Diagnosis Of Allergic Rhinitis Research Articles

Circulating interleukin-27 is associated with the risk of chronic periodontitis and allergic rhinitis: A Mendelian randomization analysis

Background Chronic periodontitis (CP) and allergic rhinitis (AR) have attracted wide attention as global public health problems with high incidence. Recent studies have shown that circulating interleukin-27 (IL-27) is associated with the risk of CP and AR. The aim of this study is to analyze the causal effect between them using Mendelian randomization (MR) Methods Bidirectional MR analyses were performed with the use of publicly available genome-wide association study (GWAS) data. Summary data on circulating IL-27, CP, and AR published in genome-wide association studies were collected. Instrumental variables (IV) were extracted using assumptions of correlation, independence and exclusivity as criteria. Inverse variance weighting (IVW) was used as the main method, combined with weighted median method (WM) and MR-Egger and other MR Analysis methods for causal inference of exposure and outcome. Cochran’s Q and MR-Egger intercept were used for sensitivity analysis Results The IVW study showed a causal effect between increased circulating IL-27 levels and increased risk of CP (OR = 1.14, 95%CI = 1.02–1.26, p = .020). Similarly, the increase of circulating IL-27 level had a causal effect on the decreased risk of AR (OR = 0.88, 95%CI = 0.80–0.97, p = .012). In addition, IVW study found that there was a causal between the increased risk of CP and circulating IL-27 level (OR = 1.05, 95%CI = 1.01–1.10, p = .016). However, there was no significant causal relationship between the risk of AR and circulating IL-27 levels (OR = 0.97, 95%CI = 0.91–1.02, p = .209). no significant heterogeneity or horizontal pleiotropy was found in sensitivity analysis. Conclusions There is a causal effect between circulating IL-27 level and CP, AR, which will help to find new ideas and methods for the diagnosis and treatment of CP and AR.

Multi-omic integration reveals alterations in nasal mucosal biology that mediate air pollutant effects on allergic rhinitis.

Allergic rhinitis is a common inflammatory condition of the nasal mucosa that imposes a considerable health burden. Air pollution has been observed to increase the risk of developing allergic rhinitis. We addressed the hypotheses that early life exposure to air toxics is associated with developing allergic rhinitis, and that these effects are mediated by DNA methylation and gene expression in the nasal mucosa. In a case-control cohort of 505 participants, we geocoded participants' early life exposure to air toxics using data from the US Environmental Protection Agency, assessed physician diagnosis of allergic rhinitis by questionnaire, and collected nasal brushings for whole-genome DNA methylation and transcriptome profiling. We then performed a series of analyses including differential expression, Mendelian randomization, and causal mediation analyses to characterize relationships between early life air toxics, nasal DNA methylation, nasal gene expression, and allergic rhinitis. Among the 505 participants, 275 had allergic rhinitis. The mean age of the participants was 16.4 years (standard deviation = 9.5 years). Early life exposure to air toxics such as acrylic acid, phosphine, antimony compounds, and benzyl chloride was associated with developing allergic rhinitis. These air toxics exerted their effects by altering the nasal DNA methylation and nasal gene expression levels of genes involved in respiratory ciliary function, mast cell activation, pro-inflammatory TGF-β1 signaling, and the regulation of myeloid immune cell function. Our results expand the range of air pollutants implicated in allergic rhinitis and shed light on their underlying biological mechanisms in nasal mucosa.

To Explore the Etiology, Pathogenesis, Diagnosis and Treatment Ideas of Allergic Rhinitis in Children based on the Triple Energizer Theory

To Explore the Etiology, Pathogenesis, Diagnosis and Treatment Ideas of Allergic Rhinitis in Children based on the Triple Energizer Theory

Early-life gut microbiota associates with allergic rhinitis during 13-year follow-up in a Finnish probiotic intervention cohort.

