Epidemiology of allergic rhinitis and associated risk factors in Asia

Real-world efficacy of sublingual immunotherapy with Japanese cedar pollen for cypress pollinosis

Background

It remains unclear whether allergen immunotherapy with Japanese cedar pollen extract is effective for Japanese cypress pollinosis in real-world settings.

Objective

We sought to investigate the Japan-wide prevalence of cypress pollinosis, the efficacy of cedar sublingual immunotherapy (SLIT) on cypress pollinosis, the role of serum-specific IgE levels in pollinosis, and patients' interest in the development of cypress SLIT.

Methods

A cross-sectional, multicenter study using self-administered questionnaires was conducted in regions of Japan where cedar and cypress pollen dispersals are prevalent. This study included patients aged 5 to 69 years who received cedar SLIT in 2023.

Results

Of 2597 participants analyzed, 84.5% experienced pollinosis symptoms during the cypress season before receiving cedar SLIT. Among these patients, 40.2% felt that cedar SLIT was less effective during the cypress season than during the cedar season. The longer the patients received cedar SLIT, the greater the inefficacy perceived during the cypress versus the cedar season. In the symptomatic patients, serum IgE levels were significantly higher for cedar and cypress as compared with those observed in subjects without symptoms during the cypress season. No significant differences were reported in IgE levels for cedar and cypress between patients reporting either high or lower efficacy for the cedar SLIT during cypress season. Interest in cypress SLIT was seen in 78.4% of these patients.

Conclusions

Although there is a bias based on regional distribution, cedar SLIT has induced a limited efficacy on cypress pollinosis in real-world settings, suggesting a need for the development of cypress SLIT.

Prenatal exposure to heavy metals and childhood atopic disease

INTRODUCTION

Our objective was to determine the relationship between biomarkers of exposure to eleven heavy metals measured at birth and atopic disease in offspring up to 5.5 years.

METHODS

Heavy metals were measured in women of the ELFE cohort from: maternal urine (n = 804; arsenic [As], cadmium [Ca], cesium [Cs], chromium [Cr], cobalt [Co], nickel [Ni], antimony [Sb], tin [Sn] and vanadium [V]), hair (n = 1649; mercury [Hg]), and cord blood (n = 1525; lead [Pb]) collected at birth. Data on atopic diseases (eczema, food allergy, wheezing, asthma, and rhinitis) were collected from 2 months to 5.5 years. Five multimorbidity clusters were previously identified using latent class analysis: "asymptomatic", "early wheeze without asthma", "allergies without asthma", "asthma only", and "multimorbidity". Multinomial logistic regression was performed, using the asymptomatic cluster as the reference, to determine the relationship between heavy metal concentrations and atopic diseases.

RESULTS

Concentrations of Co were negatively associated with the multimorbidity cluster in the whole sample (OR 0.66 [95% CI 0.49, 0.89]). In boys, Cs was associated with lower odds of belonging to the early wheeze without asthma (0.71 [0.52, 0.97]) and multimorbidity clusters (0.54 [0.35, 0.82), while Sn was negatively associated with the multimorbidity cluster (0.66 [0.46, 0.96]). Results with binary outcomes supported findings from cluster analyses.

CONCLUSION

Exposure to some heavy metals assessed at delivery was inversely associated with the risk of atopic diseases, especially among boys. Further research should focus on heavy metal subtypes to distinguish between the more and less toxic forms.

The relationship of polyunsaturated and monounsaturated fatty acids intake and serum concentrations on inhalant allergen sensitization and allergic rhinitis development

BACKGROUND

The increasing prevalence of allergic rhinitis may be attributed to lifestyle changes such as dietary habits. Regarding dietary factors, n-3 and n-6 polyunsaturated fatty acids (PUFAs) are considered to be involved in the pathogenesis. Therefore, we examined whether the intake and serum concentrations of fatty acids affect inhaled allergen sensitization and the development of allergic rhinitis.

METHODS

In total, 571 participants (20-69 years) from the Iwaki Health Promotion Project, a community-based project in 2022, were surveyed. Based on the results of PUFA intake and serum fatty acid concentrations obtained using a self-administered diet-history questionnaire, we examined whether n-3 or n-6 PUFAs were involved in reducing or increasing the risk of sensitization, respectively, and developing the disease. We also analyzed whether monounsaturated fatty acids-palmitoleic acid and oleic acid-were risk factors for sensitization and development. Univariate dietary intake, serum concentration, and logistic regression analyses were performed to identify the risk factors.

RESULTS

Our study revealed that higher serum concentrations of n-3 PUFAs were associated with a decreased risk of developing rhinitis, but had no effect on allergen sensitization in younger age group <50 years. Furthermore, palmitoleic acid had increased sensitization, and oleic acid may also increase the risk of the allergen sensitization.

CONCLUSIONS

n-3 PUFAs may reduce the risk of developing allergic rhinitis. Notably, palmitoleic acid may be a new risk factor that increases the risk of inhalant allergen sensitization and allergic rhinitis. These findings are significant in understanding the role of dietary factors in allergic rhinitis.

Association of Abnormal Body Weight and Allergic Rhinitis-A Systematic Review and Meta-Analysis

OBJECTIVE

Allergic rhinitis (AR) is a prevalent inflammatory condition of the nasal mucosa, with significant burden worldwide. While studies have demonstrated a relationship between body mass index (BMI) and other atopic diseases, its association with AR is uncertain. This study aims to clarify the association between non-normal BMI and AR.

DESIGN

According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, independent authors screened studies for eligibility, extracted data and assessed bias of included studies using the Newcastle-Ottawa scale and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. A random-effects meta-analysis was used to pool maximally covariate-adjusted estimates. Additional subgroup and bias analyses were performed.

DATA SOURCES

PubMed, Embase, Cochrane Library, SCOPUS and CINAHL were searched from inception to 14 January, 2024.

ELIGIBILITY CRITERIA

Observational studies investigating the association between non-normal BMI and AR in both children and adults.

RESULTS

We included 32 articles comprising 2,008,835 participants. The risk of bias was low (N = 20) or moderate (N = 12) and GRADE certainty of evidence was very low to low. Pooled cross-sectional analyses indicated that obese children (OR = 0.99, 95% CI = 0.96-1.03, I2 = 0%), obese adults (OR = 1.11, 95% CI = 0.92-1.33, I2 = 73%), overweight children (OR = 1.02, 95% CI = 0.98-1.06, I2 = 35%), and overweight adults (OR = 1.13, 95% CI = 0.90-1.40, I2 = 0%) showed similar odds of AR compared to controls. Additionally, longitudinal analyses did not identify any evidence for an association between overweight (OR = 1.03, 95% CI = 0.85-1.24, I2 = 29%) or underweight (OR = 1.09, 95% CI = 0.77-1.54, I2 = 72%) children and AR risk. These results remained largely robust across various subgroups and sensitivity assessments.

CONCLUSION

Abnormal BMI may not be associated with AR. This study adds to the expanding literature on the association between non-normal BMI and atopic diseases. Further prospective studies are needed to explore the longitudinal relationship between BMI and AR and the effect of weight loss interventions on AR, given the limits of existing literature.

TRIAL REGISTRATION

PROSPERO CRD42024503589.

Association between Clinical Factors and Surgical Outcomes for Patients with Persistent Allergic Rhinitis

Objective: While septoplasty with turbinoplasty is commonly performed for patients with nasal obstruction, no study has addressed its efficacy and related determinants in patients with allergic rhinitis (AR) and various symptoms. This study aimed to identify potential factors associated with surgical outcomes in patients with persistent AR (PAR) who underwent septoplasty with turbinoplasty. Methods: We prospectively recruited patients with PAR and positive allergy test results for surgical treatment. We also collected relevant preoperative laboratory data. The Sinonasal Outcome Test-22 (SNOT-22) survey was administered to all patients one day before and one year after surgery. Results: A total of 128 patients who completed a one-year postoperative follow-up were enrolled. The total SNOT-22 score and five subdomain scores significantly improved postoperatively. We found that women and those with higher preoperative SNOT-22 scores experienced more postoperative improvement and had a greater potential to reach minimal clinically important differences (MCID). A preoperative SNOT-22 score greater than the determined cut-off value of 42.5 had an approximately 6-fold likelihood of MCID achievement. Patients in the nasal obstruction group and non-smokers demonstrated greater postoperative improvement in the sleep subdomain. Conclusions: Women with PAR and those with a preoperative SNOT-22 score above 42.5 were preferable candidates for surgery and expressed greater satisfaction. Notably, rhinologic presentations and non-rhinologic symptoms of PAR patients could benefit from within one year after surgery. Here, we discuss the factors associated with subjective surgical outcomes to help physicians and patients with AR in preoperative consultations.

