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Araújo BCL, de Melo Lima TRC, de Gois-Santos VT, Nascimento GKBO, Martins-Filho PR, de Magalhães Simões S. Comparative analysis of masseter muscle electrical activity by nasal patency in children with rhinitis and asthma: a pilot observational study. Eur Arch Otorhinolaryngol 2024; 281:2733-2738. [PMID: 38418553 DOI: 10.1007/s00405-024-08482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 03/01/2024]
Abstract
PURPOSE This pilot cross-sectional study aimed to evaluate differences in electromyographic activity patterns of the masseter muscle according to the nasal patency in children with rhinitis and asthma. METHODS The study included 43 children aged 5-14 years with rhinitis and/or asthma. Patients underwent peak nasal inspiratory flow (PNIF) measurement to assess nasal patency, and electromyographic evaluation of the right and left masseter muscles during chewing and at rest. Electromyographic activity patterns according to nasal patency were compared using the Mann-Whitney test, and effect sizes were measured using the Glass rank biserial (rb) correlation. A p-value of < 0.05 was considered statistically significant. RESULTS No significant differences in electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing were found between the groups. However, we found that patients with low nasal patency had a median electric activity of the right masseter muscle during maximum contraction of 60.53 (51.74-72.43), while those with adequate nasal patency had a median of 77.40 (56.71-88.45). Although the difference in myoelectric activity between the groups did not reach statistical significance (p = 0.061) at the adopted significance level of 5%, the size of the difference between groups were considered moderate (rb = 0.338) and a potential association between nasal patency and the muscular function of the masseter muscle could be suggested. CONCLUSION The study found no differences in the electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing among children with rhinitis and asthma based on nasal patency. Further research with larger sample sizes is needed to validate these findings and gain a better understanding of the impact of nasal patency on the muscular function of the masseter muscle.
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Affiliation(s)
- Brenda Carla Lima Araújo
- Department of Speech Therapy, Pós-Graduação em Ciências da Saúde, Federal University of Sergipe-UFS, Rua Cláudio Batista, S/N. Bairro Sanatório, Aracaju, Sergipe, 49060-100, Brazil.
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
| | - Thales Rafael Correia de Melo Lima
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Vanessa Tavares de Gois-Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Gerlane Karla Bezerra Oliveira Nascimento
- Department of Speech Therapy, Pós-Graduação em Ciências da Saúde, Federal University of Sergipe-UFS, Rua Cláudio Batista, S/N. Bairro Sanatório, Aracaju, Sergipe, 49060-100, Brazil
| | - Paulo Ricardo Martins-Filho
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Applied Health Sciences Program, Federal University of Sergipe, Lagarto, Brazil
| | - Silvia de Magalhães Simões
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Bartley J, Hankin R. A nasal airflow oscillation device targeting nasal congestion: a preliminary report. Eur Arch Otorhinolaryngol 2024; 281:2743-2747. [PMID: 38436754 PMCID: PMC11024000 DOI: 10.1007/s00405-024-08576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Upper respiratory tract complaints are common in the general population. A safe, non-pharmacologic treatment would be an attractive option for many patients either as an alternative to existing therapies, or as a complementary therapy. This study assessed the acceptability, safety and possible efficacy of a nasal airflow oscillation device in a group of people suffering chronic nasal congestion. METHODS Subjects with a known history of nasal congestion, but without fixed anatomical obstruction, participated in a prospective clinical study. Efficacy was assessed using peak nasal inspiratory flow (NPIF) and a 10-point visual analogue scale (VAS) administered before and after the oscillation device had been worn for twenty minutes. RESULTS Twenty-one subjects (mean age 37 years; 43% female) were enrolled in the study. After treatment with the small nasal airflow oscillation device for twenty minutes, average NPIF increased significantly from 84.8 L/minute to 99.0 L/minute (p < 0.05). There was a corresponding significant reduction in the VAS score for nasal congestion (p < 0.05). Similar significant improvements were also seen for the immediate sensation of nasal drainage, sinonasal pressure and overall sinonasal symptoms (p < 0.05). There was no change in the sense of smell (p = 0.37). Subjects rated ease of use highly; average = 9.1 (Range 7-10). CONCLUSION Treatment of nasal congestion with the nasal airflow oscillation device was found to result in significant improvement in NPIF after twenty minutes of use. Initial patient-reported outcomes improved significantly, and the treatment was safe and highly acceptable. TRIAL REGISTRATION Public clinical trial registration: Universal Trial Number (U1111-1259-0704). Australian New Zealand clinical trials registration: ACTRN12623001307695.
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Affiliation(s)
- Jim Bartley
- Department of Otolaryngology - Head and Neck Surgery, Manukau Superclinic, 901 Great South Road, Manukau City Centre, Auckland, 2104, New Zealand.
| | - Robin Hankin
- Computer and Mathematical Sciences, University of Stirling, Stirling, FK9 4LA, Scotland, UK
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Chew CC, Lim XJ, Letchumanan P, George D, Rajan P, Chong CP. The effectiveness of pharmacist-led educational model in adult patients with allergic rhinitis: a single-center randomized control trial protocol (AR-PRISE RCT). Trials 2024; 25:279. [PMID: 38664701 PMCID: PMC11044482 DOI: 10.1186/s13063-024-08111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Chii-Chii Chew
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, 11800, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia.
| | - Pathma Letchumanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Doris George
- Pharmacy Department, Hospital Taiping, Ministry of Health, Taiping, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Chee Ping Chong
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, 11800, Malaysia
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Cruz ÁA, Bousquet J. Rhinitis phenotypes based on multimorbidities. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00397-0. [PMID: 38641129 DOI: 10.1016/j.jaip.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Affiliation(s)
| | - Jean Bousquet
- University Hospital Montpellier, Montpellier, France
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Coelho SD, Maricoto T, Taborda-Barata L, Annesi-Maesano I, Isobe T, Sousa ACA. Relationship between flame retardants and respiratory health- A systematic review and meta-analysis of observational studies. Environ Pollut 2024; 347:123733. [PMID: 38458527 DOI: 10.1016/j.envpol.2024.123733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Chronic respiratory diseases are a dealing cause of death and disability worldwide. Their prevalence is steadily increasing and the exposure to environmental contaminants, including Flame Retardants (FRs), is being considered as a possible risk factor. Despite the widespread and continuous exposure to FRs, the role of these contaminants in chronic respiratory diseases is yet not clear. This study aims to systematically review the association between the exposure to FRs and chronic respiratory diseases. Searches were performed using the Cochrane Library, MEDLINE, EMBASE, PUBMED, SCOPUS, ISI Web of Science (Science and Social Science Index), WHO Global Health Library and CINAHL EBSCO. Among the initial 353 articles found, only 9 fulfilled the inclusion criteria and were included. No statistically significant increase in the risk for chronic respiratory diseases with exposure to FRs was found and therefore there is not enough evidence to support that FRs pose a significantly higher risk for the development or worsening of respiratory diseases. However, a non-significant trend for potential hazard was found for asthma and rhinitis/rhinoconjunctivitis, particularly considering urinary organophosphate esters (OPEs) including TNBP, TPHP, TCEP and TCIPP congeners/compounds. Most studies showed a predominance of moderate risk of bias, therefore the global strength of the evidence is low. The limitations of the studies here reviewed, and the potential hazardous effects herein identified highlights the need for good quality large-scale cohort studies in which biomarkers of exposure should be quantified in biological samples.
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Affiliation(s)
- Sónia D Coelho
- Centre for Environmental and Marine Studies (CESAM), Department of Biology, University of Aveiro, Portugal
| | - Tiago Maricoto
- Beira Ria Health Unit, Aveiro Health Center, Ílhavo, Portugal; GRUBI - Systematic Reviews Group, Faculty of Health Sciences & UBIAir - Clinical & Experimental Lung Centre, CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
| | - Luís Taborda-Barata
- GRUBI - Systematic Reviews Group, Faculty of Health Sciences & UBIAir - Clinical & Experimental Lung Centre, CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Center, Covilhã, Portugal
| | - Isabella Annesi-Maesano
- Institute Desbrest of Epidemiology and Public Health, INSERM and Montpellier University, Department of Allergology and Respiratory Medicine, Montpellier University Hospital, Montpellier, France
| | - Tomohiko Isobe
- Health and Environmental Risk Division, National Institute for Environmental Studies, Tsukuba, Japan
| | - Ana C A Sousa
- Comprehensive Health Research Centre (CHRC) and Department of Biology, School of Science and Technology, University of Évora, Portugal
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Förster-Ruhrmann U, Olze H. [Importance of aspirin challenges in patients with NSAID-exacerbated respiratory disease]. HNO 2024:10.1007/s00106-024-01460-9. [PMID: 38597968 DOI: 10.1007/s00106-024-01460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is often characterized by a severe course of chronic rhinosinusitis with nasal polyps (CRSwNP), comorbid asthma, and NSAID hypersensitivity. The gold standard for N-ERD diagnosis is challenge with acetylsalicylic acid (ASA). In expert recommendations, the diagnosis of N-ERD is established based on a plausible positive history of NSAID hypersensitivity and CRSwNP with asthma. OBJECTIVE The following review describes the performance of ASA challenges and their sensitivity and specificity. It also examines the extent to which a positive history of NSAID hypersensitivity correlates with ASA challenge results in clinical trials and when ASA challenges should be performed. RESULTS AND CONCLUSION ASA challenges have high sensitivity and specificity. In clinical ASA challenge studies, there is a high concordance between a positive history of NSAID hypersensitivity obtained by rhinologists and the measured data of ASA challenge in patients with CRSwNP and comorbid asthma. Therefore, ASA challenge is primarily indicated in patients with an unclear history of NSAID hypersensitivity.
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Affiliation(s)
- Ulrike Förster-Ruhrmann
- HNO-Klinik, Charité - Universitätsmedizin Berlin (CCM/CVK), Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Heidi Olze
- HNO-Klinik, Charité - Universitätsmedizin Berlin (CCM/CVK), Charitéplatz 1, 10117, Berlin, Deutschland
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Peters RL, Soriano VX, Allen KJ, Tang MLK, Perrett KP, Lowe AJ, Wijesuriya R, Parker KM, Loke P, Dharmage SC, Koplin JJ. The Prevalence of IgE-Mediated Food Allergy and Other Allergic Diseases in the First 10 Years: The Population-Based, Longitudinal HealthNuts Study. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00277-0. [PMID: 38597846 DOI: 10.1016/j.jaip.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND There are limited longitudinal data on the population prevalence of allergic conditions during childhood, and few studies have incorporated the reference standard oral food challenge to confirm food allergy. OBJECTIVE To describe the population prevalence of IgE-mediated food allergy, eczema, asthma, and rhinitis at ages 6 and 10 years in Melbourne, Australia. METHODS The HealthNuts study recruited 5,276 1-year-old infants in Melbourne, Australia, with repeat assessments at ages 6 and 10 years. At ages 6 and 10 years, carers completed a questionnaire on symptoms and doctor diagnosis of allergic conditions (International Study of Asthma and Allergies in Children). Children were invited to attend a clinic assessment including skin prick test, lung function tests, and oral food challenges when indicated. To minimize the impact of attrition bias, prevalence estimates among participants at ages 6 and 10 years were weighted to reflect characteristics of the whole cohort at recruitment. RESULTS In total, 4,455 and 4,065 families participated at ages 6 and 10 years, respectively (84% and 77% of the original cohort). Of those, 73% and 55% of participants ages 6 and 10 years, respectively, completed clinical assessments. Overall, 36.5% (95% CI, 34.8-38.2) and 38.2% (95% CI, 36.5-40.1%) of 6- and 10-year-olds had at least one current allergic disease, and around one third of those had two or more allergic diseases. Food allergy occurred in 6.4% (95% CI, 5.6-7.2) of 6-year olds and 6.3% (95% CI, 5.5-7.2) of 10-year-olds. Among infants with challenge-confirmed food allergy in infancy, 45% had persistent disease at age 10 years. The prevalence of current diagnosed asthma at ages 6 and 10 years were 12.1% (95% CI, 10.9-13.3) and 13.1% (95% CI, 11.9-14.4), respectively, current eczema decreased slightly from 15.3% (95% CI, 14.1-19.7) at age 6 years to 12.9% (95% CI, 11.7-14.2) at age 10 years, and current rhinitis increased from 15.1% (95% CI, 13.9-16.5) at age 6 years to 25.0% (95% CI, 23.4-26.7) at age 10 years. CONCLUSIONS Allergic diseases affect 40% of primary school-age children; one third have multiple allergic diagnoses. Challenge-confirmed food allergy prevalence remains high, and 45% of infants with food allergy have persistent disease to age 10 years.
