Presence Of Nasal Symptoms Research Articles

ROLE OF SEPTOPLASTY AND FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN THE TREATMENT OF RHINOGENIC HEADACHE

INTRODUCTION: Rhinogenic headaches are basically described as headache or facial pain caused by rhinological source. The presence of nasal symptoms & it’s temporal relationship with headache is the key factor that can guide the diagnosis and patient management. AIMS: This study aims to evaluate the efficacy of Septoplasty with Functional endoscopic sinus surgery (F.E.S.S) in the management of Rhinogenic headache. MATERIALS & METHODS: It was a Prospective study conducted in M.G.M Medical College & associated M.Y group of hospitals from March 2019 to March 2020. 64 patients of age group 18 years to 60 years having chronic rhinosinusitis with headache included in the study. After detailed history and thorough examination, nasal endoscopy and CT Paranasal sinus was done. Patients not responding to conservative management were selected for undergoing functional endoscopic sinus surgery. RESULTS: A total of 64 patients were included in the study,34 male & 30 female with the mean age group of 31.4 & 30.1 years respectively. Out of 64 patients,67% were completely free from headache,15% were significantly improved,7% had mild relief & 11% did not show any benefit in headache from surgery. Postoperatively, there was statistically significant difference was found patient’s symptomatology (i.e. p value =0.0165). CONCLUSION: To make the diagnosis both anatomical & infective factors needed to be considered. Correction of obvious anatomic abnormalities in carefully selected patients can significantly improve several important clinical outcomes from abolishing headache completely to decreasing its intensity and frequency of episodes. KEY-WORDS: Rhinogenic headaches, Septoplasty, Chronic rhinosinusitis, F.E.S.S, Nasal endoscopy

Evaluation of sleep quality and risk of obstructive sleep apnea in patients referred for aesthetic rhinoplasty.

ImportanceAesthetic rhinoplasty is the fifth surgical procedure most performed worldwide by plastic surgeons. With the growing demand for rhinoplasty, there is an unmet need for research into the profile of patients who seek aesthetic nasal surgery in an attempt to improve not only cosmetic dissatisfactions, but also the manifestations of other, possibly interrelated disorders, especially sleep disturbances. ObjectiveTo evaluate the sleep quality and the risk of Obstructive Sleep Apnea in patients referred for aesthetic rhinoplasty, as well as the association of these conditions with nasal symptoms. Design: Cross-sectional study performed at the period of June/2016 to August/2017. Setting: Department of Otolaryngology and Head and Neck Surgery - Universidade Federal de São Paulo. Participants: Patients of both sexes, aged 18 to 65 years, who were referred for aesthetic rhinoplasty. We evaluated 46 patients, two of whom were excluded because they were outside the inclusion age criteria. Main Outcome(s) and Measure(s): Anterior rhinoscopy and the following validated surveys were used. Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Nasal Obstruction Symptom Evaluation scale; Berlin Questionnaire. The visual analog scale for snoring was also used. ResultsOf the 44 participants, 18 (41%) were males and 26 (59%) were females. 82% had poor sleep quality. 46% presented excessive daytime sleepiness. There was a high risk for Obstructive Sleep Apnea in 27%. Regarding to nasal symptoms, the mean score in the Nasal Obstructive Symptoms Evaluation was 66.25±25.38. When comparing the groups with good and poor sleep quality, we observed a higher risk for Obstructive Sleep Apnea (p=0.05) in patients with poor sleep quality. Patients at high risk for Obstructive Sleep Apnea had higher scores on the Nasal Obstructive Symptoms Evaluation (p=0.001) and on the analogue snoring scale (p<0.001) compared to patients at low risk. ConclusionsWe observed a high occurrence of poor sleep quality in participants. All participants who were at high risk for obstructive sleep apnea were also classified as having poor sleep quality. An association was also observed between the presence of high risk for obstructive sleep apnea and presence of nasal symptoms.

Allergic rhinitis versus Idiopathic rhinitis: Are there differences in the symptomatology and nasal obstruction?

