Treatment Of Allergic Rhinitis Research Articles

Intranasal Morphology Transformation Nanomedicines for Long-Term Intervention of Allergic Rhinitis.

Intranasal administration has been widely explored as a potential treatment for allergic rhinitis, and improving intranasal penetration and retention of drugs is a challenging requirement to further improve efficacy. Delivery strategies of nanocarriers that enhance mucosal adhesion or mucus penetration have been proposed to improve nasal drug delivery; however, delivery efficiency remains limited by excessive pulmonary deposition and nonspecific cell phagocytosis. In this work, a "nasal in situ assembly" strategy was presented to construct intranasal morphology transformation nanomedicines with enhanced effective drug concentration for long-term intervention of allergic rhinitis. The polymer-polypeptide nanomedicine (PHCK) with a CCR3 antagonistic peptide (C) and a pH-responsive polyethylene glycol (H) was developed, encapsulating ketotifen (KT). PHCK nanoparticles displayed nasal mucosa permeability and transformed to nanofibers in the acidic environment of the nasal cavity, realizing responsive burst release of KT simultaneously. The fibrotic reassembly reduced the cellular internalization of nanomedicine and increased the CCR3 blockade on the eosinophil (EOS) membranes. Both in vitro and in vivo data indicated that PHCK achieved improved drug accumulation and retention in the nasal cavity and decreased pulmonary deposition, then effectively inhibited mast cell degranulation and EOS chemotaxis. This study demonstrates that the "nasal in situ assembly" strategy can improve drug delivery efficiency upon nasal responsive morphologic transformation, providing exploratory perspectives for nasal delivery platforms establishment and boosting therapeutic effect of allergic rhinitis.

Extracellular vesicles from adipose stem cells ameliorate allergic rhinitis in mice by immunomodulatory.

Human adipose tissue-derived stem cells (hADSCs) exert potent immunosuppressive effects in the allogeneic transplantation treatment. In mouse model of allergic rhinitis (AR), ADSCs partially ameliorated AR. However, no study has evaluated the potential therapeutic effects of hADSC-derived extracellular vesicles (hADSC-EVs) on AR. Female BALB/c mice were sensitized and challenged with ovalbumin (OVA) to induce AR. One day after the last nasal drop, each group received phosphate buffered saline (PBS) or hADSC-EVs treatment. Associated symptoms and biological changes were then assessed. hADSC-EV treatment significantly alleviated nasal symptoms, and reduced inflammatory infiltration. Serum levels of OVA-specific IgE, interleukin (IL)-4 and interferon (IFN)-γ were all significantly reduced. The mRNA levels of IL-4 and IFN-γ in the spleen also changed accordingly. The T helper (Th)1/Th2 cell ratio increased. The treatment efficacy index of hADSC-EV was higher than that of all human-derived MSCs in published reports on MSC treatment of AR. ADSC-EVs exhibited a greater therapeutic index in most measures when compared to our previous treatment involving ADSCs. These results demonstrated that hADSC-EVs could ameliorate the symptoms of AR by modulating cytokine secretion and Th1/Th2 cell balance. hADSC-EVs could potentially be a viable therapeutic strategy for AR. Further animal studies are needed to elucidate the underlying mechanisms and to optimize potential clinical protocols.

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.

Preliminary analysis of seasonal pollen allergens of allergic rhinitis in a hospital of Nanchang City

