Intermittent Rhinitis Research Articles

Pharmacotherapy of allergic rhinitis: position of a clinical pharmacologist

Pharmacotherapy for allergic rhinitis is based on different categories of drugs used either in monotherapy or in combination regimens. The current clinical guidelines suggest a stepwise approach to pharmacotherapy for allergic rhinitis. The use of intranasal corticosteroids is considered as the preferred second-stage pharmacotherapy. Inadequate control of AR symptoms in first-line therapy is a common problem. Integrated care pathways (ICP), developed taking into account the data obtained about patients using a mobile application, suggest the use of intranasal corticosteroids as the first line of therapy, including in patients with intermittent rhinitis who have not previously received treatment when assessing the condition according to the VAS for more than 5 points, in patients who received earlier treatment when assessing the condition according to the VAS less than 5 points. According to the data in the medical decision support system and continuing medical education UpToDate, inhaled corticosteroids are considered as the first-line drugs for the pharmacotherapy of allergic rhinitis. In terms of pharmacodynamic efficacy, intranasal corticosteroids are comparable to each other. The selection criteria can be considered: the value of systemic absorption; lipophilicity; the start time of the action; frequency of introduction, organoleptic properties; the possibility of influencing non-nasal symptoms. The use of sprays containing both a glucocorticoid and an antihistamine (mometasone furoate/azelastine hydrochloride) opens up additional pharmacotherapeutic possibilities in the treatment of allergic rhinitis.

Adverse reaction to Ficus Carica: reported case of a possible cross-reactivity with Der p1

BackgroundFicus carica is an edible fruit, belonging to the Moraceae family, rarely described as cause of food allergy. We describe the first case of fig allergy that occurred as a cross-reactivity between fig and Derp 1.Case presentationWe present a case of a 10-years-old-girl, with a history of no-seasonal mild intermittent rhinitis, who experienced an immediate reaction after ingestion of a fresh fig. Skin prick tests (SPT) with commercial extracts of food, airborne allergens, latex and panallergens (profilin, PR-10 and lipid transfer protein) were performed. SPT revealed a sensitization only for dermatophagoides farina and dermatophagoides pteronyssinus which was then confirmed with by specific IgE assay (UniCAP, Phadia, Uppsala, Sweden). We also carried out a positive SPT with a commercial fig allergen (Lofarma, Milan, Italy) and prick-by-prick (PBP) both with skin and pulp of green raw and cooked fig. Fig specific serum IgE levels were 1.08 U/ml and specific IgE for rDer p1 was 16.20 U/ml (total serum IgE = 377 U/ml). In contrast specific IgE levels for latex, LTP, profilin, PR-10 and pollen allergens were negative.ConclusionThe ficin, the major fig allergen, belongs to cysteine protease family like Der p 1. The symptoms presented by our patient could be related to a cross reactivity between these two proteins which present a structural homology.

The impact of allergic rhinitis on quality of life: a study in western Iran

Introduction: Chronic diseases, due to their prolonged and debilitating nature, dramatically affect patient quality of life. Allergic rhinitis (AR) is one of the most common chronic diseases. The present study aimed to determine quality of life in patients with allergic rhinitis in Western Iran.
 Methods: In a cross-sectional study, 146 patients with AR were enrolled in this study. The required data were collected using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). The questionnaire was distributed among the patients by a physician and analysis of data was carried out by SPSS version 16.
 Results: Of the total of 146 AR patients admitted to the clinic, 61% were female and 39% were male; the mean age was 29±10.17. Rhinorrhea (82.2%) was the most common symptom, and moderate to severe intermittent rhinitis (38.4%) was the most common type of the disease. A dramatic reduction in quality of life was observed in 62% of the patients, and the severity of the disease significantly reduced the quality of life (P=0.000).
 Conclusion: Allergic rhinitis can adversely affect every aspect of a patient's life, including sleep quality, mood and daily activities.

Allergic respiratory disease: Different allergens, different symptoms.

