Allergic Rhinitis Control Research Articles

Appropriate protocol of treatment modulation for seasonal allergic rhinitis caused by cypress pollens

Objective: To investigate appropriate protocol of treatment modulation for seasonal allergic rhinitis (AR) patients, in order to promote the implementation of personalized medicine. Methods: Total of 124 AR patients allergic to cypress pollens were recruited from January to February 2020 in Department of Allergy in Peking Union Medical College Hospital, 43 males and 81 females with an average age of (41±9) years. The patients were divided into two groups with block randomization method. In the first group, treatment was modulated every two days according to the average daily rhinoconjunctivitis symptom score of the last two days (short-term symptom-score group); while in the second group, therapy regimen was adjusted every week based on the Allergic Rhinitis Control Test (ARCT) score of the last week (long-term ARCT group). The treatment level was up-regulated when the cypress pollen count increased and stayed at a high level (step-up pharmacotherapy stage); and treatment was down-regulated while the pollen count decreased (step-down pharmacotherapy stage). Daily symptom scores, medicine scores, and ARCT scores of the two groups were recorded and compared. Results: During the whole cypress pollen season, the daily rhinoconjunctivitis symptom score of short-term symptom-score group was significantly lower than that in long-term ARCT group(2.4±1.0 vs 2.7±1.0, P<0.01), and the difference between the two groups was more pronounced in the step-up pharmacotherapy stage than that in the step-down pharmacotherapy stage, while there was no statistical difference between the daily medicine scores of the two groups (P>0.05). During the pollen rising period, the ARCT score of short-term symptom-score group was significantly better than that of long-term ARCT group (21(19, 22) vs 20 (17, 21), P=0.049); while in the pollen peak period and decreasing period, the ARCT scores of the two groups showed no statistical difference (P>0.05). The proportion of incompliance with doctor's advice was higher in long-term ARCT group compared to that in short-term symptom-score group (30.1% vs 6.7%, P<0.001). Conclusion: The protocol of treatment modulation for seasonal AR patients allergic to pollens should be developed flexibly according to the variation trend of pollen allergen exposure, so as to implement the idea of personalized medicine.

Vitamin D, Zinc and Ear Nose Throat Disorders: Novel Findings

Vitamin D and Zinc (Zn) play a crucial role in human biochemistry. Over the last decade, there has been a better understanding on the significant role of vitamin D and zinc in ear, nose, and throat disorders. They are responsible for regulating mucosal immunity. Although vitamin D recognized as a key micronutrient, there is a pervasive vitamin D deficiency globally. Zinc as a critical trace element in human metabolism, facilitates the antioxidant activity and toxin excretion, plays a vital role in hearing system, acts as a cofactor in many enzymes. Zinc tasks in diseases related to mucosal defense, control of seasonal allergic rhinitis and healing of scar tissues. Zinc is an abundant intracellular trace element. Even though a mild zinc deficiency can manifest with serious clinical pictures like impaired immune defense.

Three-month Effects of Immunotherapy on Clinical Features and Pulmonary Function Tests of Patients with Allergic Rhinitis Concomitant with or without Asthma

Objective: We aimed to evaluate our patient’s treatment responses to three-month immunotherapy for allergic rhinitis with or without asthma, and to investigate the factors affecting treatment&#x0D; Material and Methods: A total of 53 patients receiving subcutaneous immunotherapy for allergic rhinitis with or without asthma were included in the study. All patients were positive for mite skin prick test. Asthma was present as a concomitant disease in 28(52.8%) patients. Patients with and without asthma were classified in two groups as “Allergic rhinitis + Asthma+” and “Allergic rhinitis+ Asthma-“. The values of pulmonary function tests of all patients, and in rhinitis with asthma patients, the Asthma Control Test scores before and after three months of treatment were recorded.&#x0D; Results: In “Allergic rhinitis + Asthma+” and “Allergic rhinitis + Asthma-“groups, male/female ratio was 7/21 and 10/15, mean age was 33±9 and 32±9 years. No statistically significant differences were present between the pre-treatment and 3-month-treatment values of pulmonary function test. The difference between the pre-treatment and 3-month treatment asthma control test scores was strongly significant.&#x0D; Conclusion: In allergic rhinitis, which is quite commonly associated with asthma, the control of asthma is also provided with the treatment of allergic rhinitis. By using pulmonary function test in allergic rhinitis and asthma control test in asthma, we showed that the effectiveness of allergen specific immunotherapy started in 3 months which was earlier from current literature.

