Symptoms Of Rhinoconjunctivitis Research Articles

Satisfaction, Qol and adherence of patients allergic to dust mites and/or pollens undergoing sublingual immunotherapy.

Aim: Sublingual immunotherapy (SLIT) changes history of allergic respiratory disease (ARD). However, adherence is a barrier for optimal outcomes. Patients & methods: In the QUALI study, 859 patients with house-dust mite (HDM) and/or pollen induced ARD uncontrolled with symptomatic treatment and undergoing SLIT for at least 6 months or including one pre-coseason (pollen) were collected. Results & conclusion: SLIT significantly improved allergic rhinoconjunctivitis (ARC) and asthma symptom control, leading to reduced medication, meaningful health-related quality of life gain, improved nasal, ocular and bronchial symptoms and everyday life activities. Patients were highly satisfied and most of them adhered to SLIT, being forgetfulness the main non-adherence motive. SLIT is a quick effective treatment against persistent moderate-to-severe symptoms in ARC and asthma but it should been improve forgetfulness, as non-adherence reason.

Ragweed in South America: the relevance of aerobiology stations in Latin America

AbstractPollen, particularly from the Ambrosia genus, plays a pivotal role in triggering allergic rhinoconjunctivitis symptoms. This review delves into the global background of Ambrosia, focusing on its origins, invasive potential, and spread to South America. The ecological niche for Ambrosia species is explored, emphasizing its stability globally but exhibiting unique and dynamic features in South America. Information on Ambrosia pollen concentration in South America is summarized, revealing varying levels across countries. The establishment of new aerobiology stations, as highlighted in the latest findings, contributes valuable data for understanding allergen risk management in the region. The health perspective addresses the rise in allergic diseases due to climate change, emphasizing the need for continuous monitoring, especially in South America. Agricultural damage inflicted by Ambrosia is discussed, emphasizing its invasive potential, high seed production, and negative impact on crops, forage quality, and livestock. The review also positions Ambrosia as a marker of climate change, discussing the effects of global warming on pollen seasons, concentrations, and allergenic characteristics. The importance of expanding aerobiology stations in South America is underscored, requiring collaborative efforts from government, scientific societies, and academic institutions. The review concludes by advocating for increased monitoring to address potential challenges posed by Ambrosia, offering a basis for tailored interventions and future research in South American regions.

Identification and sensitization to environmental fungal spores in Lima City, Peru

To identify and registry the most important fungal spores trapped in our aerobiology station, as well as to report the prevalence of skin sensitization to these allergens. The pollen counts were made according to standardized technique with a Burkard seven days spore trap, following the American Academy of Allergy, Asthma and Immunology (AAAAI) through National Allergy Bureau (NAB) recommendations. The trap was installed on the roof of Clinica SANNA, El GOLF, San Isidro, which is 20 m high, 12°5'54"S 77°3'6"W in the west-south of the Lima urban area. The sampling period was performed from September 2020 to October 2021. Skin prick tests were carried out according to the recommendations of the Spanish Society of Allergology and Clinical Immunology (SEAIC) in 200 patients (18 to 60 years old) with symptoms of rhinoconjunctivitis and/or asthma, who were evaluated in the Allergology Service of Clinica SANNA el Golf. Allergenic extracts were applied, dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis), cat and dog danders, cockroach (Periplaneta americana), grass 6 mix, weed mix, molds (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, Penicillium notatum, Nigrospora spp.), INMUNOTEK-Spain provided the extracts. We also tested other fungal allergens such as Fusarium spp, Stemphylium spp, Curvularia spp, a mixture of Helmintosporum/Dreschlera spp. from the DIATER-Argentina laboratory. We identified spores of Alternaria alternata, Cladosporium spp., Nigrospora spp., Stemphylium spp., Fusarium spp., Curvularia spp., Dreschlera/Helmintosporum spp. The patients showed sensitization to Cladosporium herbarum (14%), Fusarium spp. (13,5%), Nigrospora spp. (8%), Alternaria Alternata (7%), Stemphylium (6%), Dreschlera/Helmintosporium spp. (5,5%), Curvularia spp. (3%), Aspergillus fumigatus (2,5%). The inhabitants of the south-western area of the urban city of Lima are exposed to different fungal spores with allergenic potential, with a higher concentration being identified during the summer/autumn months. Cutaneous sensitization is demonstrated in variable percentages to the fungal spores identified in this aerobiological sampling. The results of this study should be expanded and compared with data in the forthcoming years, identify seasonal and annual fluctuations and extend the traps to other locations in Lima.

