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

The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial

Abstract Objective: We aimed to evaluate the effect of radiofrequency turbinate reduction as an initial treatment on clinical improvement, inflammatory mediators, and remodeling process. Methods: Between July 2018- February 2020, 32 patients with moderate-severe persistent AR were randomly divided into 2 groups. Intervention group received radiofrequency turbinate reduction followed by intranasal steroid and Antihistamine H-1 (AH-1), control group received intranasal steroid and AH-1. Both groups were evaluated for clinical improvement (using visual analogue scale based on total nasal symptoms score, peak nasal inspiratory flow, and turbinate size using imageJ) after 4 and 8 weeks of treatment. Inflammatory mediators (ELISA from nasal secretions was performed to measure ECP, IL-5, and HSP-70) and remodeling markers (nasal biopsy followed by immunohistochemistry examination was performed to evaluate MMP-9, TIMP-1, and PAI-1) were evaluated in week 4. Results: Three patients dropped out of the study, resulting in 16 patients in intervention group and 13 patients in control group. At week 4, clinical response improved significantly in the intervention group compared to control group (Chi-Square test, p<0.05). Compared to control, intervention group experienced a reduction of IL-5 and no significant change in ECP level (Mann Whitney test, p>0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher in intervention group (unpaired t-test, p< 0,05). Meanwhile, increase in HSP-70 in the intervention group was slightly lower than in control group, but the difference with control group was not significant (Mann Whitney test, p>0.05). Conclusion: Early radiofrequency turbinate reduction followed by pharmacotherapy given to persistent moderate-severe AR patients give more improvement only in early clinical symptoms and reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapies for the management of moderate-severe persistent AR. However, further investigation with a larger sample size and longer follow-up period is needed. Level of evidence: 1B.

Rinitis alérgica, apnea-hipopnea obstructiva del sueño y sensibilización a ácaros / Allergic rhinitis, obstructive sleep apnea-hypopnea and mite sensitization

La asociación de rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño se presenta en diferentes edades. En la rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño, puede estar involucrada la sensibilización a ácaros, principalmente: Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis. Con el objetivo de diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño se seleccionaron 120 individuos del registro de alergia del Policlínico Previsora, Camagüey, Cuba, con diagnóstico presuntivo de rinitis alérgica y edad entre 5 y 15 años cumplidos. Todos tenían realizada la prueba de punción cutánea con Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis; algunos también, la poligrafía cardiorrespiratoria mediante el dispositivo ApneaLinkAirTM (Resmed Corp., RFA), utilizando el marcaje automático de eventos. La muestra fue de 40 casos (respiración oral, ronquidos) y 80 controles (sin respiración oral, ni ronquidos). La media del tamaño del habón fue de 7,9 mm en los casos y 4,1 mm en los controles (p꞊0,030). El índice de apnea-hipopnea fue positivo en 47 (39,1 por ciento) pacientes, de ellos, 36 (30 por ciento) casos y 11 (9,1 por ciento) controles (p=0,001). La sensibilidad y especificidad de la poligrafía cardiorrespiratoria mostró valores de 85,00 por ciento y 91,25 por ciento respectivamente que permiten afirmar el grado de eficacia de la prueba para diagnosticar apnea e hipopnea obstructiva del sueño. Los pacientes con síndrome de apnea-hipopnea obstructiva del sueño en los casos y controles presentaron incremento, con predominio para casos. La poligrafía cardiorrespiratoria con el dispositivo ApneaLink permite hacer el diagnóstico del síndrome de apnea-hipopnea obstructiva del sueño en rinitis alérgica(AU)

The association of allergic rhinitis and obstructive sleep apnea-hypopnea syndrome occurs at different ages. In allergic rhinitis and obstructive sleep apnea-hypopnea syndrome, sensitization to mites may be involved, mainly: Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis. With the objective to diagnose obstructive sleep apnea-hypopnea syndrome, 120 individuals were selected from the allergy registry of the Previsora Polyclinic, Camagüey, Cuba, with a presumptive diagnosis of allergic rhinitis and ages between 5 and 15 years old. All had the skin prick test with Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis; some also, cardio-respiratory polygraphy with the ApneaLink AirTM device (Resmed Corp., RFA), using automatic event marking. The sample consisted of 40 cases (oral breathing, snoring) and 80 controls (no oral breathing or snoring). The mean size of the wheal was 7.9 mm in the cases and 4.1 mm in the controls (p꞊0.030). The apnea and hypopnea index was positive in 47 (39.1 percent) patients, of which 36 (30 percent) were cases and 11 (9.1 percent) were controls (p=0.001). The sensitivity and specificity of the cardiorespiratory polygraphy showed values of 85.00 percent and 91.25 percent, respectively, which allow affirming the degree of efficacy of the test to diagnose obstructive sleep apnea-hypopnea. Patients with obstructive sleep apnea-hypopnea syndrome in cases and controls presented an increase, with a predominance for cases. Cardiorespiratory polygraphy with the ApneaLink device allows the diagnosis of obstructive sleep apnea-hypopnea syndrome in allergic rhinitis(AU)

Tratamiento de la rinitis alérgica en época de pandemia. Documento de consenso de sociedades médicas de América Latina y el Caribe / Treatment of allergic rhinitis in pandemic times. Consensus statement from medical societies of Latin America and the Caribbean

