Clinical Symptoms Of Allergic Rhinitis Research Articles

MicroRNA-155 is a critical regulator of regulatory T cells in OM-85 Broncho-Vaxom treated experimental models of allergic rhinitis

<abstract><sec> <title>Background</title> <p>Bacterial lysates could alleviate the clinical symptoms of allergic rhinitis (AR) and decrease the recurrent rate of AR through regulation of regulatory T cell (Treg) cells. However, the molecular regulatory mechanisms of bacterial lysates to Treg are still unclear.</p> </sec><sec> <title>Objective</title> <p>We aimed to investigate the importance of microRNA-155 (miR-155) to Treg cells function in OM-85 Broncho-Vaxom (OM-85 BV) treated experimental mouse models of AR.</p> </sec><sec> <title>Methods</title> <p>AR mouse models were established and treated by intranasal administration of OM-85 BV to investigate the role of bacteria lysate for Treg cell function. The proliferation of Treg cells in peripheral blood was examined. The mRNA levels of IL-10, transforming growth factor-β (TGF-β) were examined by real-time PCR. miR-155 mimics and inhibitor were used to verify the role of miR-155 for Treg cells function.</p> </sec><sec> <title>Results</title> <p>OM-85 BV, miR-155 mimics or their combination reduced total cells, lymphocytes, neutrophils and eosinophils in nasal lavage fluid of AR mouse models and improved allergic symptoms. OM-85 BV promoted the proliferation of Treg and the expression of Foxp3, IL-10 and TGF-β both <italic>in vivo</italic> and <italic>in vitro</italic>. The miR-155 enhanced the proliferation and function of Treg.</p> </sec><sec> <title>Conclusions</title> <p>MiR-155 promotes Treg cells function in OM-85 BV bacteria lysate treated experimental models of AR and alleviate the upper airway allergic inflammation in AR mice.</p> </sec></abstract>

Phototherapy as a Treatment for Dermatological Diseases, Cancer, Aesthetic Dermatologic Conditions and Allergenic Rhinitis in Adult and Paediatric Medicine.

The development of light-emitting diodes (LEDs) has led to an increase in the use of lighting regimes within medicine particularly as a treatment for dermatological conditions. New devices have demonstrated significant results for the treatment of medical conditions, including mild-to-moderate acne vulgaris, wound healing, psoriasis, squamous cell carcinoma in situ (Bowen's disease), basal cell carcinoma, actinic keratosis, and cosmetic applications. The three wavelengths of light that have demonstrated several therapeutic applications are blue (415 nm), red (633 nm), and near-infrared (830 nm). This review shows their potential for treating dermatological conditions. Phototherapy has also been shown to be an effective treatment for allergenic rhinitis in children and adults. In a double-anonymized randomized study it was found that there was 70% improvement of clinical symptoms of allergic rhinitis after intranasal illumination by low-energy narrow-band phototherapy at a wavelength of 660 nm three times a day for 14 consecutive days. Improvement of oedema in many patients with an age range of 7-17 were also observed. These light treatments can now be self-administered by sufferers using devices such as the Allergy Reliever phototherapy device. The device emits visible light (mUV/VIS) and infra-red light (660 nm and 940 nm) wavelengths directly on to the skin in the nasal cavity for a 3 min period. Several phototherapy devices emitting a range of wavelengths have recently become available for use and which give good outcomes for some dermatological conditions.

Immunotherapy in the Treatment of Allergic Rhinitis in Children.

