Presence Of Rhinitis Research Articles

Risk Factors for Asthma Onset Between the Ages of 12 and 40: Results of the FENASMA Study

Objectives To describe the clinical profile of patients with asthma and to identify possible risk factors for its development in subjects over the age of 12. Patients and methods A multicenter study of cases and controls. Recruited for inclusion were case subjects between the ages of 12 and 40 diagnosed with asthma, with an onset of symptoms after the age of 12. Control subjects were selected, with ages between 12 and 40, who did not have childhood asthma and did not present symptoms of asthma at the time of the study. Results We evaluated 923 subjects: 247 cases and 671 controls, 54.9% were women. Mean age of the cases was 28.3±8.2; mean age of controls was 30.8±7.1 ( P<.001). In the logistic regression analysis, it was observed that the determining factors for the of the presence of asthma were hypersensitivity to animals or other allergens, presence of rhinitis, family history of asthma, occupational risk/exposure to irritants and the hypersensitivity/intolerance to NSAIDs. In said analysis, it was also demonstrated that age was a protection factor, as well as level of education. Conclusions The risk factors for the development of asthma at an adult age are hypersensitivity to animals or other allergens, rhinitis, family history of asthma, occupational risk/exposure to irritants and the hypersensitivity/intolerance to NSAIDs, while age and level of education are protection factors.

Factores de riesgo de asma de inicio entre los 12 y 40 años. Resultados del estudio FENASMA

Objectives To describe the clinical profile of patients with asthma and to identify possible risk factors for its development in subjects over the age of 12. Patients and methods A multicenter study of cases and controls. Recruited for inclusion were case subjects between the ages of 12 and 40 diagnosed with asthma, with an onset of symptoms after the age of 12. Control subjects were selected, with ages between 12 and 40, who did not have childhood asthma and did not present symptoms of asthma at the time of the study. Results We evaluated 923 subjects: 247 cases and 671 controls. 54.9% were women. Mean age of the cases was 28.3 ± 8.2; mean age of controls was 30.8 ± 7.1 (p < 0.001). In the logistic regression analysis, it was observed that the determining factors for the of the presence of asthma were hypersensitivity to animals or other allergens, presence of rhinitis, family history of asthma, occupational risk/exposure to irritants and the hypersensitivity/intolerance to NSAIDs. In said analysis, it was also demonstrated that age was a protection factor, as well as level of education. Conclusions The risk factors for the development of asthma at an adult age are hypersensitivity to animals or other allergens, rhinitis, family history of asthma, occupational risk/exposure to irritants and the hypersensitivity/intolerance to NSAIDs, while age and level of education are protection factors.

Prevalencia y características de la rinitis en pacientes asmáticos de las consultas de Atención Primaria, Alergología y Neumología en España (Estudio AIR)

Background and objectives Rhinitis and asthma are linked by common epidemiological, clinical and inflammatory features. The objective of the AIR study was to understand the prevalence and characteristics of rhinitis in adult asthmatic patients who were seen in either primary or secondary care (Allergy or Pulmonology) in Spain. Patients and methods This was a prospective epidemiological study with the participation of 1,369 randomly selected physicians. Five thousand six hundred sixteen asthmatic patients older than 18 years of age were selected and the study was carried out between February-September 2006. Demographic data, rhinitis prevalence, pulmonary function, allergy tests and treatments were analyzed. Results Some 75% (N = 4,212) of the asthmatic patients presented with additional rhinitis and these were characterised as being both younger (41.3 vs 50.4 years; p < 0.0001) and with less severe asthma (FEV 1 = 86.6 vs 79.3%, p < 0.0001) than asthmatic patients without rhinitis. A positive correlation was found between asthma and rhinitis severity (p < 0.0001) whilst atopy was significantly associated with the presence of rhinitis (81 vs 48%; OR: 4.80; CI 95%: 4.2-5.5). The presence of co-morbid rhinitis was associated with a higher number of asthma exacerbations (p < 0.001). Conclusions Some 75% of our asthmatic patients had associated rhinitis and this association was more frequent in atopic subjects. There is a positive correlation between the severity of rhinitis and asthma and between the number of asthma exacerbations and the presence of rhinitis. These results support the main message of ARIA and GEMA recommendations regarding the integral management of airways to improve the control of asthma.

