Monthly Archives

June 2021

Future of Allergic Rhinitis Management

By | Selected articles

Sophia Linton, Alyssa G. Burrows, Lubnaa Hossenbaccus, Anne K. Ellis

Ann Allergy Asthma Immunol . 2021 May 7;S1081-1206(21)00337-9. doi: 10.1016/j.anai.2021.04.029. Online ahead of print.

Allergic rhinitis is a chronic inflammatory condition that affects up to 30% of people in America. Immunoglobulin E-mediated hypersensitivity responses to allergens cause it. This review aimed to provide a complete, clinical assessment of therapeutic agents and practices to manage allergic rhinitis.

A systematic review of the literature was completed using PubMed, published abstracts and virtual presentations, and results published on Manuscripts with trial results, case reports, case series, and clinical trial data were selected.

Social media, telemedicine, and mHealth demonstrated useful tools for integrated care for allergic rhinitis management, as they can connect allergologists and their patients. A multidisciplinary approach is positive for optimal control of allergic rhinitis. Pharmacotherapy is the standard of care for the management of allergic rhinitis (azelastine hydrochloride and fluticasone propionate, or a combination of both) and represents the future of allergic rhinitis care. Intralymphatic immunotherapy (ILIT) and peptide immunotherapy (PIT) are the most promising new allergen immunotherapy options, with better time and cost-effectiveness than subcutaneous immunotherapy and sublingual immunotherapy, with studies demonstrating positive results. Studies of targeted biologics for allergic rhinitis are ongoing.

Probiotics, in particular, Bifidobacterium spp may be beneficial for allergic rhinitis management and as an add-on to allergen immunotherapy (AIT).

In conclusion, being a chronic and often comorbid condition, allergic rhinitis requires integrated care for optimal management. New formulations and combinations of existing treatments are the most promising and deserve future research.

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covid and rinitis

How does allergic rhinitis impact the severity of COVID-19?: a case-control study

By | Selected articles

Ali Guvey

Eur Arch Otorhinolaryngol . 2021 May 1;1-5. doi: 10.1007/s00405-021-06836-z. Online ahead of print.


SARS-CoV-2, which leads to coronavirus disease (COVID-19), is an exceptionally infectious disease which symptoms include fever, cough, fatigue, and dyspnea, and sometimes can be fatal in people with risk factors. Initially, some allergic diseases, including asthma, were defined as risk factors and poor outcomes. The objective of this study was to evaluate how allergic rhinitis affects the severity of COVID-19.

This was a case-control study conducted at Sakarya Educational and Research Hospital, Toyota Hospital, and Yenikent State Hospital between March 18, 2020, and August 30, 2020. It included 125 randomly selected patients previously diagnosed with allergic rhinitis before being diagnosed with COVID-19; and a control group of 125 patients without allergic rhinitis and diagnosed with COVID-19.

Patients were assessed regarding symptoms, lifestyle (smoke), comorbidities, and length of hospitalization.

The two groups did not have statistical differences in asymptomatic patients, smokers, hospitalization status, and length.

Two patients from each group went to an intensive care unit, and three patients died: one patient with allergic rhinitis and two from the control group.

In conclusion, allergic rhinitis did not impact the severity of COVID-19. However, more studies are needed with patients with allergic rhinitis and COVID-19.

This document is only available for registered healthcare professionals


Advanced Biomarkers: Therapeutic and Diagnostic Targets in Urticaria

By | Selected articles

Yue Zhang, Hanyi Zhang, Shengyi Du, Siyu Yan, Jinrong Zeng

Int Arch Allergy Immunol . 2021 Apr 29;1-15. doi: 10.1159/000515753. Online ahead of print.

Urticaria is a skin disease characterized by rapid onset of hives (superficial dermis edema, erythema, pruritus, or burning sensation), which can be worsened by angioedema (edema of the deep dermis, fat tissue, and gastrointestinal tract). It reduces the quality of life of people and can consist of recurrent attacks. It can be considered acute urticaria or chronic urticaria if it takes longer than six weeks.

Chronic spontaneous urticaria is the most common and can be induced by autoreactivity or other causes. The diagnosis of chronic urticaria is usually complex and requires the exclusion of recurrent angioedema or hereditary angioedema, so biomarkers are essential to diagnose urticaria patients.