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Affiliation(s)
- Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
| | - Victoria X Soriano
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrian J Lowe
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rushani Wijesuriya
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kayla M Parker
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Paxton Loke
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
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Ren J, Wang C, Zhang P, Xu J, Bao Y. Epidemiological characterization and risk factors of rhinitis and rhinoconjunctivitis among preschool children in Shanghai, China. Int J Pediatr Otorhinolaryngol 2024; 179:111906. [PMID: 38492328 DOI: 10.1016/j.ijporl.2024.111906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/14/2023] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Previous studies have reported an increasing prevalence of childhood allergic rhinitis in developing countries. There is still a lack of the recent epidemiology of allergic rhinitis among Chinese preschool children. Therefore, this study explored the prevalence of rhinitis symptoms and identified their associations with potential risk factors among children at the age of 3-6 in Shanghai, China. METHODS Validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was adopted to collect information about rhinitis symptoms and potential risk factors. Univariate and multivariate logistic regression analyses were used to assess associations between risk factors and allergic rhinitis and rhinoconjunctivitis. RESULTS A total of 6183 questionnaires were included in our study. The prevalence of rhinitis ever, current rhinitis, and physician-diagnosed rhinitis were 32.6%, 29.2%, and 14.3%, respectively, while the prevalence of current rhinoconjunctivitis was 11.3%. The higher prevalence was observed in boys than in girls in terms of rhinitis ever, current rhinitis, current rhinoconjunctivitis and doctor-diagnosed rhinitis. Autumn had the highest prevalence among four seasons. In our multivariate logistic regression analyses, history of allergic diseases and paracetamol use in the last year showed positive associations with the increased risk of both current rhinitis and rhinoconjunctivitis, and antibiotic use was an independent significant risk factor only for current rhinitis. Genetic factors, including maternal and paternal rhinitis, asthma, and eczema, were significantly associated with the prevalence of current rhinitis. Similar associations were seen between these factors and current rhinoconjunctivitis, except for paternal eczema. Among environmental factors, smoking exposure at home, heavy truck traffic in home's street, floor heating system were independent risk factors for both current rhinitis and rhinoconjunctivitis in the adjusted model, while cleaning the house less than once a week was only associated with current rhinitis. CONCLUSION The prevalence of current rhinitis was 29.2% among children aged 3-6 in Shanghai, China. Sex differences and seasonal variations were observed in the prevalence of rhinitis symptoms. The identified risk factors would provide a basis for policy makers and medical experts to take intervention measures to prevent allergic rhinitis and rhinoconjunctivitis.
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Affiliation(s)
- Jie Ren
- Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Chengdong Wang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
| | - Pingbo Zhang
- Shanghai Tonxin Clinic, Shanghai, 200082, China; Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Jing Xu
- Yangpu District Maternity and Child Healthcare Hospital, Shanghai, 200082, China
| | - Yixiao Bao
- Shanghai Tonxin Clinic, Shanghai, 200082, China.
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Wise SK, Hamzavi-Abedi Y, Hannikainen PA, Anand MP, Pitt T, Savoure M, Toskala E. Rhinitis Disease Burden and the Impact of Social Determinants of Health. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00336-2. [PMID: 38570070 DOI: 10.1016/j.jaip.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
Social determinants of health (SDHs) have a substantial impact on patient care and outcomes globally, both in low- to middle-income countries and in high-income countries. In the clinic, lack of availability of diagnostic tools, inequities in access to care, and challenges obtaining and adhering to prescribed treatment plans may further compound these issues. This article addresses a case of rhinitis in the context of SDHs and inequities in care that may affect various communities and populations around the world. SDHs may include various aspects of one's financial means, education, access to medical care, environment and living situation, and community factors, each of which could play a role in the rhinitis disease manifestations, diagnosis, and management. Allergic and nonallergic rhinitis are considered from this perspective. Rhinitis epidemiology, disease burden, and risk factors are broadly addressed. Patient evaluation, diagnostic tests, and management options are also reviewed, and issues related to SDHs are noted. Finally, inequities in care, knowledge gaps, and unmet needs are highlighted. It is critical to consider SDHs and care inequities when evaluating and treating patients for rhinitis and other allergic conditions.
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Affiliation(s)
- Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Ga.
| | - Yasmin Hamzavi-Abedi
- Departments of Pediatrics and Medicine, Division of Allergy and Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | | | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research, Mysore, Karnataka, India
| | - Tracy Pitt
- Department of Paediatrics, Humber River Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marine Savoure
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Elina Toskala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pa
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10
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Böscke R. [Difficult-to-treat chronic rhinosinusitis-when the standard treatment is not effective and biologics are not available]. HNO 2024; 72:231-241. [PMID: 38472346 DOI: 10.1007/s00106-024-01443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND In recent years, significant improvements have been made in the treatment options for uncontrolled chronic rhinosinusitis (CRS) refractory to standard medical and surgical therapy. This is the result of a better understanding of the pathophysiology and the resulting development of biologicals for CRS with nasal polyps (CRSwNP). However, biologics are not (yet) available for all patients in Europe. OBJECTIVE Based on the session "Difficult-to-treat CRS, when biologics are not available" at the 29th Congress of the European Rhinologic Society (ERS) 2023 in Sofia, Bulgaria, the treatment options for uncontrolled CRS with the exclusion of biologics will be discussed. MATERIALS AND METHODS The content of the presentations "Is there a place for antibiotics?" "Indications for revision surgery," "Novel systemic treatment options," "Novel local treatment options," and "Phototherapy for nasal polyps" are outlined and supported by a review of the literature. RESULTS Various treatment options are available for managing uncontrolled CRS, even if biologic treatments are unavailable. Treatment options for type‑2 (T2) CRS include steroid rinses, repeated short-term oral steroids, steroid-eluting stents, and extended sinus surgery. In the case of nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD), acetylsalicylic acid (ASA) desensitization can be considered. Non-T2 endotypes or CRS without nasal polyps (CRSsNP) may benefit from several weeks of macrolides and xylitol rinses. CONCLUSION To accurately assess the efficacy of second-line therapies for treatment of difficult-to-treat CRS within an endotype-specific framework, additional controlled clinical trials are needed that take into account the heterogeneity of CRS endotypes.
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Affiliation(s)
- Robert Böscke
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Evangelisches Krankenhaus Oldenburg, Medizinischer Campus der Carl-von-Ossietzky Universität Oldenburg, Steinweg 13-17, 26122, Oldenburg, Deutschland.
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Modée Borgström A, Mogensen H, Engmér Berglin C, Knutsson J, Bonnard Å. Occurrence of mucosa-affecting diseases of the upper airways in middle ear cholesteatoma patients: a nationwide case-control study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08567-3. [PMID: 38517544 DOI: 10.1007/s00405-024-08567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/18/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Exploring a possible link between upper airway inflammation and the development of cholesteatoma by studying the association between mucosa-affecting diseases of the upper airways and cholesteatoma surgery. METHODS This is a nationwide case-control study of 10,618 patients who underwent surgery for cholesteatoma in Sweden between 1987 and 2018. The cases were identified in the National Patient Register and 21,235 controls matched by age, sex and place of residency were included from national population registers. Odds ratios (OR) and corresponding 95% confidence intervals were used to assess the association between six types of mucosa-affecting diseases of the upper airways and cholesteatoma surgery. RESULTS Chronic rhinitis, chronic sinusitis and nasal polyposis were more common in cholesteatoma patients than in controls (OR 1.5 to 2.5) as were both adenoid and tonsil surgery (OR > 4) where the strongest association was seen for adenoid surgery. No association was seen between allergic rhinitis and cholesteatoma. CONCLUSION This study supports an association between mucosa-affecting diseases of the upper airways and cholesteatoma. Future studies should aim to investigate the mechanisms connecting mucosa-affecting diseases of the upper airways and cholesteatoma formation regarding genetic, anatomical, inflammatory and mucosa properties.
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Affiliation(s)
- Agnes Modée Borgström
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden.
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Engmér Berglin
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Knutsson
- Department of Otolaryngology, Västerås Hospital, Västerås, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Region Västmanland, Centre for Clinical Research, Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Åsa Bonnard
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
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Zhao P, Kariya S, Higaki T, Makihara S, Rikimaru T, Okano M, Ando M. Chronic rhinosinusitis possibly associated with decreased lung function in chronic cough patients. Braz J Otorhinolaryngol 2024; 90:101424. [PMID: 38581960 PMCID: PMC11004496 DOI: 10.1016/j.bjorl.2024.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVES The purpose of this study is to investigate the lung function in Chronic Rhinosinusitis (CRS) patients with Chronic Cough (CC). METHODS A total of 1413 CC patients were retrospectively screened and 109 CRS patients with CC were enrolled. Lung function, Lund-Mackay Computed Tomography (CT) score, smoking status, peripheral blood eosinophil count, and immunoglobulin E concentration in serum samples, and Sino-Nasal Outcome Test were examined. Normal control subjects are also recruited. RESULTS The Forced Expiratory Volume in 1 second (FEV1.0), Percent Predicted FEV1.0, and FEV1.0/Forced Vital Capacity (FVC) ratio in the patients were significantly low as compared with the control subjects. The FEV1.0/FVC ratio was negatively correlated with the Lund-Mackay CT scores of the patients with a high CT score. CONCLUSIONS The CRS patients with CC should be investigated with lung function. In addition, the multidisciplinary evaluation including a pulmonologist is needed to manage the CRS patients with CC. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Pengfei Zhao
- Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences, Department of Otolaryngology-Head and Neck Surgery, Okayama, Japan.
| | - Shin Kariya
- Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences, Department of Otolaryngology-Head and Neck Surgery, Okayama, Japan; Kawasaki Medical School, Department of Otolaryngology-Head and Neck Surgery, Kurashiki, Japan
| | - Takaya Higaki
- Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences, Department of Otolaryngology-Head and Neck Surgery, Okayama, Japan
| | - Seiichiro Makihara
- Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences, Department of Otolaryngology-Head and Neck Surgery, Okayama, Japan
| | - Toru Rikimaru
- Fukuoka Sanno Hospital, Division of Respiratory Medicine, Fukuoka, Japan
| | - Mitsuhiro Okano
- Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences, Department of Otolaryngology-Head and Neck Surgery, Okayama, Japan; International University of Health and Welfare School of Medicine, Department of Otorhinolaryngology, Narita, Japan
| | - Mizuo Ando
- Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences, Department of Otolaryngology-Head and Neck Surgery, Okayama, Japan
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Ferraiolo PN, Dortas SD, Cruz FCD, Ramos PCDS, Elabras Filho J, Marques MDPC, Valete-Rosalino CM. Development of a mobile app for the evaluation of patients with chronic rhinosinusitis. Braz J Otorhinolaryngol 2024; 90:101375. [PMID: 38237485 PMCID: PMC10828589 DOI: 10.1016/j.bjorl.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. METHODS A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. RESULTS Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. CONCLUSION The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Priscila Novaes Ferraiolo
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil.
| | - Sergio Duarte Dortas
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Fabiana Chagas da Cruz
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Priscilla Campos de Souza Ramos
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - José Elabras Filho
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Marise da Penha Costa Marques
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Cláudia Maria Valete-Rosalino
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brazil
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Jang JH, Yang EM, Lee Y, Shin YS, Ye YM, Park HS. Diagnostic biomarkers for chronic rhinosinusitis in adult asthmatics in real-world practice. World Allergy Organ J 2024; 17:100879. [PMID: 38380106 PMCID: PMC10877182 DOI: 10.1016/j.waojou.2024.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/06/2024] [Accepted: 01/27/2024] [Indexed: 02/22/2024] Open
Abstract
Background Chronic rhinosinusitis (CRS) is a common comorbid condition of asthma that affects the long-term outcome of asthmatic patients. CRS is a heterogeneous disease requiring multiple biomarkers to explain its pathogenesis. This study aimed to develop potential biomarkers for predicting CRS in adult asthmatic patients in a real-world clinical setting. Methods This study enrolled 108 adult asthmatic patients who had maintained anti-asthmatic medications, including medium-to-high doses of inhaled corticosteroid plus long-acting β2-agonists, and compared clinical characteristics between patients with CRS (CRS group) and those without CRS (non-CRS group). CRS was diagnosed based on the results of paranasal sinus X-ray and/or osteomeatal-unit CT as well as clinical symptoms. Type-2 parameters, including blood eosinophil count, serum levels of periostin/dipeptidyl peptidase 10 (DPP10) and clinical parameters, such as FEV1% and fractional exhaled nitric oxide (FeNO), were analyzed. All biomarkers were evaluated by logistic regression and classification/regression tree (CRT) analyses. Results The CRS group had higher blood eosinophil counts/FeNO levels and prevalence of aspirin-exacerbated respiratory disease (AERD) than the non-CRS group (n = 57, 52.8% vs. n = 75, 47.2%; P < 0.05), but no differences in sex/smoking status or asthma control status were noted. The CRS group had higher serum periostin/DPP10 levels than the non-CRS group. Moreover, logistic regression demonstrated that serum periostin/DPP10 and the AERD phenotype were significant factors for predicting CRS in asthmatic patients (adjusted odds ratio, 2.14/1.94/12.39). A diagnostic algorithm and the optimal cutoff values determined by CRT analysis were able to predict CRS with 86.27% sensitivity (a 0.17 negative likelihood ratio). Conclusion Serum periostin, DPP10 and the phenotype of AERD are valuable biomarkers for predicting CRS in adult asthmatic patients in clinical practice.
