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The effect of allergic rhinitis and urticaria on school performance

By | Exclusive content of bilastine, New

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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References:

  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: https://pacientes.seicap.es/es/urticaria-en-ni%C3%B1os-s%C3%ADntomas-y-tratamiento_67451. Acceso: septiembre 2022.
  7. ¿Qué problemas tienen en la escuela los niños con asma o alergia? Disponible en: https://seicap.es/alergia/que-problemas-tienen-en-la-escuela-los-ninos-con-asma-y-alergia/. 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 | New, 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.

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Acute Urticaria and Anaphylaxis: Differences and Similarities in Clinical Management

By | New, 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.

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

By | New, 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.

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

By | New, 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.

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

By | New, 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.

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Update on pathomechanisms and treatments in allergic rhinitis

By | Selected articles

Zhang Y, Lan F, Zhang L

Allergy. 2022 Jul 27. doi: 10.1111/all.15454. Online ahead of print.

Allergic rhinitis represents a worldwide health problem with increasing prevalence and relationship to a growing medical and socioeconomic burden. The objective of this review was to recognize immune cells such as type 2 innate lymphocytes (ILC2s), T helper (Th2) 2 cells, follicular helper T cells, follicular regulatory T cells, regulatory T cells, B cells, dendritic cells, and epithelial cells in allergic rhinitis pathogenesis.

It is important to have an in-depth understanding of the mechanisms of allergic rhinitis to help with the identification of biomarkers and eventually provide valued parameters o guide tailored targeted therapy. Allergen-specific immunotherapy is the only etiological treatment option for allergic rhinitis with evidence for effectiveness and that has been gaining increased attention. This immunotherapy recently demonstrated effectiveness and evidence in several randomized controlled trials and long-term real-life studies. The research of biologics as therapeutic options for allergic rhinitis has only involved anti-IgE and anti-type 2 inflammatory agents; nevertheless, the cost-effectiveness of these agents still needs to be explained.

During the COVID-19 pandemic, allergic rhinitis has not showed a risk factor for severity and mortality of COVID-19, however this needs to be confirmed in multi-centre, real-life studies worldwide.

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In silico Identification of Immune Cell-Types and Pathways Involved in Chronic Spontaneous Urticaria Connor Prosty

By | Selected articles

Prosty C, Gabrielli S, Ben-Shoshan M, Le M, Giménez-Arnau AM, Litvinov IV, Lefrançois P, Netchiporouk E

Front Med (Lausanne). 2022 Jul 7;9:926753. doi: 10.3389/fmed.2022.926753. eCollection 2022.

Chronic spontaneous urticaria (CSU) is defined by the presence of wheals and/or angioedema that occur in the absence of specific external stimuli and persist for more than 6 weeks. Its immunopathogenesis is not yet fully understood, but there are new trends on dividing patients into auto allergic and autoimmune subtypes.

The aim of this study was to investigate immune cells and pathways of CSU through the reanalysis of available transcriptomic data.

Investigators obtained microarray data of CSU and healthy control skin and blood from the Gene Expression Omnibus. Differentially expressed genes were analyzed using ToppGene and KEGG and cell-type enrichment was determined by CIBERSORT and xCell and correlated with clinical characteristics.

Th2 (IL-4/13 signaling) and Th17-related (IL-17/23 signaling) patways were found to be upregulated in lesional samples. CIBERSORT analysis showed that non-lesional samples had increased regulatory T-cells and resting mast cells. The xCell analysis revealed no significant differences between samples, however, Th2 scores in both types of samples correlated positively with disease severity. There were few differentially expressed genes and pathways identified between CSU and healthy control blood samples.

These results revealed and supported the connection of Th2 and Th17-related genes and pathways in CSU. Th2 scores related to disease severity, where increased resting mast cell and Treg scores in non-lesional samples indicate local suppression of wheal formation. Furthermore, disease activity seemed to be restricted to the skin as there were limited findings from blood. More studies are needed to further support this information.

