Symptoms Of Allergic Rhinitis Research Articles

Role of Vitamin D in Allergic Diseases

Introductions: Vitamin D has gained recognition in recent decades not only as a key regulator of calcium and phosphorus metabolism and bone health but also as an important factor modulating the immune system. Research indicates that vitamin D influences both innate and adaptive immune responses, which is significant in the treatment of allergic and inflammatory diseases. Vitamin D has a beneficial effect on asthma exacerbations and may help reduce respiratory inflammation, as well as alleviate symptoms of allergic rhinitis. Vitamin D deficiency may increase the risk of food allergies, worsen symptoms of atopic dermatitis, and contribute to the transition from acute to chronic urticaria. Conversely, supplementation may help prevent allergies, reduce the severity of atopic dermatitis by supporting skin barrier function and antimicrobial peptide production, and relieve symptoms in patients with chronic urticaria. Purpose of the study: The review article aims to present the current state of knowledge on the role of vitamin D in the treatment of asthma, allergic rhinitis, food allergies, atopic dermatitis, chronic urticaria, and eczema. Material and methods: To summarize the current knowledge on the topic, a literature review of English language papers with a focus on the most current literature was performed. The review was conducted with the PubMed database with 64 works used, accessed before October 2024. Conclusions: Although the impact of blood vitamin D levels on the development and progression of allergic diseases has not yet been fully clarified, scientific studies suggest its significant role in modulating immune responses. Due to its immunoregulatory properties, vitamin D offers new hope for more effective treatment and prevention of allergic diseases.

Impact of the COVID-19 pandemic and lockdown measures on clinical visits and subjective symptoms in childhood allergic rhinitis induced by house dust mites in Shanghai

BackgroundEstablishing the interaction between aeroallergens and air pollution in children with house dust mite induced allergic rhinitis (HDM-AR) remains challenging, especially in urban areas. The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown measures provided a valuable opportunity.MethodsWe analyzed the clinical data of HDM-AR children between March and August in 2018–2020, and classified the children according to the type and the degree of HDM sensitization. The records of patients’ hospital visits, allergic rhinitis symptoms assessments, and air pollution measurements in Shanghai were used to assess the differences before (2018–2019) and during the pandemic (2020), as well as during lockdown (March-June) and unlockdown (July-August) period in 2020.ResultsThe study included 1570 HDM-AR children aged 2 to 8 years old, 815 (51.9%) were monosensitized to HDM (mono-HDM-AR), and 755 (48.1%) were polysensitized to HDM (poly-HDM-AR). There was a significant increase in the rate of clinical visits among children with HDM-AR during the COVID-19 pandemic compared to pre-pandemic (P < 0.001), particularly among older children aged 7–8 years (P = 0.01). During the unlockdown period, there was a notable decrease in clinical visits for children with poly-HDM-AR (P < 0.001). Children with high levels of HDM sensitization exhibited significant symptom improvement in unlockdown period (P < 0.001). Although the air pollutants concentration had improved during the study, there was no effect on the improvement of HDM-AR children as expected.ConclusionsThe COVID-19 pandemic and its associated lockdown measures provided a unique context to observe the dynamics of management in children with HDM-AR. The findings underscore the complexity of managing allergic conditions in pediatric populations, highlighting the influence of environmental and lifestyle changes on disease presentation and the need for tailored approaches to treatment during periods of societal disruption.

A Prospective, Multicenter European Study on the Effects of Anatolian Propolis and Hypertonic Saline Combination Nasal Spray on Allergic Rhinitis Symptoms.