Estudio aerobiológico en Lima, Perú. ¿Tipuana- Tipu, tal vez un nuevo alérgeno?

Introduction:Knowledge about local airborne allergens in any geographical area is essential for effective diagnosis and treatment of allergic diseases. Tipuana tipu, tree of the Fabaceae family, native from South America, it is present in the main avenues of metropolitan Lima and in some parks (big gardens) of the city. The objective was to report the Tipuana tipu pollen how a new allergen capable of triggering allergic symptoms. Methods:The pollen counts were made according to standardized technique with a Burkard seven days following the European Aerobiology Society´s Network Group recommendations.1 The trap was installed on the roof of Clinica SANNA el GOLF, San Isidro, which is 20 m high, 12°5'54"S 77°3'6"W in the west-south of the Lima urban area. The sampling period was performed from September 2020 to October 2021. Collection of Tipuana tipu pollens and Preparation of Tipuana tipu pollen extracts 1:20 w/v was done using a previously described method.2We carried out systematic skin prick testing with Tipuana tipu pollen extract and other aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis), molds (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, Penicillium notatum), cat and dog danders, Periplaneta americana, grass 6 mix, weed mix (Inmunotek, Spain) on 80 patients (18 to 50 years) seen in our allergy center, they suffering from November to January rhinitis and/or conjunctivitis symptoms. The majority living near avenues and large green areas, where Tipuana trees grew. Results:We found a total of 952 grains/m3 of Tipuana tipu pollen between November 2020 to January 2021, with the maximum concentration of 37 grains/m3 on December 10th. We also found other airborne pollen Types: Poaceae, Myrtaceae, Compositae and Betulaceae.14/80 patients (17.5%) showed positive skin prick test only to Tipuana tipu extract. Most of the patients with positive tests to Tipuana extract presented symptoms of rhinoconjunctivitis during the Tipuana pollination period. Four patients showed positive skin prick test to Tipuana tipu and grass 6 mix extracts, most of the rest of our patients were sensitized to dust mites extracts (Dermatophagoides pteronyssinus).Conclusions:The west-south population of Lima urban city is exposed to Tipuana tipu pollen. We do not found previous publications about Tipuana tipu allergy. Almost 18% of the patients tested in our sample were mono-sensitized to this pollen. The results of this study should be compared with data from the forthcoming years, to identify seasonal and annual fluctuations, extend the traps to other locations in Lima, and of course try to standardize and improve the Tipuana tipu pollen extract.

SQ sublingual immunotherapy tablets for children with allergic rhinitis: A review of phase three trials.

To provide paediatricians with a summary of efficacy and safety of SQ sublingual immunotherapy (SLIT) tablets from phase three, randomised, double-blind, placebo-controlled trials in children and adolescents with allergic rhinitis or rhinoconjunctivitis, with and without asthma. PubMed searches were conducted and unpublished data were included if necessary. Of the 93 publications, 12 were identified reporting 10 trials. One trial was excluded as paediatric-specific efficacy data were unavailable. The nine eligible trials evaluated grass, house dust mite, ragweed and tree SLIT tablets. Consistent reductions in allergic rhinitis or rhinoconjunctivitis symptoms and medication use were observed with SQ SLIT tablets versus placebo. In a five-year trial, sustained reduction of allergic rhinoconjunctivitis symptoms, asthma symptoms and medication use were observed with SQ grass SLIT tablet versus placebo. The number-needed-to-treat to prevent asthma symptoms and medication use in one additional child during follow-up was lowest in younger children. SQ SLIT tablets were generally well tolerated across trials. Evidence supports use of SQ SLIT tablets in children and adolescents with allergic rhinitis or rhinoconjunctivitis, with and without asthma. Long-term data demonstrate disease-modifying effects of SQ grass SLIT tablet and suggest the clinical relevance of initiating allergy immunotherapy earlier in the disease course.

Aerobiological study in Lima, Perú. ¿Tipuana-Tipu, perhaps a new allergen?

