Background and Objective: Allergicrhinitis can be stimulated by several allergens. Molds are among these allergens and it is important to assess their frequencyin different geographic area. Hence, we aimed at determining the frequencyofmoldallergensinallergicrhinitispatients referred to specialized clinics of Tabriz Imam Reza hospital, 2011.
Allergicrhinitis (AR) is a prevalent disease worldwide, affecting 10% to 25% of the world population. AR’s prevalence has increased during the past few decades. Rhinitis is defined as an inflammation of the nasal mucosa and is characterized by one or more of the following symptoms: congestion, rhinorrhea, itching of the nose, postnasal drip, and sneezing. Atopy is known to increase the risk of developing allergic disorders such as AR; this is the tendency to produce the IgE antibody in response to low doses of aeroallergens. The aim of this study was to evaluate atopy through different methods in an elderly population in Covilhã. The population of this study consisted in two groups of individuals of Beira Interior: one of young adults (born between January 1976 and December 1993) and another of elderly (born before 1944). A standardised questionnaire was carried out in all volunteers. In addition, they were evaluated by three commonly used approaches: Skin Prick Tests (SPT), total serum IgE and Phadiatop. The study sample included 403 volunteers. Although all patients answered the questionnaire, only 381 patients were evaluated for SPT reaction to 5 common regional aeroallergens and only 356 accepted to collect blood for total IgE and Phadiatop determination. Data analysis was based on Phadiatop results. Among the 356 random subjects involved, 239 were elderly (mean age = 73; 141 females) and 117 were young adults (mean age= 28; 70 females). Of these, 96 volunteers (38 elderly and 58 young adults) had positive Phadiatop and 48 (21 elderly and 27 young adults) had positive SPT. Furthermore, significant differences were found on both groups, concerning to academic degree, social class and residence. This study suggests that elderly subjects are less atopic than younger subjects in the population under study. In both groups atopy prevalence according to Phadiatop, was higher in men; a significant correlation was found between Phadiatop positivity and positive SPT. In what concerns total IgE, no significant relation exists between was found on its concentration values and volunteers’ age. AR was defined with positive Phadiatop and presence of disease symptoms. 69 volunteers had AR (42 young adults and 27 elderly). Of those, elderly are more sensitized to outdoor allergens than young adults and less sensitized to indoor allergens, but not significantly. Overall, the population that has positive TCA for outdoor allergens feels like pollen season increases their symptoms. With this study was possible to conclude that AR has a higher prevalence on young adults and affects more men in both groups.
The results obtained for the 46 asthm atic children studied show ed that they invariably had perennial allergicrhinitis. This association suggests an im portant role ofallergicrhinitis both in the triggering and evolution of bronchial asthm a. N asal obstruction is of itself an im portant contributing factor by inducing buccal respiration and thus preventing the patients from utilizing the filtration and air conditioning system s of the nose(21). A t the sam e tim e, chronic inflam m ation of the nasopharyngeal m ucosa leads to anatom ical and functional changes, thus low ering both the specific and nonspecific defense ability and leading to a higher susceptibility to infection. This statem ent is suppprted by high frequencyof hypertrophied tonsils and of cervical adenopathy detected in these patients. It should be pointed out here that the the present data agrees w ith those obtained by Tuft and M uller(21), w ho reported that one third of the asthm atic children studied by them had allergicrhinitis before the onset of asthm . Thus, the role ofallergicrhinitis m ay be to facilitate viral infection of the respiratory tract through the nasal route. A m ong the possibly deteriorated specific defense m echanism s m ay be the local production of secretory IgA at the nasal m ucosa level, an antibody responsible for, am ong other functions, the fight against viral infections. Low secretory IgA levels have been detected inpatients w ith allergicrhinitis,
As for the limitations of our study, the identification of SI and depression was not confirmed by means of a precise instrument. We used the BDI-II, which has been validated in multiple occasions; however, this tool only determines the presence of SI within the last two weeks, and this may reflect the presence of triggering psychological factors other than the influence of allergy on SI. With the purpose of not overestimating the frequencyof SI, we excluded adolescents and elderly adults from our study, since the reported proportion of SI in these age groups is higher. Therefore, our results must be interpreted with caution regarding age. Similarly, we highlight the fact that the results of this study reflect the behavior of highly selected subjects who were also recruited from a hospital that serves the general population in an area where most patients have a low socioeconomic level. Another limitation was the gender disproportion of the allergicrhinitis and allergic asthma groups when compared with the control group. Other types of variables, such as unemployment, smoking, alcohol consumption, recent loss of loved ones, and sleep disorders, were not considered in the data analysis. Nevertheless, among the strengths of the present study, we must highlight that the diagnosis ofallergic asthma was not made based on questionnaires or on the review of medical records; it has been established by clinical history, physical examination, and pulmonary function tests compatible with reversible airway obstruction, whereas atopy was defined by a positive result in a skin prick test against regional aeroallergens.