Impact of Rhinitis on Asthma Control in Children: Association With FeNO

Background. The prevalence of rhinitis is high and frequently observed in association with asthma. Although the persistence of predisposing factors such as rhinitis is frequently observed in adults, this has not yet been confirmed in children. Aims. The aim of this present work is to show the relationship between rhinitis and asthma control in asthmatic children. Methods. The authors carried out a cross-sectional study by collecting clinical, spirometric, and fractional exhaled nitric oxide (FeNO) data in children aged from 4 to 17 years. Results. One hundred seventeen children were included. Asthma control was optimal in 37.6%, suboptimal in 55.5% and poor in 7.3% of cases. A 74.3% of children were atopic and 62.5% had symptoms 34 of rhinitis. Rhinitis was more frequent when control of asthma was worse (p = .0001). Age (p = .002), asthma control (p < .001), atopy (p = .001), and presence of rhinitis (p = .012) were significantly associated with FeNO. Conclusions. Our study confirms the strong relationship between upper airways and poor asthma control in the asthmatic child. Symptoms of rhinitis may be partly responsible for the increased fractional exhaled nitric oxide (FeNO) level, independently of the control of asthma. Evaluation of rhinitis should be included to improve assessment of asthma control in children.

Determination of parameters related to nasal inspiratory pressures in children utilizing valved-holding chambers (valved spacers)

The administration of medication by the nasal route using valved spacers, may be an alternative for the concomitant treatment of allergic rhinitis and asthma. The aim of this study was to determine if children are capable, in using a spacer and face mask, of opening the inspiratory valve using only nasal inhalation. Prospective cross-sectional. The study included 85 children aged 4-9 years. Four types of valved spacers connected to a digital vacuum manometer were evaluated. The patients were prompted to inhale through their nose and the pressure reached in the first curve, maximal peak and time between the start of the inspiratory action and the first effective inspiration (opening of the valve) were determined. The results were compared with factors such as age, weight, BMI, gender, and presence of rhinitis or asthma. In two of the spacers, the valve opened in 98.8% of the tests with nasal inspiration only. The spacer ACE holding chamber showed initial and maximal inspiratory pressures that were significantly greater than with the others (p<0.001). No correlation was observed between the parameters examined for each spacer and the patient variables considered. The results suggest that children 4-9 years old are able to open the spacer valve with only nasal inspiration. The spacer ACE holding chamber was shown to be significantly more effective than the others tested. Studies that demonstrate that air inspired nasally reaches the lungs effectively are necessary so that this airway can be utilized for the administration of therapeutic agents.

Long-Term Prognosis of Asthma Is Good—A 12-Year Follow-Up Study. Influence of Treatment

The number of studies on the prognosis of bronchial asthma (BA) is rather limited. The aim of the study was to determine the evolution of BA in a long-term 12-year follow-up and to investigate possible contributing factors. One hundred and sixty-three patients who visited the Out-patient Clinic for BA from1989 to1993 (Visit 1) were included in the study. They were re-evaluated during 2003–2005 (Visit 2). At both visits, the patients filled in a special questionnaire, underwent skin tests, spirometry, methacholine challenge and they were classified into three severity groups according to GINA of 1992 as: Mild, Moderate, and Severe asthma. At Visit 1, 95 (58.3%) patients were classified in the mild asthma group, 45 (27.6%) in moderate and 23 (14.1%) in severe; whereas at Visit 2, 107 (65.6%) patients had mild asthma, 44 (27%) moderate and 12 (7.4%) severe. At Visit 1 asthma severity was associated with male gender, younger age, and the absence of rhinitis. At Visit 2 on the other hand, asthma severity was associated with older age, longer duration of disease, smoking and again the absence of rhinitis and increased BHR at both visits. Inhaled corticosteroid use correlated with improvement in lung function. Long-term prognosis of BA was good and outcome was favorably influenced by male gender, early and mild onset of disease, absence of smoking and presence of rhinitis.

