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Campo P, Canonica GW. Local Allergic Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1430-1433. [PMID: 38641133 DOI: 10.1016/j.jaip.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
Local allergic rhinitis (LAR) is defined by a clinical history suggestive of allergic rhinitis (AR), negativity of systemic IgE measurement and positive response to nasal allergen challenge (NAC). The term local respiratory allergy includes LAR, local allergic asthma (positive response in bronchial allergen challenge) and dual allergic rhinitis defined by the coexistence of AR and LAR. LAR worsens in severity and presence of comorbidities over time, and it is an independent entity from AR. Prevalence is higher in Mediterranean countries. LAR onset occurs during childhood in 36% of cases. Physiopathological features of LAR are: increased nasal eosinophilic inflammation, tryptase and eosinophil cationic protein, and presence of nasal specific IgE in secretions of 20-40% of subjects. A recent study demonstrated increase in sequential class switch recombination to IgE markers in mucosa of LAR with accumulation of IgE+ CD38+ plasmablasts. Moreover, there is increased expression in B cells of mucosal homing receptors CXCR3+ and CXCR4 in peripheral blood, with accumulation of Th9 and Th2 cells. NAC is the gold standard in the diagnosis of LAR. The measurement of specific IgE in nasal secretions basophil activation test or are still not suitable for diagnosis. There is ample evidence of the usefulness of allergen immunotherapy in the treatment in LAR after 4 DBPCRT in 152 patients. In conclusion, knowledge about LAR is continuously increasing, with detailed definition of physiopathological mechanisms and new phenotypes. More awareness of the disease should be promoted among different specialists, and NAC must be considered an essential diagnostic tool in any age group, including children.
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Affiliation(s)
- Paloma Campo
- U.G.C. Alergología, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milano, Italy
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2
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Roberto G, Barberi S, Marseglia GL, Licari A. What's new in pediatric asthma and rhinitis phenotypes and endotypes? Curr Opin Allergy Clin Immunol 2024; 24:73-78. [PMID: 38295125 DOI: 10.1097/aci.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW This review explores the evolving landscape of pediatric asthma and rhinitis, focusing on identifying and characterizing different subtypes. RECENT FINDINGS Childhood asthma and rhinitis are prevalent respiratory conditions frequently occurring together. To address the need for a precise definition of these diseases, an unbiased and comprehensive phenotyping approach has been undertaken with hypothesis-free analysis of extensive datasets to uncover new relationships among clinical, environmental, and biological characteristics. On the other hand, the concept of endotype is elaborate and multifaceted, representing distinct pathophysiological mechanisms underlying the clinical presentation and requires the identification of reliable biomarkers. The recognition of multiple inflammatory endotypes underscores the need for in-depth characterization, which could revolutionize the treatment landscape. SUMMARY Comprehending phenotypes and endotypes is crucial for customizing effective and personalized management approaches for children with asthma and rhinitis. More precise and efficient care can be administered through recognition and detailed characterization, ultimately enhancing patients' quality of life.
