Allergic Rhinitis Control Research Articles

Sleep breathing disorders in adolescents with asthma.

Background. Childhood asthma, a chronic inflammatory disease, is linked to sleep-breathing disorders (SBD). The vulnerability of asthmatic children to SBDs is well-established, yet limited research focuses on adolescents. This study addresses the research gap, exploring the frequency and risk factors of SBD in adolescents with asthma. Methods. A cross-sectional study was conducted among 98 adolescents (12-17 years) with asthma at a Lisbon healthcare facility. Comprehensive assessments, including sociodemographic data, medical history, lung function variables, and validated questionnaires for SBD risk (Pediatric Sleep Questionnaire), rhinitis control, and asthma control (Control of Allergic Rhinitis and Asthma Test and Asthma Control Test), were employed. Results. The study revealed a substantial frequency of SBD symptoms, with 25.5% of adolescents classified as high-risk based on the Pediatric Sleep Questionnaire. Significant associations were identified between high SBD risk and elevated body mass index (BMI), uncontrolled rhinitis, and uncontrolled asthma. Logistic regression analysis confirmed elevated BMI as a robust predictor of SBD risk, indicating a 5.9-fold increase compared to normal-weight counterparts. Conclusions. This study contributes valuable insights into the interplay between asthma and SBD in adolescents. The high prevalence of SBD symptoms, particularly among those with excess weight and uncontrolled respiratory symptoms, underscores the need for targeted preventive strategies. The identified risk factors, notably elevated BMI, provide clinicians with actionable information for intervention, emphasizing the importance of addressing modifiable factors associated with asthma and SBD in this specific population.

Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) Written Allergic Rhinitis Questionnaire for phone survey in children aged 6‒7 years

ObjectiveTo validate and assess the reproducibility of the ISAAC Written Allergic Rhinitis Questionnaire (WARQ) for children aged between 6 and 7 years by telephone contact. MethodsObservational study through interviews with guardians of children aged 6–7 years using the ISAAC Allergic Rhinitis (AR) module questionnaire in three different phases separated by 2 weeks each: telephone interviews in the first and third contacts and face-to-face interviews, with the same guardian of telephone interviews, in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients. ResultsData from 94 children (48 from the allergic rhinitis Control Group ‒ CG) were analyzed. Reproducibility showed perfect agreement (100%) for the question number 1 – Which refers to the symptoms of AR, ever: “Has your child ever had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?” and for the question number 2 – Which refers to current symptoms of AR: “In the past 12 months, has your child had a problem with sneezing or a runny or a blocked nose when he/she did not have a cold or the flu?” A strong agreement was also observed for the question number 3 (κ = 0.871) – it defines the presence of comorbidity of allergic rhinoconjuntivitis “In the past 12 months, has this nose problem been accompanied by itchy-watery eyes?” The validation showed high specificity (≥76.7%) and sensitivity (≥98%) for all questions, except for the ones related to seasonality and intensity of symptoms. ConclusionsOur results showed that the ISAAC AR module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of AR. It may be an appropriate alternative tool in epidemiological studies of childhood AR, especially in periods of social isolation, such as Coronavirus pandemic. Level of evidenceCohort Study. Level IV

Impact of asthma and allergic rhinitis control on sleep disordered breathing in pediatrics

AimThe aim of our study is to assess the quality of sleep in children with asthma and/or allergic rhinitis, as well as the impact of the control of allergic respiratory diseases on sleep disturbances. Materials and methodsIt is an observational cross-sectional study on children attending pediatric allergy appointments at a portuguese tertiary hospital (G1), and compared to a control population (G2). The asthma and rhinitis control was determined using the Control of Allergic Rhinitis and Asthma Test (CARAT/CARATKids) questionnaires. Sleep was evaluated using the Pediatric Sleep Questionnaire (PSQ). G1 included 61 patients and G2 included 100 children. ResultsAbout a third of the children in the study group had sleep-related breathing disorders (SDB), compared to 9 % on the control group (p-value <0.05). There was a significant positive correlation between uncontrolled asthma and allergic rhinitis, and SDB (p-value <0.05). ConclusionSDB is more prevalent among children with asthma and/or allergic rhinitis. The absence of control of the allergic respiratory diseases has a negative impact on sleep. We recommend large cross-sectional studies to better comprehend the exact relationship between the two conditions, as well as the use of objective diagnostic tools. We believe it is essential to implement early screening for sleep disorders in children with allergic respiratory diseases, through validated questionnaires.

