Allergic Rhinitis And Its Impact On Asthma Classification Research Articles

Asthma is associated with increased severity and duration of rhinitis: A study with the Allergic Rhinitis and its Impact on Asthma classes in the Constances cohort.

Few population-based studies have described allergic rhinitis (AR) according to the Allergic Rhinitis and its Impact on Asthma (ARIA) classification, and none have assessed the impact of asthma on this classification. Our aims were to 1) describe AR according to four ARIA classes and 2) within each of the four ARIA classes, compare participants with AR alone versus those with AR and asthma. Cross-sectional analyses were performed using data from the 2014 annual follow-up questionnaire of the French adult population-based cohort Constances. Current AR was defined by the report of sneezing, runny, or blocked nose in the last 12months and the report of nasal allergies. Following ARIA recommendations, rhinitis was classified according to its severity (mild or moderate-severe) and duration (intermittent or persistent). Ever asthma was also defined by a questionnaire. Among the 4675 participants with AR (57% women, mean age 50.2±12.7years), 44% were classified as mild/intermittent, 16% mild/persistent, 25% moderate-severe/intermittent, and 15% moderate-severe/persistent. Within each of the four ARIA classes, compared to participants with rhinitis alone, participants with rhinitis and asthma had significantly more severe symptoms, more conjunctivitis, a higher mean eosinophil count and more treatments with intra-nasal corticosteroids and oral antihistamines co-medication. This is a paradigm shift study as for the first time this large population-based study in adults showed that asthma status has a profound effect on the ARIA classification. Rhinitis alone and rhinitis with asthma represent two distinct phenotypes. These results reinforce the need to include asthma status in the ARIA classification and guidelines.

Risk Factors and Comorbidities Associated With the Allergic Rhinitis Phenotype in Children According to the ARIA Classification.

PurposeData are lacking on the association between the allergic rhinitis (AR) phenotype and sensitization to specific allergens or bronchial hyperresponsiveness (BHR) in children. We here investigated risk factors and comorbidities, including sensitization to specific allergens and BHR, for the AR phenotype by AR and its Impact on Asthma (ARIA) classification in a general population-based birth cohort study.MethodsWe enrolled 606 children aged 7 years from the Panel Study of Korean Children. The AR phenotype was assigned in accordance with the ARIA classification in children. Skin prick tests and Provocholine provocation test were performed. Risk factors and comorbidities for AR phenotypes were then analyzed.ResultsThe prevalence of mild and moderate to severe AR in our study cohort was 37.2% and 8.8%, respectively. Recent use of analgesics or antipyretics and current cat ownership were associated with the risk of mild persistent AR. Sensitizations to Dermatophagoides Pteronyssinus (Der p), Japanese hop and cat were associated with moderate to severe persistent AR. Children with moderate to severe AR had a higher risk of current asthma and BHR compared to mild AR cases (adjusted odds ratio [aOR], 5.26; 95% confidence interval [CI], 1.77–15.62). Moderate to severe AR with allergic sensitization was associated with the highest risk of BHR (aOR, 11.77; 95% CI, 3.40–40.74).ConclusionsModerate to severe-persistent AR is more closely related to respiratory comorbidities and sensitizations than mild AR. Stratifying the AR phenotype by ARIA classification may assist in disease management.

Comparison of exhaled nitric oxide levels in pediatric patients with allergic rhinitis

ObjectiveTo determine whether the measurement of exhaled nitric oxide (eNO) can help distinguish children with allergic rhinitis (AR) from healthy controls and whether eNO in children with AR correlates with disease severity. MethodsFrom August 2015 to 2016, children aged 5–15 years of age grouped into those with allergic rhinitis (n = 40) and those classified as healthy control subjects (n = 40) had exhaled nitric oxide (eNO) levels measured. The eNO level was additionally compared to the patient's clinical disease severity according to the ARIA (Allergic Rhinitis and its Impact on Asthma) classification. ResultsMean eNO in children with AR (12.64 ± 14.67 ppb) was significantly higher than that in the healthy control group (7.00 ± 6.33 ppb) (p-value = 0.046). In the persistent AR group (17.11 ± 18.40 ppb), eNO level was significantly higher than individuals in the intermittent AR group (8.59 ± 8.88 ppb, p-value = 0.024) and the healthy control group (7.00 ± 6.33 ppb, p-value = 0.008). Among children with AR, eNo was not significantly different with relationship to gender, age, weight and passive smoking exposure. ConclusionsExhaled nitric oxide may be elevated in children with AR that do not have concomitant asthma. This suggests exhaled nitric oxide may show utility as a parameter to monitor the severity of allergic rhinitis and to monitor the efficacy of the treatment. Physicians should consider comorbid AR when utilizing exhaled nitric oxide as a monitoring parameter in the treatment of asthma.

