Symptoms Of Allergic Rhinoconjunctivitis Research Articles

176 Sublingual Immunotherapy for Grass Pollen Allergy in Children

BackgroundSublingual immunotherapy (SLIT) using grass pollen extracts is an attractive treatment option compared with subcutaneous immunotherapy (SCIT) for children suffering with the symptoms of seasonal allergic rhino-conjunctivitis, with or without asthma. However, evidence for the efficacy of SLIT in children remains unclear. The objective was to undertake a systematic review of the available literature to identify high quality paediatric studies of SLIT for grass pollen allergy to assess the safety and benefits of SLIT compared with standard medication alone.MethodsMEDLINE, EMBASE, CINAHL, NHSEED, DARE and Cochrane were searched from 1st Jan 2000 to June 2010. A pre-specified inclusion criteria was used to select studies, which were assessed for the risk of bias using the Jadad scale. The outcomes of interest were data from the studies including the reduction of nasal, eye and chest symptoms, use of symptom relieving medication and safety.ResultsNine studies met the inclusion criteria. A narrative synthesis on the safety of SLIT found a high incidence of mild, adverse events. Outcomes were pooled using Rev Man 5 and the random effects model. Inter-study heterogeneity was measured using the I2 statistic and was <70% in all meta-analyses. The reduction of total allergic rhino-conjunctivitis symptom scores indicated a small highly significant reduction with non-significant heterogeneity. (SMD –0.24, 95%, CI–0.38 to –0.11 P = 0.0005), (I2 15% P = 0.32). The reduction in total relief medication use scores compared to placebo was non-significant. (SMD-0.25 CI -0.50, 0.01, P = 0.06). I2 67% (P = 0.006).ConclusionsSLIT has a small benefit on symptoms but does not demonstrate a significant reduction in medication use. This justifies current SLIT use in paediatric allergy in the UK where availability is limited to children who remain symptomatic despite having proven concordance using optimised symptom relieving medication and children in whom SCIT is contra-indicated.

Dose-related Effects of Ragweed Allergy Immunotherapy Tablet on Nasal and Ocular Symptoms of Allergic Rhinoconjunctivitis During the Peak Ragweed Pollen Seasons in Europe and North America

Dose-related Effects of Ragweed Allergy Immunotherapy Tablet on Nasal and Ocular Symptoms of Allergic Rhinoconjunctivitis During the Peak Ragweed Pollen Seasons in Europe and North America

408 Prevalence and Risk Factors Associated to Symptoms of Rhinoconjunctivitis in Mexican School Children. A Multicenter Study

BackgroundAccording to ISAAC symptoms of allergic rhinoconjunctivitis (RC), have a worldwide prevalence of 8.5% in school children. Multiple risk factors had been associated with its prevalence, though little is known about the regional variations of these risk factors.ObjectiveIdentify the prevalence and the main risk factors associated to the presence of symptoms of rhinoconjunctivitis in the last 12 months in Mexican school children.MethodsCross-sectional, multicenter, prospective, based in ISAAC methodology of 9 registered sites in 8 cities (north, center and south of the Mexican Republic) with a validated and standardized survey applied to tutors of children aged 6 to 7 years old. Risk analysis was made through multivariate logistical regression, central tendency and dispersion measures were obtained with respective 95% confidence intervals.Results24,902 surveys were obtained. The prevalence and 95%CI of symptoms of rhinitis was as follows: Monterrey 23%(21.4-24.5%), Mexicali 28.7% (26.9-30.5%), Ciudad Victoria 21.3%(19.7-22.8%), Villahermosa 39% (37-41%), North Federal District 45.6% (44.1-47.2%), Toluca-18.6% (17.3-20%), Tijuana 24.5% (22.9-26.1%), southeast Federal District 53%(50.7-55.4%) Veracruz 25% (23.1-26.8%) and conjunctivitis: Monterrey 8.8% (7.8-9.9%), Mexicali 13.2%(11.9-14.5%), Ciudad Victoria 7.3%(6.3-8.3%), Villahermosa 18.7% (17-20.3%), North Federal District 20.4%(19.1-21.7%), Toluca 7.3%(6.4-8.2%), Tijuana 8.7%(7.6-9.7%), southeast Federal District 25.1%(23-27.1%) Veracruz 8.7% (7.5-9.9%). The prevalence de rhinoconjunctivitis were 12.8%.Identified risk factors for the presence of rhinitis in the last 12 months were: asthma symptoms in the last 12 months OR-2.59 (95% CI, 2.25-2.98; P ≤ 0.0001), wheezing ever OR-1.78 (95% CI, 1.61-1.96; P ≤ 0.0001), eczema symptoms in the last 12 months OR-1.61 (95% CI, 1.35-1.93; P ≤ 0.0001), atopic dermatitis ever OR-2.97 (95% CI, 2.52-3.51; P ≤ 0.0001).Identified risk factors for the presence of conjunctivitis in the last 12 months were: wheezing ever OR-1.88 (95% CI, 1.64-2.16; P ≤ 0.0001), asthma symptoms in the last 12 months OR-2.97 (95% CI, 2.52-3.51; P ≤ 0.0001) eczema symptoms in the last 12 months OR-1.95 (95% CI, 1.58-2.41; P ≤ 0.0001), atopic dermatitis ever OR-2.14 (95% CI, 1.81-2.54; P ≤ 0.0001).ConclusionsThe highest prevalence of rhinoconjunctivitis in Mexican School Children is in the southeast of the Federal District.The presence of asthma symptoms in the last 12 months, wheezing ever, eczema symptoms in the last 12 months, atopic dermatitis ever, risk factors are present symptoms of rhinoconjunctivitis.