Perinatal and early-life factors reported to affect risk of allergic diseases may be mediated by changes in the gut microbiota. Here, we explored the associations between the infant gut microbiota and allergic morbidity in childhood until 13 years of age in a subgroup of the FLORA probiotic intervention cohort. A mixture of four probiotic strains with galacto-oligosaccharides was administrated to the mothers from the 36th week of the pregnancy and later to their infants until 6 months of age. The infants were monitored for the manifestations of atopic eczema, food allergy, allergic rhinitis, and asthma by a pediatrician at 2 and 5 years of age; the allergic status was subsequently verified by a questionnaire at 10 and 13 years of age. The fecal microbiota at 3 months was profiled by 16S rRNA amplicon sequencing targeting the V3-V4 region, with and without adjusting for potentially important early-life factors. Overall, the positive diagnosis for allergic rhinitis between 2 and 13 years was associated with microbiota composition both in non-adjusted and adjusted models. This association was more pronounced in children born to one parent with confirmed atopic diseases compared to those who had two atopic parents and was characterized by a lower relative abundance of Bifidobacterium and Escherichia/Shigella spp. and a higher proportion of Bacteroides. While the probiotic and galacto-oligosaccharides intervention in the entire cohort was previously shown to reduce the prevalence of eczema to a certain extent, no associations were found between the 3-month gut microbiota and childhood eczema in the studied sub-cohort.IMPORTANCEAllergic diseases have increased in prevalence during the past decades globally. Although probiotics have been considered a promising strategy for preventing certain allergy related symptoms, studies connecting the infant gut microbiota and later life allergic morbidity in various populations remain limited. The present study supports an association between the infant microbiota and allergic morbidity after first years of life, which has been rarely examined.CLINICAL TRIALSRegistered at ClinicalTrials.gov (NCT00298337).

Pilot study to determine asthma-like symptoms in the Sverdlovsk region

Introduction. Bronchial asthma (BA) occupies one of the leading places in the structure of chronic nonspecific lung diseases in children. At an early age it develops in a relationship between genetic and environmental factors and often does not have a characteristic clinical picture. Allergic rhinitis (AR) increases the risk of developing and severity of asthma. Assessing the risk of developing BA and AR in children is necessary for timely diagnosis. Purpose of the study. To identify the prevalence of symptoms of bronchial asthma in children in the Sverdlovsk region using the example of Yekaterinburg and Nizhny Tagil using Russian versions of the Asthma Prediction Tool and ISAAC questionnaires and analyze the data obtained. Materials and methods. 64 children aged 6-8 years who did not have chronic lung diseases were studied: 30 people - in the Children's Hospital No. 8 of Yekaterinburg and 34 - in kindergarten No. 201 of Nizhny Tagil using Russified versions of the “Asthma Prediction Tool” and ISAAC questionnaires, filled out official representatives of children after informed consent to conduct the study. 64 correctly completed questionnaires were analyzed. Results. The proportion of children with an average and high risk of developing asthma: in Yekaterinburg 26.67%, in Nizhny Tagil - 35.29%. Symptoms of AR were detected in 60% of children from Yekaterinburg and in 82.35% from Nizhny Tagil, which is 2.5 and 1.6 times more common than the established diagnosis of AR, respectively. In Yekaterinburg, a high risk of asthma is associated with an allergic phenotype based on the frequency of concomitant atopic dermatitis (16.67% compared with 10% in the low-risk group, p = 0.0159) or its absence (63.33% and 10%, respectively, p= 0.0159), in Nizhny Tagil this relationship was not confirmed when tested by a two-sided Fisher test. The frequency of cases of hereditary predisposition to allergic pathology does not have significant differences between high (medium) and low risk groups in both cities. Conclusion. In Russia, 4.8 additional cases of asthma and status asthmaticus per 100 thousand children are associated with air quality. In 2021, the Sverdlovsk region is noted as one of the priority subjects of the Russian Federation in terms of the number of asthma diseases associated with the aerogenic factor in the environment of children. Although the observed trend in the predominance of cumulative symptoms of asthma and AR in children in Nizhny Tagil, in comparison with Yekaterinburg, is not statistically significant, it correlates with a higher level of aerogenic air pollution, this indirectly confirms the absence of a statistically significant relationship with a family history of allergic pathology. However, the connection with man-made pollutants is not taken into account in the ISAAC questionnaires. To confirm that the prevalence of asthma and AR symptoms is higher than those obtained in multicenter studies among children of a similar age, a survey of at least 350 people will be required. In any case, it is necessary to study the role of priority pollutants in the formation of airway hyperresponsiveness, asthma and AR, in order to find effective preventive measures.

