Nasal Pruritus Research Articles

Altered expression of long noncoding RNAs regulating neutrophilic inflammation in peripheral blood was associated with symptom severity in patients with house dust mite-induced allergic rhinitis.

Long noncoding RNAs (lncRNAs) have been implicated in a diverse array of human immune diseases; however, a comprehensive understanding of the expression and function of lncRNAs in the peripheral blood leukocytes of individuals suffering from house dust mite (HDM)-induced allergic rhinitis (AR) remains elusive. To explore the potential roles and functions of long noncoding RNAs (lncRNAs) in the pathogenesis of AR. Sequencing analysis was performed on peripheral blood leukocytes collected from patients with HDM-induced AR and healthy controls (HCs) to elucidate the expression patterns of lncRNAs. Differentially expressed (DE) lncRNAs were identified and validated, and further correlation analyses were conducted to explore their associations with visual analog scale (VAS) scores and cytokine levels in the serum and nasal secretions. Additionally, bioinformatics analyses were performed to predict the potential pathways influenced by DE lncRNAs. Finally, the diagnostic potential of these lncRNAs in AR was assessed via receiver operating characteristic (ROC) curve analysis. Significant differences in the expression profiles of lncRNAs and mRNAs were detected between AR patients and HCs. Four lncRNAs were markedly upregulated in AR patients. AC011524.2 was positively correlated with nasal pruritus (r = 0.4492, P = 0.0411). AL133371.3 was positively correlated with runny nose (r = 0.4889, P = 0.0245). AC011524.2 was positively correlated with CXCL8 (r = 0.4504, P = 0.0035). AL133371.3 was significantly positively correlated with only IL-17 (r = 0.4028, P = 0.0100). IL-4 in the serum was positively related to IL-17 in the serum (r = 0.4163, P = 0.0002). CXCL5 in the serum was positively correlated with IFN-γ (r = 0.3336, P = 0.0354) in nasal secretions. The area under the curve (AUC) of the ROC curve resulting from the integration of the 4 lncRNAs exhibited a remarkable value of 0.940 for AR diagnosis. Our results identified several lncRNAs associated with AR symptoms and inflammatory cytokines. Specifically, AC011524.2 and AL133371.3 exhibited strong correlations with diverse AR manifestations and serum cytokines, suggesting their pivotal role in the pathogenesis of AR, likely via neutrophil- and Th17-related pathways. However, the precise underlying mechanisms are still elusive, necessitating further exploration.

The burden of allergic rhinitis is undermanaged in a large proportion of Chinese young adults from Singapore

BackgroundAllergic rhinitis (AR) is a nasal disorder characterized by the simultaneous manifestation of at least 2 out of 4 possible symptoms: rhinorrhea, nasal itching, nasal pruritus, and sneezing. Presently, among Chinese young adults from Singapore, we characterised AR phenotypes, established Total Nasal Symptom Score (TNSS) baselines, and examined the management of AR. MethodsParticipants completed an investigator-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and underwent a skin prick test (SPT). Individuals exhibiting sensitization during the SPT while having at least 2 rhinitis symptoms were identified as AR cases, then categorized into Allergic Rhinitis in Asthma (ARIA) classifications. ResultsThere were 9323 subjects analyzed. AR prevalence was estimated at 35.4%. Rhinorrhea was perceived as the most severe (mean Nasal Symptom Score (mNSS) ± SD: 1.42 ± 0.74), while nasal pruritus was the least severe (mNSS ± SD: 1.24 ± 0.68). Among moderate-severe AR (68.1%), most were affected by either troublesome symptoms (27.7%) or sleep disturbances (18.4%). By ARIA classes, 26.6% were mild intermittent, 5.4% were mild persistent, 50.3% were moderate-severe intermittent, and 17.6% were moderate-severe persistent. The mean TNSS (mTNSS) of AR cases was 4.43 (SD = 2.49) and between AR classifications, the mTNSS was significantly different. Notably, a large proportion of AR cases remained undiagnosed (85.2%), untreated (72.5%), or both (65.4%); 19.8% self-medicated for AR. ConclusionsThere was a significant difference in TNSS of the AR phenotypes, and among phenotypes with a higher mTNSS, a large proportion remained untreated, undiagnosed, or both. The evidence indicates an existing burden of AR among Chinese young adults in Singapore which is notably undermanaged.

