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Rinitis alérgica

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

By Artículos seleccionados, Selected articles

Viera RJ, Pham-Thi N, Anto JM

J Allergy Clin Immunol Pract. 2022 Aug 20;S2213-2198(22)00820-0. doi: 10.1016/j.jaip.2022.08.015. Versión digital previa a la impresión.

Allergic rhinitis has a high prevalence, with more than 400 million affected globally. The aim of this study was to use real-world data to assess the impact of allergic rhinitis on academic performance (measured through a visual analog scale – VAS education – and the WPAI+CIQ:AS questionnaire), and to identify factors associated with the impact of allergic rhinitis on academic performance.

Data from 1970 users of the MASK-air® mHealth app between 13 and 29 years old was used. Researchers assessed the correlation between variables calculating the impact of allergies on academic performance (VAS education, WPAI+CIQ:AS impact of allergy symptoms on academic performance, and WPAI+CIQ:AS percentage of education hours lost due to allergies), and other variables. Furthermore, they have identified factors linked to the impact of allergic symptoms on academic productivity through statistical models.

VAS education was strongly correlated with the WPAI+CIQ:AS impact of allergy symptoms on academic productivity, VAS global allergy symptoms, and VAS nose. In multivariable regression models, immunotherapy showed a strong negative association with VAS education. Poor rhinitis control, measured by the combined symptom-medication score, was associated with worse VAS education, higher impact on academic productivity, and higher percentage of missed education hours due to allergy.

In conclusion, allergy symptoms and worse rhinitis control are correlated with worse academic productivity, while immunotherapy is linked to higher productivity.

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

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Ridolo E, Incorvaia C, Pucciarini F, et al.

Clin Mol Allergy. 2022 Aug 10;20(1):9. doi: 10.1186/s12948-022-00176-x.

Allergic rhinitis is caused by pollens and its symptoms include sneezing, nasal congestion, rhinorrhea, nasal itching and airflow obstruction. Allergic rhinitis diagnosis is usually made based on clinical history, skin prick tests and biomarkers measurement of specific IgE, but there is space for precision medicine to provide more accurate diagnostic tools.

The aim of this review was to describe the advances in the treatment of seasonal allergic rhinitis and evaluate the drugs to be used according to the grade of disease and the characteristics of the patients, and the role of allergen immunotherapy.

The experts concluded that treatment of allergic rhinitis includes various agents, depending on the severity of the disease. Allergen immunotherapy has high evidence of demonstrated efficacy demonstrated, and precision medicine is improving a lot the diagnosis of allergic rhinitis. Nevertheless, there is a long-term low adherence to allergen immunotherapy that needs to be resolved in the future.

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

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Bousquet J, Toumi M, Sousa-Pinto B, et al.

J Allergy Clin Immunol Pract . 2022 Aug 4;S2213-2198(22)00749-8. doi: 10.1016/j.jaip.2022.07.020. Online ahead of print.

Allergic rhinitis has a lifetime prevalence of up to 50% in some countries. This constitutes a high burden in social, school and work life. The aim of this report is to demonstrate that Value-Added Medicines such as the use of on-demand (PRN) nasal sprays may be enough to manage allergic rhinitis.

Value-Added Medicines consists of the research of existing medicines for new therapeutic purposes.

Current treatment for allergic rhinitis consists in continuous long-term treatments after clinical trials carried for at least 14 days with over 70% adherence. A new format to treat allergic rhinitis could be using on demand treatments according to symptoms, instead of the continuous treatment.

Real-world data found that 90% of the patients increase their medications to control symptoms during the pollen season, including oral H1-antihistamines, which is not in line with the recommendations.

As most patients who request for a primary care appointment have uncontrolled symptoms, they don’t follow the long-term prescription and self-medicate.

In conclusion, real-life data indicates that patients prefer on-demand treatment instead of continuous and this should be reflected in the upcoming orientations: individualized treatment according to symptom profile, severity, and duration, along with the patient’s preference for oral or intranasal administration.

