Rinitis alérgica en pediatría: recomendaciones para su diagnóstico y tratamiento / Allergic rhinitis in pediatrics: recommendations for diagnosis and treatment

La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes de la infancia. Sin embargo, permanece subdiagnosticada y subtratada. Su prevalencia ha aumentado en los últimos años y varía del 2 % al 25 %. Los síntomas de la RA incluyen estornudos, prurito, rinorrea y congestión nasal. Un correcto diagnóstico y tratamiento de la RA y sus comorbilidades, tales como rinosinusitis con o sin poliposis nasal, conjuntivitis, otitis media, asma bronquial e infecciones del tracto respiratorio, son importantes para reducir el impacto negativo en la afectación de la calidad de vida del paciente y sus familiares, y los gastos sanitarios que ocasiona. La inmunoterapia alérgeno específica, en pacientes correctamente seleccionados, previene nuevas sensibilizaciones y reduce la hiperreactividad bronquial asociada a la RA. Considerando todos estos factores, el Comité Nacional de Alergia de la Sociedad Argentina de Pediatría propone recomendaciones basadas en la evidencia actual.

Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations

Skin prick test reactivity to aeroallergens in Jordanian allergic rhinitis patients

Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis. The aim of this cross-sectional study was to investigate the pattern of skin prick test reactivity to various aeroallergens among allergic rhinitis patients attending outpatient clinics in Amman, Jordan. Skin prick test with 18 standardized allergen extracts was performed on 538 patients. Most allergic rhinitis patients in the study sample had polysensitization. Grasses mix [51.4% of patients], thistleweed [46.9%] and olive tree [45.3%] pollens were the most common allergens in this group of patients [all seasonal]. Cat allergen was the most common perennial allergen [41.6%], followed by dust mite Dermatophagoides pteronyssinus [32.9%]. These allergens should be given the highest priority when educating allergic rhinitis patients in Amman regarding allergen avoidance strategies

Obstrução nasal / Nasal obstruction

A obstrução nasal, apesar de ser uma queixa bastante frequente na prática médica, nem sempre é valorizada, podendo refletir alterações da anatomia e fisiologia nasal tanto em indivíduos saudáveis quanto em algumas doenças, como veremos a seguir.A investigação de suas causas pode levar a vários diagnósticos, desde a um simples resfriado, que habitualmente não exige tratamento específico, até tumores cujo tratamento pode necessitar de grandes intervenções cirúrgicas. Neste artigo as autoras discorrem sobre as causas mais frequentes de obstrução nasal, os principais métodos de investigação e a abordagem terapêutica geral.

Rinometria acústica e testes de provocação nasal / Acoustic rhinometry and nasal provocation tests

A rinometria acústica é uma técnica que possibilita a avaliação da geometria nasal pela emissão e captação ondas sonoras na entrada da cavidade nasal, com a mensuração de seu volume em diferentes pontos. A rinometria acústica não depende da cooperação do paciente e consiste em método confiável e reprodutível para a análise do volume nasal de crianças e de adultos.Os testes de provocação nasal (TPN) são bioensaios que tentam reproduzir ou simular diferentes agravos sofridos pela mucosa nasal, em condições padronizadas e reprodutíveis. Os TPN consistem, basicamente, na instilação de concentrações crescentes de agentes capazes de induzir resposta local com o desencadeamento de sintomas (espirros, coriza e prurido) e alterações no fluxo aéreo nasal. TPN são considerados como importante ferramenta para estudo da fisiopatologia de rinopatias crônicas, como a rinite alérgica. Além disso, os TPN também podem ser empregados no seguimento temporal da gravidade da doença e na avaliação de resposta a diversos tratamentos e intervenções. Medidas objetivas devem ser empregadas no seu monitoramento e a rinometria acústica, por suas características, representa uma promissora opção.

