Rhinoconjunctivitis Quality Of Life Questionnaire Research Articles

Serum Periostin as a Biomarker for Predicting Clinical Response to House Dust Mite Sublingual Immunotherapy in Allergic Rhinitis

House dust mite (HDM) sublingual immunotherapy (SLIT) has proven to be effective for allergic rhinitis (AR), but its efficacy varies among patients. No candidate biomarkers for prediction of response to SLIT are available. Periostin, a matricellular protein, is involved in pathophysiology of AR, and its serum levels reflect airway allergic inflammation. To evaluate the relationship between serum periostin levels and current rhinitis control before and after standardized quality (SQ)-HDM SLIT, and to investigate the role of periostin in predicting clinical response. One hundred eleven subjects with HDM-induced AR were randomized to receive either SLIT plus pharmacotherapy or pharmacotherapy alone, for 48 weeks. At enrollment and the end of study, clinical characteristics and biomarkers that included serum periostin, serum HDM-specific IgE (s-IgE), total IgE, blood eosinophil counts, and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were measured. The association between clinical indices or biomarkers and clinical response to SLIT was analyzed. A response to SLIT was recorded in 64% (32 of 50) patients. High serum periostin levels (>30.2 ng/mL) were associated with an effective response to SLIT, and the magnitude of RQLQ improvement was correlated with the level of serum periostin. The sensitivity and specificity based on receiver operating characteristic analysis for periostin were higher than those of s-IgE. Multivariate regression analysis showed that serum periostin was an independent factor for SLIT responders. Serum periostin appears to be a useful biomarker for predicting the response to SQ-HDM SLIT in patients with AR.

Rhinologic disease and its impact on sleep: a systematic review.

Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea-hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease-specific patient-reported outcome measures (PROMs; 22-item Sino-Nasal Outcome Test [SNOT-22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.

EFFECTIVENESS OF CINNAMON BARK EXTRACT IN THE TREATMENT OF ALLERGIC RHINITIS

OBJECTIVE: The purpose is to evaluate the effectiveness and safety of intranasal cinnamon extract (CE) in the management of patients with allergic rhinitis (AR). METHODS: This is a systematic review, using the standard methodological procedures recommended by Cochrane to search six databases: Cochrane, PUBMED, EMBASE and LILACS, from database inception up to May 2020, to identify randomized controlled trials evaluating the use of CE in treatment for AR. RESULTS: We included two trials involving a total of 100 participants. The studies were at low risk of bias. All studies had similar participant selection criteria and outcome measurement, enabling a meta-analysis. Both studies used a validated instrument (Rhinoconjunctivitis quality of life questionnaire – RQLQ) for this primary outcome (SMD -1.06; 95% confidence interval (CI) -1.58 to -0.59, P &lt;0.0001). . All studies resulted in at least some clinical benefit with the use of CE compared to placebo. None of the included studies reported any significant adverse effects. CONCLUSION: Despite the evidence from two studies showed certain positive effects of response for CE under evaluation in treatment of AR. We found no evidence regarding the effectiveness of cinnamon bark extract for allergic rhinitis. Well-conducted randomized clinical trials using CE are needed to further advance our understanding of the effectiveness of AR.

Quality of life assessment in patients treated with nasal corticotherapy for allergic rhinitis: A cohort study

IntroductionAllergic rhinitis (AR) is a chronic nasal pathology induced by an inflammation of the mucous membranes due to a dependent IgE reaction following allergenic exposure. The main symptoms are rhinorrhea, nasal itching, nasal obstruction and sneezing bursts. It highly affects the patient quality of life (QoL) in many levels making it a public health issue.The aim of this study is to assess the QoL of patients with AR as well as the level of its improvement after nasal corticotherapy. Materials and methodsFrom June 2019 to February 2020, a prospective study was carried out based on the use of the validated Arabic version of the RQLQ (Rhinoconjunctivitis Quality of Life Questionnaire) on a cohort of AR patients to measure their QoL before and after three months of treatment by “Budesonide”. ResultsA total of 70 patients participated in the study with an average age of 39.54 years with a sex ratio of 0.60. Their total RQLQ score was up to 4.28, improved to 2.35 after treatment. Also, a statistically significant improvement in sub-scores was also observed (p < 0.001): activities (from 4.43 to 2.29), nasal symptoms (from 5.00 to 2.80), eye symptoms (from 3.38 to 1.80), practical problems (from 4.29 to 2.18), general problems (from 4.63 to 2.78) and emotional state (from 4.28 to 2.43). ConclusionThe RQLQ is a reliable tool to evaluate the QoL in AR patients, stating the negative influence of AR on patients daily life and the effectiveness of nasal corticosteroid treatment.