Ragweed Allergy Immunotherapy Tablet Reduces Nasal and Ocular Symptoms of Allergic Rhinoconjunctivitis Over the Peak Ragweed Pollen Season in North America

Ragweed Allergy Immunotherapy Tablet Reduces Nasal and Ocular Symptoms of Allergic Rhinoconjunctivitis Over the Peak Ragweed Pollen Season in North America

488 The Effect of Specific Immunotherapy on the Clinical Response in Patients with Grass-pollen Induced Rhinoconjunctivitis

BackgroundSpecific immunotherapy (SIT) has a significant potential in the treatment of allergic rhinitis and allergic conjunctivitis. The aim of the study was to evaluate the effect of specific immunotherapy (SIT) in patients with grass-pollen induced allergic rhinitis and allergic conjunctivitis.MethodsTwenty-six patients with pollen induced rhinoconjunctivitis and positive history for more than 2 years were included in our study. They had skin prick test of ≥ 5 mm, age range from 18 to 44 years and all underwent conjunctiva provocation tests before and after 1 year of SIT. Clinical severity score of nasal and conjunctiva symptoms during the season was assessed by 4-point arbitrary rating scale from 0 to 3. Conjunctiva provocations were performed out of the season until allergic symptoms occurred, achieving the allergen threshold dose (ATD).ResultsAfter 1 year of SIT, we have noticed reduction of clinical symptoms present in allergic conjunctivitis: burning, itching, lacrimation and hyperemia (P < 0,05). We have found also reduction in clinical symptoms of allergic rhinitis: secretion, irritation, itching and nasal blockade (P < 0,01). The patients tolerated significantly higher allergen doses in provocation tests after 1 year of SIT, reaching new ATD.ConclusionsSIT reduces the clinical symptoms of allergic rhinoconjunctivitis and modifies the inflammatory response after specific allergen challenge.

Timothy Grass Allergy Immunotherapy Tablets Reduce Nasal and Ocular Symptoms Associated With Allergic Rhinoconjunctivitis During Grass Pollen Season in North American Children and Adults: 2 Randomized, Placebo-Controlled Trials

The nasal and ocular symptoms of allergic rhinoconjunctivitis (ARC) are bothersome with a substantial negative impact on quality of life. The effect of Timothy grass allergy immunotherapy tablet (grass AIT) treatment on individual ARC symptoms was assessed in 2 randomized, double-blind trials in North American adults and children with grass pollen-induced ARC.