Presentation and diagnosis of allergic fungal sinusitis

Allergic fungal sinusitis [AFS] is a form of fungal disease that has recently been considered a distinct clinicopathologic entity. Other forms of fungal sinusitis include acute-fulminant [invasive], chronic indolent [invasive] and mycetoma [non-invasive]. Objectives were to assess the presentation and to describe the diagnostic techniques for allergic fungal sinusitis in our setup. Descriptive study was conducted in the Department of ENT and Head and Neck Surgery, Khyber Medical College and Khyber Teaching Hospital, Peshawar from January 2002 to April 2008. Twenty-three cases of allergic fungal sinusitis [ASF] were selected for the study. Data like, name, age, sex, address, clinical features, labs [Eosinophil count] and imaging studies [CT and/or MRI] were recorded, including the pre- and postoperative treatment, operative findings and postoperative results, recurrence of disease were also recorded. Surgical procedures were performed on all cases followed by medical treatment. Study revealed that AFS is a disease of younger age, mainly occurring in 2[nd] and 3[rd] decade of life, with male to female ratio 1:1.3. Allergic rhinitis [91%] and nasal polyposis [91%] were important associated factors. Nasal obstruction [96%], nasal discharge [91%], post-nasal discharge [87%] and unilateral multi sinus extension were important clinical features. Increased eosinophil count and increased IgE level was found in 78% cases. Histopathological analysis showed fungal hyphae in all cases and aspergillus was predominant organism on culture. Orbital erosion was seen in 78% and skull base erosion was observed in 9%. Recurrence of disease was seen in nine cases. Allergic fungal sinusitis [AFS] is a disease of young immunocompetent adults. Nasal obstruction, nasal discharge, nasal allergy and proptosis were the most common presentations. Initial diagnosis of allergic fungal sinusitis requires high index of suspicion in patients presenting with chronic rhinosinusitis, such cases should be properly evaluated. Differentiation from invasive forms of fungal sinus disease is crucial

Asociación entre rinitis alérgica y asma / Association between allergic rhinitis and asthma

Se estudiaron 70 pacientes con edades comprendidas entre 2 y 12 años, provenientes del Hospital Universitario "Antonio Patricio de Alcalá" de Cumaná, Estado Sucre, con la finalidad de determinar la asociación entre asma y rinitis alérgica. El grupo estuvo compuesto por 50 niños alérgicos y 20 niños sanos de ambos sexos. A cada uno se le aplicó un cuestionario para identificar los síntomas que experimentaban con mayor frecuencia y se les realizó exámenes de laboratorio para la determinación de IgE total, cuantificación de eosinófilos absolutos en sangre y en moco nasal. El 72,0 por ciento de los niños alérgicos presentaron síntomas de rinitis alérgica y de asma simultáneamente, el 16,0 por ciento sólo presentó asma y el 12,0 por ciento rinitis alérgica. Se hallaron diferencias estadísticas altamente significativas (P<0,001); entre las variables IgE, contaje de eosinófilos en moco y eosinófilos absolutos del grupo alérgico con respecto a los controles. Se observó una correlación estadística altamente significativa (P<0,001) entre el contaje de eosinófilos en moco y sangre y la concentración sérica de IgE. Los resultados obtenidos respaldan la hipótesis de que el asma y la rinitis alérgica están asociadas y son manifestaciones de una misma entidad patológica

It were studied 70 patients between 2 and 12 years old, coming from Universitary Hospital "Antonio Patricio de Alcalá", from Cumaná, Sucre State, with the objective to determine the association between asthma and allergic rhinitis. The sample was composed of 50 allergic and 20 healthy children, of both sexes. To each one was applied a questionnaire to identify the most frequent symptoms and was realized laboratory tests to determine total IgE and absolute quantification of blood and nasal snot eosinophiles. 72 percent of allergic children had both allergic rhinitis and asthma symptoms. 16 percent presented only asthma and 12 percent only allergic rhinitis. There were significant statistical differences (P<0.001) between the following variables: total IgE, counting of nasal snot and blood eosinophiles in the allergic sample with respect to the control sample. It was observed a highly significant statistical correlation (P<0.001) between counting of nasal snot and blood eosinophiles and serum levels of IgE. The results obtained reinforce the hypothesis that asthma and allergic rhinitis are associated and both are the manifestation from a similar pathological entity

Prevalência de asma e rinite alérgica em escolares no município de Santo Ângelo/RS / Prevalence of asthma and allergic rhinitis among students from Santo Ângelo/RS

