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Sánchez-Hernández MC, Dordal MT, Navarro AM, Dávila I, Fernández-Parra B, Colás C, Rondón C, Del Cuvillo A, Vega F, Montoro J, Lluch-Bernal M, Matheu V, Campo P, González ML, González-Pérez R, Izquierdo-Domínguez A, Puiggros A, Velasco M, Fernández-Palacín A, Valero A. Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma? Eur Ann Allergy Clin Immunol 2021; 54:277-283. [PMID: 34313088 DOI: 10.23822/eurannaci.1764-1489.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis.
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Affiliation(s)
| | - M T Dordal
- Allergy Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - A M Navarro
- Allergology UGS, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - I Dávila
- Allergy Service, Hospital Universitario de Salamanca, Salamanca, Spain
| | - B Fernández-Parra
- Department of Allergology, Hospital El Bierzo, Ponferrada, León, Spain
| | - C Colás
- Department of Allergology, Hospital Clínico Universitario, Zaragoza, Spain
| | - C Rondón
- Allergy Unit, Hospital Universitario Regional de Málaga-ARADyAL, UMA, Málaga, Spain
| | - A Del Cuvillo
- Asthma and Rhinitis Unit, Department of Otorhinolaryngology, Hospital de Jerez, Jerez, Spain
| | - F Vega
- Department of Allergology, Hospital de la Princesa, Instituto de Investigación Sanitaria (IP), Madrid, Spain
| | - J Montoro
- Allergy Unit, Faculty of Medicine, Hospital de Líria, Universidad Católica de Valencia, San Vicente Mártir, Valencia, Spain
| | - M Lluch-Bernal
- Department of Allergology, Hospital La Paz, Madrid, Spain
| | - V Matheu
- Allergy Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - P Campo
- Allergy Unit, Hospital Universitario Regional de Málaga-ARADyAL, UMA, Málaga, Spain
| | - M L González
- Department of Allergology, Hospital Clínico San Carlos, Madrid, Spain
| | - R González-Pérez
- Allergy Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - A Izquierdo-Domínguez
- Allergy Service, Allergy Unit, Consorci Sanitari de Terrassa, Clinica Diagonal, Barcelona, Spain
| | - A Puiggros
- Allergy Unit, Hospital Quirón, Barcelona, Spain
| | - M Velasco
- Allergy Unit, CCEE Araba, Vitoria, Spain
| | - A Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, Universidad de Sevilla, Spain
| | - A Valero
- Department of Pneumology and Allergy, Hospital Clínic i Universitari, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Spain
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Affiliation(s)
- V Herrera-Lasso
- Allergy Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain
| | - M T Dordal
- Allergy Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain
| | - G Alonso
- Anesthesiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - I Camprubí
- Anesthesiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - R Lleonart
- Allergy Unit, Internal Medicine Department, Bellvitge University Hospital, Barcelona, Spain
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3
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Izquierdo-Domínguez A, Bobolea I, Doña I, Campo P, Segura C, Ortega N, González R, Delgado J, Torres MJ, Dordal MT. Statement of the Spanish Society of Allergology and Clinical Immunology on Provocation Tests With Aspirin/Nonsteroidal Anti-inflammatory Drugs. J Investig Allergol Clin Immunol 2019; 30:1-13. [PMID: 31530511 DOI: 10.18176/jiaci.0449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options. Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for provocation testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective was to draft an easy-toread, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated.
