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Introduction: It was intended to research the level changes and clinical significance of interleukin (IL)-10, transforming growth factor β1 (TGF-β1), and CD4+CD25 cytokines in paediatric allergic rhinitis (AR) accompanied with allergic asthma (AA). Material and methods: Eighty children of AA with AR receiving immunotherapy indications were included as the experimental group (EG), while another 40 healthy children in the same period were selected as the control group (CG). IL-10, TGF-β1, and CD4+CD25 levels in cells of the two groups before and after treatment were compared and analysed. Results: The serum TGF-β1 level was determined as 1,045.7 ±44.7 pg/ml in the EG at admission, remarkably higher than that in the CG (p < 0.05). The IL-10 level was 21.4 ±2.8 pg/ml; CD4+CD25 cells accounted for 9.2 ±2.4%, CD4+CD25high cells accounted for 0.6 ±0.3%. These were all greatly lower than those in the CG (p < 0.05). At discharge, the serum TGF-β1 level in the EG was 903.7 ±29.4 pg/ml, which was still memorably higher than that in the CG (p < 0.05). The IL-10 level changed to 32.8 ±3.7 pg/ml; the percentage of CD4+CD25 was 11.3 ±1.8, respectively, among CD4+T cells. These were also notably lower than those in the CG at discharge (p < 0.05). Conclusions: IL-10, TGF-β1, and CD4+CD25 level changes in cells might be of reference value as therapeutic indicators for clinical treatment or evaluation of paediatric AR with AA. [ABSTRACT FROM AUTHOR]

Background People of all ages are primarily affected by the chronic inflammatory disease asthma, which is most common in children. A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire found 7.7% of Nile Delta schoolchildren had asthma. This research was to show is their association between the underlying gene polymorphisms of NOD2 and serum level of INF beta and atopic asthma phenotype in Egyptian children and evaluate is their relationship between NOD2 gene polymorphism and the serum level of INF beta. Methods The 127 asthmatic children in this case-control study had typical asthma symptoms, and the 39 age- and sex-matched healthy controls. Subjects were divided in to three groups: Atopic asthma phenotype group: included 60 asthmatic children who had allergic rhinitis and atopic dermatitis as a predominant symptom, Wheezy phenotype group: included 67 asthmatic children presented predominantly with wheezes and controls: 39 healthy controls were chosen because they appeared to be in good health, had no history of symptoms similar to those of asthma, and had no relatives who had allergies or asthma. Results Total serum IgE and eosinophil percentage in control groups showed a positive correlation (r=0.640, P=0.006). In asthmatics, serum INF-β and IgE correlated positively (r=0.217, P=0.031). Increased Serum eosinophilic percentage was associated with decreased serum INF-β and increased serum IgE. Conclusions In comparison to the wheezy phenotype group, the percentage of eosinophils is significantly higher in the atopic asthma phenotype. Serum INF-β and IgE levels went up in tandem with the percentage of eosinophils in the blood. rs2066845 NOD2 genotype The GG genotype increased the risk of asthma in general but not the type of asthma. [ABSTRACT FROM AUTHOR]

Environmental factors play an important role in the development and exacerbation of allergic rhinitis (AR) in childhood. Indoor air pollution, such as house dust mites and secondhand smoke, can significantly increase the onset of AR, while pet dander may affect the exacerbation of AR symptoms in children. Furthermore, traffic related air pollution and pollen are outdoor air pollutants that can affect immune competency and airway responsiveness, increasing the risk of AR in children. Climate change has increased AR in children, as growth patterns of allergenic species have changed, resulting in longer pollen seasons. More extreme and frequent weather events also contribute to the deterioration of indoor air quality due to climate change. Additionally, viruses provoke respiratory tract infections, worsening the symptoms of AR, while viral infections alter the immune system. Although viruses and pollution influence development and exacerbation of AR, a variety of treatment and prevention options are available for AR patients. The protective influence of vegetation (greenness) is heavily associated with air pollution mitigation, relieving AR exacerbations, while the use of air filters can reduce allergic triggers. Oral antihistamines and intranasal corticosteroids are common pharmacotherapy for AR symptoms. In this review, we discuss the environmental risk factors for AR and summarize treatment strategies for preventing and managing AR in children. [ABSTRACT FROM AUTHOR]

Introduction: Seasonal allergic rhinitis (SAR) and bronchial asthma are typical manifestations of pollen-food sensitization in adults. There is limited information regarding the sensitization patterns of pollen-food allergy in children. Aim: To evaluate the prevalence of SAR in children with pollen-food sensitization and assess the impact of food allergens on nasal symptoms. Material and methods: Forty-three children with pollen-food sensitization aged 2--14 years were evaluated for evidence of SAR. The inclusion criteria was IgE-mediated sensitization to pollen and homologous food allergens. The control group consisted of 19 children with SAR caused by pollen without sensitization to homologous food allergens. Results: Allergic rhinitis was the main symptom in 65.1% of children; in 25.6% an association between ingestion of pollen-related foods and nasal symptoms was observed. The simultaneous sensitization to animal origin food allergens was stated in 63.3% of children with SAR. In 25.6% anaphylactic reactions to foods were registered. 37.2% of children were asymptomatic to pollen origin foods despite pollen-food sensitization. The statistically significant differences between values were noticed in comparison to the control group. Conclusions: Allergic rhinitis is a common manifestation of pollen-food sensitization in children and this type of immunological hyperreactivity should be taken into account regardless of age. The lack of association of symptoms with plant origin foods in the majority of cases and the asymptomatic course of food sensitization in more than one third of patients indicates the need for follow-up and being careful in routine recommending the avoidance diet. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. AD affects 10--20% of children worldwide and persists into adulthood in a minority of cases, affecting approximately 2--3% of the adult population, with an increased prevalence over the past decades in developed countries. Atopy is a genetic tendency to overproduce IgE class antibodies in response to common antigens found in the environment. Concurrence of different atopy such as allergic rhinitis or asthma in children with AD is estimated at 80%. AD is characterized by a vicious cycle of an allergic immune response. The emerging picture of the AD is a complex disorder with barrier dysfunction, immunological, genetic and environmental factors all playing key roles. Patients with severe or persistent disease and their families experience significant impairment in their quality of life, and in addition, AD places a heavy economic burden on society as a whole. Pathogenesis, the role of the epidermal barrier, mechanisms of cells apoptosis, the role of T cells and cytokines in AD are discussed in this article. [ABSTRACT FROM AUTHOR]

Asthma and allergic rhinitis (AR) are frequently associated. The objective of the treatment of asthma and AR should be the control of symptoms and disease progression. Therefore, the combined measurement of disease control is desirable. In this regard, a questionnaire able to together assess asthma and AR control has been validated: the CARAT (Control of Allergic Rhinitis and Asthma Test). A further pediatric version (CARATkids) has been generated. The current real-world study used different disease control measures in children and adolescents with asthma and rhinitis. A total of 138 children and adolescents were recruited at three allergy centers. CARAT, CARATkids, ACT (Asthma Control Test), cACT (children ACT), GINA (Global Initiative for Asthma) disease control classification, VAS (Visual Analog Scale) for asthma and nasal symptoms, and lung function were used in all subjects. There was a predominance of males (67.4%) and asthma was well-controlled (according to GINA classification) in about half the subjects. In children, the median CARAT and cACT values were 5 and 22 respectively. In adolescents, the median CARAT and ACT values were 23 for both tests. There were significant differences between CARAT and ACT (p = 0.035) as well as between CARATkids and cACT (p = 0.0001). However, the tests' outcomes were different as assessed in different domains. CARAT and CARATkids are disease-control measurements that give additional information to other tests, therefore, these different questionnaires to measure disease control complement each other. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is the most frequent allergic disease. Prevalence in children and teenagers in Argentina ranges between 22.3% and 34.9%. Given this situation, members of the scientific committees of Pediatrics and Rhinitis of the Argentinian Association of Allergy and Clinical Immunology (AAAeIC) have reviewed scientific evidence in order to update the therapeutic regulations of this pathology in the pediatric population. The classification and categorization of AR are currently in full review all around the world. It is necessary to make a differential diagnosis with other non-allergic types of rhinitis in children, and to confirm AR based on the clinical history, physical examination, determination of bio-markers, and/or skin tests. Non-pharmacological treatment includes education and guidelines of environmental control for allergens such as dust mites, anemophilous fungi, animal epithelium, and pollens. Step pharmacological therapy is proposed according to the control of the disease. Second-generation, non-sedating anti-histamines are the first line of therapy. The association with oral decongestants is not recommended in children under 4 years of age. Inhaled corticosteroids are the first choice for both moderate and severe forms. This document warns pediatricians about the importance of an early diagnosis, the rational use of step pharmacological therapy, and specific immunotherapy in children. [ABSTRACT FROM AUTHOR]

