Perennial Allergic Rhinitis Patients Research Articles

Comparison of Allergen Immunotherapy Alone and in Conjunction With Turbinate Surgery for Nasal Obstruction in Perennial Allergic Rhinitis Patients.

Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT-with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P = .048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P = .002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (-13.9 ± 110.3 L/minute vs -3.4 ± 78.1 L/minute, P = .049) and NAR (-0.120 ± 0.342 Pa/cm³/second vs -0.093 ± 0.224 Pa/cm³/second, P = .050). Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone.

Bacterial Microbiome and Altered Immune Status in Perennial Allergic Rhinitis Patients in Ukraine

Bacterial Microbiome and Altered Immune Status in Perennial Allergic Rhinitis Patients in Ukraine

Comparative efficacy and acceptability of licensed dose intranasal corticosteroids for moderate-to-severe allergic rhinitis: a systematic review and network meta-analysis.

No evidence shows that one intranasal corticosteroid (INCS) is better than another for treating moderate-to-severe allergic rhinitis (AR). This network meta-analysis assessed the comparative efficacy and acceptability of licensed dose aqueous INCSs. PubMed/MEDLINE, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until 31 March 2022. Eligible studies included randomized controlled trials comparing INCSs with placebo or other types of INCSs in patients with moderate-to-severe allergic rhinitis. Two reviewers independently screened and extracted data following the Preferred Reporting Items in Systematic Reviews and Meta-analysis guideline. A random-effects model was used for data pooling. Continuous outcomes were expressed as standardized mean difference (SMD). The primary outcomes were the efficacy in improving total nasal symptom score (TNSS) and treatment acceptability (the study dropout). We included 26 studies, 13 with 5,134 seasonal AR patients and 13 with 4,393 perennial AR patients. Most placebo-controlled studies had a moderate quality of evidence. In seasonal AR, mometasone furoate (MF) was ranked the highest efficacy, followed by fluticasone furoate (FF), ciclesonide (CIC), fluticasone propionate and triamcinolone acetonide (TAA) (SMD -0.47, 95% CI: -0.63 to -0.31; -0.46, 95% CI: -0.59 to -0.33; -0.44, 95% CI: -0.75 to -0.13; -0.42, 95% CI: -0.67 to -0.17 and -0.41, 95% CI: -0.81 to -0.00), In perennial AR, budesonide was ranked the highest efficacy, followed by FF, TAA, CIC, and MF (SMD -0.43, 95% CI: -0.75 to -0.11; -0.36, 95% CI: -0.53 to -0.19; -0.32, 95% CI: -0.54 to -0.10; -0.29, 95% CI: -0.48 to -0.11; and -0.28, 95% CI: -0.55 to -0.01). The acceptability of all included INCSs was not inferior to the placebo. According to our indirect comparison, some INCSs have superior efficacy to others with moderate quality of evidence in most placebo-controlled studies for treating moderate-to-severe AR.

Essential oil (EO) nasal spray use in seasonal allergic rhinitis

Allergic airway disease (AAD) imposes a large burden on the quality of with an increasing percentage of this population using integrative medicine that includes include herbal medicine and EO therapy. Recently research suggests EO nasal spray provided significant relief in perennial allergic rhinitis patients measured by the Allergic Rhinitis Control Test. Thus EO could be an option for AAD patients who wish to explore more natural methods of allergic symptom relief.

The impact of propolis on clinical manifestations and specific IgE levels against salsola in perennial-allergic rhinitis patients.

Objectives: Propolis has an anti-inflammatory effect induced by inhibiting cyclooxygenase, subsequent inhibition of prostaglandin and nitric oxide synthesis, reduction of inflammatory cytokines, and eventually immunosuppressive activity [1-3]. This study aims to evaluate the impact of propolis on clinical features and specific IgE levels against salsola in perennial allergic rhinitis patients. Methods: Thirty patients diagnosed with perennial allergic rhinitis with salsola-positive skin prick test were enrolled in this randomized controlled clinical trial and divided into two groups. The intervention group received the propolis (200 mg per day), and the control group received a placebo for four months, besides intranasal corticosteroids. At baseline and the end of the intervention, the level of Salsola-specific IgE was measured by the RAST method. To assess the propolis effect on the quality of life and disease severity, miniRQLQ and SNOT22 questionnaires were completed by patients before and after the intervention. Results: According to Table 1, Serum IgE level showed decreasing changes (-0.057) despite increasing changes in the control group (1.039). However, these differences were not statistically significant (P = 0.967). Based on the miniRQLQ questionnaire, quality of life improved in both groups without any significant difference (P = 0.930). According to the SNOT-22 questionnaire, both groups' nasal and sinus problems decreased significantly. However, the intervention type did not affect this decrease and was observed over time in both groups (P> 0.05). Conclusion: Propolis supplementation did not significantly affect various laboratory parameters, clinical symptoms, and quality of life of patients with allergic rhinitis.

