rinitis alergica

1. Ann Allergy Asthma Immunol. 2015 Aug;115(2):137-42. doi:10.1016/j.anai.2015.05.019.

No hypothalamic-pituitary-adrenal function effect with beclomethasonedipropionate nasal aerosol, based on 24-hour serum cortisol in pediatric allergicrhinitis.

Hampel FC Jr(1), Nayak NA(2), Segall N(3), Small CJ(4), Li J(4), Tantry SK(4).

Author information: (1)Central Texas Health Research, New Braunfels, Texas. Electronic address:[email protected]. (2)Sneeze, Wheeze, and Itch Associates, LLC, Normal, Illinois. (3)Georgia Allergy and Respiratory, Atlanta, Georgia. (4)Teva BrandedPharmaceutical Products R&D, Inc, Frazer, Pennsylvania.

BACKGROUND: Intranasal corticosteroids are the mainstay of allergic rhinitis (AR)treatment. Their potential to suppress the hypothalamic-pituitary-adrenal axisshould be evaluated, especially after long-term daily use in children.OBJECTIVE: To evaluate the effects of treatment with non-aqueous beclomethasonedipropionate (BDP) nasal aerosol on hypothalamic-pituitary-adrenal axis function in children with perennial AR.METHODS: In this double-blinded, placebo-controlled, parallel-group study,patients (6-11 years old) with perennial AR were randomized (2:1) to BDP nasalaerosol at 80 μg/day (n = 67) or placebo (n = 32). The primary end point waschange from baseline in 24-hour serum cortisol (SC) weighted mean for BDP nasalaerosol and placebo after 6 weeks of treatment, which was analyzed in theper-protocol population.RESULTS: The per-protocol population included 97 patients (BDP nasal aerosol, n =66; placebo, n = 31). Baseline geometric mean SC weighted mean values weresimilar in the 80-μg/day BDP nasal aerosol and placebo groups (5.97 and 6.47μg/dL, respectively). After 6 weeks' treatment, geometric mean values were 6.19and 7.13 μg/dL, respectively, with no decrease from baseline in either group.Geometric mean SC ratio of BDP nasal aerosol at 80 μg/day to placebo was 0.91(95% confidence interval 0.81-1.03), indicating predefined noninferiority. SCconcentration-time profiles were similar for the placebo and 80-μg/day BDP nasal aerosol groups at baseline and week 6. BDP nasal aerosol at 80 μg/day wasgenerally well tolerated.CONCLUSION: In pediatric patients with perennial AR, 24-hour SC profiles werecomparable for BDP nasal aerosol and placebo, indicating that once-daily BDPnasal aerosol treatment did not significantly affecthypothalamic-pituitary-adrenal axis function.TRIAL REGISTRATION: ClinicalTrials.gov; NCT01697956.

Copyright © 2015 American College of Allergy, Asthma & Immunology. Published byElsevier Inc. All rights reserved.

PMID: 26250771 [PubMed - indexed for MEDLINE]

2. Ann Allergy Asthma Immunol. 2015 Aug;115(2):130-6. doi:10.1016/j.anai.2015.05.012. Epub 2015 Jun 24.

Efficacy and safety of beclomethasone dipropionate nasal aerosol in children withperennial allergic rhinitis.

Berger WE(1), Jacobs RL(2), Amar NJ(3), Tantry SK(4), Li J(4), Small CJ(4).

Author information: (1)Allergy and Asthma Associates of Southern California, Mission Viejo,California. Electronic address: [email protected]. (2)Biogenics ResearchInstitute, San Antonio, Texas. (3)Allergy Asthma Research Institute, Waco, Texas.(4)Teva Branded Pharmaceutical Products R&D, Inc, Frazer, Pennsylvania.

BACKGROUND: Beclomethasone dipropionate (BDP) nasal aerosol (non-aqueous) isapproved for management of seasonal and perennial allergic rhinitis (PAR) inadolescents and adults.OBJECTIVE: To evaluate the efficacy and safety of BDP nasal aerosol at 80 μg/day in children with PAR.METHODS: This 12-week, phase 3, double-blinded, placebo-controlled,parallel-group study randomized 547 children (4-11 years old) with PAR toonce-daily BDP nasal aerosol at 80 μg/day or placebo. The primary end point waschange from baseline in average morning and evening reflective total nasalsymptom score (rTNSS) during the first 6 weeks of treatment in patients 6 to 11years old. Changes from baseline in average morning and evening instantaneousTNSS (iTNSS) in children 6 to 11 years old and average rTNSS and iTNSS inchildren 4 to 11 years old were assessed during the first 6 weeks of treatment.RESULTS: Improvements were significantly greater with BDP nasal aerosol than withplacebo during the first 6 weeks of treatment in children 6 to 11 years old inaverage morning and evening rTNSS and iTNSS (mean treatment difference -0.66 [P =.002] and -0.58 [P = .004], respectively). Improvements in average morning andevening rTNSS and iTNSS also were significantly greater in patients 4 to 11 yearsreceiving BDP nasal aerosol than with placebo during the first 6 weeks oftreatment (P = .002 and P = .004, respectively). Similar improvements were seenduring 12 weeks of treatment. The safety profile of BDP nasal aerosol wascomparable to that of placebo.CONCLUSION: The BDP nasal aerosol at 80 μg/day in children 4 to 11 years old was well tolerated and effective in controlling nasal symptoms of PAR.TRIAL REGISTRATION: www.clinicaltrials.gov, identifier NCT01783548.



3. Arch Dis Child. 2015 Jun;100(6):576-82. doi: 10.1136/archdischild-2014-306300.Epub 2015 Apr 2.

Optimal management of allergic rhinitis.

Scadding GK.

Allergic rhinitis (AR), the most common chronic disease in childhood is oftenignored, misdiagnosed and/or mistreated. Undertreated AR impairs quality of life,exacerbates asthma and is a major factor in asthma development. It can involvethe nose itself, as well as the organs connected with the nose manifesting avariety of symptoms. Evidence-based guidelines for AR therapy improve diseasecontrol. Recently, paediatric AR guidelines have been published by the EuropeanAcademy of Allergy and Clinical Immunology and are available online, as are apatient care pathway for children with AR and asthma from the Royal College ofPaediatrics and Child Health. Management involves diagnosis, followed byavoidance of relevant allergens, with additional pharmacotherapy needed for most sufferers. This ranges, according to severity, from saline sprays, throughnon-sedating antihistamines, oral or topical, with minimally bioavailableintranasal corticosteroids for moderate/severe disease, possibly plus additional antihistamine or antileukotriene. The concept of rhinitis control is emerging,but there is no universally accepted definition. Where pharmacotherapy fails,allergen-specific immunotherapy, which is uniquely able to alter long-termdisease outcomes, should be considered. The subcutaneous form (subcutaneousimmunotherapy) in children has been underused because of concerns regardingsafety and acceptability of injections. Sublingual immunotherapy is bothefficacious and safe for grass pollen allergy. Further studies on other allergensin children are needed. Patient, carer and practitioner education into AR and itstreatment are a vital part of management.

Published by the BMJ Publishing Group Limited. For permission to use (where not

already granted under a licence) please go tohttp://group.bmj.com/group/rights-licensing/permissions.

PMCID: PMC4514979PMID: 25838332 [PubMed - indexed for MEDLINE]

4. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43. doi:10.1177/0194599814561600.

Clinical practice guideline: Allergic rhinitis.

Seidman MD(1), Gurgel RK(2), Lin SY(3), Schwartz SR(4), Baroody FM(5), BonnerJR(6), Dawson DE(7), Dykewicz MS(8), Hackell JM(9), Han JK(10), Ishman SL(11),Krouse HJ(12), Malekzadeh S(13), Mims JW(14), Omole FS(15), Reddy WD(16), WallaceDV(17), Walsh SA(18), Warren BE(18), Wilson MN(19), Nnacheta LC(20); GuidelineOtolaryngology Development Group. AAO-HNSF.

Author information: (1)Department of Otolaryngology-Head and Neck Surgery, Henry Ford West BloomfieldHospital West Bloomfield, Michigan, USA [email protected]. (2)Department ofSurgery Otolaryngology-Head and Neck Surgery University of Utah, Salt Lake City, Utah, USA. (3)Johns Hopkins School of Medicine, Department of Otolaryngology-Headand Neck Surgery, Baltimore, Maryland, USA. (4)Virginia Mason Medical Center,Seattle, Washington, USA. (5)University of Chicago Medical Center, Department of Otolaryngology, Chicago, Illinois, USA. (6)Birmingham VA Medical Center,Birmingham, Alabama, USA. (7)Otolaryngology, Private Practice, Muscatine, Iowa,USA. (8)Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri, USA. (9)Pomona Pediatrics, Pomona, New York, USA. (10)EasternVirginia Medical School, Norfolk, Virginia, USA. (11)Cincinnati Children'sHospital Medical Center, Cincinnati, Ohio, USA. (12)Wayne State University,Philadelphia, Pennsylvania, USA. (13)Georgetown University Hospital, Washington, DC, USA. (14)Wake Forest Baptist Health, Winston Salem, North Carolina, USA.(15)Morehouse School of Medicine, East Point, Georgia, USA. (16)Acupuncture andOriental Medicine (AAAOM), Annandale, Virginia, USA. (17)Florida AtlanticUniversity, Boca Raton, Florida and Nova Southeastern University, Davie, Florida,USA. (18)Consumers United for Evidence-based Healthcare, Fredericton, NewBrunswick, Canada. (19)Louisiana State University School of Medicine, NewOrleans, Louisiana, USA. (20)Department of Research and Quality, American Academyof Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.

Comment in Otolaryngol Head Neck Surg. 2015 Feb;152(2):193-4.

OBJECTIVE: Allergic rhinitis (AR) is one of the most common diseases affectingadults. It is the most common chronic disease in children in the United Statestoday and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5billion in direct health expenditures annually. It can impair quality of lifeand, through loss of work and school attendance, is responsible for as much as $2to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there isconsiderable variation in their use. This clinical practice guideline wasundertaken to optimize the care of patients with AR by addressing qualityimprovement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and managementoptions.PURPOSE: The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to managepatients with AR as well as to optimize patient care, promote effective diagnosisand therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR.Children under the age of 2 years were excluded from the clinical practice

guideline because rhinitis in this population may be different than in olderpatients and is not informed by the same evidence base. The guideline is intendedto focus on a limited number of quality improvement opportunities deemed mostimportant by the working group and is not intended to be a comprehensivereference for diagnosing and managing AR. The recommendations outlined in theguideline are not intended to represent the standard of care for patientmanagement, nor are the recommendations intended to limit treatment or careprovided to individual patients.ACTION STATEMENTS: The development group made a strong recommendation thatclinicians recommend intranasal steroids for patients with a clinical diagnosisof AR whose symptoms affect their quality of life. The development group alsomade a strong recommendation that clinicians recommend oralsecond-generation/less sedating antihistamines for patients with AR and primarycomplaints of sneezing and itching. The panel made the following recommendations:(1) Clinicians should make the clinical diagnosis of AR when patients presentwith a history and physical examination consistent with an allergic cause and 1or more of the following symptoms: nasal congestion, runny nose, itchy nose, orsneezing. Findings of AR consistent with an allergic cause include, but are notlimited to, clear rhinorrhea, nasal congestion, pale discoloration of the nasalmucosa, and red and watery eyes. (2) Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of AR who do not respondto empiric treatment, or when the diagnosis is uncertain, or when knowledge ofthe specific causative allergen is needed to target therapy. (3) Cliniciansshould assess patients with a clinical diagnosis of AR for, and document in themedical record, the presence of associated conditions such as asthma, atopicdermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, andotitis media. (4) Clinicians should offer, or refer to a clinician who can offer,immunotherapy (sublingual or subcutaneous) for patients with AR who haveinadequate response to symptoms with pharmacologic therapy with or withoutenvironmental controls. The panel recommended against (1) clinicians routinelyperforming sinonasal imaging in patients presenting with symptoms consistent witha diagnosis of AR and (2) clinicians offering oral leukotriene receptorantagonists as primary therapy for patients with AR. The panel group made thefollowing options: (1) Clinicians may advise avoidance of known allergens or may advise environmental controls (ie, removal of pets; the use of air filtrationsystems, bed covers, and acaricides [chemical agents formulated to kill dustmites]) in patients with AR who have identified allergens that correlate withclinical symptoms. (2) Clinicians may offer intranasal antihistamines forpatients with seasonal, perennial, or episodic AR. (3) Clinicians may offercombination pharmacologic therapy in patients with AR who have inadequateresponse to pharmacologic monotherapy. (4) Clinicians may offer, or refer to asurgeon who can offer, inferior turbinate reduction in patients with AR withnasal airway obstruction and enlarged inferior turbinates who have failed medicalmanagement. (5) Clinicians may offer acupuncture, or refer to a clinician who canoffer acupuncture, for patients with AR who are interested in nonpharmacologictherapy. The development group provided no recommendation regarding the use ofherbal therapy for patients with AR.

© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.


5. Curr Med Res Opin. 2015 Mar;31(3):391-6. doi: 10.1185/03007995.2015.1009532. Epub2015 Feb 9.

Intranasal budesonide in children affected by persistent allergic rhinitis andits effect on nasal patency and Nasal Obstruction Symptom Evaluation (NOSE)score.

Zicari AM(1), Occasi F, Montanari G, Indinnimeo L, De Castro G, Tancredi G, Duse

M.

Author information: (1)'Sapienza' University of Rome, Department of Pediatrics , Rome , Italy.

Erratum in Curr Med Res Opin. 2015;31(7):1449. Giulia, Montanari [corrected to Montanari,Giulia].

BACKGROUND: Intranasal steroids are recognized as an effective treatment forallergic rhinitis (AR) although their effect on nasal patency has never beenevaluated with an objective instrument such as anterior rhinomanometry inchildren. Moreover this effect has been widely assessed with total Nasal Symptom Scores (NSS) including all symptoms of allergic rhinitis and not with scoresspecifically focused on nasal obstruction such as the Nasal Obstruction SymptomEvaluation score (NOSE).MATERIALS AND METHODS: Sixty children (42 males and 18 female) aged 6-10 years,affected by persistent AR, were randomized and divided in two groups of 30children to be included in an unblinded trial: one group treated with intranasal budesonide and isotonic nasal saline for 2 weeks and the other group treated onlywith isotonic nasal saline for 2 weeks. Each child underwent rhinomanometry andcompleted the NSS and the NOSE scores before and after treatment.RESULTS: At the baseline nasal patency and NSS total score, NOSE total scoreswere correlated (r=-0.29, p<0.001; r=-60, p<0.001). After 2 weeks of treatmentimprovements in nasal patency, NSS and NOSE were seen (Δ NSS 4.13 ± 1.38 vs 1.33 ± 1.93, p<0.001; Δ NOSE 34 ± 17.97 vs 9 ± 18.21, p<0.001; Δ nasal patency -26.13 ± 25.25 vs -11.83 ± 11.31, p<0.001). Correlations were found between rhinitisduration and Δ nasal patency and Δ NOSE (r=-0.84, p<0.001; r=0.43, p<0.01).CONCLUSION: Intranasal budesonide is effective in increasing nasal patency inchildren. Moreover the NOSE score was strongly correlated with nasal flow and,hence, this score should be regarded as a valid and reliable instrument inchildren.


6. Ann Allergy Asthma Immunol. 2015 Feb;114(2):141-7. doi:10.1016/j.anai.2014.11.012.

Efficacy of daily intranasal fluticasone propionate on ocular symptoms associatedwith seasonal allergic rhinitis.

Ratner P(1), Van Bavel J(2), Mohar D(3), Jacobs RL(4), Hampel F(5), Howland W(6),Karwal R(7).

Author information: (1)Sylvana Research Associates, San Antonio, Texas. Electronic address:[email protected]. (2)Isis Clinical Research, Austin, Texas.(3)Kerville Research Associates, Kerrville, Texas. (4)Biogenics ResearchInstitute, San Antonio, Texas. (5)Central Texas Health Research, New Braunfels,Texas. (6)Sirius Clinical Research, Austin, Texas. (7)GlaxoSmithKline ConsumerHealthcare, Parsippany, New Jersey.

BACKGROUND: Allergic rhinitis (AR) is an inflammatory condition of the nasalmucosa characterized by symptoms of nasal discharge, itching, sneezing, andcongestion. Ocular symptoms are commonly associated with AR and include itchingor burning, tearing or watering, and redness. Intranasal corticosteroids are amainstay of treatment, and their effect on nasal symptoms is well described.OBJECTIVE: To demonstrate that a 14-day course of 200 μg/d of nasal fluticasonepropionate is superior to placebo in relieving ocular symptoms associated withAR.METHODS: This was a randomized, double-blind, parallel group, multicenter study

comparing 200 μg/d of fluticasone propionate with placebo in patients withseasonal allergic rhinitis. The primary end point was mean change from baselinein patient-rated reflective total ocular symptom score (rTOSS). Key secondary endpoints included mean change from baseline in the morning and evening rTOSS,end-of-treatment assessment of response, and effect on activities of dailyliving. The primary analysis was performed using analysis of covariance with alinear fixed-effects model.RESULTS: Fluticasone was statistically significantly more efficacious in reducingthe ocular symptoms of AR than placebo. The least squares mean difference in the change from baseline of rTOSS was -0.36 (P = .002). A statistically significantdifference in mean change from baseline was observed in favor of fluticasone for morning and evening rTOSS. Significantly more patients taking fluticasoneachieved an overall response compared with placebo. Fluticasone had asignificantly greater effect on daily living activities and was well tolerated.CONCLUSION: This study supports the efficacy of fluticasone in treating ocularsymptoms associated with AR.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01817790.



