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Introduction: Allergic rhinoconjunctivitis (AR) is an IgE-mediated inflammation of nasal and ocular mucosa after environmental allergen exposure, mainly by house dust mites (HDM). AR affects more than one third of the population worldwide and it is associated with loss of quality of life (QoL). Aim: To analyse the improvement in the QoL in 50 patients with moderate-persistent AR due to house HDM before and after receiving 1 year of subcutaneous specific aeroallergen immunotherapy treatment (SAIT). Material and methods: A prospective observational study was performed based on clinical practice in 50 patients with moderate-severe persistent AR due to HDM and candidates to SAIT. Forty-one patients completed the study. Patients were evaluated with the ESPRINT short-version QoL questionnaire, a score of medication use and visual analogue scale (VAS) symptom score, prior to and 12 months after SAIT. Results: Forty-one patients (25 women, mean age 26.9 years). Mean ESPRINT values prior to the start SAIT was 3.06 (moderate-severe) and 1 year after starting subcutaneous SAIT the mean value dropped in all patients to 0.88 (mild). The VAS score symptom dropped from 8.26 to 3.68. 97.56% of patients used 3 or more drugs (oral antihistamine, ophthalmic/intranasal antihistamine, intranasal corticosteroid and/or oral antileukotrienes) prior to starting SAIT, and 1 year after it, 58.53% used one on-demand medication to control symptoms, oral antihistamine or nasal spray, and not daily use. Conclusions: Subcutaneous SAIT seems to be a valid treatment in our patients with moderate-persistent AR due to HDM, since it reduces the ESPRINT score, VAS score and the use of medication. An improvement in the quality of life and satisfaction was observed by the patients themselves. [ABSTRACT FROM AUTHOR]

Objective • The differential gene analysis of ferroptosis inreating allergic rhinitis with Bu-Zhong-Yi-Qi-Decoction based on GEO using network pharmacology and molecular docking . Method • This study used databases such as TCMSP to search for traditional Chinese herbal medicine’s active ingredients and targets in Bu-Zhong-Yi-Qi-Decoction in treating allergic rhinitis. GeneCards, OMIM, TTD, and PharmaGkb were used to obtain disease targets for allergic rhinitis, and R language was used to screen Bu-Zhong-Yi- Qi-Decoction as the main target for treating allergic rhinitis. Retrieve the gene dataset of allergic rhinitis using the GEO database, analyze ferroptosis-related genes, and select the intersection of effective targets of Bu-Zhong-Yi- Qi-Decoction for treating allergic rhinitis and ferroptosisrelated genes of allergic rhinitis, draw protein interaction networks using the STRING database, use Cytoscape software to construct the target regulatory network of Bu-Zhong-Yi-Qi-Decoction for treating allergic rhinitis and ferroptosis related genes, and then use the CytoNCA plugin to screen key targets. Using R language, Gene ontology, and the biological pathway enrichment analysis were performed on the predicted targets related to the treatment of allergic rhinitis and ferroptosis with Bu-Zhong-Yi-Qi-Decoction. Selecting key targets and active ingredients for molecular docking to explore the potential mechanism of Bu-Zhong-Yi-Qi-Decoction in treating ferroptosis in allergic rhinitis. Result • After searching the TCMSP database, a total of 182 active ingredients were obtained from 8 traditional Chinese medicines of Bu-Zhong-Yi-Qi-Decoction, such as naringenin, kaempferol, Isorhamnetin, corresponding to 3023 targets and 2025 targets related to allergic rhinitis. There are 30 remarkably enriched Go analyses for biological function of potential target genes of Bu-Zhong- Yi-Qi-Decoction in allergic rhinitis, such as regulation of apoptotic signaling pathway, cellular response to peptide, wound healing, etc. Among them, there are 7 key genes related to the treatment of allergic rhinitis and ferroptosis with Bu-Zhong-Yi-Qi-Decoction, namely TP53, MAPK1, MAPK14, HIF1A, AR, CAV1, GSK3B. Conclusion • The treatment of allergic rhinitis with Bu-Zhong-Yi-Qi-Decoction is a process involving multiple divisions, targets, and pathways. These results indicated that oral Bu-Zhong-Yi-Qi-Decoction may effectively treat allergic rhinitis in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of Peitu Shengjin prescription versus H1 antihistamine in the treatment of allergic rhinitis. Methods: Electronic searching "China Knowledge Network", "Wanfang Database", "Vip Database", "Chinese Biomedical Literature Database", PubMed, Embase, The Cochrane Library, all published on the prescription of Peitu Shengjin prescription comparison H1 antihistamine In randomized controlled trials (RCTs) of drug treatment of allergic rhinitis, two researchers screened the literature according to the inclusion and exclusion criteria, and conducted Meta-analysis using RevMan5.3 software. Results: A total of 22 studies were involved, involving a total of 1463 subjects, including 822 in the treatment group and 641 in the control group. Meta-analysis results show that compared with oral H1 antihistamines, Peitu Shengjin prescription can improve the total effective rate of allergic rhinitis (RR=1.19, 95%CI [1.14, 1.24], P<0.00001); reduce recurrence Rate (RR=0.46, 95% CI [0.23, 0.90], P=0.02); reduce serum IL-6 (MD=-17.33, 95% CI [-21.96, -12.70], P<0.00001) and serum IL-8 (MD=-100.35, 95% CI [-175.18, -25.52], P=0.009); reduce the patient's total score of symptoms and signs (SMD=-1.21, 95% CI [-1.82, -0.61], P<0.0001) And TCM symptom scores (SMD = -0.98, 95% CI [-1.28, -0.68], P <0.00001); superior to the control group in improving patients' nasal congestion, nasal itching, and turbinate/nasal mucosa enlargement, in improving runny nose There is no obvious advantage compared with the control group in terms of sneezing symptoms; in terms of safety, there are fewer mild adverse reactions in the treatment group (RD=-0.05, 95% CI [-0.09, -0.00], P=0.04). Conclusion: Compared with H1 antihistamine, Peitu Shengjin prescription can improve clinical efficacy, improve patients' symptoms and signs and TCM symptoms, regulate immune function, and is not easy to relapse and has good safety. [ABSTRACT FROM AUTHOR]

Rationale: Sensitization to Fel d 1 (Felis domesticus allergen 1) contributes to persistent allergic rhinitis and asthma. Existing treatment options for cat allergy, including allergen immunotherapy, are only moderately effective, and allergen immunotherapy has limited use because of safety concerns. Objectives: To explore the relationship among the pharmacokinetic, clinical, and immunological effects of anti-Fel d 1 monoclonal antibodies (REGN1908-1909) in patients after treatment. Methods: Patients received REGN1908-1909 (n = 36) or a placebo (n = 37) in a phase 1b study. Fel d 1-induced basophil and IgE-facilitated allergen binding responses were evaluated at baseline and Days 8, 29, and 85. Cytokine and chemokine concentrations in nasal fluids were measured, and REGN1908-1909 inhibition of allergen-IgE binding in patient serum was evaluated. Measurements and Main Results: Peak serum drug concentrations were concordant with maximal observed clinical response. The anti-Fel d 1 IgE/cat dander IgE ratio in pretreatment serum correlated with Total Nasal Symptom Score improvement. The allergen-neutralizing capacity of REGN1908-1909 was observed in serum and nasal fluid and was detected in an inhibition assay. Type 2 cytokines (IL-4, IL-5, and IL-13) and chemokines (CCL17/TARC, CCL5/RANTES [regulated upon activation, normal T-cell expressed and secreted]) in nasal fluid were inhibited in REGN1908-1909-treated patients compared with placebo (P < 0.05 for all); IL-13 and IL-5 concentrations correlated with Total Nasal Symptom Score improvement. Ex vivo assays demonstrated that REGN1908 and REGN1909 combined were more potent than each alone for inhibiting FcεRI- and FcεRII (CD23)-mediated allergic responses and subsequent T-cell activation. Conclusions: A single, passive-dose administration of Fel d 1-neutralizing IgG antibodies improved nasal symptoms in cat-allergic patients and was underscored by suppression of FcεRI-, FcεRII-, and T-helper cell type 2-mediated allergic responses. Clinical trial registered with www.clinicaltrials.gov (NCT02127801). [ABSTRACT FROM AUTHOR]

