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November 2022

The effect of allergic rhinitis and urticaria on school performance

By Exclusive content of bilastine

Allergic rhinitis (AR) and urticaria, also known as hives, are very frequent conditions1, although their impact is often minimised or overlooked.2

  • Both AR and urticaria can affect the quality of life of children and adolescents, causing limitations on their daily activity, as well as emotional, practical and sleep disruptions. As a result, these conditions may have a negative impact on school attendance and academic performance.1

According to the European Academy of Allergy and Clinical Immunology (EAACI), rhinitis is characterised by at least two of the following nasal symptoms: rhinorrhoea, nasal congestion, repeated sneezing or itching. Depending on its pathophysiology, it is classified as allergic rhinitis, infectious rhinitis or non-allergic and non-infectious rhinitis.2

Furthermore, rhinitis is often associated with eye symptoms of allergic conjunctivitis (red eyes, tearing or itchy eyes, also called ocular pruritus), leading to what is known as rhinoconjunctivitis.2

Rhinoconjunctivitis is common in school-aged children and adolescents with an overall average prevalence of 8.5% and 14.6% in the 6-7-year age group and 13-14-year age group, respectively. The prevalence of this condition appears to be increasing, particularly among adolescents.3

The International Study of Asthma and Allergies in Childhood (ISAAC) found that in a group of patients aged 6-7 years, girls showed a lower incidence of rhinoconjunctivitis than boys. On the contrary, in a group of adolescents (13-14 years), females displayed a higher prevalence as compared to their male counterparts. None of the results in both cases showed any variation according to the region where the patients lived.4

On the other hand, urticaria is characterised by the appearance of very pruritic (itchy) rashes or hives, which has a major impact on the quality of life of patients who suffer it.3 It is a highly prevalent condition, and an estimated 15-24% of the general population suffers it at some point in their lives. In paediatric patients, the prevalence of urticaria in children between 3 and 6 years is up to 43.9%.5


In children, unlike adults, acute urticaria (it remits within 6 weeks) is more common (prevalence between 1%-14% in children) than the chronic or persistent form (prevalence between 0.1%-1.8% in children).1

Acute urticaria is appears suddenly and can persist from a few hours to a maximum of 6 weeks.5 Allergic reactions to food, medicines or insect bites, viral infections, as well as anything that can trigger an immediate skin reaction are the most common causes of acute urticaria.5,6

Chronic urticaria can be caused by cold, heat, water, rubbing, among other triggering factors, but it can also arise spontaneously and there is no known cause. It is estimated that approximately half of chronic urticaria cases last less than one year, although in 11-15% of cases persistence goes beyond 5 years.5

What is the impact of these pathologies on school performance?

The symptoms of rhinitis, including sneezing, itching, nasal congestion and rhinorrhoea, disrupt sleep quality and sleep quantity, causing the child to feel sleepy during the day.7,8

  • Daytime sleepiness may contribute to impair a child’s ability to concentrate, be more distracted or less attentive, affecting school performance. 8
  • Moreover, sleep deprivation may lead to restlessness, irritability and moodiness in children.8

In the case of urticaria, pruritus or itching can also cause irritability and behavioural problems in children, as well as poor sleep quality and daytime drowsiness, which affect their performance at school.7 In fact, there are scales to assess the degree of disease activity according to the severity measurements, which can become intense and bothersome enough to interfere with daily activities or sleep.5