7. Ann Allergy Asthma Immunol. 2015 Feb;114(2):134-40. doi:10.1016/j.anai.2014.11.015.

SQ house dust mite sublingually administered immunotherapy tablet (ALK) improves allergic rhinitis in patients with house dust mite allergic asthma and rhinitissymptoms.

Mosbech H(1), Canonica GW(2), Backer V(3), de Blay F(4), Klimek L(5), Broge L(6),Ljørring C(6).

Author information: (1)Allergy Clinic, Copenhagen University Hospital Gentofte, Hellerup, Denmark.Electronic address: [email protected]. (2)Allergy and Respiratory DiseaseClinic, University of Genova-IRCCS AOU San Martino, San Martino, Italy.(3)Bispebjerg University Hospital, Copenhagen, Denmark. (4)Chest DiseasesDepartment, Strasbourg University Hospital, University of Strasbourg, Strasbourg,France. (5)Center for Rhinology and Allergology, Wiesbaden, Germany. (6)ALK,Hørsholm, Denmark.

BACKGROUND: House dust mite (HDM) allergy is associated with persistent allergic rhinitis (AR) and allergic asthma.OBJECTIVE: To investigate the efficacy and safety of a SQ HDM sublinguallyadministered immunotherapy tablet (ALK, Hørsholm, Denmark) in adults andadolescents with HDM respiratory allergic disease and report the AR results.METHODS: Six hundred four subjects at least 14 years old with HDM AR and mild to moderate HDM allergic asthma were randomized 1:1:1:1 to double-blinded dailytreatment with 1, 3, 6 SQ-HDM or placebo. End-of-treatment rhinoconjunctivitissymptoms and medication score were predefined extrapulmonary end points. Asubgroup analysis was conducted post hoc in subjects with a total combinedrhinitis score (TCRS) > 0 (ie, with AR symptoms and/or AR medication use duringthe 4-week baseline period). The subgroup was comprised of 498 subjects (82%).RESULTS: In the subgroup, the absolute difference in end-of-treatment TCRSbetween 6 SQ-HDM and placebo was -0.78 (95% confidence interval -1.47 to -0.07,relative difference 28.8%, P = .0357). Furthermore, a significant difference was found for the total score of the Rhinitis Quality of Life Questionnaire withStandardized Activities RQLQ(S) and for the individual domains: activities,sleep, non-nose and non-eye symptoms, and nasal symptoms. For the TCRS andRhinitis Quality of Life Questionnaire score, a dose response was seen, withnumerically lower, nonsignificant differences for 1 and 3 SQ-HDM. The predefined

analysis for the entire trial population showed no statistically significantdifference between the placebo and actively treated groups. No safety concernswere observed.CONCLUSION: Efficacy in mild to severe AR of 6 SQ-HDM compared with placebo wasdemonstrated by statistically significant improvements in TCRS and RhinitisQuality of Life Questionnaire score in subjects with AR present at baseline. The treatment was well tolerated.TRIAL REGISTRATION: EudraCT, no 2006-001795-20; ClinicalTrials.gov, identifierNCT00389363.



8. Allergy. 2015 Mar;70(3):302-9. doi: 10.1111/all.12560. Epub 2015 Jan 14.

Safety of sublingual immunotherapy Timothy grass tablet in subjects with allergicrhinitis with or without conjunctivitis and history of asthma.

Maloney J(1), Durham S, Skoner D, Dahl R, Bufe A, Bernstein D, Murphy K, WasermanS, Berman G, White M, Kaur A, Nolte H.

Author information: (1)Merck & Co., Inc., Whitehouse Station, NJ, USA.

BACKGROUND: Patients with asthma may be more susceptible to adverse events (AEs) with sublingual immunotherapy tablet (SLIT-tablet) treatment, such as severesystemic reactions and asthma-related events. Using data from eight trials ofgrass SLIT-tablet in subjects with allergic rhinitis with/without conjunctivitis (AR/C), AE frequencies were determined in adults and children with and withoutreported asthma.METHODS: Data from randomized, double-blind, placebo-controlled trials of Timothygrass SLIT-tablet MK-7243 (2800 BAU/75 000 SQ-T, Merck/ALK-Abelló) were pooledfor post hoc analyses. Subjects with uncontrolled and severe asthma were excludedfrom the trials. Frequencies for treatment-emergent AEs (TEAEs), local allergicswelling (mouth or throat), systemic allergic reactions, and asthma-relatedtreatment-related AEs (TRAEs) were calculated.RESULTS: Among adults (n = 3314) and children (n = 881), 24% and 31%,respectively, had reported asthma. No serious local allergic swellings or serioussystemic allergic reactions occurred in subjects with asthma treated withSLIT-tablet. There was no evidence of increased TEAEs, systemic allergicreactions, or severe local allergic swellings in adults or children with asthmatreated with grass SLIT-tablet versus subjects without asthma in or outside ofpollen season. There were 6/120 asthma-related TRAEs assessed as severe withgrass SLIT-tablet and 2/60 with placebo, without a consistent trend amongsubjects with and without asthma (5 and 3 events, respectively).CONCLUSIONS: In the AR/C subjects with reported well-controlled mild asthmaincluded in these studies, grass SLIT-tablet did not increase TEAE frequency,severe local allergic swelling, or systemic allergic reactions versus subjectswithout asthma. There was no indication that treatment led to acute asthmaworsening.

© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


9. Immunol Allergy Clin North Am. 2015 Feb;35(1):185-98. doi:10.1016/j.iac.2014.09.003. Epub 2014 Oct 18.

Pediatric allergic rhinitis.

Tharpe CA(1), Kemp SF(2).

Author information: (1)Division of Clinical Immunology and Allergy, Department of Medicine, TheUniversity of Mississippi Medical Center, 768 Lakeland Drive, Building LJ,Jackson, MS 39216, USA. (2)Division of Clinical Immunology and Allergy,Department of Medicine, The University of Mississippi Medical Center, 768Lakeland Drive, Building LJ, Jackson, MS 39216, USA. Electronic address:[email protected].

Allergic rhinitis is a common pediatric problem with significant comorbiditiesand potential complications. This article is an overview of the epidemiology,pathophysiology, and current therapeutic strategies. Allergic rhinitis managementin a specific child is age dependent and influenced by the severity and frequencyof the symptoms and the presence of any concurrent conditions. Current strategiespermit symptomatic control and improved quality of life for most patients.

Copyright © 2015 Elsevier Inc. All rights reserved.


10. Am J Rhinol Allergy. 2014 Nov-Dec;28(6):471-6. doi: 10.2500/ajra.2014.28.4112.Epub 2014 Oct 20.

300IR 5-Grass pollen sublingual tablet offers relief from nasal symptoms inpatients with allergic rhinitis.

Serrano E(1), Wahn HU, Didier A, Bachert C.

Author information: (1)Ear, Nose and Throat Department, Larrey Hospital, Toulouse, France.

BACKGROUND: 300IR 5-grass pollen sublingual immunotherapy tablets have beenapproved for the treatment of allergic rhinitis (AR) with or withoutconjunctivitis in adults and children >5 years with grass pollen allergy. Thisstudy was designed to review data on nasal symptoms with 300IR 5-grass pollensublingual tablets in adults and children.METHODS: We reviewed data from four double-blind, placebo-controlled, randomized clinical trials. Two groups of patients who received a daily dose of eitherplacebo or 300IR 5-grass pollen sublingual tablets starting 4 months before theexpected start of the pollen season and continuing through the season werecompared (analysis of covariance) for scores of sneezing, rhinorrhea, nasalpruritus, nasal congestion, total nasal symptom score (TNSS), and adultRhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores.RESULTS: Data for 266 children (one pediatric trial) and 1036 adults (threetrials) were analyzed. Compared with the placebo groups, mean TNSS in the 300IRgroups was lower by 22% in children and 19-36% in adults. Among the four nasalsymptoms, the lowest scores relative to placebo were for nasal congestion inchildren (31%) and adults (43%). Mean adult RQLQ scores were 21-31% lower in the 300IR group than in the placebo group.CONCLUSION: Allergen immunotherapy with 300IR 5-grass pollen sublingual tabletswas consistently associated with AR symptom relief in adults and children andprovided a clinically meaningful improvement in quality of life.


11. Curr Opin Otolaryngol Head Neck Surg. 2014 Dec;22(6):487-94. doi:10.1097/MOO.0000000000000101.

Specific immunotherapy for allergic rhinitis in children.

Wang C(1), Zhang L.

Author information: (1)aDepartment of Otolaryngology, Head and Neck Surgery, Beijing TongrenHospital, Capital Medical University bBeijing Key Laboratory of Nasal Diseases,Beijing Institute of Otolaryngology, Beijing, People's Republic of China.

PURPOSE OF REVIEW: Allergic rhinitis is a highly prevalent inflammatory diseaseaffecting 20-40% of the children worldwide. Allergen-specific immunotherapy (SIT)is an effective treatment for allergic rhinitis. This article reviews the recent advances in SIT for children.RECENT FINDINGS: In current clinical practice, immunotherapy is delivered aseither subcutaneous immunotherapy or sublingual immunotherapy (SLIT). Mostmeta-analyses and reviews concluded a trend that subcutaneous immunotherapy wasbetter than SLIT in reducing symptoms of allergic rhinitis and rescue medication use, however, SLIT has a better safety profile than subcutaneous immunotherapy.Additionally, the absence of pain on administration of therapy is a character of SLIT, which is well suited for children. T regulatory cells, especially Tr1 cellsthat secrete interleukin-10 and induce production of immunoglobulin G4, play arole during SIT.SUMMARY: Although there is substantial evidence for effectiveness of bothsubcutaneous immunotherapy and SLIT, safer and more effective SIT approaches are needed. New approaches to improve SIT include omalizumab pretreatment, use ofrecombinant allergens, and alternate routes of administration.


12. Pediatr Allergy Immunol. 2014 Nov;25(7):724-8. doi: 10.1111/pai.12279.

Resveratrol plus carboxymethyl-β-glucan may affect respiratory infections inchildren with allergic rhinitis.

Miraglia Del Giudice M(1), Maiello N, Decimo F, Capasso M, Campana G, Leonardi S,Ciprandi G.

Author information: (1)Department of Pediatrics, Second University of Naples, Naples, Italy.


13. Allergol Int. 2014 Sep;63(3):357-75. doi: 10.2332/allergolint.14-RAI-0768.

Japanese Guideline for Allergic Rhinitis 2014.

Okubo K(1), Kurono Y(2), Fujieda S(3), Ogino S(4), Uchio E(5), Odajima H(6),Takenaka H(7); Japanese Society of Allergology.

Author information: (1)Department of Otorhinolaryngology, Nippon Medical School, Tokyo, Japan.(2)Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School ofMedical and Dental Sciences, Kagoshima University, Kagoshima, Japan. (3)Division of Otorhinolaryngology Head & Neck Surgery, Department of Sensory and LocomotorMedicine, Faculty of Medical Science, University of Fukui, Fukui, Japan.(4)School of Allied Health Sciences, Osaka University Graduate School ofMedicine, Osaka, Japan. (5)Department of Ophthalmology, Fukuoka UniversityHospital, Fukuoka, Japan. (6)Department of Pediatrics, National HospitalOrganization, Fukuoka National Hospital, Fukuoka, Japan. (7)Osaka MedicalCollege, Osaka, Japan.

Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but of the three, it is the only type I allergic disease. Allergic rhinitis includes pollinosis, which is intractable and reduces quality of life (QOL) when itbecomes severe. A guideline is needed to understand allergic rhinitis and to use this knowledge to develop a treatment plan. In Japan, the first guideline wasprepared after a symposium held by the Japanese Society of Allergology in 1993.The current 7th edition was published in 2013, and is widely used today. Toincorporate evidence based medicine (EBM) introduced from abroad, the most recentcollection of evidence/literature was supplemented to the Practical Guideline forthe Management of Allergic Rhinitis in Japan 2013. The revised guideline includesassessment of diagnosis/treatment and prescriptions for children and pregnantwomen, for broad clinical applications. An evidence-based step-by-step strategyfor treatment is also described. In addition, the QOL concept and cost benefitanalyses are also addressed. Along with Allergic Rhinitis and its Impact ofAsthma (ARIA), this guideline is widely used for various clinical purposes, such as measures for patients with sinusitis, childhood allergic rhinitis, oralallergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regardingallergic rhinitis in Japan was added to the end of this guideline.


14. Pediatr Ann. 2014 Aug;43(8):e192-200. doi: 10.3928/00904481-20140723-09.

New developments in the treatment of pediatric allergic rhinitis andconjunctivitis.

Lierl MB.

The primary care physician is the first line of treatment for allergic rhinitis, which affects approximately one-fourth of children in the United States. There isan increasing trend toward self-management by patients or parents due tohigh-deductible insurance plans and the over-the-counter availability of allergy medications. The primary care physician can offer guidance on appropriateselection of medications and potential adverse effects. Vitamin D deficiency has been proposed as a potential contributing factor in patients with allergicdiseases, and studies are underway to determine whether supplementation withvitamin D is helpful for these conditions. Sublingual immunotherapy has recently received US Food and Drug Administration approval for grass and ragweedallergens; many children will be interested in this alternative to allergy shots.The relative advantages and disadvantages of sublingual vs subcutaneousimmunotherapy are discussed.

Copyright 2014, SLACK Incorporated.


15. Allergol Int. 2014 Dec;63(4):543-51. doi: 10.2332/allergolint.14-OA-0688. Epub2014 Jul 25.

Efficacy and safety of fluticasone furoate nasal spray in Japanese children with perennial allergic rhinitis: a multicentre, randomized, double-blind,placebo-controlled trial.

Okubo K(1), Okamasa A(2), Honma G(2), Komatsubara M(2).

Author information: (1)Department of Head & Neck and Sensory Organ Science, Graduate School ofMedicine, Nippon Medical School, Tokyo, Japan. (2)Development and Medical AffairsDivision, GlaxoSmithKline K.K., Tokyo, Japan.

BACKGROUND: Fluticasone furoate nasal spray (FFNS) is a glucocorticoid developed for the treatment of allergic rhinitis (AR). This is the first randomizedclinical trial to assess the efficacy and safety of FFNS in Japanese childrenwith perennial AR (PAR).METHODS: In this multicentre, randomized, double-blind, placebo-controlled,parallel-group, phase III study, 261 children aged 6 to <15 years were treatedwith FFNS 55μg, once daily or placebo for two weeks. Nasal and ocular symptomswere rated by parents/guardians/patients in the patient daily diary. The primary endpoint was the mean change from baseline in the three total nasal symptom score(3TNSS). In addition, rhinoscopic findings were rated by the investigators as an efficacy measure. As a safety measure, adverse events and clinical chemistry and hematology were evaluated.RESULTS: Mean change from baseline over the entire treatment period in 3TNSS was greater in the FFNS 55μg group compared with placebo, and the difference wasstatistically significant (p < 0.001). Significant improvements in rhinoscopicfindings of swelling of inferior turbinate mucosa and quantity of nasal dischargewere also observed. The total ocular symptom score (TOSS) was reducedsignificantly in the FFNS 55μg group, compared with placebo, in the second weekin a subgroup of patients with baseline TOSS > 0. The incidence of adverse eventswas similar between FFNS 55μg(18%) and placebo (19%).CONCLUSIONS: Two-week treatment with FFNS 55μg, once daily is effective andtolerable in Japanese children aged 6 to <15 years with PAR.


16. Kulak Burun Bogaz Ihtis Derg. 2014 Jul-Aug;24(4):217-24. doi:10.5606/kbbihtisas.2014.48108.

Quality of life in patients with persistent allergic rhinitis treated withdesloratadine monotherapy or desloratadine plus montelucast combination.

Erdoğan BA(1), Sanlı A, Paksoy M, Altın G, Aydın S.

Author information: (1)Department of Otolaryngology, Dr. Lütfi Kırdar Kartal Training and ResearchHospital, 34890 Cevizli, Kartal, İstanbul, Turkey. [email protected].

OBJECTIVES: This study aims to compare the effectiveness of desloratadinemonotherapy and desloratadine plus montelukast combination therapy on quality of life in patients with persistent allergic rhinitis.PATIENTS AND METHODS: This study consists of 40 patients (28 females, 12 males,mean age 29.8 years; range 17 to 44 years) referred to ear, nose, and throatoutpatient clinic between May 2010 and September 2010. A six-week randomized,double-blind, cross-sectional study was performed in two arms: In group 1, 20patients received desloratadine (5 mg/d) alone; in group 2, 20 patients received desloratadine (5 mg) plus montelukast (10 mg) combination therapy. Quality oflife was assessed on the day before starting treatment and on the last day ofeach treatment period using the Rhinoconjunctivitis Quality of Life Questionnaireand Nighttime Symptom Scores.RESULTS: In group 1, the mean quality of life scores before and after treatmentwere 3.17 and 2.43, respectively. In group 2, the mean quality of life scoresbefore and after treatment were 2.94 and 1.73, respectively.CONCLUSION: Desloratadine plus montelukast combination therapy may have apositive impact on quality of life, sleep symptoms in particular.


17. J Allergy Clin Immunol Pract. 2014 Jul-Aug;2(4):421-7. doi:10.1016/j.jaip.2014.04.008. Epub 2014 May 21.

Growth velocity reduced with once-daily fluticasone furoate nasal spray in

prepubescent children with perennial allergic rhinitis.

Lee LA(1), Sterling R(2), Máspero J(3), Clements D(4), Ellsworth A(4), PedersenS(5).