Object: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. Methods: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. Results: A detailed guideline about all aspects of allergic rhinitis was created. Conclusion: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals. [ABSTRACT FROM AUTHOR]

In this study, we aim to evaluate the efficacy and safety of Guizhi Decoction associated formulas for the treatment of allergic rhinitis. A total of seven online databases were searched to collect studies published up to Feb 23rd, 2020. Study quality of each included article was evaluated by the Cochrane Collaboration risk of bias tool. Systematic reviews were conducted based on the Cochrane systematic review method by using RevMan 5.3 Software. Among the included trials, Guizhi Decoction associated formulas alone (or plus Western medicine, or acupoint-based therapy) were main therapies in experimental groups. Interventions in control groups include Western medicine, Guizhi Decoction associated formulas alone, Chinese patent medicine, and placebo control. Primary outcomes in this study include recovery rate, accumulative marked effective rate, accumulative effective rate, and recurrence rate. Finally, 23 trials involving 2281 participants were included. Results of systematic reviews show that Guizhi Decoction and associated formulas alone, plus Western medicine or plus acupoint-based therapies, were significantly better compared with using Western medicine alone in terms of efficacy. In addition, the formulas plus nasal TCM fumigation therapy could improve effective rate for AR treatment compared to using the formulas alone. More types and cases of adverse events were reported in the control groups (Western medicine alone), but events of included trials were all mild and did not need specific medical intervention. More RCTs of high quality, and large sample size, with appropriate blinding methods or nonblinded pragmatic trials of Guizhi Decoction and associated formulas for AR are needed. [ABSTRACT FROM AUTHOR]

Background: Allergen-specific immunotherapy is an important therapeutic alternative for the management of allergic rhinitis and asthma. Objective: To evaluate the efficacy and safety of subcutaneous immunotherapy with allergens in patients with respiratory allergy at the University Hospital of Puebla after twelve months of treatment. Methods: Longitudinal, sequential, analytical, quasi-experimental, prolective study. For twelve months we included patients with asthma and/or rhinitis, sensitized to aeroallergens, aged 4 to 65 years and of both genders. The CARAT and Portnoy questionnaires were collected every two months to assess efficacy and safety, respectively. Results: 47 patients were included, 37 (78.7 %) women. The average age was 29.8 years. 76.6 % had a diagnosis of allergic rhinitis and 23.4 % of asthma and allergic rhinitis. When comparing the average score of the initial CARAT against the final average by means of a t test, a t value of -8.86 and a p < 0.05 were obtained. It was obtained a total frequency of local adverse reactions of 19 % and systemic adverse reactions of 2.1 % at 6 and 12 months of treatment. Conclusions: The immunotherapy scheme evaluated, derived from the Mexican clinical practice guidelines of immunotherapy 2011, is effective with a convenient safety profile. [ABSTRACT FROM AUTHOR]

Objective: To study the mechanism of ephedra in treating allergic rhinitis by network pharmacology. Methods: the chemical components and corresponding targets of ephedra were searched and screened by TCMSP database. With "allergic rhinitis "as the key word, diseaserelated genes were searched in GeneCards and OMIM database. Using Venny2.1.0 mapping, Venn diagram and drug - disease common targets, network visualization software Cytoscape 3.6.1 track production elements - targets - disease network diagram, String database build their proteins interact with each other (PPI), and using R language to do gene ontology (GO) functional enrichment and pathway analysis and kyoto encyclopedia of genes and genome (KEGG) pathway enrichment analysis. Results: ephedrine was screened for 136 efficacy components and 88 common targets, and was predicted to intervene and regulate allergic rhinitis through AGE-RAGE signaling pathway in diabetic complications, Fluid shear stress and atherosclerosis, IL-17 signaling pathway, TNF signaling pathway and other signaling pathways in diabetic complications. Conclusion: preliminary prediction of the target and pathway of ephedra in the treatment of allergic rhinitis through network pharmacology can provide direction and evidence for the next experiment and clinic. [ABSTRACT FROM AUTHOR]

Introduction. Facial candling is a traditional method used for relieving symptoms of allergic rhinitis (AR). This study aims to investigate the knowledge and perception of facial candling in a sample of staff and students in a public university in Malaysia. Methods. An online questionnaire survey method was used. Based on sample size calculation, a total of 1,508 UiTM staff and students from ten selected campuses of Universiti Teknologi MARA (UiTM) were invited to participate in this survey. An up-to-date e-mail list of staff in the selected campuses was used as the sampling frame for the study, whereas the students were recruited from the official university student Facebook portal. Results. A total of 788 respondents participated in this survey, 72.2% of them knew about facial candling, though only 35.4% had tried the treatment. Approximately one-fifth of respondents agreed that facial candling might treat AR. It was found that a higher number of users than nonusers agreed that facial candling was a traditional medicine (78.9% vs 55.0%); could be used on the face and ears (83.5% vs 45.4%); and could be self-administered at home (83.5 vs 45.4%). Interestingly, more than half of them were uncertain about its long-term effects and adverse reactions. Conclusion. This study confirms the facial candling use among patients with AR although the percentage is low. The patients and general public need to be better informed about the use of facial candling in AR and its associated risks. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the effect of Seogeum therapy on nasal eosinophil, nasal symptoms, and rhinitisrelated quality of life in college students with allergic rhinitis. Methods: A nonequivalent control group pre-post test design was used. There were 26 subjects in the experimental group and 26 subjects in the control group. The experimental group received Seogeum therapy on both hands 12 times for three weeks. The collected data were analyzed with SPSS 21.0 version using χ2-tests, Fisher’s exact test, independent t-test, and repeated measure of the ANOVA Results: After three weeks the positive rate of nasal eosinophils (p=.048) significantly decreased in the experimental group than in the control group. The experimental group demonstrated significantly lower total nasal symptom score (p=.032) and higher rhinitis-related quality of life (p<.001) compared to the control group. Conclusion: These findings showed that Seogeum therapy is effective as well as beneficial in relieving nasal symptoms and improving the rhinitis-related quality of life in college students with allergic rhinitis. Thus, Seogeum therapy may be an alternative nursing intervention for those suffering from allergic rhinitis. [ABSTRACT FROM AUTHOR]

In this article, as an experiment, the effectiveness of Nasonex in allergic rhinitis after rhinoplasty is examined in detail. Influence of gks on allergic rhinitis and the prostoperative period. Bioavailability of various gks on the body, in particular mometasone furoate. [ABSTRACT FROM AUTHOR]

Introduction: The goal of treatment in allergic rhinitis is a complete elimination of symptoms or achieving significant clinical improvement. The role of the pharmacist has been receiving particular attention in terms of the initial diagnosis and treatment of allergic rhinitis patients and their sufficiently early referral to a specialist in case of persistent symptoms. Aim: This study attempted to estimate the rates of nasal OTC use in patients diagnosed with allergic rhinitis. Material and methods: Study population was 18,578 subjects (4,192 patients diagnosed with AR and 14,386 healthy controls): children aged 6-7 years, adolescents aged 13-14 years, and adults aged 20-44 years. We used translated and validated versions of ECRHS and ISAAC questionnaires. Results: The rates of nasal decongestant use in the allergic rhinitis group were 60.4% in children, 50.7% in adolescents, and 43.0% in adults, with these figures significantly higher than in the control group (p < 0.05). The most common nasal agent was Oxymetazoline and Xylometazolini hydrochloridum 0.1%. Conclusions: Over a half of the evaluated allergic rhinitis patients used nasal decongestants, which poses a potential risk of uncontrolled side effects. There is an urgent need to introduce patient education on medical treatment. [ABSTRACT FROM AUTHOR]