Allergic rhinitis (AR)is an inflammation of the nasal membranes characterized by multiple allergic symptoms. It is a widespread health problem that affects patients' ability to engage in social and physical activity, which lowers their quality of life. The pathophysiology of AR is complex and requires sensitization and the development of a specific immune response to the allergen. Allergen-specific immunotherapy (AIT) is a therapeutic method that induces specific immune tolerance to allergens. The objectives of this review are to demonstrate the mechanismof action of immunotherapy,explain how it alleviates clinical symptoms of allergic rhinitis,list the indications and contraindicationsof immunotherapy in the treatment of allergic rhinitis, andidentify different modalities of allergen immunotherapy, their disease-modifying effects, as well as their potential risks and benefits. The review of the literature highlights that T-cell and B-cell responses to inhaled allergens are altered by AIT, which decreases both early and late reactions to allergen exposure. To induce clinical and immunologic tolerance, especially in the pediatric age, escalating dosages of the causing allergen are administered subcutaneously or sublingually. AIT is indicated for severe persistent AR when avoidancemeasures and medications are inadequate to control the symptoms. To conclude, AIT is a disease-modifying therapy that is safe and effective for the treatment of allergic rhinitis. It is indicated when the symptoms are uncontrolled or when there are undesirable effects from pharmacotherapy.

Genes related to allergen exposure in allergic rhinitis: a gene-chip-based study in a mouse model

BackgroundThe typical clinical symptoms of allergic rhinitis (AR) are known to be associated with allergen exposure; however, the underlying mechanisms are not fully understood. We wanted to gain a comprehensive view of the molecular mechanisms related to allergen exposure in a well-controlled mouse model of AR.MethodsAn OVA-induced AR model was developed. Two hours and 4 weeks after the last OVA challenge, AR symptoms and local immune responses were assessed. At the same time, differentially expressed genes (DEG) in nasal mucosa were identified by gene expression microarray and further analyzed by bioinformatics methods. Verification of DEG was done by quantitative RT-PCR and immunohistochemistry.ResultsThe number of nasal rubbings and sneezes, serum OVA-specific IgE concentrations, and the number of neutrophils and eosinophils in the nasal mucosa were significantly increased at 2 h and decreased at 4 weeks after the last allergen challenge compared to controls. A total of 2119 DEG were identified, and their expression dynamics were clustered into 8 profiles. Enriched functions in Profile 5, which had a similar trend to clinical features, were mainly related to inflammatory and immune response to environmental factors, eosinophils and neutrophils chemotaxis, and cell migration. Gene co-expression Network for genes from profile 5 identified BCL3, NFKB2, SOCS3, and CD53 having a higher degree. Profile 6 showed persistence of inflammatory and immune response at 4 weeks after the last allergen challenge. Olfactory and coagulation functions were enriched mainly in profiles with downward trends.ConclusionsA wide range of genes with sequential cooperative action were identified to be associated with allergen exposure in AR. BCL3 may be the most vital in symptoms manifestation. Moreover, some inflammatory responses persisted for a period after allergen exposure, supporting a new treatment strategy of targeting inflammation out of season. This study may contribute to a better understanding of AR pathogenesis and provide potential therapeutic targets for AR patients.

Determination of co-sensitization is an important step in improving the effectiveness of allergen-specific immunotherapy in patients with pollen disease

In order to increase the effectiveness of allergen-specific immunotherapy in patients with pollen disease, the profile of allergen sensitization was determined at the molecular level, performed in 47 patients with clinical manifestations of seasonal rhinoconjunctivitis and perennial allergic rhinitis during a long time period. Allergic examination of patients included history taking, molecular blood tests using ALEX technology to determine the level of specific antibodies class lgE of major and minor components of pollen and household allergens and diagnostic skin tests (pre-test). Assessment of the main clinical manifestations of allergic rhinitis was performed according to the recommendations of the European Association of Allergists and Immunologists. The severity of nasal symptoms was determined by the TNSS scale, and ocular symptoms - by the TOSS scale. Integral assessment of the intensity of clinical symptoms of allergic rhinitis was calculated as the sum of scores by the main symptoms. According to the results of molecular allergy diagnostics, the profile of allergic sensitization in patients with pollen disease was determined, which established the presence of specific lgE - antibodies to major allergy components of ragweed pollen (nAmb a1) – in 91.5±4.1% of patients, wormwood (nArt v3, nArt v1) – in 40.4±7.2%, meadow thyme (rPh1 p1, rPh1 p5b) – in 17.0±5.5%, house dust mites (Der p1, Der p2) – in 29.8±6,7%. Developed on the basis of molecular allergy diagnostics, the profile of allergological sensitization to allergocomponents allows to obtain complete and detailed information on patient sensitization (diagnose a real allergy), cross-reactivity to other allergens, justify the feasibility and predict the effectiveness of allergen-specific immunotherapy.

