Rinitis alérgica en pediatría: recomendaciones para su diagnóstico y tratamiento / Allergic rhinitis in pediatrics: recommendations for diagnosis and treatment

La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.

Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations

Evaluation of the prevalence of stress and its phases in acute myocardial infarction in patients active in the labor market / Avaliação da prevalência do estresse e suas fases no infarto agudo do miocárdio em pacientes atuantes no mercado de trabalho

Introduction: Acute myocardial infarction is a social health problem of epidemiological relevance, with high levels of morbidity and mortality. Stress is one of the modifiable risk factors that triggers acute myocardial infarction. Stress is a result of a set of physiological reactions, which when exaggerated in intensity or duration can lead to imbalances in one's organism, resulting in vulnerability to diseases. Objective: To identify the presence of stress and its phases in hospitalized and active labor market patients with unstable myocardial infarction and observe its correlation with the life of this population with stress. Methods: The methodology used was a quantitative, descriptive and transversal research approach conducted with a total of 43 patients, who were still active in the labor market, presenting or not morbidities. Data collection occurred on the fourth day of their hospitalization and patients responded to Lipp's Stress Symptom Inventory for adults. Results: Thirty-one patients (72.1%) presented stress and twelve (27.8%) did not. In patients with stress, the identified phases were: alert - one patient (3.2%); resistance -twenty-two patients (71.0%); quasi-exhaustion - six patients (19.4%) and exhaustion - two patients (6.5%). All women researched presented stress. Conclusion: The results suggest a high level of stress, especially in the resistance phase, in the male infarcted population, hospitalized and active in the labor market. .

Introdução: O infarto agudo do miocárdio é um problema de saúde coletiva com altos índices de morbimortalidade com relevância epidemiológica. O estresse é um dos fatores de risco modificáveis desencadeantes do infarto agudo do miocárdio. O estresse é composto por um conjunto de reações fisiológicas que, se exageradas em intensidade ou duração, podem levar a um desequilíbrio do organismo, propiciando vulnerabilidade às doenças. Objetivo: Identificar a presença ou não do estresse e as fases do mesmo, em pacientes com infarto agudo do miocárdio, ativos no mercado de trabalho. Métodos: Pesquisa de abordagem quantitativa, descritiva e transversal que analisou 43 pacientes com diagnóstico de infarto agudo do miocárdio entre 21 e 65 anos, ativos no mercado de trabalho com ou sem comorbidades. A coleta de dados ocorreu no quarto dia de hospitalização; os pacientes responderam ao Inventário de Sintomas de Stress para adultos de Lipp. Resultados: A média de idade foi de 50,3 anos. A incidência de infarto agudo do miocárdio nos homens foi de 91% e nas mulheres de 9%. Em relação à escolaridade até o segundo grau entre homens e mulheres foi de 16% e com segundo grau completo ou mais, de 84%. Apresentaram estresse 31 pacientes (72,1%), não apresentaram estresse 12 (27,9%). Nos pacientes com estresse, as fases identificadas foram: alerta: 1 paciente (3,2%); resistência: 22 pacientes (71,0%); quase-exaustão: 6 pacientes (19,4%) e exaustão: 2 pacientes (6,5%). Todas as mulheres da pesquisa apresentaram estresse. Conclusão: Os resultados encontrados sugerem um elevado nível de estresse, principalmente na fase de resistência, na população de cardiopatas em infarto agudo do miocárdio ativos no mercado de trabalho. .

Respiratory allergy to moth: the importance of sensitization to Bombyx mori in children with asthma and rhinitis / Alergia respiratória à mariposa: importância da sensibilização à Bombyx mori em crianças com asma e rinite

OBJECTIVE: this study aimed to prepare a silkworm moth (Bombyx mori) antigenic extract and to perform skin prick tests with this extract in patients with allergic respiratory diseases; to evaluate serum specific immunoglobulin E (IgE) to Bombyx mori using ImmunoCAP(r) system and to report the frequency of positivity between the two methods and with clinical data. METHODS: this was a cross-sectional study with 99 children and adolescents diagnosed with asthma and/or allergic rhinitis, who had skin reactivity to at least one of the six aeroallergens tested. Clinical data were evaluated: skin prick tests with Bombyx mori in-house extract, and total and specific IgE analysis using ImmunoCAP(r) were performed. RESULTS: the frequency of Bombyx mori specific IgE was found to be 52.5% and 60% using the skin prick test and ImmunoCAP(r), respectively. An association between a positive skin test for Bombyx mori and the presence of allergic rhinitis, atopic dermatitis, and urticaria was observed, but the same was not true for asthma or allergic conjunctivitis. There was no relation with the severity of asthma or rhinitis symptoms. CONCLUSIONS: a high frequency of sensitization to Bombyx mori was observed in a selected population of patients with respiratory allergic diseases in the city of Curitiba, state of Paraná, Brazil. The extract prepared from the wings of this moth species is effective in demonstrating this sensitivity. .