Objectives: The current study examined the effectiveness of Rhinapi, a hypertonic saline nasal spray with Anatolian propolis added, on allergic rhinitis (AR) symptoms in a European population. Methods: Four hundred and forty AR patients (251 males and 189 females) from various European centers were enrolled. Nasal examination, overall symptom scores, individual AR symptoms (nasal discharge, sneezing, nasal itching, and nasal obstruction), and quality of life (QoL) were assessed before and after 3 weeks of treatment with Rhinapi, the nasal spray made of hypertonic saline with Anatolian propolis added (Bee&You, Istanbul, Turkey). Results: Rhinapi nasal drop use was associated with a substantial decrease (P < .05) in AR symptom ratings, including nasal discharge, sneezing, nasal itching, and nasal obstruction. QoL scores showed a significant improvement (P < .05), and the spray also alleviated swelling and improved concha color (P < .05). Conclusion: Rhinapi, Anatolian propolis-added hypertonic saline nasal spray (Bee&You, Istanbul, Turkey), when used for 3 weeks, reduced AR symptom scores and improved QoL. Both the concha color and the edema were also enhanced.

Resveratrol plus carboxymethyl-β-glucan for children with respiratory diseases.

Respiratory infections in children, ranging from mild to severe, are a leading cause of school absences and medical visits, creating significant socio-economic burdens for families. Recent interest has focused on resveratrol, a natural polyphenol known for its antioxidant, anti-inflammatory, and antiviral properties. When combined with carboxymethyl-β-glucan (CM-glucan), a modified polysaccharide with immunostimulatory effects, this formulation has shown potential benefits in managing respiratory diseases.Our research examines five randomized clinical trials investigating the efficacy of resveratrol and CM-glucan nasal solutions in children. The trials included children with recurrent respiratory infections (RRIs) and allergic rhinitis. The results demonstrate significant reductions in key respiratory symptoms, including nasal congestion, sneezing, coughing, and fever. In addition to symptomatic relief, the treatment was associated with fewer medical visits, decreased medication use, and reduced school absences. Importantly, the combination also showed efficacy in decreasing wheezing episodes in non-atopic children with RRIs and improving symptoms of allergic rhinitis. While these findings are promising, the studies are limited by small sample sizes and short-term follow-up periods, raising questions about the long-term efficacy and safety of the treatment. Mild and transient nasal irritation was the only reported side effect. Based on these concepts, the combination of resveratrol and carboxymethyl-β-glucan could be considered a valuable add-on strategy, complementing standard pharmacological treatments for pediatric respiratory infections and allergic conditions.

The role of epithelial alarmins and Th2 cytokines in the inflammatory response in allergic rhinitis

Allergic rhinitis (AR) occupies a leading position among the causes of morbidity throughout the world, to date, it has been diagnosed in 400 million people. In the formation and progression of AR, a significant role is assigned to cytokines associated with the second type of immune response, in particular, IL-4, IL-5, IL-9, IL-13, IL-25, IL-33, thymic stromal lymphopoietin (TSLP). This literature review provides information on the influence of the listed mediators on the structural cells of the nasal cavity and blood immune cells (T- and B-lymphocytes, eosinophils, macrophages, dendritic cells), and discusses their association with the manifestation of AR symptoms and the severity of the disease. The results of studies aimed at establishing the level of IL-4, IL-5, IL-9, IL-13, IL-25, IL-33 and TSLP in biological fluids (blood serum, nasal lavage) and their expression in nasal epithelial cells in patients with AR compared to healthy people are assessed.

Altered expression of long noncoding RNAs regulating neutrophilic inflammation in peripheral blood was associated with symptom severity in patients with house dust mite-induced allergic rhinitis.

