Mild Rhinitis Research Articles

An ayurvedic approach to immunomodulation employing a green delivery of phytonutrients: A randomized, double-blind, placebo-controlled study on mild allergic rhinitis

Allergic rhinitis (AR) is a common disorder caused by immune system dysregulation. The present contribution describes a randomized, double-blind, placebo-controlled comparative evaluation of the influence of a unique food-grade co-delivery form of curcumin and ashwagandha extracts (CQAB) in comparison to a bioavailable curcumin formulation (CGM) and placebo employing healthy participants, (n = 96), characterized with mild AR. The subjective measurements (TNSS, BIS and POMS-SF questionnaires) clearly demonstrated the efficacy of CQAB over CGM in the alleviation of AR symptoms and hence the quality of life. Further, CQAB administration also showed significant modulation of biochemical parameters (significant decrease in Th2 cytokines, pro-inflammatory cytokines, CD4+/CD8+ ratio and IgE, and a significant increase in Th1 cytokines, anti-inflammatory cytokine IL-10 as well as for the immunoglobulins IgG, IgM, and IgA) in support of its improved immune-balancing effect, compared to CGM. Both CQAB and CGM were well tolerated without any adverse events.

Safety of immunotherapy with Alternaria alternata glutaraldehyde-polymerized allergen extract in adults and children.

Allergies to fungi, such as Alternaria alternata, are significant contributors to respiratory conditions like asthma and rhinitis. Immunotherapy with native A. alternata extracts often results in high rates of adverse reactions. This study evaluates the safety of immunotherapy using glutaraldehyde-polymerized A. alternata extracts in both pediatric and adult populations. This observational real-world study involved 738 patients (435 children and 303 adults) monosensitized to A. alternata or polysensitized together to other allergens. Patients received personalized immunotherapy containing polymerized A. alternata extract, either alone or in combination with other polymerized allergens. The concentration of each polymerized allergen in the therapeutic vaccine was 10,000 TU/mL. Side reactions were classified and recorded based on immediate and delayed onset, and their severity was graded according to the EAACI guidelines. All side reactions were expected and related to the intrinsic properties of allergens. The number of injections administered was 7392, with 4137 to children and 3255 to adults. Thirteen relevant local reactions (0.24% in children, 0.09% in adults) and seven systemic reactions (0.09% overall) were observed. Systemic reactions included mild to moderate symptoms, such as mild bronchospasm and rhinitis. Severe reactions were not reported. Immunotherapy with glutaraldehyde-polymerized A. alternata, alone or in combination with other polymerized allergens, is safe and well-tolerated in both children and adults. The polymerized extracts allow for higher concentrations and faster administration schedules, providing an effective treatment option for patients with fungal allergies, including those polysensitized to multiple allergens.

Serum IgE levels and absolute eosinophil counts with treatment response in patients with allergic rhinitis: A prospective study

: Allergic rhinitis (AR) is a highly prevalent, chronic disease, with variable incidence rates. Clinically manifests as nasal discharge, congestion, nasal itching, sneezing and watery eyes. Treatment approach is based on duration and severity of symptoms. Second generation antihistamines are the drug of choice. Serum Ig E and Absolute Eosinophil Counts (AEC) have the potential to be the viable prognostic markers. The present study aims to assess the relationship of Serum IgE and AEC with treatment response in patients with allergic rhinitis.40 patients of allergic rhinitis were included in the study and were categorized into mild, moderate and severe allergic rhinitis according to ARIA guidelines. Pre-treatment sample for serum IgE and AEC was taken followed by 4 weeks of medical management according to categories. Post- treatment sample was taken and improvement assessed on the basis of fall in serum IgE and AEC levels.A total 40 patients were enrolled ranging from 14-60 years of age (mean age 28.75±11.23years) with female preponderance (52.5%). Most common presenting symptom being sneezing. Significant decline in pre-treatment AEC and serum IgE levels was observed.The findings of the study indicates that treatment response had an association with AEC and Serum IgE levels.

Repurposing Anticancer Drugs Targeting the MAPK/ERK Signaling Pathway for the Treatment of Respiratory Virus Infections.

