Intermittent Allergic Rhinitis Research Articles

Efficacy and safety of the combination nasal spray olopatadine hydrochloride-mometasone furoate in the treatment of allergic rhinitis

Abstract Introduction Pharmacotherapy is the main pillar in the treatment of allergic rhinitis. While antihistamines (AH) and intranasal glucocorticosteroids (INCS) have long been part of the therapeutic standard, a pharmacological combination of both active substances in a nasal spray has so far only been implemented and made available in two preparations in Germany. Recently, an intranasal olopatadine hydrochloride-mometasone furoate (Olo-Mom) combination was introduced as a nasal spray for the treatment of seasonal and perennial allergic rhinitis. Methods In a literature search, treatment options for allergic rhinitis were analyzed and the available evidence was determined by searching Medline, PubMed, and the national and international study (ClinicalTrials.gov) and guideline registers and the Cochrane Library. Human studies published on the topic in the period up to and including August 2023 were taken into account. Results Based on the international literature and previous experience, the results are summarized and recommendations are given. The drugs used in the pharmacotherapy of AR primarily include INCS, intranasal and oral AH, leukotriene antagonists, intranasal cromoglicic acid preparations, intranasal and oral vasoconstrictors, and nasal rinses. For patients with intermittent and persistent allergic rhinitis, INCS are the first-line therapy, but in many patients they do not work sufficiently or quickly enough. The fixed combination Olo-Mom nasal spray showed significant improvements in the Reflective Total Nasal Symptom Score (rTNSS) in two phase II clinical trials with twice-daily and once-daily administration. In phase III studies, Olo-Mom nasal spray administered twice daily showed significant improvements in rTNSS compared to placebo, olopatadine monotherapy, and mometasone monotherapy. Conclusion In summary, AH and INCS will remain the main groups of active ingredients in the treatment of allergic rhinitis in the future. In combination preparations such as the new combination nasal spray olopatadine hydrochloride-mometasone furoate, they are highly effective and safe, thus opening up new perspectives, especially for patients with moderate and severe allergic rhinitis from the age of 12 years.

Clinical relevance of cluster analysis in phenotyping allergic rhinitis in the paediatric population of the Kuyavian-Pomeranian voivodeship, Poland.

Allergic rhinitis (AR) is the most common allergic disease in the world, and additionally, its prevalence is successively increasing. Children with AR constitute a heterogeneous group of patients differing both in the course of AR and in the frequency of asthma coexistence. It is possible to identify children with AR at risk of a more severe course of the disease by analysing the potential family, environmental and clinical factors related to the development of the disease; the findings will help identify patients with a higher risk of developing asthma in the future, and who will benefit the most from early allergen-specific immunotherapy. Evaluation of clinical relevance of cluster analysis in phenotyping AR based on an analysis of selected clinical and environmental factors. The study sample was 80 children (7-17 y.o.) with AR, including 28 children with associated asthma. The effects of AR symptoms on the patients daily functioning, skin prick tests (Allergopharma), allergen-specific IgE for airborne allergens (Biocheck GmbH), total cholesterol, cholesterol high-density lipoprotein (HDL), cholesterol low-density lipoprotein (LDL), triglyceride levels in the blood (ARCHITECTcSystem), FeNO and nNO concentrations (HypAir FeNO Medisoft) and results of methacholine challenge test (Lungtest 1000Ispa) were analysed. Four clusters of patients with AR were extracted, differing in the incidence and severity of AR symptoms and the coincidence of asthma. Most of the children from cluster 1 (n = 24; 85.71%) and cluster 2 (n = 15; 78.95%) had persistent AR, while most of the children from cluster 3 (n = 11; 73.33%) and cluster 4 (n = 14; 77.78%) had intermittent AR. The co-occurrence of asthma was significantly higher in cluster 1 than in other clusters (p = 0.0002). Children in clusters 3 and 4 reported a lower impact of AR symptoms on daily functioning (p = 0.0153). Children in cluster 1 had significantly more often an abnormally high total cholesterol level (p = 0.033) and in cluster 4 significantly more often abnormally high triglyceride levels (p = 0.009) were observed. Patients in cluster 2 were significantly less likely to have abnormal high LDL levels (p = 0.015). Children with AR from the Kuyavian-Pomeranian voivodeship differing in the course of AR, the frequency of coexistence of asthma, and occurrence of lipid parameter abnormalities.