Abstract Emerging researches found that air pollution had some effects on childhood allergic rhinitis, but the associations between gestational and early life exposure to air pollution and childhood allergic rhinitis are unclear. This study aimed to analyze the association between gestational and early life exposure to air pollutants and childhood allergic rhinitis. There are 3165 preschool children from Wuhan and Ezhou during November to December 2017. Parents or guardians reported information on childhood allergic rhinitis, lifestyle, the health status of children and family members. The concentration of NO 2 , PM 2.5 , and PM 10 (2011–2016) were estimated by a spatiotemporal model with satellite remote sensing and land use information. We used binary logistic regression models to estimate adjusted odds ratio (aOR) and 95% confidence intervals (95%CI) for 1 μg/m3 of increase in each air pollutant during pregnancy and early life. We found that 639 (20.2%) children were diagnosed as allergic rhinitis among 3165 children. After adjusting for covariates, exposure to air pollution during pregnancy and the first year of life were significantly associated with childhood allergic rhinitis. Excessive exposure to PM 2.5 and PM 10 both increased the prevalence of childhood allergic rhinitis during pregnancy (PM 2.5 : aOR = 1.232, 95%CI: 1.201–1.263; PM 10 : aOR = 1.063, 95%CI: 1.052–1.075) and in the first year of life (PM 2.5 : aOR = 1.032, 95%CI: 1.006–1.059; PM 10 : aOR = 1.018, 95%CI: 1.005–1.031). The relationship of exposure to NO 2 and childhood allergic rhinitis was only significant for exposure during the first year of life (aOR = 1.013, 95%CI: 1.002–1.025). In summary, our findings suggested that gestational and early life exposure to air pollution is a risk factor for childhood allergic rhinitis. Highlights • Gestational and early life exposure to air pollution is a risk factor. • The effects of gestational exposure on childhood allergic rhinitis are strong. • The effects of exposure to PM on childhood allergic rhinitis are strong. [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]

Context * Allergic rhinitis is a chronic disease that usually affects children. Its etiology has been investigated for years. Objective * The aim of the study was to evaluate the diagnostic value of immunoglobulin G4 (IgG4) against common food allergens, to determine the correlation between it and immunoglobulin E (IgE), and to evaluate the role of IgG4 (ie, whether its presence should be considered to be a significant factor that induces hypersensitivity or whether an effector role in allergic rhinitis could be attributed to it). Design * This research was conducted as a randomized controlled trial. Setting * The research team performed the study in the Department of Otolaryngology and Sleep Center, Cheng Ching General Hospital-Chung Kang Branch (Taichung, Taiwan). Participants * The participants were 46 patients-29 boys and 17 girls-with an average age of 8.02 ± 2.92 y-who had been diagnosed with allergic rhinitis. Outcome Measures * Blood samples were collected from the participants. The total IgE, food-specific IgE, and food-specific IgG4 in their sera were measured using the proprietary BioIC system, which is based on the principles of the enzyme-linked immunosorbent assay (ELISA). Results * In terms of total IgE, 20 patients (43.5%) had a concentration of 1000 IU/mL. Regarding specific IgG4, 89.1% of patients were highly reactive to egg white IgG4, whereas >50% were highly reactive to egg yolk, milk, peanuts, almonds, wheat, and soybeans. Regression analysis to test the correlation between specific IgE and specific IgG4 revealed that egg whites, milk, peanuts, and almonds had significant correlations (P < .001). Conclusion * Total IgE varies widely in children with allergic rhinitis but remains one of the references for diagnosis. The main inhalational allergens are dust mites, followed by grass pollen, molds, German cockroach, and animal dander. Food allergy generates highly concentrated IgG4 and may play a role in children with allergic rhinitis. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the association between respiratory syncytial virus (RSV) infection in early infancy and health conditions such as asthma and respiratory allergies at 6 years of age in a cohort of US children born at term with no medical issues at birth.Methods: Data (1542 records) from the Infant Feeding Practices Study II and the Year Six Follow-Up study were used in the analysis. Descriptive statistics and logistic regression were conducted to estimate the magnitude and direction of potential associations between children's health conditions such as asthma, hay fever, or respiratory allergy, and RSV infection during infancy.Results: A substantial proportion of children with RSV infection in infancy were reported to have developed asthma (10.3%) and hay fever or respiratory allergy (9.4%) by 6 years of age. Analyses revealed that children with RSV infection in infancy were more likely to develop asthma (odds ratio 1.99, 95% confidence interval 1.06-3.74), and hay fever or respiratory allergy (odds ratio 2.13, 95% confidence interval 1.28-3.57) by 6 years of age. In addition, the risk of developing asthma and hay fever or respiratory allergy by 6 years of age increased considerably with a family history of these conditions.Conclusions: Our findings support the need for understanding and monitoring the long-term health outcomes of RSV infection in infancy. Appropriate prevention and treatment measures for RSV infection during infancy may reduce the incidence of associated long-term adverse health outcomes. Knowledge of the long-term complications of RSV infection in infancy, such as asthma, hay fever, or respiratory allergy, can aid in the prevention and better management of these health conditions. [ABSTRACT FROM AUTHOR]

Highlights • Both rs7130588_AG and rs7927894_CT genotypes in EMSY region were associated with a significantly increased risk of allergic rhinitis (AR). • The rs7130588_G allele was associated with a high risk of moderate-to-severe AR. • The rs2227284_TG genotype at the IL4 locus was significantly associated with decreased risk of AR; the protective effect on the different severity of AR. • A significantly positive association of one haplotype in EMSY region with AR. • A protective effect with one haplotype in IL4 on AR. Abstract Background Allergic rhinitis (AR) is one of the most common respiratory diseases in children. It is caused by a combination of genetic and environmental factors. Moderate-to-severe AR decreases the quality of life and social performance in children. Objective To investigate whether polymorphisms in previously published genome-wide association studies (GWAS) allergic disease loci are associated with childhood AR and the severity of AR symptoms in a Chinese Han population. Methods A case-control study was conducted in 503 pediatric patients with AR and 393 control Chinese school-aged subjects. AR severity was classified as mild or moderate-to-severe according to the AR and its Impact on Asthma (ARIA) guidelines. Overall, 16 tagged single-nucleotide polymorphisms (tSNPs) of published GWAS associations with allergic diseases were selected. All subjects were genotyped and analyzed for the 16 selected tSNPs using the improved multiplex ligation detection reaction (iMLDR) technique. Results Both rs7130588_AG and rs7927894_CT genotypes in EMSY region were associated with a significantly increased risk of AR (1.75-fold and 1.50-fold) compared to the AA and CC genotypes, respectively, specific to moderate-to-severe AR. The difference of rs7130588 genotypes in cases vs. controls was still statistically significant under the additive model after multiple test correction to adjust the false discovery rate (FDR) with an adjusted odds ratio of 1.818 and 95% confidence interval (CI) of 1.240–2.664 (P FDR = 0.0349). The rs7130588_G allele was only associated with a high risk of moderate-to-severe AR (1.85-fold, P age and gender_adjustment = 0.003). The rs2227284_TG genotype at the IL4 locus was significantly associated with a 0.65-fold decreased risk of AR compared to the TT genotype. The protective effect of the rs2227284_G allele was also found in different severity of AR. Haplotype analysis showed a significantly increased AR risk associated with the haplotype G-T-T (rs7130588-rs2155219-rs7927894) and a protective effect with the haplotype C-G-C (rs2243250-rs2227284-s2243290). Conclusions The loci in EMSY and IL4 can be considered as a hereditary marker for childhood AR. The rs7130588_G allele seems to predispose only to moderate-to-severe AR, though other mechanisms are also likely to be involved. [ABSTRACT FROM AUTHOR]

