Assessing the health impact of interventions for baker's allergy and asthma in supermarket bakeries: a group randomised trial.

PURPOSE: To assess the impact of an intervention for baker's allergy and asthma in supermarket bakeries. METHODS: A group randomised trial conducted in 31 bakeries (n = 337 bakers) that were randomly assigned to one of two intervention groups (n = 244 bakers) and a control group (n = 93 bakers). Health data collected prior to and 1-year after the intervention included information obtained from an ECRHS questionnaire; tests for atopy and serum-specific IgE to cereal flours; fractional exhaled nitric oxide (FeNO). Data from the two intervention groups were combined to form one intervention group for purposes of the statistical analysis. RESULTS: At 1 year of follow-up, the incidence and level of decline of work-related ocular-nasal and chest symptoms, sensitisation status and elevated FeNO (FeNO > 25 ppb) was similar in both intervention and control groups. The mean FeNO difference was also similar across both groups (2.2 ppb vs 1.7 ppb, p = 0.86). In those with FeNO > 25 ppb at baseline, the decline was greater in the intervention compared to control group (16.9 ppb vs 7.7 ppb, p = 0.24). Multivariate logistic regression models (adjusting for smoking, baseline sensitisation to cereal flour, baseline FeNO > 25 ppb) did not demonstrate an appreciable FeNO decline (≥ 10%) in the intervention compared to control group. However, stratification by the presence of work-related ocular-nasal symptoms in bakers at baseline demonstrated a significant FeNO decline (≥ 10%) in the intervention compared to the control group (OR 3.73, CI 1.22-11.42). CONCLUSION: This study demonstrates some evidence of an intervention effect on FeNO 1 year after an intervention, particularly in bakers with work-related ocular-nasal symptoms.

Effects of Intranasal Cellulose Powder on Asthma Control in Children With Mild-to-Moderate Perennial Allergic Rhinitis: A Randomized, Placebo-Controlled Trial.

BACKGROUND: Perennial allergic rhinitis (PAR) often coexists in asthmatic patients. Intranasal cellulose powder (ICP) was reportedly effective in ameliorating PAR. OBJECTIVE: We investigated whether ICP is equally effective compared with intranasal corticosteroids in improving asthma control as well as nasal symptoms among children with PAR and allergic asthma (AA). METHODS: Between July 2015 and September 2016, we did a single-center, randomized, placebo-controlled trial. Asthmatic children aged 6 to 11 years with mild-to-moderate PAR were randomly assigned to formoterol/budesonide inhalation (4·5 µg/80 µg, twice daily) plus intranasal budesonide 64 µg twice daily (group A), ICP 250 µg thrice daily (group B), or intranasal placebo 250 µg thrice daily (group C) for 8 weeks. The primary outcome was change in asthma control test for children (C-ACT) score from baseline to week 8 posttreatment. Changes in spirometry, peak expiratory flow (PEF), fractional exhaled nitric oxide (FeNO), and visual analog scale (VAS) for nasal and ocular symptoms were detected as secondary outcomes. RESULTS: We included 121 patients (38 in group A, 41 in group B, and 42 in group C) in full-analysis set. C-ACT score was markedly higher at week 8 compared with baseline (mean difference: 5.11, 6.05, and 4.85 points in groups A, B, and C, respectively; P < .05). There were interactions between baseline and treatment in C-ACT scores ( P < .05). Group B demonstrated greater improvement in C-ACT score than group C among children with baseline C-ACT score of 6 to 18. 95% confidence intervals of group A at baseline overlapped with those of groups B and C. The treatment achieved reduced VAS symptoms in groups A and B but not in group C. Incidence of adverse events was comparable. No serious adverse event was reported. CONCLUSIONS: ICP could be recommended for children with PAR and AA who have poorer asthma control.

Efficacy of allergen-blocker mechanical barrier gel on symptoms and quality of life in patients with allergic rhinitis.