La rinitis alérgica ha ido en aumento en los países latinoamericanos, dando lugar a una creciente población de pacientes que necesitan tratamiento médico para esta afección respiratoria. Su similitud con la COVID-19 en cuanto a síntomas y la posibilidad de concurrencia con esta, hacen que la rinitis alérgica sea de particular interés para los sistemas de salud. Los países de América Latina y el Caribe han sido particularmente vulnerables por múltiples desafíos, entre estos, las altas tasas de pobreza, el acceso limitado a la atención médica y las limitaciones en la prestación de servicios básicos de salud, así como la ausencia de guías de tratamiento para la rinitis alérgica en situación de pandemia. Con el objetivo de proporcionar orientación esencial para los equipos multidisciplinarios de América Latina y el Caribe con respecto a la evaluación y el tratamiento de la rinitis alérgica durante la pandemia de COVID-19, se revisó literatura científica publicada sobre tratamiento de la rinitis alérgica y COVID-19, y se consideró la opinión de profesionales líderes de sociedades científicas de la región. Se analizaron las diferentes medidas para evitar contagios, y las diferentes estrategias de tratamiento con énfasis en la terapia intranasal y el tratamiento con vacunas contra la alergia. Se formuló una declaración de posicionamiento con la intención de mantener la continuidad del servicio médico en el contexto de una pandemia y minimizar la propagación, infección y complicación asociada con el coronavirus tipo 2 del síndrome respiratorio agudo severo en pacientes con seguimiento o comenzando tratamiento para la rinitis alérgica(AU)

Allergic rhinitis has been increasing in Latin American countries, leading to a growing population of patients who need medical treatment for this respiratory condition. Its similarity to COVID-19 in terms of symptoms and the possibility of concurrence with it, make allergic rhinitis of particular interest to health systems. The countries of Latin America and the Caribbean have been particularly vulnerable due to multiple challenges, including high poverty rates, limited access to medical care and limitations in the provision of basic health services, as well as the absence of guidelines of treatment for allergic rhinitis in a pandemic situation. With the aim of to provide essential management for multidisciplinary teams in Latin America and the Caribbean regarding the evaluation and treatment of allergic rhinitis during the COVID-19 pandemic, published scientific literature on the treatment of allergic rhinitis and COVID-19 was reviewed, and the opinion of leading professionals from scientific societies in the region was considered. The different measures to avoid infections and the different treatment strategies were analyzed, with an emphasis on intranasal therapy and treatment with allergy vaccines. A position statement was formulated with the intention of maintaining continuity of medical service in the context of a pandemic and minimizing the spread, infection and complication associated with severe acute respiratory syndrome coronavirus 2 in patients undergoing or starting treatment for allergic rhinitis(AU)

Factores de riesgo clínicos y sociodemográficos asociados a dermatitis atópica en niños: Un estudio observacional de centro único / Clinical and sociodemographic risk factors associated with atopic dermatitis in children: A single-center observational study

Introducción: La dermatitis atópica es un trastorno cutá-neo atópico, inflamatorio de tipo crónico con aparición más frecuente en niños antes de los 5 años de edad. El objetivo del presente estudio fue determinar factores de riesgo clínicos y sociodemográficos asociados a dermatitis atópica en un grupo de niños escolares en Riobamba-Ecuador. Métodos: El presente estudio observacional incluyó escolares en el periodo junio - agosto 2020. Con una muestra probabilística se incluyeron casos con dermatitis atópica (DA) y un grupo control. Las variables fueron Dermatitis atópica, edad, sexo, antecedentes familiares y personales de atopia, exposición materna al humo del tabaco en el período de gestación o en la infancia, duración de lactancia materna exclusiva, nivel de instrucción de los padres, tipo de residencia, tipo de familia, presencia de niños mayores y mascotas en casa, frecuencia de aseo, duración de la ducha. Se pre-senta Odds Ratio con el inter-valo de confianza del 95%. Resultados: Se incluyeron 175 escolares, 28 (14.2%) con DA. OR para exposición a tabaquismo pasivo en la infancia = 3.7, OR para familias pequeñas = 2.5 (P=0.042), OR para el antecedente materno de rinitis alérgica 2.6, OR para dermatitis atópica en padres = 9.0. Conclusión: Se confirma que el antecedente familiar de enfermedades como rinitis alérgica y dermatitis atópica así como el antecedente personal de enfermedades que forman parte del espectro atópico diferentes de DA, la exposición al humo del tabaco en el hogar y la convivencia con un reducido número de integrantes dentro de la familia son factores de riesgo asociados a dermatitis atópica.

Introduction: Atopic dermatitis is a chronic inflammatory atopic skin disorder with the most frequent onset in children under five. This study aimed to determine clinical and socio-demographic risk factors associated with atopic dermatitis in a group of school children in Riobamba, Ecuador. Methods: The present observational study included school-children in the period June - August 2020. A probabilistic sample included cases with atopic dermatitis (AD) and a control group. The variables were atopic dermatitis, age, sex, family and personal history of atopy, maternal exposure to tobacco smoke during pregnancy or in childhood, duration of exclusive breastfeeding, parental educational level, type of residence, family type, presence of older children and pets at home, frequency of grooming, and duration of showering. The odds ratio is presented with a 95% confidence interval. Results: A total of 175 school-children were included, 28 (14.2%) with AD. Alternatively, for exposure to secondhand smoke in childhood = 3.7, OR small families = 2.5 (P =0.042) OR for maternal history of allergic rhinitis 2.6, OR atopic dermatitis in parents = 9.0. Conclusion: It is confirmed that the family history of diseases such as allergic rhinitis and atopic dermatitis, as well as the personal history of diseases that are part of the atopic spectrum other than AD, expo-sure to tobacco smoke at home and living with a small number of members within the family, are risk factors associated with atopic dermatitis.