Lolium multiflorum (Lm) grass pollen is the major cause of pollinosis in Southern Brazil. The objectives of this study were to investigate immunodominant components of Lm pollen allergens and the cross-reactivity of IgE with commercial grass pollen allergen extracts. Thirty-eight serum samples from patients with seasonal allergicrhinitis (SAR), 35 serum samples from patients with perennial allergicrhinitis (PAR) and 30 serum samples from non-atopic subjects were analyzed. Allergen sensitization was evaluated using skin prick test and serum IgE levels against Lm pollen extract were determined by ELISA. Inhibition ELISA and immunoblot were used to evaluate the cross-reactivity of IgE between allergens from Lm and commercial grass pollen extracts, including L. perenne (Lp), grass mix I (GI) and II (GII) extracts. IgE antibodies against Lm were detected in 100% of SAR patients and 8.6% of PAR patients. Inhibition ELISA demonstrated IgE cross-reactivity between homologous (Lm) and heterologous (Lp or GII) grass pollen extracts, but not for the GI extract. Fifteen IgE-binding Lm components were detected and immunoblot bands of 26, 28-30, and 32-35 kDa showed >90% recognition. Lm, Lp and GII extracts significantly inhibited IgE binding to the most immunodominant Lm components, particularly the 55 kDa band. The 26 kDa and 90-114 kDa bands presented the lowest amount of heterologous inhibition. We demonstrated that Lm extract contains both Lm-specific and cross-reactive IgE-binding components and therefore it is suitable for measuring quantitative IgE levels for diagnostic and therapeutic purposes inpatients with pollinosis sensitized to Lm grass pollen rather than other phylogenetically related grass pollen extracts.
Unlike allergicrhinitis (AR), there are no speciﬁc diagnostic tests for non-allergicrhinitis (NAR). Diagnosis is primarily based on rhinitis symptoms, which include nasal congestion, rhinorrhea, sneezing, itching, and impaired sense of smell, for greater than one hour most days in the absence of identiﬁable allergy by allergy testing. 1 AR is an immunoglobulin E (IgE)-mediated non- infectious disease of the nasal mucosa following contact with allergens. Previous studies have demonstrated that imbalance of T helper 1 / T helper 2 (Th1/Th2) cell-mediated immunity plays an important role in the pathogenesis of AR, which is character- ized by the Th2 cell mediated inﬂammation. 2 Although chronic inﬂammation has proven to be an integral component of AR, there is great debate regarding this facet in NAR, since some studies have suggested that exclusion of inﬂammation is indica- tive in vasomotor rhinitis. Other studies have demonstrated that all patients with non-allergicrhinitis with eosinophilia syn- drome (NARES) have high degree of chronic eosinophilic inﬂam- mation. 3,4 NARES, which accounts for 14% ofrhinitispatients, is deﬁned by a syndrome of nasal hyper-reactivity for more than three months, the absence of atopic factor, and a profound nasal eosinophilia with more than 20% eosinophils in the total granu- locytic or mononuclear cell population. 4
This cross-sectional study was performed on 100 consecutive patients who referred to the ENT ambulatory unit of Mashhad University of Medical Sciences (MUMS, Mashhad, Iran) during the year 2012. The patients were diagnosed with CRS by the senior author according to the clinical, endoscopic, and radiologic diagnostic criteria of Rhinosinusitis Symptom Inventory (RSI). For ethical purposes, candidates were informed of the study and gave their consent before undergoing physical examination and skin prick tests. Their identities were kept confidential and the procedure was free of charge. The patient was excluded from the study if CRS could not be confirmed or the questionnaire was incomplete. Nasal polyps were detected by nasal endoscopy and classified into grades 1,2, and 3. Polyps restricted to the middle meatus were scored as grade 1 or mild, Polyps extending beyond the middle turbinate were scored as grade 2 or moderate, Polyps that filled the nasal cavity or extended to or beyond the inferior turbinate were scored as grade 3 or severe (5).The following were measures of outcome: The distribution of age and sex, frequencyof signs, and major and minor symptoms, the prevalence of allergies and common allergens, the prevalence of asthma and smoking habit.