Spanish population is rather homogeneous in its genetic and sociocultural characteristics, but allergen sensitization shows wide geographical variations. We aimed at assessing whether sensitization to different allergens in the diverse geographical areas induced different clinical and quality-of-life characteristics in adult patients with a first-time diagnosis of rhinitis and/or asthma. Two sequential, identically designed studies were carried out to evaluate such associations (PERFILAR I and II). PERFILAR II was an extension of PERFILAR I with additional allergens being included. Both phases were epidemiological, descriptive, cross-sectional, nonintervention multicenter studies. Participants were required to have lived for at least the last 2years in the geographical zone. Asthma control assessment was based on ACQ-5. Health-related quality of life was evaluated with validated scales for rhinitis (ESPRINT-15) and asthma (Mini-AQLQ). Skin prick tests were used to identify sensitization to involved allergens. A total of 301 physicians recruited 2711 patients for PERFILAR I+II. Sensitization to allergens was significantly different in patients with rhinitis with/without asthma. Seasonal allergens were associated with rhinitis, a longer time to asthma development, and more severe and commonly intermittent rhinitis. HDM were associated with more common rhinitis, and Alternaria was associated with asthma. The study confirms an association of geographical areas with relevant allergens and allergic clinical picture. Different types of aeroallergens and specific sensitization profiles are associated with different allergic clinical pictures (rhinitis with/without asthma), different clinical symptoms, and different levels of severity. This could have implications to predict later clinical course and to select appropriate management approaches.

A new approach to elimination of nasal obstruction in intermittent allergic and acute infectious rhinitis

The authors present the results of the study of decongestant effect of a cosmetic gel as a method of transcutaneous impact on nasal obstruction in intermittent allergic and acute infectious rhinitis. Preclinical study using Wistar rats on the acute formalin rhinosinusitis confirmed morphologically the presence of decongestant and anti-inflammatory effect on the mucous membrane of the nasal cavity at external gel application on the face skin. Clinical study by the method of active anterior rhinomanometry confirmed the improvement of nasal breathing in 20 minutes after the gel application on the skin of the nasal dorsum in acute infectious and allergic intermittent rhinitis. For the first time the authors proved the possibility of effecting the nasal obstruction by applying the active ingredient on the face skin.

Therapeutic effect of the preparation Aqua Maris® Ectoin in patients with allergic intermittent rhinitis

The objective of the work: to assess therapeutic efficacy on the preparation AquaMaris® Ectoin as a “barrier solution” for patients with AIR. Patients and methods. The examination was performed at the period of April, 17 to May 24, 2015 in Moscow region. 36 patients at the age of 20 to 45 years with AIR were observed. According to the general diagnostic standards the examination included: medical history data, survey, skin test with the basic set of inhalation allergens, defining the specific IgE-antibodies to pollen antigens in the serum, cytological analysis of the nasal secretion, otorhinolaryngological examination with the topical syndromes record. The spray AquaMaris® Ectoin used in the work is a natural product that contains a combination of ectoin and isotonic solution of sea salt. The patients were prescribed the preparation Aqua Maris® Ectoin according to the following treatment regimen: 1–2 spray into each nostril 3–4 times per day. When required the preparation was allowed to use as frequently as necessary. Results. All the patients were divided into 3 groups: - Group 1 – the patients in which the application of the preparation Aqua Maris® Ectoin resulted in reduction of the syndromes (20 of 34 patients; 59%); - Group 2 – the patients in which the condition became worse (6 of 34 patients; 18%); - Group 3 – the patients in which the AIR symptoms severity did not change (8 of 34 patients; 23%). Therefore, the number of patients in which the application of the preparation Aqua Maris® Ectoin resulted in reduction of the syndromes exceeded the number of patients where the AIR symptoms severity did not change or the condition became worse, by 2.6 and 3.3 times. The highest number of patients noted the following symptoms of deterioration of the condition: conjunctiva and lids inflammation, tears, nasal itching, post-nasal drip, impaired olfaction against the background of the low concentration of eosinophils in the nasal secretion. Conclusion. Therefore, the application of the monotherapy with the preparation Aqua Maris® Ectoin at the early stage of development of allergic seasonal inflammation of the upper respiratory tract provides significant decrease in the allergic load on the nasal mucosa of the sensitized organism. In view of this fact, the inclusion of the preparation Aqua Maris® Ectoin into the standard of allergic rhinitis treatment as a “barrier solution” is deemed important.