Potential of BAFF in Nasal Secretions as a Marker of Allergic Rhinitis Severity in Children

B cell activating factor of the TNF family (BAFF), which is important for B cell maturation, proliferation, survival, and T cell–independent class-switch recombination, is thought to be involved in IgE production in allergic diseases, but there are insufficient data. In the present study, we investigated involvement of BAFF in the pathogenesis and clinical symptoms of allergic rhinitis.

Endoscopic posterior nasal neurectomy in persistent allergic rhinitis: a clinical study

A B S T R A C T Background: In the last decades, incidence of allergic rhinitis (AR) showed steadily increase in developed and developing countries; with profound effects on patient life and overall health care system. In intractable AR, endoscopic neurectomy of posterior nasal nerve had been introduced as a curative alternative. However, its efficacy and safety not adequately addressed. Objective: The current study aimed to present our clinical experience with endoscopic posterior nasal neurectomy [safety and efficacy] and to address its effect on the patient quality of life. Methodology: A sixty-three patients with AR were included. Clinical symptoms of AR had been assessed before and at 3, 6 and 12 months after surgery using a numerical score. In addition, patients had been asked to fill a 28-items rhinoconjunctivitis quality of life (RQoL) questionnaire. Results: There was progressive and significant improvement of clinical symptoms and improvement of the RQoL scores after surgery when compared to preoperative values. All scores reduced significantly at 3 months with subsequent reduction at 6 months which become stable to the end of the first year, except quality of life which showed another significant reduction at the end of the first year when compared to values at the 6th postoperative month. No major complications had been recorded, and the overall successful control on nasal symptoms had been recorded for 68.3%, 81.0%, 88.9% and 79.4% for sneezing, itching, rhinorrhea and nasal obstruction, respectively. Conclusion: Endoscopic posterior nasal neurectomy is an effective and safe surgical technique for treatment of AR resistant to medical therapy.

Leukotriene A4 Hydrolase Is a Candidate Predictive Biomarker for Successful Allergen Immunotherapy.

BackgroundAllergic rhinitis is a common disorder that affects 10% to 40% of the population worldwide. Allergen immunotherapy (AIT) represents the only therapy that has the potential to resolve clinical symptoms of allergic rhinitis. However, up to 30% of patients do not respond to AIT. Biomarkers predicting the clinical efficacy of AIT as early as possible would significantly improve the patient selection and reduce unnecessary societal costs. Methods Artemisia pollen allergic patients who received at least 1-year AIT were enrolled. Clinical responses before and after 1-year AIT were evaluated to determine AIT responders. Artemisia specific IgE and IgG4 levels were measured by using ImmunoCAP and enzyme-linked immunosorbent assay (ELISA) separately. Stepwise regression analysis was performed to identify which rhinitis-relevant parameters explained the most variability in AIT results. Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics was applied to identify the potential candidate biomarkers in the sera of responders and non-responders collected before and after 1-year therapy. The diagnostic performance of the potential biomarkers was then assessed using enzyme-linked immunosorbent assay (ELISA) in 30 responders and 15 non-responders.Results Artemisia specific IgE and IgG4 levels were elevated only in the responders. Regression analysis of allergic rhinitis-relevant parameters provided a robust model that included two most significant variables (sneeze and nasal congestion). Thirteen candidate biomarkers were identified for predicting AIT outcomes. Based on their association with allergy and protein fold change (more than 1.1 or less than 0.9), four proteins were identified to be potential biomarkers for predicting effective AIT. However, further ELISA revealed that only leukotriene A4 hydrolase (LTA4H) was consistent with the proteomics data. The LTA4H level in responders increased significantly (P < 0.001) after 1-year therapy, while that of non-responders remained unchanged. Assessment of LTA4H generated area under curve (AUC) value of 0.844 (95% confidence interval: 0.727 to 0.962; P < 0.05) in distinguishing responders from the non-responders, suggesting that serum LTA4H might be a potential biomarker for predicting the efficiency of AIT.ConclusionSerum LTA4H may be a potential biomarker for early prediction of an effective AIT.