Allergen-specific immunoglobulin E and allergic rhinitis severity.

Background:Allergic rhinitis (AR) is a common disorder. The diagnosis is based on the concordance between allergy sensitization and history. Serum allergen specific immunoglobulin E (sIgE) assessment allows characterization of the relevant sensitizing allergens. Presently, Allergic Rhinitis and its Impact on Asthma (ARIA) classification subdivides AR based on symptoms severity and duration. However, the relationship between sIgE levels and symptom severity is still a matter of debate.Objective:Therefore, this study aimed at relating sIgE levels with symptom severity assessed by ARIA classification in a group of patients with AR.Methods:We enrolled 217 patients with AR (123 women; median age, 39.5 years). The sIgE levels (expressed in kUA/L) to house-dust mite were detected by the fluorescence enzyme immunoassay in peripheral blood samples. The IgE calibrators were traceable to the second international reference preparation 75/502 of human serum IgE from the World Health Organization. Symptom severity was assessed by ARIA classification.Results:We found a significant difference in sIgE levels in patients with mild intermittent versus mild persistent symptoms (p < 0.05), mild intermittent versus moderate-to-severe persistent symptoms (p < 0.001), moderate-to-severe intermittent versus moderate-to-severe persistent symptoms (p < 0.01), and mild persistent versus moderate-to-severe persistent symptoms (p < 0.05).Conclusion:Analysis of these findings indicated that the sIgE level to house-dust mite might be a reliable biomarker for symptom severity in patients with AR. This outcome might be clinically relevant, particularly in candidates for immunotherapy.

Effectiveness of Allergic Rhinitis Management Related to WHO Guideline on Allergic Rhinitis and Its Impact on Asthma (ARIA)

Background : The standard procedure of Allergic Rhinitis (AR) Management in Indonesia is based on Allergic Rhinitis and Its Impact on Asthma (ARIA) World Health Organization (WHO) 2008 guideline; however, it needs some adjustment to get an effective use locally in Indonesia. The data related to the problem however did not exist in Indonesia. The study aimed to evaluate the effectiveness of AR patient management based on the ARIA WHO guideline in the Department of Otorhinolaryngology-Head and Neck Surgery Dr. Hasan Sadikin General Hospital Bandung. Methods : The study was conducted from September to October 2015 using quantitative descriptive design to observe the development of ARIA classification, total nasal symptom score (TNSS), and quality of life (QoL) during the first 6 months of therapy. The data were obtained from medical records of AR patients who visited the Rhinology-Allergy clinic Department of Otorhinolaryngology-Head and Neck Surgery Dr. Hasan Sadikin General Hospital within one year. Thirty three patients were included in the study using total sampling. Results : There was significant improvement (p<0.001) in ARIA classification, TNSS, and QoL between the initiation of therapy, the third, and the sixth month. In contrary, there was no significant difference in ARIA classification (p=0.109), TNSS (p=0.317), and QoL (p=1.000) between the third and the sixth month of therapy. Conclusions : Allergic rhinitis patient management based on the 2008 ARIA WHO guideline is effective. [ AMJ .2016;3(4):538–44] Keywords: Allergic rhinitis, asthma, effectiveness, management DOI: 10.15850/amj.v3n4.651

Relationship Between Allergic Rhinitis and Mental Health in the General Korean Adult Population.