Author information: (1)Respiratory Research and Development, GlaxoSmithKline, Research Triangle Park,NC. Electronic address: [email protected]. (2)Department of OtolaryngologyCarolina Research, Orangeburg, SC. (3)Allergy and Respiratory Research Unit,Fundacion CIDEA, Buenos Aires, Argentina. (4)Respiratory Research andDevelopment, GlaxoSmithKline, Research Triangle Park, NC. (5)Pediatric ResearchUnit, Kolding Hospital, Kolding, Denmark.

BACKGROUND: The effect of fluticasone furoate nasal spray (FFNS) on growth inprepubescent children has not been evaluated.OBJECTIVE: To characterize the difference in mean prepubescent growth velocities,as determined by stadiometry, between patients treated continuously for 1 yearwith FFNS 110 mcg once daily and placebo nasal spray.METHODS: This was a multicenter, randomized, double-blind, placebo-controlled,parallel-group 76-week safety study. Nasal symptom assessments were used as ameasure of adherence. Eligible patients were ages 5 to <8.5 years at screeningand had at least a 1-year clinical history and diagnosis of perennial allergicrhinitis, including a positive skin test or specific IgE to an appropriateperennial allergen within the past year.RESULTS: One hundred eighty-six patients in the FFNS group and 187 patients inthe placebo group completed the entire 52-week treatment period. Duringtreatment, the least squares mean growth velocity was 5.19 cm/y for the FFNSgroup and 5.46 cm/y for the placebo group; mean difference, -0.270 cm/y (95%CI, -0.48 to -0.06 cm/y). Other safety assessments, including 24-hour urinarycortisol excretion, were comparable between the treatment groups. Dailyreflective total nasal symptom scores declined similarly in both the FFNS andplacebo groups.CONCLUSION: Once-daily treatment with FFNS over 52 weeks in prepubescent childrenresulted in a small reduction in growth velocity compared with placebo.Clinicians will need to balance the reduction in growth observed with FFNS to itspotential for clinical benefit.

Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published byElsevier Inc. All rights reserved.


18. Asian Pac J Allergy Immunol. 2014 Jun;32(2):166-70. doi:10.12932/AP0339.32.2.2013.

Evaluation of animated cartoon-aided teaching of intranasal corticosteroidadministration technique among Thai children with allergic rhinitis.

Indradat S(1), Jirapongsananuruk O, Visitsunthorn N.

Author information: (1)Division of Allergy and Immunology, Department of Pediatrics, Faculty ofMedicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand 10700.

BACKGROUND: Correct use of intranasal corticosteroid (INCS) and compliance withtreatment is very important for the treatment of allergic rhinitis (AR). Ananimated cartoon-aided teaching method for INCS administration was created todecrease the workload of health care professionals. The aim of this study was to compare the performance of children with AR in using INCS between a group whowere instructed using animated cartoon-aided teaching and those receiving only anoral presentation without demonstration.METHODS: The study was a prospective randomized controlled trial in children aged

5-16 years with moderate to severe intermittent or persistent AR who had neverused INCS. The patients were randomly divided into 2 groups; 1) those receivingteaching about how to use INCS by an oral presentation without demonstration and 2) by animated cartoon-aided teaching. The performance of the children wasrecorded after the initial training using a five-point checklist. If they wereunable to use the INCS correctly after the first teaching session, the sameinstructions were repeated and a second assessment was performed.RESULTS: A total of 80 patients, 40 each group, underwent randomization. The rateof achieving competency for the patients after the first instruction using theanimated cartoon-aided teaching group was significantly higher than that for the oral presentation group (57.5% VS 27.5%; P = 0.007). The cumulative success rate for the second assessment of the animated cartoon-aided group was alsosignificantly higher than for those receiving only an oral presentation (95% VS60%, P = 0.004).CONCLUSION: With regard to mastering the correct method for INCS usage,instruction using animated cartoon-aided teaching is better than oralpresentation without demonstration. However, the best method for teachingpatients how to use INCS is a combination of oral explanation and demonstrationby cartoon-aided teaching. The teaching should be repeated periodically to remindpatients of the correct method for INCS usage.


19. BMJ. 2014 Jul 1;349:g4153. doi: 10.1136/bmj.g4153.

Allergic rhinitis in children.

Barr JG(1), Al-Reefy H(2), Fox AT(2), Hopkins C(2).

Author information: (1)Department of ENT surgery, Guy's and St Thomas' Hospitals NHS FoundationTrust, London SE1 9RT, UK [email protected]. (2)Department of ENT surgery, Guy'sand St Thomas' Hospitals NHS Foundation Trust, London SE1 9RT, UK.

Erratum in BMJ. 2014;349:4923.


20. Curr Med Res Opin. 2014 Oct;30(10):1931-5. doi: 10.1185/03007995.2014.938731.Epub 2014 Jul 7.

Resveratrol plus carboxymethyl-β-glucan reduces nasal symptoms in children withpollen-induced allergic rhinitis.

Miraglia Del Giudice M(1), Maiello N, Capristo C, Alterio E, Capasso M, PerroneL, Ciprandi G.

Author information: (1)Department of Women and Children and General and Specialized Surgery, SecondUniversity of Naples , Naples , Italy.

OBJECTIVE: Allergic rhinitis (AR) is caused by an IgE-mediated inflammatoryreaction consequent to the exposure to causal allergen. Resveratrol is a natural non-flavonoid polyphenol, exerting anti-inflammatory activity; β-glucan is apolysaccharide with immuno-modulatory properties. Thus, this study aimed toinvestigate whether these combined compounds are able of relieving nasal symptomsin children with AR due to pollen allergy.RESEARCH DESIGN AND METHODS: The present study was conducted asplacebo-controlled, double-blinded, and randomized. Globally, 68 children (36males; mean age 7.9 years) were treated with resveratrol plus β-glucan or placebo

(the diluent of active drug) two sprays (100 µL/spray) in each nostril threetimes/day for 2 months. Nasal symptoms, including itching, sneezing, rhinorrhea, and obstruction, were assessed at baseline and after treatment. Use of rescuemedication, such as cetirizine syrup, was also evaluated.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID NCT02130440.RESULTS: Children treated with active drug achieved a significant reduction inall nasal symptoms: itching (p = 0.0001), sneezing (p = 0.0009), rhinorrhea(p = 0.009), and obstruction (0.002) as well as antihistamine use (p = 0.003).Placebo did not affect nasal complaints and cetirizine use. The intergroupanalysis showed that active treatment was significantly superior to placebo aboutreduction of AR symptoms and rescue medication use.CONCLUSIONS: The present preliminary study firstly showed that intranasalresveratrol plus carboxymethyl-β-glucan is capable of significantly improvingnasal symptoms in children with pollen-induced AR.


21. Rhinology. 2014 Jun;52(2):133-6. doi: 10.4193/Rhin.

Application of Peak Nasal Inspiratory Flow reference values in the treatment ofallergic rhinitis.

de Souza Campos Fernandes S, Ribeiro de Andrade C, da Cunha Ibiapina C.

Comment in Rhinology. 2014 Dec;52(4):444. Rhinology. 2014 Dec;52(4):444.

OBJECTIVE: To assess the applicability of the Peak Nasal Inspiratory Flow (PNIF) curves in follow-up of children in the treatment of allergic rhinitis.METHODS: Prospective study of 40 patients with AR, grouped in corticosteroidspray versus physiological saline solution use. Follow up for 10 weeks throughclinical score and PNIF percentages in relation to the reference curves, withwas-out at week 8. Statistical assessment of the effect of treatment on variationof PNIF and clinical score was calculated by ANOVA model and Multiple Comparison of Means Test - Least Significant Difference.RESULTS: There was a statistically significant influence of the group, time andinteraction between time and group on PNIF percentages. Throughout follow up,patients from the treatment group had mean PNIF percentages significantly higher than the placebo group. Clinical score results also demonstrated a statistically significant influence between the groups, time and interaction between time andgroup.CONCLUSION: Increase in PNIF percentage values observed in children treated with intranasal corticosteroids revealed the applicability of PNIF curves in theirfollow up.


22. NPJ Prim Care Respir Med. 2014 Jun 5;24:14012. doi: 10.1038/npjpcrm.2014.12.

Adolescent seasonal allergic rhinitis and the impact of health-care professional training: cluster randomised controlled trial of a complex intervention inprimary care.

Hammersley VS(1), Elton RA(1), Walker S(1), Hansen CH(2), Sheikh A(3).

Author information: (1)Allergy and Respiratory Research Group, Centre for Population Health Sciences,The University of Edinburgh, Edinburgh, UK. (2)School of Molecular and ClinicalMedicine, The University of Edinburgh, Western General Hospital, Edinburgh, UK.(3)1] Allergy and Respiratory Research Group, Centre for Population Health

Sciences, The University of Edinburgh, Edinburgh, UK [2] Division of GeneralInternal Medicine and Primary Care, Brigham and Women's Hospital, Harvard MedicalSchool, Boston, MA, USA.

BACKGROUND: Seasonal allergic rhinitis is typically poorly managed, particularly in adolescents, in whom it is responsible for considerable morbidity. Ourprevious work has demonstrated that if poorly controlled this can impaireducational performance.AIM: The primary aim of this trial was to assess the impact of a primarycare-based professional training intervention on clinical outcomes in adolescentswith seasonal allergic rhinitis.METHODS: Cluster trial in which UK general practice staff were randomised to ashort, intensive workshop on the evidence-based management of seasonal allergicrhinitis. The primary outcome measure was the change in the validatedRhinoconjunctivitis Quality of Life Questionnaire with Standardized Activities(RQLQ(S)) score between baseline and 6 weeks post intervention (minimalclinically important difference=0.5). Secondary outcome measures of interestincluded health-care professionals' knowledge and confidence in managing seasonalallergic rhinitis, number of seasonal allergic rhinitis-related consultations,relevant treatments prescribed and symptom scores.RESULTS: Thirty-eight general practices were randomised (20 in the interventionarm) and 246 patients (50.2% males, mean age 15 years) were included in theprimary outcome analysis. Health-care professionals' knowledge and confidence of the clinical management of seasonal allergic rhinitis improved. This did not,however, result in clinically or statistically significant improvements inRQLQ(S): -0.15, (95% confidence interval, -0.5 to +0.2). There were nodifferences in consultation frequency, treatments issued for seasonal allergicrhinitis or symptom scores.CONCLUSIONS: Although associated with increases in professionals' self-assessedconfidence and understanding of seasonal allergic rhinitis management, thisintensive training workshop did not translate into improvements in adolescents'disease-specific quality of life or a reduction in rhinitis symptoms.


23. Allergy Asthma Proc. 2014 Jul-Aug;35(4):332-7. doi: 10.2500/aap.2014.35.3770.Epub 2014 May 27.

Comparative safety and efficacy of two formulations of mometasone nasal spray in adult seasonal allergic rhinitis.

Kuna P(1), Wasiak W, Jones S, Kreft KZ.

Author information: (1)Division of Internal Medicine, Asthma and Allergy, Barlicki UniversityHospital, Medical University of Lodz, Lodz Poland.

Mometasone furoate as a nasal spray is an effective treatment for seasonalallergic rhinitis (SAR). An aqueous mometasone nasal spray containing the sameactive substance and excipients as the originator product (reference mometasone) has been developed. This study was designed to establish therapeutic equivalence of test mometasone to reference mometasone and superiority over placebo for thetreatment of SAR in adults. In this multicenter, randomized, double-blind,placebo- and active-controlled, fixed-dose study, patients aged ≥18 years withSAR were randomized 2:2:1 to reference mometasone, test mometasone, or placebofor 28 days. Patients recorded nasal and ocular symptoms daily. The primary endpoint was change from baseline in the pooled 24-hour reflective total nasalsymptom score (rTNSS). Safety and tolerability included evaluation by adverseevents (AEs), physical (including nasal) examinations, vital signs assessments,laboratory evaluations, and change in concomitant medications. Four hundred twopatients received reference mometasone (n = 156), test mometasone (n = 163), or

placebo (n = 83). The intent-to-treat population (ITT) comprised 399 patients,and the per-protocol (PP) population comprised 327 patients. The 95% confidenceintervals for the treatment difference (reference minus test mometasone) inchange from baseline in pooled 24-hour rTNSS were within prespecified equivalencelimits for the PP and ITT populations. Both active treatments showed superiority over placebo (p = 0.0019-0.0087). No significant difference was seen between testmometasone and reference mometasone for any secondary efficacy variables.Treatment-emergent AE incidence was low. No deaths or serious AEs were reported. The test mometasone is efficacious in the treatment of SAR in adults and shows a favorable safety profile. The results indicate that the test mometasone istherapeutically equivalent to the reference mometasone.


24. Int Arch Allergy Immunol. 2014;163(4):313-8. doi: 10.1159/000360734. Epub 2014Apr 29.

A nasally applied cellulose powder in seasonal allergic rhinitis in adults withgrass pollen allergy: a double-blind, randomized, placebo-controlled,parallel-group study.

Åberg N(1), Ospanova ST, Nikitin NP, Emberlin J, Dahl Å.

Author information: (1)Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden.

BACKGROUND: A nasally applied cellulose powder is increasingly used in manycountries as a remedy for allergic rhinitis. In 2009, a 4-week study in birchpollen-allergic children showed a reduction in nasal symptoms. The best effectoccurred on days with lower pollen counts. The present study in grasspollen-allergic adults used the same basic design.METHODS: In May 2013, a double-blind, placebo-controlled study was conducted in108 patients with allergic rhinitis due to grass pollen (18-40 years of age). SMSon mobile phones were used as reminders of treatment and reporting of symptomscores.RESULTS: We found significant reductions in severity scores for sneezing, runnynose, stuffy nose and symptoms from eyes and lower airways, both separately andtogether (all p < 0.001). Reflective opinion of effect and guess on treatment at follow-up visits (both p < 0.001) confirmed a high efficacy. No clinicallysignificant adverse effects were reported.CONCLUSIONS: The product provided significant protection against all seasonalallergic rhinitis symptoms from both upper and lower airways during the grasspollen season in an adult population. The magnitude and scope of efficacy supportthe use of the product as an early choice in the treatment of allergic rhinitis.

© 2014 S. Karger AG, Basel.


25. Allergy. 2014 Jul;69(7):828-33. doi: 10.1111/all.12413. Epub 2014 May 12.

Is chronic rhinosinusitis related to allergic rhinitis in adults and children?Applying epidemiological guidelines for causation.

Georgalas C(1), Vlastos I, Picavet V, van Drunen C, Garas G, Prokopakis E.

Author information: (1)Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, theNetherlands.

The relationship between allergic rhinitis and chronic rhinosinusitis has beenassessed in a number of observational and experimental studies. In this review,we attempt their synthesis and evaluation using the modified Bradford Hillguidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended atleast as an initial measure of symptoms relief.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


26. J Allergy Clin Immunol Pract. 2014 May-Jun;2(3):332-40.e1. doi:10.1016/j.jaip.2014.02.001.

Omalizumab for the treatment of inadequately controlled allergic rhinitis: asystematic review and meta-analysis of randomized clinical trials.

Tsabouri S(1), Tseretopoulou X(2), Priftis K(3), Ntzani EE(4).

Author information: (1)Department of Paediatrics, University of Ioannina School of Medicine,Ioannina, Greece. (2)Evidence-based Medicine Unit, Department of Hygiene andEpidemiology, University of Ioannina School of Medicine, Ioannina, Greece.(3)Third Department of Paediatrics, University of Athens School of Medicine,Attikon University Hospital, Athens, Greece. (4)Evidence-based Medicine Unit,Department of Hygiene and Epidemiology, University of Ioannina School ofMedicine, Ioannina, Greece. Electronic address: [email protected].

BACKGROUND: Patients with moderate-to-severe allergic rhinitis who areinadequately controlled despite treatment according to current rhinitismanagement guidelines have a significant unmet medical need. Such patients have anegative impact on daily functioning and are at risk of developing seriouscomorbidities, such as asthma and chronic rhinosinusitis.OBJECTIVE: To assess the efficacy and safety of omalizumab in poorly controlledallergic rhinitis under a meta-analysis framework.METHODS: MEDLINE and the Cochrane Central Register of Controlled Trials weresearched through September 2013. Studies on the efficacy of omalizumab inallergic rhinitis that assessed clinical outcomes were selected. Descriptive and quantitative information was extracted; mean differences and relative riskestimates were synthesized under a fixed or random effects model. Heterogeneitywas assessed by using the Q statistic and the I(2) metric. Subgroup analyses wereperformed for the presence of specific immunotherapy treatment.RESULTS: Of the 352 citations retrieved, 11 studies of 2870 patients were finallyincluded. A statistically significant reduction in the daily nasal symptomseverity score (standardized mean difference -0.67 [95% CI, -1.3 to -0.31]; P <.0001; I(2), 92%) and a statistically significant reduction in daily nasal rescuemedication score (-0.22 [95% CI, -0.39 to -0.05; P = .01; I(2), 58%) wereobserved. There was not a statistically significant difference in the occurrence of any adverse event (relative risk 1.06 [95% CI, 0.94-1.19; I(2), 55%).CONCLUSIONS: Omalizumab is statistically significantly associated with symptomrelief, decreased rescue medication use, and improvement of quality of life inpatients with inadequately controlled allergic rhinosinusitis.



27. Int J Pediatr Otorhinolaryngol. 2014 Jul;78(7):1115-8. doi:10.1016/j.ijporl.2014.04.026. Epub 2014 May 5.

The effectiveness of nasal saline irrigation (seawater) in treatment of allergic rhinitis in children.

Chen JR(1), Jin L(1), Li XY(2).

Author information: (1)Department of Otolaryngology-Head and Neck Surgery, Shanghai Children'sHospital, Shanghai Jiaotong University, Shanghai, China. (2)Department ofOtolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, ShanghaiJiaotong University, Shanghai, China. Electronic address: [email protected].