The relationship between vitamin D and moderate/severe persistent allergic rhinitis

BackgroundVitamin D is a fat-soluble vitamin that plays an important role in regulation of the immune system. However, there is still a lack of consensus on the relationship between vitamin D and allergic rhinitis (AR). In this study, we explored the relationship between 25-hydroxyvitamin D [25(OH)D3] and moderate-to-severe persistent AR. Patients and methodsThirty-nine adult patients with moderate-to-severe persistent AR and 20 healthy people serving as a control group were recruited at the affiliated Chengdu University Hospital of Traditional Chinese Medicine from June 2018 to January 2019. The subjects were selected at random and participated voluntarily in our research. Vitamin D3 levels were determined in the blood samples of all subjects. Levels of IFN-γ, IL-4, IL-10 and total immunoglobulin E(IgE) were measured in the AR group, and scores on a visual analogue scale (VAS) and on a nasal-ocular- conjunctival quality-of-life questionnaire (Rhinoconjunctivitis Quality of Life Questionnaire, RQLQ) were also recorded for the AR group. ResultsThere was a significant difference in 25(OH)D3 levels between the control group and the AR group (P<0.01). In the correlation analysis, a positive correlation was observed between IFN-γ and 25(OH)D3, but a negative correlation was seen between total IgE, IL-4, VAS and RQLQ scores in the AR patient group. However, multiple linear regression analysis revealed no significant correlation between total IgE, IL-4 and 25(OH)D3. ConclusionIn the correlation analysis, we confirmed that serum 25(OH)D3 displays significant negative correlation with total IgE, IL-4, VAS and RQLQ scores, which indicates that the lower the 25(OH)D3 level, the higher the VAS and RQLQ scores, and thus the more severe the symptoms in AR patients.

Acupuncture in addition to budesonide does not further improve RQLQ apart from the sleep domain

BACKGROUND: Acupuncture can effectively alleviate the nasal symptoms of allergic rhinitis (AR); however, the mechanism is unclear. Previous studies suggested it may be related to improve hypothalamus-pituitary-adrenal (HPA) axis dysfunction. MATERIALS and METHODS: The study was a randomised controlled trial including ninety patients with moderate to severe persis- tent AR. Subjects were randomised 1:1:1 to the 8-weeks treatment with mind-regulating acupuncture combined with intranasal glucocorticosteroids (INGC), conventional acupuncture combined with INGC and INGC alone (MA, CA, GC respectively). The primary outcome was the change from baseline in the Visual Analogue Scale (VAS) score of nasal symptoms. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was a key secondary outcome. The levels of corticotrophin releasing hormone (CRH), cortisol (COR) and adrenocorticotropic hormone (ACTH) were also analysed. RESULTS: MA, CA and GC reduced VAS score and total RQLQ by a similar degree, but the sleep domain of RQLQ significantly impro- ved in MA and CA compared to GC. Meanwhile, the COR and ACTH level increased, and CRH level decreased after treatment in MA and CA, but the changes showed no difference among the three groups after Bonferroni correction. CONCLUSIONS: Although acupuncture combined with INGC may have potential effect on sleep quality, the combination therapy cannot further improve nasal symptoms or RQLQ compared to INGC alone in AR patients. The influence of acupuncture on HPA axis needs to be further explored.

Effectiveness and safety of different traditional Chinese medicine therapies for allergic rhinitis: A protocol for systematic review and network meta analysis.