Increased expression of type 2 innate lymphoid cells in pediatric patients with allergic rhinitis.

Type 2 innate lymphoid cells (ILC2s) are a newly identified group of innate immune cells. ILC2s promote features of allergic airway diseases through the secretion of Th2 type cytokines, including interleukin (IL)-4, IL-5 and IL-13. It remains unknown whether ILC2s aggregate in the peripheral blood. The present study examined the ILC2 levels in pediatric patients with allergic rhinitis (AR), and the correlation with the severity of clinical symptoms. Flow cytometry detected the ILC2s frequency in the peripheral blood of 12 healthy controls (HCs), 12 patients with AR sensitized only to house dust mites (HDM-AR), and 18 AR patients monosensitized to other antigens including weeds, animal danders and Blattella germanica, but not including HDM (non-HDM-AR). Clinical symptoms of AR were expressed according to the Total 5 Symptom Score (T5SS). The percentages of ILC2s in the peripheral blood were increased significantly in patients with HDM-AR and non-HDM-AR, compared with that in the HCs. A subgroup analysis of patients with AR indicated that the proportion of ILC2s was significantly increased in HDM-AR in comparison with that in non-HDM AR. Furthermore, there was a notable correlation between ILC2 levels and T5SS scores. ILC2s frequencies in PBMC were increased significantly in pediatric patients with AR, irrespective of the type of allergen. HDM may trigger more severe allergic reactions and an increase in the number of ILC2s. These discoveries indicate the unique function of ILC2 in AR and provide a potential therapeutic target.

Immunotherapy and probiotic treatment for allergic rhinitis in children

Background Allergic rhinitis is a global health problem that is increasing in prevalence. Many kinds of therapy have been tried, such as antihistamines, probiotics, and immunotherapy. Immunotherapy may restore the patient’s normal immunity against the specific allergen, while probiotics may modify the natural course of allergy.&#x0D; Objective To evaluate probiotics and immunotherapy for improving clinical symptoms of allergic rhinitis.&#x0D; Methods This randomized controlled trial (RCT) involved 64 patients, aged 3-18 years, and diagnosed with persistent allergic rhinitis in the Department of Child Health, Sardjito General Hospital from April 2016 until May 2017. Patients were randomly allocated into three therapy groups: group A (standard therapy/cetirizine only), group B (standard and probiotic therapy), and group C (standard therapy and immunotherapy). Clinical symptoms of allergic rhinitis including sneezing, rhinorrhea, and itchy nose, were evaluated for 7 weeks and classified as improved or not improved. The significance of the data was analyzed using proportion test.&#x0D; Results Sixty-four patients completed 7 weeks of therapy, 15 subjects in group A, 26 in group B, and 23 in group C. Group C showed significantly more improvement of sneezing and rhinorrhea compared to both group A (Z=5.71; Z=7.57, respectively) and group B (Z=2.82; Z=6.90, respectively). However, itchy nose was not significantly improved in group C compared to group B (Z=0.50), but was significantly improved in group C compared to group A (Z=10.91). Group B had significant improvement of sneezing, rhinorrhea, and itchy nose compared to group A (Z=3.81, Z=2.86, and Z=10.91, respectively).&#x0D; Conclusion The combined standard-immunotherapy group has significantly superior improvement compared to the combined standard-probiotic group and the standard therapy group, in terms of sneezing and rhinorrhea in children with persistent allergic rhinitis.