PurposeThis study was conducted to evaluate the association between AR and mental health status in the general Korean adult population and to investigate the relative burden of AR on mental health using the Allergic Rhinitis and Its Impact on Asthma (ARIA) classification.MethodsA cross-sectional study was performed by using data from 11,154 individuals, 19 years old or older in the Korean National Health and Nutrition Examination Survey 2011-2012. Univariate analysis was conducted in the healthy AR groups with weighted prevalence of demographic characteristics, socioeconomic status, and comorbid diseases. Subanalysis that classified AR severity according to the ARIA classification was carried out to evaluate the relationship of AR severity with mental health. The odds ratios (ORs) for each component representing mental health status were estimated by multiple logistic regression analysis with confounder adjustment.ResultsUnivariate analysis with the chi-square test after adjustment for age, sex, body mass index, smoking status, alcohol use status, and exercise status, components representing mental health status showed a linear relationship with the severity of AR according to the ARIA classification. Stress, depressive mood, suicidal thoughts, and psychological consultation factors were correlated with AR after adjustment for demographic characteristics and socioeconomic status. Even after adjustment for comorbid allergic diseases, the correlation remained significant with stress, depressive mood, and psychological consultation factors (OR [95% CI]; 1.227 [1.042, 1.445], 1.368 [1.095, 1.71], 1.804 [1.096, 2.969], respectively).ConclusionsPatients with AR appear to be at higher risk of mental disorders in the general Korean adult population. Moreover, persistent or severe AR was correlated with poor mental health. Therefore, better control of AR may be conducive to better mental health, and more attention should be paid to the psychological status of AR patients.

Rinitis alérgica en pacientes asmáticos

Allergic rhinitis and bronchial asthma are airways chronic inflammatory processes, with a correlation of 28-78%. To determine the prevalence and classification of allergic rhinitis on asthmatic patients, according to the workshop Allergic Rhinitis and its Impact on Asthma (ARIA), and to assess the total serum concentrations of IgE and the presence of nasal and blood eosinophilia. A study was done with asthmatic patients ages 7 to 14, attending the Pediatric Service at the Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Estado Zulia, Venezuela. Subjects were polled for signs and symptoms suggesting allergic rhinitis and its impact on quality of life. Blood and nasal swab samples were taken to perform laboratory tests in study. There were 60 asthmatic patients, 73.3% males and 70% scholar age patients. The prevalence of allergic rhinitis was 93.3%, according to ARIA classification. Mild intermittent group was the most frequent type, with 42.8% the most frequent clinic sign was the allergic shiners (86.6%), and the predominant symptom was the nasal aqueous trickle (83.3%), while sleep disorders were the most common affection of quality of life (39.2%). In 85.7% of patients eosinophil percentage was higher than 3%, whereas in 75% total serum IgE values were higher than 100 Ul/mL. In patients with rhinitis, 61.9% of the nasal mucus showed altered eosinophils percentage higher than 10%. A high prevalence of allergic rhinitis is present in asthmatic patients, confirmed by laboratory tests, which proves an inflammatory response mediated by IgE.

5-grass pollen tablets achieve disease control in patients with seasonal allergic rhinitis unresponsive to drugs: a real-life study

BackgroundAn important subpopulation in allergic rhinitis is represented by patients with severe form of disease that is not responsive to drug treatment. It has been reported that grass pollen subcutaneous immunotherapy is effective in drug-resistant patients. In a real-life study, we evaluated the efficacy of 5-grass pollen tablets in patients with grass pollen-induced allergic rhinitis not responsive to drug therapy.MethodsWe carried out this multicenter observational study in adults and adolescents with grass-induced allergic rhinitis not responsive to drug therapy who were treated for a year with 5-grass pollen tablets. Clinical data collected before and after sublingual immunotherapy (SLIT) included Allergic Rhinitis and its Impact on Asthma (ARIA) classification of allergic rhinitis, response to therapy, and patient satisfaction.ResultsForty-seven patients entered the study. By ARIA classification, three patients had moderate to severe intermittent allergic rhinitis, ten had mild persistent allergic rhinitis, and 34 had moderate to severe persistent allergic rhinitis. There were no cases of mild intermittent allergic rhinitis before SLIT. After SLIT, 33 patients had mild intermittent allergic rhinitis, none had moderate to severe intermittent allergic rhinitis, seven had mild persistent allergic rhinitis, and seven had moderate to severe persistent allergic rhinitis. The mean medication score decreased from 4.2±1.3 before to 2.4±2.0 after SLIT (P<0.01), representing a reduction of 42%. The response to treatment before SLIT was judged as poor by 70% of patients and very poor by 30%. Patient satisfaction was significantly increased after SLIT (P<0.01).ConclusionIn real life, most patients with grass pollen-induced allergic rhinitis not responsive to drug treatment can achieve control of the condition with one season of treatment using 5-grass pollen tablets.

Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study

Information on rhinitis epidemiology in preschool children is scarce. To estimate, in children with 3-5years of age, current rhinitis prevalence, to describe rhinitis symptoms and associated sociodemographic characteristics, and to report allergic rhinitis and its impact on asthma (ARIA) classification. Cross-sectional, nationwide, population-based study including children aged 3-5years. A multistep selection strategy was used to obtain a representative sample. Data were collected at kindergartens and parish centers by face-to-face interview to caregivers, using an adapted ISAAC questionnaire. 'Current rhinitis' (CR) was defined as the presence of ≥1 rhinitis symptom (repeated sneezing and/or itchy nose, blocked nose for >1h, or runny nose without having a cold/flu) in the last year. Rhinitis lasting ≥4days/week and ≥4 consecutive weeks was classified as persistent. Moderate-severe disease interfered 'a moderate amount' or 'a lot' in daily activities. Five thousand and eighteen children were included. CR prevalence was 43.4% [95% CI (42.0-44.8%); n=2179] and that of physician-diagnosed rhinitis was 11.7% [95% CI (10.8-12.6%); n=588]. Of children with CR, 67% reported blocked nose, 48% rhinorrhea, and 46% sneezing/itchy nose. Considering ARIA classification, 30% of the population had mild intermittent, 3% mild persistent, 7% moderate-severe intermittent, and 3% moderate-severe persistent rhinitis. Children with CR had more current wheezing, physician-diagnosed asthma, self-reported food allergy, and family history of allergic disease. These characteristics were also associated with persistent and moderate-severe rhinitis. This is the first nationwide population-based study reporting rhinitis prevalence and ARIA classification in preschool children. In this age-group, rhinitis is frequent and underdiagnosed. About 25% children with rhinitis presented moderate-severe disease.

Ingestion of honey improves the symptoms of allergic rhinitis: evidence from a randomized placebo-controlled trial in the East Coast of Peninsular Malaysia

BACKGROUND AND OBJECTIVESThe role of honey in the treatment of allergic rhinitis (AR) is controversial. We studied the complementary effect of ingestion of a high dose of honey, in addition to standard medications, on AR.DESIGN AND SETTINGSProspective randomized placebo-controlled study. Subjects were recruited from an otolaryngology clinic in 2 tertiary referral centers in the East coast of Peninsular Malaysia. The study period ranged from April 2010-April 2011.METHODSForty AR patients were divided equally into a case group and a control group. All the subjects received a daily dose of 10 mg of loratadine for 4 weeks. The case group ingested 1 g/kg body weight of honey daily in separate doses for the 4-week period. The control group ingested the same dose of honey-flavored corn syrup as placebo. AR symptoms were scored at the start, week 4, and week 8 of the study.RESULTSThere were no significant differences between the mean total symptom score of the case and the control groups at the start of the study. At week 4, both groups showed progressive improvement in the symptoms; at week 8, only the case group showed a continuous improvement in the symptom score. Only the group that ingested honey showed a significant improvement in individual AR symptoms. The improvement persisted for a month after the cessation of the treatment.CONCLUSIONHoney ingestion at a high dose improves the overall and individual symptoms of AR, and it could serve as a complementary therapy for AR.

Classification of Allergic Rhinitis: What is Most Suitable in Korea?

Classification of Allergic Rhinitis: What is Most Suitable in Korea?