Respiratory virus infections remain a significant challenge to human health and the social economy. The symptoms range from mild rhinitis and nasal congestion to severe lower respiratory tract dysfunction and even mortality. The efficacy of therapeutic drugs targeting respiratory viruses varies, depending upon infection time and the drug resistance engendered by a high frequency of viral genome mutations, necessitating the development of new strategies. The MAPK/ERK pathway that was well delineated in the 1980s represents a classical signaling cascade, essential for cell proliferation, survival, and differentiation. Since this pathway is constitutively activated in many cancers by oncogenes, several drugs inhibiting Raf/MEK/ERK have been developed and currently used in anticancer treatment. Two decades ago, it was reported that viruses such as HIV and influenza viruses could exploit the host cellular MAPK/ERK pathway for their replication. Thus, it would be feasible to repurpose this category of the pathway inhibitors for the treatment of respiratory viral infections. The advantage is that the host genes are not easy to mutate such that the drug resistance rarely occurs during short-period treatment of viruses. Therefore, in this review we will summarize the research progress on the role of the MAPK/ERK pathway in respiratory virus amplification and discuss the potential of the pathway inhibitors (MEK inhibitors) in the treatment of respiratory viral infections.

Evaluation of Clinical Communication in Pharmacy Undergraduates in Brazil: A Multicentric Study

ObjectiveTo assess the clinical communication characteristics of pharmacy undergraduates, estimate differences in this specific competency, and produce recommendations for further education and training. MethodsAnalysis of communication competence between 110 pharmacy students in the last graduation year from each of the 5 Brazilian regions and a simulated patient with complaints of mild allergic rhinitis passive of resolution with non-prescription medicines. The simulated appointment was recorded, and the video was analyzed using the 2 main elements: biomedical/task-focused and socio-emotional exchange of the Roter Interaction Analysis System. ResultsThe total of utterances/speech from the pharmacist to the patient was 183.4; there was a statistically significant difference according to the Brazilian region. In the consultation, the frequency with which pharmacy students returned to the segment was evaluated, with a total mean clinical history segment 2 of mean 5.60; in segment 4, which is the counseling phase, an average of 4.80. In the task codes and the socio-emotional codes, there was a statistically significant difference between the codes when compared by region. We compare by sex because it is said that women talk more than men. There was a statistically significant difference in socio-emotional code and biomedical/focused and task being higher for women. ConclusionThe level of communication competence of students should be that desired for graduation, in all regions. There seems to be a difference between training and level of competence. Considering gender, although the consultation time is similar, it appears that the quality of communication is higher for women.

Evaluating Positional Obstructive Sleep Apnea in Children: Prevalence, Characteristics, and Risk Factors.

This study investigates the prevalence, risk factors, and clinical characteristics of positional obstructive sleep apnea (POSA) among pediatric patients diagnosed with obstructive sleep apnea (OSA). A total of 1,236 children aged 0 to 17 years who underwent nocturnal polysomnography (PSG) and completed the Sleep Questionnaire were included. After excluding those with an AHI <1, neurological or muscular disorders, or insufficient sleep time in specific positions, 908 patients remained: 158 with POSA and 750 with non-positional OSA (NPOSA). Propensity score matching (PSM) was applied at a 1:2 ratio, resulting in a final sample of 153 POSA and 306 NPOSA patients. Data analyses were performed using R software (version 4.2.3). The prevalence of POSA was 12.8%. After PSM, patients with POSA had a lower overall AHI (8.66 vs 10.30), REM-AHI (14.30 vs 17.40), and NREM-AHI (7.43 vs 8.77) compared to those with NPOSA. POSA patients also had a shorter total sleep time (411 vs 427minutes), spent less time in the supine position (168 vs 225minutes), and more time in non-supine positions (241 vs 202minutes) than NPOSA patients. Additionally, while the supine AHI was higher in POSA patients (15.60 vs 10.30), the non-supine AHI was lower (5.00 vs 11.00) compared to NPOSA patients. The minimum oxygen saturation was slightly higher in POSA patients (0.88 vs 0.87). All differences were statistically significant (P < 0.05). Risk factors for POSA included mild OSA, allergic rhinitis, non-allergic rhinitis, and obesity. The prevalence of POSA in children is lower than in adults, and its severity is less than that of NPOSA. Compared to NPOSA patients, POSA patients had significantly higher AHI during supine sleep and lower AHI during non-supine sleep. POSA patients also spent more time in non-supine positions, suggesting that avoiding supine sleep may help reduce apnea events. These findings highlight the importance of monitoring and managing sleep posture in POSA patients.