A Study to Evaluate the Role of Probiotics in Allergic Rhinitis

To compare treatment outcomes in allergic rhinitis patients with and without probiotics. The present study was conducted in the Out Patient Department of ENT in a Tertiary Care Hospital w.e.f. April 2023 till March 2024. Total 106 patients of allergic rhinits were included in the study and were divided randomly into 2 groups with 53 in each group. Group A was given probiotics along with standard treatment of antihistaminics and topical steroids and group B was given antihistaminics and topical steroids only. Total Nasal Symptoms Score (TNSS) of all patients was calculated at the time of enrollment and after 8 weeks post treatment. Based on the pre-treatment and post-treatment TNSS, an analysis was made whether probiotics could be an add-on therapy along with the standard treatment given for allergic rhinitis from past so many years. We conducted our study on 106 patients with mean age of 28.1 ± 8.91 years.44% were male and 56% were female. In group A pre-treatment TNSS was 8.057 + 2.307 and post treatment TNSS was 0.887 + 0.776. In group B pre-treatment TNSS was 9.45 + 0.514 and post treatment was 1.89 + 0.776. The mean post-treatment TNSS in group A was lower than the group B. This difference was statistically significant with p value of < 0.05. Based on the study we can suggest that probiotics could be a potential add-on strategy in the management of allergic rhinitis. Probiotic supplement action seems to be effective in ameliorating allergic rhinitis symptoms and improving the quality of life. However further clinical and molecular studies are required to improve our knowledge about interactions among candidate probiotics and host microbiome, cells and immune defenses, in order to create efficacious interventions.

The efficacy and safety of radiofrequency ablation for allergic rhinitis: a systematic review and meta-analysis

OBJECTIVE

This systematic review aims to synthesise findings from randomised, controlled trials and assess the efficacy and safety of radiofrequency ablation in treating allergic rhinitis.

METHODS

A thorough search was conducted across PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang, Chinese Scientific Journal, and Chinese Biomedical Literature databases from their inception until October 2023. The primary outcome measure was the total effective rate, with secondary outcomes including adverse events.

RESULTS

This review included 15 randomised, controlled trials involving 1430 patients. The pooled analysis revealed a statistically significant effect on the total effective rate (odds ratio = 3.27, 95 per cent confidence interval = 2.37 to ~4.51). However, no statistical significance was observed in adverse events (odds ratio = 1.18, 95 per cent confidence interval = 0.67 to ~2.08).

CONCLUSIONS

Based on the analytical results, radiofrequency ablation emerges as an efficacious and safe treatment modality for allergic rhinitis. Given the constraints posed by a limited sample size, it is imperative that forthcoming clinical trials adhere rigorously to the gold standard of randomised, controlled trials for the purpose of corroborating these conclusions.

Recent developments in immunotherapy approaches for allergic rhinitis

Allergic rhinitis (AR) poses a significant global health burden, with the potential to progress to asthma, thereby impacting patients' quality of life. Immunotherapy has demonstrated effectiveness in mitigating clinical symptoms by altering the underlying disease mechanisms of AR. This article provides a thorough review of the current state of immunotherapy for AR, encompassing various facets of immunotherapeutic strategies, elucidating their mechanisms and clinical implications. By presenting a nuanced understanding of the present landscape of immunotherapy for AR, this review aims to serve as a valuable reference for informing clinical treatment strategies. The subsequent analysis of diverse immunotherapeutic pathways offers a comprehensive understanding of their mechanisms and clinical implications. A meticulous examination is conducted on subcutaneous immunotherapy, sublingual immunotherapy, oral immunotherapy, intralymphatic immunotherapy, and innovative intravenous gold-induced autologous serum injection therapy. Each pathway is systematically elucidated, with its distinctive features and potential contributions to managing AR emphasized. In conclusion, synthesizing epidemiological insights, immunotherapeutic nuances, and pathway-specific analyses encapsulates a profound understanding of immunotherapy for AR.

Exploration of Allergic Rhinitis: Epidemiology, Predisposing Factors, Clinical Manifestations, Laboratory Characteristics, and Emerging Pathogenic Mechanisms

Allergic rhinitis (AR) is a widespread allergic condition, with its prevalence continuing to rise globally. This disease has a significant impact on patients' quality of life. Understanding the underlying pathophysiology is important to develop better-targeted therapies. For decades, the primary assumption has been that an allergy is caused by unbalanced and overactive immunological responses against allergens, driven mainly by activated T helper 2 (Th2) cells and due to aberrant T-regulatory cells. The more recent hypothesis that is gaining attention relies on the dysregulation of the epithelial barrier, which might result in allergen uptake as a primary defect in the pathogenesis of allergic reactions. The nasal epithelial barrier is considered a crucial first line of defense in the upper airway, as it protects the host's immune system from exposure to allergens. Thus, this review will discuss AR's epidemiology, predisposing factors, clinical manifestations, laboratory characteristics, and pathogenic mechanisms.

Fungi-sensitized individuals have unique profiles where Alt a 1 dominates promoting response to grass, ragweed and cat allergens

Introduction

The aim of our work was to determine comprehensively the sensitization profile of patients hypersensitive to fungal allergenic components in the Ukrainian population, identifying features of their co-sensitization to allergens of other groups and establishing potential relationships between causative allergens and their ability to provoke this hypersensitivity.

Methods

A set of programs was developed using Python and R programming languages, implementing the K-means++ clustering method. Bayesian networks were constructed based on the created clusters, allowing for the assessment of the probabilistic interplay of allergen molecules in the sensitization process of patients.

Results and discussion

It was found that patients sensitive to fungi are polysensitized, with 84.77% of them having unique allergological profiles, comprising from 2 to several dozen allergens from different groups. The immune response to Alt a 1 may act as the primary trigger for sensitization to other allergens and may contribute to a high probability of developing sensitivity to grasses (primarily to Phl p 2), ragweed extract, and the Amb a 1 pectate lyase, as well as to pectate lyase Cry j 1 and cat allergen Fel d 1. Individuals polysensitized to molecular components of fungi were often sensitive to such cross-reactive molecules as lipocalins Fel d 4 and Can f 6, as well. Sensitivity to Ambrosia extract which dominated in the development of sensitization to ragweed pollen indicating the importance of different allergenic components of this plant's pollen. This hypothesis, along with the assumption that Phl p 2 may be the main trigger for sensitivity to grasses in patients with Alternaria allergy, requires further clinical investigation.

Clinical practice guideline for acupuncture and moxibustion: Allergic rhinitis

Acupuncture is one of the most effective complementary therapies for allergic rhinitis (AR) and has been recommended by several clinical practice guidelines (CPGs) for AR. However, these CPGs mentioned acupuncture without making recommendations for clinical implementation and therapeutic protocols, therefore limiting the applicability of acupuncture therapies for AR. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies have initiated a project to develop the CPG for the use of acupuncture and moxibustion to treat AR. This CPG was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role. The clinical questions, recommendations and therapeutic protocols were all formulated by the GDG using the modified Delphi method. The CPG contains recommendations for 15 clinical questions about the use of acupuncture and moxibustion interventions. These include one strong recommendation for the intervention based on high-quality evidence, three conditional recommendations for either the intervention or standard care, and 11 conditional recommendations for the intervention based on very low quality of evidence. The CPG also provides one filiform needle acupuncture protocol and five moxibustion protocols extracted based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Du SH, Chen S, Wang SZ, Wang GQ, Du S, Guo W, Xie XL, Peng BH, Yang C, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Allergic rhinitis. J Integr Med. 2024; 22(3): 245-257.

The effectiveness of pharmacist-led educational model in adult patients with allergic rhinitis: a single-center randomized control trial protocol (AR-PRISE RCT)

BACKGROUND

Allergic rhinitis is a chronic respiratory disorder that significantly impacts patients' quality of life (QoL) and work performance. Pharmacists are recognized as suitable professionals to provide patient education and pharmaceutical care for managing allergic rhinitis patients. However, local clinical practice guidelines, particularly regarding pharmaceutical care in public healthcare institutions, are lacking. This study protocol outlines a randomized controlled trial (RCT) designed to evaluate the effectiveness of a pharmacist-led educational model (AR-PRISE Model) in managing allergic rhinitis in adult patients compared to standard pharmaceutical care. The AR-PRISE model delivers patient educational material and a pharmaceutical care algorithm.

