Fire needle acupuncture at Neiyingxiang (EX-HN 9) in the treatment of moderate and severe refractory perennial allergic rhinitis: A case report.

RATIONALE: In recent decades, the incidence of perennial allergic rhinitis (PAR) has been increasing annually. However, some patients could not achieve adequate symptomatic relief with routine pharmacological treatment. Consequently, there exists an urgent clinical imperative for the development of safe and efficacious treatments with sustained therapeutic impact to ameliorate the symptomatic burden and enhance the quality of life. PATIENT CONCERNS: The patient was a 35-year-old woman. She had suffered moderate and severe refractory PAR for decades and failed to sustain symptom mitigation from regular treatment. DIAGNOSES: Perennial allergic rhinitis. INTERVENTIONS: The patient underwent a 4-week course of fire needle acupuncture at Neiyingxiang, administered weekly, during which all allopathic medication was discontinued. OUTCOMES: The total nasal symptoms score, total non nasal symptoms score, rhinoconjunctivitis quality of life questionnaire, and the total nasal resistance of the patient were decreased after treatment and achieved symptomatic relief. Follow-up conducted 3 months post-treatment revealed enduring symptom relief, with only sporadic nasal congestion elicited by cold stimulus. LESSONS: This case proves that, fire needle acupuncture at Neiyingxiang may be beneficial in treating moderate and severe refractory PAR patient and have a lasting effect.

Changes in olfaction & quality of life following standard medical therapy in patients with intermittent & persistent allergic rhinitis.

Background & objectives: Allergic rhinitis (AR) is an inflammatory disease prevalent worldwide which can affect both olfaction and quality of life (QoL). The objective of the present study was to assess olfaction and QoL changes in patients with AR before and after medical therapy. Methods: Adult participants (>18 yr) with AR were recruited for this study. These patients prospectively underwent olfaction testing using the modified Connecticut Chemosensory Clinical Research Centre Test and QoL assessment using Rhinoconjunctivitis QoL Questionnaire (RQLQ) before and after standard medical therapy with topical steroids and/antihistaminics. Results: Of the 150 patients recruited, 72 per cent had intermittent AR. The symptom of hyposmia was present in 34 patients (22.7%) and was more prevalent in patients with moderate-to-severe type of AR (P<0.001). However, olfaction testing revealed hyposmia/anosmia in 44 patients (29.3%). Mean composite olfaction scores were significantly higher in patients with mild AR compared to moderate/severe AR (P=0.026). The pre-therapy mean composite olfaction score in the 34 patients with olfaction disturbances was 3.1 standard deviation (±1.06 SD). Following therapy, the mean composite olfaction score rose to 4.3 (±1.34 SD) and this change was found to be significant (P<0.001). Mean pre-therapy RQLQ scores were 2.87 (0.06-5.33) overall. Significant improvement was also found in RQLQ scores following therapy (P<0.001). Mean RQLQ scores were significantly lower in those with moderate-to-severe AR (P<0.001) as well as those with intermittent AR (P=0.004). Nine patients had persistently high RQLQ scores after medical therapy. Interpretation & conclusions: Both olfaction and QoL showed significant improvement after medical therapy in Indian adults with AR. In those patients who do not improve, other causes must be sought for the persistent symptoms.

Aqueous intradermal low-dose house dust mite immunotherapy in tropical settings: a valid cost-effective approach for developing nations?