Rhinoconjunctivitis prevalence and associated factors in school children aged 6–7 and 13–14 years old in Bogota, Colombia

ObjectiveAllergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of rhinoconjunctivitis and determine clinical, social and environmental associated factors, among school children aged 6–7 years and adolescents aged 13–14 years in Bogotá, Colombia. MethodsWe used ISAAC (International Study of Asthma and Allergies in Childhood) phase III study methodology and questionnaire for design and data collection, and we did a secondary analysis of these data. The sample consisted of 3830 registers from adolescents between 13 and 14 years old and 3256 registers from children between 6 and 7 years. ResultsThe prevalence of rhinoconjunctivitis symptoms in the last year was 17.2% (95% CI, 15.9–18.5) in children vs. 24.9% (95% CI, 23.6–26.3) in adolescents. In both groups there was a female predominance in children (17.8% vs. 16.5%), and in the teenagers group (28.0% vs. 21.4%), though the differences were not statistically significant.The factors associated with rhinoconjunctivitis in the group of 6–7 years where: asthma [OR 3.9; (95% CI, 2.8–5.4)], atopic dermatitis [OR 2.3; (95% CI, 1.7–3.1)], use of acetaminophen in the last year [OR 2.6; (95% CI, 1.4–4.9)], use of antibiotics in the first year of live [OR 1.7; (95% CI, 1.3–2.3)], higher maternal education [OR 1.5; (95% CI, 1.0–2.3)] and cesarean delivery [OR 1.6; (95% CI, 1.2–2.1)].Among the 13–14 year age-group, factors associated with rhinoconjunctivitis included: asthma [OR 2.6; (95% CI, 2.0–3.4)], atopic dermatitis [OR 1.8; (95% CI, 1.4–2.3)], use of acetaminophen in the last year [OR 1.8; (95% CI, 1.4–2.4)], consumption of fast-food three times or more per week [OR 1.5; (95% CI, 1.2–2.0), ever smoked [OR 1.4; (95% CI, 1.2–1.7)] and meat consumption was protective factor [OR 0.7; (95% CI, 0.5–0.9)]. ConclusionIn both studied groups, the estimated prevalence of rhinoconjunctivitis symptoms was relatively high. Future in-depth research is needed to assess the complex interactions between allergic rhinoconjunctivitis symptoms and social and environmental factors.

Mometasone Furoate Nasal Spray Relieves the Ocular Symptoms of Seasonal Allergic Rhinoconjunctivitis

Recent studies have examined the effects of intranasal corticosteroids (INSs) in relieving the ocular symptoms of seasonal allergic rhinoconjunctivitis (SAR) and perennial allergic rhinitis. However, because most of these studies were based on subjective assessments by patients, the associated factors and mechanism of action are unknown. A single-center, randomized, double-blind, parallel-group study was carried out in which patients with SAR were randomly assigned to an INS mometasone furoate nasal spray (MFNS) group or to a placebo group and treated once daily for 4 weeks. Substance P concentrations in tears were measured, ocular and nasal symptoms were recorded by patients in an allergy diary, and findings were recorded by an ophthalmologist. There was no significant difference between treatment groups in the mean change from baseline of substance P concentration in tears after 4 weeks of treatment, but the mean change tended to increase in the placebo group and tended to decrease in the MFNS group (P = 0.089). All ocular and nasal symptom scores, except eye tearing, were significantly lower in the MFNS group than in the placebo group. Furthermore, substance P concentrations were strongly correlated with ocular and nasal symptom scores. In patients with SAR, INSs tend to decrease the substance P concentration in tears, which is correlated with the severity of ocular and nasal symptoms.

