Sex Dimorphism in Pain Threshold and Neuroinflammatory Response: The Protective Effect of Female Sexual Hormones on Behavior and Seizures in an Allergic Rhinitis Model.

Our previous research demonstrated that allergic rhinitis could impact behavior and seizure threshold in male mice. However, due to the complex hormonal cycles and hormonal influences on behavior in female mice, male mice are more commonly used for behavioral tests. In this study, we aimed to determine whether these findings were replicable in female mice and to explore the potential involvement of sexual hormones in regulating neuroinflammation in an allergic model. Our results indicate that pain threshold was decreased in female mice with allergic rhinitis and the levels of IL-23/IL-17A/IL-17R were increased in their Dorsal root ganglia. However, unlike males, female mice with AR did not display neuropsychological symptoms such as learning and memory deficits, depression, and anxiety-like behavior. This was along with decreased levels of DNA methyl transferase 1 (DNMT1) and inflammatory cytokines in their hippocampus. Ovariectomized mice were used to mitigate hormonal effects, and the results showed that they had behavioral changes and neuroinflammation in their hippocampus similar to male mice, as well as increased levels of DNMT1. These findings demonstrate sex differences in how allergic rhinitis affects behavior, pain sensitivity, and seizure thresholds. Furthermore, our data suggest that DNMT1 may be influenced by sexual hormones, which could play a role in modulating inflammation in allergic conditions.

Remotely Provided Open-Label Placebo Reduces Frequency of and Impairment by Allergic Symptoms.

OBJECTIVE: Placebos being prescribed with full honesty and disclosure (i.e., open-label placebo [OLP]) have been shown to reduce symptom burden in a variety of conditions. With regard to allergic rhinitis, previous research provided inconclusive evidence for the effects of OLP, possibly related to a separate focus on either symptom severity or symptom frequency. Overcoming this limitation of previous research, the present study aimed to examine the effects of OLP on both the severity and frequency of allergic symptoms. METHODS: In a randomized-controlled trial, patients with allergic rhinitis ( N = 74) were randomized to OLP or treatment as usual (TAU). Because of the COVID-19 pandemic, OLP was administered remotely in a virtual clinical encounter. Participants took placebo tablets for 14 days. The primary outcomes were the severity and frequency of allergic symptoms. The secondary end point was allergy-related impairment. RESULTS: OLP did not significantly improve symptom severity over TAU ( F (1,71) = 3.280, p = .074, η2 = 0.044) but did reduce symptom frequency ( F (1,71) = 7.272, p = .009, η2 = 0.093) and allergy-related impairment more than TAU ( F (1,71) = 6.445, p = .013, η2 = 0.083), reflecting medium to large effects. The use of other antiallergic medication did not influence the results. CONCLUSIONS: Although OLP was able to lower the frequency of allergic symptoms and allergy-related impairment substantially, its effects on symptom severity were weaker. The remote provision of OLP suggests that physical contact between patients and providers might not be necessary for OLP to work.

Major Depressive Disorder Enhances Th2 and Th17 Cytokines in Patients Suffering from Allergic Rhinitis and Asthma.

INTRODUCTION: Major depressive disorder (MDD) can impact the severity of allergic rhinitis (AR) and asthma (AA). Here, we evaluated the cytokine production by T-cells from AR and AA patients with or without MDD. The effect of serotonin on the in vitro T-cell response was also evaluated. METHODS: The cytokines produced by activated T-cells were measured by Luminex and flow cytometry. In some cell cultures, serotonin was added. RESULTS: MDD not only enhanced the production of Th2- and Th17-related cytokines, but also, the levels of interleukin (IL)-5 and IL-17 were directly correlated with the severity of depression and anxiety symptoms. As compared with AR, the levels of IL-17 were higher and the release of IL-10 was lower in activated T-cell cultures from AA patients, mainly those with MDD. In AA/MDD patients, the severity of anxiety symptoms and lung disease was directly correlated with Th17-like and hybrid Th2/Th17 cells, but inversely correlated with IL-10-secreting CD4+ T-cells. Finally, the addition of serotonin reduced the production of Th2- and Th17-related cytokines, but elevated IL-10 secretion in cell cultures from both AR and AA patients. CONCLUSIONS: Our findings suggest that not only the occurrence of MDD but also the severity of anxiety symptoms, may adversely affect the outcome of allergic reactions by favoring the production of cytokines implicated in the pathogenesis of AR and AA, a phenomenon that was attenuated by serotonin.