PROPOSE: Allergic rhinitis (AR) is a very common, chronic and global health problem. In the last two decades, the efficiency of barrier-enforcing measures in AR has been investigated. In this study, we aimed to evaluate the effect of allergen-blocker mechanical barrier gel (MBG) (AlerjiSTOP®) treatment on symptoms and quality of life score (QoLS) in patients with seasonal and perennial allergic rhinitis. METHODS: A single-center, prospective study was conducted between January 2017 and May 2018. Patients diagnosed with allergic rhinitis with a visual analogue scale (VAS) of 5 or higher (moderate/severe) were enrolled in the study. Patients were evaluated in terms of VAS, nasal symptom score (NSS), ocular symptom score (OSS), total symptom score (TSS) and QoLS at baseline, 1 week and 1 month of MBG treatment. RESULTS: A total of 83 patients with AR were enrolled in the study. Clinical and laboratory examinations showed that 50 (60.2%) patients were mono-sensitized. Allergen-blocker mechanical barrier gel treatment was performed as monotherapy in 22 (26.5%) patients. Median VAS, NSS, OSS and TSS decreased from 7 to 4, 8 to 3, 4 to 0 and 12 to 4, respectively (p < 0.0001). Correlation analysis revealed positive correlations between lower pediatric rhinoconjunctivitis quality of life questionnaire scores for patients under 12 years of age and decrease in VAS, NSS and TSS (r = 0.380, p = 0.008; r = 0.544, p < 0.0001; r = 0.543, p < 0.0001). Positive correlations were detected between lower rhinoconjunctivitis quality of life questionnaire (self-administered) scores for patients ≥ 12 years of age and decrease in VAS, NSS, OSS and TSS (r = 0.703, p < 0.0001; r = 0.465, p = 0.005; r = 0.526, p = 0.001; r = 0.624, p < 0.0001). CONCLUSION: In conclusion, we found significant decrease in all symptom scores and improvement in QoLS of patients treated with MBG as monotherapy and combination therapy.

Prevalence of risk factors of allergic diseases among children aged 8-9 years in poltava region (the results of the first stage of the research).

OBJECTIVE: Introduction: According to the European Academy of Allergology and Clinical Immunology (EAACI, 2016), allergy is the most common chronic disease in Europe. The aim: The aim of the investigation is to study the spread of risk factors of allergic reactions in children who are 8-9 years old of Poltava region. PATIENTS AND METHODS: Materials and methods: The investigation included two stages: the 1st contained interviewing; the 2nd one - additional clinical and lab investigation of children, who require the further diagnosis specification. RESULTS: Results: 1068 children who are 8-9 years old were interviewed based on questionnaires: 56,2% males and 43,8% females. Children were divided into residents (49,2%), and villagers (50,8%). In order to identify allergic diseases the division in family was the next: the presence of bronchial asthma was present in 38 people (3,6%), allergic rhinitis or allergic conjunctivitis - 128 people (12,0%), atopic dermatitis - 54 people (5,1%), food allergy - 129 people (12,1%), medicinal allergy - 25 people (11,7%). Analyzing the influence of trigger factors, it should be noted that in the risk group there are children who received cow's milk as substitutes for breast milk (38.1%), children who had a history of helminthal invasion (19.6%), children where parents smoke (45.9%), one third of parents (31.9%) complained of frequent respiratory viral infections in their children. CONCLUSION: Conclusions: Presented epidemiological investigation allowed studying the prevalence of diagnosed allergic diseases in children of Poltava region and determining children's category who require additional diagnostics of chronic allergic diseases.

MP29-02 reduces nasal hyperreactivity and nasal mediators in patients with house dust mite-allergic rhinitis.

BACKGROUND: Nasal hyperreactivity (NHR) is an important clinical feature of allergic rhinitis (AR). The efficacy of MP29-02 (azelastine hydrochloride (AZE) and fluticasone propionate [FP]) nasal spray on local inflammatory mediators and NHR in AR is unknown. We tested if MP29-02 decreases inflammatory mediators and NHR in AR and if this effect is due to restoration of nasal epithelial barrier function. METHODS: A 4-week double-blinded placebo-controlled trial with MP29-02 treatment was conducted in 28 patients with house dust mite (HDM) AR. The presence of NHR was evaluated by measuring reduction in nasal flow upon cold dry air exposure. The effects of AZE ± FP on barrier integrity and airway inflammation were studied in a murine model of HDM-induced NHR and on reduced activation of murine sensory neurons and human mast cells. RESULTS: MP29-02 but not placebo reduced NHR (P < .0001 vs P = .21), levels of substance P (P = .026 vs P = .941), and ß-hexosaminidase (P = .036 vs P = .632) in human nasal secretions. In wild-type C57BL6 mice, the reduction in ß-hexosaminidase levels (P < .0001) by AZE + FP treatment upon HDM challenge was found in parallel with a decreased transmucosal passage (P = .0012) and completely reversed eosinophilic inflammation (P = .0013). In vitro, repeated applications of AZE + FP desensitized sensory neurons expressing the transient receptor potential channels TRPA1 and TRPV1. AZE + FP reduced MC degranulation to the same extent as AZE alone. CONCLUSION: MP29-02 treatment reduces inflammatory mediators and NHR in AR. The effects of AZE + FP on MC degranulation, nasal epithelial barrier integrity, and TRP channels provide novel insights into the pathophysiology of allergic rhinitis.