Allergic rhinitis in the pregnant women

The objective of the present work was to elucidate the specific features of the clinical picture of allergic rhinitis in the pregnant women. The study included 156 pregnant women presenting with the persisting form of the disease and 63 patients having its intermitting form. The character of the endoscopic manifestations of rhinitis, chronic tonsillitis, and gastroesophageal reflux was evaluated with the use of a scoring system. The progressive development of the clinical symptoms of allergic rhinitis during pregnancy related neither to the contacts with allergens nor to the discontinuation of pharmacotherapy was documented in 33 and 23% of the patients presenting with the persistent and intermitting forms of the disease, respectively. The symptoms of rhinitis in the pregnant women may be influenced by the presence of gastroesophageal reflux (the endoscopic evidence of this condition was documented in 84.6% of the examined patients with persisting form of the disease and in 40.3% of those having intermitting form) and chronic tonsillitis (purulent contents in the palatine tonsil lacunes were found in 46.8 and 40.3% of the women presenting with the persisting and intermitting forms of allergic rhinitis respectively). In 42% of the cases, the cause behind the negative dynamics or the absence of any dynamics during the treatment of allergic rhinitis was the withdrawal of the prescribed pharmacotherapy by the patients themselves. This observation gives evidence of the importance of explaining to the pregnant women suffering from allergic rhinitis the necessity of compliance with the prescribed treatment modalities in order to reduce the probability of development of complications of this condition.

IMPACT OF ENVIRONMENTAL POLLUTION ON THE PREVALENCE OF ALLERGIC DISEASES AMONG THE EMPLOYEES OF INDUSTRIAL SITES LOCATED AT FORMER URANIUM ORES MINES

The article presents the study of prevalence of allergic diseases among the employees of industrial sites located at former uranium ores mines in Lermontov region. The aim of the research was to study the spectrum of etiologically significant allergens, prevalence and clinical features of allergic diseases among the employees of industrial sites located at former uranium ores mines in Lermontov region. Materials and Methods. Analysis of data of screening questioning, clinical laboratory, functional and allergological methods of examination was performed. Results. The high prevalence of allergic diseases among employees of hydrometallurgical plant (OJSC GMP) and electromechanical plant (LLC EMP): 27,1 and 24,7%, respectively was found. Two employees of OJSC GMP and one of LLC EMPin 2014 had latent sensitization to pollen, but in 2015 demonstrated severe clinical symptoms of allergic rhinitis (AR). Conclusion. Respiratory forms of Ig-Emediated allergy - AR, bronchial asthma (BA) prevailed in the structure of allergic diseases among the employees of industrial sites located at former uranium ores mines in Lermontov region. 19,6% of OJSC GMP and 16,4% of LLC EMP employees showed an increased level of total IgE in the blood serum. No correlation between the increased total IgE and the presence of allergic deseases was established. These results can be explained by the weakening of the T-suppressor inhibitory mechanism that promotes IgE synthesis in response to antigenic stimulation (allergens, chemical factors, etc.).

Targeting the PGD2/CRTH2/DP1 Signaling Pathway in Asthma and Allergic Disease: Current Status and Future Perspectives

Prostaglandin D2 (PGD2) released by degranulating mast cells is believed to play a key role in orchestrating mechanisms of inflammation in allergies and asthma. The biological effects of PGD2 are mediated by D-prostanoid (DP1), CRTH2 (DP2), and thromboxane prostanoid (TP) receptors. The CRTH2 receptor is involved in induction of migration and activation of T helper type 2 (Th2) lymphocytes, eosinophils, and basophils; up-regulation of adhesion molecules; and promotion of pro-inflammatory Th2-type cytokines (interleukin [IL]-4, 5, 13), whereas the DP receptor is associated with relaxation of smooth muscles, vasodilation, inhibition of cell migration, and apoptosis of eosinophils. A number of CRTH2/PGD2 receptor antagonists have been investigated in asthma and allergic diseases. The CRTH2 antagonist (OC000459) or dual CRTH2 and TP receptor antagonist (ramatroban) were effective in reducing eosinophilia, nasal mucosal swelling, and clinical symptoms of allergic rhinitis, with the latter drug registered for clinical use in this indication. OC000459 and setipiprant reduced the late but not early phase of response in an allergen challenge in atopic asthmatics. In persistent asthma, some molecules induced limited improvement in lung function, quality of life, and asthma symptoms (OC000459, BI671800), but in other trials with AMG 853 and AZ1981 these findings were not confirmed. The clear discrepancy between animal studies and clinical efficacy of CRTH2 antagonism in allergic rhinitis, and lack of efficacy in a general cohort of asthmatics, highlight the issue of patient phenotyping. There is no doubt that the PGD2/CATH2/DP1 pathway plays a key role in allergic inflammation and further studies with selective or combined antagonisms in well defined cohorts of patients are needed.