The Relationship between Serum Vitamin D Levels with Allergic Rhinitis Incidence and Total Nasal Symptom Score in Allergic Rhinitis Patients

Background: There is a correlation between allergies and insufficiency in 25-Hydroxyvitamin D. However, there exists a scarcity of studies that have investigated the measurement of Vitamin D levels association with allergic rhinitis. Objective: To assess the correlation between serum vitamin D levels and the occurrence of allergic rhinitis, as well as the overall nasal symptom score in individuals with allergic rhinitis. Study Design: Cross sectional study. Settings: Department of ENT, Abbas Institute of Medical Sciences, Muzaffarabad Pakistan. Duration: January 2022 to June 2022. Methods: The study included all individuals diagnosed with AR, who received treatment and were monitored. The exclusion criteria employed in this study encompassed several categories. Firstly, pediatric patients were excluded from the analysis. Secondly, patients with insufficient follow-up data were also excluded. Results: There were 34.67% male and 65.33% were female. In age groups, 54.67% were aged 19-39, 25.33% were aged 40-59, 12% were aged 60-70, and 6.67% were over 70. Almost 74.67% had low Vitamin D levels, 20% had normal levels, and 5.33% had high levels. About 17.33% had intermittent symptoms, while the majority (82.67%) had persistent symptoms. In terms of TNSS, 44% had mild symptoms, while 56% had moderate to severe symptoms. Results showed a strong relationship between Vitamin D levels and the severity of nasal symptoms in individuals with allergic rhinitis. The P-value of &lt;0.001 indicates a highly significant difference. Specifically, those with mild allergic rhinitis had notably higher Vitamin D levels (22.42±3.87 ng/ml) compared to those with moderate to severe symptoms (15.31±2.64 ng/ml). Conclusion: In this research, we investigated the connection between vitamin D insufficiency and allergic rhinitis (AR). We detected a meaningful association between vitamin D insufficiency and increased eosinophil counts, while there was no significant correlation with serum IgE levels.

A multicomponent nutraceutical (&lt;i&gt;Perilla frutescens&lt;/i&gt;, quercetin, and vitamin D3) as add-on therapy in patients with grass pollen-induced mild persistent asthma and rhinitis

Background Allergic asthma is an inflammatory disease characterized by a type 2 immune response. Pollens are a common cause of seasonal asthma. Allergic rhinitis (AR) frequently associates with asthma. The treatment usually aims at controlling inflammation and relieving symptoms. Inhaled corticosteroids are the most effective controller and short-acting b2-agonists (SABA) as a reliever for asthma. Oral antihistamines and nasal corticosteroids (NC) are the mainstays for AR. A multicomponent nutraceutical containing perilla, quercetin, and vitamin D3 significantly prevented AR exacerbations in children. Thus, the current study explored the add-on use in adult patients with mild persistent asthma and AR due to grass pollen allergy.&#x0D; Methods The treatment lasted three months. Asthma and AR symptoms, asthma control test, spirometry, nasal eosinophils, and use of rescue medications (SABA and NC) were evaluated in the previous grass season and throughout the treatment. All patients were treated with ciclesonide (320 mcg/day) and cetirizine (10 mg/day). Patients were randomly stratified into Group A, taking the nutraceutical, and Group B using the predetermined therapy.&#x0D; Results 90 patients (13-59 years old) were enrolled, and 84 completed the trial. Group A significantly improved all outcomes (p&lt;0.001). Group B did not achieve an improvement in AR symptoms, nasal eosinophils, and nasal steroid use. The intergroup analysis showed that Group A patients experienced less severe bronchial symptoms (- 32 %), AR symptoms (- 39 %), better asthma control (+ 38 %), higher FEV1 (+ 10 %), lower SABA (- 30 %) and NC use (- 41 %), and nasal eosinophils count (- 35 %) than Group B (p&lt;0.0001 for all).&#x0D; No clinically relevant adverse events occurred.&#x0D; Conclusion A multicomponent nutraceutical containing perilla, quercetin, and vitamin D3, as an add-on treatment to inhaled ciclesonide and cetirizine, provided a clinically relevant benefit in patients with mild persistent asthma and AR due to grass pollen uncontrolled by standard therapy.