Study objectiveTwo large groups of rhinitis have been described: allergic and non-allergic. Up to 50% of patients with non-allergic rhinitis do not have a clear aetiology underlying their symptoms and present so-called idiopathic rhinitis. There is a lack of studies comparing the different types of rhinitis. The aim of this study is to analyse differences in severity, symptoms and degree of nasal obstruction between allergic rhinitis and idiopathic rhinitis. Patients and methodsA descriptive and analytical observational study in adult patients diagnosed with persistent allergic rhinitis and idiopathic rhinitis. Data collected included the total severity score on a visual analogue scale, sociodemographic variables, presence of nasal symptoms and their severity, and peak nasal inspiratory flow. ResultsOne hundred and eight (65.06%) patients with allergic rhinitis and 58 (34.94%) with idiopathic rhinitis were recruited. The mean severity score was 6.27±1.85 for idiopathic rhinitis and 6.68±2.23 for allergic rhinitis (P=0.050), with a higher percentage of allergic rhinitis patients referring to their disease as “Severe” (P=0.006). Allergic rhinitis patients were more likely to present sneezing, itching and anterior rhinorrhoea. A greater degree of nasal obstruction in peak nasal inspiratory flow was noted in asthmatic patients (P=0.001). ConclusionIdiopathic rhinitis and allergic rhinitis are two different disease entities, which have different clinical characteristics, as well as different comorbidities. Clinical and demographic differences have been found, emphasizing the importance of distinguishing these two entities since effective specific treatments exist for each situation.

Adherence to Continuous Positive Airway Pressure therapy in Singaporean patients with Obstructive Sleep Apnea

PurposeTo investigate the rates of Continuous Positive Airway Pressure (CPAP) uptake and adherence amongst Singaporean patients diagnosed with Obstructive Sleep Apnea (OSA), and to evaluate factors correlated with CPAP uptake and adherence. Study designRetrospective review of medical records. MethodsMedical records were reviewed for baseline demographics, daytime sleepiness, presence of nasal symptoms and OSA severity, initial treatment choice, the rate of CPAP treatment uptake and CPAP adherence at 1 and 12 months. Results2160 patients were diagnosed with OSA within the 5-year period (2011–2015). 463 (21.4%) had mild OSA, 583 (27.0%) had moderate OSA and 1114 (51.6%) had severe OSA. For initial therapy, 751 (34.8%) patients opted for a 1-month CPAP trial, 288 (13.3%) patients chose surgery upfront, 291 (13.5%) patients chose adjunctive treatments (weight loss, positional therapy, dental appliance, intranasal steroid spray for allergic rhinitis) and 830 (38.4%) patients rejected all forms of treatment.337 out of 751 patients (44.9%) were adherent to CPAP therapy during the 1 month trial. 381 out of 751 (50.7%) patients took up CPAP therapy following the trial period, of which 299 out of 381 (78.5%) patients were adherent to CPAP therapy at 1 year.CPAP adherence during the 1-month trial was a predictor for eventual CPAP treatment uptake and CPAP adherence at 1 year (p < 0.001). Age (p < 0.001), BMI (p < 0.001) and normal ESS (p = 0.01) were predictors of treatment rejection.24 patients underwent upper airway surgery during their first year of using CPAP. 21 out of the 24 patients (87.5%) were adherent to CPAP at 1 year after undergoing surgery. These patients had a higher rate of CPAP adherence compared to the overall cohort (87.5% versus 78.5%), but this was not statistically significant (p > 0.05). ConclusionSingaporean patients who accept CPAP therapy after an initial 1-month CPAP trial will generally be adherent to CPAP therapy. Initial patterns of CPAP usage are predictive of long term CPAP adherence. However, there is a high rate of CPAP treatment rejection both at the time of diagnosis and after the CPAP trial. Upper airway surgery in selected patients may improve CPAP adherence.

Nasal vestibulitis: an under-recognized and under-treated side effect of cancer treatment?