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Update on pathomechanisms and treatments in allergic rhinitis

By Selected articles

Zhang Y, Lan F, Zhang L

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

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

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

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

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Mechanism of Lower Airway Hyperresponsiveness Induced by Allergic Rhinitis Yiting Liu

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Liu Y, Sha J, Meng C, Zhu D

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

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

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

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

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

By Artículos seleccionados, Selected articles

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

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

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

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

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

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

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

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Kim HJ, Kim JH, Han S, Kim W

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

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

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

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

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

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Comorbid allergic rhinitis and asthma: important clinical considerations

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Nappi E, Paoletti G, Malvezzi L, Ferri S, Racca F, Messina MR, Puggioni F, Heffler E, Canonica GW

Expert Rev Clin Immunol. 2022 Jun 19:1-12. doi: 10.1080/1744666X.2022.2089654. Epub ahead of print. PMID: 35695326.

There are several links between asthma and allergic rhinitis in the same patient, although these conditions are frequently underdiagnosed with suboptimal clinical outcomes. The two conditions coexist and share clinical, pathogenic, and pathophysiological mechanisms.

The aim of this article was to review the major links between the mechanisms of allergic rhinitis and asthma, as well as their treatment according to existing guidelines, focusing on treatment of allergic rhinitis in patients with comorbid asthma.

The authors concluded there are some unmet needs for patients with asthma and allergic rhinitis. Not all allergic rhinitis patients are screened for asthma. This screening should be conducted with a multidisciplinary approach to characterize the journey of patients with respiratory allergies to subsequently refer adequately to Allergy/Asthma centers. There may be advantages in treatment with allergen immunotherapy and/or biosimilars, which might represent encouraging advances in the management of both conditions.

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The Impact of Bilastine on Symptoms of Allergic Rhinitis and Chronic Urticaria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

By Articles about Bilastine, Publicaciones sobre Bilastina

Abdelshafy AM, Abdallah SY, Hassan AF, Mohamed HA, Kamal NM, Ali ST, Abdelhaleem IA

Am J Rhinol Allergy. 2022 May 20:19458924221097449. doi: 10.1177/19458924221097449. Epub ahead of print. PMID: 35593100

Allergic diseases are immunological reactions with symptoms that may impact quality of life. Bilastine, is a novel oral second-generation H-1 antihistamine, with high selectivity to H1 receptors and with anti-inflammatory properties, however there is not enough evidence regarding the drug efficacy.

The objective of this study was to assess the efficacy and safety of bilastine compared with placebo and other active antihistamines in patients with allergic rhinitis or chronic urticaria.

A literature search was made for randomized controlled trials which assessed bilastine effects on symptomatic hyper histaminic allergic conditions. Data on total symptoms scores (TSS), total nasal symptom scores (TNSS), discomfort associated with these allergic conditions measured by visual analog score (VAS), and quality of life (QoL) for allergic rhinitis and urticaria was collected. Other outcomes such as clinical global impression and safety profiles were reported. The studies were statistically analysed.

The analysis included 9 randomized controlled trials which included 3801 participants. The meta-analysis shown that bilastine was superior to placebo, improving TSS, TNSS, VAS, and QoL in participants with allergic rhinitis or chronic urticaria. Furthermore, bilastine was comparable to other antihistamines such as cetirizine, fexofenadine, and loratadine regarding these outcomes, with a safe and tolerable profile and with no difference in the incidence of adverse events.

In conclusion, bilastine improved TSS in hyper histaminic allergic conditions involving nasal symptoms in allergic rhinitis with a safe and effective manner. It decreased the discomfort associated with the condition resulting in better QoL of the participants.

