis due to DP. The anti-apoptotic effect of DP was blocked by TLR4i, an inhibitor of TLR4, rottlerin, an inhibitor of PKCδ, PD98059, an inhibitor of ERK, and BAY-11-7085, an inhibitor of NF-κB. DP induced PKCδ, ERK, and NF-κB activation in a time-dependent manner. DP inhibited the cleavage of procaspase 3 and procaspase 9. The expression of IL-6, IL-8, TNF-α, G-CSF, GM-CSF, and CCL2 increased in the supernatant collected from the normal and AR neutrophils after DP treatment and the supernatant inhibited the apoptosis of normal and AR neutrophils. In summary, DP has anti-apoptotic effects on neutrophils of normal and AR subjects through the TLR4/PKCδ/ERK/NF-κB pathway, and this finding may contribute to solution of the pathogenic mechanism of allergic diseases triggered by DP.
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Affiliation(s)
- Eun Hye Kim
- Department of Biomedical Laboratory Science, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Ji-Sook Lee
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan, Republic of Korea
| | - Na Rae Lee
- Department of Biomedical Laboratory Science, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Seung Yeop Baek
- Department of Senior Healthcare, BK21 plus program, Graduated School, Eulji University, Daejeon, Republic of Korea
| | - Eun Jeong Kim
- Department of Senior Healthcare, BK21 plus program, Graduated School, Eulji University, Daejeon, Republic of Korea
| | - Soo Jin Lee
- Department of Pediatrics, School of Medicine, Eulji University, Daejeon, Republic of Korea
- * E-mail: (ISK); (SJL)
| | - In Sik Kim
- Department of Biomedical Laboratory Science, School of Medicine, Eulji University, Daejeon, Republic of Korea
- Department of Senior Healthcare, BK21 plus program, Graduated School, Eulji University, Daejeon, Republic of Korea
- * E-mail: (ISK); (SJL)
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Anti-inflammatory effect of IL-37b in children with allergic rhinitis. Mediators Inflamm 2014; 2014:746846. [PMID: 25177111 PMCID: PMC4142748 DOI: 10.1155/2014/746846] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 07/04/2014] [Accepted: 07/14/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Interleukin-37 (IL-37), a newly described member of IL-1family, functioned as a fundamental inhibitor of innate inflammatory and immune responses, especially its isoform IL-37b. Objective. This study was undertaken to evaluate the expression and regulation of IL-37b in children with allergic rhinitis (AR). Methods. Forty children with AR and twenty-five normal controls were included. The relationship between IL-37b and Th1/2 cytokines production in serum and nasal lavage was examined by enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells (PBMCs) were purified for in vitro regulation experiment of IL-37b. Intranasal mometasone furoate was given in AR children and IL-37b change after one-month treatment was detected using ELISA. Results. We observed significantly decreased IL-37b expression levels in both serum and nasal lavage compared to controls. IL-37b was negatively correlated with Th2 cytokines. Our results also showed that IL-37b downregulated Th2 cytokine expressed by PBMCs and this modulation was through mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) pathway. We also found that intranasal mometasone furoate therapy can promote nasal IL-37b expression. Conclusion. IL-37b may be involved in Th2 cytokine regulation in AR and its expression was related to the efficacy of intranasal steroid therapy.
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La Grutta S, Landi M, Braido F, Montalbano L, Ferrante G, Malizia V, Fassio O, Canonica GW, Baiardini I. RHINASTHMA-Adolescents: a new quality of life tool for patients with respiratory allergy. Pediatr Allergy Immunol 2014; 25:450-5. [PMID: 24913826 DOI: 10.1111/pai.12242] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Specific instruments for health-related quality of life (HRQoL) assessment in adolescents with rhinoconjunctivitis or asthma are available. None of them evaluates rhinitis and asthma together, although they often coexist. Our aim was to validate a HRQoL questionnaire for adolescents with rhinoconjunctivitis, asthma, or both. METHODS A pool of 38 items covering the main symptoms and problems related to respiratory allergy was generated based on literature review, clinical experience, and unstructured interviews to 54 adolescents. The items were randomly listed and presented to 88 consecutive outpatients (44 M; mean age 15.2 ± 3.1). Patients had to indicate which item they had experienced and, for each selected item, its importance on a four-point scale (1 = not at all; 4 = very much). Twelve items were excluded from the list, because of low importance. In the validation phase, 102 patients (54 M; mean age 15.36 ± 1.12) completed the KINDL, a generic HRQoL tool, and the new questionnaire (RHINASTHMA-Adolescents). RESULTS Factor analysis revealed a five-dimensional structure, which explained up to 71.23% of the total variance. Association between RHINASTHMA-Adolescents and KINDL scores was all in the expected direction. Internal consistency for the extracted factors was satisfactory: Upper Airways (0.81), Lower Airways (0.89), Emotions (0.85), Social Relationship (0.79), Daily life management (0.74). Reliability was good for all factors with a Pearson coefficient ranged from 0.91 to 0.99. CONCLUSIONS RHINASTHMA-Adolescents is the first tool for evaluating HRQoL in patients with rhinitis and/or asthma. It provides a simple assessment and met the standards of validity, internal consistency, and reliability.
