Eficacia y seguridad de la combinación de fexofenadina con montelukast en el tratamiento de la rinitis alérgica / Efficacy and safety of combined therapy of fexofenadine and montelukast for the treatment of allergic rhinitis

El propósito de este trabajo fue revisar la literatura científica que evalúa la eficacia y seguridad de las monoterapias de fexofenadina y montelukast, la terapia combinada (fija o en asociación) de montelukast - fexofenadina, así como de montelukast con otros antihistamínicos de segunda generación en el tratamiento de la rinitis alérgica. Se realizó una estrategia de búsqueda bibliográfica de múltiples etapas, en donde se identificaron estudios basados en ensayos clínicos y estudios no aleatorizados (ensayo controlado no aleatorizado, controlado antes-después, de series de tiempo interrumpidas, con controles históricos, de cohorte, de casos y controles, estudio transversal, y series de casos) en pacientes con rinitis alérgica, en las bases de datos MEDLINE/ PubMed, Scopus, Web of Science, Biblioteca Cochrane, Redalyc y Colección BVS y debido a la cantidad de resultados obtenidos se incluyó la búsqueda en Hinari. Con base en esta revisión se concluye que las combinaciones de antihistamínicos de segunda generación y antagonistas de leucotrienos y, en particular, la combinación fija de fexofenadina ­ montelukast es eficaz, segura y favorece la adherencia al tratamiento, y a largo plazo también ayuda a alcanzar el objetivo terapéutico.

The purpose of this work was to review the scientific literature that evaluates the efficacy and safety of monotherapies of fexofenadine and montelukast, the combined therapy (fixed-dose or separate drug combinations) of montelukast-fexofenadine, as well as the use of montelukast together with other second-generation antihistamines in the treatment of allergic rhinitis. A multistage literature search strategy was designed, including clinical trials and non-randomized studies (non-randomized controlled trial, controlled before-after study, interrupted time series study, historical control study, cohort study, case-control study, crosssectional study, and case series) evaluating patients with allergic rhinitis. The databases MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, Redalyc, BVS Collection, and, due to the number of results obtained, Hinari were included. Based on this review, the conclusion is that the combinations of secondgeneration antihistamines with leukotriene antagonists and, in particular, the fixed combination of fexofenadine-montelukast are effective, safe and promote treatment adherence. In the long term, they also help achieve therapeutic goals.

Two Cases Successfully Treated with Mokuboito on the Basis of Shinkahiken (Epigastric Stuffiness and Strong Resistance) / 日本東洋医学雑誌

Mokuboito is usually used for the treatment of patients with dyspnea and edema due to chronic heart failure. We herein report two cases successfully treated with mokuboito on the basis of shinkahiken (epigastric stuffiness and strong resistance). Case 1 was a 28-year-old woman. She had been experiencing occasional bouts of epigastralgia for 12 years, but they had worsened two months before the first visit to our department. When she was examined, however, the cause of epigastralgia could not be determined and she was diagnosed with functional gastroenteropathy. After being introduced to our department, she was treated with various Kampo formulas, but the symptom was poorly improved. Case 2 was a 74-year-old man who was prescribed hachimijiogan and shoseiryuto for an overactive bladder and perennial allergic rhinitis. His symptoms were stable, but suddenly deteriorated after two months. In both cases, when changing treatment to mokuboito on the basis of shinkahiken, the symptoms were improved. These results suggest that mokuboito can be used in a wide range of cases with shinkahiken.

Prescription Profile and Clinical Outcomes in Patients with Allergic Rhinitis Treated with Oral Antihistamines or Nasal Corticosteroids

Abstract Introduction Oral antihistamines and intranasal corticosteroids have been shown to be effective and safe for the treatment of allergic rhinitis; however, the evidence suggests a level of superiority of corticosteroids, so they should be preferred over the former. Objective To know the prescription profile of two second generation antihistamines (cetirizine and levocetirizine) and two nasal corticosteroids (mometasone and furoateciclesonide) in a cohort of patients with allergic rhinitis, and to compare the clinical outcomes obtained. Methods A cohort study was carried including patients with allergic rhinitis treated with cetirizine, levocetirizine, mometasone furoate or ciclesonide. The improvement was evaluated with the total nasal symptoms score (TNSS). This scale yields results between 0 and 12. Zero indicates absence of symptoms. Results A total of 314 patients completed 12 weeks of follow-up. Seventy-five percent were treated with antihistamines, 20% with corticosteroids, and 5% with a combination of the above. The TNSS median for corticosteroid was 2.5 points; for antihistamines, its was 5 points, and for combination, it was 4 points. We found differences between corticosteroids and antihistamines. Conclusion The prescription percentage of second generation oral antihistamines is higher than that of intranasal corticosteroids. However, patients with allergic rhinitis treated with the second option obtained better control of symptoms.