Do products containing menthol exacerbate allergic rhinitis? A narrative review.

The aim of this paper is to review whether products containing menthol exacerbate allergic rhinitis. A literature survey was performed on PubMed, Google and Google Scholar concerning allergic rhinitis (AR). Allergic rhinitis is an inflammatory condition of the nasal mucosa characterized by wheeze, congestion, nasal pruritus and discharge, or any combination thereof. Menthol is a naturally occurring phytochemical, with the formula C10H20O. The L-isomeric form creates the typical odor of peppermints and causes a sensation of coolness when applied to the skin or mucosae. Inhaling menthol vapor is known to affect the respiratory system in a number of different ways. The cooling agent, menthol, is also recognized as a trigger for asthma, AR and urticaria. The menthol molecule stimulates the TRPM8 receptor and may stimulate histamine release in a dose-dependent manner from RBL-2H3 cell cultures. The addition of menthol to products produces symptomatic relief in some patients by providing an impression of freer nasal air flow. It does this by stimulating cold receptors on branches of the fifth cranial nerve. Menthol is capable of provoking allergic hypersensitivity reactions and disorders, including asthma, AR and urticaria. It may also trigger an anaphylactic response. The use of menthol-containing products is best avoided in cases where an allergic disorder exists.

DIFFERENTIATION BETWEEN ALLERGIC AND NON-ALLERGIC RHINITIS IN CHILDREN WITH CHRONIC RHINITIS, ALLERGY CLINIC, PHRAMONGKUTKLAO HOSPITAL

Background: Chronic rhinitis in children is a common problem. Investigation to diagnose allergic rhinitis (AR) using a skin prick test for aeroallergens requires a specialist doctor, which is not simply performed in primary health care facilities. Therefore, diagnosing patients with AR and non-allergic rhinitis (NAR) is based on clinical symptoms essential for treatment planning. This study compared clinical symptoms between AR and NAR, comorbidities, disease severity, and common aeroallergen sensitization.
 Methods: A retrospective descriptive study was conducted among participants aged between 2-18 years with chronic rhinitis who were treated at the Department of Allergy and Immunology, Division of Pediatrics, Phramongkutklao Hospital, between 2014 and 2018. The medical records were reviewed on clinical symptoms, allergic test results, environmental data, and the severity according to Allergic Rhinitis and its Impact on Asthma (ARIA) classification. If the patient tested positive for aeroallergen, the allergist diagnosed AR. NAR is characterized by the same symptoms but with a negative skin prick test.
 Results: Three hundred and seven participants were included. Among these patients, 226 (73.6 %) were categorized as AR, and 81 (26.4%) were NAR. The AR group had a higher percentage of males than the NAR group. Nasal pruritus and ocular symptoms were more commonly found in AR than in NAR. Regarding comorbidities, both groups had similar snoring, sinusitis, asthma, and atopic dermatitis. The most common aeroallergens among AR patients were Dermatophagoides pteronyssinus (82.7%), Dermatophagoides farinae (81.4%), followed by American cockroaches (38.1%), and German cockroaches (37.6%). Cat owners were associated with cat sensitization in AR patients (OR =2.77; 95% CI = 1.27-5.88).
 Conclusions: In this study, the proportion of AR was higher than NAR. Nasal pruritus, ocular symptoms, or both strongly supported AR. The most common aeroallergen sensitization was house dust mites, followed by cockroaches. Initial treatment with antihistamine and other drugs can improve the severity of the disease.

Real-Life Effectiveness of Benralizumab, Mepolizumab and Omalizumab in Severe Allergic Asthma Associated with Nasal Polyps.

