Concomitant Allergic Rhinitis Research Articles

Allergen-specific immunotherapy for allergic asthma: What’s new?

Allergen-specific immunotherapy for inhalant allergies, using allergen extracts of proven value, is highly effective in selected patients with allergic rhinoconjunctivitis and allergic asthma. Both subcutaneous and sublingual immunotherapy (SLIT) have been shown to modify the underlying cause of the disease, with long-term clinical benefits that persist for years after their discontinuation. Real-world studies have confirmed the long-term efficacy of allergen immunotherapy in allergic rhinitis (AR) and asthma and shown a reduction in the incidence of lower respiratory tract infections. Sublingual house dust mite (HDM) immunotherapy has been suggested to improve innate antiviral immunity—a likely explanation for this finding. Based on robust randomized controlled trials, the Global Initiative for Asthma (GINA) guideline has incorporated the use of SILT for the treatment of adults with HDM-driven asthma and concomitant AR, with sub-optimal control, regardless of the use of low-to-high doses of inhaled corticosteroids, as long as the patient’s forced expiratory volume in 1 second (FEV1) is > 70%.

Markers of eosinophilic airway inflammation in patients with asthma and allergic rhinitis.

Background: Measurement of airway inflammation is an important step to determine phenotype of asthma and allergic rhinitis (AR). Objective: To assess the level of nitric oxide in exhaled air (FeNO), nasal fraction of nitric oxide (nasal NO), their relationship with clinical control and blood eosinophils in patients with steroid-naive mild and moderate asthma and AR. Methods: One hundred forty-seven patients (65 men), ages 26-49.5 years (mean age, 32 years) with AR (n = 81) or AR and concomitant asthma (n = 46) and 20 healthy subjects were included in a single-center cohort study. All the patients underwent spirometry with reversibility test. Control of asthma and AR was assessed by using the Asthma Control Questionnaire and the visual analog scale, respectively. Levels of FeNO and nasal NO were measured by chemiluminescent analyzer, peripheral blood eosinophils were counted by automatic analyzer. Results: The FeNO level was significantly elevated in the patients with asthma and concomitant AR compared with the healthy subjects and was associated with control of both asthma and AR. There was no correlation between nasal NO and control of AR. Receiver operating characteristic analysis revealed that the level of eosinophils of 150 cells/μL may be a cutoff for lower airway eosinophilic inflammation. Blood eosinophils count was unable to distinguish eosinophilic and non-eosinophilic upper airway inflammation. Conclusion: We confirm that FeNO but not nasal NO is a marker of eosinophilic airway inflammation in patients with mild-moderate steroid-naive AR and concomitant asthma. A blood eosinophil level of ≥150 cells/µL may be a simple marker of eosinophilic airway inflammation in patients with asthma. However, its low specificity requires repeated measurements and use in combination with other biomarkers.

Decreasing prevalence of atopic dermatitis in Swedish schoolchildren: three repeated population-based surveys.

The prevalence of atopic dermatitis (AD) has increased over several decades and now affects about one-fifth of all children in high-income countries (HICs). While the increase continues in lower-income countries, the prevalence of AD might have reached a plateau in HICs. To investigate trends in the prevalence of AD and atopic comorbidity in schoolchildren in Sweden. The study population consisted of three cohorts of children (median age 8 years) in Norrbotten, Sweden, for 1996 (n = 3430), 2006 (n = 2585) and 2017 (n = 2785). An identical questionnaire that included questions from the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was used in all three cohorts. Trends in AD prevalence were estimated, as well as trends in atopic comorbidity. AD prevalence was estimated both according to the ISAAC definition of AD and by adding the reported diagnosis by a physician (D-AD). The prevalence of AD decreased in the last decade, from 22.8% (1996) and 21.3% (2006) to 16.3% (2017; P < 0.001). The prevalence of D-AD was lower, but the same pattern of decrease was seen, from 9.3% (1996) and 9.4% (2006) to 5.7% (2017; P < 0.001). In all three cohorts, AD was more common among girls than boys (18.9% vs. 13.8% in 2017; P < 0.001). Children from the mountain inlands had a higher prevalence of AD than children from coastal cities (22.0% vs. 15.1% in 2017; P < 0.001). In comparing D-AD, there were no significant differences between the sexes or between inland or coastal living. Concomitant asthma increased over the years from 12.2% (1996) to 15.8% (2006) to 23.0% (2017; P < 0.001). Concomitant allergic rhinitis and allergic sensitization increased from 1996 (15.0% and 27.5%) to 2006 (24.7% and 49.5%) but then levelled off until 2017 (21.0% and 46.7%). The prevalence of AD among schoolchildren in Sweden decreased over the study period, whereas atopic comorbidity among children with AD increased. Although a decrease was seen, AD is still common and the increase in atopic comorbidity among children with AD, especially the increase in asthma, is concerning.