Introduction:Traditional Chinese medicine has been widely used in the treatment of allergic rhinitis. However, currently randomized controlled trials (RCTs) and meta-analysis only compare 1 or 2 types of traditional Chinese medicine therapies, and the comprehensive ranking of efficacy and safety of multiple traditional Chinese medicine therapies for the treatment of allergic rhinitis has not been completed. Therefore, the purpose of this network meta-analysis is to evaluate the efficacy and safety of different traditional Chinese medicine therapies for the treatment of allergic rhinitis.Methods and analysis:Three English databases of PubMed, Embase, Cochrane Library, and 2 Chinese databases of CNKI and Wanfang were searched from their inceptions to September 1, 2020. At the same time, in order to prevent omissions, we also compared the previous meta-analysis to determine the final included trials. The main evaluation outcome was the total Clinical Score (total nasal symptom score [TNSS]), the secondary evaluation outcome was the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and adverse events. The Cochrane Collaboration's Tool was used to evaluate the methodological quality of articles, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument was used to evaluate the quality of evidence. Network meta-analysis was completed by using Stata Statistical Software (Version 14.0, Stata Corporation, College Station, TX).Results:This study will compare and rank the different traditional Chinese medicine therapies for allergic rhinitis.Conclusion:This study is the first time to use network meta-analysis (NMA) to compare the efficacy and safety of traditional Chinese medicine for the treatment of allergic rhinitis, which will provide ideas and methods for the clinical treatment for allergic rhinitis.INPLASY registration number:No. INPLASY202080119

Sergančiųjų alerginiu rinitu gyvenimo kokybės ir klinikinių simptomų pokytis taikant intranazalinę fototerapiją

Žinoma, kad fototerapija teigiamai veikia imuninius procesus gleivinėje. Yra duomenų, kad intranazalinė fototerapija (IF), skleidžianti UV-A (25 proc.), UV-B (5 proc.) ir regimąją šviesą (70 proc.), gali būti veiksminga gydant alerginį rinitą (AR) nepriklausomai nuo simptomus sukėlusio alergeno, taip pat gali būti taikoma ieškant alternatyvų medikamentiniam gydymui. Tyrimo tikslas. Įvertinti intranazalinės fototerapijos poveikį klinikiniams alerginio rinito simptomams ir gyvenimo kokybei pacientų, sergančių nuolatiniu AR. Tyrimo metodai. Tyrimas atliktas Lietuvos sveikatosmokslų universiteto ligoninės Kauno klinikų Imunologijos ir alergologijos klinikoje. Jame dalyvavo sergantieji nuolatiniu vidutinio sunkumo arba sunkiu AR (ARIA diagnostiniai kriterijai). Alerginis įsijautrinimas patvirtintas odos dūrio mėginiais ir (arba) specifinio imunoglobulino E (Ig E) antikūnų įkvėpiamiems alergenams nustatymu kraujo serume. IF procedūros kartotos tris kartus per savaitę, dviejų savaičių laikotarpiu didinant dozę. Standartinis AR gydymas tyrimo metu nebuvo tęstas. Prieš ir po IF gydymo gyvenimo kokybė vertinta pagal E. Juniper adaptuotą klausimyną (angl. the Rhinoconjunctivitis Quality of Life Questionnaire, standardized version, RQLQ(s)), įvertintas bendrasis nosies simptomų balas (angl. Total Nasal Symptom Score, TNSS). Kiekvienos procedūros metu, naudojant vizualinę atitikmens skalę (angl. Visual Analogue Scale, VAS), įvertintas AR klinikinių simptomų sunkumas. Tyrimo rezultatai. 73 proc. tiriamųjų IF poveikį įvertino teigiamai. Nustatyta, kad po IF gydymo pagerėjo tiriamųjų gyvenimo kokybė, nes statistiškai reikšmingai sumažėjo Klausimyno (RQLQ(s)) visų poskalių balai. Po gydymo statistiškai reikšmingai sumažėjo visi TNSS skalės balai: nosies užgulimas, rinorėja, čiaudulys, miego sutrikimai, bendrieji simptomai. VAS skalės balai po gydymo taip pat sumažėjo statistiškai reikšmingai. Išvados. Intranazinė fototerapija gali palengvinti AR simptomus ir pagerinti pacientų gyvenimo kokybę.