Effect of nasal glucocorticoid combined with loratadine or montelukast on allergic rhinitis

Objective:To evaluate the effect of nasal glucocorticoid combined with second-generation antihistamines or leukotriene receptor antagonists on the treatment of moderate severe allergic rhinitis, and explore the optimal scheme of personalized treatment for AR patients.Method:Fiftyseven patients with persistent moderatesevere allergic rhinitis were randomly divided into three groups and treated by mometasone furoate aqueous nasal spray (group MOM), mometasone furoate aqueous nasal spray combined with loratadine (group MOM+L), mometasone furoate aqueous nasal spray combined with montelukast (group MOM+M) for 4 weeks. Four major clinical symptoms of allergic rhinitis: nasal congestion, nose itching, sneezing and runny nose were evaluated by "symptom rating score" before treatment and after treatment for 4 weeks.Result:After treatment, the total nasal symptom scores of each group showed a decreasing tendency, and the differences between various time points were statistically significant (P< 0.05). For the symptom of nasal congestion, the symptom score of MOM+M group was significantly lower than that of MOM group and MOM+L group at the 2nd and 4th week after treatment. For the symptoms of sneezing and nasal itching, MOM+L group had the lowest score at each time point after treatment and the difference was statistically significant compared with MOM group (P< 0.05), but there was no significant difference between MOM group and MOM+M group (P> 0.05). For the symptom of runny nose, the score of MOM+L group was significantly lower than MOM group (P< 0.05) at the 1st and 2nd week, MOM+M group was significantly lower than MOM group (P< 0.05) at the 2nd and 4th week, while there was no significant difference between MOM+L group and MOM+M group (P> 0.05).Conclusion:Nasal glucocorticoid alone or combined with secondgeneration antihistamines or leukotriene receptor antagonists can effectively control nasal symptoms of moderatesevere allergic rhinitis, yet the effect of combination therapy is better. For nasal congestion, nasal glucocorticoid combined with leukotriene receptor antagonists have a better effect. For nasal itching and sneezing, the choice of nasal glucocorticoid combined with second-generation antihistamines may be more sensible. For runny nose, nasal glucocorticoid combined with second-generation antihistamines or leukotriene receptor antagonists have similar efficacy.

The use of modern topical medications for the stepwise treatment of allergic rhinitis: the effectiveness and prospects for the further extension of their application

The objective of the present work was to summarize the results of clinical studies designed to evaluate the effectiveness of 'Momate Rhino Advance' in the form of the nasal spray (based on the fixed combination of mometasone furoate and azelastine) that finds an increasingly wide application for the treatment of allergic rhinitis. The available data give evidence that this medication can be prescribed to the patients presenting with the severe and moderate form of allergic rhinitis. The treatment should be started with the use of the combined preparation and continued, after the adequate control of the clinical symptoms of allergic rhinitis is achieved, using 'Momate Rhino' during the next 2-4 weeks for the reliable management of the disease. It is concluded that the proposed strategy makes it possible to avoid the simultaneous application of multiple medications (polypragmasy) and thereby reduce the intake of medicines by the patients suffering from allergic rhinitis.