METHOD

This is a 6-month, single-center, prospective, randomized, two-arm, and parallel-group controlled trial. The trial recruits patients attending the otorhinolaryngology clinics of a tertiary referral hospital. Participants are randomized into control or intervention groups in a 1:1 ratio using permuted block randomization. The total number of participants estimated is 154, with each group requiring 77 participants. The control group receives standard pharmaceutical care, while the intervention group receives pharmacist-led education according to the AR-PRISE model. Both groups are assessed for middle turbinate endoscopy findings, disease severity, knowledge level, symptom control, medication adherence, and QoL at baseline and the end-of-study follow-up (day 180 ± 7). Depending on feasibility, intermediate follow-ups are conducted on days 60 ± 7 and 120 ± 7, either virtually or face-to-face. During intermediate follow-ups, participants are assessed for symptom control, medication adherence, and QoL. The intention-to-treat analysis includes all participants assigned to each group. An independent T-test compares the mean difference in knowledge level between the two groups. A two-way repeated measures ANOVA analysis is employed to determine between-group differences for scores of symptom control, adherence rate, and QoL. A P-value < 0.05 is considered statistically significant.

DISCUSSION

This study protocol will provide a framework for conducting a randomized controlled trial (RCT) to evaluate the effectiveness of pharmacist-led education intervention in managing allergic rhinitis within public healthcare settings. The parameters measured in this trial will quantify outcomes associated with improvements in symptoms and QoL. By systematically assessing these outcomes, we aim to contribute valuable insights into the role of pharmacist-led interventions in enhancing the management of allergic rhinitis in public healthcare settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06027736 . Registered on 9 July 2023-retrospectively registered.

Medicinal plants for allergic rhinitis: A systematic review and meta-analysis

Herbal medicine is popularly used among patients who suffer from allergic rhinitis. This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of single medicinal plants in the management of allergic rhinitis. We searched MEDLINE, CENTRAL, and Web of Science for randomised controlled trials which evaluated the use of single medicinal plant for allergic rhinitis among adults and children. Twenty-nine randomised controlled trials (n = 1879) were eligible while 27 (n = 1769) contributed data for meta-analyses. Most studies (studies = 20) compared medicinal plants against placebo and Petasites hybridus was most frequently investigated (studies = 5). Very-low-to-low-certainty evidence suggests that compared to placebo, single medicinal plants may improve overall total nasal symptoms (SMD -0.31, 95% CI -0.59 to -0.02; participants = 249; studies = 5; I2 = 21%) especially nasal congestion and sneezing; and rhinoconjunctivitis quality of life (RQLQ) scores (MD -0.46, 95% CI -0.84 to -0.07; participants = 148; studies = 3; I2 = 0%). Moderate-certainty evidence show no clear differences between single medicinal plants and antihistamine in overall symptoms (Total nasal symptoms: SMD -0.14, 95% CI -0.46 to 0.18; participants = 149; studies = 2; I2 = 0%). As adjunctive therapy, moderate-certainty evidence shows that medicinal plants improved SNOT-22 scores when given as intranasal treatment (MD -7.47, 95% CI -10.75 to -4.18; participants = 124; studies = 2; I2 = 21%). Risk of bias domains were low or not clearly reported in most studies while heterogeneity was substantial in most pooled outcomes. Route of administration and age were identified to be plausible source of heterogeneity for certain outcomes. Medicinal plants appear to be well tolerated up to 8 weeks of use. Clear beneficial evidence of medicinal plants for allergic rhinitis is still lacking. There is a need for improved reporting of herbal trials to allow for critical assessment of the effects of each individual medicinal plant preparation in well-designed future clinical studies.

Nutraceuticals and non-pharmacological remedies for managing patients with allergic rhinitis

Allergic rhinitis (AR) is a common disease characterized by type 2 inflammation and typical symptoms. Although pharmacologic treatment can be effective, prolonged administration of drugs can be associated with adverse reactions and seldom reduction of effectiveness. Therefore, complementary medicine is widespread in clinical practice, mainly in pediatric settings, and pleasing to parents. We reviewed and discussed the most relevant nutraceuticals and non-pharmacological remedies used in managing patients with AR. Nutraceutical, according to Defelice is "a food (or part of a food) that provides medical or health benefits, including the prevention and/or treatment of a disease," and is commonly prescribed by pediatrics as well as self-prescription by parents. There is evidence that some components exert beneficial effects in AR. Some compounds, including micronutrients, vitamins, probiotics, herbal medicines, hyaluronic acid, and saline solutions, could positively and safely be used in children with AR as add-on remedies.

Effect of Air Pollutants and Meteorological Factors on Daily Outpatient Visits of Allergic Rhinitis in Hohhot, China

Objective

There is limited evidence that atmospheric pollutants are associated with the number of allergic rhinitis (AR) visits. This study aimed to investigate the relationship between atmospheric pollutants and meteorological factors and the number of daily visits for AR in Hohhot City, providing a theoretical basis for further research on the effects of atmospheric pollutants on AR.

Methods

Microsoft Excel 2016 was used to collect and organize the AR outpatient consultation data, air pollution and meteorological data in Hohhot City during 2018-2020, and the data were descriptively analyzed and Spearman correlation test was performed using SPSS22.0; A generalized additive model was built in R4.2.3 to analyze the effect of air pollution on the number of AR visits and its lagged and cumulative effects, while the robustness of the model was tested using a two-pollutant analysis. Finally, we analyzed the effects of the interaction of temperature, relative humidity and pollutants on the number of AR visits.

Results

The daily average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3 in Hohhot during 2018-2020 were 38.1 μg/m3, 83.3 μg/m3, 36.1 μg/m3, 15.1 μg/m3, 14.2 mg/m3, and 99.95 μg/m3, respectively, with the concentrations of PM2.5 and PM10 exceeding the secondary limit of the national standard. The results of the generalized additive model analysis showed that the RR and 95% CI of the effect of each 10 μg/m3 increase in pollutant concentration (1 mg/m3 increase in CO) on the number of AR outpatient clinics were 1.008 (1.001-1.016), 1.002 (1-1.005), 1.072 (1.033-1.113), 1.020 (1007-1.034), 1.033 (1.014-1.052), 0.987 (0.9804-0.9936).

Conclusion

Short-term exposure to PM2.5, PM10, SO2, NO2, and CO was significantly associated with an increase in AR clinic visits, and short-term exposure to O3 was significantly associated with a decrease in allergic rhinitis clinic visits.

Environmental Risk Factors, Protective Factors, and Biomarkers for Allergic Rhinitis: A Systematic Umbrella Review of the Evidence

Many potential environmental risk factors, protective factors, and biomarkers of AR have been published, but so far, the strength and consistency of their evidence are unclear. We conducted a comprehensive review of environmental risk, protective factors, and biomarkers for AR to establish the evidence hierarchy. We systematically searched Embase, PubMed, Cochrane Library, and Web of Science electronic database from inception to December 31, 2022. We calculated summary effect estimate (odds ratio (OR), relative risk (RR), hazard ratio (HR), and standardized mean difference (SMD)), 95% confidence interval, random effects p value, I2 statistic, 95% prediction interval, small study effects, and excess significance biases, and stratification of the level of evidence. Methodological quality was assessed by AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). We retrieved 4478 articles, of which 43 met the inclusion criteria. The 43 eligible articles identified 31 potential environmental risk factors (10,806,206 total population, two study not reported), 11 potential environmental protective factors (823,883 total population), and 34 potential biomarkers (158,716 total population) for meta-analyses. The credibility of evidence was convincing (class I) for tic disorders (OR = 2.89, 95% CI 2.11-3.95); and highly suggestive (class II) for early-life antibiotic use (OR = 3.73, 95% CI 3.06-4.55), exposure to indoor dampness (OR = 1.49, 95% CI 1.27-1.75), acetaminophen exposure (OR = 1.54, 95% CI 1.41-1.69), childhood acid suppressant use (OR = 1.40, 95% CI 1.23-1.59), exposure to indoor mold (OR = 1.66, 95% CI 1.26-2.18), coronavirus disease 2019 (OR = 0.11, 95% CI 0.06-0.22), and prolonged breastfeeding (OR = 0.72, 95% CI 0.65-0.79). This study is registered in PROSPERO (CRD42022384320).

Correlations between IL-36 family cytokines in peripheral blood and subjective and objective assessment results in patients with allergic rhinitis

BACKGROUND

Interleukin (IL)-36 family cytokines have received increasing attention, especially in the fields of inflammation and immunity research. However, whether IL-36 family cytokine levels are correlated with the results of the assessment of allergic rhinitis (AR) and affect the severity of AR remains unknown. Therefore, this study aimed to investigate the correlations between IL-36 family cytokine levels and subjective and objective assessment results and to further analyze the possible mechanisms of IL-36 family cytokines in the development of AR.