Biological therapies are available for the treatment of the severe allergic asthma (SAA) with blood eosinophil count ≥ 0.3 × 109/L. Several of them also showed benefits on nasal polyps (NP), one of the most frequent comorbidities of the severe asthma, but comparative studies on their effectiveness in the association SAA-NP are currently lacking. The aim of this study is to compare the effectiveness of benralizumab, mepolizumab and omalizumab in patients with SAA-NP in real-life settings. A retrospective, observational, multicenter real-life study was realized including patients with SAA-NP treated by benralizumab, mepolizumab or omalizumab for 6months. We analysed the nasal and respiratory symptoms, the number of asthma attacks and salbutamol use/week, acute sinusitis and severe exacerbation rates, the asthma control score, the lung function parameters, the NP endoscopic score, the sinus imaging and the blood eosinophil count 6months before and after treatment. Seventy-two patients with SAA-NP were included: 16 treated by benralizumab, 21 by mepolizumab and 35 by omalizumab. After 6months of treatment, almost all studied parameters were improved (except sinus imaging) with a greater effect of omalizumab on the nasal pruritus (p = 0.001) and more benefits of benralizumab on exacerbations rate, asthma attacks per week and lung function (all p < 0.05). Benralizumab and mepolizumab were more effective to improve the NP endoscopic score and the blood eosinophil count (both p < 0.001). All three biological therapies showed effectiveness by improving asthma and nasal outcomes in patients with SAA-NP. Several differences have been found that should be confirmed by larger comparative studies.

Impact of the COVID-19 national lockdown in the allergic rhinitis symptoms in patients treated with immunotherapy at two allergy referral centers in Bogotá, Colombia.

BackgroundCoronavirus disease‐19 (COVID‐19) “lockdowns” caused an abruptly restricted access to health care services such as immunotherapy for allergic rhinitis (AR) and led to higher exposure to indoor allergens. This study aimed to assess the impact of COVID‐19 lockdowns on AR symptoms reported by the patients treated with immunotherapy who attended the Hospital Fundación Santa Fe de Bogotá and Unidad Médico Quirúrgica de Otorrinolaringología, Colombia.MethodsPre–post study that included patients with AR confirmed diagnosis (prick test), treated with immunotherapy before and after COVID‐19 lockdowns on March–June 2020. Visual analog scales (VAS) and sociodemographic questionnaires were applied to assess AR symptoms (nasal obstruction, pruritus, rhinorrhea, and ocular symptoms) and their associated factors.ResultsA total of 318 participants were included, and their mean age was 18.9 years (SD: 12.8). The median number of immunotherapy doses applied before isolation was 11 (interquartile range [IQR]: 6–19), and the median number of immunotherapy doses missed during isolation was three doses (IQR: 2–3). Up to 38.4% of the AR patients reported that their symptoms got worse during lockdowns. A pre–post mean difference in the VAS score of 0.5 was found for nasal obstruction (p = .01), 0.7 for pruritus (p < .001), 0.7 points for rhinorrhea (p < .001), and 0.8 for ocular symptoms (p < .001). Factors associated with worsening of AR symptom scores were pet ownership, atopic dermatitis, lower educational level, and a low number of immunotherapy doses applied before lockdowns.ConclusionA large proportion of patients reported worsening of their AR symptoms, probably due to higher exposure to indoor AR allergens and interruption of immunotherapy during COVID‐19 lockdowns.

M040 MAST CELL ACTIVATION SYNDROME IN THE SETTING OF ACUTE HYPOTENSION AND ALTERED MENTAL STATUS

Mast cell activation syndrome (MCAS) is a condition in which patients experience recurrent episodes of anaphylactic symptoms due to idiopathic mast cell mediator release. MCAS symptoms include hypotension or flushing and at least one of the following: pruritus, urticaria, angioedema, nasal congestion, nasal pruritus, wheezing, throat swelling, headache, and/or diarrhea.