English

OBJECTIVES: 1. To evaluate the efficacy of Immunotherapy in improvement of nasal symptoms in patients with Allergic Rhinitis. 2. To evaluate the adverse reactions of Immunotherapy in patients suffering with allergic rhinitis. MATERIALS AND METHODS: Study group included 138 patients with Allergic rhinitis, who presented in Department of ENT, during July 2011 to March 2014. Patients with clinical history of allergic rhinitis were screened with total serum IgE. Patients with elevated total serum IgE were investigated with skin prick test. Patients with positive skin reactions were treated with sub cutaneous immunotherapy. Development of adverse reactions during administration of immunotherapy was assessed. A follow up period of 18 months was considered for the study. A relief in clinical symptoms of allergic rhinitis at the end of 18 months was considered. CONCLUSION: Immunotherapy offers significant improvement in relief of clinical symptoms of allergic rhinitis with minimal adverse reactions over a long time. Total serum IgE forms an affective screening tool in diagnosis of allergic rhinitis. Immunotherapy appears as a safe alternative treatment for the management of allergic rhinitis.

John Bostock

John Bostock

The Effectiveness of Modern Antihistamines for Treatment of Allergic Rhinitis - An IPD Meta-Analysis of 140,853 Patients

Allergic rhinitis represents a worldwide health problem. The prevalence is increasing. The aim of this study was to analyse the correlation between the severity of allergic rhinitis and an adequate treatment dose of modern oral antihistamines. From a comprehensive databank containing data from ten different open-label prospective observational studies including raw data of 140,853 patients with allergic rhinitis, symptomatology variables were analysed and scored to study the effects of treatment with four antihistamines (Desloratadine, Ebastine, Fexofenadine, Levocetirizine) alone or in combination with intranasal corticosteroids. The patient data were collected in 23,606 study centres from Germany, mostly medical specialist and some primary care physicians in private practice. The analyses were performed via individual patient data meta-analysis techniques. Finally 92,900 patient data from nine of ten studies could be analysed. One study with data of 47,953 patients was excluded due to incomplete treatment documentation. Both monotherapy analysis subgroups (Total Symptom Score and Total Nasal Symptom Score) were significantly better than those of their combinations with intranasal steroids. Monotherapy with levocetirizine was determined to be significantly more effective in lowering the Total Symptom Score (p < 0.001) and the Total Nasal Symptom Score (p < 0.05) than the other antihistamines. In the next stage, a greater positive effect of levocetirizine was demonstrated in relation to the severity of the clinical symptoms of allergic rhinitis (Total Nasal Symptom Score in cases with severe symptomatology [effect size = -0.09]). Levocetirizine asserted itself as the only antihistamine compared with the others as significant in this analysis. The study authors recommend monotherapy with the new-generation antihistamine levocetirizine, especially in severe cases of allergic rhinitis.

Evaluation of Clinical and Immunological Responses: A 2-Year Follow-Up Study in Children with Allergic Rhinitis due to House Dust Mite

Background. Allergic rhinitis is a disease with polarization towards Th2 and a defect of regulatory T cells. Immunological changes have been reported after immunotherapy treatment. However, there is not much known about the natural course of allergic rhinitis with respect to clinical manifestation and the relation with immunological responses. Objective. To evaluate clinical symptoms of allergic rhinitis, in relation to in vivo allergen-specific skin responses and in vitro allergen-specific effector and regulatory T cells determined at baseline and after two years. Methods. From a large trial, 59 children were randomly selected. The following variables were compared: clinical symptoms, allergen skin tests, specific IgE, T-cell proliferation, IL-5, IL-13, IFN-gamma, IL-10, TGF-beta, CD4+CD25hi cells, and Foxp3 expression. Results. Allergic symptoms had decreased after two years. Whereas skin test reactions correlated between years 0 and 2, there was no change in the size of the reaction. Also, proinflammatory reactions did not change after two years, with a positive correlation between years 0 and 2. No relevant changes were observed with respect to regulatory cells. Conclusion. Whereas, comparable to immunotherapy, allergic complaints decrease, the immunological changes of specific T-cell activity (both effector cells and regulator cells) which are observed after immunotherapy, do not change.

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.