Efficacy of Montelukast in Allergic Rhinitis Treatment: A Systematic Review and Meta-Analysis.

In treating allergic rhinitis, montelukast has the potential to be used as an alternative or addition to an oral antihistamine or intranasal corticosteroid. The objective of this systematic review was to assess the effectiveness of montelukast in treating allergic rhinitis. An electronic literature search was performed using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from 1966 to 21 January 2019. The eligibility criteria were randomized controlled trials comparing montelukast with placebo or other standard treatments. The primary outcomes assessed were daytime nasal symptom score (DNS) and night-time nasal symptom score (NNS). The secondary outcomes assessed were composite nasal symptom score (CSS), daytime eyes symptom score (DES), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). The meta-analysis was conducted using Review Manager 5.3 software based on the random-effects model. Fifteen studies of 10387 participants met the inclusion criteria. Montelukast was more effective than placebo in improving DNS (mean difference [MD] - 0.12, 95% confidence interval [CI] - 0.15 to - 0.08; p < 0.001), NNS (MD - 0.09, 95% CI - 0.13 to - 0.05; p < 0.001), CSS (MD - 0.08, 95% CI - 0.11 to - 0.06; p < 0.001), DES (MD - 0.17, 95% CI - 0.33 to - 0.02; p < 0.030), and RQLQ (MD - 0.34, 95% CI - 0.49 to - 0.20; p < 0.001). Oral antihistamine was superior to montelukast in improving DNS (MD 0.08, 95% CI 0.03-0.13; p = 0.002), CSS (MD 0.03, 95% CI - 0.02 to 0.07; p = 0.27), DES (MD 0.06, 95% CI 0-0.12; p = 0.040), and RQLQ (MD 0.03, 95% CI - 0.05 to 0.12; p = 0.430). Montelukast was superior to oral antihistamine in improving NNS (MD -0.03, 95% CI - 0.08 to 0.03; p = 0.330). Intranasal fluticasone spray was superior to montelukast in improving DNS (MD 0.71, 95% CI 0.44-0.99; p < 0.001) and NNS (MD 0.63, 95% CI 0.29-0.97; p < 0.001). Combined montelukast and oral antihistamine was superior to oral antihistamine in improving DNS (MD - 0.15, 95% CI - 0.27 to - 0.03; p = 0.010), NNS (MD - 0.16, 95% CI - 0.28 to - 0.05; p = 0.006), CSS (MD - 0.12, 95% CI - 0.25 to - 0.01; p = 0.070), DES (MD - 0.12, 95% CI - 0.30 to 0.06; p = 0.180), and RQLQ (MD - 0.10, 95% CI - 0.28 to 0.08; p = 0.290). Combined montelukast and OAH was superior to montelukast in improving DNS (MD 0.15, 95% CI 0.08-0.21; p < 0.001), NNS (MD 0.05, 95% CI - 0.09 to 0.19; p = 0.510), CSS (MD 0.1, 95% CI 0.03-0.17; p = 0.007), DES (MD 0.18, 95% CI 0-0.36; p = 0.050), and RQLQ (MD 0.07 95% CI - 0.15 to 0.29; p = 0.530). Montelukast is more effective than placebo in treating the overall symptoms of allergic rhinitis while the combined therapy of montelukast and an oral antihistamine is superior to either montelukast or an oral antihistaminealone.