Parents’ smoking habit and prevalence of atopic eczema in 6-7 and 13-14 year-old schoolchildren in Spain. ISAAC Phase III

Background and AimsAtopic eczema (AE) is the most frequent inflammatory skin disease in childhood in the western world. Several studies have reported a significant increase of prevalence in recent decades and the environmental factors implicated in its aetiology, including environmental tobacco smoke.This study aims to investigate the possible association of AE prevalence in Spanish schoolchildren aged 6-7 and 13-14 years in relation to their parents’ smoking habits. MethodsWe conducted a cross-sectional population-based study with 6-7 year-old (n=27805) and 13-14 year-old (n=31235) schoolchildren from 10 Spanish centres. AE prevalence was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and the Spanish Academy of Dermatology criteria, used in Spain to diagnose AE. ResultsAn association was found in schoolchildren aged 6-7 (adjusted for gender, presence of asthma, presence of rhinitis, siblings and mother's level of education) between AE being clinically diagnosed with the mother's smoking habit (RPRa 1.40, 1.10-1.78) and there being more than 2 smokers at home (RPRa 1.34, 1.01-1.78). Regarding the presence of itchy rash, an association was observed with fathers who smoke (RPRa 1.40, 1.13-1.72). Among the 13-14 year-olds, no association was observed in relation to either clinically diagnosed AE or the appearance of itchy rash with parents’ smoking habit. ConclusionsOur results indicate the risk for children of being exposed to environmental tobacco smoke in terms of AE, especially when they are younger.

Atendimento otorrinolaringológico do Sistema Único de Saúde de crianças e adolescentes em três municípios brasileiros

A criação de um banco de dados sobre as demandas otorrinolaringológicas no SUS poderá fornecer informações para organizar estratégias de saúde e criar ou otimizar recursos do governo ou privados. OBJETIVOS: Determinar em pacientes até 17 anos de idade: 1) As principais doenças otorrinolaringológicas diagnosticadas; 2) Exames complementares mais solicitados; 3) Medicamentos mais prescritos; 4) Procedimentos ambulatoriais realizados e as indicações cirúrgicas; 5) Estado empregatício dos pais e o número de irmãos dependentes; 6) Comparar e analisar estatisticamente os dados nos locais estudados. MATERIAL E MÉTODO: Estudo prospectivo e análise estatística das variáveis obtidas nas primeiras-consultas na Policlínica de Mariana, na sede Consórcio Intermunicipal de Saúde da Microrregião de Sete Lagoas e na Triagem da Otorrinolaringologia da UNIFESP-EPM. RESULTADOS: Há diferenças estatisticamente significativas quanto às variáveis idade, média salarial dos pais empregados, número de irmãos até 17 anos, rinite, doenças otológicas, exames solicitados, prescrições e indicações de cirurgias micro-otológicas. CONCLUSÕES: O diagnóstico mais encontrado foi respiração oral. O exame complementar e a cirurgia mais indicados foram a radiografia de cavum e a adenoamigdalectomia. O nível de desemprego, a baixa média salarial e o número de dependentes na família dificultam tratamentos que não estejam disponíveis na rede pública de saúde.

