Physician-diagnosed Allergic Rhinitis Research Articles

Epidemiology of Allergic Rhinitis in Children: a Systematic Review and Meta-Analysis.

Allergic Rhinitis (AR) is associated with significant clinical and socio-economic burdens. AR is a frequent risk factor for other atopic diseases, such as asthma. Thus, a comprehensive updated description of the epidemiology of AR in the pediatric population is needed to understand its implications better. To determine the incidence, prevalence and epidemiology of AR among children over the last ten years. We conducted a systematic review and meta-analysis using a protocol registered and published with the international prospective register of systematic reviews (PROSPERO register number: CRD42022332667). We searched databases, registers, and websites for cohort or cross-sectional studies published between 2012 and 2022, evaluating the epidemiology (incidence or prevalence) of AR in the pediatric population. We assessed study quality and risk of bias using items derived from the Strengthening the Reporting of Observational Studies in Epidemiology Statement. Twenty-two studies were included in the analysis. The overall prevalence of physician-diagnosed AR was 10.48%, the overall prevalence of self-reported current (last 12 months) AR was 18.12%, the overall prevalence of self-reported lifetime AR was 19.93%. Incidence could not be determined. The analysis of prevalence of AR over the time showed a rising trend in physician-diagnosed AR over the years (8.39% in 2012-2015 vs 19.87% in 2016-2022). AR has significant impacts on the pediatric population, with an increasing trend for diagnosed AR over the years. Further investigations concerning incidence, comorbidities, diagnosis and treatment are needed to provide a complete overview of the disease, its burden and management.

Clinical Characteristics, Health Care Resource Utilization, and Prescription Patterns of Japanese Patients with Physician-Diagnosed Allergic Rhinitis: A Secondary Use of Database Study

Introduction: Allergic rhinitis (AR) is associated with a substantial health care burden. In Japan, clinical patient profiles in real-life settings and evidence on economic burden of AR are limited. We studied clinical characteristics of patients with AR in Japan, and their impact on health care resource utilization (HCRU) and associated costs. Methods: This was a noninterventional study in patients aged ≥2 years with ≥2 physician-diagnosed AR, from a Japanese Claims Database, conducted from 2009 to 2018. The study comprised 6 cohorts; 1 primary, 3 secondary (cohorts 1, 2, 2-s), and 2 comparison cohorts 1 and 2-s (matched surgery and non-surgery). The primary objective was to describe demographic and clinical characteristics of patients in primary cohort. The secondary objectives were assessment of demographic and clinical characteristics in secondary cohorts and comparison of HCRU-related variables and allergic comorbidities between comparison cohorts. Results: Of 5,260,253 subjects data retrieved, 879,348 were included in primary cohort, with demographics and clinical characteristics being consistent across study period. Most frequent AR-related comorbidities were allergic conjunctivitis (41.7%) and asthma (38.6%). By 2018, 4,246 patients were included in secondary cohort 1, 866,453 in secondary cohort 2, 258,855 in secondary cohort 2-s, 3,496 in comparison cohort 1, and 13,984 in comparison cohort 2-s. Monthly HCRU-related variables between comparison cohort 1 and comparison 2-s indicated that AR-related surgeries and prescriptions peaked in prepollen and pollen seasons, respectively. HCRU and related costs were comparable but slightly higher in surgery than in non-surgery cohort. Conclusion: Real-world evidence of patients with AR highlights the need for cost-effective health care with opportunities for developing novel therapies.

Sleep-related Breathing Disorders in Children with Asthma: Impact on Asthma Control.

To investigate the frequency of sleep-related breathing disorder and the relationship between asthma control and sleep-related breathing disorder in children with persistent asthma. Comparative cross-sectional study. University of Health Sciences, Hamidiye Etfal Training and Research Hospital, Istanbul/Turkey, from January 2019 to June 2019. Children aged 4-11 years with persistent asthma were included. At enrollment, socio-demographic and asthmatic characteristics were investigated, and pediatric sleep questionnaire and childhood asthma control tests were administered. Out of 120 patients, 75 (62.5%) were males and 45 (37%) females. According to GINA guidelines, asthma was well controlled in 23.3% children, partially controlled in 50.8% children and uncontrolled in 25.8% children. The frequency of habitual snoring was reported as 20.8% and the frequency of sleep-related breathing disorder was 29.2%. The prevalence of sleep-related breathing disorders was significantly higher in the uncontrolled asthma group (p <0.001). Significant-independent efficacy of physician-diagnosed allergic rhinitis, habitual snoring, and low asthma control test scores was observed in predicting sleep-related breathing disorders in multivariate logistic regression model (p <0.001). Uncontrolled asthma is associated with sleep-related disordered breathing. The authors suggest that allergic rhinitis, habitual snoring, and low asthma control test scores are important risk factors for sleep-related breathing disorders in children with persistent asthma. Asthma, Asthma control test, Allergic rhinitis, Habitual snoring, Pediatric sleep questionnaire, Sleep-related breathing disorder.

