Effective Treatment For Allergic Rhinitis Research Articles

The Use of Azelastine Hydrochloride/Fluticasone Propionate in the Management of Allergic Rhinitis in Asia: A Review.

The incidence of allergic rhinitis (AR) in Asia and the world is steadily rising. Patients experience incomplete symptom relief despite existing treatment options, which warrants the need for new therapeutic regimes. Azelastine hydrochloride/fluticasone propionate (MP-AzeFlu), a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate has been indicated in the treatment of AR. The current review discusses the effects of MP-AzeFlu versus conventional therapies in achieving superior clinical improvement with a very rapid onset of action (5 minutes). The superiority of MP-AzeFlu in offering complete symptom control with sustained relief in patients with AR compared to the existing therapeutic options is also discussed. MP-AzeFlu has been shown to improve the quality of life for patients with AR, thereby enhancing patient adherence to therapy and establishing its preference for the treatment of AR. Currently, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines recommend the use of a combination of intranasal corticosteroids and intranasal antihistamines as first-line treatment in patients with persistent AR with visual analog scores ≥5 or when prior treatment with single agents has been ineffective. Widely published data on the efficacy and safety of its prolonged use in adults and children have validated that effective treatment of AR can be achieved with MP-AzeFlu.

The Effect of Intranasal Steroid on Nasal Mucociliary Clearance in Allergic Rhinitis

Intranasal glucocorticosteroids are the most effective treatment for allergic rhinitis and are recommended as first-line therapy for patients with moderate to severe Allergic Rhinitis, particularly when nasal congestion is the prominent symptom. The use of intranasal corticosteroids showed to affect the mucociliary action by decreasing the prolonged mucociliary clearance time and increasing the mucociliary clearance rate. Keywords: AR- Allergic Rhinitis, INCS- Intranasal corticosteroid, NMC- Nasomucociliary clearance, MCT- Mucociliary Clearance Time, MCR- Mucociliary clearance rate, OAH- Oral antihistamine

Serum exosomal miR-146a-3p associates with disease severity and efficacy of sublingual immunotherapy in allergic rhinitis

BackgroundSublingual immunotherapy (SLIT) is an effective treatment for allergic rhinitis (AR), but its efficacy is variable among individuals. This study aimed to characterize serum exosome-derived microRNAs (miRNAs) and evaluate their abilities in predicting the efficacy of SLIT in AR. MethodsRNA sequencing was performed to explore differentially expressed exosomal miRNAs in serum exosomes between AR patients and healthy controls (HCs). Sequencing analysis results were verified in an independent cohort, and the correlations between the levels of exosome-derived miRNAs and disease severity were evaluated. The most promising miRNAs were further tested in two AR cohorts treated with SLIT to assess their abilities in predicting short and long-term efficacy, respectively. ResultsThe exosome-derived miRNAs profiling in the AR group was significantly different from the HC group, and differentially expressed genes were enriched and clustered in pathways such as PI3K-Akt and ErbB signalling pathways. The top three most significant miRNAs were verified by reverse transcription-polymerase chain reaction (qRT-PCR), and results showed that miR-146a-3p levels were significantly elevated in the AR group and correlated with the total and specific gE levels, the visual analogue scale of the total nasal symptom score (all p < 0.05). Further data in the first validation cohort suggested that miR-146a-3p levels were significantly downregulated in the effective group, and logistic regression showed that miR-146a-3p levels were associated with the short-term efficacy of SLIT(p < 0.05). The receiver operating characteristic (ROC) curve showed that miR-146a-3p could early predict SLIT efficacy (AUC = 0.669, p = 0.047). In the second validation cohort, miR-146a-3p levels were also decreased in the effective group and the ROC curve further confirmed its reliable accuracy in predicting the long-term efficacy of SLIT in AR patients (AUC = 0.749, p < 0.001). ConclusionSerum exosome-derived miRNAs may be involved in the development of AR and associated with its disease severity. Serum exosome-derived miR-146a-3p seems to be a novel biomarker for predicting the short and long-term efficacies of SLIT in AR patients.