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Affiliation(s)
- Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy; Department of Science for Health Promotion and Mother and Child, University of Palermo, Palermo, Italy
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24
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Luo R, Liu W, Wang J, Chen Y, Sun C, Zhou L, Li Y, Deng L. Role of BAFF in pediatric patients with allergic rhinitis during sublingual immunotherapy. Eur J Pediatr 2014; 173:1033-40. [PMID: 24585100 DOI: 10.1007/s00431-014-2287-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/09/2014] [Accepted: 02/16/2014] [Indexed: 01/19/2023]
Abstract
UNLABELLED Sublingual immunotherapy (SLIT) is the only therapeutic option for allergic rhinitis (AR) that modifies the immunological process to an allergen, rather than treating symptoms simply. However, its regulatory mechanisms are largely unknown. B-cell-activating factor of the TNF family (BAFF) plays very important roles in the development, differentiation, and proliferation of B cells and T cells. The aim of this study was to identify the role of BAFF during SLIT in pediatric patients with AR. Seventy-two house dust mite (HDM)-sensitized pediatric patients with AR were enrolled in this study. Thirty-six pediatric patients received HDM allergen extract for SLIT and 36 pediatric patients received placebo. Serum and nasal aspirate of different time points during treatment was collected and used for enzyme-linked immunosorbent assay (ELISA) of BAFF and related cytokines, respectively. Peripheral blood mononuclear cells were collected and stimulated by HDM allergen with or without rhBAFF after 12 months of treatment. Our results showed that the expression of BAFF protein decreased during the SLIT treatment compared with that in the placebo group after 6 months of therapy, and this trend lasted for 12 months. The decreased BAFF expression was positively related to Th2 cytokines and increased IL-10 expression. BAFF was also related to local production of IgA. In vitro experiments showed that BAFF can promote Th2 cytokines and inhibit IL-10 expression by PBMCs. CONCLUSION During SLIT, BAFF expression was decreased and related to low Th2 cytokine expression and enhanced IL-10 expression. Besides, BAFF may contribute to local production of IgA. Our results suggested that BAFF may be an important biomarker during SLIT. Authors' summary. Sublingual immunotherapy (SLIT) is the only therapeutic option for allergic rhinitis (AR) that modifies the immunological process to an allergen, rather than simply treating symptoms. However, its regulatory mechanisms are largely unknown. B-cell-activating factor of the TNF family (BAFF) plays very important roles in the development, differentiation, and proliferation of B cells and T cells. Our results showed that during SLIT, BAFF expression was decreased and related to low Th2 cytokine expression and enhanced IL-10 expression. Besides, BAFF may contribute to local production of IgA. Our results suggested that BAFF may be an important biomarker during SLIT.
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Affiliation(s)
- Renzhong Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, No. 9 Jinsui Road, Guang Zhou, 510623, China,
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25
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Everhart RS, Kopel SJ, Esteban CA, McQuaid EL, Klein R, McCue CE, Koinis-Mitchell D. Allergic rhinitis quality of life in urban children with asthma. Ann Allergy Asthma Immunol 2014; 112:365-70.e1. [PMID: 24589166 DOI: 10.1016/j.anai.2014.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/14/2014] [Accepted: 02/05/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urban children with asthma and allergic rhinitis (AR) are at risk for experiencing worse AR-related quality of life (QOL). Although AR may be underdiagnosed and undertreated in urban minority children, research has not considered which illness-related indicators (eg, AR control) may contribute to AR QOL in this population. OBJECTIVE To examine associations among AR control, asthma control, allergy symptoms, asthma symptoms, and AR QOL in a sample of 195 urban caregivers and their children with asthma (7-9 years of age) from African American, Latino, and non-Latino white backgrounds. Racial and ethnic differences in AR QOL were also examined. METHODS Families resided in 1 of 4 cities selected as recruitment sources because of their high concentrations of ethnic minority and non-Latino white, urban families. Caregivers and children completed a series of interview-based and clinician-based assessments across one academic year and 4-week periods to track daily asthma and nasal symptoms. RESULTS Better AR control was associated with higher AR QOL (β = -.32, P < .01) and all QOL subscales. AR control predicted AR QOL over and above asthma control (β = -.28, P < .01). Controlling for AR control, non-Latino white children reported better QOL related to practical problems than both Latino and African American children (P < .05). CONCLUSION Findings suggest that strategies to enhance AR control in urban children with asthma may assist in improving AR QOL. Non-Latino white children may experience less impairment of their AR QOL because of practical problems (eg, blow nose) than African American or Latino children with asthma.
