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AR archivos - Bilastina

temporada polen sintomas

Pollen season is reflected on symptom load for grass and birch pollen-induced allergic rhinitis in different geographic areas – an EAACI Task Force Report

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Pfaar O, Karatzas K, Bastl K, Berger U, Buters J, Darsow U, Demoly P, Durham SR, Galán C, Gehrig R, Gerth van Wijk R, Jacobsen L, Katsifarakis N, Klimek L, Saarto A, Sofiev M, Thibaudon M, Werchan B, Bergmann KC.

Allergy. 2019 Nov 13. doi: 10.1111/all.14111. [Epub ahead of print]

Allergic rhinitis is a condition that affects quality of life and has a high economic burden. Allergen immunotherapy (AIT) may be effective in seasonal and perennial allergic rhinitis, depending on the intensity and duration of pollen exposure. The European Academy of Allergy and Clinical Immunology (EAACI) task force evaluated pollen and symptom data from German and aimed at extrapolating these data in other European geographical areas such as Austria, Finland and France and assess their suitability for AIT and clinical support.

They used data from 23 pollen monitoring stations from Austria, Finland and France from 2014-2016. Afterwards, they studied the correlation between birch and grass pollen concentration during the birch and grass pollen season defined by the EAACI criteria and total nasal symptoms and medication scores reported by allergic rhinitis patients.

The analysis showed that there is a correlation of peak pollen period start and end and pollen-induced symptom loads reported by allergic rhinitis patients during birch and grass pollen season.

This task force concluded that the EAACI definitions on pollen season for both birch and grass are also valid for Austria, Finland and France, which may be of interest of use in clinical trials on AIT and also in daily clinical routine.

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interacciones contaminacion rinitis

Interactions between air pollution and pollen season for rhinitis using mobile technology: a MASK-POLLAR study

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Bédard A, Sofiev M, Arnavielhe S, Antó JM, Garcia-Aymerich J, Thibaudon M, Bergmann KC, Dubakiene R, Bedbrook A, Onorato G, Annesi-Maesano I, Pépin JL, Laune D, Zeng S, Bousquet J, Basagaña X.

J Allergy Clin Immunol Pract. 2019 Nov 28. pii: S2213-2198(19)30962-6. doi: 10.1016/j.jaip.2019.11.022. [Epub ahead of print]

The POLLAR project (Impact of Air POLLution in Asthma and Rhinitis) assesses if there are associations between major air pollutants and allergic rhinitis control. Former studies have suggested an interaction between air pollution and pollen exposure with an impact on symptoms.

This study included 3323 participants from Northern and Central Europe who recorded the daily impact of allergic symptoms in a validated mobile tool for rhinitis management using visual analogue scales during 2017 and 2018. Pollutant levels were assesses using a system for integrated modelling of atmospheric composition and pollens were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for gender, age, treatment and country. Analyses were stratified by pollen seasons to investigate interactions between air pollutants and pollen exposure.

Stronger associations between uncontrolled rhinitis and pollutants were observed during the grass pollen season. Also, days with uncontrolled allergic rhinitis increased by 25% for an interquartile range increase in pollutants levels during the grass pollen season.

The MASK-POLLAR study concluded that there may be a relationship between uncontrolled allergic rhinitis and air pollution and that this relationship is modified in the grass pollen season.

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serum ige eosinofilos

Determination of Serum IgE and Eosinophils as a Diagnostic Indicator in Allergic Rhinitis

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Sharma M, Khaitan T, Raman S, Jain R, Kabiraj A.

Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 3):1957-1961. doi: 10.1007/s12070-018-1383-7. Epub 2018 May 2.

Allergic rhinitis is the most increasing allergic respiratory disorder. It affects 10-20% of the population and is clinically identified by symptoms such as nasal discharge, itching, sneezing and nasal congestion. The objectives of this study were to determine if serum IgE and eosinophil levels have a correlation with allergic rhinitis. A total of 155 participants (113 patients and 42 healthy controls, 81 women) of different ages (1 month – 75 years old) were included in this retrospective study. Blood samples were collected from all participants and analysed to determine serum IgE and eosinophil levels. A Pearson’s correlation was performed to establish a relationship between serum log IgE and eosinophil levels. The statistical analysis of the samples demonstrated that the mean values of serum found that these were higher in participants with allergic rhinitis than in healthy controls. Also, in participants with allergic rhinits, a predominance in men was seen in mean serum log IgE levels, whereas women predominance was seen in mean eosinophil counts. A small positive correlation was established between serum log IgE and eosinophil levels. This study showed that elevated serum IgE and eosinophil levels were observed in patients with allergic rhinitis with predominance in men and younger age group.

Serum IgE and eosinophils can serve as a simple, non-invasive and reliable tool for allergic rhinitis diagnosis.

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enfoque rinitis alergica

Approach to Patients with Allergic Rhinitis: Testing and Treatment

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Cox L.