Objectives Allergic rhinitis (AR), a common chronic inflammatory disease in the upper airways. The prevalence of AR in children seems to be increasing recently, and the most significant causes of the increase are thought to be changes in environmental factors, especially air pollution. However, we could not find any meta-analysis on the risk of air pollution exposure on the prevalence of AR in childhood. The aim of this research was to carry out a meta-analysis on the results of recent studies (21 s t century) to present valid information about exposure to air pollution and risk of prevalence of childhood AR. Methods PubMed, Science, Google Scholar, Elsevier and MDPI web database were searched up to January 1, 2000 to February 28, 2018. Including of air pollution and AR in childhood related to the observation of literature. Meta-analysis, study quality assessment, heterogeneity analysis and publication bias test were using Stata-MP 14.1 and Review Manager version 5.3 software. Results 13 studies will be included in the meta-analysis (8 cross-sectional studies, 5 cohort studies). Exposure to NO 2 (OR Europe  = 1.031, 95%CI [1.002,1.060], P = 0.033; OR Asia  = 1.236, 95%CI [1.099,1.390], P = 0.000; OR overall  = 1.138, 95%CI [1.052,1.231], P = 0.001); Exposure to SO 2 (OR Europe  = 1.148, 95%CI [1.030,1.279], P = 0.012; OR Asia  = 1.044, 95%CI [0.954,1.142], P = 0.352; OR overall  = 1.085, 95%CI [1.013,1.163], P = 0.020); Exposure to PM 10 (OR Europe  = 1.190, 95%CI [1.092,1.297], P = 0.000; OR Asia  = 1.075, 95%CI [0.995,1.161], P = 0.066; OR overall  = 1.125, 95%CI [1.062,1.191], P = 0.000); Exposure to PM 2.5 (OR Europe  = 1.195, 95%CI [1.050,1.360], P = 0.007; OR Asia  = 1.163, 95%CI [1.074,1.260], P = 0.000; OR overall  = 1.172, 95%CI [1.095,1.254], P = 0.000). Conclusions Exposed to air pollution probable is a risk of prevalence of childhood AR. And the prevalence of AR will be increase when exposed to NO 2 , SO 2 , PM 10 and PM 2.5 , but maybe the relationship between SO 2 /PM 10 and prevalence of AR are not closely in Asia. [ABSTRACT FROM AUTHOR]

Background: There are few clinical trials that assess the efficacy of antihistamines in very young children. Rupatadine is a second-generation antihistamine indicated for the treatment of allergic rhinitis (AR) and urticaria. In this study, AR symptoms were evaluated before and after daily 1 mg/mL rupatadine oral solution administration in 2–5-year-old children. Methods: A multicenter open-label study was carried out in 2–5-year-old children with AR. Safety assessments were collected during the study including spontaneous adverse events, vital signs, and electrocardiogram (QTc interval). Additionally, evaluations of Total Five Symptoms Score (T5SS, including: nasal congestion; sneezing; rhinorrhoea; itchy nose, mouth, throat, and/or ears; and itchy, watery, and red eyes) were analyzed. Symptoms were evaluated by parents/legal guardian before and after 4 weeks of rupatadine administration, dosed according to body weight. Results: A total of 44 children received the study treatment. Only 15 adverse events were reported. All of them were of mild intensity and considered not related to the study treatment. No patient exceeded the standard parameter of >450 ms in the last visit, for the QTc interval on their electrocardiograms. From a maximum score value of 15, T5SS values at Day 14 (6.35) and Day 28 (5.42) were both statistically significant different (p [ABSTRACT FROM AUTHOR]

The article discusses association between serum zonulin presence and severity of atopic dermatitis in children in the absence of immunoglobulin E (IgE) and eosinophil. Also included are measuring zonulin concentration by using a competitive enzyme linked immunosorbent assay (ELISA) and determining relation between serum zonulin concentration and hay fever.

Background: Allergic rhinitis (AR) is a common pediatric disorder. Vitamin D is known to have effect on helper T-cells, regulatory T-cells, activated B-cells and dendritic cells linking vitamin D to various immune-related conditions and allergies. Vitamin D can significantly affect the outcome of allergic responses in AR. Objective: To study the effect of vitamin D supplementation in the treatment of children with AR. Materials and methods: Forty-two children with AR and low 25 hydroxy (OH) D3 levels were included in the study. Total Nasal Symptom Score (TNSS) and 25 (OH) D3 levels were measured before and after treatment. They were divided in two groups randomly. Both groups were given standard treatment for AR. One group received oral vitamin D (cholecalciferol: 400-800 IU as per age of the child) for 21 days. The results were compared with the other group being treated similarly but without supplementation of vitamin D. Results: Clinical improvement in terms of reduction in the TNSS was significant in the post-Vitamin D supplemented group (TNSS score pre-treatment and post treatment were 10.6 ± 2.65 and 2.76 ± 1.6 respectively in Vitamin D supplemented group and 11.04 ± 1.93 and 4.66±1.99 in the pre and posttreatment group in those who were not supplemented) (p=0.01). Significant improvement of Vitamin D levels was found post-treatment in Vitamin D supplemented group (23.06 ± 9.73 ng/ml) as compared to pretreatment (18.13 ± 4.55 ng/ml) (p<0.05) while there was no significant difference in group not supplemented with Vitamin D (pre and post treatment 18.01 ± 3.95 ng/ml and 17.99 ± 3.83 ng/ml respectively). Conclusion: Supplementation of vitamin D in patients with AR leads to significant clinical improvement. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Allergic rhinitis (AR) is immunologically and morphologically related to disorders in the lower airway. We investigated the relationship between the anatomy of the intranasal cavity and small airway resistance in subjects with nonallergic rhinitis (NAR). Methods: We enrolled 226 children who were 7 years old and participated in the Seongnam Atopy Project 2016. We evaluated nasal patency using acoustic rhinometry to measure the volume of the nasal cavity at 0‐5 cm, and measured lung function of the lower airway using an impulse oscillometry system (IOS) and spirometry. We also performed skin prick tests for 18 aero‐allergens, and measured blood total eosinophil counts (TEC) and rhinitis symptom scores for the previous month using a visual analog scale (VAS, range: 0‐10). Results: We examined 226 children, 71 (31.7%) with AR, and 62 (27.7%) with NAR. Nasal patency in children with AR (median: 8.28 mm3, IQR: 7.07‐9.83) was lower than that of healthy children (median: 9.3 mm3, IQR: 7.69‐10.64, P = 0.011). Multivariate regression analysis showed that nasal patency was inversely associated with IOS resistance at 5 Hz after adjustment for compounding factors (B = −0.005, SE = 0.0032, P = 0.041). Analysis of NAR subjects, according to quartiles of nasal patency and quartiles of small airway resistance (Rrs5), indicated that nasal patency decreased as Rrs5 increased (linear trend: P = 0.020). Conclusion: Nasal symptoms and TEC negatively correlated with nasal patency. Children with AR and NAR who had poor nasal patency had increased small airway resistance. [ABSTRACT FROM AUTHOR]

Background: GSP301 is a fixed-dose combination (FDC) of the antihistamine olopatadine hydrochloride and the corticosteroid mometasone furoate developed as a single nasal spray (NS). Objective: To assess the relative bioavailability of mometasone administered as GSP301 FDC versus two mometasone monotherapy NS formulations. Methods: In this single-dose, open-label, crossover study, healthy adults (age range, 18-65 years) were randomized equally to one of six treatment sequences for three 72-hour treatment periods with GSP301 (olopatadine 665 μg-mometasone 50 μg), the mometasone furoate monotherapy component of GSP301 (MF-sponsor, 50 μg), and U.S. Food and Drug Administration- approved mometasone (MF, 50 μg); all the treatments were administered as two sprays per nostril. To evaluate the relative bioavailability of mometasone, pharmacokinetic (PK) estimates, the maximum plasma concentration (Cmax), the area under the plasma concentration time curve (AUC) from time 0 to the last time point with measurable concentration (AUC0-t), and AUC from time 0 to time infinity (AUC0-∞) were compared by analysis of variance. Safety and tolerability were also assessed. Results: A total of 30 healthy subjects were randomized. Most subjects were white men who were not obese, mean age of ~43 years. The geometric mean ratios for natural log transformed Cmax, AUC0-t, and AUC0-∞ of mometasone in GSP301 to MF-sponsor were 113.83, 118.36, and 118.50, respectively. For GSP301 and MF, geometric mean ratios for Cmax, AUC0-t, and AUC0-∞ were 141.84, 109.92, and 115.14, respectively. The percentages of subjects who reported treatment-emergent adverse events (TEAE) were 10.0%, 13.3%, and 10.3% for GSP301, MF-sponsor, and MF treatments, respectively. All TEAEs were mild, and none resulted in discontinuation. Conclusion: Mometasone bioavailability with GSP301 was comparable with MF-sponsor and MF monotherapies. A slightly higher Cmax was observed with GSP301 than with MF, but AUC was comparable. The addition of olopatadine to mometasone in GSP301 did not considerably affect the PK of mometasone. GSP301 was well tolerated, with only mild adverse events reported. [ABSTRACT FROM AUTHOR]