Citrus juice fermented with Lactobacillus plantarum YIT 0132 alleviates symptoms of perennial allergic rhinitis in a double-blind, placebo-controlled trial.

This study aimed to examine whether citrus juice fermented with Lactobacillus plantarum YIT 0132 (LP0132), which was pasteurised after fermentation, could alleviate the symptoms of perennial allergic rhinitis in a double-blind, placebo-controlled, parallel-group trial. Subjects with perennial allergic rhinitis consumed LP0132-fermented juice (n=17) or unfermented citrus juice (placebo; n=16) once a day for 8 weeks. During the pre-intervention and intervention periods, the subjects recorded nasal symptoms (number of sneezing attacks, number of nose-blowing incidents, and stuffy nose score). The primary endpoint, nasal symptoms score (NSS), was scored from 0 to 4 according to the 'Practical Guideline for the Management of Allergic Rhinitis in Japan 2009' using a combination of the three nasal symptom items. Blood samples were collected at pre-intervention and at 8 weeks after commencing the intervention. There were several significant improvements not only in the LP0132 group but also in the placebo group because of potential anti-allergic effects of citrus. Compared with the placebo group, the LP0132 group showed a significant reduction in the NSS and stuffy nose score during the intervention period. Also, the LP0132 group, but not the placebo group, showed significant attenuation of type 2 helper T cells (Th2 cells)/helper T cells, serum total immunoglobulin E (IgE), and eosinophil cationic protein (ECP), and showed significant augmentation of type 1 helper T cells (Th1 cells)/Th2 cells at 8 weeks of intervention compared with baseline. It is suggested that daily intake of fermented citrus juice containing heat-killed LP0132 has beneficial effects on symptoms of perennial allergic rhinitis, and these benefits may be associated with the attenuation of Th2 cells, total IgE, and ECP via the immunomodulating activities of LP0132.

Efecto de la lactancia materna en la calidad de vida y en el desarrollo de la dermatitis atópica / Effect of breastfeeding on quality of life and on the development of atopic dermatitis

Introducción: la dermatitis atópica (DA) es una patología de prevalencia creciente y de gran repercusión social. Siendo su etiología de origen multifactorial, analizamos si factores ambientales, especialmente la lactancia materna (LM), intervienen en su desarrollo y evolución. Los objetivos son evaluar la gravedad clínica y la calidad de vida de los niños con DA, detectar diferencias en la edad de diagnóstico según el tipo de lactancia recibida y estimar la asociación de padecer DA según las variables de interés analizadas. Material y métodos: estudio de casos y controles apareado por edad y sexo en población infantil de Atención Primaria. Se realiza mediante el cumplimiento de tres cuestionarios a niños que acuden a las revisiones de salud establecidas por la Consellería de Sanidad de Valencia. Los datos recogidos se analizarán con el programa SPSS®. Resultados: la DA se presenta más precozmente en los varones. Se observó un efecto protector de la LM frente a la lactancia artificial (LA) sobre el desarrollo de la DA (odds ratio [OR]: 0,15; intervalo de confianza del 95% [IC 95%]: 0,09-0,24), frente a procesos de alergia al polen o rinitis alérgica (OR: 0,35; IC 95%: 0,17-0,73), frente a la piel seca (OR: 0,22; IC 95%: 0,14-0,36), al picor (OR: 0,50; IC 95%: 0,27-0,93) y paralelamente en la repercusión de características clínicas y en la calidad de vida (puntuación del cuestionario Índice de Calidad de Vida de la Dermatitis Atópica Infantil [ICVDAI]: 2,3 ±3,5 frente a 0,7 ±0,1; p<0,001). Conclusión: la elección de la LM mejora la calidad de vida en los niños, protege frente a la aparición de DA, de alergia al polen o rinitis alérgica y frente a algunas características clínicas cutáneas (AU)