Long noncoding RNAs (lncRNAs) have been implicated in a diverse array of human immune diseases; however, a comprehensive understanding of the expression and function of lncRNAs in the peripheral blood leukocytes of individuals suffering from house dust mite (HDM)-induced allergic rhinitis (AR) remains elusive. To explore the potential roles and functions of long noncoding RNAs (lncRNAs) in the pathogenesis of AR. Sequencing analysis was performed on peripheral blood leukocytes collected from patients with HDM-induced AR and healthy controls (HCs) to elucidate the expression patterns of lncRNAs. Differentially expressed (DE) lncRNAs were identified and validated, and further correlation analyses were conducted to explore their associations with visual analog scale (VAS) scores and cytokine levels in the serum and nasal secretions. Additionally, bioinformatics analyses were performed to predict the potential pathways influenced by DE lncRNAs. Finally, the diagnostic potential of these lncRNAs in AR was assessed via receiver operating characteristic (ROC) curve analysis. Significant differences in the expression profiles of lncRNAs and mRNAs were detected between AR patients and HCs. Four lncRNAs were markedly upregulated in AR patients. AC011524.2 was positively correlated with nasal pruritus (r = 0.4492, P = 0.0411). AL133371.3 was positively correlated with runny nose (r = 0.4889, P = 0.0245). AC011524.2 was positively correlated with CXCL8 (r = 0.4504, P = 0.0035). AL133371.3 was significantly positively correlated with only IL-17 (r = 0.4028, P = 0.0100). IL-4 in the serum was positively related to IL-17 in the serum (r = 0.4163, P = 0.0002). CXCL5 in the serum was positively correlated with IFN-γ (r = 0.3336, P = 0.0354) in nasal secretions. The area under the curve (AUC) of the ROC curve resulting from the integration of the 4 lncRNAs exhibited a remarkable value of 0.940 for AR diagnosis. Our results identified several lncRNAs associated with AR symptoms and inflammatory cytokines. Specifically, AC011524.2 and AL133371.3 exhibited strong correlations with diverse AR manifestations and serum cytokines, suggesting their pivotal role in the pathogenesis of AR, likely via neutrophil- and Th17-related pathways. However, the precise underlying mechanisms are still elusive, necessitating further exploration.

Bleaching Agents: A Review of Their Utilization and Management

Exposure to disinfectants, cleansers, and bleaching chemicals irritates the eyes, respiratory systems, and skin, triggering asthma and allergic rhinitis symptoms. Bleach, as the major constituent of cleansers, when used improperly or mixed with other indoor cleaning agents, produces harmful halogenated volatile organic compounds. This manuscript assesses the influence of excessive exposure to disinfectants, including bleaching agents, when used against infectious conditions related to SARS-COVID-19 and its management. The use and impact of different bleaching agents in cleansing and their associated problems have been analyzed and presented in this review. This analysis focuses on the conventional and post-pandemic approach towards bleaches. Usage of bleaching agents increased by a staggering 20.4% and 16.4% from January to March 2020 compared to the same period in 2018 and 2019. Mounting use of bleaching agents during the COVID-19 pandemic resulted in negative health effects like asthma, eye irritation, and skin allergies. An approximately 42% rise in poisoning cases, including a few deaths, has been associated with exposure to harmful chemicals involving bleaches during the recent pandemic. Bleaching agents are the primary sources of hazardous indoor pollutants; therefore, despite their importance in disinfection, their utility must be substantiated based on legal guidelines, disposal, and remedial measures. Thus, conducting future occupational exposure assessment studies for bleach hazard management is crucial.

Short-term influence of Immufen™ on mild allergic rhinitis: a randomized, double-blind, placebo-controlled study.

Allergic rhinitis (AR) is an IgE-mediated reaction to inhaled allergens, and is a prominent health concern affecting approximately 400 million people worldwide. A comprehensive understanding of AR's pathophysiology is imperative for developing novel therapies, especially considering its frequent co-morbidity with asthma and conjunctivitis. The escalating prevalence of AR is correlated with increased urbanization and environmental pollutants, recognized as prominent contributing factors. Dysregulation in immune networks, Th1/Th2 cytokine imbalance, activation of mast cells and eosinophils are implicated in AR progression. Classic AR symptoms include nasal congestion, nasal itching, rhinorrhea, and sneezing which significantly impact the quality of life, social interactions, and workplace productivity. This randomized, double-blind, placebo-controlled, three-arm, three-sequence study was aimed to assess the efficacy of supplementation of a co-delivery form of turmeric extract with ashwagandha extract (CQAB) in comparison with a bioavailable curcumin (CGM) and placebo in alleviating AR symptoms and enhancing the quality of life in individuals with mild AR. Participants received either placebo, CGM, or CQAB twice/day for 28 days, and subjective measures were recorded at the baseline and at the end of study. CQAB supplementation demonstrated a significant (P < 0.05) improvement in Total Nasal Symptom Score (TNSS) compared to placebo and CGM. Furthermore, CQAB administration resulted in enhanced sleep quality (P < 0.05) as evaluated by the BIS questionnaire, heightened energy levels, and decreased fatigue and overall mood disturbance (POMS-SF) compared to both placebo and CGM. The results suggests that CQAB has the potential to be used as a dietary supplement in alleviating AR discomforts. https://ctri.nic.in/Clinicaltrials/login.php; Identifier CTRI/2021/01/030355.