Properties of Olopatadine Hydrochloride, a New Antiallergic/Antihistamine Drug

Olopatadine hydrochloride (CAS 140462-76-6, KW-4679, AL-4943A; hereinafter referred to as olopatadine) is a novel antiallergic drug that is a selective histamine H1 receptor antagonist possessing inhibitory effects on the release of inflammatory lipid mediators such as leukotriene and thromboxane from human polymorphonuclear leukocytes and eosinophils. Olopatadine also inhibits the tachykininergic contractions in guinea pig bronchi by prejunctional inhibition of peripheral sensory nerves. Oral administration of olopatadine at doses of 0.03 mg/kg or higher reduces the symptoms of experimental allergic cutaneous responses and rhinoconjunctivitis in sensitized animals. Preclinical and clinical evaluations have demonstrated that olopatadine is a safe drug. After oral administration to healthy volunteers, olopatadine was rapidly and extensively absorbed. Unlike most other antiallergic drugs which are eliminated via hepatic metabolism, olopatadine is mainly excreted into urine. Olopatadine did not affect cytochrome P450 activities in human liver microsomes and consequently drug-drug metabolic interactions are unlikely. In double-masked clinical trials, olopatadine was shown to be effective at alleviating symptoms of allergic diseases. The drug (Allelock) was approved in Japan for the treatment of allergic rhinitis, chronic urticaria, eczema dermatitis, prurigo, cutaneous pruritus, psoriasis vulgaris and erythema exsudativum multiforme in December, 2000. An ophthalmic solution of olopatadine is also useful for the treatment of allergic conjunctivitis: this formulation (Patanol) was approved in the USA and the European Union for the treatment of seasonal and perennial allergic conjunctivitis in 1996 and 2002, respectively.

Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia

The prevalence of asthma and allergic diseases has been found to be increasingly rapidly, especially in developing countries. Environmental factors have been found to be important contributors to the manifestations of allergic diseases. Air pollution has been extensively studied in different regions of the world. The levels of ambient air pollutants in many Asian countries are very high when compared with those in developed Western countries. However, the prevalence of asthma was relatively low across many Asian countries. Many studies have clearly documented that environmental air pollution is an important factor resulting in exacerbations of asthma. In particular, levels of traffic-related pollutants are increasing rapidly across many Asian countries in parallel with the level of urbanization and economic development. The loss of protective factors associated with a rural environment will further contribute to the adverse effect on patients with allergic diseases such as asthma. In this review the roles of air pollution were examined in relation to the inception and exacerbations of allergic diseases in Asia.

Analysis of allergen immunotherapy studies shows increased clinical efficacy in highly symptomatic patients

The assessment of allergen immunotherapy (AIT) efficacy in the treatment for seasonal allergic rhinoconjunctivitis (SAR) symptoms is challenging. Allergen immunotherapy differs from symptomatic therapy in that while symptomatic therapy treats patients after symptoms appear and aims to reduce symptoms, AIT is administered before symptoms are present and aims to prevent them. Thus, clinical studies of AIT can neither establish baseline symptom levels nor limit the enrolment of patients to those with the most severe symptoms. Allergen immunotherapy treatment effects are therefore diluted by patients with low symptoms for a particular pollen season. The objective of this analysis was to assess the effect possible to achieve with AIT in the groups of patients presenting the most severe allergic symptoms. Study centres were grouped into tertiles categorized according to symptom severity scores observed in the placebo patients in each centre (low, middle and high tertiles). The difference observed in the average score in each tertile in active vs placebo-treated patients was assessed. This allowed an estimation of the efficacy that could be achieved in patients from sites where symptoms were high during the pollen season. An increased treatment effect was observed in the most severe patients and was independent of the study analysed and symptom score used. The use of a tertile approach to analyse efficacy in AIT in SAR clinical studies can give a more accurate assessment of potential clinical benefit.

Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta‐analysis

SummaryBackground. Allergic conjunctivitis (AC) is a common manifestation and represents an important co‐morbidity of allergic rhinitis (AR). Sublingual immunotherapy (SLIT) is an effective and safe treatment for nasal symptoms of AR; its effectiveness is however less well established for ocular symptoms.Objectives. To evaluate the effectiveness of SLIT in reducing ocular symptoms, the need for ocular treatments and the threshold exposure for conjunctival immediate allergen sensitivity (CIAS).Methods. We searched eight databases up to January 2010. We included only randomized controlled trials (RCT), double‐blind and placebo‐controlled evaluating the efficacy of SLIT in patients with symptoms of allergic rhinoconjunctivitis (ARC) or AC. Primary outcome measures were total ocular symptom scores, individual ocular symptoms scores (itchy eyes, eye redness, watery eyes, swelling eyes), eye drops use and CIAS. Meta‐analysis was undertaken using RevMan 5 software.Results. From 811 abstracts that were screened, 109 studies were reviewed in their full text version. Forty two trials including 3958 participants (n=2011 SLIT and n=1947 placebo) had data suitable for inclusion in the meta‐analysis. SLIT induced a significant reduction on both total ocular symptom scores (SMD: −0.41; 95%CI: −0.53 to −0.28; I2: 59%) and individual ocular symptoms scores [red (−0.33; −0.45 to −0.22), itchy (−0.31; −0.42 to −0.20) and watery eyes (−0.23; −0.34 to −0.11)] compared with placebo. Participants in the SLIT group showed an increase in the threshold dose for the CIAS (SMD: 0.35; 0.00–0.69). No significant reduction was observed on eye drops use (SMD: −0.10; −0.22 to 0.03).Conclusions and Clinical Relevance. SLIT is effective in reducing total and individual ocular symptom scores in subjects with ARC or conjunctivitis. No significant reduction was observed in ocular eye drops use. Cite this as: M. A. Calderon, M. Penagos, A. Sheikh, G. W. Canonica and S. R. Durham, Clinical &amp; Experimental Allergy, 2011 (41) 1263–1272.