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Mechanism of Lower Airway Hyperresponsiveness Induced by Allergic Rhinitis Yiting Liu

By | Artículos seleccionados, Selected articles

Liu Y, Sha J, Meng C, Zhu D

J Immunol Res. 2022 Jul 12;2022:4351345. doi: 10.1155/2022/4351345. eCollection 2022.

Allergic rhinitis affects up to 40% of adults and 25% of children globally, however its mechanisms are not yet well elucidated. The majority of people with allergic rhinitis also have lower airway hyperresponsiveness, and an allergic rhinitis occurrence can increase this hyperresponsiveness.

The aim of this review was to understand the mechanism of the effect of allergic rhinitis on the lower airways. The effects of allergic rhinitis on the lower airways were studied in terms of epidemiology, anatomy, pathophysiology, nasal function loss, inflammation drainage, nasobronchial reflex, and whole-body circulatory flow to elucidate the mechanisms involved and provide patterns for future diagnosis, treatment, and experiments.

Researchers concluded that these mechanisms cannot be explained by a single mechanism, but by an interaction of several ones. The hyperresponsiveness of the lower airway may be caused by the rhinopulmonary reflex, lower airway drainage of allergens and nasal obstruction. However, it may also be caused by circulating factors such as IL-5 that stimulate bone marrow cells to differentiate into eosinophils and for IL-4 and IL-13 to upregulate adhesion- and chemotaxis-related proteins. More studies are needed to design future diagnosis and treatment approaches.

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Urticaria in Pregnancy and Lactation

By | Artículos seleccionados, Selected articles

Kocatürk E, Podder I, Zenclussen AC, Kasperska Zajac A, Elieh-Ali-Komi D, Church MK, Maurer M

Front Allergy. 2022 Jul 7;3:892673. doi: 10.3389/falgy.2022.892673. eCollection 2022.

More women than men suffer from chronic urticaria, and they are mostly affected in their reproductive age, including pregnancy. Sex hormones affect mast cell biology and the hormonal changes that occur in pregnancy modulate inflammatory conditions such as chronic urticaria.

Pregnancy-related changes in the immune system, involving local adaptation of innate and adaptive immune responses and skewing of adaptive immunity toward a Th2/Treg profile were found to be related to changes in inflammatory diseases. The PREG-CU study provided the first insights on the effect of pregnancy on chronic urticaria, the outcomes of pregnancy in pregnant women with chronic urticaria and safety of urticaria medications and revealed that chronic urticaria improves during pregnancy in half of pregnant women, whereas it worsens in one-third. Also, two of five pregnant women with chronic urticaria experience flare-ups during pregnancy.

The international EAACI/GALEN/EuroGuiDerm/APAAACI guideline for urticaria recommends the same management strategy in pregnant and lactating women with chronic urticaria: start with standard doses of second-generation (non-sedative) H1 antihistamines and increase the dose up to 4-folds in case of no response. Antihistamine-refractory patients should be given omalizumab.

The PREG-CU study assessed treatments and their outcomes during pregnancy: H1 antihistamines, montelukast, omalizumab, cyclosporine-A and systemic steroids, however there isn’t still enough information on the management of chronic urticaria during pregnancy.

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Usage patterns of oral H1-antihistamines in 10 European countries: A study using MASK-air® and Google Trends real-world data

By | Artículos seleccionados, Selected articles

Vieira RJ, Sousa-Pinto B, Anto JM, Sheikh A, Klimek L, Zuberbier T, Fonseca JA, Bousquet J

World Allergy Organ J. 2022 Jun 24;15(7):100660. doi: 10.1016/j.waojou.2022.100660. eCollection 2022 Jul.

Real-world data may help provide important data on different conditions, namely allergic rhinitis. However, evaluating this information can represent a challenge, as results from internet users may be influenced by different factors, from the real epidemiology of the conditions being evaluated, but also by the attention they get in the media.

