Allergic Rhinitis: Manifestations and Response to Treatment

1995 ◽  
Vol 112 (5) ◽  
pp. P93-P93
Author(s):  
Robert M. Naclerio ◽  
Fuad M. Baroody

Educational objectives: To understand the contribution of allergic inflammation of the upper airway to diseases of the ears, paranasal sinuses, and lungs; to understand available and new treatments for allergic rhinitis, with their side effects and costs; and to formulate a comprehensive approach to the management of the allergic patient.

1992 ◽  
Vol 13 (9) ◽  
pp. 323-328
Author(s):  
Frank S. Virant

Epidemiology Allergic rhinitis affects as many as 8% to 10% of children in the United States. Many of these children suffer significant morbidity, leading to millions of lost school days annually. Morbidity is amplified when these children concurrently suffer from complications of allergic rhinitis, such as recurrent otitis media or chronic sinus disease. Typically, children who have allergic rhinitis have a family history of atopic disorders. Upper airway allergy may become manifest at any age, but the appearance of symptoms is most common during childhood or young adulthood. Clinical signs of rhinitis may be perennial, seasonal, or episodic, and the primary focus of complaints may relate to secondary problems, including ear, sinus, or lung disease. Pathophysiology In the allergic patient, disease is mediated by the production of antigenspecific IgE by the patient's B lymphocytes. Current research suggests that the primary defect may be the excessive production of interleukin 4 (IL-4) or a deficient level of gamma interferon (γ-INF) when a T-cell is presented with an antigen. This constellation of immunomodulators directs the B-cell to produce IgE rather than the IgG response of the non-allergic patient. Clinical disease occurs when an allergen reacts with antigen-specific IgE on the patient's nasal mast cells. When these factors combine, the mast cell is activated to release a variety of preformed and newly produced mediators, including histamine, leukotrienes, and prostaglandins (Fig 1).


2016 ◽  
Vol 1 (1) ◽  
pp. 22
Author(s):  
Nazli Zainuddin ◽  
Nurul Azira Mohd Shah ◽  
Rosdan Salim

Introduction: The role of virgin coconut oil in the treatment of allergic rhinitis is controversial. Thus, the aim of the present study is to determine the effects of virgin coconut oil ingestion, in addition to standard medications, on allergic rhinitis. We also studied the side effects of consumption of virgin coconut oil. Methods: Fifty two subjects were equally divided into test and control groups. All subjects received a daily dose of 10mg of loratadine for 28 days. The test group was given 10ml of virgin coconut oil three times a day in addition to loratadine. The symptoms of allergic rhinitis were scored at the beginning and end of the study. Results:, the symptom score were divided into nasal and non-nasal symptom scores. Sneezing score showed a significant difference, however the score was more in control group than test group, indicating that improvement in symptom was more in control group. The rest of the nasal symptom and non-nasal symptom score showed no significant difference between test and control groups. Approximately 58% of the test subjects developed side effects from consumption of virgin coconut oil, mainly gastrointestinal side effects. Conclusion: In the present study, ingestion of virgin coconut oil does not improve the overall and individual symptoms of allergic rhinitis, furthermore it has side effects.


Author(s):  
E.V. Prosekova ◽  
A.I. Turyanskaya ◽  
N.G. Plekhova ◽  
M.S. Dolgopolov ◽  
V.A. Sabynych

