Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.656
Filtrar
1.
Medicine (Baltimore) ; 103(19): e38084, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38728514

RESUMO

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis, characterized by excessive immune responses to environmental molds or fungi. The diagnosis and classification of AFRS into systemic and local types remain clinically challenging due to overlapping characteristics. This study investigated the prevalence of AFRS, its manifestation and associated factors in systemic and local AFRS. A total of 200 patients diagnosed with fungal rhinosinusitis underwent both skin provocation tests (SPT) and nasal provocation tests (NPT) to confirm AFRS and classify systemic and local types. Patients were considered to have AFRS if either the SPT or NPT was positive. Among these, patients with systemic AFRS were those who had a SPT positive. Local AFRS was when patients had a negative SPT and a positive NPT. Medical history, serum total IgE level, nasal endoscopy examinations, and CT scans were also recorded. Most patients were female (65.8%), with a mean age of 55.6 years (SD = 14.4). Based on the SPT and NPT results, 31% of patients (n = 62) were diagnosed with AFRS. Among these, 54.8% (n = 34) had systemic AFRS, while 45.2% (n = 28) had local AFRS. Patients with AFRS exhibited significantly higher levels of total IgE, eosinophils, and more pronounced signs and symptoms compared to those without AFRS. However, no statistically significant differences were observed between patients with systemic AFRS and those with local AFRS. AFRS was prevalent in our study. Among patients with AFRS, both systemic AFRS and local AFRS were also prevalent. While allergic indicators and clinical presentations can aid in AFRS diagnosis, minimal distinctions were observed between systemic and local AFRS. A comprehensive assessment incorporating both local and systemic allergic responses through provocation tests, such as a combination of skin and nasal tests, is imperative for optimizing AFRS diagnosis and management.


Assuntos
Rinite Alérgica , Sinusite , Testes Cutâneos , Humanos , Feminino , Masculino , Sinusite/imunologia , Sinusite/microbiologia , Sinusite/complicações , Sinusite/epidemiologia , Sinusite/diagnóstico , Pessoa de Meia-Idade , Rinite Alérgica/imunologia , Rinite Alérgica/epidemiologia , Rinite Alérgica/complicações , Rinite Alérgica/diagnóstico , Adulto , Idoso , Testes de Provocação Nasal , Imunoglobulina E/sangue , Prevalência , Micoses/imunologia , Micoses/epidemiologia , Micoses/diagnóstico , Micoses/complicações , Sinusite Fúngica Alérgica
2.
Clin Exp Allergy ; 54(7): 489-499, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38616622

RESUMO

BACKGROUND: The fluctuation in concentrations of airborne allergens frequently presents a challenge to assessing the efficacy of allergen immunotherapy (AIT) in 'field' studies. Allergen exposure chambers (AECs) are specialized medical installations developed to expose individuals to allergens at defined and consistent concentrations under a controlled environment. The aim of the study was to validate the provocation test with timothy grass pollen as well as to assess its safety in the AEC in patients with allergic rhinitis. METHODS: In the ALLEC® AEC, varying concentrations of timothy grass pollen were dispersed. Allergic symptoms were measured by total nasal symptom score (TNSS), acoustic rhinometry, peak nasal inspiratory flow (PNIF) and nasal discharge volume. Lung function, assessed through peak expiratory flow rate (PEFR) and forced expiratory volume in the first second (FEV1), was used to evaluate safety. RESULTS: The consistency of the test was proved by the stability of environmental conditions, including temperature, humidity and CO2 levels, as well as constant concentrations of grass pollen at predetermined levels ranging from 1000 to 10,000 particles per cubic meter (p/m3). Allergic individuals developed symptoms at concentrations of 3000 p/m3 and above, across all measured endpoints. Lung function was not affected throughout all the challenges. The reproducibility of symptoms was confirmed throughout the tests. The concentration of 8000 p/m3 together with a challenge duration of 120 min was found to be optimal. CONCLUSION: The study demonstrates that the ALLEC® grass pollen exposure chamber provides a reliable and safe method for inducing repeatable symptoms in patients with allergic rhinitis. This approach can be effectively applied for allergy diagnostics and clinical endpoint determination during AIT.