Sublingual immunotherapy for treating allergic conjunctivitis

Allergic ocular symptoms, although frequently trivialised, are common and represent an important comorbidity of allergic rhinitis. Sublingual Immunotherapy (SLIT) is an effective and well-tolerated treatment for allergic rhinitis, but its effects on symptoms of ocular allergy have not been well established. To evaluate the efficacy of SLIT compared with placebo for reductions in ocular symptoms, topical ocular medication requirements and conjunctival immediate allergen sensitivity. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 1), MEDLINE (January 1950 to January 2011), EMBASE (January 1980 to January 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2011), Web of Science (January 1970 to January 2011), Biosis Previews, (January 1979 to January 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (January 2011), ClinicalTrials.gov (www.clinicaltrials.gov) (January 2011), the Australian New Zealand Clinical Trials Registry (ANZCTR) (www.actr.org.au) (July 2010), SCOPUS (November 2008) and the UK Clinical Trials Gateway (January 2010). There were no language or date restrictions in the search for trials. All electronic databases except for SCOPUS, the UK Clinical Trials Gateway and ANZCTR were last searched on 19 January 2011. Randomised controlled trials (RCTs), double-masked and placebo controlled, which evaluated the efficacy of SLIT in patients with symptoms of allergic rhinoconjunctivitis (ARC) or allergic conjunctivitis (AC). The primary outcome was the total ocular symptom scores. Secondary endpoints included individual ocular symptom scores (such as itchy eyes, red eyes, watery eyes, swollen eyes), ocular medication scores (eye drops) and conjunctival immediate allergen sensitivity (CIAS). Data were analysed and reported as standardised mean differences (SMDs) using Review Manager software. Forty-two trials (n = 3958 total participants; n= 2011 SLIT and n = 1947 placebo) had available data to evaluate the efficacy of SLIT on AC and were included in the meta-analyses. Heterogeneity among studies (I(2) statistic) was around 50% or below for all endpoints. Sublingual immunotherapy induced a significant reduction in both total ocular symptom scores (SMD -0.41; 95% confidence interval (CI) -0.53 to -0.28; P < 0.00001; I(2) = 59%) and individual ocular symptom scores for red eyes (SMD -0.33; 95% CI -0.45 to -0.22; P < 0.00001; I(2) = 27%), itchy eyes (SMD -0.31; 95% CI -0.42 to -0.20; P < 0.00001; I(2) = 46%) and watery eyes (SMD -0.23; 95% CI -0.34 to -0.11; P < 0.0001; I(2) = 42%) compared to placebo. Those participants having active treatment showed an increase in the threshold dose for the conjunctival allergen provocation test (SMD 0.35; 95% CI 0.00 to 0.69; P = 0.05; I(2) = 43%). No significant reduction was observed in ocular eye drops use (SMD -0.10; 95% CI -0.22 to 0.03; P = 0.13; I(2) = 34%). Overall, SLIT is moderately effective in reducing total and individual ocular symptom scores in participants with ARC and AC. There were however some concerns about the overall quality of the evidence-base, this relating to inadequate descriptions of allocation concealment in some studies, statistical heterogeneity and the possibility of publication bias. There is a need for further large rigorously designed studies that study long-term effectiveness after discontinuation of treatment and establish the cost-effectiveness of SLIT.

