December 2020

Dec 16

Allergic rhinitis: impact on quality of life of adolescents

By Bilastina Selected articles

C S Rosario

Eur Ann Allergy Clin Immunol . 2020 Nov 12. doi: 10.23822/EurAnnACI.1764-1489.176. Online ahead of print.

One of the faster phases of human development is adolescence, with biological maturity anteceding psychosocial maturity. 15% of young people between 13 and 14 years old suffer from allergic rhinitis, double that of those with 6-7 years old. The prevalence of allergic rhinitis is higher in boys up to 10 years old. It reverses to girls having a higher prevalence during adolescence, and by adulthood, there are no differences in prevalence between genders.

Changes that occur in adolescence have health consequences over the life-course and impact the quality of life. Allergic rhinitis has a significant impact on the quality of life of adolescents and their parents: most antihistamines have sedating effects, school absences, and lower performance due to distraction, fatigue, and irritability. It also has a negative impact on the parents, who may become anxious, overprotective, and need to miss work.

Digital technology is the way to help an original approach to characterize allergic rhinitis signs and symptoms, as well as their connection with other allergic conditions. The treatment’s achievement lies in the partnership between teenagers with allergic rhinitis and mobile technology, letting them have more information available on the disease and its treatment.

In conclusion, there is some knowledge on challenges adolescents with asthma face, but some information lacks allergic rhinitis challenges.

This document is only available for registered healthcare professionals

Dec 16

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COVID-19 and allergy: How to take care of allergic patients during a pandemic?

By Bilastina Selected articles

Antonella Cianferoni, Martina Votto

Pediatr Allergy Immunol. 2020 Nov;31 Suppl 26:96-101. doi: 10.1111/pai.13367.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease, also known as COVID-19, constitutes a new threat for everybody due to its high infection rate and morbidity and mortality in vulnerable populations. People with allergic rhinitis need continuity of care by allergists during the pandemic. Allergists face the challenge of protecting themselves from becoming infected and providing care to people with allergic rhinitis. They need to be ready to work safely with adequate changes in their practice until either a universal vaccine or herd immunity is achieved. Some of the diseases under the attention of allergists are not considered risk factors but have symptoms such as cough and sneezing in differential diagnosis with COVID-19.

Below is a summary of how to treat specific conditions in the allergy office:

Skin testing can be delayed as often information is not essential for the patient’s immediate treatment.
Food challenges may be delayed except for peanut challenge in infants or for introducing a food critical for appropriate nutrition to avoid intervention such as a G tube or NG tube placement.
Patients on immunotherapy, the administration can be spaced to up to 6 weeks to reduced visits during the pandemic, with the possibility of dose adjustment until the regular schedule is resumed. However, the initiation of immunotherapy should be avoided.
Spirometry may cause aerosolization. Therefore, people with COVID-19 or flu-like symptoms should not be tested. All routine testing should be postponed during the pandemic phase.
Asthma is a risk factor for severe disease in the case of coronavirus 2 infections. Nevertheless, current recommendations are to continue to follow guidelines of treatment.
Patients with allergic rhinitis should continue their treatment. There is no evidence that these patients are at risk of severe complications during a COVID-19 infection. Allergic rhinitis may be evaluated via remote medicine, or telephone and evaluation of allergy may be postponed.

Any suggestions may change rapidly based on the evolving situation of each territory. Limiting in-person visit may have significant financial consequences, and also, at a certain point, delay of procedure may represent a more substantial risk for the patient than the potential risk of being exposed to COVID-19 and should be take under consideration.

This document is only available for registered healthcare professionals

Dec 16

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The usage, quality and relevance of information and communications technologies in patients with chronic urticaria: A UCARE study

By Bilastina Selected articles

Marcus Maurera, et al.

World Allergy Organ J . 2020 Oct 30;13(11):100475. doi:10.1016/j.waojou.2020.100475. eCollection 2020 Nov.

Chronic urticaria is characterized by itchy wheals, angioedema, or both for six weeks or more. It impacts patients’ physical and emotional quality of life. People with chronic urticaria and other chronic conditions are information seekers from information and communications technologies (ICTs). This study aimed to evaluate the frequency of use and preference of ICTs from chronic urticaria patients.

This was a cross-sectional study that included 1800 patients with chronic spontaneous urticaria or chronic inducible urticaria, over 12 years old, recruited from primary healthcare centers, university hospitals, or specialized clinics UCARE (Urticaria Centers of Reference and Excellence) in 16 countries. Patients were requested to complete a 23-item questionnaire with questions about the use of ICT, including the type, frequency, preference, and quality. Answers were registered in a database. ICTs were then categorized into three groups: one-to-one: SMS, WhatsApp, Skype, and email; one-to-many: YouTube, web browsers, blogs or forums; and many-to-many: Instagram, Twitter, Facebook, and LinkedIn.