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Affiliation(s)
- Jae-Hyuk Jang
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun-Mi Yang
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Youngsoo Lee
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yoo Seob Shin
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young-Min Ye
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
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15
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Kim DH, Kim SW, Kim SW, Stybayeva G, Hwang SH. An indirect comparative analysis of two posterior nasal nerve ablation techniques for treating chronic rhinitis: A systemic review and meta-analysis. Am J Otolaryngol 2024; 45:104130. [PMID: 38039909 DOI: 10.1016/j.amjoto.2023.104130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis evaluates and compares the effects of two treatments that ablate the posterior nasal nerves for rhinitis-related symptoms: cryotherapy and radiofrequency neurolysis. METHODS We reviewed studies retrieved from PubMed, SCOPUS, Embase, the Web of Science and the Cochrane database up to June 2023. Papers reporting quality-of-life and rhinitis-related symptom scores before and after cryotherapy, and sham-controlled studies, were analyzed. RESULTS In total, 738 patients enrolled in 10 studies were evaluated. Both cryotherapy and radiofrequency neurolysis significantly improved rhinitis-related symptoms including congestion, itching, rhinorrhea, and sneezing, and quality of life during 12 months of follow-up. Radiofrequency neurolysis was significantly more effective than cryotherapy in terms of reducing total nasal symptom scores at up to 12 months postoperatively. In terms of individual symptoms, itching, rhinorrhea, and congestion were significantly alleviated or tended to be reduced more by radiofrequency neurolysis than by cryotherapy. The improvements in the minimal clinically important difference in total nasal symptom scores (1.0 point) after 3 months of cryotherapy and radiofrequency therapy were 81.8 % and 92.7 %, respectively. CONCLUSIONS Cryotherapy and radiofrequency neurolysis both improved rhinitis-symptom and quality-of-life scores. Especially, radiofrequency neurolysis showed the better effectiveness for improving the nasal symptoms related to the rhinitis than cryotherapy.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Airaksinen L, Suojalehto H, Lindström I, Sund J, Pallasaho P, Puustinen A. Characterization of Relevant Bovine Dander Allergen Components. J Investig Allergol Clin Immunol 2024; 34:20-29. [PMID: 36193743 DOI: 10.18176/jiaci.0863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Diagnostic tests in occupational allergic diseases are highly dependent on the quality of available allergen extracts and specific IgE tests. To enhance diagnostic testing in cattle-related occupational rhinitis, asthma, and urticaria, we produced an in- house cow dander extract, assessed its allergen profile and performance in clinical tests, and compared it with commercial bovine dander extracts. METHODS One hundred patients with a suspected cattle-related occupational disease underwent skin prick tests (SPTs) with in-house and 1 or 2 commercial bovine dander extracts. Nasal allergen provocation tests were performed on 31 patients with suspected occupational rhinitis. We used Western blot to study the specific IgE-protein reactions from the sera of the patients with positive provocation test results and identified allergens from immunoblot bands using tandem mass spectrometry. RESULTS The odorant-binding protein Bos d OBP, bovine serum albumin (Bos d 6), and the lipocalin (Bos d 2) were identified as the major allergens. We found a total of 24 bovine dander allergens, of which several were formerly unknown. The sensitivity and specificity of the in-house extract in SPTs were 100% and 94%, respectively, in 87 patients. The SPT results were negative in 20 healthy controls. Nasal allergen provocation tests with in-house extract detected occupational rhinitis with 100% sensitivity in 21 patients. The provocation results remained negative in 5 healthy controls. CONCLUSIONS Three major and several minor allergens in bovine dander caused occupational rhinitis. Diagnosis of bovine allergen-related occupational diseases requires a sufficient concentration and variety of tested allergens.
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Affiliation(s)
- L Airaksinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - H Suojalehto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - I Lindström
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Sund
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - P Pallasaho
- Finnish Institute of Occupational Health, Helsinki, Finland
- Western Uusimaa Wellbeing Services County, Western Uusimaa, Finland
| | - A Puustinen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Helsinki University, Helsinki, Finland
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Dong Y, Lau HX, Suaini NHA, Kee MZL, Ooi DSQ, Shek LPC, Lee BW, Godfrey KM, Tham EH, Ong MEH, Liu N, Wong L, Tan KH, Chan JKY, Yap FKP, Chong YS, Eriksson JG, Feng M, Loo EXL. A machine-learning exploration of the exposome from preconception in early childhood atopic eczema, rhinitis and wheeze development. Environ Res 2024; 250:118523. [PMID: 38382664 DOI: 10.1016/j.envres.2024.118523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/19/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Most previous research on the environmental epidemiology of childhood atopic eczema, rhinitis and wheeze is limited in the scope of risk factors studied. Our study adopted a machine learning approach to explore the role of the exposome starting already in the preconception phase. METHODS We performed a combined analysis of two multi-ethnic Asian birth cohorts, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) and the Singapore PREconception Study of long Term maternal and child Outcomes (S-PRESTO) cohorts. Interviewer-administered questionnaires were used to collect information on demography, lifestyle and childhood atopic eczema, rhinitis and wheeze development. Data training was performed using XGBoost, genetic algorithm and logistic regression models, and the top variables with the highest importance were identified. Additive explanation values were identified and inputted into a final multiple logistic regression model. Generalised structural equation modelling with maternal and child blood micronutrients, metabolites and cytokines was performed to explain possible mechanisms. RESULTS The final study population included 1151 mother-child pairs. Our findings suggest that these childhood diseases are likely programmed in utero by the preconception and pregnancy exposomes through inflammatory pathways. We identified preconception alcohol consumption and maternal depressive symptoms during pregnancy as key modifiable maternal environmental exposures that increased eczema and rhinitis risk. Our mechanistic model suggested that higher maternal blood neopterin and child blood dimethylglycine protected against early childhood wheeze. After birth, early infection was a key driver of atopic eczema and rhinitis development. CONCLUSION Preconception and antenatal exposomes can programme atopic eczema, rhinitis and wheeze development in utero. Reducing maternal alcohol consumption during preconception and supporting maternal mental health during pregnancy may prevent atopic eczema and rhinitis by promoting an optimal antenatal environment. Our findings suggest a need to include preconception environmental exposures in future research to counter the earliest precursors of disease development in children.
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Affiliation(s)
- Yizhi Dong
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore.
| | - Hui Xing Lau
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.
| | - Noor Hidayatul Aini Suaini
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.
| | - Michelle Zhi Ling Kee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.
| | - Delicia Shu Qin Ooi
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Keith M Godfrey
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom; MRC Lifecourse Epidemiology Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
| | - Elizabeth Huiwen Tham
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Nan Liu
- Duke-NUS Medical School, National University of Singapore, Singapore; Health Services Research Centre, Singapore Health Services, Singapore, Singapore; Institute of Data Science, National University of Singapore, Singapore.
| | - Limsoon Wong
- School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore.
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital (KKH), Singapore.
| | - Jerry Kok Yen Chan
- Duke-NUS Medical School, National University of Singapore, Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital (KKH), Singapore.
| | - Fabian Kok Peng Yap
- Duke-NUS Medical School, National University of Singapore, Singapore; Department of Paediatrics, KK Women's and Children's Hospital (KKH), Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore; Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
| | - Johan Gunnar Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; Folkhälsan Research Center, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Finland.
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore.
| | - Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Margulis I, Jrbashyan J, Bitterman Fisher S, Feibish N, Stein N, Cohen-Kerem R. Rhinitis medicamentosa - comparing two treatment strategies: a retrospective analysis. J Laryngol Otol 2024:1-7. [PMID: 38311332 DOI: 10.1017/s0022215124000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Rhinitis medicamentosa poses a therapeutic challenge for both patients and physicians. Treatment strategies vary, starting with avoidance of decongestants, followed by medications or surgical intervention. This study aimed to compare two treatment strategies for this condition. METHODS A review was conducted of patients diagnosed with rhinitis medicamentosa from 2013 to 2021, who were managed conservatively with medications or surgically by inferior turbinate reduction. RESULTS Forty-seven patients were included: 21 patients were treated conservatively and 26 underwent turbinate reduction. Following surgical therapy, the frequency of using decongestants was significantly reduced (p < 0.001), with a significant improvement in Sino-Nasal Outcome Test-22 scores (p < 0.001). The conservative treatment group was significantly older with more co-morbidities. Following medical therapy, the conservative treatment group had a significant decrease in the frequency of decongestant use, but there was no significant improvement in their Sino-Nasal Outcome Test-22 scores. CONCLUSION Compared to conservative treatment, inferior turbinate reduction for rhinitis medicamentosa resulted in reduced decongestant use and improved quality of life.
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Affiliation(s)
- Itai Margulis
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Jenny Jrbashyan
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Sivan Bitterman Fisher
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Nir Feibish
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Raanan Cohen-Kerem
- Department of Otolaryngology - Head and Neck Surgery, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport Faculty of Medicine, and Technion - Israel Institute of Technology, Haifa, Israel
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Amini H, Amini M, Wright RO. Climate Change, Exposome Change, and Allergy: A Review. Immunol Allergy Clin North Am 2024; 44:1-13. [PMID: 37973255 PMCID: PMC11000425 DOI: 10.1016/j.iac.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Climate change is a major threat to human respiratory health and associated allergic disorders given its broad impact on the exposome. Climate change can affect exposure to allergens, such as pollen, dust mites, molds, as well as other factors such as temperature, air pollution, and nutritional factors, which synergistically impact the immune response to these allergens. Exposome change can differentially exacerbate allergic reactions across subgroups of populations, especially those who are more vulnerable to environmental stressors. Understanding links between climate change and health impacts can help inform how to protect individuals and vulnerable populations from adverse health effects.
