Features Of Allergic Rhinitis Research Articles

Correlation between Absolute Eosinophil Counts (AEC) and Nasal Symptoms Using NOSE Scale in Allergic Rhinitis

Introduction: Allergic Rhinitis is a symptomatic disorder of the nose induced after allergen exposure due to an IgE-mediated inflammation of membranes lining the nose. It is clinically defined as a symptomatic condition with four major symptoms as anterior or posterior rhinorrhoea, sneezing, nasal itching & nasal congestion. Objective: To study the association of absolute eosinophil count (AEC) and nasal symptoms using Nasal obstruction symptom evaluation (NOSE) scale in allergic rhinitis. Methods: The study was conducted in a General Hospital, Rangamati, Bangladesh over a period of January to June 2021. Patients having symptoms of allergic rhinitis like sneezing, nasal pruritis, rhinorrhoea, nasal congestion, eye watering and itching, pharyngeal itching were included as a part of the study. A detailed clinical examination was performed, NOSE scale form was given to the patient and scoring was done according to the marks on each question, and AEC values were assessed. Results: Total 125 patients were studied. Groups were made according to AEC value and NOSE score. As per our study patients with higher AEC value have higher NOSE score. Conclusion: NOSE score evaluation is simple, economical, and non-invasive. Hence it may be used as an alternative for AEC value in clinical setup. Our study indicated that patients with a higher NOSE score with features of allergic rhinitis were having a higher AEC value. However we feel that it is not as accurate as absolute eosinophil count and nasal eosinophilia.

Immunological features of allergic rhinitis in combination with chronic rhinosinusitis of bacterial etiology

Rhinitis is a socially significant and widespread disease. Often, various forms of rhinitis are combined, and thus cause severe clinical manifestations, insufficient effectiveness of drug treatment, as well as difficulties in differential diagnosis. It is known that a significant number of patients have a combination of allergic rhinitis (AR) with chronic rhinosinusitis of bacterial etiology. This condition is based on a chronic multifactorial inflammatory process of the nasal mucosa, which determines the steady progression of the disease. Of interest is the study of a number of allergo-immunological parameters in nasal secretions in order to assess local inflammation and changes in mucosal immunity in allergic rhinitis in combination with chronic rhinosinusitis of bacterial etiology (AR with HRSBE). Mucosal immunity and biological mediators determine local inflammation and pathophysiological response to etiological factors in the immunopathogenesis of AR with CRSBE. The work carried out the determination of the level of cytokines: IL-4, IL-10, TGF-â1, IFNã spontaneous and induced; immunoglobulins: IgA, IgM, IgG, sIgA in nasal secretions; leukotrienes: LT C4/ D4/E4 and LTB4 in plasma and total IgE in serum in patients with AR with moderate-severity HRSBE without exacerbation. It has been shown that the leading role in the formation of the inflammatory process in AR with CRSBE belongs to cytokines: IL-4, IL-10, TGF-â; immunoglobulins: IgM, sIgA; leukotrienes: LT C4/D4/E4 and LTB4 and total IgE. Induced cytokine production largely reflects the reserve capabilities of immunocompetent cells in response to the action of a pathogenic factor. The results obtained are associated with the persistent course of allergic and infectious inflammation and the progression of the disease. Thus, cytokines: IL-4, IL-10, TGF-â1; immunoglobulins: IgM, sIgA, IgE total and LT C4/D4/E4 and LTB4 make a significant contribution to pathogenetic mechanisms, determining the clinical course of AR with CRSBE, and can serve as biological markers of the activity of the pathological process. Undoubtedly, the immune mechanisms in the combined pathological inflammatory reaction from the mucosa in AR with HRSBE are complex and multifaceted. A personalized approach to the treatment of patients with AR with CRSBE is determined by the severity and intensity of the inflammatory reaction, as well as mucosal mucosal immunity disorders. The study of the role and significance of the production of leading cytokines, immunoglobulins in nasal secretions, as well as leukotrienes and total IgE in the blood will help the doctor in determining the tactics and duration of pharmacotherapy.