To evaluate the frequency of nasal symptoms termed nasal vestibulitis, including nasal dryness, crusting, bleeding, and pain, among patients receiving systemic, antineoplastic therapy. Patients undergoing systemic antineoplastic therapy were interviewed regarding the presence of nasal symptoms. In an explorative approach, Fisher's exact tests were used to identify groups in which frequencies of nasal symptoms were higher than the comparator arm. To account for potential confounding factors, including demographic variables and concurrent therapies, logistic regression analyses were performed, and estimated proportions with their standard errors (SEs) and odds ratios (ORs) were reported. Forty-one percent of the 100 surveyed patients had nasal symptoms, including dryness, pain, bleeding, and scabbing. Higher frequencies were reported among those who had received taxanes (71%) and VEGF-related therapies (78%). For the patients who had received taxanes, after controlling for other factors, the odds of experiencing nasal symptoms were 4.86 times higher than those for patients who did not receive taxanes (90% CI 2.01, 11.76). For patients who received VEGF-related therapies, after controlling for other factors and exposure to taxanes, the odds of experiencing nasal symptoms were 7.38 (90% CI 1.68, 32.51) times higher than those for patients who did not. Sixty-one percent of patients with symptoms said they reported them to their provider, but only 41% of chart notes contained documentation of such; 49% of patients reported treating their symptoms. Nasal vestibulitis is common among patients receiving taxane- and VEGF-related therapies; these symptoms are infrequently recorded or treated by healthcare providers.

Nasal vestibulitis as an under-recognized and undertreated side effect of cancer treatment.

219 Background: Dryness, crusting, and bleeding of the nares due to inflammation, termed nasal vestibulitis (NV), is infrequently reported as a side effect of cancer treatments. However, one study described 115 patients who developed NV while undergoing targeted therapies; many were treated with bacitracin ointment (Ruiz et al Sup Care Cancer 2015). Methods: This study surveyed 94 patients regarding the presence of nasal symptoms during cancer treatments. Participants were consented for the study if they had undergone at least 6 weeks of cancer-directed therapy in the Mayo Clinic Chemotherapy Unit. They were asked about types of nasal symptoms, severity, and symptom treatments. A chart review was then conducted to determine documentation of symptoms, the presence of concurrent illnesses, and cancer treatment regimens. Results: Ninety-four patients completed questionnaires, with 41% reporting unpleasant nasal symptoms that they attributed to cancer treatments. Of the symptomatic patients, 46% had dryness, 33% had discomfort, 54% had bleeding, and 46% had scabbing. Average severity was 1.9 on a scale from 1 to 3 (1 = mild, 3 = severe). Symptoms were noted in patients undergoing a variety of cancer treatment regimens, with the highest frequency in patients undergoing a taxane-containing regimen (46%). 62% of patients with symptoms said they reported them to their provider, but only 41% of chart notes (for 16 patients) contained documentation of such, most frequently described as “allergies” or “epistaxis.” Only 10% of symptomatic patients had nasal swabs; all of which were obtained during respiratory illness or pre-op. 49% of patients with nasal symptoms reported treating their symptoms. Antihistamines (7 patients), nasal saline (6 patients), or nasal lubricants (i.e. Vaseline; 7 patients) were used; 2 patients applied bacitracin. 18% of symptomatic patients had providers who recommended treatments, including 2 patients who were thought to have concurrent infection and were treated with antibiotics. Conclusions: NV symptoms are prevalent among oncology patients, but infrequently recorded or treated by providers.

Upper respiratory symptoms worsen over time and relate to clinical phenotype in chronic obstructive pulmonary disease.

How nasal symptoms in patients with chronic obstructive pulmonary disease (COPD) change over time and resolve during naturally occurring exacerbations has not been described previously. To evaluate the evolution and impact of upper airway symptoms in a well-defined COPD cohort when stable and at exacerbation. Patients in the London COPD cohort were asked about the presence of nasal symptoms (nasal discharge, sneezing, postnasal drip, blocked nose, and anosmia) over an 8-year period (2005-2013) every 3 months at routine clinic visits while in a stable state and daily during exacerbations with the use of diary cards. Data were prospectively collected, and, in a subgroup of patients, COPD Assessment Test scores and human rhinovirus identification by polymerase chain reaction were available. Patients were also defined as having infrequent or frequent exacerbations (<2 or ≥2 exacerbations/yr, respectively). At an aggregate of 4,368 visits, 209 patients with COPD were asked about their nasal symptoms. At 2,033 visits when the patients were stable, the odds ratio (OR) for nasal discharge increased by 1.32% per year (95% confidence interval [CI], 1.19-1.45; P < 0.001); the OR for sneezing increased by 1.16% (95% CI, 1.05-1.29; P = 0.005); the OR for postnasal drip increased by 1.18% (95% CI, 1.03-1.36; P = 0.016); and the OR for anosmia increased by 1.19% (95% CI, 1.03-1.37; P = 0.015). At visits when the patients were having exacerbations, nasal discharge was present for 7 days and blocked nose, sneezing, and postnasal drip increased for just 3 days. Anosmia did not change. Nasal discharge was more likely in patients with frequent exacerbations (OR, 1.96; 95% CI, 1.17-3.28; P = 0.011), and COPD Assessment Test scores were higher by 1.06 units (95% CI, 0.32-1.80; P = 0.005) when patients were stable and higher by 1.30 units (95% CI, 0.05-2.57; P = 0.042) during exacerbations. Upper airway symptoms increase over time in patients with COPD and are related to the frequent exacerbation phenotype. These longitudinal changes may be due to increasing airway inflammation or to progression of COPD.