Assessment of disease control in allergic rhinitis

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative has had a significant impact, by raising awareness of allergic rhinitis (AR) and improving the diagnosis and treatment of AR sufferers. ARIA classifies the severity of AR as "mild" or "moderate/severe" on the basis of "yes"/"no" answers to four questions. This two-point classification has been criticized as providing little guidance on patient management; patients with "mild" AR are unlikely to consult a physician, whereas the group of patients with "moderate/severe" seen by specialists is heterogeneous. These perceived shortcomings have prompted attempts to improve the ARIA classification or, by analogy with the Global Initiative for Asthma (GINA), adopt approaches based on "disease control" in AR. Even though "disease severity", "disease control" and "responsiveness to treatment" are different (albeit related) metrics, they are not mutually exclusive. Currently, there is no single, accepted definition, but we propose that "disease control" in AR can combine (i) measurements of the severity and/or frequency of daily or nocturnal symptoms, (ii) impairments in social, physical, professional and educational activities, (iii) respiratory function monitoring and (iv) exacerbations (e.g. unscheduled medical consultations and rescue medication use). Although control-based classifications have a number of limitations (e.g. their dependence on treatment compliance and the patient's psychological status), these instruments could be used as an adjunct to the ARIA severity classification and regional practice parameters. Here, we assess the strengths and weaknesses of the current two-level ARIA classification, analyze published proposals for its modification and review the literature on instruments that measure AR control. We conclude that there is a need for research in which severity is compared with control in terms of their effects on patient management.

Seasonal Specificity of Seasonal Allergens and Validation of the ARIA Classification in Korea

PurposeIn Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification.MethodsTwo hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification.ResultsSeasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications.ConclusionsSeasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.

Validation of the modified allergic rhinitis and its impact on asthma (ARIA) severity classification in allergic rhinitis children: the PEDRIAL study

A modified allergic rhinitis and its impact on asthma (ARIA) (m-ARIA) criterion to classify the severity of allergic rhinitis (AR) has recently been validated in both treated and untreated adult patients; however, such information in children is lacking. The aim of this study was to validate this m-ARIA severity criterion, which allows for discrimination between moderate and severe AR, in a large pediatric patient sample population. The m-ARIA classification categorizes AR severity into mild (no affected items), moderate (1-3 affected items), and severe (all four affected items). We applied this modified criterion to untreated AR pediatric patients aged 6-12years, through an observational, cross-sectional, and multicenter study. AR symptoms were assessed using the Total Four Symptom Score (T4SS), and the severity was evaluated by both ARIA severity items and visual analogue scale (VAS). Allergic rhinitis pediatric patients (N=1269) from 271 centers were included. Among them, 59.5% had intermittent and 40.5% persistent disease; 89.9% had moderate/severe AR using the original ARIA (o-ARIA) classification and 59.5% had moderate, while 30.5% had severe AR using the m-ARIA criterion. Using the m-ARIA, significantly higher T4SS and VAS scores were obtained when comparing severe with moderate AR. The m-ARIA severity classification is a useful clinical tool to discriminate moderate from severe AR among untreated pediatric patients.

Positioning of antihistamines in the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines

SummaryAllergic rhinitis (AR) is a major health problem with high and ever‐increasing prevalence worldwide. At least one‐fifth of adults in industrialized countries are estimated to have AR, defined as nasal and eye symptoms that are sufficiently severe to have a substantial negative impact on the quality of life (QoL). The former classification of AR comprised seasonal AR (SAR) and perennial AR (PAR), which did not adequately reflect the presentation and clinical course of the disease. The Allergic Rhinitis and its Impact on Asthma (ARIA) classification is based on the duration of symptoms and the disease severity. Both intermittent AR (IAR: symptoms ≤ 4 days/week or ≤ 4 consecutive weeks) and persistent AR (PER: symptoms &gt; 4 days/week and &gt; 4 consecutive weeks) may be mild, moderate, or severe based on the QOL impairment (sleep, daily activities/leisure, work productivity/school performance) and bothersome symptoms. Despite its disabling effects, AR remains a condition where affected individuals do not seek appropriate treatment, are undertreated and do not adhere well to treatment, which all lead to low disease control and high societal costs. The four pillars of AR treatment are allergen and pollutant avoidance, patient education, pharmacotherapy and allergen‐specific immunotherapy. Oral antihistamines, together with intranasal corticosteroids and leucotriene antagonists, constitute important pharmacological options for the treatment of AR at all levels of severity. New second‐generation antihistamines are H1‐receptor antagonists with high efficacy (rapid onset of action for AR symptoms, sometimes even on nasal congestion, improvement of QoL and additional anti‐allergic effects) and safety (low sedation rates). Although new antihistamines have been studied and approved for SAR and PAR, only some of them have been reported to show efficacy and safety for treatment of AR under the ARIA classification: levocetirizine (high efficacy) and rupatadine (dual antihistamine and anti‐PAF effects) for PER, and desloratadine (high safety) for both IAR and PER.