Long-term Outcomes of Turbinate Surgery in Patients With Allergic Rhinitis

Turbinate surgery is an effective treatment for allergic rhinitis (AR) refractory to medical treatment. However, the long-term outcomes of turbinate surgery are still unclear and have not yet been confirmed by a meta-analysis and systematic review of the literature. To investigate the long-term outcomes and safety of turbinate surgery in AR by performing a meta-analysis. MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through April 2021. Studies that analyzed turbinate surgery alone, had a follow-up period of more than 1 year, examined long-term efficacy of turbinate surgery, used current turbinate surgery methods, and were published in a peer-reviewed journal were included. Full-text reviews were performed by 2 independent reviewers. Conflicts were resolved by a third reviewer. Descriptive and quantitative data were extracted; weighted mean difference (WMD) was synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and the I2 metric. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The long-term outcomes of turbinate surgery on subjective nasal symptoms and objective parameters. Of the 3962 citations retrieved, 18 studies comprising 1411 patients were included. Findings showed significantly decreased symptom scores in nasal obstruction (WMD, 4.60, 95% CI, 3.43-5.76), rhinorrhea (WMD, 3.12; 95% CI, 1.97-4.28), sneezing (WMD, 2.64; 95% CI, 1.74-3.54), itching (WMD, 1.75; 95% CI, 1.20-2.30), and nasal resistance (WMD, 0.16; 95% CI, 0.08-0.24) and a significant increased total nasal volume (WMD, 0.96; 95% CI, 0.73-1.19). There was no significant difference in the occurrence of any complication. More than 1 year after surgery, the improvements in nasal obstruction (WMD, 5.18; 95% CI, 3.00-7.37), rhinorrhea (WMD, 3.57; 95% CI, 1.78-5.37), and sneezing (WMD, 2.95; 95% CI, 1.58-4.32) were maintained. In this systematic review and meta-analysis, turbinate surgery was associated with positive outcomes in AR and maintained the association during long-term follow-up. The rate of complications is also low. These findings can guide the preoperative counseling of patients with AR being considered for turbinate surgery.

A Brief Analysis of the Correlation Between Allergic Rhinitis and Traditional Chinese Medicine Constitution

Allergic rhinitis (AR) and is a type of allergic diseases caused by an inflammation of the nasal mucosa caused by allergens. Clinically, AR is a common allergic disease and is difficult to treat. Due to differences in individual constitutions also known as body type, the severity of the disease is also different and it may even affect the daily life of the patient if it is severe. The effective treatment of AR has become a hot topic in current allergic disease research. Traditional Chinese Medicine’s understanding of constitution is based on the “Yellow Emperor’s Internal Classic” book, and Professor Wang Qi put forward the “physical constitution theory of traditional Chinese medicine”. The constitution is a key internal factor of the occurrence and development of diseases. It is believed in Traditional Chinese medicine (TCM) that the constitution can be regulated, and rectifying the patient’s imbalanced constitution has a positive effect on the diagnosis, treatment, and prognosis of the disease. Therefore, based on the “physical constitution theory of TCM”, this study considers the idea of treating body differently applying TCM constitution in the treatment of AR as the breakthrough point, and explores the correlation between AR and TCM constitution. The results show that TCM constitution is an intrinsic factor affecting the pathogenesis of AR. The use of TCM constitution theory in the treatment of AR has a positive effect and should be popularized in application.

Diverse immune mechanisms of allergen immunotherapy for allergic rhinitis with and without asthma

Allergen immunotherapy (AIT) is an effective treatment for allergic rhinitis, inducing long-term clinical tolerance to the sensitizing allergen. Clinical tolerance induction can be achieved when AIT is administered for at least 3 years. AIT is associated with the modulation of innate and adaptive immune systems. This comprises inhibition of IgE-dependent activation of mast cells and basophils in the local target organ, suppression of TH2 cells, immune deviation toward TH1 cells, induction of T and B regulatory cells, and production of allergen-neutralizing antibodies. However, recent developments in their underpinning mechanisms have revealed that AIT, administered subcutaneously or sublingually, induces immune regulation through novel cell targets and molecular mechanisms. This comprehensive review discusses how immune tolerance driven by subcutaneous immunotherapy and sublingual immunotherapy is associated with the induction of a novel regulatory subset of innate lymphoid cells and suppression of proinflammatory TH2, allergen-specific TH2 (TH2A), and T follicular helper cells. Moreover, they are associated with exhaustion of TH2A cells and differential expression of nasal and systemic IgA antibodies. Uncovering the underpinning mechanisms of a successful AIT and immune tolerance induction will allow the development of targeted therapeutics for allergic rhinitis with and without asthma.

Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

BackgroundSublingual immunotherapy tablets (SLIT-T) are an effective treatment for allergic rhinitis (AR), but some patients experience local allergic reactions (LAR) in the first few weeks of treatment that can lead to treatment discontinuation. Although oral antihistamines are recommended for the treatment and pretreatment of LAR associated with SLIT-T, there are no clinical trial data to support this recommendation. Rupatadine is an H1 antihistamine that also inhibits platelet activating factor activity. The objective of this case series is to describe real-world clinical situations in which rupatadine was used to treat or mitigate SLIT-T–related LAR.Case presentationsFive cases are presented by the managing allergist and off-label use of rupatadine is their expert opinion only. Patients in all 5 cases were treated with a SLIT-T (e.g. ragweed, tree, grass, or house dust mites) for the management of allergic rhinitis and experienced bothersome LAR with the first SLIT-T administration. In 3 cases, rupatadine 10 mg was administered for the immediate treatment of LAR (either in-office with the first SLIT-T dose or for subsequent LAR experienced at home) and the symptoms resolved. In 3 cases, pretreatment with other second-generation H1 antihistamines was unable to prevent LAR and the patients discontinued the SLIT-T. In these 3 cases, switching to pretreatment with rupatadine allowed the patients to restart and tolerate SLIT-T treatment with minimal or no LAR. In these patients with an established history of LAR, proactive pretreatment with rupatadine in subsequent seasons or with initiation of a different SLIT-T mitigated the previously experienced LARs.ConclusionsIn the cases presented, treatment with rupatadine resolved LAR associated with SLIT-T treatment and rupatadine pretreatment appeared to mitigate subsequent LAR. Rupatadine may be an option to treat or improve the tolerability of the SLIT-T, potentially improving early treatment persistence.

Development of MIF/IL-1β biosensors for discovery of critical quality attributes and potential allergic rhinitis targets from clinical real-world data by intelligent algorithm coupled with in vitro and vivo mechanism validation

There are still huge challenges from clinical real-world data to accurate targets and critical quality attributes (CQAs) for effective treatment of allergic rhinitis (AR). Here, we present a novel integrated strategy that biosensors and intelligent algorithms were used to angle AR targets and CQAs from clinical real world. Firstly, bagging and boosting partial least squares discrimination analysis (PLS-DA) and Monte-Carlo sampling were proposed to screen accurate AR targets. Macrophage migration inhibitory factor (MIF) and Interleukin-1beta (IL-1β) potential targets were obtained based on large-scale analysis of one thousand proteins and in-depth precise screening of seventy proteins. Furthermore, high electron mobility transistor (HEMT) biosensors were fabricated and successfully modified by MIF and IL-1β potential targets with a low detection concentration as 1 pM and quantitative range from 1 pM to 10 nM. Surprisingly, through MIF/IL-1β biosensors, we angled 5-O-methylvisammioside, amygdalin, and cimicifugoside three CQAs. The strong interaction was discovered among three CQAs and MIF/IL-1β biosensors with almost all KD up to 10−11 M. Finally, interaction among three CQAs and MIF/IL-1β biosensors were evaluated by in vitro and vivo experiments. In this paper, two critical potential targets and three effective CQAs for AR treatment were discovered and validated by biosensor and advanced algorithms. It provides a superior integrated idea for angling critical targets and CQAs from clinical real-world data by biosensors and informatics.