Background: Allergic Rhinitis (AR) is the most common allergic disease worldwide. The present study, evaluated effects of synbiotic on gene expression of interferon-gamma (IFN-γ), interleukin-4 (IL-4), interleukin-10 (IL-10), interleukin-17 (IL-17), transforming growth factor beta (TGF-β), and forkhead box P3 (FoxP3) in AR patients who received concomitant immunotherapy in a placebo-controlled clinical trial. Materials and Methods: Twenty AR patients were randomized in synbiotic and placebo groups and received cluster immunotherapy for 2 months. RNA was extracted from peripheral PBMCs, then the cDNA synthesized. Subsequently, SYBR Green real-time Reverse transcription polymerase chain reaction technique was employed for studying the expression of mentioned genes. In addition, SNOT-22 and mini-Rhinoconjunctivitis Quality of Life Questionnaire questionnaires were completed by patients. Data were analyzed before and also 2 and 6 months after intervention. Results: Clinical symptoms and quality of life were improved with immunotherapy, but there was no significant difference between the placebo and synbiotic groups. Gene expression of IFN-γ, TGF-β, and FoxP3 was increased whereas the gene expression of IL-4 and IL-10 decreased, but not significant. Interestingly, the gene expression of IL-17 in the synbiotic group was significantly decreased versus placebo after 2 months (P = 0.001) and also at the end of intervention (P = 0.0001) comparing with the time zero. Conclusion: Significant reduction in the IL-17 gene expression following administration of synbiotic versus placebo shows the importance of synbiotic in control of the immunopathogenesis of AR. Further studies with more samples are recommended. In addition, evaluating the effects of synbiotic in patients who do not undergo immunotherapy is suggested to get a better conclusion. [ABSTRACT FROM AUTHOR]

Introduction: Allergic conditions present a serious problem for the Polish population. The most common form of allergy is allergic rhinitis. Due to its chronic nature and a complex pathophysiological mechanism the allergic rhinitis could be associated with others comorbidities. That is why it is a poses a considerable bio-psychosocial problem both for the affected individual patient and for the healthcare system. Aim: To identify organizational factors and analyse their effect on patients with chronic allergic conditions. Material and methods: The study group comprised 9,370 respondents (including 1,967 patients with allergic rhinitis (AR), 372 patients with self-reported bronchial asthma (BA1), and 351 patients with physician-diagnosed bronchial asthma (BA2)) aged from 20 to 44 years, some of whom were additionally examined (skin pick tests) in an outpatient setting. The findings obtained in the outpatient subgroup (n = 4,783) were analysed in more detail. The study was based on translated and validated ECRHS and ISAAC questionnaires. Results: Over a half of the evaluated patients with AR visited a specialist due to their symptoms. Some respondents neither visited their doctor regularly nor had regular check-ups, which undoubtedly affected their quality of life. Conclusions: The authors propose an organizational model incorporating the position of a healthcare educator (HE) as a coordinator in the process of managing chronic allergic conditions in adult patients within the Polish healthcare system. Adult patient education by the HE would include introducing the principles of secondary and tertiary prevention in order to improve the quality of life in patients with chronic allergic conditions. [ABSTRACT FROM AUTHOR]

The paper discusses the classification and forms of allergic rhinitis with a special focus on seasonal allergic rhinitis (SAR). The general principles of SAR management are presented, including the role of nasal glucocorticoids, nasal and oral antihistamines, and antileukotrienes. Based on the latest guidelines, the current rules for the selection of drugs in the therapy of SAR are given, paying special attention to the initial treatment. The aim of the paper is to present updated guidelines for the pharmacological management of patients with seasonal allergic rhinitis. [ABSTRACT FROM AUTHOR]

Abstract The aim of this work was to prepare new mucoadhesive nasal decongestant nanoparticles obtained by direct crosslinking between the cationic polymer chitosan and the anionic drug cromolyn. Different chitosan/cromolyn molar ratios were used in order to obtain nanoparticles of suitable size, encapsulation efficiency/drug loading and mucoadhesion. Moreover, the ability of the nanoparticles to deliver cromolyn into and through the nasal mucosa was evaluated. The obtained positively charged nanoparticles, sized 180–400 nm, showed interesting properties in terms of yield, mucoadhesion, encapsulation efficiency and drug loading. Release and permeation/penetration data indicated the ability of the nanoparticles to retain a high amount of cromolyn inside the mucosa, which is rich in mast cells. These findings suggest developing decongestant nanoparticles for potential treatment of allergic rhinitis. Graphical abstract Unlabelled Image [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate potential development of montelukast sodium (MTS) as a nasal spray. Materials and methods: The formulations were prepared using hydroxypropyl cellulose (HPC) and carbomer 940 (C940). The prepared formulations were evaluated for clarity, pH, hydrodynamic size, zeta potential, viscosity, contact angle, surface tension, droplet size distribution, muco-adhesiveness, drug release, and stability. The suitable formulations were also assessed for their effects on nasal epithelial cells. Results and discussion: At room temperature (25 °C), the formulation containing 0.01% w/v C940 exhibited suitable viscosity and rheological properties. Spray droplets were in ranges of 10-40 µm, which are suitable for nasal administration. The works of adhesion of the formulations containing HPC or C940 were in the range of 0.8-4.0 and 0.2-27 µJ, respectively. In addition, the formulation containing 0.01% w/v C940 and the 0.5-15 µg/50 µL concentrations of MTS showed no signs of cytotoxicity and did not open the tight junction of nasal epithelial cells. Conclusion: The formulated MTS nasal spray is ideal for nasal administration for the treatment of allergic rhinitis. The formulation containing 0.01% w/v C940 had no toxicity nor alteration on the tight junction of nasal epithelial cells. [ABSTRACT FROM AUTHOR]

Abstract Objectives Given the increasing prevalence of AR amongst children, we aimed to review the literature regarding the future of AR in this population. Methods We searched the PubMed, Google and Proquest Central databases at Kırıkkale University Library. Search terms used were: "allergic rhinitis", "children", "paediatric", "allergy", "future", "risk factors", "treatment", "pharmacotherapy" and/or "allergen – specific immunotherapy". With regard to risk factors for allergic rhinitis, the terms " Environmental factors", "Improved hygiene", "Increased indoor allergen exposure", "Farms, villages, worms, and other parasites", "Environmental toxicants", "Diet", "Lifestyle changes", "Air pollution" and "Climate factors" were searched for. "Prevention of allergic diseases" and "Allergen-specific immunotherapy in the future" were also included in the search. Results AR has a high prevalence and causes considerable morbidity, has associated comorbidity and features specific complications. The principal treatments rely on avoiding the allergens responsible, and administering drug treatment or immunotherapy, which targets specific antigens. Genetic drift does not explain the rising prevalence of allergic disorders, but multifactorial environmental factors are likely culprits. Amongst such environmental factors to consider are the rise in caesarean births, decreases in breast feeding, dietary changes resulting in less fresh produce being consumed, the eradication of intestinal worm infestations, alterations in the way homes are aired and heated, children taking less exercise and being outdoors for shorter periods, whilst also having more contact with pollution. Conclusion Barring substantial lifestyle alterations, more and more children are likely to develop AR. It may prove feasible to stop allergy developing in the first place through manipulation of the microbiome, but the exact format such a modification should involve remains to be discovered. Molecular allergological techniques do offer the prospect of more precisely targeted immunotherapy, the sole disease modifier at present. However, at present the complexity and cost of such interventions prevents their widespread use and research in this area is still needed. The majority of children with AR are going to be managed using nasal saline sprays, since they are the most straightforward and least risky alternative for first line treatment. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • PM2.5 exposure exacerbates AR in mice. • PM2.5 regulates the polarization of the Th1/Th2 balance by epigenetic regulation. • The ERK-DNMT pathway was involved in epigenetic regulation of PM2.5. Abstract Allergic rhinitis (AR) is a common chronic inflammatory disease that has a significant impact on the quality of life of patients. Our previous study suggested that PM2.5 might affect pediatric AR through epigenetic regulation, but the underlying mechanisms remained unclear. In this study, an experimental murine AR model was created, and the nasal symptoms, pathological changes, the DNA methylation level of the IFN- γ gene promoter and activation of the ERK-DNMT pathway were evaluated after treatment with PM2.5. Our results showed that PM2.5 exposure led to more severe symptoms of AR in mice. In addition, PM2.5 exposure significantly decreased the percentage of Th1 T cells in the AR group, and this change was correlated with increased DNA methylation of the IFN-γ gene promoter in CD4 + T cells (r=-0.916, p = 0.029). In addition, PM2.5 exposure increased the activation of the ERK-DNMT pathway in CD4+ T cells, and inhibiting this effect rescued the polarization of the Th1/Th2 balance toward Th2, thereby decreasing the risk of AR. Our findings demonstrate that PM2.5 exposure could exacerbate AR by increasing the DNA methylation of the IFN-γ gene promoter in CD4 + T cells via the ERK-DNMT pathway, and these effects were rescued when the ERK-DNMT pathway was inhibited. [ABSTRACT FROM AUTHOR]