The Clinical Stage of Allergic Rhinitis is Correlated to Inflammation as Detected by Nasal Cytology

Allergic rhinitis (AR) is the most common allergic disease. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines classify AR according to its duration and severity and suggest recommended treatments, but there is evidence that these guidelines are insufficiently followed. Considering the validity of histopathological data, physicians are more likely to be persuaded by such information on AR. Thus, we attempted to define the severity of AR by nasal cytology on the basis of the ARIA classification. We examined 64 patients with AR caused by sensitization to grass pollen. We clinically defined AR according to the ARIA classification and performed nasal cytology by Rhino-probe sampling, staining and reading by optical microscopic observation. Clinically, 22 (34.4%), 21 (32.8%), 10 (15.6%), and 11 (17.2%) patients had mild intermittent, moderate-to-severe intermittent, mild persistent, and moderate-to-severe persistent AR, respectively. Nasal cytology detected neutrophils in 49 patients, eosinophils in 41 patients, mast cells in 21 patients, and lymphocytes or plasma cells in 28 patients. The patients with moderate-to-severe AR had significantly more mast cells and lymphocytes/ plasma cells than those with mild AR. Our findings demonstrate that the ARIA classification of AR severity is associated with different cell counts in nasal cytology; especially, moderate-to-severe AR shows significantly increased counts of mast cells and lymphocyte or plasma cells. The ease of performing nasal cytology ensures is feasibility as an office AR diagnostic procedure for primary care physicians, able to indicate when anti-inflammatory treatments, such as intranasal corticosteroids and subcutaneous or sublingual allergen immunotherapy, are needed.

Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in a pediatric population: The PEDRIAL study

Allergic rhinitis (AR) is the commonest chronic disease in children. Allergic Rhinitis and its Impact on Asthma (ARIA) classification based on symptom duration (intermittent vs. persistent) and severity (mild vs. moderate/severe) has not been yet validated in children. Thus our objective was to validate ARIA classification in children, after determining the severity and duration of AR in a pediatric population, using ARIA definitions. Children aged 6-12 with a diagnosis of AR were included in an observational, cross-sectional, multicenter study. Patients were classified according to ARIA guidelines. AR symptoms were assessed using the Total Four Symptoms Score (T4SS). Severity was also evaluated by the patient using a visual analogue scale (VAS). Comparisons were made by means of a statistical analysis. One thousand two hundred and seventy-five children from 271 centers were included. Among them, 59.5% had intermittent and 40.5% persistent AR, while 60.7% seasonal and 39.3% perennial according to dated classification, with significant differences existing between one classification and another; 89.7% had moderate/severe rhinitis. Significantly higher T4SS and VAS scores were obtained in moderate/severe compared to mild AR. In our experience, the current ARIA classification can be considered a valid tool also in children from 6- to 12-yr old.

Efficacy of Desloratadine in Persistent Allergic Rhinitis – A GA2LEN Study

Background: The ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines proposed a classification for allergic rhinitis based on the duration of symptoms (intermittent or persistent) rather than on the time of allergen exposure (seasonal or perennial). There had been no placebo-controlled, randomized, clinical trial of desloratadine (DL) in patients with persistent allergic rhinitis to date. Objectives: To assess the efficacy and safety of DL in patients with persistent allergic rhinitis based on the ARIA classification. Methods: Patients 12 years of age and older with persistent allergic rhinitis were assessed over 85 days of treatment with DL 5 mg once daily (n = 360) or placebo (n = 356). The primary endpoint was the AM/PM reflective total 5-symptom score (T5SS) averaged over days 1–29. Secondary endpoints included AM/PM instantaneous T5SS and individual symptoms, therapeutic response, symptom severity assessed by a visual analogue scale and quality of life. Results: The mean reduction in AM/PM reflective T5SS was significantly greater with DL than placebo over days 1–29 (–3.76 vs. –2.87, p < 0.001) and on each individual day (p < 0.05). The mean AM instantaneous T5SS was significantly reduced with DL compared with placebo as early as day 2 (–1.90 vs. –1.46; p < 0.001). The therapeutic response and improvement in quality of life were significantly greater with DL than placebo (p < 0.001 for each). The frequency of treatment-related adverse events was low and similar between DL (10.0%) and placebo (8.4%). Conclusions: This study showed DL to be effective and safe in the treatment of persistent allergic rhinitis.