Baseline characterization of a cohort of colombian patients with chronic rhinosinusitis with nasal polyps

To present the baseline clinical and demographic characteristics of CRSwNP patients over the age of 18 enrolled in a Patient Support Program (PSP) prior to biologic treatment. Descriptive, cross-sectional study performed in a Colombian CRSwNP asthma PSP sponsored by Sanofi from Aug-2021 to Jul-2022. Data was collected from CRSwNP patients, prior to the start of Dupilumab treatment, who consented to the use of their data. The following information was reported: Age, reporting city, treating medical specialty, comorbidities, and persistence of treatment. 339 patients were included, 171 (50,4%) were women and 168 (49,6%) were men. The mean age at Dupilumab treatment initiation was 52,4 years. 62,8% began treatment during adulthood (26-59y), while 34.1% started at elderly (+60y) and 3.1% were young adults (18-25y). Most cases (29,7%) were included in Bogotá, followed by Antioquia (19%), Valle del Cauca (7,3%) and the remaining 44% nationwide. Comorbidities were present in 67,1% of the patients, with diagnosis of allergic rhinitis, atopic dermatitis, asthma, and other non-type 2 inflammatory diseases. Nasal surgical history was present in 89,6% of the patients, most of them with one to three previous surgeries. Continuous treatment was observed in 70,3% of patients for 6 to 12 months, in 21,3% for more than 12 months and in 8,4% for less than six months. The most frequently treating medical specialty was otorhinolaryngology (79,6%), followed by allergology (16%) and other medical professionals (4,4%). There is concordance with the literature on a higher presentation of the disease in women than in men. There is a large proportion of patients with nasal surgical history and type 2 inflammatory comorbidities by the moment of biologic treatment initiation. The care and identification of CRSwNP colombian patients is mainly provided by otorhinolaryngologists, followed by allergologists.

Integrated traditional Chinese and western medicine expert consensus on the diagnosis and treatment of combined allergic rhinitis and asthma syndrome

Combined allergic rhinitis and asthma syndrome (CARAS) refers to a common respiratory disease that occurs simultaneously with clinical or subclinical allergic symptoms of the upper respiratory tract (allergic rhinitis) and the lower respiratory tract (asthma). The incidence of CARAS is high and the quality of life of the patients is greatly affected. At present, treatment of this comprehensive disease is often carried out separately in the otorhinolaryngology and respiratory departments. One of the reasons is a lack of coordinated treatment consensus on the comprehensive management of this disease. As a common respiratory disease, this syndrome also has a profound clinical basis of traditional Chinese medicine in its diagnosis and treatment. Therefore, the Allergy Committee of Chinese Association of Integrative Medicine organized domestic experts in respiratory medicine, otolaryngology, allergy, pediatrics, traditional Chinese Medicine internal medicine and other related fields to discuss and summarize the etiology and anatomical characteristics, pathophysiology and pathogenesis, laboratory examination, diagnostic evaluation and differential diagnosis as well as treatment of both traditional Chinese medicine and western medicine, in order to provide integrated diagnosis and treatment opinions for this common integrative disease of upper and lower respiratory system in clinical practice.

Quantitative assessment and correlational analysis of subjective and objective indicators in patients with allergic rhinitis.

The diagnosis of allergic rhinitis is mainly based on the typical medical history, clinical manifestations, and corresponding allergen test results of the patients. However, there are often clinical inconsistencies among the 3. To study the clinical characteristics of patients with allergic rhinitis from both subjective and objective aspects to determine the correlations between the quantitative assessment outcomes of subjective and objective indicators. A total of 111 patients with allergic rhinitis who visited our outpatient clinic from June 2022 to December 2022 were selected. The 22-item sino-nasal outcome test (SNOT-22) and the visual analog scale (VAS) for the severity of the disease were used to score the subjective indicators of allergic rhinitis. The objective indicators of allergic rhinitis were evaluated by serum inhalant allergens immunoglobulin E test, nasal endoscopy modified Lund-Kennedy (MLK) scoring method, and acoustic rhinometry. SNOT-22 score, total VAS score for symptoms, and the VAS score for nasal itching were positively correlated with the number of positive allergens (r = 0.266, P = 0.005, r = 0.576, P < 0.001, and r = 0.271, P = 0.004, respectively). No differences were found in all subjective indicators scores between the total immunoglobulin E positive and negative groups (P > 0.05). SNOT-22 score, total VAS score for symptoms, and the VAS score for nasal congestion were positively correlated with MLK total score of nasal endoscopy (r = 0.343, P < 0.001, r = 0.438, P < 0.001, and r = 0.225, P = 0.018, respectively). Parameters of acoustic rhinometry were not correlated with the subjective indicators scores of allergic rhinitis (P > 0.05). A multifaceted quantitative assessment of allergic rhinitis using a combination of subjective and objective methods can help physicians make an accurate diagnosis and create reasonable treatment plans.

The Associations of Prenatal Exposure to Fine Particulate Matter and Its Chemical Components with Allergic Rhinitis in Children and the Modification Effect of Polyunsaturated Fatty Acids: A Birth Cohort Study.

