Allergic Rhinitis Asthma Research Articles

The burden of allergic rhinitis is undermanaged in a large proportion of Chinese young adults from Singapore

BackgroundAllergic rhinitis (AR) is a nasal disorder characterized by the simultaneous manifestation of at least 2 out of 4 possible symptoms: rhinorrhea, nasal itching, nasal pruritus, and sneezing. Presently, among Chinese young adults from Singapore, we characterised AR phenotypes, established Total Nasal Symptom Score (TNSS) baselines, and examined the management of AR. MethodsParticipants completed an investigator-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and underwent a skin prick test (SPT). Individuals exhibiting sensitization during the SPT while having at least 2 rhinitis symptoms were identified as AR cases, then categorized into Allergic Rhinitis in Asthma (ARIA) classifications. ResultsThere were 9323 subjects analyzed. AR prevalence was estimated at 35.4%. Rhinorrhea was perceived as the most severe (mean Nasal Symptom Score (mNSS) ± SD: 1.42 ± 0.74), while nasal pruritus was the least severe (mNSS ± SD: 1.24 ± 0.68). Among moderate-severe AR (68.1%), most were affected by either troublesome symptoms (27.7%) or sleep disturbances (18.4%). By ARIA classes, 26.6% were mild intermittent, 5.4% were mild persistent, 50.3% were moderate-severe intermittent, and 17.6% were moderate-severe persistent. The mean TNSS (mTNSS) of AR cases was 4.43 (SD = 2.49) and between AR classifications, the mTNSS was significantly different. Notably, a large proportion of AR cases remained undiagnosed (85.2%), untreated (72.5%), or both (65.4%); 19.8% self-medicated for AR. ConclusionsThere was a significant difference in TNSS of the AR phenotypes, and among phenotypes with a higher mTNSS, a large proportion remained untreated, undiagnosed, or both. The evidence indicates an existing burden of AR among Chinese young adults in Singapore which is notably undermanaged.

Health-related quality of life in asthma measured by the World Health Organization brief questionnaire (WHO-BREF) and the effect of concomitant allergic rhinitis-A population-based study.

The impact of allergic rhinitis (AR), a common comorbidity in asthma, on global quality of life (QoL) using generic QoL questionnaires has not been extensively evaluated. This was a cross-sectional population-based study among adults ≥18 years old. Generic QoL was measured using the World Health Organization (WHO) questionnaire (WHOQOL-BREF), and asthma control was assessed using the Asthma Control Test. Participants were categorized into four groups: Group 1 (No asthma, no AR), Group 2 (Asthma only), Group 3 (AR only) and Group 4 (Concomitant asthma and AR). The student t-test or the ANOVA was used for comparison between groups and based on the level of asthma control. Linear regression was used to assess the association between the level of asthma control and QoL scores, adjusted for age and sex. A p-value of less than 0.05 was considered significant for all associations. There were 9115 participants; 906 (9.9%) had asthma, and 1998 (21.9%) had AR. The lowest QoL scores were in the environment domain. Mean QoL scores were significantly lower in asthma compared to 'no asthma' and in AR compared to 'no AR'. Either asthma or rhinitis (Group 2 or 3) had significantly lower scores compared to no disease (Group 1) only in the environment domain, but the concomitant disease (Group 4) had lower scores across all categories and domains. Scores were significantly lower for uncontrolled asthma compared to controlled asthma and for 'concomitant asthma and AR' compared to 'asthma only'. Increasing age and uncontrolled asthma predicted worse health-related quality of life (HRQoL) consistently. Although asthma and AR negatively impact HRQoL independently, concomitant asthma and AR are worse. Uncontrolled asthma underpins poor QoL in asthma because QoL is not impaired in controlled disease. This underscores the need for recognition and treatment of AR in asthma and reinforces the benefits of achieving asthma control as a priority in asthma treatment.