The disorder of nasa have been described widely by all the Acharyas. Acharya Susrutha has described 31 nasagatha rogas 1 . Among them pratishyaya is one of the most important disease. He has described the disease very elaborately including its complications as diseases of eyes, nose and ear. On the basis of signs and symptoms, the disease pratishyaya can be compared to allergicrhinitisin modern medicine characterized by sudden and frequent attacks of sneezing, profuse watery nasal discharge associated with nasal obstruction which is intermittent watering of eyes, heaviness of head, respiratory distress and anosmia 2 . Allergic reaction is produced when the body comes in contact with allergens little dust, dander, pollens then certain chemicals are produced in the body called histamines which releases into the blood stream and produces symptoms like excess mucus production, swelling of affected tissues, itching, sneezing, rashes etc., The treatment modalities adopted are, administration of antihistamines, nasal decongestants, steroids, electro- cautry, sub mucosal diathermy and turbinectomy 3 . With all these sophisticated methods and technique the patients are not satisfied as they don’t have complete relief and chances of reoccurrence are more. Hence these hindrances of western medicine have stressed upon to find out an effective simple treatment which can overcome the symptoms ofallergicrhinitis and prevent its further reoccurrence by enhancing the body immunity, so from the repeated advocacy by acharya Sushruta, acharya charaka 4 and other ancient acharyas of Indian Medicine, it has been decided to try Shadbindu gritha nasya and Haridra khanda both locally and systemically in the management of Pratishyaaya- AllergicRhinitis. Hence
The nasal mucosa and the paranasal sinus mucosa are one and the same since there are no barriers between these two compartments. Considering the concept ofallergic airway disease, it would be expected that a large percentage ofpatients with allergicrhinitis would present inflammation of the paranasal sinuses. The primary objective of the present study was to use computed tomography to determine the frequencyof radiological abnormalities compatible with paranasal sinus inflammation inpatients with allergicrhinitis. The secondary objectives were to look for correlations between abnormalities on computed tomography scans of the paranasal sinuses and the severity ofrhinitis symptoms and to use anterior rhinoscopy to evaluate the abnormalities described and the severity of cutaneous reactions to allergens.
Allergicrhinitis (AR), commonly referred to as hayfever, is a chronic upper respiratory condition resulting from inflammation of the nasal mucosa. The common symptoms of AR include sneezing, rhinorrhoea and nasal congestion, induced by an immunological response following exposure to allergens such as pollen, house dust mites, moulds and animal dander in sensitised individuals . While AR is often portrayed as a nuisance or trivial condition, the reality is that uncontrolled AR is a disabling and intrusive disease: disabling in terms of its chronicity, and intrusive in terms of its symptom burden and impact on patients’ lives and the lives of their families. Poorly controlled AR can have a substantial negative impact on a patient’s quality of life, including impairments in concentration, work productivity, social interactions and sleep. It is a significant cause of morbidity and imposes a high socioeconomic burden due to the direct treatment costs and the indirect costs due to absenteeism from the workplace and reduced productivity at work [2–4]. The impact of poorly controlled AR can also extend into co-existing asthma, where it can worsen asthma symptom control and increase the risk of exacerbations or flare-ups .
In recent years, evidence has emerged showing that increasing number ofpatients previously diagnosed with nonallergic or idiopathic rhinitis developed a local allergic response with nasal-specific IgE (sIgE) production and positive nasal allergen provocation test . These findings suggest the presence of local allergicrhinitis (entopy) which could not be revealed by the classic skin tests. Local IgE production was also shown in bronchial mucosa ofpatients with atopic and non-atopic asthma . Critisizm against the presence of local allergic reactions was supported by the detecting IgE and undetectable allergens; how- ever, the data about local allergic reaction limited to nasal mucosa are increasing.