Abstract Background Allergic rhinitis (AR) is the main cause of irreversible blindness in older individuals. Our study aims to identify the key genes and upstream regulators in AR. Methods To screen pathogenic genes of AR, an integrated analysis was performed by using the microarray datasets in AR derived from the Gene Expression Omnibus (GEO) database. The functional annotation and potential pathways of differentially expressed genes (DEGs) were further discovered by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. We constructed the AR-specific transcriptional regulatory network to find the crucial transcriptional factors (TFs) which target the DEGs in AR. Electronic validation was performed to verify the DEGs obtained by integrated analysis. Results From two GEO datasets obtained, we identified 793 DEGs (460 up-regulated and 333 down-regulated genes) between AR and normal control (NC). After GO and KEGG analysis, chronic inflammatory response and MAPK signaling pathway were significantly enriched pathways for DEGs. The expression of 6 genes (CLC, CST1, CRTAM, ILK, STAT1, and POSTN) was detected. The 6 genes in GEO: GSE51392 dataset played the same pattern with that in our integrated analysis. Conclusions The dysregulation of 3 genes (CST1, CLC and STAT1) may be involved in the pathogenesis of AR. AP-1 was associated with AR by regulating CST1 and CLC. Our finding can contribute to developing new potential biomarkers, revealing the underlying pathogenesis, and further raising new therapeutic targets for AR. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a chronic disease affecting a large amount of the population. To optimize treatment and disease management, it is crucial to detect patients suffering from severe forms. Several tools have been used to classify patients according to severity: standardized questionnaires, visual analogue scales (VAS) and cluster analysis. The aim of this study was to evaluate the best method to stratify patients suffering from seasonal AR and to propose cut-offs to identify severe forms of the disease. In a multicenter French study (PollinAir), patients suffering from seasonal AR were assessed by a physician that completed a 17 items questionnaire and answered a self-assessment VAS. Five methods were evaluated to stratify patients according to AR severity: k-means clustering, agglomerative hierarchical clustering, Allergic Rhinitis Physician Score (ARPhyS), total symptoms score (TSS-17), and VAS. Fisher linear, quadratic discriminant analysis, non-parametric kernel density estimation methods were used to evaluate miss-classification of the patients and cross-validation was used to assess the validity of each scale. 28,109 patients were categorized into “mild”, “moderate”, and “severe”, through the 5 different methods. The best discrimination was offered by the ARPhyS scale. With the ARPhyS scale, cut-offs at a score of 8–9 for mild to moderate and of 11–12 for moderate to severe symptoms were found. Score reliability was also acceptable (Cronbach’s α coefficient: 0.626) for the ARPhyS scale, and excellent for the TSS-17 (0.864). The ARPhyS scale seems the best method to target patients with severe seasonal AR. In the present study, we highlighted optimal discrimination cut-offs. This tool could be implemented in daily practice to identify severe patients that need a specialized intervention. [ABSTRACT FROM AUTHOR]

Objective: To study and review the currently available mobile applications relating to allergic rhinitis. Methods: The Apple and Google mobile app stores were queried with search terms relating to allergic rhinitis. Apps were assigned to categories and analyzed based on description and characteristics such as popularity, reviews, cost, platform, and physician involvement in development. Results: A total of 72 apps related to allergic rhinitis were identified. Fifty-four apps were unique, with 18 apps found on both operating systems. Forty (55.5%) apps were available in the Apple App store, and 32 (44.4%) apps were available in the Google Play app store. They were grouped into the following categories: patient education (18; 25%), journals (15; 20.8%), symptom tracking (14; 19.4%), clinical/private practice (13; 18.1%), pollen forecast (7; 9.7%), medical education (4; 5.6%), and other (1; 1.4%). The majority of apps were free of charge (67; 93.1%), with paid apps ranging from $1.47 to $4.99. Apps that were reviewed had an average rating of 3.9 out of 5. Physicians were involved in the development of 37 (51.4%) apps. Conclusions: The collection of mobile apps developed for allergic rhinitis includes those for both educational and clinical use. Mobile apps may have an increasing role in otolaryngic allergy and rhinology practices in the future. Thus, continued research is warranted to determine the best way to ensure the accuracy and quality of app content as well as the extent mobile apps can benefit allergic rhinitis patients. [ABSTRACT FROM AUTHOR]

Introduction: Allergic rhinitis (AR) is a disorder with high prevalence worldwide. Identification of clinically relevant allergens is the key step for the diagnosis, allergen avoidance and allergen specific immunotherapy for AR. Areas covered: With the new findings of mechanisms of AR and the development of technology, much progress has been achieved in the diagnosis of AR recently. We review the recent advances about local IgE, in vivo and in vitro tests, cytological diagnosis and nitric oxide (NO) in the diagnosis of AR. Expert commentary: AR is traditionally diagnosed with the combined evaluation of history and allergen sensitization by in vivo skin prick tests and in vitro allergen specific IgE in serum, to confirm the correlation between clinical history and potential allergens. Nasal provocation test and local IgE measurement can be used to diagnose local AR. Allergen microarray has the ability to detect more potential allergens. Basophil activation and mast cell activation tests can be used in allergen diagnosis and to modify the response to immunotherapy, while cytological diagnosis is useful in the differential diagnosis of AR and non-AR. Nasal NO has been confirmed to be an optimal biomarker to discriminate between AR and non-AR. [ABSTRACT FROM AUTHOR]

Glycyrrhizic acid (GA), the major bioactive component of glycyrrhiza, possesses anti-inflammatory, anti-allergic, and immunomodulatory activities. This study aimed to investigate the in vitro anti-allergic effect of GA through the OX40 receptor in patients with allergic rhinitis. Purified naive CD4+ T cells of patients with allergic rhinitis (n = 12) were activated with anti-CD3/anti-CD28 with and without anti-OX40 agonist mAbs and then treated with 50, 100, and 200 μM GA and 0.1 μM dexamethasone. Cells were incubated (72 h) to measure cell proliferation. Expression of OX40 in anti-OX40 mAb stimulated CD4+ T cells was evaluated by flow cytometry. mRNA expression of the OX40 receptor and T-bet, GATA-3, and forkhead box P3 (FoxP3) transcriptional factors were measured by a quantitative polymerase chain reaction. The levels of interleukin (IL)-4, IL-10, and interferon-γ (IFN-γ) were also measured. GA inhibited significantly the augmented T cell proliferation induced with anti-OX40 mAb. Protein and gene expression of OX40 was also decreased significantly. Dexamethasone and GA inhibited T-bet and GATA-3 genes expression, but this inhibition was only significant for GATA-3. In contrast, enhanced gene expression of FoxP3 was seen using 200 μM GA and dexamethasone. The levels of IL-4, IL-10, and IFN-γ decreased after treatment with both dexamethasone and GA, but the ratio of IFN-γ/IL-4 (Th1/Th2 balance) increased significantly due to 200 μM GA treatment. This study suggests that GA may have a therapeutic effect on allergic rhinitis, partly by modulation of the Th1/Th2 balance through suppression of OX40 and increasing the activity of regulatory T cells. [ABSTRACT FROM AUTHOR]