Assuntos
Alérgenos , Phleum , Pólen , Rinite Alérgica Sazonal , Humanos , Phleum/imunologia , Masculino , Feminino , Pólen/imunologia , Adulto , Alérgenos/imunologia , Rinite Alérgica Sazonal/diagnóstico , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/terapia , Rinite Alérgica Sazonal/fisiopatologia , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Rinite Alérgica/imunologia , Pessoa de Meia-Idade , Câmaras de Exposição Atmosférica , Adulto Jovem , Reprodutibilidade dos Testes , Testes de Provocação Nasal , Testes de Função Respiratória
3.
J Allergy Clin Immunol Pract ; 12(6): 1430-1433, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38641133

RESUMO

Local allergic rhinitis (LAR) is defined by a clinical history suggestive of allergic rhinitis (AR), negativity of systemic IgE measurement and positive response to nasal allergen challenge (NAC). The term local respiratory allergy includes LAR, local allergic asthma (positive response in bronchial allergen challenge) and dual allergic rhinitis defined by the coexistence of AR and LAR. LAR worsens in severity and presence of comorbidities over time, and it is an independent entity from AR. Prevalence is higher in Mediterranean countries. LAR onset occurs during childhood in 36% of cases. Physiopathological features of LAR are: increased nasal eosinophilic inflammation, tryptase and eosinophil cationic protein, and presence of nasal specific IgE in secretions of 20-40% of subjects. A recent study demonstrated increase in sequential class switch recombination to IgE markers in mucosa of LAR with accumulation of IgE+ CD38+ plasmablasts. Moreover, there is increased expression in B cells of mucosal homing receptors CXCR3+ and CXCR4 in peripheral blood, with accumulation of Th9 and Th2 cells. NAC is the gold standard in the diagnosis of LAR. The measurement of specific IgE in nasal secretions basophil activation test or are still not suitable for diagnosis. There is ample evidence of the usefulness of allergen immunotherapy in the treatment in LAR after 4 DBPCRT in 152 patients. In conclusion, knowledge about LAR is continuously increasing, with detailed definition of physiopathological mechanisms and new phenotypes. More awareness of the disease should be promoted among different specialists, and NAC must be considered an essential diagnostic tool in any age group, including children.


Assuntos
Imunoglobulina E , Rinite Alérgica , Criança , Humanos , Alérgenos/imunologia , Dessensibilização Imunológica/métodos , Testes de Provocação Nasal , Rinite Alérgica/imunologia , Rinite Alérgica/diagnóstico , Animais
4.
HNO ; 72(7): 494-498, 2024 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-38597968

RESUMO

BACKGROUND: Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is often characterized by a severe course of chronic rhinosinusitis with nasal polyps (CRSwNP), comorbid asthma, and NSAID hypersensitivity. The gold standard for N-ERD diagnosis is challenge with acetylsalicylic acid (ASA). In expert recommendations, the diagnosis of N-ERD is established based on a plausible positive history of NSAID hypersensitivity and CRSwNP with asthma. OBJECTIVE: The following review describes the performance of ASA challenges and their sensitivity and specificity. It also examines the extent to which a positive history of NSAID hypersensitivity correlates with ASA challenge results in clinical trials and when ASA challenges should be performed. RESULTS AND CONCLUSION: ASA challenges have high sensitivity and specificity. In clinical ASA challenge studies, there is a high concordance between a positive history of NSAID hypersensitivity obtained by rhinologists and the measured data of ASA challenge in patients with CRSwNP and comorbid asthma. Therefore, ASA challenge is primarily indicated in patients with an unclear history of NSAID hypersensitivity.


Assuntos
Anti-Inflamatórios não Esteroides , Aspirina , Asma Induzida por Aspirina , Humanos , Aspirina/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Asma Induzida por Aspirina/diagnóstico , Sensibilidade e Especificidade , Sinusite/induzido quimicamente , Sinusite/diagnóstico , Reprodutibilidade dos Testes , Hipersensibilidade a Drogas/diagnóstico , Medicina Baseada em Evidências , Rinite/induzido quimicamente , Rinite/diagnóstico , Testes de Provocação Brônquica , Testes de Provocação Nasal/métodos
5.
Allergy ; 79(8): 2197-2206, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38483174

RESUMO

BACKGROUND: Local allergic rhinitis (LAR) is defined by chronic nasal symptoms, absence of atopy, positive nasal allergen challenge (NAC) and a good response to subcutaneous allergen immunotherapy (SCIT). We sought to investigate SCIT capacity to induce local and systemic blocking antibodies in LAR patients. METHODS: A RDBPC study of grass SCIT was performed, with participants receiving either SCIT (Group A; n = 10) or placebo (Group B; n = 14) in the first 6 months. Both groups subsequently received SCIT for 12 months at Year 2. Nasal and serum antibodies (IgG4, IgA1 and IgA2) and their inhibitory capacity were measured at multiple timepoints. RESULTS: The allergen concentration tolerated increased significantly at 6 months (Group A; p = .047) and 24 months (Group B; p = .049) compared with baseline and persisted until the end of the study. Induction of serum sIgA1 to Phl p was seen in Groups A and B, albeit the former being induced earlier (1.71-fold, p = .027). A significant induction in sIgG4 to Phl p 1 and 5 was observed in serum of Group A (p = .047 and p = .0039) and sIgA2 to Phl p in Group B (p = .032 and p = .0098) at 18 and 24 months, respectively. Both local and systemic blocking antibodies can inhibit allergen-IgE complexes binding to CD23 on B cells, and this correlated with level of allergen tolerated intra-nasally in Group A (serum; 𝜌 = -.47, p = .0006, nasal; 𝜌 = -.38, p = .0294). CONCLUSIONS: Grass pollen SCIT induced functional systemic blocking antibodies that correlate with the concentration of allergen tolerated following NAC, highlighting their potential as a biomarker of SCIT in LAR.


