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

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

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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.

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Cold urticaria what we know and what we do not know

Cold urticaria what we know and what we do not know

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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.

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nasal allergen challenge in allergic rhinitis

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

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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.

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rinitis

EUFOREA treatment algorithm for allergic rhinitis

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P W Hellings, et al.

Rhinology . 2020 Sep 29. doi: 10.4193/Rhin20.246. Online ahead of print.

Allergic rhinitis is the most common chronic inflammatory condition. It affects more than 100 million people living in Europe, with a significant impact on individuals, society, and health economies. Most times, patients prefer to self-manage the condition by visiting pharmacies rather than seeking medical advice due to the long wait for an appointment.

Other difficulties to an effective and appropriate allergic rhinitis treatment include the inability to recognize and diagnose it and adequately prescribe a treatment. Lately, there has been a shift into more patient-approach to allergic rhinitis management, focusing on personalized, predictive, preventative, and participatory strategies.

The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and global key opinion leaders have developed a treatment algorithm to facilitate allergic rhinitis treatment in real-life settings. This guide includes a checklist of what to do when assessing patients, including a list of symptoms suggestive of allergic rhinitis, questions on suspected asthma, and instructions on using the visual scales. It consists of five steps: diagnosis, patients classification, therapy definition, product selection, and treatment plan activation. Patient education is central at all stages and their participation in the decision-making process and goal-setting.

This algorithm is concise, simple to use, suitable for all stakeholders, including pharmacies, primary care physicians, ENT doctors, pulmonologists, allergologists, and pediatricians. It provides evidence-based and expert-endorsed recommendations for the management of allergic rhinitis. The full pocket guide is available on the EUFOREA website (www.euforea.eu).

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urticaria y antihistaminicos H1

Current and emerging pharmacotherapy for chronic spontaneous urticaria: a focus on nonbiological therapeutics

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Kam Lun Hon, Joyce T. S. Li, Alexander K.C. Leung, Vivian Lee

Expert Opin Pharmacother. 2020 Sep 29. doi: 10.1080/14656566.2020.1829593. Online ahead of print.

Urticaria is characterized by pruritic wheals of the skin’s superficial layers, which occurs for six weeks or longer, with no apparent cause. It is a condition that reduces the quality of life of the patient and may have a significant economic and social burden. The objective of this revision was to review the guidelines for urticaria management.

According to the joint initiative of the EU-founded network of excellence, the Global Allergy and Asthma European Network, the European Academy of Allergology and Clinical Immunology, the World Allergy Organization, and the European Dermatology Forum, management of urticaria should be done in a stepwise manner. Second-generation H1-antihistamines are considered first-line treatment. Whenever symptoms are not adequately controlled, treatment should follow the algorithm. This algorithm includes an increase of the dose of second-generation H1-antihistamines, alongside first-generation H1-antihistamines, H2 antagonists, omalizumab, ciclosporin A, or short-term corticosteroids if needed. New treatments on development include spleen tyrosine kinase inhibitor, Bruton tyrosine kinase inhibitor, prostaglandin D2 receptor inhibitor, H4-antihistamines, and biologics. Alternative agents include leukotriene receptor antagonists, anticoagulant and antifibrinolytic agents, antidepressants, vitamin D, and other anti-inflammatory or immune-suppressing agents.

According to the authors, second-generation H1-antihistamines should always be considered the first-line therapeutic option for urticaria management. For those who do not respond to a higher dose of H1-antihistamines, guidelines recommend adding omalizumab. Well-designed trials are required to draw clear conclusions.

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asma alergia y covid

ACE2 expression in allergic airway disease may decrease the risk and severity of COVID-19

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Sunita Chhapola Shukla

Eur Arch Otorhinolaryngol. 2020 Oct 6;1-4. doi: 10.1007/s00405-020-06408-7. Online ahead of print.

At the start of the COVID-19 pandemic, allergic rhinitis, allergy, asthma, and chronic obstructive pulmonary disease were considered risk factors because they tend to aggravate during respiratory viral infections and upper respiratory tract symptoms viral infections, allergic rhinitis, and influenza overlap during COVID-19 early stages. This review aimed to revise recent studies published that do not prove that allergy and asthma are risk factors or increase severity for COVID-19.

Recent literature has not shown that airways allergic diseases are a high-risk factor or increase the severity of COVID-19. The reason is that there is a reduction in angiotensin-converting enzyme 2 (ACE2) gene expression in the nose and bronchial cells of allergic airway diseases.