Polyunsaturated fatty acids (PUFAs) have been shown to protect against fine particulate matter in aerodynamic diameter ()-induced hazards. However, limited evidence is available for respiratory health, particularly in pregnant women and their offspring. We aimed to investigate the association of prenatal exposure to and its chemical components with allergic rhinitis (AR) in children and explore effect modification by maternal erythrocyte PUFAs. This prospective birth cohort study involved 657 mother-child pairs from Guangzhou, China. Prenatal exposure to residential mass and its components [black carbon (BC), organic matter (OM), sulfate (), nitrate (), and ammonium ()] were estimated by an established spatiotemporal model. Maternal erythrocyte PUFAs during pregnancy were measured using gas chromatography. The diagnosis of AR and report of AR symptoms in children were assessed up to 2 years of age. We used Cox regression with the quantile-based g-computation approach to assess the individual and joint effects of components and examine the modification effects of maternal PUFA levels. Approximately and 8.07% of children had AR and related symptoms, respectively. The average concentration of prenatal was . was positively associated with the risk of developing AR [hazard ratio ; 95% confidence interval (CI): 1.16, 2.96 per ] and its symptoms (; 95% CI: 1.22, 2.62 per ) after adjustment for confounders. Similar associations were observed between individual components and AR outcomes. Each quintile change in a mixture of components was associated with an adjusted HR of 3.73 (95% CI: 1.80, 7.73) and 2.69 (95% CI: 1.55, 4.67) for AR and AR symptoms, with BC accounting for the largest contribution. Higher levels of n-3 docosapentaenoic acid and lower levels of n-6 linoleic acid showed alleviating effects on AR symptoms risk associated with exposure to and its components. Prenatal exposure to and its chemical components, particularly BC, was associated with AR/symptoms in early childhood. We highlight that PUFA biomarkers could modify the adverse effects of on respiratory allergy. https://doi.org/10.1289/EHP13524.

Antibiotic exposure during pregnancy increases risk for childhood atopic diseases: a nationwide cohort study

PurposeThe prevalence of atopic diseases has increased in recent decades. A possible link between antibiotic use during pregnancy and childhood atopic disease has been proposed. The aim of this study is to explore the association of antibiotic exposure during pregnancy with childhood atopic diseases from a nationwide, population-based perspective.MethodsThis was a nationwide population-based cohort study. Taiwan’s National Health Insurance Research Database was the main source of data. The pairing of mothers and children was achieved by linking the NHIRD with the Taiwan Maternal and Child Health Database. This study enrolled the first-time pregnancies from 2004 to 2010. Infants of multiple delivery, preterm delivery, and death before 5 years old were excluded. All participants were followed up at least for 5 years. Antenatal antibiotics prescribed to mothers during the pregnancy period were reviewed. Children with more than two outpatient visits, or one admission, with a main diagnosis of asthma, allergic rhinitis, or atopic dermatitis were regarded as having an atopic disease.ResultsA total of 900,584 children were enrolled in this study. The adjusted hazard ratios of antibiotic exposure during pregnancy to childhood atopic diseases were 1.12 for atopic dermatitis, 1.06 for asthma, and 1.08 for allergic rhinitis, all of which reached statistical significance. The trimester effect was not significant. There was a trend showing the higher the number of times a child was prenatally exposed to antibiotics, the higher the hazard ratio was for childhood atopic diseases.ConclusionsPrenatal antibiotic exposure might increase the risk of childhood atopic diseases in a dose-dependent manner.

Identification of diagnostic signature, molecular subtypes, and potential drugs in allergic rhinitis based on an inflammatory response gene set.