METHODS

An enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of the IL-36 family cytokines IL-36α, IL-36β, IL-36γ, IL-36Ra, and IL-38 in the peripheral blood of patients with AR. The condition of patients with AR was assessed by 22-item sino-nasal outcome test (SNOT-22) score, visual analogue scale (VAS) scores for disease severity, and serum inhalant allergen immunoglobulin E (IgE) detection. Correlations between IL-36 family cytokine levels and subjective and objective assessment results in patients with AR were analyzed.

RESULTS

The concentration of IL-36α in the peripheral blood of patients with AR was the highest, and the concentration of IL-36β was the lowest. The concentration of IL-36α was higher in juvenile patients than in adult patients, and there was a difference in the IL-36Ra level between the perennial allergen group and the seasonal allergen group. There was a positive correlation between IL-36α level and IL-36γ level, IL-36γ level and IL-36Ra level, and IL-36Ra level and IL-38 level, and IL-36β level was positively correlated with IL-36Ra and IL-38 levels, respectively. IL-36α level was positively correlated with VAS score for nasal congestion symptom. IL-36β level was positively correlated with the total VAS score for ocular symptoms and VAS scores for ocular itching and eye pain symptoms. However, there was no correlation between the levels of all cytokines in IL-36 family and SNOT-22 score, the number of positive inhaled allergens, or the highest positive intensity of allergen specific immunoglobulin E (sIgE).

CONCLUSION

Peripheral blood IL-36 family cytokines play an important role in AR, and the concentrations of IL-36α and IL-36β were related to the severity of symptoms in patients with AR.

Exploring the latest understanding on the role of immune mediators, genetic and environmental factors in pathogenesis of allergic rhinitis: a systematic review

Introduction

Despite well-defined clinical phenotypes of chronic rhinitis, the underlying in-depth pathophysiological mechanism, particularly with reference to the involvement of immune mediators, genetic, and environmental factors, are still not fully understood. Therefore, our aim was to give updated information on the pathogenesis of allergic rhinitis (AR), with an emphasis on the role of cytokines in adults aged 18 years and above. Additionally, we investigated the impact of genetic and environmental factors in the pathogenesis of AR.

Results

A search in various databases identified 1,178 records, and 18 studies were ultimately selected from January 2018 to April 2023. The total sample size in our studies was 4,317, with 2,186 in the experimental and 2,131 in control groups, respectively. The mean age was 33.4 years, with 43% were male, while 57% were female. According to the selected studies, various factors, including immune mediators, particularly cytokines, genetic, and environmental factors, were identified in the development of AR.

Conclusion

The selected studies presented findings on different factors and sub-factors in the pathogenesis of AR, making it a challenge for us to compare their results. However, based on our findings, researchers can link our identified factors to potential therapies for AR.

Effects of pollen concentration on allergic rhinitis in children: A retrospective study from Beijing, a Chinese megacity

With global climate change and rapid urbanization, the prevalence of allergic diseases caused by pollen is rising dramatically worldwide with unprecedented complexity and severity, especially for children in mega-cities. However, because of the lack of long time-series pollen concentrations data, the accurate evaluation of the impact of pollen on allergic rhinitis (AR) was scarce in the Chinese metropolis. A generalized additive model was used to assess the effect of pollen concentration on pediatric AR outpatient visits in Beijing from 2014 to 2019. A stratified analysis of 10 pollen species and age-gender-specific groups was also conducted during the spring and summer-autumn peak pollen periods separately. Positive associations between pollen concentration and pediatric AR varied with the season and pollen species were detected. Although the average daily pollen concentration is higher during the spring tree pollen peak, the influence was stronger at the summer-autumn weed pollen peak with the maximum relative risk 1.010 (95% CI 1.009, 1.011), which was higher than the greatest relative risk, 1.003 (95% CI 1.002, 1.004) in the spring peak. The significant adverse effects can be sustained to lag10 during the study period, and longer in the summer-autumn peak (lag13) than in the spring peak (lag8). There are thresholds for the health effects and they varied between seasons. The significant effect appeared when the pollen concentration was higher than 3.74 × 105 grain·m-2·d-1 during the spring tree pollen peaks and 4.70 × 104 grain·m-2·d-1 during the summer-autumn weed pollen peaks. The stratified results suggested that the species-specific effects were heterogeneous. It further highlights that enough attention should be paid to the problem of pollen allergy in children, especially school-aged children aged 7-18 years and weed pollen in the summer-autumn peak pollen period. These findings provide a more accurate reference for the rational coordination of medical resources and improvement of public health.

The Trend of the Burden of Allergic Rhinitis Pre- and Post-COVID-19 Pandemic in the Urban Population of Perak, Malaysia

Aims

This study aims to determine the trend of allergic rhinitis (AR) prevalence in a tertiary hospital between 2017 and 2022, and to compare its prevalence pre- and post-COVID-19 pandemic.

Methods

This was a cross-sectional study involving the extraction of all Malaysian patients' medical records who were diagnosed with AR and attended the otorhinolaryngology outpatient clinic of a government-funded tertiary hospital in Malaysia between 2017 and 2022.

Results

3,744 cases out of the 57,968 first-encounter outpatient visits to the otorhinolaryngology clinic were extracted for analysis. Overall, the prevalence of AR cases ranged from 1.83 to 9.23% between 2017 and 2022. There was a significant drop of 21.38 to 70.22% between the pre- and post-COVID-19 pandemic (p < 0.001). Males (0.34 to 1.60%) were more prevalent in the 6 to 18 year old than females (0.09 to 1.23%). The trend shifted with age, whereby females (0.50 to 2.45%) experienced a higher prevalence than males (0.21 to 1.77%) as they aged from 19 to 59. The Malay (1.01 to 4.59%) demonstrated a two-time higher prevalence than the Chinese (0.30 to 2.01%) and Indian (0.40 to 2.14%) ethnicities. After stratifying by gender and ethnicity, Indian women (0.17 to 1.09%) had a higher rate of AR than their Chinese counterparts (0.12 to 0.99%) across all years.

Conclusion

The AR prevalence consistently ranged from 8.14 to 9.23% pre-pandemic. A remarkable drop was observed post-pandemic, ranging from 1.83 to 6.40%. A gender shift from male to female predominance as age progressed. The Malay had the highest prevalence of AR.

Fungal Aeroallergens-The Impact of Climate Change

The incidence of allergic diseases worldwide is rapidly increasing, making allergies a modern pandemic. This article intends to review published reports addressing the role of fungi as causative agents in the development of various overreactivity-related diseases, mainly affecting the respiratory tract. After presenting the basic information on the mechanisms of allergic reactions, we describe the impact of fungal allergens on the development of the allergic diseases. Human activity and climate change have an impact on the spread of fungi and their plant hosts. Particular attention should be paid to microfungi, i.e., plant parasites that may be an underestimated source of new allergens.

Diagnostic Value and Clinical Application of Nasal Fractional Exhaled Nitric Oxide in Subjects with Allergic Rhinitis

PURPOSE

Nitric oxide (NO) is a potential marker in the diagnosis and monitoring of treatment for the management of patients with allergic rhinitis (AR). The study aimed to determine the value of nasal fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment response of AR patients.

METHODS

The participants were divided into control and allergic rhinitis groups based on the clinical symptoms and skin prick tests. The AR group was treated with intranasal corticosteroid after the diagnosis. The nasal fractional exhaled nitric oxide (FENO) levels were compared between control and AR groups. In the AR group, the visual analogue scale (VAS), Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, and nasal fractional exhaled nitric oxide (FeNO) were assessed pre- and post-treatment.

RESULTS

One hundred ten adults were enrolled. The nasal FeNO level was significantly higher in AR compared to control (p < 0.001). Both the subjective (VAS and NOSE), both (p < 0.01) and objective (nasal FeNO, p < 0.001) assessments showed significant different pre- and post-treatment. The threshold level of nasal FeNO in the diagnosis of AR was 390.0 ppb (sensitivity of 73% and specificity of 80%) based on the receiver operator characteristic curve.

CONCLUSION

Nasal FeNO level is significantly higher in AR compared to control group with significant difference pre- and post-treatment. The findings suggest nasal FeNO can serve as an adjunct diagnostic tool together with the monitoring of treatment response in AR.