The study was aimed to analyze the seasonal pollen allergen spectrum of patients with allergic rhinitis (AR) in Nanchang city, and to provide evidence for improving the clinical diagnosis, treatment, prevention and epidemiology of seasonal AR. A retrospective analysis was conducted on the results of skin prick test (SPT) among 1 752 patients with AR in outpatient at Department of Otolaryngology, the First Affiliated Hospital of Nanchang University from September 2020 to August 2021 (a total of 1 069 males and 683 females, age ranged from 2 to 84 years old). SPSS 22.0 software was used to analyze the positive rates of main allergens and their differences in gender, age, and month of visit. Differences among groups were compared by student t test, Wilcox rank sum test, or χ2 test. The results showed that among 1 752 SPT-positive patients, the number of simple seasonal AR and the number of perennial combined seasonal AR were 102 (5.82%) and 281 (16.04%), respectively. There was no significant difference between male and female patients in positive seasonal pollen allergens (χ2=2.181, P>0.05), but the positive rate of indoor seasonal pollen allergens in males was higher than that in females (χ2=7.901, P<0.05). The seasonal pollen allergens ranking top 5 of the positive rates were willow (6.62%, 116/1 752), humulus scandens (5.71%, 100/1 752), rape (5.54%, 97/1 752), grey pigweed (4.62%, 81/1 752) and birch (3.60%, 63/1 752). The positive rates of indoor and seasonal pollen allergens increased first and then decreased in different age groups, and the highest positive rates of seasonal pollen allergens were in the age group of 31-40 years old, with statistical significance compared with other groups (χ2=61.269, P<0.05). The seasonal allergen positive rate showed two peaks in time: March to May and September to November. The positive rate of pollen in spring was 60.27% (132/219), which was significantly higher than that in autumn (39.73%,87/219) (χ2=9.247, P<0.05). The positive rate of pollen combination in spring and autumn was 68.29% (112/164), which was significantly higher than that in spring and autumn alone (18.9%,31/164) and (12.8%, 21/164) (χ2=14.731, P<0.05). In summary, pollen allergy in Nanchang City cannot be ignored, accounting for more than 20% of the total number of AR. The incidence of seasonal AR in Nanchang City showed two peaks (March to May and September to November). The common allergens for seasonal AR in Nanchang City were willow, humulus scandens, rape, grey chenopods and birch.

Intranasal combo: fixed-dose combination of mometasone furoate and olopatadine hydrochloride in therapeutic strategies for rhinosinusitis.

A novel strategy for the treatment of allergic rhinitis results from the innovative combination of antihistamine and intranasal corticosteroid drugs. By combining two preparations with different mechanism of action, this novel approach facilitates quick and effective controls of all upper respiratory tract allergy symptoms. The article presents the results of a study of olopatadine hydrochloride and mometasone furoate fixed-dose combination (GSP301) administered intranasally from a spray formulation, with an attempt at positioning the treatment within the ARIA and EPOS guidelines.

Imaging anatomy of the vidian canal and its clinical significance.

Vidian neurectomy (VN) is an effective surgical treatment for severe allergic rhinitis (AR). However, little research has been conducted on the imaging anatomy of the vidian canal (VC). This study aimed to analyze the computed tomography (CT) imaging of the VC and its surrounding structures and investigate the morphometric characteristics and clinical significance of VN. We analyzed 118 paranasal sinus CT scans (55 male and 63 female patients), with axial, coronal, and sagittal slices being used in the study. Among the 118 patients in this study, the average length of the VC in male and female patients was 14.00±3.35 and 12.51±3.42 mm, respectively; the transverse diameter of the posterior segment of the VC in females was larger than that in males; and the length of the VC and the distance between VC and foramen rotundum (FR) in males were longer than those in females. The angle between the VC and the sagittal plane and the angle between the sphenopalatine foramen (SPF) and the VC in females were larger than those in males, and the distance between the attachment to the end of the middle turbinate (MT) and the VC was greater. Type 2 VC occupied a dominant position. The VC was mostly at the same line as the medial wall of the maxillary sinus (MS) and was located on the medial side of the medial pterygoid plate (MPTG). The highest point of the VC was mostly superior to that of the palatovaginal canal (PVC). Most of the VC was inferior to the internal carotid artery (ICA), and no cases were observed in which the VC was above the ICA. Some of the measurements of the VC and its surrounding structures were correlated. The position and morphometric information of the VC could be reflected in a CT scan, which may contribute to the evaluation of VN preoperatively and postoperatively.

Aurantio-obtusin alleviates allergic responses in ovalbumin-induced rhinitis

Allergic rhinitis (AR) is a growing global health concern. Despite being non-fatal, it has a detrimental effect on people's quality of life and poses a significant economic burden. In this study, we aimed to evaluate the anti-allergic effects of aurantio-obtusin against ovalbumin-induced murine model of allergic rhinitis. Aurantio-obtusin was administered to rats orally after sensitization to ovalbumin. Results of the study suggested that aurantio-obtusin causes a significant reduction in nose rubs and sneeze as compared to the vehicle-treated disease control group. The aurantio-obtusin treated group showed a dose-dependent significant reduction in serum TNF-α, IL-4, and IL-6 levels as well as histamine levels in the nasal mucosa. Additionally, it decreased neutrophil and eosinophil numbers in blood of AR rats'. In the nasal tissues of the vehicle-treated rats that were subjected to an OVA challenge, the histology of the nasal mucosa of AR rats revealed aberrant histological changes. A variety of histological abnormalities, including vascular congestion in the nasal mucosa, substantial inflammatory cell infiltration, and obvious alveolar wall oedema were present. In the rats treated with aurantio-obtusin, these characteristics were reversed. Collectively, the findings suggests that aurantio-obtusin could be used to enhance current AR treatment approaches.

