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Rinitis alérgica archivos - Bilastina

Manifesto on united airways diseases (UAD): an Interasma (global asthma association – GAA) document

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Angelica Titiu, et al.

Received 21 Oct 2020, Accepted 17 Jan 2021, Accepted author version posted online: 25 Jan 2021, Published online: 05 Mar 2021

The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members.

The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change. UAD refers to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient’s health status and requiring an integrated diagnostic and therapeutic plan. The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient’s quality of life.

The Manifesto concludes that patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD. Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.

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Biologics for the Use in Chronic Spontaneous Urticaria: When and Which

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Marcus Maurer, David A. Khan, Daniel Elieh Ali Komi, Allen P. Kaplan

J Allergy Clin Immunol Pract . 2021 Mar;9(3):1067-1078. doi: 10.1016/j.jaip.2020.11.043.

Urticaria treatment has evolved a lot during the past decade. Current guidelines for the treatment of chronic spontaneous urticaria recommend the use of omalizumab, an IgE-targeted biologic. IgE has high-affinity to the receptor FcεRI, and degranulate skin mast cells, which are responsible for the development of signs and symptoms of urticaria, itchy wheals and angioedema. This study aims to review the existing understanding of the pathogenesis of chronic urticaria and its autoimmune endotypes.

Omalizumab is the only licensed biologic for use in chronic urticaria from 12 years old age. It is recommended as the third step of the therapy in patients who have failed standard or high-dose second-generation antihistamines and is generally well tolerated. Omalizumab has multiple potential mechanisms of action in chronic urticaria, with effects on mast cells and basophils, reducing mediators’ release and decreasing FcεRI expression. It has been approved for chronic urticaria at doses of 150 or 300 mg every 4 weeks. Poor responders may benefit from shortening the dosing interval to every 2 or 3 weeks or by adjunctive therapy with cyclosporine 3 mg/kg/day for 4 months each.

Some other biologic drugs used as off-label in chronic urticaria include dupilumab, benralizumab, mepolizumab, reslizumab, and secukinumab. New biologics under development aim to reduce mast cell activation by blocking activating pathways or engaging inhibitory receptors or mast cell numbers. These include ligelizumab and GI-301, avdoralimab, tezepelumab, lirentelimab, LY3454738, and CDX-0159 at different stages of development.

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Health Disparities in Allergic and Immunologic Conditions in Racial and Ethnic Underserved Populations

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Carla M. Davis, et al.

J Allergy Clin Immunol . 2021 Mar 10;S0091-6749(21)00365-1. doi: 10.1016/j.jaci.2021.02.034. Online ahead of print.

Health disparities negatively impact groups with greater social or economic obstacles in health based on race, ethnicity, religion, socioeconomic status, gender, age, disability, sexual orientation, and/or geographic location. The American Academy of Allergy, Asthma, and Immunology participated in a Commission to End Health Disparities 10 years ago. This study describes health disparities in allergy/immunology in racial and ethnic underserved populations and how they address people with allergic rhinitis and other allergic conditions.

Certain racial and ethnic populations are frequently not included in guidelines of care for patients with allergic rhinitis. Racial minorities show less allergic rhinitis prevalence, probable due to variability in self-reporting the disease: a 2017 report revealed that 5% of black children and 5% of Hispanic children had allergic rhinitis, compared to 9% of white children.

It is known that allergic rhinitis significantly impacts the quality of life and morbidity in underserved populations, and allergic rhinitis control was associated with fewer school absences.

Studies have shown that low-income and minority groups are less likely to receive allergen immunotherapy and have highlighted that additional burdens faced by these minorities can contribute to fewer resources needed to adhere to AIT schedules.

In conclusion, adherence could be improved when medical resources are provided to increase specialty care access in underserved communities. Observational and interventional studies are important for allergic rhinitis diagnosis, management, and outcomes for these underserved populations. A multi-level approach should also be addressed, involving patients, health providers, local agencies, professional societies, and national governmental agencies.

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Repositioning of histamine H1 receptor antagonist: Doxepin inhibits viropexis of SARS-CoV-2 Spike pseudovirus by blocking ACE2

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Shuai Ge, Xiangjun Wang, Yajing Hou, Yuexin Lv, Cheng Wang, Huaizhen He

Eur J Pharmacol . 2021 Jan 23;896:173897. doi: 10.1016/j.ejphar.2021.173897. Online ahead of print.