Subcutaneous Allergen Immunotherapy in Children: Real Life Compliance and Effect of COVID-19 Pandemic on Compliance

Background: Subcutaneous allergen immunotherapy (SCIT) is an effective treatment for allergic rhinitis, asthma, and venom allergy. Compliance is essential for SCIT to obtain maximal benefit as it is a long-term treatment. Objectives: This study aimed to determine the level of real-life SCIT compliance in pediatric patients and the associated factors. Additional aims were to determine how SCIT compliance was affected by the COVID-19 pandemic and why some patients dropped out SCIT. Method: Pediatric patients diagnosed with allergic rhinitis, allergic asthma, or venom allergy that received SCIT between September 2012 and July 2020 were analyzed. Results: The study included 201 children (66.7% male) with a median (interquartile range) age of 12.8 years (9.4–15.2) at the time of the first SCIT injection. The overall compliance rate before COVID-19 pandemic was 86.1%. Short SCIT follow-up time and venom anaphylaxis were found to be risk factors for drop out. The leading causes of drop outs were moving to another city/country (32.1%), symptom improvement (17.8%), treatment ineffectiveness (14.2%), and adverse reactions (14.2%). Among the 108 patients that were still receiving SCIT during the COVID-19 pandemic, 31 (28.7%) dropped out the therapy. The most frequent reasons for drop-out were fear of being infected with COVID-19 (35.4%) and thinking that the AIT practise stopped due to COVID-19 pandemic (29%). Male gender and older age were found to be the independent risk factors for drop-out of SCIT. Conclusions: Real life compliance in children was found 13.9% and it was higher than adults. Nearly one-third of children dropped out during the CO­VID-19 pandemic. Male gender and older age are associated with SCIT drop-out during the COVID-19 pandemic.

Review of Systemic Reactions to Subcutaneous Immunotherapy Based on Injection Schedule in a Single Allergy Practice

Subcutaneous allergen immunotherapy (SCIT) is an effective treatment for allergic rhinitis, asthma, and venom hypersensitivity. Although rare, severe, and potentially life-threatening systemic reactions (SR) such as anaphylaxis can occur. However, our knowledge of SR between SCIT buildup (standard and accelerated) is limited. This study aimed to compare SCIT-related reactions between standard buildup (18-shot or 30-shot) and accelerated buildup (cluster).

The Effectiveness and Safety of Thunder Fire Moxibustion for Treating Allergic Rhinitis: A PRISMA Compliant Systematic Review and Meta-Analysis.

Background Allergic rhinitis (AR) is a noninfectious inflammatory disease caused by allergic individuals exposed to allergens. Western medicine therapy for treating AR causes obvious adverse events, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Therefore, we conducted this meta-analysis to evaluate the effectiveness and safety of TFM for treating AR. Methods PubMed, Web of Science, Embase, the Cochrane Library, CNKI, WanFang, VIP, and CBM from inception to April 5, 2020, were searched without any language restriction. Reviewers identified studies, extracted data, and assessed the quality, independently. The primary outcomes were the total effective rate and the TNSS. The secondary outcomes included TNNSS, RQLQ, VAS, serum IgE, IgA, or IgG level, and adverse events. Randomized controlled trials (RCTs) were collected; methodological quality was evaluated using the Cochrane risk of bias assessment tool (RoB), and the level of evidence was rated using the GRADE approach. Meta-analysis was performed using the RevMan5.3.0 software. Results A total of 18 RCTs were included, including 1600 patients. The results of this meta-analysis showed a statistically significant effect in a total effective rate of T = TFM (RR = 1.07; 95% CI [1.03, 1.12]; P = 0.45; I2 = 0%) and T = TFM + other treatments (RR = 1.18; 95% CI [1.11, 1.25]; P = 0.03; I2 = 53%). In addition, TFM intervention also showed significant difference in total symptom score (T = TFM + other treatments) (MD = −1.42; 95% CI [−1.55, −1.29]; P = 0.03; I2 = 60%) in patients with AR. Conclusion Existing evidence shows that TFM is safe and effective for AR. Due to the universal low quality of the eligible trials and low evidence level, we should draw our conclusions with caution. Therefore, clinical researchers should carry out more large-sample, multicentre, high-quality randomized controlled clinical trials in the future to verify the clinical efficacy of TFM in treating AR.

The effectiveness of thunder fire moxibustion for treating allergic rhinitis: A protocol for systematic review and meta analysis.