Bioinformatics analysis of nasal epithelial cell gene expression in seasonal and perennial allergic rhinitis

Objective: Transcriptome sequencing and bioinformatics analysis were performed on the gene expression of nasal epithelial cells in patients with seasonal allergic rhinitis (AR) and perennial AR, so as to obtain the differences in the gene expression of nasal epithelial cells between seasonal AR and perennial AR. Methods: The human nasal epithelial cell line(HNEpC) was cultured in vitro, treated with 100 μg/ml mugwort or house dust mite (HDM) extracts for 24 hours. Total cell RNA was extracted, and quantitative real-time polymerase chain reaction (qPCR) was used to detect the expression of cytokines, including IL-6, IL-8, IL-33 and thymic stromal lymphopoietin (TSLP). From November 2019 to November 2020, 3 seasonal AR patients, 3 perennial AR patients, and 3 healthy controls who attended the Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University were analyzed. The patients' primary nasal epithelial cells were cultured in vitro, treated with corresponding allergens for 24 hours. Total RNA was extracted for transcriptome sequencing, and the sequencing results were analyzed by bioinformatics. Results: The qPCR results showed that the cytokines IL-6, IL-8, IL-33 and TSLP of HNEpC treated with mugworts extracts and HDM extracts had the same trend of change. After the nasal epithelial cells from patients with seasonal AR and perennial AR were treated with corresponding allergens, there were differences in biological processes and signal pathways between those and control. Gene ontology (GO) enrichment analysis showed that the differentially expressed genes (DEG) in AR patients allergic to mugwort were mainly enriched in the oxidation-reduction process, the negative regulation of apoptosis process, and the cell adhesion; the DEG in AR patients allergic to HDM were mainly enriched in cell adhesion, the negative regulation of cell proliferation and the response to drug. Enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway showed that the DEG of AR patients allergic to mugwort were significantly enriched in arachidonic acid metabolism, p53 signaling pathway and transforming growth factor β (TGF-β) signaling pathway, while the DEG of AR patients allergic to HDM were mainly enriched in cells cycle, Fanconi anemia pathway and DNA replication. Gene Set Enrichment Analysis (GSEA) showed that the inflammatory response, TNF-α/NF-κB signaling pathway and IL-2/STAT5 signaling pathway were significantly up-regulated in AR patients allergic to mugwort, indicating the promotion of inflammatory response; and AR patients allergic to HDM had significant down-regulation of G2M, E2F, and MYC, indicating the inhibition of cell proliferation. The protein-protein interaction network showed that TNF and CDK1 were the most interacting proteins in mugwort and HDM allergic AR patients, respectively. Conclusion: Seasonal AR and perennial AR may affect the different biological processes and signal pathways of nasal epithelial cells, leading to differences in the occurrence and development of AR.

The Long-Term Effect of Vitamin D Supplementation on Quality of Life in Persistent (Perennial) Allergic Rhinitis Patients.

Vitamin D is one of the thoroughly studied risk factors in the pathogenesis of allergic rhinitis (AR). Low serum level of vitamin D is well documented in the urban population of India. The supplementation policy of vitamin D is not uniform among practitioners. The study aims to assess the impact of vitamin D deficiency on AR & long-term quality of life in perennial AR patients with low vitamin D levels after its supplementation in the urban population.The policy for evaluation of serum level of vitamin D & its supplementation in deficit patients in AR is not uniform in our hospital. The data was extracted from the hospital records & the patients came to OPD in the year 2018-2019. Inclusion criteria were the clinical diagnosis (ARIA guideline) of the perennial form of AR where vitamin D assessment was performed before prescribing treatment & the patients received a complete course of vitamin D as per the recommendation followed in our Institute. The patients received oral antihistaminic & topical steroids based nasal spray and were clubbed together as a control group whereas, in the study group, the patients were pooled together who received vitamin D supplementation along with oral antihistaminic & topical steroids based nasal spray. Pre-treatment & post-treatment (at 8weeks, 6months, and 12months) SNOT-22 scores were obtained from the records. The data were analyzed statistically using repeated measures ANOVA test. The study showed a significant decrease in the SNOT-22 score in both Groups in comparison to pre-treatment scores, but post-treatment group comparison was not found statistically significant at each point of comparison. The scores were found on the lower side in the study group at the initial two evaluation points whereas it was higher at the third point of evaluation. This study showed the additional therapeutic effect of vitamin D supplementation as an adjunct in the treatment of perennial AR patients but the effectiveness of the treatment does not last forever so maintenance therapy is required especially in areas following the Indian lifestyle.