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Affiliation(s)
- A Izquierdo-Domínguez
- Allergy Service, Consorci Sanitari de Terrassa, Barcelona, Spain.,Allergy Unit, Clínica Diagonal, Barcelona, Spain
| | - I Bobolea
- Allergy Section, Servei de Pneumologia i Al.lèrgia Respiratòria, Hospital Clínic, Barcelona, Spain
| | - I Doña
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - P Campo
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - C Segura
- UGC Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - N Ortega
- Allergy Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - R González
- Allergy Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - J Delgado
- UGC Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M J Torres
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - M T Dordal
- Allergy Unit, Servei de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, Spain
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4
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Valero A, Navarro AM, Del Cuvillo A, Alobid I, Benito JR, Colás C, de Los Santos G, Fernández Liesa R, García-Lliberós A, González-Pérez R, Izquierdo-Domínguez A, Jurado-Ramos A, Lluch-Bernal MM, Montserrat Gili JR, Mullol J, Puiggròs Casas A, Sánchez-Hernández MC, Vega F, Villacampa JM, Armengot-Carceller M, Dordal MT. Position paper on nasal obstruction: evaluation and treatment. J Investig Allergol Clin Immunol 2018; 28:67-90. [PMID: 29345622 DOI: 10.18176/jiaci.0232] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 11/20/2022] Open
Abstract
Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.
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Affiliation(s)
- A Valero
- Servicio de Neumología y Alergia, Hospital Clínic; Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES Barcelona, Spain
| | - A M Navarro
- UGC Alergología, Hospital El Tomillar AGS Sur Sevilla, Spain
| | - A Del Cuvillo
- Unidad de Rinología y Asma, UGC Otorrinolaringología, Hospital de Jerez, Cádiz, Spain
| | - I Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Hospital Clínic, Barcelona, Spain
| | - J R Benito
- Unidad de Rinología, UGC ORL, Hospital Universitario Puerto Real, Cádiz, Spain
| | - C Colás
- Hospital Clínico-Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - G de Los Santos
- Unidad de Rinología y Base del cráneo anterior, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - A García-Lliberós
- Servicio de Otorrinolaringología, Sección de Rinología, Hospital de Manises, Valencia, Spain
| | - R González-Pérez
- Unidad de Alergia, Hospital del Tórax, Complejo Hospital Universitario Nuestra S. de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - J R Montserrat Gili
- Sección de Rinología del Servicio de ORL, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d' ORL, Hospital Clínic i Universitari; Immunoal•lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES, GA2LEN, EUFOREA, Barcelona, Spain
| | | | | | - F Vega
- Servicio de Alergia, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria - Hospital Universitario de La Princesa (IP), Madrid, Spain
| | - J M Villacampa
- Servicio de Otorrinolaringología y Patología Cérvico-facial, Hospital Universitario Fundación Jiménez Díaz IDC, Madrid, Spain
| | - M Armengot-Carceller
- Servicio de Otorrinolaringología, Hospital Universitari i Politècnic la Fe, Universitat de València, Valencia, Spain
| | - M T Dordal
- Unitat d'Al·lèrgia, Badalona Serveis Assistencials, Badalona, Spain.,Servei d'Al·lèrgia, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
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Colás C, Brosa M, Antón E, Montoro J, Navarro A, Dordal MT, Dávila I, Fernández-Parra B, Ibáñez MDP, Lluch-Bernal M, Matheu V, Rondón C, Sánchez MC, Valero A. Estimate of the total costs of allergic rhinitis in specialized care based on real-world data: the FERIN Study. Allergy 2017; 72:959-966. [PMID: 27886391 DOI: 10.1111/all.13099] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 11/21/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the socioeconomic importance of allergic rhinitis (AR), very few prospective studies have been performed under conditions of clinical practice and with a sufficiently long observation period outside the clinical trial scenario. We prospectively estimated the direct and indirect costs of AR in patients attending specialized clinics in Spain. METHODS Patients were recruited at random from allergy outpatient clinics in 101 health centers throughout Spain over 12 months. We performed a multicenter, observational, prospective study under conditions of clinical practice. We analyzed direct costs from a funder perspective (healthcare costs) and from a societal perspective (healthcare and non-healthcare costs). Indirect costs (absenteeism and presenteeism [productivity lost in the workplace]) were also calculated. The cost of treating conjunctivitis was evaluated alongside that of AR. RESULTS The total mean cost of AR per patient-year (n = 498) was €2326.70 (direct, €553.80; indirect, €1772.90). Direct costs were significantly higher in women (€600.34 vs €484.46, P = 0.02). Total costs for intermittent AR were significantly lower than for persistent AR (€1484.98 vs €2655.86, P < 0.001). Total indirect costs reached €1772.90 (presenteeism, €1682.71; absenteeism, €90.19). The direct costs of AR in patients with intermittent asthma (€507.35) were lower than in patients with mild-persistent asthma (€719.07) and moderate-persistent asthma (€798.71) (P = 0.006). CONCLUSIONS The total cost of AR for society is considerable. Greater frequency of symptoms and more severe AR are associated with higher costs. Indirect costs are almost threefold direct costs, especially in presenteeism. A reduction in presenteeism would generate considerable savings for society.