An Overview of Antihistamines and their Properties used for Treatment of Different Diseases.

By comparing the histamine impact to the instant response to an injected foreign protein in previously sensitized animals, one might hypothesize that histamine may be involved in this reaction. Through all four of the recognized types of histamine receptors, histamine is also essential for the control of immunological function and acute and chronic allergic inflammation. Recent evidence points to anti-IgE antibodies and specific antibodies to cytokines like IL-4 or IL-5 that are associated with allergic inflammation as probable causes of Allergic Rhinitis. The therapeutic advantage of antihistamines is a decrease in allergy symptoms and any other allergy-related symptoms. We research the many diseases and dose forms in which antihistamines are used. Pediatric age groups have never been thoroughly studied for firstgeneration antihistamines. Oral antihistamines are suggested as the first line of therapy for people with mild to severe intermittent Allergic Rhinitis symptoms. Currently, approximately 100 different antihistamine-containing medicines and around 20 different H1-receptor antagonists are available for therapeutic use. Antihistamines of the second generation are more efficient and secure than those of the first generation. We conducted a research on the sedative and non-sedative effects of antihistamines used to treat various diseases. The present investigation highlights the use of antihistamines in various diseases at different ages, their sedative and non-sedative effect, and their utility in treating insomnia based on their safety and current use among the patient population, as well as our observation.

Quality of life of children with allergic rinitis and ways of correction

Introduction. Allergic rhinitis is a common disorder that significantly impairs the children’s quality of life. The problem is particularly pertinent in relation to the paediatric population living in areas with advanced manufacturing industries, where well-known trigger factors, being added by increased concentration of pollutants in the atmospheric air, further complicate the selection of an effective course of treatment.Aim. To determine the effectiveness of a course of treatment with an antihistamine medicine Cetirizine based on the assessment of quality-of-life criteria for children with intermittent allergic rhinitis (IAR) in the Chelyabinsk region.Materials and methods. A prospective study of 147 children with respiratory allergic diseases living in the Chelyabinsk region was conducted. The quality of life of children who received a course of treatment with the antihistamine medicine was assessed using the Paediatric Quality-of-Life inventory (PedsQL) that consisted of combined Likert scales (school life, social, physical functioning, etc.), clinical symptoms were assessed using a developed visual analogue scale.Results and discussion. The assessment findings confirmed that the use of Cetirizine in the complex therapy of intermittent allergic rhinitis and associated comorbid conditions made it possible to significantly improve the clinical symptoms and quality of life of children over the entire treatment period.The most striking positive response in the form of decreased nasal obstruction was seen during the prescribed treatment in patients of Groups 1 and 2. Thus, the filling VAS ratings for children with mild to moderate IAR showed that only 10 (20%) patients in Group 1 experienced mild nasal breathing difficulty. Patients with severe IAR reported a decrease in nasal obstruction only by the end of two-month treatment.Conclusion. Cetirizine demonstrated a good effect of blocking H1-histamine receptors, high bioavailability, good tolerability and safety in the treatment of allergic rhinitis in children with comorbid conditions.

Real-world physician practices on the diagnosis and management of allergic rhinitis in the Philippine setting.

Physician awareness and adherence to guidelines varies among countries and between types of physician practice. Identifying the needs of the physician and patient is essential to improve patient outcome. Data on physician diagnosis and management of allergic rhinitis (AR) in the Philippines is currently limited. Study objectives are to assess awareness and use of guidelines, practices on diagnosis and management of intermittent and persistent AR, reasons for choice of therapy, and familiarity with immunotherapy. A cross-section of 590 specialist and 223 subspecialist physicians from 17 regions of the Philippines were surveyed from October 2021 to July 2022. Survey consisted of a 12-point validated online questionnaire on knowledge and use of guidelines for diagnosis and treatment, use of diagnostic tests, preferred pharmacologic treatment, preferred adjuvant therapy, reasons for treatment choice, and familiarity with immunotherapy. Seventy-seven percent of respondents used Allergic Rhinitis and its Impact on Asthma guidelines for diagnosis and management of AR. Three-fifths of respondents "always" routinely evaluated AR patients' history and performed a physical examination for asthma; 57% of respondents "always" routinely evaluated asthma patients' history and performed a physical examination for AR. Allergy testing was "sometimes" recommended by 62.2%. Oral second-generation antihistamines were the preferred choice for the treatment of intermittent AR. Intranasal steroids were the preferred treatment for persistent AR. Top reasons for choice of treatment were guideline recommendations, efficacy, onset of action, cost, and availability of treatment. Filipino specialists and subspecialists are aware and use guidelines in diagnosis and management of AR. Clinical history and physical examination are the cornerstone of diagnosis. Management practices for intermittent and persistent AR are similar for both groups. Recognizing the role of patient treatment preferences and allergen-specific immunotherapy remains to be a gap in the management of AR by Filipino physicians.

