Comorbidity of bronchial asthma and allergic rhinitis in its alternative course in school-age children

The study of the comorbidity of bronchial asthma (BA) and allergic rhinitis (AR) in children will expand the understanding of the pathogenetic mechanisms of the most trending childhood allergic diseases. Purpose — to investigate some clinical and paraclinical features of AR in its alternative course in schoolchildren for the optimization of the personalized antiinflammatory therapy of patients with comorbidity of BA and AR. Materials and methods. A comprehensive clinical and paraclinical examination of 66 of school-age children with BA with concomitant AR has beenperformed. Depending on the course of AR, patients have been divided into 2 groups: group I — 34 children with BA and intermittent AR (mean age — 13.4±0.8 years, the proportion of boys — 70.5%), group II — 32 asthma patients, which have signs of persistent AR (mean age — 12.1±1.1 years) (p>0.05), the proportion of boys — 81.2% (p>0.05). The diagnosis of BA and AR was established according to the modern requirements. All children underwent a study of bronchial lability by assessing their response to dosed exercise and inhalation of short-acting β2-adrenomimetics (200 mcg salbutamol) followed by calculation of bronchial lability, considered as the sum of its components — indicies of bronchospasm and bronchodilation. Results. Patients with persistent allergic rhinitis have had a more severe and less controlled course of bronchial asthma with a 3.0-fold increased risk. The baseline spirographic examination has showed that patients with intermittent allergic rhinitis were three times more likely to have FEV1<80% and the higher chances of marked airway lability at the level of small bronchi, including by forced midexpiratory flow rate as well. Conclusions. The comorbid course of bronchial asthma and intermittent allergic rhinitis in children was accompanied by a lower chance of uncontrolled asrhma, along with a higher probability of developing nonspecific airway hyperreactivity. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: bronchial asthma, allergic rhinitis, children.

Elevated Serum Level of CD48 in Patients with Intermittent Allergic Rhinitis

<b><i>Background:</i></b> In the pathogenesis of intermittent allergic rhinitis (IAR), the inflammatory reaction is of importance. CD48, belonging to the CD2 family, participates in mast cell-stimulating cross-talk, facilitates the formation of the mast cell/eosinophil effector unit, and is expressed by eosinophils. <b><i>Objectives:</i></b> To assess the serum level of soluble form of CD48 (sCD48) in patients with IAR during and out of the pollen season and correlate with the disease severity and with eosinophil-related parameters. <b><i>Materials and Methods:</i></b> Sixty-three patients (female: 79%; mean age: 30.58) were included to the study. Forty-five patients were assessed during the pollen season and other 42 patients during out of the pollen season. Twenty-four patients (female: 37.50%; mean age: 27.90) were evaluated twice, during the pollen season and out of the pollen season. sCD48, ECP, eotaxin-1/CCL11 serum levels together with complete blood count, and fractional exhaled nitric oxide bronchial and nasal fraction (FeNO) were performed. The severity of symptoms was assessed using the Total Nasal Symptom Score (TNSS), and neutrophil-to-lymphocyte (NLR) and eosinophil-to-lymphocyte (ELR) ratios were calculated. <b><i>Results:</i></b> sCD48 serum level, FeNO nasal and bronchial fractions, and TNSS were significantly higher in the IAR group in the pollen season compared with out of the pollen season. Differences in ECP, eotaxin-1/CCL11 serum levels, and NLR and ELR were not significant between season and out of the season. No correlations were found between sCD48 and eosinophil-related parameters. <b><i>Conclusions:</i></b> sCD48 may be a biomarker to the exacerbation phase in patients with IAR. One can assume that CD48 participates in the pathogenesis of IAR.

Potential Differences between Local and Systemic Allergic Rhinitis Induced by Birch Pollen

<b><i>Introduction:</i></b> Different endotypes of rhinitis are known, but its pathomechanism has not been conclusively established. For example, the precise difference between systemic allergic rhinitis (SAR) and local allergic rhinitis (LAR) is still being checked. Comparison of patients with LAR and with allergies to birch of those with intermittent allergic rhinitis, same allergy, or with non-allergic rhinitis (NAR) was the purpose of this study. <b><i>Methods:</i></b> Twenty-six patients with LAR, 18 with SAR and allergy to birch, and 21 with NAR were included. Patients who met the inclusion criteria were selected to undergo the following procedures at baseline: medical examinations, nasal provocation test (NPT), detection of nasal-specific IgE to birch as well as basophil activation test (BAT). All immunological parameters were detected before and after NPT. <b><i>Results:</i></b> Concentration of nasal IgE to Bet v1 increased comparably in the LAR and SAR groups after NPT to birch as follows: in 21 (81%) patients with LAR, 14 (78%) with SAR, and in everyone in the NAR group. Serum concentration of allergen-specific IgE to Bet v1 increased significantly from a median of 20.7 (25–75% interval: 11.2–35.6) IU/mL to 29.9 (13.6–44.1) (<i>p</i> = 0.028) after NPT in patients with SAR. Allergen-specific IgE to Bet v1 was absent in all patients with LAR and NAR before and after NPT. BAT with Bet v1 was positive in 22 (85%) patients with LAR, in 14 (78%) with SAR, and 2 (9.5%) with NAR. <b><i>Conclusion:</i></b> These obtained data suggest there are no potential mechanisms that could explain LAR compared to SAR.

Deranged Pulmonary Function Tests in Allergic Rhinitis in North Indian Patients

Introduction: Significant associations between allergic rhinitis and bronchial asthma have been established and as a result of bronchial hyper-responsiveness, patients can have deranged pulmonary function tests. We aim to compare previous such studies with the result of our study done in India wherein we identify among allergic rhinitis patients who despite not having overt asthmatic symptoms, have pulmonary function derangements, quite possibly at a subclinical disease level. Materials and Methods: We studied 74 patients of allergic rhinitis and after meticulous clinical work up, they underwent blood tests including hemogram, absolute eosinophil count, and total serum IgE followed by pulmonary function tests. Results: Out of 74 patients 60 (81%) had intermittent allergic rhinitis whereas only 14 (19%) had persistent allergic rhinitis. Pulmonary function tests showed reversible obstruction, ie, >10% improvement in FEV1 with inhaled bronchodilators (as seen in asthma) in 18 (24.3%), mild obstruction in 14, and moderate obstruction in 4 cases. Conclusion: The study emphasizes the importance of pulmonary symptoms and the performance of pulmonary function tests in cases of allergic rhinitis patients to rule out latent asthma.