Frequência alélica e potencial regulatório de polimorfismosno gene NELL1 em uma população da Bahia ­ Brasil / Allele frequency and regulatory potential of polimorphisms in NELL1 gene in a population of Bahia ­ Brazil

Introdução: o gene NELL1 codifica a proteína semelhante ao fator de crescimento epidérmico (do inglês Epidermal Growth factor (EGF)-like). GWASs e estudos de associação com genes candidatos têm sido utilizados para estabelecer a conexão entre polimorfismos de nucleotídeo único (SNP) no NELL1 e diversas doenças. Objetivo: descrever a frequência alélica e o potencial regulatório dos polimorfismos do gene NELL1, estudados em uma população de Salvador (Bahia, Brasil) e descrever a frequência desses polimorfismos e a associação com diversas doenças, em populações africana, ameríndia, asiática e europeia. Metodologia: 1094 participantes foram recrutados através do Programa de Controle da Asma e da Rinite Alérgica no Estado da Bahia (ProAR). Os indivíduos tiveram o DNA genômico extraído e genotipado, utilizando-se a plataforma Illumina. Os SNP foram consultados através da plataforma SeattleSec Annotation. As bases de dados NCBI, RegulomeDB e Haploview 4.2 foram utilizadas para as análises. Resultados: foram analisados 346 SNPs do gene NELL1. Desses, 53 SNPs tiveram o MAF variando entre 50% e 40% e função intrônica. Os SNPs rs10833465 (alelo A), rs908944 (alelo C), rs1516766 (alelo A), rs10766739 (alelo G) e rs11025878 (alelo G) apresentam uma pontuação de 3, de acordo com o banco do RegulomeDB. O SNP rs7117671, com pontuação 2b, pode ter impacto regulatório e funcional. 101 SNPs apresentaram o MAF entre 39% e 20%. Dos polimorfismos menos frequentes nessa população, 192 apresentaram um MAF entre 19% e 2%. Discussão: alguns SNPs, com diferentes frequências, apresentaram alta probabilidade de impacto funcional. Foram encontrados, na literatura, estudos de associação dos SNPs e osteoporose, doenças metabólicas, condições inflamatórias, doenças neuropsiquiátricas e tumores malignos. Conclusão: ospolimorfismos do gene NELL1 estudados apresentaram diferentes frequências na população desse estudo e tiveram seus alelos associados a doenças em diferentes populações. Sugere-se que sejam realizados mais estudos.

Introduction: the NELL1 gene encodes the epidermal growth factor (EGF)-like protein. GWASs and association studies with candidate genes have been used to establish the connection between single nucleotide polymorphisms (SNP) in NELL1 and various diseases. Objective: to describe the allele frequency and regulatory potential of NELL1 gene polymorphisms studied in a population from Salvador, Bahia, Brazil; and to describe the frequency of these polymorphisms, and the association with various diseases, in African, Amerindian, Asian and European populations. Methodology: one thousand and ninety-four (1094) participants were recruited through the Program for the Control of Asthma and Allergic Rhinitis in the State of Bahia (ProAR). Individuals had their genomic DNA extracted and genotyped using the Illumina platform. The SNPs were consulted through the SeattleSec Annotation platform. The NCBI, RegulomeDB and Haploview 4.2 databases were used for the analyses. Results: four hundred and seventy-three (346) NELL1 gene SNPs were analyzed. Of these, 53 SNPs had MAF ranging between 50% and 40% and intronic function. The SNPs rs10833465 (A allele), rs908944 (C allele), rs1516766 (A allele), rs10766739 (G allele) and rs11025878 (G allele) showed a score of 3, according to the RegulomeDB database. SNP rs7117671, with score 2b, may have regulatory and functional impact. One hundred and eighteen (101) SNPs presented MAF between 39% and 20%. Of the less frequent polymorphisms in this population, 192 had a MAF between 19% and 2%. Discussion: some SNPs, with different frequencies, presented a high probability of functional impact. Studies on the association of SNPs and osteoporosis, metabolic diseases, inflammatory conditions, neuropsychiatric diseases and malignant tumors were found in the literature. Conclusion: the NELL1 gene polymorphisms studied showed different frequencies in the population of this study and had their alleles associated with diseases in different populations. It is suggested that further studies be carried out.

Associação entre nascidos por cesárea e desenvolvimento de doenças alérgicas em crianças e adolescentes: revisão sistemática e metanálise / Association between cesarean births and the development of allergic diseases in children and adolescents: systematic review and meta-analysis

Introdução: a via de nascimento tem sido considerada como um possível fator de risco para a ocorrência de doenças alérgicas em crianças e adolescentes, sendo este um dado preocupante, tendo em vista o aumento da prevalência dessas afecções no mundo.Objetivo: Analisar a associação entre o nascimento por cesárea e o desenvolvimento de doenças alérgicas em crianças e adolescentes. Metodologia: revisão sistemática com metanálise de estudos indexados nas bases de dados PubMed, Science Direct e Biblioteca Virtual em Saúde, com uso dos descritores em saúde: "cesarean section", "hypersensitivity", "allergic rhinitis", "asthma", "atopic dermatitis", "food allergy", "child", "adolescent". A qualidade dos estudos foi avaliada através da ferramenta Quality Assessment Tool for Quantitative Studies ­ (QATQS). Resultados: foram incluídos 23 trabalhos na revisão e 21 foram selecionados para metanálise. A prevalência de cesárea variou de 7,8% a 50,8% e a prevalência de doenças alérgicas esteve entre 0,77% e 42,5% na população nascida por essa via. Observou-se uma associação positiva entre parto por cesárea e presença de rinite alérgica (OR=1,30; IC95%: 1,18-1,43) e asma (OR=1,44; IC95%: 1,38-1,49), não sendo encontrada associação significante entre a cesariana e o desenvolvimento de dermatite atópica (OR=1,02; IC95%: 0,96-1,09) ou alergia alimentar (OR=0,99; IC95%: 0,82-1,19). Conclusão: o nascimento pela via de parto cirúrgico pode estar contribuindo com o aumento do número de casos de alergias na população pediátrica e, ainda que haja heterogeneidades entre os estudos analisados, existem riscos que devem ser levados em conta na análise dessa relação em futuros trabalhos que investiguem essa problemática.