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.

Evaluation of local nasal immunotherapy to Dermatophagoides sp. in patients with allergic rhinitis

Introduction: The aim of this study was to evaluate the clinical efficacy of allergen-specific nasal immunotherapy (LNIT) by observing the improvement in the patient’s quality of life, and the side effects of this route of immunotherapy. Methods: From a cohort of 2687 patients with perennial rhinitis treated at the Clinical and Experimental Immunology Service-Hospital Geral-Santa Casa da Misericórdia do Rio de Janeiro for 5 years, a total of one hundred thirty six patients positive in the prick test for Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df), were divided into two groups of cases (n=108) and controls (n=28) undergoing or not LNIT, both submitted to the same type of control treatment for the same amount of time. Both groups were classified into mild, moderate and severe rhinitis. Quality of life was assessed based on a questionnaire for Rhinoconjunctivitis, carried out at each visit, with a rating from 0 to 6 according to the increasing degree of difficulty in performing common tasks or nasal, ocular or other symptoms. Results: No systemic side effects or bronchospasms were observed in the cases. Both patients and controls with moderate and severe rhinitis had quality of life grades 3 and 4; 5 and 6 respectively, before immunotherapy. Comparison of cases with controls during the controller medication phase associated with nasal immunotherapy (cases) showed an improvement in quality of life for both (Grades: 0-2, after 5 weeks). Full use of the controller medication was 15 weeks followed by more eighteen weeks with half doses. Patients under LNIT, when the control medication was withdrawn after the sixth series of nasal immunotherapy, maintained the improvement in quality of life with grades of 0-1, not requiring regular and frequent use of symptomatic therapy. Until the final evaluation time, three years and two months, the patients who remained until the end of the immunotherapy regimen (n=89) did not present or significantly reduced the need for control medication, remaining with a degree of quality of life: Degree: 0 and 1.The controls, in the period of 33 weeks of return for consultations, with the withdrawal of the controller medication, reported that they needed the frequent use of controller medicines due to the recurrence of symptoms. The quality of life questionnaire showed a worsening, with grades ranging from 3 to 5, when evaluated in this phase without regular symptomatic medication. Conclusions: The of LNIT performed with full concentrations, did not show secondary reactions with risks to patients and that the effect of inducing tolerance to the antigens of Dermatophagoides sp. was achieved, based on the observation of the decrease in the use of control medications for signs and symptoms and mainly by the improvement in the patients’ quality of life.

Allergic bronchopulmonary aspergillosis in identical twins: Effectiveness of dupilumab

Allergic bronchopulmonary aspergillosis in identical twins: Effectiveness of dupilumab

Diamine Oxidase Activity Deficit and Idiopathic Rhinitis: A New Subgroup of Non-Allergic Rhinitis?

Idiopathic rhinitis represents more than 50% of non-allergic rhinitis, a heterogeneous group that involves the symptomatic inflammation of the nasal mucosa. The TRPV1 receptor of unmyelinated C-type neurons appears to be involved in its pathophysiology. Histamine, whose main catabolic enzyme is DAO, is one of the mediators that can activate this receptor. The failure of DAO causes an increase in the level of histamine in the body and, consequently, the activation of TRPV1. The objective was to investigate the existence of a DAO enzyme activity deficit in idiopathic rhinitis and its correlation with symptoms. A cross-sectional study was conducted in 116 idiopathic rhinitis patients, and DAO activity, nasal peak inspiratory flow, and rhinitis severity were recorded. The prevalence of a DAO activity deficit was 41.38% (95%CI 0.33−0.50; p = 0.05). The DAO activity in patients with mild rhinitis was 52.93 ± 8.72 HDU/mL, in those with moderate rhinitis it was 120.33 ± 71.63 HDU/mL, and in those with severe rhinitis it was 92.58 ± 27.75 HDU/mL (p = 0.006). The NPIF in patients with a DAO activity deficit was 107.92 ± 34.05 L/min, compared to 72.35 ± 27.16 L/min in patients with normal enzymatic activity (p < 0.001), demonstrating a linear correlation between activity levels and nasal obstruction (−0.45; p < 0.001). Therefore, patients with a DAO deficiency and idiopathic rhinitis could present a milder disease course, because the repeated and continuous activation of TRPV1 led to a partial or total decrease in their response (desensitization). This new theory represents a different perspective for the study of idiopathic rhinitis and its relationship with TRPV1, with the regulation or modulation of the desensitization of TRPV1 being an important therapeutic target for patients with idiopathic rhinitis in the future.