INTRODUCTION: Aqueous allergen injections, an effective and century-old technique, is considered a second-line approach in daily clinical practice. Inconveniences still surround conventional subcutaneous immunotherapy (SCIT) administration, such as a need for frequent injections, prolonged up-dosing schedules, elevated costs, and the unlikely possibility of a systemic reaction. The intradermal immunotherapy route (IDR) might favorably impact many of the aforementioned issues (Table 1). House dust mite (HDM) allergens are the main perennial sensitizers in the tropics, and as such, are solely employed in immunotherapy treatments. METHODS: We carried out a year-long real-life study in 25 perennial allergic rhinitis children, symptomatic on exposure to house dust, employing an intradermal low-dose allergen mix consisting of 50 ng of Dermatophagoides pteronyssinus/Dermatophagoides farinae and 120 ng of Blomia tropicalis, under a unique cost-wise protocol. Basal symptoms/signs and face Visual Analog Scale (fVAS) scores were recorded for 2 weeks and later compared with those registered throughout the 1-year treatment. Serum-specific IgG4 and IL-10 levels were employed in the assessment of the immune responses. RESULTS: Symptoms/signs and fVAS scores were significantly reduced from days 42 and 49, respectively, and remained so until treatment completion. Increases in specific IgG4's and IL-10 levels reflected significant immune responses. Injections were well tolerated and families reported improved health status (quality of life, QoL). CONCLUSIONS: A unique cost-effective immunotherapy alternative for deprived allergic communities in tropical settings is depicted; further research is needed.

Efficacy and safety of electric heating moxibustion for perennial allergic rhinitis: protocol for a randomized controlled trial.

BACKGROUND: Allergic rhinitis (AR) is an IgE-mediated disease that adversely affects quality of life. Many studies report that moxibustion is an effective treatment for perennial allergic rhinitis (PAR). However, it is difficult to perform moxibustion on the face because of possible burning of the skin and the noxious effects of smoke. Electric heating moxibustion does not have these limitations. The purpose of this clinical trial is to assess the possibility of treating PAR with electric heating moxibustion and to assess the feasibility of conducting a clinical test on a larger scale. METHODS: This is a randomized, open-label, assessor-blind, parallel-design pilot clinical study. We will recruit 40 eligible participants and randomly allocate them into an electric heating moxibustion group or an acupuncture group at a 1:1 ratio. Patients in both groups will receive eight treatments over 4 weeks, and the final follow-up will be 4 weeks after the last treatment. Eleven acupuncture points will be used for patients in both groups (EX-HN3 and bilateral EX-HN-8, LI20, LI4, GB20, and ST36). The primary outcome measure is change in the Total Nasal Symptom Score, and the secondary outcome measures are changes in the Rhinoconjunctivitis Quality of Life Questionnaire, nasal endoscopy index for pattern identification, pattern identification questionnaire for AR, total IgE, eosinophil count, and adverse effects. DISCUSSION: This clinical trial will examine the effect of electric heating moxibustion on PAR. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03342105 . Registered on 14 November 2017.

Symptomatic treatment of pollen-related allergic rhinoconjunctivitis in children: randomized controlled trial.

BACKGROUND: About 12% of children are affected by allergic rhinoconjunctivitis (AR). Although the main symptomatic treatments are intranasal corticosteroids (INCS) (daily or on demand) and oral antihistamines, it remains unclear which treatment provides the best relief of symptoms. Therefore, this study examines whether daily use of INCS is superior to on-demand use or to oral antihistamines on demand. METHODS: A single-blinded randomized controlled trial in children (aged 6-18 years) with pollen-related AR. Patients received either INCS daily (fluticasone propionate), INCS on demand (fluticasone propionate) or oral antihistamine on demand (levocetirizine) for 3 months during the grass pollen season. A daily online symptom diary on both nose and eye symptoms was completed. The primary outcome was the percentage of symptom-free days. RESULTS: A total of 150 children were randomized. The percentage symptom-free days was in favour of INCS on demand (30%) compared with INCS daily (22%), that is 8% difference (95% CI -5 to +21%; not significant). The antihistamine on-demand group had 15% symptom-free days, that is 7% difference compared to INCS daily (95% CI -6 to +19%;, not significant). Patients in the INCS on-demand group used on average 61% less fluticasone than patients in the INCS daily group during the study period (P < 0.0001). CONCLUSIONS: This trial with three parallel treatment groups shows that INCS daily was not superior to INCS on demand or to antihistamine on demand regarding the number of symptom-free days. An on-demand INCS strategy has the advantage of a lower overall corticosteroid exposure and less costs.