Introduction: the route of birth has been considered as a possible risk factor for the occurrence of allergic diseases in children and adolescents, which is a worrying fact, given the increasing prevalence of these conditions in the world. Objective: to analyze the association between cesarean birth and the development of allergic diseases in children and adolescents. Methodology: systematic review with meta-analysis of studies indexed in the PubMed, Science Direct and Virtual Health Library databases, using the health descriptors: "cesarean section", "hypersensitivity", "allergic rhinitis", "asthma", "atopic dermatitis", "food allergy", "child", "adolescent". The quality of studies was assessed using the Quality Assessment Tool for Quantitative Studies ­ (QATQS). Results: 23 papers were included in the review, and 21 were selected for meta-analysis. The prevalence of cesarean sections varied from 7.8% to 50.8%, and the prevalence of allergic diseases was between 0.77% and 42.5% in the population born through this route. A positive association was observed between cesarean delivery and the presence of allergic rhinitis (OR = 1.30; 95% CI: 1.18-1.43) and asthma (OR = 1.44; 95% CI: 1.38-1,49), with no significant association between cesarean section and the development of atopic dermatitis (OR = 1.02; 95% CI: 0.96-1.09) or food allergy (OR = 0.99; 95% CI: 0.82-1.19). Conclusion: birth through surgical delivery may be contributing to the increase in the number of cases of allergies in the pediatric population and, although there are heterogeneities between the studies analyzed, there are risks that must be taken into account when analyzing this relationship in future works to investigate this issue.

Efecto placebo en otorrinolaringología: revisión de la literatura / Placebo effect in otorhinolaryngology: a narrative review

Resumen La palabra placebo ha sido usada, indistintamente, para referir a una sustancia o procedimiento que es "inerte" ("placebo") y al efecto que ocurre como consecuencia de la administración de un placebo ("efecto placebo"). El efecto placebo es un fenómeno psicobiológico que ha sido explicado desde el conductismo (condicionamiento clásico), desde fenómenos preconscientes (expectativas o "efecto placebo clásico"), desde el cognitivismo (disonancia cognitiva) y también a nivel neurobiológico. No obstante, los ensayos clínicos abiertos que verifican la respuesta a placebo desafían el mecanismo de la expectativa, dando lugar al análisis bayesiano, que integra sensaciones, experiencias, predicciones y claves del contexto; biológicamente, el efecto placebo no es inerte. Por tanto, el placebo ocupa un lugar relevante en la práctica clínica y en la investigación biomédica. Se realizó una búsqueda sistemática sobre placebo y otorrinolaringología en las bases de datos PubMed/Medline, SciELO y Cochrane Library. Se incluyeron estudios primarios y revisiones sistemáticas de la literatura. En cuanto a intervenciones placebo, la literatura publicada indica mejorías significativas en síntomas nasales y calidad de vida en rinitis alérgica (estacional y perenne) y disminución del dolor posoperatorio en amigdalectomía. En la enfermedad de Méniere, las intervenciones placebo son comparables a las de uso habitual, incluyendo las quirúrgicas. No se encontraron ensayos clínicos abiertos en otorrinolaringología ni evidencia sobre otras patologías del área. Las intervenciones y el efecto placebo abren un campo de investigación y desarrollo en otorrinolaringología que desafía la comprensión actual de las patologías, su funcionamiento, su tratamiento y la relación terapéutica.

Abstract The word placebo has been used interchangeably to refer to a substance or procedure that is "inert" ("placebo") and the effect that occurs as a consequence of its administration ("placebo effect"). The placebo effect corresponds to a psychobiological phenomenon that has been explained from behaviorism (classical conditioning), from preconscious phenomena (expectations or "classical placebo effect"), from cognitivism (cognitive dissonance) and at the neurobiological level as well. Nevertheless, some open-label trials that verify the response to placebo challenge the expectation mechanism, giving rise to Bayesian analysis, which integrates sensations, experiences, predictions and context clues; therefore, biologically, the placebo effect is not inert. The placebo has a relevant place both in clinical practice and in biomedical research. We conducted a systematic search on placebo and otolaryngology in PubMed/Medline, SciELO and Cochrane Library databases. We included primary studies and systematic reviews. Regarding placebo interventions, the available literature points out significant improvements in nasal symptoms and quality of life in allergic rhinitis (seasonal and perennial) and a decrease in post-tonsillectomy pain. In Méniére's disease, placebo interventions have demonstrated to be comparable to treatment-as-usual, including surgical interventions. No open-label clinical trials were found in otolaryngology, as well as no evidence on other diseases in the area. Placebo interventions and their effects open a field of research and development in otolaryngology, challenging the current understanding of pathologies, their functioning, their treatment and the therapeutic relationship.

Allergic rhinitis improvement after septorhinoplasty in a sample of allergic rhinitis patients with septal deviation: a quasi-experimental study

ABSTRACT BACKGROUND: Allergic rhinitis (AR) is a chronic inflammatory disease that affects almost 30% of the adult population. OBJECTIVE: To describe and compare the evolution of symptoms in patients diagnosed with AR and septal deviation prior to and following septoplasty (STP). DESIGN AND SETTING: Quasi-experimental study developed in A Coruña University Hospital. METHODS: Patients aged 18-65 years who had been diagnosed with AR and septal deviation were recruited. Obstruction airflow was evaluated before and after surgery, by means of anterior rhinomanometry (RNM). Severity symptoms and quality of life were assessed using a visual analogue scale (VAS) and the ESPRINT questionnaire, respectively. RESULTS: A total of 50 subjects underwent STP and 42 were included in this study. Their mean age at the time of surgery was 34.16 ± 9.74 years (range 18-64). Significant reductions in mean VAS and ESPRINT were observed after surgery (P < 0.01). These outcomes were considered to represent an overall improvement in quality of life. The RNM results also improved significantly, from mean values of 478.07 ± 165.4 cm3/s before STP to 826.4 ± 175.5 cm3/s afterwards (P < 0.01). CONCLUSIONS: The negative correlations of VAS and ESPRINT with RNM, from before and to after STP, demonstrate the efficacy of scales and questionnaires as objective methods for determining obstruction in the absence of rhinomanometry. Patients with allergic rhinitis and septal deviation showed improvements in obstruction severity and medication use after STP.