This study compared real-world data from MASK-air®, a mobile app for allergic rhinitis on the usage of oral H1-antihistamines from 2016 to 2020 in 10 European countries with Google Trends data on the relative volume of search for these antihistamines.

5 different oral H1-antihistamines were selected for each country and the investigators perceived a perfect agreement on the order of antihistamine use in MASK-air® and Google Trends in France, Germany, Sweden, and the United Kingdom. Different levels of agreement were observed in the remaining countries (Italy, Poland, Portugal, Spain, Switzerland, Netherlands). Sales data-wise, there was a consistency in data from Google Trends and MASK-air® in France, Germany and the United Kingdom.

In conclusion, these results suggest that the mobile app MASK-air® data may have a common trend in relation to other real-world data, however, more studies are needed.

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Lack of Clinical Relevance of Bilastine-Food Interaction in Healthy Volunteers: A Wheal and Flare Study

By | Articles about Bilastine, Publicaciones sobre Bilastina

Coimbra J, Puntes M, Gich I, Martínez J, Molina P, Antonijoan R, Campo C, Labeaga L

Int Arch Allergy Immunol. 2022 Jun 14:1-10. doi: 10.1159/000524856. Publicación electrónica previa a la edición impresa. PMID: 35700691.

Bilastine is a second-generation antihistamine with good selectivity for H1-receptors, and no brain-penetration. The objective of this study was to compare the pharmacodynamic activity of bilastine administered under fasting and fed conditions in healthy volunteers.

This was a randomized, open-label, two-period, crossover study involving 24 healthy participants who were given 20 mg of once-daily oral bilastine for 4 days under fasting and fed conditions, with a 7-day washout period. The plasma concentrations of bilastine plasma were measured for 24 h after the first and fourth doses in each period. Pharmacodynamic activity was assessed by wheal and flare surface inhibition and subjective assessment of itching, after intradermal injection of histamine.

When administered under fed vs. fasting conditions, the exposure to bilastine 20 mg decreased (mean maximum plasma concentration and area under the curve from time 0 to 24 h decreased by 34.27% and 32.72% [day 1], respectively, and 33.08% and 28.87% [day 4]). Despite this decrease, the antihistaminic effect of bilastine 20 mg did not change with food. On day 1, as measured by wheal and flare surface inhibition,

the maximum effect and duration of action of bilastine did not differ significantly between fasting and fed conditions, with only a short 30-min delay in the onset of wheal inhibition. On day 4, bilastine’s pharmacodynamic effects were not significantly affected under any condition.

In conclusion, the pharmacokinetic interaction of bilastine with food does not mean a significant reduction of its peripheral antihistaminic efficacy.

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Urticaria (angioedema) and COVID- 19 infection

Chronic Urticaria: The Need for Improved Definition

By | Artículos seleccionados, Selected articles

Gómez RM, Bernstein JA, Ansotegui I, Maurer M

Front Allergy. 2022 Jun 9;3:905677. doi: 10.3389/falgy.2022.905677. PMID: 35769560; PMCID: PMC9234868.

Chronic urticaria is usually diagnosed after daily or almost daily presence of symptoms for more than 6 weeks. Urticaria symptoms include pruritic wheals or hives, accompanied by angioedema in 40% of cases. Up to 20% of patients have isolated angioedema. Chronic urticaria represents a significant burden which has been extensively reported with numerous validated patient-reported outcome measures that represent a significant impact on several aspects of life ranging from physical discomfort to personal mood changes (anxiety and depression) which frequently interferes with interpersonal relationships, daily activities including work and school. It is not a surprise that management of chronic urticaria is related to substantial

costs to health care systems due to recurrent medical visits and treatments. Consequently, it is crucial to generate awareness among healthcare payors and other stakeholders on the prevalence of chronic urticaria and its impact on quality of life and on the economic burden it has on society. There is no consensus on diagnostic and management criteria for CU, which makes this task more challenging.

In conclusion, the health and economic burden of chronic urticaria is significant and should not be underestimated. The significant impact of this condition requires that physicians and other health care providers understand how to properly identify and manage this condition.

