Academic literature on the topic 'Persistent allergic rhinitis'

61 people suffering from persistent allergic rhinitis and asthma accompanying food allergies were studied using case histories, the NHANES questionnaire, polyspecific serum levels, allergen-specific IgE, IL4, IFNg and IL10 assays, and allergy skin tests. Four different endotypes have been identified, including entopic, which can be the basis for new approaches to the diagnosis and treatment of allergic rhinitis and asthma.

Introduction. Diseases associated with immunoglobulin E hypersensitivity, such as allergic rhinitis, may have different clinical expressions. Patients with allergic rhinitis often have associated diseases, comorbidities, which supports the concept of allergy as a systemic disease. The aim of this study was to evaluate the incidence and types of comorbidities in allergic rhinitis. We also evaluated the possible effects of certain clinical and demographic parameters on the onset of comorbidities. Material and Methods. This retrospective, observational, and cross-sectional study included patients with a clinical diagnosis of allergic rhinitis treated at the Department of Ear, Nose and Throat in the period from October 2011 to April 2013. The collected data were analyzed using the Statistical Analysis System (Institute Inc. NC, USA) program, version 9.1.3. Results. The study included 319 patients with allergic rhinitis. Allergic rhinitis was intermittent in 30.7% of cases, persistent in 37.9%, and persistent with seasonal exacerbation in 31.3% of patients. We found that 86.8% of patients had some form of comorbidity. The most common were conjunctivitis (50.2%), almost equal percentage of asthma (29.8%) and chronic rhinosinusitis (28.8%), followed by otitis media with effusion (8.8%), atopic dermatitis (5.2%), urticaria (4.1%), and laryngitis (3.8%). Persistent allergic rhinitis, with persistent nasal obstruction as the dominant symptom, was significantly associated with chronic rhinosinusitis. Positive family history was significantly associated with the occurrence of asthma and allergic rhinitis. Conclusion. The results of our study showed that allergic rhinitis is rarely an isolated condition and it should always be observed in the context of the allergic respiratory syndrome.

Mites can sensitize and induce atopic disease in predisposed individuals and are an important deteriorating factor in patients with allergic rhinitis, asthma, and atopic dermatitis. Although Pyroglyphidae mites have been extensively studied, very scarce reports are available on Cheyletidae spp. especially regarding human respiratory pathology. The main objective of the present study is to investigate the clinical role of this predator mite (Cheyletus eruditus) as a respiratory antigen in a selected sensitized human population. Fifty-two adult patients were recruited from the outpatient allergy clinic to assess their eligibility for the study. The thirty-seven subjects with persistent allergic rhinitis (PAR) who fulfilled the ARIA criteria had a positive IgE response confirmed by skin prick test (SPT) toC. eruditus. Only those individuals (37/47) with a positive SPT toC. eruditusshowed a positive nasal provocation test (NPT), while 10 patients with nonallergic mild-to-moderate persistent rhinitis,control group, had a negative NPT withC. eruditus. The present paper describes a new role for the predator miteCheyletus eruditusas a respiratory allergen in a selected subset of patients in a subtropical environment afflicted with persistent nonoccupational allergic rhinitis.

AbstractBackgroundEosinophils are the principal effector cells involved in the pathogenesis of allergic rhinitis. Cell numbers increase in non-allergic rhinitis patients with eosinophilia, aspirin hypersensitivity and nasal polyposis, as well as in allergic rhinitis patients. Exfoliative nasal cytology can be used in the differential diagnosis of allergic rhinitis.ObjectiveTo evaluate nasal eosinophilia in nasal smears of patients with mild, persistent and intermittent allergic rhinitis.MethodsThe study comprised 60 patients with allergic rhinitis and 20 healthy volunteers. The patients were divided into intermittent and persistent allergic rhinitis groups. Nasal smear status, eosinophil numbers and Total Nasal Symptom Scores were compared.ResultsNasal smear results were pathological in 40 of 60 allergic rhinitis patients, which was significantly higher than the rate in controls. The mean nasal eosinophilia score was significantly higher in the intermittent allergic rhinitis than in the persistent allergic rhinitis group (p= 0.029). There was a positive correlation between nasal eosinophilia score and Total Nasal Symptom Score (r = 0.652;p< 0.05) in persistent allergic rhinitis and intermittent allergic rhinitis patients.ConclusionThe nasal smear test is inexpensive, objective and simple to perform, and should be part of the diagnostic investigation.