The spread of the coronavirus SARS-CoV-2 has continuously threatened our global health since the end of 2019. There is an urgent need for effective drugs and vaccines to fight the COVID-19; however, this may take longer than expected. One of the feasible strategies to combat this situation is to repurpose existing drugs, shorten the development time, and fight this virus outbreak.

It has been shown that histamine H1 receptor antagonists (H1-antihistamines) have broad-spectrum antiviral effects.

This study’s objective was to screen potential drugs among histamine H1 receptors that may have the capacity to inhibit the infection by the SARS-CoV-2 virus.

Five FDA-approved H1-antihistamines were found to have bioaffinity to angiotensin-converting enzyme 2 (ACE2), based on the model of ACE2 overexpressing HEK293T cell membrane chromatography.

Afterward, the interaction between these drugs and ACE2 was determined by frontal analysis and surface plasmon resonance (SPR), which also consistently demonstrated that these hits bind to ACE2 at micromolar levels of affinity.

A pseudovirus assay has helped identify that doxepin could inhibit SARS-CoV-2 spike pseudovirus from entering the ACE2-expressing cell, reducing the infection rate to 25,8%.

Doxepin may be a viable drug candidate for clinical trials to fight COVID-19. It is now recommended to compare these results with in vivo results and provide evidence for clinical trials’ final attempt. (215 words)

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Allergic rhinitis: impact on quality of life of adolescents

Allergic rhinitis: impact on quality of life of adolescents

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C S Rosario

Eur Ann Allergy Clin Immunol . 2020 Nov 12. doi: 10.23822/EurAnnACI.1764-1489.176. Online ahead of print.

One of the faster phases of human development is adolescence, with biological maturity anteceding psychosocial maturity. 15% of young people between 13 and 14 years old suffer from allergic rhinitis, double that of those with 6-7 years old. The prevalence of allergic rhinitis is higher in boys up to 10 years old. It reverses to girls having a higher prevalence during adolescence, and by adulthood, there are no differences in prevalence between genders.

Changes that occur in adolescence have health consequences over the life-course and impact the quality of life. Allergic rhinitis has a significant impact on the quality of life of adolescents and their parents: most antihistamines have sedating effects, school absences, and lower performance due to distraction, fatigue, and irritability. It also has a negative impact on the parents, who may become anxious, overprotective, and need to miss work.

Digital technology is the way to help an original approach to characterize allergic rhinitis signs and symptoms, as well as their connection with other allergic conditions. The treatment’s achievement lies in the partnership between teenagers with allergic rhinitis and mobile technology, letting them have more information available on the disease and its treatment.

In conclusion, there is some knowledge on challenges adolescents with asthma face, but some information lacks allergic rhinitis challenges.

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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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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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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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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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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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Transition of adolescents and young adults with allergy and asthma

EAACI Guideline on the effective transition of adolescents and young adults with allergy and asthma

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Graham Roberts, et al.

Allergy. 2020 Jun 19. doi: 10.1111/all.14459. Online ahead of print.

Adolescents and young adults represent a large group of patients with allergic rhinitis and/or asthma. Most times their treatment is complicated due to the biological and psychosocial changes that occur as they grow. Sometimes they have difficulty in understanding the consequences of their disease, failing to take responsibility for self-management, leading to suboptimal adherence and other negative consequences. The transitional care should address the psychological, medical, educational and vocational needs of adolescents and young adults.

The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline that provides evidence-based recommendations for healthcare professionals to support the transitional care of adolescents and young adults with allergic rhinitis and/or asthma.

This guideline includes general recommendations on operating a clinical service for these patients, which include: starting the transition as early as 11-13 years old, using a structured, multidisciplinary approach, ensuring they fully understand their condition and have resources they can access, active monitoring of adherence and discussing any implications for further education and work.

Specific allergy and asthma transition recommendations include simplifying medication regimes and using reminders, focusing on areas where these patients are not confident and involving peers in training them. Identifying and managing psychological and socioeconomic issues impacting disease control and quality of life; enrolling the family in assisting them to undertake self-management and encouraging them to let their friends know about their allergies and asthma are also recommendations of this guideline.

National healthcare systems may need to adapt these recommendations according to each culture. If optimal care is received by adolescents and young adults, they will become expert adult patients with the knowledge and skills to manage their condition throughout their lifes.

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