What lies beyond Asthma Control Test: Suggestions for clinical practice

Background: Asthma Control Test (ACT ™) validity relies on Global Initiative for Asthma (GINA) definition of control. It includes neither reversibility nor inflammation assessment despite their importance as hallmark of asthma, partially unrelated to symptoms. Furthermore though rhinitis may affect the patient's perception of asthma control, its impact on ACT accuracy has not been systematically evaluated. Objective: To explore ACT validity according to a definition of control including: forced expiratory volume in 1 s (FEV1) ≥ 80%, negative reversibility test, exhaled nitric oxide at a flow rate of 50 ml/s (FeNO) < 50 ppb. Results: 177 asthmatics referring to our Unit have been studied. ACT with cut-off score ≥20 showed a good positive predictive value (83.5%) but low sensitivity (47.8%), specificity (66.7%), and negative predictive value (26.5%). ROC curves analysis indicates that ACT in patients with mild intermittent rhinitis is more reliable (AUC: 0.714; p < 0.05) than in patients with nasal polyposis/chronic rhino-sinusitis (AUC: 0.176; p > 0.05). Considering asthma classification, the probability that ACT detects patients with uncontrolled asthma is significantly higher in moderate persistent asthma subgroup than in mild persistent asthma one (OR 5.464; IC 95%: 2.5-11,9; p < 0.05). Conclusions: As ACT mainly relies on patient's reported outcomes, it may not completely reflect the airways inflammation and airways obstruction. The presence and severity of rhinitis may affect ACT outcome. The awareness of the variables that could influence ACT evaluation is much more important in the primary care setting where ACT may often represent the only tool for asthma assessment.

Practice parameters for sublingual immunotherapy

The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, meta-analysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre co-seasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient's tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).

Mediators, Receptors, and Signalling Pathways in the Anti-Inflammatory and Antihyperalgesic Effects of Acupuncture.

Acupuncture has been used for millennia to treat allergic diseases including both intermittent rhinitis and persistent rhinitis. Besides the research on the efficacy and safety of acupuncture treatment for allergic rhinitis, research has also investigated how acupuncture might modulate immune function to exert anti-inflammatory effects. A proposed model has previously hypothesized that acupuncture might downregulate proinflammatory neuropeptides, proinflammatory cytokines, and neurotrophins, modulating transient receptor potential vallinoid (TRPV1), a G-protein coupled receptor which plays a central role in allergic rhinitis. Recent research has been largely supportive of this model. New advances in research include the discovery of a novel cholinergic anti-inflammatory pathway activated by acupuncture. A chemokine-mediated proliferation of opioid-containing macrophages in inflamed tissues, in response to acupuncture, has also been demonstrated for the first time. Further research on the complex cross talk between receptors during inflammation is also helping to elucidate the mediators and signalling pathways activated by acupuncture.

Relationship between seasonal respiratory allergies and cashew's pollination period in students at a university of northeast Brazil

Results The questionnaire was answered by a total of 108 students, aged 16-40 years, 80% (84) between 19-25 years. Of the total, 68% (73) reported symptoms of allergic rhinitis, and 70% (52) intermittent rhinitis and 65% (48) had moderate to severe. 40% (43) reported having allergic conjunctivitis, intermittent was the majority (77%), being ocular pruritus the main symptom. Of the total, 17% (18) said they experience symptoms of asthma, 75% intermittent asthma. 33% had worsening of symptoms in the second half of the year. As to the triggering factors, about 30% reported worsening with dust and mold, and 8% believe that pollination of cashew aggravates their symptoms.

Nasal Allergy and Otitis Media : A Real Correlation ? = إلتهاب الأذن الوسطى و الأرجية الأنفية : علاقة حقيقية ؟

The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion (OME) and persistent allergic rhinitis symptoms versus intermittent rhinitis in children. The study included 100 atopic children (52 boys, 48 girls) aged 5-9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests (SPTs), mucociliary transport time (MCTt) and Eustachian tube function tests were performed. The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus, 34 to grass pollen and 16 to Parietaria. Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group (21 ± 2 mins) versus the intermittent group (16 ± 2 mins) with a significant difference (P <0.01). Mean eosinophil cationic protein (ECP) values in the middle ear effusions of children who had undergone myringotomy were 251 ± 175.2 μg/L, and mean ECP blood values were 25.5 ± 16.3 μg/L, with significant differences (P < 0.001). There was a significant association between OME, delayed MCTt, ECP values in middle ear effusion and persistent symptoms of allergic rhinitis. These results suggest a direct involvement of the middle ear mucosa as a target organ in persistent forms.