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Affiliation(s)
- Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cynthia A Esteban
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Robert Klein
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christine E McCue
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island
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Sung MS, Choi JW, Hwang YJ, Kim SW. Risk factors influencing bronchial hyperresponsiveness to methacholine in school age and adolescence of atopic dermatitis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.3.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Myong Soon Sung
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
| | - Jin Wook Choi
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
| | - Young Jin Hwang
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
| | - Sung Won Kim
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
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Morais-Almeida M, Santos N, Pereira AM, Branco-Ferreira M, Nunes C, Bousquet J, Fonseca JA. Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study. Allergy 2013; 68:1278-88. [PMID: 24053488 DOI: 10.1111/all.12221] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Information on rhinitis epidemiology in preschool children is scarce. OBJECTIVES To estimate, in children with 3-5 years of age, current rhinitis prevalence, to describe rhinitis symptoms and associated sociodemographic characteristics, and to report allergic rhinitis and its impact on asthma (ARIA) classification. METHODS Cross-sectional, nationwide, population-based study including children aged 3-5 years. A multistep selection strategy was used to obtain a representative sample. Data were collected at kindergartens and parish centers by face-to-face interview to caregivers, using an adapted ISAAC questionnaire. 'Current rhinitis' (CR) was defined as the presence of ≥1 rhinitis symptom (repeated sneezing and/or itchy nose, blocked nose for >1 h, or runny nose without having a cold/flu) in the last year. Rhinitis lasting ≥4 days/week and ≥4 consecutive weeks was classified as persistent. Moderate-severe disease interfered 'a moderate amount' or 'a lot' in daily activities. RESULTS Five thousand and eighteen children were included. CR prevalence was 43.4% [95% CI (42.0-44.8%); n = 2179] and that of physician-diagnosed rhinitis was 11.7% [95% CI (10.8-12.6%); n = 588]. Of children with CR, 67% reported blocked nose, 48% rhinorrhea, and 46% sneezing/itchy nose. Considering ARIA classification, 30% of the population had mild intermittent, 3% mild persistent, 7% moderate-severe intermittent, and 3% moderate-severe persistent rhinitis. Children with CR had more current wheezing, physician-diagnosed asthma, self-reported food allergy, and family history of allergic disease. These characteristics were also associated with persistent and moderate-severe rhinitis. CONCLUSIONS This is the first nationwide population-based study reporting rhinitis prevalence and ARIA classification in preschool children. In this age-group, rhinitis is frequent and underdiagnosed. About 25% children with rhinitis presented moderate-severe disease.
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Affiliation(s)
| | | | | | | | | | - J. Bousquet
- Department of Allergy and Respiratory Diseases; University Hospital and INSERM; Montpellier; France
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28
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Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW, Papadopoulos NG, Rotiroti G, Scadding G, Timmermans F, Valovirta E. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2013; 68:1102-16. [PMID: 23952296 DOI: 10.1111/all.12235] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2013] [Indexed: 12/13/2022]
Abstract
Rhinitis is a common problem in childhood and adolescence and impacts negatively on physical, social and psychological well-being. This position paper, prepared by the European Academy of Allergy and Clinical Immunology Taskforce on Rhinitis in Children, aims to provide evidence-based recommendations for the diagnosis and therapy of paediatric rhinitis. Rhinitis is characterized by at least two nasal symptoms: rhinorrhoea, blockage, sneezing or itching. It is classified as allergic rhinitis, infectious rhinitis and nonallergic, noninfectious rhinitis. Similar symptoms may occur with other conditions such as adenoidal hypertrophy, septal deviation and nasal polyps. Examination by anterior rhinoscopy and allergy tests may help to substantiate a diagnosis of allergic rhinitis. Avoidance of relevant allergens may be helpful for allergic rhinitis (AR). Oral and intranasal antihistamines and nasal corticosteroids are both appropriate for first-line AR treatment although the latter are more effective. Once-daily forms of corticosteroids are preferred given their improved safety profile. Potentially useful add-on therapies for AR include oral leukotriene receptor antagonists, short bursts of a nasal decongestant, saline douches and nasal anticholinergics. Allergen-specific immunotherapy is helpful in IgE-mediated AR and may prevent the progression of allergic disease. There are still a number of areas that need to be clarified in the management of rhinitis in children and adolescents.
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Affiliation(s)
| | - M. Xatzipsalti
- First Department of Pediatrics; P. & A. Kyriakou Children's Hospital; Athens; Greece
| | | | - A. Custovic
- Manchester Academic Health Science Centre; NIHR Respiratory and Allergy Clinical Research Facility; The University of Manchester; University Hospital of South Manchester NHS Foundation Trust; Manchester; UK
| | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense; Denmark
| | - P. W. Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals of Leuven; Catholic University of Leuven; Leuven; Belgium
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens; Greece
| | | | - G. Scadding
- Royal National Throat Nose and Ear; Hospital - Part of UCL Hospitals NHS Foundation Trust; London; UK
| | - F. Timmermans
- Nederlands Anafylaxis Netwerk; Dordrecht; the Netherlands
| | - E. Valovirta
- Terveystalo Turku; Allergy Clinic; University of Turku; Turku; Finland
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Association between allergic rhinitis and asthma control in Peruvian school children: a cross-sectional study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:861213. [PMID: 23984414 PMCID: PMC3741928 DOI: 10.1155/2013/861213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Asthma and allergic rhinitis are highly prevalent conditions that cause major illness worldwide. This study aimed to assess the association between allergic rhinitis and asthma control in Peruvian school children. METHODS A cross-sectional study was conducted among 256 children with asthma recruited in 5 schools from Lima and Callao cities. The outcome was asthma control assessed by the asthma control test. A score test for trend of odds was used to evaluate the association between allergic rhinitis severity and the prevalence of inadequate asthma control. A generalized linear regression model was used to estimate the adjusted prevalence ratios of inadequate asthma control. RESULTS Allergic rhinitis was present in 66.4% of the population with asthma. The trend analysis showed a positive association between allergic rhinitis and the probability of inadequate asthma control (P < 0.001). It was associated with an increased prevalence of inadequate asthma control, with adjusted prevalence ratios of 1.53 (95% confidence interval: 1.19-1.98). CONCLUSION This study indicates that allergic rhinitis is associated with an inadequate level of asthma control, giving support to the recommendation of evaluating rhinitis to improve asthma control in children.