Low ACE2 expression in airway cells of individuals with allergic rhinitis and allergic asthma decreases their susceptibility to COVID-19 and may not be a risk factor for severe infection. However, this is not true for the nonatopic asthma phenotype. More studies are needed to understand the impact of respiratory allergic diseases and T2 inflammatory response on COVID-19 severity and susceptibility. It is essential to continue asthma and allergic rhinitis treatments with inhaled corticosteroids, biologics, and allergen immunotherapy during the COVID-19 pandemic.

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rinithis alercica aerosoles nasales

As-needed versus regular use of fluticasone furoate nasal spray in patients with moderate to severe, persistent, perennial allergic rhinitis: a randomized controlled trial

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Torpong Thongngarm, Chamard Wongsa, Phichayut Phinyo, Paraya Assanasen, Pongsakorn Tantilipikorn, Mongkhon Sompornrattanaphan

J Allergy Clin Immunol Pract . 2020 Oct 10;S2213-2198(20)31107-7. doi: 10.1016/j.jaip.2020.09.057. Online ahead of print.

Allergic rhinitis is one of the most common diseases globally, and its prevalence is up to 50 % in children and 40 % in adults. It has a high economic burden and impacts the quality of life of patients. Allergic rhinitis related to house-dust mites or common indoor allergens is denominated perennial allergic rhinitis. The regular use of intranasal corticosteroids is recommended for the treatment of perennial allergic rhinitis. Due to the lack of studies that evaluate the “as-needed” use of intranasal corticosteroids, this study aimed to compare the efficacy between the as-needed and regular use of these products moderate-to-severe perennial allergic rhinitis.

This randomized controlled trial included 103 participants for six weeks. Participants were assigned to fluticasone furoate nasal spray (27,5 mg), two sprays once daily for one week, followed by as-needed use for five weeks (FF-as-needed) or two sprays once daily for six weeks (FF-regular). The primary endpoint was a change in the total nasal symptom score (TNSS), and secondary endpoints included a change in nasal peak inspiratory flow (NPIF), rhinoconjunctivitis quality of life-36 questionnaire score (RCQ-36), and cumulative fluticasone furoate dose.

Participants were divided into FF-as-needed (n = 51) and FF-regular (n = 52). The mean change of TNSS between the two groups was not significant at six weeks; however, the FF-regular group tendency was to a greater improvement in TNSS. The NPIF mean change was greater in the FF-regular group. Both groups had similar improvements in RCQ-36. The mean cumulative FF dose in the as-needed group was half of the regular group.

In conclusion, perennial allergic rhinitis patients from both groups had similar improvements in TNSS and quality of life, with those from the as-needed group having half of the exposure to intranasal corticosteroids.

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urticaria and covid

Management of urticaria in COVID-19 patients: A systematic review

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Eyad Abuelgasim, Ann Christine Modaragamage Dona, Rajan Singh Sondh, Amer Harky

Dermatol Ther. 2020 Sep 28;e14328. doi: 10.1111/dth.14328. Online ahead of print.

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), has resulted in an increased healthcare burden, with different symptoms manifesting in other patients. The evidence of skin manifestations similar to urticaria is also growing. The objective of this systematic revision was to review the current literature on urticaria in COVID-19 patients.

According to PRISMA guidelines, investigators carried out an extensive literature search in Medline, EMBASE, Scopus, Cochrane, and Google Scholar, using “COVID-19”, “Coronavirus”, “SARS-CoV-2”, “urticaria”, “angioedema” and “skin rash” until August 2020. Articles related to urticaria and/or angioedema due to COVID-19 and its management and outcome were included.

From the 169 articles returned by the search, 25 of them met the inclusion criteria. These articles were case reports, which related 26 patients infected with SARS-CoV-2 with symptoms such as urticaria and/or angioedema. Most patients (69%, n = 16) were over 50 years old. Treatment with antihistamines and/or steroids resolved the symptoms in different time frames, from less than 24 hours to up to 2 weeks. There was no report of recurrent cases of urticaria or non-responsiveness to treatment.

Patients infected with SARS-CoV-2 who develop urticaria symptoms should be managed with antihistamines. The use of a low prednisolone dose should be evaluated according to each patient in the shortest duration possible until symptoms are controlled.