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Affiliation(s)
- Heresh Amini
- Department of Environmental Medicine and Public Health, Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA.
| | - Mohamad Amini
- Department of Dermatology, Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
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Kim DH, Kim SW, Kim SW, Stybayeva G, Hwang SH. Effectiveness of temperature-controlled radiofrequency neurolysis of the posterior nasal nerve to treat chronic rhinitis: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:537-545. [PMID: 37728632 DOI: 10.1007/s00405-023-08242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluates the effect of TRNP on rhinitis-related symptoms. METHODS We reviewed studies retrieved from PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database to June 2023. Studies that evaluated quality-of-life and rhinitis-related symptom scores before and after treatment were analyzed, as was one sham-treatment-controlled study. RESULTS In total, 406 patients evaluated in five studies were analyzed. TRNP significantly improved rhinitis-related symptoms-congestion, itching, rhinorrhea, and sneezing-for up to 12 months after treatment, compared to before treatment. The most significant symptom decreases were those of rhinorrhea and nasal congestion. Rhinitis-related symptoms had improved significantly at 3 months after TRNP, compared to sham surgery. TRNP improved disease-specific quality-of-life scores on the Rhinoconjunctivitis Quality of Life Questionnaire at 6 months after treatment, compared to before treatment. The rates of clinical improvement in terms of all nasal symptoms (reduction > 30% from baseline) and in quality of life (minimal clinically important difference > 0.4) after TRNP were 79% and 84% respectively. There was no severe adverse event associated with either device use or the overall procedure. CONCLUSIONS TRNP treatment improved subjective symptoms related to rhinitis, especially rhinorrhea and nasal congestion, and also improved disease-specific quality-of-life scores.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Toyokuni K, Yamamoto-Hanada K, Yang L, Hagino K, Harama D, Omori M, Matsumoto Y, Suzuki D, Umezawa K, Takada K, Shimada M, Hirai S, Ishikawa F, Hamaguchi S, Saito-Abe M, Sato M, Miyaji Y, Kabashima S, Fukuie T, Noguchi E, Suzuki K, Ohya Y. Influence of household pet ownership and filaggrin loss-of-function mutations on eczema prevalence in children: A birth cohort study. Allergol Int 2024:S1323-8930(24)00004-2. [PMID: 38302328 DOI: 10.1016/j.alit.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/05/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The association between pet exposure in infancy, early childhood eczema, and FLG mutations remains unclear. METHODS This was a birth cohort study performed in Tokyo, Japan. The primary outcome was current eczema based on questionnaire responses collected repeatedly from birth to 5 years of age. Generalized estimating equations and generalized linear modeling were used to evaluate the association. RESULTS Data from 1448 participants were used for analyses. Household dog ownership during gestation, early infancy, and 18 months of age significantly reduced the risk of current eczema. Household cat ownership also reduced the risk of current eczema, albeit without statistical significance. The combined evaluation of children from households with pets, be it cats, dogs or both, the risk of current eczema at 1-5 years of age was lower in those with household pet exposure ownership during gestation (RR = 0.59, 95 % CI 0.45-0.77) and at 6 months (RR = 0.49, 95 % CI 0.36-0.68). , Reduced risks of eczema were also observed at 2-5 (RR = 0.52, 95 % CI 0.37-0.73) and 3-5 years of age (RR = 0.50 95 % CI 0.35-0.74) when the respective household pet ownership were evaluated at 18 months and 3 years of age. These protective associations of reduced risk of eczema were only observed in children without FLG mutations. CONCLUSIONS Household dog and pet (dog, cat, or both) ownership was protective against early childhood eczema in a birth cohort dataset. This protective association was observed only in children without FLG mutations, which should be confirmed in studies with larger cohorts.
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Affiliation(s)
- Kenji Toyokuni
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan; Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Aichi, Japan
| | | | - Limin Yang
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kouhei Hagino
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Daisuke Harama
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Marei Omori
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuaki Matsumoto
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Daichi Suzuki
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kotaro Umezawa
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuma Takada
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mami Shimada
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seiko Hirai
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Fumi Ishikawa
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan; Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Aichi, Japan
| | - Sayaka Hamaguchi
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mayako Saito-Abe
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan; Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yumiko Miyaji
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Shigenori Kabashima
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Emiko Noguchi
- Department of Medical Genetics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
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22
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Squillacioti G, Bellisario V, Ghelli F, Marcon A, Marchetti P, Corsico AG, Pirina P, Maio S, Stafoggia M, Verlato G, Bono R. Air pollution and oxidative stress in adults suffering from airway diseases. Insights from the Gene Environment Interactions in Respiratory Diseases (GEIRD) multi-case control study. Sci Total Environ 2024; 909:168601. [PMID: 37977381 DOI: 10.1016/j.scitotenv.2023.168601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
Air pollution is a leading risk factor for global mortality and morbidity. Oxidative stress is a key mechanism underlying air-pollution-mediated health effects, especially in the pathogenesis/exacerbation of airway impairments. However, evidence lacks on subgroups at higher risk of developing more severe outcomes in response to air pollution. This multi-centre study aims to evaluate the association between air pollution and oxidative stress in healthy adults and in patients affected by airway diseases from the Italian GEIRD (Gene Environment Interactions in Respiratory Diseases) multi-case control study. Overall, 1841 adults (49 % females, 20-83 years) were included from four Italian centres: Pavia, Sassari, Turin, and Verona. Following a 2-stage screening process, we identified 1273 cases of asthma, chronic bronchitis, rhinitis, or COPD and 568 controls. Systemic oxidative stress was quantified by urinary 8-isoprostane and 8-OH-dG. Individual residential exposures to NO2, PM10, PM2.5, and O3 were derived using an innovative five-stage machine-learning-based approach. Linear mixed regression models tested the association between oxidative stress biomarkers and air pollution tertiles, adjusting by age, sex, BMI, smoking, education and season, with recruiting centres as random intercept. Only cases exhibited higher levels of log-transformed 8-isoprostane and 8-OH-dG in association with NO2 (β: 0.30 95 % CI: 0.08-0.52 and 0.20 95 % CI: 0.03-0.37), PM10 (0.34 95 % CI: 0.12-0.55 and 0.21 95 % CI: 0.05-0.37) and PM2.5 (0.27 95 % CI: 0.09-0.49 and 0.18 95 % CI: 0.02-0.34) as compared to the first tertile of exposure. No significant associations were observed for summer O3. Our findings suggest that exposure to air pollution may increase systemic oxidative stress levels in people suffering from airway diseases. This introduces a potential novel approach available for future epidemiological studies and Public Health for effective prevention strategies oriented at the quantification of early biological effects in susceptible people, whose additional risk level might be currently underrated. Air-pollution-mediated exacerbations, driven by oxidative stress, still deserve our attention.
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Affiliation(s)
- Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
| | - Valeria Bellisario
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
| | - Federica Ghelli
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Angelo G Corsico
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; SC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Italy.
| | - Pietro Pirina
- Clinical and Interventional Pulmonology, University Hospital Sassari (AOU), Sassari, Italy; Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
| | - Sara Maio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Massimo Stafoggia
- Department of Epidemiology of the Lazio Region Health Service, ASL Roma 1, Rome, Italy.
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
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Esmaeilzadeh H, Yousefi MR, Mortazavi N, Gholami MA, Vali M, Dastgheib SA. Tic disorder in allergic rhinitis children and adolescents: a case-control study. BMC Pediatr 2024; 24:20. [PMID: 38183026 PMCID: PMC10768233 DOI: 10.1186/s12887-023-04482-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Allergic rhinitis is the most common allergic disease. It can accompany psychological disorders such as tic disorders due to the prolonged course of the symptoms of allergic rhinitis. This pioneer case-control study aims to investigate tic disorders in children and adolescents under 18 years of age diagnosed with allergic rhinitis. METHOD The case group in this study consisted of patients who had both allergic rhinitis and tic disorders. Patients with allergic rhinitis without tic disorders were also enrolled as the control group with matched gender and age. Demographic characteristics, tic classifications, and contributing factors for allergic rhinitis and tic disorders were studied among the cases. Tic disorders were evaluated using DSM-5 criteria for the classification of tic disorders. RESULTS 47 patients in the case group and 47 patients in the control group were included in this study. 53.2% and 46.8% were males and females in the case group, respectively. The mean age of the patients was 10.46 ± 3.97 years old. Sound tics were more common among the patients compared to motor tics. Patients with concomitant AR and tic disorders had more days per week with AR symptoms (P-value ≤ 0.001; OR (every day vs. three days a week = 11.02(2.98, 40.76))). Most patients with sound tick were women (p: 0.026), and most patients with motion tic were in the Provisional tic disorder group (p: 0.001). The history of infantile eczema was seen more in patients without sound tic (p: 0.025), and otitis media was significantly less common among patients with sound tics (p: 0.026). Provisional tic disorder was the most common class among the patients. In the case group (coexistence between allergic rhinitis and tic) compared to the control group, patients had significantly more days with AR symptoms per week. CONCLUSION This preliminary study indicates that Provisional tic disorder was the most common classification of tic among patients with allergic rhinitis, especially in patients with motor tics. Asthma in motor tics, a history of food allergy in infancy, and a history of infantile eczema were also common among patients with vocal tics. Also, patients with allergic rhinitis and tic had more severe disease (more symptoms per week) than those with rhinitis alone. These findings emphasize the association of tic disorders with immunological pathways.
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Affiliation(s)
- Hossein Esmaeilzadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- MD/MPH Program, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Negar Mortazavi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Dastgheib
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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24
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Russel SM, Gosman RE, Gonzalez K, Wright J, Frank-Ito DO. Insights into exercise-induced rhinitis based on nasal aerodynamics induced by airway morphology. Respir Physiol Neurobiol 2024; 319:104171. [PMID: 37813324 PMCID: PMC11037931 DOI: 10.1016/j.resp.2023.104171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Exercise-induced rhinitis (EIR) is a poorly understood phenomenon that may be related to increased inspiratory airflow. Characterization of the development of EIR is important to understand contributing factors. OBJECTIVE To characterize how different nasal morphologies respond to airflow-related variables during rapid/deep inspiratory conditions. METHODS Subject-specific nasal airways were reconstructed from radiographic images. Unilateral airways were classified as Standard, Notched, or Elongated accord to their distinct nasal vestibule morphology. Computational fluid dynamics simulations were performed at various airflow rates. RESULTS For all simulated flow rates, average resistance at the nasal vestibule, airflow velocity and wall sheer stress were highest in Notched. Average mucosal heat flux was highest in Standard. Notched phenotypes showed lower mean percent increases from 10 L/min to 50 L/min in all computed variables. CONCLUSION Resistance values and airflow velocities depicted a more constricted nasal vestibule in the Notched phenotypes, while perception of nasal mucosal cooling (heat flux) favored the Standard phenotypes. Different nasal phenotypes may predispose to EIR.
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Affiliation(s)
- Sarah M Russel
- University of North Carolina - Chapel Hill, Department of Otolaryngology/Head & Neck Surgery, Chapel Hill, NC, USA; Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Raluca E Gosman
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Katherine Gonzalez
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Joshua Wright
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Dennis O Frank-Ito
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA.
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25
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Geng X, Xue J, Zheng H, Suo L, Zeng H, Zhao M, Song S, Liu Y, Zhao C, Yang P. The association between CD46 expression in B cells and the pathogenesis of airway allergy. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166845. [PMID: 37579982 DOI: 10.1016/j.bbadis.2023.166845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
CD46 can facilitate the production of IgE. Activation of CD46 may contribute to the pathogenesis of allergic diseases. The aim of this study is to elucidate the association between CD46 expression in B cells and the pathogenesis of airway allergy. In this study, peripheral B cells were collected from a group of patients suffering from allergic rhinitis (AR). An AR mouse model was established to test the role of CD46 in the development of airway allergy. The results showed elevated amounts of IGE in peripheral CD46+ B cells of AR patients. CD46+ B cells of AR patients showed high reticulum endoplasmic (ER) stress status. The expression of CD46 in peripheral B cells was positively associated with the AR response in patients. The production of IgE in mice with airway allergy was prevented by ablating CD46 expression in B cells. Exposure to aluminum hydroxide up regulated the expression of Cd46 in B cells through exacerbating ER stress. Administration of Cd46 shRNA carrying nanoparticles attenuated experimental airway allergy. In conclusion, peripheral B cells in AR patients display elevated CD46 expression. Cd46 ablation in B cells can mitigate the production of IgE in mice and attenuate experimental airway allergy.
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Affiliation(s)
- Xiaorui Geng
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Jinmei Xue
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Haoyue Zheng
- Shenzhen Clinical School of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China; Institute of Allergy & Immunology of Shenzhen University, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen, China
| | - Limin Suo
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Haotao Zeng
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Miao Zhao
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Shuo Song
- Institute of Allergy & Immunology of Shenzhen University, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen, China; Department of General Practical Medicine, Third Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Yu Liu
- Institute of Allergy & Immunology of Shenzhen University, State Key Laboratory of Respiratory Diseases Allergy Division at Shenzhen University, Shenzhen, China.
| | - Changqing Zhao
- Department of Otolaryngology, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, China.
| | - Pingchang Yang
- Shenzhen Clinical School of Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China.
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Sio YY, Victoria Nanong GA, Lim JA, Matta SA, Say YH, Teh KF, Wong YR, Rawanan Shah SM, Reginald K, Chew FT. Sensitization to oil palm pollen associates with risks and severity of allergic diseases. World Allergy Organ J 2024; 17:100853. [PMID: 38235258 PMCID: PMC10792632 DOI: 10.1016/j.waojou.2023.100853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/11/2023] [Accepted: 11/25/2023] [Indexed: 01/19/2024] Open
Abstract
Background Elaeis guineensis (Ela g, oil palm) pollen is one of the most predominant species of inhalant allergens in the tropical Southeast Asia region; however, its association with the manifestation of allergic diseases remains largely unexplored. This study aimed to determine the sensitization pattern of oil palm pollen and associate this with the risk and severity of allergic diseases. Methods Participants were recruited as a part of the Singapore and Malaysia cross-sectional genetic and epidemiological study (SMCSGES). Two independent cohorts were recruited: n = 564 serum samples were collected and serological assessment was performed against a panel of 16 crude inhalant allergens including house dust mite, pet, insect, pollen, and fungal allergens; n = 13 652 Singapore/Malaysia Chinese young adults were recruited and skin prick test was used to assess oil palm sensitization, which was tested for its association with the risk and severity of asthma, allergic rhinitis (AR), and atopic dermatitis (AD). Results The sensitization rate of oil palm pollen is 9.6% in the n = 564 Singapore/Malaysia cohort. In the n = 13 652 Singapore/Malaysia Chinese cohort, oil palm sensitization significantly associates with increased risks of asthma (p = 1.34x10-4), AR (p = 2.91x10-13), and AD (p = 6.95x10-7). Asthmatic patients with oil palm sensitization have increased risks of wheezing (p = 0.00995), nocturnal cough (p = 0.0122), and exacerbations (p = 0.00139) in the past 12 months. AR patients with oil palm sensitization also have an increased risk of developing moderate-to-severe symptoms (p = 0.00113). Conclusions We have identified significant associations of oil palm sensitization with increased risks, exacerbations, and the severity of symptoms of allergic diseases in the tropical Southeast Asian region (Singapore/Malaysia).