Ayurveda Management of Allergic Rhinitis: Protocol for a Randomized Controlled Trial.

Allergic rhinitis (AR) is the inflammation of the membranes lining the nose due to allergen exposure and is characterized by sneezing, nasal congestion, itching of the nose, or postnasal discharge. The prevalence varies worldwide, perhaps due to the geographic and aeroallergen differences, with 10% to 30% of the world's population experiencing AR. In this study, Anu Taila Nasya, Naradiya Laxmivilas Rasa, and Shirishadi Kwath will be compared to a fluticasone nasal spray. The primary aim is to assess the efficacy of Ayurvedic management for AR (or vataja pratishyaya) by comparing it to a conventional control group. The secondary aims are to determine the mean change in the nasal endoscopy index and the mean change in the laboratory tests. This ongoing study is an open-label randomized controlled interventional trial, with a sample size of 90 both in the trial and standard control group (including dropouts, 20%), and will be carried out for 24 months. Participants in the trial group will receive Ayurvedic treatment, that is, Anu Taila Nasya (6 drops in each nostril for 7 days for 3 consecutive weeks), Naradiya Laxmivilas Rasa (250 mg twice per day), and Shirishadi Kwath (40 ml twice per day for 45 days). The participants in the control group will receive a fluticasone propionate nasal spray (2 sprays once per day for 45 days). The primary outcome will include the mean change in the Control of Allergic Rhinitis and Asthma Test score, and the secondary outcomes will include the mean change in the nasal endoscopy index (assessment of nasal membrane color, pale or hyperemia; rhinorrhea, watery or yellow; and inferior turbinate swelling, hypertrophy) and the mean change in the laboratory tests. As of May 2024, 72 patients have been enrolled in both groups. Data analysis should be completed by February 2025. The study will be reported following standard guidelines for reporting randomized controlled trials. Clinical results will be disseminated through conferences and peer-reviewed publication in a relevant journal. The Ayurvedic approach could be an evidence-based therapeutic tactic for the management of AR. Clinical Trials Registry India CTRI/2023/06/053395; https://tinyurl.com/564d2zz8. DERR1-10.2196/56063.

Impact of Allergic Rhinitis Control on Work Productivity and Costs: A Real-World Data MASK-air Study

BackgroundAllergic rhinitis (AR) has a substantial socioeconomic impact associated with impaired work productivity. ObjectiveTo study the impact of AR on work productivity and estimate the corresponding indirect costs for 40 countries. MethodsWe conducted a cross-sectional study using direct patient data from the MASK-air® app on users with self-reported AR. We used the Work Productivity and Activity Impairment Questionnaire: Allergy Specific to measure the impact of AR on work productivity (presenteeism and absenteeism). Weekly indirect costs were estimated per country, for each level of rhinitis control and considering patients with and without asthma. ResultsWe assessed data from 677 weeks (364 patients), 280 of which were reported by patients with asthma. Regarding presenteeism, the median impact of AR in weeks of poor disease control was 60.7% (P25-P75=24.9-74.2%), while partial and good disease control were respectively associated with an impact of 25.0% (P25-P75=12.1-42.4%) and 4.4% (P25-75=0.8-12.9%). In poorly-controlled weeks, presenteeism was associated with indirect costs ranging from 65.7 US Dollars purchase power parity (US$ PPPs) (P25-P75=29.2-143.2) in Brazil to 693.6 US$ PPP (P25-P75=405.2-1094.9) in Iceland. Median absenteeism per week was of 0% for all levels of rhinitis control. Patients with AR+asthma showed higher overall work impairment than patients with AR alone, particularly in poorly-controlled weeks (median work impairment in AR alone=39.1% [P25-P75=12.5-71.9%]; median work impairment in AR+asthma=68.4% [P25-P75=54.6-80.2%]). ConclusionPoor AR control was associated with decreased work productivity and increased indirect costs, particularly in patients with AR+asthma. The estimates from this study underpin the economic burden of AR.

