scholarly journals Prevention and Management with Pro-, Pre and Synbiotics in Children with Asthma and Allergic Rhinitis: A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 934
Author(s):  
Lien Meirlaen ◽  
Elvira Ingrid Levy ◽  
Yvan Vandenplas
Keyword(s):  
Allergic Rhinitis ◽  
Genetic Background ◽  
Animal Studies ◽  
Allergic Diseases ◽  
Confounding Factors ◽  
Substantial Evidence ◽  
Children With Asthma ◽  
Probiotic Strains ◽  
Asthma Outcomes ◽  
English Articles

Allergic diseases including allergic rhinitis and asthma are increasing in the developing world, related to a westernizing lifestyle, while the prevalence is stable and decreasing in the industrialized world. This paper aims to answer the question if prevention and/or treatment of allergic rhinitis and asthma can be achieved by administrating pro-, pre- and/or synbiotics that might contribute to stabilizing the disturbed microbiome that influences the immune system through the gut–lung axis. We searched for relevant English articles in PubMed and Google Scholar. Articles interesting for the topic were selected using subject heading and key words. Interesting references in included articles were also considered. While there is substantial evidence from animal studies in well controlled conditions that selected probiotic strains may offer benefits in the prevention of wheezing and asthma, outcomes from clinical studies in infants (including as well pre- and postnatal administration) are disappointing. The latter may be related to the multiple confounding factors such as environment, strain selection and dosage, moment of administration and genetic background. There is little evidence to recommend administration of pro, pre- or synbiotics in the prevention of asthma and allergic rhinitis in children.

scholarly journals Research on the improvement of allergic rhinitis in asthmatic children after reducing dust mite exposure: a randomized, double-blind, cross-placebo study protocol

2020 ◽  
Author(s):  
Ming Chen ◽  
YuFen Wu ◽  
Shuhua Yuan ◽  
Jiande Chen ◽  
Luanluan Li ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Allergic Diseases ◽  
House Dust Mites ◽  
Life Questionnaire ◽  
Dust Mites ◽  
Double Blind ◽  
Asthma Control Questionnaire ◽  
Asthmatic Children ◽  
Dust Mite ◽  
Children With Asthma

Abstract Background: Allergic rhinitis (AR) in children has become a major respiratory inflammatory disease with a high incidence that is increasing yearly. In China, 54.93% of children with asthma have AR, which often requires synchronous treatment. House dust mites (HDMs) are common allergens that often cause attacks of AR and asthma. Reducing allergen exposure is one of the most important measures to control and treat AR and asthma attacks. Hestelia Mite Bait, containing 0.1% emamectin, is a new tool for trapping and killing dust mites that can reduce the number of dust mites on mattresses, thereby may reduce stimulation by allergens and ultimately improve asthma and rhinitis symptoms. This single-centre, randomized double-blind cross-placebo trial will explore the improvement of allergic rhinitis in asthmatic children after reducing dust mite exposure.Methods: We will recruit 60 children (aged 3-12 years) who have been diagnosed with allergic rhinitis and asthma and are allergic to dust mites as confirmed by a serum allergen test. Participants will randomly receive the Hestelia Mite Bait intervention for 8 weeks and the placebo intervention for 8 weeks. There will be a 4-week washout period between the two interventions. The primary outcome is the v isual analogue scale (VAS) score of AR symptoms; the secondary outcomes include the Rhinitis Control Assessment Test (RCAT) score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score , changes in the dust mite level, drug usage for asthma and AR , Asthma Control Questionnaire-5 (ACQ-5) score, frequency of acute asthma attacks and emergency visits, and frequency of hospitalization.Discussion: This study will scientifically and objectively evaluate the improvement effect on rhinitis and asthma after reducing dust mite exposure and provide a convenient means for the prevention and treatment of children's airway allergic diseases in the future.Trial registration : ChiCTR1900024688 (www.chictr.org.cn) registration date: July 21, 2019

scholarly journals Prevalence and comorbidity of asthma, allergic rhinitis and eczema among school children in Republic of Srpska: A cross-sectional study