To report the Tipuana tipu pollen as a new allergen capable of triggering allergic symptoms. The pollen counts were made according to standardized technique with a Burkard seven days following the European Aerobiology Society´s Network Group recommendations.1 The trap was installed on the roof of Clinica SANNA, El Golf, San Isidro, which is 20 m high, 12°5'54"S 77°3'6"W in the west-south of the Lima urban area. The sampling period was performed from September 2020 to October 2021. Collection of Tipuana tipu pollens and Preparation of Tipuana tipu pollen extracts 1:20 w/v was done using a previously described method.2 We carried out systematic skin prick testing with Tipuana tipu pollen extract and other aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis), molds (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, Penicillium notatum), cat and dog danders, Periplaneta americana, grass six mix, weed mix (Inmunotek, Spain) on 80 patients (18 to 50 years old) seen in our allergy center, they suffering from november to january rhinitis and/or conjunctivitis symptoms. The majority living near avenues and large green areas, where Tipuana trees grew. We found a total of 952 grains/m3 of Tipuana tipu pollen between November 2020 to january 2021, with the maximum concentration of 37 grains/m3 on December 10th. We also found other airborne pollen Types: Poaceae, Myrtaceae, Compositae and Betulaceae. 14/80 patients (17,5%) showed positive skin prick test only to Tipuana tipu extract. Most of the patients with positive tests to Tipuana extract presented symptoms of rhinoconjunctivitis during the Tipuana pollination period. Four patients showed positive skin prick test to Tipuana tipu and grass 6 mix extracts, most of the rest of our patients were sensitized to dust mites' extracts (Dermatophagoides pteronyssinus). The west-south population of Lima urban city is exposed to Tipuana tipu pollen. We do not foud previous publications about Tipuana tipu allergy. Almost 18% of the patients tested in our sample were mono-sensitized to this pollen. The results of this study should be compared with data from the forthcoming years, to identify seasonal and annual fluctuations, extend the traps to other locations in Lima, and of course try to standardize and improve the Tipuana tipu pollen extract.

Association of allergies in children younger than 3 years with levels of maternal intake of n-3 polyunsaturated fatty acids or fish during pregnancy: A nationwide birth cohort study, the Japan Environment and Children's Study

BackgroundN-3 polyunsaturated fatty acids (PUFAs) have anti-inflammatory properties and are expected to prevent the onset of allergies. However, epidemiological studies investigating the relationship between child allergies and maternal intake of n-3 PUFAs or fish have yielded inconsistent results. MethodsFollowing exclusions from a dataset comprising 103,057 records from the Japan Environment and Children's Study, 72,105 participants were divided into five groups according to mothers' intake of n-3 PUFAs or fish during pregnancy to assess the risk of their children being diagnosed with allergy by 3 years old. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for child allergies were calculated using multivariable logistic regression analyses with reference to the lowest intake group. ResultsLevels of maternal intake of n-3 PUFAs or fish showed inverted associations (i.e., reduced risk) with the incidence of physician-diagnosed allergic rhinoconjunctivitis or parent-reported symptoms of current rhinitis with eye symptoms at different time points and the cumulative incidence from birth to 3 years of age. Inverted associations were also found for current wheeze at 1-<2 years of age and current eczema at 1-<2 and 0-<3 years of age. However, for food allergies, no significant associations were observed in the incidence in each group compared with the lowest intake group at any age. ConclusionsThe findings suggest that n-3 PUFA intake during pregnancy may reduce the risk of developing allergic diseases and symptoms in children. In addition, consumption of n-3 PUFAs or fish is very unlikely to increase the risk of allergy given that the results are from a country with high fish consumption. Trial registration: UMIN000030786 https://rctportal.niph.go.jp/detail/um?trial_id=UMIN000030786.

Efficacy observation and compliance analysis of pollen allergen drops in seasonal allergic rhinitis