Efficacy and safety of rupatadine fumarate in the treatment of perennial allergic rhinitis: A multicenter, double-blinded, randomized, placebo-controlled, bridging study in Koreans.

The efficacy of rupatadine for the treatment of AR has been confirmed in numerous clinical studies, however there are very few studies on asian patients. To assess the safety and efficacy of rupatadine fumarate in the treatment of Korean perennial allergic rhinitis (PAR) patients. A multicenter, double-blind, randomized, placebo-controlled, comparative study of rupatadine fumarate and bepotastine besilate was conducted. Each group was administered rupatadine, bepotastine or placebo for 4 weeks. Primary parameters for efficacy included morning and evening symptom reduction from baseline at 4 weeks. Treatment safety and tolerability were evaluated according to a self-reported incidence and type of adverse events at each follow up visit. Rupatadine showed a significant reduction in symptoms at morning and evening evaluations, in both 5TSS (-5.69, P < 0.0006) and 4NTSS (-4.74, P < 0.0015) compared to placebo. There was a significant reduction from baseline for 5TSS (-65.4%, P = 0.002) and 4NTSS (-63.7%, P = 0.003) with rupatadine compared with placebo. At evening evaluations, there were significant reductions of 5TSS (-63.2%, P = 0.009) and 4NTSS (-61.6%, P = 0.013) for the rupatadine group. Compared with bepotastine, rupatadine showed greater reduction in the morning symptoms at 4 weeks. When individual symptoms were assessed with 12-hour reflective mean daily symptom score, rupatadine showed better efficacy than placebo in sneezing (P = 0.016) and rhinorrhea (P = 0.097). The rate of adverse events showed no statistical significance. Rupatadine is a safe and effective treatment option for Korean PAR patients and possibly a better choice over bepotastine for controlling morning symptom.

Observation and analysis of systemic reactions to house dust mite subcutaneous immunotherapy in 362 patients with allergic rhinitis

Objective: To investigate the frequency and severity of systemic reactions (SRs) to standardized house dust mite subcutaneous immunotherapy (SCIT) in patients with perennial allergic rhinitis (AR), and to analyze the clinical risk factors. Methods: The clinical data of 362 patients including 209 males and 153 females, aged from 5 to 55 years old receiving SCIT at the Department of Otorhinolaryngology, the Third People's Hospital of Changzhou were collected from May 2014 to July 2017. The SRs were classified as early-onset and delayed-onset, and 4 grades (grade Ⅰ to Ⅳ) to assess severity. The records of SRs were retrospectively analyzed, including the numbers/frequencies, symptoms and signs, onset of reaction and treatment. And the relationships between SRs and patient's age, gender, allergen injection dose, accompanied allergic diseases were explored. All the statistical analyses were conducted using SPSS 19.0. Results: There were 57 cases (15.75%) of SRs in 362 patients. All the patients received a total of 12 308 injections and 111 SRs (0.90%) were observed. Among them, 31 (27.93%) were early-onset reactions and 80 (72.07%) were delayed-onset reactions; most of the SRs were grade Ⅰ reactions (n=83, 74.78%), followed by grade Ⅱ (n=25, 22.52%), grade Ⅲ (n=3, 2.70%), and no fatal reactions occurred. The incidence of SRs in patients>14 years old was higher than that in patients ≤14 years old according to the number of cases and injections (35.14% vs 13.54%, 2.34% vs 0.76%, χ(2) value was 11.679, 28.162, respectively, all P<0.05), but no significant differences of SRs were observed in gender (18.66% vs 11.76%, 5.98% vs 5.62%, χ(2) value was 3.166, 0.095, respectively, all P>0.05). Fifteen SRs (13.51%) occurred during the build-up phase and 96 (86.49%) during the maintenance phases. SRs could occur in lots of dose phases, and 95 (85.59%) were distributed at high concentrations more than 40 000 SQ-U. The incidence of SRs in patients with multiple allergic diseases was significantly higher than that in patients with AR alone, with asthma or atopic dermatitis (30.67% vs 11.85%, χ(2)=15.875, P<0.001). Meanwhile, the incidence of SRs in patients with pure AR was also significantly lower than that in patients with other allergic diseases (5.26% vs 20.56%, χ(2)=13.783, P<0.001). Conclusions: The incidence of SRs is less than 1% according to the injection times, the severity of SRs is mostly slight, and the safety and tolerance are good during standardized house dust mite SCIT in perennial AR patients. Delayed-onset SRs are more common. The incidence of SRs is significantly correlated with age, high dose of allergen vaccine injection, and concomitant other allergic diseases (asthma, atopic dermatitis, etc).