The effectiveness of anti-IgE therapy for allergic rhinitis in patients with severe atopic bronchial asthma and concomitant allergic rhinitis in real clinical practice

BACKGROUND: Omalizumab, by binding IgE in atopic patients, can improve clinical and functional parameters and patients' quality of life.
 AIMS: to evaluate efficacy of anti-IgE-therapy in patients with allergic rhinitis treated with omalizumab for concomitant severe atopic asthma in real clinical practice.
 MATERIALS AND METHODS: An open, non-interventional, prospective and non-randomized study in a real clinical practice.
 The study was conducted in the Sverdlovsk region in October 2021 based on a regional registry of adult patients with severe asthma with chronic nasal inflammatory diseases and receiving targeted therapy. Dynamics of nasal symptoms was assessed using SNOT-22 questionnaire and visual analogue scale initially, after 4 and 12 months of omalizumab therapy. Peripheral blood eosinophils level was also assessed before and after 4 months of omalizumab therapy.
 RESULTS: The study included 26 patients. Assessment of nasal symptoms dynamics using the SNOT22 questionnaire at baseline and after 4 months on omalizumab therapy revealed decrease in the severity of symptoms (p 0.001): baseline - 46.8522.04 points (95% CI 37.94-55.75), after 4 months - 30.6514.81 points (95% CI 24.67-36.64). Also improvement in SNOT22 questionnaire score was revealed in 18 patients treated with omalizumab during 12 month: before therapy - 47.5 points (Q₁ -Q₃: 35.7-59.3), after 4 months - 30.4 points (Q₁- Q₃: 22.1-38.1), after 12 months - 24.9 points (Q₁ -Q₃: 16.9-32.9) (p = 0.001). Improvement in rhinitis symptoms control was observed according to the VAS scale: VAS before therapy - 8.0 points (Q₁-Q₃: 6.2-9.0), after 4 months - 5.0 points (Q₁- Q₃: 3.2-5, 8), after 12 months of treatment - 5.0 points (Q₁-Q₃: 4.0-6.8). The level of eosinophils (n=16) decreased from 510.9317.9 (95% CI 341.5680.3) cells /l to 327.4217.7 (95% CI 211.4443.5) cells /l after 4 months of anti-IgE-therapy (p0.041).
 CONCLUSIONS: Omalizumab in real clinical practice has demonstrated improvement of rhinitis symptoms control and quality of life in patients with allergic rhinitis with concomitant severe atopic asthma. It was accompanied by a statistically significant decrease in peripheral blood eosinophils level, that largely determines airway inflammation severity and clinical manifestations of allergic rhinitis and bronchial asthma.

Association between house dust mites sensitization and level of asthma control and severity in children attending Mansoura University Children\u2019s Hospital

BackgroundHouse dust mites (HDM) are considered as a major source of indoor aeroallergen all over the world that precipitate allergic reactions including rhinoconjunctivitis, food allergy, atopic dermatitis, and allergic asthma. In this study, we aimed to assess the clinical and laboratory profile of some Egyptian asthmatic children who are sensitized to house dust mites and determine the association of HDM sensitization and severity of asthma according to recent GINA guidelines.ResultsThe most frequent clinical phenotype among the HDM-positive group was a cough (96.7%), while the clinical phenotypic wheeze was frequent in HDM negative group (96.7%). There is a statistically significant difference between studied cases classified according to sensitivity to HDM regarding level of asthma control (50.0% were uncontrolled among cases sensitive to HDM and 56.7% of cases non-sensitive to HDM were controlled (p = 0.001*). Severity according to treatment results was significantly higher among cases sensitive to HDM (26.7% of cases sensitive to HDM versus 3.3% of cases non-sensitive to HDM), p = 0.017.ConclusionsHDM sensitization is associated mainly with cough asthma phenotype and allergic rhinitis in our studied cases. HDM sensitization increases asthma severity and decreases the ability to control asthma symptoms.Trial registrationClinicalTrial.gov, NCT04958616.