Analysis of patient factors associated with hospital visits for allergic rhinitis in Japanese adult patients: A cross-sectional study.

OBJECTIVE: Allergic rhinitis (AR) is one of the most common diseases in Japan. However, several AR patients do not seek optimal treatments at clinics/hospitals. This may affect the patient's quality of life and labor productivity. In this study, we assessed the characteristics of the outpatients' AR and factors associated with their hospital visit, using the dataset obtained from a nation-wide survey in Japan. METHODS: In this cross-sectional study, we used data from the nation-wide 2013 and 2016 Comprehensive Survey of Living Conditions (CSLC) in Japan. We analyzed the data of AR outpatients through logistic regression, using the outcome as the dependent variable, and age groups, sex, household size, educational status, smoking history, alcohol use, household expenditure, psychological distress, quality of sleep, asthma and atopic dermatitis outpatients as explanatory variables. RESULTS: Among the data of 317,984 outpatients aged between 20 and 79 years in 2016 CSLC survey, the proportion of AR outpatients was significantly less among current smokers (odds ratio (OR); 0.47, 95% confidence interval (CI); 0.43-0.51, P < 0.001) and those with large household sizes (OR; 0.80, 95% CI; 0.72-0.89, P < 0.001). Conversely, the proportion of AR outpatients was significantly more among subjects with a past smoking habit (OR; 1.19, 95% CI; 1.08-1.31, P < 0.001), insufficient sleep (OR; 2.93, 95% CI; 2.52-3.42, P < 0.001), psychological distress (OR; 1.71, 95% CI; 1.62-1.80, P < 0.001), high household expenditures (OR; 1.68, 95% CI; 1.56-1.80, P < 0.001), and asthma and atopic dermatitis outpatients (OR; 8.97, 95% CI; 8.13-9.89 P < 0.001 for asthma and OR; 7.61, 95% CI; 6.76-8.58 P < 0.001 for atopic dermatitis). We observed the same trend using the dataset of 2013 CLSC survey. CONCLUSION: This study revealed that smoking habit, psychological distress, insufficient sleep, high household expenditures and outpatients with other allergic diseases are the factors associated with AR outpatient visit.

Effectiveness and safety of ear acupuncture for allergic rhinitis: A protocol of randomized controlled trial.

BACKGROUND: Allergic rhinitis is a global problem. About 10% to 40% of the global population is affected by allergic rhinitis and is on the rise, which has a significant health and economic impact on society. Ear acupuncture is a non-invasive acupuncture therapy, which has been used in the treatment of allergic rhinitis, and some positive results have been reported, but there is not enough evidence to prove its efficacy and safety. METHODS: This is a single-center, randomized, single-blind, sham-controlled trial. With the approval of the ethics committee of our hospital, participants with allergic rhinitis will be randomly assigned to receive either real or sham ear acupuncture once a week for 8 weeks, followed by 12 weeks of follow-up. Evaluate the patient's nasal symptom score and Standardised Rhinoconjunctivitis Quality of Life Questionnaire score, and monitor adverse events. Finally, the data are analyzed by SPSS 22.0 software. DISCUSSION: The results of this study will determine the efficacy and safety of ear acupuncture in the treatment of allergic rhinitis and provide a basis for promoting the application of ear acupuncture in the treatment of allergic rhinitis. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/MVEF7.

The Degree of Stress in Patients With Empty Nose Syndrome, Compared With Chronic Rhinosinusitis and Allergic Rhinitis.