Evaluation of neutrophil-to-lymphocyte ratio in patients with symptomatic rhinitis

Objectives: In this study, we aimed to measure the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) in both perennial allergic rhinitis (AR) and non-allergic rhinitis (NAR) patients during their period of active symptoms. Patients and Methods: A total of 161 patients (101 males, 60 females; mean age 34.0±11.1 years; range, 18 to 56 years) consisting of 70 persistent allergic rhinitis (PAR) and 39 NAR patients diagnosed between March 2018 and March 2019 in the adult allergy outpatient clinic, having a Total Nasal Symptom Score (TNSS) of ≥8, and recent complete blood count results available before undergoing any medical treatment and 52 control patients (28 males, 24 females; mean age 31.7±7.8 years; range, 18 to 44 years). The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Results: There was no statistically significant difference in the age or gender between the groups (p&gt;0.05). There was no statistically significant difference in the neutrophil, lymphocyte, and NLR between the groups (p&gt;0.05). Conclusion: Our study shows that NLR is not a useful tool in the diagnosis and management of treatment in PAR and NAR in adults

Allergen-specific immunotherapy enhances CD8+ CD25+ CD137+ regulatory T cells and decreases nasal nitric oxide.

4-1BB (CD137), a member of the inducible tumor necrosis factor receptor (TNFR) family, is expressed on regulatory T (Treg) cells and regulates Treg cells to control allergic inflammation. Pam3CSK4, a synthetic TLR2 ligand that can expand CD8+ Treg function, is a promising adjuvant for allergen immunotherapy (IT). We examined whether Dermatophagoides pteronyssinus (Der p) IT and Pam3CSK4 could enhance CD8+ CD25+ CD137+ Treg suppressive function to decrease nasal nitric oxide (nNO) levels. Nasal symptom scores, nNO levels, PBMCs, and inferior turbinate biopsies were obtained from 40 mite-sensitive perennial allergic rhinitis (PAR) patients before and after one year of Der p IT and 30 non-allergic control subjects. CD137 expression on CD8+ CD25+ T cells and suppressive function of CD8+ CD25+ CD137+ Tregs was measured using flow cytometry. Cytokine levels were analyzed by ELISA. Inducible nitric oxide synthase production by nasal epithelial cells after co-culturing with CD8+ CD25+ CD137+ T cells was analyzed by Western blotting. Der p IT improved nasal symptom scores, decreased nNO levels, and increased CD137 expression on CD8+ T cells in PBMCs and nasal mucosa. Pam3CSK4 expanded the CD8+ CD25+ CD137+ population in PBMCs. Pam3CSK4-stimulated CD8+ CD25+ CD137+ Tregs induced IL-10 and TGF-β and suppressed CD4+ CD25- T-cell proliferation mainly by cell contact inhibition. CD8+ CD25+ CD137+ Tregs cultured with nasal epithelial cells suppressed Der p 2-induced iNOS production. Silencing CD137 in sorted CD8+ CD25+ T cells decreased Pam3CSK4-activated Foxp3 expression. Der p IT expanded CD8+ CD25+ CD137+ Tregs and decreased nNO levels. Induced CD137 expression on CD8+ CD25+ Tregs by Pam3CSK4 stimulation may help suppress allergic inflammation during IT.

Bronchial challenge in perennial allergic rhinitis patients without asthma – a clinico spirometric correlation

Bronchial challenge in perennial allergic rhinitis patients without asthma – a clinico spirometric correlation

Evaluation of Inferior Turbinate Stroma with Ultrasound Elastography in Allergic Rhinitis Patients.