OBJETIVO: preparar extrato antigênico da mariposa do bicho-da-seda (Bombyx mori) e realizar testes cutâneos com esse extrato em pacientes com doenças respiratórias alérgicas, avaliar IgE sérica específica para Bombyx mori usando o sistema ImmunoCAP(r) e comparar a frequência de positividade entre os dois métodos e com dados clínicos. MÉTODOS: Estudo transversal com 99 crianças e adolescentes com diagnóstico de asma e/ou rinite alérgica, que apresentaram reação cutânea a pelo menos um dos seis aeroalérgenos testados. Os dados clínicos foram avaliados; testes cutâneos com extrato de Bombyx mori e análise de IgE total e específica por ImmunoCAP(r) foram realizados. RESULTADOS: a frequência de IgE específica para Bombyx mori foi de 52,5% e 60%, respectivamente, pelo teste cutâneo e ImmunoCAP(r). Foi observada uma associação entre o teste cutâneo positivo para Bombyx mori e a presença de rinite alérgica, dermatite atópica e urticária, mas o mesmo não ocorreu para a asma ou conjuntivite alérgica. Não houve relação com a gravidade dos sintomas de asma ou rinite. CONCLUSÕES: alta frequência de sensibilização à Bombyx mori foi encontrada em uma população selecionada de pacientes com doenças alérgicas respiratórias na cidade de Curitiba, estado do Paraná, Brasil. O extrato preparado a partir das asas dessa espécie de mariposa é eficaz em demonstrar essa sensibilidade. .

Comparação temporal das prevalências de asma e rinite em adolescentes em Fortaleza, Brasil: temporal changes / Prevalences of asthma and rhinitis among adolescents in the city of Fortaleza, Brazil

OBJETIVO: Descrever as prevalências de asma e rinite em adolescentes de 13-14 anos de idade em Fortaleza (CE) em 2010 e compará-las com as prevalências obtidas em um inquérito em 2006-2007. MÉTODOS: Estudo transversal envolvendo uma amostragem probabilística de 3.015 e 3.020 adolescentes, respectivamente, em 2006-2007 e 2010, utilizando o protocolo do International Study of Asthma and Allergies in Childhood. RESULTADOS: Na comparação entre os dois períodos, não houve diferenças significativas em relação a sibilos cumulativos, asma ativa, quatro ou mais crises de sibilos no último ano, prejuízo do sono por sibilos > 1 noite/semana e crises limitando a fala. Em 2010, houve um aumento significativo na prevalência de sibilos após exercícios, tosse seca noturna e asma diagnosticada (p < 0,01 para todos). Em 2010, houve uma redução significativa na prevalência de rinite diagnosticada (p = 0,01), enquanto não houve diferenças significativas entre os dois períodos nas prevalências de rinite cumulativa, rinite atual e rinoconjuntivite. Em ambos os períodos, tosse seca noturna, rinite atual e rinoconjuntivite foram significativamente mais prevalentes nas mulheres que nos homens (p < 0,01 para todos). Também nos dois períodos, asma ativa, rinite atual e rinoconjuntivite foram significativamente mais prevalentes nos alunos das escolas particulares do que naqueles das escolas públicas (p < 0,01 para todos). CONCLUSÕES: Nossos dados mostram que as prevalências de sintomas de asma e rinite continuam altas entre os adolescentes de 13-14 anos em Fortaleza, com predomínio no gênero feminino e em alunos de escolas particulares.

OBJECTIVE: To describe the prevalences of asthma and rhinitis in adolescents (13-14 years of age) in the city of Fortaleza, Brazil, in 2010, comparing the results with those obtained in a prevalence survey conducted in 2006-2007. METHODS: This was a cross-sectional study involving probabilistic samples of 3,015 and 3,020 adolescents in surveys conducted in 2006-2007 and 2010, respectively. The International Study of Asthma and Allergies in Childhood protocol was used on both occasions. RESULTS: Comparing the two periods, there were no significant differences regarding cumulative wheezing, active asthma, four or more wheezing attacks within the last year, sleep disturbed by wheezing more than one night per week, and speech-limiting wheezing. The prevalences of exercise-induced wheezing, dry cough at night, and physician-diagnosed asthma were significantly higher in 2010 than in the 20062007 period (p < 0.01 for all). The prevalence of physician-diagnosed rhinitis was significantly lower in 2010 (p = 0.01), whereas there were no significant differences between the two periods regarding cumulative rhinitis, current rhinitis, and rhinoconjunctivitis. In both periods, dry cough at night, current rhinitis, and rhinoconjunctivitis were significantly more prevalent in females than in males (p < 0.01 for all). Also in both periods, active asthma, current rhinitis, and rhinoconjunctivitis were more prevalent in private school students than in public school students (p < 0.01 for all). CONCLUSIONS: Our data show that the prevalences of asthma and rhinitis symptoms remain high among females and private school students.