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30
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Kose S, Tatar B, Atalay S, Erden M, Tatar E. Latex-related allergy in hemodialysis patients. Ren Fail 2013; 35:888-90. [DOI: 10.3109/0886022x.2013.794677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Prevalence of allergic rhinitis in patients with attention-deficit/hyperactivity disorder: a population-based study. Eur Child Adolesc Psychiatry 2013; 22:301-7. [PMID: 23274480 DOI: 10.1007/s00787-012-0369-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/16/2012] [Indexed: 10/27/2022]
Abstract
Allergic rhinitis (AR) is common in children. Characteristic symptoms of AR may result in daytime inattention, irritability, and hyperactivity, which are also components of ADHD. Conflicting data in previous studies exist regarding the relationship between ADHD and AR. The aim of this study was to examine the prevalence and risk of AR in ADHD patients in Taiwan. We conducted a cross-sectional study using the National Health Insurance Research Database in Taiwan. The study subjects included 469 patients who received psychiatric care for ADHD in 2005 and the general population (n = 220,599). Distributions of age, gender, and living areas as well as allergic diseases in the general population and in the ADHD group were examined by χ2 tests. Multivariate logistic regression models were used to analyze the risk factors of AR. The prevalence of AR in ADHD group and the general population was 28.4 and 15.2%, respectively. The prevalence of asthma was 9.6% in ADHD group and 6.4% in the general population. Both the prevalence of AR (p < 0.001) and asthma (p = 0.008) was significantly higher in ADHD group than the general population. The multivariate logistic regression analysis showed that ADHD patients had an increased rate of AR than general population (OR = 1.83; 95% CI = 1.48-2.27; p < 0.0001), and asthma was strongly associated with AR (OR = 9.28; 95% CI = 8.95-9.63; p < 0.0001). Our data showed that ADHD patients had an increased rate of AR. Therefore, psychiatrists should be more aware of the comorbidity of AR when treating ADHD patients.
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32
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Kwon EB, Baek JH, Kim HY, Yoon JW, Shin YH, Jee HM, Choi SH, Han MY. Relationship between the asthma and rhinitis in asthmatic children: comparison of allergic rhinitis and nonallergic rhinitis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.3.241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eun Byul Kwon
- Department of Pediatrics, Bundang Jaesaeng Hospital, Seongnam, Korea
| | - Ji Hyeon Baek
- Department of Pediatrics, CHA University College of Medicine, Seongnam, Korea
| | - Hyeong Yun Kim
- Department of Pediatrics, Bundang Jaesaeng Hospital, Seongnam, Korea
| | - Jung Won Yoon
- Department of Pediatrics, Myuongji Hospital, Goyang, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA University College of Medicine, Seongnam, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA University College of Medicine, Seongnam, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA University College of Medicine, Seongnam, Korea
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Newcomb P, Cyr A. Conditions associated with childhood asthma in north Texas. ISRN ALLERGY 2012; 2012:823608. [PMID: 23762604 PMCID: PMC3671704 DOI: 10.5402/2012/823608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 07/19/2012] [Indexed: 11/23/2022]
Abstract
Introduction. The purpose of this study was to identify significant associations between asthma diagnosis, comorbid conditions, and social problems in children. Method. This study explored data collected in a unique, regional survey of children's health in north Texas originally administered in 2009 to a random sample of 21,530 households with children from 0 to 14 years of age. Descriptive statistics were compiled for the subsample of children with asthma, associations of interest were identified, and strengths of relevant associations were calculated. Results. The prevalence of asthma in school-aged children in the target area is 19-25%, which exceeds both national and state values. Statistically significant associations were found between asthma and allergies, sleep problems, and tonsillectomy. Significant associations were identified between asthma and school absences, academic problems, and behavior problems in school. There was a significantly greater prevalence of obesity/overweight among children with asthma than without asthma. Discussion. Children with asthma are at high risk for impairment in multiple dimensions. Thorough assessment, including comprehensive medical, social, and environmental histories, is critical in management of pediatric asthma.