Background: GSP301 is a fixed-dose combination of the antihistamine olopatadine hydrochloride and the corticosteroid mometasone furoate developed as a single nasal spray. Objective: To assess the relative bioavailability of olopatadine administered as GSP301 versus two olopatadine monotherapy nasal spray formulations. Methods: In this single-dose, open-label, crossover study, healthy adults (18-65 years old) were equally randomized to one of six treatment sequences for three 48-hour treatment periods with GSP301 (olopatadine 665 μg-mometasone 50 μg), the olopatadine monotherapy component of GSP301 (OLO-sponsor; 665 μg) and U.S. Food and Drug Administration approved olopatadine (OLO; 665 μg); each treatment was administered as a single dose (two sprays in each nostril). To assess the relative bioavailability of olopatadine in the fixed-dose nasal spray versus two monotherapies, pharmacokinetic (PK) estimates, maximum plasma concentration (Cmax), area under the plasma concentration time curve (AUC) from time 0 to the last time point with measurable concentration (AUC0-t), and AUC from time 0 to time infinity (AUC0-∞) were compared by analysis of variance. Safety and tolerability were also evaluated. Results: A total of 30 healthy adults (mean age, 43.1 years) were randomized. The majority of the subjects were white men. The geometric mean ratios for natural log transformed Cmax, AUC0-t, and AUC0-∞ of olopatadine in GSP301 and OLOsponsor were 86.63, 86.92, and 92.83, respectively. For GSP301 and OLO, geometric mean ratios for Cmax, AUC0-t, and AUC0-∞ were 84.68, 87.87, and 93.80, respectively. The percentage of subjects who reported treatment-emergent adverse events (AE) for GSP301, OLO-sponsor, and OLO were 13.8, 10.3, and 10.0%, respectively, with mild AEs reported. One subject withdrew from the study due to an AE (minor oropharyngeal pain) during OLO treatment, before receiving GSP301. Conclusion: Olopatadine bioavailability with GSP301 was comparable with OLO-sponsor and OLO. The presence of mometasone in GSP301 did not considerably affect the PK of olopatadine. GSP301 was well tolerated, with only mild AEs reported. [ABSTRACT FROM AUTHOR]

Background: Results of epidemiologic studies have determined several risk factors for asthma in school-age children. Objective: To examine whether parental and perinatal risk factors, along with infantile feeding patterns, were associated with asthma in children with grass pollen allergy and allergic rhinitis. Methods: We retrospectively analyzed the data of our cohort, which consisted of children with allergic rhinitis. Only children with grass pollen sensitization were enrolled. A detailed questionnaire regarding demographic features and perinatal events was given to the parents. Results: A total of 293 children (200 boys [68.3%]; with median age, 10.2 years [interquartile range {IQR}, 7.4 -13.0 years]) were included. A total of 109 children (37.2%) had accompanying asthma. The median age of onset of rhinitis symptoms was earlier (5.3 years [IQR, 4.0-8.0 years] versus 7.0 years [IQR, 5.0 -10.0 years]; p = 0.001), histories of prematurity (16.7 versus 6.5%; p = 0.006), preeclampsia (5.5 versus 0%; p = 0.001), neonatal intensive care unit admission (15.1 versus 6.0%; p = 0.01), phototherapy (17.9 versus 7.1%; p = 0.004), early formula feeding (58.7 versus 41.2%; p = 0.006), and parental asthma (25.0 versus 11.4%; p = 0.002) were more frequent in children with asthma. Multivariate logistic regression analysis revealed prematurity (odds ratio [OR] 2.78 [95% confidence interval [CI],1.24-6.24]; p = 0.013), history of formula feeding (OR 1.81 [95% CI, 1.09 -3.01]; p = 0.022), and parental asthma (OR 2.37 [95% CI, 1.22- 4.63]; p = 0.011) were associated with asthma in school-age children with grass pollen-induced allergic rhinitis. Conclusion: Close monitoring of patients with these risk factors may help with an earlier diagnosis of asthma and prompt initiation of therapeutic interventions in children with allergic rhinitis and who were sensitized to grass pollen. [ABSTRACT FROM AUTHOR]

Objectives Allergic rhinitis (AR) and asthma often occur concomitantly and are the two most common inflammatory conditions of the airways in children. Large-scale studies investigating the comorbidity of asthma and AR in children are rare. So, we performed a meta-analysis to describe the comorbidity rate of asthma and AR in Chinese children. Methods We retrieved related studies from Pubmed, Science, Springer, Elsevier, Embase, BMJ, and four Chinese biomedical databases, including Wanfang Data, VIP, CBM, and CNKI. From these individual studies, the comorbidity rate of asthma and AR in Chinese children was extracted and pooled to generate summary effect estimates in R version 3.2.3. Results The meta-analysis included 25 cross-sectional studies. The results indicated that in China, the incidence of asthma in children with AR is 35.01% (95% CI: 32.32%–37.70%) and the incidence of AR in children with asthma is 54.93% (95% CI: 53.05%–56.80%). Conclusions The comorbidity of AR and asthma is high in Chinese children. Statistically, the prevalence of AR was higher in children with asthma, as opposed to the prevalence of asthma in children with AR. The comorbidity rate of AR and asthma signifies the importance of improving the recognition and treatment under both conditions by respiratory physicians and otolaryngologists. [ABSTRACT FROM AUTHOR]

Background Allergic rhinitis is a chronic and recurrent nasal condition. It is often neglected in children with late presentation. This study aimed at determining the prevalence, sociodemographic features, comorbid illnesses, complications and quality of life in children with allergic rhinitis in the study institution. Materials and methods This is a prospective hospital based study of children with allergic rhinitis in Ekiti state university teaching hospital, Ado Ekiti. The study was carried out in ENT department over a period of two years (between June 2015 to May 2017). Informed consent was obtained from the parents/guardian/patients and consented patients were enrolled into the study. Data were obtained by pretested interviewers assisted questionnaire. Details of their history, physical examination and investigations were carried out and findings were documented. All data obtained were descriptively analysed using SPSS version 18.0 and presented in simple tables and charts. Ethical clearance was sought for and obtained from the ethical committee of the hospital. Results A total of 4341 patients were seen out of which 265 were children with allergic rhinitis. Prevalence of allergic rhinitis in children in this study was 6.1%. There were 63.0% males with male to female ratio of 2:1. Allergic rhinitis was peaked at preschool age group (1–5 years) accounted for 47.9%. A total of 42.3% participants were living in urban setting while 57.7% were from rural setting. Majorities (40.4%) of the patients were in nursery and parent's major occupation was mainly farming in 27.2%. There was positive family history of allergy in 54.7% patients. Perennial allergic rhinitis were noted in 63.8% patients while seasonal allergic rhinitis were noted in 36.2% patients. Major form of allergens was inhalant 81.8% and the least form of allergen was ingestant 5.7%. The commonest identified trigger factors among the study population were as follows: dust, cold weather and smoke which were accounted for 59.6%, 37.4% and 18.9% of the study patients respectively. Other noted triggering factors were soap and perfume which accounted for 4.2% and 1.1% respectively. Major associated comorbid illnesses among the patients were tonsils hypertrophy, adenoid hypertrophy and inferior turbinate hypertrophy which accounted for 55.5%, 46.4% and 40.4% respectively. Clinical presentations of allergic rhinitis in this study were mainly 75.8% nasal blockage, 65.3% runny nose and 8.5% recurrent sneezing. Commonest complications of allergic rhinitis were 35.1% pharyngitis, 32.1% otitis media and 28.3% headache. Treatment of allergic rhinitis leads to improvement on the clinical features in 90.1% patients. No significant improvement in clinical features were noticed in 9.8% patients. None of the studied patients reported worse clinical condition after treatment of allergic rhinitis. No mortality was recorded from allergic rhinitis in this study. Conclusion Allergic rhinitis affect all paediatric age group and there were delayed presentation in the participants. There were associated comorbid illnesses, complications and affectation of quality of life at presentation in majority of the patients. [ABSTRACT FROM AUTHOR]