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Null association between serum 25-hydroxyvitamin D levels with allergic rhinitis, allergic sensitization and non-allergic rhinitis: A Mendelian randomization study

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Qi Feng, Klaus Bønelykke, Weronica Ek, Bo CHawes, Shuai Yuan, Ching Cheung, Gloria Li, Raymond Leung, Bernard Cheung

Clin Exp Allergy. 2020 Sep 18. doi: 10.1111/cea.13739. Online ahead of print.

Allergic rhinitis and allergic sensitization are the most common and prevalent allergic conditions in the world. It has been suggested that serum 25-hydroxyvitamin D might have a role in immunomodulation and, consequently, in allergic rhinitis and allergic sensitization. This study aimed to assess a causal association between 25-hydroxyvitamin D levels and risk of allergic rhinitis or allergic sensitization, using two-sample Mendelian randomization (MR) approach.

Instrumental variables identified seven single nucleotide polymorphisms (SNPs) associated with serum 25-hydroxyvitamin D levels. The primary objective was allergic rhinitis, and the secondary objectives were allergic sensitization and non-allergic rhinitis. Two cohort studies provided the genome-wide association summary statistics of the outcomes. MR analysis with a random-effects inverse variance weighted method was performed as the primary analysis to estimate the overall effect size. Sensitivity analysis using the weighted median method and MR-Egger regression method was conducted. A subgroup analysis based on 25-hydroxyvitamin D synthesis-SNPs was also applied.

There wasn’t a causal association between serum 25-hydroxyvitamin D and risk of allergic rhinitis, and subgroup analysis also showed no relation between 25-hydroxyvitamin D synthesis-related SNPs and outcomes. The same results were obtained for sensitivity analysis.

In conclusion, this study did not find any evidence that supports a causal association between serum 25-hydroxyvitamin D levels and risk of allergic rhinitis, allergic sensitization, or non-allergic rhinitis in the European-ancestry population. This conclusion is against the use of vitamin D supplementation for the prevention of allergic diseases.

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para identificar personas con rinitis alérgica.

Can we identify allergic rhinitis from administrative data: A validation study

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Katja Biering Leth-Møller, Tea Skaaby, Flemming Madsen, Janne Petersen

Pharmacoepidemiol Drug Saf. 2020 Sep 23. doi: 10.1002/pds.5120. Online ahead of print.

The prevalence of allergic rhinitis has been increasing, with more than one in five people being affected. The objective of this study was to evaluate the validity of 13 different Danish prescription algorithms and hospital data to identify people with allergic rhinitis.

This study included 10 653 Danish adults in two time periods. Investigators used a positive serum-specific IgE and self-reported nasal symptoms as the primary gold-standard of allergic rhinitis. The secondary gold standard of allergic rhinitis was self-reported physician diagnosis. They calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value, and corresponding 95 % confidence intervals for each register-based algorithm in the two periods.

All algorithms had a low sensitivity, irrespective of the definition of allergic rhinitis or period. The highest positive predictive values were achieved for algorithms that required antihistamines and intranasal corticosteroids, with a value of 0.69 (0.62 – 0.75) and a corresponding sensitivity of 0.10 (0.09 – 0.12) for the primary gold standard of allergic rhinitis.

In conclusion, due to the low use of prescription medication among those with allergic rhinitis, sensitivity was low (≤ 0.40) for all algorithms irrespectively of the definition of allergic rhinitis. Algorithms based on antihistamines and intranasal corticosteroids granted the highest PPVs. Nevertheless, PPVs were still moderate, due to low sensitivity, when applying a strict gold standard (sIgE and nasal symptoms). Studies using administrative data must consider how to reliably identify allergic rhinitis, for example, using different data sources, and how a potential misclassification will

impact their results.

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Positive effect of Helicobacter pylori treatment on outcome of patients with chronic spontaneous urticaria

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Mohammed Elhendawy, Maha Hagras, Shaimaa Soliman, Engi Seif Shaker

Am J Clin Pathol. 2020 Sep 17;aqaa134. doi: 10.1093/ajcp/aqaa134. Online ahead of print.

