Monthly Archives

September 2020

rinitis 1990-2010

Comparison of allergens and symptoms in patients with allergic rhinitis between 1990s and 2010s

By | Artículos seleccionados, Selected articles

Ji Heui Kim, Shin Ae Kim, Ja Yoon Ku, Won Ki Cho and Chol Ho Shin

Allergy Asthma Clin Immunol. 2020 Jul 1;16:58. doi: 10.1186/s13223-020-00455-9. eCollection 2020.

Allergic rhinitis is a common chronic upper airway inflammatory disease characterized by nasal obstruction, rhinorrhea, sneezing, and itching of the eyes/nose. Its prevalence has been increasing steadily in Korea. Although Korean people’s lifestyle and environment have been changing, the corresponding changes in the characteristics of allergic rhinitis have not been documented. This study’s objective was to describe the changes in allergens and clinical manifestations of allergic rhinitis in Korean patients between 1990 and 2010.

Patients diagnosed with allergic rhinitis in 1990 and 2010 were evaluated and answered a symptom questionnaire. The two sets of patients were compared regarding the differences in allergens and the results of the questionnaire.

Compared with the set of 1990 patients, the rate of sensitization to house dust mites, cockroaches, Aspergillus, Alternaria, and tree pollen significantly increased, and that to cat fur significantly decreased in patients from the 2010s (p < 0,05). The distribution of patients with moderate-to-severe nasal obstruction and itching of the eyes/nose increased (p < 0,05), as well as that of patients with minor symptoms, such as olfactory disturbances, cough, sore throat, and fatigue (p < 0,01).

In conclusion, Korean people with allergic rhinitis from 2010 have different symptom severity and allergen reactivity and type. These results may reflect changes in Korea’s environmental conditions and lifestyle, which may be useful for patient counseling and management.

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Rinitis alérgica

Perception and control of allergic rhinitis in primary care

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Pascal Demoly, Isabelle Bossé and Pascal Maigret

NPJ Prim Care Respir Med. 2020 Aug 20;30(1):37. doi: 10.1038/s41533-020-00195-8.

People with chronic diseases behave according to their perception of the disease, which may impact treatment results. The prevalence of allergic rhinitis is high, around 400 million people worldwide. However, it is poorly self-recognized by patients, as well as it is poorly controlled. The PETRA study’s objective was to evaluate the management of allergic rhinitis by patients and their general practitioners and to describe the relationship between disease perception, patient behavior, and treatment outcomes.

The PETRA study was a cross-sectional study that included 2001 participants between May and October 2017. The study’s main objective was to precisely identify and describe factors associated with a poor perception of the disease in people with allergic rhinitis. 201 French general practitioners selected 1929 patients for analysis (mean age: 39 years; intermittent/persistent symptoms: 46.2/52.3%). 71,7% of the participants had uncontrolled allergic rhinitis (ARCT score < 20), 53,6% had a good perception of their illness (BIPQ score < 5), and 14,1% of the patients had also been diagnosed with asthma.

A poor perception of allergic rhinitis was related to ear, nose, and throat complications, nasal pruritus, uncontrolled allergic rhinitis, and asthma. Also, there was a strong negative correlation between the BIPQ and ARCT scores: the poorer the patient’s perception, the less the disease was controlled.

In conclusion, the PETRA cohort included a high proportion of patients with moderate to severe allergic rhinitis symptoms and a low disease control level. It was shown that many patients were not satisfied with their treatment and did not perceive their disease very well. Although no causal relationship could be drawn from this study, results suggest that improving the perception of allergic rhinitis could be beneficial and lead to better control of symptoms.

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Cansancio, urticaria y mujeres

Fatigue is Common and Predicted by Female Gender and Sleep Disturbance in Patients with Chronic Spontaneous Urticaria

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Kemal Erol, Sule Ketenci Ertas, Ragıp Ertas

J Allergy Clin Immunol Pract . 2020 Aug 25;S2213-2198(20)30836-9. doi: 10.1016/j.jaip.2020.08.020. Online ahead of print.

Chronic spontaneous urticaria is a chronic disease characterized by wheals and pruritus and/or angioedema. Most urticaria patients are women who have their quality of life reduced due to the impact of the disease on daily life and sleep quality. Fatigue is a common symptom in urticaria. This study’s objective was to assess fatigue and how it affects people with chronic spontaneous urticaria compared to healthy people.

This study included 103 patients with chronic spontaneous urticaria and 35 age and gender-matched healthy controls. They were assessed for fatigue with the Fatigue Severity Scale (FSS) and VAS-Fatigue. Duration, activity, and control of disease, as well as anxiety, depression, and quality of life, were also evaluated.

No significant associations were seen in disease activity, disease control scores, FSS, positivity for anti-nuclear antibodies, and IgE levels between fatigued and non-fatigued patients with urticaria. Fatigued patients had significantly higher CRP levels (p=0,009). Also of note was the significant correlation between total FSS score and chronic urticaria quality of life in patients with chronic spontaneous urticaria, where women with urticaria and with disturbed sleep complained of fatigue.