OBJECTIVE: To evaluate the effect of nasal saline irrigation in the treatment of allergic rhinitis (AR) in children and to assess whether nasal saline irrigation could be used as a complementary therapy for AR in children in combination withthe intranasal corticosteroids (INS).METHOD: In total, 61 children with AR were divided into three groups: the nasalirrigation, intranasal corticosteroid, and combined treatment groups. Symptomsand signs of AR and eosinophils (EOS) in the nasal secretions were evaluatedafter 4 weeks, 8 weeks, and 12 weeks of treatment.RESULTS: In AR children treated with nasal irrigation and a decreased the INSdose, a significant improvement in symptoms and signs and a significant decrease in the mean EOS count in nasal secretions were observed at week 12.CONCLUSION: Nasal saline irrigation with physiological seawater is well toleratedand benefits the patients with AR, and can thus be considered a good adjunctivetreatment option to maintain the effectiveness of the INS at a lower dose, thusresulting in reduced side effects and a decreased economic burden.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.


28. Am J Rhinol Allergy. 2014 Mar-Apr;28(2):131-9. doi: 10.2500/ajra.2014.28.4006.

Efficacy and safety of sublingual immunotherapy in children aged 3-13 years with allergic rhinitis.

Shao J(1), Cui YX, Zheng YF, Peng HF, Zheng ZL, Chen JY, Li Q, Cao LF.

Author information: (1)Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong UniversitySchool of Medicine, Shanghai, China.

BACKGROUND: Sublingual immunotherapy (SLIT) is recommended for allergic diseases.However, clinical studies containing evidence-based data of this treatment inyoung children, which is rarely reported in the literature, are needed. Thisstudy was designed to assess the efficacy and safety of SLIT in children,including very young children.METHODS: Two hundred sixty-four children aged 3-13 years old (133 children, 3-5years old) with Dermatophagoides farinae-induced allergic rhinitis with orwithout asthma treated by standard pharmacotherapy had randomly received eitherSLIT (SLIT group) or no SLIT (control group) for 12 months. Symptoms,medications, visual analog scale (VAS) and presence of adverse events (AEs) were assessed at monthly visits. Skin-prick test and Dermatophagoides farinae-specificIgE and IgG4 were measured before and after treatment.RESULTS: Both treatments were effective in the global clinical scores during the first seven visits when compared with baseline (all, p < 0.01), and SLIT showedlower symptoms scores and VAS scores throughout this period (all, p < 0.01).These improvements continued until the later visits only in the SLIT group. Also,the asthma medication consumption was decreased by SLIT treatment only at the endof study (p < 0.01). The specific IgG4 was significantly increased after SLITtreatment when compared with the control group, but no significant change of

specific IgE was observed in either groups. In the SLIT group, there was nosignificant difference between children less than or more than 5 years old interms of clinical efficacy, onset of action, immunologic parameters, and safety. No severe systemic AEs were reported.CONCLUSION: SLIT is effective and well-tolerated in children with allergicrhinitis 3-13 years old.


29. Am J Rhinol Allergy. 2014 Mar-Apr;28(2):e107-14. doi: 10.2500/ajra.2014.28.4040.

Prevalence, risk factors and comorbidities of allergic rhinitis in South Korea:The Fifth Korea National Health and Nutrition Examination Survey.

Rhee CS(1), Wee JH, Ahn JC, Lee WH, Tan KL, Ahn S, Lee JH, Lee CH, Cho YS, ParkKH, Lee KH, Kim KS, Lee A, Kim JW.

Author information: (1)Department of Otorhinolaryngology-Head and Neck Surgery, Seoul NationalUniversity Bundang Hospital, Seoul National University College of Medicine,Seongnam, South Korea.

BACKGROUND: There has been no nationwide epidemiological investigation ofallergic rhinitis (AR) that was diagnosed by both questionnaires and laboratorytests in Korea. This study investigated the prevalence, risk factors, andcomorbidities of AR in South Korea.METHODS: The Korean National Health and Nutritional Examination Survey examined arepresentative sample of the Korean population. A total of 2305 participantsunderwent immunoradiometric assay for specific IgE antibodies against commonindoor allergens. Healthy, atopy only, and AR groups were defined according tothe results of allergen test. The weighted prevalence for each group wascalculated. Risk factors including food and comorbidities were identified usingunivariate or multivariate analyses. The patients were also categorized into foursubgroups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA)classification and associated comorbidities were analyzed.RESULTS: The prevalence of atopy only and AR was 30.0 ± 1.2% and 16.2 ± 1.0%,respectively. The multivariate analysis showed that the prevalence was influencedby sex (p < 0.01) for atopy only and sex (p = 0.09), age (p = 0.02), maritalstatus (p = 0.24), and stress level (p = 0.30) for AR. Compared with the healthy group, asthma (odds ratio [OR] = 4.77), nasal polyp (NP; OR = 3.44), chronicrhinosinusitis (OR = 13.93), and olfactory dysfunction (OR = 4.88) were moreprevalent in the AR group. Based on the ARIA guideline, intermittent mildrhinitis was most common (58.1%). Asthma was correlated to severity and atopicdermatitis and NPs was associated with persistency. Daily intake of less mackereland more carrots, bread, and bean curd were associated with the increased risk ofAR.CONCLUSION: Prevalence, risk factors, and comorbidities of AR were evaluated inthe general Korean population, which will contribute to prevention and treatment of AR and its comorbidities in Koreans.


30. Allergy Asthma Proc. 2014 Mar-Apr;35(2):163-70. doi: 10.2500/aap.2014.35.3728.

Effect of intranasal triamcinolone acetonide on basalhypothalamic-pituitary-adrenal axis function in children with allergic rhinitis.

Georges G(1), Kim KT, Ratner P, Segall N, Qiu C.

Author information: (1)GlaxoSmithKline, Research Triangle Park, North Carolina, USA.

Intranasal corticosteroids are the most effective medication class forcontrolling allergic rhinitis (AR) symptoms. However, limited data are available on their effects on basal hypothalamic-pituitary-adrenal (HPA) axis function inchildren. This study was designed to determine the effect of 6-week triamcinoloneacetonide aqueous (TAA-AQ) nasal spray treatment on HPA axis function bymeasuring 24-hour serum cortisol area under the curve (AUC(0-24h)) in childrenwith AR aged 2-11 years. This phase 4, multicenter, double-blind,placebo-controlled, parallel-group study randomized children with AR to receiveTAA-AQ (110 μg, 2-11 years old, or 220 μg, 6-11 years old) or placebo. At pre-and posttreatment domiciled visits, 24-hour serum cortisol and reflective totalnasal symptom scores (rTNSSs) were assessed. Safety assessment includedtreatment-emergent adverse events (TEAEs) at each visit and trough levels of24-hour serum cortisol. A total of 140 subjects (mean age, 7.2 years; males, 59%)were randomized; 66 from each group completed treatment. The ratio of TAA-AQ toplacebo for change from baseline in serum cortisol AUC(0-24h) was 0.966 (95%confidence interval, 0.892-1.045). Reduction from baseline in mean rTNSS wassignificantly greater in the TAA-AQ than in the placebo group (difference: least square mean ± SE = -0.85 ± 0.24; p = 0.0007). The safety profile was similar(TEAEs, TAA-AQ, 27.5%; placebo, 25.4%), and so was the mean change in serumcortisol trough level (TAA-AQ, -0.4 μg/dL; placebo, -0.1 μg/dL; p = 0.1818 fortreatment difference) from pre- to posttreatment. TAA-AQ was safe, welltolerated, and not associated with clinically meaningful suppression of serumcortisol AUC(0-24h) in children with AR. Clinical trial NCT01154153,www.clinicaltrials.gov.


31. BMC Complement Altern Med. 2014 Apr 6;14:128. doi: 10.1186/1472-6882-14-128.

A randomised multicentre trial of acupuncture in patients with seasonal allergic rhinitis--trial intervention including physician and treatment characteristics.

Ortiz M(1), Witt CM, Binting S, Helmreich C, Hummelsberger J, Pfab F, WullingerM, Irnich D, Linde K, Niggemann B, Willich SN, Brinkhaus B.

Author information: (1)Institute of Social Medicine, Epidemiology and Health Economics,Charité-Universitätsmedizin Berlin, Berlin, Germany. [email protected].

BACKGROUND: In a large randomised trial in patients with seasonal allergicrhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue medication. The aim of this paper is to describe the characteristics of thetrial's participating physicians and to describe the trial intervention inaccordance with the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guidelines, to make details of the trial intervention moretransparent to researchers and physicians.METHODS: ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) was a three-armed,randomised, controlled multicentre trial. 422 SAR patients were randomised tosemi-standardised acupuncture plus rescue medication (RM, cetirizine), shamacupuncture plus RM or RM alone. We sent a questionnaire to trial physicians inorder to evaluate their characteristics regarding their education about andexperience in providing acupuncture. During the trial, acupuncturists were asked to diagnose all of their patients according to Chinese Medicine (CM) as a basisfor the semi-standardised, individualized intervention in the acupuncture group. Every acupuncture point used in this trial had to be documented after eachsessionRESULTS: Acupuncture was administered in outpatient clinics by 46 (mean age47 ± 10 years; 24 female/ 22 male) conventionally-trained medical doctors (67%with postgraduate specialization such as internal or family medicine) with

additional extensive acupuncture training (median 500 hours (1st quartile 350,3rd quartile 1000 hours with 73% presenting a B-diploma in acupuncture training(350 hours)) and experience (mean 14 years in practice). The most reportedtraditional CM diagnosis was 'wind-cold invading the lung' (37%) and 'wind-heatinvading the lung' (37%), followed by 'lung and spleen qi deficiency' (9%). Thetotal number of needles used was higher in the acupuncture group compared to the sham acupuncture group (15.7 ± 2.5 vs. 10.0 ± 1.6).CONCLUSIONS: The trial interventions were provided by well educated andexperienced acupuncturists. The different number of needles in both intervention groups could be possibly a reason for the better clinical effect in SAR patients.For future trials it might be more appropriate to ensure that acupuncture andsham acupuncture groups should each be treated by a similar number of needles.TRIAL REGISTRATION: ClinicalTrials.gov: NCT00610584.


32. PLoS Med. 2014 Mar 11;11(3):e1001611. doi: 10.1371/journal.pmed.1001611.eCollection 2014.

Active or passive exposure to tobacco smoking and allergic rhinitis, allergicdermatitis, and food allergy in adults and children: a systematic review andmeta-analysis.

Saulyte J(1), Regueira C(1), Montes-Martínez A(1), Khudyakov P(2), TakkoucheB(1).

Author information: (1)Department of Preventive Medicine, University of Santiago de Compostela,Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red deEpidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain. (2)Departments ofEpidemiology and Biostatistics, Harvard School of Public Health, Boston,Massachusetts, United States of America.

BACKGROUND: Allergic rhinitis, allergic dermatitis, and food allergy areextremely common diseases, especially among children, and are frequentlyassociated to each other and to asthma. Smoking is a potential risk factor forthese conditions, but so far, results from individual studies have beenconflicting. The objective of this study was to examine the evidence for anassociation between active smoking (AS) or passive exposure to secondhand smokeand allergic conditions.METHODS AND FINDINGS: We retrieved studies published in any language up to June30th, 2013 by systematically searching Medline, Embase, the five regionalbibliographic databases of the World Health Organization, and ISI-Proceedingsdatabases, by manually examining the references of the original articles andreviews retrieved, and by establishing personal contact with clinicalresearchers. We included cohort, case-control, and cross-sectional studiesreporting odds ratio (OR) or relative risk (RR) estimates and confidenceintervals of smoking and allergic conditions, first among the general population and then among children. We retrieved 97 studies on allergic rhinitis, 91 onallergic dermatitis, and eight on food allergy published in 139 differentarticles. When all studies were analyzed together (showing random effects modelresults and pooled ORs expressed as RR), allergic rhinitis was not associatedwith active smoking (pooled RR, 1.02 [95% CI 0.92-1.15]), but was associated withpassive smoking (pooled RR 1.10 [95% CI 1.06-1.15]). Allergic dermatitis wasassociated with both active (pooled RR, 1.21 [95% CI 1.14-1.29]) and passivesmoking (pooled RR, 1.07 [95% CI 1.03-1.12]). In children and adolescent,allergic rhinitis was associated with active (pooled RR, 1.40 (95% CI 1.24-1.59) and passive smoking (pooled RR, 1.09 [95% CI 1.04-1.14]). Allergic dermatitis wasassociated with active (pooled RR, 1.36 [95% CI 1.17-1.46]) and passive smoking(pooled RR, 1.06 [95% CI 1.01-1.11]). Food allergy was associated with SHS (1.43 [1.12-1.83]) when cohort studies only were examined, but not when all studies

were combined. The findings are limited by the potential for confounding and biasgiven that most of the individual studies used a cross-sectional design.Furthermore, the studies showed a high degree of heterogeneity and the exposureand outcome measures were assessed by self-report, which may increase thepotential for misclassification.CONCLUSIONS: We observed very modest associations between smoking and someallergic diseases among adults. Among children and adolescents, both active andpassive exposure to SHS were associated with a modest increased risk for allergicdiseases, and passive smoking was associated with an increased risk for foodallergy. Additional studies with detailed measurement of exposure and better casedefinition are needed to further explore the role of smoking in allergicdiseases.


33. J Laryngol Otol. 2014 Mar;128(3):242-8. doi: 10.1017/S002221511400036X. Epub 2014Mar 11.

Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids: a randomised, double-blind, placebo-controlled study.

Goh BS(1), Ismail MI(2), Husain S(1).

Author information: (1)Department of Otorhinolaryngology Head and Neck Surgery, Universiti KebangsaanMalaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur,Malaysia. (2)Department of Otorhinolaryngology, Hospital Melaka, Malacca,Malaysia.

OBJECTIVE: This study investigated improvements in quality of life associatedwith eight weeks of montelukast and/or intranasal steroid treatment for moderate to severe allergic rhinitis.METHODS: A single-centre, prospective, randomised, double-blind,placebo-controlled study was carried out. Assessments were made using theRhinoconjunctivitis Quality of Life Questionnaire and symptom scales.RESULTS: A total of 128 patients (aged 13-51 years) were randomly assigned to oneof two groups. In the montelukast group, patients were treated with montelukasttablets and fluticasone propionate nasal spray (n = 64). In the placebo group,treatment comprised a placebo and fluticasone propionate. The results showedsignificant improvements in symptom scores and quality of life scores for bothgroups after one month and two months of treatment, compared with baselinevalues; these improvements were significantly greater for the montelukast groupcompared with the placebo group. The mean number of loratadine tablets taken byeach patient during the study period was only 0.73 for the montelukast groupcompared with 9 for the placebo group.CONCLUSION: The combination of montelukast tablets and fluticasone propionatenasal spray improved symptom control and overall quality of life for moderate to severe allergic rhinitis patients.


34. Int Forum Allergy Rhinol. 2014 Jan;4(1):43-8.

A pilot study of the effects of intranasal budesonide delivered by NasoNeb® onpatients with perennial allergic rhinitis.

Brown K, Lane J, Silva MP, DeTineo M, Naclerio RM, Baroody FM.

BACKGROUND: We investigated whether nebulization of budesonide via a NasoNeb®device would treat perennial allergic rhinitis.METHODS: We performed a parallel, randomized, double-blind, placebo-controlled,pilot study in subjects (n = 40) with perennial allergic rhinitis. Afterrecording baseline symptoms, subjects were randomized to budesonide respules(0.25 mg) or an equivalent placebo for 26 days. Nasal peak inspiratory flow(NPIF) and nasal symptoms (graded on a 0–3 scale) were recorded by the subjectstwice daily. Rhinoconjunctivitis quality of life (RQOL) as well as nasal volume, measured by acoustic rhinometry, was obtained at baseline, after 2 weeks, and at the end of treatment.RESULTS: The average change from baseline in symptoms over the treatment periodwas greater for the group on budesonide (−3.33) compared to placebo (−1.98) (p = 0.45). When the average change from baseline over the treatment period wascompared between the groups, budesonide resulted in higher NPIF (36.4 L/min) thanplacebo (18.7 L/min), p = 0.094. QOL improved in both groups compared to baselinewith no significant difference between the groups. Although acoustic rhinometryindicated a larger volume in the group treated with budesonide on the last trial visit, the differences between the groups were not significant when accountingfor the baseline values.CONCLUSION: Compared to placebo, administration of nebulized budesonide insubjects with perennial allergic rhinitis resulted in improvements in symptomsand objective measures of nasal congestion which approached but did not achievestatistical significance. A higher dose of active agent, a less effective placeboand a larger number of subjects might have improved statistical significance.


35. J Allergy Clin Immunol Pract. 2013 May-Jun;1(3):214-26; quiz 227. doi:10.1016/j.jaip.2013.03.012. Epub 2013 Apr 29.

Current and future directions in pediatric allergic rhinitis.

Gentile D(1), Bartholow A(1), Valovirta E(2), Scadding G(3), Skoner D(4).

Author information: (1)Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa. (2)Turku Allergy Center, Turku, Finland. (3)TheRoyal National Throat, Nose and Ear Hospital, London, United Kingdom. (4)Divisionof Allergy, Asthma and Immunology, Department of Medicine, Allegheny GeneralHospital, Pittsburgh, Pa. Electronic address: [email protected].

BACKGROUND: Allergic rhinitis (AR) is a common pediatric problem thatsignificantly affects sleep, learning, performance, and quality of life. Inaddition, it is associated with significant comorbidities and complications.OBJECTIVE: The aim was to provide an update on the epidemiology, comorbidities,pathophysiology, current treatment, and future direction of pediatric AR.METHODS: Literature reviews in each of these areas were conducted, and theresults were incorporated.RESULTS: The prevalence of AR is increasing in the pediatric population and isassociated with significant morbidity, comorbidities, and complications. Themainstay of current treatment strategies includes allergen avoidance,pharmacotherapy, and allergen specific immunotherapy.CONCLUSIONS: In the future, diagnosis will be improved by microarrayedrecombinant allergen testing and therapy will be expanded to include emergingtreatments such as sublingual immunotherapy and combination products.