To study the efficacy and compliance analysis of pollen allergen drops in the treatment of allergic rhinitis. The method of single-center controlled was used to analyze the dates' results. From July 2021 to September 2021, 80 patients with seasonal allergic rhinitis were referred to the clinic of otorhinolaryngology in First Hospital of Shanxi Medical University.40 patients received sublingual immunotherapy (SLIT group), and the other 40 patients received symptomatic drug treatment as the control group. The total rhinoconjunctivitis symptom score (TRSS), the visual analogue scale(VAS), total medication score (TMS) and combined scores of medication and rhinoconjunctivitis symptoms (CSMRS) of the patient before the start of the treatment and after the first year of the treatment were compared to assess the efficacy of sublingual immunotherapy of Artemisia pollen. Follow the shedding during the study, the safety of the drug and the causes for compliance analysis were analyzed and recorded. The results of comparison with TRSS, VAS, TMS and CSMRS in two groups in the period of pretherapy were as follows: TRSS(12.393±3.023, 12.450±3.029, t=-0.077, P=0.939), VAS(8.357±1.026, 8.400±0.982, t=-0.173, P=0.862), TMS(3.214±0.568, 3.175±0.501, t=0.301, P=0.764), CSMRS (5.286±0.680, 5.253±0.677, t=0.199, P=0.843), there was no significant difference (P>0.05); lower observed symptom scores were got in the post-treatment pollen peak SLIT group compared to the control group, TRSS(3.964±1.551, 7.750±2.169, t=-7.918, P<0.05), VAS(2.893±0.956, 5.175±1.481, t=-8.286, P<0.05), TMS (1.821±0.863, 3.175±0.501, t=-8.163, P<0.05), CSMRS (2.489±0.921, 4.468±0.601, t=-10.723, P<0.05), and the differences between the groups were statistically significant (P<0.05); the SLIT group significantly reduced all symptom scores at the first peak compared to the starting, TRSS(12.393±3.023, 3.964±1.551, t=20.576, P<0.05), VAS (8.357±1.026, 2.893±0.956, t=30.070, P<0.05), TMS (3.214±0.568, 1.821±0.863, t=7.151, P<0.05), CSMRS(5.286±0.680, 2.489±0.921, t=14.533, P<0.05) and there was statistical difference (P<0.05). No significant adverse reactions occured during medication in the SLIT group. A total of 12 cases were shed in the SLIT group, so the compliance rate was 70%. The four reasons were that patients considered the course was long (4 cases, 33%); the drugs were expensive (3 cases, 25%); patients were busy with their work and life (3 cases, 25%); patients were affected by the outbreak (2 cases, 17%). In summary, Artemisia pollen sublingual drops may improve the symptoms of the patients who got allergic rhinitis caused by Artemisia pollen after the treatment for one year. However, due to the lack of sufficient understanding of immunotherapy or the difficulty in adhering to standardized medication, the compliance with sublingual immunotherapy is still poor, the compliance with sublingual immunotherapy needs to be further improved through patient education.

Environmental exposure and sensitization patterns in a Swiss alpine pediatric cohort

BackgroundThe level of environmental exposure throughout life may contribute to the prevalence of allergic sensitization and allergic disease. The alpine climate has been considered a healthy climate with little allergen exposure and pollution. We conducted a cross-sectional study to investigate local environmental exposure and concomitant prevalence of allergic sensitization among local school children born and raised in an alpine environment. MethodsClinical and demographic data were collected with a questionnaire. Allergen content was assessed in residential settled dust samples, lifetime exposure to pollen and air pollution was calculated using data from national pollen and air pollution monitoring stations, and the allergic sensitization profile was determined with component resolved diagnostics (ISAC®). Univariate and multivariate regression models were used to estimate the relation between exposure and sensitization. ResultsIn a cohort of children born and raised in an alpine environment, sensitization to aeroallergens is quite common (38%), especially to grass (33%) and cat (16%). House dust mite allergen was detected in up to 38% of residential dust samples, but sensitization to HDM was low (2.5%). Pollutant levels were low, but an increasing trend was observed in the amount of ozone and PM10. Living close to a busy road was associated with increased odds OR (95% CI) for being sensitized to any allergen 2.7 (1.0–7.2), to outdoor allergens 2.8 (1.1–7.1) and being sensitized plus reporting symptoms of rhinoconjunctivitis 4.4 (1.3–14.8) and asthma 5.5 (1.4–21). Indoor living conditions, including the presence of visible mold, increased the odds of being sensitized to indoor allergens (1.9 (1.1–3.2) and being sensitized plus reporting symptoms of rhinoconjunctivitis 1.9 (1.0–3.6) and asthma 2.1 (1.0–4.1). ConclusionIn a healthy alpine environment, pollution might still be an important factor contributing to allergic sensitization.

HMGN2 and Histone H1.2: potential targets of a novel probiotic mixture for seasonal allergic rhinitis.

