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Co-Existence of Asthma and Allergic Rhinitis: A 23-Year Follow-Up Study of College Students
Abstract
The purpose of this study is to examine the co-existence of asthma and allergic rhinitis among former college students who were diagnosed with these diseases either before or after their freshman year. A total of 738 former Brown University students (69% males and 31% females) who were evaluated and underwent skin testing during their freshman year completed a 23-year follow-up questionnaire inquiring of their history of allergies and asthma. The mean age of the participants at the time of the follow-up study was 40 years. In this group, the cumulative incidence of asthma was 11.3% (84/738), hay fever was 41.5% (306/738), and nonseasonal allergic rhinitis was 14.0% (103/738). The cumulative incidence of allergic rhinitis (hay fever) and/or nonseasonal allergic rhinitis (was 45.8% (338/738). Among the 84 individuals with a cumulative incidence of asthma, 63 (75.0%) had a history of hay fever, 27 (32.1%) had a history of nonseasonal allergic rhinitis, and 72 (85.7%) had a history of allergic rhinitis. Among the 306 participants with a cumulative incidence of hay fever, 63 (20.6%) had a history of asthma. Twenty-seven (26.2%) of the 103 individuals with a history of nonseasonal allergic rhinitis had a cumulative incidence of asthma. Among the 338 individuals with a cumulative incidence of allergic rhinitis 72 (21.3%) had a history of asthma. Among the participants with a history of both asthma and hay fever, 44.8% developed hay fever first, 34.5% developed asthma first, and 20.7% developed both diseases at the same time. Among the individuals with a history of asthma and nonseasonal allergic rhinitis, 38.5% developed nonseasonal allergic rhinitis first, 30.8% developed asthma first, and 30.8% developed both diseases at the same time. This study further demonstrates the frequent co-existence of asthma and allergic rhinitis. Among asthmatics, allergic rhinitis occurred in 85.7%. Only 14.3% of asthmatics did not have allergic rhinitis. Among individuals with allergic rhinitis, asthma occurred in 21.3%. Also, allergic rhinitis often precedes or occurs at the same time as asthma.
... Similar data were already reported in the literature, with a variable prevalence between 20% and 50% of patients with allergic rhinitis [9,10]. The prevalence found in the present research was higher compared to the study published in 1998, where the prevalence of asthma in patients with allergic rhinitis was lower (21.3%) after 23 years of follow up [27]. But Greisner et al. [27] included all patients with allergic rhinitis at the same age (first year of faculty), not only patients with persistent forms and different ages. ...
... The prevalence found in the present research was higher compared to the study published in 1998, where the prevalence of asthma in patients with allergic rhinitis was lower (21.3%) after 23 years of follow up [27]. But Greisner et al. [27] included all patients with allergic rhinitis at the same age (first year of faculty), not only patients with persistent forms and different ages. The patients from the present research had a median age of 27.5 year, higher than the age of patients from the Greisner study. ...
... The authors included only patients with persistent allergic rhinitis in this study, knowing that duration of symptoms and their severity are risk factors for asthma development [30,32]. A duration of allergic rhinitis over 12 months was considered a risk factor for asthma occurrence similar to other previous studies, in both adults and children [3,27]. The severity of disease was not correlated with asthma occurrence in this research. ...
Background and Objectives: The evolution of allergic rhinitis to asthma is a part of “atopic march”. The aim of this study was to analyze possible predictive markers for asthma occurrence in patients with allergic rhinitis to house dust mites (HDM). Materials and Methods: Fifty-eight patients with persistent allergic rhinitis (PAR) were included. The clinical, biological evaluation and fractionated exhaled nitric oxide (FeNO) measurement were performed at enrolment. The patients were clinically evaluated after one year to determine asthma occurrence. Results: The severity of rhinitis symptoms, levels of total immunoglobulin E (IgE), ICAM-1, VCAM-1, E-selectin and IL-6, but not IL-8 and TNF-α were higher in patients with allergic rhinitis who developed asthma compared to non-asthmatics, but the differences were not significant to considered them as predictive factors for asthma occurrence. The risk of asthma was independently influenced by patients aged over 30 years ((OR-3.74; CI95% 0.86–16.31; p = 0.07), a duration of allergic rhinitis over 12 months ((OR-4.20; CI95% 0.88–20; p = 0.07) and a basal FeNO over 28 parts per billion (pbb) ((OR-18.68; CI95% 3.79–92.05; p < 0.001). Conclusion: Clinical and biological parameters may predict asthma occurrence in patients with persistent allergic rhinitis to HDM. Adult patients with a longer duration of rhinitis symptoms and a high level of FeNO have a greater risk to develop asthma.
... Allergic rhinitis (AR) often coexists with asthma. Up to 80% of patients with asthma are affected by AR and 40% of AR cases are concomitant with asthma (1)(2)(3). It is therefore hypothesized that AR and asthma may represent two manifestations of the same disease (4). ...
... Conversely, it has also been reported that nasal allergen exposure has no effects on lower airway inflammation (10). In a previous study, it was reported that either AR symptoms presented prior to asthma or asthma symptoms presented prior to AR during the study period (2). The association between eosinophilic inflammation in the upper and lower airways may differ in patients with CARAS initially presenting with AR and patients initially presenting with asthma; however, this remains unclear. ...
... Although there eosinophilic inflammation is present in the lower airways of patients with AR only, it may be decreased in patients with AR only compared with patients of CARAS (16). In some patients, AR may develop into asthma under persistent exposure to allergens (2). No significant differences were observed in the percentage of eosinophils in the upper and lower airways in the CARAS-AR and CARAS-AS groups, which suggests that patients with CARAS initially presenting with AR and patients with those initially presenting with asthma may have similar inflammatory mechanisms in the upper and lower airways. ...
Allergic rhinitis (AR) and asthma often coexist. The terminology combined allergic rhinitis and asthma syndrome (CARAS) was introduced to describe patients with combined AR and asthma. The aim of the present study was to evaluate the correlation between eosinophilic inflammation in the upper and lower airways of patients with CARAS. Stable patients with CARAS initially presenting with AR or asthma were recruited. Healthy subjects and patients with AR alone were recruited as controls. Clinical characteristics, including disease history, lung function, nasal airway inspiratory resistance and upper and lower airway eosinophilic inflammation were evaluated and compared. A total of 73 subjects (22 patients with CARAS initially presenting with AR, 15 patients with CARAS initially presenting with asthma, 25 patients with AR alone and 11 healthy subjects) were studied. The nasal symptoms visual analogue scale scores at the week prior to enrollment and nasal airway inspiratory resistances were comparable among the groups. The percentage of predicted forced expiratory volume in 1 sec and percentage of predicted maximal middle expiratory flow in patients with CARAS initially presenting with asthma were significantly lower compared with the other three groups (P<0.05). No significant different in the percentage of eosinophils in the nasal lavage was observed between patients with CARAS and those with AR only; however, it was significantly increased compared with healthy subjects (P<0.05). The fractional concentration of exhaled nitric oxide and percentage of eosinophils in the sputum were significantly increased in patients with CARAS compared with those in the AR only and healthy subject groups (P<0.05). The difference in the percentage of eosinophils in the nasal lavage and sputum between patients with CARAS initially presenting with AR and initially presenting with asthma was not significant; however, a positive correlation between the percentage of eosinophils in the upper and lower airways was present in patients with CARAS initially presenting with AR only (r=0.526, P=0.030).