Food-induced immediate response of the esophagus in pediatric eosinophilic esophagitis.

Food-induced immediate response of the esophagus (FIRE) is a new phenomenon that has been described in eosinophilic esophagitis (EoE) patients. It is suspected when unpleasant symptoms occur suddenly on contact of the triggering food with the esophageal surface and recur with repeated exposures. It can often be mistaken for pollen-food allergy syndrome (PFAS) and solid food dysphagia. Data on FIRE is limited to one survey study and case reports, and there are no screening studies conducted on either adults or children with EoE. In this study, we aimed to screen children aged ≥7 years old with EoE for FIRE. Demographic data were collected from medical records. A questionnaire about FIRE was applied to all participants. Skin prick tests were done on suspected patients to identify the triggering foods. FIRE is defined as suitable clinical symptoms with suspected food allergen exposure. A total of 78 patients (74.4% male, median age: 13.5 years) were included. Unpleasant and recurrent symptoms distinct from dysphagia with specific foods were reported in 16.7% of the patients, all of whom had concomitant allergic rhinitis (AR). The symptoms described by almost all patients were oropharyngeal itching and tingling (PFAS: 15.3%) excluding only one patient reporting retrosternal narrowing and pressure after specific food consumption (FIRE: 1.2%). Although definitive conclusions regarding the true prevalence of FIRE cannot be made, it does not seem to be common as PFAS. However, it deserves questioning particularly in the presence of concurrent AR and/or PFAS in children with EoE.

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

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

Immunogenetic parameters in children with atopic diseases

Objective. To determine the features of the distribution of antigens of the major histocompatibility complex in children of preschool and primary school age with atopic diseases.&#x0D; Materials and methods. Under observation there were children with a moderate course of the diseases such as atopic dermatitis, atopic dermatitis with concomitant persistent allergic rhinitis, independent persistent allergic rhinitis, atopic bronchial asthma. The patients were identified class I and class II antigens of HLA-complex.&#x0D; Results. The studies have shown that patients with atopic dermatitis had a high incidence of HLA B15, DRB1*13 and DQB1*0602-8: in patients suffering from atopic dermatitis with concomitant persistent allergic rhinitis HLA B12, B13 and DQB1 * 01; in patients with independent persistent allergic rhinitis HLA A10 and DQB1 * 201; in patients with atopic bronchial asthma HLA B18.&#x0D; Conclusions. Representation of these antigens of the HLA complex in the tissues was associated with an increase in the risk of atopic diseases by 2.34.6 times.

The Impact of Allergic Rhinitis on Asthma and Its Effect on the Quality of Life of Asthmatic Patients.

Background Allergic rhinitis (AR) and asthma are one of the most common diseases in the Kingdom of Saudi Arabia. Asthma and AR patients report significant reductions in their daily activities due to this condition. Therefore, measuring health-related quality of life (HRQOL) in adult asthmatic and AR patients and evaluating the use of allergic rhinitis treatment modalities to improve asthma control may help prevent future respiratory complications, improve patient quality of life, and reduce morbidity. Methods This cross-sectional observational study was conducted through an online self-administrated questionnaire distributed electronically on social media through "Survey Monkey" (http://www.surveymonkey.com) from April 2 to September 18, 2021. The study targeted adult patients with asthma and/or allergic rhinitis residing in the Riyadh region of Saudi Arabia. The study compared and evaluated HRQOL between three groups: asthmatic patients with concomitant AR, patients with asthma only, and patients with AR only. Results A total of 811 questionnaires were analyzed. Of those, 23.1%were diagnosed with asthma and 64% were diagnosed with allergic rhinitis; from those who were diagnosed with AR,27.2%were asthmatics.A statistically significant association was observed between receiving AR medications and asthma controlin respondents with intermittent AR(P < 0.001).However, no association was observed between asthma control and receiving medications for AR in respondents with persistent AR (P = 0.589).The average scores for all eight-itemshort-form (SF-8) QOL dimensions were lower in patients with combined asthma and AR than in patients with AR only and asthma only (P < 0.001). Conclusions This study suggested that AR was associated with more severe asthma and quality of life impairment.