Environmental and socio‐demographic factors associated to asthma in adolescents in Rio de Janeiro, Brazil

Although asthma is of frequent occurrence, little is known about the factors associated with this disease in Brazil. We studied the association between asthma, environmental and socio-demographic factors in adolescents in Nova lguacu, Rio de Janeiro State. Cross-sectional study using the questionnaires about asthma and environmental factors from the International Study of Asthma and Allergies in Childhood (ISAAC). We performed bivariate analyses between asthma and the factors studied using prevalence ratio (PR), confidence intervals of 95% (95% Cl) and Chi-squared test. Factors associated to asthma in a bivariate analysis were studied using logistic regression and odds ratio (OR). We included 3,033 students, aged 13-14 yrs, selected from 37 schools. The prevalence of asthma was 13.1%. Being female (OR = 1.40; 95%Cl:1.11-1.77), the presence of a mother who smokes (OR = 1.32; 95%Cl:1.04-1.66), a cat in the domicile (OR = 1.32; 95%Cl:1.04-1.69), being the firstborn (OR = 1.34; 95%Cl:1.07-1.68), frequent use of paracetamol (OR = 1.45; 95%Cl: 1.15-1.84), the presence of rhinitis (OR = 5.15; 95%:3.89-6.82) and eczema (OR = 2.35; 95%Cl:1.73-3.19) were independently associated to asthma. Environmental and socio-demographic factors were associated to asthma in adolescents in Rio de Janeiro, irrespective of the presence of others allergic diseases. Interventions acting on these factors may decrease the occurrence of asthma in this population.

IgE sensitisation in relation to flow-independent nitric oxide exchange parameters

BackgroundA positive association between IgE sensitisation and exhaled NO levels has been found in several studies, but there are no reports on the compartment of the lung that is responsible for the increase in exhaled NO levels seen in IgE-sensitised subjects.MethodsThe present study comprised 288 adult subjects from the European Community Respiratory Health Survey II who were investigated in terms of lung function, IgE sensitisation (sum of specific IgE), smoking history and presence of rhinitis and asthma. Mean airway tissue concentration of NO (CawNO), airway transfer factor for NO (DawNO), mean alveolar concentration of NO (CalvNO) and fractional exhaled concentration of NO at a flow rate of 50 mL s-1 (FENO 0.05) were determined using the extended NO analysis.ResultsIgE-sensitised subjects had higher levels (geometric mean) of FENO 0.05 (24.9 vs. 17.3 ppb) (p < 0.001), DawNO (10.5 vs. 8 mL s-1) (p = 0.02) and CawNO (124 vs. 107 ppb) (p < 0.001) and positive correlations were found between the sum of specific IgE and FENO 0.05, CawNO and DawNO levels (p < 0.001 for all correlations). Sensitisation to cat allergen was the major determinant of exhaled NO when adjusting for type of sensitisation. Rhinitis and asthma were not associated with the increase in exhaled NO variables after adjusting for the degree of IgE sensitisation.ConclusionThe presence of IgE sensitisation and the degree of allergic sensitisation were related to the increase in airway NO transfer factor and the increase in NO concentration in the airway wall. Sensitisation to cat allergen was related to the highest increases in exhaled NO parameters. Our data suggest that exhaled NO is more a specific marker of allergic inflammation than a marker of asthma or rhinitis.

Zolmitriptan Nasal Spray Exhibits Good Long‐Term Safety and Tolerability in Migraine: Results of the INDEX Trial

Previous studies have shown that zolmitriptan 5 mg nasal spray has a fast onset of action, high efficacy, and good tolerability in the acute treatment of migraine. Objective.-This open-label, noncomparative, multicenter, multinational phase III study was designed to further evaluate the long-term safety and tolerability of zolmitriptan 5 mg nasal spray in a population of migraineurs largely naive to triptan nasal sprays who treated multiple migraine attacks over a 1-year period. Patients were required to have an established diagnosis of migraine with or without aura (based on International Headache Society criteria), a high frequency of migraine attacks, and were allowed to treat migraine with any baseline headache intensity. A secondary objective of the study was to assess the long-term efficacy of zolmitriptan nasal spray. A subgroup analysis aimed to determine whether rhinitis had any influence on outcomes of treatment. The safety population consisted of 538 patients who treated 20,717 migraine attacks with zolmitriptan 5 mg nasal spray. Overall, adverse events occurred in 32.8% of attacks, and led to treatment withdrawal in 4.5% of patients. The most common adverse events were unusual taste (19.0%) and paresthesia (6.8%). Adverse events were generally of mild intensity, transient, and well tolerated, showing a decline in incidence over time. Serious adverse events were rare. The presence of rhinitis and use of a second dose of trial medication had no effect on the incidence of adverse events. At 2 hours, 53.8% of attacks treated with zolmitriptan nasal spray 5 mg were rendered pain free. The highest 2-hour pain free rates were seen for headaches of mild baseline intensity (83.3%), followed by headaches of moderate (56.5%), and severe (32.2%) baseline intensity. The 2-hour pain-free rate remained consistent throughout the study period. The presence of rhinitis had no effect on efficacy. Zolmitriptan 5 mg nasal spray demonstrated a well-tolerated and efficacious profile in the acute treatment of multiple migraine attacks over a 1-year period.