Sensitization characteristics of Juniperus chinensis pollen in Beijing area / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the sensitization characteristics of Juniperus chinensis pollen in patients with allergic rhinitis and/or allergic asthma in Beijing area, and to explore the characteristics of Juniper chinensis pollen sensitized population. Methods: Patients with suspected allergic rhinitis and/or asthma from January 2017 to December 2019 in the outpatient department of Allergy Department of Beijing Shijitan Hospital were selected in this study. Skin prick test (SPT) was performed with Juniper chinensis pollen allergen reagent to compare different age and disease allergen distribution, and to observe the sensitization characteristics of its population. All of the analyses were performed using SAS software version 9.4. Results: A total of 8 380 patients were enrolled in the end. The total positive rate of Juniper chinensis pollen SPT reached 49.92% (4 183/8 380). The positive rate of Juniper chinensis pollen SPT was highest in the 10-14 age group, reaching 60.99% (283/464). Compared with other age groups, there was a statistical difference (χ²=266.77, P<0.01). The SPT positive rate of patients aged less than 10 years increased with the increase of age, while the SPT positive rate of patients aged over 40 years decreased with the increase of age. Single Juniper chinensis pollen was less allergenic, accounting for about 25.05% (1 048/4 183), and the patients' age was (35.21±12.39) years. Regardless of single Juniper chinensis pollen or other pollen allergies, allergic rhinitis was the main disease. Among the patients with SPT positive Juniper chinensis pollen combined with other inhaled pollen allergens, willow pollen accounted for the first (74.99%). The positive rate of Juniper chinensis pollen was the highest in patients with single allergic rhinitis, accounting for 52.05% (3 797/7 295), and the rate in patients with single allergic asthma was the lowest, accounting for 17.49% (53/303), with statistically difference (χ²=138.99, P<0.01). Conclusions: Juniper chinensis pollen is highly sensitized in patients with allergic rhinitis and/or allergic asthma in Beijing . The positive rate of SPT is highest among 10-14 age group, most of which showed strong positive reaction, and allergic rhinitis is more common in Juniper chinensis pollen sensitization diseases.

Analysis of inhaled allergen spectrum characteristics of allergic rhinitis in 5 019 cases in Xinjiang area / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the characteristics of allergen spectrum in patients with allergic rhinitis (AR) in Xinjiang area in recent 13 years. Methods: The skin prick test (SPT) results of 5 019 AR patients from 2007 to 2019 were retrospectively summarized, and 14 allergens of different age, gender and race were analyzed. Results: The distribution of 14 allergens was significantly different in different years, the difference was significant (P<0.05). The top three positive rates of 14 allergens were quinoa 48.2% (2 398/4 970), plantain 33.3% (1 221/3 667), and Artemisia 33.1% (1 647/4 974). There was no significant difference in the positive rate of dog epithelium between different genders and ages (χ²=0.041, P>0.05; χ²=3.8, P>0.05), the difference of other allergen in positive rates was statistically significant (all P<0.05). The positive rates of Alternaria Alternata (χ²=7.3), Penicillium Sp. (χ²=0.3), Cat Epithelium (χ²=3.1), Dust Mite (χ²=1.4), Acaroid Mite (χ²=0.5) and Cockroach (χ²=2.9) had no significant difference among different races (all P>0.05). The positive rates of other eight allergens including Artemisia Vulgaris (χ²=64.9), Chenopodium (χ²=204.1), Artemisiifolia (χ²=72.4), Plantain (χ²=87.8), Phleum Pratense L(χ²=55.4), Robinia Pseudoacacia (χ²=67.8), Canis Familiari (χ²=70.8), Dog Epithelium (χ²=15.7) were significantly different among different races (all P<0.05). Conclusion: The distribution of allergens in Xinjiang area changes with time, the main allergens are mainly herbaceous, and the distribution of allergens in patients with AR is different in gender, age and race.

Experimental study of dopamine ameliorating the inflammatory damage of olfactory bulb in mice with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the effects of dopamine on olfactory function and inflammatory injury of olfactory bulb in mice with allergic rhinitis (AR). Methods: AR mouse model was established by using ovalbumin (OVA), and the mice were divided into two groups: olfactory dysfunction (OD) group and without OD group through buried food pellet test (BFPT). The OD mice were randomly divided into 2 groups, and OVA combined with dopamine (3, 6, 9 and 12 days, respectively) or OVA combined with an equal amount of PBS (the same treatment time) was administered nasally. The olfactory function of mice was evaluated by BFPT. The number of eosinophils and goblet cells in the nasal mucosa were detected by HE and PAS staining. Western blotting, immunohistochemistry or immunofluorescence were used to detect the expression of olfactory marker protein (OMP) in olfactory epithelium, the important rate-limiting enzyme tyrosine hydroxylase (TH) of dopamine, and the marker proteins glial fibrillary acidic protein (GFAP) and CD11b of glial cell in the olfactory bulb. TUNEL staining was used to detect the damage of the olfactory bulb. SPSS 26.0 software was used for statistical analysis. Results: AR mice with OD had AR pathological characteristics. Compared with AR mice without OD, the expression of OMP in olfactory epithelium of AR mice with OD was reduced (F=26.09, P<0.05), the expression of GFAP and CD11b in the olfactory bulb was increased (F value was 38.95 and 71.71, respectively, both P<0.05), and the expression of TH in the olfactory bulb was decreased (F=77.00, P<0.05). Nasal administration of dopamine could shorten the time of food globule detection in mice to a certain extent, down-regulate the expression of GFAP and CD11b in the olfactory bulb (F value was 6.55 and 46.11, respectively, both P<0.05), and reduce the number of apoptotic cells in the olfactory bulb (F=25.64, P<0.05). But dopamine had no significant effect on the number of eosinophils and goblet cells in nasal mucosa (F value was 36.26 and 19.38, respectively, both P>0.05), and had no significant effect on the expression of OMP in the olfactory epithelium (F=55.27, P>0.05). Conclusion: Dopamine can improve olfactory function in mice with AR to a certain extent, possibly because of inhibiting the activation of glial cells in olfactory bulb and reducing the apoptotic injury of olfactory bulb cells.