Efficacy of Biologic Therapies in the Management of Allergic Rhinitis: A Systematic Review.

Allergic rhinitis (AR) is a common chronic condition characterized by nasal congestion, sneezing, and itching, which significantly impacts quality of life. Traditional treatments, including antihistamines and intranasal corticosteroids, often fall short in managing moderate-to-severe cases. Recently, biologic therapies such as omalizumab and dupilumab have emerged as potential alternatives. This systematic review aims to evaluate the efficacy and safety of these biologic therapies in the management of AR. A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science to identify studies published between 2000 and 2024. Studies included were randomized controlled trials, cohort studies, and post-hoc analyses that assessed the impact of biologics on AR symptoms. Data on study characteristics, population demographics, intervention details, and outcomes were extracted and analyzed. The review included nine studies evaluating omalizumab and dupilumab. Omalizumab demonstrated significant improvements in nasal symptoms and quality of life, with notable efficacy in reducing symptoms and improving asthma control in patients with moderate-to-severe AR. Dupilumab also showed positive outcomes, particularly in patients with comorbid asthma and perennial AR, by reducing severe exacerbations and improving symptom scores. Biologic therapies, including omalizumab and dupilumab, offer promising alternatives for the management of AR, especially in cases that are severe or refractory to conventional treatments. The evidence supports their efficacy in improving symptoms and quality of life. Nevertheless, further research is required to address the limitations identified, including the need for long-term data and clarification of the mechanisms of action. These findings underscore the potential of biologics in advancing the treatment of AR and highlight the importance of ongoing research to optimize patient outcomes.

Comparison of the Efficacy and Safety of Bilastine 20mg versus Fexofenadine 180mg for Treatment of Perennial Allergic Rhinitis: Randomized Controlled Study.

Antihistamines has always remained the mainstay drug treatment for Allergic Rhinitis (AR). Bilastine is a novel, non-sedative antihistamine with a super-selective H1 receptor antagonist property. Both bilastine and fexofenadine are second generation antihistamine drugs commonly used to manage AR and Chronic Urticaria (CU). Autologous Skin Serum Test (ASST) is a practical test for histamine release in CU. These tests have been studied in AR patients with limited data studies. 114 patients diagnosed with perennial AR were recruited and divided into two groups of 57 each. One group was started Bilastine 20mg once a day and other group, fexofenadine 180mg once a day. Total Nasal Symptom Score (TNSS) was calculated at presentation and two weeks of antihistamine therapy. ASST was hypothesized to be the test for AR and performed at the time of presentation and at two weeks follow-up. Intergroup and Intragroup assessment of TNSS, ASST and its variables were done using unpaired and paired t test respectively. Patients showed reduction in symptoms of AR with both antihistamines. A significant improvement of sneezing and rhinorrhoea was seen in Fexofenadine group as compared to Bilastine group. TNSS showed statistically significant improvement in both the groups. ASST had statistically significant reduction in both the groups. Both Bilastine and fexofenadine were found to be effective in reduction of symptoms of allergic rhinitis. Bilastine was found to be more effective in overall as well as sneezing and rhinorrhoea noted two weeks after therapy. The online version contains supplementary material available at 10.1007/s12070-024-04770-0.

Prevention and alleviation of allergic rhinitis by oral administration of Lacticaseibacillus paracasei GOLDGUT-Lpc969.