The skin test is also very important in differential diagnosis of nasal disease and in determining the pattern of sensitization of the population. It is an important foundation for appropriate treatment ofallergicrhinitis, particularly with regard to speciﬁc immunotherapy and also in promoting measures to reduce patient exposure to the allergen identiﬁed. For this test, patients are examined and treatment objectives are explained to the patient. The medial surface of the volar forearm is assessed to exclude dermal lesions and is wiped with 70% alcohol. A single drop of allergen extract is placed using the dropper, at a distance of 2 cm, in a predetermined allergens sequence. A plastic device is used that limits the degree of penetration into the skin (PUNTOR, Alko do Brasil, Rio De Janeiro, Brazil) for each allergen. After 3 minutes, the excess extract is removed with a paper towel, avoiding contaminating neighboring tests. Reading takes place 15 to 20 minutes after the puncture. The presence of papules with diameters 3 mm indicates a positive reaction, and results are graduated subjectively as light, moderate, or severe. The interruption in the use of the antihistamines is necessary for at least 7 days before a cutaneous test and the RAST. 21
A llergic rhinitis is an inflammatory reaction of the nasal mucosa, in consequence of an IgE mediated hypersensitive reaction to inhaling allergens, involving different mediators and cytokine cells. Aim: The purpose of this study was to evaluate the transcriptions for IL-4, IL-5, IL-8 and IFN- gama, particularly important in the nasal allergy process, especially IL-4 and IL-5. For this study we decided to evaluate atopic patients who were free from allergic crises, with the purpose of knowing the cytokine expressions during this period. Materials and Methods: Another prospective and transversal study was carried out, selecting 30 patients, 13 of these patients were pauci-symptomatic and 17 were non atopic. The groups were selected by means of a medical interview, an otolaryngologic clinical exam and allergy skin tests - Prick Test. The cytokines were investigated in fragments of the nasal mucosa, using RT-PCR - chosen because it has good reproducibility and specificity. Results: IL-5, IL-8, IFN- gama cytokine values were kept homogeneous in relation to the control group. Only IL-4 presented significant statistic differences. Conclusion: Asymptomatic patients with allergicrhinitis presented with normalization of cytokine expression in the nasal mucosa, with exception of IL-4.
Method: A retrospective cohort study evaluating medical records of 85 children diagnosed with asthma, aged less than 9 years, of both sexes, with at least one year of follow-up in the allergy outpatient clinic. The data on the disease, weights and heights were collected through a standardized questionnaire on two occasions, with an interval of one year. The curves proposed by Tanner were applied for the analysis of the GR, and the Z-score of the GR (ZGR) was calculated.
Patients were included in the statistical analysis on the basis of completeness of clinical data and completion of .90% in the PRO questionnaires. Data are presented in percentage for demographic characteristics and clinical data, as mean 6 standard deviation for continuous variables investigated. Exploratory analysis of demo- graphic and clinical data was performed using the following procedures. Pairwise associations between categorical variables were assessed through the chi-squared test for heterogeneity. Student’s t-test was used to detect significant differences in the means of quantitative variables for independent samples. Spear- man’s rho was used to assess the relationships between variables or rank scores. Discriminant power of the POMS total score on optimal HRQoL was assessed through receiver operating characteristic (ROC) analysis. To estimate the association of each IPQ-R factor with RHINASTHMA GS scores, a linear regression model was applied (statistical significance: a = 0.05).
This study was performed in the departments of otorhinolar- yngology and microbiology and immunology of the Faculty of Medicine, Zagazig, Egypt, between May and August of 2015. Ten non-allergic healthy volunteers (ages 18–42 years, 4 females and 6 males), and 45 patients (ages 18–36 years, 25 females and 20 males) with AR date palm pollen were equally divided into three groups. Group I (GI) - patients did not receive immunotherapy, Group II (GII) - patients had initiated IT 6 months before starting the study, and Group III (GIII) - patients had initiated IT 2 years before starting the study. The ethical committee of the hospital approved the study and written informed consent was obtained from each individual. A detailed clinical history and a complete physical examination were performed for each patient. Each subject in the non- allergic group was selected according to the following criteria: no history ofallergic disease or nasal diseases, no pregnancy or lactation, and negative skin prick test. Each subject in the allergic group was selected randomly from AR patients attend- ing the allergy outpatient clinic based on the following criteria: history of persistent rhinitis for at least 2 years, positive skin prick test to Phoenix dactylifera pollen only (5-mm wheal) and no evidence of treatment with IT during the previous 10 years. Exclusion criteria included (1) acute or chronic infectious or inﬂammatory diseases (asthma, atopic dermatitis), (2) anato- mical abnormalities of upper respiratory tract, (3) those undergoing chronic treatment with systemic steroids or with systemic immunological disorders.