Effect of Probiotics on Respiratory Tract Allergic Disease and Gut Microbiota

Allergy is a hypersensitivity reaction triggered by specific cell or antibody-mediated immune mechanisms. Allergies have increased in industrialized countries in recent decades. The rise in allergic respiratory diseases such as allergic rhinitis (AR) and allergic asthma (AA) is a potential threat to public health. Searches were conducted using PubMed, Google Scholar and Medline using the following key terms: allergic rhinitis OR asthma AND probiotics, allergic airway inflammation AND immune disorders, probiotics OR gut microbiota AND allergic disease, probiotics AND inflammatory. Studies from all years were included, specifically those published within the last 10 years. Some review articles and their reference lists were searched to identify related articles. The role of microbiota in respiratory allergic diseases has attracted more and more attention. Pieces of evidence suggested that the development of allergic diseases causes a possible imbalance in the composition of the gut microbiota. Compared to colonized mice, germ-free mice exhibit exaggerated allergic airway responses, suggesting that microbial host interactions play an important role in the development of allergic diseases. Probiotics modulate both the innate and adaptive inflammatory immune responses, often used as dietary supplements to provide health benefits in gastrointestinal disorders. Probiotics may serve as immunomodulators and activators of host defense pathways. Besides, oral probiotics can modulate the immune response in the respiratory system. Recently, studies in humans and animals have demonstrated the role of probiotic in RA and AA. To understand the characterization, microbiota, and the potential role of probiotics intervention of AA/AR, this review provides an overview of clinical features of AA and AR, probiotics for the prevention and treatment of AR, AA, changes in gut microbiota, and their mechanisms of action.

Diagnosis and Treatment of Local Allergic Rhinitis.

Some patients with chronic rhinitis have a positive nasal allergen provocation test (NAPT) without systemic IgE sensitization by skin prick tests or serum allergen-specific IgE (sIgE). This novel concept is called local allergic rhinitis (LAR) and affects children and adults worldwide, but is underdiagnosed. LAR is not just the initial state of allergic rhinitis (AR), it is a unique form of chronic rhinitis that is neither classical AR nor non-AR. Many of the features of AR and LAR are similar, such as a positive NAPT, positive type 2 inflammatory markers, including the nasal discharge of sIgE, and a high incidence of asthma. A differential diagnosis of LAR needs to be considered in patients with symptoms suggestive of AR in the absence of systemic atopy, regardless of age. The diagnostic method for LAR relies on positive responses to single or multiple allergens in NAPT, the sensitivity, specificity, and reproducibility of which are high. The basophil activation test and measurement of IgE in nasal secretions also contribute to the diagnosis of LAR. Treatment for LAR is similar to that for AR and is supported by the efficacy and safety of allergen exposure avoidance, drug therapy, and allergen immunotherapy. This review discusses current knowledge on LAR.

A Multicenter Study of Prevalence and Risk Factors for Allergic Rhinitis in Primary School Children in 5 Cities of Hubei Province, China

Background: Few data are available concerning the prevalence and risk factors for allergic rhinitis (AR) in school children in Hubei Province which is located in the central part of China. This study investigated the epidemiological features of AR among school children in Hubei Province. Methods: A cross-sectional questionnaire survey on AR in school children was carried out in 5 cities in Hubei Province by cluster sampling from June to September 2018. Questionnaires were filled out by children and their parents jointly. The diagnostic criteria of AR were according to the SFAR. Questions from the questionnaire were used to examine the pattern of AR. Logistic regression analysis was used to assess the risk factors for childhood allergies. Results: The total prevalence rate of AR was 16.16%, with 24.31% (Wuhan), 4.34% (Xiangyang), 4.31% (Tianmen), 10.92% (Jingmen), and 11.42% (Huangshi), respectively. The prevalence of AR was positively correlated with gross domestic product per capita (p < 0.05). Multivariate analysis revealed that male, city of Wuhan, family history of allergy, food allergy, drug allergy, air purifier, exposure to dust, living in towns or urban area before 2 years old, maternal age for 26–35 years old, and frequent application of antibiotics increased the risk of AR, while daily outdoor time for 1–2 h, daily sleeping time >8 h, siblings, and breastfeeding for >6 months reduced the risk significantly. Conclusion: We found the apparent geographic variation of children allergies in Hubei Province. Both genetic and environment factors had impacts on the prevalence of AR in school children. Public policies should specifically target at the local risk factors for different areas.

Salvinorin A inhibits ovalbumin-stimulated allergic rhinitis and RBL-2H3 cells degranulation.