Sensitisation to mites in a group of patients with asthma in Yaounde, Cameroon: a cross-sectional study

ObjectivesSensitisation of asthmatic patients to mites in sub-Saharan Africa has been less described. The aim of this study was to assess the prevalence and determinants of sensitisation to mites in...

Visual analogue scale in patients treated for allergic rhinitis: an observational prospective study in primary care

Allergic rhinitis (AR) severity is evaluated using scores such as Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ) and total symptom score (TSS). However, a simple assessment is needed to enable physicians to evaluate the severity of the AR and the efficacy of the treatment. The main objective was to validate visual analogue scale (VAS) as a simple quantitative tool to assess the burden of AR in primary care. The study was multi-centre prospective observational conducted in patients consulting general practitioners for symptomatic rhinitis. VAS, RQLQ and TSS6 were assessed at the consultation day and 14 days later, and changes were analysed using paired test. Correlations between VAS, RQLQ and TSS6 were assessed. Cut-off levels for VAS, which discriminate significant from insignificant changes, were established using Receiver Operating Characteristic curves. A total of 990 patients were included in the study. According to allergic rhinitis and its impact on asthma classification, mild intermittent rhinitis was diagnosed in 20% patients, mild persistent in 17%, moderate/severe intermittent in 15% and moderate/severe persistent in 48%, at the consultation day. At day-14, rhinitis symptoms and QoL improved significantly in almost all patients. Impairment incurred by AR and assessed with VAS improved also. The established cut-off variation of 23 mm for VAS was associated with a cut-off variation of 0.5 for RQLQ. Sensitivity analysis with RQLQ and TSS6 scales confirmed the aptitude of the cut-off value (23 mm) to discriminate changes in symptoms and QoL. The VAS can detect with high sensitivity the variations of symptoms and QoL in patients with AR.

Immunotherapy – 2066. A study on skin prick test patterns of atopic patients managed in a tertiary care setting of Sri Lanka

according to AREA classification 1 . Presence of coexisting Asthma and allergic conjunctivitis was documented. The severity of asthma was assessed using the GINA guidelines. Informed written consent was obtained by a member of the research team. SPT was performed using a panel of 19 allergens. Positive control was done using a standard solution of histamine and the negative was performed with glycerol buffer. The resultant induration was measured using a standard scale and recorded in millimeters. A wheel of 3 mm was considered as positive. The results were analyzed in percentages. Results We studied 25 males and 29 females. The age range of patients was from 09 to 68 yrs with a mean age of 33.5yrs. A positive reaction to at least one allergen was seen in 87.1% of patients. Intermittent Rhinitis was seen in 53.7% and persistent disease was seen in 46.3%. Moderate to severe disease was found in 72.2% and the rest had mild disease. Coexisting asthma was seen in 43.6% and conjunctivitis was seen in 29.6% of the study population. The results of SPT expressed in percentages showed, Dermatophagoides farina spp. 59.3%, Dermatophagoides pteronyssinus spp. 63%, Wheat Dust 33%, Cotton Gin 33%, Rice Dust 14%, Aspergillus flavus 18.5%, Aspergillus fumigates 7.4% Aspergillus niger 11.1%, Aspergillus glaucus/amstelodami 11%, Tricho. mentagrophytes 7.4%, Candida spp. 18.5%, Cladosporum herbarium 11%, Epidermo floccosum 22.2%, German Cockroach 51.9%, American Cockroach 40.7%, Bermuda Grass 11%, Red Mulberry 7.4%, White Mulberry 11.1% and Acacia 3.7% positivity.

