Allergy and the nose

Investigational drugs for the treatment of allergic rhinitis

INTRODUCTION

Allergic rhinitis is characterized by paroxysms of sneezing, rhinorrhea and nasal obstruction. Its prevalence is increasing in industrialized countries worldwide and imposes a significant economic burden as a result of reduced school performance, work productivity and medical expenses. Allergic rhinitis impairs the quality of life of those affected, and current treatment regimens are inadequate for those whose symptoms are severe or refractory to standard drug therapies. They mainly include symptom control with intranasal glucocorticoids, oral and intranasal antihistamines.

AREAS COVERED

This article provides a review of the most current literature on research that has focused on improving the efficacy of current treatment regimens and developing new drugs. It also provides the reader with an improved understanding of the pathogenesis of allergic rhinitis, including the inflammatory mediators and cell types involved, which has led to novel treatment options that are under investigation. These new drugs aim to alter the immunologic response to allergens in order to achieve greater clinical efficacy.

EXPERT OPINION

It is our opinion that despite developments in new therapies, a multidrug approach is vital for successful treatment of allergic rhinitis. Furthermore, immunotherapy in the form of sublingual immunotherapy is a promising additional therapeutic approach that will potentially make immunotherapy available to a wider selection of eligible patients with allergic rhinitis.

Respiratory infections in adults with atopic disease and IgE antibodies to common aeroallergens

Background

Atopic diseases, including allergic rhinitis, allergic dermatitis and asthma, are common diseases with a prevalence of 30–40% worldwide and are thus of great global public health importance. Allergic inflammation may influence the immunity against infections, so atopic individuals could be susceptible to respiratory infections. No previous population-based study has addressed the relation between atopy and respiratory infections in adulthood. We assessed the relation between atopic disease, specific IgE antibodies and the occurrence of upper and lower respiratory infections in the past 12 months among working-aged adults.

Methods and Findings

A population-based cross-sectional study of 1008 atopic and non-atopic adults 21–63 years old was conducted. Information on atopic diseases, allergy tests and respiratory infections was collected by a questionnaire. Specific IgE antibodies to common aeroallergens were measured in serum. Adults with atopic disease had a significantly increased risk of lower respiratory tract infections (LRTI; including acute bronchitis and pneumonia) with an adjusted risk ratio (RR) 2.24 (95% confidence interval [CI] 1.43, 3.52) and upper respiratory tract infections (URTI; including common cold, sinusitis, tonsillitis, and otitis media) with an adjusted RR 1.55 (1.14, 2.10). The risk of LRTIs increased with increasing level of specific IgE (linear trend P = 0.059).

Conclusions

This study provides new evidence that working-aged adults with atopic disease experience significantly more LRTIs and URTIs than non-atopics. The occurrence of respiratory infections increased with increasing levels of specific IgE antibodies to common aeroallergens, showing a dose-response pattern with LRTIs. From the clinical point of view it is important to recognize that those with atopies are a risk group for respiratory infections, including more severe LRTIs.

Existence of antigen-specific immunoglobulin E is not sufficient for allergic nasal eosinophil infiltration in mice

BACKGROUND

Immunoglobulin E (IgE) is important for the development of allergic rhinitis (AR), though the contribution of IgE to the infiltration of eosinophils in the nasal mucosa has not been fully elucidated. In this study, antigen-induced sneezing and nasal eosinophil accumulation were comparatively investigated in anti-ovalbumin (OVA)-IgE transgenic (Tg) and wild-type (WT) mice.

METHODS

Tg and OVA-immunized WT mice were intranasally challenged with OVA. Antigen-specific serum IgE level, sneezing and infiltration of eosinophil into the nasal cavity were then examined.

RESULTS

The level of serum OVA-specific IgE in Tg mice was significantly higher than that in antigen-immunized WT mice. Compared to saline challenge, intranasal challenge with OVA significantly induced sneezing in both Tg and immunized WT mice. However, antigen-induced nasal eosinophil infiltration was observed in immunized WT mice but not in Tg mice.

CONCLUSIONS

IgE-mediated responses might not play a crucial role in antigen-induced eosinophil infiltration in AR.

Pathophysiology, favoring factors, and associated disorders in otorhinosinusology

The pathogenesis of rhinosinusitis (RS) is related to inflammation, caused by infections in the acute form of the disease but also by other agents in the chronic forms. Cytology allows to evaluate the defensive components, such as hair cells and muciparous cells, while the presence in the nasal mucosa of eosinophils, mast cells, bacteria and/or fungal hyphae, or spores indicates the nasal pathology. The anatomic and physiologic characteristics of the otorhinosinusal system account for the frequent concomitant involvement of the different components. The pivotal pathophysiologic sites are the ostiomeatal complex, the spheno-ethmoidal recess, and the Eustachian tube. The latter is the link with acute otitis media (AOM), which is the most common disease in infants and children and has major medical, social, and economic effects. Moreover, because of the strict relationship between upper and lower airways, nasal sinus disease may contribute to asthma and sinusitis may be considered as an independent factor associated with frequent severe asthma exacerbations. Concerning the role of allergy, the available data do not permit to attribute a central role to atopy in sinusitis and thus allergy testing should not be a routine procedure, while an allergologic evaluation may be indicated in children with OM, especially when they have concomitant rhinitis.

Hypersensitivity to Pollen of Olea Europea in Patients with Pollen Allergy in Zadar County, Croatia

Preosjetljivost na pelud masline važan je uzrok peludnih alergija u mediteranskim zemljama. Cilj ovoga rada bio je utvrditi učestalost preosjetljivosti na pelud masline među bolesnicima s peludnom alergijom u Zadru i Zadarskoj županiji. Dobivene rezultate usporedili smo s ranijim ispitivanjem preosjetljivosti na pelud masline u Dalmaciji.

Ukupno je obrađen 671 ispitanik s preosjetljivosti na peludne alergene. Od toga broja 61 % ispitanika bilo je muškog spola, a 39 % je bilo ženskog spola. Od ukupno ispitanih 53.5 % činila su djeca u dobi od 4 do 14 godina, a preostalih 46.5 % bili su odrasli u dobi od 15 do 59 godina života. Svim ispitanicima uzeta je detaljna obiteljska i osobna anamneza, napravljen klinički pregled te učinjeno kožno prick-testiranje i enzimatsko-imunološki UniCAP-test za određivanje specifičnih IgE-protutijela. Statistička obrada podataka učinjena je χ2-testom.

Preosjetljivost na pelud masline dokazana je u 8.8 % bolesnika s peludnom alergijom. Najveći broj bolesnika s preosjetljivosti na pelud masline boluje od alergijskog rinitisa, 58 % bolesnika. Postoji statistički značajna razlika u broju bolesnika između dvije ispitivane sredine, gradske i seoske. Samo 3 % bolesnika stanovnici su otoka.

Preosjetljivost na pelud masline u našem ispitivanju najniža je u odnosu na ispitivanja provedena u drugim mediteranskim zemljama. Najčešće se očituje kliničkom slikom alergijskog rinitisa, a statistički je značajno češća u gradskoj sredini. Usporedba preosjetljivosti na pelud masline tijekom dvaju ispitivanih razdoblja u našoj zemlji nije pokazala porast broja bolesnika s preosjetljivosti na pelud masline.