Pet exposure and the symptoms of asthma, allergic rhinitis and eczema in 6-7 years old children

Allergic diseases are frequent in children and their prevalence and severity differ in the different regions of the world. The association between pet ownership in childhood and subsequent asthma and sensitization is very controversial. In our survey conducted with standardized method [International Study of Asthma and Allergies in Childhood], 3200 children 6-7 years old were questioned regarding asthma, allergic rhinitis and eczema. The prevalence of Attacks and shortness of breath with wheezing during last 12 months in the children who had exposure to pets in the first year of life was 34.3% that was less than children who had not exposure [OR=3.06, 95% confidence interval [CI] 1.14-8.21, P=0.021]. Also during the past 12 months the prevalence of night dry coughs, allergic rhinitis symptoms and eczema symptoms in those who had pet exposure in the first year of their life was lower than the children did not have it. However there was no significant difference in some other symptoms of asthma in two groups. Our findings suggest that pet exposure in the first year of life can have a protective effect on asthma, allergic rhinitis and eczema

Rinite alérgica: indicadores de qualidade de vida / Allergic rhinitis: indicators of quality of life

O objetivo desta revisão foi apresentar evidências da relação entre rinite alérgica e redução da qualidade de vida. As fontes de dados foram artigos originais, revisões e consensos indexados nos bancos de dados Medline e LILACS entre 1997 e 2008. As palavras de busca foram "rinite alérgica", "qualidade de vida" e "distúrbios do sono". Os pacientes com rinite alérgica frequentemente têm redução na qualidade de vida causada pelos sintomas clássicos da doença (espirros, prurido, coriza e obstrução). Além disso, a fisiopatologia da rinite alérgica, com frequência, interrompe o sono, ocasionando fadiga, irritabilidade, déficits de memória, sonolência diurna e depressão. A carga total da doença recai não apenas no funcionamento social e físico prejudicados, mas também no impacto financeiro, que se torna maior quando se consideram as evidências de que a rinite alérgica é um possível fator casual de comorbidades, tais como a asma e a sinusite. A obstrução nasal, o mais proeminente dos sintomas, está associada a eventos respiratórios relacionados aos distúrbios do sono, uma condição que tem profundo efeito sobre a saúde mental, o aprendizado, o comportamento e a atenção. Finalmente, a rinite alérgica - doença crônica que afeta crianças, adolescentes e adultos - frequentemente é subdiagnosticada ou inadequadamente tratada. O impacto deletério dos distúrbios do sono associados à rinite alérgica sobre a habilidade para realizar as atividades de vida diária dos pacientes é um importante componente da morbidade da doença. Com um diagnóstico acurado, existem vários tratamentos disponíveis que podem reduzir a carga associada à rinite alérgica.

The objective of this review was to present evidence of the relationship between allergic rhinitis and impairment of quality of life. The data sources were original articles, reviews and consensus statements entered into the Medline and LILACS databases between 1997 and 2008. The following search terms were used: "allergic rhinitis"; "quality of life"; and "sleep disorders". Quality of life is often impaired in patients with allergic rhinitis, due to the classic symptoms of the disease (sneezing, pruritus, rhinorrhea and nasal obstruction). In addition, the pathophysiology of allergic rhinitis often disrupts sleep, leading to fatigue, irritability, memory deficits, daytime sleepiness and depression. The total burden of this disease goes beyond impairment of physical and social functioning. It has also a financial impact, which becomes greater when we consider the evidence that allergic rhinitis is a possible causal factor of comorbidities, such as asthma and sinusitis. Nasal obstruction, the most prominent symptom, is associated with sleep disorders, which can have a profound effect on mental health, learning, behavior and attention. Finally, allergic rhinitis-a chronic condition that affects adults, adolescents and children-is often underdiagnosed or inadequately treated. The deleterious impact that allergic rhinitis-related sleep disorders have on patient capacity to perform activities of daily living is an important component of the morbidity of the disease. With an accurate diagnosis, there are various available treatments that can reduce the burden of allergic rhinitis.

Fatores de risco para visitas à emergência por exacerbações de asma em pacientes de um programa de controle da asma e rinite alérgica em Feira de Santana, BA / Risk factors for ER visits due to asthma exacerbations in patients enrolled in a program for the control of asthma and allergie rhinitis in Feira de Santana, Brazil

OBJETIVO: Determinar os fatores de risco para atendimentos de emergência por exacerbações da asma em pacientes acompanhados em um centro de referência. MÉTODOS: Estudo de coorte prospectiva de 253 crianças e adultos com asma e monitorados por 12 meses no Centro de Referência do Programa de Controle da Asma e Rinite Alérgica de Feira de Santana, BA. RESULTADOS: As exacerbações foram frequentes, e 36,5 por cento dos pacientes buscaram assistência em serviços de emergência no período de 12 meses. Os fatores de risco associados às exacerbações foram idade > 20 anos (OR = 1,34; IC95 por cento: 1,06-1,70); residência em zona urbana (OR = 1,19; IC95 por cento: 1,06-1,33); baixa escolaridade (OR = 1,53; IC95 por cento: 1,00-2,39); asma grave (OR = 1,65; IC95 por cento: 1,24-2,18); e rinite crônica (OR = 2,20: IC95 por cento: 1,00-4,80). CONCLUSÕES: Ter de rinite crônica, asma mais grave e baixa escolaridade foram os principais fatores de risco para atendimentos de emergência por exacerbações da asma nesta coorte. Esses resultados são semelhantes àqueles descritos para pacientes com asma sem tratamento regular.