Purpose: Berberine and coenzyme Q10 (CoQ10) are agents with anti-inflammatory and antioxidant characteristics. The purpose of this study was to investigate the effectiveness of berberine and CoQ10 on allergic rhinitis.Methods: This study involved 30 Sprague-Dawley rats, and allergic rhinitis model was established with induction of ovalbumin. Rats were randomized into five groups. The first represented the control group, in which no allergy was established. The second represented the allergy group, in which allergy was induced but no treatment was given. In the remaining three groups, following induction of allergy, desloratadine at a dose of 10 mg/kg was given to Group 3, 100 mg/kg dose of berberine to Group 4, and 20 mg/kg dose of CoQ10 to Group 5. Nasal symptom scores, and plasma immunoglobulin-E, interleukin (IL)-4, IL-13, malondialdehyde (MDA) and nitric oxide (NO) levels were examined at the end of the study. Rats’ nasal tissues were also subjected to histopathological immunohistochemical examination.Results: Nasal symptom scores, and plasma immunoglobulin-E, IL-4, IL-13, MDA and NO levels increased significantly in rats with induced allergic rhinitis. Berberine and CoQ10 significantly reduced these elevated levels. CoQ10 was also found as effective as desloratadin in terms of nasal symptom scores and biochemical parameters. At histopathological examination, severe allergic inflammation was observed in rats from allergic rhinitis group. At all treatment groups, the histopathological changes were significantly improved and only a mild inflammation was determined. Also, immunochemistry showed a significant improvement in all three treatment groups. Coenzyme Q10 and berberine were both effective in suppressing allergy symptoms.Conclusion: We think that berberine and coenzyme Q10 can usefully be employed as therapy due to their antioxidant and anti-inflammatory effects in an experimentally induced allergic rhinitis model. [ABSTRACT FROM AUTHOR]

Abstract Allergic rhinitis (AR) is a global health problem because of its steadily increasing incidence and prevalence that currently affects about 30% of people worldwide. β-eudesmol has various beneficial effects, including anti-cancer and anti-allergic activities. However, the effects of β-eudesmol on AR have not yet been clarified; thus, we investigated the effects of β-eudesmol in an ovalbumin-induced AR animal model using enzyme-linked immunosorbent assay, histamine assay, Western blotting, and hematoxylin and eosin staining methods. β-eudesmol reduced the nasal rubs score and levels of histamine and immunoglobulin E in serum of AR mouse. In addition, the levels of thymic stromal lymphopoietin, interleukin-1β, tumor necrosis factor-α, and macrophage inflammatory protein-2 were down-regulated and infiltration of eosinophils and the level of intercellular adhesion molecule-1 were inhibited by β-eudesmol administration. β-eudesmol administration also reduced active caspase-1 and nuclear factor-κB DNA binding activity in nasal mucosa tissues of AR mice. Taken together, these results indicate that β-eudesmol would be effective for the treatment of allergic and inflammatory diseases, such as AR. Highlights • β-eudesmol reduced nasal rubs score, histamine, and IgE in an allergic rhinitis (AR) murine model. • β-eudesmol inhibited TSLP level and eosinophil infiltration in AR mice. • β-eudesmol decreased caspase-1 activation and NF-kB activity in nasal mucosa tissues of AR mice. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent studies suggest that T helper 17 (Th17) cell subset, a distinct pro‐inflammatory CD4 +  T cell lineage, may play an important role in the pathophysiology of allergic rhinitis (AR). However, the regulation of Th17 response in allergic disease is not well characterized. Methods: Thirty AR and 30 healthy children were enrolled. Serum leptin and OPN levels were measured, and their correlation with IL‐17 expression was analyzed using enzyme‐linked immunosorbent assay (ELISA). Th17 cell differentiation and cytokine production in peripheral blood mononuclear cell (PBMCs) stimulated by leptin and OPN and related inhibitors were analyzed by ELISA. AR mice models were also established to verify the effect of leptin and OPN on Th17 cell regulation. Immunoprecipitation was performed to explore the interaction between OPN and leptin in Th17 cells. Results: Our results showed that elevated serum leptin and OPN in AR children were correlated with serum IL‐17 level (r = .53, P < .01). The recombinant leptin and OPN enhanced Th17 responses from PBMCs synergistically through nuclear factor κB (NF‐κB), mitogen‐activated protein kinase (MAPK), and c‐Jun N‐terminal kinase (JNK) pathway and β3 integrin receptor. The AR mice showed as more severe Th17 responses and symptoms compared with control mice. Immunoprecipitation showed that OPN and leptin may interact with each other directly, and this process may be mediated by β3 integrin. Conclusions: Our data provide evidence that upregulation of leptin and OPN promotes Th17 responses in AR, and this process may be achieved through NF‐κB, MAPK, and JNK pathway and β3 integrin. [ABSTRACT FROM AUTHOR]

Abstract: Background: The use of allergen immunotherapy (AIT) for allergic rhinitis and its clinical efficacy in clinical trials depends on the effective determination of pollen allergen exposure time periods. We evaluate pollen data from Germany to examine the new definitions on pollen season and peak pollen period start and end as proposed by the European Academy of Allergy and Clinical Immunology (EAACI) in a recently published Position Paper. The aim was to demonstrate the ability of these definitions to mirror symptom loads for grass and birch pollen‐induced allergic rhinitis based on real‐life data. Methods: Data coming from four pollen monitoring stations in the Berlin and Brandenburg area in Germany and for 3 years (2014‐2016) were used to investigate the correlation of season definitions, birch and grass pollen counts and total nasal symptom and mediation scores as reported by patients in “Patients Hay fever Diaries” (PHDs). After the identification of pollen periods on the basis of the EACCI criteria, a statistical analysis was employed, followed by a detailed graphical investigation. Results: The analysis revealed that the definitions of pollen season as well as peak pollen period start and end as proposed by the EAACI are correlated to symptom loads for grass and birch pollen‐induced allergic rhinitis reported by patients in PHDs. Conclusion: Based on our analysis, the validity of the EAACI definitions on pollen season is confirmed. Their use is recommended in future clinical trials on AIT as well as in daily routine for optimal patient care. [ABSTRACT FROM AUTHOR]

Abstract: Background: Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect “real‐world” everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real‐life treatment of allergic rhinitis (AR) using mobile technology. Methods: A mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries. Results: A total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1‐antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control). Conclusions: This study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses. [ABSTRACT FROM AUTHOR]

Carbinoxamine maleate is an antihistamine drug with mild sedation effects, which is used to treat seasonal and perennial allergic rhinitis clinically. In order to optimize drug therapy, reduce drug accumulation, lessen the frequency of adverse effects and facilitate clinical research, a high performance liquid chromatography tandem mass spectrometry assay was firstly established and fully validated for the quantitative admeasurements of carbinoxamine. After extraction with ethyl acetate, the chromatographic separation was implemented on a C18 column (Hypersil GOLD, 100 mm × 2.1 mm, 3.0 μm) using gradient elution with water (containing 0.1% formic acid) and methanol at the flow rate of 0.4 mL/min. The analytes were measured under multiple reactions monitoring (MRM) mode with m/z 291.2 → 202.1 for carbinoxamine and m/z 285.0 → 193.2 for diazepam (IS) using electrospray ionization source (ESI) in the positive ion mode. A satisfactory linearity was obtained over the wide extent of 0.1–100.0 ng/mL ( r  > 0.99). Inter- and intra-day precision and accuracy of the assay were favorably accorded with the currently recognized limits (< 8.9%). The mean extraction recoveries for carbinoxamine ranged from 74.00% to 86.4%. The pharmacokinetic characteristics of carbinoxamine were subsequently evaluated in beagles. Following intragastric administration (0.534 mL/kg), carbinoxamine possessed a large apparent volume of distribution of the central compartment ( Vc  = 1005.7 ± 945.9 L/kg), oral clearance ( Cl  = 112.446 ± 53.249 L/h/kg), and a relatively long absorption time ( T max  = 2.38 ± 1.00 h). This analytical method with adequate sensitivity was applicable to pharmacokinetic study and could monitor concentrations of carbinoxamine in beagle plasma. Moreover, the methodology could be used for further bioequivalence determination and addressing metabolism associated with the drug. [ABSTRACT FROM AUTHOR]

