Current practice of allergy diagnosis and the potential impact of regulation in Europe.

In the European Union (EU), the regulatory framework regarding diagnostic allergen extracts is currently in the process of being implemented at the national level. Due to these regulations, the initial and periodic renewal expenses for the registration of diagnostic allergen extracts may render extract production unprofitable. Consequently, many extracts may be at risk of removal from the market. The current survey, which was conducted by a task force of the European Academy of Allergy and Clinical Immunology, aimed to assess the current practice of allergy diagnosis in Europe. This survey revealed that skin tests continue to be the main diagnostic procedure and are used as the first option in almost two-third of all types of allergic diseases and in 90% of individuals suffering from respiratory allergies. Therefore, there is a need to ensure the availability of high-quality allergen extracts to maintain the common diagnostic procedures used by EU professionals. To reach this goal, it is necessary to align efforts and establish active partnerships between manufacturers, relevant scientific societies, consumer organizations and authorities to maintain the availability of these diagnostic tools.

Allergic rhinitis: can we identify nonadherence to therapy and its predictors easily in daily practice?

BACKGROUND: Allergic rhinitis (AR) is a common chronic condition with significant consequences if left untreated (e.g., poor health outcomes, disease progression, and increased health care costs). However, about half of all patients do not fill their prescription.The factors associated with adherence are complex, and many remain poorly defined and understood. OBJECTIVES: This pilot study had 2 objectives. First, to determine whether the medication adherence report scale (MARS) can be applied to identify adherence/nonadherence in patients with AR using patients with chronic obstructive pulmonary disease (COPD) as controls. Second, to identify AR profiles that indicate a particularly high risk of nonadherence. METHODS: AR patients completed the Eysenck Personality Questionnaire-Revised Abbreviated-Form (EPQR-A), the Short Form 36 Health Survey (SF-36), the Mini Rhinitis Quality of Life Questionnaire (Mini-RQLQ), and the MARS. Symptom severity was assessed before and after treatment. RESULTS: The study population comprised 85 AR patients and 50 COPD patients. Females had worse adherence (significant only in total and unintentional scores) and higher extraversion scores. None of the personality traits predicted adherence. Neuroticism was negatively correlated with the SF-36 score (P < .001). A low to moderate correlation was observed between posttreatment improvement in specific/ generic health-related quality of life and MARS scores in AR patients (P = .002, r = 0.332; and P = .022, r = -0.251; respectively). Higher educational level was found to significantly increase adherence (P = .01, r = 0.223). CONCLUSIONS: Our study did not reveal a personality effect. However, it did suggest that use of a brief, self-completed medication adherence questionnaire in daily practice can enable health professionals to identify suboptimal adherence in patients who would benefit from close follow-up.

Evaluation of quality of life: impact of allergic rhinitis on asthma.

BACKGROUND: Health-related quality of Life (HRQOL) has been considered an important variable to be managed in airway diseases. Allergy and asthma can reduce HRQOL as a result of profound physical and psychosocial complications. Most patients with asthma also suffer from rhinitis, which also impairs quality of life. However, the impact of allergic rhinitis on asthmatic patients has not been investigated. OBJECTIVE: Our objective was to evaluate HRQOL in patients with asthma alone, allergic rhinitis alone, or both diseases. METHODS: We compared HRQOL in 316 patients with both diseases or either asthma or rhinitis using the Short Form-36 questionnaire. Data were also collected on patients' sociodemographic characteristics, atopic state, body mass index (BMI), and education. RESULTS: A total of 232 patients with allergic rhinitis, 40 with asthma, and 44 with both diseases were enrolled. The mean (SD) age was 32 (13) years and 65% were females. HRQL was significantly lower in patients with asthma, with or without rhinitis, than in those with allergic rhinitis alone. Female sex, older age, increased BMI and less educational status were found to be the major determinants of impaired quality of life in patients with allergic rhinitis or asthma. CONCLUSIONS: The impact of rhinitis on asthma seems to play a minor role in HRQOL.

Prevalence of latex sensitivity among patients with chronic renal failure: a new risk group?

Latex has been documented as causing immediate hypersensitivity reactions in forms ranging from contact urticaria to severe anaphylaxis. The prevalence of latex allergy appears to be higher in certain risk groups as a result of increased exposure or an increased intrinsic predilection for atopy. The purpose of the present study was to assess latex sensitivity in a large group of patients who are undergoing regular dialysis because of chronic renal failure (CRF) and to evaluate the relationship between latex sensitivity and skin prick test (SPT) responses to fruit allergens. Of the 268 patients tested, 3 subjects (1.1%) were found to have latex sensitivity via SPT. Although atopy was not demonstrated in any SPT positive subjects, there appears to be a considerable degree of crossreactivity between latex and certain fruit allergens which can be suggested as one subtext in the SPT positive patients. In conclusion, CRF patients with no history of hypersensitivity reactions should not be considered at risk for developing latex sensitization despite their frequent exposure.

Bronchial hyperreactivity and immunoglobulin E in Behçet's disease.