Effect of Cold Temperature on the Severity of Allergic Rhinitis Based on Visual Analog Scale (VAS) Score Among Medical Students of Malikussaleh University

BACKGROUND: Allergic rhinitis is a common condition caused by inflammation of the nasal mucosa after exposure to allergens and is mediated by Immunoglobulin E (IgE). Cold temperatures can aggravate the symptoms of allergic rhinitis. Allergic rhinitis is not fatal, but it can cause a decrease in the patient's quality of life if the symptoms are severe. The severity of allergic rhinitis symptoms is difficult to measure as it should match patient's perception, so VAS is a quantitative measurement tool used. Although VAS is a simple and easy-to-use tool, its use as self-monitoring for AR patients is still infrequent to minimize symptom exacerbations and maintain control of allergic rhinitis. AIMS: This study aims to examine the effect of cold temperature on the severity of allergic rhinitis based on VAS score. METHOD: This research is an experimental with a one-group pretest-posttest study. The study samples involved 75 students suffering from allergic rhinitis assessed with the Score for Allergic Rhinitis (SFAR) questionnaire assessment from the class of 2020, 2021, and 2022. Subjects’ pain level was measured before and after the intervention. The intervention was in the form of cold temperature exposure for 15 minutes in a room with a temperature of 18℃. Data were analyzed using the Wilcoxon test. RESULT: The results showed that the mean VAS score before the intervention was 0 while after the intervention was 38.61 ± 24.07. This shows that the mean VAS score after the intervention is higher than the mean VAS score before the intervention (p-value = 0.00 &lt;0.05). CONCLUSION: The results of this study indicate that the effect of cold temperature can increase the severity of allergic rhinitis.

Features of the formation of early immunological tolerance during immunotherapy with allergens in patients with allergic rhinitis

BACKGROUND: The effectiveness of allergen-specific immunotherapy has been proven in studies. Studying the level and expanded spectrum of Th1, Th2, Treg and Breg cytokines against the background of allergen-specific immunotherapy, as well as allergen-specific IgG4 (asIgG4), is promising, which will clarify the mechanisms of the effectiveness of allergen-specific immunotherapy in patients with allergic rhinitis. AIM: To evaluate the clinical effectiveness of allergen-specific immunotherapy in patients with allergic rhinitis and to identify the most significant biomarkers of the formation of early immunological tolerance. MATERIALS AND METHODS: We examined 30 patients with allergic rhinitis aged 19 to 60 years who received allergen-specific immunotherapy. The clinical effectiveness was assessed using the validated Combined Symptom Medication Score (CSMS). All patients had their serum levels of IL-4, IL-13, IFN-γ, IL-12, IL-10, TGF-β, and asIgG4 of enzyme-linked immunosorbent assay recorded at baseline and 6 months after the start of allergen-specific immunotherapy. RESULTS: Allergen-specific immunotherapy has been demonstrated to be highly clinically effective in achieving control of allergic rhinitis. At baseline, the total CSMS score was 3.75 [3.33; 4.5], at the end of 6 months ― 1.83 [1.17; 2.67] (p=0.000002). When analyzing the dynamics of the cytokine profile and asIgG4, an increasing in the level of TGF-β (p=0.000002), IL-12 (p=0.000002) and asIgG4 (p=0.000003) was revealed, as well as a decreasing in the level of IL-4 (p=0.000024) 6 months after the start of allergen-specific immunotherapy. We did not register an increase in IFN-γ and the expected increase in IL-10 and decrease of IL-13. The correlation and principal component analysis showed that the clinical effect of allergen-specific immunotherapy was associated with an increase in TGF-β and IL-12, a moderate increase in asIgG4 with a decrease of IL-4. CONCLUSION: The results demonstrate the high clinical effectiveness of allergen-specific immunotherapy within 6 months from the moment of its initiation. Significant marker of the effectiveness of allergen-specific immunotherapy at the stage of early tolerance formation is TGF-β, which increasement was in correlation with an increased IL-12 with a decrease of IL-4. The increase in asIgG4 is less pronounced. The conducted correlation and principal component analysis showed the relationship of the discussed biomarkers with the CSMS, which may indicate in favor of their choice as potential biomarkers for assessing the effectiveness of allergen-specific immunotherapy.