Links between rhinitis and asthma

There is compelling evidence of a close relationship between the upper and lower airways in asthma and rhinitis. Rhinitis is present in the majority of patients with asthma, and a significant minority of patients with rhinitis have concomitant asthma. Similarities between the two conditions occur in the nature of the inflammation present in the target tissues. A common initiating step in the inflammatory process of allergic airways disease is the presence of immunoglobulin E providing an adaptor molecule between the offending allergen and inflammatory cell activation and mediator release. Differences in the two conditions arise largely from the structural differences between the nose and the lungs. In an asthmatic, concomitant allergic rhinitis increases healthcare costs and further impairs quality of life. The presence of rhinitis should always be investigated in children and young adults with asthma. Subjects with allergic rhinitis have an increased risk of developing asthma and may form a suitable population for secondary intervention to interrupt the 'allergic march'.

Rhinitis in 10-year-old children and early life risk factors for its development.

To study the prevalence, characteristics of and risk factors for childhood rhinitis. In a whole population birth cohort study (n = 1,456) the prevalence and characteristics of rhinitis among 10-y-old children were examined. At this age 1373 children (94%) completed standardized questionnaires, 1,043 (72%) skin-prick testing, 953 (65%) serum inhalant immunoglobulin E antibody screening and 784 (54%) methacholine bronchial challenges. At the age of 10 y the prevalence of hayfever ever was 18.6% and current nasal symptoms (rhinitis) 22.6%. Rhinitis at 10 y was largely seasonal and associated with low morbidity, although 62.7% of cases required pharmacological treatment. Atopy (positive skin test) and other allergic states were associated with rhinitis (p < 0.001). Wheeze or diagnosed asthma was higher with coexistent rhinitis. Among wheezing children physician-diagnosed asthma (p < 0.024) and inhaled corticosteroid use (p < 0.001) were greater with the presence of rhinitis. Significant bronchial hyperresponsiveness (methacholine concentration giving a 20% fall in forced expiratory volume in I s <4.0 mg ml(-1)) was greater if rhinitis was present even when the child did not wheeze (p < 0.001). Risk factor analysis for rhinitis identified the independent significance for atopy (p < 0.001) and eczema (p = 0.009) at the age of 4 y plus paternal rhinitis (p < 0.001), maternal rhinitis (p = 0.033) and maternal food allergy (p = 0.016). Rhinitis is common at the age of 10 y, with strong associations with atopy, wheezing, asthma and bronchial hyperresponsiveness. An inherited predisposition towards atopy appears to predominate over environment in the aetiology of this state.

Skin prick test reactivity to common aeroallergens in asthmatic patients with and without rhinitis.