Allergic Rhinitis, Conjunctivitis, and Sinusitis

Allergic rhinitis is an IgE-mediated inflammatory response in the nose to foreign substances known as allergens. It can be classified as seasonal or perennial, depending on the allergens triggering the reaction. This characterization is good for identifying allergen triggers but is limited because it is based on the duration of outdoor exposure (e.g., grass pollinates for 2 months in Chicago and nearly 11 months in Texas). Also, some perennial allergens, such as dust mites, have seasons. The Allergic Rhinitis in Asthma (ARIA) classification was developed to focus on therapy. It assumes that exposure to perennial and to seasonal allergen leads to the same immunologic response. ARIA places patients into the categories of mild intermittent, mild persistent, moderate/severe intermittent, and moderate/severe persistent to recommend treatment and emphasizes the link between allergic rhinitis and asthma.1 This review contains 5 figures, 12 tables, and 59 references. Key Words: Sinusitis, infection, allergy, antibiotic, decongestant, antihistamine

Allergic Rhinitis, Conjunctivitis, and Sinusitis

Allergic rhinitis is an IgE-mediated inflammatory response in the nose to foreign substances known as allergens. It can be classified as seasonal or perennial, depending on the allergens triggering the reaction. This characterization is good for identifying allergen triggers but is limited because it is based on the duration of outdoor exposure (e.g., grass pollinates for 2 months in Chicago and nearly 11 months in Texas). Also, some perennial allergens, such as dust mites, have seasons. The Allergic Rhinitis in Asthma (ARIA) classification was developed to focus on therapy. It assumes that exposure to perennial and to seasonal allergen leads to the same immunologic response. ARIA places patients into the categories of mild intermittent, mild persistent, moderate/severe intermittent, and moderate/severe persistent to recommend treatment and emphasizes the link between allergic rhinitis and asthma.1 This review contains 5 figures, 12 tables, and 59 references. Key Words: Sinusitis, infection, allergy, antibiotic, decongestant, antihistamine

Сlinical case of focal alopecia in a child with atopy

Alopecia areata is a common inflammatory immune-mediated disorder in which autoimmune response is triggered against hair follicles, thus leading to non-scarring hair loss on the scalp, face and other parts of the skin. Despite numerous studies concerning this issue, today there is no consensus on the etiology and pathogenesis of focal alopecia. In the literature, special attention is paid to association of focal alopecia with autoimmune diseases, such as rheumatoid arthritis, celiac disease, type 1 diabetes, psoriasis, autoimmune thyroiditis, vitiligo. Recent studies have identified the association of focal alopecia with atopic diseases (allergic rhinitis, bronchial asthma, atopic dermatitis) and the early debut of severe forms of hair loss. The aim of this study was to present a clinical case of focal alopecia in an 8-year-old girl with atopic bronchial asthma and seasonal allergic rhinitis. As based on detection of eosinophilia in peripheral blood and a high concentration of total IgE in serum, one may assume that atopic alopecia is the cause of focal hair losses in a child with atopy. The patient underwent skin prick testing, in order to determine sensitization for food components, pollen and fungal allergens. As a result of skin testing, a hyperergic reaction (> 15 mm in diameter) to tree pollen was revealed, a positive response (6-9 mm) to oatmeal, a weakly positive reaction (3-5 mm) to whole chicken egg, carrots, tomato, apple, pear, pollen of meadow, cereal, weed grasses was also revealed. With regard of these allergological data, an individual diet was recommended with the elimination of causally significant allergens (including those eliciting weakly positive reactions), external treatment, i.e., topical calcineurin inhibitors administered for 1 month. One month later, an improvement of the pathological process was registered, and 6 months from the start of therapy, complete restoration of hair follicles was noted in the focus of alopecia. The patient was monitored for a year, no complaints of hair loss were noted. The positive effect of elimination against the background of the appropriate elimination diet with respect to causally significant allergens, was also noted when treating her for respiratory allergy, i.e., the patient did not have seasonal manifestations of hay fever over the next pollination period. This clinical case is demonstrated in order to draw special attention of dermatologists, allergologists, immunologists, general practitioners to the issues of focal alopecia in children against the background of typical allergic diseases.