Effects of NLRP3-mediated pyroptosis on olfaction dysfunction in allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the relationship between NLRP3-mediated pyroptosis and olfactory dysfunction (OD) in allergic rhinitis (AR), and to evaluate the therapeutic potential of CY-09, a selective NLRP3 inhibitor for OD. Methods: An AR mouse model was established with ovalbumin, and the olfactory function of AR mice was detected by the buried food pellet test. Mice with OD were intraperitoneally injected with CY-09 or saline. The activation of microglia and astrocytes in olfactory bulb was detected by immunohistochemistry. The expression level of pyroptosis associated protein was detected by Western blot. The level of pyroptosis associated proinflammatory factor mRNA was determined by real-time PCR. SPSS 24.0 software was used for statistical analysis. Results: After the test, ovalbumin successfully established AR mice model, in which 52.5% (21/40) of them showed OD. The number of activated microglia and astroglia in olfactory bulb tissue in OD group were more than those in non-OD group (all P<0.05). Compared with the control group, the expression of NLRP3, caspase-1 and gasdermin D (GSDMD) was significantly increased in the olfactory bulb of the OD group (all P<0.05). CY-09 could significantly reduce the level of NLRP3, caspase-1, GSDMD, IL-1β and IL-18 expression, and inhibite the activation of microglia and astrocytes in the olfactory bulb tissues (all P<0.05). Conclusion: NLRP3-mediated pyroptosis is closely related to the OD associated with AR. CY-09 could improve the olfactory function in AR mice, which may be related to blocking the NLRP3-mediated pyroptosis.

Bioinformatics analysis of nasal epithelial cell gene expression in seasonal and perennial allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

Objective: Transcriptome sequencing and bioinformatics analysis were performed on the gene expression of nasal epithelial cells in patients with seasonal allergic rhinitis (AR) and perennial AR, so as to obtain the differences in the gene expression of nasal epithelial cells between seasonal AR and perennial AR. Methods: The human nasal epithelial cell line(HNEpC) was cultured in vitro, treated with 100 μg/ml mugwort or house dust mite (HDM) extracts for 24 hours. Total cell RNA was extracted, and quantitative real-time polymerase chain reaction (qPCR) was used to detect the expression of cytokines, including IL-6, IL-8, IL-33 and thymic stromal lymphopoietin (TSLP). From November 2019 to November 2020, 3 seasonal AR patients, 3 perennial AR patients, and 3 healthy controls who attended the Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University were analyzed. The patients' primary nasal epithelial cells were cultured in vitro, treated with corresponding allergens for 24 hours. Total RNA was extracted for transcriptome sequencing, and the sequencing results were analyzed by bioinformatics. Results: The qPCR results showed that the cytokines IL-6, IL-8, IL-33 and TSLP of HNEpC treated with mugworts extracts and HDM extracts had the same trend of change. After the nasal epithelial cells from patients with seasonal AR and perennial AR were treated with corresponding allergens, there were differences in biological processes and signal pathways between those and control. Gene ontology (GO) enrichment analysis showed that the differentially expressed genes (DEG) in AR patients allergic to mugwort were mainly enriched in the oxidation-reduction process, the negative regulation of apoptosis process, and the cell adhesion; the DEG in AR patients allergic to HDM were mainly enriched in cell adhesion, the negative regulation of cell proliferation and the response to drug. Enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway showed that the DEG of AR patients allergic to mugwort were significantly enriched in arachidonic acid metabolism, p53 signaling pathway and transforming growth factor β (TGF-β) signaling pathway, while the DEG of AR patients allergic to HDM were mainly enriched in cells cycle, Fanconi anemia pathway and DNA replication. Gene Set Enrichment Analysis (GSEA) showed that the inflammatory response, TNF-α/NF-κB signaling pathway and IL-2/STAT5 signaling pathway were significantly up-regulated in AR patients allergic to mugwort, indicating the promotion of inflammatory response; and AR patients allergic to HDM had significant down-regulation of G2M, E2F, and MYC, indicating the inhibition of cell proliferation. The protein-protein interaction network showed that TNF and CDK1 were the most interacting proteins in mugwort and HDM allergic AR patients, respectively. Conclusion: Seasonal AR and perennial AR may affect the different biological processes and signal pathways of nasal epithelial cells, leading to differences in the occurrence and development of AR.