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  1. Church MK, et al. Bilastine: a lifetime companion for the treatment of allergies. Curr Med Res Opin. 2020;36(3):445-454.
  2. Roberts G, et al. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy. 2013;68:1102-1116.
  3. Papadopoulos NG, Zuberbier T. The safety and tolerability profile of bilastine for chronic urticaria in children. Clin Transl Allergy. 2019;9:55.
  4. Mallol J, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: A global synthesis. Allergol Immunopathol. 2013;41(2):73-85.
  5. Rodríguez del Río P, Ibáñez Sandín MD. Urticaria y angioedema. Pediatr Integral. 2013; XVII(9):616-27.
  6. Urticaria en niños: síntomas y tratamiento. Disponible en: Acceso: septiembre 2022.
  7. ¿Qué problemas tienen en la escuela los niños con asma o alergia? Disponible en: Accesso: septiembre 2022.
  8. Jáuregui I, et al. Rinitis alérgica y rendimiento escolar. Investig Allergol Clin Immunol. 2008;18(Suppl. 1):32-9.
  9. Wang XY, et al. Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine. Ther Clin Risk Manag. 2016;12:585-97.
  10. Zuberbier T, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. 2022;77(3):734-66.
  11. Scadding GK, et al. Allergic Rhinitis in Childhood and the New EUFOREA Algorithm. Front Allergy. 2021;2:706589.
  12. Toral Pérez MT, et al. Farmacoterapia de las enfermedades alérgicas. Protoc Diagn Ter pediatr. 2019;2:35-49.
  13. Jaurégui I, et al. Bilastine: a new antihistamine with an optimal benefit-to-risk ratio for safety during driving. Expert Opin Drug Saf. 2016;15(1):89-98.
  14. Kawauchi H, et al. Antihistamines for Allergic Rhinitis Treatment from the Viewpoint of Nonsedative Properties. Int J Mol Sci. 2019;20(1):213.
  15. Leceta A, et al. Bilastine 10 and 20 mg in paediatric and adult patients: an updated practical approach to treatment decisions. Drugs Context. 2021;10:2021-5-1.
  16. Novák Z, et al. Safety and tolerability of bilastine 10 mg administered for 12 weeks in children with allergic diseases. Pediatr Allergy Immunol. 2016;27(5):493-8.
  17. Álvaro Lozano M. Urticaria y angioedema. Protoc diagn ter pediatr. 2019;2:149-60.

New transcriptome and clinical findings of platelet-activating factor in chronic spontaneous urticaria: Pathogenic and treatment relevance

By Artículos seleccionados, Selected articles

Andrades E, Clarós M, Torres JV

Biofactors . 2022 Aug 4. doi: 10.1002/biof.1880. Online ahead of print.

Urticaria is characterized by transient wheal-and-flare skin reaction with pruritus. More than 5 million people suffer from persisting urticaria symptoms in Europe, causing a huge burden on patients and healthcare systems. The aim of this study was to evaluate the relevance of Platelet Activating factor (PAF) in chronic spontaneous urticaria (CSU).

Skin samples of 45 patients with moderate/severe CSU and 17 healthy controls were analyzed for the expression and cellular location of PAF receptor (PAFR) and serum levels of PAF and PAF acetylhydrolase (PAF-AH). Serum PAF and PAF-AH levels were assessed by ELISA and compared between patient and healthy controls and also between those refractory and non-refractory to 2nd-generation H1-antihistamines. PAFR mRNA expression was significantly higher in LS-CSU versus HCs (p = 0.014). PAFR positive staining in immunohistochemistry was mainly found in the epidermal basal layer in HCs, while it was largely present along the epidermis in LS-CSU samples. Endothelial cells showed PAFR expression exclusively in LS-CSU and NLS-CSU samples. PAFR expression was observed in the nerves of HC, LS-CSU, and NLS-CSU samples. Double PAFR/CD43 expression demonstrated that T-lymphocytes were the main cell type from the wheal inflammatory infiltrate expressing PAFR. A significantly lower PAF-AH/PAF ratio was observed in 2nd-generation H1-antihistamines non-responders versus responders (6.1 vs. 12.6; p = 0.049).

In conclusion, this study corroborates that PAF is a mediator of wheal pathogenesis in CSU and suggests that PAF could be a potential biomarker of 2nd-generation H1-antihistamines refractoriness due to the significantly lower PAF-AH/PAF ratio in 2nd-generation H1-antihistamines non-responders vs responders.

This document is only available for registered healthcare professionals


Acute Urticaria and Anaphylaxis: Differences and Similarities in Clinical Management

By Artículos seleccionados, Selected articles

Ensina LF, Min TK, Félix MMR, et al.

Front Allergy. 2022 Apr 15;3:840999. doi: 10.3389/falgy.2022.840999. eCollection 2022.

Acute urticaria is common and presents with wheals and/or angioedema. These symptoms are also frequent in anaphylaxis, a life-threatening reaction that must be immediately treated. In both conditions, mast cells have a central role in their mechanism of action. Although these similarities, the diagnostic approach is usually different, as it depends on the suspicious triggers, age of the patient and region where they’re based.

Anaphylaxis must be treated with adrenaline as first-line while urticaria flares can be treated with H1-antihistamines are the first choice.

The best approach to prevent anaphylaxis or acute urticaria episodes is to avoid the trigger that is responsible for the reaction, having in consideration that a solution may be desensitization to drugs and foods in selected patients to improve their quality of life.