Effect of curcumin on nasal symptoms and airflow in patients with perennial allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a common disorder that can significantly affect patient quality of life. Previous studies have found that curcumin had anti-inflammatory and antioxidant effects and clinical benefits in cancer and asthma. OBJECTIVE: To determine the efficacy of curcumin in the treatment of AR and to explore the molecular mechanisms involved. METHODS: In a randomized, double-blind study, 241 patients with AR received either placebo or oral curcumin for 2 months. The therapeutic effects of curcumin were evaluated by nasal symptoms and nasal airflow resistance. In addition, the production of interferon γ, interleukin (IL) 4, IL-10, and tumor necrosis factor α from mononuclear cells and IL-8, soluble intercellular adhesion molecule, polyethylene glycol 2, and leukotriene C4 from polymorphonuclear neutrophils were compared before and after curcumin treatment. RESULTS: Curcumin alleviated nasal symptoms (sneezing and rhinorrhea) and nasal congestion through reduction of nasal airflow resistance. Curcumin was found to exert diverse immunomodulatory effects, including suppression of IL-4, IL-8, and tumor necrosis factor α and increased production of IL-10 and soluble intercellular adhesion molecule. However, curcumin did not affect the release of prostaglandin E2 and leukotriene C4 from polymorphonuclear neutrophils. CONCLUSION: This pilot study provides the first evidence of the capability of curcumin of improving nasal airflow and modulating immune response in patients with AR.

Persons with allergy symptoms use alternative medicine more often.

INTRODUCTION: The aim of the study is to indicate the relation between the use of alternative medicine and the occurrence of allergic diseases in the Polish population of adults in the age of 20-44 years. Moreover the additional aim of the study is to define the relation between the sex, age and place of living and the use of alternative medicine. MATERIAL AND METHODS: The data from the project Epidemiology of Allergic Diseases in Poland (ECAP) has been used for analysis. This project was a continuation of the European Community Respiratory Health Survey II. The questions on alternative medicine were asked to the group of 4671 respondents in the age of 20-44 years. Additionally outpatient tests were performed in order to confirm the diagnosis of allergic diseases. RESULTS: The total of 22.2% of respondents that participated in the study have ever used alternative medicine (n = 4621). A statistically significant relation between the use of alternative medicine and declaration of allergic diseases and asthma symptoms has been demonstrated (p < 0.001). No statistically significant relation between the use of alternative medicine by persons diagnosed by a doctor with any form of asthma or seasonal allergic rhinitis (p > 0.05) has been demonstrated. CONCLUSIONS: The occurrence of allergic diseases and asthma influences the frequency of alternative medicine use. However the frequency of alternative medicine use does not depend on allergic disease or asthma being confirmed by a doctor.

Clinical bystander effect exerted by allergen immunotherapy: a hypothesis.

Allergen Immunotherapy (AIT) is able to restore a physiological Th1 response and Tregs function. This effect is allergen-specific, even though it has been reported that it may also be non-specific, such as also extended to allergens not used in AIT. This immunological phenomenon may also be of clinical nature. This case report shows that a poly-allergic patient, successfully treated with Parietaria extract, also achieved a clinical tolerance towards other causal allergens, such as mites and cat. Of course, this was an anecdote, but it is reasonable to prospect the hypothesis that a bystander clinical effect may be observed during AIT in poly-allergic patients.

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.

Homeopathy for allergic rhinitis: protocol for a systematic review.