Gut microbial characteristics of adult patients with allergy rhinitis

BackgroundAlthough recent studies have indicated that intestinal microbiota dweller are involved in the pathogenesis of allergy rhinitis (AR), the influence of gut microbiota on AR adult has not been fully elucidated yet. Hence, we carried out this study to uncover the distinctive bacterial taxa that differentiate allergy rhinitis patients from healthy individuals. Feces samples from thirty three AR patients and thirty one healthy individuals were analyzed by 16S rRNA gene sequencing.ResultsResults showed that the bacterial diversity in AR group was significantly higher than that of the non-AR group. Bacterial communities between AR and non-AR group were significantly differentiated as revealed by Principal coordinates analysis (PCoA) and the variation within non-AR were higher than that of the counterpart. Firmicutes, Fusobacteria, Actinobacteria, Cyanobacteria and Chloroflexi were the significantly differed phyla taxa and the top significantly distinguished bacterial genus included Prevotella_9, Phascolarctobacterium, Roseburia, Megamonas, Alistipes, Lachnoclostridium and Fusobacterium. The higher network complexity in AR group were dominated by taxa belonging to Firmicutes. The predicted function, alpha linolenic acid metabolism and bacterial invasion of epithelial cells pathway were higher in non-AR group while gonadotropin-releasing hormone (GnRH) signaling pathway, Fc γ-R mediated phagocytosis and endocytosis were higher in AR patients. Although the bacterial diversity between moderate and severe AR patients showed no significant difference, the significant correlation between featured genus and total nasal symptom score or rhinoconjunctivitis quality of life questionnaire, such as Butyricicoccus and Eisenbergiella, revealed the potential to intervene the AR status by means of gut microbiota.ConclusionsIn conclusion, patients with allergy rhinitis had distinguished gut microbiota characteritics in comparison with healthy controls. The results suggest that gut microbiota might play crucial roles in influencing the course and different symptoms of AR.Trial registration ChiCTR, ChiCTR1900028613. Registered 29 December 2019, https://www.chictr.org.cn/showproj.aspx?proj=47650.

Research on allergic rhinitis improvement in asthmatic children after dust mite exposure reduction: a randomized, double-blind, cross-placebo study protocol

BackgroundAllergic rhinitis (AR) in children is a major respiratory inflammatory disease with a high incidence that is increasing yearly. In China, 54.93% of children with asthma have AR, which often requires synchronous treatment. House dust mites (HDMs) are common allergens that often cause attacks of AR and asthma. Reducing allergen exposure is one of the most important measures to control and treat AR and asthma attacks. Hestelia Mite Bait, containing 0.1% emamectin, is a new tool for trapping and killing dust mites, reducing the number of dust mites on mattresses and thereby potentially reducing stimulation by allergens and ultimately improving asthma and rhinitis symptoms. This single-centre, randomized, double-blind, cross-placebo trial will explore the improvement in AR in asthmatic children after dust mite exposure reduction.MethodsWe will recruit 60 children (aged 3–12 years) who have been diagnosed with AR and asthma and are allergic to dust mites as confirmed by a serum allergen test. Participants will randomly receive the Hestelia Mite Bait intervention for 8 weeks and the placebo intervention for 8 weeks. There will be a 4-week washout period between the two interventions. The primary outcome is the visual analogue scale (VAS) score of AR symptoms; the secondary outcomes include the Rhinitis Control Assessment Test (RCAT) score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, changes in the dust mite level, drug usage for asthma and AR, Asthma Control Questionnaire-5 (ACQ-5) score, and frequencies of acute asthma attacks, emergency visits, and hospitalizations.DiscussionThis study aims to scientifically and objectively evaluate the effects of mite bait on rhinitis and asthma improvement after dust mite exposure reduction and provides a convenient means for future prevention and treatment of allergic diseases involving the airways in children.Trial registrationwww.chictr.org.cn ChiCTR1900024688. Registered on July 21, 2019

Long-term efficacy of injected allergen immunotherapy for treatment of grass pollen allergy in elderly patients with allergic rhinitis.

Background: The effect of prolonged allergen immunotherapy is still insufficiently known, especially in elderly patients. Objective: The effect after a 3-year course of injected allergen-specific immunotherapy (AIT) for grass pollen allergy in elderly patients with allergic rhinitis was observed. Methods: Thirty-eight elderly patients (mean ± standard deviation, 66.2 ± 2.7 years old) who received preseasonal injected AIT or placebo for grass pollen allergy were monitored for 3 years and compared with a placebo group. The combined symptom medication score (CSMS), serum level of immunoglobulin G4 (IgG4) to phleum pratense 5 (Phl p5) and quality of life were assessed immediately after AIT and 3 years later. Results: After AIT, the CSMS was significantly decreased from 2.15 (range, 1.27-3.00) to 1.13 (range, 0.79-1.36) (p = 0.03) and remained lower (1.41 ± 0.72 versus 2.41 ± 1.11) than that in the placebo group during the 3 years after AIT. Serum-specific IgG4 against increased during the course of AIT and remained at a high level during further observation. Quality of life, based on the Rhinoconjunctivitis Quality of Life Questionnaire, was significantly decreased in the patients who received AIT from 1.51 (95% confidence interval [CI], 1.21-1.84) to 1.01 (95% CI, 0.93-1.87) (p < 0.05) and was decreased to 0.97-1.26 (95% CI, 0.88-1.82) during the 3 years after discontinuation of AIT. Conclusion: A prolonged positive effect after AIT for grass pollen allergy was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect.Clinical trial MC56871/12, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</ext-link>.