Assuntos
Alérgenos , Dessensibilização Imunológica , Poaceae , Pólen , Rinite Alérgica , Humanos , Dessensibilização Imunológica/métodos , Dessensibilização Imunológica/efeitos adversos , Alérgenos/imunologia , Alérgenos/administração & dosagem , Masculino , Feminino , Pólen/imunologia , Adulto , Poaceae/imunologia , Rinite Alérgica/imunologia , Rinite Alérgica/terapia , Pessoa de Meia-Idade , Anticorpos Neutralizantes/imunologia , Anticorpos Neutralizantes/sangue , Adulto Jovem , Testes de Provocação Nasal , Administração Intranasal , Resultado do Tratamento , Imunoglobulina E/imunologia , Imunoglobulina E/sangue , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/terapia , Injeções Subcutâneas
6.
Rhinology ; 62(3): 299-309, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38372647

RESUMO

BACKGROUND: Nasal hyperreactivity (NHR) is prevalent in all chronic upper airway inflammatory phenotypes, including allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP). Although NHR in patients with non-allergic rhinitis is mediated by neuronal pathways, AR and CRSwNP are mainly characterized by type 2 inflammation. METHODS: Eighteen healthy controls and 45 patients with symptomatic AR/CRSwNP underwent a cold, dry air (CDA) provocation test for objective diagnosis of NHR. Before and after, questionnaires were filled out and nasal secretions and biopsies were collected. Markers for neurogenic inflammation (substance P, calcitonin gene-related peptide, neurokinin A), epithelial activation (IL-33), and histamine were measured in secretions by ELISA; and expression of neuronal markers PGP9.5, TRPV1, and TRPM8 was studied in biopsies by RT-q-PCR. Effects of histamine on TRPV1/A1 were studied with Ca2+-imaging using murine trigeminal neurons. RESULTS: CDA-provocation reduced peak nasal inspiratory flow (PNIF) of patients with subjective NHR but not of non-NHR controls/patients CDA-provocation reduced peak nasal inspiratory flow (PNIF) of patients with subjective NHR but not of non-NHR controls/patients. Subjective (subjectively reported effect of CDA) and objective (decrease in PNIF) effects of CDA were significantly correlated. Levels of neuropeptides and histamine in nasal secretions and mRNA expression of PGP9.5, TRPV1, and TRPM8 correlated with CDA-induced PNIF-reduction. CDA-provocation induced an increase in IL-33-levels. Both TRPV1 and TRPA1 expressed on afferent neurons were sensitized by exposure to histamine. CONCLUSION: NHR is not an on/off phenomenon but spans a continuous spectrum of reactivity. A neurogenic inflammatory background and increased histamine-levels are risk factors for NHR in AR/CRSwNP.


Assuntos
Pólipos Nasais , Rinite Alérgica , Sinusite , Canais de Cátion TRPV , Humanos , Sinusite/metabolismo , Pólipos Nasais/metabolismo , Pólipos Nasais/complicações , Rinite Alérgica/metabolismo , Doença Crônica , Masculino , Feminino , Adulto , Canais de Cátion TRPV/metabolismo , Pessoa de Meia-Idade , Canais de Cátion TRPM/metabolismo , Mucosa Nasal/metabolismo , Histamina/metabolismo , Ubiquitina Tiolesterase/metabolismo , Camundongos , Rinite/metabolismo , Animais , Estudos de Casos e Controles , Testes de Provocação Nasal , Rinossinusite
7.
Int Arch Allergy Immunol ; 185(5): 436-448, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38266498