... CARAS is a new medical concept proposed in recent years [17], and two symptoms of allergic rhinitis and asthma are similar in pathogenesis, genetic changes, local pathological changes, immune function and pathogenesis [3,18]. 40% of allergic rhinitis cases are concomitant with asthma while up to 80% of asthma patients are affected by allergic rhinitis [19][20][21]. The incidence of CARAS is increasing worldwide year by year and CARAS has become a global health problem [22], especially very common in clinical practice in China [23]. ...
... The incidence of CARAS is increasing worldwide year by year and CARAS has become a global health problem [22], especially very common in clinical practice in China [23]. Suffering from CARAS with serious symptoms, patients tend to have recurrent episodes [24], yet there is still a lack of effective treatment [20], and the pathogenesis is also not fully understood. ...
... Чаще всего заболевание дебютирует в первой половине жизни. АР часто ассоци ирован с БА, которая выявляется у 15-38% пациентов с АР [1, 2, 4-8, [11][12][13][14][15][16][17][18][19][20][21][22]. В то же время 55-85% пациентов с БА отмечают симптомы АР [1-8, [11][12][13][14][15][16][17][18][19][20][21][22]. ...
... АР часто ассоци ирован с БА, которая выявляется у 15-38% пациентов с АР [1, 2, 4-8, [11][12][13][14][15][16][17][18][19][20][21][22]. В то же время 55-85% пациентов с БА отмечают симптомы АР [1-8, [11][12][13][14][15][16][17][18][19][20][21][22]. В зависимости от этиологического фактора: -сезонный АР (САР); -круглогодичный/бытовой АР (КАР), или профессиональный АР. ...
... Rhinitis is a common problem [1][2][3] and is troublesome on its own, but it has also been shown to be a risk factor for developing bronchial hyper-responsiveness and asthma [4,5]. Multimorbidity involving the triad of rhinitis, asthma and eczema exists among both atopic and non-atopic individuals, although the prevalence is higher among atopic individuals [6][7][8][9]. ...
... About 74-90% of subjects with allergic asthma also have rhinitis [5,10,11]. Rhinitis, irrespective of atopic status, is a risk factor for developing asthma, but it has also been found that the co-occurrence of the two conditions is much more likely in atopic individuals [2,3,11]. The worldwide prevalence of allergic rhinitis, asthma and eczema in children under 18 years of age is 13%, 12% and 8% respectively [1]. ...
Background:
Rhinitis is a common problem within the population. Many subjects with rhinitis also have atopic multimorbidity, such as asthma and eczema. The purpose of this investigation was to compare subjects with only rhinitis to those that have rhinitis, asthma and/or eczema in relation to immunoglobulin E (IgE) sensitization, inflammatory markers, family history, lung function and body mass index (BMI).
Methods:
A total of 216 adult subjects with rhinitis from the European Community Respiratory Health Survey II were investigated with multiplex component allergen analysis (103 allergen components), total IgE, C-reactive protein, eosinophilic cationic protein, fractional exhaled nitric oxide and spirometry. Rhinitis, eczema, asthma and parental allergy were questionnaire-assessed.
Results:
Of the 216 participants with rhinitis, 89 also had asthma and/or eczema. Participants with rhinitis that also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62-7.30, adjusted for sex, age, mother's allergy, total IgE and forced expiratory volume (FEV1)). The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01-1.21) adjusted for sex, age, mother's allergy, total IgE and FEV1. When analysing different types of sensitization, the strongest association with atopic multimorbidity was found in participants that were IgE-sensitized both to perennial and seasonal allergens (4.50, OR: 95% CI 1.61-12.5). Maternal allergy (2.75, OR: 95% CI 1.15-4.46), high total IgE (2.38, OR: 95% CI 1.21-4.67) and lower FEV1 (0.73, OR: 95% CI 0.58-0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers.
Conclusion:
IgE polysensitization, to perennial and seasonal allergens, and levels of total IgE seem to be the main determinants of atopic multimorbidity in subjects with rhinitis. This indicates that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.
... Approximately 40% of AR patients have asthma symptoms, and approximately 80% of asthmatic patients have symptoms of AR [9][10][11]. In 1998, William et al. [12] reported a 23-year follow-up study that involved a total of 738 college students. The students' responses to the questionnaire revealed a frequent combination of asthma and AR. ...
Allergic rhinitis is a global illness that puzzles many researchers. Most patients with allergic rhinitis also have lower airway hyperresponsiveness, and an allergic rhinitis attack can increase lower airway hyperresponsiveness. However, the mechanism of the effect of allergic rhinitis on the lower airways is still unclear. In this paper, the effects of allergic rhinitis on the lower airways are studied in terms of epidemiology, anatomy, pathophysiology, nasal function loss, inflammation drainage, nasobronchial reflex, and whole-body circulatory flow to determine the mechanism involved and provide ideas for future diagnosis, treatment, and experiments.
... Studies have also identified a temporal relation between the onset of rhinitis and asthma, with rhinitis frequently preceding the development of asthma (Eggleston, P.A. 1988; Linna, O. et al 1992). One study from Sweden showed that almost 40% of subjects with allergic rhinitis developed asthma or lower-airways symptoms over an eleven year period (Danielsson, J. et al. 1997), while in the USA, among the participants in a prospective study with a history of both asthma and hay fever, 44.8% developed hay fever first, 34.5% developed asthma first, and 20.7% developed both diseases at the same time (Greisner, W.A. et al. 1998). Rhinitis has been identified as an independent risk factor for asthma in both atopic (Plaschke, P.P. et al. 2000), and non-atopic subjects with normal IgE levels (Leynaert, B. et al. 1999). ...
p>By studying the baseline characteristics of inflammation in the lower airways of allergic asthmatic and rhinitic individuals, followed by controlled diesel exhaust exposure and re-analysis of the inflammation, the studies presented in this thesis have attempted to shed light on the transition phase of asymptomatic inflammation to clinical asthma and the role that air pollution might play in augmenting this transition.
The first study characterises the cellular inflammation in the lower airways of non-asthmatic, asymptomatic allergic rhinitic subjects, comparing them to asthmatic individuals treated with either β2-agonists alone or with and inhaled corticosteroids and healthy controls. As anticipated, asthmatic subjects treated with β2-agonists alone had increased numbers of eosinophils and mast cells compared to healthy subjects, while those asthmatics on inhaled corticosteroids had a statistically significant increase in neutrophils. Subjects with allergic rhinitis had similar inflammatory changes in the lower airways to those detected in the asthmatics treated with β2-agonists alone, but important differences included a smaller increase in effector cells such a eosinophils and an additional increase in the total number of T lymphocytes - specifically in the sub-population of CD8+ T-suppressor lymphocytes. The lack of asthmatic symptoms in the allergic rhinitic subjects may be a dose-dependent effect with insufficient inflammatory cells present to result in bronchoconstruction; or it may be as a result of the different ratio of CD4+/CD8+ T-cells, with the increase in CD8+ T-suppressor lymphocytes having a protective effect.
