Rhinitis Symptom Control Research Articles

The effect of mask use on allergic rhinitis symptoms during COVID-19 pandemic

Aims: Inspiratory particle load including the allergens in the inhaled air is decreased by the use of the mask, which is one of the methods for COVID-19 protection. The aim of the study is to investigate the effect of masks used by seasonal allergic rhinitis patients with pollen allergy on the control of rhinitis symptoms.
 Methods: Mask usage characteristics of patients (mask type used, average number of days per week for mask usage, daily usage time),whether there was a change in the time spent outdoors during the pandemic compared to the pre-pandemic period, and rhinitis complaints and frequency of rhinitis-related drug use before the pandemic compared to the pandemic period were investigated.
 Results:The frequency of nasal discharge (6.62±1.69; 6.00±1.89: p

Intranasal corticosteroid and antihistamine combinations in the treatment of allergic rhinitis: the role of the novel formulation olopatadine/mometasone furoate

ABSTRACT Introduction Allergic rhinitis (AR) is a common disease with an important impact on the quality of life and very high management costs. In many patients, the poor control of rhinitis symptoms often requires the use of different drugs, and polytherapy tends to reduce therapeutic adherence. According to the latest version of ARIA guidelines, the currently recommended drugs for the treatment of moderate-to-severe AR are second-generation antihistamines, intranasal corticosteroids, and their combination, even in a single nasal spray device. A single medication with a rapid onset of action, acting on breakthrough symptoms too, would be advantageous, also in terms of patient compliance. Areas covered GSP301 (olopatadine 600 µg – mometasone furoate 25 µg) is a novel intranasal formulation, combining the second-generation antihistamine olopatadine hydrochloride with mometasone furoate. Here, we review the evidence for GSP301, especially concerning the efficacy and safety profile of this intranasal combination in the treatment of AR. Expert opinion The evidence provided in the current review clearly supports the use of GSP301 as a novel intranasal corticosteroid/antihistamine combination with a well-documented efficacy and safety profile in terms of rapid symptom relief and good tolerability.

Efficacy and predictors of rapid response to omalizumab therapy in patients with seasonal allergic rhinitis: a cohort study

BACKGROUND: The availability of anti-IgE therapy for allergic rhinitis has actualized the need to develop variants of this treatment according to predictors of rapid response and techniques of treatment initiation.
 AIM: To study the efficacy and predictors of response to omalizumab in patients with seasonal allergic rhinitis.
 MATERIALS AND METHODS: Patients with moderate or severe seasonal allergic rhinitis in which traditional treatment for at least 3 months was not effective in the previous pollen season or in the current season were included. The decision to prescribe omalizumab was made based on the visual analog scale (VAS) in the previous or current season. The dosage and frequency of administration (every 2 or 4 weeks) were determined according to the table of values provided in the instructions. The patients were observed for 2 months. At follow-up visits (1 and 2 months later), allergic rhinitis symptom control was assessed using VAS and total nasal symptoms score (TNSS). Therapy was considered effective when the VAS remained 30 or decreased 30 after 4 and 8 weeks from the start of therapy, depending on the initiation period.
 RESULTS: The study enrolled 30 patients with allergic rhinitis history of 14 years, sensitization to 2 groups of allergens in 19 (63.3%) cases and bronchial asthma in 18 (60%). Omalizumab was initiated before the pollen season in 6 (20%) patients and during the season in 24 (80%) patients. After 4 weeks, allergic rhinitis manifestations were controlled in 23 (77%) patients, and by week 8, 100% of the patients with allergic rhinitis had fully responded to therapy. By 4 weeks of follow-up, the severity of allergic rhinitis symptoms on the VAS and TNSS scales decreased by 2.7 and 4.7 times, respectively. The proportion of patients with a slow response by week 4 of therapy was 23%. Body mass index (lower in the slow response group) and history of bronchial asthma (2.6 times longer in the slow responders) were associated with the achievement of this outcome. No adverse events were recorded.
 CONCLUSIONS: In patients with seasonal allergic rhinitis, omalizumab allows the control of disease manifestations after 4 weeks of therapy with its maintenance in the follow-up. Predictors of rapid response have been revealed; however, their clinical significance requires further study.

Efficacy of Chinese Medicine Acupoint Application Combined with Montelukast on Children with Perennial Allergic Rhinitis: A Randomized Controlled Trial.