RESUMO

BACKGROUND: Dust mites are the leading cause of respiratory allergic diseases worldwide. Allergy to storage mites (SMs) has mostly been related to occupational exposures. However, recent studies have shown that sensitisation to SM, such as Lepidoglyphus destructor (Lep d), is of considerable importance also in urban populations, with high prevalence in dust samples of domestic environments. Co-sensitisation between house dust mites (HDMs) and SM is now regarded as very frequent in some regions, and cross-reactivity between them seems to be narrow. Therefore, SM allergenic capacity is increasingly a subject of study. The nasal provocation test (NPT), as an in vivo technique, could be considered the gold standard for the clinical relevance assessment of an allergen, in polysensitised rhinitis patients. OBJECTIVE: The objective of this study was to analyse the clinical relevance of the SM Lep d, by assessing the relationship between in vivo sensitisation and expression of allergic respiratory disease in an urban setting. PATIENTS AND METHODS: In our study, we enrolled a total of 32 allergic patients with rhinitis (with or without asthma) with proven sensitisation by skin prick test (SPT) and specific IgE (sIgE) to HDMs and/or SM. Patients underwent NPT with Lep d using subjective (Lebel Symptom Score Scale) and objective measurements (peak nasal inspiratory flow [PNIF]) for assessment of nasal response. RESULTS: Most of the patients with positive SPT and sIgE to Lep d had a positive NPT (24/27; 89%). True Lep d allergy, assessed by a positive NPT, could be predicted by a SPT wheal size >9.7 mm and a sIgE >0.42 kUA/L, with 100%/95.7% sensitivity and 75.0%/83.3% specificity, respectively. Co-sensitisation between Lep d and Der p was high, 75.0%. Asthma was more frequent in the positive Lep d NPT group (54 vs. 12%, p < 0.05). Significantly more patients from this group reported physical exercise, nonspecific irritants, and respiratory infections as relevant triggers of respiratory symptoms (p < 0.01-p < 0.05). CONCLUSIONS: To our knowledge, this is the first study to show that sensitisation to Lep d may have clinical relevance in a non-occupational setting. In this group, there seems to be a relationship between allergy to Lep d and severity of respiratory disease, with more bronchial inflammation, when comparing with mite-allergic patients sensitised only to HDM. Therefore, the authors consider that sensitisation to Lep d should be considered when assessing and treating allergic respiratory disease in urban environments.


Assuntos
Imunoglobulina E , Testes de Provocação Nasal , Rinite Alérgica , Testes Cutâneos , Adolescente , Adulto , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Alérgenos/imunologia , Relevância Clínica , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Rinite Alérgica/diagnóstico , Rinite Alérgica/imunologia , Rinite Alérgica/etiologia , Ácaros
8.
Nutrients ; 15(17)2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37686848

RESUMO

Thanks to their valuable assessment possibilities (subjective complaints and changes in nasal patency during the examination), nasal provocation tests may serve as an alternative tool for oral food challenges in the future. However, this test requires successive attempts to regulate its methodology in order to develop a standardized lyophilisate form and determine the threshold dose for a positive result. The study objective was to present the methodological foundation for nasal food allergen provocation tests induced by freeze-dried powdered chicken egg whites. A control group of 25 individuals with no history of allergy to chicken eggs or any other allergy was included in the study. Optical rhinometry and visual analog scales were used to assess the response of nasal mucosa to local allergen challenges. Minor variations in nasal flows, as measured by optical rhinometry, were observed in the provocation tests. The mean optical density measurements (as measured regardless of the allergen dose used) varied from positive to negative values and vice versa, e.g., amounting to 0.018 OD (standard deviation 0.095) at 15 min and -0.011 OD (standard deviation 0.090) at 30 min. No significant differences were observed concerning the perceived nasal discomfort using the visual analog scale. Due to the absence of nasal mucosal reactivity, nasal challenge is an excellent methodological tool for implementing food allergen tests.


Assuntos
Hipersensibilidade , Testes de Provocação Nasal , Humanos , Alimentos , Mucosa Nasal , Alérgenos
9.
J Allergy Clin Immunol ; 152(5): 1167-1178.e12, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37536510

RESUMO

BACKGROUND: There is limited knowledge on how local cytokine secretion patterns after nasal allergen challenge correlate with clinical symptoms especially with regard to the "late allergic response," which occurs in approximately 40% to 50% of patients with allergy. OBJECTIVE: We sought to characterize the immunologic and clinical nasal responses to birch pollen allergen challenge with a special focus on the late allergic response. METHODS: In this randomized, double-blind, placebo-controlled trial, birch pollen-allergic participants were challenged with birch pollen extract (n = 20) or placebo (n = 10) on 3 consecutive days. On days 1 and 3, nasal secretions were collected at selected time points over a 24-hour time course for the measurement of 33 inflammatory mediators. Clinical responses were determined through subjective symptom scores and objective nasal airflow measurements. RESULTS: Provoked participants had significantly greater clinical responses and showed significant increases in tryptase and the soluble IL-33 receptor serum stimulation 2 (sST2) in nasal secretions within minutes compared with the placebo group. Eight of 20 provoked participants displayed high IL-13 levels 2 to 8 hours after allergen provocation. This group also showed significant changes in clinical parameters, with a secondary drop in nasal airflow measured by peak nasal inspiratory flow and increased symptoms of nasal obstruction, which significantly differed from IL-13 nonresponders after 6 hours. CONCLUSIONS: IL-13 response status correlates with clinical responses and type 2 cytokine responses in the late phase after allergen provocation.