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Affiliation(s)
- C. Colás
- Department of Allergology; Hospital Clínico-Instituto de Investigación Sanitaria de Aragón; Zaragoza Spain
| | - M. Brosa
- Oblikue Consulting; Barcelona Spain
| | - E. Antón
- Department of Allergology; University Hospital Marqués de Valdecilla; Santander Spain
| | - J. Montoro
- Allergy Unit; Hospital Universitario Arnau de Vilanova; Facultad de Medicina; Universidad Católica de Valencia “San Vicente Mártir”; Valencia Spain
| | - A. Navarro
- UGC Intercentros Alergología de Sevilla; Hospital El Tomillar; Sevilla Spain
| | - M. T. Dordal
- Department of Allergology; Hospital Municipal; Badalona Serveis Assistencials; Badalona Spain
- Sant Pere Claver Fundació Sanitària; Barcelona Spain
| | - I. Dávila
- Department of Allergology; University Hospital of Salamanca; Instituto de Investigaciones Biosanitarias de Salamanca; IBSAL; Salamanca Spain
| | | | - M. D. P. Ibáñez
- Department of Allergology; Hospital Infantil Universitario Niño Jesús; IIS Princesa; Madrid Spain
| | | | - V. Matheu
- Department of Allergology; Hospital Universitario de Canarias; Tenerife Spain
| | - C. Rondón
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. C. Sánchez
- UGC Neumología-Alergia; Complejo Hospitalario Universitario de Huelva; Spain
| | - A. Valero
- Allergy Unit; Servei de Pneumologia i Al.lèrgia Respiratòria; Hospital Clínic; Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona; Spain
- Centro de Investigación Biomédica en red en Enfermedades Respiratorias (CIBERES); Barcelona Spain
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Lluch-Bernal M, Dordal MT, Antón E, Campo P, Colás C, Dávila I, Del Cuvillo Bernal A, Fernández-Parra B, González R, González ML, Matheu V, Montoro J, Panizo C, Rondón C, Sánchez MC, Valero A, Vega F, Velázquez E, Navarro A. Nasal Hyperreactivity: Nonspecific Nasal Provocation Tests. Review by the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology. J Investig Allergol Clin Immunol 2015; 25:396-407. [PMID: 26817136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to most people. This response is caused by dysregulation of the autonomic nervous system at various levels of the nasal autonomic reflex arc. Various stimuli (methacholine, histamine, adenosine 5'-monophosphate, cold air, mannitol, rapsaicin, phentolamine, and distilled water) have been used in an attempt to find the test that most reliably differentiates between healthy individuals and patients and also between different types of rhinitis. Despite the small number of publications available, in the present review, we provide an update on current nonspecific nasal provocation techniques. The studies published to date are not comparable: the stimuli applied act through different mechanisms and are used to assess different pathways, and the methodologies differ in terms of selection of participants, concentrations used, and assessment of response (criteria for positivity). Given the limited use of nonspecific nasal provocation tests in routine clinical practice, we believe that more studies are warranted to address the research issues we present at the end of the present review, for example, the need to standardize the methodology for each test or even the clinical benefits of knowing whether or not a patient has nasal hyperreactivity.