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Affiliation(s)
- Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Salvatore Barberi
- Pediatric Unit, Rho and Garbagnate Milanese Hospital, ASST-Rhodense, Milan, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
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3
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Wang XK, Zheng QL, Sun JN. Efficacy of the posterior nasal nerve resection combined with hormone transnasal nebulization on difficult-to-treat rhinosinusitis: a retrospective analysis. Braz J Otorhinolaryngol 2024; 90:101413. [PMID: 38537503 PMCID: PMC10987833 DOI: 10.1016/j.bjorl.2024.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE A retrospective analysis was performed to explore the clinical effect of the Posterior Nasal Nerve (PNN) resection combined with hormone transnasal nebulization on Difficult-to-Treat Rhinosinusitis (DTRS). METHODS A total of 120 DTRS patients were selected and divided into a control group (n = 60) and a study group (n = 60) according to different treatments. The control group patients were treated via PNN resection, followed by normal saline transnasal nebulization; the study group patients were given PNN resection and then treated with budesonide suspension transnasal nebulization. Subsequently, the comparison was performed between the two groups in terms of (1) Clinical baseline characteristics; (2) Sino-nasal Outcome Test (SNOT)-22 scores before treatment and after 3-months, 6-months and 12-months of treatment; (3) Lund-MacKay scores before treatment and after 10, 30, 90, and 180 days of treatment; (4) Incidence of adverse reactions during treatment. RESULTS There was no significant difference in SNOT-22 or Lund-Kennedy scores between the two groups before treatment (p > 0.05). After treatment, the SNOT-22 and Lund-Kennedy scores of the control and the study groups were decreased, and compared with the control group, the SNOT-22 and Lund-Kennedy scores in the study group improved more significantly (p < 0.05). In addition, the study group and the control group presented with 1 and 4 cases of nasal adhesion, 2 and 3 cases of epistaxis, 1 and 4 cases of sinus orifice obstruction, 1 and 3 cases of lacrimal duct injuries, respectively. The incidence of adverse reactions in the study group was significantly lower than that in the control group (8.3% vs. 23.3%) (p < 0.05). CONCLUSION PNN resection combined with hormone transnasal nebulization treatment can improve the symptoms and quality of life of DTRS patients, with good clinical efficacy but few adverse reactions. Therefore, such combination treatment deserves a promotion and application clinically. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Xin-Ke Wang
- The Third Hospital of Ninghai County, Department of Otorhinolaryngology, Ningbo, China
| | - Qi-Ling Zheng
- Yuyao People's Hospital of Zhejiang Province, Department of Otolaryngology Head and Neck Surgery, Yuyao, China
| | - Jia-Ning Sun
- Yuyao People's Hospital of Zhejiang Province, Department of Otolaryngology Head and Neck Surgery, Yuyao, China.
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4
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González-Torres L, García-Paz V, Meijide A, Goikoetxea MJ, Salgado MA, Sanz ML, Vila L. Local allergic rhinitis in children: Clinical characteristics and role of basophil activation test as a diagnostic tool. Int J Pediatr Otorhinolaryngol 2023; 172:111645. [PMID: 37481991 DOI: 10.1016/j.ijporl.2023.111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/12/2023] [Accepted: 07/02/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Local allergic rhinitis (LAR) is a condition involving a localized nasal allergic response in absence of systemic atopy. Most studies on LAR have been performed in adults. We aimed to describe clinical characteristics of LAR pediatric patients, its clinical evolution over a 7-year follow-up period and to study the role of basophil activation test (BAT), for its diagnosis. METHODS Forty-four children with non-allergic rhinitis (NAR) were included (24 males, 20 females, aged under 15 years). Nasal allergen provocation test (NAPT) and BAT were performed with Dermatophagoides pteronyssinus and Phleum pratense. RESULTS Seven patients (16%) were diagnosed of LAR. Six reacted to D pteronyssinus and one to P pratense. All LAR and 86% of NAR patients presented perennial symptoms. Fifty-seven percent of NAR and LAR patients referred persistent symptoms. Around half of NAR and LAR patients reported mild-moderate clinical manifestations. Three LAR patients associated conjunctival symptoms, proportionally more than NAR patients (19%, 7 out of 37). NAR patients presented bronchial asthma (n = 10) more frequently than LAR children (n = 1). More than half of LAR and NAR patients presented family history of atopy. BAT was negative in all LAR patients. On follow-up, 3 LAR patients and 10 of the 25 NAR patients who agreed to be retested, presented systemic sensitization. Dust mites were the most frequent allergen involved. CONCLUSIONS LAR should be ruled out in children with NAR. Almost half of children with LAR develop systemic sensitization over time. BAT shows low sensitivity for the diagnosis of LAR in children.