Assuntos
Hipersensibilidade , Rinite Alérgica Sazonal , Humanos , Interleucina-13 , Pólen , Alérgenos , Citocinas , Mucosa Nasal , Testes de Provocação Nasal
10.
Int J Pediatr Otorhinolaryngol ; 172: 111645, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37481991

RESUMO

BACKGROUND: Local allergic rhinitis (LAR) is a condition involving a localized nasal allergic response in absence of systemic atopy. Most studies on LAR have been performed in adults. We aimed to describe clinical characteristics of LAR pediatric patients, its clinical evolution over a 7-year follow-up period and to study the role of basophil activation test (BAT), for its diagnosis. METHODS: Forty-four children with non-allergic rhinitis (NAR) were included (24 males, 20 females, aged under 15 years). Nasal allergen provocation test (NAPT) and BAT were performed with Dermatophagoides pteronyssinus and Phleum pratense. RESULTS: Seven patients (16%) were diagnosed of LAR. Six reacted to D pteronyssinus and one to P pratense. All LAR and 86% of NAR patients presented perennial symptoms. Fifty-seven percent of NAR and LAR patients referred persistent symptoms. Around half of NAR and LAR patients reported mild-moderate clinical manifestations. Three LAR patients associated conjunctival symptoms, proportionally more than NAR patients (19%, 7 out of 37). NAR patients presented bronchial asthma (n = 10) more frequently than LAR children (n = 1). More than half of LAR and NAR patients presented family history of atopy. BAT was negative in all LAR patients. On follow-up, 3 LAR patients and 10 of the 25 NAR patients who agreed to be retested, presented systemic sensitization. Dust mites were the most frequent allergen involved. CONCLUSIONS: LAR should be ruled out in children with NAR. Almost half of children with LAR develop systemic sensitization over time. BAT shows low sensitivity for the diagnosis of LAR in children.


Assuntos
Asma , Rinite Alérgica , Rinite , Adulto , Masculino , Feminino , Humanos , Criança , Idoso , Rinite/diagnóstico , Teste de Degranulação de Basófilos , Rinite Alérgica/diagnóstico , Alérgenos , Asma/diagnóstico , Testes de Provocação Nasal , Testes Cutâneos
11.
Artigo em Chinês | MEDLINE | ID: mdl-37253514

RESUMO

Objective:To compare the clinical value of visual analogue scale (VAS), Lebel scale and total nasal symptom scores (TNSS) in evaluating nasal allergen provocation test (NAPT). Methods:A total of 151 patients suspected of allergic rhinitis admitted to the Department of Otolaryngology-Head and Neck Surgery of our hospital from April 2020 to September 2020 were included, of which 76 were positive for house dust mites and 75 were negative for allergens. Nasal airway resistance(NAR) was measured by active anterior nasal manometry. Nasal symptoms were evaluated by VAS, Lebel and TNSS. House dust mite allergen was used for NAPT by spray method. An increase≥40% in NAR was used as the gold standard for objective evaluation of NAPT. ROC curves of VAS, Lebel and TNSS were drawn to compare the evaluation effectiveness of different subjective evaluation methods, and the optimal critical point of each ROC curve was obtained. Results:With NAR increased by ≥40% as the gold standard, the area under ROC curve of VAS was 0.884, and the sensitivity and specificity were 97.75% and 80.65%, respectively. The area under ROC curve of Lebel was 0.773, and the sensitivity and specificity were 68.54% and 75.81%, respectively. The area under ROC curve of TNSS was 0.792, and the sensitivity and specificity were 68.54% and 79.03%, respectively. There was no significant difference between Lebel and TNSS(P>0.05). The VAS differed significantly from Lebel and TNSS(P<0.05). The Kappa values of VAS, Lebel, TNSS and NAR were 0.803, 0.432 and 0.459, respectively. Conclusion:The VAS, Lebel, TNSS subjective scale and NAR are consistent in evaluating the efficacy of NAPT, with the VAS assessment showing highest consistency with NAR. As objective assessment instruments are not widely used in China, subjective assessment method could be adopted to evaluate the efficacy of NAPT in clinical practice, and VAS scale is recommended as a priority.


Assuntos
Alérgenos , Rinite Alérgica , Animais , Humanos , Testes de Provocação Nasal/métodos , Rinite Alérgica/diagnóstico , Nariz , Pyroglyphidae
12.
Artigo em Chinês | MEDLINE | ID: mdl-37253515

RESUMO

Objective:To investigate the value of nasal provocation test(NPT) in evaluating the efficacy of allergen immunotherapy(AIT) in patients with dust mite induced allergic rhinitis(AR). Methods:A total of 83 patients with dust mite induced AR with/without asthma were included. Symptom score(SS), daily medication score(DMS), combined symptom and medication score(CSMS), rhinoconjunctivitis quality of life questionnaire(RQLQ), NPT and skin prick test(SPT) were assessed before and after 1 year AIT. Results:There were statistical differences in SS(P<0.000 1), DMS(P<0.000 1), CSMS(P<0.000 1), and RQLQ(P<0.000 1) after 1 year of AIT compared with pre-treatment. The effective rate of CSMS was 73.49%, and the effective rate of NPT was 42.17%. CSMS was consistent with NPT in efficacy assessment(Kappa=0.437, P<0.001); while in 54 patients with pre-treatment NPT concentrations other than the original concentration, CMSM and NPT showed better consistence(Kappa=0.895, P<0.001). Among the 48 patients with ineffective NPT assessment in the first year, 25 patients completed the second-year follow-up, and 12 patients(48.00%) showed effective in NPT. However, 10 out of 12 patients(83.33%) with NPT concentration other than original solution pre-treatment showed effective NPT at the second year. Conclusion:NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients, especially for patients with positive NPT induced at lower concentrations before treatment.