BACKGROUND: Depression is a mental health disease of growing public health concern because depressive mood affects the sufferer's daily life and is also associated with productivity decline. Depression that is caused by other diseases or substances is referred to as secondary depression, which is an important distinction because curing the underlying cause could subsequently regulate depressive mood. Empty nose syndrome (ENS), also known as "paradoxical obstruction of the nose," is a condition in which the major symptom is difficulty breathing, despite having sufficient breathing space in the nose. Empty nose syndrome has been increasing in prevalence in Korea. We found that patients with this ENS have a tendency toward depressive mood, which can escalate so far as to lead to suicide attempts. Thus, herein, we aimed to investigate the psychological burden on patients with ENS. METHODS: We divided patients into 4 groups: ENS (group A), chronic rhinosinusitis with polyp (CRS c polyp, group B), chronic rhinosinusitis without polyp (CRS s polyp, group C), and allergic rhinitis (AR, group D). We estimated and compared Beck Depression Inventory (BDI) scores among the 4 groups, and we investigated the relationship between depression index and nasal cavity area in patients with ENS. RESULTS: The ENS group (A) had depression prevalence of 71% with varying severity, which was much higher than group B (19%), group C (15%), and group D (27%). The correlation between nasal cavity volume and BDI score for the ENS group was not statistically significant. CONCLUSION: The degree and severity of depression in patients with ENS was higher than in patients with CRS or AR. Furthermore, there was no relationship between depression severity and nasal cavity volume in the patients with ENS. Thus, physicians should be careful not to dismiss the accompanying mental health problems of patients with ENS.

Multimorbidity in asthma, association with allergy, inflammatory markers and symptom burden, results from the Swedish GA2 LEN study.

BACKGROUND: Asthma is common worldwide and a large part of subjects with asthma have concomitant allergic multimorbidity in the form of rhinitis and/or eczema. OBJECTIVE: The aim of this study is to investigate whether the presence of allergic multimorbidity in asthma relates to allergic sensitization, allergic and respiratory symptoms, quality of life, inflammatory markers, lung function, use of medication and background factors. METHODS: A total of 437 asthmatics from the (GA2 LEN) cross-sectional survey in Sweden were grouped depending on the presence of rhinitis and/or eczema. The impact of allergic multimorbidity was assessed in terms of allergic sensitization, allergic and respiratory symptoms, quality of life, type-2 inflammatory markers (exhaled nitric oxide, eosinophil activation markers, periostin), lung function, use of medication and background factors. RESULTS: Subjects with asthma, rhinitis and eczema were more likely to be sensitized to seasonal allergens (67% vs 32%, P < .001), food allergens (54% vs 18%, P < .001) and to have a higher degree of sensitization than subjects with only asthma (23% vs 10%, P < .001). Subjects with allergic multimorbidity more often had allergic reactions to food (28% vs 10%, P = .002), more respiratory symptoms and anxiety/depression (40% vs, 14%, P < .001) than subjects with only asthma, despite having similar levels of type 2 inflammatory markers. Individuals with allergic multimorbidity were more likely to be diagnosed with asthma before the age of 12 (48% vs 27%, P = .016) and to have maternal heredity for allergy (53% vs 33%, P = .011) than subjects with only asthma. CONCLUSION AND CLINICAL RELEVANCE: Asthmatics with allergic multimorbidity are more likely to be sensitized to seasonal aeroallergens, food allergens and they have a higher degree of sensitization compared with those with only asthma. Allergic multimorbidity is associated with respiratory and allergy symptoms, anxiety and/or depression.

Improvement in Psychological Condition of Patients With Persistent Moderate-Severe Allergic Rhinitis by Drug Therapy Combined With Psychological Intervention.