Background:Allergic rhinitis (AR) is a chronic disease, resulting in severe syndromes such as sneezing, itching, nasal blockage, and rhinorrhea. The major medications treating AR cause side effects, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Thus, this systematic review and meta analysis aims to systematically evaluate the effectiveness and safety of TFM in the treatment of AR.Methods:Nine databases, including Medline, PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database (WF), Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) from inception to July 2020 will be searched. In addition, the grey literature and the references of all included literature will be retrieved manually. Reviewers will identify studies, extract data and assess the quality independently. The outcomes of interest include: total nasal symptom score, total non-nasal symptom score, rhinitis quality of life questionnaire, visual analog scale, Laboratory indicators: serum immunoglobulin E, immunoglobulin A, or immunoglobulin G level and adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis will be performed using RevMan5.3.0 software.Results:Because the review is ongoing, no results can be reported.Conclusions:The findings from this review will provide reliable evidence for effectiveness and safety of TFM for AR.Ethics and dissemination:Ethical approval requirements are not necessary for this review. This systematic review and meta analysis will be disseminated online and on paper to help guide the clinical practice better.PROSPERO Registration number:CRD42019141113

Determinants and Factors of Satisfaction with Sublingual Immunotherapy in Patients with Allergic Rhinitis.

Allergen specific immunotherapy provides effective treatment of allergic rhinitis. Despite its efficacy, it can be signifi-cantly compromised by a possible treatment dissatisfaction of patients. To explore determinants and factors of satisfaction with sublingual immunotherapy in patients with allergic rhinitis. A total number of 191 patients with allergic rhinitis who completed a three-year course of sublingual im-munotherapy were included in the study. Of these, 76 had house dust mite (HDM) allergy - 42 men (55.26%) and 115 had grass pollen allergy - 63 men (54.78%) (mean age 27.3 years, SD: 6.14). The patients assessed their satisfaction using a visual analog scale. Health- Related Quality of Life was assessed by Rhinoconjunctivitis Quality of Life questionnaire. A visual analog scale was used to determine severity of the allergic rhinitis. The mean overall satisfaction, compared with that in previous therapy, increased significantly from 4.80 (SD 2.16) to 7.47 (SD 2.05) in the grass pollen allergy group and from 3.42 (SD 2.31) to 7.61 (SD 2.38) in the patients with HDM SLIT (p< 0.001). No relation between satisfaction and sex, type of immunotherapy extracts and duration of the disease was established. A strong correlation was found between satisfaction with treatment and quality of life (R=0.62) and severity of allergic rhinitis (R=0.69) after a three-year course. The results of this real-life study demonstrated that most patients with allergic rhinitis appeared to be satisfied with a three-year course of sublingual immunotherapy. The study provided evidence that reduction in severity of symptoms and improvement in quality of life could determine satisfaction with treatment.

Effects of a Novel Barley-Based Formulation on Allergic Rhinitis: A Randomized Controlled Trial.

Current treatment options for Allergic Rhinitis (AR) may have their own limitations and side effects. This study aimed to investigate the effects of Ma-al-Shaeer (MS), a novel natural formulation based on Hordeum vulgare, in the treatment of AR compared with Fexofenadine (FX). A total of 77 patients with AR were divided into two groups: MS group (n=38) and FX group (n=39). The first group received 15 g of dried MS powder, and the second group received 60 mg of FX twice daily for 14 days. At baseline (week zero) and after the 14-day treatment period (week two), both groups were evaluated for sneezing, rhinorrhea, nasal congestion, nasal itching, post nasal drip, eye, throat, or ear symptoms, headache, cough, mental function, quality of life scores, blood eosinophil count and total IgE levels. Rhinitis control assessment tests were conducted at week zero and again at one week after cessation of treatment (week three) in both groups. All symptoms of AR except cough were significantly reduced in both groups; for nasal congestion, post nasal drip, and headache, the MS treatment was found to be superior. Rhinitis control was significantly increased after treatment in both groups (p value < 0.001). Both drugs significantly reduced total IgE levels. There was no significant change in eosinophil count in either group. MS formulation based on H. vulgare may be an effective treatment for AR. Further studies are needed to confirm the effect of MS as an alternative treatment in AR.