The aim of this study was to investigate the prevalence of skin prick test (SPT) reactivity to common aeroallergens among Malaysian asthmatic patients with and without rhinitis. An SPT using eight aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, cat fur, cockroach, Acacia sp., Bermuda grass, Aspergillus fumigatus and Aspergillus niger) was performed on 206 asthmatic patients. One hundred and forty patients (68%) were reactive to at least one of the aeroallergens. Among the SPT-positive patients, a positive prick test reaction to the house dust mites, D. pteronyssinus (93.6%), and D. farinae (81.4%) was most common, followed by cat fur (20.0%), cockroach (7.9%), Bermuda grass (7.9%), Acacia sp. (7.9%), A. fumigatus (0.7%) and A. niger (0.7%). A history of rhinitis was elicited in 111 (53.9%) patients and 95 (85.3%) of these patients were SPT-positive compared with only 45 (47.4%) of 95 patients with asthma symptoms alone (P < 0.001). The presence of rhinitis and a young age of onset of asthma were independent factors for positive SPT reaction to at least one of the aeroallergens. The prevalence of SPT reactivity to common aeroallergens is high among Malaysian asthmatics, particularly in those with an early age of onset and in those with coexisting rhinitis.

Treating the allergic patient: think globally, treat globally.

Treating the allergic patient: think globally, treat globally.

Eosinophilic angiocentric fibrosis of the sinonasal tract: Report on the clinicopathologic features of a case and review of the literature

Eosinophilic angiocentric fibrosis (EAF) is a rare fibroinflammatory lesion of the sinonasal tract that occurs mainly in young to middle-aged female patients. Only two previous cases affecting male patients have been reported, and its etiopathogenesis remains unknown. The authors report on the third case of the entity in a male patient and review the 12 previously reported cases. A 52-year-old male patient was initially seen with a 15 years history of allergic rhinitis, progressive nasal obstruction, and left-sided hearing loss. All laboratory tests were unremarkable, except the nasal discharge eosinophil count that showed a conspicuous eosinophilia. The video-assisted-nasofibroscopic examination and CT scans disclosed a thickened deviated nasal septum with a subjacent infiltrative lesion. The histologic analysis of the nasal septum showed a variable mixed inflammatory cellular infiltration mainly composed of eosinophils, plasma cells, and histiocytes with a perivascular distribution; in other areas, an angiocentric fibrosing lesion with a peculiar perivascular onion-skin pattern was observed. The patient had a partial resection of the lesion with symptomatic control. The presence of rhinitis and nasal eosinophilia in our case associated with the clinical aspects of the previously reported cases further support an allergic cause for EAF.

Predictors of a normal chest x-ray in respiratory syncytial virus infection.

Respiratory syncytial virus (RSV) accounts for the majority of lower respiratory tract infections (LRTI) in infants and young children. A chest x-ray is frequently performed in infants with LRTI caused by RSV. The aim of this study was to develop and validate a prediction model to estimate the probability for a normal chest x-ray in children with RSV infection. For this purpose, easy obtainable diagnostic parameters were used. This prediction model may be applied to decide which patients do not require a chest x-ray. The data of 287 children admitted with RSV infection or diagnosed as such in the outpatient department of the Sophia Children's Hospital between 1992-1996 were studied. The derivation set comprised 232 patients (1992-1995), and the validation set contained 55 patients (1995-1996). A chest x-ray was designated as normal when atelectasis, hyperinflation, or pulmonary infiltrates were absent. In order to develop a prediction model, patient history and clinical and laboratory variables were consecutively entered into a logistic regression model according to the diagnostic workup that was practiced at the time. Variables with P < or = 0.10 were retained in the model. The predictive accuracy of the multivariable models was examined using the area under receiver operating curve (ROC-area). In 202 (87%) patients from the derivation set, a chest x-ray was performed. A normal chest x-ray could be predicted by increasing age, increasing birth weight, presence of rhinitis, absence of retractions, and increasing arterial oxygen saturation. The ROC-area was 0.80 in the derivation and validation sets. This prediction model was transformed into a score chart. In conclusion, a normal chest x-ray can accurately be predicted, using a model including easily obtainable patient characteristics, and clinical and laboratory variables. This model may be a useful tool in deciding whether or not to perform a chest x-ray in patients with RSV infections.

Atopy in children with otitis media with effusion.