Efficacy of desloratadine in intermittent allergic rhinitis: a GA2LEN study

The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines proposed a classification for allergic rhinitis based on the duration of symptoms (intermittent, persistent) rather than on the time of allergen exposure (seasonal, perennial). There is no placebo-controlled, randomized clinical trial on intermittent allergic rhinitis (IAR) to date. Desloratadine (DL) is recommended for the first-line treatment of seasonal and perennial allergic rhinitis. To assess the efficacy and safety of DL in subjects with IAR based on the ARIA classification. Patients over 12 years of age with IAR were assessed over 15 days of treatment with DL 5 mg once daily (n = 276) or placebo (n = 271). The primary endpoint was the AM/PM reflective total 5 symptom score (T5SS). Secondary endpoints included AM/PM instantaneous T5SS and individual symptoms, therapeutic response, symptom severity by visual analogue scale, and quality-of-life. The mean reduction of AM/PM reflective T5SS was significantly greater with DL than with placebo over 15 days (-3.01 vs-2.13, P < 0.001) and on each individual day (P < 0.05). Mean AM instantaneous T5SS was reduced significantly with DL compared to placebo as early as day 2 (-1.84 vs-0.89; P < 0.001). The therapeutic response and improvement in quality-of-life were significantly greater with DL than with placebo (P < 0.001 for each). The frequency of treatment-related adverse events was low and similar between DL (7.2%) and placebo (7.0%). This is the first large trial to show that treatment can be effective in IAR. Desloratadine was effective and safe.

Desloratadine treatment for intermittent and persistent allergic rhinitis: A review

Background: Allergic rhinitis (AR) has a high prevalence and substantial impact on quality of life (QoL). The traditional classification of AR as either seasonal or perennial is being superseded in many countries by the ARIA (Allergic Rhinitis and its Impact on Asthma) definitions, in which the term intermittent AR denotes the presence of symptoms for <4 days a week or <4 weeks, and the term persistent AR denotes the presence of symptoms for >4 days a week for >4 weeks. These definitions, particularly that of persistent AR, may better reflect the true pattern of AR as it is experienced by patients. Desloratadine has been approved by the European Medicines Evaluation Agency for the treatment of intermittent and persistent AR, as defined by the ARIA classification. Objective: The purpose of this review was to assess data concerning desloratadine in relation to the ARIA definitions of intermittent and persistent AR. Methods: Relevant clinical studies and information on treatment guidelines were identified through searches of the English-language literature indexed on MEDLINE through May 2007. Search terms included intermittent AR, persistent AR, seasonal AR, perennial AR, and desloratadine. Results: Desloratadine has been found to be effective and well tolerated in studies in subjects with symptoms of AR analogous to/consistent with the ARIA definitions of intermittent and persistent disease. In a 2-week, randomized, double-blind, placebo-controlled study in subjects with a ≥2-year history of intermittent AR, desloratadine was associated with greater reductions relative to placebo in congestion scores ( P < 0.05) and total symptom scores (TSS) ( P <0.01). In a 4-week, multicenter, randomized, double-blind, placebo-controlled study in subjects with a ≥2-year history of perennial AR, desloratadine had greater efficacy than placebo in terms of reductions in TSS as early as day 2 ( P ≥ 0.02), as well as reductions in nasal and nonnasal symptom scores ( P ≥0.04). A 4-week, randomized, double-blind, placebo-controlled study assessing QoL found that desloratadine improved QoL scores to a greater extent than placebo in subjects with a ≥2-year history of perennial AR ( P = 0.009). Conclusions: According to the ARIA guidelines, second-generation antihistamines are a cornerstone of pharmacologic therapy for AR. Desloratadine is effective in the treatment of AR across all classifications of disease, either seasonal/perennial or intermittent/persistent.