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Affiliation(s)
- Patricia Newcomb
- College of Nursing, University of Texas at Arlington, 411 South Nedderman Drive, Arlington, TX 76019, USA
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Cingi C, Songu M, Ural A, Annesi-Maesano I, Erdogmus N, Bal C, Kahya V, Koc EAO, Cakir BO, Selcuk A, Ozlugedik S, Onal K, Midilli R, Ecevit C, Pinar E, Akoglu E, Okuyucu S, Erkan AN. The Score For Allergic Rhinitis study in Turkey. Am J Rhinol Allergy 2012; 25:333-7. [PMID: 22186248 DOI: 10.2500/ajra.2011.25.3665] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clinical definition of allergic rhinitis (AR) is difficult to use in epidemiological settings of large populations where it is impossible to obtain the laboratory evidence of each immune response. However, the standardization of the definition of AR in epidemiological studies is of crucial importance. This study was designed to estimate the prevalence of AR in an adult general population with respect to seven distinct geographical regions in Turkey. METHODS Individuals were evaluated with the Score for Allergic Rhinitis (SFAR) questionnaire for a national cross-sectional study. The Turkish version of the SFAR questionnaire was tested for clarity and sensitivity in a small sample of the general population. RESULTS Among the 3967 interviewed subjects, the overall prevalence of AR was 29.6%, with regional variations (from 21.0% in the southeastern Anatolia region to 36.1% in the Marmara region). The prevalence was higher in women and in urban area of residence. CONCLUSION This national survey confirmed the elevated prevalence of AR in Turkey. Our findings may contribute to the formulation of the public health policy and development of preventive and therapeutic strategies for AR in eastern Europe.
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Affiliation(s)
- Cemal Cingi
- Department of Otorhinolaryngology, Osmangazi University Medical Faculty, Eskisehir, Turkey.
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Ballardini N, Kull I, Lind T, Hallner E, Almqvist C, Östblom E, Melén E, Pershagen G, Lilja G, Bergström A, Wickman M. Development and comorbidity of eczema, asthma and rhinitis to age 12: data from the BAMSE birth cohort. Allergy 2012; 67:537-44. [PMID: 22335548 DOI: 10.1111/j.1398-9995.2012.02786.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Allergy-related diseases are a public health issue, but knowledge on development and comorbidity among children is scarce. The aim was to study the development of eczema, asthma and rhinitis in relation to sex and parental allergy, in a population-based cohort, during childhood. METHODS At 1, 2, 4, 8 and 12 years, parental questionnaires were used to obtain data on allergy-related diseases. Complete data for all five follow-up occasions were available from 2916 children. Odds ratios for the risk of any allergy-related disease in relation to heredity and sex were calculated using generalized estimating equations. RESULTS At 12 years, 58% of the children had had eczema, asthma and/or rhinitis at some time. Disease turnover was high for all three diseases throughout the study. Comorbidity increased with age, and at 12 years, 7.5% of all the children were affected by at least two allergy-related diseases. Parental allergy was associated with increased comorbidity and more persistent disease and increased the risk of having any allergy-related disease (adjusted OR 1.76; 95% CI 1.57-1.97) up to 12 years. Male sex was associated with an increased risk throughout childhood. Boys and girls did not differ in disease persistence, and for comorbidity, the differences were minor. CONCLUSIONS Allergy-related diseases may affect a majority of children. Eczema, asthma and rhinitis develop dynamically throughout childhood, and allergic comorbidity is common. These findings indicate that allergy-related diseases should be neither seen nor studied as isolated entities.
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Affiliation(s)
| | - I. Kull
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - T. Lind
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - E. Hallner
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | | | | | | | - G. Pershagen
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | | | - A. Bergström
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
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Abstract
Allergic rhinitis affects up to 40% of children but is commonly undiagnosed. Careful assessment of nasal symptoms allows for the most appropriate therapeutic options to be chosen. Allergen avoidance is often difficult in practice. Antihistamines are of limited benefit in allergic rhinitis caused by house dust mite and other perennial allergens, where symptoms, predominantly nasal obstruction, are not histamine mediated. In contrast, symptoms triggered by pollen, such as nasal itch, rhinorrhoea and sneezing, are relieved by antihistamines. Intranasal steroids are the treatment of choice for persistent moderate-severe allergic rhinitis and are more effective than antihistamines for relief of nasal obstruction. Failure to respond to intranasal medications is often caused by poor compliance or inefficient use of nasal sprays. Immunotherapy may be a useful, if expensive, option, particularly where symptoms are because of a specific pollen. The benefits of immunotherapy in house dust mite-induced rhinitis and asthma remain controversial.
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Affiliation(s)
- Paul J Turner
- Department of Allergy and Immunology, The Children's Hospital at Westmead, New South Wales, Australia.