OBJECTIVE: To determine the risk factors for ER visits due to asthma exacerbations in patients monitored at a referral center. METHODS: Prospective cohort study of 253 outpatients (children and adults) with asthma who were monitored for 12 months at the Referral Center of the Program for the Control of Asthma and Allergic Rhinitis in the city of Feira de Santana, Brazil. RESULTS: Exacerbations were common, and 36.5 percent of the patients sought ER treatment within the twelve-month period. The risk factors for asthma exacerbations were being over 20 years of age (OR = 1.34: (95 percent CI: 1.06-1.70), residing in an urban area (OR = 1.19; 95 percent CI: 1.06-1.33); having a low level of education (OR = 1.53: 95 percent CI: 1.00-2.39); having severe asthma (OR = 1.65; 95 percent CI: 1.24-2.18); and having chronic rhinitis (OR = 2.20; 95 percent CI: 1.00-4.80). CONCLUSIONS: In this cohort, having chronic rhinitis, having asthma that is more severe and having a low level of education were the main risk factors for ER visits due to asthma exacerbations. These results are similar to those reported for asthma patients who are receiving no regular treatment.

Risk factors of bronchial asthma in two contrasting settings–metropolitan and coastal areas of Bangladesh: A case control study.

Background. Seven million people are suffering from bronchial asthma in Bangladesh. But scanty data is available to explain the risk factors for asthma in Bangladesh. Methods. This population-based, age, sex, and economic status matched case-control study was conducted to identify the risk factors responsible for the development of bronchial asthma in two contrasting settings, the metropolitan capital city and coastal area of Bangladesh. A structured pre-tested questionnaire was filled up by face-to-face interviews with the patients or parents of patients with bronchial asthma and the normal controls after a respiratory physician confirmed the diagnosis on the basis of history, physical examination and spirometry. Results. Presence of allergic problems was recognised as risk factors for the development of bronchial asthma. Concomitant existence of atopic diseases, like allergic rhinitis, eczema and allergic conjunctivitis were found to be significant risk factors in both the settings. History of early childhood lung infections, like pneumonia, bronchiolitis and intake of antibiotics and paracetamol in last 12 months were also observed to be the risk factors in both the areas. Though most of the so-called allergic foods were statistically found to be a protective factor in both the settings [odds ratio (OR) 0.48, 95% confidence intervals (CI) 0.37-0.63 in city area and OR 0.80, 95% CI 0.66-0.96 in coastal area], this was considered to be an artifact. Conclusions. Several common risk factors for the development of bronchial asthma were identified in both city and coastal areas of Bangladesh. Bronchial asthma prevention campaign in Bangladesh may focus on sensitising the people on these risk factors.

Prevalência de asma e rinite alérgica em escolares no município de Santo Ângelo/RS / Prevalence of asthma and allergic rhinitis among students from Santo Ângelo/RS

Introdução: A asma é uma doença inflamatória crônica, caracterizada por hiper-responsividade das vias aéreas inferiores que se manifesta por episódios recorrentes de sibilância, dispnéia, aperto no peito e tosse. Objetivo: Determinar a prevalência de asma e rinite alérgica em adolescentes do município de Santo Ângelo/RS. Metodologia: Foi realizado um estudo observacional, prospectivo e transversal; a amostra foi constituída por estudantes de 13 a 14 anos. Foram investigadas as variáveis: sexo, idade e interferência dos sintomas das doenças nas atividades diárias através da aplicação de um questionário epidemiológico padronizado do ISAAC (International Study of Asthma and Allergies in Childhood). Resultados: O número de questionários aplicados foi de 1.031, sendo considerados válidos 979 (94,9 por cento). A prevalência de asma nos adolescentes foi de 10,5 por cento, baseada na questão “já teve ou tem asma”. A prevalência de rinite alérgica foi de 34,6 por cento, baseada na questão “já teve ou tem rinite alérgica”. Quanto à polinose “alergia ao pólen na primavera” a prevalência foi de 30,4 por cento. Considerando-se o sub-diagnóstico das doenças, a prevalência de prováveis asmáticos foi de 12 por cento e a de adolescentes com provável rinite de 12 por cento. Conclusão: A prevalência de asma no presente estudo mostrou-se entre os valores médios mundiais e nacionais, já as prevalências de rinite alérgica e polinose mostraram-se elevadas de acordo com as médias de outros estudos. Estes dados apontam que em Santo Ângelo/RS essas doenças constituem um problema de saúde pública entre os adolescentes.