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

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

56-Year-Old Woman With Bilateral Lower Extremity Edema

A 56-year-old woman presented to the primary care clinic for evaluation of a 2-year history of bilateral lower extremity edema. She denied dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. She also denied having any abdominal pain, nausea, vomiting, or diarrhea. Review of systems was positive for long-standing intermittent dysphagia with solid foods. Her medical history was notable for mild intermittent asthma, allergic rhinitis, and long-standing peripheral eosinophilia of unclear significance. Her medication list included rare meloxicam, daily ciclesonide inhaler, and albuterol inhaler as needed. She denied tobacco, alcohol, or recreational drug use. CORRECT ANSWERS: 1. e. 2. e. 3. c. 4. a. 5. a.

Symptom control and health-related quality of life in allergic rhinitis with and without comorbid asthma: A multicentre European study.

Allergic rhinitis (AR) is a major non-communicable disease that affects the health-related quality of life (HRQoL) of patients. However, data on HRQoL and symptom control in AR patients with comorbid asthma (AR+asthma) are lacking. In this multicentre, cross-sectional study, patients with AR were screened and administered questionnaires of demographic characteristics and health conditions (symptoms/diagnosis of AR and asthma, disease severity level, and allergic conditions). HRQoL was assessed using a modified version of the RHINASTHMA questionnaire (30, 'not at all bothered' - 150 'very much bothered') and symptom control was evaluated by a modified version of the Control of Allergic Rhinitis/Asthma Test (CARAT) (0, 'no control' - 30, 'very high control'). Out of 643 patients with AR, 500 (78%) had asthma as a comorbidity, and 54% had moderate-severe intermittent AR, followed by moderate-severe persistent AR (34%). Compared to the patients with AR alone, patients with AR+asthma had significantly higher RHINASTHMA (e.g., median RHINASTHMA-total score 48.5 vs. 84, respectively) and a significantly lower CARAT score (median CARAT-total score 23 vs. 16.5, respectively). Upon stratifying asthma based on severity, AR patients with severe persistent asthma had worse HRQoL and control than those with mild persistent asthma. The association was significantly higher among non-obese participants compared to obese ones, with RHINASTHMA-upper symptoms score but not with CARAT. Our observation of poorer HRQoL and symptoms control in AR patients with comorbid asthma supports the importance of a comprehensive approach for the management of AR in case of a comorbid allergic condition.

The role of IL-33 and IL-1β in the development of persistent allergic rhinitis in overweight/obese children

