Una plaga citadina peligrosa: los murciélagos / A dangerous urban pest: bats

Los murciélagos son mamíferos vertebrados presentes en la Ciudad de Buenos Aires, estimándose una población de 4 animales por habitante. Son portadores de varias enfermedades importantes y además empeoran las condiciones respiratorias de enfermos crónicos. En el campo cumplen una interesante función, ya que se alimentan de insectos perjudiciales para las siembras. El guano puede ser útil en el abono de la tierra debido al aporte de carbono y nitrógeno. En las ciudades su presencia tiene consecuencias diferentes. Se encuentran en los taparrollos de las habitaciones, así como también en todas las oquedades de muros, árboles, grietas, etc. Se exponen aquí los peligros y los cuidados que deben tenerse en la Ciudad de Buenos Aires ante la invasión de estos quirópteros. (AU)

Bats are vertebrate mammals present in the City of Buenos Aires, with an estimated population of 4 animals per inhabitant. They are carriers of several important diseases and also worsen the respiratory conditions of the chronically ill. In rural areas they fulfill an interesting function, since they feed on insects harmful to crops. Guano can be useful in soil fertilization due to its contribution of carbon and nitrogen. In cities their presence has different consequences. They are found in the roll covers of the rooms as well as in all the hollows of walls, trees, cracks, etc. The dangers and precautions to be taken in the city of Buenos Aires in the face of the invasion of these chiroptera are described here. (AU)

Sensitisation to House Dust Mite Component Der p 23 Is Associated with Severe Symptoms and Asthma in Allergic Rhinitis Patients.

INTRODUCTION: House dust mite (HDM) is an important source of airborne allergens in China as it contains several allergenic components that can cause allergic rhinitis (AR) and other allergic diseases. This study aimed to determine the clinical characteristics and disease severity in AR patients sensitised to different allergenic HDM components. METHODS: This was a retrospective study, which examined 129 patients who were first diagnosed with only HDM-induced AR at the Department of Allergy of Beijing Tongren Hospital from December 2019 to April 2021. Clinical characteristics and disease severity of the patients were assessed based on the sensitisation to specific Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f) allergenic components, including Der p 1, Der p 2, Der p 23, Der f 1, and Der f 2, employing multiple correspondence analysis (MCA) with correspondence analysis chart of MCA. RESULTS: Among HDM-induced AR cases, the positive rate of Der p 1 was the highest (87.6%), followed by Der p 2 (78.3%), Der f 2 (76.64%), Der f 1 (68.2%), and Der p 23 (37.2%). Multiple correspondence analyses showed that sensitisation to Der p 23 was associated with severe AR symptoms and asthma; sensitisation to Der p 2, Der f 1, and Der f 2 was associated with moderate AR; and no sensitisation to Der p 23 was associated with mild AR. CONCLUSION: Der p 23 sensitisation is prevalent in northern China and may be associated with severe symptoms and asthma in AR patients.

Triamcinolone Acetonide in the Treatment of Perennial Allergic Rhinitis: A post hoc Analysis of Quality of Life during a Phase III Study.

INTRODUCTION: Allergic rhinitis (AR) is a disease that affects ≤24% of people in Russia, significantly impairing quality of life (QoL). Intranasal corticosteroids, such as triamcinolone acetonide (TAA), are considered effective drugs for treatment. A post hoc analysis of data (phase III NASANIF trial) examined weekly QoL changes in patients receiving TAA for the treatment of perennial AR (PAR). METHODS: NASANIF (NCT03317015) was a double-blind, parallel group, multicenter, prospective, noninferiority, phase III clinical trial. Patients with PAR were randomized (1:1) to receive TAA or fluticasone propionate (FP) for 4 weeks. Here, a post hoc analysis measures QoL using a shortened Rhinoconjunctivitis Quality of Life Questionnaire (miniRQLQ). Differences in miniRQLQ score were evaluated using a mixed linear model and descriptive statistics. A subgroup analysis was performed in patients with a previous diagnosis of allergic conjunctivitis. RESULTS: Of 260 patients eligible for randomization, 128 each completed treatment with TAA or FP. Overall and individual domain scores progressively improved and were significantly different versus baseline at week 4 in both treatment groups: LS mean difference TAA: -30.92 (95% CI [-33.01 to -28.83]), p < 0.001, and FP: -31.13 (-33.23 to -29.04), p < 0.001. In both arms of the subgroup, there was a significant reduction in eye symptoms. There was no significant difference between the TAA and FP treatment groups in any analyses. CONCLUSIONS: TAA is effective in improving overall and individual domains of QoL in patients with PAR, over 4 weeks. Patients with a previous diagnosis of allergic conjunctivitis experienced significant improvements in QoL related to the resolution of these symptoms.