The association of absolute eosinophil count, serum immunoglobulin E and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis

Abstract OBJECTIVE. This study aimed to analyse the association of absolute eosinophil count (AEC), serum IgE and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis. MATERIAL AND METHODS. This study involved 50 patients with signs and symptoms of allergic rhinitis who underwent a clinical examination and various tests, including spirometry, and were followed up regularly. Patients found to have bronchial asthma or nasal polyposis were treated accordingly. RESULTS. The study found the prevalence of bronchial asthma in patients with allergic rhinitis to be 58% and that the severity of bronchial asthma was reduced significantly, with lesser acute attacks and reduced hospitalizations with the effective treatment of allergic rhinitis (p=0.064). CONCLUSION. This study showed that elevated AEC and serum IgE were significantly associated with co-existing allergic rhinitis and bronchial asthma and increased the chance of co-existence of these two pathologies. Spirometry is a useful tool for observing the response to treatment.

Chlorpheniramine maleate containing chitosan-based nanoparticle-loaded thermosensitive in situ gel for management in allergic rhinitis.

The aim of the present study was to fabricate a thermosensitive gel containing chlorpheniramine maleate (CPM)-loaded nanoparticles following intranasal administration for effective treatment of allergic rhinitis. Chitosan-based nanoparticles were prepared by a precipitation method followed by the addition of developed NPs within the poloxamer 407- and carbopol 934P-based mucoadhesive thermoreversible gel. Developed formulations were evaluated for particle size, PDI, % entrapment efficiency, and % cumulative drug permeation. NP3 formulation was found to be optimized on the basis of minimum particle size (143.9nm), maximum entrapment efficiency (80.10 ± 0.414%), and highest drug permeation (90.92 ± 0.531%). The optimized formulation NP3 was then formulated into thermoreversible in situ gel. This intensifies the contact between the nasal mucosa and the drug and increases and facilitates the drug absorption which results in increased bioavailability. G4 formulation was selected as the optimized formulation on the basis of gelation ability and mucoadhesive strength. Histology was carried out to examine the damage caused by the optimized G4 formulation. Results revealed no visual signs of tissue damage thus indicated safe nasal delivery of nanoparticulate in situ gel formulation G4. Thus, intranasal CPM NP-loaded in situ gel was found to be a promising formulation for the management of allergic rhinitis.

Evaluation of Sub cutaneousRush Immunotherapy Effectiveness in Perennial Allergic Rhinitis after a Year from Treatment.

Allergen immunotherapy is an effective treatment for allergic rhinitis. Conventional immunotherapy takes at least 5 to 6 months to reach the maintenance dosage; nonetheless, rush immunotherapy accelerates to reach the maintenance dose several months earlier. However, the safety and efficacy of this treatment has not been widely investigated. The objective of the present study was to determine the efficacy of subcutaneous rush immunotherapy in the patients with perennial allergic rhinitis after a year from treatment. This study was carried out on a total of 15 patients with allergic rhinitis who received rush immunotherapy and were evaluated for the quality of life and clinical symptoms improvement with Sino-Nasal Outcome TestQuestionnaire (SNOT-22) and Mini Rhino conjunctivitis Quality of Life Questionnaire (RQLQ) before and after a year from treatment. Moreover, specific weed mix Immunoglobulin E(IgE)was measured before and after a year from treatment. Statistical analysis was performed using SPSS software (version 16) (P<0.05). The comparison of specific IgE indicated a significant reduction between before and after a year from treatment (P=0.005for pigweed)(P=0.022 for salsola). There was a significant decrease in clinical symptoms according to SNOT-22 Questionnaire [(mean score: 46.00, before the treatment) and (mean score: 14.06, after the treatment)]. The quality of life for most of the patients was moderate (46.7%) before the treatment and good (80%) after the treatment, which was considered statistically significant (P>0.001). Rush immunotherapy is an effective treatment in the patients with allergic rhinitis. It seems to be an alternative treatment in cases that need more rapid treatment. However, it is recommended to carry out other studies on the control group.