Currently, the assessment of chronic urticaria activity depends on the Urticaria Activity Score (UAS), with few evaluation indicators. Consistent biomarkers are needed to assess urticaria.

This article summarizes advanced biomarkers and related pathogenic pathways recently discovered, such as the cell adhesion/chemotaxis pathway, interleukin (IL)-6/Janus tyrosine kinase/STAT pathway, IL-17/IL-23 pathway, basophil- and mast cell-related pathway, coagulation/fibrinolysis-related pathways, single-nucleotide polymorphism, and some other pathways.

This review aims to discover adequate biomarkers to assess disease activity, find novel therapeutic targets, and predict the patients’ response to therapeutic agents (table 1).


Table 1. Biomarkers uses in urticaria



IL-6 IL-33

Dimeric TCTP



Siglec-8 IL-23




5-HT transporter protein


Vitamin D3/VDBP SSA


Substance P


Keratin86; desmocollin 1; lectin, galactoside-binding, soluble, 7; lactotransferrin; keratin, type II cytoskeletal 4; keratin 31; keratin 80; premature ovarian failure, 1B; plakophilin 1; defensin, alpha 3, and neutrophil-specific

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The Diagnostic Workup in Chronic Spontaneous Urticaria-What to Test and Why

By | Selected articles

Martin Metz

J Allergy Clin Immunol Pract . 2021 Apr 20;S2213-2198(21)00435-9. doi: 10.1016/j.jaip.2021.03.049. Online ahead of print.

Chronic spontaneous urticaria (CSU) consists of wheals, angioedema, or both for longer than six weeks. Guidelines have limited procedures during the routine workup; however, some patients might need additional investigations. The objective of this article is to propose recommendations for the diagnostic and evaluation of some urticaria patients.

An extensive literature search was performed to identify important questions that should define diagnostic procedures based on expert consensus and published evidence.

The authors proposed seven questions for all chronic spontaneous urticaria patients: Confirm (rule out a differential diagnosis); Cause (look for indications of CSU); Cofactors (identify potential triggers, aggravators); Comorbidities (check for chronic inducible urticaria, autoimmunity, and mental health); Consequences (identify problems with sleep, distress, sexual health, work, and social performance); Components (assess potential biomarkers or predictors of treatment response); Course (monitor CSU activity, impact, and control).

Also, a complete medical history should be conducted in the assessment of the patient. CSU should be confirmed in all patients through a differential diagnosis, including blood testing for CRP and/or erythrocyte sedimentation rate and complete blood count with differential.

In conclusion, based on the answers, a decision for or against more diagnostic tests should be conducted by the specialist to prevent unnecessary and expensive testing and increase treatment effectiveness.

This document is only available for registered healthcare professionals


Heterogeneity of the pharmacologic treatment of allergic rhinitis in Europe based on MIDAS and OTCims platforms

By | Selected articles

Jean Bousquet

Clin Exp Allergy . 2021 Apr 20. doi: 10.1111/cea.13884. Online ahead of print.

Allergic rhinitis is a prevalent chronic condition. There are different treatments across countries in Europe that depend on the cost and sales too. The objective of this study was to evaluate practices in Europe to implement the Good Practice of DG Santé (MASK-air). A secondary purpose included understanding the differences and propose improvement strategies.

This study consisted of analyzing a pharmaco-epidemiological database to evaluate prescribed allergic rhinitis treatment from 2016 to 2018 in the five principal markets in the EU (France, Germany, Italy, Poland, and Spain). To gather this information, the IQVIA platforms for prescribed medicines (MIDAS®—Meaningful Integration of Data, Analytics, and Services) and for OTC medicines (OTC International Market Tracking—OTCims) were used.

The analyses excluded intranasal decongestants as they are seldom prescribed for allergic rhinitis. France leads concerning the other countries in costs and Standard Units (SU). All other countries are similar in respect to SU. However, Poland’s costs are lower than the remaining. The use of medication is very different, though: in 2018, intranasal corticosteroid was the first treatment in Poland (70,0%), France (51,3%), Spain (51,1%), and Germany (50,3%). Systemic antihistamines were more sold in Italy (41,4%), followed by 30,1% of intranasal corticosteroids. In 2016 and 2017, the results were similar.

This study represents an excellent interest in assessing the differences in allergic rhinitis treatment in Europe and can be a start for future studies of treatment trends.

This document is only available for registered healthcare professionals


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