Epidemiological prospective study on estimating the coexistence of allergic rhinitis and asthma in adult patients

Background: Both allergic rhinitis and asthma are immunoglobulin E-mediated allergies, triggered by similar allergens and have inter-related inflammatory and pathophysiological mechanisms. Objective: To evaluate the prevalence coexistence of allergic rhinitis and asthma who are attending allergy outpatient clinics. Methods: This epidemiological prospective study was carried out during the period January 2019 to March 2020. With the help of questionnaire demographic data and baseline clinical features along with a personal and family history of allergic were noted. According to the Allergic Rhinitis and its Impact on Asthma guidelines and Global Initiative for Asthma both allergic rhinitis and asthma were classified. Prevalence of coexist were estimated from the detailed statistical analysis. Results: Data were obtained from 650 asthma patients with mean age of 41.5 years. Among 650 patients, asthma was major complaint of 340 and 310 patients visited for allergic rhinitis. Concomitant allergic rhinitis affected 85% of patients with asthma. The high prevalence of the co-existence of rhinitis was found in patients with intermittent asthma (88%) and low rate was found with severe persistent asthma (34%). The prevalence of the comorbidity of asthma and rhinitis decreased as age of patents increased. Family histories, smoking habits, association with pets or animals have significant impact on the coexistence. Conclusion: This study indicated that the allergic rhinitis is coexist with asthma and at higher rate in the older patients with severe the asthma. This study reinforces the need for early diagnosis and guideline-based management of allergic rhinitis in patients with asthma.

Physician beliefs and management practices of coexistent Asthma-Allergic Rhinitis: Indian results from multi-country ASPAIR study

Frequent coexistence and strong etiological linkage between asthma and allergic rhinitis (AR) result in higher burden with comorbid condition than individual disease. To understand attitude, perceptions, and current management practices among general practitioners (GPs) and pediatricians towards coexistent asthma-AR. A cross sectional survey was conducted in India, China, Malaysia, Vietnam, etc. Results presented here are focused on India. Physicians working in public and private sector of 10 Metropolitan cities were approached in person for this survey. A representative national sample of physicians was recruited at hospitals and clinics using a probability-based sampling methodology for a total of 200 physician in India. 98 GPs and 102 pediatricians in India were surveyed. Clinical features and family history of atopy was used by 96% and 82% physicians, respectively to form a diagnosis of asthma. 54% of physicians enquired about common triggers, 48% conducted spirometry. 25% of physicians used patient outcome questionnaires to assess control. AR was diagnosed by nasal (91% of physicians) or ocular symptoms (72% of physicians) and 32% performed skin prick test or serum Immunoglobulin E (IgE). In uncontrolled coexisting asthma-AR, 78% of physicians modified treatment, 21% of physicians referred to a specialist. 88% of physicians were concerned that treating both conditions required added medications, 59% of physicians felt managing both simultaneously was difficult, and 55% of physicians believed it was enough to manage more severe condition. Study highlights low implementation of guidelines despite awareness and need for continued medical education to encourage appropriate diagnosis and management of co-existent asthma-AR. Though the physicians are aware of the guidelines, there was poor utilization in clinical practice. This indicates a need for increase in awareness of guideline recommendations on co existent asthma-AR and improving management of patients. This also eludes to the development of an easy to use diagnostic tool for asthma- AR co-existence.

Precision medicine in atopic diseases.

To analyze the status of precision medicine in atopic diseases. Atopic diseases are increasingly recognized as heterogeneous in nature and they can be quite different in severity, response to therapy, triggers, genetic back ground, ancestral risk and type of inflammation. This significant variability in the landscape of atopic diseases is not reflected in the common treatment guidelines that follow 'one fits all' approach for their management. Such an approach is largely based on minimal 'phenotype' elements, such as severity of disease and response to therapy and does not reflect the information accumulate in the last 20 years about particular pathogenic pathways (endotypes) leading to disease (phenotypes) based on biomolecular analysis of the single individuals. Accumulating data have defined asthma allergic rhinitis, food allergy based on their endotypes and clinically relevant phenotypes. In general, atopic diseases can be largely classified as high or low Th2 inflammatory status, which may explain the severity and response to therapy. Precision medicine is aiming to use known endotype phenotype to guide specific individualized treatment. The work aimed in deep characterization of diseases to guide the disease management is crucial in light of the availability of ever more precise treatment able to target specific pathways.

Creating individual level air pollution exposures in an anonymised data safe haven: a platform for evaluating impact on educational attainment.