36. Int Forum Allergy Rhinol. 2014 Feb;4(2):110-6. doi: 10.1002/alr.21246. Epub 2013 Nov 4.

The role of secondhand smoke in allergic rhinitis: a systematic review.

Hur K(1), Liang J, Lin SY.

Author information: (1)Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD.

BACKGROUND: The objective of this work was to systematically review existingliterature on the association between allergic rhinitis (AR) and secondhandsmoking (SHS) in children and adults.METHODS: We performed a literature search encompassing the last 25 years inPubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL),Cochrane CENTRAL, Web of Science, Scopus, and EMBASE. Inclusion criteria includedEnglish language papers containing original human data with greater than 6subjects. Data was systematically collected on study design, patientdemographics, clinical characteristics/outcomes, and level-of-evidence (OxfordCenter of Evidence-Based Medicine). Quality assessment of the studies wasperformed using the Newcastle-Ottawa scale. Two investigators independentlyreviewed all manuscripts.RESULTS: The initial search yielded 590 abstracts, of which 40 articles wereincluded. 12 (37.5%) of the 32 articles studying children and 5 (62.5%) of the 8 articles studying adults showed a statistically significant association betweenAR and SHS. One article was a prospective cohort study (Level 2b) and all otherarticles were case-control studies (Level 3b). For characterizing AR, 10 (25%)studies included skin-prick testing and 5 (12.5%) used in vitro testing. Fordetermining presence of SHS, 39 (97.5%) of the studies used questionnaires and 1 article used a cotinine/creatinine ratio.CONCLUSION: This review demonstrated a majority of adult studies vs a minority ofchildren studies found a significant association between AR and SHS. However, thepercent difference between age groups was not statistically significant. Further higher-quality studies with validated methods for diagnosing AR and quantifyingSHS exposure should be performed to better evaluate the relationship between ARand SHS in adults and children.

© 2013 ARS-AAOA, LLC.


37. Curr Med Res Opin. 2014 Jun;30(6):1131-7. doi: 10.1185/03007995.2014.882299. Epub2014 Jan 30.

Barrier-enforcing measures as treatment principle in allergic rhinitis: asystematic review.

Andersson M(1), Greiff L, Ojeda P, Wollmer P.

Author information: (1)Department of Otorhinolaryngology, Skåne University Hospital , Sweden.

BACKGROUND AND OBJECTIVES: Barrier-enforcing measures have been suggested astreatment options for allergic rhinitis. This review identifies and describes theliterature on the subject.METHODS: Relevant publications were searched for in the PubMed database (searchentries: 'allergic rhinitis' and 'treatment'). The evaluation comprised condition(seasonal or perennial allergic rhinitis), type of intervention, duration oftreatment, study design, peer review status or not, number of test subjects, type

of allergen exposure, and outcome in terms of effects or not on nasal symptoms ofallergic rhinitis.RESULTS: Fifteen studies were either identified in the PubMed database search or from the reference lists of identified publications. Seven wereplacebo-controlled, randomized, and peer-reviewed, and symptom-reducing effectswere reported by all of these reports. Limitations of this review reflect thatthe remainder of the studies had inferior designs, particularly lack of placebocontrol.CONCLUSIONS: Barrier-enforcing measures as achieved by nasal administrations ofcellulose powder and microemulsions, respectively, have symptom-reducing effects in allergic rhinitis.


38. Ann Pharmacother. 2013 Sep;47(9):1175-81. doi: 10.1177/1060028013503125.

Effect of inhaled corticosteroids on long-term growth in pediatric patients with asthma and allergic rhinitis.

Hoover RM(1), Erramouspe J, Bell EA, Cleveland KW.

Author information: (1)Department of Pharmacy Practice and Administrative Sciences, College ofPharmacy, Idaho State University, Pocatello, ID, USA.

OBJECTIVE: To evaluate the effect of orally and nasally inhaled corticosteroids(ICS) on final adult height in pediatric patients with mild to moderatepersistent asthma and allergic rhinitis.DATA SOURCES: MEDLINE (1975-April 2013), Cochrane Library (through 2012), andInternational Pharmaceutical Abstracts (1975-April 2013) were searched forprospective clinical trials assessing the effects of orally or intranasally ICSuse on growth in pediatric patients with asthma or allergic rhinitis using theterms inhaled/intranasal corticosteroid, linear growth, height, and asthma orallergic rhinitis.STUDY SELECTION AND DATA EXTRACTION: Eligible articles included double-blind,randomized, placebo-controlled studies of at least 1 year with growth velocity orheight as the primary outcome.DATA SYNTHESIS: Seven trials and 1 follow-up study analyzing the effects oforally ICSs were examined. Of these studies, 4 found a delay in growth in atleast 1 subset of its participants of approximately 1 cm, 1 study found adecrease in final adult height of 1.2 cm, and 3 studies found no effect. Of the 4studies examining nasally ICS, 1 found evidence of growth delay in a subgroupusing supratherapeutic dosing. There are conflicting data on whether ICS usecauses long-term growth reduction in pediatric patients. The concern surrounding their long-term use including a potential delay or decrease in growth may result in underuse and potential mismanagement of persistent asthma and/or allergicrhinitis. Patients should be treated with the lowest effective corticosteroiddose to achieve symptomatic control while minimizing excessive systemic effects. Orally ICS use may cause a delay in growth, but a decrease in final adult height (1.2 cm) has been documented in only one study. This single report should notpreclude daily use of inhaled corticosteroids if needed to decrease the morbidityand mortality associated with pediatric reactive airway disease.CONCLUSIONS: Continued studies on the systemic effects of ICS are required beforetruly understanding the class's effect on growth in pediatric patients withasthma and allergic rhinitis. What is understood, however, is the detriment andpotential danger of mismanaged asthma care.


39. Otolaryngol Head Neck Surg. 2014 Jan;150(1):22-7. doi: 10.1177/0194599813510892.

Epub 2013 Nov 14.

Inconclusive evidence for allergic rhinitis to predict a prolonged or chroniccourse of acute rhinosinusitis.

Frerichs KA(1), Nigten G, Romeijn K, Kaper NM, Grolman W, van der Heijden GJ.

Author information: (1)Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center RudolfMagnus, University Medical Center Utrecht, Utrecht, the Netherlands.

OBJECTIVE: To systematically review the evidence on allergic rhinitis as apredictor for a prolonged or chronic course in adult patients with acuterhinosinusitis.DATA SOURCES: Pubmed, EMBASE, and the Cochrane library.REVIEW METHODS: A systematic literature search was performed on March 15, 2013.During screening of title and abstract, 3 authors independently selected studies on allergic rhinitis as a predictor for the course of acute rhinosinusitis inadults. The reported study design was assessed for directness of evidence andrisk of bias. We aimed to extract prior and posterior probabilities for aprolonged or chronic course of acute rhinosinusitis.RESULTS: Of 13,202 retrieved articles, 2 articles were eligible for studyassessment. They provided a high directness of evidence but carried a high riskof bias. The studies showed an incidence of a prolonged and chronic course of,respectively, .19 (95% confidence interval [CI] .16-.23) and .05 (95% CI,.02-.13). In patients with allergic rhinitis, the incidence was .25 (95% CI,.18-.35) and .14 (95% CI, .04-.34), so the added value of allergic rhinitis topredict a prolonged course is 6% and to predict a chronic course 8%.CONCLUSION AND RECOMMENDATION: While the 2 included studies suggest that allergicrhinitis adds little to the prediction of a prolonged or chronic course inpatients with acute rhinosinusitis, they carry a high risk of bias. As theavailable evidence does not provide grounds for different management of patients with and without allergic rhinitis, namely, according to clinical practiceguidelines, both can be managed with expectant observation and symptomatictreatment.


40. Int J Pediatr Otorhinolaryngol. 2013 Dec;77(12):1922-4. doi:10.1016/j.ijporl.2013.10.006. Epub 2013 Oct 19.

Effectiveness of montelukast in pediatric patients with allergic rhinitis.

Yilmaz O(1), Altintas D, Rondon C, Cingi C, Oghan F.

Author information: (1)Celal Bayar University Medical Faculty, Department of Pediatric Allergy andPulmonology, Manisa, Turkey. Electronic address: [email protected].

Allergic rhinitis (AR) is one of the most common chronic diseases of childhoodand carries significant morbidity as well as physical and psychosocialconsequences. Therapy aims to alleviate clinical symptoms, prevent complications and improve psychosocial consequences. Leukotrienes which are amongst the mainmediators in pathogenesis of AR have chemotactic properties and lead to increasedvascular permeability. Thus, leukotriene antagonism may be an effectivetherapeutic option in treatment of allergic diseases, specifically AR.Montelukast which is a leukotriene receptor type I inhibitor has variableefficacy in children with AR and the guidelines recommend its use in childrenwith seasonal AR aged six years and above. Although its efficacy is inferior toanti-histamines and intranasal corticosteroids, combination treatment may warrantclinical efficacy. Therefore, montelukast may be considered to be awell-tolerated therapeutic option for children with AR with minor side effects

though long term results need to be assessed. In conclusion, larger scaleresearch enrolling pediatric cases with seasonal and persistent AR are requiredbefore concise recommendations about montelukast use in pediatric AR can be made.



41. J Pharm Sci. 2013 Dec;102(12):4213-29. doi: 10.1002/jps.23720. Epub 2013 Nov 1.

An overview of the pediatric medications for the symptomatic treatment ofallergic rhinitis, cough, and cold.

Fan Y(1), Ji P, Leonard-Segal A, Sahajwalla CG.

Author information: (1)Division of Clinical Pharmacology II, Office of Clinical Pharmacology, U.S.Food and Drug Administration, Silver Spring, Maryland, 20993.

Upper respiratory infections and allergic rhinitis are common diseases inchildren. In recent years, U.S. Food and Drug Administration has been promotingpediatric drug development with marketing exclusivity incentives andrequirements. The assessment of clinical pharmacology, efficacy, and safety data has facilitated pediatric drug development and provided appropriate labeling for pediatric use. Regulatory decision making involves multiple evaluation processes,including drug exposure comparison between adult and pediatric population,formulation bridging, dose selection, and evaluation of efficacy and safety inpediatric patients. This article reviews the pediatric drugs indicated for cough,cold, and allergic rhinitis, focusing on the utility of clinical pharmacology,safety, and efficacy data in determining the pediatric dosing regimen and theapproaches taken for regulatory decision making.

© 2013 Wiley Periodicals, Inc. and the American Pharmacists Association.


42. Ann Allergy Asthma Immunol. 2013 Nov;111(5):408-414.e1. doi:10.1016/j.anai.2013.07.033. Epub 2013 Aug 28.

Efficacy and safety of beclomethasone dipropionate nasal aerosol in pediatricpatients with seasonal allergic rhinitis.

Storms WW(1), Segall N, Mansfield LE, Amar NJ, Kelley L, Ding Y, Tantry SK.

Author information: (1)William Storms Allergy Clinic, Colorado Springs, Colorado. Electronic address:[email protected].

BACKGROUND: Aerosolized intranasal corticosteroid formulations are desirable for many patients with allergic rhinitis (AR), especially children, who wish to avoidthe "wet feeling" and "drip down the throat" associated with aqueousformulations. Beclomethasone dipropionate (BDP) hydrofluoroalkane nasal aerosolhas been shown to be safe and effective in adolescents and adults with AR.OBJECTIVE: To evaluate the efficacy and safety of BDP nasal aerosol in pediatric patients with moderate to severe seasonal AR.METHODS: In this double-blinded, placebo-controlled study, children (6-11 yearsof age) with seasonal AR were randomized to once-daily treatment with BDP nasalaerosol 80 μg (n = 239) or 160 μg (n = 242) or placebo (n = 234). The primary endpoint was change from baseline in average morning and evening reflective totalnasal symptom score over the 2-week treatment period.

RESULTS: Treatment with BDP nasal aerosol showed significantly greaterimprovements in average morning and evening reflective total nasal symptom score vs placebo (80 μg, -0.71; 160 μg, -0.76; P < .001 for the 2 comparisons).Similarly, significantly greater improvements in average morning and eveninginstantaneous total nasal symptom score were seen with BDP nasal aerosol vsplacebo (80 μg, -0.63; 160 μg, -0.73; P < .001 for the 2 comparisons). Theincidence of adverse events from BDP nasal aerosol was comparable to that fromplacebo.CONCLUSION: BDP nasal aerosol (80 or 160 μg/d) provided significant andclinically meaningful nasal symptom relief and an established overall safetyprofile similar to that of placebo, suggesting that it is an effective andwell-tolerated treatment option for pediatric patients with moderate to severeseasonal AR.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT012073190.



43. Expert Opin Biol Ther. 2013 Nov;13(11):1543-56. doi:10.1517/14712598.2013.844226. Epub 2013 Oct 8.

Allergen immunotherapy for house dust mite: clinical efficacy and immunologicalmechanisms in allergic rhinitis and asthma.

Eifan AO(1), Calderon MA, Durham SR.

Author information: (1)Imperial College London, Allergy and Clinical Immunology , NHLI, London, SW72AZ , UK [email protected].

INTRODUCTION: There is an increasing prevalence of atopic diseases such asallergic rhinitis and asthma with house dust mite (HDM) being the common allergenthat is highly associated with allergic rhinitis and asthma. Allergen avoidanceand pharmacotherapy are part of treatment but it has proved difficult to changethe course of HDM-related allergic diseases. Allergen immunotherapy (AIT) hasbeen in use for the past century and has been shown to be effective in thetreatment of allergic respiratory disease.AREAS COVERED: This review exclusively focuses on HDM-AIT and discusses thedifferences in clinical efficacy and safety, long-term effect afterdiscontinuation and immunological changes observed in both HDM-subcutaneousimmunotherapy (SCIT) and HDM-sublingual immunotherapy (SLIT) in the treatment of allergic rhinitis and asthma in both pediatric and adult populations.EXPERT OPINION: The majority of studies involved small numbers of patients,variable doses of major allergens and are of variable quality. There is goodevidence for HDM-SCIT efficacy and its long-term effect in adults and children,whereas at the present time, evidence for HDM-SLIT is unconvincing, particularly in children. In carefully selected patients, HDM-SCIT is effective and safe. Moredefinitive trials are needed before HDM-SLIT can be recommended in routinepractice for rhinitis and/or asthma.


44. Allergy Asthma Proc. 2013 Nov-Dec;34(6):551-7. doi: 10.2500/aap.2013.34.3715.Epub 2013 Sep 27.

Validation of the allergic rhinitis treatment satisfaction and preference scale.

Turner RR(1), Testa MA, Hayes JF, Su M.

Author information: (1)Phase V Technologies, Inc., Wellesley Hills, Massachusetts, USA.

Allergic rhinitis (AR) affects 7.8% of U.S. adults and 10-30% of the populationworldwide. AR symptoms (rhinorrhea, congestion, sneezing, nasal/ocular pruritus, and postnasal drainage) significantly impact sleep and reduce cognitive andemotional functioning affecting work and school productivity. Although effective,intranasal corticoid (INS) steroid delivery systems are often associated withadverse sensory attributes, affecting patient adherence and reducing efficacy.Patient satisfaction with treatment characteristics predicts adherence levelsthat can better inform treatment decisions. This study was designed to evaluatepsychometric evidence for the self-administered Allergic Rhinitis TreatmentSatisfaction and Preference (ARTSP) scale as a patient-reported outcomes measure for use in clinical research. Analytic methods included qualitative analysis ofpatient focus groups and psychometric analysis of scale data collected from 185AR subjects enrolled in a randomized, 2-week, crossover, comparative U.S.clinical trial. Qualitative analysis conceptually supported nine treatmentsatisfaction subscales. Reliability by Cronbach alpha met accepted standards.Evidence was found for construct validity using structural equation modeling,criterion validity from correlation patterns between treatment satisfaction andhealth-related quality of life scales, and discriminant validity analysis basedon AR symptom-defined groups. Responsiveness was shown by significant change intreatment satisfaction subscales among AR symptom change groups. Scores ontreatment preference items discriminated between the aqueous and aerosol INSformulations. The ARTSP scale is a conceptually sound, reliable, valid, andresponsive measure of patient evaluations of alternative therapies, providingdetailed information about treatment characteristics that are likely to influenceadherence levels and subsequent AR clinical control.


45. Paediatr Drugs. 2013 Dec;15(6):431-40. doi: 10.1007/s40272-013-0043-3.

Pediatric allergic rhinitis and asthma: can the march be halted?

Tsilochristou OA(1), Douladiris N, Makris M, Papadopoulos NG.

Author information: (1)Allergy Unit "D. Kalogeromitros," Medical School, "Attikon" UniversityHospital, 1, Rimini str, 124 62, Chaidari, Athens, Greece,[email protected].

The strong epidemiologic and pathophysiologic link between allergic rhinitis (AR)and asthma has led to the concept of 'united airways disease' or 'respiratoryallergy', implying that allergy, in its widest sense, underlies this clinicalsyndrome. Progression from AR to asthma is frequent and part of the 'atopicmarch'. Since pediatric immune responses are more adaptable and therefore may be more amenable to treatment, interventions at early childhood are characterized bya higher chance to affect the natural history of respiratory allergy. Althoughcurrent treatments are quite effective in alleviating respiratory allergysymptoms, it has proven much more difficult to confirm any influence on theprogression of the disease. Much more promising is the field of specific allergenimmunotherapy, where current evidence, although not yet of ideal robustness,points towards a disease-modifying effect. In addition, newer or emerging,possibly more effective or more targeted interventions are promising in thepreventive sense.