Loss of smell but not taste in adult women with Turner's syndrome and other congenital hypogonadisms

ObjectivesTo assess the impact of Turner's syndrome (TS) and other congenital hypogonadisms (OCH) on the sense of smell and taste. DesignAn analytical study of three independent cohorts was designed: patients affected by TS, OCH, and a control group of healthy women taking contraception. SettingGynaecological Endocrinology Unit and Smell Clinic in Rhinology Unit of Hospital Clinic of Barcelona. ParticipantsThirty TS patients between 20 and 50 years of age receiving hormone replacement treatment (HT) were included as the exposed cohort; fourteen age-matched women with OCH taking HT were recruited; forty-three age-matched healthy controls receiving hormone contraception treatment were selected as the control group. This group was matched with an historical cohort of forty healthy women without contraception, used to validate BAST-24 in Hospital Clinic of Barcelona. InterventionsClinical history, presence of nasal symptoms, general physical examination, nasal endoscopy, and Barcelona Smell Test-24 (BAST-24) and gustometry were carried out on all patients. Main measuresTS physical dysmorphology features, intensity of nasal symptoms and signs of nasal obstruction were collected. BAST-24 test included 24 odours to assess both sensory (detection, memory and forced choice) and sensitivity (intensity, irritability, freshness and pleasantness) odour characteristics, as well as 4 tastes to evaluate taste domains (detection and forced choice). ResultsHealthy women taking hormone contraception felt odours with more intensity (p=0.002) and less irritability (p<0.001) than the historical cohort. TS patients showed a significant impairment in smell memory (p<0.005) and forced-choice (p<0.001) compared with controls taking contraception, whereas no differences were found in odour sensitivity. Detection of taste was successful in 100% of patients. When considering only individual tastes, none of them showed statistically significant differences between groups. ConclusionPatients with TS show the impairment of smell but not of taste, compared to OCH and healthy controls taking contraception. Smell sensitivity was not affected.

A prospective study of bacterial flora in nasal cavity of patients with persistent allergic rhinitis

It remains unanswered whether persistent allergic inflammation in nasal mucosa alters bacterial colonization and infection. The aim of this study was to investigate the bacterial flora in the nasal cavity of patients with persistent allergic rhinitis (PAR) and to correlate the bacteriological findings with presence of nasal symptoms, nasal eosinophil and neutrophil counts. A total of 255 subjects, aged between 6 - 74 years (mean 33.9 years) was randomly selected from a population-based rhinitis survey study in Singapore. All subjects went through a thorough medical history and nasal examinations. Serum specific IgE to a panel of common house dust mites, nasal cytological and microbiological examinations were performed. PAR was diagnosed in 107 patients and none of them had received previous regular therapy. There is a significant relationship between PAR and eosinophil grades, but not with neutrophil count. No statistically significant difference was found in quantitative and qualitative bacterial flora in nasal cavity between PAR patients and subjects with non-rhinitis or with non-allergic rhinitis. There is a significant inverse correlation between ongoing rhinorrhoea and quantitative bacterial load, and between signs of nasal mucosa (pale and edema) and the presence and type of bacterial pathogens. In conclusion, our study demonstrates that patients with untreated (or using PRN medicine) PAR do not result in a significant change in bacterial flora in their nasal cavity.