Clinical Effect Analysis of Fire-needle Acupuncture at Neiyingxiang Treating Persistent Allergic Rhinitis.

We conducted the first trial to evaluate the effect that fire-needle acupuncture at Neiyingxiang (ExHN 9) in patients with moderate to severe persistent AR. This was a randomized, single-center, sham, and placebo-controlled rial. Patients were kept blinded to their group assignment. All participants were equally assigned to the fire-needle acupuncture (FA) treatment group, sham fire-needle acupuncture (SFA) group, or loratadine group. The trial was designed with an acupuncture intervention once a week for 4 weeks and follow-up 4 weeks. The Total Nasal Symptom Scores (TNSS), Total Non-Nasal Symptom Scores (TNNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Allergic Rhinitis Control Test (ARCT), and total nasal resistance of 150 Pa were evaluated as outcome measures. A total of 180 participants were enrolled, and 175 participants completed the trials. At 2 and 4 weeks, the TNSS, TNNSS, and RQLQ scores of the FA and loratadine groups were significantly lower than those of the SFA group. At 8 weeks, the scores of loratadine group increased compared with the FA group (Cohen's d >0.80, p < 0.01). The ACRT score of the FA treatment group rose gradually. After treatment, the total nasal resistance of the FA group was significantly decreased and was lower than that of the other two groups (Cohen's d >0.80, p < 0.01). Fire-needle acupuncture at Neiyingxiang (ExHN 9) is effective for improving nasal allergy symptoms and quality of life in patients with moderate and severe persistent AR, and the duration of its effects is long. 2 Laryngoscope, 134:4471-4479, 2024.

Relevance of individual bronchial symptoms for asthma diagnosis and control in patients with rhinitis: A MASK-air study.

It is unclear how each individual asthma symptom is associated with asthma diagnosis or control. To assess the performance of individual asthma symptoms in the identification of patients with asthma and their association with asthma control. In this cross-sectional study, we assessed real-world data using the MASK-air® app. We compared the frequency of occurrence of five asthma symptoms (dyspnea, wheezing, chest tightness, fatigue and night symptoms, as assessed by the Control of Allergic Rhinitis and Asthma Test [CARAT] questionnaire) in patients with probable, possible or no current asthma. We calculated the sensitivity, specificity and predictive values of each symptom, and assessed the association between each symptom and asthma control (measured using the e-DASTHMA score). Results were validated in a sample of patients with a physician-established diagnosis of asthma. We included 951 patients (2153 CARAT assessments), with 468 having probable asthma, 166 possible asthma and 317 no evidence of asthma. Wheezing displayed the highest specificity (90.5%) and positive predictive value (90.8%). In patients with probable asthma, dyspnea and chest tightness were more strongly associated with asthma control than other symptoms. Dyspnea was the symptom with the highest sensitivity (76.1%) and the one consistently associated with the control of asthma as assessed by e-DASTHMA. Consistent results were observed when assessing patients with a physician-made diagnosis of asthma. Wheezing and chest tightness were the asthma symptoms with the highest specificity for asthma diagnosis, while dyspnea displayed the highest sensitivity and strongest association with asthma control.