Allergic rhinitis (AR) is a common nasal inflammatory disorder that severely affects an individual's quality of life (QoL) and poses a heavy financial burden. In addition to routine treatments, probiotic intervention has emerged as a promising strategy for preventing and alleviating allergic diseases. The main objective of this study was to determine the effect of a novel multi-strain probiotic mixture on AR symptoms and investigate potential targets underlying the probiotic intervention. A randomized, double-blind, placebo-controlled clinical study was conducted on AR patients who were allergic to autumnal pollens (n = 31). Placebo or a novel probiotic mixture, composed of Lactobacillus rhamnosus (L. rhamnosus) HN001, L. acidophilus NCFM, Bifidobacterium lactis (B. lactis) Bi-07, L. paracasei LPC-37, and L. reuteri LE16, was administered after 2 months. The therapeutic efficacy was evaluated by a symptom assessment scale. Before and during the pollen season, blood samples were collected, and peripheral blood mononuclear cells (PBMCs) were isolated for further tandem mass tags (TMTs)-based quantitative proteomic analyses. Potential targets and underlying pathological pathways were explored using bioinformatics methods. During the pollen season, the rhinoconjunctivitis symptom score of participants who were administered probiotics (probiotic group, n = 15) was significantly lower than those administered placebo (placebo group, n = 15) (P = 0.037). The proteomic analyses identified 60 differentially expressed proteins (DEPs) in the placebo group, and subsequent enrichment analyses enriched a series of pathways and biological processes, including signaling pathways of inflammation, coagulation cascade, lipid, carbohydrate and amino acid metabolic pathways, and transcription and translation processes. Least Absolute Shrinkage and Selection Operator (LASSO) regression extracted five main elements, namely, GSTO1, ATP2A2, MCM7, PROS1, and TRIM58, as signature proteins. A total of 17 DEPs were identified in the probiotic group, and there was no pathway enriched. Comparison of DEPs in the two groups revealed that the expression levels of the high-mobility group nucleosome-binding domain-containing protein 2 (HMGN2) and Histone H1.2 presented an opposite trend with different interventions. Our data showed that AR symptoms alleviated after treatment with the novel multi-strain probiotic mixture, and the proteomic analyses suggested that HMGN2 and Histone H1.2 might be targets of probiotic intervention for seasonal AR.

Prevalence and time trends of symptoms of allergic rhinitis and rhinoconjunctivitis in Spanish children: Global Asthma Network (GAN) study.

The time trends of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy previously described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 are unknown; or if the geographical or age differences in Spain persist. To describe the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy in different Spanish geographical areas and compare them with those of the ISAAC. Cross-sectional study of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy, carried out in 2016-2019 on 19943 adolescents aged 13-14 years and 17215 schoolchildren aged 6-7 years from six Spanish areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona, and Salamanca), through a questionnaire based on the Global Asthma Network (GAN) protocol. The prevalences of recent rhinitis and rhinoconjunctivitis (last 12 months), and nasal allergy/hay fever were 35.1%, 17.6%, and 14.6% in the adolescents and 20%, 8.5%, and 8.9% in the schoolchildren, respectively, with rhinoconjunctivitis in adolescents varying from 20.9% in Bilbao to 13.4% in Cartagena; and in schoolchildren, from 9.8% in La Coruña to 6.4% in Pamplona. These prevalences of rhinoconjunctivitis and nasal allergy in adolescents were higher than those described in the ISAAC (16.3% and 13%) and similar in schoolchildren to the ISAAC (9% and 9.4%). There has been a stabilisation of rhinitis, rhinoconjunctivitis and nasal allergy in schoolchildren that slows the previous upward trend of ISAAC; and a slight non-significant increase in rhinoconjunctivitis and nasal allergy in adolescents. The variability found in adolescents would require local research to be better understood.

Clinical efficacy in one-year treatment with Artemisia annua-SLIT drops in monosensitized and polysensitized individuals

PurposeSeasonal allergic rhinoconjunctivitis (SARC) caused by Artemisia seriously affects patients' quality of life in northern China. This study aimed to estimate further the efficacy and safety of a one-year course of Artemisia annua-sublingual immunotherapy (SLIT) on SARC patients. Materials and methodsThis was an open-label, randomized, controlled, single-centre study involving 150 SARC patients induced by Artemisia, randomized to SLIT group (n = 75, SLIT along with pharmacotherapy) or control group (n = 75, pharmacotherapy only). According to the skin prick test (SPT) results, the SLIT group was divided into monosensitized and polysensitized groups to analyze the influence of sensitization status on the efficacy of Artemisia annua-SLIT. The clinical indicators of this study were total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), combined scores of medication and rhinoconjunctivitis symptom (CSMRS), and score of visual analog scale (VAS). Safety was evaluated by the occurrence of adverse events (AEs). Daily administration of the drops was recorded in diaries by the patients. ResultsAfter nearly one year of treatment and follow-ups, there was a significant decline in TRSS, TMS, CSMRS, and VAS from the baseline scores in the SLIT group (p < 0.001). However, as pollen counts increased in 2022, indicators above in the control group increased significantly during the peak pollen phase (PPP) in 2022 grass pollen season (GPS) compared to the baseline. Meanwhile, we found no significant difference in TRSS, TMS, CSMRS, and VAS between the monosensitized and polysensitized groups (p > 0.05). Moreover, the result indicated that the clinical improvement in TRSS, TMS, CSMRS, and VAS was still observed in polysensitized patients who were allergic to Artemisia pollen and sensitized to house dust mite (HDM) (n = 15) in PPP of 2022, compared to the baseline value (p < 0.001). ConclusionArtemisia annua-SLIT was proven effective, tolerable and safe in patients with SARC after nearly one year of treatment, whether monosensitization or polysensitization.