2017 ◽  
Vol 145 (1-2) ◽  
pp. 9-13 ◽  
Author(s):  
Sanela Domuz ◽  
Adrijana Domuz ◽  
Slobodanka Petrovic
Keyword(s):  
Allergic Rhinitis ◽  
Primary Schools ◽  
Allergic Diseases ◽  
Cross Sectional Study ◽  
World Health ◽  
Sectional Study ◽  
Cross Sectional ◽  
Therapeutic Concept ◽  
Children With Asthma ◽  
The Republic

Introduction/Objective. The incidence of comorbidity of asthma and allergic rhinitis was one of the reasons for changing guidelines for the treatment of asthma and allergic rhinitis. The World Health Organization and Allergic Rhinitis and its Impact on Asthma group proposed the new diagnostic and therapeutic concept ??one airway, one disease.? Further, the presence of allergic rhinitis in children with asthma contributes significantly to low control of asthma; also, the treatment of allergic rhinitis in children with asthma has positive effects in terms of reducing the severity of asthma symptoms. The aim of this study was to determine the prevalence of allergic diseases among children in the Republic of Srpska, as well as to determine whether allergic rhinitis and eczema are more common in children with asthma. Methods. Our study was conducted as a cross-sectional study and included 3,000 children aged six to 15 years from 13 primary schools in the Republic of Srpska. The final data processing included 1,975 correctly completed questionnaires. Results. The prevalence of wheezing in the previous 12 months was 7.9%, of allergic rhinitis 12.7%, and of eczema 5%. Asthma was diagnosed by a doctor in 3.5% of the children, allergic rhinitis in 19.2%, and eczema was diagnosed in 14.5% of the children. Conclusion. Children with asthma had statistically significant higher prevalence of other alergic diseases compared to general population. Also, children with mild asthma had statistically significant risk to be undiagnosed. Undiagnosed asthma in comorbidity with other allergic diseases leads to poor asthma control in children.

O Uso dos Probióticos nas Doenças Alérgicas: Revisão de Literatura/The Use of Probiotics on Allergic Diseases: Literature Review

1970 ◽  
Vol 4 (2) ◽  
pp. 108-119
Author(s):  
Isabela Maria Anselmo Ribeiro Simões ◽  
Helba Heliane Toledo ◽  
José Henrique Pereira Pinto
Keyword(s):  
Allergic Rhinitis ◽  
Atopic Dermatitis ◽  
Food Allergy ◽  
Literature Review ◽  
Scientific Community ◽  
Allergic Diseases ◽  
Progressive Increase ◽  
Atopic Diseases ◽  
Significant Clinical Improvement ◽  
Probiotic Strains

Nas últimas décadas, observou-se o aumento progressivo das doenças alérgicas e assim, novas alternativas preventivas e de tratamento têm sido buscadas. Neste âmbito, é notável o crescimento no número de pesquisas na comunidade científica destinadas a investigar se a suplementação com substancias probióticas seria capaz de reduzir a incidência e severidade das atopias clínicas, bem como seus possíveis efeitos como estratégia de tratamento. O artigo consistiu em uma revisão bibliográfica com o objetivo de analisar a eficácia dos probióticos nas atopias clínicas como asma, rinite alérgica, dermatite atópica e alergia alimentar, bem como seus efeitos. Apesar de relatos consistentes apontarem que cepas probióticas específicas quando usadas em  determinados casos produzem melhora clínica significante, ainda se faz de extrema importância novos estudos, visando verificar e esclarecer precisamente os demais efeitos produzidos, incluindo efeitos colaterais, determinação de uma dosagem adequada, bem como a população alvo.Palavras-chave: probióticos, alergia, hipersensibilidade. ABSTRACTIn the last decades, it was observed a progressive increase of allergic diseases and consequently researchers are looking for new preventive and alternative treatments. In this context it is remarkable the growth of researcher in the scientific community,aiming to investigate whether the supplementation with probiotics substances would be able to reduce the incidence and severity of clinical atopy and its effects as a treatment strategy. The study consisted of a literature review with the aim of evaluate the clinical efficacy of probiotics in atopic diseases such as asthma, allergic rhinitis, atopic dermatitis and food allergy as well as its effects.Despite consistent reports suggest that specific probiotic strains when used in certain cases produce significant clinical improvement, it is still extremely important to have new studies in order to verify and clarify precisely other effects, including side effects, the appropriate dosage as well as the target population.Keywords: probiotics, allergy, hypersensitivity.