The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study.

Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication-specifically, short-acting beta2-agonist (SABA) overuse-is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. The initial findings regarding the app's feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices.

House dust mite sublingual allergen immunotherapy tablet is safe and well-tolerated in Dutch clinical practice.

Half (49%) of clinically diagnosed allergic rhinitis (AR) patients are sensitized to house dust mite (HDM). If allergen avoidance and symptomatic medication fail, allergen immunotherapy may be indicated. We investigated safety and tolerability of HDM-sublingual immunotherapy by HDM-SLIT tablets in Dutch daily clinical practice. Daily intake of 12 SQ-HDM SLIT-tablet was investigated in a prospective, multicenter, observational study (EUPAS43753). It comprised 4 consultations in 1 year. Data on safety, tolerability, treatment satisfaction, symptomatic medication, compliance, and clinical effectiveness (Control of Allergic Rhinitis and Asthma Test; CARAT) were collected. Descriptive and longitudinal regression data analysis were performed. Adult patients (n = 415), mean (SD) age 36.6 (12.2) years, 61.4% female and 36% asthmatic were included. The preponderance (65.1%) experienced adverse events (AEs). These, mostly mild (67%), AEs comprised: oral allergic reactions (58.6%), respiratory (12.4%) and gastrointestinal symptoms (9.4%). Sixty (14.5%) patients stopped due to AEs and 76 (18.3%) for non-AE reasons. CARAT scores improved clinically significant by 6 points and symptomatic medication use decreased from 96.1% to 77.4%. Most patients (74.5%) tolerated the treatment and were compliant (>86.5%). The majority of patients (62.4%) and investigators (69.4%) were satisfied with treatment. HDM SLIT-tablet is a safe and well-tolerated AR treatment. AEs occur often but are mostly mild and decreasing during the first year. CARAT scores improved and symptomatic medication use decreased suggesting better control of AR with treatment. Compliance, tolerability, and treatment satisfaction are good. However, patient follow-up and compliance remain important points of attention when initiating treatment.

The impact of allergic rhinitis on bronchial asthma: What therapy?

Childhood asthma constitutes a significant healthcare burden due to its chronic nature and prevalence, affecting approximately 5–10 % of the pediatric population. Asthma is often heterogeneous and characterized by chronic airway inflammation. It is classified into two main phenotypes based on airway inflammation: T2-high (eosinophilic) and T2-low (neutrophilic/pauci-granulocytic) phenotype. Allergic sensitization is commonly associated with T2-high asthma, involving T helper 2 and innate immunity cells and type 2-associated cytokines, including interleuikin-4 (IL-4), IL-5, and IL-13. Type 2 inflammation is characterized by eosinophilic infiltrate. Asthma and allergic rhinitis share common mechanisms, and their association, known as united airways disease, highlights the close interconnection between upper and lower airways. Effective allergic rhinitis control positively impacts asthma, emphasizing the importance of early identification and personalized therapeutic strategies. One is allergen immunotherapy, a disease-modifying approach demonstrating preventive and therapeutic efficacy in children. However, more research is needed to optimize pediatric allergic rhinitis management.

Intradermal Immunoglobulin E (IgE) Injection in a Specific Interval With Emollient in the Control of Chronic Idiopathic Urticaria and Allergic Rhinitis

Intradermal Immunoglobulin E (IgE) Injection in a Specific Interval With Emollient in the Control of Chronic Idiopathic Urticaria and Allergic Rhinitis

Effect of ayurvedic interventions in the management of allergic rhinitis - An open label multi-centre single arm clinical study