Behçet's disease in a multisystem panvasculitis of unknown etiology. Pulmonary manifestations are rare, and there is no specific test to establish the inflammation for the precise differentiation between the active and inactive cases. Bronchial hyperreactivity (BHR) measured by methacholine challenge test and serum total IgE concentrations were investigated in 31 patients who were followed at Behçet's Center in hospital clinic and ten healthy controls. The patients studied had no evidence of neither any pulmonary disease-both allergic and nonallergic-nor family history of atopy. In 14 patients (45.16%) with active lesions mean IgE levels were higher than inactive group, 156.43 +/- 381.14 kU/L and 94.42 +/- 147.55 kU/L respectively (p > 0.05). We found high total IgE levels in eight patients (25.81%) with BD, though they were unrelated to disease activity. In our study, BHR related with Behçet's chronicity were also found to be positive in eight patients (25.81%). Mean time elapsed since the first diagnosis of the disease in patients with positive BHR was (11.13 +/- 3.72 years) significantly longer than inactive group (7.10 +/- 4.49 years) (p < 0.05). No correlation was found between BHR and serum IgE levels in patients with clinical symptoms. Therefore, we suggest that BHR may probably reflects nonspecific inflammation which is seen in BD, but cannot be regarded as a specific marker.

Effect of pretreatment with heparin on pulmonary and cutaneous response.

Although anticoagulant properties of glycosaminoglycan heparin are primary in medicine, a variety of other biological functions related to heparin have been suggested. Since heparin is a selective inhibitor of inositol triphosphate (IP3) receptors that are involved in release of calcium in mast cells and many other cells, it is possible that heparin may act as a natural anti-inflammatory molecule and modify these reactions. Therefore, the purpose of the present study was to determine the role of heparin in allergic inflammatory responses: the pulmonary reaction and the cutaneous response, in a double-blind, placebo-controlled, crossover randomized trial. To evaluate the effect of heparin on methacholine-induced bronchoconstriction, nebulized heparin (20,000 units) was administered to 12 asthmatics and nonspecific challenge was performed immediately thereafter. Measurements of Raw and SGaw were obtained before and 1 hr after nebulization of heparin. In 12 other allergic subjects, heparin (25 U/kg) was given intravenously 10 min before skin prick test. We demonstrated that pretreatment with heparin reduced skin test reactivity from 24.06 +/- 1.2 mm to 18.26 +/- 2.27 mm and increased the methacholine PC20 value from 1.69 +/- 0.48 mg/ml to 8.14 +/- 3.11 mg/ml (p < 0.05), but did not prevent an increase in Raw and/or a decrease in SGaw. Heparin modified the methacholine-induced bronchoconstrictor response, but this did not reflect a protective effect in airway resistance and specific conductance. These data suggest that anti-inflammatory effects of heparin are time-dependent and/or that heparin may have a transient inhibitory role in allergic reactions.

House dust mite fauna in Turkey.

Storage and house dust mites (HDM) appear to be important allergen sources in sensitive patients. The acarofauna of dust samples collected from 133 homes located in five regions of Anatolia with different weather conditions were evaluated. HDM and/or storage mites were found in 32 samples. Twenty of them were identified as containing D. pteronyssinus and D. farinae, and 21 had storage mites. Lepidoglyphus destructor and Gamasidae were the most frequently found, followed by Cheyletus eraditus, Glycyphagidae and Acaridae, Tydeus interruptus and Glycyphagus domesticus, Gohieria fusca and Cryptostigmata. The presence of mite species seemed to be related to the climate, and particularly to humidity. Therefore, mites in samples obtained from the northern Anatolia region were found at higher rates. The data is consistent with the fact that allergic patients in Turkey have significant exposure to HDM, and a variety of storage mites may be clinically important as well. Because of the partial cross-reactivity between D. pteronyssinus and storage mites, we conclude that in Turkey, storage mites should be included in standard skin testing when allergic asthma and/or rhinoconjunctivitis is suspected.

The effectiveness of benzyl benzoate and different chemicals as acaricides.

Several observations have indicated that house-dust mites (HDM) play an important role in allergic diseases. Thus, the primary form of treatment should aim at reducing exposure to HDM for these patients. Allergen-avoidance measures in homes have been demonstrated to be beneficial in decreasing the risk of sensitization, severity of symptoms, bronchial reactivity, and basophil sensitivity. Various chemical methods, as well as physical measures, have been tried to eliminate mite allergens from house dust. However, none have gained wide acceptance because of the lack of effectiveness and safety, and the high cost. It is clear that new approaches are required for effective long-term control of HDM allergens. This study compared the acaricidal activities of phenyl salicylate, tea leaf extract (high tannic acid content), and essential oils (eucalyptus and laurel) with that of benzyl benzoate. The contact, short-duration persistence, and residual effects of various concentrations of these chemicals and benzyl benzoate were assessed in laboratory conditions with specially designed wells. Our data suggest that benzyl benzoate may not be effective when applied according to the manufacturer's instructions, but may be effective when applied more frequently (i.e., three to four times a year) and for longer periods (up to 24 h) even with lower concentrations (0.4%). Essential oils were shown to have little acaricidal activity, but virtually no effect was observed with tea. Among the chemicals used, phenyl salicylate seems to be promising as an alternative acaricide.