Allergic rhinitis (AR) is a long‐term noncommunicable inflammatory disease of the nasal mucosa mediated by immunoglobulin E and is mainly caused by exposure of genetically susceptible individuals to environmental allergens. Mast cells contribute to the pathogenesis of allergic and nonallergic inflammatory diseases. Salvinorin A has been previously shown to inhibit leukotriene production and mast cell degranulation to suppress airway hyperresponsiveness caused by sensitization; thus, we hypothesized that salvinorin A has an anti‐AR effect. We tested this hypothesis using monoclonal anti‐2,4,6‐dinitrophenyl immunoglobulin E/human serum albumin‐induced rat basophilic leukemia cells (RBL‐2H3 cells) and ovalbumin (OVA)‐induced AR in mice as in vivo and in vitro AR models, respectively. The expression levels of histamine, β‐hexosaminidase, interleukin‐4 and tumor necrosis factor‐α were decreased by salvinorin A in vitro. Granule release and F‐actin organization were also suppressed by salvinorin A. Furthermore, salvinorin A inhibited OVA‐induced features of AR in mice, including nasal rubbing and sneezing, as well as increased OVA‐specific immunoglobulin E, histamine, tumor necrosis factor‐α and interleukin‐4 levels. In addition, salvinorin A decreased the phosphorylation of phosphoinositide 3‐kinase/Akt in vitro and in vivo. Our work suggests that salvinorin A suppresses AR caused by sensitization by inhibiting the inflammatory responses of mast cells; thus, salvinorin A may have potential for treatment of AR.

Коморбідність бронхіальної астми та алергічного риніту за його альтернативного перебігу в дітей шкільного віку

The study of the comorbidity of bronchial asthma (BA) and allergic rhinitis (AR) in children will expand the understanding of the pathogenetic mechanisms of the most trending childhood allergic diseases. Purpose — to investigate some clinical and paraclinical features of AR in its alternative course in schoolchildren for the optimization of the personalized antiinflammatory therapy of patients with comorbidity of BA and AR. Materials and methods. A comprehensive clinical and paraclinical examination of 66 of school-age children with BA with concomitant AR has beenperformed. Depending on the course of AR, patients have been divided into 2 groups: group I — 34 children with BA and intermittent AR (mean age — 13.4±0.8 years, the proportion of boys — 70.5%), group II — 32 asthma patients, which have signs of persistent AR (mean age — 12.1±1.1 years) (p&gt;0.05), the proportion of boys — 81.2% (p&gt;0.05). The diagnosis of BA and AR was established according to the modern requirements. All children underwent a study of bronchial lability by assessing their response to dosed exercise and inhalation of short-acting β2-adrenomimetics (200 mcg salbutamol) followed by calculation of bronchial lability, considered as the sum of its components — indicies of bronchospasm and bronchodilation. Results. Patients with persistent allergic rhinitis have had a more severe and less controlled course of bronchial asthma with a 3.0-fold increased risk. The baseline spirographic examination has showed that patients with intermittent allergic rhinitis were three times more likely to have FEV1&lt;80% and the higher chances of marked airway lability at the level of small bronchi, including by forced midexpiratory flow rate as well. Conclusions. The comorbid course of bronchial asthma and intermittent allergic rhinitis in children was accompanied by a lower chance of uncontrolled asrhma, along with a higher probability of developing nonspecific airway hyperreactivity. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: bronchial asthma, allergic rhinitis, children.

Prevalence of Allergic Rhinitis in Children with Adenotonsillar Hypertrophy Referred to Imam Khomeini Hospital of Ahvaz from 2019 to 2020

Background: Allergic diseases are among the most common chronic conditions in pediatrics. Objectives: This study aimed to evaluate the relative frequency of allergic rhinitis (AR) in children with adenotonsillar hypertrophy. Methods: In this descriptive study, 175 patients with adenotonsillar hypertrophy referred to the Imam Khomeini hospital of Ahvaz from March 2019 to March 2020 were enrolled. Allergic rhinitis was diagnosed based on the Score for AR (SFAR) questionnaire. The questionnaire, including the expert-designed SFAR, has eight main components that evaluate eight quantitative features of AR, and each was designated with a specific weighted score based on previous clinical studies. The total score could vary from 0 to 16. Frequency and percentage were used to describe the data. The chi-square test and Fisher's exact test were used to analyze the data. Results: One hundred seventy-five patients with adenotonsillar hypertrophy in the age range of 1 to 17 years were studied. Ninety-one patients (52%) were male, and 84 patients (48%) were female. Based on the score obtained from the questionnaire, 146 patients (83.4%) had a score of less than seven, indicating susceptibility to AR. Twenty-nine patients (16.6%) had a score equal to or higher than 7, confirming the diagnosis of AR. The Chi-square test showed that AR was significantly associated with all the components of the questionnaire, except for cigarette smoking (P-value &lt; 0.001). Conclusions: This study showed the strong association of AR with some demographic factors. Allergic rhinitis could potentially increase the risk of adenotonsillar hypertrophy in children.