Triamcinolone Acetonide in the Treatment of Perennial Allergic Rhinitis: A post hoc Efficacy Analysis of a Phase III Study Performed in Russia.

INTRODUCTION: Allergic rhinitis (AR) is a disease which affects >24% of the population in Russia. Triamcinolone acetonide (TAA) is a corticosteroid used for treating AR. This post hoc analysis assesses the efficacy of intranasal TAA in improving perennial AR (PAR) symptom scores over 4 weeks. METHODS: NASANIF (NCT03317015) was a double-blind, parallel-group, multicenter, prospective, non-inferiority, phase III clinical trial in which patients with PAR were randomized (1:1) to receive TAA or fluticasone propionate (FP) over 4 weeks. Our post hoc analysis evaluates weekly change in PAR symptoms using the reflective Total Nasal Symptom Score (rTNSS), overall and for individual symptoms (sneezing, nasal itching, rhinorrhoea, and nasal obstruction). Proportion of patients and time to achieve a ≥50 or ≥75% reduction in rTNSS were assessed. For rTNSS endpoints, a linear mixed-model methodology was used; for time-to-event endpoints, cumulative incidence functions were estimated using the Kaplan-Meier method, in the per-protocol population. RESULTS: Of 260 patients, 128 each completed the study and were randomized to receive TAA or FP. From baseline to week 4, the changes in total rTNSS were -7.78 (95% CI: -8.1701 to -7.3967; p < 0.001) and -7.52 (-7.9053 to -7.1320; p < 0.001) for TAA and FP, respectively. Individual symptoms improved significantly from baseline. The proportion of patients achieving ≥50 and ≥75% reductions in total rTNSS was 88.0 and 67.2%, respectively in the TAA group. No significant differences were observed between the TAA and FP in any analyses. CONCLUSIONS: TAA produced effective and prolonged improvement of PAR symptoms over a 4-week treatment period.

Gene Expression Analysis by Real-Time PCR in Nasal Brushings of Adult Patients with Allergic Rhinitis, Suspected Allergic Rhinitis, and Nonallergic Rhinitis.

BACKGROUND: Epithelial gene expression in allergic rhinitis patients has been evaluated by microarray. However, gene expression in patients with nonallergic rhinitis and suspected allergic rhinitis who reported allergen-related nasal symptoms but presented a negative atopic test was unknown. OBJECTIVES: The aim of this study was to observe and compare epithelial gene expression in patients with allergic rhinitis, suspected allergic rhinitis, and nonallergic rhinitis. METHODS: Nasal brushings were collected from healthy controls and from patients with allergic rhinitis, suspected allergic rhinitis, and nonallergic rhinitis. The expressions of 20 genes selected from a previous microarray study were measured by real-time PCR. Associations of these genes with allergen type, disease duration and severity, the grade of nasal smear eosinophilia, and serum total IgE were analyzed. RESULTS: Twelve genes were confirmed to be upregulated in current adult allergic rhinitis patients allergic to multiple allergens, and 10 of them were also increased in the suspected allergic rhinitis and nonallergic rhinitis groups. TFF3 and ITLN1 expressions were increased in allergic rhinitis and suspected allergic rhinitis, but not nonallergic rhinitis. Different expressions between the allergic rhinitis and nonallergic rhinitis groups were found for 3 genes: CST1, TFF3, and ITLN1. In the allergic rhinitis patients, all 12 genes were upregulated in the seasonal and perennial groups; 9 of these 12 genes were also upregulated in the mixed group. In suspected allergic rhinitis patients, all 12 genes were upregulated in the perennial group; 8 of these 12 genes were also upregulated in the seasonal group and only 5 in the mixed group. No gene expression was associated with disease duration and serum total IgE. GCNT3 was positively correlated with the grade of nasal smear eosinophilia in the suspected allergic rhinitis group. Different genes were found to be associated with disease severity in different rhinitis groups. CONCLUSIONS: Patients with allergic rhinitis, suspected allergic rhinitis, and nonallergic rhinitis showed much similarity with regard to epithelial gene expression; most genes were related to Th2 inflammation. CST1, TFF3, and ITLN1 might have the ability to differentiate allergic rhinitis from nonallergic rhinitis. Understanding the mechanisms underlying different types of rhinitis may be helpful for rhinitis diagnosis and treatment.