Severity Assessment of Japanese Cedar Pollinosis Using the Practical Guideline for the Management of Allergic Rhinitis in Japan and the Allergic Rhinitis and its Impact on Asthma Guideline

This study intended to assess the severity of Japanese cedar pollinosis using the Practical Guideline for the Management of Allergic Rhinitis in Japan (PG-MARJ) and the Allergic Rhinitis and its Impact on Asthma (ARIA) Guideline. An Internet questionnaire survey of patients with pollinosis was conducted in mid-May 2011 and responses were obtained from 3382 individuals who had potential symptoms of Japanese cedar pollinosis from February to early May 2011 and who had experienced such symptoms for at least two pollen seasons. According to PG-MARJ, 23.5% of the respondents had severest rhinitis, 29.4% severe rhinitis, 31.3% moderate rhinitis, 13.8% mild rhinitis and 2.0% asymptomatic rhinitis. According to ARIA, 67.2% of them had moderate/severe persistent rhinitis, 23.8% moderate/severe intermittent rhinitis, 4.4% mild persistent rhinitis and 4.6% mild intermittent rhinitis. Moderate to severe rhinitis was diagnosed in more than 80% of the respondents according to PG-MARJ, while moderate/severe rhinitis was diagnosed in more than 90% of the respondents according to ARIA. Most of the respondents suffered relatively severe pollinosis. More than 80% of the respondents had all the three major symptoms (i.e., sneezing, rhinorrhea and nasal blockage). Disagreement in the severity assessment between the two guidelines was noted in approximately 20% of the respondents.

Impact of Allergic Rhinitis Symptoms on Quality of Life in Primary Care

Background: Allergic rhinitis (AR) impairs quality of life (QoL), sleep and work. The Allergic Rhinitis and its Impact on Asthma (ARIA) classification is widely used, but the impact of the different symptoms on QoL is not clear. Objective: To describe characteristics of patients consulting in primary care for AR and to study the impact of AR symptoms and the ARIA classes on QoL. Methods: A multicenter prospective observational cross-sectional study assessed the visual analogue scale (VAS) in the management of AR in 990 patients consulting general practitioners for AR. Patients were classified according to the four classes of ARIA. VAS, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and total symptom score (TSS) for nasal and non-nasal symptoms were evaluated. VAS and TSS measures were compared with RQLQ. Results: Mild intermittent rhinitis was diagnosed in 20% of patients, mild persistent rhinitis in 17%, moderate/severe intermittent rhinitis in 15% and moderate/severe persistent rhinitis in 48%. The presence of treatments did not affect VAS levels. Both severity and duration of rhinitis had an impact on QoL and VAS levels. Ocular symptoms (OR: 2.78, 95% CI: 1.965–3.939) including eyelid edema (OR: 2.07, 95% CI: 1.274–3.360) and asthenia (OR: 2.73, 95% CI: 1.922–3.877) had more impact on RQLQ than nasal obstruction (OR: 1.61, 95% CI: 1.078–2.405) and nasal pruritus (OR 1.45, 95% CI: 1.028–2.042). Sneezing and rhinorrhea did not impact RQLQ. Conclusions: This study confirmed that ocular symptoms and, to a lesser degree, nasal obstruction and pruritus have a significant impact on QoL.

The complex link between severity of asthma and rhinitis in mite allergic patients

The aim of the study was to evaluate the link between the severity of upper and lower airways diseases in mite allergic patients with respiratory allergy. A multicentre, observational, cross-sectional study was carried out in 556 consecutively enrolled mite allergic patients with rhinitis and asthma comorbidity attending a specialist unit. Severity assessment of rhinitis and asthma was evaluated in accordance with ARIA and GINA guidelines. Reliable data were available for 518 patients. The distribution of rhinitis severity was: 15.6% mild intermittent rhinitis, 4.4% moderate-severe intermittent rhinitis, 30.3% mild persistent rhinitis and 49.6% moderate persistent rhinitis. The distribution of asthma severity was: 41.3% mild intermittent asthma, 14.3% mild persistent asthma, 19.1% moderate persistent asthma and 25.3% severe persistent asthma. In patients with moderate-severe persistent rhinitis (49.5%) a significant trend (p = 0.005) was found pointing to an increased link with asthma severity. A link between respective severities of rhinitis and asthma was found in only half of mite allergic patients with rhinitis and asthma.