Assuntos
Pyroglyphidae , Rinite Alérgica , Animais , Humanos , Alérgenos , Testes de Provocação Nasal , Qualidade de Vida , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Dessensibilização Imunológica , Testes Cutâneos , Poeira
13.
Artigo em Chinês | MEDLINE | ID: mdl-37253513

RESUMO

The allergen nasal provocation testing(NPT), in which allergens are applied directly to the nasal mucosa under standard and controlled conditions to provoke the main symptoms of allergic rhinitis(AR), reproduces the response of the upper respiratory tract to natural exposure to allergens under controlled conditions and is the only test currently available to confirm nasal reactivity to allergens. It is invaluable in studying the mechanisms of AR and in assessing the response to novel anti-allergic treatments. The test may play an increasingly important role in clinical practice, especially in the identification of local AR, the diagnosis of occupational AR, the clarification of the composition of allergens, the assessment of the efficacy of AR treatment and the selection of candidates undergoing allergen immunotherapy. This article reviewed the application of NPT in the diagnosis of allergic and non-allergic rhinitis, and also introduces the indications, contraindications, advantages and limitations of NPT in evaluating nasal response.


Assuntos
Rinite Alérgica , Rinite , Humanos , Alérgenos , Rinite/diagnóstico , Testes de Provocação Nasal , Rinite Alérgica/diagnóstico , Mucosa Nasal
14.
Rhinology ; 61(3): 287-288, 2023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-36912435

RESUMO

Local allergic rhinitis (LAR) is one of the endotypes of rhinitis. Despite much data about epidemiology diagnosis and treatment in adult patients with LAR, there is little information on children. Many studies indicate the need for such an assessment of the phenomenon in children, which results in one meta-analysis based on young patients selected from cohorts of patients of different ages.


Assuntos
Rinite Alérgica , Rinite , Adulto , Humanos , Criança , Rinite Alérgica/epidemiologia , Testes de Provocação Nasal/métodos , Testes Cutâneos
15.
J Allergy Clin Immunol ; 151(5): 1215-1222.e4, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36828083

RESUMO

Nasal allergen challenge (NAC) is applied in a variety of settings (research centers, specialty clinics, and hospitals) as a useful diagnostic and research tool. NAC is indicated for diagnosis of seasonal and perennial allergic rhinitis, local allergic rhinitis, and occupational rhinitis; to design the composition of allergen immunotherapy in patients who are polysensitized; and to investigate the physio-pathological mechanisms of nasal diseases. NAC is currently a safe and reproducible technique, although it is time- and resource-consuming. NAC can be performed by a variety of methods, but the lack of a uniform technique for performing and recording the outcomes represents a challenge for those considering NAC as a clinical tool in the office. The availability of standardized allergens for NAC is also different in each country. The objective of this workgroup report is to review the current information about NAC, focusing on the practical aspects and application for diagnosis of difficult rhinitis phenotypes (eg, local allergic rhinitis, occupational rhinitis), taking into account the particular context of practice in the United States and the European Union.


Assuntos
Rinite Alérgica Perene , Rinite Alérgica , Rinite , Sinusite , Humanos , Alérgenos/uso terapêutico , Rinite/diagnóstico , Rinite/terapia , Rinite Alérgica/terapia , Rinite Alérgica/tratamento farmacológico , Rinite Alérgica Perene/diagnóstico , Dessensibilização Imunológica , Testes de Provocação Nasal/métodos
16.
Int Arch Allergy Immunol ; 184(4): 366-369, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36599313

RESUMO

BACKGROUND: Exposure to mosquitoes in the Tropics is perennial, and their somatic and saliva antigens have shown IgE binding capacity, although it is not clear whether this is due to cross-reactivity or primary sensitization. Inhalation of these allergens could trigger an allergic response. OBJECTIVE: The aim of the study was to evaluate the clinical relevance of sensitization to Aedes aegypti in a group of patients with allergic rhinitis. METHODS: A cross-sectional study with allergic rhinitis subjects and healthy controls sensitized to mosquito extract was performed. Sensitization to mosquito and house dust mites was evaluated using skin prick test (SPT) and antibody determination by ELISA. Nasal provocation test (NPT) with whole-body extract was used to determine clinical relevance. RESULTS: Allergic rhinitis patients were more sensitized to mosquito extract than controls with (+) SPT (66.6% vs. 7.6%). From these (+) SPT patients, 44.5% had (+) NPT, and just two (11%) presented mono-sensitization to mosquito. Antibody reactivity was similar between patients and controls; however, (+) NPT patients showed a tendency to had higher levels of IgE and IgG4. DISCUSSION: Mosquitoes are perennial in most tropical areas, and their body allergens could be associated with respiratory allergies.