Introdução: A asma é uma doença inflamatória crônica, caracterizada por hiper-responsividade das vias aéreas inferiores que se manifesta por episódios recorrentes de sibilância, dispnéia, aperto no peito e tosse. Objetivo: Determinar a prevalência de asma e rinite alérgica em adolescentes do município de Santo Ângelo/RS. Metodologia: Foi realizado um estudo observacional, prospectivo e transversal; a amostra foi constituída por estudantes de 13 a 14 anos. Foram investigadas as variáveis: sexo, idade e interferência dos sintomas das doenças nas atividades diárias através da aplicação de um questionário epidemiológico padronizado do ISAAC (International Study of Asthma and Allergies in Childhood). Resultados: O número de questionários aplicados foi de 1.031, sendo considerados válidos 979 (94,9 por cento). A prevalência de asma nos adolescentes foi de 10,5 por cento, baseada na questão “já teve ou tem asma”. A prevalência de rinite alérgica foi de 34,6 por cento, baseada na questão “já teve ou tem rinite alérgica”. Quanto à polinose “alergia ao pólen na primavera” a prevalência foi de 30,4 por cento. Considerando-se o sub-diagnóstico das doenças, a prevalência de prováveis asmáticos foi de 12 por cento e a de adolescentes com provável rinite de 12 por cento. Conclusão: A prevalência de asma no presente estudo mostrou-se entre os valores médios mundiais e nacionais, já as prevalências de rinite alérgica e polinose mostraram-se elevadas de acordo com as médias de outros estudos. Estes dados apontam que em Santo Ângelo/RS essas doenças constituem um problema de saúde pública entre os adolescentes.

Introduction: Asthma is an inflammatory chronic disease, characterized as a hyperresponsivity of the lower airways that manifests itself through recurrent episodes of sibilance, dyspnea, chest pressure, and coughing. Aim: To determine the prevalence of asthma and allergic rhinitis in adolescents living in the municipality of Santo Ângelo/RS. Methods: An observational transversal, prospective study was performed, the sample comprising 13- and 14-year-old students. The variables sex, age, and interference of the symptoms of the disease in the daily activities were investigated through the administration of the standardized epidemiological questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). Results: Of the 1,031 questionnaires responded, 979 (94.9 percent) were considered as valid. The prevalence of asthma among the adolescents was 10.5 percent, based on the question: “Have you ever had asthma?”. The prevalence of allergic rhinitis was 34.6 percent, based on the question “Have you ever had allergic rhinitis?. As for pollen allergy during the spring, the prevalence was 30.4 percent. Considering the underdiagnosis of the diseases, the prevalence of probable asthmatics was 12 percent and of adolescents with probable rhinitis was 12 percent. Conclusion: The prevalence of asthma in the present study was consistent with the reported mean world and national values, but the prevalences of allergic rhinitis and pollen allergies were high as compared to the means reported elsewhere. The data indicate that in Santo Ângelo, RS these conditions are a public health problem among adolescents.

Efectos de la inmunoterapia sobre la hiperreactividad bronquial de pacientes con rinitis alérgica / Effects of immunotherapy on bronchial hyperresponsiveness in patients with allergic rhinitis

La rinitis Alérgica es una enfermedad respiratoria crónica, inducida por una inflamación mediada por IgE en las membranas que recubren la nariz; con una prevalencia importante entre el 10% y el 25% de la población y una morbilidad con deterioro de la calidad de vida. Asma y rinitis son enfermedades comórbidas que surgieren el concerpto de una vía única, ya que comparten el mismo mecanismo inmunológico y una característica clínica que es la presencia de HRB; aunque en la rinitis es menos frecuentes, su presencia es considerada un factor de riesgo para el futuro desarrollo de Asma Bronquial. El tratamiento de la Rinitis Alérgica contempla: - la evitación del alérgeno - farmacoterapia - inmunoterapia específica, siendo considerada como la única terapia capaz de cambiar el curso de la enfermedad. Los Objetivos de este estudio fueron: 1) Evaluar los efectos de la inmunoterapia sobre la HRB de pacientes con rinitis alérgica, luego de un año de tratamiento. 2) Valorar la respuesta al tratamiento, mediante variables inmunológicas. 3) Evaluar la respuesta al tratamiento mediante escala de síntomas y consumo de medicación. 4) Determinar dosis alergénicas mínimas seguras y efecaces para el control de los síntomas...