Elevated Levels of Activated and Pathogenic Eosinophils Characterize Moderate-Severe House Dust Mite Allergic Rhinitis.

Eosinophils play a critical role in the pathogenesis of allergic airway inflammation. However, the relative importance of eosinophil activation and pathogenicity in driving the progression of disease severity of allergic rhinitis (AR) remains to be defined. We aimed to assess the relation of activated and pathogenic eosinophils with disease severity of patients with AR. Peripheral blood and nasal samples were collected from patients with mild (n = 10) and moderate-severe (n = 21) house dust mite AR and healthy control subjects (n = 10) recruited prospectively. Expressions of activation and pathogenic markers on eosinophils in the blood and nose were analyzed by flow cytometry. The eosinophilic cation protein- (ECP-) releasing potential and the pro-Th2 function of blood eosinophils were compared between the mild and moderate-severe patients and healthy controls. Our results showed that the numbers of activated (CD44+ and CD69+) and pathogenic (CD101+CD274+) eosinophils in the blood and nose as well as blood eosinophil progenitors were increased in moderate-severe AR compared with the mild patients and healthy controls. In addition, the levels of activated and pathogenic eosinophils in the blood were positively correlated with the total nasal symptom score and serum ECP and eosinophil peroxidase (EPX) levels in patients with AR. Furthermore, the blood eosinophils obtained from the moderate-severe patients exhibited a higher potential of releasing ECP and EPX induced by CCL11 and of promoting Th2 responses than those from the mild patients and healthy controls. In conclusion, patients with moderate-severe AR are characterized by elevated levels of activated and pathogenic eosinophils, which are associated with higher production of ECP, EPX, and IL-4 in the peripheral blood.

[Observation and analysis of systemic reactions to house dust mite subcutaneous immunotherapy in 362 patients with allergic rhinitis].

Objective: To investigate the frequency and severity of systemic reactions (SRs) to standardized house dust mite subcutaneous immunotherapy (SCIT) in patients with perennial allergic rhinitis (AR), and to analyze the clinical risk factors. Methods: The clinical data of 362 patients including 209 males and 153 females, aged from 5 to 55 years old receiving SCIT at the Department of Otorhinolaryngology, the Third People's Hospital of Changzhou were collected from May 2014 to July 2017. The SRs were classified as early-onset and delayed-onset, and 4 grades (grade Ⅰ to Ⅳ) to assess severity. The records of SRs were retrospectively analyzed, including the numbers/frequencies, symptoms and signs, onset of reaction and treatment. And the relationships between SRs and patient's age, gender, allergen injection dose, accompanied allergic diseases were explored. All the statistical analyses were conducted using SPSS 19.0. Results: There were 57 cases (15.75%) of SRs in 362 patients. All the patients received a total of 12 308 injections and 111 SRs (0.90%) were observed. Among them, 31 (27.93%) were early-onset reactions and 80 (72.07%) were delayed-onset reactions; most of the SRs were grade Ⅰ reactions (n=83, 74.78%), followed by grade Ⅱ (n=25, 22.52%), grade Ⅲ (n=3, 2.70%), and no fatal reactions occurred. The incidence of SRs in patients>14 years old was higher than that in patients ≤14 years old according to the number of cases and injections (35.14% vs 13.54%, 2.34% vs 0.76%, χ(2) value was 11.679, 28.162, respectively, all P<0.05), but no significant differences of SRs were observed in gender (18.66% vs 11.76%, 5.98% vs 5.62%, χ(2) value was 3.166, 0.095, respectively, all P>0.05). Fifteen SRs (13.51%) occurred during the build-up phase and 96 (86.49%) during the maintenance phases. SRs could occur in lots of dose phases, and 95 (85.59%) were distributed at high concentrations more than 40 000 SQ-U. The incidence of SRs in patients with multiple allergic diseases was significantly higher than that in patients with AR alone, with asthma or atopic dermatitis (30.67% vs 11.85%, χ(2)=15.875, P<0.001). Meanwhile, the incidence of SRs in patients with pure AR was also significantly lower than that in patients with other allergic diseases (5.26% vs 20.56%, χ(2)=13.783, P<0.001). Conclusions: The incidence of SRs is less than 1% according to the injection times, the severity of SRs is mostly slight, and the safety and tolerance are good during standardized house dust mite SCIT in perennial AR patients. Delayed-onset SRs are more common. The incidence of SRs is significantly correlated with age, high dose of allergen vaccine injection, and concomitant other allergic diseases (asthma, atopic dermatitis, etc).