Intranasal meningoencephalocele in a 1‐year‐old Staffordshire Bull Terrier with unilateral destructive rhinitis

AbstractAn 18‐month‐old male neutered Staffordshire Bull Terrier presented for chronic sneezing, left‐sided rhinorrhea and epistaxis associated with previous nasal planum depigmentation and pruritus. Physical examination did not demonstrate bone asymmetry or depigmentation, but showed reduced airflow through the left nostril. No neurologic abnormalities were present. CT identified severe destruction of the left nasal turbinates and defect of the left cribriform plate, with protrusion of the left olfactory lobe into the caudal part of the nasal cavity. Rhinoscopy did not identify fungal plaques or foreign material, and nasal biopsies were consistent with lymphoplasmacytic destructive rhinitis. Tissue cultures were negative. Clinical signs completely resolved after 2 weeks of doxycycline treatment and did not recur. There was no development of neurologic abnormalities in the 12 months after diagnosis. This is the first case report of canine meningoencephalocele presenting with rhinitis‐associated signs without detectable neurologic abnormalities.

Inferior Turbinate Reduction during Rhinoplasty: Is There Any Effect on Rhinitis Symptoms?

Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged ≥ 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups ( p < 0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days ( p = 0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days ( p < 0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. Trial Registration ClinicalTrials.gov database (NCT01457638 and NCT02231216).

Effect of intranasal corticosteroid treatment on allergen-induced changes in group 2 innate lymphoid cells in allergic rhinitis with mild asthma.

Allergic rhinitis is characterized by rhinorrhea, nasal congestion, sneezing and nasal pruritus. Group 2 innate lymphoid cells (ILC2s), CD4+ T cells and eosinophils in nasal mucosa are increased significantly after nasal allergen challenge (NAC). Effects of intranasal corticosteroids (INCS) on ILC2s remain to be investigated. Subjects (n=10) with allergic rhinitis and mild asthma were enrolled in a single-blind, placebo-controlled, sequential treatment study and treated twice daily with intranasal triamcinolone acetonide (220µg) or placebo for 14days, separated by a 7-day washout period. Following treatment, subjects underwent NAC and upper airway function was assessed. Cells from the nasal mucosa and blood, sampled 24h post-NAC, underwent flow cytometric enumeration for ILC2s, CD4+ T and eosinophil progenitor (EoPs) levels. Cell differentials and cytokine levels were assessed in nasal lavage. Treatment with INCS significantly attenuated ILC2s, IL-5+ /IL-13+ ILC2s, HLA-DR+ ILC2s and CD4+ T cells in the nasal mucosa, 24h post-NAC. EoP in nasal mucosa was significantly increased, while mature eosinophils were significantly decreased, 24h post-NAC in INCS versus placebo treatment arm. Following INCS treatment, IL-2, IL-4, IL-5 and IL-13 were significantly attenuated 24h post-NAC accompanied by significant improvement in upper airway function. Pre-treatment with INCS attenuates allergen-induced increases in ILC2s, CD4+ T cells and terminal differentiation of EoPs in the nasal mucosa of allergic rhinitis patients with mild asthma, with little systemic effect. Attenuation of HLA-DR expression by ILC2s may be an additional mechanism by which steroids modulate adaptive immune responses in the upper airways.

Nasal irrigation with Glycyrrhiza glabra extract for treatment of allergic rhinitis – A study of in vitro, in vivo and clinical trial

