ABSTRACT
Introducción. Se han observado alteraciones espirométricas en pacientes con rinitis, sin asma, proporcionales al grado clínico de la rinitis establecido por la guía Allergic Rhinitis and its Impact on Asthma (ARIA). Recientemente se ha validado una nueva clasificación de la rinitis como ARIA modificada (ARIAm), que disocia la forma moderada de la grave. Se desconoce el impacto de la rinitis sobre la función pulmonar considerando su frecuencia y gravedad por separado. Objetivos. Determinar las posibles alteraciones de la función pulmonar y su potencial reversibilidad al broncodilatador en niños y adolescentes con rinitis alérgica y no alérgica sin asma, de acuerdo a su frecuencia (intermitente y persistente) y gravedad (leve, moderada y grave) establecida según ARIAm. Población y métodos. Estudio observacional, analítico de corte transversal, que incluyó pacientes de ambos sexos, entre 5 y 18 años, con rinitis alérgica y no alérgica, sin asma. Se realizó espirometría por curva flujo-volumen y se analizó la existencia de anormalidades en la función pulmonar y la respuesta broncodilatadora en relación con el grado de rinitis por ARIAm ajustando un modelo logístico. Se consideró un valor de p<0,05 para establecer significación estadística. Resultados. Se incluyeron 189 pacientes. En 42 (22,2%) se observó al menos un parámetro alterado en la función pulmonar. Los pacientes con rinitis persistente exhibieron mayor afectación de la función pulmonar que los de grado intermitente (p=0,0257). El defecto funcional fue más frecuente en las formas grave y moderada que en el grado leve (p=0,0052) y fue independiente de la condición de atopia (p=0,1574 para frecuencia y p =0,5378 para gravedad). No se encontró diferencia en la reversibilidad al broncodilatador entre los grupos (p=0,1859 y p=0,0575, respectivamente). Conclusiones. La alteración de la función pulmonar se asoció con rinitis persistente. Fue más prevalente en las formas moderada y grave pero no existieron diferencias significativas entre ambas. El defecto funcional se demostró tanto en rinitis alérgica como no alérgica. (AU)
Background: Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, proportional to the clinical grade established by Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline. Recently has been validated a new criteria of rhinitis classification designed as ARIA modified (ARIAm), which allow to discrimination moderate to severe grades. Rhinitis impact on lung function according to frequency and severity considering separately is unknown. Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic and nonallergic rhinitis without asthma, according to the frequency and severity criteria of rhinitis classified by ARIAm. Methods: In an observational cross sectional study we included children and adolescents aged 5 to 18 years with symptoms of allergic and nonallergic rhinitis without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIAm using an adjusted logistic model. A p value <0.05 was considered statistically significant. Results: We studied 189 patients; 42 (22.2%) had some spirometric abnormalities. Patients with persistent rhinitis had greater impairment of lung function compared to intermittently grade (p = 0.0257). The functional defect was more frequent in rhinitis severe and moderate than mild grade (p = 0.0052) and was independent of atopy status both frequency (p = 0.1574) and severity (p=0.5378). There was no difference in bronchodilator reversibility between groups (p = 0.1859 and p = 0.0575 respectively). Conclusion: Impaired lung function was associated with persistent rhinitis. It was more prevalent in moderate and severe rhinitis, but there wasn't a significant difference between them. The functional defect was demonstrated in both allergic and nonallergic rhinitis.(AU)
Subject(s)
Humans , Child , Adolescent , Respiratory Function Tests , Rhinitis, Allergic , Asthma , Skin TestsABSTRACT
Introduction: Allergic rhinitis and asthma frequently coexist but has rarely been evaluated in Lebanese children. Aim: This prospective study aimed to estimate the prevalence of allergic rhinitis in asthmatic children in Lebanon, and to ascertain whether allergic rhinitis is a risk factor for the severity of asthma. Patients and Methods: Parents of 124 children aged 1-13 years admitted to the pediatric floor of the Makassed General Hospital between July 2008 and March 2009 and diagnosed as having asthma; parents were interviewed and followed up with a questionnaire concerning allergic rhinitis symptoms and signs with para-clinical data if available. The questionnaire was based on a study done in France by Hammouda et al. (2005). This was modified from an adult score for allergic rhinitis (SFAR). Results: This well recognized score defines the association of allergic rhinitis and asthma in children. A score of ³ 9 out of 17 total score corresponds to the presence of allergic rhinitis in asthmatic children. The prevalence of allergic rhinitis was recognized in 67 patients out of 124 (54%). This prevalence was evident mainly in the age group 3-5 years. Conclusion: Allergic rhinitis is prevalent in children of the Lebanese population, the severity of asthma was found to be clearly associated with allergic rhinitis. The SFAR modified for children was found to be a simple and reliable tool to detect allergic rhinitis in asthmatic children.