IntroductionThere is a lack of evidence on the adverse effects of air pollution on cognition for people with air quality-related health conditions. We propose that educational attainment, as a proxy for cognition, may increase with improved air quality. This study will explore whether asthma and seasonal allergic rhinitis, when exacerbated by acute exposure to air pollution, is associated with educational attainment.ObjectiveTo describe the preparation of individual and household-level linked environmental and health data for analysis within an anonymised safe haven. Also to introduce our statistical analysis plan for our study: COgnition, Respiratory Tract illness and Effects of eXposure (CORTEX).MethodsWe imported daily air pollution and aeroallergen data, and individual level education data into the SAIL databank, an anonymised safe haven for person-based records. We linked individual-level education, socioeconomic and health data to air quality data for home and school locations, creating tailored exposures for individuals across a city. We developed daily exposure data for all pupils in repeated cross sectional exam cohorts (2009-2015).ConclusionWe have used the SAIL databank, an innovative, data safe haven to create individual-level exposures to air pollution and pollen for multiple daily home and school locations. The analysis platform will allow us to evaluate retrospectively the impact of air quality on attainment for multiple cross-sectional cohorts of pupils. Our methods will allow us to distinguish between the pollution impacts on educational attainment for pupils with and without respiratory health conditions. The results from this study will further our understanding of the effects of air quality and respiratory-related health conditions on cognition.HighlightsThis city-wide study includes longitudinal routinely-recorded educational attainment data for all pupils taking exams over seven years;High spatial resolution air pollution data were linked within a privacy protected databank to obtain individual exposure at multiple daily locations;This study will use health data linked at the individual level to explore associations between air pollution, related morbidity, and educational attainment.

Precision medicine in united airways disease: A "treatable traits" approach.

United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.

Cutaneous toxicities of epidermal growth factor receptor inhibitors: A prospective study in 60 Asian patients.

Several prospective studies have been conducted in epidermal growth factor receptor (EGFR) inhibitor-related cutaneous reactions in Caucasian patients, but prospective studies in Asian populations are scarce. To investigate the cutaneous side effects of EGFR inhibitors in Asian cancer patients and to assess tumor response to dermatologic manifestations. Sixty patients with lung or colorectal cancer who were receiving EGFR inhibitors were prospectively followed for at least one year by oncologists and dermatologists. Of 60 patients (33 males, 27 females), 46 lung cancer patients received erlotinib (n=29) and gefitinib (n=17). Cetuximab was prescribed in 14 colorectal cancer patients. Fifty-eight patients (58/60, 96.7%) developed cutaneous reactions. The most common reactions were xerosis (82.8%), acne (79.3%), and skin desquamation (62.1%). Most reactions were mild and well-tolerated. Of 14 patients who had severe reactions, temporary treatment interruption was necessary in 3 patients and a decreasing dose was required in another 3 patients. There were no statistically significant differences in type, severity, or number of cutaneous reactions between responders (29/58) and non-responders (29/58) to EGFR inhibitors. At median follow-up time of 11.92±1.08 months, no patient died from cutaneous toxicities. Nine patients died from cancer and 11 patients lost to follow-up. In this Asian population, almost all patients (96.7%) developed cutaneous toxicities of EGFR inhibitors. Xerosis, acne, and desquamation were common in Asian cancer patients. Most reactions were mild and well tolerated. Due to limited number of patients, this study did not show significant associations between cutaneous toxicities and tumor response.

Polymorphism 4G/5G of the plasminogen activator inhibitor 1 gene as a risk factor for the development of allergic rhinitis symptoms in patients with asthma.