To evaluate the efficacy of Chinese medicine acupoint application (CMAA) combined with Western medicine for perennial allergic rhinitis (PAR) in children. In this prospective, parallel, randomized, placebo-controlled and single-blind trial from August to September, 2017, 180 children with PAR were randomly assigned to an integrative group (CMAA and Montelukast), CMAA group (CMAA and placebo tablet), or Montelukast group (placebo CMAA and Montelukast). Participants were applied with CMAA for 6 sessions over 2 weeks, and/or Montelukast Chewable Tablet orally once daily for 12 weeks. The changes in severity of symptoms were measured by Visual Analog Scale (VAS) and rhinitis control assessment test (RCAT) at 0, 2, 4 and 12 weeks of treatment. Blood samples were collected for serum interleukin-4, interferon gamma γ and T helper type 1 (Th1)/Th2 flow cytometric analysis at the time points of 0, 4 and 12 weeks. Eight cases dropped out from the trial, 3 in the integrative group, 2 in the CMAA group and 3 in the Montelukast group. The VAS scores decreased significantly while the RCAT scores increased significantly in all three groups at 4 and 12 weeks compared with baseline (P<0.01 or P<0.05). The VAS scores were significantly lower while the RCAT scores were significantly higher in the integrative and CMAA groups than the Montelukast group at 2 and 4 weeks (P<0.01 or P<0.05). At 2, 4 and 12 weeks, the scores of nasal congestion, sneezing, sleep problem, and rhinitis symptom control in the integrative and CMAA groups increased significantly compared with baseline (P<0.01 or P<0.05). The least percentages of Th2 and the most alleviated Th2 shift (highest Th1/Th2) were observed in the integrative group at 12 weeks compared with the other two groups (P<0.05). The combination of CMAA with Montelukast might be more effective and appropriate than either option alone for children with PAR. (Registered at Chinese Clinical Trial Register, registration No. ChiCTR-IOR-17012434).

Evaluation of Allergic Diseases, Symptom Control, and Relation to Infections in a Group of Italian Elite Mountain Bikers.

This study estimates the prevalence of allergic diseases in a group of Italian elite mountain bikers, compares the prevalence of infectious episodes between allergic and nonallergic athletes, and evaluates asthma and rhinitis symptom control in allergic athletes. Two hundred twenty-six Italian nonsmoking mountain bikers received by mail the Allergy Questionnaire for Athletes (AQUA) and completed it. The RhinAsthma Patient Perspective (RAPP) questionnaire was sent to the 108 participants with a positive AQUA score and 104 returned the questionnaire. Athletes with an AQUA score ≥5 or <5 were defined AQUA+ (allergic) or AQUA- (nonallergic), respectively. RhinAsthma Patient Perspective questionnaire total score ≥15 was indicative of a poor control of symptoms. Of the 226 athletes, 47.8% were AQUA+, whereas 52.2% were AQUA-. A higher number of AQUA+ athletes reported frequent upper respiratory tract infections (URTIs) and herpes labialis than AQUA- athletes (P < 0.001), and the prevalence of URTI was greater in the subgroup of AQUA+ athletes who trained ≥3 hours per session. According to RAPP questionnaire score, 21.1% of AQUA+ mountain bikers had a poor control of asthma and rhinitis symptoms. Our study shows a high prevalence of allergy among Italian elite mountain bikers whose asthma and rhinitis symptoms are poorly controlled in about a fifth of the sample. Allergic athletes, mainly those training more than 3 hours per session, are at higher risk of URTI and herpes labialis. Screening programs to detect allergic diseases and to evaluate symptom control in athletes should be strongly encouraged.

Clinical Control in the Dual Diagnosis of Obstructive Sleep Apnea Syndrome and Rhinitis: A Prospective Analysis