46. Am J Rhinol Allergy. 2013 Jul-Aug;27(4):299-303. doi: 10.2500/ajra.2013.27.3923.

Randomized double-blind placebo-controlled crossover study of efficacy of pollen blocker cream for perennial allergic rhinitis.

Li Y(1), Wang D, Liu Q, Liu J.

Author information: (1)Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, FudanUniversity, Shanghai, China.

BACKGROUND: This study evaluates the efficacy and safety of a pollen blockercream in treatment of perennial allergic rhinitis (PAR) in a Chinese population.METHODS: A randomized double-blind placebo-controlled, crossover trial wasconducted in the Outpatient Department of the Eye, Ear, Nose, and ThroatHospital, Fudan University, Shanghai, China. Patients diagnosed with PAR wererandomly assigned to receive pollen blocker cream or placebo, which was appliedand evenly distributed to the lower internal nose region three times daily for a total of 30 days. The primary outcome measures for efficacy were nasal symptomscores (NSSs) and quality of life scores (QoLSs). Medication scores and adverseevents were also monitored.RESULTS: After application of pollen blocker, the mean NSS fell from 23.1 to 12.4points, and the QoLSs fell from 83.9 to 53.2 points (p < 0.001). The decrease in NSSs of pollen blocker (10.7) was highly significant compared with the placebo(3.6; p < 0.001). The decrease in QoLSs of pollen blocker was 30.7 compared with 7.1 in the placebo group, and the difference was also significant (p < 0.05).Interestingly, the mean NSS of the placebo group also decreased from 23.7 to 20.1(p < 0.05). Additionally, the efficacy of pollen blocker was superior to theplacebo both in adults and in children. However, there was no significantdifference for individual symptoms of rhinorrhea, nasal itching, sneezing, andnasal congestion between the pollen blocker group and placebo group (p > 0.05).Only one mild epistaxis was reported.CONCLUSION: The pollen blocker was significantly more effective than the placebo in relieving allergy symptoms and improving life quality of PAR in 30 Chinesepeople.


47. Recent Pat Inflamm Allergy Drug Discov. 2013 Sep;7(3):223-8.

New patents of fixed combinations of nasal antihistamines and corticosteroids in allergic rhinitis.

Wolthers OD(1).

Author information: (1)Asthma and Allergy Clinic, Children's Clinic Randers, Dytmærsken 9, 8900Randers, Denmark. [email protected]

During the last few years, fixed combinations of intranasal antihistamines andcorticosteroids have been introduced for treatment of allergic rhinitis. The aim of this systematic review was to assess recent patents and clinical evidence for fixed combinations of intranasal antihistamines and intranasal corticosteroids inallergic rhinitis. Data base searches revealed that intranasal combinations ofthe antihistamine azelastine with the corticosteroids mometasone furoate,ciclesonide and fluticasone propionate, respectively, have been patented. Fourrandomized, double-blinded, parallel-group, placebo-controlled, multicentertrials sponsored by the manufacturer evaluated the fixed combination ofintranasal azelastine 125 µg and fluticasone propionate 50 µg administered as onedose per nostril b.i.d. in patients with moderate-to-severe symptomatic allergic rhinitis ≥ 12 years of age. Three of the studies were published as ameta-analysis which found the fixed combination of azelastine and fluticasonepropionate statistically significantly more efficacious in reducing baseline

total nasal symptom score by 5.7 as compared to azelastine (4.4; P < 0.001),fluticasone propionate (5.1; P < 0.001) and placebo (3.0; P < 0.001). Thefindings were supported by secondary assessments of scores of specific nasal and ocular symptoms. Pharmacokinetic studies have revealed no drug-drug interactions but a discrete increase in bioavailability of fluticasone propionate which wasconsidered clinically unimportant. Further efficacy and quality-of-life studiesof combination products of nasal antihistamines and corticosteroids are needed,especially, in primary care settings and in children before fixed combinationtreatment can be considered first line therapy in allergic rhinitis. Fixedcombination treatment of azelastine and fluticasone propionate may offeradditional benefit to selected populations of adolescents and adults withmoderate-to-severe symptoms.


48. Asian Pac J Allergy Immunol. 2013 Jun;31(2):142-7. doi:10.12932/AP0262.31.2.2013.

The effect of six-weeks of sauna on treatment autonomic nervous system, peaknasal inspiratory flow and lung functions of allergic rhinitis Thai patients.

Kunbootsri N(1), Janyacharoen T, Arrayawichanon P, Chainansamit S, Kanpittaya J, Auvichayapat P, Sawanyawisuth K.

Author information: (1)School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand.

BACKGROUND: Allergic rhinitis is a chronic respiratory disease. Sympathetichypofunction has been identified in allergic rhinitis patients.OBJECTIVE: To investigate the effects of six weeks of repeated sauna treatment onthe autonomic nervous system, peak nasal inspiratory flow (PNIF) and lungfunctions in Thai patients with allergic rhinitis.METHODS: Subjects were diagnosed with allergic rhinitis clinically by anattending physician based on history, physical examination and positive reactionsto a skin prick test. Subjects were randomly assigned to two groups.Controlsubjects received education and maintained a normal life. The sauna group received sauna treatment over a six-week period, 3 days per week, with 6 sets of 5 minutes per set per day, totaling 30 minutes. Each 5 minute set alternated witha 5 minute period of rest. Heart rate variability (HRV), peak nasal inspiratoryflow and lung function were measured at the beginning and after three and sixweeks of sauna treatment. The HRV measurement is composed of three components,including low frequency (indicating sympathetic function in normal units orn.u.), high frequency (indicated parasympathetic function in n.u.), and the ratioof LF/HF (indicating the balance of the autonomic system).RESULTS: Twenty-six allergic rhinitis patients, 12 males and 14 femalesparticipated in this study, 13 in the control group and 13 in the sauna treatmentgroup; there were 6 males in each group. Baseline characteristics for the controland sauna treatment groups were comparable. There were significant changes in theHRV after six weeks of sauna treatment. The high frequency component wassignificantly lower in sauna treatment group (51.8 vs 35.4), while the lowfrequency component and LF/HF ratio were significantly higher in sauna treatment group than in the control group (48.1 vs 64.5 and 0.9 vs 2.5, respectively). The PNIF and the forced expiratory volume in one second, or FEV1, were alsosignificantly higher in sauna treatment group (103.0 vs 161.9 and 80.1 vs 95.6,respectively).CONCLUSION: The six weeks of repeated sauna treatment can increase sympatheticactivity, PNIF, and FEV1 in Thai patients with allergic rhinitis.


49. Health Technol Assess. 2013 Jul;17(27):vi, xi-xiv, 1-322. doi: 10.3310/hta17270.

A systematic review and economic evaluation of subcutaneous and sublingualallergen immunotherapy in adults and children with seasonal allergic rhinitis.

Meadows A(1), Kaambwa B, Novielli N, Huissoon A, Fry-Smith A, Meads C, Barton P, Dretzke J.

Author information: (1)Department of Public Health, Epidemiology and Biostatistics, University ofBirmingham, Birmingham, UK.

BACKGROUND: Severe allergic rhinitis uncontrolled by conventional medication can substantially affect quality of life. Immunotherapy involves administeringincreasing doses of a specific allergen, with the aim of reducing sensitivity andsymptomatic reactions. Recent meta-analyses have concluded that both subcutaneousimmunotherapy (SCIT) and sublingual immunotherapy (SLIT) are more effective than placebo in reducing symptoms. It is uncertain which route of administration ismore effective and whether or not treatment is cost-effective.OBJECTIVE: To determine the comparative clinical effectiveness andcost-effectiveness of SCIT and SLIT for seasonal allergic rhinitis in adults and children.DATA SOURCES: Electronic databases {MEDLINE, EMBASE, The Cochrane Library[Cochrane Central Register of Controlled Trials (CENTRAL)], NHS EconomicEvaluation Database (NHS EED)} and trial registries (from inception up to April2011).REVIEW METHODS: Standard systematic review methods were used for study selection,data extraction and quality assessment. Double-blind randomised,placebo-controlled trials of SCIT or SLIT, or of SCIT compared with SLIT, andeconomic evaluations were included. Meta-analysis and indirect comparisonmeta-analysis and meta-regression were carried out. A new economic model wasconstructed to estimate cost-utility.RESULTS: Meta-analyses found statistically significant effects for SCIT and SLIT compared with placebo across a number of outcome measures and for the vastmajority of subgroup analyses (type and amount of allergen, duration oftreatment). There was less evidence for children, but some results in favour ofSLIT were statistically significant. Indirect comparisons did not provideconclusive results in favour of either SCIT or SLIT. Economic modelling suggestedthat, when compared with symptomatic treatment (ST), both SCIT and SLIT maybecome cost-effective at a threshold of £20,000-30,000 per quality-adjustedlife-year (QALY) from around 6 years, or 5 years for SCIT compared with SLIT (NHSand patient perspective).LIMITATIONS: It is uncertain to what extent changes in the outcome measures used in the trials translate into clinically meaningful benefits. Cost-effectivenessestimates are based on a simple model, limited data and a number of assumptions, and should be seen as indicative only.CONCLUSIONS: A benefit from both SCIT and SLIT compared with placebo has beenconsistently demonstrated, but the extent of this effectiveness in terms ofclinical benefit is unclear. Both SCIT and SLIT may be cost-effective comparedwith ST from around 6 years (threshold of £20,000-30,000 per QALY). Furtherresearch is needed to establish the comparative effectiveness of SCIT comparedwith SLIT and to provide more robust cost-effectiveness estimates.FUNDING: The National Institute for Health Research Health Technology Assessment programme.


50. Curr Med Res Opin. 2013 Oct;29(10):1329-40. doi: 10.1185/03007995.2013.821055.Epub 2013 Aug 6.

Efficacy, safety, and optimal dose selection of beclomethasone dipropionate nasalaerosol for seasonal allergic rhinitis in adolescents and adults.

Raphael GD(1), Berger WE, Prenner BM, Finn AF Jr, Kelley L, Tantry SK.

Author information: (1)Bethesda Allergy, Asthma and Research Center, LLC , Bethesda, MD , USA.

OBJECTIVE: Some patients with allergic rhinitis (AR) may prefer nonaqueousintranasal corticosteroid aerosols because of unwanted attributes of aqueousformulations. The mandatory removal of chlorofluorocarbon-propelled nonaqueousaerosols from the market limited available treatment options. To fulfill thisunmet need, a nonaqueous, hydrofluoroalkane-propelled beclomethasone dipropionate(BDP) nasal aerosol was developed and approved for treatment of AR nasalsymptoms. As part of the development program, this dose-ranging study evaluatedthree doses of BDP nasal aerosol to determine the optimally safe and effectivedose for adolescent and adult patients (≥12 years old) with seasonal AR (SAR).METHODS: After a 7 to 21 day placebo run-in period, eligible patients with SARwere randomly assigned to once-daily BDP nasal aerosol 80 µg, 160 µg, 320 µg, or placebo. The primary endpoint was the change from baseline in average a.m. andp.m. patient-reported reflective total nasal symptom scores (rTNSS) over 2 weeks.Safety and tolerability were also assessed. A potential study limitation could belack of objective assessment of AR symptoms.RESULTS: Significant improvements were seen in average a.m. and p.m. rTNSS (leastsquares [LS] mean treatment difference, -0.63; 95% CI: -1.13, -0.13; p = 0.013)as well as in average a.m. and p.m. instantaneous TNSS (iTNSS; LS mean treatment difference, -0.60; 95% CI: -1.09, -0.11; p = 0.016) with BDP nasal aerosol320 µg/day compared with placebo. Although there were numerical improvements frombaseline in patient-reported rTNSS and iTNSS with BDP nasal aerosol 80 µg and160 µg, these doses did not achieve statistical significance compared withplacebo. BDP nonaqueous nasal aerosol was well tolerated at all doses tested,with a safety profile comparable to that of placebo.CONCLUSIONS: These data indicate that 320 µg/day of BDP nasal aerosol is theoptimally safe and effective dose for the treatment of SAR in adolescent andadult patients. Trial registration NCT: #NCT00854360.


51. Ann Allergy Asthma Immunol. 2013 Jul;111(1):56-63. doi:10.1016/j.anai.2013.04.008. Epub 2013 May 3.

Cost-effectiveness for acupuncture in seasonal allergic rhinitis: economicresults of the ACUSAR trial.

Reinhold T(1), Roll S, Willich SN, Ortiz M, Witt CM, Brinkhaus B.

Author information: (1)Institute for Social Medicine, Epidemiology and Health Economics, Charité -University Medical Center, Berlin, Germany. [email protected]

BACKGROUND: Allergic rhinitis (AR) is a frequent allergic disorder with asignificant economic effect on health care costs and productivity.OBJECTIVE: To assess the cost-effectiveness of acupuncture for patients withseasonal AR (SAR) in Germany.METHODS: The present analysis was part of the Acupuncture in Seasonal AllergicRhinitis (ACUSAR) trial, a 3-arm randomized, controlled, multicenter trial inpatients with SAR, comparing acupuncture plus rescue medication (RM), penetratingsham acupuncture plus RM, and a control group receiving RM alone. Measures forhealth economic analyses were costs and health-related quality of life.Incremental cost-effectiveness ratio was calculated for different scenarios onthe duration of acupuncture effects and was expressed as costs per

quality-adjusted life-year gained. The study was conducted from society's andfrom a third-party payer's perspective.RESULTS: From 422 initially randomized patients, a total of 364 patients withcomplete data on costs and quality of life were included in the health economicevaluation. Patients receiving acupuncture or sham acupuncture caused highercosts than patients in the RM group. Patients in the acupuncture group gainedsignificantly more quality-adjusted life-years compared with the RM group.Depending on different scenarios, the incremental cost-effectiveness ratio foracupuncture patients was between €31,241 (approximately US $38.569) and €118,889 (approximately US $146,777) from society's perspective and between €20,807(approximately US $25,688) and €74,585 (approximately US $92.080) from athird-party payer's perspective.CONCLUSION: Acupuncture is an effective intervention that results in improvedquality of life in patients with SAR. However, in times of limited resources for health care, acupuncture for AR may not be a cost-effective intervention.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00610584.



52. Ann Allergy Asthma Immunol. 2013 Jul;111(1):45-50. doi:10.1016/j.anai.2013.04.013. Epub 2013 May 12.

Ocular safety of fluticasone furoate nasal spray in patients with perennialallergic rhinitis: a 2-year study.

LaForce C(1), Journeay GE, Miller SD, Silvey MJ, Wu W, Lee LA, Chylack LT Jr.

Author information: (1)North Carolina Clinical Research, Raleigh, North Carolina, USA.

BACKGROUND: This is the first study, to our knowledge, to evaluate the oculareffects of an intranasal corticosteroid during 2 years of treatment for perennialallergic rhinitis (PAR).OBJECTIVE: To assess ocular safety in adult and adolescent patients 12 years and older with PAR after 2 years of continuous treatment with fluticasone furoatenasal spray (FFNS), 110 μg once daily, and placebo.METHODS: This was a 2-year, randomized, double-blind, placebo-controlled study ofonce-daily FFNS, 110 ìg, and placebo in 548 patients 12 years and older with PAR.The primary ocular safety end points were time to first occurrence of an eventfor the Lens Opacities Classification System, Version III (LOCS III), posteriorsubcapsular opacity (PSO) and time to first occurrence of an event forintraocular pressure (IOP).RESULTS: On the basis of survival analyses, the difference between the treatment groups for time to first occurrence of a LOCS III PSO and time to firstoccurrence of an IOP event was not statistically significant (P = .39 and P =.34, respectively). Changes from baseline in visual acuity, LOCS III PSO,cortical opacity, LOCS III nuclear opacity and nuclear color, IOP, and horizontalcup-to-disc similar between treatment groups. There were no ophthalmic-relatedadverse events of LOCS III PSO or IOP that led to early withdrawal. The mostcommon drug-related adverse event was epistaxis (FFNS, 28%; placebo, 14%).CONCLUSION: These data neither support nor negate current recommendations forregular ophthalmic monitoring in patients treated with intranasalcorticosteroids.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00682643.



53. Mediators Inflamm. 2013;2013:345217. doi: 10.1155/2013/345217. Epub 2013 Apr 27.

Evaluation of clinical and immunological responses: a 2-year follow-up study inchildren with allergic rhinitis due to house dust mite.

Moed H(1), Gerth van Wijk R, Hendriks RW, van der Wouden JC.

Author information: (1)Department of General Practice, Erasmus MC-University Medical CenterRotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. [email protected]

Background. Allergic rhinitis is a disease with polarization towards Th2 and adefect of regulatory T cells. Immunological changes have been reported afterimmunotherapy treatment. However, there is not much known about the naturalcourse of allergic rhinitis with respect to clinical manifestation and therelation with immunological responses. Objective. To evaluate clinical symptomsof allergic rhinitis, in relation to in vivo allergen-specific skin responses andin vitro allergen-specific effector and regulatory T cells determined at baselineand after two years. Methods. From a large trial, 59 children were randomlyselected. The following variables were compared: clinical symptoms, allergen skintests, specific IgE, T-cell proliferation, IL-5, IL-13, IFN-gamma, IL-10,TGF-beta, CD4(+)CD25(hi) cells, and Foxp3 expression. Results. Allergic symptoms had decreased after two years. Whereas skin test reactions correlated betweenyears 0 and 2, there was no change in the size of the reaction. Also,proinflammatory reactions did not change after two years, with a positivecorrelation between years 0 and 2. No relevant changes were observed with respectto regulatory cells. Conclusion. Whereas, comparable to immunotherapy, allergiccomplaints decrease, the immunological changes of specific T-cell activity (both effector cells and regulator cells) which are observed after immunotherapy, donot change.