Rhinitis is a complex condition characterized by various subtypes, including allergic rhinitis (AR), which involves inflammatory reactions. The objective of this research was to identify crucial genes associated with inflammatory response that are relevant for the treatment and diagnosis of AR. We acquired the AR-related expression datasets (GSE75011 and GSE50223) from the Gene Expression Omnibus (GEO) database. In GSE75011, we compared the gene expression profiles between the HC and AR groups and identified differentially expressed genes (DEGs). By intersecting these DEGs with inflammatory response-related genes (IRGGs), resulting in the identification of differentially expressed inflammatory response-related genes (DIRRGs). Afterwards, we utilized the protein-protein interaction (PPI) network, machine learning algorithms, namely least absolute shrinkage and selection operator (LASSO) regression and random forest, to identify the signature markers. We employed a nomogram to evaluate the diagnostic effectiveness of the method, which has been confirmed through validation using GSE50223. qRT-PCR was used to confirm the expression of diagnostic genes in clinical samples. In addition, a consensus clustering method was employed to categorize patients with AR. Subsequently, extensive investigation was conducted to explore the discrepancies in gene expression, enriched functions and pathways, as well as potential therapeutic drugs among these distinct subtypes. A total of 22 DIRRGs were acquired, which participated in pathways including chemokine and TNF signaling pathway. Additionally, machine learning algorithms identified NFKBIA, HIF1A, MYC, and CCRL2 as signature genes associated with AR's inflammatory response, indicating their potential as AR biomarkers. The nomogram based on feature genes could offer clinical benefits to AR patients. We discovered two molecular subtypes, C1 and C2, and observed that the C2 subtype exhibited activation of immune- and inflammation-related pathways. NFKBIA, HIF1A, MYC, and CCRL2 are the key genes involved in the inflammatory response and have the strongest association with the advancement of disease in AR. The proposed molecular subgroups could provide fresh insights for personalized treatment of AR.

The impact of maternal anxiety during pregnancy on children's eczema and allergic rhinitis: The Ma'anshan birth cohort study

ObjectiveThe objective of this study was to investigate the associations between maternal exposure to anxiety during pregnancy and the susceptibility of offspring to eczema and allergic rhinitis and the possibility of sensitivity periods and cumulative effects. MethodsThe study's sample consisted of 3160 mother-child pairs from the Ma'anshan Birth Cohort Study. Maternal anxiety was repeatedly measured in the 1st, 2nd, and 3rd trimesters of pregnancy using the Chinese version of the Pregnancy-Related Anxiety Scale. Information regarding children's eczema and allergic rhinitis diagnoses was collected through parental reports at 12, 24, 36 and 48 months of age. Binary logistic regression models were used for statistical analysis and corrected for multiple comparisons using the false discovery rate (FDR) method. ResultsChildren whose mothers experienced anxiety throughout pregnancy had the highest odds of developing total eczema (aOR 1.45, 95% CI 1.02–2.07) and total allergic rhinitis (aOR 1.67, 95% CI 1.17–2.37) between the ages of 6 and 48 months. The higher the trajectory of the maternal anxiety scores throughout pregnancy, the higher the odds of total eczema (aOR 1.65, 95% CI 1.14–2.40) and allergic rhinitis (aOR 1.84, 95% CI 1.28–2.66) in their offspring. The association between maternal anxiety and children's eczema was mainly concentrated in the first 24 months, whereas the association with allergic rhinitis was mainly concentrated in the 36–48 months. ConclusionMaternal anxiety during any trimester of pregnancy, especially with a consistently high trajectory of anxiety scores, was associated with higher odds of children's eczema and allergic rhinitis.

Factors contributing to the diagnosis and onset prediction of perennial allergic rhinitis in high-risk children: A sub-analysis of the CHIBA study

BackgroundThis study aimed to clarify the diagnostic and predictive factors for perennial allergic rhinitis (PAR) onset in children by analyzing the results of the Chiba High-risk Birth Cohort for Allergy study, which examined newborns with a family history of allergies. MethodsOverall, 306 pregnant women were recruited. Their newborns were examined by otolaryngologists and pediatric allergists at 1, 2, and 5 years of age. Participants with clinical and laboratory data available at all consultation points were considered eligible. ResultsAmong 187 eligible participants, the prevalence rates of PAR were 2.1%, 4.3%, and 24.1% at 1, 2, and 5 years of age, respectively. AR-specific nasal local findings and eosinophils in nasal smear were observed in a substantial number of patients with PAR at 1 and 2 years of age. Factors present up to 2 years of age that were associated with PAR onset at 5 years of age, in descending order, were as follows: sensitization to house dust mites (HDM), nasal eosinophilia, and sensitization to cat dander. In 44 cases with HDM sensitization, nasal eosinophilia up to 2 years of age achieved a sensitivity of 76.0% and a specificity of 73.7% for predicting PAR onset at 5 years. ConclusionsRhinitis findings and nasal eosinophilia are useful auxiliary diagnostic items for pediatric PAR. Sensitization to HDM and nasal eosinophilia were the most influential factors associated with future PAR onset. A combination of these factors may facilitate the prediction of PAR onset.

A Perception-Based Survey on Practice Patterns Pertaining to the Diagnosis and Management of Allergic Rhinitis in India.