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Affiliation(s)
- L González-Torres
- Allergy Pediatric Unit, Complexo Hospitalario Universitario, A Coruña, Spain
| | - V García-Paz
- Allergy Pediatric Unit, Complexo Hospitalario Universitario, A Coruña, Spain
| | - A Meijide
- Allergy Unit, Complexo Hospitalario Universitario de Vigo, Spain
| | - M J Goikoetxea
- Allergy Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - M A Salgado
- Allergy Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - M L Sanz
- Allergy Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - L Vila
- Allergy Pediatric Unit, Complexo Hospitalario Universitario, A Coruña, Spain.
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5
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Nasal eosinophilia as a preliminary discriminative biomarker of non-allergic rhinitis in every day clinical pediatric practice. Eur Arch Otorhinolaryngol 2023; 280:1775-1784. [PMID: 36271956 DOI: 10.1007/s00405-022-07704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/12/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Non-allergic rhinitis (NAR) in children, named local allergic rhinitis (LAR) and non-allergic rhinitis with eosinophilia syndrome (NARES), are recently termed entities in childhood characterized by symptoms suggestive of allergic rhinitis in the absence of systemic atopy. Nasal eosinophils (nEo) are the principal cells involved in the allergy inflammation and nasal allergen provocation test is the gold standard method for the diagnosis, albeit with several limitations. The aim of this study was to validate the presence of nEo in combination with the therapeutic response to nasal steroids, as a preliminary discriminator of NAR in real life data. METHODS In a prospective cohort study, 128 children (63.3% male, aged 72 ± 42 m) with history of NAR were enrolled and followed up for 52 ± 32 m. Nasal cytology was performed and nasal steroids trial was recommended initially in all and repeatedly in relapsing cases. Response to therapy was clinically evaluated using 10-VAS. RESULTS Significant nEo was found in 59.3% of the cases and was related to reported dyspnea episodes. 23.4% had no response to therapy, whereas 51.5% were constantly good responders. Response to therapy was related to nEo and a cutoff point of 20% was defined as the most reliable biological marker with 94% sensitivity and 77% specificity. CONCLUSIONS In children with symptoms of NAR, the presence of nEo > 20% constantly responding to nasal steroid therapy, is a clear indicator of atopy. In an everyday clinical setting, it emerged as an easy, preliminary, cell biomarker suggestive of further investigation such as NAPT, to discriminate LAR from NARES.
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6
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Prieto A, Rondón C, Eguiluz-Gracia I, Muñoz C, Testera-Montes A, Bogas G, Nuñez Cuadros E, Campo P, Torres MJ. Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents. Pediatr Allergy Immunol 2021; 32:953-962. [PMID: 33598969 DOI: 10.1111/pai.13474] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Three allergic phenotypes of rhinitis have been described in adults: allergic rhinitis (AR), local allergic rhinitis (LAR), and dual allergic rhinitis (DAR, coexistence of AR and LAR). Nevertheless, most centers follow a diagnostic approach only based on skin prick test and serum allergen-specific IgE (collectively called atopy tests, AT). This approach prevents the recognition of LAR and DAR, the diagnosis of which requires a nasal allergen challenge (NAC). Here, we investigate the existence of LAR and DAR phenotypes in children and adolescents, and the misdiagnosis rate associated with a work-up exclusively based on AT. METHODS Clinical data were obtained during physician-conducted interviews, and AT and NAC were systematically performed in 5- to 18-year-old patients with chronic rhinitis. The misdiagnosis rate was defined as the proportion of cases where AT and NAC results were discordant. RESULTS A total of 173 patients (mean age 15.1 years, 39.9% male) completed the study. AR (positive AT and NAC), LAR (negative AT and positive NAC), DAR (positive AT and NAC for some allergens and negative AT and positive NAC for other allergens), and non-allergic rhinitis (negative NAC) were diagnosed in 45.7%, 24.9%, 11.6%, and 17.9% of individuals, respectively. The clinical profile was comparable among allergic phenotypes, but allergic patients had a significantly earlier rhinitis onset, higher conjunctivitis prevalence, and more severe disease than NAR individuals. A diagnostic work-up exclusively based on AT misclassified 37.6% of patients. CONCLUSIONS LAR and DAR represent relevant differential diagnosis in pediatric rhinitis. NAC increases the diagnostic accuracy of clinical algorithms for rhinitis in children and adolescents.