Identification of clusters of asthma control: A preliminary analysis of the Inspirers studies

Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, &gt;24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT -T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16­‑46) years, were analysed. Three clusters were identified [mean CARAT -T (min -max)]: cluster 1 [27(24 -30)], cluster 2 [19(14 -23)] and cluster 3 [10(2 -13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Furthermore, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symptoms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow -up time among the three clusters. Conclusion: An unsupervised method based on CARAT- -T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut -off similar to the established in the validation study of CARAT and an additional cut -off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.

Effect of the Use of Intranasal Spray of Essential Oils in Patients with Perennial Allergic Rhinitis: A Prospective Study

Introduction: Among allergic rhinitis (AR) symptoms, nasal obstruction particularly affects the quality of life. Antihistamines and intranasal corticosteroids are the most frequently prescribed symptomatic drugs, but their efficacy is often incomplete. Essential oils (EO) have shown an anti-inflammatory effect and potential in treating patients with AR. The aim of this study was to evaluate the effectiveness of a hypertonic EO-based nasal spray on perennial AR (PAR) symptoms. Methods: This prospective, open-label, non-randomized, multicentric trial included 43 patients with PAR sensitized to mites, not controlled for more than a year. All were treated with Puressentiel® Respiratory-Decongestant Nasal Spray for 30 days. Their usual treatment remained unchanged during the study period. Before and after treatment, each participant filled out a rhinitis questionnaire, the Allergic Rhinitis Control Test (ARCT). A nasal inspiratory peak flow (NIPF) was performed. Results: The mean ARCT was 16.4 and 20.5 at D0 and D30, respectively (p < 0.001); the mean increase between D0 and D30 was 4.1 (p < 0.001). The proportion of patients with controlled rhinitis after 30 days of treatment was 69.8 versus 14% before treatment (p < 0.001). The mean NIPF was 86.5 L/min and 105.1 L/min at D0 and D30, respectively (p < 0.001); the mean increase between D0 and D30 was 18.5 L/min. Conclusion: A hypertonic EO-based nasal spray could be a new and natural option in the management of PAR. It could also be used as an add-on therapy when nasal symptoms are not fully controlled.

Role of septoplasty in allergic rhinitis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; It is a prospective study of 30 cases of allergic rhinitis with deviated nasal septum presented to our hospital. Analysis is done on the basis of age and sex distribution, severity of the symptoms pre and post operatively, according to nasal obstruction symptom evaluation (NOSE) scale and allergic rhinitis control test (ARCT) questionnaire which assess the quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Detailed history taking and clinical examination was done. All the patients were assessed the severity of their symptoms based on a NOSE scale. An ARCT questionnaire was given to patients prior to surgery(septoplasty) and after 3 months of it.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In study we have observed that in the age group was 20-30years. Majority of the patients were males. The most common symptom is nasal obstruction followed by sneezing, rhinorhhea, pruritis, headache etc. The mean decrease in the NOSE score was statistically significant (before septoplasty NOSE score =14.6 and after septoplasty NOSE score=8.1). There is also improvement in quality of life which was measured by allergic rhinitis control test (ARCT) score. ARCT before septoplasty 10.2 and after 19.2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study shows most common combined symptoms are nasal blockage with rhinorrhoea, more affecting the age group of 18 to 30 years, males, with deviated nasal septum towards left seen more commonly. Patients of allergic rhinitis with deviated nasal septum are benefited with septoplasty, improved symptoms like nasal obstruction and stuffiness etc. and the quality of life by decrease in the severity of allergic symptoms.&lt;/p&gt;