OBJECTIVE: To investigate the effect of drug treatment combined with psychological intervention on mental disorders in patients with persistent moderate-severe allergic rhinitis. METHODS: Sixty patients with persistent moderate-severe allergic rhinitis who met the criteria were randomly divided into 2 groups: control group and experimental group. The control group was only given medication, whereas the experimental group was given psychological intervention on the basis of the same medication. Cognitive behavioral therapy was used for psychological intervention. After 12 weeks of treatment, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and rhinoconjunctivitis quality of life questionnaire (RQLQ) were used to evaluate the changes in anxiety, depression, and quality of life before and after treatment. RESULTS: The SAS and SDS scores of the control group after treatment were lower than those before treatment, and the difference was statistically significant. Similarly, the SAS and SDS scores of the experimental group after treatment were lower than those before treatment with statistically significant difference. In addition, after treatment, the SAS and SDS scores of the experimental group were statistically lower than those of the control group. The results of RQLQ showed that the scores of each dimension in the control group after treatment were lower than those before treatment, and the difference was statistically significant. Similar results were found in the experimental group. After treatment with these 2 different schemes, the RQLQ scores of sleep, nonnasal/eye symptoms, and emotion in the experimental group were statistically lower than those in the control group. CONCLUSION: Drug therapy or drug therapy combined with psychological intervention can alleviate anxiety and depression of patients with persistent moderate-severe allergic rhinitis and improve their quality of life. Moreover, based on the effect of improving mental disorder and quality of life of patients, drug therapy combined with psychological intervention is better than drug treatment alone.

Quality of life of patients undergoing specific allergen immunotherapy in allergic rhinitis.

INTRODUCTION: Although allergic diseases have been known since antiquity, both their understanding and systematics came later. The World Allergy Organization (WAO) defines the phenomenon of atopy as a predisposition of a person or family to the uncontrolled synthesis and release of IgE antibodies. Allergic rhinitis (AR) is one of the most important clinical diseases of rhinitis (NN, rhinitis). AR significantly reduces the quality of life, tends to increase, and its consequences may be life-threatening diseases. OBJECTIVE: The aim of the study is to determine the quality of life of patients who underwent specific allergen immunotherapy in allergic rhinitis. MATERIAL AND METHODS: The study was conducted at the Center for Specialist Allergology in Lublin between October 2018 - February 2019. The study covered a group of 157 patients. The diagnostic method used was a questionnaire. The first research tool was own questionnaire consisting of 31 questions. The second tool was the standardized questionnaire, the Polish version of the SF-36 Quality of Life Questionnaire. RESULTS: Studies have shown statistically significant changes in the symptoms of before and after immunotherapy, which means improving the quality of life and reducing the severity of symptoms and problems of respondents after therapy. The respondents were not in the best of health (50%). Over 50% of respondents said that the immunotherapy process significantly reduced personal / family expenses for treatment associated with allergic rhinitis. CONCLUSIONS: The conducted process of specific allergen immunotherapy improved the quality of life of respondents by increasing awareness of the quality of life through the prism of health change in relation to the general indicator in the area of mental problems by reducing their nuisance value more than in the area of somatic symptoms.

Efficacy of Montelukast in Allergic Rhinitis Treatment: A Systematic Review and Meta-Analysis.