Расширение спектра изучаемых клонов Тхелперов определило более сложные иммунные механизмы реализации аллергического воспаления. Цель. Характеристика показателей и взаимосвязей цитокинового профиля сыворотки и субпопуляционного состава Тлимфоцитов периферической крови у детей с бронхиальной астмой и аллергическим ринитом. Материалы и методы. Проведено комплексное обследование 150 детей в возрасте 311 лет с верифицированным диагнозом бронхиальной астмы, аллергического ринита и 30 здоровых сверстников. Иммунологические параметры крови оценивали методом проточной цитометрии, концентрации интерлейкинов и IgE в сыворотке крови определяли методом твердофазного иммуноферментного анализа. При статистической обработке использовали программы Statistica 10 с критическим уровнем значимости р0,05. Результаты. У детей с аллергическими заболеваниями в сыворотке крови определены высокие уровни содержания интерлейкинов4, 8, 13, 17А, сопоставимый с показателями группы контроля уровень IL17F и низкое содержание IFNy. При бронхиальной астме и аллергическом рините у детей выявлено увеличение количества CD3CD8CD45RO, CD3CD8CD45RACD45RO Тлимфоцитов и CD3CD4 Тхелперов и повышение количество Th17 при снижении CD3CD4CD45RO клеток памяти. В группе здоровых детей популяция Th17 составляла 9,491,6, у детей с аллергическими заболеваниями количество данных клеток было значимо выше 14,50,77 (р0,001). Анализ сывороточного содержания цитокинов у детей с изолированным течением БА и в сочетании с аллергическим ринитом выявил разнонаправленные корреляции, отличающиеся по силе и направленности от таковых в группе здоровых детей. Заключение. У детей при изолированном течении бронхиальной астмы и в сочетании с аллергическим ринитом выявлены: сопоставимое с показателями здоровых детей количество CD3CD4 Тклеток, дисбаланс в субпопуляционном составе Тхелперов за счет преобладания Th2 и Th17, активация синтеза IL17A, IL4, IL8, IL13, низкий уровень сывороточного IFNy, изменения силы и направленности взаимосвязей цитокинового профиля и спектра субпопуляций Тлимфоцитов.Expansion of the range of examined Thelper clones has determined more complex immune mechanisms for the implementation of allergic inflammation. Objective. To characterize the parameters and relationships between the serum cytokine profile and Tlymphocyte subpopulation in peripheral blood of children with bronchial asthma and allergic rhinitis. Materials and methods. 150 children aged between 311 years old with bronchial asthma, and allergic rhinitis and 30 healthy volunteers were examined. Immunological parameters were assessed by flow cytometry, the concentration of serum interleukins and IgE were determined by means of enzymelinked immunosorbent assay. Statistical analysis was performed with Statistica 10 program with a critical level of significance p0.05. Results. High levels of interleukins 4, 8, 13, 17A were determined, IL7F level was not significantly different from that in control group and low level of IFNy was found in the serum of children with allergic diseases. The number of CD3CD8CD45RO, CD3CD8CD45RACD45RO Tlymphocytes, CD3CD4 Thelper cells and Th17 were increased and at the same time CD3CD4CD45RO memory cells were decreased In bronchial asthma and allergic rhinitis children. Number of Th17 cells in healthy children was 9.491.6, in allergic children it was significantly higher 14.50.77 (p0.001). Analyses of serum cytokine count in children with isolated BA and in association with allergic rhinitis revealed multidirectional correlations differing in strength and direction from those in the group of healthy children. Conclusion. In children with isolated bronchial asthma and associated with allergic rhinitis the following parameters were found: CD3CD4 Tcells count was comparable to that in healthy children, the imbalance of Thelper subpopulation: prevalence of Th2 and Th17, activation of IL17A, IL4, IL8, IL13 synthesis and low level of serum IFNy.


2021 ◽  
pp. 026988112110152
Author(s):  
Melike Kevser Gul ◽  
Elif Funda Sener ◽  
Muge Gulcihan Onal ◽  
Esra Demirci

Objective: Atomoxetine (ATX), one of the most commonly used drugs after stimulants in attention deficit hyperactivity disorder (ADHD) treatment, is an inhibitor of the norepinephrine transporter ( NET/SLC6A2), which is also associated with the etiology of ADHD. In this study, we aimed to investigate the effect of NET gene polymorphisms on response to ATX treatment and to find the answers to the questions about whether there is a relationship between the severity of the disorder and the observed side effects in children with ADHD. Method: About 100 children with ADHD and 80 healthy controls (HCs) were included in this study. The dose of ATX was started at 0.5 mg/kg/day and titrated at 1.2 mg/kg/day. Response to treatment of 78 patients was evaluated 2 months after the beginning of the treatment. After whole blood samples were obtained, DNAs were isolated, and samples were stored at −80°C. Two single-nucleotide polymorphisms (SNPs) (rs12708954 and rs3785143) were analyzed by real-time quantitative PCR (qRT-PCR). Results: The patients with both rs12708954 and rs3785143 heterozygous genotype had better treatment response and more side effects than patients with wild type. There was not found any association between any of the investigated NET polymorphisms and ADHD severity. Conclusion: It was, however, found that the NET rs12708954 and rs3785143 genotypes affect the treatment response to ATX in our study; thus, further studies with a large population are needed to understand the effects of NET polymorphisms on treatment, side effects, and also the severity of ADHD.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rana Harhay ◽  
Wajiha Jeelani ◽  
Barbine Tchamba Agbor Agbor ◽  
Teresa Hennon ◽  
Brian H. Wrotniak ◽  
...  