Perception and control of allergic rhinitis in primary care

Perception of a chronic illness is a driver of patient behaviour that may impact treatment outcomes. The cross-sectional PETRA study was designed to describe the links between disease perception, patient behaviour and treatment outcomes in adults with allergic rhinitis (AR). Overall, 687 French general practitioners (GPs) included 1929 analysable patients (mean age: 39 years; intermittent/persistent symptoms: 46.2/52.3%). Of the patients, 14.1% had also been diagnosed with asthma; 71.7% had uncontrolled AR (ARCT score < 20), and 53.6% had a good perception of their illness (BIPQ score < 5). Factors significantly associated with poor perception of AR were ENT (ear/nose/throat) complications, nasal pruritus, uncontrolled AR and asthma. A strong negative correlation was observed between the BIPQ and ARCT scores: the poorer the patient’s perception, the less the AR was controlled. Although no causal relationship could be drawn, GP-driven improvement of AR perception could lead to better control of symptoms.

The Measurement of Asthma and Allergic Rhinitis Control in Children and Adolescents.

Asthma and allergic rhinitis (AR) are frequently associated. The objective of the treatment of asthma and AR should be the control of symptoms and disease progression. Therefore, the combined measurement of disease control is desirable. In this regard, a questionnaire able to together assess asthma and AR control has been validated: the CARAT (Control of Allergic Rhinitis and Asthma Test). A further pediatric version (CARATkids) has been generated. The current real-world study used different disease control measures in children and adolescents with asthma and rhinitis. A total of 138 children and adolescents were recruited at three allergy centers. CARAT, CARATkids, ACT (Asthma Control Test), cACT (children ACT), GINA (Global Initiative for Asthma) disease control classification, VAS (Visual Analog Scale) for asthma and nasal symptoms, and lung function were used in all subjects. There was a predominance of males (67.4%) and asthma was well-controlled (according to GINA classification) in about half the subjects. In children, the median CARAT and cACT values were 5 and 22 respectively. In adolescents, the median CARAT and ACT values were 23 for both tests. There were significant differences between CARAT and ACT (p = 0.035) as well as between CARATkids and cACT (p = 0.0001). However, the tests’ outcomes were different as assessed in different domains. CARAT and CARATkids are disease-control measurements that give additional information to other tests, therefore, these different questionnaires to measure disease control complement each other.

Immunotherapy in allergic diseases - improved understanding and innovation for enhanced effectiveness.

Allergen immunotherapy leads to tolerance through multiple mechanisms that include tolerogenic dendritic cells and T and B regulatory cells. These induced cellular populations produce mediators to skew the immune response to a tolerogenic milieu that, among others, results in IgG4 blocking antibodies formation and lowered FcE receptors. All lead in decreased effector responses from mast cells, eosinophils, and basophils thus limiting the allergic inflammation. Clinically, this results in better allergic rhinitis control and, of importance, asthma prevention. Newer approaches include modified allergens, second generation adjuvants/carriers and routes of administration, all aiming to increased efficacy with parallel no compromise of safety.

Effect of nasal irrigation on allergic rhinitis control in children; complementarity between CARAT and MASK outcomes