The Analysis of Hematological Parameters in Patients Presented with Allergic Rhinitis Symptoms

The aim of this study was to perform the analysis of hematological parameters in patients with allergic rhinitis symptoms. 181 patients underwent the skin prick test and completed the symptoms inquiry form were included in the study. We measured RBC (Red blood cells), Hb (hemoglobin), Htc (hemotocrit), WBC (white blood cells), PLT (platelet) and MPV (mean platelet volume) of the subjects. The relationship of the skin prick test positivity, allergic symptoms, severity and duration of symptoms, with the hematological parameters are analysed. Hematologic parameters were in normal ranges in patients who presented with symptoms of chronic rhinitis. There was no correlation between skin prick test positivity and hematological parameters. In the Alergic rhinitis group, RBC and Hb were seen to be affected by duration of illness and not to be affected by allergen distribution. WBC was seen to decrease as the duration of illness prolonged in both allergic and non-allergic groups. The presence of nasal symptoms was found to be associated with high RBC, Hb, Htc values. In the AR group, the RBC and Hb were found to have been affected by the duration of illness, and unaffected by the allergen distribution.

Asthma Control Test and Peak Expiratory Flow Rate: Independent Pediatric Asthma Management Tools

Background: Management of asthma reflects the complexity of the pathogenesis. According to current National Heart Lung Blood Institute (NHLBI) guidelines, asthma control can be assessed using the validated asthma control test, measures of airway function, and overall assessment of risk and quality of life. We hypothesized that the asthma control test and measures of airway function are independent tools in asthma management. We also studied whether the presence of nasal symptoms is correlated to these measures. Methods: Serial visits (n = 45) to a pediatric respiratory clinic in an underserved area of San Diego County with a predominantly Hispanic population were reviewed. Patients were included if they were able to perform airway function tests and had more than one provider visit. Patients with other major diseases were excluded. We determined whether uncontrolled asthmatics, defined as an Asthma Control test (ACT) score of 19 or less, had lower % predicted peak expiratory flow Measurements as a group compared to those with higher scores. In addition, the individual ACT and airway function results were analyzed. Patients with and without nasal symptoms at the time of presentation were sub-analyzed to determine differences in ACT and peak flow measurements. Results: Based on n = 45 physician visits, the mean ACT score was 21 +/− 3.3 (range 12–25) and the mean peak expiratory flow rate (PEFR) was 87.4% +/− 11 (range 65–109%). Patients with ACT scores < / = to 19 or lower (< / = 90%) PEFRs were determined not to have more nasal symptoms. The measures of ACT and peak expiratory flow were independent and not correlated. Conclusions. Our study indicates that ACT and PEFR are distinct parameters used to manage patients in a pediatric outreach asthma clinic.

THE ASTHMA CONTROL TEST AND PEAK EXPIRATORY FLOW RATE ARE INDEPENDENT PEDIATRIC ASTHMA MANAGEMENT TOOLS IN AN OUTPATIENT SETTING

PURPOSE: We hypothesized that the asthma control test (ACT) and %predicted peak expiratory flow rate (PEFR) are independent clinical management tools. We also studied whether the presence of nasal symptoms regardless of etiology is correlated to these measures.

Effect of Rural Environment on the Prevalence of Rhinitis in Children From Mexicali BC, Mexico

ISEE-824 Introduction: Asthma and allergic diseases in children have increased in many countries in the last decades and multiple theories try to interpret these changes. Some studies mention that lifestyle and living early ages in a rural environment can reduce the risk of atopy. Objective: We conducted a cross-sectional study to determine the prevalence of asthma and allergic rhinitis and identify the role of the rural environment in the development of these illnesses in a random sample of schoolchildren (n = 2087) aged 6 to 7 years residing in Mexicali, Baja California, Mexico. Materials and Methods: The methodology proposed by the International Study of Asthma and Allergies in Childhood (ISAAC) phase 1 was applied. Information was obtained through a standardized questionnaire completed by the children's parents. The information was analyzed using logistic regression models adjusted for potential confounders. Results: The prevalence of wheezing in the last 12 months and allergic rhinitis (defined by the presence of nasal symptoms and nasal and ocular symptoms) were 10.5% [95% confidence interval (CI) 9.1%–11.9%], 25.0% (95% CI 23.0%–27.0%), and 10.5% (95% CI 9.1%–11.8%), respectively. The children that report living in the rural environment in the first years of life presented a low risk for allergic rhinitis OR (odds ratio) = 0.43 (95% CI 0.24–0.77) for nasal symptoms and OR = 0.39 (95% CI 0.16–0.93) for nasal and ocular symptoms, adjusted by family history of asthma, type of school, animal in home, humidity in home, passive smoking, and pesticides exposure. Conclusions: Our results support the role of the rural environment as protector for rhinitis. We observed that the contact with certain factors related to the rural environment, especially in the first years of life, can modify the development of these illnesses independently of the family history of asthma.