Analysis of the associations of chemokine receptors expression on circulating Tfh2 and Th2 cells with sIgE level and disease severity in patients with AR / 中华耳鼻咽喉头颈外科杂志

Objective: To clarify the chemotactic characteristics of type 2 helper T cells (Th2 cells) and type 2 follicular helper T cells (Tfh2 cells) in peripheral blood of patients with allergic rhinitis (AR), and to explore the associations between the chemokine receptors expression and the levels of antigen-specific IgE (sIgE) and the severity of the disease. Methods: The peripheral blood mononuclear cells of 41 patients with AR (20 males and 21 females, aged 35.0 (24.5, 47.0) years) and 42 healthy controls (24 males and 18 females, aged 35.0 (24.8, 46.5) years) treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2017 to February 2018 were isolated. The expressions of chemokine receptor (CCR)2, CCR3, CCR4, CCR5, CCR7, CCR8, chemokine C-X3-C-motif receptor 1 (CX3CR1) and C-X-C motif receptor 4 (CXCR4) in Th2 and Tfh2 cells were explored by fluorescence activated cell sorting (FACs). The relationship between the expression of these chemokine receptors in Th2 cells and Tfh2 cells and the levels of serum sIgE and the scores of visual analogue scale (VAS) was analyzed. Graphpad prism 7.0 software was used for statistical analysis. Results: The significant differences in chemotactic characteristics between Th2 cells and Tfh2 cells in the control group were found: Th2 cells highly expressed chemokine receptors CCR2, CCR3, CCR5, CCR8 and CX3CR1, while Tfh2 cells highly expressed immune cell homing chemokine receptors CCR7 and CXCR4. AR patients, compared to the control, expressed higher levels of CCR2, CCR5 and CX3CR1 on peripheral Th2 cells(all P<0.01). At the same time, the proportion of CCR2+and CCR5+Th2 cells was positively correlated with VAS score (r value was 0.58 and 0.61, respectively, both P<0.01). In AR patients, higher expression levels of CCR7 on Tfh2 cells were detected (P<0.01), and the proportion of CCR7+Tfh2 cells was positively correlated with the level of serum sIgE (r=0.51, P<0.01). Conclusion: The percentage of CCR2+ and CCR5+ Th2 cells in peripheral of AR patients can reflect the severity of AR to some extent, while the percentage of CCR7+ Tfh2 cells is positively correlated with the level of serum sIgE.

Endoscopic posterior nasal neurectomy for the treatment of allergic rhinitis: anatomy and analysis of clinical efficacy / 中华耳鼻咽喉头颈外科杂志

Objective: To propose total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle from anatomy for the treatment of allergic rhinitis, and to explore its clinical application. Methods: Two fresh cadaveric heads (4 sides) were dissected through endoscopic transnasal middle meatus approach at Otorhinolaryngology Anatomy Laboratory of China-Japan Friendship Hospital. The structures of the craniofacial bone related to the surgical approach were observed. Twelve patients with allergic rhinitis who treated in Department of Otorhinolaryngology, China-Japan Friendship Hospital from Feb. 1 2019 to Jun. 10 2021 were selected. All the patients were treated by posterior nasal neurotomy with the technique of complete transection of sphenopalatine neurovascular bundle and followed up for 1 year after sugery. During the follow-up, 2 patients were lost. The other 10 patients included 4 males and 6 females, aging from 29 to 69 years. Visual Analogue Scale (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were used to evaluate the effect of the surgery. SPSS 25.0 software was used for statistical analysis. Results: Important anatomic landmarks of transnasal middle meatus approach were obtained during anatomy, such as ethmoid crest, sphenopalatine foramen/notch, palatine orbital process and sphenopalatine process. The postoperative VAS scores of nose, eye, pharynx, ear and whole body and total VAS scores were significantly lower than those before operation, with statistically significant difference (nose 2.50±1.70 vs 6.47±2.17, eyes 1.15±0.89 vs 3.60±2.57, pharynx 1.30±1.36 vs 4.25±3.64, ear 1.10±1.03 vs 2.67±2.00, whole body 1.08±1.24 vs 3.60±1.17, total 7.13±4.31 vs 20.58±9.05, all P<0.05). The postoperative RQLQ scores of sleep, nose, eyes, practical problems, emotion, activity and the total RQLQ scores of patients were significantly lower than those before operation, with statistically significant difference (sleep 0.80±0.69 vs 2.93±1.33, nose 1.38±1.18 vs 3.93±1.50, eyes 0.58±0.66 vs 1.80±1.25, practical problems 1.10±1.22 vs 3.03±1.84, emotion 1.00±1.81 vs 2.58±2.00, activity 2.77±2.93 vs 6.00±1.85, total 8.99±8.92 vs 22.42±8.69, all P<0.05). There was no significant difference in preoperative and postoperative scores of non-nasal/ocular symptoms (1.37±1.60 vs 2.16±1.12, P=0.166). There was no other complication except 2 cases with short-term postoperative numbness. Conclusions: Total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle is a safe, effective and feasible method for the treatment of intractable allergic rhinitis, and its long-term efficacy needs further observation.

Dendrobium nobile protects against ovalbumin-induced allergic rhinitis by regulating intestinal flora and suppressing lung inflammation / 中国天然药物

Antibiotic exposure-induced dysbiosis of the intestinal flora increases the risk of developing allergic rhinitis. Hence, regulating the balance of intestinal flora may be useful for preventing and treating allergic rhinitis. However, the underlying mechanism is unclear. Dendrobium nobile (Shihu) exhibits anti-inflammatory and immune activities. Hence, in this study, we investigated the mechanism via which Shihu may improve allergic rhinitis. Mouse models of allergic rhinitis with intestinal flora dysbiosis (Model-D, antibiotics induce intestinal flora dysbiosis with ovalbumin-induced allergy) and normal intestinal flora with allergic rhinitis (Model-N, ovalbumin-induced allergy) were established. The effect of Shihu on intestinal flora and inflammation caused during allergic rhinitis were analyzed. Allergic symptoms, infiltration of hematoxylin and eosin in the lungs and nose, and the release of various factors [interleukin (IL)-2, IL-4, IFN-γ, IL-6, IL-10, and IL-17] in the lungs were evaluated. The results indicate that intestinal flora dysbiosis exacerbated lung and nose inflammation in allergic rhinitis. However, treatment with the Shihu extract effectively reversed these symptoms. Besides, the Shihu extract inhibited the PI3K/AKT/mTOR pathway and increased the level of Forkhead box protein in the lungs. Additionally, the Shihu extract reversed intestinal flora dysbiosis at the phylum and genus levels and improved regulator T cell differentiation. Furthermore, in the Model-D group, the Shihu extract inhibited the decrease in the diversity and abundance of the intestinal flora. Screening was performed to determine which intestinal flora was positively correlated with Treg differentiation using Spearman's correlation analysis. In conclusion, we showed that Shihu extract restored the balance in intestinal flora and ameliorated inflammation in the lungs of allergic rhinitis mice and predicted a therapeutic new approach using Traditional Chinese Medicine to improve allergic rhinitis.