Ethnopharmacological relevanceGlycyrrhiza glabra, a family of licorice and a traditional Chinese medicine with sweet taste and favorable smell, has anti-inflammatory, anti-allergic and immunomodulatory functions.Aim of the study: We developed a licorice extract (LE) by using glycyrrhiza glabra and administered it through nasal irrigation to treat allergic rhinitis (AR). Materials and methodsLE was prepared into extract powder, and the anti-inflammatory effect of the LE was evaluated by calcium ionophore-induced activated mast cell model (in vitro). Then, local passive anaphylaxis assays were applied to investigate the anti-IgE-mediated allergic reaction of the LE in mice (in vivo). A developed LE was administered through nasal irrigation to treat AR in clinic settings. A total of 60 participants diagnosed with AR were included in this clinical trial; they were randomly assigned to three interventions: licorice nasal irrigation (LNI), corticosteroid nasal irrigation (CNI), and saline nasal irrigation (SNI). They performed nasal irrigation once a day for 1 month. Both subjective questionnaires (22-item Sino-Nasal Outcome Test [SNOT-22] and visual analog scale [VAS]) and objective examinations (acoustic rhinometry and nasal endoscopy) were used for effectiveness assessments. ResultsAll three interventions could improve SNOT-22 scores, but the effects of LNI and CNI were more significant. According to VAS scores for nasal blockage, rhinorrhea, sneezing, nasal pruritus, postnasal discharge, and olfactory disturbance, the effect of LNI was superior to those of CNI and SNI. The results of rhinometry revealed that LNI significantly improved nasal resistance. Endoscopic analysis showed that both LNI and CNI, but not SNI, could significantly improve turbinate hypertrophy. Moreover, the best procedural comfort was found for LNI, which had no side effects or complications during the trial. ConclusionsLNI is a natural, safe, and innovative therapy that can effectively treat AR. Its effect is superior to those of CNI and SNI, and it has greatly improved procedural comfort.

Validity and Reliability of The Indonesian Modification of Score for Allergic Rhinitis

Abstract: Allergic rhinitis (AR) is a nasal inflammation caused by IgE-mediated reacions after inhaled the allergens. It’s characterized as symptoms of sneezing, airflow obstruction, nasal pruritus, and often clear nasal discharge. The prevalence of AR is about 5-40% in the general population and still rising. Multiple non-instrumental tests for AR were reported though few were validated. Score for Allergic Rhinitis (SFAR) is a valid instrument to screening AR. The purpose of this study was to perform adaptation and cultural translation and validation of the SFAR questionnaire for the Indonesian language. This was a cross sectional study to assess the validity and reliability of the Indonesian modification of Score for Allergic Rhinitis. The study conduct in 59 subjects. The Indonesian modification of SFAR instrument is valid and reliable as an instrument for screening AR with r values ranging from 0.345 to 0.730. Internal consistency shows that Cronbach's alpha is 0.803. The validation and reliability test of Indonesian modification of Score for Allergic Rhinitis was performed and valid and reliable as an instrument for assessing allergic rhinitis. Keywords: Allergic Rhinitis, Score for Allergic Rhinitis, Validity, Indonesian Version.

Efficacy of Shadbindu Ghrita Nasya (Nasal Medication) in Vataja Pratishyaya/Allergic Rhinitis: A Case Study

Background: Vataja pratishyaya is a disease affecting the nasal cavity. The clinical features of vataja pratishyaya include anaddha nasa (nasal obstruction), pihita nasa (stuffy nose), tanusarava (thin, watery discharge), bhrisha kshava (excessive sneezing), shirovyatha (headache), swarpopaghata (change of voice) and chirapaka (chronic perpetuation). Due to the similarity in symptomatology, the disease is compared to allergic rhinitis in modern parlance. Sushruta mentions snehana type of navana nasya to treat vataja pratishyaya/allergic rhinitis and emphasises the importance of optimal dose measured as per magadga mana to treat these conditions. In this paper, a case of vataja pratishyaya/allergic rhinitis and its management with shadbindu ghrita nasya with a textual dose of 12 ml to each nostril is discussed. Methods: The patient suffering from vataja pratishyaya/allergic rhinitis was treated with 2 courses of Shadbindu ghrita nasya, each course consisting of one sitting per day for 7 days. In each sitting 12 ml of shadbindu ghrita was poured into each nostril. Result: Patient’s clinical status was assessed on 7th, 21st and 28th day. Remission of symptoms like sneezing, rhinorrhoea, nasal pruritus, nasal congestion, itching in the eyes, and palate was observed after first course of nasya and on 21st day. Complete remission of almost all symptoms was observed after 2 courses of treatment. Patient was followed up for 4 months and no recurrence of symptoms observed. Conclusion: A case of vataja pratishyaya/allergic rhinitis outlines a clear history and resolution of symptoms and signs following 2 courses of shadbindu ghrita nasya for 7 days administered as per snehana nasya schedule is very effective in complete resolution of symptoms in vataja pratishyaya/allergic rhinitis.