POLLEN INDUCED ANAPYLAXIS THROUGH SKIN ABRASION

<h3>Introduction</h3> Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast cell- and basophil-derived mediators into the circulation. We present an unusual case of anaphylaxis to pollen exposure through abraded skin secondary to a skateboard accident. <h3>Case Description</h3> A 19- year-old women with past medical history of mild allergic rhinitis treated with OTC antihistamines as needed had a skate board accident that led to large abrasion" road rash" on the right posterior thigh and buttocks. She notices the abrasion occurred on ground where there was a significant degree of pollen dust which contaminated her abrasion significantly. One hour later, she developed diffuse urticaria, dyspnea and wheezing. She went to emergency room and was treated with epinephrine intramuscular injection, methylprednisolone, diphenhydramine IV and albuterol. She was admitted overnight for observation with no biphasic reaction. No clear source for the anaphylaxis was immediately noted as there had been no new foods, medications, insect sting or history of exercise induced anaphylaxis. On subsequent evaluation she was found to have markedly elevated timothy grass pollen IgE (96.7 kU/L) known to be pollinating at the time. <h3>Discussion</h3> Grass pollens hypersensitivity is common allergic rhinitis trigger, however, anaphylaxis from exposure via a skin abrasion is not reported to the best of our knowledge. We would like to draw attention that grass pollen sensitization as a potential source of anaphylaxis following exposure to the blood stream via significant abraded skin.

Effects of Topical Application and Oral Intake of Rosa damascena on Acute Pain in Adults: A Systematic Review and Meta-analysis.

ObjectivesTo conduct a systematic review and meta-analysis of available studies regarding the effects of the traditional herb Rosa damascena (as topical application and oral intake) on the severity of acute pain in adults.MethodsA systematic search was performed on the following databases: Cochrane Central Register of Controlled Trials, PubMed, Scopus, Web of Science Core Collection, Embase, Cumulative Index to Nursing and Allied Health Literature, Scientific Information Database, and Magiran from inception to 20 March 2021. We included parallel-group and cross-over randomized controlled trials that compared the effects of any products containing R damascena in oral and topical administration forms to placebo, non-treatment, or conventional treatment. Two researchers independently performed the document screening and selection, data extraction, and risk of bias assessment. A random-effect model was used to pool the data.ResultsFrom a total of 11 studies that met the inclusion criteria, four studies administered R damascena through topical application and seven by oral intake. Nine studies recruited only females. Ten studies had parallel-group design, while one adopted cross-over design. The oral intake of Rdamascena reduced pain severity non-significantly (standardized mean difference (SMD) = -0.55, 95% CI: -1.27–0.17; p =0.132). However, the topical application of this treatment had no pain-alleviating effect (SMD = 0.10, 95% CI: -0.75–0.96; p =0.814). One study reported mild allergic rhinitis as an adverse effect of the treatment. Risk of bias assessment revealed that three of the eleven studies had good methodological quality, six had fair quality, and two were of poor quality.ConclusionsThis systematic review and meta-analysis suggests that the oral intake of R damascena may have a non-significant alleviating effect on acute pain severity in adults. However, its topical application has not shown pain-alleviating effect. More robust randomized controlled trials are needed for accurate estimation of the effects of oral and topical use of R damascena on the severity of different types of acute pain in adults.

Canine sporotrichosis: Case report

Sporotrichosis is a fungal zoonosis that can affect several species of animals. The present report refers to a 1-year-old female Shih-tzu dog, domiciled, who presented nasal swelling with depigmentation, serosanguineous secretion, sneezing and inspiratory dyspnea. After ruling out the suspicion of neoplasia by histopathology, which showed a result compatible with mild lymphoplasmacytic rhinitis, the patient was referred for consultation with an immunologist. To carry out a differential diagnosis, he went to the São Paulo Zoonoses Surveillance Division, where material was collected from the nostrils using a swab for fungal culture, positive for Sporothrix spp. The dog had no history of contact with animals with sporotrichosis, and the main suspicion of infection was through the soil of a potted plant, located in the residence. Treatment was performed with Itraconazole 10 mg/kg SID for 11 weeks, and continued for another 10 weeks after complete remission of the lesion. After 2 weeks of antifungal suspension, the animal returned with increased nasal volume and dyspnea, requiring resumption of treatment with itraconazole, with total remission of the lesion after 12 weeks. Veterinarians must be aware of the epidemiological context of the region and incorporate sporotrichosis into their routine as a differential diagnosis in cases in which the patient presents skin lesions and follow the patient after treatment is discontinued to assess recurrence.