Adverse Events for Monoclonal Antibodies in Patients with Allergic Rhinitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

(1) Background: Allergic rhinitis (AR) is a common disease in otolaryngology and novel biological therapies are required for clinical needs. To assess the tolerability of monoclonal antibodies, justifying their clinical applications, we presented a comprehensive safety profile of biologics in AR; (2) Methods: A systematic literature search was conducted following PRISMA guidelines for randomized clinical trials comparing monoclonal antibodies and placebo in AR. PubMed, Web of Science, Medline, and Cochrane were searched up until 9 January 2023. Among 3590 records in total, 12 studies with more than 2600 patients were included. Quality was assessed for all studies using Cochrane risk-of-bias tool for randomized trials, and subgrouped meta-analysis was performed; (3) Results: We accomplished an up-to-date literature overview and analysis on adverse events of monoclonal antibodies in AR. Total, common, severe, discontinuation-causing, and serious adverse events failed to reach statistical significance. Country was an essential factor for heterogeneity, and urticaria was the adverse event at highest risk (RR 2.81, 95% CI 0.79-9.95); (4) Conclusions: Monoclonal antibodies are considered well tolerated and relatively safe in patients with AR. The regions of patients and hypersensitive adverse reactions such as urticaria require a special caution in biological treatments in AR.

Individual multidisciplinary clinical phenotypes of nasal and ocular symptoms in hay fever: Crowdsourced cross-sectional study using AllerSearch

BACKGROUND

Multidisciplinary efforts to prospectively collect and analyze symptoms of hay fever are limited. We aimed to identify the characteristics of nasal and ocular symptoms of hay fever, using the AllerSearch smartphone application.

METHODS

This mobile health-based prospective observational study using the AllerSearch smartphone application was conducted between February 1, 2018, and May 1, 2020. Individuals who downloaded AllerSearch from Japan and provided comprehensive self-assessments (including 17 items related to quality of life [QoL]-related items) were included. The characteristics and risk factors for allergic rhinitis (AR) and allergic conjunctivitis (AC) were identified using hierarchical heat maps and multivariate logistic regression.

RESULTS

Of the 9041 participants with hay fever, 58.8% had AR and AC, 22.2% had AR, and 5.7% had AC. The AR-AC comorbid cohort showed worse symptoms of hay fever and QoL scores than the other cohorts. Factors (odds ratio, 95% confidence interval) associated with AR-AC included a lower age (0.98, 0.97-0.98), female sex (1.31, 1.19-1.45), liver disease (1.58, 1.26-2.35), dry eye disease (1.45, 1.30-1.63), unknown dry eye disease status (1.46, 1.31-1.62), contact lens use discontinuation during the hay fever season (1.69, 1.28-2.23), and bedroom flooring material other than hardwood, carpet, tatami, or vinyl (1.91, 1.16-3.14).

CONCLUSIONS

Analysis of medical big data for hay fever performed using a mobile health app helped identify risk factors and characteristics of AC, AR, and AR-AC. Phenotyping of highly variable symptoms of hay fever, such as nasal and ocular symptoms, can facilitate better-quality clinical care.

Prevalence, causes and treatments of allergic rhinitis in Malaysia: a literature review

Recently, allergic rhinitis (AR) cases have been surging rapidly in many developing countries. However, the prevalence, risk factors and treatment modalities for AR within the Malaysian population have not been thoroughly evaluated. The present study aimed to provide a complete review of literature on allergic rhinitis in Malaysia. Available data indicated that the prevalence of AR varied across different age groups and regions in Malaysia, but there is an increasing trend among the younger population. The key contributing factor is exposure and sensitization towards several airborne allergens, mainly house dust mites, cat fur and fungi, with possible genetic predispositions. In addition, variations in the symptom severity may be associated with racial orientations. For management of the disease, standard prescriptions of conventional drugs (antihistamines, intranasal corticosteroids and nasal decongestants) remain as the treatment of choice. A small proportion of the native residents tend to resort to alternative approaches of self-healing through aromatherapy and natural food consumption such as tiger’s milk mushroom and Tualang honey. In conclusion, the increase in the cases of AR in Malaysia is due to environmental and genetic factors which requires proper medical intervention as treatment strategies. The utilization of holistic approaches requires further studies and clear understanding prior to their integration into the standard of care. There are still many gaps in the knowledge and management of allergic rhinitis which demands further attention from the research community.

Nasal irrigation with various solutions for adults with allergic rhinitis: A protocol for systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Nasal douching or irrigation has been recommended for adjunctive therapy of sinonasal diseases including allergic rhinitis (AR) for many years. Previous study reported large-volume high-pressure device as an effective standard application, but the solutions was remains controversy. This study systematically review the clinical efficacy of nasal irrigation with various solutions for adults with AR from medical literature.

METHODS

This research systematically asses clinical trial about nasal irrigation with various solutions for adults with AR from medical literature. The sources were PubMed, ProQuest, Scopus, Cochrane Register of Controlled Trials databases, and gray literature from google scholar and RAMA repository limited to English and Bahasa Indonesia language articles, published from January 2017 to July 2022. Only randomized controlled trials involving the human subjects studies will be included. The inclusion criteria research must be related to nasal irrigation for AR, and should be full texted available. Literature management, screening, data extraction will use Rayyan.ai tools. The quality assessment of qualified paper and risk of bias will be assessing independent conducted by 2 reviewer with risk of bias 2. We will use Review Manager (RevMan) [Computer program] Version 5.4. The Cochrane Collaboration, 2020 tools to produce the systematic review and meta-analysis.

RESULTS

After completion of the study process, the data analysis and review will be reported. The results will be publicized through a peer-review journal publication.

CONCLUSION

The results of the systematic review will summarize the efficacy of various nasal irrigation for adults with AR, so it can be used as clinician recommendation.

Medication Adherence to Intranasal Corticosteroids in Allergic Rhinitis Patients with Comorbid Medical Conditions

Background: To determine medication adherence to intranasal corticosteroid spray (INCS) among allergic rhinitis (AR) patients with comorbid medical conditions. Methods: A cross-sectional study was conducted. Adults above 18 years old with persistent symptoms of AR and comorbid physician-diagnosed asthma, eczema, diabetes mellitus (DM) and hypertension (HPT) were included. The severity of symptoms was assessed by the total nasal symptom score (TNSS), medication adherence was based on the patients’ diaries and barriers to adherence were analyzed by the Brief Medication Questionnaire. Results: 185 participants were enrolled. The medication adherence was 58.9%. Medication adherence was significantly superior in participants with elevated total serum immunoglobulin E (IgE) (χ2 = 8.371, p < 0.05), house dust mite (HDM) allergy to Dermatophagoides pteronyssinus (DP) type (χ2 = 5.149, p < 0.05) and severe TNSS at the first visit (χ2 = 37.016, p < 0.05). Adherence was twice more likely in DP allergy, 2.7 times more likely in elevated total IgE and 15 times more likely in severe TNSS at the first visit. Among the barriers to adherence was lack of symptoms, taking medication only when necessary, fear of adverse effects, running out of medication, experiencing bothersome effects, ineffective response, forgetfulness and taking too many medications. Only lack of symptoms, taking medication when symptomatic, fear of adverse effects and running out of medication were significant. No significant association was found between asthma/eczema (χ2 = 0.418, p > 0.05), HPT/DM (χ2 = 0.759, p > 0.05) and multi-medicine use (χ2 = 1.027, p > 0.05) with medication adherence. Conclusions: Patients having AR with severe nasal symptoms at first presentation, who are sensitized to DP HDM and who have elevated total serum IgE levels have a higher adherence to INCS use. The use of multiple medicines had no impact on the adherence to INCS. As a lack of symptoms was a barrier towards adherence, the benefits of using INCS according to the prescribed dose and frequency must be emphasized to patients with mild and moderate AR at each medical visit. A good rapport between patients and their health care providers is needed to build trust and overcome the barriers, particularly to allay the fears of adverse effects of INCS. The other barriers, such as running out of supply, can be overcome by posting medications directly to patients by the healthcare providers.

Risk perceptions of a population living near a municipal waste incinerator and associated factors with the prevalence of environmental disease

Background

This study investigated the risk perceptions, prevalence of environmental diseases (EDs) and associated factors with the prevalence of environmental disease among the population living near an incinerator.

Methods

Study area were divided into 3 local areas near the incinerator by distance (A, B, C) and control area (D) by distance and geographic isolation. A Questionnaire was conducted with 1,380 in local residents (A, B, C) and 390 in control area (D), gathered information of demographic characteristics, lifestyle, perception of damage by incinerators, experience of EDs (atopic dermatitis, allergic rhinitis, asthma) diagnosed by physician. Analysis of variance, χ² test, and Kruskal Wallis test was applied to determine the difference by area. Logistic regression analysis was performed to identify factors associated with the prevalence of allergic rhinitis.