Rinite alérgica na visão do paciente / Allergic rhinitis from a patient's perspective

Os sintomas nasais têm impacto na vida dos pacientes com rinite alérgica. A maioria das pessoas alérgicas relata impacto negativo dos sintomas de alergia no trabalho e no desempenho escolar. Dentre todos os sintomas de alergia, o mais incômodo é a obstrução nasal, embora outros sintomas também tenham impacto na qualidade de vida dos pacientes, especialmente no sono. Os anti-histamínicos orais e corticosteroides nasais são as medicações mais frequentemente utilizadas para o tratamento de rinite, seguidos por descongestionantes orais ou intranasais. Os pacientes alérgicos frequentemente compram medicações sem prescrição médica nas farmácias, e nem sempre estão satisfeitos com o tratamento que lhes é oferecido. Os médicos devem trabalhar mais na comunicação com os pacientes alérgicos para atender às suas necessidades, abordando medo de efeitos colaterais, preocupações quanto aos sintomas de alergia e como estes interferem na qualidade de vida. Desse modo, a educação do paciente baseada em melhor comunicação pode facilitar o controle da rinite alérgica.

Nasal symptoms have an impact on the daily lives of patients with allergic rhinitis. Most allergic individuals report a negative impact of allergy symptoms on work and school performance. Among all allergy symptoms, the most bothersome is nasal congestion, although other symptoms also have an impact on patients' quality of life, especially on their sleep. Oral antihistamines and intranasal corticosteroids are the most frequently used medications for rhinitis, followed by oral or intranasal decongestants. Allergic patients frequently purchase different over-the-counter medications and sometimes are not satisfied with proposed treatments. Physicians should improve the communication with allergic patients to meet their needs, addressing fear of side effects, concerns about allergy symptoms and how they impact quality of life. Thus, educating patients through better communication may improve the control of allergic rhinitis.

A influencia de fatores ambientais na qualidade de vida e na sintomatologia de criancas com rinite alergica / The impact of environmental factors on quality of life and symptoms of children with allergic rhinitis

A rinite alérgica é uma inflamação da mucosa nasal, induzida pela exposição a alérgenos, responsável por impacto negativo sobre a capacidade cognitiva dos afetados. OBJETIVO: Correlacionar a média da qualidade de vida de crianças e adolescentes com sintomas de rinite alérgica com a presença de fatores ambientais domiciliares relatados na literatura como desencadeantes das crises alérgicas. MÉTODO: Estudo de coorte histórica com corte transversal no qual foram convidadas a participar 120 crianças e adolescentes com manifestações clínicas de rinite alérgica, as quais foram divididas em dois grupos, de acordo com a quantidade de fatores ambientais inadequados em seus domicílios. Aplicou-se, então, o questionário PedsQL 4.0 para quantificação da qualidade de vida com posterior comparação entre os grupos. RESULTADOS: Não foi encontrada diferença significante (p > 0,05) na média dos escores do questionário PedsQL ao comparar a qualidade de vida dos participantes com a presença dos fatores ambientais inadequados avaliados no estudo, porém, notou-se maior incidência de manifestações alérgicas nas crianças com maior número desses fatores. CONCLUSÃO: Os fatores ambientais inadequados estudados não tiveram relação com a qualidade de vida dos pacientes. No entanto, a análise das moradias e sintomatologia dos mesmos sugere que o ambiente interferiu no aparecimento das manifestações alérgicas. .