Salivary Immunoglobulin A, E, and G4 Levels Specific to Dermatophagoides pteronyssinus in Allergic Rhinitis Patients Treated With Subcutaneous Immunotherapy.

Allergen-specific immunotherapy (AIT) is an effective treatment for allergic rhinitis (AR). During the course of AIT, many biomarkers in body fluids change. It is necessary to find effective indicators of AIT. To examine levels of salivary immunoglobulin A, E, and G4 (IgA, IgE, and IgG4, respectively) specific to Dermatophagoides pteronyssinus (Dp-IgA, Dp-IgE, and Dp-IgG4, respectively) and their changes in AR patients undergoing subcutaneous immunotherapy (SCIT). This study included 82 patients with AR sensitized only to Dp and 14 healthy controls. Among patients with AR, 30 patients were not treated with specific immunotherapy (group A), while the remainder (n = 52) received house dust mite SCIT in the up-dosing phase (n = 27; group B) or the maintenance treatment phase (n = 25; group C). Dp-IgA, Dp-IgE, and Dp-IgG4 levels in the saliva were measured using the enzyme-linked immunosorbent assay. Clinical symptoms, concomitant medication, and the Rhinoconjunctivitis Quality of Life Questionnaire score were recorded and correlated with immunoglobulin levels. Salivary Dp-IgG4 and Dp-IgA levels were significantly lower in AR patients than in healthy controls ( P < .001 for both), while Dp-IgE levels were significantly higher ( P < .001). SCIT resulted in sustained increases in Dp-IgG4 and Dp-IgA in the maintenance phase compared to the up-dosing phase ( P < .001 for both), whereas Dp-IgE only increased in the up-dosing phase ( P = .004, P < .0125). There was no correlation between the different salivary immunoglobulins and clinical scores during SCIT. This study shows that allergen-specific IgE levels are increased in the saliva of sensitized patients, suggesting that measuring salivary IgE testing should be further considered for the diagnosis of AR. Moreover, allergen-specific IgA and IgG4 in the saliva, which may play protective roles against allergy, may serve as objective indicators for evaluating treatment response to SCIT. However, none of the immunoglobulin reflects subjective symptoms.

Onset of Action of the Fixed Combination Intranasal Azelastine-Fluticasone Propionate in an Allergen Exposure Chamber

A fixed-dose combination of intranasal azelastine hydrochloride and fluticasone propionate (MP-AzeFlu) is the most effective treatment of allergic rhinitis, but its onset of action requires further investigation. To compare the onset of action of MP-AzeFlu with the free combination of oral loratadine (LORA) and intranasal fluticasone propionate (INFP). In this single-center, randomized, placebo-controlled, double-blind, double-dummy, 3-period crossover trial, allergic rhinitis symptoms were induced in asymptomatic patients by ragweed pollen challenge in an allergen environmental exposure chamber. Patients received single-dose MP-AzeFlu, LORA/INFP, or placebo and were monitored for 4 hours. The primary outcome was onset of action measured by total nasal symptom score (TNSS). Secondary measures were total ocular symptom score (TOSS), total score of the 7 nasal and ocular symptoms (T7SS), and the global visual analog scale (VAS). The full analysis set included 82 patients, of which 78 completed all treatments. TNSS was significantly reduced versus placebo from 5 minutes for MP-AzeFlu and 150 minutes for LORA/INFP onward (both P < .05) till the end of assessment (0-4 hours). MP-AzeFlu reduced TNSS to a greater extent at each time point from 5 to 90 minutes (P < .05) and over the entire assessment interval (P ≤ .005) versus LORA/INFP or placebo. No statistically significant difference between LORA/INFP and placebo was observed over the assessment interval (P= .182). The onset of action of MP-AzeFlu assessed by TOSS, T7SS, and VAS was 10 minutes, 2 hours earlier than with LORA/INFP. MP-AzeFlu had a more rapid onset of action (5 minutes) and was more effective than LORA/INFP.

Cochrane Corner: Saline irrigation: a cheap and effective treatment for allergic rhinitis.

Cochrane Corner: Saline irrigation: a cheap and effective treatment for allergic rhinitis.