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Affiliation(s)
- Yang Yie Sio
- Department of Biological Sciences, National University of Singapore, Singapore
| | | | - Jie Ann Lim
- Department of Biological Sciences, National University of Singapore, Singapore
| | - Sri Anusha Matta
- Department of Biological Sciences, National University of Singapore, Singapore
| | - Yee-How Say
- Department of Biological Sciences, National University of Singapore, Singapore
- Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR) Kampar Campus, Kampar, Perak, Malaysia
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Keng Foo Teh
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Yi Ru Wong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Smyrna Moti Rawanan Shah
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Kavita Reginald
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Fook Tim Chew
- Department of Biological Sciences, National University of Singapore, Singapore
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27
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Tosca MA, Trincianti C, Naso M, Nosratian V, Ciprandi G. Treatment of Allergic Rhinitis in Clinical Practice. Curr Pediatr Rev 2024; 20:271-277. [PMID: 37702169 DOI: 10.2174/1573396320666230912103108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/10/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
Allergic rhinitis is a prevalent condition among children, with its occurrence reaching up to 40% of the general population in some geographical areas. A type 2 immunity sustains allergic rhinitis. Consequently, type 2 inflammation leads to eosinophilic infiltrate of the nasal mucosa. Allergic inflammation causes the symptom occurrence. Typical nasal symptoms include nasal itching, sneezing, watery rhinorrhea, and nasal congestion. Nasal congestion depends on vasodilation and increased mucus production. These conditions result in nasal obstruction. Nasal obstruction is closely associated with type 2 inflammation. Allergic rhinitis usually occurs in association with other allergic conditions, in particular allergic conjunctivitis and asthma. The effective management of allergic rhinitis involves avoiding triggering allergens and employing pharmacological treatments as per ARIA guidelines. These treatments may include intranasal/oral antihistamines or/and nasal corticosteroids. In particular, antihistamines are particularly indicated for symptoms consequent to mediators' release, mainly concerning histamine. These histamine-dependent symptoms include itching, sneezing, and rhinorrhea. Nasal obstruction, being associated with inflammation, is responsive to corticosteroids, administered mostly intranasally. The fixed combination of a topical antihistamine plus a topical corticosteroid is very effective, but is indicated for adolescents only. However, nasal lavage is safe, cheap, and adequate, thus its use is prevalent. Namely, nasal lavage allows to remove secretions, allergens, mediators. In addition, hypertonic solutions exert a decongestant activity. On the other hand, the allergen-specific immunotherapy is still the only causal treatment. Nutraceuticals have also been used to relieve symptoms. The objective of this review is to explore and compare the traditional and new therapeutic approaches for pollen-induced allergic rhinitis in children.
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Affiliation(s)
| | | | - Matteo Naso
- Allergy Center, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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28
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Flores NM, Lovinsky-Desir S, Divjan A, Hoepner LA, Zou J, Miller RL, Herbstman JB, Perera FP, Perzanowski MS, Chen Q. Trajectory analysis of rhinitis in a birth cohort from lower-income New York City neighborhoods. J Allergy Clin Immunol 2023:S0091-6749(23)02415-6. [PMID: 38104949 DOI: 10.1016/j.jaci.2023.11.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Rhinitis is a prevalent, chronic nasal condition associated with asthma. However, its developmental trajectories remain poorly characterized. OBJECTIVE We sought to describe the course of rhinitis from infancy to adolescence and the association between identified phenotypes, asthma-related symptoms, and physician-diagnosed asthma. METHODS We collected rhinitis data from questionnaires repeated across 22 time points among 688 children from infancy to age 11 years and used latent class mixed modeling (LCMM) to identify phenotypes. Once children were between ages 5 and 12, a study physician determined asthma diagnosis. We collected information on the following asthma symptoms: any wheeze, exercise-induced wheeze, nighttime coughing, and emergency department visits. For each, we used LCMM to identify symptom phenotypes. Using logistic regression, we described the association between rhinitis phenotype and asthma diagnosis and each symptom overall and stratified by atopic predisposition and sex. RESULTS LCMM identified 5 rhinitis trajectory groups: never/infrequent; transient; late onset, infrequent; late onset, frequent; and persistent. LCMM identified 2 trajectories for each symptom, classified as frequent and never/infrequent. Participants with persistent and late onset, frequent phenotypes were more likely to be diagnosed with asthma and to have the frequent phenotype for all symptoms (P < .01). We identified interaction between seroatopy and rhinitis phenotype for physician-diagnosed asthma (P = .04) and exercise-induced wheeze (P = .08). Severe seroatopy was more common among children with late onset, frequent and persistent rhinitis, with nearly 25% of these 2 groups exhibiting sensitivity to 4 or 5 of the 5 allergens tested. CONCLUSIONS In this prospective, population-based birth cohort, persistent and late onset, frequent rhinitis phenotypes were associated with increased risk of asthma diagnosis and symptoms during adolescence.
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Affiliation(s)
- Nina M Flores
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY.
| | - Stephanie Lovinsky-Desir
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY; Division of Pulmonary Medicine, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Adnan Divjan
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Lori A Hoepner
- Data Coordinating Center, Columbia University, New York, NY
| | - Jungang Zou
- Department of Biostatistics, Mailman School of Public Health, New York, NY
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, New York, NY
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Li W, Harvey RJ, Kalish L. Response to letter to the editor regarding "Long-term treatment outcomes in refractory rhinitis medicamnetosa managed with nasal surgery". Int Forum Allergy Rhinol 2023; 13:2264-2265. [PMID: 37817418 DOI: 10.1002/alr.23287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Affiliation(s)
- William Li
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, New South Wales, Sydney, Australia
| | - Richard John Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, New South Wales, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Sydney, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, New South Wales, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, New South Wales, Sydney, Australia
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30
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Takaoka M, Suzuki K, Norbäck D. Rhinitis in Japanese students - associations with window pane condensation, recent indoor painting, wooden home and dog allergen at school. Int J Environ Health Res 2023; 33:1502-1514. [PMID: 35881888 DOI: 10.1080/09603123.2022.2104225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
We studied risk factors for rhinitis in Japanese homes and schools. A questionnaire was sent to students in four schools (12-15 y age), 1048 (99.2%) participated. Crowdedness and furry pet allergens were measured in their classrooms. Household environment data was collected by a questionnaire. Risk factors were identified by multi-level logistic regression with mutual adjustment. The prevalence of current rhinitis was 60.3%, current rhinoconjunctivitis 24.4% and weekly rhinitis 29.5%. Window condensation (AORs1.69-1.90) and indoor painting (AORs1.72-1.76) at home were associated with rhinitis. The association between painting and rhinitis was stronger in girls (interaction p = 0.002) and in wooden homes (interaction p = 0.05). Dog allergen (Can f 1) in classroom air was associated with rhinitis (p = 0.04). In conclusion, window pane condensation and indoor painting can be household risk factors for rhinitis and dog allergen may be a risk factor in Japanese schools. Girls can be more sensitive to emissions from indoor paint than boys.
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Affiliation(s)
- Motoko Takaoka
- Department of Biosphere Sciences, School of Human Sciences, Kobe College, Nishinomiya, Japan
| | - Kyoko Suzuki
- Department of Biosphere Sciences, School of Human Sciences, Kobe College, Nishinomiya, Japan
| | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University and University Hospital, Uppsala, Sweden
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31
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Rohila V, Nirwan S, Samdhani S, Soni S, Sharma PK. Association of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio with Persistent Allergic Rhinitis. Indian J Otolaryngol Head Neck Surg 2023; 75:2842-2846. [PMID: 37974892 PMCID: PMC10645861 DOI: 10.1007/s12070-023-03557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/31/2023] [Indexed: 11/19/2023] Open
Abstract
Allergic rhinitis is a disease that affects approximately 15-25% of the World population. It is characterized by itching, sneezing, and nasal or postnasal drip. Generally, diagnosis is based on clinical findings and patient history. Laboratory tests that can be used in the diagnosis and clinical course of AR are still limited and should be improved. Neutrophil-lymphocyte ratio (NLR) and Platelet Lymphocyte Ration(PLR) are novel markers for the evaluation of inflammation. This study aims to investigate whether NLR and PLR, would be useful in diagnosis and monitoring the severity of disease in allergic rhinitis. It is a 1 year cross sectional study which assesses 140 patients, 70 belonging each to case and control group. NLR and PLR ratio was measured and compared in case and control groups. Mean NLR was 1.92 in patient group and in control group it was 1.54 (P value < 0.001). Mean PLR was 1.33 in patient group and in control group it was 0.88 (p < 0.001). Mean NLR in mild cases was 1.68 and in moderate to severe cases was 2.15 (p value 0.002). Mean PLR was 1.49 in moderate to severe disease and in mild disease it was 1.18 (p value 0.006). To conclude NLR and PLR were significantly higher in moderate to severe allergic rhinitis and not so in mild cases. Hence in allergic rhinitis NLR and PLR can be used as a marker of severity of disease according to symptoms of the disease.
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Affiliation(s)
- Vikas Rohila
- Dept of ENT, SMS Medical college, Jaipur, Rajasthan India
| | | | - Sunil Samdhani
- Dept of ENT, SMS Medical college, Jaipur, Rajasthan India
| | - Samanvaya Soni
- Dept of ENT, SMS Medical college, Jaipur, Rajasthan India
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32
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Jenkins CR, Singh D, Ducharme FM, Raherison C, Lavoie KL. Asthma and Rhinitis Through the Lifespan of Nonpregnant Women. J Allergy Clin Immunol Pract 2023; 11:3578-3584. [PMID: 37802256 DOI: 10.1016/j.jaip.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
Increasingly, clinical practice guidelines advocate a precision medicine-based approach to care for asthma. This focus requires knowledge of not only different asthma phenotypes and their associated biomarkers but also sex and gender differences through the lifespan. Evidence continues to build in favor of different lifetime prevalence, clinical presentations, responses to management, and long-term prognosis of asthma. Women transition through many biological and psychosocial phases in their lives, all of which may interact with, and influence, their health and well-being. Historically, explanations have focused on hormonal effects on asthma in reproductive life, but a greater understanding of mechanisms starting before birth and changing over a lifetime is now possible, with immunologic, inflammatory, and hormonal factors playing a role. This article describes the evidence for the differences in asthma and rhinitis between men and women at different stages of life, the potential underlying mechanisms that contribute to this, and the implications for management and research. Future research studies should systematically report sex differences in asthma so that this knowledge can be used to develop a personalized approach to care, to achieve best possible outcomes for all.