Allergic rhinitis is an inflammation of the nasal mucosa caused by exposure to allergens, which impairs the cognitive capabilities of the affected. OBJECTIVE: To correlate the mean scores of quality of life of children and adolescents with symptoms of allergic rhinitis and the presence of household environmental factors described in the literature as allergy triggers. METHOD: This cross-sectional retrospective cohort study included 120 children and adolescents presenting clinical manifestations of allergic rhinitis. The subjects were divided into two groups based on the number of allergy-triggering environmental factors seen in their households. Scale PedsQL 4.0 was used to quantify quality of life and allow further comparisons between groups. RESULTS: No statistically significant differences (p > 0.05) were seen in the PedsQL mean scores when participant quality of life was analyzed vis-a-vis triggering environmental factors. However, the incidence of allergy manifestations was higher in children exposed to more environmental factors. CONCLUSION: The studied environmental factors were not correlated with patient quality of life. However, the analysis of patient households and symptoms indicates the environment played a role in the onset of allergy events. .

Seasonal Specificity of Seasonal Allergens and Validation of the ARIA Classification in Korea

PURPOSE: In Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification. METHODS: Two hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification. RESULTS: Seasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications. CONCLUSIONS: Seasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.

Pathophysiology, Diagnosis, and Treatment of Allergic Rhinitis / 대한이비인후과학회지

Allergic rhinitis (AR) requires treatment with a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR include allergen avoidance, pharmacotherapy, immunotherapy, and surgery. Recently, anti-IgE antibody and specific antibody to cytokines, such as interleukin (IL)-4 or IL-5, have emerged in connection with understandings of the mechanisms of AR. Sublingual immunotherapy has been widely used based on its efficacy, safety, and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, it is thought that antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients' main symptoms, the duration and severity of AR, patients' compliance, the safety of medication, and cost-effectiveness should be considered when treatment options are selected. In this aspect, physicians should be aware of the etiology, pathophysiology, symptoms, signs, and diseases related to AR in order to make correct diagnoses and choose proper treatment options for each patient.

Avaliações objetiva e subjetiva da obstrução nasal em crianças e adolescentes com rinite alérgica / Objective and subjective assessments of nasal obstruction in children and adolescents with allergic rhinitis

OBJETIVO: Relacionar a avaliação objetiva da obstrução nasal por rinometria acústica (volume dos cinco primeiros centímetros da cavidade nasal) e rinomanometria anterior ativa (resistência nasal total) com a avaliação subjetiva (escore de obstrução). MÉTODO: Participaram do estudo 30 pacientes (7 a 18 anos) com rinite alérgica persistente e 30 controles. O escore foi referido para cavidade nasal total e narinas em separado. As três variáveis foram mensuradas nos momentos basal e após indução de obstrução nasal. RESULTADOS: Houve correlações significantes e negativas entre resistência e volume nasal em todos os grupos e situações de avaliação, exceto para narina mais obstruída, grupo controle, pós-obstrução. Para a cavidade nasal total, não houve correlação significante entre as variáveis objetivas e subjetiva, exceto entre escore e volume na cavidade nasal total no grupo controle pós-obstrução. Na narina mais obstruída, houve correlação significante e negativa para escore e resistência e significante e positiva para escore e volume nasal no grupo total, momento basal. Não houve diferença nítida nos coeficientes de correlação entre pacientes e controles, e estes não se alteraram após a indução de obstrução nasal. CONCLUSÕES: Avaliação objetiva da obstrução nasal não apresentou correlação significativa com a avaliação subjetiva na cavidade nasal total, mas sim na avaliação unilateral. Houve correlação entre avaliações objetivas. Rinite alérgica ou obstrução nasal aguda não interferiram na correlação entre as avaliações objetiva e subjetiva da obstrução nasal. Sugere-se utilidade no acréscimo de métodos objetivos para avaliação da obstrução nasal em pesquisas e, na sua impossibilidade, avaliação das narinas em separado.

OBJECTIVE: To correlate objective assessment of nasal obstruction, as measured by acoustic rhinometry (volume of the first 5 cm of the nasal cavity) and active anterior rhinomanometry (total nasal airway resistance), with its subjective evaluation (obstruction scores). METHOD: Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The obstruction score was reported for the whole nasal cavity and for each nostril separately. The three variables were measured at baseline and after induction of nasal obstruction. RESULTS: There were significant and negative correlations between resistance and nasal volume in all groups and scenarios, except for the most obstructed nostril, in the control group, post-obstruction. For the whole nasal cavity, there was no significant correlation between objective and subjective variables except between score and total nasal cavity volume in the control group, post-obstruction. Regarding the most obstructed nostril, we found a significant negative correlation between score and resistance and a significant positive correlation between score and volume for the total group at baseline. There were no clear differences in the correlation coefficients found in patients and controls. The correlation coefficients did not change after induction of nasal obstruction. CONCLUSIONS: Objective assessment of nasal obstruction did not correlate significantly with subjective evaluation for the nasal cavity as a whole, but there was a correlation for unilateral assessments. There was correlation between the objective evaluations. Allergic rhinitis and acute induction of nasal obstruction did not affect the correlation between objective and subjective assessments of nasal obstruction. Addition of an objective method for evaluation of nasal obstruction could be useful in the research setting; if no such method can be used, each nostril should be evaluated separately.