BACKGROUND: Few works were devoted to the study of the role of cytokines in children with allergic rhinitis (AR) with comorbid obesity.&#x0D; AIMS: To study the level of cytokines interleukin (IL)1, IL-33, IL-6, tumor necrosis factor (TNF)-, and total IgE in the blood serum of overweight/obese children with intermittent and persistent AR.&#x0D; MATERIALS AND METHODS: This cross-sectional observational study analyzed 69 children aged 710 years with AR in the remission period and was conducted from November 2020 to February 2021. All children went through a comprehensive examination for 3 days, including the definition of the serum concentrations IL-1, IL-33, IL-6, TNF-, and total IgE. Before blood sampling, children did not use nasal glucocorticosteroids, antileukotriene drugs for the last 4 weeks, and antihistamines for the last 7 days. Bioimpedansometry was used to assess the body weight by calculating the %FM (percentage of body fat mass).&#x0D; RESULTS: The study included 44 children with AR and overweight/obesity (group I) and 25 children with AR and normal body weight (group II). The analysis of AR showed that in group I, intermittent AR was detected in 11 (25.0%) children (subgroup IA), whereas a persistent course was found in 33 children (75.0%) (subgroup IB). In group II, intermittent AR was detected in 13 (52.0%) children (subgroup IIA), whereas persistent AR in 12 children (48.0%) (subgroup IIB). The level of IL-1 in the blood serum was significantly higher in the subgroup IB than in subgroup IA (p=0.009). The concentration of IL-33 in children with persistent AR and obesity was significantly lower than that in children with intermittent AR and obesity (p=0.039). The level of IL-33 in the serum negatively correlated with %FM in group IA (r=-0.6673, p=0.035). The concentration of IL-1 negatively correlated with %FM in group IIB (r=-0,738, p=0,037). The levels of IL-6, TNF, and total IgE in obese children did not depend on the severity of AR.&#x0D; CONCLUSIONS: The predictors of persistent AR in children with obesity are a decrease in the level of IL-33 and an increase in IL-1 in the blood serum. The negative correlation between the degree of obesity and IL-33 concentration in children with intermittent AR opens a window of opportunity for the personified management of children with AR and comorbid obesity.

Significance of modern antihistamines in the treatment of patients with allergic rhinitis

Allergic rhinitis (AR) is one of the most common diseases in the world, which is based on immunoglobulin E (IgE) – mediated inflammation that develops after contact with various allergens. About 40 % of people suffer from various allergic diseases, every 3 rd inhabitant of the Earth has symptoms of allergic rhinitis and every 10 th has bronchial asthma. The early phase of allergen binding to IgE antibodies occurs within a few minutes after contact, the late phase develops after 4–6 hours. In addition to the airborne pathway of penetration, contact with the allergen is possible through the skin and mucous membranes, gastrointestinal tract, with parenteral administration of drugs. Taking into account the etiotropic factor, there are year-round allergic rhinitis (CAR) and seasonal (SAR). By the nature of the course, intermittent and persistent allergic rhinitis are distinguished. The most basic symptoms of allergic rhinitis include: sneezing, rhinorrhea, nasal congestion, itching, decreased sense of smell. Treatment includes antihistamines, intranasal steroids, leukotriene receptor antagonists and immunotherapy. To date, antihistamines of the second generation are recommended and widely used for the treatment of patients with allergic rhinitis, the main representative of which is levocetirizine (levocetirizine dihydrochloride). The purpose of the work is an analytical review of the results of clinical trials of levocetirizine for allergic rhinitis. The article discusses in detail the prevalence, etiology and pathogenesis, classification of the disease, treatment regimens for patients with allergic rhinitis, and provides two own clinical observations. Based on the data of a number of studies, the advantages of using antihistamines of the second generation in allergic rhinitis have been demonstrated, expanding not only the possibilities of treating patients, but also preventing the transition of the disease into a chronic process.

Low Level of Advanced Glycation End Products in Serum of Patients with Allergic Rhinitis and Chronic Epstein-Barr Virus Infection at Different Stages of Virus Persistence.

Advanced glycation end products (AGEs) are formed in a nonenzymatic reaction of the reducing sugars with amino groups of proteins, lipids, and nucleic acids of different tissues and body fluids. A relatively small number of studies have been conducted on the role of AGEs in allergic inflammation. In this study, patients with allergic rhinitis (AR) were examined for the presence of Epstein-Barr virus and the content of fluorescent and nonfluorescent AGEs. We have also determined the level of a unique epitope (AGE10) which was recently identified in human serum using monoclonal antibodies against synthetic melibiose-derived AGE (MAGE). The levels of AGE10 determined with an immunoenzymatic method revealed no significant difference in the patients' blood with intermittent AR and chronic EBV persistence in the active and latent phases. It has been shown that there is a statistically significantly smaller amount of AGEs and pentosidine in groups of patients, both with and without viremia, than in healthy subjects. In turn, higher levels of immune complexes than of AGE10 were detected in the groups of patients, in contrast to the control group, which had lower levels of complexes than AGE10 concentration. In patients with active infection, there is even more complexes than of noncomplexed AGE10 antigen. The lower level of AGE in allergic rhinitis patient sera may also be due, besides complexes, to allergic inflammation continuously activating the cells, which effectively remove glycation products from the body.