BACKGROUND: Allergic rhinitis is a global health problem that is often treated with homeopathy. The objective of this review will be to evaluate the effectiveness of homeopathic treatment of allergic rhinitis. METHODS/DESIGN: The authors will conduct a systematic review. We will search Medline, CENTRAL, CINAHL, EMBASE, AMED, CAM-Quest, Google Scholar and reference lists of identified studies up to December 2013.The review will include randomized controlled trials that evaluate homeopathic treatment of allergic rhinitis. Studies with participants of all ages, with acute or chronic comorbidities will be included. Patients with immunodeficiency will not be included. The diagnosis will be based on the published guidelines of diagnosis and classification. Studies of all homeopathy modalities (clinical, complex and classical homeopathy, and isopathy) will be included. We will include trials with both active controls (conventional therapy, standard care) and placebo controls.The primary outcomes are: an improvement of global symptoms recorded in validated daily or weekly diaries and any scores from validated visual analogue scales; the total Quality of Life Score (such as the Juniper RQLQ);individual symptoms scores which include any appropriate measures of nasal obstruction, runny nose, sneezing, itching, and eye symptoms; and number of days requiring medication. Secondary outcomes selected will include serum immunoglobin E (IgE) levels, individual ocular symptoms, adverse events, and the use of rescue medication.Treatment effects will be measured by calculating the mean difference and the standardized mean difference with 95% confidence interval (CI) for continuous data. Risk ratio or, if feasible, odds ratio will be calculated with 95% CI for dichotomous data. After assessing clinical and statistical heterogeneity, meta-analysis will be performed, if appropriate. The individual participant will be the unit of analysis. Descriptive information on missing data will be included about participants missing due to drop out, whether there was intention to treat or per protocol analysis and missing statistics. A number of subgroups, homeopathic potency, age groups, and types of allergic rhinitis (seasonal or perennial) will be analyzed. Sensitivity analysis will be performed to explore the impact of risk of bias on overall treatment effect. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42013006741.

Diagnostic and therapeutic approaches in respiratory allergy are different depending on the profile of aeroallergen sensitisation.

BACKGROUND: There are few studies which analyse the characteristics of allergic respiratory disease according to profiles of sensitisation to different allergens. This study describes the clinical features and therapeutic approaches, according to the sensitisation profile to relevant aeroallergens, in a sample of adult patients with a first-time diagnosis of respiratory allergy (rhinitis and/or asthma). METHODS: 1287 patients, enrolled consecutively in the spring of 2010 by 200 allergy specialists, were classified into four groups according to sensitisation to significant allergens in each geographical area (grass pollen, olive pollen, grass and olive pollen, house dust mites). Information was obtained on demographics, diagnostic procedures used, treatments prescribed, clinical characteristics of the rhinitis, and severity and control of asthma. RESULTS: Of the patients, 58.6% had rhinitis only and 38.7% had both rhinitis and asthma. Patients with more severe rhinitis had more severe and poorer controlled asthma. Sensitisation to different allergens was not associated with significant differences in severity and control of asthma, but patients with house dust mite allergy presented persistent rhinitis more frequently. Allergy to grass pollen was significantly associated with food allergies. Differences were observed in the frequency of prescription of immunotherapy and antileukotrienes in patients allergic to house dust mites and of topical corticosteroids in patients with pollen allergy. CONCLUSIONS: It was observed in this study that in respiratory allergy disease, there are clinical differences as well as differences in diagnostic procedure and therapeutic attitudes, depending on the clinically relevant allergen.

1,25(OH)2D3 and specific IgE levels in children with recurrent tonsillitis, and allergic rhinitis.

OBJECTIVES: We investigated 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] and specific immunoglobulin E (IgE) levels in children with recurrent tonsillitis (RT) plus allergic rhinitis (AR). METHODS: Thirty children with RT+AR were included in the study group, and 30 healthy children comprised the control group. AR-related symptoms were determined using a symptom scale. 1,25(OH)2D3 and specific IgE measurements were made in both groups. RESULTS: The 1,25(OH)2D3 value was significantly lower in the RT+AR group than in the control group. Specific IgE (mixed) panels were in normal limits in both groups; whereas specific IgE (mixed) grass pollen panel value of RT+AT group was significantly higher than that of the control group. Higher nasal itching, nasal obstruction, and concha edema scores were related to significantly higher specific IgE values for the (mixed) grass pollen panel, whereas higher sneeze scores were related to higher specific IgE values for the (mixed) pediatric panel. CONCLUSIONS: Children with grass pollen allergy may not be exposed to sufficient sunlight. With reduced 1,25(OH)2D3, T helper cells may increase, and allergic response also increases. As allergic events increased, these children did not go outside and thus lacked sun exposure. This vicious cycle must be broken, and children with RT+AR should have sunlight exposure to increase 1,25(OH)2D3 levels.