Влияние интраназального препарата рекомбинантного интерферона α-2b на динамику клинических, функциональных и иммунологических показателей у пациентов с сочетанным течением аллергического ринита и бронхиальной астмы

Objective. A longitudinal cohort study was conducted to assess the effect of intranasal recombinant interferon α-2b-based medicine (Grippferon) on clinical, functional and immunological parameters in patients with concomitant bronchial asthma (BA) and allergic rhinitis (AR). Patients and methods. Twelve children aged between 10 and 17 years were examined. Clinical symptoms and nasal respiratory function, the content of VEGF, interleukins IL-1, -2, -4, -6, eosinophilic cationic protein (ECP) and total IgE in nasal secretions were assessed on days 1 and 31. Results. The study results showed a statistically significant increase in nasal respiratory flow (p = 0.001), a decrease in the severity of nasal (p = 0.002) and sinonasal symptoms (p = 0.0015), a reduction in VEGF concentration in nasal secretions (p = 0.014) and a downward trend in ECP (p = 0.09) and IL-4 (p = 0.10) levels. No statistically significant changes in IL-1, IL-6, and IgE content were found. Conclusion. The intranasal use of recombinant interferon α-2b-based medicine (Grippferon) for prevention of acute respiratory viral infections is well-tolerated by patients with AR and BA with shown notable improvement in nasal respiratory function, decrease in the severity of nasal and sinonasal symptoms and downward trends in the content of several T2 inflammation biomarkers in nasal secretions. Key words: interferon α-2b, cytokines, allergic rhinitis, bronchial asthma, acute respiratory viral infections, prevention, Grippferon

Characteristics of the patients with asthmarhinitis multimorbidity.

Asthma and allergic rhinitis frequently coexist and have been regarded as a single airway disease. Clinical features of patients with asthmarhinitis multimorbidity may change depending on the allergic sensitization pattern. The aim of our study is to determine the frequency, type, and characteristics of the patients with asthma-rhinitis multimorbidity. Patients who were followed up with a diagnosis of asthma between 2015 and 2020 in our clinic were included in our crosssectional study. Sociodemographic and clinical characteristics of the patients, rhinitis symptoms, and atopy status according to the results of the skin prick test, and sp IgE were recorded from the patient files. Asthma-rhinitis multimorbidity was seen in 138 (113 F/25 M) out of 405 asthmatics and the mean age was 45.51 ± 13.56 years. They were younger and the age of onset of asthma was earlier than asthma patients without rhinitis. The rate of concomitant allergic rhinitis (AR) was 25.9%, and the rate of non-allergic rhinitis (NAR) was 8.1% in the entire group. There was no difference between patients with AR and NAR in terms of comorbidities such as NSAID sensitivity, nasal polyps, chronic rhinosinusitis, and bronchiectasis but, gastroesophageal reflux disease was more common in those with NAR than in those with AR (39.4%, 18.1%, respectively, p= 0.01). Of 105 asthmatic patients accompanied by allergic rhinitis, 41 (39.09%) were monosensitized, and 64 (60.95%) were polysensitized. House dust mites were found to be the most common responsible allergen in monosensitized patients. Sensitization to two allergens was the most common pattern among polysensitized patients, and mites and mold association was the most frequent. Patients with monosensitized allergic rhinitis had more severe asthma and a higher rate of NSAID sensitivity than polysensitized patients (p= 0.03, p= 0.04, respectively). There was no difference in the control level, frequency of eosinophilia, and other comorbidities. Our patients with asthma-rhinitis multimorbidity were mostly polysensitized. The most responsible allergen for the sensitization was house dust mites, regardless of whether the patient was monosensitized or polysensitized.