BACKGROUND: In treating allergic rhinitis, montelukast has the potential to be used as an alternative or addition to an oral antihistamine or intranasal corticosteroid. OBJECTIVE: The objective of this systematic review was to assess the effectiveness of montelukast in treating allergic rhinitis. METHODS: An electronic literature search was performed using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from 1966 to 21 January 2019. The eligibility criteria were randomized controlled trials comparing montelukast with placebo or other standard treatments. The primary outcomes assessed were daytime nasal symptom score (DNS) and night-time nasal symptom score (NNS). The secondary outcomes assessed were composite nasal symptom score (CSS), daytime eyes symptom score (DES), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). The meta-analysis was conducted using Review Manager 5.3 software based on the random-effects model. RESULTS: Fifteen studies of 10387 participants met the inclusion criteria. Montelukast was more effective than placebo in improving DNS (mean difference [MD] - 0.12, 95% confidence interval [CI] - 0.15 to - 0.08; p < 0.001), NNS (MD - 0.09, 95% CI - 0.13 to - 0.05; p < 0.001), CSS (MD - 0.08, 95% CI - 0.11 to - 0.06; p < 0.001), DES (MD - 0.17, 95% CI - 0.33 to - 0.02; p < 0.030), and RQLQ (MD - 0.34, 95% CI - 0.49 to - 0.20; p < 0.001). Oral antihistamine was superior to montelukast in improving DNS (MD 0.08, 95% CI 0.03-0.13; p = 0.002), CSS (MD 0.03, 95% CI - 0.02 to 0.07; p = 0.27), DES (MD 0.06, 95% CI 0-0.12; p = 0.040), and RQLQ (MD 0.03, 95% CI - 0.05 to 0.12; p = 0.430). Montelukast was superior to oral antihistamine in improving NNS (MD -0.03, 95% CI - 0.08 to 0.03; p = 0.330). Intranasal fluticasone spray was superior to montelukast in improving DNS (MD 0.71, 95% CI 0.44-0.99; p < 0.001) and NNS (MD 0.63, 95% CI 0.29-0.97; p < 0.001). Combined montelukast and oral antihistamine was superior to oral antihistamine in improving DNS (MD - 0.15, 95% CI - 0.27 to - 0.03; p = 0.010), NNS (MD - 0.16, 95% CI - 0.28 to - 0.05; p = 0.006), CSS (MD - 0.12, 95% CI - 0.25 to - 0.01; p = 0.070), DES (MD - 0.12, 95% CI - 0.30 to 0.06; p = 0.180), and RQLQ (MD - 0.10, 95% CI - 0.28 to 0.08; p = 0.290). Combined montelukast and OAH was superior to montelukast in improving DNS (MD 0.15, 95% CI 0.08-0.21; p < 0.001), NNS (MD 0.05, 95% CI - 0.09 to 0.19; p = 0.510), CSS (MD 0.1, 95% CI 0.03-0.17; p = 0.007), DES (MD 0.18, 95% CI 0-0.36; p = 0.050), and RQLQ (MD 0.07 95% CI - 0.15 to 0.29; p = 0.530). CONCLUSIONS: Montelukast is more effective than placebo in treating the overall symptoms of allergic rhinitis while the combined therapy of montelukast and an oral antihistamine is superior to either montelukast or an oral antihistamine alone.

[Evaluation and analysis of anxiety, depression and quality of life in vasomotor rhinitis].

Objective: To evaluate the mental state and quality of life in patients with vasomotor rhinitis (VMR) before and after treatment, and to provide guidance for improving the overall health of VMR patients. Methods: Two hundred and twenty VMR patients (VMR group, 118 males, 102 females; aged from 18 to 72 years old), three hundred and twenty allergic rhinitis (AR) patients (AR group, 178 males, 142 females; aged from 18 to 79 years old) from January 2016 to September 2019 were selected in the otolaryngology clinic of Affiliated Hospital of Guizhou Medical University, four hundred and twenty-three healthy people (control group, 243 males, 180 females; aged from 19 to 70 years old) were selected in physical examination center at the same time by continuous enrollment method, symptom check list (SCL-90), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the mental state of VMR patients before and after treatment, and 12-item short form health survey version 2.0 (SF-12v2) was used to evaluate their quality of life, statistical data were collected and analyzed by ANOVA and t-test. Results: The scores of eight factors (physical function, role physical function, general health, vitality, role-emotional, mental health) of SF-12v2 in VMR patients before treatment were lower than that of posttreatment, that of AR patients and the control group, the differences were significant (all P<0.05), the scores of somatization, obsession, depression, anxiety and psychosis in SCL-90 in VMR patients before treatment were significantly higher than that of posttreatment, that of AR patients and the control group (all P<0.05), the SAS and SDS in VMR patients before treatment (51.28±16.32; 53.28±18.55) were significantly higher than that of posttreatment (38.53±13.21; 39.35±13.34), that of AR patients (42.23±14.32; 43.32±13.78) and the control group (29.78±10.07;33.46±10.55; t(SAS) were 9.007, 6.813 and 20.59; t(SDS) were 9.043, 7.154 and 17.260, all P<0.05). Conclusion: VMR patients generally suffer from psychological damage, which seriously affects the quality of life of the patients. On the basis of routine treatment, we should attach more importance to the negative psychology of VMR patients and intervene when necessary.