Life-long endogenous estrogen exposure is associated with prevalence of allergic rhinitis in postmenopausal women.

OBJECTIVES: The aim of the study was to investigate the influence of life-long endogenous estrogen exposure on prevalence of chronic rhinitis including allergic rhinitis (AR) in the postmenopausal period. METHODS: In this cross-sectional study, a total of 3,043 postmenopausal women who participated in the Korea National Health and Nutrition Examination Survey V were included. Participants with symptoms including sneezing, rhinorrhea, nasal obstruction, or nasal itching were considered to have chronic rhinitis. In subgroup analysis, the AR group comprised participants with rhinitis with positive findings in at least one of three specific immunoglobulin E. Univariable and multivariable logistic analyses were performed to evaluate the relationship between rhinitis and estrogen-related factors including age at menarche, age at menopause, age at first delivery, parity, and duration of breast-feeding. RESULTS: Participants with chronic rhinitis (17.6%) had higher parity (odd ratio [OR] = 1.17, P = 0.0135) and shorter duration of breast-feeding (OR = 0.98, P = 0.0388) than controls. In subgroup analysis, participants with AR (7.1%) had younger age at menarche (OR = 0.56, P = 0.0028) and older age at menopause (OR = 1.42, P = 0.0060) after adjustment of confounding factors. There was a positive association between age at menopause and specific immunoglobulin E for both cockroach (OR = 1.38, P = 0.0132) and dogs (OR = 1.38, P = 0.0302). Longer postmenopausal duration was positively associated with cockroach allergen sensitization (OR = 1.25, P = 0.201). CONCLUSIONS: Longer duration of reproductive period was associated with higher prevalence of AR and aeroallergen sensitization in the postmenopausal period. Moreover, cockroach allergen sensitization was associated with a longer postmenopausal period.

Dampness, mould, onset and remission of adult respiratory symptoms, asthma and rhinitis.

STUDY QUESTION: Is dampness and indoor mould associated with onset and remission of respiratory symptoms, asthma and rhinitis among adults? MATERIALS AND METHODS: Associations between dampness, mould and mould odour at home and at work and respiratory health were investigated in a cohort of 11 506 adults from Iceland, Norway, Sweden, Denmark and Estonia. They answered a questionnaire at baseline and 10 years later, with questions on respiratory health, home and work environment. RESULTS: Baseline water damage, floor dampness, mould and mould odour at home were associated with onset of respiratory symptoms and asthma (OR 1.23-2.24). Dampness at home during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.21-1.52). Dampness at work during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.31-1.50). Combined dampness at home and at work increased the risk of onset of respiratory symptoms and rhinitis. Dampness and mould at home and at work decreased remission of respiratory symptoms and rhinitis. THE ANSWER TO THE QUESTION: Dampness and mould at home and at work can increase onset of respiratory symptoms, asthma and rhinitis, and decrease remission.

Alteration of -656(G/T) and -607(C/A) polymorphisms in interleukin-18 (IL-18) gene in house dust mite-sensitive allergic rhinitis patients in Thailand.