Effectiveness of complex treatment associated with ozone therapy on clinical indicators and immunity status in children with atopic dermatitis and concomitant allergic rhinitis

Objective. To evaluate the effectiveness of complex treatment in combination with ozone therapy in children with moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis.&#x0D; Materials and methods. Under observation were children of preschool and primary school age with moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis. In these children, we studied clinical indicators, the content of populations and subpopulations of lymphocytes in the blood, immunoglobulins and circulating immune complexes in the blood serum, phagocytosis indicators, expression of toll-like receptors on leukocytic cells. Patients were divided into two groups depending on the therapy. The first group received complex conventional therapy, the second group received complex treatment in combination with ozone therapy.&#x0D; Results. It was found that in the first group of patients during the period of clinical remission, changes in immunological reactivity persisted. In the second group of patients, a more rapid onset of clinical remission was recorded, during which normalization of most immunity parameters was noted. The duration of complete clinical remission in the second group of patients more than twofold exceeded its duration in the first group of patients.&#x0D; Conclusions. The inclusion of ozone therapy in complex treatment of preschool and primary school children suffering from moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis provides a more rapid onset of clinical remission. During the period of clinical remission, normalization of most immunity parameters, a pronounced increase in the expression of toll-like receptors-2 and toll-like receptors-6 on lymphocytes, monocytes and neutrophils are recorded. This indicates an increase in nonspecific antibacterial resistance. Conducting a repeated course of complex treatment in combination with ozone therapy ensures the preservation of complete clinical remission, the duration of which is twice as long as in the first group. High therapeutic effect of ozone, the availability of ozone therapy, the absence of complications and adverse reactions when using complex treatment in combination with ozone therapy allow us to recommend the widespread use of this method in children of preschool and primary school age suffering from moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis.

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

BACKGROUND: Omalizumab, by binding IgE in atopic patients, can improve clinical and functional parameters and patients' quality of life.&#x0D; AIMS: to evaluate efficacy of anti-IgE-therapy in patients with allergic rhinitis treated with omalizumab for concomitant severe atopic asthma in real clinical practice.&#x0D; MATERIALS AND METHODS: An open, non-interventional, prospective and non-randomized study in a real clinical practice.&#x0D; The study was conducted in the Sverdlovsk region in October 2021 based on a regional registry of adult patients with severe asthma with chronic nasal inflammatory diseases and receiving targeted therapy. Dynamics of nasal symptoms was assessed using SNOT-22 questionnaire and visual analogue scale initially, after 4 and 12 months of omalizumab therapy. Peripheral blood eosinophils level was also assessed before and after 4 months of omalizumab therapy.&#x0D; RESULTS: The study included 26 patients. Assessment of nasal symptoms dynamics using the SNOT22 questionnaire at baseline and after 4 months on omalizumab therapy revealed decrease in the severity of symptoms (p 0.001): baseline - 46.8522.04 points (95% CI 37.94-55.75), after 4 months - 30.6514.81 points (95% CI 24.67-36.64). Also improvement in SNOT22 questionnaire score was revealed in 18 patients treated with omalizumab during 12 month: before therapy - 47.5 points (Q₁ -Q₃: 35.7-59.3), after 4 months - 30.4 points (Q₁- Q₃: 22.1-38.1), after 12 months - 24.9 points (Q₁ -Q₃: 16.9-32.9) (p = 0.001). Improvement in rhinitis symptoms control was observed according to the VAS scale: VAS before therapy - 8.0 points (Q₁-Q₃: 6.2-9.0), after 4 months - 5.0 points (Q₁- Q₃: 3.2-5, 8), after 12 months of treatment - 5.0 points (Q₁-Q₃: 4.0-6.8). The level of eosinophils (n=16) decreased from 510.9317.9 (95% CI 341.5680.3) cells /l to 327.4217.7 (95% CI 211.4443.5) cells /l after 4 months of anti-IgE-therapy (p0.041).&#x0D; CONCLUSIONS: Omalizumab in real clinical practice has demonstrated improvement of rhinitis symptoms control and quality of life in patients with allergic rhinitis with concomitant severe atopic asthma. It was accompanied by a statistically significant decrease in peripheral blood eosinophils level, that largely determines airway inflammation severity and clinical manifestations of allergic rhinitis and bronchial asthma.