Allergic rhinitis (AR) is a widespread upper airway disorder characterized by inflammation of the nasal passages. It is immunologically mediated via the hypersensitivity type I mechanism, which is primarily elicited by the immunoglobulin E (IgE)-linking allergen-induced imbalance of the Th2/Th1 immune response. Owing to the limited efficacy of current medications, probiotics have received attention for their potential in preventing and ameliorating AR. In this study, a Lacticaseibacillus paracasei strain, GOLDGUTLpc969 (Lpc969), isolated from the feces of healthy adults, was proven to be effective in preventing AR by LPA-induced RBL-2H3 in-vitro and OVA-induced AR mice in-vivo evaluation. The strain significantly attenuated the release of histamine and degranulation in LPS-induced RBL-2H3 cells. In the OVA-induced AR mice, L. paracasei GOLDGUT-Lpc969 also exhibited a significant decrease in disease indicators such as the disease activity index (DAI score), serum IgE, and serum histamine. Treatment with L. paracasei GOLDGUT-Lpc969 led to significant suppression of the Th2-related cytokines IL-4, IL-5, IL-6, IL-13, and TNF-α in the serum of mice. Furthermore, a comparison of the genomes of three previously reported AR-effective L. paracasei strains (including GOLDGUTLpc969) and one non-effective L. paracasei strain revealed that the gene K03671 may play a key role in alleviating AR symptoms. In conclusion, this study highlights the efficacy of L. paracasei GOLDGUT-Lpc969 in AR prevention by suppressing the Th2 immune response and proposes the potential involvement of the functional gene K03671 in ameliorating AR symptoms. Therefore, L. paracasei GOLDGUT-Lpc969 shows promise as a probiotic for preventing AR.

Natural products for the treatment of allergic rhinitis: focus on cellular signaling pathways and pharmacological targets.

Allergic rhinitis is an inflammatory disease dependent on immunoglobulin E and causes inflammation of the nasal mucosa, leading to decreased quality of life for affected patients. Since common treatments, including corticosteroids and antihistamines, have temporary therapeutic effects and numerous side effects, investigating natural compounds effective in improving allergic rhinitis with low complications and high efficacy can be significant and necessary. This study aims to present a comprehensive and critical evaluation of the effect of natural compounds in improving allergic rhinitis. Studies were identified through systematic searches of ScienceDirect, PubMed, Scopus, and Web of Sciences databases. Eligibility checks were conducted based on predefined selection criteria. Forty-six articles were included in this study. Phytochemicals, including flavonoids, alkaloids, terpenoids, and other compounds showed significant anti-inflammatory and antihistaminic effects. These compounds alleviate allergic rhinitis symptoms by inhibiting inflammatory mediators, oxidative stress, apoptosis, and key signaling pathways such as MAPK/NFκB and TLR4/MyD88/NF-κB. Phytochemicals exhibit anti-inflammatory and antioxidant properties, making them.

The value of objective methods for assessing nasal breathing function in the diagnostic algorithm for allergic rhinitis

The visual analogue score (VAS) is recommended to assess the severity of symptoms of allergic rhinitis (AR), but despite its advantages, it is a tool for subjective assessment of symptoms and often does not correlate with the true state of nasal patency. Anterior active rhinomanometry (AAR) is the method to objectify obstructive changes in the nasal cavity in patients with AR and is the most accurate method to assess nasal breathing function from a physiological and aerodynamic point of view. In addition, AAR with a decongestant test allows a differential diagnosis of the causes of nasal obstruction. Our study showed that there was no correlation between VAS and AAR scores. In addition, we found the importance of performing AAR with a decongestant test and subsequent assessment of unilateral flow and resistance parameters, which allowed us to suspect the presence of structural changes in the nasal cavity in patients with AR, as recorded as a result of anterior rhinoscopy and/or endoscopic examination. Thus, in addition to the use of VAS, it is necessary to include AAR in the diagnostic algorithm for AR, which allows not only to confirm the presence or absence of nasal breathing impairment, but also to differentiate the causes of its occurrence for the subsequent selection of the optimal management of patients with AR.