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Efficacy and Safety of Bilastine in the Treatment of Allergic Rhinitis: A Systematic Review and Meta-analysis

By Articles about Bilastine, Publicaciones sobre Bilastina

Singh Randhawa A, Mohd Noor N, Md Daud MK, Abdullah B

Front Pharmacol. 2022 Jan 10;12:731201. doi: 10.3389/fphar.2021.731201. PMID: 35082662; PMCID: PMC8784885

Rhinitis is an inflammation of the nasal epithelium, leading to rhinorrhoea, nasal blockage, itching and sneezing. Allergic rhinitis is the most common form of rhinitis and occurs following exposure to allergens. Bilastine is one of the non-sedating second generation H1 oral antihistamines for allergic rhinitis. The objective of this study was to review the efficacy and safety of bilastine in treating allergic rhinitis.

This review was made after an electronic literature search of bilastine-related publications of randomized controlled trials comparing bilastine with placebo and standard pharmacotherapy up to March 2021. The included studies had to have description of diagnosis of AR established by clinicians and the outcomes with a minimum of 2 weeks of follow-up period.

The primary outcomes evaluated were total symptom score (TSS), nasal symptom score (NSS) and non-nasal symptom score (NNSS). The secondary outcomes were discomfort due to rhinitis, quality of life (QoL) and adverse events. The risk of bias and quality of evidence for all studies were also taken into consideration.

There were 135 records identified on the literature search after removal of duplicates. Following screening and review, 15 full-text articles were evaluated for eligibility. Five trials involving 3,329 patients met the inclusion criteria.

From the five trials included, bilastine was superior to placebo in improving TSS, NSS, NNSS, rhinitis discomfort score and QoL but demonstrated a comparable efficacy with other oral antihistamines in TSS, NSS, NNS, rhinitis discomfort score and QoL. The only adverse event where bilastine showed difference from placebo was in somnolence, and also with fewer incidence of somnolence compared to cetirizine. The overall quality of evidence ranged from moderate to high quality.

In conclusion, bilastine is safe and effective in the treatment of overall symptoms of allergic rhinitis with comparable efficacy and safety with other antihistamines except somnolence: while bilastine has a comparable efficacy to cetirizine, somnolence is notably fewer in bilastine.

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Intralymphatic immunotherapy with one or two allergens renders similar clinical response in patients with allergic rhinitis due to birch and grass pollen

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Ahlbeck L, Ahlberg E, Björkander J, Aldén C, Papapavlou G, Palmberg L, Nyström U, Retsas P, Nordenfelt P, Togö T, Johansen P, Rolander B, Duchén K, Jenmalm MC

Clin Exp Allergy. 2022 Jun;52(6):747-759. doi: 10.1111/cea.14138. Epub 2022 Apr 1. PMID: 35332591

Nearly 1/3 of the adult population of Sweden report allergic rhinitis. Although the prevalence of allergic sensitization is up to nearly half of the patients, there is a gap for a fast, efficient, and safe way to stimulate tolerance in patients with severe allergic rhinitis.

The aim of this study was to assess the safety and efficacy after intralymphatic immunotherapy with one or two allergens: birch- or grass pollen or both and to determine its immune modulatory effects including changes in spontaneous and allergen-induced cytokine and chemokine production, and proportions of T helper cell subsets in circulation.

People with severe birch and timothy allergy were randomized and received three doses of 0.1 ml of birch and 5-grass allergen extracts (10,000 SQ units/ml), or birch and placebo or 5-grass and placebo by ultrasound-guided injections into inguinal lymph nodes at monthly intervals. Characteristics reported before treatment and after each birch and grass pollen season included: rhinoconjunctivitis total symptom score, medication score and rhinoconjunctivitis quality of life questionnaire and circulating proportions of T helper subsets and allergen-induced cytokine and chemokine production (analysed by flow cytometry and Luminex).