The second study undertaken in this thesis has demonstrated that the neutrophilic and mast cell inflammation still persists in the lower airways of healthy subjects 18 hours after diesel exhaust exposure in addition to an increase in the numbers of eosinophils. However, subjects with asthma and allergic rhinitis failed to show increase inflammation in the bronchial biopsies, although allergic rhinitics did have an increase in neutrophils in the bronchial wash.</p
... This new intravascular pathway may play a significant role during haemostasis by enabling fibrin gel formation at the site of the developing thrombus (148). 28 Chapter 1. General Introduction ...
p>The work contained in this thesis explores the expression of TF, TFPI and KGF in the nasal epithelium (mucosal biopsy) and nasal lavage fluid in subjects with allergic rhinitis and in addition in a group with seasonal allergic rhinitis out of season following a nasal allergen challenge. Similarly in the lower airway the expression of TF, TFPI and KGF has been determined in the bronchial epithelium and in bronchoalveolar fluid in mild and severe asthmatic subjects and in a group of moderate asthmatics following endobronchial allergen challenge. This is the first work investigating the expression of TF, TFPI and KGF in allergic airways disease. These studies demonstrate that TF is expressed by the airway epithelium, with significantly greater expression in the upper airway in comparison with the lower airways. There was a trend towards increased expression in the upper airway with more acute inflammation but a significant increase in the lower airways in subjects with severe asthma in comparison with both mild asthmatic subjects and healthy controls. There was little demonstratable epithelial expression of TFPI. The nasal allergen challenge study suggested that TFPI is not synthesised locally but does increase with acute inflammation due to plasma exudation. This suggests that TF, produced locally, balanced by TFPI from the circulation, may have a role in epithelial repair in the airways. In addition our studies demonstrate that KGF is expressed in the airway and that the expression is significantly higher in the upper airway in comparison with the lower airway. KGF expression was significantly higher in those with mild asthma than controls but the expression was not increased in subjects with severe asthma. This may represent the effect of steroids on the mesenchymal cells. In the upper airway KGF expression was elevated post allergen challenge.</p
... Concurrent allergic rhinitis may be present in approximately 85% of patients with asthma [22]. According to the united airway disease concept, both asthma and rhinitis affect the respiratory tract mucosa and is part of the same disease process. ...
Background
Exacerbations of acute asthma are frequent presentations to the Emergency Department (ED) and contribute to ED overcrowding and healthcare cost. The purpose of this study was to evaluate whether ED clinicians are implementing secondary asthma prevention measures prior to discharging patients after an acute asthma exacerbation and also to determine whether ED clinicians are able to correctly demonstrate how to use an asthma metered dose inhaler (MDI) device.
Methods
Consenting doctors employed at four EDs situated in the Gauteng province of South Africa were asked to complete a questionnaire and thereafter demonstrate the technique of using an MDI device. Collected data was presented using descriptive statistics.
Results
Eighty-six doctors were included in the study. Of these, 18 (20.9%) routinely checked that inhaler technique was correct, 50 (58.1%) routinely enquired regarding adherence to their asthma treatment, 8 (9.3%) routinely informed patients of the side effects of asthma medication, 16 (18.6%) routinely provided patients with a written asthma action plan, 7 (8.1%) routinely evaluated for the presence of concurrent allergic rhinitis and 53 (61.6%) routinely counselled patients regarding smoking cessation. With regards to correctly demonstrating how to use an MDI device, only 23 (26.74%) physician participants performed all eight steps correctly.
Conclusion
This study indicates that secondary asthma prevention measures are not adequately addressed by clinicians prior to discharging patients from the ED after an acute asthma attack. It is recommended that ED clinicians are educated with regards to the importance of these measures.
... We have not found any published study on the onset of AC in relation to its comorbidities, to place it chronologically in the so-called allergic march. Some M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n studies have shown how rhinitis from the clinical point of view precedes asthma (27). In our study we indirectly found that rhinitis discreetly preceded conjunctivitis while the onset of asthma was later. ...
Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis.
... Asthma and rhinitis can sometimes start simultaneously, or asthma may even precede rhinitis. In one of the previous study in rhinitis and asthma, 45% developed rhinitis earlier than asthma, 35% developed rhinitis later of asthma, and 21% experienced both conditions simultaneously [26] . In the present study, 76% subjects showed allergic rhinitis before or at the same time as asthma. ...
... IgE-опосредованный механизм воспаления, запускаемый в ответ на воздействие аллергена, является общим для аллергических заболеваний и объясняет частое сочетание АР с аллергическим конъюнктивитом, атопическим дерматитом, бронхиальной астмой. БА выявляется у 15-38% больных АР, в то же время 55-85% больных с БА отмечают симптомы АР [34,[42][43][44][45]. Неконтролируемое течение АР способно ухудшить течение БА и часто препятствует достижению ее контроля. ...
The current state of the patients’ management with nasal polyposis and allergic rhinitis has become the basis for a deep analysis of the currently available data on the prevalence of diseases (with a focus on severe forms), as well, available possibilities and disadvantages of conservative therapy are considered. The approaches to assessing the severity and control of diseases and the influence of an uncontrolled course on the quality of the patients’ life are presented. Particular attention is paid to a new class of drugs – monoclonal antibodies, which might change the patients’ treatment paradigm of severe uncontrolled course of allergic rhinitis and nasal polyposis. The efficacy and safety issues of immunobiological therapy are discussed on the example of the IgE-targeted medicine omalizumab. The potential place of the drug in the treatment of the mentioned above forms of nasal polyposis and allergic rhinitis is indicated.
... Allergic rhinitis and asthma have been reported between 40% and 85% in various studies. Allergic rhinitis and asthma are both chronic heterogeneous disorders, However, the mechanisms in which both diseases occur are similar (1) . Atopy is the most important risk factor in the development of both diseases. ...
Introduction: A complete blood count is a cost-effective test that is easy to study. The neutrophil/lymphocyte and eosinophil / lymphocyte ratio calculated from this test are used in both prognosis and classification in some diseases with chronic inflammation. In our study, neutrophil/lymphocyte and eosinophil / lymphocyte ratio of patients with allergic rhinitis and asthma together with asthma or will be examined. Materials and methods: A total of 600 patients with asthma, allergic rhinitis and allergic rhinitis and asthma who did not have 3 diseases were selected from 20-65 years old patients who applied between 2017 and 2019 for this study. These patients were divided into 4 equal groups of 150 people who were sex and age-matched. Group 1 is the control group, Group 2 is only allergic rhinitis disease, Group 3 has only asthma, and Group 4 has both allergic rhinitis and asthma. All patients with asthma and allergic rhinitis were selected from these patients. Hemogram of these patients were analyzed retrospectively. Age, sex, neutrophil, eosinophil, lymphocyte values and rates were recorded. Results: In terms of neutrophil to lymphocyte ratio, a significant difference was observed when compared with the control group of allergic rhinitis group, asthma group and allergic rhinitis + asthma group. AR + Asthma group did not show a significant difference in terms of NLR compared to AR and asthma group. A significant difference was observed in terms of eosinophil to lymphocyte ratio compared to the control group of allergic rhinitis group, asthma group and AR + asthma group. No significant difference was observed between the AR + asthma group compared to AR and asthma group. (p> 0,088, p> 0,073) Conclusion: For the NLR group, no difference was observed between the patients with asthma and allergic rhinitis. For ELR, there was no difference in terms of only asthma or allergic rhinitis.
