The aspects of local allergic rhinitis in Polish children and adolescents.

Introduction: Local allergic rhinitis (LAR) is one of the endotypes of rhinitis which occurs commonly in different age groups. Aim: To present the occurrence and characteristics of LAR in Polish children and adolescents. Material and methods: In the study protocol, three hundred sixty-one patients aged 5-17 with chronic rhinitis were included from 8 centres in Poland. Medical history and diagnostic procedures were performed with aeroallergens: skin prick tests, allergen-specific serum IgE and nasal provocation tests. In addition to LAR, allergic rhinitis (AR), dual allergic rhinitis (DUAL) and non-allergic rhinitis (NAR) were explored and compared. Results: LAR was confirmed in 21% of patients, systemic allergic rhinitis (SAR) in 43.9%, DUAL in 9.4% and NAR in 33.9% of patients. Based on nasal provocation test (NPT), allergy to HDM prevailed in the LAR group (68%), grass in the SAR group (58%), and grass and HDM in the DUAL group (32% and 64%). Girls were prevalent in the LAR group, and severe rhinitis and asthma were more common than other endotypes (p < 0.05). Conclusions: LAR is a common disease in children and adolescents and is often associated with severe rhinitis and frequently coexists with asthma.

Acquired Angioedema in Selected Neoplastic Diseases.

Background and Objectives. Acquired angioedema is a relatively common revelation accompanying some diseases such as autoimmune or cancer. The study aimed to assess the incidence of one subtype of angioedema-C1-INH-AAE (acquired angioedema with C1 inhibitor deficiency). Material and methods. The study was retrospective and based on 1 312 patients with a final diagnosis of breast cancer, colorectal cancer, or lung cancer: 723 women and 589 men with a mean age of 58.2 ± 13.5 years. The cancer diagnosis according to the ICD (International Classification of Diseases)-10 code, medical history including TNM (Tumour, Node, Metastasis) staging, histopathology, and assessment of the occurrence of C1-INH-AAE angioedema were analysed. Results. C1-INH-AAE occurred more often in patients with cancer than in the control group, as follows: 327 (29%) vs. 53 (6%) for p < 0.05. C1-INH-AAEs were observed most often in the group of patients diagnosed with breast cancer compared to colorectal and lung groups: 197 (37%) vs. 108 (26%) vs. 22 (16%) (p < 0.05). A higher incidence of C1-INH-AAE was observed in the early stages of breast cancer. However, there was no relationship between the occurrence of C1-INH-AAE and the BRCA1 (Breast Cancer gene 1)/BRCA2 (Breast Cancer gene 2) mutation or histopathological types of breast cancer. Conclusion. Angioedema type C1-INH-AAE occurs more often in patients with selected neoplastic diseases, especially in the early stages of breast cancer.

Omalizumab added to allergen immunotherapy increased the effect of therapy in patients with severe local allergic rhinitis.

BACKGROUND: Allergen immunotherapy (AIT) is effective in patient with local allergic rhinitis (LAR). However, AIT may not always achieve the optimal treatment effect. OBJECTIVE: To present short study with clinical cases of LAR combined therapy with sublingual immunotherapy (SLIT) and omalizumab in patients with house dust mite (HDM) allergy and compared it to therapy with omalizumab alone. METHODS: Patients with severe LAR and hypersensitivity to HDMs were included. SLIT for HDMs was launched in a perennial protocol using SQ-HDM SLIT tablets with omalizumab. The total rhinitis symptom score (TRSS), total medication score (TMS) and combined total score (CTS) were assessed after one year. RESULTS: After 12 months, significant improvements in all analyzed parameters in the patients on SLIT+ omalizumab therapy were observed: a reduction in the TRSS from 1.21 ± 0.33 to 0.6 ± 0.28 (p < .05), a reduction in the TMS from 2.25 ± 1.05 to 0.88 ± 0.31 (p < .05) and a reduction in the CTS from 3.46 ± 0.57 to 1.48 ± 0.51 (p < .05). This improvement in TRSS, TMS also in CTS was significantly greater than in the rest of the group with SLIT alone or omalizumab alone. CONCLUSION: Omalizumab may be a valuable treatment that increases the effectiveness of immunotherapy in patients with severe LAR.

Allergy to Der p 23 influences the cytokine profile in patients with allergic asthma - a preliminary study.