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Affiliation(s)
- Ana Prieto
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Carmen Rondón
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Candelaria Muñoz
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain
| | - Gador Bogas
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | | | - Paloma Campo
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Maria J Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain.,Laboratory for Nanostructures for the Diagnosis and Treatment of Allergic Diseases, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
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7
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Testera-Montes A, Salas M, Palomares F, Ariza A, Torres MJ, Rondón C, Eguiluz-Gracia I. Local Respiratory Allergy: From Rhinitis Phenotype to Disease Spectrum. Front Immunol 2021; 12:691964. [PMID: 34149736 PMCID: PMC8206788 DOI: 10.3389/fimmu.2021.691964] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Local respiratory allergy (LRA) is defined by the negativity of atopy tests, a clinical history suggestive of airway allergy and a positive response to the nasal and/or bronchial allergen challenge. The clinical spectrum of LRA is comprised of three conditions: local allergic rhinitis (LAR) and local allergic asthma in non-atopic patients, and dual allergic rhinitis (coexistence of allergic rhinitis and LAR) in atopic individuals. LRA is an independent disease phenotype not progressing to atopy over time, but naturally evolving to the clinical worsening and the onset of comorbidities. Published data suggests that LRA is mediated through the mucosal synthesis of allergen-specific (s)IgE, which binds to FcϵRI on resident mast cells, and in >50% of cases traffics to the blood stream to sensitize circulating basophils. To date, 4 clinical trials have demonstrated the capacity of allergen immunotherapy (AIT) to decrease nasal, conjunctival and bronchial symptoms, to improve quality of life, to increase the threshold dose of allergen eliciting respiratory symptoms, and to induce serum sIgG4 in LRA individuals. Collectively, these data indicate that local allergy is a relevant disease mechanisms in both atopic and non-atopic patients with airway diseases.
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Affiliation(s)
- Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain.,Allergy Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Red Tematica de Investigacion Colaborativa en Salud (RETICS) de Asma, Reacciones Adversas y Alergicas (ARADyAL), Málaga, Spain
| | - Maria Salas
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain.,Allergy Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Red Tematica de Investigacion Colaborativa en Salud (RETICS) de Asma, Reacciones Adversas y Alergicas (ARADyAL), Málaga, Spain
| | - Francisca Palomares
- Allergy Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Red Tematica de Investigacion Colaborativa en Salud (RETICS) de Asma, Reacciones Adversas y Alergicas (ARADyAL), Málaga, Spain
| | - Adriana Ariza
- Allergy Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Red Tematica de Investigacion Colaborativa en Salud (RETICS) de Asma, Reacciones Adversas y Alergicas (ARADyAL), Málaga, Spain
| | - María J Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain.,Allergy Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Red Tematica de Investigacion Colaborativa en Salud (RETICS) de Asma, Reacciones Adversas y Alergicas (ARADyAL), Málaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain.,Laboratory for Nanostructures for the Diagnosis and Treatment of Allergic Diseases, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
| | - Carmen Rondón
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain.,Allergy Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Red Tematica de Investigacion Colaborativa en Salud (RETICS) de Asma, Reacciones Adversas y Alergicas (ARADyAL), Málaga, Spain
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain.,Allergy Group, Instituto de Investigación Biomédica de Málaga-IBIMA and Red Tematica de Investigacion Colaborativa en Salud (RETICS) de Asma, Reacciones Adversas y Alergicas (ARADyAL), Málaga, Spain
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8
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Papadopoulos NG, Aggelides X, Stamataki S, Prokopakis E, Katotomichelakis M, Xepapadaki P. New concepts in pediatric rhinitis. Pediatr Allergy Immunol 2021; 32:635-646. [PMID: 33475171 DOI: 10.1111/pai.13454] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Rhinitis-and especially allergic rhinitis (AR)-remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Xenophon Aggelides
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Stamataki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, University of Crete, School of Medicine, Heraklion, Greece
| | | | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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9
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Bousquet J, Grattan CE, Akdis CA, Eigenmann PA, Hoffmann-Sommergruber K, Agache I, Jutel M. Highlights and recent developments in allergic diseases in EAACI journals (2019). Clin Transl Allergy 2020; 10:56. [PMID: 33292572 PMCID: PMC7712618 DOI: 10.1186/s13601-020-00366-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to support health promotion in which prevention of allergy and asthma plays a critical role and to disseminate the knowledge of allergy to all stakeholders including the EAACI junior members. There was substantial progress in 2019 in the identification of basic mechanisms of allergic and respiratory disease and the translation of these mechanisms into clinics. Better understanding of molecular and cellular mechanisms, efforts for the development of biomarkers for disease prediction, novel prevention and intervention studies, elucidation of mechanisms of multimorbidities, entrance of new drugs in the clinics as well as recently completed phase three clinical studies and publication of a large number of allergen immunotherapy studies and meta-analyses have been the highlights of the last year.