РАСПРОСТРАНЕННОСТЬ АЛЛЕРГИЧЕСКОГО РИНИТА И БРОНХИАЛЬНОЙ АСТМЫ СРЕДИ ГОРОДСКИХ ДЕТЕЙ ДОШКОЛЬНОГО ВОЗРАСТА: РЕЗУЛЬТАТЫ ОДНОМОМЕНТНОГО ИССЛЕДОВАНИЯ

The aim of the trial was to study the prevalence and clinical and allergic characteristics of allergic rhinitis (AR) and bronchial asthma (BA) in urban preschool children. Materials and methods of research: a one-minute study was carried out on an urban sample of 3–6 year olds (n=3205), consisting of 2 stages – screening and clinical. The study of the prevalence of AR and BA symptoms at the screening stage was carried out by questioning parents using the ISAAC questionnaire. At the clinical stage, the diagnosis of AR and BA was verified based on the diagnostic criteria of the ARIA (2008 revision) and GINA (updated 2017) documents. At the clinical stage, skin prick testing with extracts of inhalation and food allergens from Allergopharma Joachim Ganzer KG (Germany) was carried out. Results: the prevalence of AR and BA among urban children 3–6 years of age was 10,6 and 5,7%, respectively. 80 (52,0%) children with AR and 42 (32,8%) children with BA have not previously been diagnosed in practical healthcare institutions. 107 (69,5%) children with AR and 76 (59,4%) children with BA had a mild severity of the disease, 4 (2,6%) children with AR and 2 (1,6%) children with BA had major severity. 80 (62,5%) of children with BA are diagnosed with a controlled course of the disease and 48 (37,5%) have a partially controlled/uncontrolled course of the disease. Most often, in children with AR and BA, sensitization to the D. pteronyssinus mite was recorded – 95 (61,%) and 68 (53,1%), birch pollen – 63 (40,9%) and 42 (32,8%) and cat allergens – 30 (19,5%) and 20 (15,6%), respectively. Conclusion: the prevalence of AR and BA among preschool children was 10,6 and 5,7%, respectively. More than half of children with AR and 1/3 of children with BA do not have a diagnosis established in practical health care institutions. Most often, in 3–6 years old children with AR and BA, sensitization to the D. pteronyssinus mite, birch pollen and cat allergens is recorded.

Developing nomograms for identifying allergic rhinitis among chronic rhinitis: A real-world study

BackgroundIt is difficult to discriminate allergic rhinitis (AR) and nonallergic rhinitis (NAR) in clinical practice due to the similar clinical manifestations. The study was to assess both the demographical and clinical features of AR and NAR in the real-world data of outpatients in China. MethodsIt was a cross-sectional real-world study. AR and NAR were defined based on both subjective symptoms and objective specific serum IgE test. General demographic characteristics as well as clinical information were documented. Patients were further classified according the seasons of initial visiting hospital (during pollen seasons or not). A scoring system presented as nomograms for presence of AR was performed. ResultsIn the pollen season group, age distribution, the duration of rhinitis, comorbidity of asthma, food allergies, and score of coughing were found significantly associated with AR. Additionally, in the non-pollen season group, we found that ethnicity, age distributions, duration of rhinitis, comorbidity of asthma, food allergies, and family history of allergy, together with scores of gritty eyes were associated factors of AR. Based on multivariate logistic model, we built two nomograms which included previously identified significant risk factors that could be acquired easily during clinical practice with predictive variables to assess their roles in predicting the risk of AR among outpatients with rhinitis. ConclusionsThe characteristics of patients with different phenotypes of chronic rhinitis are distinctive in different seasons and the developed nomogram in this study might be beneficial for clinical practice.

Prevalence of Allergic Rhinitis and Associated Risk Factors in 6 to 12 Years Schoolchildren From Wuhan in Central China: A Cross-sectional Study.