BackgroundNasal irrigations (NI) are increasingly used as an over-the-counter adjunctive treatment for allergic rhinitis (AR), but clinical studies on their effectiveness are limited.MethodsAn open-label, controlled, non-randomized, real-life study was conducted to evaluate the effectiveness of NI with a new hypertonic solution as add-on treatment for AR. Children and adolescents with AR were prescribed symptomatic treatment. The active group also received an additional sea-water NI solution supplemented with algae extracts. The primary endpoint was symptom control, assessed by the control of allergic rhinitis and asthma test (CARAT) questionnaires. Moreover, the MASK/Allergy Diary was used to track symptoms and daily medication use that were combined in a novel total symptom/medication score (TSMS).ResultsWe assessed 76 patients. Overall, there was a significant improvement of CARAT results (median Z-score change of 1.1 in the active/NI group vs. 0.4 in the control group; p = 0.035). Among patients > 12 years old (n = 51), there was a significant improvement in CARAT10 results among participants receiving NI (21.0 to 25.5; p < 0.001), but not in the regular treatment group (21.5 to 24.0; p = 0.100). For children < 12 years old (n = 25), the ΝΙ group had significantly improved symptom control (CARATKids results: 5.0 to 2.0; p = 0.002), in contrast to the control group (4.0 to 2.5; p = 0.057). MASK data on allergic symptoms were comparable between groups. However, the NI group had lower TSMS, more days with < 20% symptoms and fewer days using symptomatic treatment (26.9% vs. 43.5%; p = 0.005).ConclusionAddition of NI with a sea-water solution to regular treatment improved AR symptom control. CARAT questionnaires and MASK application can be useful outcome tools in real-life studies.

Evaluation of the effects of allergic rhinitis treatment on sexual functioning, sleep, and fatigue parameters

Study objectiveTo evaluate the impact of intranasal corticosteroids on quality of life (QoL) in AR patients compared to control groups. Patients and methodsIn a prospective study, we enrolled AR subjects (18–45 years old) and healthy controls at Amiralmomenin Hospital, Guilan University of Medical Sciences, in 2014–2015. After signing informed consent, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Multidimensional Fatigue Inventory (MFI), as well as the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF) questionnaires. Patients were then treated with intranasal corticosteroids. After 6 weeks, the outcomes were re-evaluated. Statistical analysis of the extracted data was conducted using Stata 13.0. ResultsA total of 96 subjects (48 males and 48 females) and 96 controls participated in this study. We measured optimal control of allergic rhinitis using the CARAT (U) questionnaire. Improvement in SNOT-22 score in men and women was 14.0 and 5.2 points, respectively. Men with AR had a significantly worse sexual function score. After treatment, erectile dysfunction improved significantly. However, there was no significant difference in overall FSFI score at baseline between women with AR and controls. At baseline, 62.5% of men and 54.2% of women in the AR group reported pathologic fatigue, which with treatment fell to 22.9% and 35.4%, respectively. ConclusionWe noted detrimental effects of allergic rhinitis on various aspects of QoL in men and women. Intranasal corticosteroids diminished these negative effects of allergic rhinitis.

Interactions Between Air Pollution and Pollen Season for Rhinitis Using Mobile Technology: A MASK-POLLAR Study

Several studies have suggested an interaction between air pollution and pollen exposure with an impact on allergy symptoms. However, large studies with real-life data are not available. To investigate associations between major air pollutants (ozone and particulate matter with a diameter of <2.5 μm) and allergic rhinitis (AR) control during grass and birch pollen seasons as well as outside the pollen season. The daily impact of allergic symptoms was recorded by the Allergy Diary (Mobile Airways Sentinel NetworK [MASK-air]) app (a validated mHealth tool for rhinitis management) using visual analog scales (VASs) in Northern and Central Europe users in 2017 and 2018. Uncontrolled AR was defined using symptoms and medications. Pollutant levels were assessed using the System for Integrated modeLing of Atmospheric coMposition database. Pollen seasons were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for sex, age, treatment, and country. Analyses were stratified by pollen seasons to investigate interactions between air pollutants and pollen exposure. A total of 3323 geolocated individuals (36,440 VAS-days) were studied. Associations between uncontrolled rhinitis and pollutants were stronger during the grass pollen season. Days with uncontrolled AR increased by 25% for an interquartile range increase in ozone levels during the grass pollen season (odds ratio of 1.25 [95% CI, 1.11-1.41] in 2017 and of 1.14 [95% CI, 1.04-1.25] in 2018). A similar trend was found for particulate matter with a diameter of less than 2.5 μm, especially in2017. These results suggest that the relationship between uncontrolled AR and air pollution is modified by the presence of grass pollens. This study confirms the impact of pollutants in the grass pollen season but not in the birch pollen season.