scholarly journals Original Article. Sensitization to Aeroallergens in Pediatric Patients with Allergic Rhinitis and Asthma

2016 ◽  
Vol 9 (2) ◽  
pp. 139-144
Author(s):  
Nikolay K. Balgaranov ◽  
Lachezar S. Nikolov ◽  
Nadia I. Kolarova-Yaneva ◽  
Vania N. Nedkova ◽  
Kristina Ts. Tabakova ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Pediatric Patients ◽  
Dominant Role ◽  
Allergic Diseases ◽  
Indoor Allergens ◽  
Children With Asthma ◽  
Study Population ◽  
Skin Prick Tests ◽  
Allergen Extracts

Summary Asthma and allergic rhinitis are common in childhood. Establishing sensitization to aeroallergens is crucial to effectively prevent exacerbation of these respiratory allergic diseases. The study aimed to evaluate sensitization to the most common aeroallergens in children with asthma and allergic rhinitis.We establishedacorrelation between patients sensitized to indoor, outdoor and simultaneously to both allergens. The study population consisted of 276 patients (168 boys and 108 girls) ages 4 to 16 years with asthma (A) and allergic rhinitis (AR). Skin prick tests were performed with 21 commercial allergen extracts: pollens, mites, epithelia and insects, and molds. We found that 217 patients were sensitized to at least one aeroallergen: 117 patients hadapositive result to mites, 92 to pollens, 72 to epithelia and insects, and 63 - to mold allergens. Dermatophagoides pteronyssinus was the most prevalent aeroallergen. Sensitized only to indoor allergens were 104 patients, 60 - only to outdoor allergens, and 53 were sensitized to both. Mites were the most frequent aeroallergens in children with Aand AR. Lately there has been foundasignificant increase in rates of sensitization to mold allergens, especially to Alternaria alternata. Our study has confirmed the dominant role of indoor allergens in children with respiratory allergic diseases.

scholarly journals Research on the improvement of allergic rhinitis in asthmatic children after reducing dust mite exposure: a randomized, double-blind, cross-placebo study protocol

2020 ◽  
Author(s):  
Ming Chen ◽  
YuFen Wu ◽  
Shuhua Yuan ◽  
Jiande Chen ◽  
Luanluan Li ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Allergic Diseases ◽  
House Dust Mites ◽  
Life Questionnaire ◽  
Dust Mites ◽  
Double Blind ◽  
Asthma Control Questionnaire ◽  
Asthmatic Children ◽  
Dust Mite ◽  
Children With Asthma

Abstract Background: Allergic rhinitis (AR) in children has become a major respiratory inflammatory disease with a high incidence that is increasing yearly. In China, 54.93% of children with asthma have AR, which often requires synchronous treatment. House dust mites (HDMs) are common allergens that often cause attacks of AR and asthma. Reducing allergen exposure is one of the most important measures to control and treat AR and asthma attacks. Hestelia Mite Bait, containing 0.1% emamectin, is a new tool for trapping and killing dust mites that can reduce the number of dust mites on mattresses, thereby potentially reducing stimulation by allergens and ultimately improving asthma and rhinitis symptoms. This single-centre, randomized double-blind crossa-placebo trial will explore the improvement of allergic rhinitis in asthmatic children after reducing dust mite exposure.Methods: We will recruit 60 children (aged 3-12 years) who have been diagnosed with allergic rhinitis and asthma and are allergic to dust mites as confirmed by a serum allergen test. Participants will randomly receive the Hestelia Mite Bait intervention for 8 weeks and the placebo intervention for 8 weeks. There will be a 4-week washout period between the two interventions. The primary outcome is the visual analogue scale (VAS) score of AR symptoms; the secondary outcomes include the Rhinitis Control Assessment Test (RCAT) score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, changes in the dust mite level, drug usage for asthma and AR, Asthma Control Questionnaire-5 (ACQ-5) score, and frequencies of acute asthma attacks, emergency visits, and hospitalization.Discussion: This study will scientifically and objectively evaluate the improvement effects on rhinitis and asthma after reducing dust mite exposure and will provide a convenient means for the prevention and treatment of children's airway allergic diseases in the future.Trial registration: ChiCTR1900024688 (www.chictr.org.cn) registration date: July 21, 2019

scholarly journals Epidemiological studies as a basis of information for diagnosis of the allergic diseases of the respiratory system and skin of the children 6–7 and 13–14 years in the Grodno region