Abstract BACKGROUND: The symptoms of Allergic Rhinitis,resemble the clinical presentation of Vataja Pratishyaya, a type of Pratishyaya, narrated in the Ayurveda classical texts. An exploratory clinical study was planned to assess the the safety and potential effect of a combination therapy of Ayurveda interventions, viz., Ayush VPR (a coded Ayurvedic formulation), Shirishadi Kwath (Anubhoota Yoga), and Nasya (intranasal drug administration) with Anutaila. MATERIALS AND METHODS: The study was an open-label, multicenter, prospective clinical study with pre-test and post-test design. Sixty participants aged between 18 and 65 years with the symptoms of AR were enrolled in the study as per the inclusion and exclusion criteria. The interventions given to the participants were Ayush VPR (3.5 g) powder, twice a day with honey and ghee after food, Shirishadi Kwath (20 ml) twice a day, orally on an empty stomach, and Anutaila Nasya (intranasal drug administration) for 7 days for two consecutive cycles with an interval of 7 days. The participants were assessed weekly for a total duration of 28 days. This was followed by a 28-day follow-up period, with assessments conducted at intervals of 14 days. The primary outcome was change in the CARAT (Control of Allergic Rhinitis and Asthma Test) score. RESULTS: Data of 60 participants were used for analysis. The mean age of participants was 35.8 ± 12.12., and the proportion of males and females were comparable with 51.7% females among the total participants. The mean CARAT score improved from baseline to the subsequent follow-ups at 7th, 14th, 21st, and 28th days. A significant improvement in the mean total CARAT score (P &lt; 0.001) was observed after the 28th day of treatment and also at the end of the 56th day in comparison to baseline. CONCLUSION: The Ayurvedic formulations, Shirishadi Kwath, Ayush VPR, and Anutaila, are safe and significantly reduce rhinorrhea, nasal itching, sneezing fits, nasal congestion, and nasal obstruction. The present study reveals that the Ayurvedic treatment provided highly significant relief from AR.

The oral bacteriomes of patients with allergic rhinitis and asthma differ from that of healthy controls.

Allergic rhinitis and asthma are two of the most common chronic respiratory diseases in developed countries and have become a major public health concern. Substantial evidence has suggested a strong link between respiratory allergy and upper airway dysbacteriosis, but the role of the oral bacteriota is still poorly understood. Here we used 16S rRNA massive parallel sequencing to characterize the oral bacteriome of 344 individuals with allergic rhinitis (AR), allergic rhinitis with asthma (ARAS), asthma (AS) and healthy controls (CT). Four of the most abundant (>2%) phyla (Actinobacteriota, Firmicutes, Fusobacteriota, and Proteobacteria) and 10 of the dominant genera (Actinomyces, Fusobacterium, Gemella, Haemophilus, Leptotrichia, Neisseria, Porphyromonas, Prevotella, Streptococcus, and Veillonella) in the oral cavity differed significantly (p ≤ 0.03) between AR, ARAS or AS and CT groups. The oral bacteriome of ARAS patients showed the highest intra-group diversity, while CT showed the lowest. All alpha-diversity indices of microbial richness and evenness varied significantly (p ≤ 0.022) in ARAS vs. CT and ARAS vs. AR, but they were not significantly different in AR vs. CT. All beta-diversity indices of microbial structure (Unifrac, Bray-Curtis, and Jaccard distances) differed significantly (p ≤ 0.049) between each respiratory disease group and controls. Bacteriomes of AR and ARAS patients showed 15 and 28 upregulated metabolic pathways (PICRUSt2) mainly related to degradation and biosynthesis (p < 0.05). A network analysis (SPIEC-EASI) of AR and ARAS bacteriomes depicted simpler webs of interactions among their members than those observed in the bacteriome of CT, suggesting chronic respiratory allergic diseases may disrupt bacterial connectivity in the oral cavity. This study, therefore, expands our understanding of the relationships between the oral bacteriome and allergy-related conditions. It demonstrates for the first time that the mouth harbors distinct bacteriotas during health and allergic rhinitis (with and without comorbid asthma) and identifies potential taxonomic and functional microbial biomarkers of chronic airway disease.