Application of fractional exhaled nitric oxide and nasal nitric oxide in control evaluation of bronchial asthma and diagnosis of allergic rhinitis in children / 中国当代儿科杂志

OBJECTIVES@#To study the association of fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) with asthma control and their value in the diagnosis of allergic rhinitis in children.@*METHODS@#A total of 186 children aged 5-12 years, who attended the outpatient service of the Department of Respiration, Shanghai Children's Hospital due to bronchial asthma and/or allergic rhinitis or who underwent physical examination, were enrolled as subjects, with 52 children in the asthma group, 60 children in the asthma+allergic rhinitis group, 36 children in the allergic rhinitis group, and 38 children in the control group. FeNO, nNO, and pulmonary function were compared between groups.@*RESULTS@#The asthma+allergic rhinitis, asthma, and allergic rhinitis groups had a significantly higher level of FeNO than the control group (P<0.05). The asthma+allergic rhinitis and allergic rhinitis groups had a significantly higher level of nNO than the asthma and control groups (P<0.05). The uncontrolled asthma and partially controlled asthma groups had significantly higher levels of FeNO and nNO than the completely controlled asthma group (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that nNO had an area under the ROC curve of 0.91, with a sensitivity of 80.0% and a specificity of 89.5% in the diagnosis of allergic rhinitis in children with asthma (P<0.05).@*CONCLUSIONS@#The combined measurement of nNO and FeNO can be used to evaluate the control of asthma, and the measurement of nNO can help with the diagnosis of allergic rhinitis in children with bronchial asthma.

Involvement and therapeutic implications of airway epithelial barrier dysfunction in type 2 inflammation of asthma / 中华医学杂志(英文版)

Type 2 inflammation is a complex immune response and primary mechanism for several common allergic diseases including allergic rhinitis, allergic asthma, atopic dermatitis, and chronic rhinosinusitis with nasal polyps. It is the predominant type of immune response against helminths to prevent their tissue infiltration and induce their expulsion. Recent studies suggest that epithelial barrier dysfunction contributes to the development of type 2 inflammation in asthma, which may partly explain the increasing prevalence of asthma in China and around the globe. The epithelial barrier hypothesis has recently been proposed and has received great interest from the scientific community. The development of leaky epithelial barriers leads to microbial dysbiosis and the translocation of bacteria to inter- and sub-epithelial areas and the development of epithelial tissue inflammation. Accordingly, preventing the impairment and promoting the restoration of a deteriorated airway epithelial barrier represents a promising strategy for the treatment of asthma. This review introduces the interaction between type 2 inflammation and the airway epithelial barrier in asthma, the structure and molecular composition of the airway epithelial barrier, and the assessment of epithelial barrier integrity. The role of airway epithelial barrier disruption in the pathogenesis of asthma will be discussed. In addition, the possible mechanisms underlying the airway epithelial barrier dysfunction induced by allergens and environmental pollutants, and current treatments to restore the airway epithelial barrier are reviewed.

Vitamin D supplementation in pregnant women or infants for preventing allergic diseases: a systematic review and meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

BACKGROUND@#It is still unclear if and to what extent antenatal or infant or childhood vitamin D supplementation would affect the development of allergy diseases later in life. This study aimed to review the efficacy of vitamin D supplementation in pregnant women, infants, or children for the prevention of allergies.@*METHODS@#MEDLINE (PubMed), EMBASE (OVID), and the Cochrane Central Register of Controlled Trials were searched up to March 1, 2020. We included only randomized controlled trials (RCTs). We performed a systematic review and meta-analysis for vitamin D supplementation in primary allergy prevention. These trials were assessed for risk of bias using the Cochrane Collaboration domains and the consensus was reached via discussion with the full study group. We descriptively summarized and quantitatively synthesized original data to evaluate vitamin D supplementation in primary allergy prevention by using Review Manager software for meta-analysis.@*RESULTS@#The search yielded 1251 studies. Seven RCTs were included in this analysis. A meta-analysis revealed that vitamin D supplementation for pregnant women or infants may not decrease the risk of developing allergic diseases, such as asthma or wheezing (supplementation for pregnant women, risk ratio [RR]: 1.01, 95% confidence interval [CI]: 0.81-1.26, P = 0.90, I2 = 47%; supplementation for infants, RR: 1.00, 95% CI: 0.70-1.43, P = 0.99, I2 = 0%; supplementation for pregnant women and infants, RR: 0.35, 95% CI: 0.10-1.25, P = 0.11), eczema (supplementation for pregnant women, RR: 0.95, 95% CI: 0.80-1.13, P = 0.77, I2 = 0%; supplementation for infants, RR: 0.84, 95% CI: 0.64-1.11, P = 0.19, I2 = 42%), allergic rhinitis (supplementation for pregnant women, RR: 0.93, 95% CI: 0.78-1.11, P = 0.15, I2 = 47%), lower respiratory tract infection (LRTI) (supplementation for pregnant women, RR: 0.97, 95% CI: 0.85-1.11, P = 0.59, I2 = 0%), or food allergy.@*CONCLUSIONS@#Supplementation of vitamin D in pregnant women or infants does not have an effect on the primary prevention of allergic diseases.@*SYSTEMATIC REVIEW REGISTRATION@#PROSPERO (CRD42020167747).