People with chronic urticaria have chronic hives, itching, and wheels that come and go for long periods. Chronic spontaneous urticaria represents 80 – 90 % of chronic urticaria cases, and the release of histamine and other inflammatory mediators from mast cells and basophils may be immunoglobulin E (IgE)–mediated or non-IgE-mediated. Helicobacter pylori is a gram-negative bacterium with a high prevalence worldwide, and that persistently colonizes the stomach. Its presence is associated with an increased risk of peptic ulcer and gastric cancer. The association between Helicobacter pylori and chronic spontaneous urticaria is controversial. This study’s objective was to assess the relationship between Helicobacter pylori eradication therapy and chronic spontaneous urticaria remission.

This was a randomized, double-blind, placebo-controlled pilot study that included 72 patients with urticaria. From these, 27 were positive for Helicobacter pylori stool antigen and PCR in gastric biopsy and were randomly assigned to receive anti-Helicobacter pylori treatment or placebo.

Participants with Helicobacter pylori had significantly lower hemoglobin concentrations with microcytic hypochromic anemia and a significantly higher occurrence of dyspepsia symptoms. All Helicobacter pylori patients (except 2) had significant improvement of the urticaria itching and red wheals after two weeks of therapy compared to placebo.

This study showed an association between chronic spontaneous urticaria and the presence of Helicobacter pylori in the gastric tissue. Patients with urticaria who do not respond to usual chronic urticaria treatment should be tested for Helicobacter pylori as therapy of Helicobacter pylori showed to improve the symptoms of chronic spontaneous urticaria.

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Avances y desarrollos novedosos en la rinitis alérgica

Advances and novel developments in allergic rhinitis

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Yifan Meng, Chengshuo Wang, Luo Zhang

Allergy. 2020 Sep 9. doi: 10.1111/all.14586. Online ahead of print.

Allergic rhinitis is a condition of the upper airways, with a high prevalence worldwide, characterized by symptoms such as nasal obstruction, rhinorrhea, sneezing, and nasal pruritus. This is due to inhaled allergens and respective mucosal inflammation. This review’s objective was to highlight novel mechanisms and treatments of allergic rhinitis to optimize its management.

Proteins such as histone deacetylase (HDAC) and mucin 1 (MUC1) have a role in the epithelial tight junction barrier’s integrity. Inflammatory mediators, such as type 2 innate lymphoid cells (ILC2), myeloid dendritic cells (mDC), and plasmacytoid dendritic cells (pDC), are involved in the development of allergic rhinitis. Other risk factors include genetic susceptibility, age, intrauterine growth restriction, fetal oxidative balance, diet, environmental changes, and essential roles in allergic rhinitis.

Management of allergic rhinitis includes patient education, pharmacotherapy, allergen-specific immunotherapy, and biologics. Novel therapies include highly purified allergens, allergoids, peptides, and new adjuvants for use in specific allergen immunotherapy and specific monoclonal antibodies for blocking the effects of immune mediators.

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This study aimed to compare the gastrointestinal composition between adults and children suffering from allergic rhinitis.

Comparison of the gastrointestinal composition between adults and children suffering from allergic rhinitis

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Annabelle M Watts; Nicholas West; Ping Zhang; Peter Smith; Allan Cripps; Amanda Cox

Int Arch Allergy Immunol. 2020 Sep 24;1-12. doi: 10.1159/000510536. Online ahead of print.

The gut microbiota has an essential role in the development and regulation of local and systemic immunity. Allergic rhinitis, such as various immune-mediated conditions, has been associated with abnormal gut microbial colonization patterns in children; however, there is not enough data regarding adults. This study aimed to compare the gastrointestinal composition between adults and children who suffer from allergic rhinitis.

This was a cross-sectional study that included 57 adults with allergic rhinitis and 23 healthy controls. Investigators compared samples of their stools via next-generation sequencing of the V3-V4 hypervariable regions of the 16S rRNA gene. Investigators used a reference-based approach with the NCBI database to taxonomic classification and identity approach.

Participants with allergic rhinitis had a significant reduction in species richness. They also had declines in operational taxonomic unit counts and diversity indices. In contrast, they had significantly more Bacteroidetes than healthy controls, as well as an increased abundance of Parabacteroides and a reduced abundance of Oxalobacter and Clostriadiales.

Adults with allergic rhinitis have a different gut microbiome than healthy controls, with reduced microbial diversity and altered abundance of some microbes. Identifying the metabolites and mechanisms underlying the relationship microbiota-host will improve how the gut microbiome composition regulates immunity and may be of interest to potential therapeutic options for allergies.

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rinitis 1990-2010

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

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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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