Management of patients with seasonal allergic rhinitis: Diagnostic consideration of sensitization to non-frequent pollen allergens.

BackgroundDiagnosis of pollen allergies is mainly based on test allergens for skin prick testing. In the minimum battery of test inhalant allergens recommended by the Global Allergy and Asthma European Network 10 pollen allergens are included. Complementary other pollen allergens may need to be considered; however, respective awareness may not always be granted. Furthermore, at least in Germany, the situation may be even more complicated by the fact that test allergens need regulatory approval. A decline in commercially available test allergens may result in a diagnostic gap regarding patients with non‐frequent allergies. How many patients with non‐frequent pollen allergies would be affected by this gap? The data presented here partly answer this question.MethodsThe study consisted of a descriptive and an analytical part. In the descriptive part, sensitization to frequent pollen allergens (alder, hazel, birch, sweet grasses; according to the German Therapy Allergen Ordinance) and to respective non‐frequent pollen allergens (cypress, Japanese cedar, ash, plane tree, olive, Bermuda grass, wall pellitory, plantain, goosefoot, mugwort, ragweed, and saltwort) was measured in adult patients with physician‐diagnosed allergic rhinitis from two German federal states, namely North‐Rhine Westphalia (n = 360) and Bavaria (n = 339), using skin prick testing and/or ISAC technology. Furthermore, respective regional pollen data were assessed. In the analytical part, sensitization data were correlated with each other and with anamnestic data on symptom periods.ResultsSensitization to frequent pollen allergens ranged from 45% (sIgE to Aln g 1/Alder, NRW) to 72% (prick test reactivity to birch, NRW). Sensitization to non‐frequent pollen allergens ranged from 0% (sIgE to Amb a 1/ragweed, NRW) to 41% (prick test reactivity to olive, Bavaria). Sensitization data partly correlated with each other and in connection with symptom periods showed a partly similar seasonal pattern as pollen data.ConclusionsSensitization to non‐frequent pollen allergens have to be considered when examining patients with respective seasonal symptoms, and test (and respective therapy) allergens for non‐frequent pollen allergies need to be available. Further prerequisites for adequate patient management would be a nationwide pollen monitoring system giving continuous pollen data and a systematic sensitization monitoring at patient level.

Four subtypes of childhood allergic rhinitis identified by latent class analysis.

Childhood allergic rhinitis (AR) is clinically heterogenous. We aimed to identify distinct phenotypes among children with AR using data-driven techniques and to ascertain their association with patterns of symptoms, allergic sensitization, and comorbidities. We recruited 510 children with physician-diagnosed AR, of whom 205 (40%) had asthma. Latent class analysis (LCA) was performed to identify latent structure within the data set using 17 variables (allergic conjunctivitis, eczema, asthma, family history of asthma, family history of allergic rhinitis, skin sensitization to 8 common allergens, tonsillectomy, adenoidectomy). A four-class solution was selected as the optimal model based on statistical fit. We labeled latent classes as: (1) AR with grass mono-sensitization and conjunctivitis (n=361, 70.8%); (2) AR with house dust mite sensitization and asthma (n=75, 14.7%); (3) AR with pet and grass polysensitization and conjunctivitis (n=35, 6.9%); and (4) AR among children with tonsils and adenoids removed (n=39, 7.6%). Perennial AR was significantly more common among children in Class 2 (OR 5.83, 95% CI 3.42-9.94, p<.001) and Class 3 (OR 2.88, 95% CI 1.36-6.13, p=.006). Mild and intermittent AR symptoms were significantly more common in children in Class 2 compared to those in Class 1. AR was more severe in Class 1 compared to other 3 classes, indicating that upper respiratory symptoms are more severe among children with isolated seasonal rhinitis, than in those with rhinitis and coexisting asthma. We have identified 4 phenotypes in school-age children with AR, which were associated with different patterns of clinical symptoms and comorbidities.