Background: The safety of a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) has been established in adults and adolescents with allergic rhinitis but not in children <12 years old. Objective: To evaluate the safety and tolerability of an intranasal formulation of AZE and FP in children ages 4-11 years with allergic rhinitis. Methods: The study was a randomized, 3-month, parallel-group, open-label design. Qualified patients were randomized in a 3:1 ratio to AZE/FP (n = 304) or fluticasone propionate (FP) (n = 101), one spray per nostril twice daily, and to one of three age groups: ≥4 to <6 years, ≥6 to <9 years, and ≥9 to <12 years. Safety was assessed by child- or caregiver-reported adverse events, nasal examinations, vital signs, and laboratory assessments. Results: The incidence of treatment-related adverse events (TRAEs) was low in both the AZE/FP (16%) and FP-only (12%) groups after 90 days' continuous use. Epistaxis was the most frequently reported TRAE in both groups (AZE/FP, 9%; FP, 9%), followed by headache (AZE/FP, 3%; FP, 1%). All other TRAEs in the AZE/FP group were reported by ≤1% of the children. The majority of TRAEs were of mild intensity and resolved spontaneously. Results of nasal examinations showed an improvement over time in both groups, with no cases of mucosal ulceration or nasal septal perforation. There were no unusual or unexpected changes in laboratory parameters or vital signs. Conclusion: The intranasal formulation of AZE and FP was safe and well tolerated after 3 months' continuous use in children with allergic rhinitis. [ABSTRACT FROM AUTHOR]

Objectives: The association between AS (asthma) and dental caries is controversial, while that between allergic rhinitis (AR) and caries has not been established. This study aimed to verify the relationship among AR, AS and dental caries. Design: Retrospective cohort study. Setting: Data from Health Insurance Database of the Taiwan's National Health Insurance Research Database. Participants: Nine thousand and thirty‐eight children born in 2004 were obtained. Their claims data were evaluated from birth to the age of 9 years. Main outcome measures: The frequencies of clinical visits for dental caries were calculated for primary teeth (age 1‐5) and for dental transitional period (age 6‐9). Differences in the frequencies of clinical visits for caries in AR vs non‐AR and AS vs non‐AS children were compared. Correlation between AR, AS and caries frequencies was studied, and the influences of AR drugs on the development of caries were evaluated. Results: After adjusting for confounding factors and AS case, the frequencies of clinical visits for caries were higher in AR (increased by 13%‐25% and P<.001 at different age periods). The AR frequencies significantly correlated with caries frequencies in children with AR. Different AR drugs also correlated with caries formation. After adjusting for confounding factors and AR case, there was no relationship between AS and caries in children. Conclusion: Asthma is not associated with dental caries, but AR can increase the frequency of clinical visits for caries. Medications for AR may also play a role in caries formation. Thus, AR may be a risk factor for childhood dental caries. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We aim to describe the data collected from India during phase 3 of the International study of asthma and allergy in childhood (ISAAC) study. Prevalence, severity, and population characteristics associated with rhinitis, rhinoconjunctivitis, and eczema were assessed. Methods: Children from two age groups (6‐7 and 13‐14 years) were included in the study as per the ISAAC protocol. The symptoms of allergy and associated features were assessed using a questionnaire. Results: The prevalence of allergic rhinitis among the 6‐7 years age group was 11.3%, while it was 24.4% in the 13‐14 years age group. The prevalence of allergic rhinoconjunctivitis was 3.9% in the 6‐7 years age group and 10.9% in the 13‐14 years age group. The prevalence of eczema was 2.8% in the 6‐7 years age group and 3.7% in the 13‐14 years age group. The passage of trucks near home, parental smoking, use of paracetamol, use of antibiotics, cooking with firewood, and television watching were associated with allergic rhinitis, rhinoconjunctivitis, and eczema. Maternal smoking was the strongest of all the associated features for allergic rhinitis, rhinoconjunctivitis, and eczema, especially in the 6‐7 years age group (odds ratio: 1.9, 95% CI: 1.5‐2.4; odds ratio: 2.9, 95% CI, 2.2‐3.9; and odds ratio: 3.5, 95% CI: 2.6‐4.8, respectively). Conclusion: Allergic conditions like allergic rhinitis, rhinoconjunctivitis, and eczema are prevalent among Indian children and are associated with environmental tobacco smoke, paracetamol use, antibiotic use, television watching, and outdoor and indoor air pollution. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D deficiency has been proposed as a potential contributing factor in patients with allergic diseases. We compared the clinical and immunological effects of vitamin D supplementation to placebo during the pollen season in children with allergic rhinitis.Material and methods: Thirty-eight children aged 5-12, sensitive to grass pollen, participated in a prospective, randomized, double-blind, placebo-controlled trial. Children received either vitamin D 1000 IU daily supplementation or placebo. We studied symptoms/medication score, lung function, exhaled nitric oxide concentration (FENO), methacholine bronchial provocation test and serum level of 25(OH)D, as well as; CD4+CD25+Foxp3+ cells, TLR4, IL-1, IL-6, TNF and the IL-10 and transforming growth factor β1 (TGF-β1) levels in cell culture supernatants.Results: Vitamin D therapy was effective in reduction of the symptoms/medication score (p = 0.0371). In vitamin D group an increase in the CD4+CD25+Foxp3+ cells (7.06 vs. 10.5%; p = 0.0013) and serum 25(OH)D concentration (49.6 vs. 96.6 ng/ml; p = 0.0001) and in control group an increase in FENO (15.6 vs. 21 ppb; p = 0.0331) and serum 25(OH)D level were observed (82.9 vs. 100.3 ng/ml; p = 0.0003).We revealed a higher increase from baseline in the percentage of CD4+CD25+Foxp3+ cells in the vitamin D group compared to the control group (p = 0.0058). A significant correlation between CD4+CD25+Foxp3+ cell induction and FENO reduction in the vitamin D group was observed (p = 0.0217).Conclusions: Vitamin D 1000 IU as a supplementary treatment of grass pollen allergy in children with allergic rhinitis during the pollen season significantly reduced the symptoms/medication score. The study revealed an immunological effect of vitamin D. [ABSTRACT FROM AUTHOR]

Background: It is difficult to identify the onset of allergic rhinitis in infants because making a conclusive diagnosis can be challenging. Objective: We used a combination of cell differentials in nasal swabs and immunoglobulin E (sIgE) antibody values to food and inhalant allergens to make the diagnosis and identify relevant allergens for investigation of the onset of allergic rhinitis. Methods: We studied 302 children, 2 to 120 months old, who visited our clinic for rhinorrhea. Nasal swabs were taken from all children, and neutrophils (N), eosinophils (Eo), and mast cells (Mc) were identified by nasal cytology and their numbers were estimated. Levels of sIgE antibodies to various food and inhalant allergens were determined in patients with nasal Eo and Mc. Results: Percentages of participants with Eo-Mc and Eo-Mc-N at 2–14 (n 84), 15–24 (n 57), 25–60 (n 73), and 61–120 months of age (n 88) were 20, 23, 58, and 65%, respectively. There were no significant differences between the 2–14 and 15–24, and 25–60 and 61–120 months age groups, but there was a significant difference between the 15–24 and 25–60 months age groups (p 0.00013). The percentages of participants with sIgE antibodies to food and inhalant allergens as solitary or main allergen were 12%/0% at 2–14 months old, 10.5%/7% at 15–24 months old, 1.3%/42.4% at 25–60 months old, and 0%/56.8% at 61–120 months old, respectively with a significant difference between 15–24 and 25–60 months old groups (p 0.00025) for inhalant allergens. Conclusion: Allergic rhinitis associated with inhalant allergens in infants 15 months of age is rare, but it is tempting to postulate that symptoms of rhinitis in these infants may be associated with sIgE antibodies to food allergens. Transition of sIgE responses from food to inhalant allergens occurred after 15 months of age, and sIgE antibodies to inhalant allergens were predominant after 25 months. [ABSTRACT FROM AUTHOR]

Background: One of the most important aspects of sublingual immunotherapy (SLIT) is the regimen of administration. Aim: To find any differences in symptom-medication scores between the two groups of SLIT tablets and drops, given pre-coseasonally (starting 8 weeks before the pollen season) in children with rhinoconjunctivitis allergy to grass pollen. The secondary outcome were the differences in lung function and induction of T-regulatory forkhead box P3 (FOXP3) positive cells. Methods: This was a retrospective, secondary analysis of pooled data obtained from our two prospective randomized placebo controlled trials that involved children who underwent SLIT. Forty-one children, ages 6-18 years, with allergic rhinitis (AR), sensitive to grass pollen, participated in the study. Results: Treatment with both tablets and drops significantly reduced all symptoms (nasal, asthma, and ocular) within the groups; there was no significant difference between both groups. When compared with the tablet therapy, there was a trend for drops therapy to be more effective in the reduction of combined symptom-medication score, but the difference was not statistically significant (p = 0.1036); there was no significant difference in asthma and nasal scores. We showed a significant decrease in the fractional exhaled nitric oxide level comparable in both immunotherapy groups. There were no differences between the groups in the induction of CD4+ CD25+ FOXP3+-positive cells in peripheral blood. Conclusions: Both protocols showed similar decreases in symptom-medication scores; however, when compared with tablet therapy, there was a trend for drops therapy to be more effective in the reduction of combined symptom-medication score. [ABSTRACT FROM AUTHOR]