Med Clin North Am. 2020 Jan;104(1):77-94. doi: 10.1016/j.mcna.2019.09.001. Review.

Allergic rhinitis is a very common condition, affecting approximately 113 million in Europe and 30 to 60 million in the United States. Allergic rhinitis treatment is usually symptomatic, nevertheless it has both high economic burden and impact in the quality of life of patients.

Allergen immunotherapy (AIT) is a well-established and proven effective treatment of allergic rhinitis because it treats its symptoms but also the underlying cause of allergic rhinitis by stimulating immunologic changes that produce long-term allergen-specific tolerance.

The investigator produced a literature review on AIT and concluded that besides reducing symptoms, it improves overall quality of life of patients with allergic rhinitis. The 2 most commonly prescribed AIT routes are SCIT (subcutaneous immunotherapy) and SLIT (sublingual immunotherapy), which have comparable efficacy. The safety profile of SLIT is superior to SCIT, but both have been shown to have poor adherence in real-life studies. AIT has shown to prevent the progression of allergic rhinitis to asthma and may provide long-term clinical benefits after discontinuation of medications, which can translate into cost savings, when compared to standard treatment. However, more research is needed.

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prevalencia apnea obstructiva

The prevalence of high risk of obstructive sleep apnea in patients with allergic rhinitis

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Wongvilairat S, Assanasen P, Banhiran W, Tantilipikorn P, Bunnag C.

Although allergic rhinitis (AR) has not been acknowledged as a strong risk factor for obstructive sleep apnea (OSA), several pathophysiological linkages between these two conditions have frequently been reported. However, epidemiological data relating to the prevalence of OSA in patients with AR remain scarce.The objective of this study is to investigate the prevalence of patients at high risk for OSA among patients with AR, and to determine the relationship between OSA and severity of AR.

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historia rinitis alergica

History of allergic rhinitis and risk of asthma; a systematic review and meta-analysis

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Tohidinik HR, Mallah N, Takkouche B.

Allergic rhinitis has been suspected to be a risk factor for asthma in several studies but this association is not firmly established. The objective of this study was to synthesize the evidence of the association between allergic rhinitis and the risk of asthma through a systematic review and meta-analysis.

We performed a search in Medline, Scopus, ISI Proceedings databases and other databases from inception until February 2019, followed by manual search to identify potentially relevant case-control and cohort studies that reported relative risk estimates and confidence intervals of the association between allergic rhinitis and asthma. Cross-sectional studies were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed and random effects models and quality of studies was assessed through a modified version of the Newcastle-Ottawa scale.

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Recent developments and highlights in allergic rhinitis

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Meng Y, Wang C, Zhang L.

(2019) Allergy. 2019 Sep 30. doi: 10.1111/all.14067. [Epub ahead of print] Review.

Allergic rhinitis is characterized by symptoms of sneezing, rhinorrhea, nasal obstruction, and pruritus caused by inhaled allergens and involving mucosal inflammation. Allergic rhinitis is a disease with high prevalence all over the world.

This review aimed at highlighting recent developments in the etiology and management of allergic rhinitis.

Exposure of atopic individuals to external environmental factors such as ambient air pollutants, aeroallergens and climate play a crucial role in the pathogenesis of allergic rhinitis. When the nasal mucosa is exposed to inciting allergens such as pollen and dust mites, innate and adaptive immune cells are involved in the pathophysiologic mechanism of allergic rhinitis, which induce specific immunoglobulin E (IgE) production, activation of eosinophils, and degranulation of mast cells and basophils, with the consequent clinical symptoms.

At a cellular and molecular mechanism, several studies reported the role of IL-17 in allergic rhinitis. Serum IL-17 levels are significantly associated with allergy severity during the pollen season and are considered a marker of allergy severity in allergic rhinitis patients.

Current treatment options include patient education, irritant and allergen avoidance measures, pharmacotherapy, allergen immunotherapy, nasal irrigation and other less common measures such as acupuncture and surgery. Recent studies have strengthened the evidence base for the treatment of all aspect of allergic rhinitis.

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The Role of Mobile Health Technologies in Allergy Care: an EAACI Position Paper.

Quality of Life and Work Productivity Impairment of Patients with Allergic Occupational Rhinitis

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Maher Maoua, et al.

(2019) Tanaffos

Allergic rhinitis impacts negatively the quality of life and occupational activities of patients.

A 10-year duration cross-sectional study evaluated the quality of life and work productivity of patients diagnosed with allergic occupational rhinitis. Quality of Life was assessed by the Mini-RQLQ (rhinitis quality of life questionnaire) and work impairment was assessed by the Work Productivity and Activity Impairment questionnaire.

This study included 414 participants from both genders and with a mean age of 38 years old. Most of them were workers from the textile and clothing industry. Absenteeism was not relevant, however participants experienced activity limitations and practical problems, reducing productivity and quality of life.