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Sánchez-Hernández MC, Montero J, Rondon C, Benitez del Castillo JM, Velázquez E, Herreras JM, Fernández-Parra B, Merayo-Lloves J, Del Cuvillo A, Vega F, Valero A, Panizo C, Montoro J, Matheu V, Lluch-Bernal M, González ML, González R, Dordal MT, Dávila I, Colás C, Campo P, Antón E, Navarro A. Consensus document on allergic conjunctivitis (DECA). J Investig Allergol Clin Immunol 2015; 25:94-106. [PMID: 25997302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Allergic conjunctivitis (AC) is an inflammatory disease of the conjunctiva caused mainly by an IgE-mediated mechanism. It is the most common type of ocular allergy. Despite being the most benign form of conjunctivitis, AC has a considerable effect on patient quality of life, reduces work productivity, and increases health care costs. No consensus has been reached on its classification, diagnosis, or treatment. Consequently, the literature provides little information on its natural history, epidemiological data are scarce, and it is often difficult to ascertain its true morbidity. The main objective of the Consensus Document on Allergic Conjunctivitis (Documento dE Consenso sobre Conjuntivitis Alérgica [DECA]), which was drafted by an expert panel from the Spanish Society of Allergology and Spanish Society of Ophthalmology, was to reach agreement on basic criteria that could prove useful for both specialists and primary care physicians and facilitate the diagnosis, classification, and treatment of AC. This document is the first of its kind to describe and analyze aspects of AC that could make it possible to control symptoms.
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Rondón C, Dávila I, Navarro Pulido AM, Sánchez MC, Montoro J, Matheu V, Lluch-Bernal M, Fernández-Parra B, Ibáñez MD, Dordal MT, Colás C, Antón E, Valero A. Clinical Management and Use of Health Care Resources in the Treatment of Nasal Polyposis in Spanish Allergy Centers: The POLAR Study. J Investig Allergol Clin Immunol 2015; 25:276-282. [PMID: 26310042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Nasal polyposis (NP) is a chronic inflammatory disease that constitutes a major health problem with significant comorbidities and a considerable associated socioeconomic burden. OBJECTIVE To describe the clinical features and management of patients with NP attending Spanish allergy centers, the use of health care resources, and the degree of compliance with the diagnostic and therapeutic recommendations of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). METHODS We performed a multicenter, observational, and cross-sectional epidemiologic study of 671 patients consulting for NP in 67 Spanish allergy departments. We used sociodemographic and clinical questionnaires to evaluate clinical characteristics, use of health care resources, diagnostic methods, and treatment administered. RESULTS NP was closely associated with asthma (66%), allergic rhinitis (45.9%), and hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (26%). Atopy was present in the 50% of cases, with Dermatophagoides pteronyssinus as the most frequent sensitizing allergen. Eleven percent of NP patients visited the emergency department during the previous year, and more than 58% used primary care, allergy, or otorhinolaryngology services. The most frequently used diagnostic tests were skin prick tests (93.6%) and anterior rhinoscopy (79.4%). Intranasal corticosteroids were the drug class most frequently prescribed by allergists (74.6%). Specific immunotherapy was prescribed in 21% of patients. CONCLUSIONS NP is a chronic inflammatory disease that generates considerable use of health care resources. The close association with atopy, asthma, and NSAID hypersensitivity highlights the usefulness of an allergy workup in all patients with NP. Analysis of the clinical management of NP by allergists in Spain revealed a high degree of compliance with EPOS diagnostic and therapeutic recommendations.
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Dordal MT, Lluch-Bernal M, Sánchez MC, Rondón C, Navarro A, Montoro J, Matheu V, Ibáñez MD, Fernández-Parra B, Dávila I, Conde J, Antón E, Colás C, Valero A. Allergen-specific nasal provocation testing: review by the rhinoconjunctivitis committee of the Spanish Society of Allergy and Clinical Immunology. J Investig Allergol Clin Immunol 2011; 21:1-12. [PMID: 21370717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Specific nasal provocation testing (NPT) consists of eliciting a response from the nasal mucosa by controlled exposure to allergens. It is indicated in the diagnostic confirmation of allergic rhinitis and when discrepancies arise or difficulties exist in the assessment of a patient's medical history and the results of skin and/or serological tests. The technique is also applied to evaluate sensitivity to the allergen, the efficacy and safety profile of treatment, and in research on the pathophysiological mechanisms of nasal response to allergens. NPT also provides information on the etiology of occupational respiratory diseases of allergic origin. Although there have been many studies and publications on the use and standardization of bronchial provocation tests with allergen, few analyze specific NPT. In this review, the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology discuss the methodology, monitoring, and assessment of allergen-specific NPT in order to provide a practical and up-to-date review of the technique.