Determinants and Factors of Satisfaction with Sublingual Immunotherapy in Patients with Allergic Rhinitis.

Allergen specific immunotherapy provides effective treatment of allergic rhinitis. Despite its efficacy, it can be signifi-cantly compromised by a possible treatment dissatisfaction of patients. To explore determinants and factors of satisfaction with sublingual immunotherapy in patients with allergic rhinitis. A total number of 191 patients with allergic rhinitis who completed a three-year course of sublingual im-munotherapy were included in the study. Of these, 76 had house dust mite (HDM) allergy - 42 men (55.26%) and 115 had grass pollen allergy - 63 men (54.78%) (mean age 27.3 years, SD: 6.14). The patients assessed their satisfaction using a visual analog scale. Health- Related Quality of Life was assessed by Rhinoconjunctivitis Quality of Life questionnaire. A visual analog scale was used to determine severity of the allergic rhinitis. The mean overall satisfaction, compared with that in previous therapy, increased significantly from 4.80 (SD 2.16) to 7.47 (SD 2.05) in the grass pollen allergy group and from 3.42 (SD 2.31) to 7.61 (SD 2.38) in the patients with HDM SLIT (p< 0.001). No relation between satisfaction and sex, type of immunotherapy extracts and duration of the disease was established. A strong correlation was found between satisfaction with treatment and quality of life (R=0.62) and severity of allergic rhinitis (R=0.69) after a three-year course. The results of this real-life study demonstrated that most patients with allergic rhinitis appeared to be satisfied with a three-year course of sublingual immunotherapy. The study provided evidence that reduction in severity of symptoms and improvement in quality of life could determine satisfaction with treatment.

Cetirizine modifies quality of life and symptoms in children with seasonal allergic rhinitis: a pilot study.

Background and aim:Seasonal allergic rhinitis (SAR) is a common disease in childhood that is characterized by bothersome symptoms and impaired quality of life (QoL). As histamine is the pivotal pathogenic mediator in SAR, antihistamines are the first-line option in the treatment. Cetirizine is a well-known effective antihistamine. This real-life pilot study aimed to investigate the effectiveness of a 4-week continuous cetirizine treatment in a group of Italian children with SAR.Methods:Total symptom score (TSS) and the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) were assessed at baseline and the end of the treatment.Results:Cetirizine significantly improved QoL (in all domains) and symptom severity (p<0.001 for both).Conclusions:The present preliminary study showed that a 4-week cetirizine treatment was able to improve QoL significantly. Cetirizine treatment also significantly reduced symptom severity in Italian children with SAR and was safe.

House Dust Mite Sublingual Immunotherapy in Children Versus Adults With Allergic Rhinitis.

There are only a few studies in which the clinical efficacy of SLIT has been compared between children and adults. In addition, there is a lack of research on other factors, associated with the treatment, including immunological parameters and quality of life (QOL). To compare the effects of sublingual immunotherapy (SLIT) in adults and children on various factors: clinical efficacy, quality of life (QOL), satisfaction, immunological parameters, and adverse events. Subjects who were sensitized to house dust mites and treated with SLIT for at least 2 years were enrolled. Seventy patients who completed questionnaires measuring nasal symptoms and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores and underwent serologic tests for immunological parameters at initial, 1-year, and 2-year follow-up were selected and divided into two groups based on age: a child group (age 4-12 years, n = 44) and an adult group (age 19-59 years, n = 26). The Total Nasal Symptom Score (TNSS) was significantly decreased after 2 years of SLIT in both the child and adult groups (p < 0.001, both); however, changes in TNSS from baseline did not significantly differ between the two groups (p = 0.365). More patients in adult group were satisfied with SLIT than those in child group (p = 0.050), and changes in RQLQ score from baseline tended to be larger in adult group (p = 0.089). The levels of immunological parameters at baseline were significantly higher in the child group than in the adult group; however, changes in the levels of these parameters were not significantly different. Although more adult patients were satisfied with SLIT, the clinical effects of SLIT on nasal symptoms were comparable between child and adult groups. Despite different immunological values at baseline between the two groups, changing patterns of immunological parameters did not differ.