[The correlation of serum specific IgE detection and skin prick test in allergic rhinitis].

OBJECTIVE: To investigate the correlation between serum specific immunoglobin E(sIgE) and skin prick test(SPT) and their differences of the positive rate. METHOD: One hundred and nine patients with allergic rhinitis were detected the serum slgE. The patients had positive symptoms and signs, positive SPT results with at least one allergen. RESULT: Specific IgE and SPT results of Dp,Df and Artemisia showed a positive correlation (r = 0.520, 0.4413, 0.764, P < 0.01). sIgE positive rates were 55.0%, 54.1% and 17.4% for Dp, Df and Artemisia respectively, whereas SPT positive rates were 68.8%,79.8% and 27.5% respectively. The difference between the positive rates of the sIgE and SPT was significant (chi2 = 27.93,18. 20,60. 60, are P< 0.01). CONCLUSION: There was a good correlation between specific IgE and SPT. SPT is more sensitive than sIgE, but SPT can not substitute for slgE,vice versa.

Allergic rhinitis: what's best for your patient?

The algorithm and recommendations provided here can help you take an evidence-based approach to your patient's allergic rhinitis.

Clinical effect of catgut implantation at acupoints for allergic rhinitis: study protocol for a randomized controlled trial.

BACKGROUND: Catgut implantation at acupoints has been used in China to treat allergic rhinitis (AR) for a long time. However, its efficacy and safety in the treatment of AR is controversial due to the poor quality of the clinical trial of this therapy. This study aims to identify whether catgut implantation at acupoints is indeed an effective and safe treatment for patients with persistent or intermittent allergic rhinitis (PER or IAR) by comparing with sham catgut implantation treatment. METHODS AND DESIGN: This study compares real versus sham catgut implantation at acupoints in 242 patients with a history of PER or IAR and with a positive skin prick test (SPT). The trial will be conducted in the Teaching Hospital of Chengdu University of Traditional Chinese Medicine. In the study, patients will be randomly assigned by computer-generated randomization list into two groups and assessed prior to treatment. Then, they will receive two sessions of treatments (once per 2 weeks) for 4 consecutive weeks and have a follow-up phase of 12 weeks. The administration of catgut implantation (or sham-control) at acupoints follows the guidelines for clinical research on acupuncture (WHO Regional Publication, Western Pacific Series No.15, 1995), and is performed double-blindly by a well-trained physician in acupuncture. The main outcome measures include the primary and secondary indicators. Primary indicators are subjective symptoms scores evaluated by visual analogue scales (VAS) and Rhinoconjunctivitis Quality of Life Questionnaires (RQLQ). The secondary indicators are the results of laboratory examinations, such as serum allergen-specific IgE, nasal inflammatory cells counts (mast cells, eosinophils, and T cells) and nitric oxide concentration in nasal excretion. The use of anti-allergic medication will also be recorded as one of the secondary indicators. Furthermore, adverse events will be recorded and analyzed. If any participants withdraw from the trial, intention-to-treat analysis (ITT) and per-protocol (PP) analysis will be performed. DISCUSSION: The important features of this trial include the randomization procedures, large sample, and a standardized protocol of catgut implantation at acupoints. This trial will be the first study with a high evidence level in China in order to assess the efficacy and safety of catgut implantation at acupoints in treatment of AR following a randomized, double-blind sham-controlled method. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-TRC-12002191.

Detecting local immunoglobulin E from mucosal brush biopsy of the inferior turbinates using microarray analysis.