Xiaoqinglong decoction improves allergic rhinitis by inhibiting NLRP3-mediated pyroptosis in BALB/C mice

Ethnopharmacological relevanceXiaoqinglong decoction (XQLD), first recorded in Shang Han Lun, is a traditional Chinese medicine prescribed for the treatment of allergic rhinitis (AR). XQLD alleviates the clinical symptoms of AR by inhibiting the occurrence of an inflammatory response, but the specific regulatory mechanism remains unclear. Aim of the studyNLRP3-mediated pyroptosis is closely related to AR pathogenesis. Hence, this study aimed to explore the potential role of NLRP3-mediated pyroptosis pathway in the AR-associated pharmacological mechanism of XQLD. Materials and methodsBALB/C mice models of AR was established by using ovalbumin (OVA) and aluminum hydroxide sensitization. After intragastric administration of different dosages of XQLD, nasal allergic symptoms were observed. The expression of OVA-sIgE and Th2 inflammatory factors (IL-4, IL-5, and IL-13) in serum was detected by ELISA. The histopathological morphology and expression of inflammatory factors in nasal mucosa along with pyroptosis were investigated. Molecular docking was performed to analyze the binding of representative compounds of XQLD with NLRP3. Activation of the NLRP3 inflammasome was detected by immunofluorescence and western blotting. ResultsXQLD significantly improved the nasal allergic symptoms of mice, reduced the degree of goblet cell proliferation, mast cell infiltration, and collagen fiber hyperplasia in nasal mucosa. Meanwhile, it could downregulate the expression of Th2 inflammatory factors (IL-4, IL-5, and IL-13) in serum and nasal mucosa. XQLD significantly reduced the number of GSDMD and TUNEL double-positive cells and IL-1β and IL-18 expression. Molecular docking confirmed that seven representative compounds of XQLD had good binding properties with NLRP3 and were able to inhibit the activation of the NLRP3 inflammasome. ConclusionsThe representative compounds of XQLD might inhibit pyroptosis in nasal mucosa mediated by the NLRP3 inflammasome to helping the recovery of AR, which provides a new modern pharmacological proof for XQLD to treat AR.

Effect of Body Weight on Response to Nasal Glucocorticoid Treatment in Allergic Rhinitis.

Allergic rhinitis is among the most common chronic diseases in the world. Obesity can lead to a chronic systemic inflammatory process. In this study, we evaluated the effects of body weight on the response to treatment of allergic rhinitis with nasal corticosteroids. Two groups of patients diagnosed with allergic rhinitis were compared: one composed of obese patients and one composed of normal weight patients. Nasal endoscopy, peak nasal inspiratory flow, quality of life, the VAS, SNOT22, and NOSE-5 questionnaires, and the concentration of nasal cytokines (INF-γ, TNF-ᾳ, IL-4, IL-5, IL-6, and IL-10) through nasal brushing were evaluated before and after treatment with 400 mcg/day nasal beclomethasone. No differences were identified between the groups in nasal endoscopy, peak nasal inspiratory flow, the VAS, SNOT22, and NOSE-5 questionnaires, or in the cytokines INF-γ, TNF-ᾳ, IL-4, IL-5, IL-6, and IL-10 prior to nasal corticosteroid treatment. Both groups showed improvement in the VAS, SNOT-22, and NOSE-5 questionnaires and an increase in peak nasal inspiratory volumes after treatment. In the eutrophic group, there was an increase in INF-γ and IL-5 after treatment. When comparing the variation in cytokines before and after treatment between groups, IL-10 was the cytokine that showed altered behavior dependent on weight. Obesity did not seem to impact nasal symptoms and physiology and presented a similar clinical response to treatment with nasal corticosteroids to normal weight patients. However, obese patients had an impaired anti-inflammatory response during treatment with nasal corticosteroids.