The experimental model of combined allergic rhinitis and asthma syndrome (CARAS) has shown that CpG oligodeoxynucleotides (CpG-ODNs) are potential inhibitors of type 2 helper cell-driven inflammatory responses. Currently available CpG-ODNs modestly inhibit allergic responses in CARAS, while a combination strategy for upper airway treatment by co-administration of CpG-ODNs and glucocorticoids may show good efficacy. This study aimed to assess the therapeutic effects of CpG-ODNs combined with budesonide (BUD) on upper and lower-airway inflammation and remodeling in mice with CARAS induced by chronic exposure to ovalbumin (OVA), exploring the possible underlying molecular mechanisms. A BALB/c mouse model of chronic CARAS was established by systemic sensitization and repeated challenge with OVA. Treatment with CpG-ODNs or BUD by intranasal administration was started 1 h after OVA challenge. Then, nasal mucosa and lung tissues were fixed and stained for pathologic analysis. The resulting immunologic variables and TSLP-DC-OX40L axis parameters were evaluated. Both CpG-ODNs and BUD intranasal administration are effective on reducing Th2-type airway inflammation and tissue remodeling. Co-administration of CpG-ODNs and BUD was more effective than each monotherapy in attenuating upper and lower-airway inflammation as well as airway remodeling in chronic CARAS. Notably, combination of CpG-ODNs with BUD modulated the TSLP-DC-OX40L axis, as demonstrated by decreased TSLP production in the nose and lung, alongside decreased TSLPR and OX40L in DC. Intranasal co-administration of CpG-ODNs and BUD synergistically alleviates airway inflammation and tissue remodeling in experimental chronic CARAS, through shared cellular pathways, as a potent antagonist of the TSLP-DC-OX40L axis. [ABSTRACT FROM AUTHOR]

Summary: Background: In humans, both basophils and dendritic cells (DCs) express the high‐affinity IgE receptor (FcεRI). Objective: To gain more insight into the relation between serum IgE levels and FcεRI expression and IgE binding by DCs and basophils in house dust mite (HDM) allergy and during subcutaneous immunotherapy (SCIT). Methods: We measured FcεRI, IgE and HDM allergen on DCs (conventional type 2 DCs, cDC2s; plasmacytoid dendritic cells, pDCs) and basophils by flow cytometry in 22 non‐allergic vs 52 allergic subjects and upon HDM SCIT in 28 allergic subjects. IgE levels were measured in serum. Results: Serum IgE correlated differentially with FcεRI expression and IgE binding depending on cell type and allergic status. In non‐allergic subjects, FcεRI/IgE surface densities increased with serum IgE to a significantly stronger degree on basophils compared to cDC2s. By contrast, in allergic subjects FcεRI/IgE surface densities increased with serum IgE to a slightly stronger degree on cDC2s compared to basophils. In addition, the data set suggests sequential loading of IgE onto FcεRI expressed by these cells (basophils>cDC2s>pDCs). Finally, HDM SCIT induced a temporary increase in serum IgE, which was paralleled by a peak in FcεRI and IgE on DCs, but not on basophils. Conclusions & Clinical Relevance: This study provides a comprehensive insight into the relation between serum IgE and FcεRI/IgE on basophils and DC subsets. The novel finding that HDM SCIT induces a temporary increase in FcεRI expression on DCs, but not on basophils, can be an incentive for future research on the potential tolerogenic role of IgE/FcεRI signalling in DCs in the setting of allergen immunotherapy. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of auricular acupressure on symptoms of patients with allergic rhinitis and their quality of life. Methods: A quasi experimental was used with a nonequivalent control group pretest-posttest method involving 56 adult outpatients who were seen in the Allergy & Asthma clinic at a tertiary referral hospital in Seoul, Korea. The experimental group (n=28) received 2 weeks of auricular acupressure to the Shenmen, wind stream, endocrine, adrenal, and lung acupuncture points; no acupressure was provided to the control group (n=28). Outcome measures included Total Nasal Symptom Score used to assess nasal symptoms, and the Rhinoconjunctivitis Quality of Life Questionnaire to assess the quality of life. Repeated measure ANOVA and independent t-test were used to calculate statistical significance. Results: The experimental group showed significant improvements in terms of allergic rhinitis symptoms (p<.001) and on the Rhinoconjunctivitis Quality of Life Questionnaire (p<.001) compared to the control group. Conclusion: Finding in this study indicate that auricular acupressure can be used as a nursing intervention to alleviate nasal symptoms and improve rhinoconjuctivitis quality of life in allergic rhinitis patients. [ABSTRACT FROM AUTHOR]

Prevalence of allergic diseases is increasing worldwide. Allergen-specific immunotherapy (ASIT) is potentially the only curative treatment for allergy, but there is a lack of reliable methods to monitor the immune responses to ASIT and to predict clinical efficacy. Recently, the definition of allergen sensitivity threshold (CD-Sens) by Basophil Activation Tests has been suggested as potential method in this context. The aim of this study was to compare trends of CD-Sens, measured by the markers CD63 and CD203c, and clinical symptoms in subjects with allergic rhinitis receiving Sublingual Immunotherapy (SLIT). 26 rhinitis patients allergic to Parietaria were selected and matched into two groups; a SLIT treated group (SG) and a reference group (RG) treated by traditional anti-allergic medications. Visual Analogue Scale (VAS) score for the four cardinal symptoms of rhinitis and peripheral blood was collected before the first dose of SLIT (T 0 ) and after 12 months (T 12 ) to define the severity of the symptoms and the sensitivity of basophils to Parietaria . The comparison between T0 and T12 in SG patients showed a significant decrease of symptom severity (VAS score) and an increased tolerability of basophils to Parietaria (CD-Sens) both by CD63 and CD203c. But, only CD203c seems to be correlated with the clinical symptoms. These data corroborate the hypothesis that SLIT could change the immunological course of allergic sensitization already in the first year, and that an immunological parameter as CD-Sens measured by CD63 and CD203c expression on stimulated basophils could be useful to monitor the changes in the immune system. [ABSTRACT FROM AUTHOR]

Epidemiological studies show female predominance in the prevalence of non- allergic rhinitis (NAR) and local allergic rhinitis (LAR). Experimental studies show female patients with allergic rhinitis (AR) demonstrate higher levels of sensitivity to irritants and airway hyperresponsiveness than males. Bronchial asthma shows female predominance in post-puberty patients, and gender interaction with severe asthma endotypes. Fibromyalgia, chronic fatigue syndrome, migraine and chronic cough, syndromes, which are commonly related to neurokinin substance P (SP) in the literature, also show strong female predominance. Studies have demonstrated that sex hormones, primarily oestrogens, affect mast cell activation. Mast cell proteases can amplify neurogenic inflammatory responses including the release of SP. Based on human epidemiological data and animal experimental data we hypothesized that female patients have different interaction between mast cell activation and neurogenic inflammation, i.e. substance P release, resulting in a different nasal symptom profile. To test the hypothesis we performed allergen and non-specific nasal challenges in patients with seasonal allergic rhinitis (SAR) out of season and looked for gender differences in subjective and objective responses. The interaction between subjective and objective reactivity was evaluated through the comparison of subjective symptom scores, concentrations of neurokinin substance P (SP) and cellular markers in nasal lavages after low doses of nasal allergen challenges. Female allergic subjects tended to have higher substance P (SP) concentrations both before and after non-specific challenges. The difference between post-allergen and post - hypertonic saline (HTS) challenge was highly significant in female patients (p = 0.001), while insignificant in male subjects (p = 0.14). Female patients had significantly stronger burning sensation after HTS challenge than male. These data indicate difference in the interaction between inflammatory cells and the neurogenic response, which is gender- related, and which may affect symptom profiles after challenges. Different regulation of neurogenic inflammation in females may have impact on symptoms and endotyping in respiratory disorders, not only in allergic rhinitis, but also asthma, chronic rhinosinusitis and irritant -induced cough. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists have a key role to play in the management of allergic rhinitis (AR). Their role is especially important because the majority of medications used to treat AR are available for purchase over-the-counter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients' self-selection often results in suboptimal treatment selection, undertreated AR and poor clinical outcomes. In order for pharmacists to optimise the care for AR patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement. Objectives: This study aimed to compare the demographics, clinical characteristics and medication selected, between pharmacy customers who choose to self-select and those who speak with a pharmacist when purchasing medication for their AR in a community pharmacy and identify factors associated with AR patients' medication(s) self-selection behaviour. Methods: A cross-sectional observational study was conducted in a convenience sample of community pharmacies from the Sydney metropolitan area. Demographics, pattern of AR symptoms, their impact on quality of life (QOL) and medication(s) selected, were collected. Logistic regressions were used to identify factors associated with participants' medication self-selection behaviour. Results: Of the 296 recruited participants, 202 were identified with AR; 67.8% were female, 54.5% were >40 years of age, 64.9% had a doctor's diagnosis of AR, and 69.3% self-selected medication(s). Participants with AR who self-select were 4 times more likely to experience moderate-severe wheeze (OR 4.047, 95% CI 1.155-14.188) and almost 0.4 times less likely to experience an impact of AR symptoms on their QOL (OR 0.369, 95% CI 0.188-0.727). Conclusions: The factors associated with AR patients' self-selecting medication(s) are the presence of wheeze and the absence of impact on their QOL due to AR symptoms. By identifying this cohort of patients, our study highlights an opportunity for pharmacists to engage these patients and encourage discussion about their AR and asthma management. [ABSTRACT FROM AUTHOR]