DIRAE study: Seasonal allergic rhinitis distribution in Spain

BackgroundNational epidemiological study to observe if among patients with pollinic seasonal allergic rhinitis (SAR), there are differences between those visited by primary care physicians (GPs) or allergists (ALs). Methods758 and 739 adults were recruited respectively by GPs and ALs. The physicians filled in a questionnaire: ARIA classification, prescribed treatment, and asthma incidence. The patient completed a visual analogical scale (VAS) to evaluate the severity of the rhinitis. Rhinitis control (controlled, partially controlled, and not controlled) was assessed by physician and patient. ResultsNo significant differences were found among patients visited by GPs or ALs concerning the ARIA classification and rhinitis severity. Treatment with oral antihistamines was 92.3% and 89.3% for GPs and ALs, respectively. The use of nasal corticosteroids was 76.7% and 60.4% for GP and AL patients, respectively. 31.9% of the patients visited by the ALs were treated with immunotherapy. The use of alternative medicine was 10.9% and 7.6% in GP and AL patients, respectively. The perception of “controlled” rhinitis was similar among patients (40.0%) and doctors (40.1%), although patients referred differences depending if they were visited by GP (44.8%) or AL (34.9%). Asthma prevalence was higher in those who suffered persistent as compared to intermittent rhinitis (OR=1.81, 95% CI: 1.39–2.36, p<0.001), and moderate/severe vs. mild rhinitis (OR=1.68, 95% CI: 1.05–2.68, p=0.029). ConclusionThe patients with pollinic SAR visited by GPs or ALs show no differences in severity. Less than half of the patients can be considered as “controlled”.

Storage mite sensitisation is associated with early life village residence in Turkey

BackgroundStorage mites (SMs) occur in house-dust and the rate of sensitisation to them is high. We aimed to investigate if past and current living conditions are associated with the risk of SM sensitisation. MethodsIn total, 321 patients (70% females) aged 33.6±11.9 years (range: 14–68 years) were studied at our allergy unit between September 2009 and December 2010. Patients with persistent or intermittent rhinitis and/or asthma were included in the study. Skin prick tests (SPTs) for SMs (Lepidoglyphus destructor, Tyrophagus putrescentiae, and Acarus siro) and other common aeroallergens were performed. Demographic data and characteristics of the patients’ homes were assessed via a questionnaire. ResultsIn all, 102 (31.8%) patients were sensitised to ≥1 SM, of whom 43.1% were also sensitised to Dermatophagoides pteronyssinus. Comparison between the SPT-negative group (n=129) and the SM-positive only group (n=33) showed that having lived in a village during the first years of life was associated with SM sensitisation. Current place of residence was not significantly associated with any of the study variables. ConclusionsLiving conditions have been changing and SM sensitisation may be associated with a history of village residence. The high rate of SM sensitisation observed in the study population might indicate the necessity of including those mite species in SPT panels, but the clinical relevance of sensitisation remains unclear. The clinical importance of SM sensitisation in urban areas should be investigated further.

A prospective, open-label, non-comparative study of palivizumab prophylaxis in children at high risk of serious respiratory syncytial virus disease in the Russian Federation.

BackgroundRespiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTIs) in children globally. Predisposing conditions for the development of serious RSV disease include preterm infants and those with cardiopulmonary illness, including congenital heart disease (CHD) and bronchopulmonary dysplasia (BPD). No vaccine is currently approved for the prevention of RSV infection. It is recommended that children at high risk be prophylactically administered palivizumab, a monoclonal antibody that has been shown in a number of clinical studies to reduce hospitalization rates due to serious RSV infection. The objective of the current study was to determine the safety and effectiveness of palivizumab in preventing serious RSV disease in high-risk children in the Russian Federation. Children at high risk of serious RSV disease (ie, born at ≤35 wk gestational age and ≤6 mo of age, and/or aged ≤24 mo with BPD or hemodynamically significant CHD) were enrolled. Subjects were to receive 3 to 5 monthly injections of palivizumab 15 mg/kg (depending on the month of the initial injection) over the RSV season. The primary endpoint was RSV-related hospitalizations. Adverse events (AEs) were reported through 100 days following the final injection.ResultsOne hundred subjects received ≥1 injection of palivizumab; 94 completed their dosing schedule. There were no RSV hospitalizations or deaths. Six of 7 subjects hospitalized for respiratory/cardiac conditions had an RSV test, which was negative in all cases. Three non-serious AEs (acute intermittent rhinitis and rhinitis, 1 subject; atopic dermatitis, 1 subject) were considered possibly related to palivizumab. All other AEs were mild or moderate and considered not related/probably not related to palivizumab.ConclusionPalivizumab was generally well tolerated and effectively prevented serious RSV infection in a mixed population of high-risk children in the Russian Federation.Trial registrationClinicalTrials.gov: NCT01006629