Globally, most chronic urticaria had access to ICT platforms (99.6%) and internet access (96.7%). One-to-one ICT platforms were used most often (85.4%), followed by one-to-many ICTs (75.5%) and many-to-many ICTs (59.2%). The use of ICT platforms increased with patient education. One-to-many was preferred for general health information and chronic urticaria information. For chronic urticaria specific information, 3 in every 4 patients used a web browser, 20.9% used YouTube, and 13.6% used Facebook. One in five patients didn’t use any form of ICT. The quality of information was rated as very interesting and of good quality for general health information (53.5%) and CU-related information (51.5%) compared to other categories.

In conclusion, the use of information and communications technologies for health and urticaria specific information is very high in all countries, with web browsers being the preferred platform.

This document is only available for registered healthcare professionals

Dec 16

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Cold urticaria what we know and what we do not know

By Bilastina Selected articles

Natalya Maltseva, et al.

Allergy . 2020 Nov 28. doi: 10.1111/all.14674. Online ahead of print.

Cold urticaria is a subtype of chronic inducible urticaria, characterized by wheals and/or angioedema that occur after cold exposure. It constitutes a challenging clinical problem due to the risk of cold-induced anaphylaxis, its long duration, and diagnostic difficulties with atypical cold urticaria. The classification of cold urticaria includes typical and atypical subtypes. Recent studies and guidelines have progressed its understanding and management.

It is thought to involve the formation of autoallergens and IgE to these autoallergens induced by cold, which provoke a release of mediators from skin mast cells.

It is known that cold-induced wheals develop on rewarming and resolve within an hour and that anaphylaxis can occur. Its diagnosis is based on the patient’s history and cold stimulation testing. Other tests include searching for underlying infections, to be done if the patient has a relevant record. The management of cold urticaria includes avoiding cold, using nonsedating antihistamines, and, if needed, omalizumab.

Questions unanswered include cold urticaria epidemiology, underlying pathomechanisms, clinical heterogeneity, and treatment outcomes.

An international multicenter observational prospective study COLD-CE is being conducted to globally improve the understanding of cold urticaria and cold anaphylaxis, with their pathophysiology representing a research priority. Oropharyngeal angioedema and/or cold anaphylaxis in cold urticaria require further studies of innovative agents. The use of genomic, postgenomic, and machine learning approaches is the next frontier in research leading to novel therapeutic targets.

This document is only available for registered healthcare professionals

Dec 16

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Repetitive nasal allergen challenge in allergic rhinitis: Priming and Th2-type inflammation but no evidence of remodelling

By Bilastina Selected articles

Nara Orban, Mikila R Jacobson, Kayhan T Nouri-Aria, Stephen R Durham, Aarif O Eifan

Clin Exp Allergy . 2020 Nov 3. doi: 10.1111/cea.13775. Online ahead of print.

Seasonal allergic rhinitis is characterized by local tissue eosinophilia and Th2-cytokines. Asthma is characterized by airway-remodeling and which conflicts with evidence for remodeling in allergic rhinitis. This study aimed to assess the relationship between allergic inflammation and features of remodeling in allergic rhinitis using a new human repetitive nasal allergen challenge.

This study included twelve patients with moderate-to-severe allergic rhinitis who underwent 5-alternate day challenges with diluent, followed after 4-weeks by 5-alternate day challenges with grass pollen extract. Nasal symptoms, Th1/Th2 cytokines in the nasal secretion, and blood were assessed. Nasal biopsies were taken one day after the first and fifth challenges with diluent and allergen. Sixteen healthy controls were challenged with diluent and allergen once. Epithelial and sub-mucosal inflammatory cells and remodeling markers were assessed by computed image analysis.

Allergic rhinitis symptoms increased after every allergen challenge compared to diluent (p<0.05), with evidence of both clinical and immunological priming. Nasal secretion tissue eosinophils and IL-5 increased significantly after nasal allergen challenge, compared to corresponding diluent challenges. Allergic rhinitis patients evidenced a correlation between submucosal mast cells and the early-phase clinical response and an association between epithelial eosinophils and IL-5 in nasal secretion. There were no differences after allergen challenge concerning epithelial integrity, reticular basement membrane thickness, glandular area, expression of markers of activation of airway-remodeling including α-SMA, HSP-47, extracellular matrix, angiogenesis, and lymphangiogenesis for allergic rhinitis compared to controls.

In conclusion, novel repetitive nasal allergen challenges in people with severe persistent allergic rhinitis yielded in tissue eosinophilia. They increased IL-5, but with no structural changes, which supports no relationship between Th2-inflammation and development of airway-remodeling in allergic rhinitis.

This document is only available for registered healthcare professionals

Allergic rhinitis: impact on quality of life of adolescents

COVID-19 and allergy: How to take care of allergic patients during a pandemic?

The usage, quality and relevance of information and communications technologies in patients with chronic urticaria: A UCARE study

Cold urticaria what we know and what we do not know

Repetitive nasal allergen challenge in allergic rhinitis: Priming and Th2-type inflammation but no evidence of remodelling

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