THE SEVERITY OF ALLERGIC RHINITIS IS RELATED TO SLEEP DISTURBANCES IN KOREAN CHILDREN AND ADOLESCENTS

<h3>Introduction</h3> In children and adolescents, disturbed sleep is known to impair quality of life. We evaluated the relationship between the severity of allergic rhinitis (AR) according to ARIA guidelines and sleep disturbances in Korean children and adolescents. <h3>Methods</h3> One hundred sixty-three allergic rhinitis patients were enrolled in this Korean Allergic Rhinitis Cohort study (KoARCo) between December 2019 and November 2020. Korean version of Pediatric Daytime Sleepiness Scale (PDSS) and Pediatric Sleep Questionnaire (PSQ) were assessed. <h3>Results</h3> According to ARIA guideline, patients with mild AR were 53.7% and moderate-severe AR were 46.3%. Meanwhile, patients with intermittent AR were 32.7% and persistent AR were 67.3%. The PDSS score for 3 out of 8 questions and the total PDSS score were higher in the patients with moderate-severe AR than mild AR. The moderate-severe AR group has more responses with sleep impairments in the 2 items of the PSQs. <h3>Conclusion</h3> Sleep disturbances were related to the severity of AR in children and adolescents in Korea. Therefore, AR should be controlled.to prevent sleep disturbances and improve quality of life.

An Observational Study of Quality of Life in Patients of Allergic Rhinitis in a Tertiary Health Care Centre of South Gujarat.

Allergic rhinitis (AR) refers to an IgE-mediated inflammation following exposure to allergen. Often deemed as a minor inconvenience rather than a disease, AR impairs the QOL. Medical treatment has a beneficial effect. To evaluate the QOL in patients of AR. Patients of AR with ≥ 18 years age, receiving treatment in our department are included. Pre and Post treatment VAS (Visual Analogue Scale) and RSDI (Rhinosinusitis Disability Index) are compared to know the effect of disease and treatment on QOL. The patients of PAR (Persistent Allergic Rhinitis) had a greater impact on QOL. In PAR, a combination of INCS (Intranasal Corticosteroids) + oral antihistaminics result in significant reduction in VAS & RSDI scores. In IAR (Intermittent Allergic Rhinitis), Oral antihistaminics monotherapy was most effective in reducing itching while Oral antihistaminics + 1 week of intranasal decongestant was most effective in reducing sneezing, running nose and nasal blockage. Oral antihistaminics + LTRA (Leukotriene Receptor Antagonist) was most effective in reducing physical RSDI score. Oral antihistaminics + 1 week of intranasal decongestantwas most effective in reducing functional and emotional RSDI score. Functional RSDI scores had improved much higher than emotional and physical scores. All these observations were statistically significant. AR does affect the QOL while pharmacotherapy helps in improving the overall QOL. Oral antihistaminic alone or in combination with local decongestant/LTRA in IAR cases while INCS + oral antihistaminic in PAR cases are significantly effective in controlling symptom scores and QOL.

An Algorithm Recommendation for Management of Allergic Rhinitis in the United Arab Emirates: A Consensus Statement from an Expert Panel

Background: Allergic rhinitis (AR) is a common chronic health problem in the United Arab Emirates (UAE). Achieving adequate symptom control is pivotal to successful AR management, which may be attained following a stepwise treatment algorithm. Despite the availability of several guideline recommendations for the best management of AR, morbidity remains high in patients with AR, with treatment goals being far from the reach. Objective: The objective of this consensus statement was to discuss the currently available knowledge on the treatment of AR and to provide an expert opinion on the use of MP-AzeFlu (azelastine HCl, AZE; 137 µg per spray) and INCS (fluticasone propionate, FP; 50 µg per spray) for the effective management of AR in the UAE. Methods: A consensus meet involving 13 otorhinolaryngologists and one pulmonologist was held in Dubai, UAE, to discuss the current understanding on the treatment and management of AR. Results: The panel advised to start AR pharmacotherapy with antihistamines (AH), leukotriene receptor antagonist (LTRA), INCS or MP-AzeFlu based on the visual analogue scale (VAS) score. In mild intermittent AR (VAS score &lt;5/10), AH or LTRA is recommended as first-line therapy. However, in case of VAS score ≥5/10 or persistent AR, and treatment failure with AHs alone, INCS or MP-AzeFlu is recommended followed by reassessment for 7 days to confirm a step-up or step-down down therapy. Patients non-responsive to therapy were advised to step-up with MP-AzeFlu. Conclusion: The panel advocated a combination of intranasal second-generation AH and INCS in a single device (Dymista®) as first-line therapy for the management of AR. The algorithm provided herein can be applied in most healthcare settings by following a step-up or step-down strategy based on the VAS scores for AR control in the UAE.