Overrating Classifier Performance in ROC Analysis in the Absence of a Test Set: Evidence from Simulation and Italian CARATkids Validation.

The use of receiver operating characteristic curves, or "ROC analysis," has become quite common in biomedical research to support decisions. However, sensitivity, specificity, and misclassification rates are still often estimated using the training sample, overlooking the risk of overrating the test performance. A simulation study was performed to highlight the inferential implications of splitting (or not) the dataset into training and test set. The normality assumption was made for the classifier given the disease status, and the Youden's criterion considered for the detection of the optimal cutoff. Then, an ROC analysis with sample split was applied to assess the discriminant validity of the Italian version of the Control of Allergic Rhinitis and Asthma Test (CARATkids) questionnaire for children with asthma and rhinitis, for which recent studies may have reported liberal performance estimates. The simulation study showed that both single split and cross-validation (CV) provided unbiased estimators of sensitivity, specificity, and misclassification rate, therefore allowing computation of confidence intervals. For the Italian CARATkids questionnaire, the misclassification rate estimated by fivefold CV was 0.22, with 95% confidence interval 0.14 to 0.30, indicating an acceptable discriminant validity. Splitting into training and test set avoids overrating the test performance in ROC analysis. Validated through this method, the Italian CARATkids is valid for assessing disease control in children with asthma and rhinitis.

Interaction between air pollution and pollen seasons on allergic rhinitis control

A few studies have suggested an interaction between air pollution and pollen exposure on allergy symptoms but more research is needed. As part of the POLLAR (Impact of Air Pollution in Asthma and Rhinitis) project, we investigated the associations between major air pollutants (ozone and PM2.5) and allergic rhinitis control, during grass and birch pollen seasons, using the Allergy Diary app (a validated mHealth tool for allergic rhinitis management). The daily impact of allergic symptoms was recorded, using visual analogue scale (VAS), by 3,328 geolocated app users in 2017 and 2018 in Northern Europe, representing 36,523 VAS days. Uncontrolled allergic rhinitis was defined either as 1) VAS≥50, 2) VAS≥35 with intra-nasal corticosteroids or azelastine-fluticasone propionate use or 3) VAS≥20 and use of ≥3 allergic rhinitis medications. For each VAS recorded with geolocation, pollutants levels were assessed using the SILAM (System for integrated modelling of atmospheric composition) database, and pollen seasons were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for gender, age, treatment and country. Positive associations were found between ozone and uncontrolled allergic rhinitis during the grass pollen season only (ORs=1.25 [1.11-1.41] and 1.14 [1.04-1.25], per interquartile range increase in ozone, for 2017 and 2018 respectively). A similar trend was found for PM2.5 levels in 2017 while results for 2018 did not suggest any effect modification by pollen seasons. These results show the importance of air pollution and allergen concentrations, and their interaction, as predictors of allergic rhinitis control.

History of allergic rhinitis and risk of asthma; a systematic review and meta-analysis