The average Adjusted Symptom Score, a new primary efficacy end‐point for specific allergen immunotherapy trials

In clinical trials, the efficacy of immunotherapy for allergic rhinoconjunctivitis symptoms is often evaluated with the average Rhinoconjunctivitis Total Symptom Score (ARTSS). Effective treatment is associated with a lower ARTSS vs. placebo but use of rescue medication to alleviate symptoms reduces the RTSS and decreases the mean difference between active treatment and placebo groups. To develop and describe the average Adjusted Symptom Score (AdSS), a new end-point reflecting symptom severity and rescue medication use in allergic rhinoconjunctivitis trials. To calculate the AdSS, the RTSS is adjusted as follows: if a patient takes rescue medication on day d, the day's AdSS (AdSS(d)) is defined as the value of RTSS(d) or AdSS(d-1), whichever is higher. The AdSS on the following day (AdSS(d+1)) is defined as the value of RTSS(d+1) or AdSS(d), whichever is higher. The average of the daily AdSSs (during the season) was calculated post hoc for two trials investigating the efficacy of five-grass pollen sublingual immunotherapy tablets in adult and paediatric patients and compared with the ARTSS and three other outcome measures (the average Rescue Medication Score (ARMS), the ARTSS and the average Combined Score). The average AdSS clearly discriminated between active and placebo treatments and confirmed the original ARTSS results. Adjustment for rescue medication use decreased the observed placebo effect. The average AdSS can be a valuable alternative to the ARTSS as a primary efficacy end-point in grass pollen allergic rhinoconjunctivitis trials. By adjusting the RTSS for rescue medication use, the AdSS can estimate symptom severity and the treatment effect more accurately. The AdSS is now being tested prospectively in large clinical trials.

Repeated Low-dose Aerosolized Dust Mite Allergen Exposure In Asthmatic And Non-asthmatic Dust Mite Allergic Patients In An Environmental Exposure Chamber Induces Specific Asthma Symptoms As Well As Allergic Rhinoconjunctivitis Symptoms

RATIONALE: Dust Mite Allergen, including Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f), is a major factor in allergic asthma disease worldwide. The Environmental Exposure Chamber (EEC), which allows for a consistent, well-controlled level of aerosolized Der p allergen exposure, was used to study the effects of Der p in both asthmatic and non-asthmatic dust mite allergic patients.

Ectoin ®, a Novel, Non-Drug, Extremophile-Based Device, Relieves Allergic Rhinoconjunctivitis Symptoms in Patients in an Environmental Exposure Chamber Model

RATIONALE: Despite the many pharmaceutical treatments available, allergy patients remain dissatisfied due to deleterious side-effects and ineffective symptom relief. A new, naturally-sourced, extremophile derived, anti-allergic device, Ectoin®, was investigated in this study. The objective was to assess the relative efficacy of Ectoin® Nasal Spray and Eye Drops compared to placebo on the complex of rhinoconjuntivitis symptoms in subjects exposed to highly controlled ragweed levels in an Environmental Exposure Chamber.

The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: Nationwide cross-sectional survey using complex sampling design

To investigate the prevalence of asthma, allergic rhinitis, and eczema, we did a cross-sectional survey of 4,003 children aged 6-7 years (students in the 1st year of elementary school) and 4,112 students aged 13-14 years (students in the 1st year of middle school), chosen from a random sample of 45 primary and 40 middle schools across the nation. The Korean-translated modified version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used in this survey. The weighted 12-month prevalence of asthma symptoms from the questionnaires was 10.3% (95% confidence interval [CI], 9.2 to 11.4) for children aged 6-7 years and 8.3% (95% CI, 7.4 to 9.2) for children aged 13-14 years. The weighted 12-month prevalence of allergic rhinoconjuctivitis symptoms was 18.9% (95% CI, 17.5 to 20.4) for children aged 6-7 years and 19.2% (95% CI, 17.9 to 20.6) for children aged 13-14 years. The weighted 12-month prevalence of eczema symptoms was 17.9% (95% CI, 16.6 to 19.3) for children aged 6-7 years and 11.2% (95% CI, 10.1 to 12.3) for children aged 13-14 years. Compared with results from a 2000 ISAAC study, the 12-month prevalence of asthma increased from 5.8% to 10.3% in children aged 6-7 years, but there was little change (from 8.7% to 8.3%) in children aged 13-14 years. The prevalence of allergic rhinoconjunctivitis and eczema has increased considerably in both age groups.