Efficacy of dupilumab on clinical outcomes in patients with asthma and perennial allergic rhinitis

BackgroundComorbid perennial allergic rhinitis (PAR) or year-round aeroallergen sensitivity substantially contributes to disease burden in patients with asthma. Dupilumab blocks the shared receptor for interleukin (IL) 4 and IL-13, key drivers of type 2 inflammation that play important roles in asthma and PAR. In the LIBERTY ASTHMA QUEST trial (NCT02414854), dupilumab reduced severe asthma exacerbations and improved forced expiratory volume in 1 second (FEV1) in patients with uncontrolled, moderate-to-severe asthma, with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers at baseline (blood eosinophils and fractional exhaled nitric oxide). ObjectiveTo assess dupilumab efficacy in LIBERTY ASTHMA QUEST patients with comorbid PAR. MethodsSevere asthma exacerbation rates, FEV1, asthma control (5-item Asthma Control Questionnaire), rhinoconjunctivitis-specific health-related quality of life (Standardized Rhinoconjunctivitis Quality of Life Questionnaire +12 scores), and type 2 inflammatory biomarkers during the 52-week treatment period were assessed. ResultsA total of 814 of the 1902 patients (42.8%) had comorbid PAR (defined as an allergic rhinitis history and ≥1 perennial aeroallergen specific immunoglobulin E (IgE) level ≥0.35 kU/L at baseline). Dupilumab, 200 and 300 mg every 2 weeks, vs placebo reduced severe exacerbations rates by 32.2% and 34.6% (P < .05 for both) and improved FEV1 at week 12 by 0.14 L and 0.18 L (P < .01 for both); greater efficacy was observed in patients with elevated baseline blood eosinophil counts (≥300 cells/μL) and fractional exhaled nitric oxide. Dupilumab treatment also numerically improved the 5-item Asthma Control Questionnaire and Standardized Rhinoconjunctivitis Quality of Life Questionnaire +12 scores and suppressed type 2 inflammatory biomarkers. ConclusionDupilumab improved key asthma-related outcomes, asthma control, and rhinoconjunctivitis-specific health-related quality of life while suppressing type 2 inflammatory biomarkers and perennial allergen-specific IgE in patients with moderate-to-severe asthma and comorbid PAR, highlighting its dual inhibitory effects on IL-4 and IL-13 and its role in managing asthma and PAR.

Application of allergic rhinitis and its impact on asthma guidelines in terms of classification, risk factors, quality of life and co-morbidities in allergic rhinitis patients in Northern India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Despite the high prevalence of allergic rhinitis, there are only few studies on application of ARIA (allergic rhinitis and its impact on asthma) guidelines.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a prospective study of 164 patients. Based on ARIA guidelines; patients were graded for severity, risk factors studied, co morbidities documented and quality of life assessed using rhinoconjunctivitis quality of life questionnaire (RQLQ). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 164 cases were studied between the age group 10-72 years of which 56.1% were males. Most common trigger observed was dust (56.1%). Allergic conjunctivitis was most common co-morbidity associated. Using RQLQ it was observed that ARIA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ARIA guidelines appropriately classify allergic rhinitis, determines risk factors and associated co-morbidities. RQLQ can be used to determine quality of life in allergic rhinitis.&lt;/p&gt;

Efficacy of dupilumab in atopic comorbidities associated with moderate-to-severe adult atopic dermatitis.