Background: In February 2015, the American Academy of Otolaryngology–Head and Neck Surgery (AAO‐HNSF) published the Allergic Rhinitis Clinical Practice Guideline (AR‐CPG). The objective of this study was to assess otolaryngologists’ perception of the accuracy and adherence to the AR‐CPG. Methods: A survey was distributed to fellows of the American Academy of Otolaryngic Allergy and members of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. A total of 601 otolaryngologists responded. The survey evaluated otolaryngologists’ demographic data, perception of the accuracy of the guideline, and adherence to the guideline action statements. Results: The majority of respondents were actively practicing (544 [90.5%]), for a duration of 11–30 years (308 [51.2%]), in a private practice setting (387 [64.4%]). The cohort was largely fellowship trained (348 [57.9%]) and had reviewed the guideline (428 [71.2%]). Most respondents perceived the guideline as being correct “a great deal” (295 [69.7%]) and deviated from the guideline “only a little” (302 [71.6%]). High rates of adherence to the strong guideline recommendations were observed. Respondents “always/most of the time” recommended intranasal steroids (581 [97.6%]), and oral antihistamines (439 [74%]) as primary therapy. Otolaryngologists in practice for longer were more likely to deviate from the guideline recommendations by obtaining sinonasal imaging (p = 0.007) and recommending oral leukotriene receptor antagonists as primary therapy (p = 0.0001). Conclusion: Overall perception of the correctness of and adherence to the AR‐CPG was high in this cohort. Targeted education resources should be provided to otolaryngologists in practice for longer in efforts to reduce harmful or unnecessary variations in care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to demonstrate the effect of nasal steroid treatment on intraocular pressure and dry eye in allergic rhinitis patients with dry eye. Materials and Methods: Twenty-nine patients with a diagnosis of allergic rhinitis and dry eye were included. Symptoms and findings of patients before and after nasal steroid therapy were compared. Result: Ocular Surface Disease Index scores for dry eye symptoms showed significant improvement after nasal steroid treatment (p = 0.003). In the Schirmer test, no significant change was observed in the right or left eye (p = 0.167 and p = 0.489). For the tear film break-up time, no significant change was observed in the right or left eye (p = 0.076 and (p = 0.170). No significant change was observed in the right eye or the left eye in an intraocular pressure test (p = 0.893 and p = 0.495). Conclusion: In our study, symptoms of dry eye with allergic rhinitis were significantly improved with nasal steroid therapy, without affecting the intraocular pressure. [ABSTRACT FROM AUTHOR]

Objective Previous reports have indicated the association of allergy with Waldeyer's ring. The aim of this prospective study was to evaluate the correlation between the allergy and the number of eosinophils in the adenoid and tonsil tissue. Methods 101 children who were underwent adenoidectomy and/or tonsillectomy were prospectively enrolled in this study. 46 children who had positive skin-prick test for at least one of the allergen panel were sensitized and 55 children were nonsensitized as a result of skin-prick test. Hematoxylin-eosin stained sections were examined under 400× magnification in a blinded fashion in 10 random sections for all samples and compared the groups. Results The number of eosinophils in adenoid and tonsil tissue was significantly higher in sensitized patients. The number of eosinophils in the adenoid and tonsil samples also were interrelated too (p < 0.001, kappa coefficient: 0.617). As a result of ROC analysis, patients with a cut-off of ≥5 eosinophils was in the sensitized group for adenoid samples [Sensitivity value: 72.09 and specifity value: 91.84]. Patients with a cut-off of ≥3 eosinophils are in the sensitized group for tonsil samples [Sensitivity value: 52.94 and specifity value: 92.11]. Conclusion Presence of sensitization can be distinguished by looking at the number of eosinophils in the adenoid and tonsil tissue. It can be used to determine whether the patient is allergic or not. Examination of the routine hematoxylin-eosin stained adenotonsillary specimen for eosinophilia will guide us the diagnosis and treatment of allergic rhinitis and also reduce the cost considerably. [ABSTRACT FROM AUTHOR]

Background Allergic rhinitis is the most common allergic disorder. Although the management of the disease is successful in many patients, based on guidelines, some of them remain with symptoms uncontrolled with pharmacotherapy. Presently, there is no substantiated information on the control of allergic rhinitis in patients who underwent sublingual immunotherapy. Objective The purpose of this prospective follow-up study was to assess the control of allergic rhinitis in adults after a three-year course of house dust mite sublingual immunotherapy. Methods This prospective real-life study was designed to include adults with moderate to severe allergic rhinitis sensitized to house dust mite who underwent a three-year course of sublingual immunotherapy. Control of symptoms was assessed by Rhinitis Control Assessment Test (RCAT) after three years of house dust mite sublingual immunotherapy. Additionally, patients assessed their symptoms by utilizing a visual analog scale. Results A total number of 86 consecutively enrolled patients (46 (53.49%) men; mean age 26.10 years (SD = 5.85)) with moderate to severe allergic rhinitis and clinically relevant sensitization to house dust mite were evaluated. When assessed by RCAT on the third year, 74 (86.05%) had well-controlled symptoms and 20 (27.03%) of them were completely controlled. A significant reduction in visual analog scale scores—from 7.52 cm at baseline to 2.31 cm—was established (P < 0.0001). There was a strong negative correlation between RCAT scores and visual analog scale (r = −0.65; P < 0.01). Conclusion This study provided evidence that a three-year course of house dust mite sublingual immunotherapy appears effective in controlling the symptoms of allergic rhinitis. [ABSTRACT FROM AUTHOR]

Background Mometasone furoate, one of the second generation intranasal corticosteroids, is currently used in suspension form due to its poor solubility. However, this is not favorable for nasal application because of the rapid elimination of the instilled drug from the nasal cavity by mucociliary clearance and delayed onset of action due to the slow dissolution of drug in suspension. Objective The aim of this study was to determine the antiallergic effects of mucoadhesive thermosensitive in situ gel containing mometasone furoate that we developed previously to prolong the contact between the drug and nasal mucosa and to prevent drainage of the formulation in an ovalbumin-induced rat model of allergic rhinitis. Methods An experimental allergic rhinitis model was developed in female Wistar albino rats by intraperitoneal injection of ovalbumin every 2 days for 14 days followed by its repeated intranasal instillation for 7 consecutive days. Intranasal instillation of ovalbumin was continued every other day for 14 days. Mometasone furoate in situ gel (5 μg/10 µl), mometasone furoate suspension (5 μg/10 µl), and physiological saline (10 µl) were administered into the bilateral nasal cavities from day 22 to day 35. Antiallergic effects were evaluated through histopathological evaluation, analysis of ovalbumin-specific serum immunoglobulin E, and a symptom score. Results Mometasone furoate in situ gel significantly decreased the nasal symptoms and ovalbumin-specific serum immunoglobulin E level as compared with mometasone furoate suspension and physiological saline. Additionally, inflammatory histological symptoms such as mucosal edema, vascular dilatation, eosinophil infiltration, and loss of cilia within the nasal mucosa of allergic rhinitis model rats were remarkably improved with the treatment of mometasone furoate in situ gel. Conclusion These results suggest that mometasone furoate in situ gel has a better therapeutic potential for the treatment of allergic rhinitis compared to mometasone furoate suspension. [ABSTRACT FROM AUTHOR]