Obstructive sleep apnea syndrome (OSAS) and allergic rhinitis (AR) are common coexisting disorders. Upper airway, specifically nasal resistance, is thought to increase during exacerbations of AR and nonallergic rhinitis (NAR), as well as in OSAS. The study objective was to determine if a correlation exists between clinical control of rhinitis and OSAS. This prospective study followed 43 patients with concurrent OSAS and AR or NAR. OSAS was diagnosed by polysomnography, and AR or NAR was diagnosed by history, skin testing, serum-specific IgE, and total IgE levels. Measurements of control of OSAS included the Epworth Sleepiness Scale (ESS) survey and compliance with continuous positive airway pressure (CPAP) device. Measurements of rhinitis control included Assessment of Nasal Symptom Severity and Assessment of Nonnasal Symptom Severity (NSS refers to both) and Global Assessment of Nasal and Nonnasal Symptom Severity surveys (GSS). Higher NSS scores correlate with more rhinitis symptoms, whereas higher GSS scores correlate with less symptoms. All patients completed the study. There was a positive correlation between ESS and NSS scores (p < 0.001), inverse correlation between ESS and GSS scores (p < 0.001), inverse correlation between CPAP compliance and NSS scores (p < 0.001), and positive correlation between CPAP compliance and GSS scores (p < 0.001). There was no statistically significant difference between the AR, NAR, and AR/NAR groups. Our study showed a statistically significant positive correlation between clinical control of rhinitis symptoms and clinical control of OSAS. This study emphasizes the importance of achieving concurrent optimal control of both OSAS and AR/NAR.

Reliability, validity, and responsiveness of the Rhinitis Control Assessment Test in patients with rhinitis

The Rhinitis Control Assessment Test (RCAT) is a brief, patient-completed tool to evaluate rhinitis symptom control. We sought to test the reliability, validity, and responsiveness of RCAT and to estimate a cut-point score and minimal important difference (MID). A total of 402 patients 12 years of age and older with allergic or nonallergic rhinitis were enrolled in a noninterventional study. Patients completed the RCAT (6 items; score range, 6-30) and had Total Nasal Symptom Scores (TNSSs) measured at baseline and 2 weeks later. Physicians completed a global assessment of rhinitis symptom control (Physician's Global Assessment) and disease severity. Internal consistency, test-retest reliability, convergent validity, known-groups validity, and responsiveness were evaluated. The MID was determined by using distribution- and anchor-based methods. Content validity of the RCAT was assessed in individual interviews with a separate group of 58 adult patients. Internal consistency and test-retest reliability of RCAT scores were 0.77 and 0.78, respectively. Convergent validity correlation between RCAT and TNSS scores was 0.57, and that between RCAT and Physician's Global Assessment scores was 0.34. Mean RCAT scores differed significantly (P < .001) across patient groups, differing in TNSS (F = 72.7), Physician's Global Assessment score (F = 28.6), and disease severity (F = 34.1) in the hypothesized direction. Results suggested a cut-point score of 21 or less can be used to identify patients who are experiencing rhinitis symptom control problems. The preliminary estimate of the MID was 3 points. Patients found RCAT items comprehensive, easy to understand, and relevant. The RCAT demonstrated adequate reliability, validity, and responsiveness and was deemed acceptable and appropriate by patients. This tool can facilitate the detection of rhinitis symptom control problems, and its brevity supports its usefulness in clinical care.

Qualitative Development of the Rhinitis Control Assessment Test (RCAT), an Instrument for Evaluating Rhinitis Symptom Control

: Effective management of allergic rhinitis requires ongoing monitoring of its control. This article describes the qualitative phase of development of a patient-completed instrument, the Rhinitis Control Assessment Test (RCAT), designed to assist patients and providers in the detection of problems with rhinitis symptom control. : To identify concepts to be measured and to develop initial questionnaire items to be tested further in the next phase of development. : A literature review and input from patient focus groups were utilized to generate concepts to be measured in the draft questionnaire. The draft items were subjected to cognitive testing to ensure that the items were understood by patients and to eliminate ambiguity as well as to select an optimal recall period and meaningful response scales. Patients aged ≥18 years self-reporting a rhinitis diagnosis who had experienced rhinitis symptoms in the past 12 months were eligible for participation in the focus groups (n = 39) and the cognitive interviews (n = 23). : This qualitative process yielded a draft instrument with 26 items assessing five constructs of rhinitis symptom control: frequency and bothersomeness of nasal and non-nasal symptoms, symptom impact, activity interference, symptom control, and medication use. A five-point Likert response scale and a 1-week recall period for each item were adopted based on patient input. : The qualitative phase of development of the RCAT produced constructs and items for an instrument that is anticipated to facilitate accurate assessment of rhinitis control and improve the quality of care for patients with allergic rhinitis.