Background: Saline nasal irrigation is labelled as an add-on treatment in patients with allergic rhinitis (AR). The primary aim of this study was to compare the efficacy of 21-day use of buffered hypertonic saline (BHS) versus normal saline solution (NSS) on reducing nasal symptoms in children with seasonal AR (SAR). Comparing their efficacy on nasal cytology counts (NCC), quality of life, and sleep quality was the secondary aim. Methods: In this 21-day, open-label, randomized controlled study, 36 SAR children (aged 6-13 years) with a Total 5 Symptom Score (T5SS) ≥ 5 received twice-daily BHS or NSS delivered through a nasal douche. Efficacy measures were least square mean changes (LSmc) in T5SS, NCC, Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), and Pittsburgh Sleep Quality Index (PSQI) scores. Results: BHS improved the T5SS total score to a greater extent than NSS (LSmc -6.45 vs. -5.45, p < 0.001). Concerning NCC, BHS significantly reduced the scores of neutrophils (LSmc -0.76, p = 0.004) and eosinophils (LSmc -0.46, p = 0.018), while NSS did not. Similarly, only BHS yielded a significant improvement in the PRQLQ score (LSmc -0.57, p = 0.009), whereas the improvement in PSQI score was comparable between the BHS (LSmc -0.77, p = 0.025) and NSS (LSmc -1.39, p < 0.001) groups. Overall, BHS was well tolerated. Conclusions: In children with SAR, BHS is effective in improving nasal symptoms and NCC, with an associated beneficial effect on quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Asthma and allergic rhinitis are diseases which require special attention in childhood. Risk factors for these diseases are manifold and include environmental factors. Previous studies have shown associations between indoor mould and respiratory diseases in children. Besides indoor mould, organic waste storage, potted plants, pets and crowding could influence the microbial indoor environment at home and the respiratory health of children. Our aim was therefore to explore the associations of these factors with airway-related symptoms and respiratory diseases in preschoolers.Methods: In this cross-sectional study we evaluated data based on parent-questionnaires regarding the health of their children from the 2014/2015 Health Monitoring Units (GME) in Bavaria. Bivariate and multivariate odds ratios (OR) with 95% confidence intervals (95%-CI) were calculated with logistic regression to explore associations between exposures (visible mould, organic waste storage, potted plants, pets and crowding) and outcome variables (doctor diagnosed allergic rhinitis with symptoms in the last 12 months, doctor diagnosed asthma with symptoms in the last 12 months, 12 month prevalence of symptoms such as dry cough at night without a cold, wheeze, wheeze attacks and allergic rhinitis symptoms).Results: We analysed data from 4732 children (response rate 56.7%) with a mean age of 5.3 years. Visible mould was present in 4.7% of all households and associated with doctor diagnosed asthma with symptoms in the last 12 months [aOR 2.16 (95%-CI 1.01-4.63)], wheeze in the last 12 months [aOR 1.60 (95%-CI 1.0-2.50)] and allergic rhinitis symptoms in the last 12 months [aOR 1.75 (95%-CI 1.07-2.87)]. Crowding was associated with dry cough at night without a cold in the last 12 months [aOR 1.71 (95%-CI 1.42-2.05). The other indoor factors showed no association with respiratory health of the children.Conclusion: Our results, in line with previous studies, showed positive associations between visible mould at home and airway-related symptoms and allergic diseases in children irrespective of the effect of the other considered indoor exposures. Despite the low prevalence of mould exposure in our study population, our results suggest intervention should be taken for those who do have visible mould exposure at home. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the frequency and absolute numbers of different subsets of peripheral blood cells, including CD4+ T cells and CD19+ interleukin (IL) 10+ B regulatory cells (Breg) and their potential association with clinical laboratory measurements in children diagnosed with simple asthma or asthma plus allergic rhinitis (AR). Method: The frequency and numbers of peripheral blood CD4+ interferon (IFN) gamma+ T-helper (Th) type 1, CD4+ IL-4+ Th2, CD4+ IL-17A+ Th17, CD4+CD25+ Forkhead Box P3+ regulatory T cells (Treg) and CD19+ IL-10+ Bregs in 22 children with asthma, 17 children with asthma and AR, and 25 healthy controls were determined by flow cytometry. The levels of serum cytokines were determined by enzyme-linked immunosorbent assay. Results: In comparison with healthy controls, patients with asthma alone had significantly increased numbers of Th1, Th2, and Th17 cells, and their cytokines but decreased numbers of Tregs and Bregs, and the cytokines IL-10 and transforming growth factor beta 1. This imbalance between effector and regulatory cells and their cytokines further increased in patients with asthma and AR. The ratios of percentage effector T cells (Th1 + Th2 + Th17) to regulatory cells (Treg + Breg) were positively correlated with fractional exhaled nitric oxide but negatively correlated with forced expiratory volume in 1 second in patients with asthma or asthma plus AR. Conclusion: The imbalance of effector T cells and regulatory cells contributed to the pathogenesis of airway inflammation of asthma and AR in children. [ABSTRACT FROM AUTHOR]

Leukotriene receptor antagonists (LTRAs) are identified as a monotherapy for asthma and allergic rhinitis; however, their use in children for treatment of these diseases has not been examined. Accordingly, the present study investigated the efficacy of pranlukast dry syrup for children with both pollinosis and asthma. The subjects were children receiving treatment for asthma who were also diagnosed with cedar pollen allergy. Patients were divided into a group that received continuous treatment with pranlukast (group A; n=20) and a group that commenced add-on treatment for pollinosis following the onset of symptoms (group B; n=20). Patients in group B were randomly allocated to subgroup B1 (add-on treatment with pranlukast dry syrup) or subgroup B2 (add-on treatment with a second-generation antihistamine). In both groups, nasal and ocular symptoms were evaluated every day and recorded in a diary. Exacerbation of nasal obstruction was demonstrated in group B; however, not in group A. There was a significant difference in symptoms observed between the two groups during the late peak pollen period (P<0.05). The incidence of nasal obstruction (defined as a nasal obstruction score =3 or use of a nasal steroid spray) was significantly lower in group A compared with group B (P<0.05). The maximum scores for sneezing and nasal obstruction during the late peak of the pollen season were lowest in group A, followed by subgroup B1 and subgroup B2. The present study demonstrated that long-term administration of LTRA for the management of asthma may improve nasal symptoms of pollinosis during the pollen season in children with pollinosis and asthma. [ABSTRACT FROM AUTHOR]

Introduction Allergic rhinitis is a common disease among children and adolescents, reaching up to 40% of the population. During childhood, it is usually underdiagnosed because it has nonspecific symptoms. It has a negative impact on quality of life and may predispose to comorbidities. The diagnosis is clinical and treatment aims prevention. Objective The objective of this study is to evaluate the quality of life in pediatric patients with allergic rhinitis. Methods This is an observational study with cross-sectional design. The population consisted of pediatric patients with allergic rhinitis treated at the Medical Clinic of Integrated Education (MCIE) - Universidade do Sul de Santa Catarina - Unisul, Tubarão, SC, Brazil. We collected data from March to June 2016 through the application of the Sociodemographic and Health Questionnaire, rhinitis module of the International Study of Asthma and Allergies in Childhood Questionnaire and the Rhinoconjunctivitis Quality of Life Questionnaire Modified. Results Out of the 69 respondents, 52.2% were boys with a mean age of 10.13 years old. The predominant education level of parents/guardians was incomplete second grade and average income level was two minimumwages. 81.2% said they had previous treatment for AR, 30.4% had asthma and 7.2% eczema. Incidence of patients smoking was absent and family (parents/guardians) smoking was 17.4%. March to July were the months of highest symptom occurrence, slightly disturbing daily activities. The mean value of severity was 51.9, nasal symptomswere themost uncomfortable, and nasal itchiness was themost cited. Conclusion Our results highlight that allergic symptoms negatively impact the life of people with allergic rhinitis, with a predominance of nasal symptoms, especially nasal itchy, representing a poor quality of life of the interviewed. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis is a known health problem worldwide. Objective: The aim of the study was to determine the association between breastfeeding and serum IgE level as well as its impact on quality of life in children with allergic rhinitis. Methodology: A cross sectional comparative study was done among pediatric patients aged 6-12 who have allergic rhinitis with evidence of positive skin prick test (SPT), for 30 specifically selected patients each for breastfed and non-breast-fed. For each patient, serum IgE was taken and interviewed using the modified allergy questionnaire by validated Sher Allergy Specialists questionnaire (Florida) and Rhinoconjuntivitis Quality of Life Questionnaires (RQLQ) by Juniper. Statistical analysis was performed using SPSS 13.0. The significant association was analyzed using Pearson's chi-square and Mann-Whitney U tests. Results: There was no significant difference (p = 0.688) with regards to serum IgE level between breastfed and non-breast-fed children. However, children who were breastfed have a better mean of quality of life (mean=1.1679) than non-breast-fed (mean=1.5274). Conclusion: Our study showed that there is no association between breastfeeding and serum IgE level. Nevertheless, the quality of life is better in breastfed children. A larger sample and longer duration of study are required to substantiate these findings. [ABSTRACT FROM AUTHOR]