Contrasting data have been found on the prevalence of atopy in children with otitis media with effusion (OME). A major issue would be to determine whether screening for atopy should be recommended. Setting Centre for Study of Otitis Media with Effusion, Tabiano Terme, Parma, Italy. The purpose of this study was to investigate the relation of OME to atopy. The subjects were 172 children with OME and a control group of 200 children. The protocol included a questionnaire survey of diseases associated with atopy, a skin-prick test and a clinical evaluation of allergic symptoms and hypersensitivity to aeroallergens. No significant difference between patients and control group was observed for family history of atopy or positive skin-prick test reactions. Symptoms associated with atopy occurred significantly more frequently in the group with OME (P<0.001), though only the presence of rhinitis or atopic eczema was significantly associated with OME. Prevalence of positive skin-prick tests results is not enhanced in children with OME. Nevertheless, the association of OME with symptoms associated with atopy suggests that such concomitant diseases may play a part in the pathogenesis of the disorder. Children with allergic rhinitis or atopic eczema should be investigated by tympanometry for OME.

Acoustic rhinometry in the pre-operative assessment of adenoidectomy candidates.

Claims have been made for the potential of acoustic rhinometry (AR) in the evaluation of adenoidectomy patients. Little evidence has been presented to support such claims, and evidence is accumulating that AR is inaccurate in reflecting anatomical reality in the nasopharynx. We set out to establish whether acoustic rhinometry studies could predict operative decision-making sufficiently for it to be of assistance to the clinician, despite these theoretical and practical obstacles. A total of 101 patients aged 2-13 years were examined by AR using the impulse technique. Parameters were chosen from the area-distance function to indicate nasopharyngeal volumes and areas (decongested and non-decongested). This information was compared with findings at EUA (examination under anaesthesia-obstruction categories: A-'good airway' to D-'severe obstruction'), operative decision (2 categories-'obstructive' = remove, versus 'non obstructive' = leave in situ) and parents' symptom scores. Twenty-one patients were also evaluated post-operatively. There was considerable overlap between the AR parameters in the groups classified at EUA as 'obstructive' or 'non obstructive', but this overlap diminished after decongestion. Logistic regression demonstrated that the decongested volume and area parameters were of significant predictive value with respect to operative decision (odds ratio for unit change in volume = 0.82; 95% C.I. = 0.70-0.97; p = 0.018). Parents' analogue scores for snoring and for [snoring+obstruction+ mouthbreathing] were also of significant predictive value. The presence of rhinitis diminishes the predictive value of AR. Acoustic rhinometry has potential as a pre-operative evaluation of the nasopharyngeal airway in adenoidectomy candidates, but the predictive value is low unless combined with clinical factors.

Prevalence of basidiomycete allergy in the USA and Europe and its relationship to allergic respiratory symptoms

A total of 701 adults living in the USA or Western Europe who had symptoms of allergic respiratory disease were skin prick tested with extracts prepared from eight basidiomycetes species and four Fungi Imperfecti species. In these subjects, the presence of asthma, rhinitis, or both was determined by questionnaire. Overall, 178/701 (25.4%) of the participants reacted to at least one basidiomycete extract. There was no difference in the prevalence of reactivity detected in the USA and Europe (P < 0.005); however, the prevalence of reactors in individual centers from both areas varied significantly. Psilocybe cubensis was the most potent allergen source in both the USA (12.3% reacted) and Europe (16.0%). Pleurotus ostreatus was second overall (10.6%) and in the USA (10.7%), and third in Europe (10.3%). Pisolithus tinctorius and Coprinus quadrifidus produced the least potent allergens, with only 5.4% of the population reacting. There was a significant relationship (P < 0.005) between basidiospore reactivity and the presence of atopy, asthma, and asthma and rhinitis. Basidiospore reactivity was not associated with the presence of rhinitis alone (P = 0.312). These results suggest that basidiomycetes are important sources of aeroallergens in geographically disparate regions and may be particularly important in patients with asthma.