Psychometric validation of the Rhinitis Control Assessment Test: a brief patient-completed instrument for evaluating rhinitis symptom control

Allergic rhinitis is common, but a validated tool for comprehensive assessment of disease control is not available. To develop a simple patient-completed instrument (the Rhinitis Control Assessment Test [RCAT]) to help detect problems with control of rhinitis symptoms. During a visit to an allergy specialist, 410 patients with allergic rhinitis completed a Total Nasal Symptom Score (TNSS) assessment and the 26-item developmental RCAT. Physicians also completed a global assessment of rhinitis symptom control for each patient. Stepwise regression methods identified 6 items from the developmental RCAT (frequency of nasal congestion, sneezing, and watery eyes; sleep interference; activity avoidance; and self-assessed control) that were most predictive of the allergist's global rating of rhinitis symptom control. A summated rating scale from these 6 items showed good convergent validity (r > 0.70) with scale scores from the TNSS. The discriminant validity of the 6-item scale was demonstrated as mean RCAT scale scores differed significantly across groups of patients differing in physician-rated disease severity (F = 54.4), TNSS severity (F = 193.8), and physician-recommended change in therapy (F = 50.6) (P < .001 for all). The RCAT, a 6-item patient-completed instrument, has satisfactory psychometric properties and seems to be a valid tool for assessing control of allergic rhinitis. Further validation studies will provide confirmation.

Safety and efficacy of radioallergosorbent test-based allergen immunotherapy in treatment of perennial allergic rhinitis and asthma

This study was undertaken to demonstrate the safety and efficacy of in vitro, radioallergosorbent test (RAST)-based inhalant allergen immunotherapy. Prospective 22 year single site clinical study, with outcome evaluations of 480 perennial allergic rhinitis patients, including 96 with concomitant asthma. Rhinitis symptom control after 2 years of immunotherapy was excellent in 32.5% of patients, good in 45.6%, and fair in 14.2%. There was no improvement in 7.7%. For patients with asthma, 81% had good or excellent pulmonary symptom improvement, and no patient failed to improve. No severe reactions occurred, but there were 5 limited systemic reactions, or 0.008% of injections, during a 2.5-year mean immunotherapy treatment course. RAST-based immunotherapy is safe and effective for patients with perennial allergic rhinitis, with or without concomitant asthma. Significance This is the first large, multiyear study of safety and efficacy of RAST-based immunotherapy for treatment of perennial allergic rhinitis and asthma. C.

Omalizumab, an anti-IgE antibody, improves both asthma- and rhinitis-related quality of life in patients with concomitant moderate-severe disease

Rationale Patients with allergic asthma (AA) frequently experience concomitant persistent allergic rhinitis (PAR). Omalizumab, a humanized monoclonal anti-IgE antibody, improves quality of life (QoL) in patients with AA or PAR. This is the first study to evaluate the effect of omalizumab on both asthma- and rhinitis-related QoL in the same patients. Methods This was a 28-week, randomized, double-blind, placebo-controlled multicenter trial of 405 patients with moderate-severe AA and comcomitant moderate-severe PAR. Patients (12-74 years) were randomized to receive either omalizumab (n=209) (at least 0.016mg/kg/IgE[IU/mL] per 4 weeks) or placebo (n=196) for 28 weeks, in addition to conventional therapies (inhaled budesonide Turbuhaler [>=400 μg/day] plus optional long-acting beta2-agonist and/or nasal steroids). QoL was measured on the Juniper asthma (AQLQ) and rhinitis (RQLQ) questionnaires (responders were those with improvement in overall score of >=1.0 on both scales). Results At baseline, there was no difference in overall QoL scores between groups (mean AQLQ: 4.0 omalizumab, 4.0 placebo; mean RQLQ: 3.8 omalizumab, 3.7 placebo). Omalizumab treatment resulted in more responders than placebo (57.7% and 40.6%, respectively; p<0.001). Compared with placebo, omalizumab improved all RQLQ domains (activities, sleep, non-nose/eye symptoms, practical problems, nasal symptoms, eye symptoms and emotional) as well as the symptoms and environmental domains of the AQLQ. More omalizumab-treated patients rated control of their asthma symptoms as excellent/good (65.6%) than placebo-treated patients (53.1%; p<0.01). Similarily, control of rhinitis symptoms was rated as excellent/good by 60.8% of omalizumab-treated patients compared with 36.2% of placebo-treated patients (p<0.001). Conclusions Omalizumab improves both asthma- and rhinitis-related QoL in patients with concomitant disease.