The neurological complications after covid-19 in children

Studies have shown that during the pandemic period, children under 5 years of age accounted for 1.8% of COVID-19 cases. After covid complications are now a major concern and represent a new disease entity known as PIMS and MIS-C. Many studies have been conducted on the pathomechanism of the virus and the clinical manifestations it causes in adults, including neurological complications.&#x0D; Symptoms are mainly associated with central and peripheral neurological disorders, ranging from mild (headache, fever, cough, pharyngitis, rhinitis and anosmia) to severe (stroke or Guillain-Barré syndrome). Dyspnoea or respiratory failure is seen in approximately 11.7% of young patients. Although SARS-CoV-2 mainly occupies the respiratory system, about 10% report gastrointestinal symptoms. CT abnormalities of the chest of children are less frequent and milder than in adults, and include opacities of frosted glass and patchy shadows. In many cases, elevated CK-MB levels have also been noted, indicating possible myocardial damage.&#x0D; Children and adolescents contribute to an increasing proportion of all Covid-19 cases. It can be due to the emergence of highly infectious variants of the virus. Many drugs have been tried in children both antiviral, antimalarial, corticosteroids and intravenous immunoglobulin or selective cytokine brokers. The only effective method of prophylaxis is two doses of BNT162b2 vaccine given 21 days apart.

SARS-CoV-2 Omicron variant causes mild pathology in the upper and lower respiratory tract of hamsters

Since its discovery in 2019, multiple variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been identified. This study investigates virus spread and associated pathology in the upper and lower respiratory tracts of Syrian golden hamsters at 4 days post intranasal SARS-CoV-2 Omicron infection, in comparison to infection with variants of concern (VOCs) Gamma and Delta as well as ancestral strain 614 G. Pathological changes in the upper and lower respiratory tract of VOC Omicron infected hamsters are milder than those caused by other investigated strains. VOC Omicron infection causes a mild rhinitis with little involvement of the olfactory epithelium and minimal lesions in the lung, with frequent sparing of the alveolar compartment. Similarly, viral antigen, RNA and infectious virus titers are lower in respiratory tissues of VOC Omicron infected hamsters. These findings demonstrate that the variant has a decreased pathogenicity for the upper and lower respiratory tract of hamsters.

Serodominance Profile in a Dust Mite Complex Region

Background/Objective: The objective of this study was to describe the molecular sensitization profile of mite allergy in an area with a high environmental exposure of house dust mites (HDM) and storage mites. Methods: Skin prick tests were performed with standardized extracts (DIATER, Madrid, Spain). A specific commercial molecular panel (MADx) for Dermatophagoides pteronyssinus (Dpt), Dermatophagoides farinae (Dfar), Lepidoglyphus destructor (Ldt), Tyrophagus putrescentiae (Tput), and Blomia tropicalis (Blot) was correlated with clinical parameters in Galician (northwestern of Spain) HDM allergic patients. Results: Fifty patients (60% female) met the inclusion and exclusion criteria. All of the patient’s present rhinitis (50), 28% (14) rhinitis and asthma, and 18% (9) atopic dermatitis (AD). Hundred patients had a positive prick test for Dpt, followed by Dfar (92%), Ldt and Tput (74%), and Blot (68%). More than 50% recognized specific IgE for Der p 1, Der p 2, reaching 86% in the case of Der p 23. No statistically significant differences in IgE levels were found between patients with/without asthma and those with mild or moderate-severe rhinitis. Der p 7 was higher among rhinitis patients (p value 0.05). AD relative risk (RR) was increased in patients sensitized to Der f 2, Der p 2, and Der p 23. Der p 10 decreases the risk to have AD (RR 0.80). Conclusion: The evaluation of IgE results in a comprehensive panel of allergens allows differentiation of serological reactivity profiles with their clinical expression, to perform an optimal management. Improvements in component resolved diagnosis and more research on the clinical relevance of mite allergens are needed to achieve a genuine diagnosis leading to specific immunotherapy.