Objectives: We investigated patterns of multimorbidities among asthma, allergies, and respiratory illnesses in preschool children. We investigated multimorbidities of lifetime asthma, allergic rhinitis, eczema, food allergy, pneumonia, and ear infections; and multimorbidities of current (in the last year before the survey) wheeze, dry cough, rhinitis, eczema, and common cold during childhood. We further analyzed whether prevalences of these multimorbidities were due to chance.Methods: A cross-sectional study was conducted in 72 kindergartens of Shanghai, China. Parents of preschool children were surveyed with a modified ISAAC questionnaire. Observed prevalences (OPs), expected prevalences (EPs), absolute excess comorbidities (AECs), and relative excess comorbidities (RECs) of various combinations of illnesses were calculated to indicate whether the combined illnesses were related.Results: We analyzed questionnaires for children aged 4–6 years, whose 13,335 questionnaires were the majority of the total 15,266 returned questionnaires (response rate: 85.3%). The studied illnesses were common. For children who had more than three lifetime or current illnesses, OPs tended to be higher than EPs. Most OPs and EPs were higher in boys than in girls, and were higher in children with a family history of atopy (FHA) than in children without FHA. AECs and RECs between boys and girls as well as between children with and without FHA were substantially different.Conclusions: Our findings suggest that multimorbidities among childhood asthma, allergies, and respiratory illnesses are likely not random, but rather share etiology. Specific patterns of childhood asthma multimorbidities perhaps differ between boys and girls and between children with and without FHA. [ABSTRACT FROM PUBLISHER]

Objective To evaluate the factors which may be related to nonadherence to intranasal corticosteroids (ICS) in the treatment of allergic rhinitis (AR) in children. Methods A prospective study was conducted on children with AR diagnosis in a tertiary referral hospital. All participants were provided with mometasone furoate nasal sprays for 30 days after the diagnosis. Caregivers were called back when the therapy was over and completed a questionnaire about the factors that may influence the adherence to the treatment. Afterwards each caregiver completed the Turkish language validated Morisky Medical Adherence Scale (MMAS-8) form. Each factor was evaluated according to MMAS-8 score and all variables were analyzed statistically. Results A total number of 76 children with a mean age of 7.82 years were included in the study. The mean overall MMAS-8 score was 2.80. There was only one factor significantly related to low adherence; the number of dependent children to the caregiver (p = 0.011). Besides this 71.51% of the answers to MMAS-8 scale were compatible with good adherence. Conclusion The clinician must consider the factors which may lead to non-adherence while setting up a treatment plan. The demographic and sociocultural factors must be taken into consideration and treatment schedule should be made in respect of daily activities of the children. Moreover the father can be involved in the therapy plan and back up the mother as they are usually the responsible parent for children's medical therapy. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between body mass index (BMI), gender, age, controller medication use, household smoke exposure, season, and allergic rhinitis status with asthma control in a group of lower income, African American children. We hypothesized that non-obese children would have better asthma control. Methods: Baseline data from a longitudinal study of children in a school-based asthma program in a Midwest urban area were analyzed. 360 children, ages 4–15 years, who were enrolled in either the 2012–2013 or 2013–2014 program were included. Asthma control was classified using criteria from the 2007 National Asthma Education and Prevention Program. Multiple ordinal regression was performed. Results: The median age was 9 years, 61% had well-controlled asthma, and 29% were obese. The model included all main effects plus two interaction terms and was significant (χ2(7) = 22.17, p =.002). Females who were normal weight (OR, 2.78; 95% CI, 1.38–5.60, p =.004) or overweight (OR, 3.12; 95% CI, 1.26–7.72, p =.014) had better asthma control than obese females. For males, there were no differences by BMI category but males without allergic rhinitis had significantly better asthma control (OR, 2.23; 95% CI, 1.25–3.97, p =.006) than those with allergic rhinitis. Conclusions: Non-obese girls and non-allergic males had better asthma control. Promotion of healthy activity and nutrition as well as management of allergic rhinitis should be part of the asthma plan in school-based programs in low income urban areas. Innovative approaches to address asthma care in low income populations are essential. [ABSTRACT FROM AUTHOR]

Background Allergic rhinitis (AR) is a significant issue in children. Treatment options include allergen avoidance, pharmacotherapy and immunotherapy. The use of nasal saline douching (NSD) in children has recently gained acceptability. However, there is limited data regarding the acceptability and tolerability of NSD in children with AR. Methods A search was conducted using Medline and Embase databases from January 1946 until June 2015 on the use of NSD in children aged 4–12 years with AR. All publications identified that assessed the beneficial effects, acceptability and tolerability were included. Results 40 studies were analyzed. Data varied considerably in terms of saline solutions used, modality of application, participant numbers, study design, follow up and outcomes. Factors that appear to influence the acceptability and tolerability of NSD include parental and health professionals' preconceptions, and characteristics of the solution. Conclusions Nasal saline douching appears to be effective, being accepted and tolerated in the majority of children (78–100%). NSD has a significant positive impact on the quality of life in children with allergic rhinitis. When used as an adjunctive treatment having mainly a cleansing property, NSD potentiates the effects and may reduce the dose required of AR medications. Among the principal factors that influence the acceptability and tolerability of NSD are the child's age, delivery system and method, and tonicity. Nasal saline douching provides an accessible, low cost, low morbidity, easy to use treatment in children with allergic rhinitis. [ABSTRACT FROM AUTHOR]

Meteorological and environmental factors influence the pathogenesis of allergic rhinitis (AR). An understanding of the risk factors will facilitate the development of diagnostic and preventative tools for AR children and improve their quality of life. However, research on the impact of these factors on subjective symptoms in AR children remains scarce. This study explored the relationships between subjective symptoms in pollen and dust mite positive AR children, and meteorological and environmental factors. Using a linear mixed effect model, we analyzed the correlations between monthly data on the subjective symptoms of 351 AR children (from the Shanghai Children's Medical Center) and meteorological and environmental factors during 2013. The monthly meteorological and environmental data were provided by the Shanghai Meteorological Service and Shanghai Environmental Protection Bureau. Temperature and humidity were negatively correlated with the subjective symptom score, with a 0.04 point increase observed for every 1 °C decrease in temperature ( P < 0.0001) or 10 % decline in humidity ( P = 0.0412). The particulate matter (PM) 10 and PM2.5 concentrations were positively correlated with the subjective symptom score, with a 10 μg/m increase in PM10 and PM2.5 yielding a 0.02 ( P = 0.0235) and 0.03 ( P = 0.0281) increase in the subjective symptom score, respectively. In conclusion, meteorological and environmental factors were correlated with subjective symptoms in AR children. Low temperatures, lower humidity, and high PM10 and PM2.5 concentrations aggravated subjective symptoms in AR children. [ABSTRACT FROM AUTHOR]

