Perennial Rhinitis Research Articles

Otitis media serosa y alergia en nuestra área sanitaria

We studied the role of allergic diseases in patients with otitis media with effusion (OME). The 40 patients diagnosed with OME in the Otorhinolaryngology Service in 2001 were referred to the Allergy Unit for evaluation. The patients were assessed through anamnesis, prick test and specific IgE determination for the allergens in our area. In 72 % of the patiens allergologic study was negative. One patient had perennial rhinitis with sensitization to house dust mites and another had seasonal rhinitis with sensitization to Gramineae pollen. Five patients showed high total IgE. Two patients had positive skin prick test and specific IgE to Gramineae pollen but were asymptomatic and a further two patients had negative anamnesis and specific IgE to Gramineae and olive pollen, respectively. Allergic disease does not cause OME except in some patients with allergic rhinitis.

Sensitization to cockroach allergens in individuals with perennial rhinitis in belarus

18 years, who achieved adequate symptoms after priming with ragweed pollen were randomized to one dose of DL 5 mg (n=81), DPH 50 mg (n=84), or placebo (n=83). A battery of repeatable, automated neuropsychological tests was administered to symptomatic subjects prior to treatment (baseline) and 90 minutes after dosing with study medication. The test battery measured vigilance as well as a broad array of cognitive functions. RESULTS: Both DL and DPH alleviated the symptoms of SAR compared to PLA (p<0.05). Treatment with DPH caused clinically meaningful decrements on all vigilance parameters (p<0.05 for DL/DPH contrasts; moderate effect sizes, ranging from .58 to .67 standard deviations). Subjects treated with DPH also performed significantly worse across all of the other cognitive domains assessed. The majority of the effect sizes for the mean DL/DPH differences were between .4 to .8 (moderate to high). The distribution of Stanford Sleepiness Scale scores also indicated significantly more sedation with DPH vs. DL or PLA (p<0.001). There was no difference in performance between subjects treated with DL and PLA on any cognitive parameter. CONCLUSION: Treatment with DL significantly improved SAR symptoms without adversely affecting cognitive performance. In contrast, DPH improved SAR symptoms but caused significant impairment of cognitive performance and significantly more sedation. Therefore, the efficacy of treatment with DPH must be balanced against the associated effects on cognitive functioning. 2 ' ~ Tecastemizole 30 mg Effectively Reduces the Symptoms of / ~ l l Allergic Rhinitis Jonathan Corren*, Paul Chervinsky§, Phillip Korenblat~, Rudolf A Baumgartner~ *Allergy Research Foundation Incorporated, Los Angeles, CA §New England Clinical Study, North Dartmouth, MA ¥St Louis University, St Louis, MO ~Sepracor incorporated, Marlborough, MA Tecastemizole (TEC) is a potent, non-sedating, once-daily antihistamine with a high affinity for the H I receptor that provides rapid and sustained relief from symptoms of allergic rhinitis. This randomized, double-blind, multicenter study evaluated the efficacy of TEC in subjects with seasonal allergic rhinitis. Subjects received placebo (PBO) or TEC 30 mg for 2 Weeks, and completed daily diary cards at 12,and 24 hours following each dose. Twelve hours after the first dose, TEC provided significant reductions in Total Symptoms Score (TSS: the sum of runny nose/postnasal drip, sneezing, itchy nose, itchy/gritty eyes, tearing/watery eyes, red/burning eyes, and ear/palate itching scores) compared with PBO (TEC LSMean1.24 over PBO, p=0.001; ie, approximately 729% over PBO). Trough TSS, measured 24 hours following the previoUs dose, was significantly decreased from baseline during the entire double-blind period (TEC LSMean -0.89 over PBO, p=0.009; ie, approximately 113% over PBO). TEC was also significantly more effective than PBO in reducing TSS, Nasal TSS, Trough Nasal TSS, Non-Nasal TSS, and Trough Non-Nasal TSS (p<0.049 for each parameter). TEC produced no significant adverse events, no change in the number or intensity of adverse events, and did not affect laboratory parameters, vital signs, or ECG results including QT intervals. Fewer TEC-treated subjects experienced sedation than PBO-treated subjects (0.5% vs 4.3%, respectively). These combined data illustrate that TEC is safe and well tolerated and provides significant allergic rhinitis symptom reduction 24 hours after dosing.

マイクロデブリッダーを用いた下鼻甲介切除術

Using an endoscopic shaver, we performed global turbinectomy of the inferior nasal turbinate mucosa for 31 patients (20 males and 11 females, aged 14-68 years) with hypertrophic rhinitis refractory to nonsurgical treatment. In addition, we applied 80%W/V trichloroacetic acid to the inferior turbinate after removing the mucosa. The mean follow-up period was 5 months, ranging from 1 to 23 months. Direct visualization with the endoscope allowed more accuracy and the electric motorized shaver ensured quick and extensive removal of excessive mucosa. The inferior turbinates from two patients were examined several months after the removal histopathologically. At 5 months after the surgery, cylindrical epithelium covered the surface of the mucosa. The number of nasal glands had decreased, and the collagen fibers had increased in the lamina propia. The results showed that the treatment was effective in 100% of the patients with nasal occlusion. Watery nasal discharge improved in 4 of the 8 patients who were followed for 6 months. This surgery is an effective treatment for perennial hypertrophic rhinitis, especially in severe cases.

Increased apoptosis of peripheral blood mononuclear cells in patients with perennial allergic asthma/rhinitis: relation to serum markers of apoptosis.

BACKGROUND: The goal of our study was to examine spontaneous and stimulated apoptosis of peripheral blood MNC from allergic patients, sensitized to Der p I antigen as compared to cells from non-atopic subjects. Furthermore we aimed to investigate which populations of mononuclear cells (lymphocytes, monocytes) undergo the apoptosis and to determine relations between apoptosis and serum levels of sFas/APO-1, ICE/caspase-1 or TNF-alpha. METHODS: The study included 17 patients with perennial, allergic asthma and/or allergic rhinitis [6 male and 11 female; mean age 29,5 years; (range 15-49)]. Apoptosis was assessed by fluorescence technique and confirmed by flow-cytometric method and DNA ladder. Serum levels of sFas, ICE/caspase-1 or TNF-alpha were determined by immunoassays (ELISA). RESULTS: Apoptotic index of unfractionated mononuclear cells (MNC) and lymphocytes (but not monocytes) were significantly higher in allergic patients as compared to non-allergic subjects after 48 and 72 hours of culture (p<0.05). Incubation of cells with ConA (10 microg/ml) resulted in a significant increase in the proportion of apoptotic cells in all populations once the apoptotic index for MNC and lymphocytes (but not monocytes) was again significantly higher in allergic as compared to non-allergic subjects after 24, 48 and 72 hour of culture. In allergic patients, mean serum sFas level, was significantly lower then in non-allergic group (mean value 624.8 pg/ml +/- 25.67 versus 802.0 pg/ml +/- 31.91; p = 0.003) and in both groups sFas level correlated inversely with apoptosis of MNC. The mean ICE/caspase-1 concentration was significantly higher in sera of allergic patients as compared to non-allergic group (mean value 27.71 pg/ml +/- 3.79 vs 23.54 pg/ml respectively; p<0.01). ICE/caspase-1 levels in allergic patients correlated with apoptotic index of mononuclear cells (r = 0.57; p<0.001). CONCLUSIONS: An increased spontaneous and mitogen-induced apoptosis of MNC from peripheral blood of atopic patients as well as different serum levels of sFas and ICE/caspase-1 correlating with apoptosis, suggest different regulation of apoptotic process in peripheral blood mononuclear cells of patients with allergic asthma and/or rhinitis.

The development of a screening questionnaire to distinguish persistent from intermittent asthma in children

The development of a screening questionnaire to distinguish persistent from intermittent asthma in children

Allergic Rhinitis and Its Impact on Asthma

Authors Jan L. Brozek, MD, PhD – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada Jean Bousquet, MD, PhD – Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France, INSERM, CESP U1018, Respiratory and Environmental Epidemiology Team, France, and WHO Collaborating Center for Rhinitis and Asthma Carlos E. Baena-Cagnani, MD – Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina Sergio Bonini, MD – Institute of Neurobiology and Molecular Medicine – CNR, Rome, Italy and Department of Medicine, Second University of Naples, Naples, Italy G. Walter Canonica, MD – Allergy & Respiratory Diseases, DIMI, Department of Internal Medicine, University of Genoa, Genoa, Italy Thomas B. Casale, MD – Division of Allergy and Immunology, Department of Medicine, Creighton University, Omaha, Nebraska, USA Roy Gerth van Wijk, MD, PhD – Section of Allergology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands Ken Ohta, MD, PhD – Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan Torsten Zuberbier, MD – Department of Dermatology and Allergy, Charite Universitatsmedizin Berlin, Berlin, Germany Holger J. Schunemann, MD, PhD, MSc – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada

House dust mite avoidance measures for perennial allergic rhinitis.

In developed countries, it is estimated that 15% of the general population suffer from one or more allergic disorders, of which allergic rhinitis is the most common. Perennial rhinitis is most often due to allergy to the house dust mite. In such patients, house dust mite avoidance is logical, but there is considerable uncertainty regarding the efficacy and effectiveness of interventions designed to reduce dust mite exposure. To assess the benefit (and harm) of measures designed to reduce house dust mite exposure in the management of house dust mite sensitive allergic rhinitis. We searched the Cochrane Controlled Trials Register, Central, MEDLINE and EMBASE. No restrictions on the language of publication were employed. The bibliography of each paper and other published reviews were checked for further references. We wrote to first authors of all included trials in an attempt to identify further published and unpublished trials. Randomised controlled trial (with or without blinding), in which house dust mite control measures have been evaluated in comparison with placebo or other dust mite avoidance measures, in patients with clinician diagnosed allergic rhinitis and confirmed allergy to dust mite. Two reviewers independently checked titles and abstracts identified by the searches and full text copies of all papers of potential relevance were considered. Trials were graded for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner. Meta-analysis was neither possible, nor considered appropriate, because of the heterogeneity of the patient groups studied; a narrative overview of the results is therefore presented. Four trials satisfied the inclusion criteria, all of which were small and of poor quality. Two trials investigated the efficacy of acaricides, a third investigated the role of high-efficiency particulate air (HEPA) filters, whilst a fourth investigated the efficacy of a bedroom environmental control program that comprised use of a barrier mattress cover, fortnightly washing of bed covers, removal of soft furnishings and daily cleaning. Each of the four trials showed the interventions to result in significant reductions in house dust mite load when compared with control. Trial results suggest that the interventions may be effective in reducing some rhinitis symptoms, though it is not possible to provide a reliable summary estimate about the magnitude of such symptom reduction. No serious adverse effects were reported from the interventions. Trials to date have been small and of poor methodological quality making it difficult to offer any definitive recommendations on the role, if any, of house dust mite avoidance measures in the management of house dust mite sensitive perennial allergic rhinitis. The results of these studies suggest that interventions designed to reduce house dust mite exposure in patients with house dust mite allergic perennial rhinitis may be of some benefit in reducing rhinitis symptoms. Data at present is only available for acaricides, HEPA filters and a bedroom-based environmental control program; therefore, if considered appropriate, these should be the interventions of choice.

Molecular mechanisms of corticosteroids in allergic diseases.

Molecular mechanisms of corticosteroids in allergic diseases.

Serum Tryptase in Allergic Rhinitis: Effect of Cetirizine Treatment

Activated mast cells release a large range of potent mediators of allergic inflammation, including proteases. The tryptase serum levels were evaluated in 13 subjects suffering from allergic perennial rhinitis. Moreover the effects of cetirizine treatment on serum tryptase were studied using the UniCap&#x2122; tryptase fluoroenzymeimmunoassay. In allergic patients the serum tryptase values (M&#x00B1;SD: 6.1 &#x00B1; 2.4 &#x03BC;g/L) were significantly (p &#x003C; 0.02) higher than the values detected in controls (3.0 &#x00B1; 1.2 &#x03BC;g/L). In allergic rhinitis, after antihistamine treatment, tryptase values (4.4 &#x00B1; 1.8 &#x03BC;g/L) decreased significantly (p &#x003C; 0.001). After two weeks from the cetirizine stop, the tryptase levels increased again (5.5 &#x00B1; 2.6 &#x03BC;g/l). The results demonstrate that mast cells are constantly activated in perennial allergic rhinitis. The antihistamine treatment is effective in reducing the tryptase release from mast cells, but the mechanism of action of cetirizine is still to understand.

Expression of costimulatory CD80/CD86-CD28/CD152 molecules in nasal mucosa of patients with perennial allergic rhinitis.

B7 molecules (CD80, CD86) and their counter-receptors, CD28 and CD152 (CTLA-4), play an important role in T cell-mediated immune responses. We previously demonstrated that B7 molecules are selectively up-regulated not only on B cells but also on T cells from the peripheral blood mononuclear cells of patients with perennial rhinitis cultured with allergen. However, the expression of CD80/CD86 molecules and their counter-receptors in nasal mucosa, the actual inflammatory site of allergic rhinitis, has not yet been clarified. Inferior turbinates from patients with either allergy to house dust or non-allergic rhinitis were excised and immunohistologically stained. In addition, the inferior turbinates were challenged with paper discs containing extracts of house dust and subsequently excised. Samples were double stained with immunofluorescent-labelled antibody to identify cells bearing CD86. Without the nasal provocation, only the expression of CD86 was increased in nasal mucosa of patients with allergic rhinitis compared with those with non-allergic rhinitis. However, following the nasal provocation with house dust, not only CD86, but also CD80, CD28, and CD152 were significantly expressed in allergic patients. Immunofluorescent double staining revealed CD86 expression in CD19, CD1a, CD14 and CD3 lymphocytes. These results indicate that the expression of CD80/CD86 molecules and their counter-receptors is induced in allergic patients following nasal provocation with allergen, suggesting a local amplification of allergen-specific immune responses in perennial rhinitis.

Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis

Allergic rhinitis (AR) is a heterogeneous disorder that despite its high prevalence is often undiagnosed. It is characterized by one or more symptoms including sneezing, itching, nasal congestion, and rhinorrhea. Many causative agents have been linked to AR including pollens, molds, dust mites, and animal dander. Seasonal allergic rhinitis (SAR) is fairly easy to identify because of the rapid and reproducible onset and offset of symptoms in association with pollen exposure. Perennial AR is often more difficult to detect than SAR because of the overlap with sinusitis, respiratory infections, and vasomotor rhinitis. SAR can result in hyperresponsiveness to allergens such as cigarette smoke, once pollen season is over. Perennial AR is defined as occurring during approximately 9 months of the year. AR affects an estimated 20 to 40 million people in the United States alone, and the incidence is increasing; an estimated 20% of cases are SAR; 40% of cases are perennial rhinitis; and 40% of cases are mixed. The pathophysiology of SAR is complex. There is a strong genetic component to the allergic response, which is driven through mucosal infiltration and action on plasma cells, mast cells, and eosinophils. The allergic response occurs in two phases, which are considered the “early” and “late” phase responses. Early phase response occurs within minutes of exposure to the allergen and tends to produce sneezing, itching, and clear rhinorrhea; late phase response occurs 4 to 8 hours after allergen exposure and is characterized by congestion, fatigue, malaise, irritability, and possibly neurocognitive deficits. The key to diagnosis of AR is awareness of signs and symptoms. IgE antibody tests to detect specific allergens are the standard method used today; however, in addition, diagnosis must be confirmed with a positive history and demonstration that the symptoms are the result of IgE-mediated inflammation. (J Allergy Clin Immunol 2001;108:S2-8.)

Pharmacokinetics of intranasal corticosteroids

Topical administration of corticosteroids can reduce the total dose of corticosteroid required to treat the patient and minimize side effects. This logic has led to the development of intranasal corticosteroids (INCS) for allergic and perennial rhinitis. The second generation of these compounds includes beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide. There is evidence that the INCS are effective in rhinitis; however, there is concern about the potential for these compounds to cause growth suppression. In one study, beclomethasone dipropionate significantly reduced growth in children; however, treatment of children with mometasone furoate nasal spray for 1 year showed no signs of growth suppression. It is evident that the differences among INCS lie in their pharmacokinetics. Structural differences among the various INCS influence their metabolism. The goal of INCS therapy is to have a high ratio of topical to systemic activity. The drug delivery device, absorption of the drug, and drug distribution all contribute to effective topical activity of an INCS. In addition, individual drug metabolism and elimination (half-life and drug clearance) also contribute to the therapeutic index of a drug. Overall, the second-generation INCS cause minimal systemic effects at recommended doses. (J Allergy Clin Immunol 2001;108:S26-31.)

Mometasone Furoate Nasal Spray in the Treatment of Perennial Non-allergic Rhinitis: A Nordic, Multicenter, Randomized, Double-blind, Placebo-controlled Study

Mometasone Furoate Nasal Spray in the Treatment of Perennial Non-allergic Rhinitis: A Nordic, Multicenter, Randomized, Double-blind, Placebo-controlled Study

The biology of dust mites and the remediation of mite allergens in allergic disease

In most temperate humid areas of the world, house dust mites are a major source of multiple allergens in house dust. Mite allergens sensitize and induce perennial rhinitis, asthma, or atopic dermatitis in a large portion of patients with allergic disease. There is convincing evidence that avoidance of mite allergen can effectively reduce allergic symptoms. Patients can be moved to a mite allergen–free environment, or mite and mite allergen abatement can be performed to reduce exposure in existing residences. Some knowledge of the biology of house dust mites is essential to understand the basis of the recommendations for reducing mites and mite allergens in homes and to appreciate the difficulty of eliminating house dust mites and mite allergens from homes. This article reviews key aspects of the biology of dust mites, the properties of mite allergens, recommendations for reducing mite and mite allergen concentrations in homes, and practical recommendations for treatment. (J Allergy Clin Immunol 2001;107:S406-13.)

Inflammatory cell and epithelial characteristics of perennial allergic and nonallergic rhinitis with a symptom history of 1 to 3 years’ duration

Background: Perennial rhinitis is an inflammatory condition of the mucosal lining of the nose that may be caused by allergic and nonallergic mechanisms. Objective: We sought to characterize the cellular pattern and structural changes in the nasal mucous membrane of patients with perennial rhinitis and compare them with those of control subjects. Methods: Biopsy specimens were obtained from 27 patients with perennial allergic rhinitis (PAR), from 12 patients with perennial nonallergic rhinitis (PNAR) with eosinophils present in the nasal smear, and from 6 control subjects without rhinitis. In 10 of 27 patients with PAR who were also allergic to pollen, biopsy specimens were taken within the respective season (PARseason). In the other 17 patients, the biopsy was taken outside the pollen season (PARoutside season). Inflammatory cells were identified by using mAbs to their unique granular proteins. Results: The characteristic feature of perennial rhinitis was the accumulation of activated (degranulated) mast cells and eosinophils in the nasal mucosa. The tissue eosinophil/neutrophil ratio was higher, and the loss of epithelial integrity was greater in all patient groups compared with the control subjects. The extent of epithelial damage was significantly larger in patients in the PARseason group compared with that in the PARoutside season and PNAR groups, which did not significantly differ from each other in this respect. The number of eosinophils and mast cells was higher in the PNAR group compared with the PAR groups. In all patient groups, the number of eosinophils correlated with the loss of epithelial integrity. The number of mast cells did not correlate with the extent of epithelial damage nor did the number of neutrophils, except in patients in the PARseason group. Conclusion: The accumulation of eosinophils and mast cells, as well as loss of epithelial integrity, was characteristic for perennial rhinitis. Loss of epithelial integrity in the nasal mucosa may be a consequence of the activity of accumulated eosinophils. (J Allergy Clin Immunol 2001;107:249-57.)

Dual Symptomatic and Exudative Nasal Responses are not Characteristics of Perennial Allergic Rhinitis

Acute and late phase (dual) symptomatic responses after allergen challenge commonly occur in allergic asthma. The aim of the present study was to explore the occurrence of allergen challenge-induced biphasic responses in patients with chronic perennial allergic rhinitis living in an area with high house dust mite (HDM) exposure. Fifteen patients with perennial rhinitis and evident allergy to HDM participated. Nasal challenges with HDM and sham were performed on separate days in a crossover design. Nasal symptoms, forced expiratory volume in 1 s (FEV1

Cetirizine/pseudoephedrine.

Cetirizine is the carboxylated metabolite of hydroxyzine, and has high specific affinity for histamine H(1) receptors. Pseudoephedrine is a sympathomimetic drug that acts directly on alpha-adrenergic receptors. black triangle Cetirizine/pseudoephedrine 5/120 mg twice daily was significantly more effective than intranasal budesonide 100 microg or placebo at improving nasal obstruction, nasal patency and reducing the volume of nasal secretion, and was significantly more effective than intranasal xylometazoline 0.1% with respect to nasal secretion, during house dust mite faeces challenge in three randomised, cross- over studies among volunteers with seasonal or perennial rhinitis. The onset of action of cetirizine/pseudoephedrine was reported to be approximately 30 minutes. black triangle The bioavailability of cetirizine and pseudoephedrine is similar after administration of cetirizine/pseudoephedrine 5/120 mg bilayer tablets or coadministration of cetirizine 5 mg tablets plus pseudoephedrine sustained-release (SR) 120 mg caplets. black triangle Cetirizine 5mg plus pseudoephedrine SR 120 mg twice daily for 2 to 3 weeks was significantly more effective than each drug given alone at reducing mean total symptom scores for seasonal or perennial allergic rhinitis in two randomised, double-blind, multicentre trials. In both studies, the mean proportion of days during which the five measured symptoms (nasal obstruction, sneezing, rhinorrhoea, nasal pruritus and ocular pruritus) were absent or mild was significantly greater in recipients of the cetirizine plus pseudoephedrine SR. black triangle In one study, cetirizine 5 mg plus pseudoephedrine SR 120 mg was significantly more effective at reducing nasal obstruction than either drug alone. black triangle Cetirizine 5mg plus pseudoephedrine SR 120 mg twice daily for 2 to 3 weeks was well tolerated in patients with seasonal or perennial allergic rhinitis. The most common adverse events were dry mouth, insomnia, headache, somnolence, asthenia and nervousness.