Immunothérapie allergénique aux pollens de graminées : profil de sécurité et d’efficacité

IntroductionRespiratory allergies to grass pollens are very widespread in the general population and the treatment is generally symptomatic which sometimes remains insufficient. Grass pollen allergen immunotherapy is currently the only etiological treatment of seasonal allergic rhinitis apart from allergenic eviction. AimThe aim was to study the effectiveness of sublingual ITA tablets with 5-grasses on allergic disease and describe the adverse effects after one year of treatment. MethodsWe conducted a prospective, descriptive and evaluative study including 40 patients suffering from grass pollen allergic rhinitis. A grass pollen sublingual allergen immunotherapy was received and patients were followed during a one-year treatment to study the efficacy and the safety profile. ResultsThe mean age was 30.9±12.25 years. The sex ratio (M/F) was 0.48. Allergic conjunctivitis was associated in 70% and allergic asthma was associated in 48% of cases. Allergen immunotherapy side effects were mild, consisting of local side effects. No severe side effects were observed. A decrease in allergic rhinitis symptoms was observed in 83% with improvement in medication score in 65%. All patients noted a decrease in conjunctivitis symptoms with a total regression in 54% of cases. A better asthma control was noted in 33%. Among the 19 patients suffering from asthma, we could decrease the drug use in 63% of cases during the first year of treatment. An improvement of the quality of life was observed in 78% of cases. Allergen immunotherapy was significantly more efficient in allergic rhinitis and conjunctivitis with patients under 30years old. ConclusionGrass pollen allergen immunotherapy leads safely to the regression of allergy symptoms and improves the therapeutic load and the quality of life.

Allergic rhinitis: a comprehensive view of the problem

Currently, allergic sensitization is considered as one of the key causes of the development of chronic inflammatory processes in the nasal cavity and paranasal sinuses. The choice of optimal drugs for the treatment of allergic rhinitis still remains a relevant, socially significant and interdisciplinary problem. The article analyzes the modern strategy for the treatment of allergic rhinitis and assesses the incidence of comorbid pathology associated with allergic sensitization in patients with this pathology. In accordance with the latest clinical guidelines, a discussion of a stepwise approach to the treatment of allergic rhinitis was carried out. Based on data from a number of studies, the advantages of prescribing intranasal corticosteroids (InGCS) and leukotriene receptor antagonists (ALR) in the treatment of allergic rhinitis, including when combined with bronchial asthma and chronic rhinosinusitis with nasal polyps, have been identified. Among the officially registered drugs for the basic treatment of allergic rhinitis, the characteristics of the original intranasal spray mometasone furoate and the leukotriene receptor blocker montelukast are described in detail. The discussion describes the possibilities of potentiating the effects of topical corticosteroids through combination with leukotriene receptor antagonists. A clinical example demonstrates the feasibility of using a combination of the intranasal corticosteroid Nasonex with the leukotriene receptor blocker Singulair to control the course of allergic rhinitis and chronic rhinosinusitis with nasal polyps and, as a consequence, prevent the development of remodeling of the respiratory tract mucosa in such patients. During a follow-up examination after 3 months of therapy, the patient noted a subjective improvement in general well-being, nasal breathing, sense of smell, normalization of sleep, and a significant decrease in nasal discharge. There is no need for decongestants, sneezing is not a concern, and there is no respiratory discomfort. The combined use of ALR and InGCS enhances the anti-inflammatory effect of therapy.

Quality of life of children with allergic rinitis and ways of correction

Introduction. Allergic rhinitis is a common disorder that significantly impairs the children’s quality of life. The problem is particularly pertinent in relation to the paediatric population living in areas with advanced manufacturing industries, where well-known trigger factors, being added by increased concentration of pollutants in the atmospheric air, further complicate the selection of an effective course of treatment.Aim. To determine the effectiveness of a course of treatment with an antihistamine medicine Cetirizine based on the assessment of quality-of-life criteria for children with intermittent allergic rhinitis (IAR) in the Chelyabinsk region.Materials and methods. A prospective study of 147 children with respiratory allergic diseases living in the Chelyabinsk region was conducted. The quality of life of children who received a course of treatment with the antihistamine medicine was assessed using the Paediatric Quality-of-Life inventory (PedsQL) that consisted of combined Likert scales (school life, social, physical functioning, etc.), clinical symptoms were assessed using a developed visual analogue scale.Results and discussion. The assessment findings confirmed that the use of Cetirizine in the complex therapy of intermittent allergic rhinitis and associated comorbid conditions made it possible to significantly improve the clinical symptoms and quality of life of children over the entire treatment period.The most striking positive response in the form of decreased nasal obstruction was seen during the prescribed treatment in patients of Groups 1 and 2. Thus, the filling VAS ratings for children with mild to moderate IAR showed that only 10 (20%) patients in Group 1 experienced mild nasal breathing difficulty. Patients with severe IAR reported a decrease in nasal obstruction only by the end of two-month treatment.Conclusion. Cetirizine demonstrated a good effect of blocking H1-histamine receptors, high bioavailability, good tolerability and safety in the treatment of allergic rhinitis in children with comorbid conditions.