Perception and control of allergic rhinitis in primary care.

Perception of a chronic illness is a driver of patient behaviour that may impact treatment outcomes. The cross-sectional PETRA study was designed to describe the links between disease perception, patient behaviour and treatment outcomes in adults with allergic rhinitis (AR). Overall, 687 French general practitioners (GPs) included 1929 analysable patients (mean age: 39 years; intermittent/persistent symptoms: 46.2/52.3%). Of the patients, 14.1% had also been diagnosed with asthma; 71.7% had uncontrolled AR (ARCT score < 20), and 53.6% had a good perception of their illness (BIPQ score < 5). Factors significantly associated with poor perception of AR were ENT (ear/nose/throat) complications, nasal pruritus, uncontrolled AR and asthma. A strong negative correlation was observed between the BIPQ and ARCT scores: the poorer the patient's perception, the less the AR was controlled. Although no causal relationship could be drawn, GP-driven improvement of AR perception could lead to better control of symptoms.

Effectiveness and safety of indirect moxibustion for the treatment of allergic rhinitis: A protocol for systematic review and meta-analysis of RCTs.

BACKGROUND: Allergic rhinitis (AR) is a common allergic disorder worldwide. Western medicine is not optimistic about the therapeutic effect of this disease. However, moxibustion can enhance vital energy or immunity through a great number of clinical trials. Thus, the aim of this systematic review and meta-analysis is to systematically evaluate the effectiveness and safety of indirect moxibustion for treating AR. METHODS: We will conduct a comprehensive literature search in Medline, PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure Database, WanFang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database from inception to August 2020 without any language restriction. In addition, we will retrieve the unpublished studies and the references of initially included literature manually. Reviewers will identify studies, extract data, and assess the quality independently. The outcomes of interest include: total effective rate, total nasal symptom score, total non-nasal symptom score, rhinitis quality of life questionnaire, visual analog scale, laboratory indicators (i.e., serum levels of IgE, IgA, or IgG), and adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Meta-analysis will be performed using RevMan 5.3.0 software. The heterogeneity test will be conducted between the studies, and P < .1 and I > 50% are the thresholds for the tests. We will utilize the fixed effects model or the random effects model according to the size of heterogeneity. RESULTS: Because the review is ongoing, no results can be reported. CONCLUSIONS: The results of this review will provide reliable evidence for effectiveness and safety of indirect moxibustion for treating AR. ETHICS AND DISSEMINATION: Ethical approval is not required for this study. This systematic review and meta-analysis will be disseminated online and on paper to help guide clinicians. PROSPERO REGISTRATION NUMBER: CRD42019140944.

Evaluation of a possible association between allergic rhinitis and depression, suicidal ideation, and suicide attempts among adolescents based on a nationwide cross-sectional study.