Effect of perennial dust mites allergy on symptom severity of autumn allergic rhinitis in adults.

Background: Multiple immunoglobulin E (IgE) mediated sensitizations and/or allergies often coexist in patients with allergic rhinitis (AR). Several simultaneous allergen exposures in multiple IgE-mediated sensitizations and/or allergies may increase the allergen load and be related to disease severity. No study has verified whether positive allergen serum IgE levels and allergen categories together are associated with AR severity in adults. Objective: To investigate the effects of perennial dust mites (DMs) allergy and multiple serum sIgE-mediated autumn pollen allergy coexistence on symptom severity in adult patients with AR in autumn. Methods: In total, 153 patients with AR and with autumn pollen allergy (Artemisia argyi, ragweed, and hop) with or without DMs allergy were recruited in the autumn pollen season. Symptom severity was assessed by using the Chinese version of the visual analog scale (VAS): four rhinitis symptoms (sneezing, rhinorrhea, nasal pruritus, and nasal congestion) and two ocular symptoms (ocular itching and/or grittiness and/or redness, and ocular tearing) were scored at approximately the same period. We measured allergen serum sIgE levels for the inhaled allergens. The effects of DMs allergy and multiple autumn pollen allergy coexistence on symptom severity were analyzed. Results: Neither the sum of the autumn pollen allergens categories (total number of positive autumn pollen allergens, i.e., Artemisia argyi or ragweed or hop positive: 1; Artemisia argyi and ragweed positive: 2; Artemisia argyi, ragweed, and hop positive: 3) nor serum sIgE levels( total sIgE levels of positive autumn pollen allergens) exerted any influence on the severity of nasal and ocular symptoms (p > 0.05). When the concomitant DMs allergy status was considered, the sum of the positive autumn pollen allergen categories and accumulated positive autumn pollen and DMs serum sIgE levels (total levels of serum sIgE of positive autumn pollen allergens plus the levels of serum sIgE of DMs) had no influence on patients' symptom severity (p > 0.05). Conclusion: The coexistence of perennial DMs allergy and multiple autumn pollen allergy did not affect the severity of symptoms among adult patients with AR and with autumn pollen allergy in autumn.

Perception and control of allergic rhinitis in primary care

Perception of a chronic illness is a driver of patient behaviour that may impact treatment outcomes. The cross-sectional PETRA study was designed to describe the links between disease perception, patient behaviour and treatment outcomes in adults with allergic rhinitis (AR). Overall, 687 French general practitioners (GPs) included 1929 analysable patients (mean age: 39 years; intermittent/persistent symptoms: 46.2/52.3%). Of the patients, 14.1% had also been diagnosed with asthma; 71.7% had uncontrolled AR (ARCT score < 20), and 53.6% had a good perception of their illness (BIPQ score < 5). Factors significantly associated with poor perception of AR were ENT (ear/nose/throat) complications, nasal pruritus, uncontrolled AR and asthma. A strong negative correlation was observed between the BIPQ and ARCT scores: the poorer the patient’s perception, the less the AR was controlled. Although no causal relationship could be drawn, GP-driven improvement of AR perception could lead to better control of symptoms.