OBJECTIVE: Der p 23 is a major allergen of Dermatophagoides pteronyssinus, which could contribute to allergic asthma. The study compared the cytokine profile (Il-1beta, Il-4, Il-5, Il-6, Il-13, Il-17, TNF-alpha) in patients with allergic asthma, with confirmed allergy to D. pteronyssinus and with the presence or absence of allergy to Der p 23. METHODS: Among 173 included patients, the following combinations were analyzed: profile A - Der p 1 (+), Der p 2 (+), and Der p 23 (-) observed in 38 (22%) patients; profile B - Der p 1 (+), Der p 2 (+), and Der p 23 (+) in 87 (50.3%) patients; and profile C - Der p 1 (-), Der p 2 (-), and Der p 23 (+) in 15 (8.7%) patients. RESULTS: The mean concentration of Il-1beta was significantly lower in profile A than in profiles B and C: 10.51 ± 5.22 (pg/ml) vs. 21.92 ± 11.34 vs. 23.1 ± 8.56 (A vs. B for p = 0.03 and A vs. C for p = 0.019). Similar trends were observed for Il-5: 38.5 ± 10.45 (pg/ml) vs. 94.8 ± 54.11 vs. 103.61 ± 34.9 (A vs. B for p = 0.008 and A vs. C for p = 0.001). CONCLUSION: The higher Il-1 and Il-5 activities observed in profiles B and C with Der p 23 (+) could be responsible for the more effective acceleration of allergic inflammation than in profile A with Der p 23.

Impact of influenza vaccination on the risk of SARS-CoV-2 infection in a middle-aged group of people.

Aims: An observational study of a retrospective cohort was performed to assess the impact of influenza vaccination (IV) on the risk of SARS-CoV-2 infection in a population of middle-aged people for 8 weeks after IV and compared with an unvaccinated group.Patients and methods: Data from 1098 middle-aged patients (53.7 ± 4.7 years) after IV and 1205 unvaccinated patients (50.1 ± 6.8 years) were analyzed based on medical documentation. The inclusion criteria were age between 40 - 60 years and IV in the period from 1-30 September 2020. The incidence of infection with SARS-CoV-2 was confirmed by PCR and the classification of ICD-10 (U07.1).Results and conclusions: After IV, patients had significantly fewer SARS-CoV-2 infections than the unvaccinated patients (P = .017). The hazard ratio was 0.74 (95% CI: 0.54-0.89). IV may partially reduce the risk of SARS-CoV-2 infection.

Can atopy have a protective effect against cancer?

BACKGROUND: An increased prevalence of allergies and an increased incidence of breast cancer have been observed. The hypothesis that atopy may have a protective effect against the risk of different types of breast cancer was evaluated. METHODS: In this study, 11,101 patients (11,101 women with a mean age of 55.2±14.7 years) with different types of breast cancer were tested for allergies. Allergies were confirmed based on the retrospective analysis of allergy diagnostic procedures in patients who had been previously diagnosed with breast cancer. The retrospective prevalence rates of active allergic diseases, including allergic rhinitis, bronchial asthma and atopic dermatitis, were assessed. All patients were also analyzed for bronchial asthma and allergic rhinitis according to the relevant guidelines. A group of healthy control patients was used for the comparisons. RESULTS: The women with breast cancer had a significantly lower incidence of IgE-mediated allergic diseases than the controls. The odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.61 (95% CI: 0.57-0.73), 0.17 (95% CI: 0.11-0.44), and 0.73 (95% CI: 0.65-0.83), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of women with breast cancer than in the patients of the control group (39.2 ± 26.2 kU/L vs. 108.5 ± 38.5 kU/L; p = 0.002). CONCLUSION: Our results suggest that the overall incidence of allergies, especially allergic rhinitis, is lower in patients with certain types of cancer than in individuals who did not have cancer. Further studies are needed to confirm our findings.

Evidence of the efficacy and safety of house dust mite subcutaneous immunotherapy in elderly allergic rhinitis patients: a randomized, double-blind placebo-controlled trial.

BACKGROUND: Allergen specific immunotherapy (AIT) in elderly patients is controversial, and there is still little evidence supporting the safety and efficacy of this treatment in this population. The study objective was to evaluate the safety and efficacy of AIT for house dust mite allergens in patients over 65 years of age with allergic rhinitis (AR) and a documented allergy to house dust mites. The primary endpoint was the change from baseline in the mean average adjusted symptom score (AAdSS) and the total combined rhinitis score (TCRS) difference in the least square means for the label compared to placebo. METHODS: Fifty-eight AR elderly patients who were monosensitized to house dust mites were individually randomized in comparable numbers to one of two parallel groups with the following interventions: 2 years of perennial AIT using PURETHAL Mites or placebo. The symptoms and medication scores were presented as the AAdSS and TCRS. Quality of life, based on the rhinoconjunctivitis quality of life questionnaire (RQLQ), nasal allergen provocation responsiveness, serum allergen-specific IgG4 to D. pteronyssinus and D. farinae and Der p1 and Der p2 were monitored. The intent-to-treat population was analysed. RESULTS: After 24 months of AIT, AAdSS significantly decreased from 4.27 ± 1.58 to 1.82 ± 0.71 (p < 0.05). The TCRS was significantly decreased after 2 years of AIT. Serum-specific IgG4 against D. pteronyssinus, D. farinae, Der p1, and Der p2 increased during the AIT trial in the study group. The RQLQ score was significantly improved in patients who received AIT, from 1.86 (95% CI 1.51-1.78) to 1.26 (95% CI 1.09-1.55). Two mild systemic anaphylactic reactions (degree I) were reported after injections in the active group during the AIT therapy. CONCLUSION: The DBPC trial showed AIT for house dust mite allergens was effective and safe in elderly patients with allergic rhinitis. TRIAL REGISTRATION: This randomized, double-blinded placebo-controlled (DBPC) trial was conducted at one centre (ClinicalTrials.gov no. NCT03209245).