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Kim H, Levin L, LeMasters GK, Villareal M, Evans S, Lockey JE, Khurana Hershey GK, Bernstein DI. Validating childhood symptoms with physician-diagnosed allergic rhinitis. Ann Allergy Asthma Immunol 2012; 108:228-31. [PMID: 22469440 DOI: 10.1016/j.anai.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/27/2012] [Accepted: 02/06/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multiple population-based and high-risk cohort studies use parental questionnaire responses to define allergic rhinitis (AR) in children. Individual questionnaire items have not been validated by comparison with physician-diagnosed AR (PDAR). OBJECTIVE To identify routine clinical questions that best agree with a physician diagnosis of AR and can be used for early case identification. METHODS Children participating in a longitudinal birth cohort study were evaluated at ages 1 through 4 and at age 7 (n = 531) using questionnaires, physical examinations, and skin prick tests (SPT) with 15 aeroallergens (AG). Parents answered 3 stem questions pertaining to their child, including presence of nasal symptoms absent a cold/flu (ISAAC-validated question), presence of hayfever, and ocular itch. Substem questions were answered with details regarding seasonality, nasal triggers, and ocular seasonality. A global assessment of allergic diseases, including AR, was performed by a specialty-trained clinician. Percent agreement, sensitivity, specificity, and positive predictive values were assessed for individual stem and substem questions. RESULTS Positive response to having hayfever and presence of ocular symptoms had the highest specificity (84% and 69%, respectively) and the highest percent agreement (74% and 68%) with PDAR. Identification of triggers for nasal and ocular symptoms had the highest sensitivity (89%). Positive predictive values ranged from 31 to 39%. Combining 2 responses with highest agreement increased specificity for PDAR to 91%. CONCLUSION Responses to hayfever and ocular symptoms had better specificity and percent agreement with PDAR than the ISAAC-validated questionnaire item. Combining 2 rhinitis questions sharply increases specificity and may improve diagnostic accuracy of clinical questions.
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Affiliation(s)
- Haejin Kim
- Department of Internal Medicine, Division of Immunology, Allergy, and Rheumatology, University of Cincinnati, Ohio, USA.
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[Allergic march in children, from rhinitis to asthma: management, indication of immunotherapy]. Arch Pediatr 2012; 19:330-4. [PMID: 22306361 DOI: 10.1016/j.arcped.2012.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 01/20/2012] [Indexed: 11/22/2022]
Abstract
Allergic rhinitis (AR) is a common IgE dependent disorder. AR is maybe one of the steps of the allergic march, which starts with atopic dermatitis and food allergy and includes atopic asthma. AR and asthma are frequently associated. AR is frequently under-diagnosed and undertreated although it affects quality of life and school performance. Management of AR depends on its severity and will associate environmental control (best guided by environmental investigation and skin testing of specific IgE antibodies), pharmacotherapy (with antihistamines and intranasal corticosteroids as first line drugs). At present allergen immunotherapy is considered in patients with severe AR, insufficiently controlled by pharmacotherapy and who demonstrate specific IgE antibodies to relevant allergens. Sublingual immunotherapy is well tolerated. Only immunotherapy with the right allergens has the potential to alter the natural history of the allergic march, by preventing the development of new allergen sensitizations and reducing the risk for the subsequent development of asthma. This fact might extend the indications of specific allergen immunotherapy. Patients (and parents) education is of utmost importance in the management of allergic disorders.
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Koster ES, Raaijmakers JAM, Vijverberg SJH, van der Ent CK, Maitland-van der Zee AH. Asthma symptoms in pediatric patients: differences throughout the seasons. J Asthma 2011; 48:694-700. [PMID: 21806485 DOI: 10.3109/02770903.2011.601780] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Seasonal variation in asthma has been widely recognized. The aim of this study was to describe seasonal patterns of asthma symptoms and asthma medication use in a cohort of pediatric asthma medication users and to study determinants of seasonal childhood asthma. METHODS For this study, 602 children participating in the Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects) cohort were included. Parents were asked about their child's respiratory symptoms and quick-reliever medication use over the past year. Logistic regression analysis was used to study determinants of seasonality in asthma control (the level of disease control based on symptoms, limitations in activities, and rescue medication use). RESULTS There was a decline in asthma symptoms and asthma medication use during the summer period and a peak occurred from autumn to spring. The prevalence of wheeze ranged from 32% in summer to 56% in autumn. The prevalence of respiratory symptoms and medication use was significantly lower during summer (p < .0001). Oral steroids and antibiotics use and strong parental necessity beliefs were associated with uncontrolled asthma, regardless of seasonality. Allergic rhinitis was associated with an increased risk of uncontrolled asthma during spring [odds ratio (OR): 1.9; 95% confidence interval (CI): 1.3-2.8] and summer (OR: 1.9; 95% CI: 1.2-3.0). Eczema was associated with a higher risk of uncontrolled asthma during autumn (OR: 1.5; 95% CI: 1.0-2.2) and winter (OR: 1.3; 95% CI: 1.0-1.9). CONCLUSION We showed seasonal patterns in asthma symptoms and medication use. Associations were shown between allergic rhinitis and asthma control during spring/summer and eczema was associated with uncontrolled asthma during autumn/winter. Seasonality in asthma morbidity and health-care use is most likely associated with atopic constitution and viral infections, which are common during fall, winter, and spring.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology & Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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Lee H, Kim GS. Geographical and sociodemographic risk factors for allergic diseases in korean children. Asian Nurs Res (Korean Soc Nurs Sci) 2011; 5:1-10. [PMID: 25029944 DOI: 10.1016/s1976-1317(11)60008-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/27/2010] [Accepted: 12/10/2010] [Indexed: 11/28/2022] Open
Abstract
PURPOSE (a) To examine geographical distribution of childhood allergic diseases in Korea and (b) to identify geographical and sociodemographic risk factors for allergic diseases. METHODS Data on doctor-diagnosed asthma during lifetime and allergic rhinitis and atopic dermatitis during the past 12 months of 8,631 children (≤ 18 years) were obtained from the Third Korea National Health and Nutrition Examination Survey, along with information on housing type and presence of an indoor smoker. The SaTScan program identified geographical case clusters of allergic diseases, and multiple logistic regression determined risk factors, including geographical case clusters, for each allergic disease. RESULTS Prevalence of asthma, allergic rhinitis, and atopic dermatitis was 3.2%, 13.2%, and 15.5%, respectively. Older children (10-18 years) were more likely to have allergic rhinitis whereas younger children were more likely to have atopic dermatitis. It is noteworthy that children living in areas of geographical risk for asthma and atopic dermatitis were more likely to develop the respective allergic disease than children living in other areas (odds ratio [OR] = 3.47 for asthma, and OR = 9.74 for atopic dermatitis). CONCLUSIONS This study indicates that the areas in which children live may influence the development of certain allergic diseases. Implications include the need to assess geographical location of children with allergic diseases and to develop community-based preventive programs for children with allergic diseases.