Allergic rhinitis (AR) is increasingly prevalent in India, affecting a significant portion of the population and adversely impacting their quality of life. This nationwide survey aimed to explore the perceptions and clinical preferences of Indian physicians regarding the perceived prevalence, common symptoms, and various available treatments for AR. This cross-sectional, observational, digital questionnaire-based survey was conducted from September 2022 to March 2023, involving physicians sharing insights on prevalence rates, diagnostic approaches, medication preferences, and immunotherapy practices in AR management. A total of 1608 physicians participated in this survey. The majority of physicians (n=684, 42.5%) reported that the prevalence of AR in routine clinical practice is between 21 and 40%. Physicians also noted a substantial burden of AR with asthma (n=626, around 40%). Total IgE count was reported as a mandatory test for the diagnosis of AR by 47.5% of physicians (n=764). For the management of mild cases of seasonal or perennial AR, 980 (60.9%) physicians preferred fexofenadine as an oral antihistamine of choice. Fluticasone furoate was the preferred intranasal corticosteroid (INCS) option (67.1% of physicians (n=1079)), for the management of patients with moderate to severe AR, the most recommended duration of INCS therapy was two to fourmonths (40.9% of physicians). Doctors recommended a montelukast and antihistamine combination in mild AR (n=152, 9.5%), mild AR not responding to antihistamine alone (n=291, 18.1%), moderate to severe AR along with INCS (n=252, 15.7%), and AR with mild asthma (n=74, 4.6%). The majority of physicians (n=1512, 75.6%) preferred using fexofenadine in combination with montelukast for the management of AR. The majority of physicians (n=839, 52.2%) opined that the efficacy rate of oral montelukast-fexofenadine was 60-90% in the management of mild-moderate AR. Around 55.3% of physicians (n=889) had not used immunotherapy in their clinical practice. These observations offer a holistic view of how Indian physicians perceive the management of AR, a condition highly prevalent in India and often associated with asthma. It also highlights the treatment strategies employed in their day-to-day clinical practice.

A Real-World Observational Study to Evaluate the Safety and Effectiveness of Fluticasone Furoate-Oxymetazoline Fixed Dose Combination Nasal Spray in Patients with Allergic Rhinitis.

Allergic rhinitis (AR) has shown an increasing prevalence leading to a considerable medical and social burden. Nasal congestion is the cardinal symptom of AR, and the upper respiratory tract is most affected by this long-lasting ailment. Intranasal corticosteroids alleviate nasal congestion, along with other symptoms of AR, but their effect is not evident immediately. Oxymetazoline has a rapid onset of action, but its use should be limited to 3-5days. The study aimed to evaluate the safety and effectiveness of the fixed-dose combination nasal spray containing fluticasone furoate and oxymetazoline hydrochloride (FF+OXY) 27.5/50mcg once daily in patients with AR in a real-world clinical setting. The study was a prospective, open-label, single-arm, multicenter, real-world observational study conducted in patients with AR for a period of 28days. Patients (n=388) with a diagnosis of AR were treated with a combination of FF+OXY nasal spray. Total nasal symptom score (TNSS), total ocular symptom score (TOSS) and total symptom score (TSS) were documented at baseline and at the end of study period. The overall effectiveness of treatment with FF + OXY was rated by the investigators as very good/good/satisfactory/poor (4-point Likert scale) for each patient. Treatment with FF+OXY resulted in significant reduction in the TNSS, TOSS and TSS, from 7.18±3.38 at baseline to 0.20±0.84 (p<0.001), from 2.34±2.29 at baseline to 0.09±0.53 (p<0.001), from 9.51±4.94 at baseline to0.29±1.32 (p<0.001) at 28days respectively. With respect to effectiveness, the investigators reported very good effectiveness in 52.12% of patients. No serious adverse events were reported. The fixed-dose combination of once-daily fluticasone furoate and oxymetazoline hydrochloride nasal spray 27.5/50mcg was effective in relieving the nasal congestion and reduction of TNSS, TOSS and TSS in patients suffering from AR. The combination was safe and well tolerated with no rebound congestion throughout the treatment period.