Перспективы использования мезенхимальных стволовых клеток обонятельной выстилки в лечении аллергического ринита и хронического полипозного риносинусита: обзор литературы

В статье представлен обзор литературы, основанный на поисковых базах Medline, Embase, PubMed, научной электронной библиотеке eLibrary, с момента их создания до 31 мая 2023 г. Клеточные технологии являются перспективными в лечении хронических неинфекционных заболеваний полости носа, таких как аллергический ринит и хронический полипозный риносинусит. Использование терапии на основе мезенхимальных стволовых клеток приводит к снижению продукции провоспалительных цитокинов, подавлению иммунного воспаления и стимуляции регенерации тканей в месте их введения. Мезенхимальные стволовые клетки способны распознавать поврежденный участок и индуцировать иммунный ответ как врожденного, так и адаптивного иммунитета в случае недостаточного иммунного ответа. С другой стороны, они подавляют функцию иммунных клеток, если в поврежденном участке формируется избыточная иммунная реакция. Таким образом, в зависимости от уровня секреции факторов воспалительной среды мезенхимальные стволовые клетки проявляют либо провоспалительную, либо противовоспалительную функцию. Дальнейшее изучение иммунных процессов при хронических неинфекционных заболеваниях полости носа будет способствовать появлению новых, более эффективных методов лечения, основанных на клеточной терапии. The article presents a literature review based on the Medline, Embase, Pubmed search databases, eLibrary scientific electronic library from the moment of their creation until May 31, 2023. Cellular technologies are promising in the treatment of chronic non- communicable diseases of the nasal cavity such as allergic rhinitis and chronic polypous rhinosinusitis. The use of mesenchymal stem cells leads to a decrease in the production of pro-inflammatory cytokines, suppresses immune inflammation and stimulates tissue regeneration at the injection site. Mesenchymal stem cells are capable of recognizing a damaged site and inducing an immune response of both innate and adaptive immunity in case of an insufficient immune response. On the other hand, they suppress the function of immune cells if an excessive immune response forms in the damaged area. Thus, depending on the level of secretion of inflammatory environment factors, mesenchymal stem cells exhibit either pro-inflammatory or anti-inflammatory functions. Further study of immune processes in chronic non-communicable diseases of the nasal cavity will contribute to the emergence of new, more effective methods of treatment based on cell therapy.

Limited beneficial effects of systemic steroids when added to standard of care treatment of seasonal allergic rhinitis

Intramuscular injections with methylprednisolone treating allergic rhinitis (AR) have a long history. Modern guidelines are designed to dissuade this treatment, but it´s frequently used, especially in primary care. This despite of concern for side effects and lack of modern placebo-controlled studies. This study was designed to evaluate if methylprednisolone, could significantly improve symptoms of birch pollen induced AR and reduce the concomitant use of standard of care medication. Forty-two patients with birch pollen induced AR were randomized to treatment with methylprednisolone (80 mg) or placebo (NaCl 0.9%). Daily symptom- and medication scores was registered for 3 weeks. Quality of life questionnaires Sino-nasal Outcome Test-22 (SNOT-22) and Juniper Rhinoconjunctivitis Quality of Life Questionaire (Juniper RQLQ) were registered at trial start and at the end of the 3 weeks period. The combined symptom- and medication scores indicate that the methylprednisolone treated group [mean Area Under the Curve (AUC) 37.1 (SD 16.2 (95% CI 29.9–44.6))] was significantly better off than the placebo group [mean AUC 49.1 (SD 10.1 (95% CI 44.5–53.7))], p = 0.008. No significant difference between the groups were found in the SNOT-22 and Juniper RQLQ analysis. Registered side effects were few and mild. The limited beneficial effects of systemic steroids when added to standard of care in combination of its potential risk for side effects, speaks against its use for treatment of severe seasonal allergic rhinitis. The lack of difference in quality-of-life further underscores this result.