The Allergic Rhinitis is a chronic respiratory disease, induced by a half-full inflammation by IgE in the mucosa that covers the nose; It has an important prevalence of between 10%y 25% of the population and a morbidity with deterioration of the quality of life. Asthma and rhinitis are comorbid diseases that suggest the concept of aunique route, since they share the same immunological mechanism and clinicalcharacteristics that is the HRB presence; although in the rhinitis this is less frequent, its presence is considered a risk factor for the future development of bronchial Asthma. The treatment of Allergic Rhinitis contemplates: Allergen avoidance Pharmacotherapy, specific Immunotherapy, being considered the only therapy able to change the course of the disease. Objetives: 1) To evaluate the effects of the immunotherapy on the HRB of patients with Allergic Rhinitis, after a year of treatment. 2) To value the response to the treatment, by means immunological variables 3) Evaluate the response to the treatment, by clinical variables: Registry medication consumption and score of symptoms. 4) Determinate dose security and efficacity for symptoms control. Randomized design double blind placebo control studied 20 adult patients who presented displayed compatible symptoms with allergic rhinitis, confirmed by skin pricktest (Alergo Pharma). The group placebo control was 8 patients (4 male, 4 female) and the group that received treatment with antigens I include 12 patients (9 m, 3 F) of whom 10 receivedtreatment with Dermatophagoides mixes and 2 patients treated with grass pollen (Alergo Pharma) All the patients were valued at the beginning and the year of treatment with subcutaneous Immunotherapy, considering the following variables: Bronchial measurement of HRB by methacolin challenge. (Chemical Sigma Co)continuous method aerosolization considering positive response a PC20=<16mg/ml...

Rinitis alérgica como causa de obstrucción de las vías áereas superiores / Allergic rhinitis caused by upper airway obstruction

La rinitis es una patología muy frecuente, siendo la rinitis alérgica la de mayor prevalencia. Esta constituye una de las causas de obstrucción de las vías aéreas superiores.

Factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España / Risk factors for symptoms of allergic rhinitis in adolescents in Castellón, Spain

OBJETIVOS: Estimar factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España. MÉTODOS: Estudio transversal de base poblacional a partir de la fase III del ISAAC (International Study of Asthma and Allergies in Childhood) llevado a cabo en 2002 entre adolescentes de 13 a 14 años. Se utilizó el cuestionario ISAAC para definir los casos de rinitis alérgica. Se estimaron razones de posibilidades (RP) y sus intervalos de confianza de 95 por ciento (IC95 por ciento) mediante modelos de regresión logística. RESULTADOS: La participación fue de 66,8 por ciento (3 995 adolescentes de un total de 5 981). La prevalencia de síntomas de rinoconjuntivitis en los últimos 12 meses fue de 16,5 por ciento, y la prevalencia de alergia nasal alguna vez, de 7,4 por ciento. Con la regresión logística, la rinoconjuntivitis se asoció a la mujer (RP=1,63; IC95 por ciento:1,33-2,00); fumar la madre en casa (RP=1,32; IC95 por ciento:1,08-1,63); historia de sinusitis (RP=2,02; IC95 por ciento:1,51-2,70), y circulación constante de camiones por la calle de residencia (RP=1,58; IC95 por ciento:1,02-2,44). De igual manera, la alergia nasal se asoció con la historia familiar de rinitis alérgica (RP=2,62; IC95 por ciento:1,90-3,63); historia de sinusitis (RP=2,65; IC95 por ciento:1,77-3,96), historia de bronquitis (RP=1,68; IC95 por ciento:1,19-2,36), y clase social, con descensos progresivos al comparar las clases superiores e inferiores. CONCLUSIONES: Diferentes factores de riesgo medioambientales se asociaron con el hecho de sufrir síntomas de alergia nasal; se sugiere la importancia de adecuar medidas preventivas específicas.