Over the past decade, the prevalence of allergic rhinitis (AR) in China increased and showed a trend of younger age. The clinical features of AR in primary schoolchildren are still not clear enough. To investigate the prevalence and epidemiological characteristics of AR among 6- to 12-year-old children in the central region of China. Children from 6 primary schools were randomly selected from urban area of Wuhan, which lies in the central region of China. The questionnaires were distributed by mobile APP and filled out by the children and their parents online together. AR was diagnosed by Score for Allergic Rhinitis. Logistic regression analysis was performed to assess the risk factors for AR. A total of 5550 valid questionnaires were returned for evaluation. The prevalence of AR among 6- to 12-year-old children in urban area of Wuhan was 28.6%. Multivariate analysis revealed that male (odds ratio [OR] = 1.521, 95% confidence interval [CI] = [1.335, 1.732]), family history of atopy (OR = 3.220, 95% CI = [2.818, 3.681]), previous food allergy (OR = 1.590, 95% CI = [1.302, 1.942]), air purifier (OR = 1.420, 95% CI = [1.240, 1.625]), exposure to dust (OR = 1.764, 95% CI = [1.410, 2.207]), maternal exposure to smoke during pregnancy (OR = 1.242, 95% CI = [1.047, 1.473]), living in towns (OR = 1.468, 95% CI = [1.043, 2.006]) or metropolis (OR = 1.629, 95% CI = [1.205, 2.201]) before 2 years old, frequent application of antibiotics are risk factors for AR, while daily outdoor time for more than 1 hour (OR = 0.770, 95% CI = [0.673, 0.881]) and breastfeeding for more than 6 months (OR = 0.799, 95% CI = [0.701, 0.910]) reduced the risk significantly. We found an unexpectedly high prevalence of AR among primary schoolchildren aged 6 to 12 years in the central region of China. Both genetic and environmental factors were associated with the development of AR.

Allergic rhinitis in children’s practice

Due to the prevalence of allergic rhinitis (AR) among the population of Russia, especially in pediatric practice, it is important today to give coverage to its clinical manifestations, principles of diagnosis, management of the patients and the possibilities to prevent exacerbations and increasing severity of illness. The authors provide the reasons behind why the intermittent AR has a persistent course. The article presents the diagnostic methods recommended in the ARIA documents. The authors note the important role of tight junctions in the nasal mucosa structure in protecting a person from aeroallergens and substantiate the rationality of prescribing systemic antihistamines to treat viral and a number of other types of infection. They also provide characteristics of minimal persistent inflammation and the distinctive features of local AR. According to the authors, the rationale for the use of complex treatment is the impossibility to completely cure AR. The article lists the activities and drugs included in the therapy regimen that is defined in the ARIA documents. However, the choice of a drug prescribed to the patient should be personified. The authors substantiate the prescription of systemic antihistamines in the development of acute respiratory viral infections caused by rhinovirus and give preference to Fenistil® due to the possibility of its use at an early age from 1 month in the form of syrup and drops as the most convenient dosage forms. The benefits of Fenistil® include: the speed of onset of a drug effect and its duration, high antihistamine activity and, as a result, pronounced itch relief, as well as the absence of a cardiotoxic effect, mild sedative effect, the ability of precise dosing and reduced production of nasal secretions. A clinical case with the rationale for the systemic use of this drug is presented. It is concluded that clinical data on the high efficacy and safety of Fenistil® entitle us to believe that its use is expedient, especially in pediatric practice.

IL-37 attenuates allergic process via STAT6/STAT3 pathways in murine allergic rhinitis

Allergic rhinitis (AR) is a common upper airway allergic disease caused by allergens triggering a type 2 immune response. The imbalance of CD4+ T cell subsets is the essential immunological feature of AR, which is mainly characterized by the predominance of T helper (Th) 2 cells. Recent studies indicated that the anti-inflammatory factor interleukin (IL)-37 is involved in the immune regulation of AR. However, the mechanism of IL-37 acts on AR has not been fully elucidated. Thus, we sought to assess the protective role of IL-37 in AR and further explore the possible mechanism. An ovalbumin (OVA)-induced AR murine model was established. After IL-37 treatment, the allergic symptoms (sneezes and nasal rubbings), nasal mucosal infiltration with eosinophils, and serum IgE production were found significantly attenuated. For CD4+ T cell subsets, the proliferation and differentiation of Th2 and Th17 cells were restrained. The relevant effector cytokines of IL-4, IL-5, IL-6, and IL-17a protein expression and transcription factors GATA3 and RORγt mRNA levels were obviously decreased. However, IL-37 had no significant effect on Th1 and Treg response including in IFN-γ, IL-10, T-bet, and Foxp3 expression. Furthermore, IL-37 was found down-regulated the STAT6, STAT3, phospho-STAT6, and phospho-STAT3 expression. In conclusion, IL-37 alleviates allergic inflammation in AR possibly through repressing STAT6 and STAT3 signaling pathways.