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Affiliation(s)
- J Bousquet
- MACVIA-France, Montpellier, France. .,CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
| | - C E Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - P A Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - K Hoffmann-Sommergruber
- Depart of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - I Agache
- Transylvania University Brasov, Brasov, Romania
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.,ALL-MED Medical Research Institute, Wrocław, Poland
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10
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Santamaría L, Calle A, Tejada-Giraldo Biol M, Calvo V, Sánchez J, Cardona R. Nasal specific IgE to Der p is not an acceptable screening test to predict the outcome of the nasal challenge test in patients with non-allergic rhinitis. World Allergy Organ J 2020; 13:100461. [PMID: 33014258 PMCID: PMC7522493 DOI: 10.1016/j.waojou.2020.100461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/01/2022] Open
Abstract
Objectives Nasal specific IgE (NsIgE) is the most common marker to identify type-2 inflammation in local allergic rhinitis (LAR). However, the comparison of NsIgE in different types of rhinitis, its frequency in tropical countries, and its diagnostic performance for predicting the outcome of a nasal challenge test (NCT) has had limited study. The main objective of this study was to explore the diagnostic performance of NsIgE to Dermatophagoides pteronyssinus (Der p) among different types of rhinitis and control subjects in a tropical population. Methods We evaluated the frequency of NsIgE, systemic atopy (serum sIgE and Skin Prick Test), and nasal eosinophils, and we performed nasal challenge tests (NCTs) with Der p in 3 groups of patients; rhinitis without atopy (RWoA) (n = 25), rhinitis with atopy (RWA) (n = 25), and control subjects (n = 18). Results NsIgE had a low sensitivity and specificity to predict a positive NCT in the RWoA group: 48% had NsIgE, but only 28% had a positive NCT. Among the RWA group 84% had NsIgE and 80% had a positive NCT; the association of NsIgE and positive NCT was high (>80%). In the control group 27.8% had NsIgE, but none had a positive NCT. Conclusions NsIgE performs poorly in predicting NCT results in patients with non-allergic rhinitis. More methodical investigations are needed in this complex area of rhinitis. In patients with allergic rhinitis, NsIgE was useful in predicting a positive nasal challenge, but not superior to the systemic atopic test.