Intranasal antihistamines and corticosteroids in the treatment of allergic rhinitis: a systematic review and meta-analysis protocol

IntroductionIntranasal antihistamines and corticosteroids are some of the most frequently used drug classes in the treatment of allergic rhinitis. However, there is uncertainty as to whether effectiveness differences may exist...

Metabolomics of nasal lavage fluid in patients with allergic rhinitis treated by Xiaoqinglong Decoction

This study used nasal lavage fluid for metabolomics to explore its feasibility, and applied it to the clinical metabolomics study of Xiaoqinglong Decoction in the treatment of allergic rhinitis(AR), aiming to investigate the molecular mechanism of Xiaoqing-long Decoction in the treatment of AR through differential changes in local nasal metabolism. AR patients were selected as the research subjects, and nasal lavage fluid was collected as the sample. Metabolomics analysis using liquid chromatography-mass spectrometry was performed on normal group, AR group, and Xiaoqinglong Decoction group. The differences in metabolic profiles among the groups were compared using principal component analysis and partial least squares discriminant analysis, and differential metabolites were identified and subjected to corresponding metabolic pathway analysis. The results showed that Xiaoqinglong Decoction significantly improved the symptoms of AR patients. The metabolomics analysis revealed 20 differential metabolites between AR group and Xiaoqinglong Decoction group. The core metabolite with a trending return in comparison to normal group was trimethyladipic acid. The metabolites were involved in multiple pathways, including β-alanine metabolism, glutathione metabolism, and phenylalanine, tyrosine, and tryptophan biosynthesis. The feasibility of applying nasal lavage fluid in nasal metabolomics was preliminarily demonstrated. Differential metabolites and enriched pathways in the treatment of AR patients with Xiaoqinglong Decoction were identified, indicating that it may improve rhinitis symptoms through the regulation of various metabolites, including antioxidant effects and correction of Th1/Th2 imbalance.

Assessing serum cytokine and immunoglobulin levels in patients with allergic rhinitis and allergic rhinoconjunctivitis before and after treatment supplemented with macromycetes

Background: In recent decades, the prevalence of allergic rhinitis (AR) has been increasing all over the world including Ukraine. Allergic rhinoconjunctivitis (ARC) is one of the most common clinical forms of AR. An imbalance between pro-inflammatory and anti-inflammatory cytokines is known to have a key role in allergic inflammation. Purpose: To compare cytokine and immunoglobulin levels among patients with AR and ARC treated with different therapeutic options. Material and Methods: Forty patients with AR and ARC (age range, 20 to 46 years) were included in the study. Disease duration ranged from 6 months to 2 years. Patients were divided into two subgroups of 20 patients each. Patients of subgroup 1 received the basic therapy (a 10-mg loratadin tablet daily and mometasone furoate nasal spray at a dosage of 200 μg once daily), whereas patients of subgroup 2, the basic therapy plus polypore macromycetes (Astmagan), one capsule twice daily. Treatment course duration was 90 days. The control group was composed of 25 healthy individuals. A comprehensive clinical immunological examination was conducted at baseline and on the completion of the treatment course. Enzyme-linked immunosorbent assay kits were used to determine serum levels of immunoglobulins A (IgA), IgM, IgG, and IgE, and cytokines (gamma interferon (IFN-γ) and IL4). Results: At baseline, serum levels of IgA, IgM and IgE were almost twice as high (р = 0.0008; 0.0005; and 0.0001, respectively); IgG, 1.2 times higher (р = 0.001); pro-inflammatory cytokine IL4, 3.5 times higher (р = 0.0001); and anti-inflammatory cytokine IFN-γ, 2.4 times lower (р = 0.0001) in patients with AR and ARC compared to controls, and these differences were significant. Astmagan, when used as an adjunct to the basic treatment of AR and ARC, contributed to 8%, 17%, 16.2%, 7.3% and 6.0% greater decreases in the serum levels of IgA, IgM, IgE, IgG and IL4, respectively, and a 16.6% greater increase in the serum level of IFN-γ compared to the basic treatment only, and these differences were significant, with an improvement in immune response to therapy.

Role of Bilastine in Allergic Rhinitis: A Narrative Review.