Abstract Background Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection. Methods Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children’s Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA. Results Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted. Conclusion Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.


2001 ◽  
Vol 31 (7) ◽  
pp. 1048-1059 ◽  
Author(s):  
I. Hussain ◽  
D. Randolph ◽  
S. L. Brody ◽  
S.-K. Song ◽  
A. Hsu ◽  
...  

2021 ◽  
Vol 7 (5) ◽  
pp. 01-09
Author(s):  
Ravi Shrivastava

Introduction: Allergic rhinitis (AR) in children is a common chronic pathology with a strong impact on patient quality of life. The main physiopathology affects the nasal cavity as a multi-factorial disease involving nasal mucosa damage, nasal inflammation with high concentrations of histamine, pro-inflammatory cytokines such as histamine, TNF-α, IL-4, IL-5, IL-6, IL-10, IL-13, and IgE antibodies on the nasal mucosa. Systemic entry of these proteins through damaged nasal mucosa maintains continued inflammatory and allergen cascades. Therefore, an ideal treatment should be multitarget in order to stop allergen exposure, inflammation, and nasal mucosa barrier degradation, but such treatments are nearly impossible to conceive. We envisaged an osmotic and protective nasal barrier film, not only capable of protecting the nasal mucosa from allergen exposure but also of trapping and neutralizing selected cytokines and cleaning the nasal surface continuously without using any harmful substance for children. Materials and Methods: We associated highly osmotic glycerol solution with specific plant polymers to conceive an osmotic but stable film. As plant polymers (tannins) can bind with selective proteins, a range of glycerol binding non-cytotoxic polymers were screened using the sandwich ELISA method to select those having binding affinity for allergen induced nasal proinflammatory cytokines. After verifying cytotoxicity and irritant potential, a 15-day observational clinical study was performed with approval from the ethics committee on 30 children aged between 4-13, suffering from allergic rhinitis. The test product (TP) was supplied in 15-ml nasal sprays and applied 2-3 times per day for a period of 15 days. Saline solution served as control (CP). The scores of nasal and ocular symptoms, effect on quality of life, eosinophil count in nasal smears, and need for antihistamine treatment was evaluated at the start, at 30 minutes and on days 2, 3 and 15 of treatment. Results: A few specific polymers were able to bind with selected cytokines and histamine at adequate filmogen concentrations. The osmotic film was stable, non-irritant and was able to clean the nasal mucosa continuously for 4-6h after each application. Clinical observations of Total Nasal Symptom Score (TNSS) grouping the scores of nasal congestion, runny nose, sneezing, and itching, revealed a strong decrease right after the 1st treatment in both groups but the reduction was much stronger and faster with the TP. The mean TNSS score reduction was 44.74% in CP vs 83.53% in the TP group after 7 days of treatment (p<0.001). Total Ocular Symptom Score (TOSS) was decreased by 21.13% and 51.41% in CP v/s 35.12 and 99.59% in TP group on days 2 and 7, respectively. Nasal smear eosinophil count was equally strongly reduced in the TP v/s CP group. No treatment-related side effects were recorded in any of the groups. Conclusion: Protecting the nasal mucosa against allergens, neutralizing inflammatory cytokines, and keeping the nasal surface clean with an osmotic polymeric film, constitute a major breakthrough for the treatment of allergic rhinitis in children. This simple but scientific and logical approach should avoid exposing children to chemicals and to their long-term side effects.


2002 ◽  
Vol 110 (6) ◽  
pp. 891-898 ◽  
Author(s):  
Christine McCusker ◽  
Martin Chicoine ◽  
Qutayba Hamid ◽  
Bruce Mazer

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