... Несмотря на то что АР не относится к числу тяжелых или угрожающих жизни заболеваний, его медико-социальное значение обусловлено высокой распространенностью среди детей, подростков и взрослых, а также сочетанностью с бронхиальной астмой (БА), которую выявляют у 15-38% больных АР [4,5]. Частота встречаемости АР у больных БА достигает 85% [6][7][8]. АР сочетан также с острым и хроническим риносинуситом, аллергическим конъюнктивитом, экссудативным средним отитом. ...
This paper assesses the efficacy of the original combined medication Allergoferon® beta (betamethasone + interferon alpha-2b) in real clinical practice among patients with seasonal allergic rhinitis (AR). The research program results demonstrated a good efficacy of the given medication: there were a decrease in nasal congestion as well as restoration of nasal breathing and in patients with concomitant allergic conjunctivitis - a reduction in the severity of eye symptoms. A low incidence of side effects was observed. It was shown that Allergoferon® beta can be recommended as monotherapy for patients with mild and moderate AR and in complex therapy for patients with severe AR.
... Известно, что у 15-38% пациентов с АР обнаруживается БА [18,19], а у пациентов с БА в 85% случаев встречается АР [20][21][22]. ...
... Therefore, there is a need to increase awareness among physicians to detect AR symptoms, confirming diagnosis of concomitant disease and optimizing management of patients with asthma. In our study, both GPs and pediatricians equally reported that in their experience of coexistent asthma in patients with AR was 28% which is similar to the previous publications [13,14]. ...
Background:
Underdiagnosis and undertreatment of allergic rhinitis (AR) in patients with asthma can worsen treatment outcomes. There is limited evidence of clinical practices for management of coexistent AR-asthma in Thailand.
Methods:
A multicountry, cross-sectional study (Asia-pacific Survey of Physicians on Asthma and allergic Rhinitis) to evaluate physician perceptions and management practices related to AR-asthma overlap in 6 Asian countries was conducted. For Thailand specifically, AR-asthma linkage questionnaires were developed and translated to Thailaland. General physicians (GPs) or pediatricians, randomly selected from hospitals in urban cities, routinely treating >10 asthma patients/month were interviewed. Here we present the results for Thailand.
Results:
Two hundred physicians (100 GPs and 100 pediatricians), of whom 70% worked in government hospitals, were interviewed. In their experience, 50% of asthma patients had AR and 28% of AR patients had asthma. Among diagnosed asthma patients, 65% of physicians routinely asked for any AR symptoms at every visit. Among diagnosed AR patients, 63% of physicians routinely asked for any asthma symptoms at every visit. In patients with coexisting AR-asthma, 91% of physicians treated both diseases simultaneously, while 6% of physicians treated asthma as a chronic disease but managed AR symptomatically. The most preferred treatment options for patients with AR-asthma were inhaled corticosteroids with intranasal steroids (46% in GPs, 71% in pediatricians).
Conclusion:
The physicians interviewed in Thailand are aware about coexistent asthma-AR. There is a need to increase the awareness further for coexistent AR-asthma and to educate nonspecialist physicians in the proper management of AR-asthma patients.
... of their nostrils which necessitate their frequent touching and squeezing of the nose (allergic salute); this leads to a shining crease on the bridge of the nose. [4][5][6] In some cases, some children may not want to touch the nostrils when they experience itching, rather they twist their upper lip from side to side in an attempt to settle the itching, this is called rabbit nosing. Majority of the children also develops redness of the eyes and excessive tearing. ...
... Eosinophilic cationic protein (ЕСР) is released by the activated eosinophils and is one of the most important mediators of allergic inflammation in the respiratory tract. Serum ECP levels>15 mg/L show allergic inflammation and require therapy (Crystal-Peters et al., 2002;Dixon et , 2006;Greisner et al., 1998). ...
Early diagnosis of rhinitis in children is important both for the therapy, as well as for prophylaxis of these diseases. The aim of this study is to evaluate the differential diagnostic possibilities of ECP in children with rhinosinusitis. In our study, 50 patients with clinical symptoms of rhinitis are divided in the following three groups: in Group 1 are included children with allergic rhinitis (n = 15, 30%), Group 2-children with non-allergic rhinitis (n = 12, 24%) and Group 3-non-allergic rhinitis with eosinophilia syndrome (n = 23, 46%). In each patient, ECP in serum and eosinophilia in nasal secretion were examined. The serum ECP levels were measured using immune methods (Pharmacia CAP). There is no statistically significant difference in the ECP levels between the three groups, although the mean ECP concentration is higher in asthmatics with allergic rhinitis. We found that the degree of allergic inflammation in allergic rhinitis with asthma can affect the serum ECP levels.
... 4 The overall burden of asthma in India is estimated at more than 15 million patients. 5 There is tremendous increase in allergic diseases in India as compared 30 years ago. Reasons attributed to the rising trend are urbanisation and lifestyle changes such as changes in dietary habits, indoor allergen exposure, vehicular pollution, crowding, environmental tobacco smoke exposure and pets at home. ...
BACKGROUND
Allergic diseases are important contributors of the overall disease burden worldwide. There is tremendous increase in the
prevalence of allergic diseases in India in the last 30 years. India is country of diversity in climate, culture, vegetation and
regional practices.
The aim of this study was to find out the difference in allergen sensitization profile of patients with nasobronchial allergy
between urban and rural area of residence.
MATERIALS AND METHODS
Study included 100 patients of nasobronchial allergy from central Rajasthan who were subjected to skin prick test with a battery
of 127 allergen solutions. The pattern of positive prick test was recorded and analysed. The study was conducted over a period
of one year.
RESULTS
The most common allergens in rural population were Insect (25.19%) and Dust allergen (17%) while in urban population it was
House Dust Mite (30%). Apart from these, sensitization to animal dander (6%) and fungal allergen (3%) was more common in
rural population while pollens (7.99%), feather (4.29%), kapok cotton (4.29%) and silk (4.29%) was more common in urban
population.
CONCLUSION
Our study concludes that a knowledge of prevalent allergens in a particular geographical area may help in education of general
precautions in patients with nasobronchial allergies. Although allergen profile between rural and urban population does not
differ significantly, yet it was observed that in rural population 20.16% of SPT were positive in contrast to 7.48% in urban
population. It clearly indicates that rural population suffers from multiple allergies and need more hygienic precautions than
urban populations.
... Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood [1], and its association with asthma [2], has clear potential for compromising athletic ability. ...
Introduction:
Limited data suggest that swimmers might be affected by rhinitis significantly more often than the general population. This can have impact on quality of life but also on performance. The aim of the present study was to determine the prevalence and impact of QOL of rhinitis in swimming compared to non-swimming athletes and controls.
Materials and methods:
This was an observational case control, questionnaire based study involving elite (n=101) and non-elite swimming athletes (n=107), non-swimming athletes (n = 38) and sex and age-matched controls (n = 50). The survey instrument consisted of a general and the miniRQLQ questionnaire. Main question used to assess the prevalence of rhinitis was from the ISAAC study.