The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis

Treatment of AR requires a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR consist of allergen avoidance, pharmacotherapy, immunotherapy and surgery. For the mechanisms of AR, anti-IgE antibody and specific antibody to cytokines such as IL-4 or IL-5 that correlate with allergic inflammation have recently emerged. SLIT is currently widely used due to its efficacy, safety and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients' main symptom, the duration and severity of AR, patients' compliance, safety of medication and cost-effectiveness should be considered when treatment options are chosen. In conclusion, physicians should be aware of etiology, pathophysiology, symptoms, signs and diseases related to AR in order to make a correct diagnosis and choose a proper treatment option for each patient.

The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis

Treatment of AR requires a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR consist of allergen avoidance, pharmacotherapy, immunotherapy and surgery. For the mechanisms of AR, anti-IgE antibody and specific antibody to cytokines such as IL-4 or IL-5 that correlate with allergic inflammation have recently emerged. SLIT is currently widely used due to its efficacy, safety and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients' main symptom, the duration and severity of AR, patients' compliance, safety of medication and cost-effectiveness should be considered when treatment options are chosen. In conclusion, physicians should be aware of etiology, pathophysiology, symptoms, signs and diseases related to AR in order to make a correct diagnosis and choose a proper treatment option for each patient.

Futura study: evaluation of efficacy and safety of rupatadine fumarate in the treatment of persistent allergic rhinitis / Estudo futura: avaliação da eficácia e segurança do fumarato de rupatadina no tratamento da rinite alérgica persistente

Allergic rhinitis affects 10-30 percent of the population, negatively impacting one's quality of life and productivity. It has been associated with sinusitis, otitis media, sleep disorders, and asthma. Rupatadine is a second generation antihistamine with increased affinity to histamine receptor H1; it is also a potent PAF (platelet-activating factor) antagonist. It starts acting quite quickly, offers long lasting effect, and reduces the chronic effects of rhinitis. AIM: this study aims to assess the efficacy and safety of rupatadine in the treatment of persistent allergic rhinitis. MATERIALS AND METHOD: this is a multi-centric open prospective study. This study included 241 patients from 13 centers in Brazil and was held between October of 2004 and August of 2005. Signs and symptoms of rhinitis and tolerance to medication were analyzed after one and two weeks of treatment. RESULTS: reduction on general scores from 8.65 to 3.21 on week 2 (p<0.001). All signs and symptoms improved significantly in the first day of treatment (p<0.001), except for nasal congestion and secretion, which improved from the second day of treatment (p<0.001). Adverse events occurred in 19.9 percent of the cases, 27.7 percent on week 1. CONCLUSION: rupatadine effectively controls persistent allergic rhinitis; it is safe and presents low incidence of side effects.

A rinite alérgica acomete 10 a 30 por cento da população, interferindo na qualidade de vida e na capacidade produtiva. Está associada à sinusite, otite, roncopatias e asma. A Rupatadina é um anti-histamínico de segunda geração, com elevada afinidade ao receptor histamínico H1 e potente inibição do fator ativador plaquetário (PAF). Tem rápido início de ação, longa duração e reduz os efeitos crônicos da rinite. OBJETIVO: Avaliar a eficácia e segurança da rupatadina no tratamento da rinite alérgica persistente. MATERIAL E MÉTODO: Estudo multicêntrico, aberto, prospectivo. Foram selecionados 241 pacientes em 13 centros no Brasil durante o período de outubro de 2004 a agosto de 2005. Foram analisados os sinais e sintomas da rinite e a tolerabilidade após 1 e 2 semanas. RESULTADOS: Redução do escore geral de 8,65 para 3,21 na semana 2 (p<0,001). Todos os sinais e sintomas melhoraram significativamente, e no primeiro dia de tratamento (p<0,001), com exceção da obstrução e secreção nasal, a partir do segundo dia (P<0,001). A frequência de eventos adversos foi 19,9 por cento, sendo 27,7 por cento na 1ª semana. CONCLUSÕES: A rupatadina é eficaz no controle da rinite alérgica persistente, é segura e apresenta baixos índices de efeitos colaterais.