54. J Negat Results Biomed. 2013 Jun 1;12:10. doi: 10.1186/1477-5751-12-10.

A phase 3 trial assessing the efficacy and safety of grass allergy immunotherapy tablet in subjects with grass pollen-induced allergic rhinitis with or withoutconjunctivitis, with or without asthma.

Murphy K, Gawchik S, Bernstein D, Andersen J, Pedersen MR.

BACKGROUND: Design and execution of immunotherapy trials for seasonal allergiesmay be complicated by numerous factors including variable allergy testingmethods, pollen levels, and timing and intensity of other seasonal allergens. We evaluated grass allergy immunotherapy tablet (AIT) treatment in North Americanadults with grass pollen-induced allergic rhinitis with or without conjunctivitis(AR/C), with/without asthma.METHODS: Subjects age 18-65 with clinical history of grass pollen-induced AR/C,with/without asthma were randomized 1:1 to once-daily 2800 BAU Timothy grass AIT (oral lyophilisate, Phleum pratense, 75,000 SQ-T, containing approximately 15 μg of Phl p 5) or placebo. The AR/C symptom and medication scores were recordeddaily. The primary end point was the average AR/C daily symptom score (DSS)during the entire grass pollen season (GPS). Ranked key secondary end points wereRhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, daily medication score (DMS), and percentage of well days, all over entire GPS. Safety wasmonitored through adverse event reporting.RESULTS: Efficacy analysis included 289 subjects. Over the entire GPS, mean DSSwas 6% lower with AIT versus placebo (5.69 vs. 6.06), but this difference was not

statistically significant (p = 0.3475) despite significantly higher immunologicalresponse in the grass AIT group. No significant between-group differences wereseen for key secondary end points. In general, DSS was high before GPS began and no clear relationship between DSS and grass pollen counts was seen during GPS. Inpost hoc analysis of subjects with pre-seasonal DSS ≤3, mean DSS and DMS wereboth significantly lower with grass AIT versus placebo (27%; p = 0.0327 and 68%; p = 0.0060, respectively). In this subgroup a relationship between DSS and grass pollen counts was observed. Grass AIT was generally well tolerated, with noevents of anaphylactic shock or respiratory compromise.CONCLUSIONS: In this trial, 2800 BAU grass AIT did not demonstrate significantsymptom improvement versus placebo. Lack of relationship between pollen count andsymptom score in the study population, and post hoc findings among subjects with low pre-seasonal symptoms, suggest that the symptoms reported in this study were not primarily reflective of the effects of grass pollen exposure.TRIAL REGISTRATION: NCT00421655.


55. Laryngoscope. 2013 Dec;123(12):2945-9. doi: 10.1002/lary.24215. Epub 2013 Jun 3.

Efficacy of intra- and extraturbinal microdebrider turbinoplasty in perennialallergic rhinitis.

Lee JY(1).

Author information: (1)Department of Otorhinolaryngology-Head and Neck Surgery, SoonchunhyangUniversity College of Medicine, Bucheon Hospital, Bucheon, South Korea.

OBJECTIVES/HYPOTHESIS: Microdebrider-assisted inferior turbinoplasty (MAIT) hasbecome a popular method for relieving symptoms of allergic rhinitis and can beperformed intraturbinally or extraturbinally. The objective of this study was to evaluate and compare the long-term efficacy of these two methods.STUDY DESIGN: Prospective randomized study.METHODS: Sixty patients diagnosed with perennial allergic rhinitis were selected.Thirty patients were treated with intraturbinal MAIT (group 1) and 30 patientswere treated with extraturbinal MAIT (group 2). Postoperative changes in nasalobstruction, rhinorrhea, sneezing, nasal itching, and postnasal drip wereevaluated 3, 6, and 12 months postoperatively. The cross-sectional area of thesecond notch and nasal cavity volume were compared at 12 months. The operationtime, duration of crust formation, and postoperative bleeding were also compared.RESULTS: All symptoms improved significantly in both groups at 3, 6, and 12months. However, when improvement of rhinorrhea, sneezing, and nasal itching was compared, improvement was statistically significant in group 2 at 12 months.Acoustic rhinometry demonstrated a significant increase in the cross-sectionalarea of the second notch and nasal cavity volume in both groups, which did notdiffer significantly between the two groups at 12 months. The operation time and duration of crust formation were longer in groups 1 and 2, respectively. Theincidence of postoperative bleeding was higher in group 2.CONCLUSION: Although both methods showed significant improvement, extraturbinalMAIT seemed more effective for long-term relief of allergic symptoms. However,the advantages and disadvantages of each method should be considered beforechoosing the surgical technique.

Copyright © 2013 The American Laryngological, Rhinological and OtologicalSociety, Inc.


56. Allergy Asthma Proc. 2013 May-Jun;34(3):283-91. doi: 10.2500/aap.2013.34.3662.

An integrated analysis of the efficacy of fluticasone furoate nasal spray versus placebo on the nasal symptoms of perennial allergic rhinitis.

Wu W(1), Walters RD, Nadeau GA, Botnick W, Broughton N.

Author information: (1)Clinical Statistics, Quantitative Sciences Division, Medicines Discovery andDevelopment, Research and Development, GlaxoSmithKline, Research Triangle Park,NC, USA.

Intranasal corticosteroids are widely prescribed for the treatment of perennialallergic rhinitis (PAR). The aim of this analysis was to determine whether thebeneficial effects of once-daily (q.d.) fluticasone furoate nasal spray (FFNS)effectively improved individual nasal symptoms of PAR. An integrated analysis wasperformed on data from three randomized, double-blind, placebo-controlled,parallel-group trials designed to evaluate the efficacy and safety of FFNS at 110micrograms, q.d. in subjects with PAR. The analysis included 460 subjects whoreceived FFNS and 459 who received placebo for 4 weeks. All subjects evaluatedthe severity of individual nasal symptoms of nasal congestion, nasal itching,rhinorrhea, and sneezing on a four-point categorical scale. The main efficacymeasures included change from baseline in daily reflective total nasal symptomscore (rTNSS), reflective daily scores for each individual symptom, and predoseinstantaneous TNSS (iTNSS). Over 4 weeks of treatment, FFNS significantlyimproved rTNSS, iTNSS, and the reflective scores for each individual symptomcompared with placebo. The least squares (LS) mean treatment difference overweeks 1-4 between FFNS and placebo for rTNSS was -0.93, ranging from -0.20 to-0.28 for the individual nasal symptoms (p < 0.001 for all versus placebo). Forthe iTNSS, the LS mean treatment difference between FFNS and placebo over weeks1-4 was -0.95 (95% CI,-1.24, -0.66; p < 0.001). FFNS at 110 micrograms q.d.effectively relieved all nasal symptoms of PAR including nasal congestion over a 24-hour period.


57. Allergy Asthma Proc. 2013 May-Jun;34(3):274-82. doi: 10.2500/aap.2013.34.3668.

Randomized controlled trial of desloratadine for persistent allergic rhinitis:correlations between symptom improvement and quality of life.

Bousquet J(1), Zuberbier T, Canonica GW, Fokkens WJ, Gopalan G, Shekar T.

Author information: (1)Hôpital Arnaud de Villeneuve, Montpellier, France. [email protected]

Allergic rhinitis (AR) symptoms can impart emotional, quality of life (QOL), and work productivity burdens, especially in persistent AR (PER). Desloratadine, anH1-receptor antagonist, has been shown to be effective against nasal and nonnasalAR symptoms and to improve QOL. Exploratory analyses were conducted to evaluatewhether desloratadine-mediated symptom improvement correlated with improvementsin QOL and productivity. The Aerius Control: Clinical and Evaluative Profile ofTreatment 2 (NCT00405964) study was a 12-week, multinational, randomized,placebo-controlled prospective study of once-daily desloratadine at 5 mg insubjects with moderate-to-severe PER. Assessments included twice-daily symptomseverity ratings (0 = none to 3 = severe; total and individual symptoms), sleepinterference (morning [A.M.]), interference with activities of daily living (ADL;evening [P.M.]), the Rhinoconjunctivitis Quality of LifeQuestionnaire-Standardized version (baseline and days 29 and 85), and the WorkProductivity and Activity Impairment-Allergy-Specific questionnaire (baseline and

weekly). Pearson product-moment correlation statistics (r) were determined toassess correlations between symptom score improvements and QOL factors. Alldesloratadine-treated patients (n = 360) were included in this exploratoryanalysis. In the desloratadine-treated patients, all correlations tested werepositive (all p < 0.0001). The highest coefficients were seen for thecorrelations between A.M./P.M. PRIOR total five-symptom score and interferencewith ADL (r = 0.72) and between A.M. NOW congestion and ADL interference (r =0.69). Continuous daily treatment of moderate-to-severe PER with desloratadine at5 mg/day significantly improved symptoms, which correlated positively, albeitmoderately, with QOL benefits and reversal of functional impairments caused byPER.


58. Laryngoscope. 2013 Jun;123(6):1334-40. doi: 10.1002/lary.23935. Epub 2013 Apr 24.

Fast onset of action of sublingual immunotherapy in house dust mite-inducedallergic rhinitis: a multicenter, randomized, double-blind, placebo-controlledtrial.

Wang DH(1), Chen L, Cheng L, Li KN, Yuan H, Lu JH, Li H.

Author information: (1)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China.

OBJECTIVES/HYPOTHESIS: To investigate how quickly an allergic rhinitis (AR)patients' symptoms will improve with sublingual immunotherapy (SLIT).STUDY DESIGN: Double-blind placebo study.METHODS: This is a multicenter, randomized, double-blind, placebo-controlledstudy of SLIT used to treat house dust mite-induced AR. A total of 120 ARpatients, aged 4 to 60 years, were treated for 6 months and randomized into twogroups: 1) SLIT with Dermatophagoides pteronyssinus (D.p.) and Dermatophagoidesfarina (D.f.) extract (n = 60) ; and 2) matched placebo controls (n = 60).Symptom, medications received, and a visual analog scale score were recordedduring the whole study. Serum-specific IgE and IgG4 to D. p. and D. f. wereassessed before and after the treatment.RESULTS: Eighty-five patients (70.8%) completed the study. Twelve patients (20%) chose to withdraw from the SLIT group, but none because of serious adverseeffects. The total symptom and visual analog scores VAS in the SLIT groupdecreased significantly when compared to the placebo controls (P <0.05) afterweek 14, as well as for the significant (P <0.05) improvement of all individualAR symptoms in the SLIT group (e.g., sneezing, nasal discharge, itching, andnasal obstruction) after week 22. There was a significant (P <0.05) increase ofIgG4 to both D.f. and D.p. in the SLIT, but not in the placebo group aftertreatment.CONCLUSION: SLIT with a mixture of D.f. and D.p. extract is an effective and safetreatment for patients with house dust mite-induced AR. Its onset of action canbe observed as early as 14 weeks after treatment.

Copyright © 2012 The American Laryngological, Rhinological and OtologicalSociety, Inc.


59. Allergol Int. 2013 Jun;62(2):245-9. doi: 10.2332/allergolint.12-OA-0510. Epub2013 Apr 25.

Comparing the effects of Botulinum Toxin-A and cetirizine on the treatment ofallergic rhinitis.

Hashemi SM(1), Okhovat A, Amini S, Pourghasemian M.

Author information: (1)Department of Otorhinolaryngology Head and Neck Surgery, Isfahan University ofMedical Sciences, Isfahan, Iran.

BACKGROUND: There are few reports on the effects of intranasal Botulinum Toxin-A (BTX-A) as a treatment of allergic rhinitis (AR). In this study, we compared the efficacy of intranasal BTX-A to cetirizine in the treatment of AR.METHODS: Fifty AR patients at the age of 26.2 ± 9.1 years (64% females), wererecruited to the trial according to the Allergic Rhinitis and its Impact onAsthma (ARIA) criteria. Participants randomly received either intranasalinjection of BTX-A (75IU Dysport®) or cetirizine (10mg/day). Symptoms (based onthe ARIA) and side effects were assessed every two weeks for two months. Quality of life was evaluated before and after the study using the Rhinasthmaquestionnaire.RESULTS: Total symptom severity score of patients significantly decreased (P <0.001) and quality of life significantly improved (P < 0.001) at the same levelin both groups. Side effects included nasal dryness (4%) and epistaxis (4%) inthe BTX-A group. In the cetirizine group 44% sleepiness and 4% blurred vision wasreported.CONCLUSIONS: Nasal injection of BTX-A shows the same therapeutic effects ascetirizine in the management of AR. Since BTX is expensive, we do not suggest it in the first line of treatment for AR. However, BTX-A is a potential treatmentfor patients who are resistant or not compliant to the routine medications of AR.Further studies are required to investigate implications and limitations of BTX-Ain the treatment of AR.


60. Pediatr Neonatol. 2013 Aug;54(4):239-45. doi: 10.1016/j.pedneo.2013.01.007. Epub 2013 Mar 5.

Comparison of mometasone furoate monohydrate (Nasonex) and fluticasone propionate(Flixonase) nasal sprays in the treatment of dust mite-sensitive children withperennial allergic rhinitis.

Mak KK(1), Ku MS, Lu KH, Sun HL, Lue KH.

Author information: (1)Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.

BACKGROUND: Various studies have investigated the efficacies of mometasonefuroate monohydrate (MFM) and fluticasone propionate (FP) nasal sprays foradults. However, research on their effectiveness for children is limited. Thisstudy compares the efficacies of MFM and FP nasal sprays in pediatric patientswith perennial-allergic rhinitis.MATERIALS AND METHODS: For this study, 94 perennial allergic rhinitis patientsaged 6-12 years were randomly assigned to two treatment groups: an MFM group and an FP group. Treatment was provided for 4 weeks. The effects of the two agentswere compared using the Pediatric Rhinoconjunctivitis Quality of LifeQuestionnaire and total symptom scores (TSSs). Nasal-peak expiratory flow ratesand eosinophil percentage in nasal smears were also compared between the twogroups.RESULTS: Patients in the MFM group exhibited significant improvement in their TSS(t = -2.65, p < 0.05). A detailed TSS analysis showed MFM to be more effectivefor relieving nasal symptoms, whereas FP was more effective for relievingnon-nasal symptoms. Patient questionnaire scores suggested a significantreduction in symptoms for both the MFM (t = -7.23, p < 0.01) and FP (t = -5.43,

p < 0.01) groups. The flow rate test results indicated significant improvementsin the MFM group (t = 2.27, p < 0.05).CONCLUSION: Following the 4-week therapy, MFM provided greater improvementcompared to FP for symptoms of childhood perennial-allergic rhinitis. Based ontheir TSSs, the MFM group experienced more effective relief of nasal symptoms,whereas the FP group experienced more effective relief of non-nasal symptoms.

Copyright © 2013. Published by Elsevier B.V.


61. Arch Immunol Ther Exp (Warsz). 2013 Aug;61(4):327-32. doi:10.1007/s00005-013-0224-3. Epub 2013 Apr 7.

Increased cys-leukotrienes in exhaled breath condensate and decrease of PNIFafter intranasal allergen challenge support the recognition of allergic rhinitis in children.

Zagórska W(1), Grzela K, Kulus M, Sobczyński M, Grzela T.

Author information: (1)Department of Pediatrics, Pneumonology and Allergology, Medical University of Warsaw, Warsaw, Poland.

Exhaled breath condensate (EBC) contains various mediators of inflammation. Sincetheir concentrations correlate with severity of inflammatory response, EBCassessment allows non-invasive detection of various respiratory tract diseasesand enables monitoring of their progression or treatment effectiveness. In thisstudy, authors evaluate the usefulness of cysteinyl leukotrienes (cysLT)measurement in EBC, as non-invasive diagnostic markers of allergic rhinitis inchildren. It has been found that the assessment of cysLT in EBC, when performedout of the natural allergen exposure, can discriminate between healthy andallergic rhinitis individuals, with sensitivity 87.8% and specificity 76.4%, atthe threshold level 39.05 pg/ml. The change of peak nasal inspiratory flow(ΔPNIF), measured before and after intranasal allergen challenge allowedrecognition of healthy/allergic rhinitis-suffering individuals with sensitivity76.8% and specificity 78.6%, at the threshold level of -3.2 l/min. When ΔPNIFassessment was combined with the measurement of cysLT in EBC, the sensitivity of such diagnostic approach reached 100% and its specificity increased up to 84.6%. The proposed algorithm was found to sufficiently discriminate between allergicrhinitis-suffering and healthy children, however, its clinical usefulnessespecially in young children requires further studies.


62. Am J Rhinol Allergy. 2013 Mar-Apr;27(2):102-8. doi: 10.2500/ajra.2013.27.3864.

Mometasone furoate nasal spray plus oxymetazoline nasal spray: short-termefficacy and safety in seasonal allergic rhinitis.

Meltzer EO(1), Bernstein DI, Prenner BM, Berger WE, Shekar T, Teper AA.