BACKGROUND: It has been previously demonstrated that local, antigen-specific immunoglobulin E (IgE) can be detected using a standard in vitro assay of lysed epithelial cells in saline, harvested via nasal mucosal brush biopsy (MBB). However, compared to surgical biopsy or serum, smaller amounts of IgE are harvested using MBB, making detection much more difficult. Microarray analysis (MA) requires less IgE for detection, making this an attractive option for MBB. The goals of this study were to compare MA to a standard IgE assay for detecting antigen-specific IgE from MBB and to test the association between the presence of multiple positive components on MA with specific IgE on standard assay and skin-prick testing (SPT) grade. METHODS: MBB samples from 18 allergic rhinitis patients, which were previously tested for antigen-specific IgE to common airborne allergens using a standard IgE assay, underwent MA for antigen-specific IgE to multiple components of airborne and food allergens. Fisher's exact probability testing was used to measure the strength of association between the 2 testing modalities for Timothy grass, ragweed, cat, Alternaria, and D. farinae. RESULTS: MA correlated very highly with standard assay (p < 0.0001) and 50% of positive antigens on MA detected multiple components to that antigen. The presence of multiple components was not associated with specific IgE levels on standard assay or SPT grade. CONCLUSION: This is the first demonstration that antigen-specific IgE in saline samples can be measured using MA. The ability of MA to measure smaller amounts of IgE, with similar accuracy, may give it a potential advantage for MBB analysis in the future.

[The analysis of the allergens in 576 patients with allergic rhinitis in Qingyang of Gansu Province].

OBJECTIVE: To investigate the allergens distribution of 576 allergic rhinitis patients in Qingyang, and to provide basic epidemiologic information for the prevention and treatment of allergic rhinitis. METHOD: Skin prick test was done to all the 576 patients with allergic rhinitis with 28 kinds of allergens. RESULT: Four hundred and eighty cases (83.3%) showed positive reaction to at least one allergen of 28 allergens. The most common allergens were Magwort (73.3%), Giant Ragweed (55.0%) Tree II (51.7%), Tree I (48.3%) Dermatophagoides farinae (43.3%) and Dermatophagoides pteronyssinus (36.7%). Moreover. the positivity decreased with age. There was no difference between male and female. CONCLUSION: The study shows that Magwort. Giant ragweed and tree II are the most important allergens on Qingyang district.

Dose-dependent clinical and immunological efficacy of sublingual immunotherapy with mite monomeric allergoid.

Sublingual immunotherapy with monomeric carbamylated allergoid (LAIS) is an effective and well tolerated treatment of respiratory allergy. The aim of the present study was to correlate the efficacy of two maintenance doses (1000 AU vs 3000 AU) of LAIS with the immunological modulation of allergen-driven Th1, Th2 and T regulatory cytokines produced in vitro by PBMCs, in patients suffering from mite allergic rhinitis. Forty-eight consecutive patients with mite allergic rhinitis were recruited. Patients were randomly assigned to group A (n=24) or group B (n=24), respectively receiving 1000 AU or 3000 AU weekly during one-year maintenance phase. Each patient was evaluated for rhinitis severity (ARIA protocol), and for drug consumption at the time of the inclusion and after 6 and 12 months of treatment. Patients were also asked to report the perceived severity of the disease and the tolerability of the treatment in a visual analogical scale (VAS). Before and at the end of the treatment allergen-driven release of cytokines by PBMCs in vitro was measured. After 1-year treatment, a statistically significant reduction of all clinical parameters was observed in all patients, associated with reduction of IL-4 and increase of INF-γ secreted in vitro by mite-challenged PBMCs. Notably, the group treated with the higher dose showed significantly better clinical and immunological results. The efficacy of LAIS is correlated to the immune modulation in a clear dose-dependent effect.

Evidence-based practice: sublingual immunotherapy for allergic rhinitis.

In this article, the authors review the current evidence regarding the public health and economic impact of allergic rhinitis. Diagnostic methods for allergic disease are discussed as well as certain nuances of allergy skin testing protocols. In addition, the evidence supporting sublingual immunotherapy (SLIT) for allergic rhinitis is reviewed, with subsequent attention to certain subgroups, such as adults and children, seasonal versus perennial allergens, and SLIT efficacy for individual antigens. The authors consider the evidence supporting appropriate SLIT dosing as well as the existing data on SLIT safety.