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Reproducibility of nasal allergen challenge responses in adults with allergic rhinitis

Reproducibility of nasal allergen challenge responses in adults with allergic rhinitis

By Selected articles

Pantin CT, Southworth T, Wetzel K, Singh D.

Allergic rhinitis is characterized by nasal inflammation that occurs in response to allergen exposure. Reproducibility of nasal secretion cytokine responses and physiological measurements are needed to determine the optimum measurements and power calculations for future studies. A group of investigators have investigated the reproducibility of nasal cytokine measurements, using ready-to-use polyvinyl acetate sponges to collect nasal secretions, and measurements of nasal physiological responses.

This study included twelve participants with allergic rhinitis and no history of respiratory disease, and twelve with asthma and allergic rhinitis. They were submitted to a nasal allergen challenge which was repeated 7-14 days later. Participants had an increase in IL-5, and in cytokines CCL11 and CXCL8 responses post-challenge (all P<0.05). Acoustic rhinometry provided good to excellent reproducibility and rhinomanometry had lower reproducibility with greater variation, with some participants unable to perform the measurement. Multiplex immunoassays provided greater sensitivity for cytokine CCL11 measurements. There were no differences between allergic rhinitis patients with and without asthma.

They concluded that polyvinyl acetate sponges are a practical and reproducible way to sample nasal secretions and acoustic rhinometry is a practical and reproducible method for assessing physiological responses

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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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conjuntivitis

Local allergic conjunctivitis: a phenotype of allergic conjunctivitis.

By Selected articles

Yamana Y, Fukuda K, Ko R, Uchio E.

Local allergic rhinitis (LAR) has been reported in the field of otolaryngology; however, the concept of local allergic conjunctivitis (LAC) has not been widely studied in the ophthalmologic community. We routinely examined total IgE levels in tear fluids (t-tIgE) and antigen-specific IgE levels in serum (s-sIgE) in patients with suspected allergic conjunctivitis, on the basis of Japanese guidelines for allergic conjunctival diseases. There are several cases in which the results of t-tIgE and s-sIgE testing are divergent. We suggest that these divergent cases correspond to LAR in otolaryngology.

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Rinitis Alergica Local

Nasal Cytology as a Diagnostic Tool for Local Allergic Rhinitis

By Selected articles

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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control de la rinitis

Adaptation to Spanish and validation of the Rhinitis Control Assessment Test (RCAT) questionnaire

By Selected articles

Del Cuvillo A, Sastre J, Colás C, Navarro AM, Mullol J, Valero A.

Spanish investigators developed and validated a national version of the rhinitis control assessment test. This test is widely used to evaluate control of patients with allergic rhinitis.

They translated and adapted the original questionnaire to Spain and prospectively evaluated its properties in regard to its validity, reliability, responsiveness, size effect, minimal important difference and cut point score.

A total of 252 allergic rhinitis patients were included. Investigators found significant and strong correlations between the Spanish rhinitis control assessment test and the total nasal symptom score and the visual analogue scale. This assessment test managed to distinguish between patients with different severity or duration of allergic rhinitis and it also linearly correlated with the improvement of allergic rhinitis.

In conclusion, the adaptation to Spanish-speaking allergic rhinitis patients was successful and can be effectively used to measure control of allergic rhinitis symptoms.

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Rinitis Alérgica

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

By Selected articles

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

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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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Cepillado nasal

Nasal mucosal brushing as a diagnostic method for allergic rhinitis

By Selected articles

Hamizan A, Alvarado R, Rimmer J, Sewell WA, Barham HP, Kalish L, Harvey

Allergen specific immunoglobulin E (spIgE) in the nasal mucosa is a biomarker for local allergic rhinitis. Inferior turbinate tissue biopsy is a sensitive method to detect nasal spIgE but is invasive. Nasal brushing is a relatively noninvasive method to detect nasal spIgE that may be of comparable diagnostic utility.

Nasal brushing constituted an easy and relatively noninvasive method to sample nasal epithelium. This sampling technique was comparable with an inferior turbinate tissue biopsy and may be developed as a diagnostic tool for the diagnosis of local allergic rhinitis.

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Allergic Rhinitis Nasal Mucosa

Modulation of Allergic Inflammation in the Nasal Mucosa of Allergic Rhinitis Sufferers With Topical Pharmaceutical Agents

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Watts AM, Cripps AW, West NP, Cox AJ

This review describes the complex pathophysiology of AR and identifies the mechanism(s) of action of topical treatments including antihistamines, steroids, anticholinergics, decongestants and chromones in relation to allergic rhinitis pathophysiology. Following the literature review a discussion on the future therapeutic strategies for AR treatment is provided.

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Enfermedades alérgicas respiratorias ambiente tropical

Diagnosis of allergic sensitization in patients with allergic rhinitis and asthma in a tropical environment

By Selected articles

Sánchez-Borges M, Capriles-Hulett A, Torres J, Ansotegui-Zubeldia IJ, Castillo A, Dhersy A, Monzón X. 

The aim of this study is to investigate the in vivo and in vitro responses of IgE antibodies to inhalant allergens in allergic patients with rhinitis and/or asthma.
This study confirms that mites are the main sensitizing agents in patients with respiratory allergic diseases in a tropical environment. There was a good correlation between the results of the skin tests and the results of the in vitro tests.

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Terapia combinada de azelastina intranasal y propionato de fluticasona

Intranasal azelastine and fluticasone as combination therapy for allergic rhinitis: therapy for allergic rhinitis: systematic review and meta-analysis

By Selected articles

Peter M. Debbaneh, Anna K. Bareiss, Sarah K. Wise and Edward D. McCoul

(2019) Otolaryngology – Head and Neck Surgery

La terapia de combinación con azelastina intranasal y propionato de fluticasona es una opción para el tratamiento de la rinitis alérgica. Esta revisión sistemática y meta-análisis examina la literatura existente para determinar la eficacia en el tratamiento de la rinitis alérgica en comparación con la monoterapia.

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Nasal IgE production in Allergic Rhinitis: Impact of Rhinovirus Infection

By Selected articles

Ahmed Hamed, DeVon C Preston, Will Eschenbacher, Dilawar Khokhar, Lisa Workman, John W Steinke, Peter Heymann, Monica Lawrence, Manuel Soto-Quiros, Thomas AE Platts-Mills, Spencer Payne, Larry Borish (2019)

Practitioners from various specialties investigated the presence of local IgE production in the nose of allergic and non-allergic people and assessed whether it was enhanced by rhinovirus.

Initial studies were performed in patients presenting to the emergency department for allergic and non-allergic respiratory complaints. Local production of specific IgE was determined by comparing ratios of specific to total IgE concentrations between nasal and serum samples.

The analysis revealed evidence of local sIgE production to Dermatophagoides pteronyssinus and Blomia tropicalis in 30.3 and 14.6% of allergic patients, respectively. Patients with active rhinovirus infection were more than twice as likely to have local sIgE, and those with sIgE being produced were three times more likely to have an asthma exacerbation.

In conclusion, local IgE production happens in allergic rhinitis and allergic asthmatics with local IgE are more likely to develop an asthma exacerbation when infected with rhinovirus.

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Rinitis alérgenos y asma en Bélgica

Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement

By Selected articles

Hellings PW, Pugin B, Mariën G, Bachert C, Breynaert C, et al.

Physicians dealing with Allergic rhinitis (AR) patients should inform patients on tolerance-inducing effects of Allergen immunotherapy (AIT) and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.

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