After treatment with one or two allergens, the three groups related less symptoms, littler use of medication and better quality of life during the birch and grass pollen seasons, at an approximate rate. The most common adverse event reported was mild local pain. IgE levels to birch decreased, whereas birch-induced IL-10 secretion increased in all three groups. IgG4 levels to birch and timothy and skin prick test reactivity persisted mainly unaffected. Conjunctival challenge tests with timothy extract indicated a superior threshold for allergen. In all three groups, regulatory T cell frequencies were augmented 3 years after treatment.

In conclusion, intralymphatic immunotherapy with one or two allergens in people with grass and birch pollen allergy was effective and safe and may be associated with other immune modulatory responses.

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Impact of Allergic Rhinitis and Asthma on COVID-19 Infection, Hospitalization and Mortality

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Jianjun Ren, et al.

J Allergy Clin Immunol Pract . 2021 Oct 30;S2213-2198(21)01202-2. doi: 10.1016/j.jaip.2021.10.049. Online ahead of print.

The COVID-19 pandemic has impacted worldwide health. Underlying diseases have been shown to affect the prevalence and outcomes of COVID-19. Allergic rhinitis and asthma can increase the susceptibility and severity of COVID-19, but it is not known to which extension. This study aimed to study the role of allergic rhinitis and/or asthma in COVID-19 infection, severity, and mortality and evaluate whether its long-term medication can affect COVID-19 outcomes.

A total of 70,557 persons who had a SARS-CoV-2 test between March 16 and December 31, 2020, in the UK Biobank were analyzed. The rate of COVID-19 infection, hospitalization, and mortality concerning existing allergic rhinitis and/or asthma were statistically analyzed, together with the impact of long-term medications and the risk of hospitalization and death due to COVID-19 infection.

People with allergic rhinitis had lower positive rates of SARS-CoV-2 tests (RR:0.75; 95%CI, 0.69-0.81, p<0.001), with men having a lower susceptibility (RR:0.74; 95%CI, 0.65-0.85, p<0.001) than women (RR:0.8; 95%CI, 0.72-0.9, p<0.001). People with asthma had comparable results if they were <65 years-old (RR:0.93; 95%CI, 0.86-1, p=0.044). People with asthma who tested positive for SARS-CoV-2 had a higher risk of hospitalization (RR:1.42; 95%CI, 1.32-1.54, p<0.001). COVID-19 mortality was not impacted by allergic rhinitis or asthma. There was no relation between COVID-19 infection and severity and conventional medications for allergic rhinitis and/or asthma.

In conclusion, allergic rhinitis and asthma (<65 years old) may be a protective factor against COVID-19 infection, with asthma increasing the risk of hospitalization.

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Particulate Matter Exposure and Allergic Rhinitis: The Role of Plasmatic Extracellular Vesicles and Bacterial Nasal Microbiome

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Jacopo Mariani, Simona Iodice, Laura Cantone, Giulia Solazzo, Paolo Marraccini, Emanuele Conforti, Pallav A. Bulsara, Maria Stella Lombardi, Robert P. Howlin, Valentina Bollati and Luca Ferrari

Int J Environ Res Public Health. 2021 Oct 12;18(20):10689. doi: 10.3390/ijerph182010689.

Particulate matter (PM) exposure is known to worsen respiratory conditions, namely allergic rhinitis. Allergic rhinitis prevalence is rising, affecting the quality of life. The objective of this study was to investigate the molecular mechanisms beneath the triggering of nasal and systemic inflammation by particulate matter, specifically the release of plasmatic extracellular vesicles and the relation between the host and nasal microbiome.

The study included 26 participants with allergic rhinitis and 24 matched healthy participants, whose reaction to PM10 and PM25 exposure was assessed on the bacteria-derived-extracellular vesicles portion (bEV) and the host-derived-extracellular vesicles (hEV), and also on the bacterial nasal microbiome (bNM). The function of bNM as a modifier of PM effects on the extracellular vesicles signaling network in the context of allergic rhinitis was also evaluated.