Aim. To assess the parameters of local immune response in patients with different forms of allergic rhinitis, associated with nasal bacterial infection. Methods. Nasal swabs and nasal epithelium samples obtained from 10 patients with seasonal allergic rhinitis aged 12 to 32 years and from 15 patients with persistent allergic rhinitis aged 18 to 45 years, as well as form the 20 healthy subjects aged 18 to 45 years without signs of allergy who were age and gender-comparable, were examined. Swabs were prepared from cell suspension, stained with 0.04% trypan blue solution, and a microscopy with the count of non-stained cells was performed. Epitheliocytes expressing toll-like receptors-2, were determined by flow cytometry. Interleukin-10 concentration in swabs was assessed by ELISA. Results. The number of epitheliocytes expressing toll-like receptors-2 was by 1.9 times lower in patients with seasonal allergic rhinitis and by 1.7 times lower in patients with persistent allergic rhinitis compared to control group. There was a reverse correlation found between the number of epitheliocytes expressing toll-like receptors-2 and interleukin-10 level in nasal swabs of healthy controls, while in patients with allergic rhinitis a it was a direct correlation. In patients with persistent allergic rhinitis S. aureus was a part of microbiota in 100% of cases and was associated with other bacteria (Str. pyogenes - 33.3%, Neisseria spp. - 66.7%). In patients with seasonal allergic rhinitis the association of S. aureus and S. hemolyticus (70.0%) was the most frequent one. In the control group, S. epidermidis (50.0%), Str. viridians (25.0%), S. hominis (25.0%) were among the nasal microbiota. There were no differences revealed between the mean levels of interleukin-10 in patients with allergic rhinitis and healthy controls. Conclusion. The number of epitheliocytes expressing toll-like receptors-2 was significantly reduced by almost 2 times in patients with persistent allergic rhinitis compared to control group. Colonization of nasal mucosa by S. aureus in patients with allergic rhinitis leads to an increase of epithelial cells expressing toll-like receptors-2.

AbstractObjectives:To observe the five-year efficacy of standardised specific subcutaneous immunotherapy for house dust mite allergy in monosensitised and polysensitised children with persistent allergic rhinitis.Methods:From January 2007 to August 2009, 236 children with persistent allergic rhinitis were divided into 2 groups: 1 group received standardised specific subcutaneous immunotherapy using house dust mite extract; the other received pharmacotherapy with intranasal corticosteroids and oral antihistamines. A total of 193 patients (106 in the immunotherapy group and 87 in the pharmacotherapy group) completed treatment. Scores for symptoms, total medication and quality of life were evaluated.Results:The subcutaneous immunotherapy group demonstrated a significant reduction in visual analogue scale scores, Rhinoconjunctivitis Quality of Life Questionnaire scores and total medication scores (p < 0.05) compared with the pharmacotherapy group. No significant differences in the visual analogue scale and Rhinoconjunctivitis Quality of Life Questionnaire scores were found between the polysensitised and monosensitised subgroups (p > 0.05). No serious adverse events occurred.Conclusion:Standardised subcutaneous immunotherapy has long-term efficacy for children with persistent allergic rhinitis. Single-allergen subcutaneous immunotherapy was appropriate for allergic rhinitis caused by multiple allergens, including house dust mites, in the paediatric population.

The purpose of this study. To investigate clinical characteristics of the allergic rhinitis in children receiving allergen-specific immunotherapy. Methods. The epidemiologic observational multicenter study was conducted with the allergists of Altai region. The participating allergists filled out the specially designed medical record card on children with allergic rhinitis receiving ASIT. The study lasted from October 2013 to March 2014. Results. Allergists have filled out medical record cards of 165 children with allergic rhinitis receiving ASIT. The average age of children was 10,5±2,3 years, with the average of 4,8±2,5 years of allergic rhinitis prior to the start of ASIT. 159 (96,2%) children had moderate/severe allergic rhinitis, and 121 (73,3%) children had persistent allergic rhinitis. In 123 (74,5%) children rhinitis was accompanied by allergic conjunctivitis, and in 70 (42,2%) children - by bronchial asthma. 69 (41,8%) children receiving ASIT were mono-sensitized, 96 (58,2%) children were polysensitized. 48,5% of children were sensitized to house dust mites, 63,6% to tree pollen, 48,5% to meadow grass pollen, 30,9% to weed pollen, and in 21,8% sensitization to epidermal allergens was found. Conclusion. The findings of the study showed that in most cases (96,2%), children with allergic rhinitis receiving ASIT had moderate/severe rhinitis and in 73,3% symptoms were persistent. In 74,5% of cases, allergic rhinitis was accompanied by allergic conjunctivitis. Most part of children receiving ASIT had multiple sensitization (58,2%). Also a delayed beginning of ASIT was observed - 4,8±2,5 year from primary diagnosis to ASIT initiation.