Asthma and allergy practice and COVID 19: a review. Part II

The aggressive SARS-CoV-2 virus mainly infects the lungs, most patients with asthma have an increased risk of infection and are likely to have a potentially more severe course of COVID-19.Materials and methods. We used various full-text and abstract databases.Patients with asthma and concomitant allergic rhinitis are among the most costly patients. The shared immunologic pathogenesis are nasal bronchial reflex, allergen sensitization, and epidemiologic studies that link asthma and allergy. There is an interrelatedness of the upper and lower airway function, the link operating directionally from the sinuses to the lungs. In addition, there is a co-occurrence of asthma and allergic rhinitis in the population. Furthermore, both conditions respond to similar treatments, including antihistamine-containing therapies that may ameliorate allergic rhinitis and also potentially help alleviate asthma symptoms.An important problem for practitioners is that patients with bronchoobstruction and allergy syndrome are often afraid of the risk of seeking medical attention during a COVID-19 pandemic and may confuse allergic symptoms with symptoms of coronavirus infection.The U.S. Centers of Disease Control and Prevention has identified algorithms for providing non-COVID-19 care during a pandemic: to quickly detect and respond to an increase in COVID-19 cases among patients with asthma; provide assistance in the safest way; keep in mind that services may need to be gradually expanded.A rapid systematic review was undertaken to inform this scientific brief. The review set out to assess the available peer-reviewed literature regarding whether PWA are at increased risk of infection with the virus that causes COVID-19, and/or of experiencing complications or death.

IL-10 AND IL-35 AS INFLAMMATION REGULATORS IN PATIENTS WITH ALLERGIC RHINITIS AND MILD ATOPIC ASTHMA

Background. Significantly less is known about the immunoregulative cytokines, especially in allergic airway disease. This study aims to present the involvement of IL-35 and IL-10 in patients with allergic rhinitis (AR) and allergic bronchial asthma (BA). Methodology. The study comprised 71 patients –AR, patients with concomitant AR and mild atopic BA, and healthy controls (HC). We examined the serum levels of IL-35 and IL-10, along with other instrumental examinations, between March and September 2021. Findings. Levels of the regulatory cytokines IL-35 and IL-10 were significantly lower in patients than in HC (87.19±11.90 vs. 96.12±1.79 pg/ml; and 30.26±17.55 vs. 111.56±65.03 pg/ml, respectively). Furthermore, threefold higher serum IL-10 levels were found in healthy subjects compared to patients (p = 0.006). No difference in the levels of interleukins was found between the studied groups. Conclusions. Our results indicate that elevated IL-35 and IL-10 may play an essential role in reducing the activity of underlying allergic inflammation in allergic respiratory diseases, although no difference in the levels of the studied cytokines was found between the different groups of patients. Therefore, we can speculate that the immunosuppressive cytokines IL-35 and IL-10 were involved in maintaining the healthy state of no inflammation.

FEATURES OF CLINICAL SYMPTOMS AND THE INFLUENCE OF RISK FACTORS ON THE OCCURRENCE OF BRONCHIAL ASTHMA IN CHILDREN OF LVIV REGION OF DIFFERENT AGES

Bronchial asthma (BA) is a common chronic pathology of the lower respiratory tract in children. The first manifestations of the disease can begin at any age, but the clinical features, of the course, are different in different periods of childhood. Manifestations and course of asthma may disappear or progress with age. Therefore, it is likely that there are differences in the pathophysiology, inflammatory response of the body and the features of the clinic of asthma in children of different ages, which affects the diagnosis and treatment. The aim of the study was to determine the features of clinical symptoms and the influence of risk factors for asthma on its occurrence in children of different ages.&#x0D; Materials and methods. We analyzed the anamnesis and clinical symptoms of 57 children aged 3 to 18 years, who were treated from September 2020 to June 2021 in the Lviv Regional Children's Clinical Hospital “OHMATDYT” and in the Lviv Municipal City Children's Clinical Hospital. The age groups did not differ statistically in the severity of asthma (P&gt; 0.05). Thus, in group 1 was 1 patient (9.09%) with mild form, 1 patient (9.09%) - moderate persistent form, 8 patients (72.73%) - with severe persistent form. Among patients of age group 2 was 1 patient (3.85%) with mild persistent form, 3 children (11.54%) - moderate and 21 children (80.77%) - with severe persistent form. In group 3 was 1 patient (5%) with a mild persistent form, 6 patients (30%) - moderate and 12 children (80%) - with a severe persistent form. The vast majority of patients were boys (84.21 ± 4.83%). All patients underwent general clinical examinations, spirometry, and allergy tests. We used the clinical-anamnestic method to perform the tasks of the work, which consisted in collecting a detailed somatic and genealogical anamnesis during the parents` questionnaire. Physical development of children was assessed using centile tables. Statistics were evaluated by calculating Student's t-test and Pearson's consistency test. Preschool children with asthma were more likely to experience shortness of breath during exercise and a wet low-yielding cough, and children of primary and secondary school age were more characterized by concomitant allergic rhinitis. Autumn was more unfavorable period for the exacerbation of clinical manifestations of asthma in children of Lviv region was period. We did not find correlation of birth weight on the timing of asthma. However, a burdensome obstetric history contributed to the early development of clinical manifestations of asthma. Preschool children were more likely to be exposed to nicotine during the antenatal period and had a shorter duration of breastfeeding, which may be a probable risk factor for asthma in preschool children. In 77% of children from different age groups were burdened with a history of allergies, with 66% of cases more pronounced in the maternal line. An analysis of physical development revealed that most preschool children were overweight.&#x0D; Conclusions. Asthma has features of clinical symptoms in children of different ages - shortness of breath during exercise and whooping cough are characteristic of preschool children, and concomitant chronic persistent rhinitis - for older age groups. Seasonal exacerbations are characteristic of asthma in children; in particular, the autumn period is more unfavorable, common for asthmatics in children of all ages among patients in Lviv region. Maternal smoking during pregnancy has a significant effect on the risk of developing asthma in children. Also, a burdened maternal allergy history and overweight child contributes to the development of asthma in children.