2015 ◽  
Vol 9 (1) ◽  
pp. 3-7
Author(s):  
Andrei Shpakou
Keyword(s):  
Allergic Rhinitis ◽  
Atopic Dermatitis ◽  
Allergic Diseases ◽  
Epidemiological Studies ◽  
Social Consequences ◽  
Rural Children ◽  
Children With Asthma ◽  
Low Incidence ◽  
The Village

Background: Widespread, medical and social consequences, impact on quality of life and the significant cost of allergic diseases justify a number of measures for the prevention of diseases. What is clear is that official statistics may not match the true prevalence of allergic diseases in general, especially asthma. Aim of the study: Estimate the prevalence of asthma and allergic diseases, the main symptoms of allergic and respiratory among urban and rural children aged 6–7 years and 13–14 years in the Grodno region carried out in accordance with internationally recognized research methodology. Material and methods: The survey questionnaire (based on a survey ISAAC) 2187 was attended by parents of children 6–7 years and 13–14 years of Grodno and region (1091 children from the city, and in 1096 from the village). 955 children aged 6–7 years, 1232 at the age of 13–14 years. Knowing this with asthma may be suspected in patients, who feel shortness of breath accompanied by wheezing, tightness in the chest or cough and allergic diseases (allergic rhinitis and atopic dermatitis), analyzed the incidence of these symptoms and diseases among children.Results: Demonstrated a low incidence of asthma among children in the age group of standardized. Parents of 30 children (1.37% respondents) confirms the existence of disease in children under physician diagnose disease. Prevalence of asthma among urban children was 1.74% (19 people) and rural – 1.0% (11 children). With a deeper analysis of responses established with 60 children (2.74%) had in the last 12 months wheezing in the chest and coughing. The incidence of allergic rhinitis and atopic dermatitis is about 4% and 10%. These diseases often found only among children with asthma. Conclusions: Since the identification of asthma in children based on the diagnosis by the doctor is not high, can’t be excluded that this reflects a failure to recognize the disease. Noted marked differences in the prevalence of respiratory symptoms, manifesting linking asthma and asthma with allergic diseases. It seems necessary to continuously monitor these phenomena through the continuation of epidemiolog-ical studies as a basis for the development of information and implementation of prevention programs and epidemiological evaluation of the effectiveness of prevention at regional and international.

ОЦЕНКА ЦИТОКИНОВОГО ПРОФИЛЯ СЫВОРОТКИ КРОВИ И СУБПОПУЛЯЦИЙ Т-ЛИМФОЦИТОВ У ДЕТЕЙ С АЛЛЕРГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ ОРГАНОВ ДЫХАНИЯ

2019 ◽  
pp. 52-60
Author(s):  
E.V. Prosekova ◽  
A.I. Turyanskaya ◽  
N.G. Plekhova ◽  
M.S. Dolgopolov ◽  
V.A. Sabynych
Keyword(s):  
Allergic Rhinitis ◽  
Bronchial Asthma ◽  
Allergic Inflammation ◽  
Allergic Diseases ◽  
Control Group ◽  
Healthy Children ◽  
Serum Cytokine ◽  
Immunological Parameters ◽  
Low Level ◽  
Level Of Significance

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.

scholarly journals Risk factors for allergic rhinitis in Costa Rican children with asthma

Allergy ◽  
2010 ◽  
Vol 65 (2) ◽  
pp. 256-263 ◽  
Author(s):  
S. Bunyavanich ◽  
M. E. Soto-Quiros ◽  
L. Avila ◽  
D. Laskey ◽  
J. M. Senter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Allergic Rhinitis ◽  
Costa Rican ◽  
Children With Asthma

scholarly journals Is suicidal ideation associated with allergic asthma and allergic rhinitis?