Results

Residents residing closer to the incinerator had negative perception in most items in questionnaire compared with control. The prevalence of allergic rhinitis was higher as they lived nearby the incinerator (p = 0.008). The associated factors with the prevalence of allergic rhinitis were carpet (odds ratio [OR]: 1.79, p = 0.001), residential area (marginally significant), duration of residence (OR: 1.09, p < 0.001). The perception of environmental pollution around the residential area was inversely associated with the prevalence of allergic rhinitis: perceived as very dissatisfied (OR: 4.21, p = 0.02) compared with very satisfied.

Conclusions

As closer to the incinerator, the risk perception tend to negative and prevalence of EDs were increased. Carpet, residential area, duration of residence and perception of environmental air pollution around the residential area were associated with prevalence of allergic rhinitis. These results may be useful for the communication with residents to discuss the environmental problems caused by the incinerator.

Allergic rhinitis in Chinese young adults from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort: Prevalence, patterns, and epidemiology of allergic rhinitis

Background

Allergic rhinitis (AR) is characterized by the occurrence of at least 2 symptoms of nasal itching, nasal blockage, rhinorrhea, and sneezing, when not afflicted with a cold or flu, with defined atopic sensitization demonstrated by skin prick test or specific IgE responses. Besides the detriment to standard of living and economic burden of AR, both multicentre and single-cohort studies have observed an increase in AR prevalence in Asia over time.

Methods

In total, 12 872 individuals, with mean age 22.1 years (SD = 4.8), were recruited from universities in Singapore and Malaysia. Each participant provided epidemiological data based on an investigator-administered questionnaire adapted from the validated International Study of Allergies and Asthma in Childhood (ISAAC) protocol, and atopy status was determined using a skin prick test (SPT) performed by qualified staff. AR was diagnosed according to Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines and a positive SPT result.

Results

Sensitization (determined by SPT) to either Blomia tropicalis or Dermatophagoides pteronyssinus was prevalent in 66.5% of the cohort. Current rhinitis (manifesting ≥2 rhinitis symptoms, within the past 12 months) was observed in 48.9% of our population, while AR, which included atopy status, was estimated at 39.4%. Sneezing and rhinorrhea were the most common symptoms among AR cases. AR prevalence decreased with increasing age (OR: 0.979; 95% CI: 0.969-0.989), while male gender (OR: 2.053; 95% CI: 1.839-2.294), and a parental history of allergic diseases (OR: 2.750; 95% CI: 2.284-3.316) were significant risk factors for AR. Upon adjustment for age, gender, and parental history, housing type (OR: 0.632; 95% CI: 0.543-0.736) and income level (>$6000 vs <$2000; OR: 2.461; 95% CI: 2.058-2.947) remained as significant risk factors for AR, while ever having kept a pet (OR: 1.167; 95% CI: 1.025-1.328) emerged as a risk factor. Conflicting results were obtained for indicators of sedentary lifestyle: frequent physical activity (OR: 1.394; 95% CI: 1.150-1.694) and increased duration spent using the TV/computer (OR: 1.224; 95% CI: 1.006-1.489) both increased the risk of AR. Lastly, we used the Quality of Diet based on Glycaemic Index Score (QDGIS) to assess the Glycaemic Index (GI) level of overall diet. We identified lower GI level of overall diet as a protective factor against AR manifestation (OR: 0.682; 95% CI: 0.577-0.807).

Conclusion

While the previously established non-modifiable risk factors for AR were present in our study population, the identification of modifiable risk factors, such as TV/computer usage, and dietary habits, opens a new area for research, both in the areas of gene-environment interaction, and management of AR.

Investigation of Bacterial Isolations and Antimicrobial Susceptibility of Chronic Rhinitis in Cats

Chronic rhinitis is a quite common upper respiratory tract (URT) disease in cats. As a result of unclear etiology, frequently, multidrug-resistant bacteria are identified. This study investigated bacterial isolations and an antimicrobial susceptibility test (AST) in chronic rhinitis in cats. The medical records of 395 cats with chronic URT signs were reviewed at the Kasetsart University Veterinary Teaching Hospital (KUVTH) between 2016 and 2021 to survey the underlying causes of URT. Then, apart from rhinitis, other causes were excluded to identify the bacterial species and antimicrobial susceptibility. The results indicated that the most frequent finding was neoplasia, followed by rhinitis and anatomical defects. Furthermore, the only significant association was between the age range and disease group, with gender, FIV, or FeLV infection not being significant. Rhinitis was 4.7 times more likely to occur than neoplasia in younger and young adult cats in the age range < 1−3 years compared to the group > 10 years. The main bacterial species was the Pseudomonas species. Antimicrobials with a susceptibility rate of more than 90% were amikacin, gentamicin, ciprofloxacin, norfloxacin, marbofloxacin, imipenem, and meropenem. In conclusion, rhinitis was the second most common chronic URT disease in cats and was more common in younger and young adult cats. The predominant bacteria with AST in this study reflect the antimicrobial resistance situation. Thus, antimicrobial usage should follow antimicrobial use guidelines first.

The Efficacy and Safety of Probiotics for Allergic Rhinitis: A Systematic Review and Meta-Analysis

Background

Probiotics have proven beneficial in a number of immune-mediated and allergic diseases. Several human studies have evaluated the efficacy and safety of probiotics in allergic rhinitis; however, evidence for their use has yet to be firmly established.

Objective

We undertook a systematic review and meta-analysis aiming to address the effect and safety of probiotics on allergic rhinitis.

Methods

We systematically searched databases [MEDLINE (PubMed), Embase, and the Cochrane Central Register of Controlled Trials] from inception until June 1, 2021. Qualified literature was selected according to inclusion and exclusion criteria, the data were extracted, and a systematic review and meta-analysis was conducted.

Results

Twenty-eight studies were included. The results showed that probiotics significantly relieved allergic rhinitis symptoms (standardized mean difference [SMD], -0.29, 95% confidence interval (CI) [-0.44, -0.13]; p = 0.0003, I ² = 89%), decreased Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores compared with the control group (SMD, -0.64, 95% CI [-0.79, -0.49], p < 0.00001, I ² = 97%), and increased T helper cell 1(Th1)/Th2 ratio (mean difference [MD], -2.47, 95% CI [-3.27, -1.68], p < 0.00001, I ² = 72%). There was no significant change in overall or specific IgE levels between probiotic-treated and placebo-treated subjects (SMD, 0.09, 95% CI [-0.16, 0.34], I ² = 0%, and SMD, -0.03, 95% CI [-0.18, 0.13], p = 0.72, I ² = 0%, respectively).

Conclusions

To sum up, probiotic supplement seems to be effective in ameliorating allergic rhinitis symptoms and improving the quality of life, but there is high heterogeneity in some results after subgroup analysis and clinicians should be cautious when recommending probiotics in treating allergic rhinitis.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42021242645).

Impact of the COVID‐19 national lockdown in the allergic rhinitis symptoms in patients treated with immunotherapy at two allergy referral centers in Bogotá, Colombia

Background

Methods

Results

Conclusion

Individual characteristics and associated factors of hay fever: A large-scale mHealth study using AllerSearch

BACKGROUND

The prevalence of hay fever, a multifactorial allergic disease, is increasing. Identifying individual characteristics and associated factors of hay fever is essential for predictive, preventive, personalized, and participatory (P4) medicine. This study aimed to identify individual characteristics and associated factors of hay fever using an iPhone application AllerSearch.

METHODS

This large-scale mobile health-based cross-sectional study was conducted between February 2018 and May 2020. Individuals who downloaded AllerSearch in Japan and provided a comprehensive self-assessment (general characteristics, medical history, lifestyle habits, and hay fever symptoms [score range 0-36]) were included. Associated factors of hay fever (vs. non-hay fever) and severe hay fever symptoms were identified using multivariate logistic and linear regression analyses, respectively.

RESULTS

Of the included 11,284 individuals, 9041 had hay fever. Factors associated with hay fever (odds ratio) included age (0.98), female sex (1.33), atopic dermatitis (1.40), history of dry eye diagnosis (1.36), discontinuation of contact lens use during hay fever season (3.34), frequent bowel movements (1.03), and less sleep duration (0.91). The factors associated with severe hay fever symptoms among individuals with hay fever (coefficient) included age (-0.104), female sex (1.329), history of respiratory disease (1.539), history of dry eye diagnosis (0.824), tomato allergy (1.346), discontinuation of contact lens use during hay fever season (1.479), smoking habit (0.614), and having a pet (0.303).