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Affiliation(s)
- Luis Santamaría
- Group of Clinical and Experimental Allergy (GACE), Clinic "IPS Universitaria", University of Antioquia, Cra 27 n 37 B sur 69 apto 510, Medellín, Colombia
| | - Ana Calle
- Group of Clinical and Experimental Allergy (GACE), Clinic "IPS Universitaria", University of Antioquia, Cra 27 n 37 B sur 69 apto 510, Medellín, Colombia
| | - Manuela Tejada-Giraldo Biol
- Group of Clinical and Experimental Allergy (GACE), Clinic "IPS Universitaria", University of Antioquia, Cra 27 n 37 B sur 69 apto 510, Medellín, Colombia
| | - Victor Calvo
- Group of Clinical and Experimental Allergy (GACE), Clinic "IPS Universitaria", University of Antioquia, Cra 27 n 37 B sur 69 apto 510, Medellín, Colombia
| | - Jorge Sánchez
- Group of Clinical and Experimental Allergy (GACE), Clinic "IPS Universitaria", University of Antioquia, Cra 27 n 37 B sur 69 apto 510, Medellín, Colombia
| | - Ricardo Cardona
- Group of Clinical and Experimental Allergy (GACE), Clinic "IPS Universitaria", University of Antioquia, Cra 27 n 37 B sur 69 apto 510, Medellín, Colombia
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11
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Eguiluz-Gracia I, Ariza A, Testera-Montes A, Rondón C, Campo P. Allergen Immunotherapy for Local Respiratory Allergy. Curr Allergy Asthma Rep 2020; 20:23. [PMID: 32430550 DOI: 10.1007/s11882-020-00920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIESW Local respiratory allergy (LRA) is an eosinophilic phenotype of chronic airway disease. Three entities have been described within the LRA spectrum: local allergic rhinitis (LAR) and local allergic asthma (LAA) in non-atopic patients, and dual allergic rhinitis (DAR) in atopic patients (coexistence of LAR and allergic rhinitis). In this article, we aim to review the current evidence on the therapeutic options for LRA. RECENT FINDINGS No controlled study has assessed the effect of standard therapy (oral antihistamines, intranasal or inhaled corticosteroids, bronchodilators) in LRA subjects. Three randomized clinical trials and one observational study demonstrated that allergen immunotherapy (AIT) is able to control nasal and ocular symptoms, decrease the need for rescue medication, and improve quality of life in LAR individuals. Nasal or inhaled steroids can be expected to improve eosinophilic inflammation in LRA patients but cannot change the natural course of the disease. Moreover, the long-term and disease-modifying effects of AIT in LRA subjects need to be investigated.
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Affiliation(s)
- I Eguiluz-Gracia
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - A Ariza
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA and ARADyAL, Málaga, Spain
| | - A Testera-Montes
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - C Rondón
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain.
| | - P Campo
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
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12
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Eigenmann P. Allergy development is influenced by microbial breast milk composition and early exposure to animals. Pediatr Allergy Immunol 2020; 31:231-232. [PMID: 32301188 DOI: 10.1111/pai.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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13
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Fischl A, Eckrich J, Passlack V, Klenke SK, Hartmann D, Herrmann E, Schulze J, Zielen S. Comparison of bronchial and nasal allergen provocation in children and adolescents with bronchial asthma and house dust mite sensitization. Pediatr Allergy Immunol 2020; 31:143-149. [PMID: 31660641 DOI: 10.1111/pai.13147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bronchial allergen provocation (BAP) is an established tool for the diagnosis of allergy in patients with asthma, but its use is limited by the potential risk of severe asthmatic reactions. Nasal provocation testing (NPT) may be an alternative safe method and does not require sophisticated equipment. OBJECTIVE The aim of this prospective study was to evaluate the concordance of both methods in patients with asthma and house dust mite (HDM) sensitization. METHODS A total of 112 patients with HDM sensitization underwent BAP and had the following parameters analysed: decrease in FEV1, exhaled NO, and total and specific IgE. Within 12 weeks, NPT with HDM was performed in 74 patients with a median age of 9 years (range, 5-16 years). The results were evaluated using the Lebel score which quantifies major symptoms like rhinorrhea, nasal obstruction, sneezes and minor symptoms, such as pruritus, conjunctivitis and pharyngitis. RESULTS Fifty-seven of 74 patients had an early asthmatic reaction, of which 41 were identified using the Lebel score. The Lebel score had a sensitivity of 71.9% and a positive predictive value (PPV) of 89.1%. In addition, an eNO ≥ 10 ppb (AUC 0.78), a specific IgE Dermatophagoïdes pteronyssinus ≥ 25.6 kU/L (AUC 0.76) and a specific IgE Dermatophagoïdes farinae ≥ 6.6 kU/L (AUC 0.78) were good predictors of an early asthmatic reaction. CONCLUSION A sequential use of NPT prior to BAP is justified to establish the relevance of HDM allergy. In patients with a negative NPT, BAP is still recommended to rule out a HDM-induced asthmatic reaction.