Combination therapy of omalizumab with house dust mite immunotherapy in chronic spontaneous urticaria associated with sensitization to dust mites-case series

Chronic spontaneous urticaria (CSU) is a heterogeneous disorder with recurrent pruritic wheals and/or angioedema. The anti-immunoglobulin E (omalizumab) is used in CSU patients resistant to four-fold second-generation anti-histamines. Most clinical trials have experienced relapse after stopping omalizumab treatment. Here, we present a case series of five cases of chronic atopic urticarial concomitant allergic rhinitis and asthma which have shown immunologically significant positivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae. Disease control was achieved (Urticaria Activity Score 7 &lt;6) in four cases by combination therapy of omalizumab with house dust mite (HDM) Allergen Immunotherapy (AIT) and remained sustained for three years on follow-up even after discontinuation of AIT for one year. We hypothesize that this combined therapy may contribute to enhanced clinical efficacy, safety, and faster achievement of disease control in CSU.

Endoscopic sinus surgery improves Eustachian tube function in patients with chronic rhinosinusitis: a multicenter prospective study

Patients with chronic rhinosinusitis (CRS) often have Eustachian tube dysfunction (ETD) symptoms. This study aimed to prospectively investigate the effect of endoscopic sinus surgery (ESS) on improvement of Eustachian tube function in CRS patients with ETD from a Chinese population and determine factors associated with improvement. A prospective study was performed in CRS patients with ETD who underwent ESS from 3 tertiary medical centers in south China. The Eustachian tube Dysfunction Questionnaire 7 (ETDQ-7), Sinonasal Outcome Test 22 (SNOT-22), tympanograms, endoscopic findings and Valsalva maneuver were recorded and analyzed preoperatively and postoperatively at 8-12 weeks. A total of 70 CRS patients with ETD were included in this study. The ETDQ-7 score and the ability of positive Valsalva maneuver in CRS patients were significantly improved postoperatively at 8-12 weeks. The number of patients with type A tympanogram was increased postoperatively. Reduced Eustachian tube mucosal inflammation was also observed postoperatively. In addition, ESS appeared to reverse slight tympanic membrane atelectasis after 8-12 weeks. Moreover, improvement in tympanogram was presented in more than half of CRS patients with concomitant otitis media with effusion postoperatively at 8-12 weeks. Univariate and multivariate analysis revealed failure of normalization of ETDQ-7 postoperatively was associated with concomitant allergic rhinitis and higher preoperative SNOT-22 score. This study confirms Eustachian tube function is often improved after ESS in CRS patients with ETD. Concomitant allergic rhinitis and higher preoperative SNOT-22 score are associated with failure of normalization of ETD symptoms.