Women with chronic spontaneous urticaria commonly experience fatigue, which is an important symptom that negatively affects their quality of life.

This document is only available for registered healthcare professionals

Urticaria Crónica Espontánea

Targeted Therapy for Chronic Spontaneous Urticaria: Rationale and Recent Progress

By | Artículos seleccionados, Selected articles

Ana M. Giménez‑Arnau, Andaç Salman

Drugs . 2020 Aug 28. doi: 10.1007/s40265-020-01387-9. Online ahead of print.

Chronic spontaneous urticaria is characterized by wheals, angioedema, or both for at least 6 weeks and can last for a long time, up to 5 years. The effects of chronic spontaneous urticaria on quality of life are comparable to psoriasis, atopic dermatitis, or even ischemic heart disease.

Antihistamines continue to be the first choice for treatment of urticaria, however rates of response are low (ranging from 38.6% in standard doses to 63.2% in higher doses), some patients don’t experience a complete of symptoms. The use of omalizumab has shown a major advance in treating patients with chronic spontaneous urticaria, however, there is a subgroup of patients who have a partial or even lack of response to omalizumab.

Some of the upcoming targeted therapies for chronic spontaneous urticaria include:

  1. anti-IgE antibodies, such as ligelizumab, a monoclonal antibody directed against the Cε3 domain of IgE and which has shown a six- to ninefold greater potency in vivo compared to omalizumab; UB-221, another monoclonal antibody against IgE with up to eightfold greater affinity for free IgE, compared to omalizumab; quilizumab, a humanized monoclonal antibody directed against membrane-bound IgE.
  2. Anti-Siglec-8. Siglecs are a transmembrane family with regulatory effects on intercellular and intracellular signaling, with Siglec-8 having expression on eosinophils and mast cells.
  3. Bruton’s Tyrosine Kinase (BTK) inhibitors. BTK is a tyrosine kinase expressed in hematopoietic cells, including macrophages, mast cells and basophils. BTK inhibitors are used to treat different malignancies of B-cell origin. Ibrutinib, dasatinib, AVL-292 and CNX-774 effectively suppressed IgE-induced activation and histamine release from basophils and mast cells.
  4. Chemoattractant receptor-homologous molecule expresses on Th2 (CRTH2) inhibitors; Spleen Tyrosine Kinase (SYK) inhibitors; Anti-CD20; Anti-IL-1; Anti-IL-4/13; and Anti-IL-5.

The future treatment of chronic urticaria will probably change once potential new treatments are completely developed.

This document is only available for registered healthcare professionals

rinitis alérgica y covid-19

Clinical presentation at the onset of COVID-19 and allergic rhinoconjunctivitis

By | Artículos seleccionados, Selected articles

Fabio Ferreli, Francesca Gaino, Elena Russo, Matteo Di Bari, Francesca Pirola, Andrea Costantino, Luca Malvezzi, Armando De Virgilio, Giovanni Colombo, Giovanni Paoletti, Emanuela Morenghi, Giorgio Walter Canonica, Giuseppe Spriano, Enrico Heffler, Giuseppe Mercante

J Allergy Clin Immunol Pract . 2020 Aug 18;S2213-2198(20)30823-0. doi: 10.1016/j.jaip.2020.08.009. Online ahead of print.

COVID-19 is characterized by various clinical conditions, from mild symptoms to pneumonia and death. Mild symptoms, such as nasal and ocular manifestations, can be confused with allergic rhinoconjunctivitis at the onset. This article describes the differences that let one distinguish COVID-19 and allergic rhinoconjunctivitis.

This study included 204 patients that were infected with coronavirus were included. They were retrospectively studied via telephone interview, where they were requested to complete a validated questionnaire, The Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ), which evaluated a series of 14 signs and symptoms on a scale from 0 to 6, indicating “not troubled” and “extremely troubled”, respectively. Patients were also asked to compare the manifestations of their last allergic symptomatic period with COVID-19 manifestations and to evaluate their sense of taste and/or smell.

Among all 204 participants, 22 were also affected by allergic rhinoconjunctivitis. Clinical manifestations of allergic rhinoconjunctivitis compared with those at the onset of COVID-19 were defined as “completely different” by 15 patients (68,2%), “different” by 3 (13.6%), and “similar” by 4 (18,2%). The two clinical presentations were never reported as “identical”.

Although COVID-19 may present some overlap in symptoms with seasonal allergies, the MiniRQLQ scored significantly different between allergic rhinoconjunctivitis and COVID-19. Also, in this study, there were no differences in taste and smell dysfunction reported. Patients with allergic rhinoconjunctivitis are familiar with its symptoms and were able to distinguish them from COVID-19 rhinoconjunctival manifestations.

This document is only available for registered healthcare professionals


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