Efficacy and safety of Artemisia annua sublingual immunotherapy in patients with seasonal allergic rhinoconjunctivitis over two pollen seasons.

This study investigates the efficacy and safety of sublingual immunotherapy (SLIT) with A. annua allergens in patients with seasonal allergic rhinoconjunctivitis over two pollen seasons. Seventy patients with moderate-severe seasonal allergic rhinoconjunctivitis were divided evenly into the SLIT and control groups. The SLIT last from 3months before the summer-autumn pollen season in 2021 till the end of the summer-autumn pollen season in 2022. The daily individual symptom score, total rhinoconjunctivitis symptom score (dTRSS), total medication score (dTMS), combined score of medication and rhinoconjunctivitis symptom (dCSMRS), visual analog scale (VAS) score, and adverse events (AEs) were evaluated. The average pollen concentration in 2022 was twice that previous two-year during the pollen season. Fifty-six patients completed treatments (SLIT group: 29, control group: 27). Compared with baseline, the individual symptoms, dTRSS, dTMS, dCSMRS, and VAS scores of SLIT group declined in 2021. After 16months of SLIT, all efficacy indexes in 2022 were still lower than baseline and equivalent to those in 2021. In control group, the efficacy indexes in 2022 were higher than that in 2020 and 2021. The efficacy indexes of SLIT group were lower than those of control group in 2021 and 2022. SLIT is effective for both mono- and poly-sensitized patients. AEs incidence in SLIT group was 82.7% without severe AEs. The A. annua-SLIT can obtain efficacy and safety over two pollen seasons for patients with moderate-severe seasonal allergic rhinoconjunctivitis.

440 Prevalence and burden of rhinoconjunctivitis in atopic dermatitis patients: a cross-sectional study

Abstract Allergic rhinoconjuncitivitis can be highly symptomatic and burdensome and complicates the management of eyelid and facial dermatitis in persons with atopic dermatitis (AD). However, little is known about the prevalence, burden and predictors of allergic rhinoconjunctivitis symptoms in patients with AD, particularly among adults. This study aims to determine the prevalence and predictors of allergic rhinoconjunctivitis severity in patients with AD. A cross-sectional, dermatology practice-based study was performed at an urban academic medical center (n = 507). Atopic dermatitis severity was assessed by investigator-assessed Eczema Area and Severity Index (EASI), body surface area (BSA), investigator’s global assessment (IGA), objective-SCORing AD and patient-reported Global Assessment (PtGA). Impact of allergic rhinoconjunctivitis symptoms was assessed by Rhinoconjunctivitis Quality of Life Questionnaire. The cohort included children (&amp;lt;18 years; n = 36, 7.1%), young adults (18–49 years; n = 281, 55.4%) and older adults (≥50 years; n = 190, 37.5%), males (n = 219, 43.2%) and females (n = 288, 56.8%), Hispanics (n = 43, 8.5%), Blacks (n = 50, 9.9%), White non-Hispanics (n = 349, 68.8%), Asians (n = 51, 10.1%) and multiracial/other race (n = 14, 2.8%); 413 (81.5%) had private insurance. Overall, 246 (48.5%) reported a history of hay fever, and 15 (3.0%) and 416 (82.1%) of patients with AD reported having trouble with one or multiple rhinoconjunctivitis symptoms in the past 2 weeks; 30 (5.9%) and 365 (72.0%) of patients with AD had quite a bit or extreme trouble with one or multiple rhinoconjunctivitis symptoms, respectively. More severe AD overall (EASI, BSA, IGA and PtGA), as well as more severe facial dermatitis, flexural eczema and xerosis were associated with worse rhinoconjunctivitis symptoms, whereas, race, gender and presence of nummular dermatitis were generally not associated with rhinoconjunctivitis symptom severity. Quite a bit or extreme trouble from one or more rhinoconjunctivitis symptoms was reported in 39 (56.5%) patients with clear/almost clear, 85 (74.6%) mild, 135 (82.8%) moderate and 106 (84.8%) severe PtGA scores. In multivariable ordinal logistic regression models that controlled for demographics, AD severity was significantly associated with higher odds of a wide range of nasal and ocular symptoms, as well as rhinoconjunctivitis symptoms negatively impacting daily activities, causing sleep and practical problems, and negative emotions. Allergic rhinoconjunctivitis symptoms occurred in more than 4 out of 5 patients with AD overall, and almost 90% of patients with severe AD. Allergic rhinoconjunctivitis was more common in those with more severe AD, and particularly those with more severe facial dermatitis, flexural eczema and xerosis. Rhinconjunctivitis symptoms negatively impact the lives of patients with AD and warrant appropriate screening and management in clinical practice.