CONCLUSIONS

Our large-scale mobile health-based study using AllerSearch elucidated distinct hay fever presentation patterns, characteristics, and factors associated with hay fever. Our study establishes the groundwork for effective individualized interventions for P4 medicine.

How bilastine is used to treat allergic rhinitis and urticaria in children

Management guidelines for allergic rhinitis and urticaria recommend oral second-generation antihistamines as first-line treatment. The efficacy and safety of bilastine, the newest nonsedating second-generation antihistamine, are well established in adolescents/adults with these allergic conditions. The bilastine development program for pediatric use (2-<12 years) followed EMA-authorized processes. Pharmacokinetic/pharmacodynamic simulation and modeling and a pharmacokinetic study were conducted to identify and confirm the pediatric dose (10 mg/day). A Phase III, multicenter, double-blind, randomized, placebo-controlled, parallel-group study was performed to confirm the safety of bilastine 10 mg/day in children. In this article, evidence is reviewed for use of bilastine in children with allergic rhinoconjunctivitis or urticaria. Several cases are presented which demonstrate its role in routine clinical practice.

The CD4+CD25+FoxP3+ Regulatory T Cells Regulated by MSCs Suppress Plasma Cells in a Mouse Model of Allergic Rhinitis

Background:

Allergic Rhinitis (AR) is the most common immunological disease that has been associated with inflammatory responses and is characterized by sneezing. Previous studies found that AR's allergen exposure significantly induces plasma cells and reduces regulatory T (Treg) cells, a population that contributes to control AR. Therefore, upregulating Treg expression can regulate plasma cells leading to inhibit sneezing in AR. Mesenchymal stem cells (MSCs) are multipotent stem cells that have the immunoregulatory and antiinflammation ability by secreting various cytokines including IL-10 and TGF-β which potent as a promising therapeutic modality for allergic airway diseases, including AR.

Objective:

To investigate the role of MSCs in generating CD4+, CD25+, and Foxp3+ Regulatory T cells associated with suppressing plasma cell in AR model.

Methods:

In this study, fifteen male Wistar rats (6 to 8 weeks old) were randomly divided into three groups (control group, sham group, and MSCs treatment group). OVA nasal challenge was conducted daily from day 15 to 21, and MSCs (1x10⁶) were administrated intraperitoneally to OVA-sensitized rats on day 21. Sneezing was observed from day 22 to 28. The rats were sacrificed on day 22 and day 28. The expression of CD4+ CD25+ Foxp3+ in Treg and plasma cells was analyzed by flow cytometry assay.

Results:

This study showed that the percentage of plasma cell and sneezing times significantly decreased in MSCs treatment. This finding was aligned with the significant increase of CD4+CD25+Foxp3+ Treg level.

Conclusion:

MSCs administration suppress plasma cells population and sneezing times by up regulating Treg to control AR.

Prevalence of asthma and allergies among children in the United Arab Emirates: A cross-sectional study

BACKGROUND

Asthma, allergic rhinitis, and atopic dermatitis are the most common chronic inflammatory disorders in children worldwide. These conditions place a significant burden on the healthcare system due to their multiple related complications and the necessity of hospital visits. This study aimed to evaluate the prevalence and severity of asthma and allergic diseases among school children aged 6-7 years and 13-14 years in Dubai and the Northern Emirates, United Arab Emirates (UAE).

PATIENTS AND METHODS

This was a multicenter, cross-sectional study that recruited children from March to June 2019 via school class registers in Dubai and the Northern Emirates, UAE. The Arabic and English versions of the International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaires on asthma, allergic rhinitis, and atopic dermatitis were completed by parents or legal guardians of children aged 6-7 years, and by the children themselves in those aged 13-14 years.

RESULTS

In this study, we included 3436 children (1944 children aged 6-7 years and 1793 children aged 13-14 years). We estimated the prevalence of asthma (11.9%), wheezing (44.2%), allergic rhinitis (46.5%), hay fever (22.1%), and atopic dermatitis (12.9%) in the 6- to 7-year-old group. In the 13- to 14-year-old group, the prevalence was 9.8%, 33.1%, 51.3%, 19.9%, and 14.6%, respectively. The prevalence of any history of asthma was higher in boys than girls in the 6- to 7-year-old group (13.9% vs. 10%) and in the 13- to 14-year-old group (11.2% vs. 8.7%). In the 6- to 7-year-old group, the highest prevalence of asthma, sneezing, and atopic dermatitis was observed in Dubai, Ajman, and Umm Al Quwain, respectively. In the 13- to 14-year-old group, the highest prevalence of asthma was observed in Ras Al Khaimah, and the highest prevalence of sneezing and atopic dermatitis was observed in Sharjah.

CONCLUSION

We found that the prevalence of asthma, allergic rhinitis, and atopic dermatitis in the UAE is comparable to that in neighboring countries; the prevalence of asthma, wheezing, and hay fever was higher in the 6- to 7-year-old group, while in the 13- to 14-year-old group, the prevalence of allergic rhinitis and atopic dermatitis was higher. Overall, the prevalence of any history of asthma was highest in Ras Al Khaimah, followed by Dubai, and lowest in Ajman. Our findings suggest that allergic disorders represent a healthcare burden in the UAE and more efforts are needed to organize nationwide campaigns to detect undiagnosed children to overcome the burden caused by these conditions.

Clinical practice guidelines for the treatment of allergic rhinitis in children with traditional Chinese medicine

Allergic rhinitis (AR) is one of the most common allergic diseases in children and it can lead to physical and mental health problems. Traditional Chinese medicine (TCM) plays an important role in understanding the phenotypes and treatment of AR. However, there are currently no normative clinical practice guidelines (CPGs) for the treatment of AR in children. The study aimed to develop an evidence-based CPG for the treatment of AR in children with TCM. Systematic literature research, expert questionnaire, and clinical evaluation after three rounds of surveys were adopted to form recommendations for treating children with AR using the Delphi method. Depending on the clinical manifestations, we finally recommended two decoctions with two Chinese patent medicines for an acute attack of AR and two decoctions for a chronic period of AR. For the acute attack of AR in children, Xinyi Qingfei decoction, Wenfei Zhiliu decoction, Xinqin granules, and Xinyi Biyan pills were suggested, whereas for the chronic period of AR, Buzhong Yiqi and Jingui Shenqi decoctions were recommended. The four external treatment methods suggested for the prevention and care of AR were body acupuncture, moxibustion, auricular point pressing, and acupoint application. The recommended levels of the suggested TCM strategies ranged from Grade B to D, indicating the weakness of the recommendations. TCM has the potential to offer new insights into phenotypes and the management of AR worldwide; however, more high-quality clinical studies are needed to improve the quality of evidence.

Evaluation of Community Pharmacists' Professional Practice and Management of Patient's Respiratory Conditions

Objectives:

We assessed the extent of community pharmacists managing respiratory conditions and their ability to make differential diagnoses between the common cold and allergic rhinitis.

Methods:

A simulated patient technique was used to achieve the study objectives. Thirty community pharmacies were randomized to be visited by a patient with allergic rhinitis symptoms, followed by a patient with common cold symptoms, and vice versa. One simulated patient visited the 15 pharmacies assigned to allergic rhinitis. Then, after 3–4 days, the pharmacies were revisited by a second simulated patient using the same symptoms; likewise, a simulated patient visited the other 15 pharmacies with common cold symptoms. Then, these pharmacies were revisited by the other simulated patient with the common cold symptoms. Descriptive statistics and correlation analyses were carried out using SPSS at alpha 0.05.

Results:

Fifteen pharmacies were used for the common cold scenario and 15 for the allergic rhinitis scenario (a total of 30 visits per scenario). Pharmacists showed overall poor skills in asking questions for differential diagnosis between the two conditions. No significant difference was found in the overall differential diagnosis score between the two groups (P = 0.744). The overall adherence to the labeling standard score was low, with an average of 2.38 (standard deviation [SD] = 2.50) out of 11, with no significant difference between the two scenarios (P = 0.332). The overall adherence score to the counseling standard was low, with an average of 2.93 (SD = 3.74) out of 15, with no significant difference between the two scenarios (P = 0.586).

Conclusion:

The simulated patient technique approach revealed a lack of ability of pharmacists in Amman, Jordan, to make differential diagnoses between the common cold and allergic rhinitis. In addition, pharmacists lacked the ability to carry out their role with respect to the management of the common cold and allergic rhinitis, including treatment recommendations, adherence to medicine labeling standards, and adherence to the counseling standard.

Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis

Background

Few studies investigated the effects of sublingual immunotherapy (SLIT) on the peripheral regulatory T cells (Tregs)/Th17 ratio.

Objective

To investigate the effectiveness of SLIT in children with allergic rhinitis (AR) and the effects on the Tregs/Th17 ratio.

Methods

This was a retrospective study of children who were treated for AR between April 2017 and March 2018 at one hospital. The patients were grouped according to the treatments they received: SLIT + pharmacotherapy vs pharmacotherapy alone.

Results

Eighty children (51 boys and 29 girls; 40/group) were included. The visual analog scale (VAS) and medication scores at 1 year in the SLIT + pharmacotherapy group were 2.70 ± 1.08 and 1.1 ± 0.8, respectively, which were lower than at baseline (7.7 ± 1.2 and 3.6 ± 1.0, respectively) (both Ps < 0.05). For the pharmacotherapy group, the VAS score was decreased at 1 year vs baseline (3.3 ± 1.2 vs 7.4 ± 1.0; P < 0.05), but the medication score did not change (P > 0.05). In the SLIT + pharmacotherapy group, the Treg percentage increased, while the Th17 percentage decreased at 1 year (both Ps < 0.01). The percentages of Tregs and Th17s did not change in the pharmacotherapy group (both Ps > 0.05).

Conclusions

SLIT + pharmacotherapy can increase the Treg percentage and decrease the Th17 percentage in the peripheral blood of children with AR.

Analysis of patient factors associated with hospital visits for allergic rhinitis in Japanese adult patients: A cross-sectional study

OBJECTIVE

Allergic rhinitis (AR) is one of the most common diseases in Japan. However, several AR patients do not seek optimal treatments at clinics/hospitals. This may affect the patient's quality of life and labor productivity. In this study, we assessed the characteristics of the outpatients' AR and factors associated with their hospital visit, using the dataset obtained from a nation-wide survey in Japan.

METHODS

In this cross-sectional study, we used data from the nation-wide 2013 and 2016 Comprehensive Survey of Living Conditions (CSLC) in Japan. We analyzed the data of AR outpatients through logistic regression, using the outcome as the dependent variable, and age groups, sex, household size, educational status, smoking history, alcohol use, household expenditure, psychological distress, quality of sleep, asthma and atopic dermatitis outpatients as explanatory variables.

RESULTS

Among the data of 317,984 outpatients aged between 20 and 79 years in 2016 CSLC survey, the proportion of AR outpatients was significantly less among current smokers (odds ratio (OR); 0.47, 95% confidence interval (CI); 0.43-0.51, P < 0.001) and those with large household sizes (OR; 0.80, 95% CI; 0.72-0.89, P < 0.001). Conversely, the proportion of AR outpatients was significantly more among subjects with a past smoking habit (OR; 1.19, 95% CI; 1.08-1.31, P < 0.001), insufficient sleep (OR; 2.93, 95% CI; 2.52-3.42, P < 0.001), psychological distress (OR; 1.71, 95% CI; 1.62-1.80, P < 0.001), high household expenditures (OR; 1.68, 95% CI; 1.56-1.80, P < 0.001), and asthma and atopic dermatitis outpatients (OR; 8.97, 95% CI; 8.13-9.89 P < 0.001 for asthma and OR; 7.61, 95% CI; 6.76-8.58 P < 0.001 for atopic dermatitis). We observed the same trend using the dataset of 2013 CLSC survey.

CONCLUSION

This study revealed that smoking habit, psychological distress, insufficient sleep, high household expenditures and outpatients with other allergic diseases are the factors associated with AR outpatient visit.

Changes in ambient temperature increase hospital outpatient visits for allergic rhinitis in Xinxiang, China

BACKGROUND

The effect of ambient temperature on allergic rhinitis (AR) remains unclear. Accordingly, this study aimed to explore the relationship between ambient temperature and the risk of AR outpatients in Xinxiang, China.

METHOD

Daily data of outpatients for AR, meteorological conditions, and ambient air pollution in Xinxiang, China were collected from 2015 to 2018. The lag-exposure-response relationship between daily mean temperature and the number of hospital outpatient visits for AR was analyzed by distributed lag non-linear model (DLNM). Humidity, long-time trends, day of the week, public holidays, and air pollutants including sulfur dioxide (SO2), and nitrogen dioxide (NO2) were controlled as covariates simultaneously.

RESULTS

A total of 14,965 AR outpatient records were collected. The relationship between ambient temperature and AR outpatients was generally M-shaped. There was a higher risk of AR outpatient when the temperature was 1.6-9.3 °C, at a lag of 0-7 days. Additionally, the positive association became significant when the temperature rose to 23.5-28.5 °C, at lag 0-3 days. The effects were strongest at the 25th (7 °C) percentile, at lag of 0-7 days (RR: 1.32, 95% confidence intervals (CI): 1.05-1.67), and at the 75th (25 °C) percentile at a lag of 0-3 days (RR: 1.15, 95% CI: 1.02-1.29), respectively. Furthermore, men were more sensitive to temperature changes than women, and the younger groups appeared to be more influenced.

CONCLUSIONS

Both mild cold and mild hot temperatures may significantly increase the risk of AR outpatients in Xinxiang, China. These findings could have important public health implications for the occurrence and prevention of AR.

The Role of Phadiatop Tests and Total Immunoglobulin E Levels in Screening Aeroallergens: A Hospital-Based Cohort Study

Background

Screening for the existence of aeroallergens in patients with possible allergic rhinitis using venous blood samples has become more popular, with advantages of increased convenience and less consumption of time.

Objective

The aim of this study was to investigate the sensitivities and specificities of Phadiatop tests and total immunoglobulin E (IgE) levels in both adults and children.

Methods

This study was conducted prospectively in a tertiary center. The process of recruitment took place from Jan 2015 to Dec 2019, and patients with clinical symptoms that suggested persistent allergic rhinitis were recruited and their serum samples collected. The results of the total IgE and Phadiatop tests as well as the positive items in the ImmunoCAP assay were recorded and analyzed.

Results

A total of 9174 cases with complete data were enrolled, including 576 children and 8598 adults. A positive result in the ImmunoCAP assay was considered a positive atopic status towards aeroallergens. While using the total IgE levels to predict positive aeroallergens, the sensitivities and specificities were 65.7% and 85.7%, respectively, for adults and 86.3% and 77.4%, respectively, for children. When we used Phadiatop tests for allergy screening, the sensitivities and specificities was 94.5% and 98.2%, respectively, for the adult group and 98.5% and 96.8%, respectively, for the pediatric group.

Conclusion

The Phadiatop test had better diagnostic power for aeroallergen detection than the serum total IgE levels, or even the dual test, for both the adult and pediatric groups in this hospital-based study. We suggest that the Phadiatop test is more cost-effective in aeroallergen screening for patients with suspected atopic airway diseases.

Potential allergenicity of Medicago sativa investigated by a combined IgE-binding inhibition, proteomics and in silico approach

BACKGROUND

Alfalfa (Medicago sativa L) is one of the most planted crops worldwide primarily used to feed animals. The use of alfalfa in human diet as sprouts, infusions and nutritional supplements is rapidly gaining popularity. Despite this, allergenicity assessment of this novel plant food is largely lacking.

RESULTS

Here, leaf protein extract of alfalfa was studied using a combined proteomics, Immunoglobulin E (IgE)-binding inhibition assay and in silico approach to find potential allergens. We have identified and annotated 129 proteins using in-gel digestion proteomics and Blast2Go suit. A search against COMPARE database, using the identified proteins as query sequences, revealed high similarity with several allergenic proteins. The Single Point Highest Inhibition Achievable assay (SPHIAa) performed on the multiplex FABER^® allergy testing system confirmed the in silico results and showed some additional potential allergens. This approach allowed the detection of proteins in alfalfa leaves cross-reacting with plant allergens from three different allergen families such as lipid transfer, thaumatin-like and Bet v 1-like protein families. In addition, the absence of structural determinants cross-reacting with seed storage allergenic proteins and with animal allergens was recorded.

CONCLUSION

This study reports for the first time potential allergenic proteins in alfalfa. The results suggest that this plant food can be safely introduced, as a protein-rich supplement, in the diet of patients allergic to animal food allergens. Allergic patients towards certain plant food allergens need to be careful about consuming alfalfa because they might have allergic symptoms. © 2020 Society of Chemical Industry.