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MESH Headings
- Administration, Intranasal
- Allergens/administration & dosage
- Allergens/immunology
- Humans
- Nasal Mucosa/immunology
- Nasal Provocation Tests/methods
- Nasal Provocation Tests/standards
- Occupational Diseases/diagnosis
- Peak Expiratory Flow Rate
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/therapy
- Rhinometry, Acoustic
- Sensitivity and Specificity
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Affiliation(s)
- M T Dordal
- Department of Allergology, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
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Ibáñez MD, Navarro A, Sánchez MC, Rondón C, Montoro J, Matéu V, Lluch-Bernal M, Fernández-Parra B, Dordal MT, Dávila I, Conde J, Antón E, Colás C, Valero A. Rhinitis and its association with asthma in patients under 14 years of age treated in allergy departments in Spain. J Investig Allergol Clin Immunol 2010; 20:402-406. [PMID: 20945606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Allergic rhinitis is the most frequent chronic allergic disease in children, and may be an important risk factor for the subsequent development of asthma. OBJECTIVE To describe the characteristics of patients younger than 14 years of age presenting with rhinitis and the possible association with asthma. METHODS We carried out a prospective, observational, descriptive, cross-sectional epidemiologic study (Alergológica 2005) of 917 patients under the age of 14 consulting for the first time in allergy departments in Spain. RESULTS Rhinitis was diagnosed in 42.5% of the children. The association between asthma and rhinitis was significantly higher in children than in adults (44.9% vs 35.5%; P<.05). Time from onset of rhinitis was significantly associated with the development of asthma (2.97 vs 2.06 years; P<.0001). Allergy was the most frequent cause of rhinitis in children with and without asthma. Allergy to epithelia and fungi was more frequent in children with rhinitis and asthma than in children with rhinitis alone. We found no differences in the frequency of treatment with immunotherapy between children with and without asthma. CONCLUSION Rhinitis was frequently associated with asthma in children consulting for the first time at allergy departments. Time since onset of rhinitis and sensitivity to epithelia and fungi were associated with the development of asthma.
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MESH Headings
- Adolescent
- Adult
- Age of Onset
- Asthma/diagnosis
- Asthma/epidemiology
- Asthma/physiopathology
- Asthma/therapy
- Child
- Child, Preschool
- Comorbidity
- Desensitization, Immunologic
- Female
- Humans
- Incidence
- Infant
- Male
- Prevalence
- Prospective Studies
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/physiopathology
- Rhinitis, Allergic, Seasonal/therapy
- Spain
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Affiliation(s)
- M D Ibáñez
- Department of Allergology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
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Navarro A, Colás C, Antón E, Conde J, Dávila I, Dordal MT, Fernández-Parre B, Ibáñez MD, Lluch-Bernal M, Matheu V, Montoro J, Rondón C, Sánchez MC, Valero A. Epidemiology of allergic rhinitis in allergy consultations in Spain: Alergológica-2005. J Investig Allergol Clin Immunol 2009; 19 Suppl 2:7-13. [PMID: 19530412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is considered to be the most frequent allergic disorder. OBJECTIVE To present the data from the Alergológica-2005 on the characteristics of patients with AR. METHODS An observational, descriptive, cross-sectional epidemiologic study was performed on 4991 patients consulting for the first time in Allergology services in Spain. RESULTS Fifty-five percent of patients consulting Allergology services for the first time were diagnosed with AR, of whom 65% also had conjunctivitis and 37% asthma. Two out of every three subjects with AR consulted their primary care physician twice in the previous 4 months. One third was treated by another specialist in the preceding year and one of every five required treatment in emergency departments. AR affected the quality of life (SF-12), in some cases causing time off work and school. The most frequently involved allergens were pollens (51%), followed by dust mites (42%). Polysensitization was found in 31% of cases. Antihistamines and nasal topical corticoids were the most widely used drugs. In 38% of patients, treatment with specific immunotherapy was begun. CONCLUSIONS AR was the leading cause of consultations in Alergológica-2005. Rhinitis was frequently associated with other allergic disorders in 65% of patients with conjunctivitis and 37% with asthma. The illness led to a substantial use of healthcare resources and significantly affected the quality of life of the sufferers.