Clinical efficacy and safety of coseasonal initiation of Artemisia annua sublingual immunotherapy on patients with Artemisia-induced rhinoconjunctivitis

PurposePatients with seasonal allergic rhinoconjunctivitis (SARC) might seek evaluation and treatment when symptoms appear during the pollen season. It is unclear whether coseasonal-initiated sublingual immunotherapy (SLIT) would be effective and safe for SARC. This study aims to identify the feasibility of initiating Artemisia annua SLIT during the pollen season. Materials and methodsSixty patients with Artemisia-induced SARC were equally recruited into the SLIT and control groups during the pollen season in 2021. The SLIT group was treated with standardized Artemisia annua SLIT drops using a modified dosing schedule combined with pharmacotherapy, while the control group only received pharmacotherapy. Diary cards for clinical symptoms, rescue medication use, and adverse events (AEs) were recorded during the pollen seasons. Objective measures, including average daily combined scores of medication and rhinoconjunctivitis symptoms (CSMRS), total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), and the score of visual analog scale (VAS) were calculated to evaluate the efficacy of SLIT. Safety was assessed through the occurrence and severity of AEs. ResultsIn total, 80.0 % (24/30) patients in the SLIT group and 86.67 % (26/30) patients in the control group completed the study. The severity of SARC, which was assessed by objective measures including CSMRS, TRSS, TMS, and VAS of the SLIT group and the control group, was generally at the same level during the 2021 pollen season, except for the medical consumption, which the score of TMS was slightly higher in the SLIT group. After one year of treatment, the scores of CSMRS, TRSS, and VAS in the SLIT group were significantly improved compared with the control group (all P < 0.001), and the difference in the TMS between the two groups disappeared (P > 0.05). Moreover, clinical improvement of the four objective measures was also observed in the SLIT group compared with the baseline value (P < 0.001). Overall, 9/24 patients in the SLIT group experienced mild local AEs, and two patients experienced mild systemic AEs during the SLIT period. ConclusionsThis controlled preliminary study identified that coseasonal-initiated Artemisia annua SLIT treatment for one year was generally safe and effective in improving the symptoms of SARC patients induced by Artemisia annua pollen.

Efficacy and safety of allergen-specific immunotherapy in children

Atopic diseases are one of the most common chronic diseases in children and adolescents. They lead to a significant deterioration in the quality of life of patients and their families. The only strategy for the treatment of atopic diseases that has a disease-modifying effect is allergen-specific immunotherapy. The purpose of this review is to summarize the literature data on the practical aspects of allergen-specific immunotherapy use in children and adolescents with allergic rhinoconjunctivitis and atopic bronchial asthma. An analysis of scientific articles has shown that allergen-specific immunotherapy can reduce the severity of symptoms of allergic rhinoconjunctivitis and/or atopic bronchial asthma and reduce the amount of pharmacotherapy, as well as reduce the risk of bronchial asthma developing in patients with allergic rhinoconjunctivitis. The current evidence of the preventive effect of allergen-specific immunotherapy in relation to the development of new sensitizations in monosensitized patients is unconvincing, and, according to many authors, new randomized clinical trials are needed. According to most experts, allergen-specific immunotherapy should be started in children from 5 years of age in the presence of proven immunoglobulin E-mediated sensitization to one or more allergens, carried out for at least 3 years, using preparations in which the presence of major allergens is documented. At the same time, both subcutaneous and sublingual administration of allergens has comparable effectiveness. Allergen-specific immunotherapy is a safe and well-tolerated treatment for children, but currently there is no generally accepted classification of possible adverse events, as well as a standardized and uniform system for assessing their severity.