Association between cancer and allergies.

BACKGROUND: The prevalence of allergies and the incidence of cancer are both increasing worldwide. It has been hypothesized that atopy may affect the risk of some cancers. METHODS: In this study, 1525 patients (754 women and 771 men with a mean age of 52.7 ± 11.9 years) with different types of cancer were examined for the presence of allergies. Allergies were confirmed based on retrospective analysis of allergy diagnostic procedures in patients previously diagnosed with cancer. All patients were also analyzed for bronchial asthma and allergic rhinitis according to relevant guidelines. A control group of patients without cancer diagnoses was used for comparison. RESULTS: Patients with cancer had significantly fewer IgE-mediated allergic diseases than the control population. For the oncological group compared to the non-cancer patients, the odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.67 (95 % CI 0.52-0.81), 0.89 (95 % CI 0.78-0.99), and 1.03 (95 % CI 0.91-1.13), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of patients with cancer than in the patients in the control group (45.98 ± 14.9 vs. 83.2 ± 40.1 IU/l; p < 0.05). There were no significant correlations between the type of cancer diagnosed and the form of allergy. CONCLUSION: Our results indicate that the overall incidence of allergies, particularly allergic rhinitis, was lower in patients with some types of cancer. Further studies are needed to confirm our findings.

The safety of specific immunotherapy for patients allergic to house-dust mites and pollen in relation to the development of neoplasia and autoimmune disease: a long-term, observational case-control study.

BACKGROUND: Specific immunotherapy (SIT) safety has been well documented. However, the prolonged late side effects in patients who terminated SIT several years previously have been reported on in only a limited number of studies. The aim of this study was to perform a 20-year post-SIT observational evaluation for the assessment of any manifestation of serious immunological disease. MATERIALS AND METHODS: In total, 1,144 patients (521 women and 623 men), with a mean age of 22.8 ± 16.9 years (at the moment of SIT completion) and who had atopic bronchial asthma and/or allergic rhinitis, were observed 20 years after immunotherapy. New neoplastic and autoimmune disease cases were monitored. The SIT group was compared to a control group consisting of 1,154 allergic patients who had never received SIT and had only had symptomatic treatment. RESULTS: There was an inverse association between SIT treatment and the prevalence of new chronic myeloid leukemia and chronic lymphoblastic leukemia cases (OR 0.32, 95% CI 0.18-0.81 and OR 0.58, CI 0.44-0.78, respectively). In other neoplastic diseases, however, prevalences similar to those observed in the control group were confirmed. There were also no significant differences in the autoimmune disease prevalence between the analyzed groups. CONCLUSION: The results of this long-term observational study indicate a lack of a significant prevalence for new instances of neoplastic and autoimmune diseases, which suggests that SIT in the long term is indeed safe.

The influence of hospitalizations due to exacerbations or spontaneous pneumothoraxes on the quality of life, mental function and symptoms of depression and anxiety in patients with COPD or asthma.

BACKGROUND: Patients with bronchial asthma or chronic obstructive pulmonary disease (COPD) frequently have a low quality of life (QoL) in addition to depression symptoms. The aim of this study was to compare the QoL, depression symptoms, mental function and anxiety in patients with asthma or COPD exacerbations or spontaneous pneumothoraxes (SP) to patients with stable disease. MATERIALS AND METHODS: Patients with a confirmed diagnosis of severe (III degree) bronchial asthma or COPD were included in this study. Prospective observations of asthma or COPD exacerbations or SP were performed over a three-year period. QoL was assessed using St. George's Respiratory Questionnaire (SGRQ). In addition, the AQ20 questionnaire (AQ20), the Hospital Anxiety and Depression Scale (HADS) and the Mini-Mental State Examination (MMSE) were administered. RESULTS: A total of 233 patients (112 with asthma and 121 with COPD; mean age 57.9 ± 11.9 years) were included in the study. Patients with COPD or asthma had a low QoL as estimated by the SGRQ (mean ± SD: 27.5 ± 12.9 and 25.1 ± 10.2 for asthma and COPD, respectively). Asthma exacerbations, COPD exacerbations or SP requiring hospitalization were associated with lower SGRQ scores over the three-year observation period (41.5 ± 11.7, 57.9 ± 14.3 and 65.3 ± 11.4, respectively). The mean MMSE score significantly decreased after an asthma exacerbation compared to the baseline (29.9 ± 2.1 versus 27.2 ± 3.1; p < 0.05). The mean MMSE score decreased after COPD exacerbations (28.5 ± 0.9 versus 26.9 ± 1.2; p < 0.05) and after COPD with an SP event (28.8 ± 1.2 versus 24.1 ± 2.2; p < 0.05). CONCLUSION: Low QoL and mental impairment were observed in patients with asthma and COPD. In addition, the QoL significantly decreased following hospitalizations due to exacerbations or SP.