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MESH Headings
- Adolescent
- Adult
- Child
- Child, Preschool
- Cross-Sectional Studies
- Delivery of Health Care/statistics & numerical data
- Female
- Humans
- Male
- Middle Aged
- Quality of Life
- Referral and Consultation
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Spain/epidemiology
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Affiliation(s)
- A Navarro
- Allergy Unit, Hospital El Tomillar, AH de Valme, Sevilla, Spain.
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Affiliation(s)
- A Valero
- Servei de Pneumologia i Allergia Respiratoria, Hospital Clinic, Villarroel, 17008036, Barcelona, Spain.
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Dordal MT, Baltazar MA, Roca I, Marques L, Server MT, Botoy J. [Nocturnal spasmodic cough in the infant. Evolution after antireflux treatment]. Allerg Immunol (Paris) 1994; 26:53-8. [PMID: 8148045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Several studies have shown the relationship between gastro-oesophageal reflux, bronchial asthma and chronic nocturnal cough and this should not be neglected, particularly in patients who present an unfavourable development in spite of conventional treatment. For diagnosis of gastroesophageal reflux, amongst other investigations, esophageal gammagraphy of swallowing, that detects alterations in the mobility of the oesophagus, secondary to a possible oesophagitis. The objective of this study was to evaluate the clinical progress and gammagraphy of a group of children with chronic predominantly nocturnal cough (with or without bronchial asthma) with initially pathological esophageal gammagraphy, after three months of treatment with gastrokinetic drugs (cisapride against domperidone) and postural dietetic limits, in comparison with a reference group who, although having followed the limits in question had not received the pharmacological treatment. From the clinical viewpoint, cough disappeared in 64.5% of cases without significant statistical differences between the two groups. Gammagraphy became normal in 20/55 cases, improved in 10/55 cases and was unchanged in 25/55. Although there was no significant difference, gammagraphy development was better in children who received domperidone. The agreement between clinical progress and gammagraphy was 60% with a large number of false positives in the gammagraphy. We believe that the simple introduction of the postural-dietetic measures may improve the clinical control in the type of patients who present with a chronic nocturnally predominant cough that does not yield to conventional treatment.
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Affiliation(s)
- M T Dordal
- Service d'Allergologie et d'Immunologie Clinique, Hôpital pour enfants et Maternité Vall d'Hebrón, Barcelone, Espagne
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Botey J, Eseverri JL, Dordal MT, Andreu J, Marín A. Alternative milk formulas in allergies to proteins in cow's milk. J Investig Allergol Clin Immunol 1993; 3:100-2. [PMID: 8281334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A variety of "hypoallergenic" formulas have appeared on the market over the last few years for feeding lactating infants prone to a high atopic risk of allergy to cow's milk. These formulas consist of soya preparations, hydrolyzed proteins and so-called basic formulas. This paper describes the main characteristics of such formulas, with particular emphasis on their tolerance, indications, related immunological aspects and antigenic capabilities. Notifications of anaphylactoid reactions with hydrolyzed proteins and the possibility of interactions with the IgE antibodies in cow's milk indicate such formulas in cases of non-IgE-mediated intolerance. Although soya preparations may be allergenic, they do not present interactions with the proteins in cow's milk; thus, they are particularly indicated in children with protein allergy to cow's milk with specific IgE antibodies.
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Affiliation(s)
- J Botey
- Department of Allergy and Clinical Immunology, Vall d'Hebron Maternity and Children's Hospital, Barcelona, Spain
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