Intranasal Phototherapy in the Patients with Perennial Allergic Rhinitis

BACKGROUND AND OBJECTIVES: Phototherapy has a profound immuno- suppressive effect and is widely used for the treatment of immune- mediated skin diseases. The purpose of this study was to investigate the effectiveness of intranasal phototherapy in treating patients with perennial allergic rhinitis. MATERIALS AND METHODS: We conducted a study on 19 patients with perennial allergic rhinitis from January 2008 to July 2008. Each intranasal cavity was illuminated three times in the first week and then once a week the following five weeks. Symptom scores and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were assessed. RESULTS: Phototherapy was well tolerated by the patients and resulted in a significant improvement of clinical symptoms for rhinorrhea, nasal obstruction, nasal itching, sneezing and total nasal score. In addition, significant improvements were achieved for itching of eyes, itching of the palate and total non-nasal symptom score except tearing and redness of eyes. After six weeks, the overall RQLQ scores significantly improved by 51% from the baseline in the treatment. CONCLUSION: These Results suggest that phototherapy is an effective modality for treating clinical symptoms of perennial allergic rhinitis and represents an alternative treatment for perennial allergic rhinitis.

The efficacy of Rhinos® SR on nasal resistance and nasal symptoms in patients with perennial allergic rhinitis : a randomized, double-blind, placebo-controlled study.

Rhinos® SR is a fixed combination of 5 mg loratadine and 60 mg pseudoephedrine immediate release and 60 mg pseudoephedrine sustained release. The present study was aimed to assess the efficacy of Rhinos® SR on nasal airway resistance (NAR) objectively using rhinomanometer and on nasal symptoms in patients with perennial allergic rhinitis (PAR) in a tropical country. This was a randomized, double-blind, parallel group study in 59 PAR patients who visited the ENT clinic at Dr. Soetomo General Hospital, Surabaya. Outpatients of both gender, having moderate to severe PAR for a minimal of 2 years, aged 12 years or older, with a total nasal symptom score (TNSS) > 6 and a nasal congestion score > 2, received Rhinos® SR or placebo twice daily for 7 days. The primary efficacy parameter was the decrease in the NAR values (measured by rhinomanometer on Day 1) of Rhinos® SR from those of placebo. The NAR values were calculated as the area under the curve (AUC) of NAR versus time. The secondary efficacy parameters were the percentage reduction of the clinical symptoms (nasal and nonnasal) evaluated by both the patient and the physician after 1 week use of Rhinos® SR or placebo. From 59 eligible patients, all completed this 1-week trial. For NAR values, after the baseline were considered as 100%, the AUC0-10 h were not significantly different between Rhinos® SR and placebo. However, as the pseudoephedrine reached its peak concentration, i.e. 2 hrs for the immediate release and 6 hrs for the sustained release, then AUC0-2 h and AUC0-6 h of Rhinos® SR were significantly lower compared to those of placebo. Total nasal symptom score (TNSS) evaluated by the patient (sum of the last 3 mornings) for Rhinos® SR decreased 33.0% from baseline (p < 0.001), for placebo decreased 21.9% from baseline (p = 0.002), but the decrease by Rhinos® SR was not significantly different from the decrease by placebo. TNSS evaluated by the physician, nasal congestion score (NCS) and total symptom score (TSS, total nasal and nonnasal), and even the individual symptom scores, evaluated by the patient and the physician, showed similar pattern, i.e. both Rhinos® SR and placebo decreased the symptoms significantly from baseline, and the decreases by Rhinos® SR were larger than the decreases by placebo, but the decreases by Rhinos® SR and placebo were not statistically different. No adverse event was found in this study. From the present study it was concluded that in patients with moderate to severe PAR in a tropical country, Rhinos® SR was effective in relieving nasal congestion by objective measurements of NAR. Rhinos® SR twice a day for 7 days was also effective in reducing the clinical symptoms of PAR although the reductions did not reach statistical significance compared to those by placebo, and was well tolerated.