ABSTRACT
Objetivo: Determinar los valores de Rantes, después de la exposición a ácaros, para evaluar su asociación con la escala ARIA, en el grupo de pacientes seleccionado. Diseño: Estudio de corte transversal. Materiales y métodos: Se incluyeron 17 pacientes que consultaron por rinitis alérgica en el Hospital de La Samaritana entre el 1 de julio del 2010 y el 1 julio del 2011, y que cumplieron los criterios de selección, de los cuales se obtuvieron 34 muestras de lavados nasales posteriores a provocación intranasal con ácaros. Resultados: Los pacientes mostraron mayor tendencia a pertenecer al grupo de síntomas de mayor severidad y frecuencia según la escala ARIA. Los valores de Rantes encontrados en lavados nasales tuvieron un promedio de 8,1 pg/ml (+/ 19DS). Conclusión: Se encontró una positividad en los valores de la citoquina CCL5 en los lavados nasales del 20% de los pacientes. El coeficiente de correlación obtenido muestra una asociación débil.
Objective: Determine the values of Rantes, after exposure to mites, to evaluate its association with ARIA scale in the group of selected patients. Design: Cross sectional survey. Materials and Methods: We included 17 patients presenting with allergic rhinitis at the Samaritan Hospital between July 1, 2010 and July 1, 2011, and met the selection criteria, of which 34 samples were obtained from nasal washes after intranasal challenge with mites. Results: Patients showed a greater tendency to belong to the group of symptoms of greater severity and frequency according to the ARIA scale. Rantes values found in nasal washes had an average of 8.1 pg/ml (+/ 19DS). Conclusions: Positivity was found in the values of the cytokine CCL5 in nasal washes of 20% of patients. The correlation coefficient shows a weak association.
Subject(s)
Humans , Rhinitis , Rhinitis, Allergic, Seasonal , Rhinitis, Allergic, PerennialABSTRACT
The nose and lung are both part of the respiratory tract. Often the diseases affecting the nose and/or the bronchi are treated separately. However, in recent years, numerous studies have highlighted the fact that the respiratory system is a single entity and the concept of "united airway disease" has become more and more important. The unity of the respiratory tract is confirmed both from a morphological and from a functional point of view. Nevertheless, this concept is also confirmed for the respiratory immune system, innervation and vascularization interesting all along the tract, from the nose to the bronchioles. When treating rhinitis, it is often necessary to assess the presence of asthma. Patients with sinusitis should be evaluated for a possible concomitant asthma. Conversely, patients with asthma should always be evaluated for possible nasal disease. The medications that treat nasal diseases appear to be useful in improving control of asthma and in reducing bronchial hyperresponsiveness as well. Physicians should always keep these notions in mind, and evaluate and treat respiratory diseases taking into account the unity of the respiratory tract.