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Affiliation(s)
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University, Manchester, United Kingdom; NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Francine M Ducharme
- Department of Pediatrics, University of Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Chantal Raherison
- Department of Pulmonology, CHU Guadeloupe, French West Indies University, Guadeloupe, French West Indies
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montréal (UQAM), Montréal, QC, Canada; Montréal Behavioural Medicine Centre (MBMC), CIUSSS-NIM, Hopital du Sacre-Coeur de Montreal, Montréal, QC, Canada
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33
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Suzuki R, Mori E, Iwasaki H, Shimamura Y, Shigeta Y, Sagara N, Aota A, Akashi K, Toyoda K, Katsunuma T. Olfactory dysfunction in Japanese children with moderate-to-severe allergic rhinitis. Auris Nasus Larynx 2023; 50:904-910. [PMID: 37012135 DOI: 10.1016/j.anl.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Detailed quantitative studies on olfaction remain inadequate in patients with paediatric allergic rhinitis (AR). This study examined olfactory dysfunction in children with AR. METHODS From July 2016 to November 2018, children aged 6-9 years were recruited and grouped as AR (n = 30) or without AR (control group, n = 10). Odour identification was evaluated by the Universal Sniff (U-Sniff) test and the Open Essence (OE). The results were compared between the AR and control groups. Intranasal mucosa findings, nasal smear eosinophil counts, blood eosinophil counts, total immunoglobulin E (IgE) levels, Japanese cedar-specific IgE and Dermatophagoides pteronyssinus-specific IgE were evaluated in all participants. Additionally, the presence of sinusitis and adenoid hypertrophy in patients with AR was also evaluated by sinus X-ray examinations. RESULTS The median U-Sniff test scores were not significantly different between the AR and control groups (9.0 vs. 10.0, respectively; p = 0.107). The OE score was significantly lower in the AR group than in the control group (4.0 vs. 8.0; p = 0.007, respectively), especially in the moderate-to-severe AR group versus the control group (4.0 vs. 8.0; p = 0.004). Furthermore, in the OE, the correct answer rates for 'wood', 'cooking gas' and 'sweaty socks' were significantly lower in the AR group than in the control group. CONCLUSIONS Paediatric AR patients can reduce olfactory identification ability, and the degree may be associated with the severity of AR in nasal mucosal findings. Furthermore, olfactory dysfunction may slow down the response to 'emergency situations', such as gas leak.
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Affiliation(s)
- Ryohei Suzuki
- Department of Pediatrics, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan; Department of Pediatrics, Fuji City General Hospital, Fuji, Japan.
| | - Eri Mori
- Department of Otorhinolaryngology, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hijiriko Iwasaki
- Department of Otorhinolaryngology, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yosuke Shimamura
- Department of Otorhinolaryngology, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasushi Shigeta
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, Fuji City General Hospital, Fuji, Japan
| | - Nagatoshi Sagara
- Department of Pediatrics, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Akiko Aota
- Department of Pediatrics, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Akashi
- Department of Pediatrics, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiko Toyoda
- Department of Radiology, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshio Katsunuma
- Department of Pediatrics, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
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Evcen R, Çölkesen F, Yıldız E, Sadi Aykan F, Kılınç M, Akkuş FA, Arslan S. Increasing Prevalence of Sensitization to Cat/Dog Allergens in the COVID-19 Pandemic. Int Arch Allergy Immunol 2023; 185:133-141. [PMID: 37918371 DOI: 10.1159/000534173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/15/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Cat and dog allergens are common indoor triggers for respiratory allergies such as allergic rhinitis and asthma. This study aims to evaluate the prevalence of cat and dog allergies in adults and analyze changes during the COVID-19 pandemic. METHODS We retrospectively analyzed the medical records of 8,102 patients who visited an allergy clinic and underwent skin prick testing (SPT) from March 2018 to March 2022: 2 years before and 2 years during the pandemic. Demographic information, clinical attributes, and laboratory results were examined based on patient records. RESULTS Of 8,102 SPTs performed, 400 (4.9%) were sensitized to cat allergen and 289 (3.6%) to dog allergen. Allergic rhinitis was the predominant clinical diagnosis in both groups. Of the 400 subjects exposed to cats, 240 (60%) experienced allergic symptoms, while of the 289 subjects exposed to dogs, 65 (22.5%) experienced allergic symptoms during exposure. Within the cat-sensitized group, anaphylaxis was observed in 5 patients (1.3%), while no cases of anaphylaxis were reported in the dog-sensitized group. Compared to the pre-pandemic period, patients presenting during the pandemic had higher rates of cat and dog sensitization (5.7% vs. 4.1%; p < 0.05, 5.2% vs. 1.7%; p < 0.05). CONCLUSION During the COVID-19 pandemic, there was an increase in cat and dog allergies among adults. Increased exposure to pet antigens, both directly and indirectly, has resulted in more people becoming sensitized to cats or dogs.
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Affiliation(s)
- Recep Evcen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Çölkesen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Eray Yıldız
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Filiz Sadi Aykan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Kılınç
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fatma Arzu Akkuş
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sevket Arslan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Jankowski R, Favier V, Saroul N, Lecanu JB, Nguyen DT, de Gabory L, Verillaud B, Rumeau C, Gallet P, Béquignon E, Vandersteen C, Patron V. Critical review of diagnosis in rhinology and its therapeutical implications. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:271-278. [PMID: 37838600 DOI: 10.1016/j.anorl.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.
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Affiliation(s)
- R Jankowski
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France.
| | - V Favier
- Département ORL, CCF et CMF, hôpital Gui-de-Chauliac, CHU de Montpellier, université Montpellier, Montpellier, France
| | - N Saroul
- Équipe ASMS, service d'oto-rhino-laryngologie et chirurgie cervico-faciale, INRAE, UNH, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - J-B Lecanu
- Service ORL & chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - D T Nguyen
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - L de Gabory
- Service d'ORL, de chirurgie cervico-faciale et pédiatrique, centre F-X Michelet, hôpital Pellegrin, CHU, université de Bordeaux, Bordeaux, France
| | - B Verillaud
- Service d'ORL, hôpital Lariboisière, AP-HP, Inserm U1131, université Paris Cité, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C Rumeau
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - P Gallet
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - E Béquignon
- Service Orl & chirurgie cervico-faciale, hôpital Henri-Mondor, CHIC Créteil, Créteil, France
| | - C Vandersteen
- Centre hospitalier universitaire, institut universitaire de la face et du cou, université Côte d'Azur, 31, avenue de Valombrose, Alpes-Maritimes, 06100 Nice, France
| | - V Patron
- Service ORL & chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France
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Jankowski R, Mathis-Marçon C, Fieux M, Barron M, Legré M, Favier V, Tiotiu A, Saroul N. Chronic nasal dysfunction: A clinical case illustrating the concept in practice. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:305-308. [PMID: 37980265 DOI: 10.1016/j.anorl.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
INTRODUCTION We illustrate the diagnostic method for chronic nasal dysfunction by an observation in which the clinical history was compared to preoperative responses on the DyNaChron self-administered questionnaire, with ENT interpretation of the sinonasal CT scan preceding and guiding nasal endoscopy. CASE REPORT The initial suspicion of rhinitis medicamentosa was transformed by the radiological and endoscopic findings of chronic respiratory rhinitis signs. Prick tests showing sensitivity to dust mites then suggested an allergic origin of the mucosal inflammation, which affected neither the olfactory nose nor the paranasal sinuses. A septal deviation hampering visualization of the right ethmoidal reliefs completed the clinical picture. Inferior turbinate hypertrophy secondary to allergic inflammation could have been aggravated by prolonged daily use of nasal vasoconstrictors. Failure of medical treatment combining nasal lavage, topical corticosteroids and an attempt at weaning led to effective medical and surgical management combining septoplasty, bilateral inferior turbinoplasty, continuation of topical corticosteroids and initiation of allergen immunotherapy. In addition to complete relief of nasal obstruction and abandonment of nasal vasoconstrictors, improved sense of smell completed the restoration of nasal comfort. DISCUSSION It is helpful to conceive the nose as being anatomically and pathophysiologically a triple organ and to evaluate therapy in terms of improvement in each symptom.
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Affiliation(s)
- R Jankowski
- Service d'ORL, CHRU Nancy, université de Lorraine, 54500 Vandœuvre-lès-Nancy, France.
| | - C Mathis-Marçon
- Service d'ORL, CHRU Nancy, université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - M Fieux
- Université de Lyon, université Lyon 1, 69003 Lyon, France; Hospices civils de Lyon, hôpital Lyon Sud, service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, 69310 Pierre-Bénite, France
| | - M Barron
- Service d'ORL, CHRU Nancy, université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - M Legré
- Service d'ORL, institut Arthur-Vernes, 75006 Paris, France
| | - V Favier
- Université de Montpellier, CHU de Montpellier, département d'ORL, CCF et CMF, hôpital Gui-de-Chauliac, Montpellier, France
| | - A Tiotiu
- Service de pneumologie, CHRU Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - N Saroul
- Université Clermont Auvergne, CHU Clermont-Ferrand, INRAE, UNH, équipe ASMS, 63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, service d'oto-rhino-laryngologie et chirurgie cervico-faciale, 63003 Clermont-Ferrand, France
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Gelardi M, Fiore V, Giancaspro R, Di Canio FM, Fiorentino C, Patruno S, Ruzza A, Cassano M. General classification of rhinopaties: the need for standardization according to etiology and nasal cytology. Eur Arch Otorhinolaryngol 2023; 280:4751-4758. [PMID: 37462742 PMCID: PMC10562500 DOI: 10.1007/s00405-023-08117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Rhinitis is as an inflammation of the nasal mucosa, characterized by high prevalence, widespread morbidity, and a significant financial burden on health care systems. Nevertheless, it is often considered as no more than a mere annoyance. This point of view has progressively led to underestimate and trivialize the disease. Therefore, there are numerous, mostly overlapping classifications of rhinopaties, but clear and standardized guidelines for diagnosis and treatment are still lacking. In the context of Precision Medicine, the development of a classification system focused on the endotypes of rhinitis to be widely adopted appears of utmost importance, also by virtue of study of the nasal immunophlogosis that, thanks to nasal cytology (NC), has recently allowed to better define the different forms of rhinitis, giving a new nosological dignity to several rhinopaties. AIM We aimed to summarize the current knowledge regarding rhinitis and to propose a systematic classification of rhinitis, based on both etiology and cytological findings.
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Affiliation(s)
- M Gelardi
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - V Fiore
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - R Giancaspro
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy.
| | - F M Di Canio
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - C Fiorentino
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - S Patruno
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - A Ruzza
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - M Cassano
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
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Kang YJ, Stybayeva G, Hwang SH. Comparative Effectiveness of Cryotherapy and Radiofrequency Ablation for Chronic Rhinitis: A Systematic Review and Meta-analysis. Clin Exp Otorhinolaryngol 2023; 16:369-379. [PMID: 37871904 DOI: 10.21053/ceo.2023.01214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/22/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES Multiple minimally invasive techniques for chronic rhinitis treatment focus on posterior nasal nerve ablation. We conducted a systematic review and meta-analysis to evaluate the efficacy of cryotherapy and radiofrequency ablation for alleviating symptoms in patients with allergic and nonallergic rhinitis. METHODS We retrieved studies from PubMed, Scopus, Embase, Web of Science, and Cochrane Database up to July 2023. Data on the impact of cryotherapy and radiofrequency ablation on quality of life and symptom ratings of rhinitis were extracted and evaluated. RESULTS An analysis of 12 studies involving 788 patients demonstrated significant improvements in quality of life and rhinitis-related symptoms (nasal obstruction, itching, rhinorrhea, and sneezing) in patients treated with cryotherapy or radiofrequency ablation (symptom score at 24 months and quality of life score at 3 months). However, radiofrequency ablation had a more positive effect on nasal symptoms after 3 months than cryotherapy. Nonallergic rhinitis patients responded more favorably to posterior nerve ablation than patients with allergic rhinitis. Both techniques enhanced disease-specific quality of life during the initial 3 months of treatment (cryotherapy, 84.6%; radiofrequency, 81.6%; P=0.564). After 3 months of treatment, a clinical improvement in all nasal symptoms (minimal clinically important difference in the total nasal symptom score: >1.0 points) was seen in 81.8% and 91.9% of patients who underwent cryotherapy and radiofrequency ablation, respectively (P=0.005), suggesting that radiofrequency is more likely to lead to clinical improvement. CONCLUSION Rhinitis-associated subjective symptom scores and quality of life may be improved by both cryotherapy and radiofrequency ablation. Ablation was more efficacious than cryotherapy for nasal symptoms in patients with nonallergic rhinitis. To corroborate these findings, further randomized controlled studies directly comparing these two techniques are warranted.