The prevalence of allergic rhinitis ( AR) and asthma has been increasing, and the comorbidity rates of these diseases are very high. Here, 176 AR patients, 124 patients with comorbid AR and asthma ( AR-A) and 206 healthy Chinese children as controls were included in a case-control study. Six single-nucleotide polymorphisms ( SNPs), miR-146a (rs2910164, rs57095329 and rs6864584), miR-196a2 (rs11614913), miR-499 (rs3746444) and miR-149 (rs2292832), were genotyped. The prevalence of homozygous miR-149 (rs2292832) CC genotype and C allele were considerably increased in AR and AR-A patients, compared with the controls. AR-A group showed higher frequencies of CC genotype and C allele of rs2292832 than AR group. No significant difference in the genotypic and allelic frequencies of other mi RNA SNPs was found between the groups. MiR-149 levels in peripheral blood mononuclear cells ( PBMCs) were significantly lower in CC (variant type) cases compared with TT ( wild-type) cases. In further experiments, PBMCs obtained from the healthy controls with CC, CT and TT genotypes were stimulated by house dust mite extracts, which led to a significant decrease in the levels of miR-149 in PBMCs obtained from CC and TT individuals. This decrease was more pronounced in CC compared with TT cases. Our results demonstrate that miR-149 rs2292832 variant is not only strongly associated with AR and AR-A, but it may lead to an increase in the susceptibility to allergies following the stimulation with an allergen, through the changes in miR149 expression. Additionally, AR patients with CC genotypes were shown to be more susceptible to asthma. [ABSTRACT FROM AUTHOR]

Objective To evaluate the impact of different types of nasal septum deformity (NSD) on nasal obstruction, rhinitis severity and response to medical treatment among pediatric persistent allergic rhinitis (PER) patients. Methods In a prospective, real-life study, 150 children and adolescents (mean age 13 ± 2.8 years, females 32.6%) diagnosed with PER according to ARIA guidelines were assessed by nasal endoscopy for NSD according to Mladina's classification, their response to medical treatment (intranasal steroids and antihistamines or antileucotriens), the presence of comorbidities, rhinitis severity (modified-ARIA criterion) and nasal obstruction visual analog scale score (VAS). Results Most patients (87%) had 1 of the 7 types of septal deformities. There was a high prevalence of bilateral (types 4 and 6; 46%) and anterior unilateral (types 1 and 2; 25%) NSD in patients not responding to medical treatment. Type 4 (OR = 6.4; p = 0.005) or type 6 (OR = 4.4; p = 0.03) NSD increased the risk of lack of improvement with medical treatment. Coexistence of anterior unilateral or bilateral NSD with severe turbinate enlargement increased >20-fold the risk of lack of improvement. Patients with bilateral NSD presented greater rhinitis severity. Non-responder adolescents displayed higher prevalence of bilateral NSD than children (53% vs. 23%; p = 0.02). Nasal obstruction VAS was higher for patients with anterior than posterior NSD, and greater for patients with bilateral NSD than any other type of septal morphology. Conclusion Nasal endoscopy shows that bilateral and unilateral anterior nasal septum deformities are strongly associated with a poor response to medical treatment, greater rhinitis severity and higher nasal obstruction VAS. Consequently, nasal endoscopy is necessary in the PER patients to understand the disease severity as well as to plan a specific surgical treatment in order to improve nasal obstruction, disease severity, and patient's quality of life. [ABSTRACT FROM AUTHOR]

Background The march from early aeroallergen sensitization to subsequent respiratory allergy is well established, but it is unclear whether early life food sensitization precedes and further increases risk of allergic airway disease. Objective To assess the association between food sensitization in the first 2 years of life and subsequent asthma and allergic rhinitis by age 10-12 years. Methods We used data from two independent cohorts: the high-risk Melbourne Atopic Cohort Study (MACS) (n = 620) and the population-based LISAplus (n = 3094). Food sensitization was assessed at 6, 12, and 24 months in MACS and 24 months in LISAplus. Multiple logistic regressions were used to estimate associations between sensitization to food only, aeroallergen only, or both and allergic airway disease. Results When compared to non-sensitized children, sensitization to food only at 12 months in MACS and 24 months in LISAplus was associated with increased risk of current asthma (aOR = 2.2; 95% CI 1.1, 4.6 in MACS and aOR = 4.9; 2.4, 10.1 in LISAplus). Similar results were seen for allergic rhinitis. Additionally, cosensitization to food and aeroallergen in both cohorts at any tested point was a stronger predictor of asthma (at 24 months, aOR = 8.3; 3.7, 18.8 in MACS and aOR = 14.4; 5.0, 41.6 in LISAplus) and allergic rhinitis (at 24 months, aOR = 3.9; 1.9, 8.1 in MACS and aOR = 7.6; 3.0, 19.6 in LISAplus). Conclusions In both cohorts, food sensitization (with or without aeroallergen sensitization) in the first two years of life increased the risk of subsequent asthma and allergic rhinitis. These findings support the role of early life food sensitization in the atopic march and suggest trials to prevent early onset have the potential to reduce the development of allergic airways disease. [ABSTRACT FROM AUTHOR]

Background: Acute urticaria is the presence of urticaria for <6 weeks, and it is the most common type of urticaria in children. Sometimes, it may be associated with anaphylaxis, a life-threatening condition. Urticaria must be differentiated from anaphylaxis because the latter may require emergency treatment. We describe a child with anaphylaxis exposed to grasses on two occasions. Case presentation: We described a 4-year-old male child with anaphylaxis exposed to grasses. Patient also suffered mild neurologic/respiratory symptoms but it is unlikely that he had anaphylaxis. Skin-prick tests were positive to Cynodon dactylis, Phalaris arundinacea and Festuca elatior. Little is known about the importance of pollens as a cause of urticaria in young children. Conclusions: The case reported here is particularly interesting because, to the best of our knowledge, anaphylaxis due to pollen exposure in children aged <4 years has not been reported before. We strongly encourage all physicians searching for the cause of acute urticaria (allergists, dermatologists, primary-care physicians) to consider the possibility of pollen allergy, and to screen these patients for pollen sensitization. [ABSTRACT FROM AUTHOR]

Background The objective of the OLFAPEDRIAL study was to assess the olfactory dysfunction in allergic paediatric population, which has been scarcely studied. Methods Observational, cross-sectional and multicentre study evaluated the sense of smell in untreated allergic rhinitis ( AR) paediatric patients aged 6-12 years. Results Forty-four per cent (551 of 1260) of children with AR reported smell dysfunction, with both loss of smell frequency (52.1%, p < 0.001) and intensity (0.75 ± 0.84, p < 0.0001) being more frequent in patients with persistent than intermittent AR (38.0% and 0.51 ± 0.73, respectively). In addition, both loss of smell frequency and intensity increased according to disease severity (m- ARIA classification) but always being significantly higher in persistent (p < 0.0001) than in intermittent AR. Conclusions Children with allergic rhinitis present a mild-moderate loss of smell frequency and intensity which is clearly related to the disease duration and severity. The loss of smell can be considered, as in adults, a clinical marker of disease severity. [ABSTRACT FROM AUTHOR]

This study aims to investigate incidence of allergic rhinitis, bronchitis and asthma, in children living near a petrochemical complex with SO 2 pollution obtained by air monitoring stations. A total of 587 children aged 11 to 14 were recruited and classified into high and low exposure groups based on a radius of 10 km from the complex. To study the influence of health on children since the operation of complex in 1999 and observe the difference of these diseases' short-term and long-term impact, we obtained the incidence rates of allergic rhinitis (ICD-9: 477), bronchitis (490–491) and asthma (493) from the Taiwan Health Insurance Database for three periods: 1999–2002, 1999–2006, and 1999–2010. Since 2001, the mean and 99th percentile of SO 2 concentrations in the high exposure area have been significantly higher than those in low exposure area. There were significant differences between the high and low exposure groups in the percentage of smoking, alcohol consumption, passive smoking exposure and incense burning habits. The incidence rates of three intervals were 26.9%, 35.7%, 41.7%; 8.3%, 8.8%, 10.2%; 18.5%, 25.0%, 26.9% for allergic rhinitis, bronchitis and asthma in high exposure group. Significant differences were found between groups for allergic rhinitis in all periods, bronchitis in the first two periods, and asthma in the first period using Student's t -test. After we adjusted age, gender, group, living near roads, incense burning and passive smoking exposure, the hazard ratios between exposure groups were 3.05, 2.74, and 1.93 for allergic rhinitis with significant difference in three periods, and 2.53, 1.92 and 1.72 for bronchitis with significant difference in first period and 1.60, 1.28 and 1.29 for asthma with significant difference in first period by Cox regression. The higher incidence of allergic rhinitis was related to boys and living near roads and the higher incidence of asthma was also related to younger children, boys, and passive smoking exposure. [ABSTRACT FROM AUTHOR]