Prevalence and risk factors of allergic rhinitis and asthma in the southern edge of the plateau grassland region of northern China: A cross-sectional study

BackgroundThe prevalence rates of allergic rhinitis (AR) and asthma in the border region of China may be different from those in the central region of plateau grasslands. A survey was performed to investigate the prevalence and risk factors for AR, asthma, and AR combined with asthma among adults (age ≥ 20 years) residing in the southern border of plateau grasslands in northern China. MethodsFrom May to August 2018, a cross-sectional survey was completed by subjects that were selected using a cluster random sampling method. The subjects completed a questionnaire and were administered skin prick tests (SPTs). Risk factors for AR, asthma, and AR combined with asthma were examined by multivariate logistic regression analyses. ResultsA total of 1815 adult subjects in the selected region completed study. The prevalence rates of physician-diagnosed AR, asthma, and AR combined with asthma were 13.9% (253), 9.8% (177), and 2.9% (52), respectively. Among the patients with AR, 20.6% were found to have concurrent asthma; among the patients with asthma, 29.4% were found to have concurrent AR. Artemisia and Humulus pollen were the most common sensitizing pollen types. Approximately 70% of subjects with AR and <30% of asthma patients were sensitized to Artemisia and Humulus pollen. Symptoms of AR and asthma mainly appeared during August. A multivariable logistic regression analysis identified sensitization pollen as an independent risk factor for both AR and AR combined with asthma (AR: OR = 16.23, 95% CI: 10.15–25.96; AR combined with asthma: OR = 6.16, 95% CI: 1.28–29.66). An age >40 years old, family history of asthma, moderate-to-severe AR, adverse food reactions, and mold allergies were independent risk factors for AR combined with asthma. ConclusionsThis study identified the prevalence rates of AR and asthma in the southern borders of the plateau grassland in northern China (>1500 m above sea level). Sensitization pollen is an independent risk factor for AR and AR combined with asthma.

Evaluation of Allergic Disease Prevalence and Related Risk Factors in Children with Autoimmune Thyroiditis

Background: Allergic and autoimmune diseases are caused by an impaired immunological response resulting from different types of T-helper (Th) cells. Since the Th cell production is in a certain balance, an inverse relationship between the 2 disease groups may exist. In this study, we aimed to investigate the frequency of allergic diseases in children with autoimmune thyroiditis (AT). Methods: Symptoms of allergic diseases were investigated by the (International Study of Asthma and Allergies in Childhood) ISAAC questionnaire. The questionnaire was administered to a group of 300 children with AT and a control group of 300 children with no known autoimmune disease. The risk factors for allergic diseases and sociodemographic characteristics were investigated. A multivariable logistic regression analysis was performed with the risk factors of allergic diseases. Results: Asthma, wheezing during the last year, wheezing with exercise, disease-free night cough, and night cough were significantly less common in patients with AT. Allergic rhinitis symptoms, except physician-diagnosed allergic rhinitis, are found significantly less frequently in patients with AT. It was found that the presence of AT and an increase in the number of children in the family reduce the risk of allergic diseases; cat-dog contact before 1 year of age and the presence of asthma, eczema, or allergic rhinitis in the mother increase the risk of allergic diseases. Conclusions: Asthma and allergic rhinitis symptoms were significantly less common in children with AT. AT reduces the risk of allergic diseases.

Association between allergic rhinitis-related factors and sleep duration in adolescents: Korea National Health and Nutrition Examination Survey V (2010–2012)