Introduction: Asthma is an inflammatory chronic disease, characterized as a hyperresponsivity of the lower airways that manifests itself through recurrent episodes of sibilance, dyspnea, chest pressure, and coughing. Aim: To determine the prevalence of asthma and allergic rhinitis in adolescents living in the municipality of Santo Ângelo/RS. Methods: An observational transversal, prospective study was performed, the sample comprising 13- and 14-year-old students. The variables sex, age, and interference of the symptoms of the disease in the daily activities were investigated through the administration of the standardized epidemiological questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). Results: Of the 1,031 questionnaires responded, 979 (94.9 percent) were considered as valid. The prevalence of asthma among the adolescents was 10.5 percent, based on the question: “Have you ever had asthma?”. The prevalence of allergic rhinitis was 34.6 percent, based on the question “Have you ever had allergic rhinitis?. As for pollen allergy during the spring, the prevalence was 30.4 percent. Considering the underdiagnosis of the diseases, the prevalence of probable asthmatics was 12 percent and of adolescents with probable rhinitis was 12 percent. Conclusion: The prevalence of asthma in the present study was consistent with the reported mean world and national values, but the prevalences of allergic rhinitis and pollen allergies were high as compared to the means reported elsewhere. The data indicate that in Santo Ângelo, RS these conditions are a public health problem among adolescents.

Efecto del ambiente rural sobre la prevalencia de rinitis alérgica en escolares de Mexicali, Baja California, México / The effects of a rural environment on the prevalence of allergic rhinitis among schoolchildren in Mexicali, Baja California, Mexico

OBJETIVOS: Determinar la prevalencia de síntomas de rinitis alérgica en escolares de Mexicali, Baja California, México, y evaluar la influencia del medio ambiente rural sobre esta afección. MÉTODOS: Estudio transversal poblacional mediante la aplicación de un cuestionario estandarizado en una muestra aleatoria de 2 087 escolares de 6 a 7 años (1 078 niñas y 1 009 niños) residentes en la ciudad de Mexicali, Baja California, México. Se evaluó la asociación entre variables de exposición y antecedentes clínicos personales y familiares, y dos variables dependientes: síntomas nasales y síntomas nasales y oculares, en ausencia de catarro o gripe, con sus razones de posibilidades (OR, odds ratios) e intervalos de confianza de 95 por ciento (IC95 por ciento). El estudio, realizado entre febrero y julio de 2004, utilizó la metodología del Estudio Internacional de Asma y Alergia en la Infancia (ISAAC). RESULTADOS: Las prevalencias generales de síntomas nasales y síntomas nasales y oculares fueron de 25,0 por ciento y 10,5 por ciento, respectivamente. Los niños y las niñas que habían vivido en el campo o zona rural en algún momento presentaron menor probabilidad de padecer síntomas nasales (OR = 0,43; IC95 por ciento: 0,24 a 0,77) y síntomas nasales y oculares (OR = 0,39; IC95 por ciento: 0,16 a 0,93), después de ajustar por factores de confusión. CONCLUSIONES: El contacto con el medio rural en los primeros años de vida disminuyó el riesgo de presentar rinitis alérgica en la población estudiada, independientemente de los antecedentes familiares de asma.

OBJECTIVES: To assess the prevalence of allergic rhinitis symptoms among schoolchildren in Mexicali, Baja California, Mexico, and determine what impact a rural environment might have on this condition. METHODS: A population-based, cross-sectional study using a standardized questionnaire administered to a random sample of 2 087 schoolchildren 6-7 years of age (1 078 girls and 1 009 boys) living in the city of Mexicali, Baja California, Mexico. The study analyzed associations between exposure variables and personal and family health history, and two dependent variables-nasal symptoms and nasal and ocular symptoms, in the absence of a cold or flu-using odd ratios (OR) and 95 percent Confidence Intervals (95 percentCI). The study took place in February-July 2004 and followed the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: The general prevalence of nasal symptoms and nasal and ocular symptoms was 25.0 percent and 10.5 percent, respectively. The boys and girls who had ever lived on a farm or in a rural area had a lower probability, adjusted for confounding variables, of presenting nasal symptoms (OR = 0.43; 95 percentCI: 0.24-0.77), or nasal and ocular symptoms (OR = 0.39; 95 percentCI: 0.16-0.93). CONCLUSIONS: In the study population, exposure to a rural environment in early childhood decreased the risk of developing allergic rhinitis, regardless of a family history of asthma.

Factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España / Risk factors for symptoms of allergic rhinitis in adolescents in Castellón, Spain

OBJETIVOS: Estimar factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España. MÉTODOS: Estudio transversal de base poblacional a partir de la fase III del ISAAC (International Study of Asthma and Allergies in Childhood) llevado a cabo en 2002 entre adolescentes de 13 a 14 años. Se utilizó el cuestionario ISAAC para definir los casos de rinitis alérgica. Se estimaron razones de posibilidades (RP) y sus intervalos de confianza de 95 por ciento (IC95 por ciento) mediante modelos de regresión logística. RESULTADOS: La participación fue de 66,8 por ciento (3 995 adolescentes de un total de 5 981). La prevalencia de síntomas de rinoconjuntivitis en los últimos 12 meses fue de 16,5 por ciento, y la prevalencia de alergia nasal alguna vez, de 7,4 por ciento. Con la regresión logística, la rinoconjuntivitis se asoció a la mujer (RP=1,63; IC95 por ciento:1,33-2,00); fumar la madre en casa (RP=1,32; IC95 por ciento:1,08-1,63); historia de sinusitis (RP=2,02; IC95 por ciento:1,51-2,70), y circulación constante de camiones por la calle de residencia (RP=1,58; IC95 por ciento:1,02-2,44). De igual manera, la alergia nasal se asoció con la historia familiar de rinitis alérgica (RP=2,62; IC95 por ciento:1,90-3,63); historia de sinusitis (RP=2,65; IC95 por ciento:1,77-3,96), historia de bronquitis (RP=1,68; IC95 por ciento:1,19-2,36), y clase social, con descensos progresivos al comparar las clases superiores e inferiores. CONCLUSIONES: Diferentes factores de riesgo medioambientales se asociaron con el hecho de sufrir síntomas de alergia nasal; se sugiere la importancia de adecuar medidas preventivas específicas.

OBJECTIVES: To estimate the risk factor for symptoms of allergic rhinitis in adolescents in Castellón, Spain. METHODS: A cross-sectional population based study of Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC) conducted in 2002 among adolescents from 13-14 years of age. The ISAAC questionnaire was used to define cases of allergic rhinitis. Logistic regression models were used to estimate odds ratio (OR) and their 95 percent confidence intervals (95 percentCI). RESULTS: Participation was 66.8 percent (3 995 adolescents of the 5 981 total). The prevalence of rhinoconjunctivitis symptoms in the last 12 months was 16.5 percent and the prevalence of nasal allergy at some point was 7.4 percent. Logistic regression showed that rhinoconjunctivitis was associated with being female (OR = 1.63; 95 percentCI: 1.33-2.00); a mother who smokes in the home (OR = 1.32; 95 percentCI: 1.08-1.63); a history of sinusitis (OR = 2.02; 95 percentCI: 1.51-2.70); and living on a street with heavy truck traffic (OR = 1.58; 95 percentCI: 1.02-2.44). Likewise, nasal allergy was associated with a family history of allergic rhinitis (OR = 2.62; 95 percentCI: 1.90-3.63); a history of sinusitis (OR = 2.65; 95 percent CI: 1.77-3.96); a history of bronchitis (OR = 1.68; 95 percentCI: 1.19-2.36); and social class, with a steady decline when comparing higher classes to lower classes. CONCLUSIONS: Various environmental risk factors were associated with the symptoms of nasal allergies, which points to the importance of implementing specific preventive measures.

Rinite alérgica: aspectos epidemiológicos, diagnósticos e terapêuticos: [revisão] / Allergic Rhinitis: epidemiological aspects, diagnosis and treatment: [review]

Este estudo tem como objetivo revisar a literatura a respeito da rinite alérgica quanto aos aspectos epidemiológicos, clínicos, diagnósticos e terapêuticos. A revisão da bibliografia foi realizada utilizando-se as bases de dados Medline, Literatura Latino-Americana e do Caribe em Ciências da Saúde e HighWire, nos últimos trinta anos, utilizando-se os descritores allergic rhinitis, epidemiology, diagnosis, e treatment. Foram selecionados 60 artigos. Este estudo destaca o aumento na prevalência da rinite alérgica, sua associação com a asma, os critérios diagnósticos e seu tratamento. A classificação da rinite alérgica é apresentada, bem como as estratégias de tratamento. As modalidades terapêuticas apresentadas e discutidas são anti-histamínicos, corticóides, imunoterapia, antileucotrienos, cromoglicato dissódico e anticorpos anti-IgE, bem como a redução da exposição aos alérgenos. Finalmente, ressalta-se a importância da abordagem da rinite alérgica em saúde pública.

This study was a review of the literature on the epidemiological, clinical, diagnostic and therapeutic aspects of allergic rhinitis. Bibliographic searches were based on the information contained within the Medline, Latin American and Caribbean Health Sciences Literature and HighWire databases, covering the last thirty years and using the following search terms: 'allergic rhinitis', 'epidemiology', 'diagnosis' and 'treatment'. Sixty articles were selected. This study describes the increase in the prevalence of allergic rhinitis, its relationship with asthma, the diagnostic criteria and the treatment. The classification of allergic rhinitis and strategies for its treatment are presented. Therapeutic modalities presented and discussed include the administration of antihistamines, corticosteroids, immunotherapy, anti-leukotrienes, sodium cromoglycate and anti-IgE antibodies, as well as minimizing exposure to inhaled allergens. Finally, the importance of the management of allergic rhinitis in public health is emphasized.

