Comparison of in vitro assay for specific IgE and skin prick test with intradermal test in patients with allergic rhinitis.

Among many diagnostic tests for allergic rhinitis, the intradermal (ID) test is practical and reliable. However, there are several factors affecting compliance, practicability and interpretation, and also problems on hypersensitivity of the ID. For these reasons, we evaluated other tests which have been thought to have high reliability as diagnostic and/or screening assays, namely, skin prick test and specific IgE detection in seventy-four perennial rhinitis patients (51 males and 23 females whose ages were between 15-60 years). In this study, Dermatophagoides pteronyssinus and D. farinae extracts, known to be the most common aeroallergens in Thailand, were used as the allergens/antigens. Compared to the standard ID test, sensitivities to D. pteronyssinus and D. farinae of the studied patients tested by skin prick test were 90.4% and 86.4%, and specificities were 99.5% and 93.1%, respectively. Sensitivities to D. pteronyssinus and D. farinae using specific IgE assay were 96.3% and 88.9%, and specificities were 96.2% and 88.9%, respectively. It was concluded that the skin prick test can be used as a screening method for patients with allergic rhinitis, while the specific IgE detection can be used as an alternative for diagnosis of patients who are susceptible to the ID test or for those who are severely susceptible to allergic rhinitis such that medication can not be withdrawn for the ID test.

A non-comparative trial of the efficacy and safety of fexofenadine for treatment of perennial allergic rhinitis.

An open-label, non-comparative study was performed in three Otolaryngology centers in Bangkok, Thailand, to assess the efficacy, safety and tolerability of fexofenadine in Thai patients with perennial allergic rhinitis. Altogether 101 perennial allergic rhinitis patients were included, 33 males and 68 females. Mean age was 33 years, average duration of symptoms was 6 years. All patients received fexofenadine hydrochloride 120 mg once daily (OD) in the morning for 2 weeks. Patients recorded their allergy symptoms daily using a 5 point rating scales in the diary card. At the end of 2 weeks, patients and investigators assessed the overall efficacy of treatment. Adverse events and onset of symptom relief were also recorded by every patient. Blood test and ECG were performed before and after treatment in one center (Siriraj Hospital). Total symptom scores and nasal scores decreased significantly from a baseline at 1 week and 2 weeks after treatment (p < 0.05). The mean onset of symptom relief was 2 hours and 12 minutes. The global assessment of the treatment by patients and investigators showed significant concordance. There was no significant change in either the vital signs, laboratory tests or ECG. The incidence of treatment related adverse events was 8% but all were mild and easily tolerated. Drowsiness was reported from only one patient. This study suggests that fexofenadine 120 mg once daily was an effective, safe and well tolerated treatment for perennial allergic rhinitis in Thai patients.

Role of allergy in nasal polyps of Thai patients.

As distinct from many countries, allergy in Thailand is of the perennial type which may play a role in the formation of nasal polyps. Forty consecutive patients with nasal polyps and 30 normal subjects as control were studied at the Allergy Clinic, Department of Otolaryngology, Pramongkutklao Hospital. A positive clinical history and skin allergy testing are diagnostic criteria for allergy. In the nasal polyps group, these were 28 males and 12 females, aged between 12-65 years, with an average age of 38.5 years. In the control group, there were 18 males and 12 females, aged between 15-53 yeas, with an average age of 34 years. All had received prick skin testing with 6 common aeroallergens. The prick skin test was considered positive when the wheal was > or = 3 mm with surrounding erythema. Twenty-four of 40 patients (60%) with nasal polyps had a positive prick skin test, while 6 in the 30 control cases (20%) had a positive prick skin test. This difference was statistically significant (P = 0.0019), Odd's ratio = 6.0 which means allergic persons were 6 times more prone to have polyps form than normal persons.

Aeroallergen sensitivity of Thai patients with allergic rhinitis.

The aim of this study was to determine the aeroallergen sensitivity of allergic rhinitis patients. A total of 100 cases (female: 59, male: 41, aged between 10-59 years, mean age 27.9 years) who were diagnosed with allergic rhinitis by history and clinical presentation, underwent a prick skin test with 30 aeroallergens, and the important sensitizing allergens were assessed. Skin test reactivity showing > or = 3 mm wheal with erythema as the positive skin test, was recorded. The results of patients with positive skin tests follow. TREES: acacia 19%, mango 16%, coconut 12%. GRASSES: bermuda 17%, johnson 21%, timothy 16%, bahia 16% orchard 18%. WEEDS: pigweed 16%, kochia 14%. MOLDS: alternaria 11%, cladosporium 11%, aspergillus 12%, penicillium 16%, helminthosporium 16%, botrytis 15%, rhodotorula 20%, fusarium 26%, curvularia 26%, smut mix 11%, rust 9%. EPIDERMALS: cat 29%, dog 28%, feathers 37%. INDOOR ALLERGENS: house dust 72%, D. pteronyssinus 76%, D. farinae 79%, American cockroach 60%, German cockroach 41%, kapok 30%. Eighty-five percent of patients sensitive to house dust mites were positive to both D. pteronyssinus and D. farinae, indicating substantial cross-reactivity. The study shows that the house dust mite and the cockroach are important aeroallergen sensitizers among the Thai population, since more than half the patients were skin-test positive to the house dust mite and the cockroach.

A preliminary study of nasal mucociliary clearance in smokers, sinusitis and allergic rhinitis patients.

Mucocillary clearance of nasal mucosa was evaluated with the saccharin test. A total of 140 subjects was divided into 4 groups: smokers, allergic rhinitis patients, sinusitis patients, and a normal control group. The mean mucociliary transit time for the normal control group (n = 40) was 12 minutes, while allergic rhinitis patients (n = 40) had a mean of 14.6 minutes. The smoker group (n = 40) could be further divided into the following subcategories: (a) those who had been smoking for less than 5 years (n = 10) had a mean of 15.2 minutes, (b) those who had been smoking for more than 5 years at less than one-pack a day (n = 11) had a mean of 14 minutes, and (c) those who had been smoking for more than 5 years at more than one-pack a day (n = 19) had a mean of 16.5 minutes. For the sinusitis patients (n = 20) the mean was 16.6 minutes. The study shows that sinusitis patients, along with those smokers who had been smoking for more than 5 years at more than one-pack a day, had a mucocillary transit time that was considered to be prolonged when compared to the normal control group (p < 0.05).

Immunological and clinical evaluation during a 12 month period of immunotherapy.

Serum IgE and IgG4 were evaluated in twenty adult allergic rhinitis subjects during a 12-month immunotherapy (IT) course against common inhalant allergens. The selection criteria for IT were the result of a prolonged history of allergic diseases and a positive skin test for common inhalant allergens. Twenty non-atopic adults served as the control group. By using enzyme-linked immunoassay a normal range of IgE and IgG4 were 78 +/- 40 IU/ml and 180 +/- 54 micrograms/ml, respectively. The changes in IgE and IgG4 levels were compared with significant improvements of symptoms and drug consumption. The clinical and laboratory responses to IT were considered good in 8 cases (40%), moderate in 7 cases (35%), and poor in the remaining 5 cases (25%). A regression analysis revealed a negative simple linear correlation between elevated level of IgG4 and diminished level of clinical symptom scores during 12 months of IT (Pearson's r = -0.7548). The serum IgG4 level after one year IT predicted change in clinical symptom scores.