This document is only available for registered healthcare professionals


Academic productivity of young people with allergic rhinitis: A MASK-air® study

By Artículos seleccionados, Selected articles

Viera RJ, Pham-Thi N, Anto JM

J Allergy Clin Immunol Pract. 2022 Aug 20;S2213-2198(22)00820-0. doi: 10.1016/j.jaip.2022.08.015. Versión digital previa a la impresión.

Allergic rhinitis has a high prevalence, with more than 400 million affected globally. The aim of this study was to use real-world data to assess the impact of allergic rhinitis on academic performance (measured through a visual analog scale – VAS education – and the WPAI+CIQ:AS questionnaire), and to identify factors associated with the impact of allergic rhinitis on academic performance.

Data from 1970 users of the MASK-air® mHealth app between 13 and 29 years old was used. Researchers assessed the correlation between variables calculating the impact of allergies on academic performance (VAS education, WPAI+CIQ:AS impact of allergy symptoms on academic performance, and WPAI+CIQ:AS percentage of education hours lost due to allergies), and other variables. Furthermore, they have identified factors linked to the impact of allergic symptoms on academic productivity through statistical models.

VAS education was strongly correlated with the WPAI+CIQ:AS impact of allergy symptoms on academic productivity, VAS global allergy symptoms, and VAS nose. In multivariable regression models, immunotherapy showed a strong negative association with VAS education. Poor rhinitis control, measured by the combined symptom-medication score, was associated with worse VAS education, higher impact on academic productivity, and higher percentage of missed education hours due to allergy.

In conclusion, allergy symptoms and worse rhinitis control are correlated with worse academic productivity, while immunotherapy is linked to higher productivity.

This document is only available for registered healthcare professionals


Current treatment strategies for seasonal allergic rhinitis: where are we heading?

By Artículos seleccionados, Selected articles

Ridolo E, Incorvaia C, Pucciarini F, et al.

Clin Mol Allergy. 2022 Aug 10;20(1):9. doi: 10.1186/s12948-022-00176-x.

Allergic rhinitis is caused by pollens and its symptoms include sneezing, nasal congestion, rhinorrhea, nasal itching and airflow obstruction. Allergic rhinitis diagnosis is usually made based on clinical history, skin prick tests and biomarkers measurement of specific IgE, but there is space for precision medicine to provide more accurate diagnostic tools.

The aim of this review was to describe the advances in the treatment of seasonal allergic rhinitis and evaluate the drugs to be used according to the grade of disease and the characteristics of the patients, and the role of allergen immunotherapy.

The experts concluded that treatment of allergic rhinitis includes various agents, depending on the severity of the disease. Allergen immunotherapy has high evidence of demonstrated efficacy demonstrated, and precision medicine is improving a lot the diagnosis of allergic rhinitis. Nevertheless, there is a long-term low adherence to allergen immunotherapy that needs to be resolved in the future.

This document is only available for registered healthcare professionals


The ARIA approach of Value-Added Medicines: as-needed treatment in allergic rhinitis

By Artículos seleccionados, Selected articles

Bousquet J, Toumi M, Sousa-Pinto B, et al.

J Allergy Clin Immunol Pract . 2022 Aug 4;S2213-2198(22)00749-8. doi: 10.1016/j.jaip.2022.07.020. Online ahead of print.

Allergic rhinitis has a lifetime prevalence of up to 50% in some countries. This constitutes a high burden in social, school and work life. The aim of this report is to demonstrate that Value-Added Medicines such as the use of on-demand (PRN) nasal sprays may be enough to manage allergic rhinitis.

Value-Added Medicines consists of the research of existing medicines for new therapeutic purposes.

Current treatment for allergic rhinitis consists in continuous long-term treatments after clinical trials carried for at least 14 days with over 70% adherence. A new format to treat allergic rhinitis could be using on demand treatments according to symptoms, instead of the continuous treatment.

Real-world data found that 90% of the patients increase their medications to control symptoms during the pollen season, including oral H1-antihistamines, which is not in line with the recommendations.

As most patients who request for a primary care appointment have uncontrolled symptoms, they don’t follow the long-term prescription and self-medicate.

In conclusion, real-life data indicates that patients prefer on-demand treatment instead of continuous and this should be reflected in the upcoming orientations: individualized treatment according to symptom profile, severity, and duration, along with the patient’s preference for oral or intranasal administration.

This document is only available for registered healthcare professionals

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