Changing prevalence of asthma and allergic diseases among Kuwaiti children: an ISAAC study [phaseIII]

To estimate the prevalence of asthma and allergic diseases in 13- and 14-year-old schoolchildren and to compare it with previous phase I data. A survey of 2,922 third and fourth grade students from randomly selected intermediate level schools across Kuwait was conducted. Supervised, self-administered, written and video questionnaires of the International Study of Asthma and Allergies in Childhood [ISAAC] was used. Of the 2,922 students, 2,882 [96.3%] completed the questionnaires. The prevalence [95% CI] in the written questionnaire for wheeze ever, current wheeze [within the last 12 months] and physician diagnosis of asthma were 13.4, 7.6 and 15.6%, respectively. The prevalence [95% CI] for symptoms of allergic rhinitis [AR] ever, current symptoms of AR, and diagnosis of AR was 41.4, 27.6 and 22.2%, respectively. The prevalence [95% CI] for itchy rash ever, current itchy rash, and diagnosis of eczema was 10.6, 8.3 and 12.8%, respectively. Comparing to ISAAC phase I data [1995-1996], the prevalence of current wheeze has decreased from 16.1 to 7.6% [p<0.001]. Current symptoms of AR decreased from 30.7 to 27.6 [p = 0.008] and current itchy rash decreased from 17.5 to 10.6% [p<0.001]. However, physician diagnoses of asthma and eczema remained the same as in the previous study, but physician diagnosis of AR increased from 17.1 to 22.2% [p<0.001]. The findings show that there is a decrease in the self-reported symptoms of allergic diseases over a 5-year period while physician diagnoses of these diseases remained the same over the same period

prevalence of asthma, allergic rhinitis and eczema in north of Iran: the international study of asthma and allergies in childhood [ISAAC]

Asthma, allergic rhinitis and eczema as a common chronic disorder in childhood, has many epidemiologic variations in different geographic areas. Uniform and standard epidemiologic researches are able to clear and modify scientific questions in this field. We carried out this study to determine the prevalence and intensity of pediatric allergic disease in our region. This analytical-cross sectional study was performed on 2 groups of children; the first group aged 6-7 years [n=3240] and the second group aged 12-14 years [n=3254] during 2002-03. According to ISAAC programming, sample size consisted of 3000 children in each group. From all students 99.3% of primary students and 88.8% of guidance students entered into study. Data was gathered by ISAAC first phase questionnaire and analyzed by SPSS 10 and Chi square test. The 12-month prevalence rates of symptoms were as follow: wheezing 16.8% and 21.7%, allergic rhinitis symptoms 14.5% and 19.9% and atopic dermatitis symptoms 4.5% and 8.2%, for younger and older age group, respectively. The prevalence of wheezing and current wheeze did not show differences according to sex [P > 0.05] but it was significantly higher in students of guidance school [P < 0.05]. The prevalence of previous history of asthma, speech disorders, wheezing after physical exercises and dry cough at night, rhinoconjuntivitis, recurrent rhinitis, eczema with pruritus, recurrent lesions and history of eczema was significantly higher in boys and in students of guidance school [P < 0.05]. The prevalence of flexor lesion did not show a significant difference according to age [P > 0.05] but in boys it was higher than in the girls [P < 0.05]. According to our findings asthma, allergic rhinitis and eczema have a moderate prevalence in this region of our country

Prevalência da rinite alérgica e seu impacto na utilização dos serviços de pronto-atendimento em um grupo de crianças e adolescentes com asma persistente moderada e grave / Prevalence of allergic rhinitis and its impact on the use of emergency care services in a group of children and adolescents with moderate to severe persistent asthma

OBJETIVOS: Avaliar a prevalência da rinite alérgica (RA) e os fatores associados à utilização de serviços de pronto-atendimento por asma aguda em crianças e adolescentes asmáticos tratados com corticóide inalatório. MÉTODOS: Foi realizado um estudo transversal, do qual participaram 126 pacientes que se encontravam em tratamento com o dipropionato de beclometasona por 3 anos. Através de modelos de regressão logística, foram avaliados os fatores associados à consulta de pronto-atendimento no terceiro ano de tratamento com dipropionato de beclometasona. RESULTADOS: A prevalência da rinite alérgica foi de 74,6 por cento (IC95 por cento 65,9-81,7). A presença de rinite alérgica (OR = 2,98, IC95 por cento 1,10-8,06) e a gravidade da asma (OR = 2,09, IC95 por cento 1,05-4,44) foram fatores independentes para consultas em pronto-atendimento. CONCLUSÃO: A rinite alérgica apresentou elevada prevalência no grupo estudado e, aliada à gravidade da asma, foi o principal fator de risco para as consultas de pronto-atendimento. Os serviços de saúde deveriam ficar atentos para o reconhecimento precoce da rinite alérgica nos pacientes com asma.