Allergic rhinitis (AR) is an IgE-mediated inflammation of the nasal membranes, which is naturally triggered by aeroallergens. House dust mites (HDM) are the most common inhalant allergens. Interleukin-18 (IL-18) has been established as an essential cytokine that can activate the generation of IgE. This randomized controlled study aimed to identify the possible relationship of the genetic variations in the IL-18 gene with AR in mite-sensitive Thai patients. Study subjects consisted of 150 AR patients and 50 normal participants. Genomic DNA of 30 randomized AR patients and 30 randomized controls were screened by sequencing for the selection of candidate single nucleotide polymorphisms (SNPs), and further analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay for all subjects. The following five SNPs were detected in the IL-18 gene: -656 G/T, -607 C/A, and -137 G/C in promoter 1 and -920 C/T and -373 C/G in promoter 2. The results showed that -656 G/T and -607 C/A SNPs were significantly correlated with IgE levels specific to Dermatophagoides pteronyssinus (Der p) allergen (P = 0.045 and P = 0.045, respectively), and significant differences were observed in the genotype distribution of AR patients when compared with controls [P = 0.044 and P = 0.044, respectively; odds ratios (ORs): 1.941 (95%CI, 1.014-3.715) and 1.941 (95%CI, 1.014-3.715), respectively]. Our findings indicate that the IL-18 alleles, -656T (rs1946519) and -607A (rs1946518), might be associated with the higher production of Der p allergen-specific IgE in mite-sensitive AR patients.

Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort.

BACKGROUND: Few studies have evaluated the association between delivery by cesarean section (CS) and asthma, allergic rhinitis and chronic rhinitis and whether this association is different in children with and without a family history of asthma. This study aims to investigate whether children born by CS have a higher chance to develop asthma, allergic rhinitis and chronic rhinitis and to evaluate the influence of parental history of asthma on these associations. METHODS: This is a cross-sectional study of 672 children nested in a birth cohort evaluated at 6-years of age. Asthma and chronic/allergic rhinitis were identified by means of the mother's responses to the ISAAC questionnaire. The association between CS, asthma, chronic rhinitis and allergic rhinitis was evaluated by multivariable logistic regression. The evidence of effect modification of parental history of asthma on the association CS and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. RESULTS: Asthma was not associated with birth by CS irrespective of parental history of asthma (odds ratio (OR) 1.03; 95 % CI 0.61-1.74). Chronic rhinitis and allergic rhinitis were both significantly associated with birth by CS but only in the subgroup of children with by parental history of asthma (OR 1.56; 95 % CI 1.04-2.34) and (OR 1.60; 95 % CI 1.01-2.55) respectively, after adjustment for confounders. The parental history of asthma was a effect modifier in the association between CS, chronic rhinitis and allergic rhinitis (p for effect modification = 0.10 and 0.02, respectively). CONCLUSION: CS increases the risk of chronic rhinitis and allergic rhinitis in children at 6 years of age with parental history of asthma. Health professionals must be alerted with regard to the increased risk of allergic rhinitis and made aware this is another reason to avoid unnecessary CS.

High-Fat and Low-Carbohydrate Diets Are Associated with Allergic Rhinitis But Not Asthma or Atopic Dermatitis in Children.

BACKGROUND: Numerous studies have suggested that nutritional intake is related to allergic diseases. Although conflicting results exist, fat intake is often associated with allergic diseases. We investigated the relationship between allergic diseases and nutritional intake after adjusting for various demographic and socioeconomic factors in a large, representative sample of Korean children. METHODS: A total of 3,040 participants, aged 4 to 13 years old, were enrolled in the present study from the Korean National Health and Nutrition Examination Survey (KNHANES), 2010-2012. Nutritional intake data, including total calories, protein, fat, carbohydrate, vitamin A, vitamin C, thiamine, riboflavin, and niacin, were retrieved from the survey using the complete 24-hour recall method. The associations between each nutritional factor and allergic rhinitis/asthma/atopic dermatitis were analyzed using simple and multiple logistic regression analyses with complex sampling. Age, sex, body mass index (BMI), number of household members, income level, and region of residence were adjusted for as covariates. RESULTS: Of the participants, 22.1%, 6.0%, and 15.5% suffered from allergic rhinitis, asthma, and atopic dermatitis, respectively. Allergic rhinitis was significantly correlated with high-fat and low-carbohydrate diets. The adjusted odds ratio (AOR) was 1.25 (95% CIs = 1.06-1.46, P = 0.007) for fat intake, denoting a 10% increase. Carbohydrate intake (10% increase) was negatively related to allergic rhinitis with an AOR of 0.84 (95% CIs = 0.74-0.95, P = 0.004). No other significant relationships were found between the retrieved nutritional factors and either asthma or atopic dermatitis. CONCLUSION: Allergic rhinitis was related to high-fat and low-carbohydrate diets. Although the underlying mechanisms and causal relationships remain elusive, the present study provides reliable evidence regarding the associations between nutritional factors and allergic rhinitis by considering numerous factors within a large and representative population.