Pollen Sensitization in Association with Allergic Rhinitis in preschool asthmatic Children

Abstract Background Grass pollens are significant elicitors of IgE-mediated allergic disease in the world and timothy grass (Phleum pratense) is an important pollen in allergy induction. Objective We sought to determine the rate of pollen sensitization in group of Egyptian asthmatic children with allergic rhinitis using timothy grass pollen as a potential triggering factor for allergic rhinitis. Patients and Methods This analytical cross sectional study was conducted on a group of preschool children following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University during the period from December 2018 to April 2019. We enrolled 52 asthmatic children with concomitant allergic rhinitis sampled in a consecutive manner. They were subjected to skin prick testing for timothy grass pollen, positive histamine control and negative control. Results The study revealed high frequency of timothy grass pollen(TGP) sensitization occurring in 60.3% of patients with concomitant allergic rhinitis .wheal diameters pointed to sensitization only rather than actual allergy to TGP. TGP sensitization showed no significant correlation to disease duration. Children with rhinosinsuitis had comparable rates of TGP sensitization to those without rhinosinsuitis. Conclusion It is concluded from our results that sensitization to timothy grass pollen (TGP) is common in allergic rhinitis. The findings are limited by the sample size and consecutive manner of sampling. Wider scale studies are needed to accurately evaluate the frequency of timothy grass pollen (TGP) sensitization in our country.

Turkish language validity and reliability of the Control of Allergic Rhinitis and Asthma Test and its comparison with other scales

Patients with asthma often suffer from concomitant allergic rhinitis (AR). The Control of Allergic Rhinitis and Asthma Test (CARAT) is a validated tool to assess asthma and rhinitis multimorbidity. Turkish language validity and reliability of CARAT and its compatibility with other scales were evaluated in the study. Patients with asthma and concomitant AR were tested with CARAT. Pulmonary function tests, Asthma Control Test (ACT), Assessment Tool for Asthma (ATA) questionnaire and visual analogue scale (VAS) were also used at the same day. With the VAS, patients determined their rhinitis symptom levels, and asthma specialist determined the rhinitis and asthma control levels separately. These questionnaires were repeated in 14 ± 2 days. Three quarters (77%) of the 100 patients were female (mean age 46.5years). The mean CARAT score was 19.6 ± 7.2. The Cronbach's alpha coefficient of the Turkish version of the CARAT scale was 0.83, showing a high level of internal consistency. Test-retest reliability coefficient was determined as r = 0.98 (p < 0.001). The Kaiser-Meyer-Olkin coefficient of the CARAT scale was 0.79. The p value of the Bartlett test was <0.001. ACT, ATA and VAS expert scales were correlated with CARAT total score (0.577 ≤ r ≤ 0.871). The CARAT scale did not show statistically significant difference according to gender, education, working status, smoking status, presence of polyps and multiple allergen sensitivity (p > 0.05). The Turkish version of the CARAT is a reliable alternative tool for physicians in determining disease control in adult patients with asthma and 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.

Konsekwencje nieleczonej lub źle leczonej astmy u dzieci

Astma jest najczęstszą przewlekłą chorobą dolnych dróg oddechowych u dzieci. Zwykle rozpoczyna się we wczesnym dzieciństwie, ma niestabilny i nieprzewidywalny przebieg. Zarówno przyczyny, jak i prawdopodobne mechanizmy patologiczne przeplatają się wzajemnie. U podłoża astmy leży proces zapalny w drogach oddechowych, w którego wyniku występują skurcz mięśniówki oskrzeli, pogrubienie ściany dróg oddechowych oraz wzmożone wydzielanie śluzu. Do czynników wpływających na złą kontrolę astmy, częste zaostrzenia zaliczamy: błędne rozpoznanie, nieprzestrzeganie zaleceń lekarskich, złą technikę podawania leków, niedostosowanie sprzętu do wieku dziecka, złą dawkę leku wziewnego, narażenie na czynniki drażniące i nasilające chorobę oraz brak leczenia współistniejącego nieżytu nosa. Konsekwencjami nieleczonej lub źle leczonej astmy u dzieci są: remodeling, upośledzenie rozwoju płuc, zwiększone ryzyko chorób płuc u dorosłych, częste zaostrzenia i infekcje dróg oddechowych, zahamowanie tempa wzrastania, otyłość, ograniczenie wydolności oddechowej i aktywności fizycznej, zaburzenia snu, obniżona jakość życia, absencja w szkole i gorsze wyniki w nauce oraz problemy psychiczne. Aby uniknąć niekorzystnych konsekwencji astmy u dzieci, należy wcześnie rozpoznać chorobę i prawidłowo ją leczyć, stosować odpowiednie, bezpieczne leki i techniki podawania, kontrolować i weryfikować postępowanie terapeutyczne, unikać czynników drażniących i nasilających objawy, edukować opiekunów i pacjentów, zachęcać do aktywności fizycznej, uprawiania sportów oraz redukcji masy ciała dzieci otyłych.