OBJECTIVES: To estimate the risk factor for symptoms of allergic rhinitis in adolescents in Castellón, Spain. METHODS: A cross-sectional population based study of Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC) conducted in 2002 among adolescents from 13-14 years of age. The ISAAC questionnaire was used to define cases of allergic rhinitis. Logistic regression models were used to estimate odds ratio (OR) and their 95 percent confidence intervals (95 percentCI). RESULTS: Participation was 66.8 percent (3 995 adolescents of the 5 981 total). The prevalence of rhinoconjunctivitis symptoms in the last 12 months was 16.5 percent and the prevalence of nasal allergy at some point was 7.4 percent. Logistic regression showed that rhinoconjunctivitis was associated with being female (OR = 1.63; 95 percentCI: 1.33-2.00); a mother who smokes in the home (OR = 1.32; 95 percentCI: 1.08-1.63); a history of sinusitis (OR = 2.02; 95 percentCI: 1.51-2.70); and living on a street with heavy truck traffic (OR = 1.58; 95 percentCI: 1.02-2.44). Likewise, nasal allergy was associated with a family history of allergic rhinitis (OR = 2.62; 95 percentCI: 1.90-3.63); a history of sinusitis (OR = 2.65; 95 percent CI: 1.77-3.96); a history of bronchitis (OR = 1.68; 95 percentCI: 1.19-2.36); and social class, with a steady decline when comparing higher classes to lower classes. CONCLUSIONS: Various environmental risk factors were associated with the symptoms of nasal allergies, which points to the importance of implementing specific preventive measures.

Rinite alérgica: aspectos epidemiológicos, diagnósticos e terapêuticos: [revisão] / Allergic Rhinitis: epidemiological aspects, diagnosis and treatment: [review]

Este estudo tem como objetivo revisar a literatura a respeito da rinite alérgica quanto aos aspectos epidemiológicos, clínicos, diagnósticos e terapêuticos. A revisão da bibliografia foi realizada utilizando-se as bases de dados Medline, Literatura Latino-Americana e do Caribe em Ciências da Saúde e HighWire, nos últimos trinta anos, utilizando-se os descritores allergic rhinitis, epidemiology, diagnosis, e treatment. Foram selecionados 60 artigos. Este estudo destaca o aumento na prevalência da rinite alérgica, sua associação com a asma, os critérios diagnósticos e seu tratamento. A classificação da rinite alérgica é apresentada, bem como as estratégias de tratamento. As modalidades terapêuticas apresentadas e discutidas são anti-histamínicos, corticóides, imunoterapia, antileucotrienos, cromoglicato dissódico e anticorpos anti-IgE, bem como a redução da exposição aos alérgenos. Finalmente, ressalta-se a importância da abordagem da rinite alérgica em saúde pública.

This study was a review of the literature on the epidemiological, clinical, diagnostic and therapeutic aspects of allergic rhinitis. Bibliographic searches were based on the information contained within the Medline, Latin American and Caribbean Health Sciences Literature and HighWire databases, covering the last thirty years and using the following search terms: 'allergic rhinitis', 'epidemiology', 'diagnosis' and 'treatment'. Sixty articles were selected. This study describes the increase in the prevalence of allergic rhinitis, its relationship with asthma, the diagnostic criteria and the treatment. The classification of allergic rhinitis and strategies for its treatment are presented. Therapeutic modalities presented and discussed include the administration of antihistamines, corticosteroids, immunotherapy, anti-leukotrienes, sodium cromoglycate and anti-IgE antibodies, as well as minimizing exposure to inhaled allergens. Finally, the importance of the management of allergic rhinitis in public health is emphasized.

Clinical profile of patients with allergic rhinitis

To find out the allergic symptoms of patients who presented to otorhinolaryngology clinic. Two hundred and fifteen patients of either sex and above the age of sixteen years who presented to otorhinolaryngology clinic suffering from allergic rhinitis were involved in the study. History of rhinorrhea, sneezing, nasal obstruction, nasal itching, epistaxis, nasal dryness and conjunctival symptoms which are generally the chief symptoms of allergic rhinitis in addition to family history of bronchial asthma and other allergies were recorded. Physical clues to allergic rhinitis were boggy, pale, or [bluish] nasal turbinates, rhinorrhea, allergic salute and allergic shiners. The commonest complaint was rhinorrhea seen in 96% of cases followed by sneezing [88%], nasal obstruction [80%], nasal itching [55%], epistaxis [17%], nasal dryness [14%] and conjunctival symptoms [12%]. Pale and hypertrophied boggy turbinates were seen in 97% of cases, allergic salute in 4% and allergic shiners in 13% of cases. In 7% of cases, the patients had mild bronchial allergy manifested by dyspnea, cough and wheezes during the attack. Positive family history of allergy was found in 25% of patients. Allergic rhinitis is a common medical condition characterized by rhinorrhea, sneezing and nasal obstruction as chief symptoms. The diagnosis rests mainly on a classic clinical picture