ObjectivesPrevious studies have shown that sleep and allergic rhinitis (AR) is closely associated, bidirectionally affecting each other. Adolescence is a period that adequate sleep is essential, and the burden of AR increases, both of which greatly affect the quality of life. The aim of the present study was to investigate the correlation between inappropriate sleep duration and each AR-related subjective/objective factor in Korean adolescents. MethodsWe analyzed the data of 1936 adolescents aged between 12 and 18 years who participated in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. Data on sleep duration, physician-diagnosed AR, and presence of rhinitis symptoms were collected using a self-administered questionnaire. Nasal endoscopic findings, including watery rhinorrhea and pale inferior turbinate mucosa, and aeroallergen sensitization based on serum specific immunoglobulin E levels were examined. ResultsThere was a higher prevalence of AR (23.68%) in the inappropriate sleep duration group than in the control group (16.56%; odds ratio = 1.56, p = 0.0024). The presence of endoscopic findings of AR showed a positive association with inappropriate sleep duration in males (odds ratio = 1.52, p = 0.008). In addition, in all three indoor allergens investigated, aeroallergen sensitization was not associated with inappropriate sleep duration. ConclusionInappropriate sleep duration was associated with increased prevalence of AR in Korean adolescents. Especially, this association was relevant in nasal endoscopic findings in male.

Prevalences of Allergic Disorders in Children with Terra Firma-Forme Dermatosis.

Background:Terra firma-forme dermatosis (TFFD) is a clinical condition that may be defined as a dirty appearance of skin. Although it has been defined for many years, its clinical value is not well known.Objective:We aimed to determine the prevalence of allergic disorders (asthma, allergic rhinitis, and eczema) to investigate if this clinical condition is associated with allergic disorders in children with TFFD.Materials and Methods:A questionnaire descriptive of allergic disorders [International Study of Asthma and Allergies in Children (ISAAC)] was applied to all children diagnosed with TFFD at the pediatric clinics during a 6-month period specified for the study. The results were compared with the two ISAAC studies that have been previously conducted in our region.Results:The prevalence of TFFD among 1695 children examined at our outpatient clinic was found to be 3.18% (n = 54). The youngest of the children was 6 months old and the oldest 13 years, with an average age of 6.08 ± 2.69 years. Our study group had significantly greater rates and intensities of lifetime wheezing, wheezing in the last 12 months (current wheezing), lifetime allergic rhinitis, allergic rhinitis in the last 12 months; and the rate of physician-diagnosed allergic rhinitis compared to the comparator groups (P < 0.005).Conclusions:The results support the view that TFFD may be a sign of associated asthma and allergic rhinitis.

Prevalence of allergic rhinitis, related comorbidities and risk factors in schoolchildren

BackgroundThe study aimed to determine the prevalence and risk factors of allergic rhinitis and related comorbidities in school-age children in Budapest, capital of Hungary. Data and epidemiological studies on this disease are still limited.MethodsA cross sectional study was conducted in 21 representative and randomly selected primary schools in 2019. International Study of Asthma and Allergies in Childhood-based questionnaires (n = 6869) inquiring about prevalence and related risk factors of allergic rhinitis were distributed to all parents. The data were characterised with standard descriptive statistics: frequencies (percentages) and means for categorical and quantitative data, respectively.Results3836 of the questionnaires (1857 M/1979F) were completed. The prevalence of current allergic rhinitis was 29.3% (1043), physician-diagnosed allergic rhinitis was 9.7% (373), cumulative allergic rhinitis was 36.2% (1289) and current allergic rhinoconjunctivitis was 16.2% (577). The presence of physician diagnosed atopic disease–asthma (p < 0.0001, OR = 4.398, 95% CI 3.356–5.807), food allergy (p < 0.0001, OR = 2.594, 95% CI 1.995–3.378), and eczema (p < 0.0001, OR = 1.899, 95% CI 1.568–2.300)-were significantly related to an increased risk of cumulative allergic rhinitis. Significant factors associated with allergic rhinitis include male gender (p < 0.0001), family history of atopy (p < 0.0001), frequent upper respiratory tract infections (p < 0.0001), tonsillectomy (p = 0.0054), antibiotics given in the first year of life (p < 0.0001), paracetamol given in the first year of life (p = 0.0038), long-lasting common infections caused by viruses and/or bacteria before the appearance of the allergy (p < 0.0001), consumption of drinks containing preservatives or colourants (p = 0.0023), duration of living in Budapest (p = 0.0386), smoking at home (p = 0.0218), smoking at home in the first year of life (p = 0.0048), birds at home (p = 0.0119), birds at home in the first year of life (p = 0.0052), visible mould in the bedroom (p = 0.0139), featherbedding (p = 0.0126), frequent or constant heavy-vehicle traffic (p = 0.0039), living in a weedy area (p < 0.0001) and living in the vicinity of an air-polluting factory or mine (p = 0.0128).ConclusionsThe prevalence of allergic rhinoconjunctivitis in 6–12-year-old children in Budapest is higher than reported for most of the surrounding European countries. While asthma (OR = 4.398) is the most significant comorbidity, environmental factors such as birds at home in the first year of life (OR = 2.394) and living in a weedy area (OR = 1.640) seem to be the most important factors associated with AR. Strategies for preventive measures should be implemented.Trial registration number: KUT-19/2019. The study was approved by the Ethics Committee at Heim Pál National Pediatric Institute,