Sensibilisation allergénique dans l’asthme dans la ville de Niamey

Study aimsTo investigate allergic sensitization in an asthmatic population at the Lamordé National Hospital (LNH) in Niamey (Niger). Patients and methodsThis was a prospective study of 123 records of patients with allergic asthma seen at the allergy unit of the Lamordé National Hospital (LNH) over a one-year period. ResultsThe average age was 27.10 years, with 22.76% of patients aged between 31 and 40 years or higher. Female predominance was noted (52%). Identification of the allergen in question was based mainly on skin prick testing (100%). Students and teachers were the most widely affected, with 42.27% and 11.38% respectively. The personal history of allergy identified was as follows: allergic rhinitis (68.29%), conjunctivitis (40.65%), atopic dermatitis (9.75%), food allergy (9.75%) and drug allergy (2.43%). Regarding family history, the most frequent cases encountered were asthma (63.41%), rhinitis (43.08%) and conjunctivitis (20.32%). Symptoms were dominated by cough (71.54%), dyspnea (56.91%), rhinorrhea (55.28%), nasal obstruction (39.83%), sibilance (39.83%), sneezing (36.58%), nasal pruritus (34.95%), anosmia (24.39%) and ocular pruritus (8.94%). The most common environmental factors were the presence of carpets (82.92%), passive smoking (11.38%) and active smoking (4.06%). Asthma was intermittent in 81.30% of cases. The main allergens identified were: cockroaches (47.15%), Dermatophagoides pteronyssinus mites (40.65%), Dermatophagoides farinae mites (37.39%), shrimps (24.39%), locusts (19.51%), cat hair (18.69%), Blomia mites (12.19%), groundnuts (4.87%), grasses (4.87%), dog hair (4.06%), whole eggs (3.25%), Alternaria (2.43%) and Aspergillus (0.81%). ConclusionAllergic asthma is common in sub-Saharan Africa. In our cohort, we showed sensitization predominantly to cockroaches, followed by D. pteronyssinus and D. farinae mites. Certain environmental factors as well as lifestyle played a role.

Mucosal leishmaniasis: A forgotten disease, description and identification of species in 50 Colombian cases

Mucosal leishmaniasis has a progressive course and can cause deformity and even mutilation in the affected areas. It is endemic in the American continent and it is mainly caused by Leishmania (Viannia) braziliensis. To describe a series of mucosal leishmaniasis cases and the infectious Leishmania species. We included 50 patients with a clinical diagnosis of mucosal leishmaniasis and parasitological confirmation, and we described their clinical and laboratory results. We performed species typing by PCR-RFLP using the miniexon sequence and hsp70 genes; confirmation was done by sequencing. The median time of disease evolution was 2.9 years (range: 1 month to 16 years). The relevant clinical findings included mucosal infiltration (94%), cutaneous leishmaniasis scar (74%), total loss of the nasal septum (24%), nasal deformity (22%), and mucosal ulceration (38%). The symptoms reported included nasal obstruction (90%), epistaxis (72%), rhinorrhea (72%), dysphonia (28%), dysphagia (18%), and nasal pruritus (34%). The histopathological study revealed a pattern compatible with leishmaniasis in 86% of the biopsies, and amastigotes were identified in 14% of them. The Montenegro skin test was positive in 86% of patients, immunofluorescence in 84%, and culture in 8%. Leishmania (V.) braziliensis was identified in 88% of the samples, L. (V) panamensis in 8%, and L. (V.) guyanensis and L. (L.) amazonensis in 2% respectively. In this study, we found a severe nasal disease with destruction and deformity of the nasal septum in 25% of the cases, probably associated with late diagnosis. Leishmania (V.) braziliensis was the predominant species. We described a case of mucosal leishmaniasis in Colombia caused by L. (L.) amazonensis for the first time.

Facteurs prédictifs de positivité des tests cutanés chez les patients présentant une symptomatologie évocatrice de rhinite allergique

Allergic rhinitis (AR) is characterized by functional nasal manifestations caused by the development of immediate IgE-mediated inflammation of the nasal mucosa in response to exposure to different types of allergens. The purpose of our study was to identify factors predicting positive prick-tests to pneumallergens in patients with AR symptoms. This was a retrospective study of patients with AR, collected over a period of 18 months between January 2017 and June 2018. Diagnosis of AR was clinical. All patients underwent complete ENT examination including nasal endoscopy and prick test with pneumallergens. In all, 148 patients were enrolled during the study period. The average patient age was 31±4 years, with female predominance (sex ratio 0.76). The main symptoms were sneezing salvos, seen in 73% of cases, followed by clear rhinorrhea (67%) and nasal pruritus (45%). Pneumallergen prick tests were positive in 65.5% of patients. The main allergens identified were mites (72 cases) followed by pollen (42 cases). The factors considered to be associated with a positive skin test were: asthma (P=0.046), the presence of the complete triad of nasal hyperreactivity (P=0.028) and severe persistent rhinitis (P=0.003). In this study, skin tests were positive in 65.5% of patients presenting AR symptoms. The main allergens identified were mites. We conclude that asthma was a factor associated with positive skin tests and with the complete triad of nasal hyperreactivity and severe persistent rhinitis.