Correlation between Serum Vitamin D Levels and Allergic Rhinitis Severity at Vajira Hospital: A Cross-Sectional Study

OBJECTIVE: Vitamin D affects the immune system and inflammatory process, and its deficiency is significantly associated with an increased prevalence of allergic rhinitis (AR). Therefore, the correlation between the serum 25-hydroxyvitamin D levels and the severity of AR symptoms must be investigated.METHODS: This research utilized a cross-sectional approach, focusing on patients aged 18 years and above diagnosed with AR at the Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand from August 15, 2023, to January 15, 2024. The relationship between AR severity and serum vitamin D levels was analyzed using Pearson correlation coefficient. AR severity on symptoms and quality of life was assessed using the Thai version of Sinonasal Outcome Test-22 (SNOT-22) and Rhinoconjunctivitis Quality of Life questionnaire-36 (RCQ-36) questionnaires. Serum-specific immunoglobulin E (IgE) and total IgE levels were also measured to examine their relationship with the serum vitamin D level.RESULTS: Among the 58 participants, 34 (58.60%) had vitamin D deficiency. These individuals with vitamin D deficiency exhibited significantly higher AR severity compared with those without vitamin D deficiency. The mean difference between these groups was 21.90 points for SNOT-22 scores (95%CI: 17.71–26.69, p-value &lt; 0.001) and 19.17 points for RCQ-36 scores (95%CI: 12.08–27.34, p-value &lt; 0.001). Further analysis revealed a significant inverse correlation between serum vitamin D level and AR severity, with Pearson correlation coefficients of −0.72 for RCQ-36 (95%CI: −0.82 to −0.56, p-value &lt; 0.001) and 0.80 for SNOT-22 (95%CI: −0.88 to −0.68, p-value &lt; 0.001). No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.CONCLUSION: A significant inverse relationship existed between serum vitamin D levels and AR severity. No correlation with serum vitamin D level was found for serum-specific IgE and total IgE levels.

The Impact of Ambient Air Pollution on Allergic Rhinitis Symptoms: A Prospective Follow-Up Study.

Air pollution has become a serious public health problem and there is evidence that air pollution affects the incidence of allergic rhinitis. To further investigate the effect of ambient air pollutants on the severity of allergic rhinitis symptoms, a prospective follow-up study in patients with allergic rhinitis was conducted. A total of 167 allergic rhinitis patients with a mean age of 35.4 years, who were visiting the hospital, were enrolled. The daily symptom severity of allergic rhinitis and the concentrations of six air pollutants, including PM2.5, PM10, SO2, CO, O3 and NO2, were collected through follow-up investigations. The impact of ambient air pollutants on symptom severity was assessed via multi-pollutant models. Among several typical ambient air pollutants, we observed correlations of allergic rhinitis symptoms with PM2.5, PM10, CO, SO2 and NO2, whereas O3 showed no such correlation. Specifically, PM2.5 and PM10 were significantly associated with sneezing and nasal blockage. NO2 was significantly correlated with symptoms of rhinorrhea, itchy nose and itchy eyes. CO was significantly linked to sneezing and nasal blockage symptoms. These air pollutants not only had a direct impact on allergic rhinitis symptoms but also exhibited a lagging effect. This study indicates that short-term exposure to air pollutants is associated with exacerbation of nasal symptoms in patients with allergic rhinitis, leading to a decline in their quality of life.

Omalizumab reduces allergic rhinitis symptoms due to Japanese cedar pollen by improving eosinophilic inflammation.

Seasonal allergic rhinitis caused by Japanese cedar pollen (SAR-JCP) is a serious social problem in Japan, affecting 38.8% of the population (1). Omalizumab, a recombinant humanised monoclonal anti-immunoglobulin (Ig)E antibody, reduces serum-free IgE levels by 84-99% (2). The reduction of serum-free IgE levels induced by omalizumab ultimately downregulates FcεRI expression in basophils and mast cells (3). Omalizumab significantly reduces nasal symptoms and improves the quality of life in patients with allergic rhinitis (4,5); however, other than a decrease in free IgE, its biomarker activity is unclear. Allergic rhinitis reactions are more pronounced in nasal secretions and mucosa than in serum; however, no studies have examined the changes in proteins in nasal secretions after omalizumab administration. In this study, we aimed to elucidate the pathophysiology of the effect of omalizumab. This may serve as a basis for the identification of new biomarkers through the examination of proinflammatory proteins in nasal secretions, which may reflect the pathophysiology more accurately than peripheral blood.