Assuntos
Aedes , Rinite Alérgica , Animais , Humanos , Estudos Transversais , Rinite Alérgica/diagnóstico , Alérgenos , Testes de Provocação Nasal , Testes Cutâneos , Imunoglobulina E , Extratos Vegetais
17.
Int Arch Allergy Immunol ; 184(1): 12-20, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36223735

RESUMO

Local allergic rhinitis (LAR) is, to date, a debated and complex entity, still orphan of global consideration and a multicentric approach. LAR does not seem to find a proper positioning in the classic classifications and phenotypes of chronic rhinitis, and its pathophysiology relies specifically on the presence of local IgE. These patients in fact have a suggestive clinical history of allergic rhinitis in the presence of negative skin prick tests and serum IgE tests for the suspect allergen. Nasal allergen challenge, assessment of local IgE, basophil activation test (BAT), and nasal cytology are, at the moment, the most used tests in the diagnostic approach to the disease, despite their limitations. Considering that the correct interpretation of diagnostic tests and their clinical relevance is fundamental in the assessment of the right diagnosis and the subsequent therapy, we propose a new diagnostic approach that encompasses all of these methodologies and suggest that several pragmatic randomized control trials as well as prospective, multicentric studies directed at the long-term follow-up of LAR be carried out to further investigate this debated entity.


Assuntos
Rinite Alérgica , Rinite , Humanos , Estudos Prospectivos , Imunoglobulina E , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Alérgenos , Testes Cutâneos , Testes de Provocação Nasal
18.
Arq. Asma, Alerg. Imunol ; 6(4): 536-540, out.dez.2022. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1509565

RESUMO

Este trabalho teve como objetivo avaliar pacientes com rinite alérgica persistente, sensibilizados a ácaros domésticos, associado à elevada sensibilização por pólen de gramíneas, sem sintomatologia estacional. Usou-se como método o diagnóstico molecular por componentes para selecionar os verdadeiramente alérgicos ao pólen de gramíneas. Foi realizado um estudo retrospectivo com análise de prontuários de pacientes em áreas de Caxias do Sul e municípios próximos no estado do RS, nos anos de 2016 e 2017, com as mesmas características climáticas. Foram selecionados 50 pacientes com alergia a ácaros, através de teste de punctura (pápula > 5 mm) associado ao pólen de gramíneas (pápula de > 7 mm) sem sintomatologia na primavera. Um total de 52% era do sexo feminino, a idade variou entre 4 e 56 anos, com uma média de 26,6 anos. Pesquisou-se a dosagem de IgE específica no soro para antígenos moleculares de pólen de gramíneas como estes: Phl p1, Phl p5, Cyn d1, em todos os pacientes. Houve 13 pacientes (26%) com diagnóstico, pelo menos, a um dos antígenos moleculares estudados. A amostra restringida apresentou 5 (10%) deles que possuíam Phl p5 > Phl p1, ou seja, eram verdadeiramente alérgicos à subfamília Poideae, enquanto 2 (4%) apresentaram Cyn d1 (subfamília Chloridoideae) > Phl p1. O estudo mostra que, em pacientes com rinite alérgica persistente, polissensibilizados a ácaros associados a pólen de gramíneas, sem sintomas estacionais característicos, os testes moleculares podem diagnosticar os verdadeiros alérgicos ao pólen.


This study aimed to evaluate patients with persistent allergic rhinitis who are sensitized to house mites and have high sensitization to grass pollen without seasonal symptoms. Molecular diagnosis was used to determine patients truly allergic to grass pollen. This retrospective study analyzed the medical records of patients from areas of Caxias do Sul and nearby municipalities (all with the same climatic characteristics) in the state of Rio Grande do Sul, Brazil between 2016 and 2017. Fifty patients allergic to dust mites were selected through a prick test (papule > 5 mm) and grass pollen (papule > 7 mm), but were asymptomatic in the spring. A total of 52% were female, and their ages ranged from 4 to 56 (mean 26.6) years. Specific serum IgE levels for grass pollen antigens, such as Phl p1, Phl p5, and Cyn d1, were investigated in all patients. Thirteen patients (26%) were diagnosed with at least one studied molecular antigen. The restricted sample included 5 (10%) patients with Phl p5 > Phl p1, ie, truly allergic to the Pooideae subfamily, while 2 (4%) had Cyn d1 (Chloridoideae subfamily) > Phl p1. The results indicate that among patients with persistent allergic rhinitis polysensitized to mites and grass pollen but without characteristic seasonal symptoms, molecular tests can diagnose those who are truly allergic to pollen.