Machine learning approach for genome-wide polymorphisms to predict childhood allergic rhinitis in a longitudinal follow-up birth cohort study

Background: Allergic rhinitis (AR) is a common chronic inflammatory disorder in children. Genetic characteristics and environmental exposures contribute to the development of allergic diseases. This study aimed to develop a predictive model using genetic single nucleotide polymorphisms (SNPs) for the development of childhood AR from a longitudinal follow-up birth cohort study.Methods: Mother-infant pairs in the birth-cohort study were recruited from night Taiwanese hospitals from 2001 to 2005. Information on children’s health status including AR occurrence was obtained via questionnaire interviews at the age of 2, 5, 10, and 14 years old. SNP Array (Axiom Genome-Wide TWB 2.0) was used for genotype measurements. We applied machine learning method to establish predictive model for childhood AR. Multiple variable regression was used to assess the association of childhood AR with genotypes and conventional risk factors.Results: Overall, 247 mother-infant pairs completed all measurements. The prevalence of ever having physician-diagnosed AR by 14 years of age was 40.1%. By decision tree analysis, 19 SNPs were found to efficiently distinguish children with or without AR. The area under the receiver operating characteristic curve (AUROC) of the predictive model was 0.825. We then used backward stepwise regression to select significant SNPs in the predictive model and 8 SNPs were selected (AURIC = 0.806). After adjusted for potential confounders of child sex and maternal education, 6 SNPs of them (i.e. CD28 rs12693993, EGFR rs117179604, FTO rs71390222, IL1RAPL1 rs1016210, SEMA3A rs1520102, and SOCS3 rs4969169) were still significantly associated with childhood AR. The AUROC was slightly improved to 0.827. Conclusion: This study provides a model for predicting the risk of childhood AR according to hereditary factors. Future functional investigations of the SNPs and verifications with additional larger cohorts are warranted.

Association between maternal age at delivery and allergic rhinitis in schoolchildren: A population-based study

BackgroundSome studies have shown associations of maternal age at delivery with asthma and food allergy in offspring. However, the relationship between maternal age at delivery and allergic rhinitis is largely unclear. This study aimed to investigate the association between maternal age at delivery and allergic rhinitis in a population sample of Asian children, and to explore potential effect modifiers. MethodsA total of 1344 singleton-birth children (763 boys, 56.8%; mean age, 6.4 years) participating in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort were evaluated by a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and interviewed by pediatricians. Allergic sensitization was determined by using Phadiatop Infant. Multiple logistic regression models with covariates adjustment were performed to investigate the association of maternal age at delivery with allergic rhinitis and allergic sensitization in offspring. ResultsAmong 1344 study children, 793 (59%) had physician-diagnosed allergic rhinitis. Advanced maternal age at delivery (≥40 years) was significantly associated with increased odds of allergic rhinitis (adjusted odds ratio [AOR] = 4.58, 95% confidence interval [CI]: 1.90–11.03) and allergic sensitization (AOR = 2.86, 95% CI: 1.13–7.22) in offspring. A sex-stratified analysis revealed that the association of advanced maternal age with allergic rhinitis was statistically significant only in female offspring (AOR = 7.02, 95% CI: 1.89–26.14). Stratified analyses by birth order or environmental tobacco smoke exposure during pregnancy did not reveal any significant differences. ConclusionAdvanced maternal age at delivery was associated with increased risk of allergic rhinitis in Asian children, probably more pronounced among girls.

Early-onset-early-resolving atopic dermatitis does not increase the risk of development of allergic diseases at 3 Years old

Epidemiological findings showed the increased risk of allergic rhinitis (AR) and asthma in the children with preceding atopic dermatitis (AD). In this study, we aimed to observe the development of allergic diseases in infantile AD patients. We followed up the prospective observational cohort enrolling two-to four-month-old exclusively breastfed infants. The presence of physician-diagnosed asthma, AR and AD at age 3 was recorded with the laboratory tests for atopic sensitization. Fifty infantile AD patients and 48 healthy controls were enrolled. The sex, age and parental atopy history were not significantly different between the two groups. At age 3, 21 (42%) patients had persistent AD in the infantile AD group while only 2 (4.2%) patients had newly diagnosed AD in the control group (p<0.001). The early-onset-early-resolving AD (subsides before age 2) did not increase the risk of AR and asthma development, and the sensitization to allergens. However, the early-onset-persistent AD (persists after age 2) increased the risk of AR development and sensitization to inhalant allergens (adjusted odds ratio 2.83, 7.07, respectively). The parental atopy status was associated with any allergic disease at age 3 (p=0.020). The maternal atopy history was the significant factor associated with AD, AR and eosinophilia at age 3 (p=0.004, 0.014, 0.031, respectively). The early-onset-early-resolving AD was not associated with allergic diseases development at age 3. The parental atopy history and early-onset-persistent AD might be the risk factors for development of allergic diseases at age 3.

Age-specific incidence of allergic and non-allergic asthma

BackgroundOnset of allergic asthma has a strong association with childhood but only a few studies have analyzed incidence of asthma from childhood to late adulthood in relation to allergy. The purpose of the study was to assess age-specific incidence of allergic and non-allergic asthma.MethodsQuestionnaires were sent to 8000 randomly selected recipients aged 20–69 years in Finland in 2016. The response rate was 52.3% (n = 4173). The questionnaire included questions on e.g. atopic status, asthma and age at asthma diagnosis. Asthma was classified allergic if also a physician-diagnosed allergic rhinitis was reported.ResultsThe prevalence of physician-diagnosed asthma and allergic rhinitis were 11.2 and 17.8%, respectively. Of the 445 responders with physician-diagnosed asthma, 52% were classified as allergic and 48% as non-allergic. Median ages at diagnosis of allergic and non-allergic asthma were 19 and 35 years, respectively. Among subjects with asthma diagnosis at ages 0–9, 10–19, 20–29, 30–39, 40–49, 50–59 and 60–69 years, 70, 62, 58, 53, 38, 19 and 33%, respectively, were allergic. For non-allergic asthma, the incidence rate was lowest in children and young adults (0.7/1000/year). It increased after middle age and was highest in older age groups (2.4/1000/year in 50–59 years old).ConclusionsThe incidence of allergic asthma is highest in early childhood and steadily decreases with advancing age, while the incidence of non-allergic asthma is low until it peaks in late adulthood. After approximately 40 years of age, most of the new cases of asthma are non-allergic.

Atopy and allergic diseases among Saudi young adults: A cross-sectional study.

ObjectiveIn this cross-sectional study, we aimed to determine the prevalence of asthma and other allergic diseases among a homogenous group of students attending the health colleges of a Saudi university and to investigate the relationship between their atopy profile and associated clinical symptoms of allergic diseases.MethodsA total of 222 students completed the International Study of Asthma and Allergies in Childhood questionnaire and underwent skin prick testing (SPT) using a standardized panel of allergenic extracts.ResultsOverall prevalence of physician-diagnosed allergic diseases was 27% for bronchial asthma (BA), 13.1% for atopic dermatitis (AD), and 5% for allergic rhinitis (AR). Atopy was present in 90 (40.5%) students. Students with atopic disease were more likely to have physician-diagnosed BA, AR, and AD. Atopy and polysensitization was more frequent among male than female students. SPT results were positive in 20.8% of participants for Bermuda grass, 18.9% for cat fur, and 12.7% for Dermatophagoides pteronyssinus.ConclusionThe prevalence of atopy and allergic diseases in Saudi young adults is high and worrisome. Comorbid allergic diseases were more prevalent among our participants with atopic disease. Determination of allergen sensitization patterns in patients with atopic disease is crucial for selecting proper preventive and therapeutic strategies.

The impact of perennial allergic rhinitis with/without allergic asthma on sleep, work and activity level

BackgroundAllergic respiratory diseases such as allergic rhinitis (AR) and allergic asthma (AA) are common conditions that can influence sleep and daytime functioning. However, the significance of this impact is unclear—particularly in perennial allergy sufferers. This study investigates the impact of perennial allergy on sleep, daily activities and productivity.MethodsAdults with self-reported or physician-diagnosed perennial AR aged ≥ 18 years were recruited in Denmark, France, Germany and Sweden. Allergy sufferers were identified using online panels closely matching national population characteristics for each country. Impact on sleep, work, productivity and activity (by the Work, Productivity and Activity Index) were analysed. Descriptive analyses were conducted.ResultsIn total, 511 subjects with perennial AR (47.4% also with seasonal allergy) completed the survey. Most subjects (77.5%) had a physician-diagnosis of AR; 46.4% were diagnosed with both AA and AR. Most subjects (65.2%) reported sensitisation to house dust mites. Of all subjects, 66.0% reported sleep problems. Subjects with sleep problems woke, on average, 3.8 times per night, with 92.0% taking 15+ min to fall asleep (22.2% took 60+ min). Upon waking at night, 40.8% struggled to get back to sleep, and 69.2% had difficulties waking in the morning due to tiredness. Disturbances in daily functioning due to sleep issues were reported in 85.5–95.0% of subjects with sleep problems across all aspects investigated. Overall work and activity impairment were 53.3% and 47.1%, respectively. Sleep issues were more frequent (78.1% vs 54.7%) in those diagnosed with both AR and AA compared to AR alone, and more burdensome, with a greater impact on daily functioning (47.0% vs 33.3%) and impairment in work and activity (62.0% and 54.9% vs 39.3% and 35.2%, respectively). Of all subjects, 20.5% were receiving AIT at the time of the survey; of these, 36.4% reported moderate or great improvement in sleep due to allergy treatment.ConclusionsIn perennial AR sufferers, sleep problems are common and impact on daily functioning, with results indicating a greater burden in those with both AR and AA compared to AR alone.

Practice Patterns for Chronic Respiratory Diseases in the Asia-Pacific Region: A Cross-Sectional Observational Study

Background: Allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis are common and little studied in the Asia-Pacific region. Objectives: We sought to investigate real-world practice patterns for these respiratory diseases in India, Korea, Malaysia, Singapore, Taiwan, and Thailand. Methods: This cross-sectional observational study enrolled adults (age ≥18 years) presenting to general practitioners (GP) or specialists for physician-diagnosed AR, asthma, COPD, or rhinosinusitis. Physicians and patients completed study-specific surveys at one visit, recording patient characteristics, health-related quality of life (QoL), work impairment, and healthcare resource use. Findings by country and physician category (GP or specialist) were summarized. Results: Of the 13,902 patients screened, 7,243 (52%) presented with AR (18%), asthma (18%), COPD (7%), or rhinosinusitis (9%); 5,250 of the 7,243 (72%) patients were eligible for this study. Most eligible patients (70–100%) in India, Korea, Malaysia, and Singapore attended GP, while most (83–85%) in Taiwan and Thailand attended specialists. From 42% (rhinosinusitis) to 67% (AR) of new diagnoses were made by GP. On average, patients with COPD reported the worst health-related QoL, particularly to GP. Median losses of work productivity for each condition and activity impairment, except for asthma, were numerically greater for patients presenting to GP vs. specialists. GP prescribed more antibiotics for AR and asthma, and fewer intranasal corticosteroids for AR, than specialists (p < 0.001 for all comparisons). Conclusions: Our findings, albeit mostly descriptive and influenced by between-country differences, suggest that practice patterns differ between physician types, and the disease burden may be substantial for patients presenting in general practice.

Effect of industrialization on allergic diseases in school children

Aim: The lifestyle and environmental changes associated with industrialization and urbanization are crucial factors in determining the prevalence of allergic diseases. Material and Methods: The aim of this study was to determine the prevalence of asthma and other allergic disorders in an industrial town.Study Design: Prospective, Cross-sectional study. This cross-sectional population-based study was conducted in Kemalpasa, Ýzmir, Turkey, which is an industrial town. Using the International Study of Asthma and Allergies in Childhood (ISAAC), the questionnaire was carried out on 1511 school-children aged between 13-14 years living in the district center. Results: The ISAAC Phase One questionnaire was answered by 1373 (90.87%) students. Six hundred ninety two (50.5%) of the children were girls and 681 (49.5%) were boys. The frequency of ever wheezing was 34%,that of current wheezing was 31.1% and that of physician-diagnosed asthma was 4.1%. The frequency of ever rhinitis was 36.6%, current rhinitis was 31.3%, current allergic rhino-conjunctivitis was 22.1% and physician-diagnosed allergic rhinitis was 11.1%. The frequency of ever eczema was 11.3% and that of physician-diagnosed eczema was 3.6%. Conclusion: The prevalence of asthma was found to be significantly higher, although there was no significant difference in allergic rhinitis and eczema compared with non-industrial neighboring states. The incidence of asthma was higher than other provinces which may be explained by the risk factors associated with this industrialized area. The fact that only children of the same age group and residence were evaluated contributed to the epidemiological value of our study.

Trends in prevalence and risk factors of allergic rhinitis symptoms in primary schoolchildren six years apart in Budapest

BackgroundFew data are available concerning the time trends and risk factors associated with allergic rhinitis (AR) in schoolchildren in Hungary. MethodsAt an interval of six years, parents of 6–12-year-old children completed identical ISAAC-based and additional questionnaires related to possible risk factors. ResultsResponse rate was 62.8% with 6335 questionnaires distributed in 2007, and 52.9% with 6441 questionnaires in 2013. The prevalence of current AR symptoms (subjects presenting clinical symptoms of AR in the past 12 months, but had yet to be diagnosed by physician) increased significantly from 14.9% to 23.5% (p<0.001). There was no significant change in the prevalence of physician-diagnosed AR (11.6–11.2%). In multivariate analysis, gender (OR 0.733; CI 0.642–0.931), a family history of atopy (OR 2.017; CI 1.669–2.436), frequent upper respiratory tract infections (OR 2.033; CI 1.659–2.492), long-lasting disease before the appearance of the allergy (OR 2.119; CI 1.311–3.428), feather bedding (OR 0.773; CI 0.599–0.996) and living in a green area (OR 1.367; CI 1.133–1.650) were found to be significant risk factors of cumulative AR in 2013. In both of the groups with (p<0.000) or without (p<0.003) AR the families with a history of atopy used feather bedding less frequently than families without atopy. ConclusionAlthough the prevalence of physician-diagnosed AR has not shown significant changes during the studied interval, the significant increase of the current AR symptoms suggests growing prevalence of AR among children in Budapest. Our results revealed new aspects of bedding customs in atopic families.

Evaluation of Allergic Symptoms Prevalence and Its Relationship with Acetaminophen/Antibiotic Use and Hospitalization Among School-Aged Children in Tehran, Iran

Background: Increasing of childhood allergic diseases throughout the world and its heavy socioeconomic burden have posed an important health concern. Therefore, providing the updated relevant epidemiological information is robustly recommended. Objectives: The study aimed to determine the prevalence of asthma, allergic rhinitis (AR), and eczema symptoms in primary school children aged 6 - 7 years and ascertain the association of acetaminophen use, antibiotic consumption, and hospitalization for respiratory infection in early life with allergic symptoms. Methods: In this cross-sectional study conducted on primary school children aged 6 - 7 years from May to July 2012 in Tehran (Iran), a total of 4993 individuals took part. Cluster sampling was used for random selection of primary schools. Data were gathered by using a modified questionnaire of international study of asthma and allergies in childhood (ISAAC). Then, the questionnaires were completed by parents of the children. Results: The prevalence rates of current wheeze, wheeze ever, current itching rash, itchy rash ever, and rhinitis ever were found to be 19.64%, 27.49%, 8.95%, 8.28%, and 21.87%, respectively. Physician-diagnosed asthma, eczema, and AR were reported in 4.32%, 7.29%, and 9.61% of children, respectively. Univariate logistic regression analysis showed that antibiotic use was significantly associated with symptoms of allergic rhinitis (P = 0.001). Also, the strongest association was found between asthma and atopic dermatitis symptoms and hospitalization due to respiratory infection in early life by multivariate analysis (P = 0.002 and P = 0.009, respectively). Conclusions: This study determined the rising pattern of allergic symptoms in 6 - 7 year old children in Tehran. Moreover, acetaminophen/antibiotic use and hospitalization due to respiratory infection in early life were detected as significant risk factors for the appearance of childhood allergic symptoms.