Allergic rhinitis (AR) is considered a trivial disease and is often self-treated with over-the-counter drugs and home remedies. However, AR is a contributing risk factor for asthma associated with complications, including chronic cough, eosinophilic esophagitis, and otitis media with effusion. In AR, inflammation is primarily mediated by histamines. Guidelines advise using second-generation oral H1 antihistamines as the primary treatment for AR. Second-generation H1 antihistamines strongly prefer the H1 receptor, limiting their ability to enter the central nervous system. Thus, they have minimal adverse effects. Among these H1 antihistamines, bilastine is highly specific for H1 receptors with a slight affinity for other receptors. It has a rapid and prolonged action, which reduces the need for frequent dosing and has better compliance. In the long term, bilastine is well-tolerated with minimal adverse effects. It is not associated with drug interactions, so dosage adjustment is unnecessary. Bilastine does not penetrate the brain and is nonsedating at 80 mg once daily. The low possibility of drug-drug interactions and pharmacokinetics of bilastine makes it suitable for elderly patients, even with compromised hepatic and renal function, without dose adjustment. This review comprehensively discusses the guidelines and the role of bilastine in treating AR. How to cite this article: Tiwaskar M, Vora A, Tewary K, et al. Role of Bilastine in Allergic Rhinitis: A Narrative Review. J Assoc Physicians India 2023;71(11):58-61.

Effect of Eriobotrya japonica Leaf Supplements on Allergic Rhinitis Symptoms and Skin Conditions in Healthy Adults: A Randomized, Double-Blind, Placebo-Controlled Study

Eriobotrya japonica (E. japonica) leaves have been used as an herbal traditional medicine in China and Japan owing to their anti-inflammatory and protective effects against skin conditions and allergy symptoms. These beneficial effects are likely mediated by the various triterpenoids present in E. japonica leaves. However, the efficacy of E. japonica leaves in the treatment of allergic rhinitis has not been evaluated in humans. Therefore, in the present study, a randomized, controlled, double-blind trial was performed on healthy adults of age &gt;20 (n = 27) who were randomly assigned to receive either 2.5 g of placebo or E. japonica leaf supplements once daily for 4 weeks. The Japanese Allergic Rhinitis Quality of Life Standard Questionnaire (JRQLQ), dermatological allergy symptoms, Dermatology Life Quality Index, and skin condition parameters were assessed at baseline and after 4 weeks. Significant differences were observed in the variability of the itchy nose, itchy eyes, and eye symptoms between the E. japonica supplementation and placebo groups after 4 weeks. Arm skin transepidermal water loss was improved only in the E. japonica supplementation group. This study suggests that E. japonica leaves can be used as a functional food ingredient to relieve allergic symptoms.

Biologic drugs and allergen immunotherapy: potential allies

Allergen-specific immunotherapy (AIT) is a proven efficacy treatment for allergic rhinitis (AR), asthma, and Hymenoptera venom allergy, but its use in food allergy (FA) is still under investigation. Because some efficacy and safety concerns still remain, biologic drugs, including omalizumab and dupilumab, have been studied as an adjunctive therapy to AIT for these conditions. In this article, the evidence supporting the use of monoclonal antibodies (mAbs) as an add-on therapy to AIT for FA, AR, asthma, and Hymenoptera venom allergy has been reviewed. The review will delve into the mechanisms of action of different mAbs, their efficacy, and how they can be integrated into personalized medicine approaches to treat allergic diseases. Furthermore, future research areas will be considered. Evidence suggests that omalizumab in combination with AIT may be a beneficial option for respiratory allergies or food desensitisation, especially during the escalation or build-up phase, when adverse events are more frequent. Currently, there is a small number of well-structured clinical trials in Hymenoptera venom allergy, and the available data consist mainly of single-case reports that provide information of limited value. Dupilumab has been studied as adjunctive therapy in patients with respiratory and FAs. Clinical trials are ongoing to evaluate the efficacy of dupilumab as monotherapy or as an adjunct to oral immunotherapy (OIT) in peanut allergy. Other studies are investigating the use of dupilumab in patients with multiple FAs and as an adjunct to milk OIT. Overall, mAbs have the potential to improve outcomes in various allergic conditions when used as an add-on to AIT, especially during the build-up phase. Further research is needed to fully understand their optimal dosing and duration of treatment, as well as to identify which patients may benefit the most from these therapies.