2018 ◽  
Vol 44 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Martín Bedolla-Barajas ◽  
Norma Angélica Pulido-Guillén ◽  
Bolívar Vivar-Aburto ◽  
Jaime Morales-Romero ◽  
José Raúl Ortiz-Peregrina ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Suicidal Ideation ◽  
Allergic Asthma ◽  
Allergic Diseases ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Control Group ◽  
Healthy Controls ◽  
Cross Sectional ◽  
And Control

ABSTRACT Objective: To investigate whether there is an association between suicidal ideation (SI) and allergic diseases in adults. Methods: This was a comparative cross-sectional study involving individuals ranging from 20 to 50 years of age recruited from a university hospital in the city of Guadalajara, Mexico. We included patients with a confirmed diagnosis of allergic asthma, those with a confirmed diagnosis of allergic rhinitis, and healthy controls. All subjects completed the Beck Depression Inventory-II (BDI-II), which includes an item that evaluates the presence of suicidal thoughts or desires within the last two weeks, in order to identify SI. Results: The sample comprised 115 patients with allergic asthma, 111 patients with allergic rhinitis, and 96 healthy controls. The number of individuals identified with SI in the three groups were, respectively, 17 (14.8%), 13 (11.7%), and 8 (8.3%). Regarding the presence of SI, no statistically significant association was found in the allergic asthma group (OR = 1.98; 95% CI: 0.78-4.64; p = 0.154) or in the allergic rhinitis group (OR = 1.46; 95% CI: 0.58-3.68; p = 0.424) when they were compared with the control group. However, the presence of depression was associated with SI in the three groups: allergic asthma (OR = 12.36; 95% CI: 2.67-57.15; p = 0.001); allergic rhinitis (OR = 6.20; 95% CI: 1.66-23.14; p = 0.006); and control (OR = 21.0; 95% CI: 3.75-117.36; p < 0,001). Conclusions: In comparison with the control group, no association was found between SI and the groups with allergic diseases. In contrast, there was association between SI and depression in the three groups.

scholarly journals CLINICAL AND IMMUNOLOGICAL EFFECTIVENESS OF TREATMENT OF RAGWEED POLLINOSIS IN THE SAMARA REGION

2021 ◽  
Vol 23 (4) ◽  
pp. 921-926
Author(s):  
N. N. Zhukova ◽  
M. V. Manzhos ◽  
L. R. Khabibulina ◽  
E. Yu. Syrtsova
Keyword(s):  
Allergic Rhinitis ◽  
Russian Federation ◽  
Allergic Diseases ◽  
Ambrosia Artemisiifolia ◽  
Control Group ◽  
Ambrosia Trifida ◽  
Results Of Treatment ◽  
Amb A 1 ◽  
The Russian Federation ◽  
Time Changes

Allergic rhinitis and bronchial asthma are widespread respiratory allergic diseases. In some territories of the Russian Federation, the dominant cause of pollinosis is ragweed. The aim of the study was to evaluate the clinical and immunological efficacy of ASIT with the allergen Ambrosia artemisiifolia in patients sensitized to Ambrosia trifida in the Samara region. Patients with proven sensitization to Ambrosia trifida was held immunotherapy with Ambrosia artemisiifolia allergoid preseason. After treatment, patients had a decrease in the severity of symptoms of allergic rhinitis according to VAS (p = 0.00001), a decrease in the need for medications (p = 0.0003), as well as the need for corticosteroids against the background of therapy from 34.6% to 0% (p = 0.00001). In 8% of cases, the result of treatment was good, in 69% satisfactory, in 23% unsatisfactory. In the control group, there were no changes in the severity of symptoms (p = 0.858). Also, in the control group, the need for medications remained unchanged and 14.3% of patients continued to use corticosteroids.After ASIT, there was a decrease in the level of IL-4 (p = 0.002), and a decrease in the ratio of IL-4/ IL-10 (p = 0.0063); at the same time, changes in the level of other cytokines (IL-10; IFNγ) were statistically insignificant (p > 0.05). Before treatment, the levels of IL-4/ IL-10 in both groups were comparable, and after treatment, the differences became statistically significant (p = 0.031). We did not get a statistically significant change in the level of IgG4 Amb a 1 or IgG4 Amb trifida. There was no correlation between the level of individual cytokines and the results of treatment. As a result of the conducted ASIT, positive clinical and immunological results were obtained. In most patients, the disease has acquired a controlled course. At the same time, the lack of excellent and low number of good results of ASIT is probably due to the intraspecific allergenic properties of ragweed. 

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