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Affiliation(s)
- Anna Fischl
- Department for Children and Adolescents, Division of Pediatric Allergy, Pulmonology, and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - Jonas Eckrich
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, University of Mainz, Mainz, Germany
| | - Vanessa Passlack
- Department for Children and Adolescents, Division of Pediatric Allergy, Pulmonology, and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - Sara-Kristin Klenke
- Department for Children and Adolescents, Division of Pediatric Allergy, Pulmonology, and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - Desiree Hartmann
- Department for Children and Adolescents, Division of Pediatric Allergy, Pulmonology, and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe University, Frankfurt, Germany
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Pediatric Allergy, Pulmonology, and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Pediatric Allergy, Pulmonology, and Cystic fibrosis, Goethe University, Frankfurt, Germany
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14
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Abstract
PURPOSE OF REVIEW Allergic rhinoconjunctivitis is the most common manifestation of allergic disease. This break in the normal natural function of the immune system to ignore harmless molecules such as pollen and pet dander to now aggressively react has lead to a substantial disease burden that is not always recognized and adequately treated. RECENT FINDINGS Individual molecular component testing may increase the predictive value of blood sIgE and clinical symptoms. Defining the most symptoms inducing allergenic protein has led to advances in peptide-based allergen immunotherapy. There have been steady consistent reports that allergy immunotherapy for children with symptomatic allergic rhinitis prevents the onset of asthma. SUMMARY Allergy immunotherapy is an effective disease-modulating treatment that alters the underlying immune dysfunction which is a currently underutilized therapy especially as it is likely effective in preventing the onset of asthma in children, at least in the short term.
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Affiliation(s)
- Sanny K Chan
- Department of Pediatrics, National Jewish Health, Division of Allergy and Immunology, Denver, Colorado, USA
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15
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How to Diagnose and Treat Local Allergic Rhinitis: A Challenge for Clinicians. J Clin Med 2019; 8:jcm8071062. [PMID: 31331047 PMCID: PMC6678883 DOI: 10.3390/jcm8071062] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic rhinitis is a very common disease that can be divided in various phenotypes. Historically, the condition has been classified into the allergic rhinitis (AR) and non-allergic non-infectious rhinitis (NAR) forms, based on the results of the classical biomarkers of atopy: skin prick test and serum allergen-specific IgE However, this classification does not reflect the complexity of the rhinitis syndrome, as illustrated by the existence of non-atopic rhinitis patients who display a nasal reactivity to environmental allergens. This new phenotype has been termed local allergic rhinitis (LAR) and can be only recognized if an additional test such as the nasal allergen challenge (NAC) is integrated in the diagnostic algorithm for chronic rhinitis. Recent data shows that the NAC is a very safe and reliable technique ready for the clinical practice. LAR is a differentiated rhinitis phenotype which often commences during childhood and quickly progresses towards a clinical worsening and the association of comorbidities in other mucosal organs. Recent evidence supports the existence of a bronchial counterpart of LAR (local allergic asthma), which highlights the pathophysiological links between the upper and lower airways and reinforces the united airways concept. Importantly, several controlled studies have demonstrated the ability of allergen immunotherapy to control LAR symptoms while the therapy is being administered. This review emphasizes the need to implement the NAC in the clinical practice in order to facilitate the recognition of LAR patients, allowing for an early prescription of specific therapies with disease-modifying potential.
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Eigenmann P. Local rhinitis needs allergen-challenges for diagnosis, late infancy supplementation of probiotics prevents eczema, and milk oral immunotherapy is effective in the long term. Pediatr Allergy Immunol 2019; 30:257-258. [PMID: 31032546 DOI: 10.1111/pai.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
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