Assessment of Satisfaction in Patients Undergoing Immunotherapy for Allergic Rhinitis Using Questionnaires / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Symptoms and their effects on functional status, as well as patient satisfaction, are important parameters in assessment of treatment results. We analyzed, using questionnaires, changes in allergic symptoms after immunotherapy and patients' satisfaction after immunotherapy. MATERIALS AND METHOD: Thirty six patients who received immunotherapy for perennial allergic rhinitis at least for one year were evaluated using questionnaires before and after immunotherapy. The questionnaires included the changes in allergic symptoms and satisfaction after immunotherapy. RESULTS: The majority of patients (83.3%) noted an improvement in general symptoms of allergic rhinitis within 1 year after beginning immunotherapy. However, only a half of patients felt satisfactory. The patients who received immunotherapy for longer duration showed tendency to feel symptom improvement in a greater degree than satisfaction. CONCLUSION: The various factors, such as treatment duration, cost, and needs or wants of patient as well as symptom improvement, should be considered to improve patient satisfaction regarding immunotherapy.

A Study of Prevalence between Allergic Rhinitis and CCR5 Gene Polymorphism Study of a Korean Population / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: CC chemokine receptor (CCR5) is characteristic of the Th 1 phenotype, the receptor of RANTES, MIP-1alphaand MIP-1beta. The receptor of CCR5 delta32 (a 32 bp deletion in the CCR5 gene, mutant type) results in the production of a non-functional receptor. Given the potential importance of CCR5 in allergic inflammation, we hypothesized that individuals carrying the CCR5 delta32 allele would show a reduced prevalence of allergic rhinitis. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 187 individuals with allergic rhinitis and from 278 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for the CCR5 gene polymorphism was used for genotyping. RESULTS: We could not find the CCR5 delta32 homozygotes and heterozygotes at all in neither of the controls nor allergic rhinitis Korean patients. CONCLUSION: Since the CCR5 delta32 allele frequency did not deviate from that in the healthy control population, it is unlikely that this allele influences predisposition to allergic rhinitis in Koreans.

A Study of Susceptibility between Allergic Rhinitis and STAT6 Gene G2964A Polymorphism Study of a Korean Population / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: T helper-type 2 cytokines, such as IL-4 and IL-13, may play a central role in allergic diseases. The proteins known as signal transducers and activators of transcription 6 (STAT-6) are key transcription factors involved in both IL-4 and IL-13 mediated biological responses. Since a polymorphism of STAT6 G2964A has been found, we investigated the association between the polymorphism of STAT6 G2964A and allergic rhinitis in Korean. SUBJECTS AND METHOD: Blood samples for genetic analysis were obtained from 229 individuals with allergic rhinitis and from 278 healthy subjects without atopic diseases. Polymerase chain reaction-based assay for the STAT6 G2964A variant was used for genotyping. RESULTS: There were no differences in the frequencies of the genotypes between the controls and patients (p>0.05). The frequencies of the STAT6 2964A allele were not statistically different between controls and allergic rhinitis patients (p>0.05). CONCLUSION: Our result suggests that the STAT6 G2964A polymorphism might not give susceptibility to the development of allergic rhinitis in Koreans.

Effect of Intranasal Corticosteroid Therapy for Perennial Nonallergic Rhinitis and Perennial Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The efficacy of intranasal corticosteroids for the treatment of allergic rhinitis has been reported. But the efficacy of intranasal corticosteroids has not been compared between perennial nonallergic rhinitis (PNAR) and perennial allergic rhinitis (PAR). METHODS: Twenty-three patients with PNAR and 19 patients with PAR were enrolled in this study. Every patient received fluticasone propionate (FP) 200 g (100 g, bid) daily for 4weeks. Control group (n=16) was received only anti-histamine (hydroxyzine 0.6 mg/kg/dose) intermittently. Efficacy of FP was evaluated by the mean change in nasal congestion, rhinorrhea, nasal itching, sneezing and total nasal symptom score (a sum of patient ratings of nasal congestion, rhinorrhea, nasal itching, and sneezing). RESULTS: Both groups (PNAR and PAR) showed similar improvement of nasal symptom with FP 200 g compared with control. (P< 0.05) In the total population, both groups showed significant improvements from baseline in TNSS compared with control during each week of treatment. (P< 0.05) In PNAR and PAR, nasal congestion was significantly improved more than in control. (P< 0.01, P< 0.01) Rhinorrhea and itching in PAR were improved more than in control. (P=0.02, P=0.03) In sneezing, all three groups showed no differences. (P=1.00, P=0.31, P= 0.29) CONCLUSION: Intranasal FP is an effective treatment for perennial nonallergic rhinitis as same as perennial allergic rhinitis.