Plasminogen activator inhibitor-1 (PAI-1) is a glycoprotein which has a role in tissue remodelling after inflammatory processes. The objective is to investigate the frequency of PAI-1 gene polymorphism (4G/5G) in patients with a lung ventilation dysfunction in asthma and allergic rhinitis. Genomic DNA was isolated and genotypes of polymorphism of PAI-1 4G/5G and ABO were determined using the methods of RT-PCR and PCR-SSP. Study group includes 145 adult patients diagnosed with chronic asthma, with all clinically relevant parameters and the laboratory markers of pO2, IgE and eosinophils in sputum and nasal swab. In the processing of data, appropriate statistical tests (Kolmogorov-Smirnov test, median, interquartile ranges, χ 2 and Mann-Whitney U tests) were used. Patients with symptoms of allergic rhinitis were significantly younger and had an almost four time higher levels of IgE (P = 0.001), higher pO2 (P = 0.002) and PEF (P = 0.036), compared to those who do not have these symptoms. Genotype PAI 4G/4G is significantly more common in patients with allergic rhinitis (28.1% vs. 16.1%; P = 0.017) compared to the genotype 5G/5G. Carriers of the genotype 4G/5G also have a borderline statistical significance. There were no statistically significant difference in the incidence of allergic rhinitis in the carriers of any ABO genotypes. The frequency of PAI genotype 4G/4G is significantly more common in patients with allergic rhinitis. The results suggest that the carriers of at least one 4G allele are at a higher risk for developing symptoms of allergic rhinitis in asthma.

Case 1: Prolonged Nasal Discharge and Facial Pain in a 17-year-old Girl

1. Elizabeth Ninan, MD* 2. Stefan Hagmann, MD, MSc* 1. *Albert Einstein College of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY. A 17-year-old girl who has a history of asthma and chronic allergic rhinitis presents with a 12-month history of persistent nasal congestion, rhinorrhea, facial pain, and headache. The diagnosis of asthma had been established at age 8 years and chronic allergic rhinitis at age 12 years. Her routine home medications include albuterol, nasal corticosteroids, antihistamines, and topical nasal decongestants. Her symptoms worsened over the last several months, and an 8-week course of oral antibiotics followed by oral corticosteroids for 2 weeks did not lead to notable symptomatic relief. At initial presentation, she is afebrile (36.9°C [98.5°F]), with a heart rate of 96 beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 96/62 mm Hg, and oxygen saturations of 99% in room air. On physical examination she is a BMI of 24.5 and appears uncomfortable. Head and neck examination reveals a nasal crease, allergic “shiners,” bilateral nasal polyps, and frontal and maxillary sinus tenderness. On auscultation, clear breath sounds without any added sounds are audible over both lungs. Findings of the remainder of the physical examination are unremarkable. Laboratory studies reveal a white blood cell count of 6,200/μL (6.2 × 109/L), with 8.4% eosinophils on the differential cell count. Computed tomography (CT) scan of …

The united airways concept: from bench to bedside

-

The immune-modulatory effects of a mixed herbal formula on dendritic cells and CD4+ T lymphocytes in the treatment of dust mite allergy asthma and perennial allergic rhinitis

Objective: Asthma and allergic rhinitis are chronic inflammatory diseases of the conducting nasal airway. Traditional Chinese medicine has long been used for supplemental therapy of allergic diseases, especially asthma and allergic rhinitis. We previously reported the effects of a mixed herbal formula in patients with allergic rhinitis. However, the immune-modulatory mechanism underlying the effects of herbal medicine for the treatment of allergic diseases remains unclear. Methods: We investigated the physiologic changes in dendritic cell (DC) and CD4+ T cell activity in patients with asthma and allergic rhinitis who were treated with a mixed herbal formula composed of Xin-yi-san + Xiao-qing-long-tang + Xiang-sha-liu- jun-zi-tang. Specifically, we set up in vitro autologous or heterologous co-culture experiments between DCs and CD4+ T cells, and used flow cytometry and ELISA to analyze the expression of surface molecules on DCs and the release of cytokines by CD4+ T cells. Results: Expression of HLA-DR on DCs was suppressed following treatment with the mixed herbal formula. Surface expression of CD40, CD54 and CD86 on DCs was also attenuated after treatment. In autologous co-cultures, CD4+ T cells increased their IL-10 production while decreasing TNF-α production. In heterologous co-cultures, IL-10 secretion by T cells was enhanced, while IL-12, IL-4, IL-5 and TNF-α secretion were reduced. Conclusion: Our mixed herbal formula attenuated the allergic reaction by modifying the physiologic function of the DC–CD4+ T cell interaction. Further investigations are necessary to understand the mechanism of immune modification mediated by the mixed herbal formula.