OBJECTIVE: We assessed associated factors for depression and suicidality among adolescents with allergic rhinitis (AR) by analyzing data from annual Korea Youth Risk Behavior Web-based Surveys (KYRBSs) completed from 2007 to 2017. METHODS: Data from the KYRBS were obtained from a stratified, multistage, clustered sample. Using self-reported questionnaires, students provided yes-or-no answers to questions addressing their doctor-diagnosed AR and self-experienced depression, suicidal ideation and suicide attempts. Associated factors for depression and suicidality were identified by logistic regression models after controlling for potential confounding factors. A total of 818,684 adolescents were targeted, and 788,411 adolescents completed the survey. RESULTS: An AR diagnosis was reported in 30.8% of respondents. Among respondents with AR, 34.5%, 18.4%, and 4.2% reported depression, suicidal ideation, and suicide attempts, respectively. Adolescents with AR were significantly more likely to have negative mental health status, including suicidality than adolescents without AR. After multiple logistic regression analyses, perception of stress was most strongly associated with depression and suicidal ideation (adjusted odds ratio: 5.16 [95% confidence interval; 5.04-5.28], 4.81 [4.65-4.98], respectively). For suicide attempts, subjective unhappiness was most strongly associated (3.63 [3.47-3.79]) among adolescents with AR. Presence of AR itself was also associated with depression and suicidality (1.10 [1.08-1.11], 1.08 [1.06-1.10], 1.05 [1.01-1.08], respectively). CONCLUSION: Adolescents with AR had significantly greater prevalence of depression and suicidality. Multidisciplinary team approaches, including psychological support, may be needed to prevent suicide among adolescents with AR, especially those with identifiable risk factors.

Quality of life in allergic rhinitis - children's and their parents' perspective in polish urban and rural population.

BACKGROUND: Allergic rhinitis is a common chronic condition in the paediatric population. No reports regarding the quality of life in children with allergic rhinitis in the Polish population have been found in the available literature. The aim of this study was to assess and compare the quality of life in patients with allergic rhinitis reported by children and their parents living in a city and in rural areas, and to evaluate the possible relationships between the quality of life and the severity of symptoms. METHODS: Two hundred and eight children with allergic rhinitis participated in the study (89 girls, aged 6-17, mean age 11.7 ± 3). Children were asked to evaluate their rhinitis symptoms by using two scales: the Total 4 Symptom Score and the Visual Analogue Scale. The quality of life assessment included the KINDL-R questionnaire. RESULTS: Both for the T4SS and the VAS scale the severity of symptoms in children with seasonal rhinitis was significantly higher than in children allergic to perennial allergens. The quality of life total scores on the KINDL questionnaire was 45.6 ± 8.5 for the children and 73.7 ± 10.7 for the parents. In all the domains, except for physical health, the child's quality of life was rated significantly higher by parents than by children. The biggest discrepancy occurred in the domains: social contacts and family. CONCLUSIONS: Allergic rhinitis can disrupt the quality of life. Parents tend to overestimate their children's quality of life comparing to the children's own assessment. The quality of life in children with allergic rhinitis correlated with the severity of the clinical symptoms of the disease. Evaluation of the quality of life in children is an essential issue in clinical investigation of patients with allergic rhinitis. It is of great importance to ask children themselves about their quality of life than rely only on parental opinion.

Cognitive and Quality of Life-Related Burdens of Illness in Pediatric Allergic Airway Disease.

OBJECTIVE: To analyze the prevalence of pediatric allergic airway disease (PAA) and recognize its impact on cognitive function, childhood activities, use of early intervention, and missed school days. STUDY DESIGN: Cross-sectional analysis of National Health Interview Survey (NHIS), 2014 to 2017. SETTING: US households. SUBJECTS AND METHODS: An NHIS survey of US children and responding caregivers was analyzed to determine the prevalence of PAA, including allergic rhinitis and allergic asthma. Associations were determined between the presence of PAA and activities limited by difficulty remembering, limitation in the amount of childhood play, use of special education/early intervention, and number of missed school days in the past 12 months. Multivariate analysis was used to adjust for age, sex, race, ethnicity, and income level. RESULTS: An estimated 11.1 million (10.6-11.6 million, 95% confidence interval) children (mean age, 9.9 years; 56.9% male) reported a diagnosis of PAA (15.1% [14.6-15.6%]). Children with PAA missed 4.0 (3.7-4.4) school days per year vs 2.2 (2.1-2.4) days for those without PAA (P < .001, adjusted). PAA was associated with limited daily activities due to difficulty with memory (odds ratio, 1.8 [1.2-2.9]), limitations in childhood play (3.2 [2.2-4.7]), and need for special education/early intervention services (1.6 [1.4-1.8]) after adjusting for age, sex, race, ethnicity, and income level. CONCLUSION: PAA is a common condition and is associated with declines in cognitive function and school attendance as well as increased use of special education/early intervention. Given the significant prevalence and burden of illness of PAA, further attention is needed to ensure timely diagnosis and treatment.

Efficacy and safety of two Ayurvedic dosage forms for allergic rhinitis: Study protocol for an open-label randomized controlled trial.

BACKGROUND: Allergic rhinitis (AR) is an immune response of the nasal mucosa to airborne allergens and involves nasal congestion, watery nasal discharge, itching of the nose, and sneezing. The symptoms of allergic rhinitis may significantly affect a patient's quality of life and can be associated with conditions such as fatigue, headache, cognitive impairment, and sleep disturbances. Various complementary and alternative medicine treatments have been used for this condition in clinical practice. The Ayurveda system of medicine is the most common complementary medicine system practiced in Sri Lanka. The aim of this study is to examine the efficacy and safety of a decoction used in traditional Ayurveda for allergic rhinitis and its ready- to-use freeze dried formulation in comparison to an antihistamine over a period of 4 weeks on relief of symptoms in allergic rhinitis. STUDY DESIGN: This is a three-arm, open-label, non-inferiority, randomized controlled clinical trial enrolling patients with AR. Tamalakyadi decoction containing 12 ingredients (TMD12), used in traditional Ayurveda and its freeze-dried formulation are the test products. The efficacy and safety of the two Ayurvedic dosage forms will be tested against the antihistamine loratadine. Patients with symptoms of AR will be allocated randomly into the three arms after a 1-week run-in period and the medications will be given orally for 28 days. Total Nasal symptom Score (TNSS) of the patients will be used as the primary efficacy endpoint. TNSS will be recorded and compared between the three arms prior to visit 1, at the end of 28 days, and end of the first and second months of follow-up. Symptom scores of daytime nasal symptoms, night time nasal symptoms, non-nasal symptoms and health-related quality of life questionnaire are used as secondary end points. DISCUSSION: This clinical trial will be able to provide evidence-based scientific data on Ayurvedic dosage form, TMD12, and the freeze-dried formulation in the treatment of allergic rhinitis. This trial is expected to develop capacity to scientifically evaluate various Ayurvedic treatments that are claimed to have efficacy in treatment of various disease conditions. TRIAL REGISTRATION: ISRCTN18149439 (6 May 2019).

Effect of parenting stress, self-esteem and parent-child interaction in parents of children with allergic rhinitis on self-esteem of children: Analysis of Actor-partner Interdependence Model.

AIM: It is important to focus on the early identification of factors that promote children's self-esteem, to foster the healthy development of children with allergic rhinitis. This study aimed to identify the effects of parents' parenting stress, self-esteem, and parent-child interaction on the self-esteem of children with allergic rhinitis. METHODS: Structural equation modeling was used to verify the conceptual model. This study was conducted on 656 children with symptoms of allergic rhinitis and their parents who participated in the 8th Panel Study on Korean Children (PSKC). Data collection involved a questionnaire on parents' parenting stress, self-esteem, parent-child interaction and self-esteem of children. Secondary data from the PSKC were analyzed using Actor-partner Interdependence Model. Data were analyzed using SPSS-WIN Version 20.0 and AMOS Version 20.0. RESULTS: In the high self-esteem group, the father's parenting stress had a partner effect on the mother's self-esteem, while the mother's self-esteem affected her parent-child interaction, which in turn affected the child's self-esteem. In the low self-esteem group, the father's parenting stress affected the mother's self-esteem, the father's self-esteem had a partner effect on the mother's parent-child interaction, and the mother's self-esteem had an indirect effect on the child's self-esteem. CONCLUSIONS: This study was conducted to provide basic data to help understand the interactions among variables related to the self-esteem of children with allergic rhinitis. The findings indicate that the model has utility in developing effective nursing intervention to promote self-esteem of children with allergic rhinitis.