The dynamics of parameters of cytokine status in patients with allergic rhinitis in view of efficiency of allergen-specific immunotherapy (ASIT) was studied in this work. 62 subjects with moderate persistent rhinitis at the age of 18-40 years old were included in the study. For specific diagnosis and treatment there we used standard allergens. ASIT was performed by the classical scheme. The concentrations of IL-4, IL-5, IL-6, IL-8 in the blood serum were measured by the enzyme immunoassay. A good or excellent effect of treatment with ASIT was achieved in 62.9% of cases, and satisfactory one in 37.1% of cases. The analysis of the dynamics of IL-4, IL-5, IL-6, IL-8 concentrations showed that the efficiency of ASIT in patients with allergic rhinitis depends on the ability of the immune system to activation by low doses of the allergen, quite fast suppression of proinflammatory cytokines induced by them, and active functioning of the system of anti-inflammatory cytokines.

Background: Persistent allergic rhinitis (PAR) is a common disorder affecting substantial number of people worldwide. In Australia, allergic rhinitis affects 16% of the population. Increasingly, patients are seeking alternative therapies especially acupuncture for allergic diseases. Objective: This study aimed to evaluate the effectiveness and safety of acupuncture in the treatment of persistent allergic rhinitis. Methods: Eighty (80) subjects aged between 16 and 70 were randomly assigned to either real or sham acupuncture groups. Each patient received either real or sham acupuncture treatments twice per week for the period of eight weeks. Daily symptom scores by subjects using five-point scale was employed as the primary outcome measure to assess the severity of nasal symptoms every day. The secondary outcome measures were rhinoconjunctivitis quality of life questionnaire (RQLQ) and relief medication scores. Relief medication scores were recorded every day by subjects whereas RQLQ assessment was monitored fortnightly throughout the trial and at the end of three-month follow-up period. Results: Compared to the control group, the real acupuncture group demonstrated more improvement of nasal symptoms after eight-week treatment and significant after the follow-up periods. Significant differences between the two groups were also shown in terms of RQLQ. While there were not significantly Relief medication scores were more reduced in real acupuncture group than those in control group, although the differences were not significant. Both real and sham acupuncture treatments were well tolerated. Conclusion: The findings of this study suggest that acupuncture is potentially an effective and safe option of treatment for persistent allergic rhinitis and it may improve patients' quality of life.