Disparate geographic prevalences of asthma, allergic rhinoconjunctivitis and atopic eczema among adolescents in five Canadian cities

To assess concordance of prevalence rates of asthma, allergic rhinoconjunctivitis and atopic eczema symptoms among adolescents in five Canadian cities. The International Study of Asthma and Allergies in Childhood Phase 3 written questionnaires were answered by 8334 adolescents aged 13 to 14 in Vancouver, Saskatoon, Winnipeg, Hamilton and Halifax, Canada. Prevalence rates of current symptoms ranged from 13.7-33.0% for wheezing, 14.6-22.6% for allergic rhinoconjunctivitis and 8.2-10.4% for atopic eczema. Using Hamilton as reference, the prevalence of wheezing was significantly higher in Halifax (OR = 1.58; 95% CI 1.36-1.84) and Saskatoon (1.27; 1.07-1.50) and significantly lower in Vancouver (0.51; 0.44-0.59). In contrast, allergic rhinoconjunctivitis was significantly more prevalent in Winnipeg (1.39; 1.16-1.68) and Halifax (1.36; 1.14-1.61) and trended lower in Saskatoon (0.81; 0.66-1.00). Atopic eczema was significantly more prevalent in Winnipeg (1.31; 1.01-1.69) and Vancouver (1.28; 1.04-1.58). Multivariable logistic regression analyses showed the region of residence, being born in Canada, recent use of acetaminophen and heavy exposure to traffic exhaust were significantly associated with all three allergic conditions, while obesity and having two or more smokers at home was only associated with increased risk for wheezing. Chinese ethnicity decreased that risk. Among five Canadian centres, the highest prevalence rates of allergic rhinoconjunctivitis or atopic eczema were not observed in the same regions as the highest prevalence rates of wheezing. This disparity in regional variations in the prevalence rates suggests dissimilar risk factors for the development or expression of wheezing (asthma), allergic rhinoconjunctivitis and atopic eczema.

Trends in the Prevalence and Severity of Symptoms of Asthma, Allergic Rhinoconjunctivitis, and Atopic Eczema

The increase in prevalence of asthma and other allergic diatheses has rarely been documented in the developing sub-Saharan countries. We assessed time trends in symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema among children in Ibadan, Nigeria, with cross-sectional data from 2 International Study of Asthma and Allergies in Childhood questionnaire-based surveys conducted 7 years apart in 1995 and in 2001-2002. The prevalence of current wheeze increased nonsignificantly in the 6- to 7-year age group (4.8%-5.5%) and significantly in the 13- to 14-year age group (10.7%-13.0%) (p = .249 and p = .005, respectively). The 12-month prevalence of allergic rhinoconjuctivitis decreased insignificantly in the 6- to 7-year age group (p = .833) but significantly in the 13- to 14-year age group (p = .001), while the diagnosis of atopic eczema decreased in both age groups. The current findings suggest that the symptoms of asthma have only increased significantly in the Nigerian adolescents.

Intranasal corticosteroids and allergic rhinoconjunctivitis

To describe recent insight into the efficacy of intranasal corticosteroids in treating ocular signs and symptoms of allergic rhinoconjunctivitis. The efficacy of intranasal corticosteroids in treating allergic nasal symptoms is well established, and recent evidence indicates that this class of medication may be effective at alleviating ocular symptoms as well. The present review reveals that the method of scoring ocular symptoms in a clinical trial may influence whether statistically significant improvements are detected among patients using intranasal corticosteroids. Improvement is more likely to be detected if symptoms are scored individually rather than pooled into a single ocular symptom score. Furthermore, the practice of allowing rescue medications likewise may preclude the ability to detect statistically significant differences in allergic eye symptoms between intranasal corticosteroids and controls. Recent data show a promising effect of intranasal corticosteroids on ocular symptoms of allergic rhinoconjunctivitis. Additional trials should be conducted that require individuals to score ocular symptoms individually and forbid the use of rescue medications.