Author information: (1)Allergy & Asthma Medical Group & Research Center, San Diego, California 92123,USA. [email protected]

BACKGROUND: Allergic rhinitis (AR) and associated congestion adversely affectpatients' lives. The intranasal corticosteroid mometasone furoate nasal spray(MFNS) is effective for AR symptoms including nasal congestion, and theintranasal decongestant oxymetazoline (OXY) is effective against nasal

congestion, but the combination has not been fully studied. This study wasdesigned to assess the efficacy of the combination of MFNS and OXY for the reliefof seasonal allergic rhinitis (SAR) symptoms.METHODS: This phase 2 controlled clinical trial randomized adolescent and adultsubjects (≥12 years; 2-year SAR) to MFNS q.d. (200 μg) + 3 sprays/nostril of OXY 0.05% (MFNS + OXY3); MFNS q.d. + 1 spray/nostril of OXY (MFNS + OXY1); MFNS q.d.;OXY b.i.d.; or placebo for 15 days, with 1-week follow-up. Coprimary end pointswere change from baseline in morning/evening (A.M./P.M.) instantaneous (NOW)total nasal symptom score (TNSS) over days 1-15 and AUC (AUC[0-4 hr]) change frombaseline in day 1 congestion.RESULTS: In 705 subjects, both combinations reduced A.M./P.M. NOW TNSS over days 1-15 significantly more than OXY b.i.d. or placebo (p ≤ 0.002). Mean standardizedAUC(0-4 hr) day 1 congestion change from baseline was significantly greater incombination and OXY b.i.d. groups (MFNS + OXY3, -0.92; MFNS + OXY1, -0.80; OXYb.i.d., -1.06) versus placebo (-0.57) and MFNS q.d. (-0.63). Combinations andMFNS q.d. were significantly effective for A.M./P.M. NOW TNSS over each weeklyperiod; OXY b.i.d. was superior to placebo in week 1. Adverse events (AEs) werefew and similar across treatments; one MFNS q.d. and one placebo subjectexperienced a serious AE, with neither considered treatment related.CONCLUSION: Combining MFNS with OXY relieves SAR symptoms, including congestion, with faster onset of action than MFNS q.d. and better sustained efficacy than OXYb.i.d.


63. J Allergy Clin Immunol. 2013 May;131(5):1361-6. doi: 10.1016/j.jaci.2013.02.013. Epub 2013 Apr 1.

Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: asystematic review and indirect comparison.

Dretzke J(1), Meadows A, Novielli N, Huissoon A, Fry-Smith A, Meads C.

Author information: (1)Department of Public Health, Epidemiology & Biostatistics, University ofBirmingham, Birmingham, United Kingdom. [email protected]

Comment in J Allergy Clin Immunol. 2015 Jan;135(1):293-4. J Allergy Clin Immunol. 2014 Mar;133(3):936.

BACKGROUND: Severe allergic rhinitis uncontrolled by pharmacotherapy canadversely affect quality of life. Both subcutaneous immunotherapy (SCIT) andsublingual immunotherapy (SLIT) have demonstrated effectiveness in this patientgroup; however, it remains uncertain which route of administration is moreeffective.OBJECTIVES: We sought to update existing systematic reviews on the clinicaleffectiveness of SCIT and SLIT versus placebo, to undertake a systematic reviewof head-to-head trials, and to compare the relative effectiveness of SCIT andSLIT in an adjusted indirect comparison.METHODS: Standard systematic review methods aimed at minimizing bias were used.Double-blind, randomized, placebo-controlled trials of SCIT or SLIT or trials of SCIT versus SLIT were included. Meta-analysis and indirect comparisonmeta-analysis with meta-regression were performed.RESULTS: Updated meta-analyses confirmed statistically significant benefits forSCIT and SLIT compared with placebo in adults and, to a lesser extent, inchildren. Only 1 head-to-head trial met the inclusion criteria; both this and theindirect comparisons did not provide conclusive results in favor of either SCITor SLIT based on symptom-medication or quality-of-life scores. There was a trend toward favoring SCIT for symptom and medication scores.CONCLUSIONS: Although there is clear evidence of effectiveness of both SCIT and

SLIT, superiority of one mode of administration over the other could not beconsistently demonstrated through indirect comparison, and further research isneeded to establish the comparative effectiveness of SCIT versus SLIT.

Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published byMosby, Inc. All rights reserved.


64. Immunotherapy. 2013 Mar;5(3):257-64. doi: 10.2217/imt.12.157.

Sublingual immunotherapy for allergic rhinitis and conjunctivitis.

Passalacqua G(1), Garelli V, Sclifò F, Canonica GW.

Author information: (1)Allergy & Respiratory Diseases, IRCCS San Martino-IST-University of Genoa,Padiglione Maragliano, L.go R. Benzi 10, 16132 Genoa, Italy. [email protected]

Sublingual immunotherapy (SLIT) for allergic respiratory diseases was firstdescribed in 1986 and immediately appeared as a viable alternative to thetraditional subcutaneous route. Since then, more than 60 randomized controlledtrials have been published, almost all with very favorable results. The averageimprovement over placebo in symptom score and medication use was always greaterthan 20%. The results of the clinical trials were pooled in severalmeta-analyses, which consistently confirmed the efficacy of the treatment. SLITis characterized by a satisfactory safety profile, its side effects being mainly limited to oral discomfort. Only six anaphylaxes and no fatalities have been sofar reported. Due to the good risk:benefit ratio, SLIT is currently beinginvestigated in diseases other than respiratory allergy, such as food allergy andatopic dermatitis.


65. JAMA Pediatr. 2013 Apr;167(4):380-6. doi: 10.1001/jamapediatrics.2013.623.

A control model to evaluate pharmacotherapy for allergic rhinitis in children.

Rachelefsky G(1), Farrar JR.

Author information: (1)Executive Care Center for Asthma, Allergy, and Respiratory Diseases, GeffenSchool of Medicine at the University of California, Los Angeles, 1131 WilshireBlvd, Ste 202, Santa Monica, CA 90401, USA.

IMPORTANCE: Although the question of whether early diagnosis and treatment ofpediatric allergic rhinitis (AR) improve disease control is important, a morecrucial question is whether we can evaluate the effect of treatment on diseasecontrol using an impairment-risk model.OBJECTIVE: To conduct a systematic review evaluating application of a controlmodel based on domains of impairment and risk (similar to that used for asthma)in pharmacotherapy for children with AR.EVIDENCE ACQUISITION: We searched the MEDLINE and EMBASE databases (January 1,1996, through May 31, 2012) for controlled studies lasting 2 weeks or longer inchildren with confirmed diagnoses of AR, including measures assessing impairment and/or risk of comorbid conditions.RESULTS: Sixteen controlled clinical trials, including more than 3000 children(aged 2-18 years) with AR (seasonal, n = 2290; perennial, n = 800), met the studycriteria. All medication classes improved impairment related to AR, butbetween-treatment comparisons were limited because of different assessments.Intranasal steroids improved risk outcomes associated with asthma and obstructive

sleep apnea. Small single studies suggested possible effects of oralantihistamines on asthma and sleep-disordered breathing. No risk data wereavailable for nasal antihistamines or montelukast sodium.CONCLUSIONS: Treatment of AR, particularly with intranasal steroids, improvesdisease control in children by reducing disease-associated impairment and risk.All AR medications with proved efficacy probably improve impairment, paralleling symptom reduction. Intranasal steroids may reduce the likelihood of comorbiditiesthat increase health care use. These observations, although limited by different protocols and outcomes measures among studies, support current practicerecommendations. Studies that use standardized measures of impairment to permitbetter comparison and appropriate protocols for risk evaluation are needed.


66. Int J Pediatr Otorhinolaryngol. 2013 May;77(5):658-65. doi:10.1016/j.ijporl.2013.01.006. Epub 2013 Feb 8.

Comparative study in the management of allergic rhinitis in children using LEDphototherapy and laser acupuncture.

Moustafa Y(1), Kassab AN, El Sharnoubi J, Yehia H.

Author information: (1)Otorhinolaryngology Unit, Department of Medical Laser Applications, NationalInstitute of Laser Enhanced Sciences, Cairo University, Egypt.

OBJECTIVE: The objective of this study was to compare the outcomes of LEDphototherapy and laser acupuncture treatment on allergic rhinitis in children.METHODS: 40 patients with perennial allergic rhinitis were divided randomly into two groups. Patient's ages ranged from 7 to 18 years. One group was subjected to LED phototherapy and the other group was managed by laser acupuncture .Thepatients were followed-up for 1 year.RESULTS: There was a significant improvement in the severity score symptoms inboth groups through and by the end of the follow up period.CONCLUSION: This led to the conclusion that both techniques are equally safe,reliable, non invasive and successful.



67. Pediatr Allergy Immunol. 2013 Mar;24(2):144-50. doi: 10.1111/pai.12036. Epub 2013Feb 6.

Rupatadine oral solution in children with persistent allergic rhinitis: Arandomized, double-blind, placebo-controlled study.

Potter P(1), Maspero JF, Vermeulen J, Barkai L, Németh I, Baillieau RA, Garde JM,Giralt J, Doménech A, Izquierdo I, Nieto A.

Author information: (1)Allergy Diagnostic and Clinical Research Unit, Department of Medicine,University of Cape Town, Cape Town, South Africa.

BACKGROUND: Allergic rhinitis (AR) is one of the most common chronic diseases in childhood. No large, multicentre clinical trials in children with persistentallergic rhinitis (PER) have previously been performed. Rupatadine, a newersecond-generation antihistamine, effective and safe in adults, is a promisingtreatment for children with AR. The aim of the present study was to evaluate the efficacy and safety of a new rupatadine oral solution in children aged 6-11 yr

with PER.METHODS: A multicenter, randomized, double-blind, placebo-controlled study wascarried out worldwide. Patients between 6 and 11 yr with a diagnosis of PERaccording to ARIA criteria were randomized to receive either rupatadine oralsolution (1 mg/ml) or placebo over 6 wk. The primary efficacy end-point was thechange from baseline of the total nasal symptoms score (T4SS) after 4 wk oftreatment.RESULTS: A total of 360 patients were randomized to rupatadine (n = 180) orplacebo (n = 180) treatment. Rupatadine showed statistically significantdifferences vs. placebo for the T4SS reduction both at 4 (-2.5 ± 1.9 vs.-3.1 ± 2.1; p = 0.018) and 6 wk (-2.7 ± 1.9 vs. -3.3 ± 2.1; p = 0.048).Rupatadine also showed a statistically better improvement in the children'squality of life compared with placebo. Adverse reactions were rare andnon-serious in both treatment groups. No QTc or laboratory test abnormalitieswere reported.CONCLUSIONS: Rupatadine oral solution (1 mg/ml) was significantly more effective than placebo in reducing nasal symptoms at 4 and 6 wk and was well toleratedoverall. This is the first large clinical report on the efficacy of an H1receptor antagonist in children with PER in both symptoms and quality of life.

© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.


68. Int Forum Allergy Rhinol. 2013 Jun;3(6):504-9. doi: 10.1002/alr.21123. Epub 2013 Jan 10.

The association between allergic rhinitis and sleep-disordered breathing inchildren: a systematic review.

Lin SY(1), Melvin TA, Boss EF, Ishman SL.

Author information: (1)Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore,MD 21287, USA. [email protected]

BACKGROUND: The objective of this work was to systematically review existingliterature on the association between allergic rhinitis (AR) and sleep-disorderedbreathing (SDB) in children.METHODS: We performed a literature search encompassing the last 25 years inPubMed, EMBASE, and Cochrane CENTRAL. Inclusion criteria includedEnglish-language papers containing original human data, number of subjects ≥7,and age <18 years old. Data was systematically collected on study design, patientdemographics, clinical characteristics/outcomes, and level-of-evidence. Twoinvestigators independently reviewed all articles.RESULTS: The initial search yielded 433 abstracts, of which 18 articles wereincluded. Twelve (67%) of the 18 articles showed a statistically significantassociation between AR and SDB. All articles were either case-series orcase-control studies. Based on the Newcastle-Ottawa scale, the quality of thearticles was determined to be fair to good. For characterizing AR, 7 (39%)studies included skin-prick testing and/or in vitro testing. For determiningpresence of SDB, 7 (39%) of the studies used polysomnographic data, of which 1study incorporated data from a home polysomnogram. Habitual snoring was the most common form of SDB studied, in 10 (56%) of the articles. Obstructive sleep apnea was studied in 6 (33%) articles.CONCLUSION: Although the majority of the studies included in this review showed asignificant association between AR and SDB, all of the studies were evidencelevel 3b and 4, for an overall grade of B- evidence (Oxford Evidence-BasedMedicine Center). Further higher-quality studies should be performed in thefuture to better evaluate the relationship between AR and SDB in children.

© 2013 ARS-AAOA, LLC.


69. Curr Allergy Asthma Rep. 2013 Apr;13(2):142-51. doi: 10.1007/s11882-012-0331-y.

Comparative analysis of allergic rhinitis in children and adults.

Izquierdo-Domínguez A(1), Valero AL, Mullol J.

Author information: (1)Department of Allergology, Hospital Quirón, Barcelona, Catalonia, [email protected]

Allergic rhinitis (AR) is a worldwide health problem that generates a significanthealthcare burden in adults, adolescents, and children. Epidemiological studieshave indicated that the prevalence of AR has progressively increased over thelast three decades in developed and industrialized countries. AR currentlyaffects up to 40 % of the worldwide population, with differences between adultsand children and different countries of the World. Although not life-threatening,AR symptoms are frequently bothersome, adversely affecting work and quality oflife of the affected patients, and causing a significant burden on both theindividual and society. The symptoms have the potential to lead to both physical and mental complications, with sleep-disordered breathing in childhood andadolescence being associated with disorders in learning performance, behavior,and attention. Clinical features and comorbidities are very important for the"allergic march", and in both adults and children there is some evidence ofassociation between AR and asthma. ARIA classifications of both symptom duration (intermittent, persistent) and severity (mild, moderate, severe) have beenvalidated in both adult and pediatric populations. Based on the duration andseverity of patient's disease, an appropriate treatment strategy has been issued for both adults and children, which consists of patient's education, allergenavoidance, and pharmacological as well as allergen-specific immunotherapytreatment. The present review will attempt to compare the characteristics of ARbetween children and adults, either in the epidemiology, clinical features,impact on QOL, and management of the disease.


70. Laryngoscope. 2013 Jan;123(1):53-6. doi: 10.1002/lary.23617. Epub 2012 Oct 15.

Comparison of buffered and nonbuffered nasal saline irrigations in treatingallergic rhinitis.

Chusakul S(1), Warathanasin S, Suksangpanya N, Phannaso C, Ruxrungtham S,Snidvongs K, Aeumjaturapat S.

Author information: (1)Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University,Bangkok, Thailand. [email protected]

OBJECTIVES/HYPOTHESIS: We aimed to study the effect of alkalinity of isotonicnasal saline irrigation on nasal symptoms, mucociliary clearance, nasal patency, and patient's preference in patients with allergic rhinitis (AR).STUDY DESIGN: A double-blind, randomized, three-arm crossover study.METHODS: Patients with AR were enrolled. Three kinds of isotonic nasal salineirrigations: nonbuffered (pH 6.2-6.4), buffered with mild alkalinity (pH7.2-7.4), and buffered with alkalinity (pH 8.2-8.4) were given one at a time, in different orders. Patients rinsed their nose with 240 ml of one solution twice

daily for 10 days and then swapped to the others. The washout period was at least5 days. Primary outcomes were nasal symptoms, mucociliary clearance time, andnasal patency. Outcomes were compared between baseline and posttreatment and alsobetween various kinds of solution. Secondary outcomes were patients' preferenceand adverse events.RESULTS: Thirty-six subjects entered the study, and there were no dropouts.Overall nasal symptom was significantly improved from baseline (P = 0.03) only bybuffered solution with mild alkalinity. Sneezing was significantly improved from baseline (P = 0.04) only by buffered solution with alkalinity. No othersignificant improvements were achieved by any solution. When comparing betweenthe three nasal irrigations, there were no differences in all parameters. Thepatients significantly preferred the buffered solution with mild alkalinity (P = 0.02).CONCLUSIONS: Buffered isotonic saline with some degree of alkalinity may improve nasal symptoms. Isotonic saline irrigations, regardless of alkalinity, may notimprove mucociliary function and nasal patency. Buffered isotonic saline withmild alkalinity is the most preferred.

Copyright © 2012 The American Laryngological, Rhinological, and OtologicalSociety, Inc.


71. Indian Pediatr. 2013 Feb;50(2):209-13. Epub 2012 Jun 10.

Effect of probiotics on allergic rhinitis in Df, Dp or dust-sensitive children: arandomized double blind controlled trial.

Lin TY(1), Chen CJ, Chen LK, Wen SH, Jan RH.

Author information: (1)Department of Laboratory Medicine, Buddhist Tzu Chi General Hospital, Hualien,Taiwan.

Comment in Indian Pediatr. 2013 Feb;50(2):195-6.

OBJECTIVE: To study, we examined the effect of Lactobacillus salivarius on theclinical symptoms and medication use among children with established allergicrhinitis (AR).DESIGN: Double blind, randomized, controlled trial.SETTING: Hualien Tzu-Chi General Hospital.METHODS: Atopic children with current allergic rhinitis received 4x10(9) colonyforming units/g of Lactobacillus salivarius (n=99) or placebo (n=100) daily as a powder mixed with food or water for 12 weeks. The SCORing Allergic rhinitis index(specific symptoms scores [SSS] and symptom medication scores [SMS]), whichmeasures the extent and severity of AR, was assessed in each subject at each ofthe visits--2 weeks prior to treatment initiation (visit 0), at the beginning of the treatment (visit 1), then at 4 (visit 2), 8 (visit 3) and 12 weeks (visit 4) after starting treatment. The WBC, RBC, platelet and, eosinophil counts as wellas the IgE antibody levels of the individuals were evaluated before and after 3months of treatment.RESULTS: The major outcome, indicating the efficacy of Lactobacillus salivariustreatment, was the reduction in rhinitis symptoms and drug scores. No significantstatistical differences were found between baseline or 12 weeks in the probiotic and placebo groups for any immunological or blood cell variables.CONCLUSIONS: Our study demonstrates that Lactobacillus salivarius treatmentreduces rhinitis symptoms and drug usage in children with allergic rhinitis.


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