The International Study of the Allergic Rhinitis Survey: outcomes from 4 geographical regions.

BackgroundAllergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea.ObjectiveWe investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions.MethodsIn this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions—Asia, Europe, the Americas, and Africa.ResultsThe prevalence of AR was reported to be 15%–25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H1-antihistamines (82.69%).ConclusionA network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

Comorbidities and Phenotypes of Rhinitis in Korean Children and Adolescents: A Cross-sectional, Multicenter Study.

PurposeRhinitis is a nasal inflammatory disease in children and adolescents. However, little is known about the phenotypes and characteristics of allergic rhinitis (AR) in Korean children and adolescents. The objective of this study was to analyze the symptoms and comorbidities of rhinitis, to compare AR to non-allergic rhinitis (NAR), and to reveal the phenotypes and features of AR in a Korean pediatric population.MethodsPatients under 18 years of age with rhinitis symptoms were recruited from January 2013 to January 2015 by pediatric allergists. We analyzed symptoms, phenotypes, comorbidities, and allergen sensitization in this cross-sectional, multicenter study.ResultsMedical records were collected from 11 hospitals. The AR group has 641 (68.3%) patients, with 63.2% of boys and 7.5 (±3.4) years of mean age. The NAR group has 136 (14.5%) patients, with 55.1% of boys and 5.5 (±2.9) years of mean age. Moderate-severe persistent AR affected 41.2% of AR patients. Nasal obstruction was more common in NAR patients (P<0.050), whereas AR patients sneezed more (P<0.050) and more commonly had conjunctivitis, asthma, and otitis media (P<0.050). Sinusitis was the most common comorbidity in both groups. Allergen sensitization was caused by house dust mites (HDMs) (90.2%), pollen (38.7%), and animal dander (24.8%) in AR patients. Pollen and animal dander sensitization significantly increased age-dependently (P<0.050), but 91.9% of AR patients were already sensitized to HDMs before 5 years old.ConclusionsOur study revealed that AR was more prevalent than NAR and that 41.2% of AR presented with moderate-severe disease in Korean pediatric populations. Sinusitis was the most common comorbidity, and sleep disturbance was associated with the severity of rhinitis. The majority of AR patients were sensitized to HDMs in preschool ages. Further studies, including nationwide and longitudinal data, will help understand the relationship between these diseases.

Pathogenesis of rhinitis.

Rhinitis is a heterogeneous condition that has been associated with inflammatory responses as in allergic rhinitis but can also occur in the absence of inflammation such as in so-called idiopathic (previously 'vasomotor') rhinitis. Allergic rhinitis affects approximately one in four of the population of westernized countries and is characterized by typical symptoms of nasal itching, sneezing, watery discharge and congestion. The intention of this review is to illustrate key concepts of the pathogenesis of rhinitis. Imbalance in innate and adaptive immunity together with environmental factors is likely to play major roles. In allergic rhinitis, initial allergen exposure and sensitization involves antigen-presenting cells, T and B lymphocytes and results in the generation of allergen-specific T cells and allergen-specific IgE antibodies. On re-exposure to relevant allergens, cross-linking of IgE on mast cells results in the release of mediators of hypersensitivity such as histamine and immediate nasal symptoms. Within hours, there is an infiltration by inflammatory cells, particularly Th2 T lymphocytes, eosinophils and basophils into nasal mucosal tissue that results in the late-phase allergic response. Evidence for nasal priming and whether or not remodelling may be a feature of allergic rhinitis will be reviewed. The occurrence of so-called local allergic rhinitis in the absence of systemic IgE will be discussed. Non-allergic (non-IgE-mediated) rhinitis will be considered in the context of inflammatory and non-inflammatory disorders.