An expert consensus on diagnostic and management criteria for chronic urticaria is needed.

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Compositional alteration of the nasal microbiome and Staphylococcus aureus-characterized dysbiosis in the nasal mucosa of patients with allergic rhinitis

By | Artículos seleccionados, Selected articles

Kim HJ, Kim JH, Han S, Kim W

Clin Exp Otorhinolaryngol. 2022 Jun 8. doi: 10.21053/ceo.2021.01928. Epub ahead of print. PMID: 35680131.

Allergic rhinitis (AR) is an IgE and Th2-mediated inflammatory nasal disease. It originates from a sensitized immune response to inhaled allergens, which is thought to result from an imbalance in the Th1-Th2 immune regulation, resulting in increased levels of Th2 cytokines. Nasal ephitelial cells exposed to allergens induce Th2 inflammatory responses that spread to the upper airway mucosa. A commensalism host-microbial can be the basis of the innate immune responses in the nasal mucosa, and the microbial characteristics of the nasal mucus can impact the mechanisms of the initial allergic response. The aim of this study was to evaluate changes in the microbial composition in the nasal mucus of patients with AR and to understand the relationship between dysbiosis of the nasal microbiome and allergic inflammation.

The investigators analyzed the microbiota of 104 samples (n=42 participants with AR vs. n=30 healthy participants), in a total of 364,923 high-quality bacterial 16S ribosomal RNA-encoding gene sequence reads. The nasal mucus of healthy participants had mainly Proteobacteria (Ralstonia genus) and Actinobacteria (Propionibacterium genus) phyla, whereas the Firmicutes (Staphylococcus genus) phylum was significantly abundant in the nasal mucus of participants with AR. More sequencing data from 32 participants (healthy participants: n=15, AR patients: n=17) shown a greater abundance of Staphylococcus epidermidis, Corynebacterium

accolens, and Nocardia coeliaca, in 41.55% of mapped sequences in the nasal mucus of healthy participants. Patients with AR had a more pronounced dysbiosis of nasal microbiome and Staphylococcus aureus exhibited the greatest abundance (37.69%).

In conclusion, this study demonstrated that the nasal mucus of patients with AR have S. aureus–dominant dysbiosis, which suggests a role of host–microbial commensalism in allergic inflammation.

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Autoimmune chronic spontaneous urticaria

By | Artículos seleccionados, Selected articles

Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, Xiang YK, Maurer M

J Allergy Clin Immunol. 2022 Jun;149(6):1819-1831. doi: 10.1016/j.jaci.2022.04.010. PMID: 35667749.

Chronic spontaneous urticaria (CSU) symptoms include the recurrent spontaneous appearance of wheals and intense itch that may last from hours to days and occur for several years. Some patients develop localized and self-limiting angioedema. These manifestations result from a temporary increase in vascular permeability. Almost 13% of patients with CSU experience angioedema and do not develop wheals.

There are 2 main autoimmune mechanisms for CSU: type I autoimmune (autoallergic) CSU, which is associated with with IgE antibodies against autoantigens; and type IIb autoimmune CSU, which is mediated by autoantibodies that activate mast cells via IgE and FceRI. Type IIb autoimmune CSU is present in almost 10% of patients and is characterized by higher disease severity, concomitant autoimmune diseases, low levels of total IgE, elevated levels of IgG-anti–thyroid peroxidase, basopenia, eosinopenia, poor response to antihistamines and to omalizumab, and a good response to cyclosporine. Some new targeted therapies are under development, such as the anti-IgE, ligelizumab, and the Bruton’s tyrosine kinase inhibitors, fenebrutinib and remibrutinib, and an anti-IL-4Ra, dupilumab.

There are missing some studies on the overlap between autoallergic and type IIb autoimmune CSU and on the optimal management of both types of autoimmune CSU, with easy-to-perform, noninvasive and inexpensive markers to assess the treatment response.

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