Dr. Ansotegui reports personal fees from Mundipharma, Roxall, Sanofi, MSD, Faes Farma, Hikma, UCB, Astra Zeneca, outside the submitted work. Dr. Bosnic‑ Anticevich reports grants from TEVA, personal fees from TEVA, Boehringer Ingelheim, AstraZeneca, Sanofi, Mylan, outside the submitted work. Dr Bousquet reports personal fees and others from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi‑Aventis, Takeda, Teva, Uriach, others from Kyomed, outside the submitted work. Dr. Boulet reports and Disclosure of potential conflicts of interest—last 3 years research grants for participa‑ tion to multicentre studies, AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi, Takeda.Support for research projects introduced by the investigator AstraZeneca, Boehringer‑Ingelheim, GlaxoSmithKline, Merck, Takeda. Consulting and advisory boards Astra Zeneca, Novartis, Methapharm. Royalties Co‑author of “Up‑To‑Date” (occupational asthma). Nonprofit grants for production of educational materials Astra‑ Zeneca, Boehringer‑Ingelheim, GlaxoSmithKline, Merck Frosst, Novartis. Conference fees AstraZeneca, GlaxoSmithKline, Merck, Novartis. Support for participation in conferences and meetings Novartis, Takeda. Other participa‑ tions Past president and Member of the Canadian Thoracic Society Respiratory Guidelines Committee; Chair of the Board of Directors of the Global Initiative for Asthma (GINA). Chair of Global Initiative for Asthma (GINA) Guidelines Dis‑ semination and Implementation Committee; Laval University Chair on Knowl‑ edge Transfer, Prevention and Education in Respiratory and Cardiovascular Health; Member of scientific committees for the American College of Chest Physicians, American Thoracic Society, European Respiratory Society and the World Allergy Organization;1st Vice‑President of the Global Asthma Organiza‑ tion “InterAsma”. Dr. Casale reports grants and non‑financial support from Stall‑ ergenes, outside the submitted work. Dr. Cruz reports grants and personal fees from GlaxoSmithKline, personal fees from Boehrinher Ingelheim, AstraZeneca, Novartis, Merk, Sharp & Dohme, MEDA Pharma, EUROFARMA, Sanofi Aventis, outside the submitted work. Dr. Ebisawa reports personal fees from DBV Technologies, Mylan EPD maruho, Shionogi & CO., Ltd., Kyorin Pharmaceuti‑ cal Co., Ltd., Thermofisher Diagnostics, Pfizer, Beyer, Nippon Chemifar, Takeda Pharmaceutical Co., Ltd., MSD, outside the submitted work. Dr. Ivancevich reports personal fees from Euro Farma Argentina, Faes Farma, non‑financial support from Laboratorios Casasco, outside the submitted work. Dr. Haahtela reports personal fees from Mundipharma, Novartis, and Orion Pharma, outside
are the objects of another paper still to be published. The assessment of joints among the groups and ages showed no statistically significant differences. We found no published papers that correlated altered speech with altered breathing. However, some studies have found dys- functional articulations inpatients with occlusion disorders due to mouth breathing, 31,32 showing that in most cases,
A new step forward on the HLA association with respiratory allergic disease demands for a much more careful approach in future studies. Besides the above considerations, HLA studies need to be done with DNA high resolution techniques and always assure four digits typing. However, high resolution data should be also analysed in the context of their serologic meaning, especially grouping antigens accordingly to their ability to interact with specific allergens. The need to enlarge the picture of possible mechanisms and pathways involved in the aetiology of the respiratory allergic disease requires the study of new DNA markers along the MHC region with particular emphasis on segments revealing linkage with the already identified genetic markers. Requiring additional efforts on research, given its enormous potential on the enlightenment of the respiratory allergic disease aetiology, is the HLA soluble forms, in particular sHLA-G.
The cognitive test assured that the questionnaire was adequately understood by both children and caregivers and allowed to improve words and expressions that were not sufficiently clear. This was a fundamental step in the development of this questionnaire, providing in-depth data, that was a major contribute to build a clear and ap- pealing questionnaire. Moreover, it allowed the assess- ment of its feasibility in the target age groups. The comments of the caregivers supported the idea that CARAT is an useful and adequate questionnaire to as- sess asthma and rhinitis control. This process may seem limited by the small number of participating children, especially in the group with 4 to 5 years old. However, as a qualitative methodology, cognitive interviews should be stopped when no more new information is being ob- tained. For children with 4 to 5 years old with a few in- terviews was clear that the type of questionnaire we were developing could not be applied. Therefore we stop to interview children from that age group.