BackgroundAllergic rhinitis has been suspected to be a risk factor for asthma in several studies but this association is not firmly established. The objective of this study was to synthesize the evidence of the association between allergic rhinitis and the risk of asthma through a systematic review and meta-analysis. MethodsWe performed a search in Medline, Scopus, ISI Proceedings databases and other databases from inception until February 2019, followed by manual search to identify potentially relevant case-control and cohort studies that reported relative risk estimates and confidence intervals of the association between allergic rhinitis and asthma. Cross-sectional studies were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed and random effects models and quality of studies was assessed through a modified version of the Newcastle-Ottawa scale. ResultsTwenty-nine eligible studies, 22 cohort and 7 case-control studies, with a total of 274489 subjects, were included in the meta-analysis. The results show that history of allergic rhinitis is significantly associated with the occurrence of asthma (OR = 3.82; 95% CI: 2.92–4.99). European studies showed a stronger association (OR = 4.35; (95% CI: 3.12–6.06) than non-European studies (OR = 2.75; 95% CI: 2.16–3.50), and case-control studies showed a stronger association (OR = 4.71; 95% CI: 3.58–6.17) than cohort studies (OR = 3.42; 95% CI: 2.60–4.50). ConclusionsThis meta-analysis shows that allergic rhinitis is strongly associated with asthma. Further prospective studies on the effect of treatment of allergic rhinitis on the development of asthma are needed. Relief of airway allergic manifestations may need dual control of allergic rhinitis and asthma. RegistrationPROSPERO database with registration number CRD42017055156.

Allergic rhinitis control: contemporary approaches to evaluation

Objectives. Allergic rhinitis (AR) is highly prevalent all around the world. It adversely affects the quality of life of patients and leads to the development of bronchial asthma, which determines its high socioeconomic burden. International and Russian authorities establish control of the disease as a primary efficacy end point of allergic rhinitis treatment. Nevertheless, there is no international, standardized, validated tool to assess control of allergic rhinitis. In this regard, this review aims to analyze research on the development of such tools and to provide their comparative analysis. Review methods. Using PubMed, Web of science and Russian Citation Index database, we searched from 1991 to 2019 with logical combinations of the following key words: “allergic rhinitis control”, “AR control”, “AR questionnaire”. A total of 96 publications were included in the study. Results. All studies were arranged in chronological order and their main results were described. Questionnaires on the quality of life, tools offered by the clinical guidelines, visual analogue scales, and specialized questionnaires for measuring the control of allergic rhinitis were considered separately. The advantages and disadvantages of these instruments are described. Conclusion. The evidence based on the quality of the tool to support the use of specialized questionnaires was shown. Many disease control scales have been validated, but have some practical disadvantages asprimary efficacy criteria in clinical practice.

The effectiveness and safety of subcutaneous immunotherapy for inhalable allergens in patients with respiratory allergies

Specific immunotherapy is a treatment aimed at modifying the course of the allergic disease, with which important immunological and clinical changes are achieved. To assess the effectiveness and safety of subcutaneous immunotherapy in patients diagnosed with respiratory allergies in the University Hospital of Puebla, Mexico. A longitudinal, analytic, quasi-experimental study. The study was carried out with patients aged four to sixty-five years, diagnosed with allergic rhinitis or asthma, with sensitization to aeroallergens, in whom immunotherapy was started. For the effectiveness assessment, the Control of Allergic Rhinitis and Asthma Test (CARAT) was used. Safety was assessed through Portnoy's Questionnaire Survey of Adverse Reactions. 59 patients were included: 72.9% were female; 23.7% of them were diagnosed with allergic rhinitis and asthma, and 76.3% were diagnosed with allergic rhinitis. The comparison of averages of the CARAT questionnaire at the beginning of the treatment and after four months of follow up showed a statistically significant positive development. An incidence of adverse local reactions of 9.03% was found; no adverse systemic reactions were reported. The assessed scheme of subcutaneous immunotherapy got to significantly decrease the asthma symptoms and AR symptoms, with a desirable safety profile.

The influence of allergic rhinoconjunctivitis on migraine disability in children.