Results:
Rhinitis was reported significantly more often by the elite swimmers (45%) than non-elite swimmers (31%), non-swimming athletes (32%) and controls (24%). Allergic rhinitis prevalence was similar in all groups (12-18%). The prevalence of non-allergic rhinitis was significantly higher in elite swimmers (33%) and non-elite swimmers (22%) compared to non-swimming athlethes and controls. Overall mean miniRQLQ score and all subdomains except the "eye" domain showed significantly reduced QOL in elite and non-elite swimmers compared to non-swimming athletes and controls. Regular nasal medication was used significantly less by elite swimmers (18%) compared to controls (67%) and non-swimming athletes (42%).
Conclusion:
This study revealed a high prevalence of non-allergic rhinitis in swimmers and related impact on QoL. These findings highlight the importance to increase the awareness toward upper airway disorders in the swimming athletes and to ensure adequate management. This article is protected by copyright. All rights reserved.
... По данным неинвазивных исследований доказано наличие воспаления нижних ДП (повышение эозинофилов в мокроте и NО в выдыхаемом воздухе) у пациентов с АР как в сезон пыльцы, так и вне его [20]. У ≥ 50 % больных АР имеется сезонная гиперреактивность ДП или верифицированный диагноз БА, в то же время > 80 % пациентов с БА страдают от сопутствующего АР [20,21]. Это послужило поводом к созданию концепции "единые ДП -единая болезнь" [20]. ...
... Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood [1], and its association with asthma [2], has clear potential for compromising athletic ability. ...
Background:
Prevalence of rhinitis in athletes has frequently been studied and varies widely from 27% to 74%. The aim of this systematic review was to examine the prevalence of rhinitis in athletes, to specifically compare the evidence of rhinitis in land-based and aquatic athletes.
Methods:
Systematic search of MEDLINE, EMBASE, and the non-MEDLINE subset of PubMed was performed from inception to March 8, 2016, to identify studies on rhinitis in athletes.
Results:
Of the 373 identified unique articles, a total of 13 studies satisfied the criteria for this review. The final group contained 9 cohort and 4 case-control studies. We found 10 studies that reported the prevalence of allergic rhinitis (21%-56.5%). In contrast, nonallergic rhinitis was identified by only 1 author (6%). We have also evaluated the prevalence of rhinitis in the separate subgroups (land, water, and cold air) where swimmers seem to be the most affected (40%-74%), followed by cross-country skiers (46%) and track and field athletes (21 to 49%).
Conclusion:
We did not reveal any convincing trend of a higher prevalence in land-based athletes compared to general population. By contrast, aquatic and cold air athletes demonstrate increased prevalence reflecting the irritant effects of their environment on the nasal mucosa.
... AR is also frequently associated with asthma, which is found in 15% to 38% of patients with AR, 4,5 and nasal symptoms are present in 6% to 85% patients with asthma. [6][7][8][9] In addition, AR is a risk factor for asthma, 4,9 and uncontrolled moderate-to-severe AR affects asthma control. 10,11 Compared with other medical conditions, AR might not appear to be serious because it is not associated with severe morbidity and mortality. ...
Background
Allergic rhinitis affects 10 to 40% of the population. It reduces quality of life, school and work performance, and is a frequent reason for office visits in general practice. Medical costs are large but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma – ARIA guidelines in 2010 prompting its update.
Objective
To provide a targeted update of the ARIA guidelines.
Methods
The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patient values and preferences, and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations.
Results
The 2016 revision of the ARIA guidelines provides updated and new recommendations about the pharmacological treatment of allergic rhinitis. It specifically addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or their combination. The ARIA guideline panel provides specific recommendations for the choice of treatment, the rationale for the choice, and discusses specific considerations that clinicians and patients may want to review in order to choose the management most appropriate for an individual patient.
Conclusions
Appropriate treatment of allergic rhinitis may improve patients’ quality of life, school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.
... The chance is higher if your mother has allergies. 25,26,27,28 Alveolitis Can refer to two inflammatory conditions. It can refer to inflammation of the alveoli in the lungs, or the dental alveolus in the jaw. ...
Fifty-two clinical samples collected from patients with postoperative wound infections in various age groups were examined for presence of multidrug-resistant bacterial pathogens – in especially – Staphylococcus aureus. The majority of samples were for age between 31 and 40 yrs (32.69%) followed by other age groups, while the lowest samples were taken from age group 1 to 10 yrs (5.76%) P<0.05. A total of 131 isolates were identified and the main causative agent was S. aureus (24 isolates 18.32%), while other bacterial types isolated from postoperative wounds were as follow: Escherichia coli 16 (12.21%), Klebsiella spp 11(8.39%), Enterobacter cloaeca 8 (6.1%), Proteus spp 7(5.34%), Pseudomonas aeruginosa 20 (15.26%), Staphylococ-cusepidermidis 11 (8.39%), Staphylococcus saprophyticus 8 (6.1%), Staphylococcus xylosus 5 (3.81%), Virid-ance streptococci 10 (7.63%), Streptococcus pyogenes 7 (5.34%), and Enterococcus faecalis 4 (3.05%) P<0.01. Sixteen antibiotics were used to test the resistance of S. aureus. Penicillin G gave 100% resistance ratio for all of 24 tested isolates, while the highly affected antibiotic was cefotaxime that gave the lowest resistance percentage (16.66%). Other antibiotics had ranges of resistance between these limits P<0.01. S. aureus developed a resistance mode for at least eight antibiotics. The biggest percentage of resistance was for the resistance of four antibiotics (21.18%) P<0.01.
Allergic disease has been an integral part of rhinology for many decades. However, the science of allergy has evolved over the years and has greatly enhanced our knowledge and understanding of the mechanisms involved.
Allergy has also developed into a specialist field of its own with dedicated trained allergists. Within ENT, there is now a substantial variation in the practice and understanding of allergy, particularly on the international scale, where many countries will have ENT surgeons who manage a dedicated allergy service.
However, whilst rhinologists will invariably manage patients with allergy in their clinical service, many will not have a dedicated interest, and the understanding of this now complex field will vary considerably.
This chapter addresses the principles and science of allergy as it relates to otorhinolaryngology, with the intention of explaining a complex field for the ENT surgeon rather than a specialist allergist. The clinical aspects of allergic rhinitis are dealt with elsewhere (please refer to Chap. 20).