Exposure to mould allergens and rhinoconjunctivitis in Korean children.

BACKGROUND: Although rhinitis is the most common allergic disease in children, few studies have explored the causal relationships between mould allergens and rhinitis. Thus, this study aimed to identify factors, especially prior exposure to mould allergens, related to rhinitis and rhinoconjunctivitis in Korean children. METHODS: Subjects in this study were 12- to 13-year-old children from 40 national middle schools who were participants of the International Study of Asthma and Allergies in Childhood (ISAAC) study in Korea. A total of 3852 children who completed the ISAAC questionnaire in 2010 and underwent a skin prick test (SPT) and blood test were enrolled in this study. RESULTS: The prevalence of symptoms suggestive of rhinitis or rhinoconjunctivitis in last 12 months was 42.7% and 19.4%, respectively. A parental history of allergies (OR = 2.03, 95% CI = 1.75-2.35; OR = 2.55, 95% CI = 2.13-3.06), visible mould or dampness (OR = 1.28, 95% CI = 1.09-1.51; OR = 1.23, 95% CI = 1.00-1.51), previous exposure to mould allergens (OR = 4.53, 95% CI = 2.32-8.84; OR = 4.98, 95% CI = 2.43-10.20), total IgE levels ≥78 kU/l (OR = 1.44, 95% CI = 1.22-1.69; OR = 1.99, 95% CI = 1.60-2.48) were risk factors for rhinitis and rhinoconjunctivitis. CONCLUSIONS: This study suggested that previous exposure to mould allergens more influenced rhinitis and rhinoconjunctivitis than visible mould or dampness, and that total IgE levels of ≥78 kU/l, which was the criterion suggested in a study of Asian children, were risk factors for rhinitis diseases.

Fetal Growth, Obesity, and Atopic Disorders in Adolescence: a Retrospective Birth Cohort Study.

BACKGROUND: Developmental status at birth and subsequent obesity have been implicated in the development of childhood atopic dermatitis (AD) and allergic rhinitis (AR). METHODS: The current study analysed the cohort data of 74 688 junior high school students from a national retrospective birth cohort study in Taiwan. A random 10% sample was selected from singleton livebirths with complete data on the analytical variables of interest. Atopic disorders, including AD and AR, were assessed by questionnaires (International Study of Asthma and Allergies in Childhood). Logistic regression analyses were applied with adjustments for related risk factors. RESULTS: Among subjects mainly 13-15 years of age, the estimated prevalence was 7.6% for AD and 22.4% for AR. While the role of fetal growth in allergic disorders was less evident, the risk of developing AD and AR were both influenced by a combination of fetal growth status and adolescent body mass index (BMI). Compared with those with normal fetal growth and school-aged BMI, the risk of developing AD increased 64% among adolescents with both restricted fetal growth and high BMI (odds ratio 1.64, 95% confidence interval 1.37, 1.97). The risk for this combination was higher than that for either restricted fetal growth or high BMI alone. Nevertheless, the overall interaction between BMI and fetal growth status on atopic disorders did not reach statistical significance. CONCLUSIONS: Excessive weight gain could be an important risk factor related to developing atopic dermatitis and allergic rhinitis during adolescence, especially among infants born small for gestational age.

New developments in the treatment of pediatric allergic rhinitis and conjunctivitis.

The primary care physician is the first line of treatment for allergic rhinitis, which affects approximately one-fourth of children in the United States. There is an increasing trend toward self-management by patients or parents due to high-deductible insurance plans and the over-the-counter availability of allergy medications. The primary care physician can offer guidance on appropriate selection of medications and potential adverse effects. Vitamin D deficiency has been proposed as a potential contributing factor in patients with allergic diseases, and studies are underway to determine whether supplementation with vitamin D is helpful for these conditions. Sublingual immunotherapy has recently received US Food and Drug Administration approval for grass and ragweed allergens; many children will be interested in this alternative to allergy shots. The relative advantages and disadvantages of sublingual vs subcutaneous immunotherapy are discussed.