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Affiliation(s)
- Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Yazici D, Ogulur I, Pat Y, Babayev H, Barletta E, Ardicli S, Bel Imam M, Huang M, Koch J, Li M, Maurer D, Radzikowska U, Satitsuksanoa P, Schneider SR, Sun N, Traidl S, Wallimann A, Wawrocki S, Zhakparov D, Fehr D, Ziadlou R, Mitamura Y, Brüggen MC, van de Veen W, Sokolowska M, Baerenfaller K, Nadeau K, Akdis M, Akdis CA. The epithelial barrier: The gateway to allergic, autoimmune, and metabolic diseases and chronic neuropsychiatric conditions. Semin Immunol 2023; 70:101846. [PMID: 37801907 DOI: 10.1016/j.smim.2023.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
Since the 1960 s, our health has been compromised by exposure to over 350,000 newly introduced toxic substances, contributing to the current pandemic in allergic, autoimmune and metabolic diseases. The "Epithelial Barrier Theory" postulates that these diseases are exacerbated by persistent periepithelial inflammation (epithelitis) triggered by exposure to a wide range of epithelial barrier-damaging substances as well as genetic susceptibility. The epithelial barrier serves as the body's primary physical, chemical, and immunological barrier against external stimuli. A leaky epithelial barrier facilitates the translocation of the microbiome from the surface of the afflicted tissues to interepithelial and even deeper subepithelial locations. In turn, opportunistic bacterial colonization, microbiota dysbiosis, local inflammation and impaired tissue regeneration and remodelling follow. Migration of inflammatory cells to susceptible tissues contributes to damage and inflammation, initiating and aggravating many chronic inflammatory diseases. The objective of this review is to highlight and evaluate recent studies on epithelial physiology and its role in the pathogenesis of chronic diseases in light of the epithelial barrier theory.
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Affiliation(s)
- Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Huseyn Babayev
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Elena Barletta
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Swiss Institute of Bioinformatics (SIB), Davos, Switzerland
| | - Sena Ardicli
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Manal Bel Imam
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Mengting Huang
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Jana Koch
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Swiss Institute of Bioinformatics (SIB), Davos, Switzerland
| | - Manru Li
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Debbie Maurer
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Urszula Radzikowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | | | - Stephan R Schneider
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Na Sun
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, PR China
| | - Stephan Traidl
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Alexandra Wallimann
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Sebastian Wawrocki
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Damir Zhakparov
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Danielle Fehr
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reihane Ziadlou
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Marie-Charlotte Brüggen
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Katja Baerenfaller
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Swiss Institute of Bioinformatics (SIB), Davos, Switzerland
| | - Kari Nadeau
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
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Chew CC, Lim XJ, Letchumanan P, Narayanan MS, Rajan P, Chong CP. Development and validation of a pharmacist-led education model in allergic rhinitis management: a multi-phase study. J Pharm Policy Pract 2023; 16:116. [PMID: 37794504 PMCID: PMC10548631 DOI: 10.1186/s40545-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patient education is identified as one of the core and fundamental management strategies in the management of allergic rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed guidance for the management of allergic respiratory disease, and the guidelines are applicable to the international context. The ARIA guidelines for the pharmacy have specifically encouraged the creation of local pharmacist-led intervention in allergic rhinitis management. This study aims to develop a pharmacist-led educational model using a multi-phase study approach. METHOD In phase one, we conducted a literature review using four databases to extract relevant articles and clinical practice guidelines published between 2017 and 2022. The information was structured into a questionnaire consisting of patient education material (10 domains with 130 items) and pharmacist counseling scopes (15 domains with 43 items), with each item having a rating scale ranging from 1 (lowest) to 9 (highest) level of agreement. Fifty-two panellists, including otorhinolaryngologists and pharmacists, were invited to complete the questionnaire. A consensus agreement was considered when at least 70% of panellists scored 7 to 9 (critically important). A two-round survey was conducted, and descriptive analysis, inter-rater reliability (≥ 0.5-1 indicate moderate to excellent reliability), variation in the relative interquartile (VRIR < 0.3 indicate good stability), and variation in the coefficient of variation (VCV < 40% considered consensus achieved) were performed. In phase two, patient education material was developed into audio-visual format, and in phase three, patients rated its understandability and actionability using a validated Patient Education Materials Assessment Tool. RESULTS In the round one Delphi survey, 43 panellists responded, with 171 out of 173 items achieving "consensus agreement" (75.4-100%). In the second survey, 32 out of 43 panellists responded, with most items (171 out of 173 items) stable across rounds and all items had acceptable internal consistency (VCV: - 12.21-15.81). Two items did not achieve "consensus agreement" (64%) but improved in round two (92.9%), however, instability was observed (VRIR: 0.36). These two items were retained in the model due to achieving the minimum level of agreement and internal consistency (VCV = 15.81). Inter-rater reliability was 0.608 and 0.970 in the respective rounds. Patients rated the educational material as understandable (81.8-100%) and actionable (100%). CONCLUSION The validated pharmacist-led education model, with its educational materials tested on end-users, provides structured patient education and pharmaceutical care in assisting patients with allergic rhinitis. The educational material allows the delivery of standardized information by the healthcare providers to the patients. Further research on the effectiveness of this model in improving patients' symptom control and quality of life is warranted.
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Affiliation(s)
- Chii-Chii Chew
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.
| | - Pathma Letchumanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Maithrea Suresh Narayanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Chee Ping Chong
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
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Eghrari-Sabet J, Williams D, Bukstein DA, Winders T, Gardner DD. Real-world use and perceptions of shared decision-making for allergy and asthma care in a US population. World Allergy Organ J 2023; 16:100828. [PMID: 37859758 PMCID: PMC10582489 DOI: 10.1016/j.waojou.2023.100828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/14/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
Background Shared decision-making (SDM), the process of engaging patients in their healthcare decisions, is an integral component of personalized medicine. The use of SDM in real-world allergy and asthma care in the United States (US) is unknown. Cross-sectional surveys of allergists and patients in a US population were conducted to assess the use and perceptions of SDM and SDM tools in real-world allergy and asthma care. Methods Allergists (N = 101) who were members of the American College of Allergy Asthma & Immunology (ACAAI) and who were also Dynata (a marketing research firm) research partners or in the Allergy & Asthma Network customer database completed an online survey from February-March 2022. Adult patients (N = 110) with asthma, allergy, and/or eczema in the United States who were participants of online research panels hosted by Dynata completed on online survey from February 1-7, 2022. Results Based on their own definition, 98% of the allergists reported familiarity with SDM, and 79% reported using it frequently. Allergists reported using SDM with an average of 44% of their patients. The most commonly used tool was the Immunotherapy SDM toolkit (40%); 43% had not used any SDM tool. Among allergists not using SDM or using it infrequently (n = 19), 42% considered it too time-consuming and 37% believed their patients have low health literacy. Of the surveyed patients, 25% reported their provider used SDM "frequently" or "occasionally" when being treated for allergies, asthma, or eczema, and 22% reported using SDM tools with their provider at some point. The most commonly used tool was the Asthma and Allergy Symptom Test (60%). Among patients whose allergists used SDM infrequently or never (n = 56), 70% reported they would be likely to ask their allergist to use SDM more often. Conclusion Survey responses revealed a disconnect between allergists and patients regarding SDM use. Barriers to SDM are consistent with those across the healthcare industry. Patients clearly expressed their desire for SDM.
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Affiliation(s)
| | - Dennis Williams
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina, Chapel Hill, NC, USA
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Jung JH, Kim KA, Choi YS, Kim ST. Effect of intralymphatic allergen-specific immunotherapy on house dust mite in a murine model of allergic rhinitis. Acta Otolaryngol 2023; 143:867-875. [PMID: 38059621 DOI: 10.1080/00016489.2023.2273405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/11/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Intralymphatic immunotherapy (ILIT) is a promising alternative for the treatment of patients with allergic rhinitis, providing similar therapeutic efficacy to conventional allergen-specific immunotherapy (AIT). However, the allergic mechanism of ILIT is not completely known. AIM The aim of this study was to determine the efficacy of ILIT in a house dust mite (HDM) mouse model of allergic rhinitis. METHODS BALB/c mice were divided into four groups: G1, control without allergy; G2, allergy sensitized with HDM; G3, allergy with ILIT (starting with HDM 1.25 μg/mL); and G4, allergy with ILIT (starting with HDM 2.5 μg/mL). After the murine model of allergic rhinitis with HDM was established, mice were administered an intralymphatic injection through the inguinal lymph nodes with HDM. RESULTS ILIT decreased serum total IgE level and eosinophil infiltration in the nasal mucosa. ILIT also decreased the expression levels of IL-13, IL-25, IL-33, IFN-γ, IL-6, and IL-17, and increased the expression of FoxP3(+) T reg cells. CONCLUSIONS AND SIGNIFICANCE Our results suggest that ILIT regulates the specific immunotherapy immunologic mechanism by downregulating Th1, Th2, and Th17 cytokines and upregulating FoxP3(+) T reg cells in the HDM allergic mouse model.
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Affiliation(s)
- Joo Hyun Jung
- Department of Otolaryngology-Head & Neck Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Kyeong Ah Kim
- Gachon Medical Research Institute, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yun Sook Choi
- Gachon Medical Research Institute, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Seon Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Bercedo-Sanz A, Martínez-Torres A, Varela ALS, Belinchón FJP, Aguinaga-Ontoso I, Díaz CG, García-Marcos L, Spain GG. Prevalence and time trends of symptoms of allergic rhinitis and rhinoconjunctivitis in Spanish children: Global Asthma Network (GAN) study. Allergol Immunopathol (Madr) 2023; 51:1-11. [PMID: 37695222 DOI: 10.15586/aei.v51i1.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/03/2022] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The time trends of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy previously described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 are unknown; or if the geographical or age differences in Spain persist. OBJECTIVE To describe the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy in different Spanish geographical areas and compare them with those of the ISAAC. METHODS Cross-sectional study of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy, carried out in 2016-2019 on 19943 adolescents aged 13-14 years and 17215 schoolchildren aged 6-7 years from six Spanish areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona, and Salamanca), through a questionnaire based on the Global Asthma Network (GAN) protocol. RESULTS The prevalences of recent rhinitis and rhinoconjunctivitis (last 12 months), and nasal allergy/hay fever were 35.1%, 17.6%, and 14.6% in the adolescents and 20%, 8.5%, and 8.9% in the schoolchildren, respectively, with rhinoconjunctivitis in adolescents varying from 20.9% in Bilbao to 13.4% in Cartagena; and in schoolchildren, from 9.8% in La Coruña to 6.4% in Pamplona. These prevalences of rhinoconjunctivitis and nasal allergy in adolescents were higher than those described in the ISAAC (16.3% and 13%) and similar in schoolchildren to the ISAAC (9% and 9.4%). CONCLUSIONS There has been a stabilisation of rhinitis, rhinoconjunctivitis and nasal allergy in schoolchildren that slows the previous upward trend of ISAAC; and a slight non-significant increase in rhinoconjunctivitis and nasal allergy in adolescents. The variability found in adolescents would require local research to be better understood.
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Affiliation(s)
- Alberto Bercedo-Sanz
- Centro de Salud Los Castros. Santander, Servicio Cántabro de Salud, Instituto de Investigación Sanitaria Valdecilla, IDIVAL, Cantabria, Spain;
| | - Antonela Martínez-Torres
- Unidad de Neumología y Alergia Pediátrica y Grupo de Investigación en Enfermería, Hospital Infantil Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria IMIB, Murcia, Spain
| | | | | | - Ines Aguinaga-Ontoso
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Navarra, Spain
| | - Carlos González Díaz
- Unidad de Alergia Infantil, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - Luis García-Marcos
- Unidad de Neumología y Alergia Pediátrica Hospital Infantil Universitario Virgen de la Arrixaca, Universidad de Murcia e Instituto Murciano de Investigación Biosanitaria IMIB, Murcia, Spain
| | - Grupo Gan Spain
- Centro de Salud Los Castros. Santander, Servicio Cántabro de Salud, Instituto de Investigación Sanitaria Valdecilla, IDIVAL, Cantabria, SpainUnidad de Neumología y Alergia Pediátrica y Grupo de Investigación en Enfermería, Hospital Infantil Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria IMIB, Murcia, SpainFundación María José Jove, Servicio Galego de Saúde (SERGAS), La Coruña, SpainCentro de Salud Pizarrales, Salamanca, Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Salamanca, SpainDepartamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, SpainIdiSNA, Instituto de Investigación Sanitaria de Navarra, Navarra, Spain.Unidad de Alergia Infantil, Hospital Universitario Basurto, Bilbao, Vizcaya, SpainUnidad de Neumología y Alergia Pediátrica Hospital Infantil Universitario Virgen de la Arrixaca, Universidad de Murcia e Instituto Murciano de Investigación Biosanitaria IMIB, Murcia, Spain
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Morinaga T, Yamamoto T, Sugimoto Y. A mouse model of food allergy permitting skin and nasal symptoms. Adv Med Sci 2023; 68:372-378. [PMID: 37797366 DOI: 10.1016/j.advms.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/26/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Developing experimental animal models that show clinical symptoms and methods for quantitative and objective evaluation are important for understanding food allergies. Therefore, this study aimed to develop an ovalbumin (OVA)-induced mouse model of food allergy and a useful method to evaluate the symptoms of food allergy. MATERIAL/METHODS Mice were sensitized via intraperitoneal injection of OVA. Subsequently, local sensitization was performed once weekly by oral administration of OVA. Itching and nasal symptoms were observed after oral administration of the antigen. First, we examined the dose-dependency of the antigen. Symptoms were checked weekly. In order to confirm food allergy symptoms, the effect of histamine H1 receptor antagonist was examined. Finally, we measured antigen-specific IgE antibody levels in the serum. RESULTS Scratching behavior, sneezing and nasal rubbing were increased. Both itching and rhinitis symptoms increased steadily, after which, the number of symptoms remained almost constant. No difference was observed between the results of 3- and 5-week-old mice. Cetirizine inhibited these symptoms in a dose-dependent manner. In addition, antigen-specific IgE antibodies were produced in both 3- and 5-week-old mice. CONCLUSIONS This method may be useful for evaluating the symptoms of skin and rhinitis that could not be assessed in the conventional food allergy model and could be induced with a low dose of antigen. In particular, the developed method, which measures the number of itching and nasal symptoms, may enable quantitative, objective, and noninvasive evaluation of food allergy severity.