OBJECTIVE:To assess the prevalence of allergic rhinitis and the factors associated with the use of emergency care services by children and adolescents with acute asthma submitted to inhaled corticosteroid therapy. METHODS: A cross-sectional study was conducted with 126 patients treated with beclomethasone dipropionate for 3 years. The factors associated with emergency care services in the third year of beclomethasone dipropionate treatment were assessed using logistic regression models. RESULTS: The prevalence of allergic rhinitis amounted to 74.6 percent (95 percentCI 65.9-81.7). The presence of allergic rhinitis (OR = 2.98, 95 percentCI 1.10-8.06) and asthma severity (OR = 2.09, 95 percentCI 1.05-4.44) were independent factors for emergency care services. CONCLUSION: The prevalence of allergic rhinitis was high and that, combined with asthma severity, constituted the major risk factor for the necessity of emergency care services. Health professionals should attempt to make an early diagnosis of allergic rhinitis in asthmatic patients.

Association of allergic rhinitis and asthma in Khartoum State - Sudan

A cross-sectional study was carried out in the departments of Physiology, National Ribat University and Ahfad University for Women between January and August 2004. to investigate the asociation of Allergic Rhinitis and Asthma in Sudanese patients and to Study the pattern of Pulmonary Function Tests [PFT] and Skin Prick Tests [SPT] hypersensitivity in Allergic Rhinitis and Asthmatic patients. Seventy three patients, 18 - 65 years of age, both sexes [40 females and 33 males] suffering from Allergic Rhinitis and /Asthma or both and forty control [26 females and 14 males] without any nasal pathology were included in the study. The forced vital capacity, peak expiratory flow rate and forced expiratory volume in first second were measured and skin prick tests for common allergens were performed. The data obtained, SPT and PFT results were analyzed and paired sample t-test was used for comparison of PFT [reversibility test] of AR with and without asthma patients and control. It was found that twenty five percent of the total AR patients have asthma where 88% of the asthmatics also have AR, but there was no significant increase in the bronchial reversibility in AR patients compared to asthmatics and control for both FEV1 [P = .069] and PEFR [P = .500]. The study showed a clear association of allergic rhinitis and asthma and PFT didn't show hypersensitivity in allergic rhinitis non-asthmatic patients

Clinical profile of patients with allergic rhinitis

To find out the allergic symptoms of patients who presented to otorhinolaryngology clinic. Two hundred and fifteen patients of either sex and above the age of sixteen years who presented to otorhinolaryngology clinic suffering from allergic rhinitis were involved in the study. History of rhinorrhea, sneezing, nasal obstruction, nasal itching, epistaxis, nasal dryness and conjunctival symptoms which are generally the chief symptoms of allergic rhinitis in addition to family history of bronchial asthma and other allergies were recorded. Physical clues to allergic rhinitis were boggy, pale, or [bluish] nasal turbinates, rhinorrhea, allergic salute and allergic shiners. The commonest complaint was rhinorrhea seen in 96% of cases followed by sneezing [88%], nasal obstruction [80%], nasal itching [55%], epistaxis [17%], nasal dryness [14%] and conjunctival symptoms [12%]. Pale and hypertrophied boggy turbinates were seen in 97% of cases, allergic salute in 4% and allergic shiners in 13% of cases. In 7% of cases, the patients had mild bronchial allergy manifested by dyspnea, cough and wheezes during the attack. Positive family history of allergy was found in 25% of patients. Allergic rhinitis is a common medical condition characterized by rhinorrhea, sneezing and nasal obstruction as chief symptoms. The diagnosis rests mainly on a classic clinical picture

Prevalence of asthma, rhinitis, and eczema among children in Vientiane city, Lao PDR.

An International Study of Asthma and Allergy in Childhood (ISAAC) revealed a wide range of prevalences of childhood asthma in the world. Lao PDR had no such epidemiological data yet. This study aimed to investigate the epidemiology of asthma, rhinitis, and eczema in children in the country. A cross-sectional study was conducted in Vientiane City, the capital of Lao PDR, in 1997 using the ISAAC questionnaire. From three primary schools and one high school, 395 children, age 6-7 years, and 468 children, age 13-14 years, were chosen. The prevalence of asthma for children aged 13-14 years in Lao PDR was 25.6%, which ranks the highest in international asthma prevalence. The prevalence in allergic-rhinoconjunctivitis of children was 24.4% and atopic eczema was 7.1%. Contrary to generally accepted risk factors, there were no associations revealed between asthma prevalence and smoking of family members (especially mothers), intake of fish/meat, and male gender.