Epidemiologic characteristics of allergic manifestations in food industry sector

Introduction Food industry is a thriving sector in Tunisia, meeting the increasing demand of our population. A variety of substances are used, from organic to chemical, exposing workers in these manufactories to multiple pathologies, essentially allergic and respiratory diseases. The aim of this study was to describe allergic manifestations among food industry employees. Methods A descriptive cross-sectional study including 90 workers in a biscuit factory carried out from January to May 2016. It included workplace description and medical study. The employees answered a standardized questionnaire and benefited from a physical exam followed by a spirometry for all participants. Results The participation rate was 95.5 %. Sex-ratio male/female was 0.18. Average age was 36 ± years old. Smokers represented 49 %. Average professional seniority was 9 ± years. Family atopy was found in 41 %. Collective and individual protective measures at workplace were not satisfactory. Nasal pruritus was reported in 11.6 % and allergic rhinitis in 19 %, ocular pruritus described in 7 %, erythemato-vesicular and pruritic lesions of hands in 10.5 %. Asthma was found in 3.5 % with no significant correlation with age, sex nor professional seniority. Spirometry showed abnormalities in 17.5 % of the participants. An obstructive respiratory disorder was found in 7 %, it was reversible after administration of salbutamol in 50 %. A restrictive respiratory disorder was suspected in 10.5 % and it had a significant link to the existence of allergic rhinitis history (P = 0.05). Conclusion Food industry exposes workers to multiple allergenic high molecular and chemical substances that can be incriminated in allergic manifestations. Periodic medical consultation and adequate preventive measures to reduce allergenic substances concentration are recommanded.

Phase III trials examining the efficacy of cetirizine ophthalmic solution 0.24% compared to vehicle for the treatment of allergic conjunctivitis in the conjunctival allergen challenge model

PurposeThe purpose of these Phase III studies was to evaluate the efficacy and safety of cetirizine ophthalmic solution 0.24% compared with vehicle in the treatment of allergen-induced conjunctivitis using the Ora conjunctival allergen challenge (CAC)® model.MethodsThe single-center (Study 1) and multi-center (Study 2), double-masked, randomized, vehicle-controlled, parallel group, CAC studies were conducted over ~5 weeks and four study visits. The study design only differed in entry criteria: Study 2 required more severe allergic conjunctivitis symptoms. Subjects were screened for an allergen response at Visits 1 and 2 and then randomized at Visit 3. Approximately 100 subjects were randomized in each study. The primary efficacy endpoints were ocular itching and conjunctival redness 15 minutes and 8 hours post-treatment, post-CAC.ResultsCetirizine treatment administered 15 minutes or 8 hours prior to CAC resulted in significantly lower ocular itching at all time points post-CAC (P<0.0001) compared to vehicle in both studies. Conjunctival redness measured by the investigator was significantly lower after cetirizine treatment compared to vehicle at 7 minutes post-CAC at both 15 minutes and 8 hours post-treatment in both studies (P<0.05). All secondary endpoints were in favor and confirmatory of cetirizine efficacy with significant improvement in chemosis, eyelid swelling, tearing, ciliary redness, and episcleral redness, as well as nasal symptoms (rhinorrhea, nasal pruritus, ear or palatal pruritus, and nasal congestion) post-CAC. The most robust treatment differences were observed in Study 2 where more severe symptoms were required for study entry (P<0.05). No safety concerns for cetirizine ophthalmic solution 0.24% were identified.ConclusionCetirizine ophthalmic solution 0.24% was shown to be efficacious in the treatment of ocular and nasal signs and symptoms associated with allergic conjunctivitis and demonstrated a favorable safety profile. Clinical efficacy was demonstrated with a 15-minute onset of action and añ8-hour duration of action.