Ciliary central microtubular orientation is of no clinical significance in bronchiectasis

It has been suggested that patients with bronchiectasis might have increased central microtubular orientation angle (CMOA), which leads to poor coordination of ciliary beating, and consequently impairment of airway defence. We have employed transmission electron microscopy to assess CMOA of ciliated nasal mucosa in a cohort of 133 (81F, 56.8+/-16.1yr) stable bronchiectasis and 59 healthy subjects (30F, 49.3+/-22.1yr). There was no significant difference in CMOA between bronchiectasis (13.2 degree) and control subjects (13.0 degree, P=0.82). There was no significant difference in CMOA among patients according to the etiology of bronchiectasis, presence of nasal symptoms, or sputum status of Pseudomonas aeruginosa infection. Patients with more severe bronchiectasis, i.e. those with FEV(1) <60%, FVC <60%, or more than 4 bronchiectatic lung lobes, had significantly lower CMOA than their counterparts (P<0.05). There was no correlation between CMOA with age, 24h sputum volume, exacerbation frequency, FEV(1), FVC, or the number of bronchiectatic lung lobes (P>0.05). CMOA correlated with ciliary beat frequency (negative), and the percent of cilia showing ultrastructural or microtubular defects (P<0.05). Central microtubular orientation angle does not correlate with clinically important parameters, in contrary to the results reported by previously published smaller scale studies.

LACK OF EFFECT OF FLUTICASONE PROPIONATE AQUEOUS NASAL SPRAY ON THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN 2- AND 3-YEAR-OLD PATIENTS

Galant SP, Melamed IR, Nayak AS, et al. Pediatrics . 2003;112:96–100 To determine the effects of fluticasone propionate (FP) (200 μg daily) on the hypothalamic-pituitary-adrenal (HPA) axis among patients 2 to 3 years of age. Children 2 to 3 years of age who demonstrated positive skin test responses to ≥1 seasonal allergen and the presence of nasal symptoms …

Effects of ipratropium bromide on hypertonic saline provocations in human nasal mucosa

Effects of ipratropium bromide on hypertonic saline provocations in human nasal mucosa

Citrus red mite (Panonychus citri) is the most common sensitizing allergen of asthma and rhinitis in citrus farmers.

To evaluate type I hypersensitivity to citrus red mite (Panonychus citri), its prevalence, and relationship to respiratory dysfunction, a cross-sectional survey was performed among citrus farmers on Cheju Island, Korea. Questionnaires, and skin prick test responses to 11 common inhalant allergens and citrus red mite were performed in 181 citrus farmers, and serum-specific IgE antibodies to citrus red mite were measured by ELISA in sera of 123 subjects. To determine airway hyperresponsiveness, methacholine bronchial provocation tests were performed in 55 subjects who complained of recurrent lower respiratory symptoms. The prevalence of asthma-based on presence of asthmatic symptoms on the questionnaire and airway hyperresponsiveness to methacholine, and allergic rhinitis based on presence of nasal symptoms on the questionnaire and positive skin-test response were 12.1% and 19.3%, respectively. The positive rate of skin responses to one or more of 11 common inhalant allergens excluding citrus red mite was 17.1%, and if citrus red mite was included, 25.9% of farmers had positive responses. On skin prick tests, citrus red mite (16.5%) was the most common sensitizing allergen, followed by cockroach (11.0%), Dermatophagoides pteronyssinus (9.9%), and D. farinae (9.3%). Among farmers with asthma and allergic rhinitis, the positive skin responses to citrus red mite were noted in 54.5 and 68.5%, respectively. Serum-specific IgE antibodies to citrus red mite were detected in 45 farmers (36. 5%) of the 123 tested, and there was significant correlation between specific IgE level and weal (A/H ratio) to citrus red mite (r = 0.57, P < 0.001). The prevalence of asthma was higher in subjects with positive skin responses or high serum-specific IgE antibodies to citrus red mite than in those without skin response or serum specific IgE (P < 0.05, respectively). Citrus red mite is the most important allergen in citrus farmers with asthma and rhinitis in which causative allergen has not been identified. It should be included in the skin test battery for screening the causative allergen in farmers exposed to citrus red mite.