The Heterogeneity Hidden in Allergic Rhinitis and Its Impact on Co-Existing Asthma in Adults: A Population-Based Survey

Background: It has been suggested that there is some overlap between allergic rhinitis (AR), sinusitis and polyposis, but this has not been fully documented. The present study aimed to evaluate the prevalence of these co-existing diseases and their impact on bronchial asthma in the general population of Italy. Methods: Within the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study, a postal screening questionnaire including questions about self-reported symptoms of asthma, AR, AR with sinusitis without nasal polyps (AR + SsNP) and AR with sinusitis with nasal polyps (AR + SwNP) was administered. Random samples of subjects aged between 20 and 44 years (n = 5,162) answered the postal questionnaire in 4 Italian centres (Pavia, Sassari, Turin, Verona). In AR subjects, the association among AR only, AR + SsNP, AR + SwNP and bronchial asthma was estimated by the relative risk ratio (RRR) using multinomial regression models. Results: The prevalence of AR in the sample was 25.4% (95% CI 24.2-26.6). A self-reported diagnosis of AR + SsNP and AR + SwNP was reported by 5.7% (95% CI 5.0-6.3) and by 1.2% (95% CI 0.9-1.5) of the subjects, respectively. Current asthma was reported by 17.5% of the AR subjects. In the adjusted multivariate analysis, the risk of having current asthma (RRR = 2.31, 95% CI 1.29-4.15), of having at least 1 asthma attack per year (RRR = 2.30, 95% CI 1.19-4.46) and of having had an emergency department admission for respiratory diseases (RRR = 5.61, 95% CI 1.81-23.92) was higher for subjects with AR + SwNP than subjects with AR only. Conclusions: The diagnosis of AR in the epidemiological setting includes heterogeneous upper airway diseases that affect the clinical features of AR and its interactions with asthma.

Clinical features of allergic rhinitis in children of Shanghai, China.

The aims of the current study were to assess the clinical features of allergic rhinitis (AR) in children in Shanghai. Serum-specific IgE (sIgE) tests were performed on samples from patients with AR symptoms from January 2011 to December 2014. A disease-related questionnaire was completed after AR diagnosis. The allergen profile and clinical features of AR were analyzed. In total, 2713 AR patients were enrolled in this study. Dermatophagoides pteronyssinus was found to be the most common offending allergen in the study population. With increasing age, the prevalence of sIgE against inhalant allergens was significantly increased; however, the opposite trend was observed for food allergens. Additionally, the proportion of children with high levels of sIgE against D. pteronyssinus increased with age. Of the AR cases, 8.6% were classified as intermittent mild, 4.2% as persistent mild, 40.5% as intermittent moderate-severe, and 46.7% as persistent moderate-severe. A family history of allergies and a patient history of allergies within 6 months of birth were significantly associated with the duration and severity of AR symptoms. The occurrence of co-morbidities, such as allergic conjunctivitis, cough, and asthma, gradually increased from intermittent mild, persistent mild, and intermittent moderate-severe to persistent moderate-severe. The most frequently used drugs were topical corticosteroids and oral antihistamines, which were used by 86.7 and 79.0% of patients, respectively. These results confirm the adequacy of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines for classifying AR patients, and advance the understanding of clinical features of AR in children in Shanghai, China.

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.

Prevalence of Blomia tropicalis allergy in two regions of South Africa.

Asthma and allergic rhinitis affect 15% and 38% of South African (SA) children, respectively. The housedust mite (HDM) is the most significant indoor aeroallergen. Typical HDM species include Dermatophagoides pteronyssinus, D. farinae and Blomia tropicalis. Conventional skin-prick testing (SPT) panels only test for Dermatophagoides. B. tropicalis has been described in the tropical and subtropical regions, but is not routinely tested for in SA. To ascertain the significance of B. tropicalis as an aeroallergen in northern coastal KwaZulu-Natal Province (KZN), a tropical environment, and in Johannesburg in the highveld, where the climate is milder and less humid. Children aged 1-18 years with features of allergic rhinitis and/or asthma were recruited over a 6-month period from Alberlito Hospital in northern KZN and the Clinton Clinic in Johannesburg. SPTs included Dermatophagoides and B. tropicalis. Sensitisation was defined as a wheal 3 mm greater than the negative control. Eighty-five subjects were included, 50 in northern KZN and 35 in the Johannesburg arm; 52% of subjects in northern KZN and 3% in Johannesburg were sensitised to B. tropicalis, with a significant difference between these centres (p<0.05). Of the 52% sensitised to B. tropicalis in northern KZN, half were sensitised only to B. tropicalis. There is a high prevalence of B. tropicalis allergy in the tropical northern KZN region and a much lower prevalence in the Johannesburg region. Routine testing for B. tropicalis allergy should be employed in northern KZN.