Mast cells play pivotal roles in innate and adaptive immunities but are also culprits in allergy, autoimmunity, and cardiovascular diseases. Mast cells respond to environmental changes by initiating regulated exocytosis/secretion of various biologically active compounds called mediators (e.g. proteases, amines, and cytokines). Many of these mediators are stored in granules/lysosomes and rely on intricate degranulation processes for release. Mast cell stabilizers (e.g. sodium cromoglicate), which prevent such degranulation processes, have therefore been clinically employed to treat asthma and allergic rhinitis. However, it has become increasingly clear that different mast cell diseases often involve multiple mediators that rely on overlapping but distinct mechanisms for release. This review illustrates existing evidence that highlights the diverse exocytic pathways in mast cells. We also discuss strategies to delineate these pathways so as to identify unique molecular components which could serve as new drug targets for more effective and specific treatments against mast cell-related diseases. [ABSTRACT FROM AUTHOR]

Introduction Allergic rhinitis (AR) affects up to 40% of the population and results in nasal itching, congestion, sneezing, and clear rhinorrhea. Objectives This study aimed to evaluate the changes in the clinical symptoms and in the level of serum interleukin (IL)-33 before and after pollen immunotherapy (IT) in patients with AR. Methods The total symptomscore and the levels of total immunoglobulin E (IgE) and IL-33 were determined in the serum of 10 non-allergic healthy controls and 45 patients with AR who were equally divided into 3 groups: GI (patients did not receive IT), GII (patients had received IT for 6 months) and GIII (patients had received IT for 2 years). Results There was a significantly higher concentration of IgE and IL-33 in the serum of patients with AR than in that of non-allergic patients. Furthermore, serum level of IL-33 decreased significantly after pollen IT. But, there was no significant reduction in the serum level of IL-33 between GII and GIII patients. Conclusion Our results show a clinical improvement associated with a decrease in serum level of IL-33 after pollen IT. [ABSTRACT FROM AUTHOR]

An editorial is presented which focuses on the guidelines presented by the European Academy of Allergy and Clinical Immunology (EAACI) for allergen immunotherapy (AIT). Topics discussed include increase in the prevalence of allergic diseases; the treatment of allergic rhinitis (AR) using allergen extracts; and safety and efficacy of AIT vaccines in adults and children both for respiratory allergy and for venom hypersensitivity.

Abstract: Background: Allergen immunotherapy has been shown to be an effective treatment for local allergic rhinitis (LAR) to house dust mites. Studies with pollen allergen immunotherapy are limited to observational studies. The aim of this study was to evaluate the clinical efficacy and safety of Phleum pratense subcutaneous immunotherapy (Phl‐SCIT) in LAR. Methods: In a randomized double‐blind placebo‐controlled study, 56 patients with moderate‐severe LAR to grass pollen received Phl‐SCIT with a depigmented polymerized pollen vaccine or placebo for the first year, and Phl‐SCIT the second one. The blind was maintained throughout the study. Primary outcome was combined symptom medication score (CSMS) during grass pollen season (GPS). Secondary clinical outcomes included organ‐specific symptoms, medication‐free days, rhinitis severity and asthma control. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal allergen provocation test (NAPT), skin testing, serum levels of specific IgG4 and specific IgE and safety were also evaluated. Results: Subcutaneous immunotherapy (SCIT) had a short‐term and sustained effect with significant improvements of all primary and secondary clinical outcomes and RQLQ score. SCIT significantly increased serum sIgG4 levels and allergen tolerance, from the 6th to 24th months of treatment. At the end of the study, 83% of patients treated with ≥6 months of SCIT tolerated a concentration of P. pratense over 50 times higher than baseline, and 56% gave a negative NAPT. SCIT was well tolerated; six mild local reactions occurred, and there were no serious adverse events related to the study medication. Conclusions: Subcutaneous immunotherapy with depigmented polymerized allergen extracts is a safe and clinically effective treatment for LAR to P. pratense. [ABSTRACT FROM AUTHOR]

The present study aimed to explore the microRNA‑let‑7e (miR‑let‑7e) expression in allergic rhinitis (AR), and to investigate the underlying molecular mechanisms. miR‑let‑7e expression in the nasal mucosa of mice and patients with AR were detected. The expression levels of three inflammatory factors, including histamine, immunoglobulin E and tumor necrosis factor‑α (TNF‑α), in the blood of AR mice and in interleukin (IL)‑13‑stimulated nasal epithelial cells (NECs) were also measured. Furthermore, the target gene of miR‑let‑7e was predicted and validated using a luciferase reporter assay. The expression levels of Janus kinase 1 (JAK1) and signal transducer and activator of transcription 3 (STAT3) were detected. The results demonstrated that miR‑let‑7e was downregulated in patients and mice with AR compared with the controls. In addition, the expression levels of inflammatory factors were higher in the blood of mice with AR compared with the control group, while miR‑let‑7e overexpression inhibited these levels in AR mice and IL‑13‑stimulated NECs. Furthermore, suppressor of cytokine signaling 4 (SOCS4) was revealed as a potential target gene of miR‑let‑7e and was negatively regulated by miR‑let‑7e. Overexpression of SOCS4 abrogated the anti‑inflammatory activity of miR‑let‑7e overexpression. Finally, miR‑let‑7e overexpression activated the JAK1/STAT3 signaling pathway. In conclusion, miR‑let‑7e may serve an important role in the progression and development of AR, while overexpression of miR‑let‑7e had an anti‑inflammatory effect by targeting SOCS4, which may be achieved by activation of the JAK1/STAT3 signaling pathway. [ABSTRACT FROM AUTHOR]

Background Sublingual immunotherapy (SLIT) can improve the symptoms of allergic rhinitis and modify its natural history; however, its efficacy varies among patients. This study aimed to determine which factors modify the effect of SLIT through post hoc analysis of a previous phase 3 trial of standardized Japanese cedar (JC) pollen extract (CEDARTOLEN ® ). Methods The study included 482 patients who had previously completed a phase 3 trial during two seasons. The SLIT and placebo groups each contained 241 subjects. Because pollen dispersal differed in the two seasons, we identified good and poor responders from the SLIT group in the 2nd season. We compared patient baseline characteristics, changes in serum immunoglobulin, and severity of symptoms in the 1st season between good and poor responders, as well as between SLIT and placebo groups. Results When we compared the baseline characteristics of good and poor responders, a significant difference was observed in body mass index (BMI) such that the patients with BMI ≥25 presented with lower treatment efficacy. No significant difference was observed in correlation with any other factors or treatment-induced alterations of serum immunoglobulin levels. We found that 75.3% of the patients with moderate symptoms and 50.9% of the patients with severe or very severe symptoms in the 1st season met our criteria for good responders in the 2nd season. Conclusions BMI might modify the effect of SLIT; however, other factors were not related clearly. The severity of symptoms in the 1st season of treatment does not predict that in the 2nd season. [ABSTRACT FROM AUTHOR]

Background: Resveratrol is a natural, nonflavonoid polyphenol, exerting anti-inflammatory activity. It has been reported that resveratrol, together with carboxymethyl-β-glucan, can reduce nasal symptoms in children with allergic rhinitis (AR). In this study, the effect of resveratrol on nasal symptoms in adults with AR was investigated. Methods: We conducted a placebo-controlled, double-blinded study. One hundred and fifty-one adults (aged 18–60 years) with severe persistent AR were divided into a placebo-treated group (n = 50), a positive control budesonide-treated group (n = 50), and a resveratrol-treated group (n = 51). They were then treated with 2 sprays (100 µL/spray) in each nostril 3 times/day for 1 month. Nasal symptoms including obstruction, itching, sneezing, and rhinorrhea, and the levels of IgE, IL-4, TNF-α, and eosinophils in the blood were assessed at baseline and after treatment. Results: Adults treated with resveratrol or budesonide achieved a significant reduction in nasal symptoms compared to the placebo-treated group. The resveratrol treatment significantly decreased the IgE, IL-4, TNF-α, and eosinophil levels in the blood. In addition, the resveratrol treatment was found to improve the quality of life of adults with AR. Conclusion: Our preliminary study showed that intranasal resveratrol is capable of significantly improving nasal symptoms in adults with AR. [ABSTRACT FROM AUTHOR]