Rhinitis is one of the most prevalent chronic diseases globally. Microbiome exposure affects the occurrence of rhinitis. However, previous studies did not differentiate allergic rhinitis (AR) and non-allergic rhinitis (NAR) in the microbial association analysis. In this study, we investigate 347 students in 8 junior high schools, Terengganu, Malaysia, who were categorized as healthy (70.9%), AR (13.8%) and NAR (15.3%) based on a self-administered questionnaire and skin prick tests of pollen, pet, mould and house dust mite allergens. Classroom microbial and metabolite exposure in vacuumed dust was characterized by PacBio long-read amplicon sequencing, quantitative PCR and LC-MS-based untargeted metabolomics. Our findings indicate a similar microbial association pattern between AR and NAR. The richness in Gammaproteobacteria was negatively associated with AR and NAR symptoms, whereas total fungal richness was positively associated with AR and NAR symptoms (p < 0.05). Brasilonema bromeliae and Aeromonas enteropelogenes were negatively associated with AR and NAR, and Deinococcus was positively associated with AR and NAR (p < 0.01). Pipecolic acid was protectively associated with AR and NAR symptoms (OR = 0.06 and 0.13, p = 0.009 and 0.045). A neural network analysis showed that B. bromeliae was co-occurring with pipecolic acid, suggesting that the protective role of this species may be mediated by releasing pipecolic acid. Indoor relative humidity and the weight of vacuum dust were associated with AR and NAR, respectively (p < 0.05), but the health effects were mediated by two protective bacterial species, Aliinostoc morphoplasticum and Ilumatobacter fluminis. Overall, our study reported a similar microbial association pattern between AR and NAR and also revealed the complex interactions between microbial species, environmental characteristics, and rhinitis symptoms.
Allergic rhinitis is one of the most common diseases (~10%–24% of the population experience allergic rhinitis in the Russian Federation) occurring in the population regardless of sex and age. The urgency of the problem is associated with an increase in the number of patients and the fact that allergic rhinitis is considered a risk factor for the development of asthma. The clinical allergic rhinitis guideline aimed to optimize patient care, up-to-date information about the epidemiology, and disease etiology and pathogenesis. Herein, we present the actual data about the allergic rhinitis classification and its clinical signs and modern (clinical, laboratory, and instrumental) and differential diagnostics. Studies reported allergic rhinitis treatment, rehabilitation, and prevention in the guidelines. The authors describe in detail the existing healthcare options for patients with allergic rhinitis, diagnostic features, and care in partial groups of population (children and pregnant women). The clinical guidelines are recommended for medical doctors (independently from qualification), under-and postgraduate students, universities tutors, residents, and researchers.
Allergic rhinitis is a burdensome disease for a significant part of the population in both adults and children. Poorly controlled allergic rhinitis can trigger exacerbations of asthma, sinusitis, and otitis media, diseases with which it shares common pathophysiologic elements. Consequently, early diagnosis and treatment should be a priority for patients and physicians, not only to control the symptoms of allergic rhinitis but also to improve the management of associated diseases. Several pharmacologic therapies can be considered in an armamentarium that includes antihistamines (intranasal and systemic), intranasal cromolyn, intranasal anticholinergic agents, intranasal steroids, systemic steroids, immunotherapy, and, most recently, leukotriene receptor antagonists. Often, combinations of these treatments are used to maximize control of refractory symptoms.
The "unified airway" describes the concept that inflammation affects upper and lower airways by similar mechanisms; this often manifests as rhinitis, rhinosinusitis, and/or nasal polyposis in the upper airway with associated asthma or bronchial inflammation in the lower airways. The relationships between eosinophilic diseases of the upper and lower airways are highlighted by examining their prevalence and treatment regimens along with the synergistic effects of treatment on upper and lower airway symptoms. It is important to recognize the interrelatedness of upper and lower airway eosinophilic disease to assess and manage patients accurately and holistically.
OR is common but often is underdiagnosed and underappreciated. The diagnosis can be difficult to make, and the history can be feigned easily, which can be problematic when questions of disability or liability arise. The diagnosis can be made with more confidence if there is coexisting OA or conjunctivitis. To avoid missing the diagnosis of OR, it is important to ask every patient that comes to the office with rhinitis or asthma symptoms, “What is your occupation?”
Allergic rhinitis and asthma are the most common causes of chronic inflammation of the upper and lower airways in childhood. However, a nasal biomarker that can link to pulmonary inflammation is yet to be found. The present paper aims to investigate the possible role in inflammation of two inducible 70-kDa Heat Shock Proteins (HSP70) members, HSPA1A/B and HSPA6, in nasal mucosa cells of allergic children through their mRNA expression analysis, and their correlation to both spirometric and FeNO values. The relationship between FeNO in lower airways and ∆Cts of HSPA1A/B in nasal mucosa seems to be influenced by clinical symptoms regardless of age, sex, and sensitization patterns. Therefore, HSP70 expression, as well as FeNO levels, could have a predictive capability to identify lower airways inflammation and thus to recognize rhinitic children having a potential risk of asthma development.
Objective:
The aim of the study was to evaluate the allergic rhinitis severity, to identify risk fac- tors associated with asthma, and to determine the frequency of comorbid conditions in allergic rhinitis patients with positive skin prick test.
Materials and methods:
Clinical characteristics of pediatric patients with allergic rhinitis were investigated. The frequency of comorbidities and risk factors for asthma development were investigated.
Results:
A total of 120 patients with a mean age of 13.05 ± 3.20 years were included in the study. Dermatophagoides pteronyssinus was the most common source of allergic sensitization (n = 78, 61.0%), whereas mild-persistent disease was the most common type of allergic rhini- tis severity (n = 44, 36.6%). Sensitization to Dermatophagoides farinea, Dermatophagoides pteronyssinus, and Alternaria was more common in patients with a moderate-severe course of allergic rhinitis than in the mild group (P = .006, P = .008, and P = .005, respectively). The most frequent comorbidity in children with allergic rhinitis was allergic conjunctivitis (71.7%). The inci- dence of asthma in those with moderate-severe allergic rhinitis was found to be significantly higher compared to those with mild disease severity (P = .009). Also, the multivariate analysis disclosed moderate-severe allergic rhinitis severity and persistent allergic rhinitis symptoms (OR: 3.822; 95% CI: 1.587-9.200; P =0.003 and OR: 0.333; 95% CI: 0.150-0.737; P =.007, respec- tively) as risk factors for asthma development.
Conclusion:
Sensitization to Dermatophagoides farinea, Dermatophagoides pteronyssinus, and Alternaria was more frequent in patients with moderate-severe allergic rhinitis course. Also, having moderate-severe allergic rhinitis severity and persistent allergic rhinitis symptoms are associated with the development of asthma. Awareness of the risk factors could prevent the progression and complications of allergic rhinitis in children.
Assessment of asthma comorbidities, conditions that adversely affect the pathobiology of asthma or impair its response to therapies, is a fundamental step in the evaluation and management of patients with difficult-to-treat asthma. Identifying and effectively treating asthma comorbidities, such as obesity, obstructive sleep apnea, and chronic sinusitis with nasal polyps may improve asthma control and reduce exacerbations. Additionally, identifying comorbid T2 inflammatory conditions may help guide optimal selection of biologic therapies. Here, we describe common comorbid conditions found in adult and pediatric difficult-to-control asthma, discuss evidence for the association with asthma morbidity and treatment benefit, and provide information on how and when to assess comorbidities.
Background
Asthma is common worldwide and a large part of subjects with asthma have concomitant allergic multimorbidity in the form of rhinitis and/or eczema.
Objective
The aim of this study is to investigate whether the presence of allergic multimorbidity in asthma relates to allergic sensitization, allergic and respiratory symptoms, quality of life, inflammatory markers, lung function, use of medication and background factors.