The association of allergic rhinitis severity with neutrophil-lymphocyte and platelet-lymphocyte ratio in children.

The aim of the study was to investigate the relationship between the severity of allergic rhinitis (AR) and neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in pediatric patients. This study is a retrospective, cross-sectional, and observational study including 200 AR patients and 160 healthy controls. Of the patients, 39% were boys with a mean age of 10.5 years. The study included children with persistent and intermittent AR. Of the controls, 50.6% were boys with a mean age of 10.3 years. We compared NLR and PLR from blood test between study and control groups. They were also compared according to AR severity within the patient group. The NLR was 1.64±1.29 in the study group whereas 1.18±0.31 in the control group. The PLR was 102.72±31.20 in the study group whereas 79.36±11.72 in the control group. When NLR and PLR were compared between groups, we found statistically significant differences in both NLR and PLR (p=0.003, p=0.001, respectively). We found a statistically significant difference when comparing both NLR and PLR in patients with intermittent and persistent AR. These rates increased with disease severity (p=0.000, p=0.000, respectively). Both NLR and PLR are useful markers for the diagnosis and severity of AR. Clinicians can use these markers to assess disease severity in pediatric patients at the beginning of the diagnostic process.

Nasal cytology can predict clinical efficacy of subcutaneous immunotherapy in intermittent allergic rhinitis.

Allergen immunotherapy (AIT) is the only disease-modifying treatment option available for patients with IgE-mediated allergic rhinitis. The identification of specific biomarkers, which may predict response to AIT, is currently an active field of research in the aspect of recommended personalization of medicine. To assess the changes in rhinological parameters in intermittent allergic rhinitis (IAR) patients resulting from subcutaneous immunotherapy (SCIT). Forty-two patients (female: 19; 45%) with IAR qualified for subcutaneous immunotherapy were enrolled in this study. Fourteen (33.3%) patients were desensitized with grass pollen allergen extracts, 12 (28.6%) with tree pollen allergen extracts, and 16 (38.1%) with grass and tree pollen allergen extracts. The patients were evaluated before AIT during the pollen season and in the next pollen season after introduction of subcutaneous immunotherapy. On both occasions, determination of total nasal symptom score (TNSS), rhinomanometry and nasal cytology were performed. All examined parameters significantly improved after one course of allergen immunotherapy: the percentage of eosinophils in nasal mucosa, TNSS and nasal resistance decreased, whereas the nasal flow rate increased. The decrease in percentage of nasal eosinophils significantly correlated with improvement in TNSS (rs = 0.39, p < 0.05) and was the highest in the subgroup sensitive to grass pollen (44.5 (40-52)). The rhinological assessment confirmed high effectiveness of SCIT in intermittent allergic rhinitis. A high percentage of eosinophils in nasal cytology before subcutaneous immunotherapy can predict its clinical efficacy for intermittent allergic rhinitis, especially in grass pollen allergy.

Changes in olfaction & quality of life following standard medical therapy in patients with intermittent & persistent allergic rhinitis.