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ácaros del polvo

Determination of the minimally important difference in a nasal symptom score in house dust mite allergy

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Devillier P, Brüning H, Bergmann KC.

House dust mite (HDM) allergens are responsible for the most prevalent persistent respiratory allergies. Clinical trials in this field often use a four-component nasal symptom score (T4NSS) as a measure of efficacy.

The MID for improvement in the T4NSS is at least -0.90 units in children, adolescents and adults suffering from HDM-induced AR. This value could be rounded up to -1 unit for convenience.

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Rinitis Alergica Local

Nasal Cytology as a Diagnostic Tool for Local Allergic Rhinitis

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Phothijindakul N, Chusakul S, Aeumjaturapat S, Snidvongs K, Kanjanaumporn J, Ruangritchankul K, Phannaso C.

Nasal eosinophilia on nasal cytology was a good screening tool for diagnosing local allergic rhinitis (LAR) because of its high sensitivity and simplicity of the procedure. Unfortunately, the low specificity of nasal eosinophilia makes the nasal provocation test (NPT) necessary for confirmation of LAR.

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Rinitis Alergica

Specific immunoglobulin E in nasal secretions for the diagnosis of local allergic rhinitis

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Meng Y, Wang Y, Lou H, Wang K, Meng N, Zhang L, Wang C.

Chinese investigators hypothesized that local serum specific immunoglobulin E (sIgE) can be used for the diagnosis of local allergic rhinitis instead of nasal allergen provocation test.

This prospective single center study included 73 chronic rhinitis patients with negative findings for serum IgE and positive findings for local eosinophils and 10 healthy patients were used as controls. All participants completed questionnaires to record demographic data, nasal symptom severity and physician-diagnosed comorbid asthma.

A visual analogue scale of 10 cm was used to record symptom severity and the allergic status was assessed by serum IgE. Nasal secretions were collected for analysis of local sIgE and eosinophils and nasal allergen provocation test was performed to confirm local allergic rhinitis.

Fourteen patients demonstrated positive local sIgE, with twelve of them having significantly higher local sIgE levels and positive nasal allergen provocation test compared to controls.

In conclusion, the measurement of local sIgE levels in nasal secretions is a reliable and effective diagnostic method for local allergic rhinitis as its sensitivity, specificity and diagnostic accuracy was over 90%.

 

 

 

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Alergenos farmacoterapia e inmunologia

Responders and nonresponders to pharmacotherapy and allergen immunotherapy

By | Selected articles

Jakalski M, Bozek A, Canonica GW.

A retrospective analysis of 1624 patients with allergic rhinitis who underwent allergen immunotherapy and 1519 matched patients who underwent only symptomatic therapy was performed.

Allergen immunotherapy is a useful treatment for allergic rhinitis; however, some patients do not achieve the expected results and its responsiveness is difficult to assess. The objective of this study was to assess potential reasons for this to happen.

Investigators registered symptoms, medication scores and quality of life related to allergic diseases before and after treatment. A cluster analysis was performed to discover any association between responsiveness to therapy and the parameters registered.

According to the Mailing criteria, which assesses responsiveness to therapy, 77,8% of patients from the allergen immunotherapy group improved 30% or more; and 62,5% of patients met the threshold of 60% or more improvement. Patients with a short history of allergic rhinitis and concomitant allergy to grass pollen or house dust mites were more frequently worse responders to allergen immunotherapy.

In conclusion, the investigators suggest that short term allergic rhinitis and monovalent allergies to grass pollen or mites could correspond to a better response to allergen treatment.

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H1 antihistaminico Rinitis Alergica

Leukotriene Receptor Antagonist Addition to H1-Antihistamine Is Effective for Treating Allergic Rhinitis: A Systematic Review and Meta-analysis

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Seresirikachorn K, Chitsuthipakorn W, Kanjanawasee D, Khattiyawittayakun L, Snidvongs K.

Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA.

For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR.

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Rinitis Alérgica

Is Quantitative sIgE Serology Suitable for Distinguishing Between Silent Sensitization and Allergic Rhinitis to Dermatophagoides pteronyssinus?

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Gellrich D, Högerle C, Becker S, Gröger M.

Objective: Our study aimed to analyze the concordance between a nasal provocation test with Dermatophagoides pteronyssinus and specific IgE measurements based on real-life data.

Despite the high correlation between sIgE levels and symptoms, no serologic parameter is sufficiently accurate to distinguish between silent sensitization and clinically relevant allergy. Therefore, nasal provocation tests remain the gold standard for assessing clinical relevance in sensitization to D pteronyssinus.

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H1 antihistaminico Rinitis Alergica

Leukotriene Receptor Antagonist Addition to H1-Antihistamine Is Effective for Treating Allergic Rhinitis: A Systematic Review and Meta-analysis

By | Selected articles

Seresirikachorn K, Chitsuthipakorn W, Kanjanawasee D, Khattiyawittayakun L, Snidvongs K.

Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA.

For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR.

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