Doenças das vias aéreas superiores / Diseases of the upper respiratory tract

Um grande número de agentes presentes no ar inalado, ambiental ou ocupacionalmente, pode causar sintomas e doenças das vias aéreas superiores. Infelizmente o estabelecimento do nexo causal entre os mais diversos tipos de exposições que podem desencadear essas doenças não faz parte da rotina dos profissionais da saúde afeitos a essa questão. Uma extensa lista desses agentes e suas relações com as atividades e o desencadeamento dessas enfermidades estão disponíveis na literatura. Destacamos as rinossinusopatias, as disfonias, as ulcerações e perfurações do septo nasal e o elevado número de neoplasias da cavidade nasal e dos seios paranasais, que podem estar associados às atividades laborativas. Os procedimentos diagnósticos para investigação da etiologia ocupacional, apesar de disponíveis, ainda são pouco utilizados rotineiramente. Geralmente o reconhecimento precoce do agente causal e o afastamento da exposição podem resolver o problema evitando sua cronificação, pois, como nas demais doenças respiratórias ocupacionais, os programas de prevenção e o controle são elementos imprescindíveis para o equacionamento dessas enfermidades.

A great number of agents found in inhaled air, whether in the environment or in the workplace, can cause symptoms and diseases of the upper respiratory tract. Unfortunately, establishing the cause-and-effect relationship between exposure to one of the various types of agents that can provoke such diseases and the diseases themselves is not routine practice among the health professionals involved. A comprehensive list of these agents and their relationships with the effects and onset of such illnesses is available in the literature. Chief among these ills are rhinosinusitis, dysphonia and ulceration/perforation of the nasal septum, as well as tumors in the nasal cavity or paranasal sinuses, all of which can be work related. Although widely available, diagnostic procedures for the investigation of occupational etiology are not yet routinely employed. In general, early identification of, and discontinuation of the contact with, the causal agent can resolve the problem, thereby averting the development of the chronic form of the disease. As with other types of occupational respiratory diseases, prevention and control programs are indispensable in the fight against these illnesses.

Surveying the prevalence of asthma, allergic rhinitis and eczema in school-children in Khon Kaen, Northeastern Thailand using the ISAAC questionnaire: phase III.

This is the second survey of schoolchildren in Khon Kaen, Northeastern Thailand, using the Thai version of the ISAAC questionnaire to examine the trend in the prevalence of asthma, allergic rhinitis and eczema, and to compare the results with the ISAAC Phase I data. We analyzed 5,075 questionnaires comprising 2,119 six- to seven- and 2,956 thirteen- to fourteen-year-old children (48 and 42 percent male, respectively). The cumulative vs. 12-month prevalence according to the written questionnaires were: 14.3 vs. 9.8% for wheezing, 42.6 vs. 33.3% for rhinitis and 13.5 vs. 11.2% for eczema, respectively. The cumulative vs. 12-month prevalence for the wheezing module, based on the video questionnaire, was 9.2 vs. 6.3%, respectively. Most Phase III prevalence was significantly lower than the first survey except for the steady, 12-month prevalence of wheeze. Our study confirms the high prevalence of allergic diseases among school-children in Northeastern Thailand; albeit, prevalence has not increased in recent years. The Thai version of the English-language ISAAC questionnaire needs to be validated before further use in epidemiological research.

Rinite alérgica / Allergic rhinitis

A rinite alérgica é uma doença crônica, cujos sintomas variam quanto à frequencia e à severidade dos sintomas. Está presente em crianças e adultos, geralmente diminuindo a qualidade de vida. O diagnóstico depende de uma história clínica minuciosamente detalhada,apoiada no exame físico e nos exames complementares. O tratamento é complexo, inclui medidas educativas, controle de ambiente, medicamentos diversos e, em alguns casos, imunoterapia especifica e cirurgia. Esta revisäo pretende abordar, de forma prática, como diagnosticar, classificar e tratar a rinite alérgica.(au)

Rhinosinusitis among the patients with perennial or seasonal allergic rhinitis.