Intranasal Versus Oral Treatments for Allergic Rhinitis: A Systematic Review With Meta-Analysis

BackgroundTreatments for allergic rhinitis include intranasal or oral medications. ObjectiveTo perform a systematic review with meta-analysis comparing the effectiveness of intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists in improving allergic rhinitis symptoms and quality of life. MethodsWe searched four bibliographic databases and three clinical trial datasets for randomised controlled trials (i) assessing patients ≥12 years old with seasonal or perennial allergic rhinitis, and (ii) comparing intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists. We performed a meta-analysis of the Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score (TOSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), development of adverse events, and withdrawals due to adverse events. Certainty of evidence was assessed using GRADE. ResultsWe included 35 studies, most of which assessed patients with seasonal allergic rhinitis and displayed an unclear risk of bias. Superiority of intranasal treatments was found for all assessed outcomes. Intranasal corticosteroids were more effective than oral antihistamines at improving the TNSS (MD=-0.86; 95%CI=-1.21;-0.51; I2=70%), TOSS (MD=-0.36; 95%CI=-0.56;-0.17; I2=0%) and RQLQ (MD=-0.88; 95%CI=-1.15;-0.61; I2=0%), being mostly associated with clinically meaningful improvements. Superiority of intranasal corticosteroids at improving the TNSS was also found against oral leukotriene receptor antagonists (MD=-1.05; 95%CI=-1.33;-0.77). Intranasal antihistamines were more effective than oral antihistamines at improving the TNSS (MD=-0.47; 95%CI=-0.81;-0.14; I2=0%) and RQLQ (MD=-0.31; 95%CI=-0.56;-0.06; I2=0%). ConclusionsRandomized controlled trials suggest that intranasal treatments are more effective than oral treatments at improving symptoms and quality of life in seasonal allergic rhinitis.

The effect of open-label placebo on allergic rhinitis symptoms: A systematic review and meta-analysis of randomized controlled trials.

The evidence regarding the open-label placebo effect on allergic rhinitis symptoms remains uncertain. Open-label placebo significantly reduced the frequency of symptoms in allergic rhinitis patients with similar safety profiles; however, there was no effect on the severity of symptoms and impairment due to symptoms. The statistically significant impact on symptom frequency can be considered not clinically significant.

The effects of mask applied aromatherapy on allergic rhinitis symptoms, fatigue, and quality of life related to allergic rhinitis in the COVID-19 era: a randomized controlled trial

The effects of mask applied aromatherapy on allergic rhinitis symptoms, fatigue, and quality of life related to allergic rhinitis in the COVID-19 era: a randomized controlled trial

Evolution, mechanism of action, and clinical applications of three generations of Antihistamines

Introduction. This review investigates the evolution, mechanisms of action, and clinical applications of three generations of antihistamines. Materials and methods: To identify relevant studies, an extensive search was performed across multiple databases, including PubMed, MEDLINE, Web of Science, and Scopus, using a strategic combination of keywords and MeSH terms. The selection process yielded relevant scientific literature sources published between 1985 and 2023. Results and discussion: the study demonstrated that the initial step in the creation and development of antihistamines involved analysing the mechanisms of anaphylaxis and allergy. This analysis led to the discovery of histamine as a mediator of allergic reactions and subsequently to the synthesis of substances with antihistamine effects, resulting in the gradual discovery of three generations of antihistamines. These drugs are designed to block H1-histamine receptors to eliminate allergic manifestations. Due to their non-selective antihistamine activity, first-generation drugs have many side effects, primarily sedation, in addition to their intended therapeutic effects. Second- and third-generation drugs are selective for peripheral H1 receptors and have significantly fewer side effects. The third generation of drugs, as active metabolites of the second generation, demonstrate the highest efficacy and safety profile. First-generation medicines are used for emergency care in acute allergic reactions and to reduce local allergy manifestations, whereas second and third generations are used to treat symptoms of seasonal and chronic allergic rhinitis. Conclusions: The significance of the study lies in the potential application of its results in the clinical practice of allergists.