Background: Diagnosis of allergic rhinitis is primarily based on history, physical examination and allergy testing. A technique that noninvasively evaluates the soft tissue changes in the nasal mucosa of allergic rhinitis patients has not been defined.Aims: To assess nasal mucosal changes and measure the submucosal fibrosis in allergic rhinitis patients with sonoelastography.Study Design:Case control study.Methods: Eighty-eight turbinates of 44 patients were included in the study. There were 23 prick test positive allergic rhinitis patients. The control group constituted 21 patients. The rhinitis quality of life questionnaire and the visual analogue scale were applied to the allergic rhinitis patients. A higher visual analogue scale score indicated more severe allergic rhinitis symptoms. Sonoelastographic measurements were made from the lateral nasal wall. The propagation speed of sound waves was recorded in m/s. The presence of asthma and the type of allergic rhinitis (seasonal or perennial) was noted.Results:Ten patients had seasonal allergic rhinitis and thirteen patients had perennial allergic rhinitis. Six patients (26.1%) had accompanying asthma along with allergic rhinitis. The median visual analogue scale score was 7 (3-9) in allergic rhinitis patients. The median symptom duration was 7 (1-24) months. The median quality of life questionnaire score was 3.39 (1.68-5.43) points. The median sonoelastography scores of allergic rhinitis patients and healthy subjects were 2.38 m/s (0.9-4.47) and 2.42 m/s (1.62-3.50), respectively. Sonoelastographic measurements of seasonal and perennial allergic rhinitis patients did not differ significantly (p>0.05). The presence of asthma did not have a significant impact on the elastography measurements (p>0.05). However, regression analysis revealed a significant inverse correlation (coefficients: B=0.005, standard error=0.097, beta 0=0.008) between the visual analogue scale and sonoelastography scores (p<0.05).Conclusion: Sonoelastography was not suitable as a diagnostic tool in allergic rhinitis. Reduced sonoelastography scores were measured in more symptomatic patients. Higher visual analogue scale scores could be an indicator of disease severity.

The role of nasal fractional exhaled nitric oxide as an objective parameter independent of nasal airflow resistance in the diagnosis of allergic rhinitis

ObjectivePatients with allergic rhinitis (AR) show augmented activity of nitric oxide (NO) metabolism, similar to those in bronchial asthma (BA). We hypothesized that measurements of nasal fractional exhaled NO (FeNO) could be used as an objective marker to detect the presence of AR. Our objective was to clarify the influence of nasal airflow resistance (NAR) on nasal FeNO levels through an exhalation maneuver in symptomatic AR patients. We also examined the diagnostic test validity of the mean nasal FeNO level for disease discrimination by means of a receiver operating characteristic (ROC) curve analysis. MethodsFifty-nine untreated perennial AR patients without BA and 60 healthy controls were enrolled in this retrospective cross-sectional study. The subjective symptoms were recorded and the disease severity was classified according to the Japanese guideline for AR. The oral and nasal FeNO measurements were carried out using a handheld electrochemical analyzer according to the ATS/ERS guidelines. NAR was measured using a rhinomanometer by the anterior method. ResultsThe patients in the moderate-to-most severe AR group showed significantly higher levels of oral FeNO compared to the controls. The AR patients in both the mild (n=25) and the moderate-to-most severe (n=34) groups showed significantly higher levels of nasal FeNO compared to the controls (44.1ppb, 54.5ppb, and 26.5ppb, respectively). There was no significant difference in total NAR between the AR patients and the controls. The results of our comparison of nasal FeNO and NAR values of the ipsilateral nasal cavity for each individual indicated no significant correlation between the two-paired parameters. The optimal cut-off point of the mean nasal FeNO level was calculated as 38.5ppb (with 71% sensitivity and 86% specificity) to discriminate the presence of AR. ConclusionNasal FeNO measurements can be an objective parameter for the diagnosis and classification of perennial AR in Japanese individuals. Nasal FeNO and NAR appear to be two independent measures that can be used to objectively evaluate nasal functions.

Nasal Expiratory Sound Analysis for Evaluation of Nasal Patency in Perennial Allergic Rhinitis Patients Treated with Nasal Corticosteroids

Purpose: To assess the efficacy of nasal expiratory sound analysis in determining the degree of nasal obstruction. Materials and Methods: We have analyzed and recorded the expiratory nasal sounds in 18 healthy controls and in 30 patients with inferior turbinate hypertrophy before and after the administration of nasal corticosteroid treatment. Analysis consisted of the time-expanded waveform, spectral analysis with time-averaged fast Fourier transform and waveform analysis of nasal sound. Results: Before treatment, an increase in sound intensity at high frequency was observed in the sound analyses of the patients, whereas after treatment, a decrease in sound intensity at high frequency was noted in the sound analyses of the patients. The differences between the patients and the control group were statistically significant. Data obtained with the Odiosoft-Rhino method were correlated with symptom scores and endoscopic examination. Conclusion: Expiratory nasal sound is a practical and objective tool, which can be reliably used not only for the assessment of the degree of nasal blockage but also for the comparison of different treatment alternatives.

Over Diagnosis of Persistent Allergic Rhinitis in Perennial Allergic Rhinitis Patients: A Nationwide Study in Mexico

Allergic rhinitis (AR) symptom phenotypes have been described, and two different classifications exist. The former classification, seasonal versus perennial AR (SAR-PAR), and the Allergic Rhinitis and Its Impact on Asthma (ARIA) classifications, intermittent (INT) versus persistent (PER; ≥4 days/wk and ≥4 consecutive weeks) and mild versus moderate/severe. ARIA cataloging of INT-PER is based on the patient's description of the frequency of symptoms. This study was designed to (1) describe the epidemiology of these two AR classifications and relate them to one another and to a visual analog severity scale (VAS) and (2) describe how the cataloging of these classifications differs between patients and allergists. Skin-prick test-positive AR patients seen nationwide by Mexican allergists completed a validated questionnaire cataloging AR. They recorded demographic data and AR severity on a VAS. The patients' physicians were also asked to classify the AR phenotypes. Of the patients, 56.5% had INT and 82.2% had PAR and moderate-severe (84.7%) AR. However, 57% of the INT-PAR patients were misdiagnosed as PER-PAR by their physicians. PER patients had more severe disease with a longer clinical history, more PAR, nose and eye symptoms, and a higher VAS score, and only 7% had mild symptoms. VAS values ≥7.45 relate to PER (sensitivity, 68%; specificity, 65%). VAS ≤6.2 indicated mild and ≥6.4 indicated moderate-severe AR. Similar to the adults, in the 2- to 11 year and 12- to 17-year age groups perennial, INT, and moderate-severe AR was the most frequent finding, but the children had more INT (p < 0.01) and mild (p < 0.03) symptoms, less SAR (p = 0.03), and more physician-diagnosed asthma (p < 0.05). Public health care (PHC) patients had more INT (p = 0.016). In the PAR group, the physicians' classification of INT-PER often goes astray. PER overdiagnoses might affect treatment decisions because PER is a more severe phenotype. VAS is useful to evaluate severity. In Mexican AR patients, rhinitis symptom phenotypes differ according to age and between private and PHC system patients.

Comparison of Mometasone Furoate Monohydrate (Nasonex) and Fluticasone Propionate (Flixonase) Nasal Sprays in the Treatment of Dust Mite-sensitive Children with Perennial Allergic Rhinitis

Various studies have investigated the efficacies of mometasone furoate monohydrate (MFM) and fluticasone propionate (FP) nasal sprays for adults. However, research on their effectiveness for children is limited. This study compares the efficacies of MFM and FP nasal sprays in pediatric patients with perennial-allergic rhinitis. For this study, 94 perennial allergic rhinitis patients aged 6-12 years were randomly assigned to two treatment groups: an MFM group and an FP group. Treatment was provided for 4 weeks. The effects of the two agents were compared using the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire and total symptom scores (TSSs). Nasal-peak expiratory flow rates and eosinophil percentage in nasal smears were also compared between the two groups. Patients in the MFM group exhibited significant improvement in their TSS (t=-2.65, p<0.05). A detailed TSS analysis showed MFM to be more effective for relieving nasal symptoms, whereas FP was more effective for relieving non-nasal symptoms. Patient questionnaire scores suggested a significant reduction in symptoms for both the MFM (t=-7.23, p<0.01) and FP (t=-5.43, p<0.01) groups. The flow rate test results indicated significant improvements in the MFM group (t=2.27, p<0.05). Following the 4-week therapy, MFM provided greater improvement compared to FP for symptoms of childhood perennial-allergic rhinitis. Based on their TSSs, the MFM group experienced more effective relief of nasal symptoms, whereas the FP group experienced more effective relief of non-nasal symptoms.