Subject(s)
Humans , Asthma , Bronchi , Bronchioles , Immune System , Lung , Nose , Nose Diseases , Respiratory System , Rhinitis , Rhinitis, Allergic, Perennial , SinusitisABSTRACT
OBJECTIVES: The Allergic rhinitis and its impact on asthma (ARIA) guidelines were suggested for use to classify allergic rhinitis (AR). However, few studies have been performed in Asians. The objective of this study is to identify the clinical characteristics of AR in Korean patients according to the ARIA guidelines. METHODS: For the study, 610 patients who had been diagnosed with allergic rhinitis at Seoul National University Bundang Hospital and 545 patients who had been diagnosed with allergic rhinitis at 3 local clinics were included. All the patients were categorized into 4 groups, such as the mild intermittent, mild persistent, moderate-severe intermittent and moderate-severe persistent groups. The patients were given a questionnaire on allergic rhinitis-related symptoms and they underwent blood tests, including the blood eosinophil count and the serum total IgE level. RESULTS: The most prevalent type was the moderate-severe persistent group (34.7%), and the moderate-severe intermittent group (17.1%) was the rarest. There were significant differences among the 4 groups for olfaction (P<0.001), self-awareness of rhinitis (P=0.013), a previous history of AR (P<0.001), self-awareness of asthma (P=0.001) and allergic conjunctivitis (P<0.001). On the allergy laboratory tests, there was a significant difference between the groups for the eosinophi count (P=0.004). The number of blood eosinophil was more in the persistent groups than in the intermittent groups. CONCLUSION: According to the ARIA guidelines, the moderate-severe persistent group was the most prevalent for Korean patients. Blood eosinophilia and olfactory dysfunction were the most severe in the moderate-severe persistent group.
Subject(s)
Humans , Asian People , Asthma , Conjunctivitis, Allergic , Eosinophilia , Eosinophils , Hematologic Tests , Hypersensitivity , Immunoglobulin E , Rhinitis , Rhinitis, Allergic, Perennial , Smell , Surveys and QuestionnairesABSTRACT
BACKGROUND AND OBJECTIVES : Allergic rhinitis has previously been classified as seasonal, perennial or occupational according to duration of exposure to allergens ; this classification, however, has posed difficulty for care providers in planning the stepwise treatment of allergic rhinitis. According to the ARIA (Allergic Rhinitis and its Impact on Asthma) workshop report, allergic rhinitis was re-classified as intermittent or persistent according to duration of symptoms, and mild or moderate-to-severe according to severity of symptoms. There has been no reports regarding the distribution of allergic rhinitis by using the new ARIA classification. We aimed to find out the distribution of allergic rhinitis according to the new ARIA classification and its usefulness in clinical use. Subjects and METHOD : A total of 502 allergic rhinitis patients were subjected to this study. They were classified under the previous classification into seasonal, perennial, and multiple. They were classified by new ARIA classification into persistent mild, persistent moderate-to-severe, intermittent mild, and intermittent moderate-to-severe. Their distribution and characteristics were analyzed. RESULTS : When classified according to previous classification, patients sensitized with perennial allergens, seasonal allergens and multi-allergens were 326 (64.9%), 63 (12.5%) and 113 (22.5%) respectively. According to the new ARIA classification, persistent mild, persistent moderate-to-severe, intermittent mild and intermittent moderate-tosevere patients were 82 (16.3%), 161 (32.1%), 159 (31.7%) and 100 (19.9%) respectively. The patients sensitized with perennial allergen were classified to persistent mild (17.5%), persistent moderate-to-severe (32.5%), intermittent mild (31.6%), intermittent moderate-to-severe (18.4%) by new ARIA classification. Half of patients with intermittent symptoms were sensitized by perennial allergen. Among the patients sensitized by only seasonal allergen, 24 (36.5%) had persistent symptoms. There were no difference in group distribution between the rhinorrhea-sneezer and blocker groups. CONCLUSION : Patient distribution by the new ARIA classification was different from the previous classification. From the point of clinicians, the new ARIA classification might be more useful for stepwise treatment and exact evaluation of allergic rhinitis patients than the previous classification.