Improvement of inattentive and hyperactive symptoms after real-life rhinitis treatment in school-aged children

ObjectivesRhinitis treatment may improve attention-deficit/hyperactivity symptoms in children. The current study evaluated changes in inattentive and hyperactive symptoms after treatment in children with chronic rhinitis. MethodsChildren aged 5–18 years with chronic rhinitis were enrolled in a 3-month prospective study. The nasal provocation test for house dust mites (HDM) and evaluation of allergen sensitization, including the skin prick test and the Phadiatop test, were performed. The severity of rhinitis was assessed according to the ARIA guideline. The total nasal symptom score and the Vanderbilt ADHD Diagnostic Rating Scale (VADRS) score for assessing inattentive and hyperactive symptoms were recorded at baseline and at 1 and 3 months after rhinitis treatment. Children with rhinitis were classified into the following two groups: HDM-induced allergic rhinitis (AR group) and non-allergic rhinitis to HDM (NAR group) based on the NPT. ResultsOverall, 83 children completed the 3-month prospective study, and they had a mean age of 9.12 ± 2.89 years and 44.6% were boys. After rhinitis treatment, VADRS scores assessed by the parents and teachers were significantly decreased compared with those at baseline (p = 0.005). In subgroup analysis, 61 (73.49%) children had AR, and 22 (26.5%) children had NAR. No significant difference in the baseline VADRS score was found between the AR and NAR groups. After treatment, VADRS scores assessed by the parents and teachers were significantly decreased only in the AR group (p < 0.001). Forty-five (54.2%) children had moderate persistent rhinitis, 29 (34.9%) had mild persistent rhinitis, and 9 (10.8%) had mild intermittent symptoms. There were no differences in baseline VADRS scores assessed by the parents and teachers among children with mild intermittent, mild persistent, or moderate persistent symptoms. The total nasal symptom score and VADRS score were significantly decreased after treatment for all severities of rhinitis compared with those at baseline. A greater baseline VADRS score was associated with substantial improvement of inattentive and hyperactive symptoms after treatment. ConclusionEarly treatment for rhinitis may improve inattentive and hyperactive symptoms in school-aged children.

Allergic rhinitis in children: a comprehensive approach to treatment

Prevalence of allergic rhinitis among chronic upper respiratory diseases in pediatrics is one of highest. Beside anti-inflammatory drugs (topical steroids, antileukotrienes, antihistamines), reliever therapies are important too in treatment of allergic rhinitis. Decongestant prescription in children should lasts no more than 7–10 days; combination of alpha1-adrenomimetic with topical antihistamines is one of possible ways to improve the efficacy, for example, the combination of dimetindene maleate with phenylephrine as nasal drops. We present the results of retrospective evaluation of 625 patients aged from 0 to 17 years with allergic rhinitis, diagnosed not less than 12 month ago. Among examined group, mild allergic rhinitis prevalence was 56.9%, moderate 37.2% and severe 5.9%. During the year all patients experienced 1754 exacerbations (on average, 2.79 ± 1.13 exacerbations per patient). Contact with allergen (35.3%) and respiratory infections (28.8%) were more prevalent reasons of exacerbation; non-specific trigger provocation (pungent smells, air humidity or temperature change etc.) (19.8%) and unknown reason (16.4%) of allerhttps://doi.org/10.21518/2079-701X-2022-16-1-184-189 gic rhinitis exacerbation were less prevalent. When treated with combined nasal drops of dimetindene maleate and phenylephrine median [Q25; Q75] duration of exacerbation was a bit shorter 7.94 [6.25; 17.15] days, than using other decongestants, but difference was statistically insignificant. Combined nasal drops were maximal clinically efficient among patients under 12 years old with exacerbations, caused by allergens contacts. We did not register any adverse events caused by decongestant treatment, during our study. Patients with allergic rhinitis should be provided with written action plan for the disease exacerbation. Using as reliever therapy combined nasal drops (dimetindene maleate and phenylephrine) registered for patients from 1 year old, decrease number of medicines and reduce allergic rhinitis exacerbations duration.