Methods
A total of 437 asthmatics from the (GA²LEN) cross‐sectional survey in Sweden were grouped depending on the presence of rhinitis and/or eczema. The impact of allergic multimorbidity was assessed in terms of allergic sensitization, allergic and respiratory symptoms, quality of life, type‐2 inflammatory markers (exhaled nitric oxide, eosinophil activation markers, periostin), lung function, use of medication and background factors.
Results
Subjects with asthma, rhinitis and eczema were more likely to be sensitized to seasonal allergens (67% vs 32%, P < .001), food allergens (54% vs 18%, P < .001) and to have a higher degree of sensitization than subjects with only asthma (23% vs 10%, P < .001). Subjects with allergic multimorbidity more often had allergic reactions to food (28% vs 10%, P = .002), more respiratory symptoms and anxiety/depression (40% vs, 14%, P < .001) than subjects with only asthma, despite having similar levels of type 2 inflammatory markers. Individuals with allergic multimorbidity were more likely to be diagnosed with asthma before the age of 12 (48% vs 27%, P = .016) and to have maternal heredity for allergy (53% vs 33%, P = .011) than subjects with only asthma.
Conclusion and clinical relevance
Asthmatics with allergic multimorbidity are more likely to be sensitized to seasonal aeroallergens, food allergens and they have a higher degree of sensitization compared with those with only asthma. Allergic multimorbidity is associated with respiratory and allergy symptoms, anxiety and/or depression.
Objective
Cross-sectional studies report relations between low nasal nitric oxide (nNO) and poor asthma control and between low nNO and chronic rhinosinusitis (CRS). In our cohort study, we studied if changes in nNO related to changes in asthma control, symptoms of CRS, or asthma or rhinitis medication.
Methods
A total of 196 subjects with predominantly mild to moderate asthma, aged 10–35 years, performed nNO measurements at both baseline and follow-up after a median of 43 (range 23–65) months. Asthma control, CRS symptoms, and medication, were questionnaire-assessed at both timepoints. IgE sensitisation against aeroallergens was quantified at baseline.
Results
There was an increase in nNO between baseline and follow-up (764 ± 269 ppb vs. 855 ± 288 ppb, p < 0.001). When adjusted for covariates, a larger increase in nNO was found in subjects sensitised to perennial aeroallergens than those not sensitised (92 (16–167) ppb), as well as in subjects with daily use of inhaled corticosteroids (ICS) at baseline but not at follow-up than those on ICS daily at both timepoints (146 (51–242) ppb). In the same model, subjects using nasal steroids daily at both timepoints had decreased nNO compared with those without such treatment at both timepoints (−185 (−321–(-48)) ppb). No relations between changes in nNO levels and changes in asthma control or symptoms of CRS were found.
Conclusion
Longitudinal changes in nNO were not related to changes in asthma control, but were related to changes in asthma or rhinitis medication.
Introduction: Asthma and allergic rhinitis are considered manifestations of the chronic inflammatory respiratory syndrome of the common airways or united airways disease. We conducted a prospective epidemiological study to evaluate the prevalence of allergic rhinitis among children already diagnosed as having asthma. Methods: A prospective epidemiological study was carried out during 2015 to 2016 at a tertiary care centre in North India. The severity of asthma was classified according to the Global Initiative for Asthma (GINA) report & allergic rhinitis according to Allergic Rhinitis and Its Impact on Asthma (ARIA). Results: A total of 64 children were screened. After excluding five subjects (7.8%), 59 subjects with asthma were analysed. We could not find any definitive correlation between severity of asthma to severity of allergic rhinitis (p > 0.05). The prevalence of co morbidity of asthma and allergic rhinitis was maximum when onset of asthma was between three to six years (70%), was 40% for < three years and 50% when age of onset was six to nine years. The age of onset of asthma in children having asthma only was five years and that of children with both asthma and allergic rhinitis was 5.5 years. This difference was not significant (p > 0.05). Conclusion: There was a high prevalence of co morbidity (50.84%) of allergic rhinitis among patients with asthma. A positive correlation was found between duration and severity of asthma, but this was not observed for allergic rhinitis. In most cases asthma preceded or started with AR.
Background
Rhinitis is the most common clinical manifestation of allergy, affecting more than 400 million people around the world. Rhinitis increases the risk of developing bronchial hyper-responsiveness and asthma. Previous studies have shown that rhinitis is closely related with the physiology, pathology, and pathogenesis of asthma. We analyzed co-expressed genes to explore the relationships between rhinitis and asthma and to find biomarkers of comorbid rhinitis and asthma.
Material/Methods
Asthma- and rhinitis-related differentially-expressed genes (DEGs) were identified by bioinformatic analysis of GSE104468 and GSE46171 datasets from the Gene Expression Omnibus (GEO) database. After assessment of Gene Ontology (GO) terms and pathway enrichment for DEGs, a protein–protein interaction (PPI) network was conducted via comprehensive target prediction and network analyses. We also evaluated co-expressed DEGs and corresponding predicted miRNAs involved in the developing process of rhinitis and asthma.
Results
We identified 687 and 1001 DEGs in bronchial and nasal epithelia samples of asthma patients, respectively. For patients with rhinitis, we found 245 DEGs. The hub-genes of PAX6, NMU, NTS, NMUR1, PMCH, and KRT6A may be associated with rhinitis, while CPA3, CTSG, POSTN, CLCA1, HDC, and MUC5B may be involved in asthma. The co-expressed DEGs of BPIFA1, CCL26, CPA3, and CST1, together with corresponding predicted miRNAs (e.g., miR-195-5p and miR-125a-3p) were found to be significantly correlated with rhinitis and asthma.
Conclusions
Rhinitis and asthma are related, and there are significant correlations of BPIFA1, CCL26, CPA3, and CST1 genes with novel biomarkers involved in the comorbidity of rhinitis and asthma.
Allergic rhinitis (AR)has negative effects in many people's healthy lives. Most of the previous studies were focused on the expression of cytokines, and few studies were analyzed from the perspective of metabolomics. Therefore, it is worthy to conduct researches on allergic rhinitis at the metabolic level. The purpose of this study was to identify differential serum biomarkers by metabolomics. In this study, the OPLS‐DA model was applied to characterize the differences of the serum samples between AR patients and healthy volunteers. A total of 10 metabolites (except hexadecanoic acid) have been found to alter significantly (p < 0.05) by the principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS‐DA), which could be the potential biomarkers. MetaboAnalyst 4.0 and pathway enrichment analysis showed that these metabolite changes mainly involved three pathways: porphyrin and chlorophyll metabolism, arachidonic acid metabolism and purine metabolism. These findings may contribute to a better understanding of the potential pathogenesis mechanisms and provides a metabolic evidence for deeper study of AR.
Background:
Perennial allergic rhinitis (PAR) often coexists in asthmatic patients. Intranasal cellulose powder (ICP) was reportedly effective in ameliorating PAR.
Objective:
We investigated whether ICP is equally effective compared with intranasal corticosteroids in improving asthma control as well as nasal symptoms among children with PAR and allergic asthma (AA).
