La rinitis alérgica local es una entidad prevalente inducida por alérgenos inhalados estacionales y perennes / Local allergic rhinitis is a prevalent entity induced by seasonal and perennial inhalant allergens

La rinitis alérgica local (RAL) es un nuevo fenotipo de rinitis con producción nasal de anticuerpos IgE específicos en ausencia de atopia sistémica que puede afectar a sujetos previamente diagnosticados de rinitis no alérgica y rinitis idiopática. Esta nueva entidad se caracteriza por la existencia de síntomas clínicos sugestivos de rinitis alérgica, producción local de IgE específica y presencia de un patrón inflamatorio Th2 en la mucosa nasal durante la exposición natural, así como tras la prueba de provocación nasal con alérgenos con producción local de IgE específica, triptasa y proteína catiónica de eosinófilos (ECP). La existencia de esta nueva entidad hace necesaria la realización de un diagnóstico alergológico preciso en pacientes con síntomas sugestivos de rinitis alérgicas cuando el prick test y la determinación de IgE específica sérica sean negativos. La detección local de anticuerpos IgE específicos en las secreciones nasales durante la exposición natural a aeroalérgenos y la respuesta positiva a la prueba de provocación nasal con aeroalérgenos con producción local de triptasa, ECP e IgE específica han demostrado ser una aproximación adecuada para detectar pacientes con RAL.

Exhaled nitric oxide, bronchial hyperresponsiveness and spirometric parameters in patients with allergic rhinitis during pollen season

Allergic rhinitis and asthma share common epidemiological features and inflammatory processes. The aim of the present study was to document the influence of natural allergen exposure in exhaled NO [eNO] and in spirometric parameters of patients with seasonal allergic rhinitis[SAR] and to investigate the differences among subjects with positive versus negative bronchial provocation to metacholine [BP[Mch]]. Twenty-six non-smoking patients [13F/13M; mean age 28.4ys] with a documented history of SAR, 15 healthy, non-atopic [6F/9M; mean age 37.1ys] and 6 non-symptomatic atopic subjects [3F/3M; mean age 36.5ys] were studied. At the first visit during pollen season each subject filled symptom-score card, underwent eNO and nasal NO [nNO] measurements and spirometry. BP[Mch] was performed within the next 10 days. At the second visit out of pollen season, all measurements but BP[Mch] were repeated. Control subjects underwent eNO and nNO measurements. eNO was significantly increased during pollen season in BP[Mch] positive vs BP[Mch] negative [46.22 +/- 32.60 vs 17.81 +/- 12.67, p=0.014] and vs non-atopic controls [11.40 +/- 5.84, p<0.001] as well as atopic controls [13.56 +/- 5.34, p=0.001]. No difference was detected out of pollen season in both patients' groups. nNO values were increased only in BP[Mch] [+] group compared to both control groups in pollen season [vs non-atopies p=0.002, vs atopies p=0.002] and only vs non-atopies out of season, p=0.004. Regression analysis has shown that the difference in FEF 25-75 values [off season-in season] is a predictor of positive BP[Mch]. eNO is markedly increased in BP[Mch] patients with allergic rhinitis while mid-expiratory flow may represent an early marker of lower airway involvement in respiratory allergy

Is pulmonary arterial pressure affected by allergic rhinitis with nasal obstruction?

Obstructive pathologies of the pulmonary tract may cause various levels of hypoxia. To compensate for the hypoxia, pulmonary arterial pressure and pulmonary arterial flow may increase. We investigated 35 patients with seasonal allergic rhinitis (AR) whether hypoxia caused by AR with a high level of obstruction in the airways may lead to an increased pulmonary arterial pressure. An echocardiographical evaluation was made following the determination of the symptomatic and non-symptomatic symptom scores. We found a positive correlation between the symptom scores both in the symptomatic and non-symptomatic periods, nasal obstruction scores and the mean pulmonary arterial pressures during these periods. Further studies with more cases are needed in order to determine the cardiac effects of hypoxia in AR, mainly pulmonary arterial hypertension.

Development of a health-related quality of life questionnaire for Thai patients with rhinoconjunctivitis.

The objective of this study was to develop a disease-specific questionnaire for patients with rhinoconjunctivitis. All patients were recruited at the Out-Patient Clinic at Siriraj Hospital. Related topics were gathered from several sources, and a list of 63 items was produced. In phase I, the first version of the questionnaire was completed by 363 patients. Forty-eight items were identified by clinical impact analysis during the item removal process, two more questions were then added, giving a total of 50. Two hundred and forty-three patients completed the second version questionnaire in phase II. The average time taken to complete the questionnaire was 6.38 minutes. The item removal process in phase II was achieved by a multi-step process. There were 36 items in the third version questionnaire which consisted of six dimensions and two independent items as follows: symptoms (17 items), physical functioning (3 items), role limitations (3 items), sleep (3 items), social functioning (3 items), emotions (5 items), general health (1 item), and absenteeism (1 item). The scores of each item ranged from 1 to 5; a lower score indicating a better quality of life. Data from the selected 36 items was extracted to test the validity and reliability of the final version. The floor and ceiling effects of the scores for each dimension were low. Multitrait multi-item analysis was conducted to examine construct validity. The scaling success of convergent and divergent validity was 100% and 94%, respectively. Internal consistency determined by Cronbach's alpha coefficient, was satisfactory (0.79-0.87). The study indicates that the questionnaire is suitable for use in clinical settings. While the test results are encouraging, further work needs to be done on the test-retest reliability and on responsiveness.

Manejo del asma bronquial y rinitis alérgica en el niño mediante un programa de control ambiental y educación familiar / Management of pediatric bronchial asthma and allergic rhinitis by means of a program of environmental control and family education

Se exponen los resultados obtenidos en el manejo inicial de un grupo de 1651 niños, residentes en el sur del Valle de México, con diagnóstico de asma bronquial y 403 con rinitis alérgica, mediante un método que incluye: a) dos cuestionarios impresos resueltos por los familiares acompañantes, b) un programa de control ambiental interior, c) informaciónn sobre ambos padecimientos en pláticas colectivas a los familiares, d) inmunoterapia específica, utilizando un panel de 12 alergenos seleccionados. Se informa además, sobre un escrutinio investigando antecedentes de valoración alergológica en 60 niños hospitalizados por asma bronquial. El método se considera de utilidad práctica para un diagnóstico oportuno y un tratamiento eficaz de ambos padecmientos