A Comparative Pilot Study of Symptom Improvement Before and After Phototherapy in Korean Patients with Perennial Allergic Rhinitis

Although allergic rhinitis is not life threatening, it significantly influences the quality of a patient's life. This study is intended to evaluate the safety and efficacy of phototherapy with low-level energy of a 650 nm laser irradiation system in perennial allergic rhinitis patients. This clinical trial was an open-label, single-center study with 42 perennial allergic rhinitis subjects. Following laser irradiation in the nasal cavity with a laser irradiation system, the efficacy at weeks 1 through 4 was determined. The symptoms were scored with four parameters (nasal obstruction, rhinorrhea, sneezing and itching) before and after illumination of the laser, and the total score was recorded. A survey of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was conducted by patients before and after treatment. Following treatment, significant improvement in the clinical symptoms of nasal obstruction (P < 0.001), rhinorrhea (P = 0.005), sneezing (P = 0.001) and itching (P = 0.003) was reported by 68% of perennial allergic rhinitis patients. The overall RQLQ scores significantly improved by 45% from the baseline with the treatment after 4 weeks. These results indicate that phototherapy is an effective modality for treating perennial allergic rhinitis and is another option in the steroid-free management of immune-mediated mucosal diseases.

通年性アレルギー性鼻炎患者の咽喉頭症状および睡眠障害におけるベポタスチンベシル酸塩の有用性

通年性アレルギー性鼻炎における咽喉頭症状，睡眠障害についての検討はそれほど多くない。今回，我々は，通年性アレルギー性鼻炎の咳嗽，咽喉頭異常感，後鼻漏および睡眠障害の臨床的特徴を明確にするために，これらの症状および所見を調査するとともに，抗ヒスタミン薬の有効性についても検討を行った。藤田保健衛生大学病院およびその関連施設を受診した通年性アレルギー性鼻炎患者28名を対象とし，全例にベポタスチンベシル酸塩を4週間経口投与した。症状および所見はアレルギー症状日記と調査票を用いて検討した。鼻の3大症状，鼻腔内所見および咳嗽では投与2週後および4週後で投与前と比較して有意にその重症度の低下を示した。咽喉頭異常感は投与4週後で投与前と比較して有意にその重症度が低下した。後鼻漏および披裂部の異常所見では，その頻度が低下する傾向を示した。後鼻漏，咳嗽および咽喉頭異常感の間では，咳嗽および咽喉頭異常感においてのみ有意な関連性を示した。今回，通年性アレルギー性鼻炎で観察された咳嗽および咽喉頭異常感は通年性喉頭アレルギーのあまい診断基準に概ね合致することから，後鼻漏による症状というより喉頭アレルギーの関与が推察された。また，睡眠障害についても抗ヒスタミン薬の投与で4週後に有意に改善した。

Measurements of Nasal Fractional Exhaled Nitric Oxide with a Hand-held Device in Patients with Allergic Rhinitis: Relation to Cedar Pollen Dispersion and Laser Surgery

There has been an increasing interest in monitoring the fractional concentrations of exhaled NO (FeNO) levels in allergic rhinitis (AR) patients. In the present study, we examined whether the nasal FeNO measurement might reflect the degree of local allergic inflammation as well as subjective symptoms. The FeNO measurement was performed using a handheld electrochemical analyzer (NObreath®) with a nose adaptor. In the cross-sectional study, 56 patients with perennial AR patients, 18 AR patients with bronchial asthma (BA), 12 patients with vasomotor rhinitis, and 30 normal subjects were enrolled. For the follow-up study, 12 seasonal allergic rhinitis (SAR) patients against Japanese cedar and 10 perennial AR patients who underwent laser surgery were examined. The AR patients and vasomotor rhinitis patients showed significantly higher oral FeNO levels as compared with the normal subjects. The nasal FeNO levels were significantly higher in the perennial AR patients with or without BA than in the normal subjects and vasomotor rhinitis patients. There were positive correlations between the nasal symptom scores and FeNO levels. The SAR patients showed a significant decrease in the nasal FeNO level after the pollen dispersion season. In addition, the therapeutic effects of laser surgery in the AR patients accompanied a significant reduction in the nasal FeNO levels one month after treatment. The nasal FeNO measurement by NObreath® is easy to perform and suitable for monitoring AR patients in various treatment modalities. Furthermore, it may have potential usefulness as a tool to improve daily clinical care.