Ефективність та безпечність інтраназального застосування фіксованої комбінації олопатадину гідрохлориду та мометазону фуроату в терапії пацієнтів з алергічним ринітом

Abstract. One of the options for pharmacotherapy of allergic rhinitis (AR) with values of visual analogue assessment of symptoms ≥ 5 is the use of intranasal H1-histamine blocker in combination with intranasal cocorticosteroid. One of the new combinations that qualitatively corresponds to this composition is the combination of olopatadine hydrochloride and mometasone furoate. The aim of the study was to study the effectiveness and safety of symptomatic therapy by the fixed combination of olopatadine hydrochloride and mometasone furoate in the form of a nasal spray in the treatment of AR. Materials and methods. 45 patients were examined, of which 37 patients completed treatment (8 patients dropped out of the study due to poor compliance). All of them made up the main group of the study (age — 29.3 (16.6; 42.0) years, men — 13 (35.0 %), women — 24 (65.0 %). The design of the study was randomized prospective with interventional model in the form of monoprescription. The diagnosis of AR was established in accordance with the ARIA guidelines. To control nasal symptoms before and during treatment, a generally accepted scoring system was used — the TNSS scale (Total nasal symptom score), eye symptoms — the TOSS scale (Total ocular symptom score) The Rhinoconjunctivitis Quality of Life mini Questionnaire (RQLQ) was used to assess the quality of life of AR patients. The results. In the course of treatment, a statistically significant improvement in nasal symptoms (TNSS) was noted — a decrease in severity from 10.11 (8.71; 11.51) points to 1.31 (1.00; 1.63) points on the 28-th day of treatment (p &lt; 0.05). A similar statistically significant improvement was observed in the severity of ocular symptoms (TOSS) — a decrease in severity from 3.31 (1.81, 4.81) points to 0.36 (0.30, 0.42) points on the 28-th day of treatment (p &lt; 0.05). A statistically significant improvement in the quality of life according to the RQLQ during treatment was noted — the score decreased from 3.04 (2.72; 3.37) points at the initial visit to 1.83 (1.61; 2.05) points on the 7-th day. 1.02 (0.86, 1.18) points on day 14, 0.63 (0.51, 0.75) points on day 21 and 0.45 (0.41, 0.49) points on day 28 treatment (p &lt; 0.05). Conclusion. A fixed combination of mometasone furoate and olopatadine hydrochloride was effective in relieving nasal and ocular symptoms in patients with moderate/severe AR, reducing the TONSS score from 13.42 (10.81; 16.03) to 1.67 (1.14; 2.20) points and in improving the quality of life, reducing the degree of discomfort from 3.04 (2.72; 3.37) points to 0.45 (0.41; 0.49) points. For 4 weeks of use, no side effects from the use of the drug were registered, which indicates good tolerability.

Serum microRNA-223 as a potential biomarker for allergic rhinitis and its correlation to eosinophil-derived neurotoxin

Allergic rhinitis (AR) is a global health problem. It is an inflammatory condition defined by a malfunction of the immune system's regulatory mechanism. MicroRNA-223 (miRNA-223) has been linked to the modulation of AR in the last few years. The goal of this study was to determine whether miR-223 can be utilized as a potential biomarker for diagnosis of AR, and whether it correlates with the total nasal symptom score (TNSS) along with serum interleukin-17 (IL-17), interleukin-4 levels (IL-4) and eosinophil-derived neurotoxin (EDN). This study included 76 adult participants, consisted of 38 AR patients and 38 apparently healthy controls. Serum levels of miR-223 were assayed using real-time PCR. The levels of EDN, IL-17 and IL-4 in the serum were determined using an enzyme-linked immunosorbent assay. The optimal cutoff value for the analyzed factors to diagnose AR was determined using a receiver operating characteristic curve analysis (ROC). The demographic features (age and gender) of the two study groups were matched. Patients with pollen-induced AR had significantly higher levels of miR-223 in their serum compared to the controls (median = 3.82; median = 1.03, respectively, p &lt; 0.001). In AR cases, a significant positive association was observed between miR-223 expression level and TNSS (r = 0.492, p = 0.002), EDN serum level (r = 0.427, p = 0.008), IL-4 serum level (r = 0.341, p = 0.036) and IL-17 serum level (r = 0.324, p = 0.047). MiR-223, at a cutoff value of 1.18, had a sensitivity and specificity of 94.9 % and 92.5%, respectively. In conclusion, miR-223 expression is significantly greater in blood of AR patients. There is a significant association between miR-223 and clinical severity of AR, each of IL-17 and IL-4 as well as EDN. Therefore, miR-223 may be employed as an effective biomarker for AR diagnosis.