Orientador: Ricardo de Lima Zollner
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: As vias aéreas superiores e inferiores constituem um sistema integrado, cuja interação é evidente na presença das doenças alérgicas, incluindo a rinite alérgica, que é co-morbidade relevante para o desenvolvimento da asma. Mecanismos já consolidados estão envolvidos, contudo o reflexo naso-brônquico, que consiste em um reflexo neural originado nas vias aéreas superiores causando impacto nas vias aéreas inferiores por meio da inflamação neurogênica foi sugerido em estudos experimentais. Evidências da presença deste reflexo em humanos baseiam-se em diferentes métodos que demonstraram prejuízo na função pulmonar após estimulação nasal, porém o monitoramento objetivo da permeabilidade nasal pela rinometria acústica associado ao estudo da função pulmonar por meio da espirometria, possibilita acessar respostas agudas nas vias aéreas após estimulação nasal, representando uma ferramenta promissora na investigação do reflexo naso-brônquico. Portanto, o objetivo deste estudo foi avaliar alterações na função pulmonar após provocação nasal, visando identificar o reflexo naso-brônquico na rinite alérgica isolada. 33 voluntários com rinite alérgica persistente moderada/grave (grupo experimento) e 10 saudáveis (grupo controle) foram submetidos a avaliação inicial e protocolo de investigação composto por espirometria e rinometria acústica basais, seguidas por teste de provocação nasal com concentrações crescentes de histamina; após aplicação de cada concentração a rinometria acústica era novamente realizada passados 1, 4, 8 e 12 minutos, sendo considerada provocação positiva após 20% de obstrução em AST-2, determinando o PN20; por fim, imediatamente nova espirometria era realizada. Ao comparar os dados de função pulmonar antes e após provocação nasal, foi observada diferença significativa no grupo rinite para VEF1 (p=0,002), CVF (p=0,005) e PFE (p=0,005), entretanto não houve variação significativa para nenhum dos parâmetros analisados no grupo controle. O reflexo naso-brônquico foi identificado a partir da variação do VEF1, após a provocação nasal no grupo controle (média acrescida de dois desvios padrões), logo 18,2% dos indivíduos com rinite apresentaram reflexo naso-brônquico (queda > 3% em VEF1). Além disso, para estes verificamos correlação positiva entre as alterações observadas em VEF1 e FEF25-75% (p=0,002 / r=0,97), sugerindo envolvimento das vias aéreas de pequeno calibre. Considerando as vias aéreas superiores, o protocolo proposto demonstrou respostas similares nos dois grupos, sem diferença significativa entre os mesmos para dose de histamina (p=0,98), tempo para atingir PN20 (p=0,97) e porcentagem de obstrução nasal (p=0,97). As alterações observadas na função pulmonar após provocação nasal sugerem a presença do reflexo naso-brônquico no paciente com rinite alérgica persistente moderada/grave. O protocolo proposto apresentou reprodutibilidade, sem intercorrências e, diante dos resultados obtidos, propomos que deva ser pensado na prática clinica com objetivo de aperfeiçoar o diagnóstico da presença do reflexo naso-brônquico, relevante para os pacientes com hiperreatividade brônquica
Abstract: Upper and lower airways consists an integrated system and their interaction becomes evident in allergic diseases, highlighting allergic rhinitis, which is co morbidity to asthma onset. Consolidated paths are involved in this crosstalk, however the nasobronchial reflex, that represents a neural reflex originated in upper airways that causes lower airways impairments was suggested in experimental studies. Evidences for the presence of this reflex in humans are based in different methods that have demonstrated impaired pulmonary function after nasal challenge, although, utilizing objective monitoring of nasal patency by acoustic rhinometry in association with pulmonary function evaluation provided by spirometry, it is possible to access acute airways responses after nasal provocations, representing to be promising tools in nasobronchial reflex investigation. Thus, the aim of this study was to evaluate changes in pulmonary function after nasal provocation, looking for nasobronchial reflex identification in subjects with isolated allergic rhinitis. 33 subjects with persistent moderate/severe allergic rhinitis and 10 healthy subjects underwent screening evaluation and investigation protocol consisting in baseline spirometric and acoustic rhinometry measurements, followed by histamine nasal provocation in increasing concentrations; after each histamine application, comparative acoustic rhinometry measurements were performed passed 1, 4, 8 and 12 minutes and positive provocation was considered after reached 20% of obstruction in MCA-2, determining the NPT20; finally, another spirometry was performed immediately NPT20 was reached. Comparing the pulmonary function before and after provocation in the rhinitis group, it was observed significant difference for FEV1 (p=0,002), FVC (p=0,005) and PEF (p=0,005), however in the same comparison for the control group no significant difference could be found for any of the analyzed parameters. Nasobronchial reflex was identified based on VEF1 percentage of variation after nasal provocation in control group (mean plus two standard deviations), 18,2% of rhinitis group presented nasobronchial reflex (> 3% fall in FEV1). Furthermore, for these ones we could verify positive correlation between VEF1 and FEF25-75% impairments (p=0,002/r=0,97), suggesting distal lower airways involvement. Considering upper airways, the proposed protocol demonstrated similar reactions in the two groups, with no significant differences between them for histamine dose (p=0,98), time to reach NPT20 (p=0,97) and percentage of nasal obstruction (p=0,97). Concluding, spirometric impairments showed here suggest the presence of nasobronchial reflex in patients with persistent moderate/severe allergic rhinitis. The proposed protocol proved to be reproducible, without intercurrences and, regarding results showed here, we propose that it should be thought in clinical practice, in order to improve the diagnosis of the presence of nasobronchial reflex, relevant to patients with bronchial hyperreactivity
Mestrado
Clinica Medica
Mestre em Clinica Medica

Nonallergic rhinitis is a heterogeneous disease consisting of wide variety of entities that present with persistent nasal symptoms. “United airways” has become a slogan verging on dogma. The concept gained momentum with the realization that the unifying atopic pathophysiology of the nose and tracheobronchial tree lead to coexistent allergic rhinitis and allergic asthma, respectively. Including nonallergic mechanisms and the differential diagnosis of comorbid rhinitides with reversible and irreversible lower airway obstructive entities is more problematic. Although the nose and foregut-derived tracheobronchial tree have distinct embryonic origins, they share exposure to air, pseudostratified epithelium with extensive submucosal glands, common elements of the innate and acquired mucosal immune systems, and extensive nociceptive and autonomic nervous system sensors and controls. Mechanisms affecting both anatomic sites are likely to develop comorbid disease. Anatomic differences contribute to discrete pathologic conditions, as allowed by the bony box of the nasal cavity versus the cartilaginous walls and elastic alveolar interstitial tethers for bronchi and bronchioles. The diverse pathologic states of the nasal mucosa and their relationships with bronchial hyperresponsiveness are the focus of the remainder of this discussion.