Mometasone Furoate Nasal Spray in the Treatment of Perennial Non-allergic Rhinitis: A Nordic, Multicenter, Randomized, Double-blind, Placebo-controlled Study

In order to evaluate the efficacy and safety of mometasone furoate nasal spray (MFNS) in patients with perennial non-allergic rhinitis (PNAR) a phase III, double-blind, randomized, placebo-controlled, Nordic multicenter study was performed at 16 sites (7 in Sweden, 3 in Denmark, 3 in Finland and 3 in Norway). A total of 329 patients (age 18-82 years) with a mean duration of PNAR of 9 years were included in the study. The total duration of the study was 11 weeks: 2 weeks of screening, 6 weeks of treatment and 3 weeks of follow-up. Inclusion criteria were unspecific rhinitis symptoms and exclusion criteria were a positive skin prick test as well as intolerance to aspirin or non-steroidal anti-inflammatory drugs. Endoscopy was performed to exclude patients with structural anomalies and nasal polyps. The primary efficacy variable was the subject's total overall evaluation. In the intention-to-treat (ITT) group of patients (n = 329) the improvement rates were 56% (MFNS) and 49% (placebo). In the per-protocol (PP) group (n = 251) the corresponding figures were 58% and 47%. Stratifying for groups of patients having moderate symptoms, the results were 54% vs 43% in the ITT group and 56% vs 41% in the PP group. The therapeutic response showed greater improvement in total nasal score as recorded by the investigator in the groups treated with MFNS as compared to the placebo group (p = 0.09 [PP], p = 0.14 [ITT]). Adverse events occurred during the study, upper respiratory tract infections and headache being the most frequently reported, but there was no statistically significant difference between MFNS and placebo. The results of this study indicate that MFNS is a safe and effective treatment for patients with PNAR.

Allergic vulvovaginitis in infancy: study of a case

the role of dust mites (Dermatophagoides pt.) in the pathogenesis of allergic vulvovaginitis is still controversial. Association between this mite and atopic dermatitis, conjunctivitis, rhinitis or asthma is already known. Some authors study the possible relationship between some vulvovaginitis and local hypersensitivity. The aim of this study was to corroborate the allergic aetiology due to the mite Dermatophagoides pt. in a girl with vulvovaginitis and perennial rhinitis. we studied a nine year-old patient with symptoms of perennial rhinitis and unspecific vulvovaginitis of torpid evolution. In vivo and in vitro allergologic tests were performed as well as complete analytic tests including immunoglobulins, urine tests, nasal culture, exudative vaginal culture, and parasitic test. Skin test was positive for Dermatophagoides pt. as well as specific IgE (99.5 kU/L). Total IgE was elevated for her age (492 kU/L). In the rest of the complementary tests, no values out of normality or pathological findings were obtained. considering these results, it was suspected that the nasal symptoms and the vulvovaginitis presented by the patient are of allergic aetiology by hypersensitivity to the mite Dermatophagoides pt. The study did not prove relation with bacteria, parasites, Candida albicans or any inhalant allergens other than mites. After three months of treatment with oral antihistamines and topical chromones, as well as environmental avoiding measures, the symptoms totally yielded.

Rhinitis and quality of life

Resume Both seasonal and perennial rhinitis may cause quite severe impairment of HRQL. Since there is a poor correlation between clinical indices of nasal inflammation and HRQL, HRQL must be measured directly and cannot be imputed from the clinical indices. There are valid, disease-specific instruments available for measuring HRQL in both adults and children with rhinitis and therefore these assessments may be included in both clinical trials and clinical practice to evaluate the component of rhinitis that ismost important to the patient.