Dupilumab is an anti-IL-4Rα antibody used in the treatment of patients with moderate-to-severe atopic dermatitis (msAD). This study explored the potential benefit of dupilumab in perennial allergic rhinoconjunctivitis (PAR) and perennial allergic asthma (PAA) caused by indoor allergens in adults with msAD. This multicentric, prospective, observational, real-life study included adult patients with msAD who had been treated with dupilumab in 16 Italian care centres. Efficacy outcomes regarding AD, PAR and PAA were collected at baseline and 16weeks. Safety was also assessed. We enrolled 123 patients with msAD. Between baseline and 16weeks of treatment, the following measurements decreased statistically significantly: Eczema Area and Severity Index, SCOring AD, Patient-Oriented Eczema Measure, pruritus score, sleep score, Dermatology Life Quality Index and IgE. Dupilumab treatment in patients with comorbid PAR (n=41) was associated with significant improvements in PAR disease control (measured using a Rhinitis Control Scoring System) and in PAR Quality of life (QoL) (measured using the Rhinoconjunctivitis QoL Questionnaire scores). In 32 patients with comorbid PAA, dupilumab significantly improved PAA control (measured using the Asthma Control Test and five-item Asthma Control Questionnaire scores) and disease-related QoL (measured using the Asthma QoL Questionnaire scores). Thirty-five patients (28.5%) developed conjunctivitis during the study period. These results support the benefits of dupilumab for adult patients with PAR and/or PAA associated with msAD.

Quality of life survey of patients with allergic rhinitis caused by airborne pollen in Inner Mongolia

Objective:To study the quality of life of patients with allergic rhinitis（AR） caused by airborne pollen in Inner Mongolia, and provide reference for overall health intervention for AR patients. Method:According to the severity of disease, 268 cases of patients was divided into mild and moderate to severe group. The patients general condition questionnaire, standardized rhinoconjunctivitis quality of life questionnaire（RQLQ）, quality of life questionare-core30（QOL-C30） were used to assess the quality of life of AR patients. At the same time 90 healthy volunteers with no symptoms of nasal（balanced gender, age） were recruited as control group. Result:In the intra-group comparison of the RQLQ questionnaire for AR patients, the total score of the RQLQ questionnaire and the 7 factor scores in the moderate to severe groups were significantly higher than those in the mild group（all P<0.05）. The QOL-C30 survey showed that the scores of the four dimensions of QOL-C30 assessment in the moderate to severe group of AR patients were generally lower than those in the control group（all P<0.05）. Compared with the control group, the score of physical function and psychological function in mild group decreased significantly（P<0.05）. Compared with the mild group, the moderate to severe groups showed significant decreases in physical function, psychological function and material life score（P<0.05）. Conclusion:Pollen, as a airborne allergen, is the main inducement of AR in Inner Mongolia. AR can seriously affect the physical and mental health of patients and reduce the quality of life. Clinical practice should focus on providing standardized treatment interventions and good health education for AR patients to improve quality of life.

Questionnaires Assessing the Quality of Life of Ocular Allergy Patients

Over the last 25 years, health-related quality of life has received increasing recognition, as it aids health practitioners in understanding the way a patient may be impacted by their health condition. Specifically, ocular allergy has been found to affect an individual emotionally, physically, socially, and economically. Hence, scientists have developed multiple questionnaires, based on the different etiologies of ocular allergy, to assess the quality of life of individuals affected by the condition. One highly regarded questionnaire is the Rhinoconjunctivitis Quality of Life Questionnaire and its variations, namely the Standardised Rhinoconjunctivitis Quality of Life Questionnaire, Mini Rhinoconjunctivitis Quality of Life Questionnaire, Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire, Adolescent Rhinoconjunctivitis Quality of Life Questionnaire, and Paediatric Rhinoconjunctivitis Quality of Life Questionnaire. Other questionnaires include the Eye Allergy Patient Impact Questionnaire and the Quality of Life of Children with Allergic Keratoconjunctivitis questionnaire, among others that are suitable for different countries. The purpose of this commentary was to identify the advantages and disadvantages of each questionnaire by critically analyzing psychometric properties, identifying which ocular allergy domains are present, and evaluating additional features that are important to a questionnaire.