Although no hypothesis is universally accepted, allergic rhinitis (AR) may play an important role in the occurrence of rhinosinusitis. This study was carried out to investigate the frequency and severity of rhinosinusitis among patients with seasonal or perennial AR. This study included 73 patients with AR. Findings related to rhinosinusitis of these patients were demonstrated by computed tomography (CT), and were scored according to the Lund-Mackay CT scan staging system. Fifty-two of the 73 patients (71.2%) were shown to have findings of rhinosinusitis. Of these 52, twenty-four patients (77.4%) had perennial AR and 28 (66.7%) patients had seasonal AR. The mean total CT staging score of rhinosinusitis was 4.2 +/- 3.2 in patients with perennial AR and 2.6 +/- 1.3 in patients with seasonal AR. Although the frequency of rhinosinusitis among patients with perennial AR was higher than among seasonal ones, this was statistically insignificant (p = 0.32). But CT staging scores of rhinosinusitis among the patients with perennial AR were significantly higher than among the seasonal AR group (p = 0.014). Although there was no significant difference between the frequency of rhinosinusitis of seasonal and perennial AR, the severity of rhinosinusitis was more severe in cases with perennial AR, in this study. Early management of an allergic disease is essential if its long-term consequences are to be prevented or minimized.

Eosinophilic mucin rhinosinusitis: terminology and clinicopathological presentation.

Many terms related to allergic fungal rhinosinusitis (AFRS) such as eosinophilic mucin rhinosinusitis (EMRS), eosinophilic fungal rhinosinusitis (EFRS), and AFRS-like syndrome have been proposed. The authors define EMRS as patients with rhinosinusitis who demonstrate eosinophilic mucin on histopathological examination. EMRS patients who demonstrate fungal hyphae within the mucin are diagnosed as having EFRS and those who cannot demonstrate fungal hyphae within the mucin are diagnosed as having EFRS-like syndrome. EFRS patients who demonstrate an allergic response to the fungi are diagnosed as having AFRS and those who cannot demonstrate any allergic responses to the fungi are diagnosed as having non-allergic fungal rhinosinusitis (NAFRS). In the United States, the prevalence of AFRS in chronic rhinosinusitis patients who require surgery is 5-10 per cent. However, the prevalence of AFRS in Thailand is not known because AFRS has never been reported and studied in Thailand. This study shows the clinical and pathological entities of patients with EMRS in King Chulalongkorn Memorial Hospital from July 2001 to July 2002. From a total of two hundred and fourteen rhinosinusitis patients who required surgery, six were diagnosed as having EMRS. Two of six EMRS patients were diagnosed as having EFRS (both of them were also diagnosed as having AFRS) and four patients were diagnosed as having EFRS-like syndrome. In this study, the prevalence of AFRS is much less than in the United States because of the limited understanding of this disease, the lack of commercially available antigens for dematiaceous fungi, and the lack of awareness and knowledge of pathologists to diagnose eosinophilic mucin and fungi within the mucin. The terms related to AFRS are also discussed in this study.

Niveles séricos de proteína cationica del eosinofilo en pacientes con asma bronquial y rinitis alérgica perenne: relación con el número absoluto de eosinofilos en sangre periférica e IGE sérica total / Level seric protein cationic of the eosinofile in patients with bronchial asthma and allergy rhinitis: relations with the absolute number of eosinofiles in periphenal blood and IGE total serum

La proteína cationica del eosinófilo (ECP)es considerada un reflejo del grado de activación del pool de eosinófilos. Nosotros analizamos la importancia de la determinación de ECP en pacientes con diagnóstico de asma bronquial (AB) y rinitis alérgica perenne (RAP). Los resultados muestran una tendencia a niveles elevados de ECP en los pacientes, con diferencias estadísticamente significativas (P=0,027) en los pacientes con RAP. Encontramos una correlación significativa en ECP con el número absoluto de eosinófilos y los niveles de IgE total (r=0,6765; P=0,0079 y r=0,6273; P=0,009 respectivamente). Podemos concluir que la determinación de los niveles séricos de ECP constituye un marcador útil de la inflamación alérgica