Prevalence of local allergic rhinitis to Dermatophagoides pteronyssinus in chronic rhinitis with negative skin prick test.

BACKGROUND: Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy that is characterized by local production of specific immunoglobulin E (sIgE), and a positive response to NAPT (nasal allergen provocation test). OBJECTIVE: The objective of this study is to investigate the prevalence of LAR in adults with chronic rhinitis (CR) and negative skin prick test to Dermatophagoides pteronyssinus (Dp), and to assess the clinical characteristics of LAR, comparing to non-allergic rhinitis (NAR). METHODS: Patients with history of CR with negative skin prick test (SPT) to Dp were recruited during January 2015-April 2016. Demographic and clinical data were obtained, and then a NAPT with Dp was performed. The immediate response to NAPT-Dp was assessed using clinical symptom score, visual analogue scale, peak nasal inspiratory flow, and acoustic rhinometry. Nasal lavage was evaluated for nasal sIgE and tryptase level. RESULTS: Sixty-two CR patients were recruited. NAPT-Dp was positive in 15/62 (24.2%) of CR patients. Most LAR patients were female (73.3%), and the mean age of all patients was 36.1 ± 10.4 years. Our evaluation of patient characteristics revealed sneezing to be the only evaluated factor to be statistically significantly different between groups [odds ratio (OR): 7.75, 95% confidence interval (CI): 1.91-31.48; p = 0.002]. CONCLUSIONS: The prevalence of LAR to Dp in Thai adults with CR and negative skin prick test was 24.2%. Most LAR patients had moderate-severe persistent severity. The clinical characteristics of LAR, sneezing was shown to be a significantly dominant symptom in LAR than in NAR.

Minimal clinically important difference for the rhinoconjunctivitis quality of life questionnaire in allergic rhinitis in Thai population.

BACKGROUND: Clinical measurement of the severity of allergic rhinitis (AR) can be assessed by symptoms score and patient quality of life (QoL). The magnitude of change in both symptoms and patient QoL should be considered in the management of AR. OBJECTIVE: The aim of this study was to determine the minimal clinically important difference (MCID) in AR in Thai population. METHODS: This prospective study recruited AR patients that attended our clinic during September 2011 to February 2012. The Rhinoconjunctivitis Quality of Life (Rcq-36) questionnaire was used to evaluate patient QoL. The Global Rating of Change Scale (GRCS) was used to assess improvement or deterioration in condition. The MCID was determined using an anchor-based method based on the GRCS, which was compared to the MCID determined by a distribution-based method based on the standard deviation (SD). RESULTS: Three hundred seventy-two patients with chronic rhinitis were recruited. Eighty-four of those had positive skin prick test and be diagnosed as AR. Of those, 79 completed the study and were included in the final analysis. A change of 2 points on the GRCS yielded an MCID for overall QoL of 0.21 ± 0.57. When applying the distribution-based method, an SD of 1.5 SD yielded an MCID for QoL of 0.27. For the rhinitis symptoms domain, the MCID was 0.42 ± 0.72. CONCLUSIONS: The MCID for overall QoL and rhinitis symptoms in Thai AR patients was found to be 0.21 ± 0.57 and 0.42 ± 0.72, respectively. MCID can be applied for determining the clinical significance of treatment efficacy in AR.

Combined radiofrequency volumetric tissue reduction and lateral outfracture of hypertrophic inferior turbinate in the treatment of chronic rhinitis: short-term and long-term outcome.

BACKGROUND: Radiofrequency volumetric tissue reduction (RFVTR) of hypertrophic inferior turbinate (IT) is an effective way to treat patients with intractable nasal mucosal obstruction. We evaluated the effectiveness of combined RFVTR and lateral outfracture (LO) of hypertrophic IT in chronic rhinitis (CR) patients on reduction of nasal obstruction, rhinorrhea, and nasal pruritus both short and long term. METHODS: Seventy-three patients with CR who failed medical treatment were recruited to undergo combined RFVTR and LO of hypertrophic IT. Nasal congestion scores were recorded before the operation, and immediately, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. Rhinorrhea and pruritic score as well as total nasal airway resistance (TNAR) and total nasal airflow (TNAF) (measured by active anterior rhinomanometry) were recorded before the operation, and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. RESULTS: Forty-five patients completed the follow-up period of 3 years. Subjects consisted of 25 male and 20 female patients, with an average age of 31 years. Nasal congestion scores were significantly improved immediately after the operation. Nasal congestion scores and TNAR values were significantly decreased whereas TNAF values were significantly increased at every time point postoperatively. Rhinorrhea and pruritic scores were also significantly improved at every time point after 2 weeks postoperatively. CONCLUSION: Combined RFVTR and LO of hypertrophic IT is an effective treatment for nasal obstruction, rhinorrhea, and nasal pruritus in CR and the result lasts up to 3 years postoperatively.

An open-label, prospective study of an oral polyvalent bacterial lysate (Luivac) in the treatment of recurrent respiratory tract infections in Thai patients.

An open-label, non-comparative study was performed in the Department of Otolaryngology, Siriraj Hospital, Bangkok, Thailand, to assess the safety, tolerability, acceptability and efficacy of an oral polyvalent bacterial lysate (Luivac) in the treatment of recurrent respiratory tract infections (RTIs) in Thai patients. Thirty-three patients were included in this study, 18 males and 15 females, with a mean age of 34.0 +/- 14.7 years. The mean number of RTIs during the 12-month period preceding the study was 9.5 per patient. During the study each patient received one tablet of Luivac daily for 28 days followed by a treatment-free period of 28 days. This was followed with another 28 days on Luivac, after which there was a 28-day treatment-free follow-up period. This study lasted 4 months with five scheduled patient visits (V1-V5). Laboratory studies were done at baseline (V1) and after treatment (V4), which included complete blood count and serum immunoglobulins (IgA, IgE, IgG and IgM). The incidence of all adverse events was 15.2% and no case was related to the studied drug. There were no clinical relevant changes in laboratory parameters after treatment. The reduction rate of RTIs per month at the end of the study period was 63.5% when compared to the average RTIs rate per month during the 12 months preceding the study. A comparison of the first study period (V1-V3) and the second study period (V3-V5) showed a reduction in duration of RTIs (23.1%), in the clinical infection score (17.5%), in the number of antibiotics used (2.1%), in the number of symptomatic treatments (3.5%), and in the number of days absent from school or work (50.0%). Overall tolerability and acceptability were assessed as very good and good in 96.8% of the patients. This study suggests that oral polyvalent bacterial lysate (Luivac) was safe and also showed a tendency to be effective in preventing RTIs in Thai patients with or without risk factors for recurrent RTIs. Other clinical advantages were reduction in the severity and duration of infection as well as in reduction of the cost of treatment and the number of days absent from school or work.