Accuracy of Nasal House Dust Mite-Specific Immunoglobulin E in Diagnosis of Local Allergic Rhinitis

Background: Local allergic rhinitis (LAR) is the symptom of allergic rhinitis in which nasal allergen-specific immunoglobulin E(IgE) is detected but has no sensitivity to systemic allergens. The gold standard test is the nasal allergen provocation test (NAPT) which requires a complicated procedure. Specific IgE in nasal mucosa test is the less invasive and easier diagnostic alternative for LAR. Aims: This review aimed to determine the validity of the nasal house dust mite - specific IgE test for LAR patients. Study designs: A meta-analysis was conducted in chronic rhinitis patients with negative skin prick test (SPT) and serum IgE. Methods: The research was using PubMed Central, Cochrane library, SAGE journals, and Science Direct were searched until July 29th, 2022. The validity of the nasal HDM - specific IgE test was compared to NAPT. Results: A total of 413 research articles were selected and five articles were included. The QUADAS-2 assessment showed minimum publication bias. The total sample was 236 patients. Pooled sensitivity 90.00%, I2= 28.95% and p=0.01. Pooled specificity 96.00%, I2= 30.28% and p=0.00. The value of the area under the curve in the SROC curve = 0.9710, statistically significant. Conclusion: The nasal HDM- specific IgE test is valid for diagnosing patients with LAR.

Quantifying the benefits of early sublingual allergen immunotherapy tablet initiation in children.

Allergic rhinitis (AR) is a chronic inflammatory disease of the upper airway, which progresses into allergic asthma (AA) in up to 45% of children. This analysis aimed to investigate clinical and economic benefits of sublingual allergen immunotherapy (SLIT tablets) initiated early in childhood for the treatment of AR by quantifying the long-term reduction in new cases of AA. A Markov model was developed to estimate the long-term effects of SLIT tablets on the risk of developing asthma. Key parameters were primarily based on data from the GRAZAX® Asthma Prevention trial and included the age- and treatment-dependent risk of developing AA as well as annual probabilities of progression/remission in AR severity. Healthcare costs were estimated using data from the REACT study. In a modelled cohort of children with moderate-to-severe seasonal AR initiated on SLIT tablets at ages 7 and 12, 24% and 29%, respectively, develop AA during a 20-year period. In comparison, when initiated at age 5, 19% develop AA. Additionally, initiation of SLIT tablets at age 5 is associated with a total healthcare cost of EUR 20,429 per patient, whereas initiation at ages 7 and 12 is associated with, respectively, EUR 21,050 and EUR 22,379 per patient 20 years after AR diagnosis. Initiation of SLIT tablets in early childhood is associated with a clinically meaningful and permanent reduction in new cases of AA and lower healthcare costs among children with AR. This finding supports the clinical relevance of initiating SLIT tablets early for children with AR to obtain long-term clinical benefits.

Artificial intelligence applications in allergic rhinitis diagnosis: Focus on ensemble learning.

The diagnosis of allergic rhinitis (AR) primarily relies on symptoms and laboratory examinations. Due to limitations in outpatient settings, certain tests such as nasal provocation tests and nasal secretion smear examinations are not routinely conducted. Although there are clear diagnostic criteria, an accurate diagnosis still requires the expertise of an experienced doctor, considering the patient's medical history and conducting examinations. However, differences in physician knowledge and limitations of examination methods can result in variations in diagnosis. Artificial intelligence is a significant outcome of the rapid advancement in computer technology today. This study aims to present an intelligent diagnosis and detection method based on ensemble learning for AR. We conducted a study on AR cases and 7 other diseases exhibiting similar symptoms, including rhinosinusitis, chronic rhinitis, upper respiratory tract infection, etc. Clinical data, encompassing medical history, clinical symptoms, allergen detection, and imaging, was collected. To develop an effective classifier, multiple models were employed to train on the same batch of data. By utilizing ensemble learning algorithms, we obtained the final ensemble classifier known as adaptive random forest-out of bag-easy ensemble (ARF-OOBEE). In order to perform comparative experiments, we selected 5 commonly used machine learning classification algorithms: Naive Bayes, support vector machine, logistic regression, multilayer perceptron, deep forest (GC Forest), and extreme gradient boosting (XGBoost).To evaluate the prediction performance of AR samples, various parameters such as precision, sensitivity, specificity, G-mean, F1-score, and area under the curve (AUC) of the receiver operating characteristic curve were jointly employed as evaluation indicators. We compared 7 classification models, including probability models, tree models, linear models, ensemble models, and neural network models. The ensemble classification algorithms, namely ARF-OOBEE and GC Forest, outperformed the other algorithms in terms of the comprehensive classification evaluation index. The accuracy of G-mean and AUC parameters improved by nearly 2% when compared to the other algorithms. Moreover, these ensemble classifiers exhibited excellent performance in handling large-scale data and unbalanced samples. The ARF-OOBEE ensemble learning model demonstrates strong generalization performance and comprehensive classification abilities, making it suitable for effective application in auxiliary AR diagnosis.