Traditional Chinese Medicine's Luffa Formula Reduces Nasal and Ocular Symptoms in Patients with Environmental and Food Allergies

Environmental allergy (EA) often coexists with other inflammatory conditions such as food allergy. It has been previously shown that the Luffa Formula in Traditional Chinese Medicine (TCM) reduces symptoms of allergic rhinoconjunctivitis in a murine model. We conducted a retrospective study on the Luffa Formula’s effect in reducing EA symptoms among people with comorbid environmental and food allergies, and conducted an in vitro study on IgE production and mast cell activation.

Allergic sensitization in low-income urban children: relationship with current symptoms of asthma and rhinitis.

Recent information on the prevalence of allergic sensitization (AS) in children from low-income urban areas is limited. We conducted a cross-sectional, randomized, population-based study to determine the prevalence of AS, and its relationship with asthma and rhinitis in low-income schoolchildren in Santiago, Chile. The parents answered a standardized questionnaire on respiratory symptoms, and a skin prick test (SPT) for common aeroallergens was performed on all children. In the 545 schoolchildren studied (mean age 8.3 ± 0.9 years), the prevalence of positive SPT was 25.5%. The current prevalence of asthma, rhinitis, and rhinoconjunctivitis was 20%, 43.4%, and 27.8%, respectively. SPT was positive in 30.6%, 32.8%, and 38.0% of children with current asthma, rhinitis, and rhinoconjunctivitis, respectively. Positive SPT was significantly associated with rhinitis and rhinoconjunctivitis (p < 0.001) but not with asthma. Breastfeeding for at least 4 months was significantly protective against AS (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.26-0.78; p = 0.008); no other factor studied was associated with AS. The prevalence of AS was low; less than 40% of children with current asthma, rhinitis, or rhinoconjunctivitis symptoms evidenced AS. The prevalence of non-atopic asthma and rhinitis is consistent with previous findings in children from low-income urban areas. Other environmental factors, such as the high burden of respiratory infections and environmental pollution, might be more critical than atopy for developing asthma and rhinitis in schoolchildren from deprived urban areas.

ELEVATED BASELINE SERUM TRYPTASE AND HEREDITARY ALPHA TRYPTASEMIA (HAT)

<h3>Introduction</h3> Hereditary alpha tryptasemia (HaT) is an autosomal dominant genetic trait characterized by elevated basal serum tryptase levels due to extra allelic copies of the tryptase alpha/beta 1 (TPSAB1) gene. HaT has been associated with multisystem complaints and as a modifier of mast cell-associated disorders and anaphylaxis. <h3>Case Description</h3> A 38-year-old male presented for evaluation of food and environmental allergies. He had severe oropharyngeal symptoms and a throat-closing sensation immediately after ingesting raw fruits and tree nuts. He also had symptoms of perennial allergic rhinoconjunctivitis with seasonal variation. Allergy skin testing showed IgE sensitivities to tree, grass and weed pollens, dust mites, mold spores, cat, dog, and cockroach. He had no IgE sensitivities to any of the fruits tested. He had IgE sensitivities to walnut, hazelnut, and almond. Given the severity of his oropharyngeal symptoms a baseline serum tryptase was checked, which was elevated at 20.3 mcg/L. Repeat determinations again showed baseline serum tryptase above 20 mcg/L. CBC with differential and CMP were within normal limits. 24-hour urinary histamine and N-methylhistamine were both within normal. Kit D16 mutation analysis was negative. TPSAB1 copy number analysis showed extra allelic alpha-tryptase copies, consistent with hereditary alpha tryptasemia (HaT). The patient received counseling and standard treatment for environmental/food allergies and tolerates allergen-specific immunotherapy. <h3>Discussion</h3> HaT is an inherited condition considered a biochemical trait and can be present in around 5% of the general population. Patients with elevated baseline serum tryptase may benefit from testing for extra allelic copies of TPSAB1.

Allergic rhinitis, rhinoconjunctivitis and hayfever symptoms among pre-school children are associated with school transport mode: an analytical cross sectional study

Allergic rhinitis, rhinoconjunctivitis and hayfever symptoms among pre-school children are associated with school transport mode: an analytical cross sectional study