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Affiliation(s)
- Takafumi Morinaga
- Laboratory of Inflammatory Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Takuya Yamamoto
- Laboratory of Inflammatory Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Yukio Sugimoto
- Laboratory of Inflammatory Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan.
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Cheah Y, Jumastapha H, Tang IP. A Rare Case of Complicated Sinonasal Meliodosis Mimicking Sinonasal Lymphoproliferative Disease. Indian J Otolaryngol Head Neck Surg 2023; 75:2564-2567. [PMID: 37636706 PMCID: PMC10447696 DOI: 10.1007/s12070-023-03792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/06/2023] [Indexed: 08/29/2023] Open
Abstract
Unilateral nasal obstruction with purulent nasal discharge is one of the presentations for sinonasal melioidosis. However, it may mimic nasal NK/T cell lymphoma. Both causing tissue destruction involving nasal septum, lateral nasal wall and palate. Here, we report a case of disseminated melioidosis involving sinonasal mimicking nasal lymphoma in a 32-year-old immunocompetent lady. She presented with prolonged fever, unilateral nasal blockage, painful facial swelling and knee pain. Clinical findings revealed extensive necrotic tissue and crusting involving right lateral wall of nasal cavity. Tissue and blood culture and sensitivity (C + S) grew Burkholderia pseudomallei. Recovery was complete after surgery and antibiotics.
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Affiliation(s)
- Yuanzhi Cheah
- Otorhinolaryngology Head and Neck Department, Sarawak General Hospital, Kuching, Sarawak Malaysia
| | - Hanzali Jumastapha
- Otorhinolaryngology Head and Neck Department, Sarawak General Hospital, Kuching, Sarawak Malaysia
- Otorhinolaryngology Head and Neck Department, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Ing Ping Tang
- Otorhinolaryngology Head and Neck Department, Sarawak General Hospital, Kuching, Sarawak Malaysia
- Otorhinolaryngology Head and Neck Department, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Malaysia
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Whittaker JD, Baker E, Kumar S, Collingwood R, West M, Lee PK. Do variations in nasal irrigation recipes and storage effect the risk of bacterial contamination? - ERRATUM. J Laryngol Otol 2023; 137:942-944. [PMID: 37293799 DOI: 10.1017/s0022215123001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Hillerich V, Valbert F, Neusser S, Pfaar O, Klimek L, Sperl A, Werfel T, Hamelmann E, Riederer C, Wobbe-Ribinski S, Neumann A, Wasem J, Biermann-Stallwitz J. Quality of life and healthcare costs of patients with allergic respiratory diseases: a cross-sectional study. Eur J Health Econ 2023:10.1007/s10198-023-01598-3. [PMID: 37414970 DOI: 10.1007/s10198-023-01598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/17/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) and allergic asthma (AA) are chronic respiratory diseases that represent a global health problem. One aim of this study was to analyze the Health-related Quality of Life (HRQoL) of the patients in order to identify statistically significant influencing factors that determine HRQoL. Another aim was to assess and analyze data on cost-of-illness from a statutory health insurance perspective. METHODS The EQ-5D-5L was used to evaluate the patients' HRQoL. To identify the factors influencing the HRQoL, a multinomial logistic regression analysis was conducted using groups based on the EQ-5D-5L index value as dependent variable. Routine data were analyzed to determine total healthcare costs. RESULTS The average EQ-5D-5L index was 0.85 (SD 0.20). A high age, the amount of disease costs, low internal health-related control beliefs and high ozone exposure in the residential area were found to be statistically significant influencing factors for a low HRQoL, whereas low age, male sex and a good possibility to avoid the allergens were found to be statistically significant factors influencing a high HRQoL. On average, the study participants incurred annual costs of €3072 (SD: 3485), of which €699 (SD: 743) could be assigned to allergic respiratory diseases. CONCLUSIONS Overall, the patients in the VerSITA study showed a high level of HRQoL. The identified influencing factors can be used as starting points for improving the HRQoL of patients with allergic respiratory diseases. From the perspective of a statutory health insurance, per person expenditures for allergic respiratory diseases are rather low.
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Affiliation(s)
- Vivienne Hillerich
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany.
| | - Frederik Valbert
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Annette Sperl
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Thomas Werfel
- Clinic for Dermatology, Allergology and Venerology, Hannover Medical School, Hanover, Germany
| | - Eckard Hamelmann
- Department for Pediatrics, Children's Center Bethel, University Bielefeld, Bielefeld, Germany
| | - Cordula Riederer
- Department of Health Services Research, DAK-Gesundheit, Hamburg, Germany
| | | | - Anja Neumann
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Jürgen Wasem
- Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
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Whittaker JD, Baker E, Kumar S, Collingwood R, West M, Lee PK. Do variations in nasal irrigation recipes and storage effect the risk of bacterial contamination? J Laryngol Otol 2023; 137:794-798. [PMID: 36503557 DOI: 10.1017/s0022215122002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Make-at-home nasal irrigation solutions are often recommended for treating chronic rhinosinusitis. Many patients will store pre-made solution for convenient use. This study investigated the microbiological properties of differing recipes and storage temperatures. METHOD Three irrigation recipes (containing sodium chloride, sodium bicarbonate and sucrose) were stored at 5oC and 22oC. Further samples were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Sampling and culturing were conducted at intervals from day 0-12 to examine for bacterial presence or persistence. RESULTS No significant bacterial growth was detected in any control solution stored at 5oC. Saline solutions remained relatively bacterial free, with poor survival of inoculated bacteria, which may be related to either lower pH or lower osmolality. Storing at room temperature increased the risk of contamination in control samples, particularly from pseudomonas. CONCLUSION If refrigerated, pre-made nasal irrigation solutions can be stored safely for up to 12 days without risking cross-contamination to irrigation equipment or patients.
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Affiliation(s)
- J D Whittaker
- ENT, Walsall Manor Hospital, Walsall Healthcare NHS Trust, UK
| | - E Baker
- Microbiology, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
| | - S Kumar
- ENT, Leicester Royal Infirmary, University Hospital of Leicester NHS Trust, UK
| | - R Collingwood
- Microbiology, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
| | - M West
- Microbiology, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
| | - P K Lee
- ENT, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Burton-on-Trent, UK
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Zeng Y, Xiao H, Gao S, Li J, Yang C, Zeng Q, Luo X, Luo R, Chen X, Liu W. Efficacy and immunological changes of sublingual immunotherapy in pediatric allergic rhinitis. World Allergy Organ J 2023; 16:100803. [PMID: 37520614 PMCID: PMC10382672 DOI: 10.1016/j.waojou.2023.100803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Background Allergen-specific immunotherapy, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), improves the disease progression of allergic rhinitis (AR). SCIT and SLIT exhibit similar efficacy, but SLIT has less systemic reactions. However, few studies have investigated the underlying mechanisms of SLIT treatment. In this study, we explored the efficacy of SLIT under different treatment durations and immunological changes. Methods This retrospective study was conducted from August 2017 to August 2022 in our hospital. A total of 314 children who underwent SLIT were divided into the following groups based on their treatment duration: the 1 year group (6 months-1 year), the 2 years group (1-2 years), and the 3 years group (2-3 years). The treatment efficacy was confirmed using a combined symptom and medication score (SMS). Multiple serum cytokines were measured using Luminex. Various immune cells in PBMCs were determined using flow cytometry. Results The total nasal symptom score (TNSS), rescue medication score (RMS), and SMS of the 3 years group was significantly different from those of the 1 years and 2 years groups. At the end of the 2 years following cessation of SLIT, the following results were observed in the 3 years group: 1) the TNSS, RMS, and SMS had significantly improved, 2) the serum IL-10, TGF-beta, and IL-35 levels had increased significantly, and 3) the percentages of regulatory T cell, regulatory B cell, and follicular regulatory T cell increased significantly. Conclusion Our results suggest that 3 years of SLIT is necessary for long-term effects and continued immunological changes.
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Affiliation(s)
- Yinhui Zeng
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Haiqing Xiao
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Shengli Gao
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Jinyuan Li
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Chao Yang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Qingxiang Zeng
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Xi Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Renzhong Luo
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Xi Chen
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Wenlong Liu
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
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50
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Rodriguez del Rio P, Caimmi D, Rico Nieto P, Vidal C, Moreno C, González-Fernández MT, Tomás-Pérez M, Beristain A, Bosse I, Trinh HB, Casale TB, Demoly P, Calderon MA. CHOICE international survey: Clusters of allergen immunotherapy prescription from French and Spanish cohorts. World Allergy Organ J 2023; 16:100791. [PMID: 37425343 PMCID: PMC10328986 DOI: 10.1016/j.waojou.2023.100791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background There is no description of the drivers of prescription for allergen immunotherapy (AIT) for respiratory allergic diseases. Methods A prospective, multicentre, observational, non-interventional real-life study was performed in France and Spain for 20 months. Data were gathered using 2 different questionnaires, anonymously collected in an online platform. No names of AIT products were recorded. Multivariate analysis and unsupervised cluster analysis were performed. Results One hundred and three physicians (50.5% from Spain and 49.5% from France) reported 1735 patients (433 in France and 1302 in Spain), 47.9% males, 64.8% adults with a mean age 26.2 years old. They suffered from allergic rhinitis (99%), allergic conjunctivitis (70.4%), allergic asthma (51.8%), atopic dermatitis (13.9%), and food allergy (9.9%). A clustering analysis based on 13 predefined relevant variables for AIT-prescription identified 5 different clusters, each of them including information regarding doctor's profile and patient demographics, baseline disease characteristics, and main AIT indication: 1) Looking at the future: focusing on asthma prevention (n = 355), 2) Efficacy after discontinuation of AIT (n = 293), 3) Fighting severe allergic disease (n = 322), 4) Looking at the present, facing current symptoms (n = 265) and 5) Doctor's own clinical experience (n = 500). Each one of these clusters have specific patients' and doctors' characteristics, representing distinctive AIT prescription drivers. Conclusion Using data-driven analysis, we identified for the first time some reasons and patterns of AIT prescriptions in real-life clinical settings. There is no uniform indication for prescribing AIT, which varies amongst patients and doctors with multiple but specific drivers, taking into account several relevant parameters.
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Affiliation(s)
| | - Davide Caimmi
- Allergy Unit, Department Respiratory Medicine and Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier and IDESP, UMR UA11 Univ. Montpellier - INSERM, Montpellier, France
| | - Pilar Rico Nieto
- Instituto de Medicina Molecular Aplicada, Facultad de Medicina San Pablo CEU Madrid, Spain
| | - Carmen Vidal
- Allergy Department, Faculty of Medicine USC and Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Carmen Moreno
- Hospital Reina Sofia, Instituto Maimonides de Investigación Biomédica de Córdoba, Red ARADyAL, Cordoba, Spain
| | - Maria Teresa González-Fernández
- Allergy Department, Faculty of Medicine USC and Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Ana Beristain
- Allergy Section, Hospital Universitario Central de Asturias Oviedo, Spain
| | - Isa Bosse
- Allergology Practice, La Rochelle, France
| | | | - Thomas B. Casale
- Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Pascal Demoly
- Allergy Unit, Department Respiratory Medicine and Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier and IDESP, UMR UA11 Univ. Montpellier - INSERM, Montpellier, France
| | - Moises A. Calderon
- Imperial College London, U.K. and Faculty of Medicine, University of Costa Rica, Spain
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