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Affiliation(s)
- Hyejung Lee
- Assistant Professor, College of Nursing, Yonsei University, Seoul, Korea
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Pham Thi T, Scheinmann P, Karila C, Laurent J, Paty E, de Blic J. Syndrome dermorespiratoire : un phénotype sévère. REVUE FRANCAISE D ALLERGOLOGIE 2011. [DOI: 10.1016/j.reval.2011.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Solé D, Camelo-Nunes IC, Wandalsen GF, Rosário NA, Sarinho EC. Is allergic rhinitis a trivial disease? Clinics (Sao Paulo) 2011; 66:1573-7. [PMID: 22179162 PMCID: PMC3164407 DOI: 10.1590/s1807-59322011000900012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 05/30/2011] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Asthma and rhinitis often coexist, which potentially increases the disease severity and can negatively impact a patients' quality of life. However, there are few reports based on data obtained from the International Study of Asthma and Allergies in Childhood examining asthma severity in combination with rhinitisrelated symptoms. OBJECTIVE To demonstrate whether current rhinitis and current rhinoconjunctivitis are associated with the development of asthma or its increasing severity in Brazilian adolescents. METHODS The prevalence of current asthma was correlated with the prevalence of current rhinitis and current rhinoconjunctivitis in adolescents (13 to 14 year olds) from 16 Brazilian centers (based on Spearman's rank correlation index). The influence of current rhinitis and current rhinoconjunctivitis on asthma presentation was also evaluated using the chi-squared test and was expressed as odds ratios with 95% confidence intervals (95%CI). RESULTS A significant positive correlation was observed between the prevalence of current asthma and current rhinitis (rs = 0.82; 95%CI: 0.60-0.93, p< 0.0001) and between the prevalence of current asthma and current rhinoconjunctivitis (rs = 0.75; 95%CI: 0.47-0.89, p < 0.0001). Current rhinitis was associated with a significantly increased risk of current asthma and of more severe asthma. Similar results were observed for current rhinoconjunctivitis. CONCLUSION In this epidemiologic study of Brazilian adolescents, the presence of current rhinitis and current rhinoconjunctivitis was associated with a high risk of developing asthma and increased asthma severity. The mutual evaluation of rhinitis and asthma is necessary to establish an adequate treatment plan.
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Affiliation(s)
- Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, Brazil.
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Maykut R, Zeiger RS, Brown MA. Asthma in pediatric patients: unmet need and therapeutic options. Clin Pediatr (Phila) 2010; 49:915-30. [PMID: 20724341 DOI: 10.1177/0009922810362590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Yawn BP. Importance of allergic rhinitis management in achieving asthma control: ARIA update. Expert Rev Respir Med 2010; 2:713-9. [PMID: 20477234 DOI: 10.1586/17476348.2.6.713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Asthma continues to be a major burden for the health and healthcare of people worldwide. The recent updates of the Global Initiative for Asthma and the National Heart, Lung and Blood Institute asthma guidelines stress the need for achieving and monitoring asthma 'control', emphasizing the importance of identifying, assessing and treating comorbid conditions. Allergic rhinitis (AR) is a major comorbid condition in people with asthma and is related to inflammation of the upper portions of the airway. Recognizing and treating AR has been shown to improve asthma control, specifically by decreasing rates of asthma attacks or asthma exacerbations. In 2008, updated Allergic Rhinitis in Asthma (ARIA) guidelines were published. The updated version of the guidelines has a familiar look, with classification systems and care algorithms that are similar to those presented in other asthma guidelines. The new ARIA guidelines make one major change that should affect the care of adults and children with asthma: everyone with asthma should be assessed for AR. In addition, AR should be considered a risk factor for asthma, and all children and adults with AR, especially persistent AR, should be assessed for asthma, including testing lung function for reversible obstruction whenever feasible. Treatment for AR follows a similar format to that for asthma, including symptom management, treatment of chronic inflammation, identification and management of triggers, including allergens, and ongoing education for self-management. Pharmacotherapies that address both asthma and AR include corticosteroids (intranasal and inhaled), leukotriene receptor antagonists, immunomodulation or immunotherapy. Too often, pharmacotherapy is not supplemented by the necessary education and evaluation related to allergen, trigger identification and management.