Investingation of immune mechanism of only house dust mite Allergen-specific immunotherapy for allergic rhinitis / 重庆医科大学学报

0.05).Conclution:The NHD house can modulate a imbalanced status of Th1/Th2 cells,Some common antigens are contained in both the dermatophagoides pteronyssinus and other allergens:pollen,fungus,et al,which are able to combine with the specific antibodies in serum.This study provides a theoretical basis for the allergen-specific immunotherapy for allergic rhinitis.

Clinical efficacy and tolerability of mometasone furoate nasal spray in perennial allergic rhinitis patients : an open multicentre study.

Mometasone furoate (MF) aqueous nasal spray has been shown to be effective and well-tolerated in the treatment of perennial allergic rhinitis (PAR). All of the sudies, however, have been conducted in Canada, UK, and Europe. Therefore, a bridging study is warranted in view of the different climatic conditions in tropical countries. To evaluate the clinical efficacy and tolerability of MF aqueous nasal spray in the treatment of PAR in a tropical country. This study was an open, non comparative, 4-week 3-centre trial in outpatients of 12 to 60 years with moderate to severe PAR of at least 2 years duration. Patients were allergic to at least one major PAR allergen, confirmed by skin prick test. They had total nasal symptom score (TNSS) of ≥ 6 and nasal congestion score (NCS) of ≥ 2 on ≥ 3 diary time points prior to baseline visit and at both screening and baseline visits. Eligible patients received MF aqueous nasal spray at baseline visit, and administered 200 µg mometasone every morning for 4 weeks. The primary clinical efficacy parameter was the mean percentage reduction of TNSS from baseline. Of 100 eligible patients, all completed this 4-week trial. The patient-evaluated TNSS (sum of the Last 3 mornings) decreased signiftcantly from baseline with a mean reduction of 60.9 % (p < 0.0001,) at week-2 and 73.6 % (p < 0.0001) at week-4. The mean reductions in physician-rated TNSS (61.7 % at week-2 and 77.8 % at week-4) were higher than those in the previous studies (43 % and 51 % at week-2, 52 % and 54 % at week-4). Similar trends were observed for nasal congestion score (NCS), other individual symptoms, total symptoms, and clinical efficacy rates. Evening symptoms were reduced similarly as morning symptoms There was no withdrawal due to adverse event. MF aqueous nasal spray, at a dose of 200 µg once daily in the morning for the treatment of moderate to severe PAR in a tropical country, was clinically effective with 24-hour control of PAR symptoms, and was well tolerated.

Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) as an Evaluator of Perennial Allergic Rhinitis Patients-The First Report- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The symptom score index (SSI) has not been able to express fully the states of the perennial allergic rhinitis patients. So, other tools were deemed necessary to not only evaluate the degree of severity but also to evaluate the efficacy of the newly developed drugs on perennial allergic rhinitis. The aim of this study was to evaluate the impact of perennial allergic rhinitis on the quality of life of patients and to verify the correlation between the nasal symptoms and other factors influencing the patients' complaints on allergic rhinitis. MATERIALS AND METHOD: One hundred and three allergic rhinitis patients who do not have nasal septal deviation, chronic rhinosinusitis and nasal polyps were subjected to study. The patients answered the quality of life questionnaire on the scale of one to five. We calculated the frequency, importance and correlation coefficient of each nasal symptom item and the other question items. We also carried out a x(2)-test for the test group and the control group. RESULTS: In addition to nasal symptoms, patients experienced impairment of the quality of life due to generalized symptoms of allergic rhinitis and practical problems. On the questionnare, generalized symptoms, practical problems, emotional problems, activity limitations and ocular symptoms were frequently checked complaint items, but sleep disorder was not. The relationship between the quality of life of patients with nasal symptoms was statistically significant, but sleep disorder was not. CONCLUSIONS: This questionnaire was effective as an evaluator of impairment of quality of life in patients with perennial allergic rhinitis.