This study has shown an association between particulate matter exposure in participants with allergic rhinitis, both in the context of bNM composition and plasmatic extracellular vesicles release, affecting in different ways the release of extracellular vesicles and the composition of bNM. More studies are needed to better understand the link between particulate matter exposure and bNM modulation and plasmatic extracellular vesicles release and characterize the different responses observed in participants after particulate matter exposure.

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Metabolomics Reveals Process of Allergic Rhinitis Patients with Single- and Double-Species Mite Subcutaneous Immunotherapy

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Zheng, P., Yan, G., Zhang, Y., Huang, H., Luo, W., Xue, M., Li, N., Wu, J. L., & Sun, B.

Metabolites . 2021 Sep 9;11(9):613. doi: 10.3390/metabo11090613.

Allergic rhinitis is also known as anaphylactic rhinitis and includes infectious inflammatory conditions of the nasal mucosa triggered by exposure to atopic allergens. House dust mites are the most common allergens in patients with rhinitis. Allergen immunotherapy (AIT) is the only treatment that can change the course of allergic rhinitis, but there is a lack of knowledge in relation to AIT with single or mixed allergens. The aim of this study was to assess and compare the clinical efficacy of single-mite subcutaneous immunotherapy or double-mite subcutaneous immunotherapy using the visual analogue scale (VAS) score and rhinoconjunctivitis quality of life questionnaire score to evaluate and compare its clinical efficacy.

Patients with allergic rhinitis caused by Dermatophagoides pternussinus and Dermatophagoides farinae received a single-mite and double-mite subcutaneous immunotherapy, respectively.

There was no significant difference in efficacy between treatments. A total of 57 metabolites were identified, among which down-stream metabolites (5(S)-HETE (Hydroxyeicosatetraenoic acid), 8(S)-HETE, 11(S)-HETE, 15(S)-HETE and 11-hydro TXB2) in the ω-6-related arachidonic acid and linoleic acid pathway showed significant differences after approximately one year of treatment with single-mite or double-mite subcutaneous immunotherapy, and the changes of the above serum metabolic components were correlated with the magnitude of rhinoconjunctivitis quality of life questionnaire improvement, respectively.

The major difference found was with 11(S)-HETE, which decreased more with single-mite immunotherapy, having the possibility to be used as a biomarker to distinguish the two treatments.

In conclusion, both treatments showed therapeutic effects on patients with allergic rhinitis, with no differences in efficacy. The production of different inflammation-related metabolites can lead to potential biomarkers.

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The effect of face mask usage on the allergic rhinitis symptoms in patients with pollen allergy during the covid-19 pandemic

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Mengi E, Kara CO, Alptürk U, Topuz B

Am J Otolaryngol . 2021 Sep 10;43(1):103206. doi: 10.1016/j.amjoto.2021.103206. Online ahead of print.

Allergic rhinitis is an inflammation of the nasal mucosa mediated by IgE. It is characterized by nasal discharge, nasal obstruction, nasal itching, and sneezing. Allergic rhinitis prevalence has been increasing worldwide and it is believed that it affects up to 40% of the population. The objective of this study was to assess the use of face masks on allergic rhinitis symptomatology in people allergic to pollen and who were using face masks during the COVID-19 pandemic.

A total of 50 participants answered over the telephone a 15-item questionnaire which was developed by a team of allergic rhinitis experts. Participants were selected from those who had had allergy tests between 2013 and 2019.

The mean age of the participants was 34.34±9.41 years old and 60% were female. The number of participants who defined their nasal symptoms as severe-moderate in the pre-pandemic was higher (46 participants) than the number of participants with severe-moderate symptoms during the pandemic (28 participants). Patients who used mask had a statistically significant decrease in nasal and ocular symptoms (p<0,001), in sneezing (p=0,029) and nasal discharge (p=0,039).

In conclusion, the use of face mask reduced allergic rhinitis symptoms in people with pollen allergy, which supports the use of face masks for people with allergic rhinitis.

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