Allergic rhinitis (AR) is an inflammatory disease prevalent worldwide which can affect both olfaction and quality of life (QoL). The objective of the present study was to assess olfaction and QoL changes in patients with AR before and after medical therapy. Adult participants (>18 yr) with AR were recruited for this study. These patients prospectively underwent olfaction testing using the modified Connecticut Chemosensory Clinical Research Centre Test and QoL assessment using Rhinoconjunctivitis QoL Questionnaire (RQLQ) before and after standard medical therapy with topical steroids and/antihistaminics. Of the 150 patients recruited, 72 per cent had intermittent AR. The symptom of hyposmia was present in 34 patients (22.7%) and was more prevalent in patients with moderate-to-severe type of AR (P<0.001). However, olfaction testing revealed hyposmia/anosmia in 44 patients (29.3%). Mean composite olfaction scores were significantly higher in patients with mild AR compared to moderate/severe AR (P=0.026). The pre-therapy mean composite olfaction score in the 34 patients with olfaction disturbances was 3.1 standard deviation (±1.06 SD). Following therapy, the mean composite olfaction score rose to 4.3 (±1.34 SD) and this change was found to be significant (P<0.001). Mean pre-therapy RQLQ scores were 2.87 (0.06-5.33) overall. Significant improvement was also found in RQLQ scores following therapy (P<0.001). Mean RQLQ scores were significantly lower in those with moderate-to-severe AR (P<0.001) as well as those with intermittent AR (P=0.004). Nine patients had persistently high RQLQ scores after medical therapy. Both olfaction and QoL showed significant improvement after medical therapy in Indian adults with AR. In those patients who do not improve, other causes must be sought for the persistent symptoms.

The Association of Sleep-Related Breathing Disorders Among Pediatric Patients with Allergic Rhinitis: A Cross-Sectional Study in a University Hospital

Introduction: Allergic rhinitis is a common condition in children linked to sleep-related breathing disorders (SRBD). Because of nasal congestion, it can cause obstructive sleep apnea, sleep fragmentation, and excessive fatigue. Studies regarding its association with SRBD is limited. Objectives: To determine the association of allergic rhinitis with sleep-related breathing disorders. Methodology: A cross-sectional analytical study involving pediatric patients diagnosed with allergic rhinitis was conducted. Allergic rhinitis severity was evaluated with the ARIA classification. SRBD was identified using the validated Filipino version of the pediatric sleep questionnaire. Potential association between allergic rhinitis and SRBD were assessed using the student’s t-test, Fisher’s exact test and odds ratio. Results: A total of 66 children with mean age 8.2 years were included in the study. The mean age, weight, height, and BMI were comparable among participants who were positive or negative for obstructive sleep apnea (OSA). Among the perceived problems related to sleeping disorders, snoring loudly, heavy breathing, dry mouth of awakening, not listening, and difficulty organizing showed different responses (p&lt;0.05) among the subgroups of allergic rhinitis. The odds ratio of snoring loudly, not listening, difficulty organizing, heavy breathing, and unfreshened in the morning were more likely among patients with mild persistent allergic rhinitis compared to patients with mild intermittent allergic rhinitis. Conclusion: There was sufficient evidence to prove the association of SRBD with severity of allergic rhinitis using the validated Filipino version of the Pediatric Sleep Questionnaire. OSA shows a greater likelihood among patients with mild persistent allergic rhinitis compared to those with mild intermittent allergic rhinitis.

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

Efficacy of sodium hyaluronate in relieving nasal symptoms of children with intermittent allergic rhinitis: a randomized controlled trial.

Nasal irrigation is recommended as add-on therapy in patients with intermittent allergic rhinitis (AR). We aimed to evaluate the clinical efficacy of adding hyaluronic acid (HA) or normal saline solution (NSS) to nasal corticosteroid (NC) therapy as add-on therapy in improving quality of life and reducing nasal symptom scores of children with intermittent AR compared to NC therapy. In this 28-day long, open-label, randomized controlled trial, one puff of NC was administered once a day through both nostrils of 76 children with SAR (6-12years old), whose Total Nasal Symptom Score (TNSS) was ≥ 4. Twenty-six patients received NC only (Group 1); 24 patients received NSS (Group 2), and 26 patients received HA (Group 3) twice a day by means of nasal douche device. Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and TNSS were measured as subjective parameters, and nasal eosinophil count (NEC) in nasal cytology, nasal airflow (NAF), and resistance were measured as objective parameters. No significant difference was found in post-treatment between groups in terms of TNSS, PRQLQ, and NEC values. Mean values of post-treatment left NAF of the groups were significantly different (p = 0.030), and the mean value of Group 3 was the highest (mean ± SD = 247.62 ± 155.8 ccm/sn). In comparing pre- and post-treatment intragroup mean total NAR (TNAR) values, a statistically significant decrease was recorded only in group three (p = 0.025). The addition of HA to NC as an adjunct therapy in children with intermittent AR has limited beneficial effects in our study and deserves further investigation. The clinical trial registration number ID:NCT04752956.