Mometasone Furoate Use for Recurrent Adenoid Hypertrophy: Randomized Controlled Clinical Trial.

Background& Objective: Adenoid hypertrophy (AH) in children is one of the most causes of nasal obstruction and is associated with many nasal and respiratory symptoms. Till now, surgery is the main option for managing the associated symptom of AH. The intranasal steroid has an effective role in the control of allergic rhinitis and associated AH. This work aimed to assess the effects of local mometasone on recurrent AH in children. Patients& Methods: A randomized controlled trial enrolled 39 patients aged between 2 and 15 years with recurrent AH. Those patients were randomly subdivided into three groups; group (A) received topical mometasone furoate (MF), group (B) did not receive any medication, and group (C) received topical normal saline. All groups were followed up for 8 weeks. Results: Patients who received Mometasone furoate had temporary relief of adenoid hypertrophy-related symptoms (84.6%) in comparison to the control group and placebo group during the duration of treatment. After cessation of treatment with local steroids, all cases experienced symptoms caused by adenoid hypertrophy, and by the end of the third month of follow up all cases underwent adenoidectomy. Conclusion: Mometasone furoate can temporarily reduce the adenoid size, reducing symptoms related to adenoid hypertrophy.

Co-treatment with Fexofenadine and Budesonide Increases FoxP3 Gene Expression in Patients with Allergic Rhinitis.

T helper type 2 (Th2), Th17, and regulatory T cells (Tregs) play essential roles in the pathogenesis and control of allergic rhinitis (AR). Fexofenadine and budesonide are first-line treatments for AR. This study aimed to investigate the effect of co-treatment with fexofenadine and budesonide on the expression of Th2, Th17, and Treg-specific transcription factors (GATA-binding protein 3 [GATA-3], RAR-related orphan receptor gamma [RORγt], and forkhead box P3 [FoxP3], respectively) in AR patients. In this study, 29 AR patients were co-treated with fexofenadine and budesonide for 1 month. Blood was collected from AR patients before and after 1 month of treatment. The gene expression levels of GATA-3, RORγt, and FoxP3 transcription factors in blood samples were measured. In addition, serum immunoglobulin E (IgE) levels and eosinophil percentages in blood samples were determined. The expression level of FoxP3 increased significantly after treatment compared with that before treatment (P < .001). In contrast, GATA-3 and RORγt expression levels did not show any noticeable changes. In addition, the percentage of peripheral blood eosinophils significantly decreased (P < .01). Serum IgE levels decreased compared with those before treatment, but the difference was not statistically significant. Furthermore, the clinical symptoms of the patients improved compared with those before treatment. Our results showed that combined treatment with fexofenadine and budesonide increased the expression level of the FoxP3 gene, decreased the percentage of peripheral blood eosinophils, and improved the clinical symptoms of AR patients. This regimen appears to improve disease symptoms, at least in part by increasing the Treg population and decreasing the eosinophil population.

Could an electronic tool to assess asthma control with a 1-day timeframe be useful for clinical management?

Could an electronic tool to assess asthma control with a 1-day timeframe be useful for clinical management?

Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study

Validated questionnaires are used to assess asthma control over the past 1-4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA). We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16-90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test-retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician. We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68-0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59-0·68). They also displayed high test-retest reliability (intraclass correlation coefficients range 0·79-0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69-0·79; effect size measures range 0·57-0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61-0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68-0·78). e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation. None.

Essential oil (EO) nasal spray use in seasonal allergic rhinitis

Allergic airway disease (AAD) imposes a large burden on the quality of with an increasing percentage of this population using integrative medicine that includes include herbal medicine and EO therapy. Recently research suggests EO nasal spray provided significant relief in perennial allergic rhinitis patients measured by the Allergic Rhinitis Control Test. Thus EO could be an option for AAD patients who wish to explore more natural methods of allergic symptom relief.