Comorbid Asthma in Allergic Rhinitis Patients in Kashmir

ABSTRACT The study was conducted in the department of otorhinolaryngology, head and neck surgery, Government Medical College, Srinagar and Associated Hospitals, Jammu and Kashmir for the period of 2 years from May 2011 to June 2013 with the aim to determine the prevalence of asthma in allergic rhinitis (AR) patients and the effect of medical management of allergic rhinitis on asthma it is a hospital based prospective study. A total of 576 patients who presented with features of AR were enrolled in the study after proper written consent was taken. All cases were evaluated for AR and for the comorbid asthma. Detailed history and clinical examination was done. Skin prick test (SPT) and spirometry was used to confirm the allergy and to detect comorbid asthma respectively. Wilsons scoring system and spirometeric parameters forced expiratory volume and forced vital capacity (FEV1/FEV25-75 and FVC) were used for pre- and post-treatment symptom comparison. Results Out of 576 patients, 117 patients were positive for SPT for various inhalant allergens, with prevalence of comorbid asthma being 41.08%. There was significant improvement in symptomology of asthma following the use of nasal inhalational steroids for AR. Wilsons score system and spirometric parameters showed marked improvement in post-treatment results, with p-value of 0.00 which is statistically highly significant. How to cite this article Biloo SR, Dar FA, Ahmad R. Comorbid Asthma in Allergic Rhinitis Patients in Kashmir. Clin Rhinol An Int J 2015;8(3):107-109.

Formulation and In-vitro Evaluation of Chewable Tablets of Montelukast Sodium

The objective of the present study is to develop chewable tablets containing different pharmaceutical compositions with simple manufacturing procedures using different excipients. Mannitols, L-HPC 11, Aspartame, Crospovidone, Crospovidone, Aerosil, and Magnesium Stearate are used as excipients for effective formulation of anti-asthmatic drug Montelukast. Montelukast is a selective, orally acting leukotriene receptor antagonist that is used for the treatment of asthma and seasonal allergic rhinitis. Montelukast chewable tablets were prepared by Direct Compression methods using suitable excipients. The chewable tablets were better presented using artificial sweetener Aspartame as flavouring agent. A total of forteen formulations were prepared and the granules were evaluated for pre-compression parameters. The formulated tablets were evaluated for post-compression parameters .The results showed that all the physical parameters were within the acceptable limits. The in vitro release study of all the formulations showed good release. The study concludes that aforementioned excipients can be used to design chewable montelukast sodium tablets.

Olive Oil Sensitivity and desensitization: a non-IgE mediated mechanism.

Introduction:The pungency of extra virgin olive oil (EVOO) is attributed to one of its phenolic compounds called oleocan- thal (OC) and is mediated through the transient receptor channel potential cation channel ankyrin subtype 1 (TRPA1) expressed in the posterior oropharynx. EVOO also mimics the pharmacology of ibuprofen in that both agents cause a dose-dependent inhibition of cyclooxygenase enzymes COX-1 and COX-2. EVOO sensitivity has been described in the literature previously however EVOO desensitization has not. Herein we report the first case of successful EVOO desensitization using a novel EVOO desensitization protocol. Case description: A 25-year-old patient with medical history significant for aspirin sensitivity, exercise induce asthma and mixed vasomotor and allergic rhinitis presented with a history of facial and tongue pruritus, throat irritation, coughing and hives within minutes of olive oil consumption. Symptoms required diphenhydramine however several prior episodes required epinephrine. A series of food and drug challenges were entertained to establish the mechanism of EVOO sensitivity in this patient. Also a novel EVOO desensitization protocol was devised. Discussion:EVOO desensitization has not been reported previously in the literature and in this report we describe the first case of successful EVOO desensitization using a novel EVOO desensitization protocol. Furthermore the patient continues to be in a desensitized state 2 years after the procedure maintained with daily doses of 10 ml EVOO. Although the mechanism of her reaction is likely due to OC stimulation of TRPA1, the mechanism of desensitization and maintenance of the desensitized state is unclear and requires further study.