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Testes Cutâneos , Testes de Provocação Nasal
19.
Int J Pediatr Otorhinolaryngol ; 157: 111138, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35429872

RESUMO

OBJECTIVES: Rhinitis treatment may improve attention-deficit/hyperactivity symptoms in children. The current study evaluated changes in inattentive and hyperactive symptoms after treatment in children with chronic rhinitis. METHODS: Children aged 5-18 years with chronic rhinitis were enrolled in a 3-month prospective study. The nasal provocation test for house dust mites (HDM) and evaluation of allergen sensitization, including the skin prick test and the Phadiatop test, were performed. The severity of rhinitis was assessed according to the ARIA guideline. The total nasal symptom score and the Vanderbilt ADHD Diagnostic Rating Scale (VADRS) score for assessing inattentive and hyperactive symptoms were recorded at baseline and at 1 and 3 months after rhinitis treatment. Children with rhinitis were classified into the following two groups: HDM-induced allergic rhinitis (AR group) and non-allergic rhinitis to HDM (NAR group) based on the NPT. RESULTS: Overall, 83 children completed the 3-month prospective study, and they had a mean age of 9.12 ± 2.89 years and 44.6% were boys. After rhinitis treatment, VADRS scores assessed by the parents and teachers were significantly decreased compared with those at baseline (p = 0.005). In subgroup analysis, 61 (73.49%) children had AR, and 22 (26.5%) children had NAR. No significant difference in the baseline VADRS score was found between the AR and NAR groups. After treatment, VADRS scores assessed by the parents and teachers were significantly decreased only in the AR group (p < 0.001). Forty-five (54.2%) children had moderate persistent rhinitis, 29 (34.9%) had mild persistent rhinitis, and 9 (10.8%) had mild intermittent symptoms. There were no differences in baseline VADRS scores assessed by the parents and teachers among children with mild intermittent, mild persistent, or moderate persistent symptoms. The total nasal symptom score and VADRS score were significantly decreased after treatment for all severities of rhinitis compared with those at baseline. A greater baseline VADRS score was associated with substantial improvement of inattentive and hyperactive symptoms after treatment. CONCLUSION: Early treatment for rhinitis may improve inattentive and hyperactive symptoms in school-aged children.


Assuntos
Rinite Alérgica Perene , Rinite Alérgica , Rinite , Alérgenos , Animais , Criança , Feminino , Humanos , Masculino , Testes de Provocação Nasal , Estudos Prospectivos , Agitação Psicomotora , Pyroglyphidae , Rinite/complicações , Rinite/diagnóstico , Rinite/tratamento farmacológico , Rinite Alérgica/complicações , Rinite Alérgica/diagnóstico , Rinite Alérgica Perene/complicações , Testes Cutâneos
20.
Allergol Immunopathol (Madr) ; 50(2): 40-47, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35257544

RESUMO

BACKGROUND: Local allergic rhinitis (LAR) is a well-defined and reported phenotype in adults, but data is scarce for children and adolescents, and it is probably an undiagnosed and highly underestimated condition in childhood. OBJECTIVES: The objectives of this systematic review were to identify original observational studies published on LAR in children and adolescents and to describe the prevalence and characteristics of this phenotype in the pediatric age group. METHODS: A systematic search was performed in PubMed and EMBASE databases. The search was limited to publications on humans, written in English, published between January 1, 2000 and September 20, 2021. Participants had to be under 18 years old and with a diagnosis of LAR confirmed by nasal allergen provocation test (NAPT). RESULTS: Ten articles were identified. Despite the wide variability of protocols, prevalence rates ranged from 3.7 to 83.3% among children previously diagnosed as having nonallergic rhinitis, being markedly lower in Eastern countries (3.7-16.6%) when compared to Western countries (22.3-83.3%). To date, no relevant clinical characteristics capable of differentiating LAR patients from other childhood rhinitis phenotypes have been identified. CONCLUSIONS: LAR is an allergic rhinitis phenotype also found in children. Population and regional differences and differences in NAPT protocols may explain the heterogeneity in LAR prevalence rates observed in different parts of the world. In addition to clarifying this large discrepancy, longitudinal studies are also needed to assess the clinical characteristics of the LAR phenotype in the pediatric age group, and its stability into adulthood must be confirmed.


Assuntos
Rinite Alérgica , Rinite , Adolescente , Adulto , Alérgenos , Criança , Humanos , Testes de Provocação Nasal/métodos , Rinite/epidemiologia , Rinite Alérgica/diagnóstico , Rinite Alérgica/epidemiologia , Testes Cutâneos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA