A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023.

An updated edition of the International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has recently been published. This consensus document, which included the participation of 87 primary authors and 40 additional consultant authors, who critically appraised evidence on 144 individual topics concerning allergic rhinitis, provides guidance for health care providers using the evidence-based review with recommendations (EBRR) methodology. This synopsis highlights topical areas including pathophysiology, epidemiology, disease burden, risk and protective factors, evaluation and diagnosis, aeroallergen avoidance and environmental controls, single and combination pharmacotherapy options, allergen immunotherapy (subcutaneous, sublingual, rush, cluster), pediatric considerations, alternative and emerging therapies, and unmet needs. Based on the EBRR methodology, ICAR:AR includes strong recommendations for the treatment of allergic rhinitis: (1) for the use of newer generation antihistamines compared with first-generation alternatives, intranasal corticosteroid, intranasal saline, combination therapy with intranasal corticosteroid plus intranasal antihistamine for patients not responding to monotherapy, and subcutaneous immunotherapy and sublingual tablet immunotherapy in properly selected patients; (2) against the use of oral decongestant monotherapy and routine use of oral corticosteroids.

Prevalence of self-reported smoking experimentation in adolescents with asthma or allergic rhinitis / Prevalência do relato de experimentação de cigarro em adolescentes com asma e rinite alérgica

Objective: To determine the prevalence of smoking experimentation among adolescents with asthma or allergic rhinitis. Methods: This was a cross-sectional study involving adolescent students (13-14 years of age) in the city of Belo Horizonte, Brazil. The participants completed the Centers for Disease Control and Prevention and International Study of Asthma and Allergies in Childhood questionnaires, both of which have been validated for use in Brazil. We calculated the prevalence of smoking experimentation in the sample as a whole, among the students with asthma symptoms, and among the students with allergic rhinitis symptoms, as well as in subgroups according to gender and age at smoking experimentation. Results: The sample comprised 3,325 adolescent students. No statistically significant differences were found regarding gender or age. In the sample as a whole, the prevalence of smoking experimentation was 9.6%. The mean age for smoking experimentation for the first time was 11.1 years of age (range, 5-14 years). Among the adolescents with asthma symptoms and among those with allergic rhinitis symptoms, the prevalence of self-reported smoking experimentation was 13.5% and 10.6%, respectively. Conclusions: The proportion of adolescents with symptoms of asthma or allergic rhinitis who reported smoking experimentation is a cause for concern, because there is strong evidence that active smoking is a risk factor for the occurrence and increased severity of allergic diseases.

Objetivo: Avaliar a prevalência da experimentação de cigarro em adolescentes com asma ou de rinite alérgica. Métodos: Estudo transversal envolvendo escolares com 13-14 anos de idade na cidade de Belo Horizonte (MG). Os escolares preencheram os questionários do Centers for Disease Control and Prevention e do International Study of Asthma and Allergies in Childhood, ambos validados para uso no Brasil. Foram calculadas as prevalências de experimentação de cigarro na população geral estudada, naqueles com sintomas de asma ou de rinite alérgica e nos subgrupos em relação ao gênero e à idade da experimentação. Resultados: A amostra foi constituída por 3.325 adolescentes. Não houve diferenças estatisticamente significativas em relação ao gênero e a idade dos participantes. Na amostra geral, a prevalência da experimentação de cigarro foi de 9,6%. A média de idade da experimentação de cigarro pela primeira vez foi de 11,1 anos (variação, 5-14 anos). Nos adolescentes com sintomas de asma e de rinite alérgica, a prevalência autorrelatada de experimentação de cigarro foi de 13,5% e 10,6%, respectivamente. Conclusões: A proporção de adolescentes com asma ou rinite alérgica que relataram ter experimentado cigarro é preocupante, visto que há fortes evidências de que o tabagismo ativo é um fator de risco para a ocorrência e maior gravidade de doenças alérgicas.

Temporal trends in the prevalence of asthma and rhinoconjunctivitis in adolescents / Evolução temporal na prevalência de asma e rinoconjuntivite em adolescentes

ABSTRACT OBJECTIVE To analyze the temporal trend of asthma and rhinoconjunctivitis prevalences as well as their symptoms in adolescents. METHODS Two cross-sectional studies were conducted using the same methodology and questionnaire as was used for adolescents aged 12 to 14 years in the Brazilian city of Florianopolis, SC, Southern Brazil. Based on the international protocol of the International Study of Asthma and Allergies in Childhood (ISAAC) study, adolescents were evaluated in 2001 and 3,150 in 2012. The schools included in this study were the same as in the 2001 study. These schools were randomly selected after stratification by network (public and private) and geographic location. The total average percentage variation was estimated for the prevalence of asthma and rhinoconjunctivitis and their symptoms. RESULTS The prevalence of reported asthma was 10.9% in 2001 and 14.8% in 2012, with an average variation of 2.8% in the period. The highest average variation in the period was observed among female adolescents (4.1%). In parallel a significant increase occurred in reported physician-diagnosed asthma, 7.3% in 2001 and 11,1% in 2012, with an annual variation of 4.5%. The largest increases in reported physician-diagnosed asthma were seen in female (5.9%) and male (4.5%) public school pupils. In addition, a significant increase in reported rhinoconjunctivitis occurred, with the average variation in the period being 5.2%. Reports of severe asthma symptoms remained unchanged during the period, while the annual variation for reported current wheezing (-1.3%) and wheezing during exercise (-1.2%) decreased. CONCLUSIONS The results showed a significant increase in the annual average variation for asthma and rhinoconjunctivitis prevalence during the 2001 to 2012 period.

RESUMO OBJETIVO Analisar a tendência temporal da prevalência de asma e de rinoconjuntivite e seus sintomas em adolescentes. MÉTODOS Foram realizados dois estudos transversais utilizando a mesma metodologia e o mesmo questionário em adolescentes de 12 a 14 anos em Florianópolis, SC. Fundamentado no protocolo internacional do estudo International Study of Asthma and Allergies in Childhood (ISAAC), foram avaliados 4.114 adolescentes em 2001 e 3.150 em 2012. As escolas estudadas foram as mesmas de estudo anterior de 2001, selecionadas aleatoriamente após estratificação por rede (pública e privada) e por localização geográfica. A variação percentual anual média total foi estimada para a prevalência de asma e seus sintomas e para rinoconjuntivite. RESULTADOS A prevalência de relato de asma foi de 10,9% em 2001 e de 14,8% em 2012, com variação média no período de 2,8%. A maior variação média no período ocorreu entre os adolescentes do sexo feminino (4,1%). Houve aumento significativo no relato de diagnóstico médico de asma, de 7,3% em 2001 para 11,1% em 2012, com variação anual de 4,5%. Os maiores aumentos no relato de diagnóstico médico de asma ocorreram em alunos do sexo feminino (5,9%) e masculino (4,5%) da rede pública. Houve incremento expressivo no relato de rinoconjuntivite, com variação média no período de 5,2%. O relato de sintomas de asma grave permaneceu inalterado e houve decréscimo na variação anual no período no relato de sibilos atuais (-1,3%) e de sibilos aos exercícios (-1,2%). CONCLUSÕES Os resultados mostraram incremento significativo na variação anual média da prevalência de asma e de rinoconjuntivite no período de 2001 a 2012.