Methods:
Between July 2015 and September 2016, we did a single-center, randomized, placebo-controlled trial. Asthmatic children aged 6 to 11 years with mild-to-moderate PAR were randomly assigned to formoterol/budesonide inhalation (4·5 µg/80 µg, twice daily) plus intranasal budesonide 64 µg twice daily (group A), ICP 250 µg thrice daily (group B), or intranasal placebo 250 µg thrice daily (group C) for 8 weeks. The primary outcome was change in asthma control test for children (C-ACT) score from baseline to week 8 posttreatment. Changes in spirometry, peak expiratory flow (PEF), fractional exhaled nitric oxide (FeNO), and visual analog scale (VAS) for nasal and ocular symptoms were detected as secondary outcomes.
Results:
We included 121 patients (38 in group A, 41 in group B, and 42 in group C) in full-analysis set. C-ACT score was markedly higher at week 8 compared with baseline (mean difference: 5.11, 6.05, and 4.85 points in groups A, B, and C, respectively; P < .05). There were interactions between baseline and treatment in C-ACT scores ( P < .05). Group B demonstrated greater improvement in C-ACT score than group C among children with baseline C-ACT score of 6 to 18. 95% confidence intervals of group A at baseline overlapped with those of groups B and C. The treatment achieved reduced VAS symptoms in groups A and B but not in group C. Incidence of adverse events was comparable. No serious adverse event was reported.
Conclusions:
ICP could be recommended for children with PAR and AA who have poorer asthma control.
Background:
Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist.
Objective:
To determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma.
Methods:
749 children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma. Rhinitis was diagnosed by questionnaire focusing on individual symptoms, and pre-defined phenotypes were determined by combining symptom patterns with skin testing and serum specific IgE.
Results:
Analyses were done on 619 children with asthma who completed at least 4 of 6 visits. Rhinitis was present in 93.5%, and phenotypes identified at baseline were confirmed during the observation/management year. Perennial allergic rhinitis with seasonal exacerbations (PARSE) was most common (34.2%) and severe. Nonallergic rhinitis was least common (11.2%) and least severe. The majority of children remained symptomatic despite the use of nasal corticosteroids ± oral antihistamines. Rhinitis was worse in difficult-to-control vs. easy-to-control asthma and its seasonal patterns partially corresponded to those of difficult-to-control asthma.
Conclusion:
Rhinitis is almost ubiquitous in urban children with asthma, and its activity tracks that of lower airway disease. PARSE is the most severe phenotype and most likely to be associated with difficult-to-control asthma. This study offers strong support to the concept that rhinitis and asthma represent the manifestations of one disease in two parts of the airways.
The upper and lower airways are linked epidemiologically and pathophysiologically. The upper and lower airways are considered a single, functional unit characterized by shared immunologic mechanisms, often referred to as the unified airway. Upper and lower airway inflammatory disease frequently coexist in the same patient. Allergic rhinitis and rhinosinusitis are associated with asthma. Treatment of both diseases impacts asthma outcomes. The otolaryngologist may be the first physician to suspect and diagnose asthma in patients with upper airway complaints. A thorough understanding of the relationship between allergic rhinitis, rhinosinusitis, and asthma will facilitate early identification of asthma and improve patient outcomes.
Allergic rhinitis (AR) is a very common disease. This condition, which predominates during the childhood years [48], is found most often in boys up to 10 years of age, and at equal rates with girls from the ages of 10–20 years. Studies conducted in many countries in recent years, thanks chiefly to the ISAAC study (Table 5.21), have revealed a significant increase in its prevalence, especially among 13- to 14-year-olds, reaching a rate of 80% in Paraguay. There is an increase in prevalence from the age of 15–17years, of 18% in girls vs 14% in boys [184]. As for the minimum age of onset, Table 5.5 shows that children as young as 1–3 months are sensi-tized to pollens. At this age children may be sensitized to HDM (house dust mite), pets and pollens [78]. While 50% of cases were diagnosed within the 1st year in the United States, this took place in an area with a dry climate and thus lacked the most well-known allergens [149]; however, the case of a little girl shown in Fig. 5.23 is eloquent. A recent study from Denmark [174] during a 6-year follow-up in a population of 7- to 17-year-old subjects reported a significant association between the SPT (skin prick tests) sensitization to grass (RR=2.6) and HDM (RR=2.7) or a positive IgE screening test (RR=2.4) and the development of AR.
Despite historical studies showing the high prevalence of rhinitis and rhinosinusitis in asthma and COPD, and the impact of diagnostic and therapeutic neglect of rhinitis and rhinosinusitis on bronchial symptoms in these patients, routine clinical experience shows that a significant portion of asthma and COPD patients are deprived of proper care for upper airways disease. Rhinitis is considered a major risk factor for asthma, with growing evidence that timely treatment for allergic rhinitis might prevent the development of asthma. In addition, early-stage treatment for CRS has been shown to be associated with a lower prevalence of asthma. Undoubtedly, a significant portion of patients with asthma and COPD benefit from optimal medical and/or surgical treatment of the upper airways. The future challenge will be to predict who might benefit from referral to an ENT specialist to optimise the upper airways treatment, taking into account preventative, predictive and personalised care in the approach.
Background: Studies about the pathogenesis of bronchial hyperreactivity (BHR) in patients with persistent allergic rhinitis (PAR) and its relationship with lower airway remodeling are extremely limited. Objective: This study evaluated bronchial vascular remodeling via the measurement of angiogenic factor, vascular endothelial growth factor-A (VEGF-A), and anti-angiogenic factor, Endostatin, and evaluated their relationship with BHR in patients with PAR. Methods: The study group consisted of 30 patients with PAR monosensitized to house dust mites and 14 non-allergic healthy controls. All subjects underwent induced sputum and methacholine (M) bronchial provocation tests. VEGF-A and Endostatin levels were measured by ELISA in induced sputum supernatants. Results: The percentages of eosinophils in induced sputum were significantly increased in patients with PAR compared with healthy controls. There were no significant differences between patients with PAR and healthy controls in terms of levels of VEGF (37.9 pg/ml, min–max: 5–373 pg/ml vs. 24.9, min–max: 8–67 pg/ml, p = 0.8 respectively), Endostatin (532.5 pg/ml, min–max: 150–2125 pg/ml vs. 644, min–max: 223–1123 pg/ml, p = 0.2 respectively) and VEGF/Endostatin ratio (0.057 vs. 0.045, p = 0.8 respectively). In addition, there were no significant differences between patients who are BHR positive (n = 8), or negative to M (n = 22) in terms of levels of VEGF, Endostatin and VEGF/Endostatin ratio and no correlations among value of PD20 to M and levels of VEGF, Endostatin and VEGF/Endostatin ratio. Conclusion: We conclude that VEGF-A and Endostatin did not differ between patients with PAR and healthy controls regardless of BHR to M. © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.
De Standaard Astma bij kinderen bestrijkt nu de leeftijd van 0 tot 16 jaar in plaats van 0 tot 12 jaar.
Bij kinderen tot 6 jaar is volzitten en recidiverend hoesten geen onderdeel meer van de symptoomdiagnose astma.
Bij kinderen vanaf 6 jaar is spirometrie haalbaar en superieur aan piekstroommeting, zowel bij diagnostiek als bij monitoring.
Cromoglycinezuur heeft geen plaats meer in de behandeling van astma bij kinderen.
ResearchGate has not been able to resolve any references for this publication.