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Affiliation(s)
- Barbara P Yawn
- Olmsted Medical Center, 210 Ninth St SE, Rochester, MN 55904, USA.
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Pinto Pereira L, Jackman J, Figaro N, Babootee N, Cudjoe G, Farrell S, Francis-Regis C, Garcia Henry K, Pandor A, Walters T, Bekele I. Health burden of co-morbid asthma and allergic rhinitis in West Indian children. Allergol Immunopathol (Madr) 2010; 38:129-34. [PMID: 20031294 DOI: 10.1016/j.aller.2009.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 09/14/2009] [Accepted: 09/16/2009] [Indexed: 12/28/2022]
Abstract
BACKGROUND Co-morbid allergic rhinitis (AR) and asthma has not been studied in Caribbean countries where there is a high prevalence of childhood asthma. METHODS Using the International Primary Care Airways Group (IPAG) guidelines to determine AR, care-givers of 393 (response rate=100%) children attending asthma clinics in selected public sector health facilities in Trinidad, West Indies, were interviewed. RESULTS Children (393) were between 2-17 years and included 239 (60.8%) boys and 154 (39.2%) girls. As many as 53.9% of children sampled (95% CI 45.9-55.8) suffered from AR. Children exposed to household smoking were nearly twice as likely to have AR (p<0.0041, OR=1.9, CI 1.22-2.88). Significantly (p<0.01) more asthmatics with AR (154, 58.6%) visited Accident and Emergency (A&E) in the past 12 months. The odds of visiting A&E at least once in the past 12 months for asthmatics with AR were 1.75 (95% CI 1.15-2.68). The average frequency of A&E visits was higher in children who also suffered from AR (1.75 vs 1.36, p<0.04). Age was negatively correlated (-0.21, p<0.005) with exacerbation frequency for asthmatics without AR suggesting A&E visits are independent of age in co-morbid disease. More children with AR (>60%) suffer day and night symptoms (p<0.001), and miss school (59.8%) (p<0.03) at least once a week (p<0.002) than asthmatics without AR (OR=1.5, 95% CI=1.03-2.30). CONCLUSIONS AR is prevalent in 53.9% of Trinidadian children with asthma. The burden of co-morbid disease in asthmatic children is associated with increased likelihood of asthma-related A&E visits, day and night symptoms and absence from school.
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Almqvist C, Bradding PB, Chakir J, Ebo D, Grattan C, Kariyawasam HH, Savilahti E, Scadding GK, Vieths S, Wardlaw AJ, Woodfolk J. Developments in the field of allergy in 2008 through the eyes of Clinical & Experimental Allergy. Clin Exp Allergy 2010; 39:1482-98. [PMID: 19954428 DOI: 10.1111/j.1365-2222.2009.03355.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In 2008, many thousands of articles were published on the subject of allergic disease with over 200 reviews, editorials and original papers in Clinical & Experimental Allergy alone. These represent a considerable amount of data and even the most avid reader could only hope to assimilate a small fraction of this knowledge. There is therefore a pressing need for the key messages that emerge from a journal such as Clinical & Experimental Allergy to be summarized by experts in the field in a form that highlights the significance of the developments and sets them in the context of important findings in the field published in other journals. This also has the advantage of making connections between new data in conditions such as asthma, where articles often appear in different sections of the journal. As can be seen from this review, the body of work is diverse both in terms of the disease of interest and the discipline that has been used to investigate it. However, taken as a whole, we hope that the reader will gain a flavour of where the field is mature, where there remain controversies and where the cutting edge is leading.
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Abstract
Childhood rhinitis may be classified into non-allergic and allergic. Allergic rhinitis is further divided into seasonal and perennial. Seasonal rhinitis is a disease particularly of teenagers and young adults and appears to be less common in primary and pre school age children. In seasonal rhinitis, with relevant grass pollen sensitization, the link between the allergen exposure and rhinitis is clear cut. However, in other situations such as perennial rhinitis and house dust mite allergen sensitization, the link between symptoms and allergen exposure is less certain. Avoidance of allergens often proves to be difficult in practice. Intranasal steroids are the treatment of choice for persistent moderate-severe allergic rhinitis and are more effective than antihistamines for relief of nasal obstruction. Antihistamines are effective for control of histamine related symptoms such as itching, rhinorrhoea and sneezing. The use and benefits of sublingual or injectable immunotherapy in children are controversial.
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Affiliation(s)
- Andrew S Kemp
- Department of Allergy and Immunology, The Children's Hospital at Westmead and University of Sydney, Sydney NSW 2145, Australia.
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