Migraine is a common condition in the pediatric population and causes a significant impact on the quality of life. Atopic disorders are some of the migraine comorbidities. We hypothesized that allergic rhinitis could aggravate migraine in the pediatric population. This cross-sectional study consecutively evaluated 90 pediatric outpatients (46 children 6-12 years of age; 44 adolescents up to 18 years of age) who sought medical assistance because of migraine at a general neurology clinic in Passo Fundo, RS, Brazil. They, and their parents, were given three questionnaires, to evaluate the diagnosis of current allergic rhinitis, allergic rhinoconjunctivitis and seasonal allergic rhinitis, as well as the disability caused by headache (ISAAC - International Study of Asthma and Allergies in Childhood; CARATkids - Control of Allergic Rhinitis and Asthma Test for Children; PedMIDAS - Pediatric Migraine Disability Assessment). The study was approved by the local ethics committee. According to the ISAAC questionnaire, children with current allergic rhinoconjunctivitis in the last year showed higher scores on the PedMIDAS than those patients without atopy (median and interquartile range 26 [10-58] vs. 5 [1-13], p = 0.008). A significant positive correlation of CARATkids scores with PedMIDAS scores was found (p = 0.007, rho = 0.39). After including other putative predictors of migraine disability (age, body mass index, time since onset of migraine) in a multiple regression analysis, only the scores on the CARATkids remained a significant independent variable correlated with PedMIDAS scores (p = 0.001; R = 0.55; R2 = 0.30). Current allergic rhinoconjunctivitis is related to enhanced disability caused by headache in childhood migraine.

Mobile technology offers novel insights into the control and treatment of allergic rhinitis: The MASK study

Mobile health can be used to generate innovative insights into optimizing treatment to improve allergic rhinitis (AR) control. A cross-sectional real-world observational study was undertaken in 22 countries to complement a pilot study and provide novel information on medication use, disease control, and work productivity in the everyday life of patients with AR. A mobile phone app (Allergy Diary, which is freely available on Google Play and Apple stores) was used to collect the data of daily visual analogue scale (VAS) scores for (1) overall allergic symptoms; (2) nasal, ocular, and asthma symptoms; (3) work; and (4) medication use by using a treatment scroll list including all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral H1-antihistamines were studied. Nine thousand one hundred twenty-two users filled in 112,054days of VASs in 2016 and 2017. Assessment of days was informative. Control of days with rhinitis differed between no (best control), single (good control for intranasal corticosteroid-treated days), or multiple (worst control) treatments. Users with the worst control increased the range of treatments being used. The same trend was found for asthma, eye symptoms, and work productivity. Differences between oral H1-antihistamines were found. This study confirms the usefulness of the Allergy Diary in accessing and assessing behavior in patients with AR. This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible.

Control of allergic rhinitis with MP-AzeFlu: a noninterventional study of a Swedish cohort.

The European Union has prioritised allergic rhinitis (AR) control. A visual analogue scale (VAS) has been endorsed as the AR control language and embedded into the most recent MACVIA-ARIA guideline. This study assessed the effectiveness and safety of MP-AzeFlu using a VAS in a real-life study in Sweden. 431 patients aged 12 years or over with ARIA-defined moderate to severe AR were included in this multicentre, prospective, non-interventional study and prescribed MP-AzeFlu. Patients assessed symptom severity using a VAS from 0 (not at all bothersome) to 100 mm (very bothersome) on Days 0, 1, 3 and 7, and after approximately 14 days in the morning before using MP-AzeFlu. Patients' perceived level of disease control was assessed on Day 3. The proportion of patients who achieved a defined VAS score cutoff for well- and partly controlled AR was also calculated. MP-AzeFlu reduced mean (SD) VAS score from 67.9 (16.1) mm at baseline to 32.1 (22.8) mm on the last day. Results were consistent irrespective of severity, phenotype, patient age class or previous treatment. By Day 3, 84.0% of patients reported well- or partly controlled symptoms. Overall, 17.7%, 32.2%, 53.8% and 64.2% of patients achieved a 38 mm or greater "well-controlled" VAS score cutoff on Day 1, 3 and 7 and last day, respectively. MP-AzeFlu provided rapid, effective and sustained symptom control in patients with AR from Sweden in a realworld setting, aligning with EU and MACVIA-ARIA initiatives and supporting the effectiveness of MP-AzeFlu for AR treatment in real life.