Introduction: atopic dermatitis (AD) is a disease of increasing prevalence and of great social impact. Its etiology has a multifactorial origin, so we analyze if environmental factors, especially breastfeeding (BF) is involved in the development of AD. The objectives are to assess the clinical severity and quality of life of children with AD, to detect differences in the age of diagnosis according to the type of lactation received, and to estimate the association of atopic dermatitis to the variables of interest analyzed. Material and methods: case-control study matched by age and sex in children in Primary Care. It has been done by filling in three different questionnaires about children who come to their routine health controls established by the Valencian Community Health Service. The data collected will be analyzed with the program SPSS. Results: atopic dermatitis has an earlier diagnosis in baby boys. A protective effect of breastfeeding vs artificial feeding in the development of AD (OR: 0.15; IC 95%: 0.09-0.24) has been observed, also vs allergy to pollen or allergic rhinitis (OR: 0.35; IC 95%: 0.17-0.73), vs dry skin (OR: 0.22; IC 95%: 0.14-0.36), itching (OR: 0.50; IC 95%: 0.27-0.93) and in parallel to the clinical characteristics and impact on quality of life (questionnaire score ICVDAI: 2.3±3.5 vs 0.7±0.1; p<0.001). Conclusion: the choice of breastfeeding improves the quality of life in children, protects against the onset of atopic dermatitis, allergy to pollen or allergic rhinitis, and against some skin clinical features (AU)

Maternal intake of vitamins A, E and K in pregnancy and child allergic disease: a longitudinal study from the Danish National Birth Cohort.

Fat-soluble vitamins A, E and K have been shown to play roles in immunity and inflammation, but studies on child allergic disease have been few and inconsistent. The aim of the present study was to examine the relationship between maternal intake of vitamins A, E and K in mid-pregnancy and child asthma and allergic rhinitis. We used data on 44 594 mother-child pairs from the Danish National Birth Cohort. Maternal intake of fat-soluble vitamins was calculated based on the information from a validated FFQ completed in mid-pregnancy. At 18 months, interviews with the mothers were conducted to evaluate doctor-diagnosed child asthma. At age 7 years, we assessed child asthma and allergic rhinitis using questions from the International Study of Asthma and Allergies in Childhood questionnaire and by national registries on hospital contacts and medication use. Current asthma was defined as asthma diagnosis and wheeze in the past 12 months by maternal report. We calculated multivariable risk ratios and 95 % CI by comparing the highest v. lowest quintile (Q) of maternal vitamin A, E and K intake in relation to child allergic disease outcomes. Maternal total vitamin K intake was directly associated with ever admitted asthma (Q5 v. Q1: 1·23, 95 % CI 1·01, 1·50) and current asthma at 7 years (Q5 v. Q1: 1·30, 95 % CI 0·99, 1·70). Weak inverse associations were present for maternal vitamin A and E intake during pregnancy with child allergic rhinitis. Maternal vitamin K intake during pregnancy may increase the risk of child asthma, and should be explored further on a mechanistic level. Conversely, maternal vitamin A and E intake may protect against child allergic rhinitis.

Supplementation with probiotics in the first 6 months of life did not protect against eczema and allergy in at-risk Asian infants: a 5-year follow-up.

BACKGROUND: Healthy gut microflora is essential for oral tolerance and immunity. A promising approach to preventing allergic diseases in genetically at-risk infants is to introduce administration of probiotics early in life when their immune system is still relatively immature. OBJECTIVE: In this follow-up study, we aim to determine if early-life supplementation with strains of probiotics has any long-term effect on allergic outcomes. METHODS: We analyzed the charts and electronic databases of the PROMPT (Probiotics in Milk for the Prevention of Atopy Trial) study cohort. This cohort consisted of 253 infants at risk for allergy who were administered cow's milk supplemented with or without probiotics from the first day of life to the age of 6 months. The cohort was then followed up until the children were 5 years old and clinical outcomes were assessed. RESULTS: Of the 253 children recruited into the study, 220 (87%) completed the follow-up. At the age of 5 years, there were no significant differences between the groups in the proportion of children who had developed any asthma, allergic rhinitis, eczema, food allergy and sensitization to inhalant allergens. Similar growth rates were observed in both groups. CONCLUSIONS: The supplementation of probiotics in early childhood did not play a role in the prevention of allergic diseases. Clinical/Key Message: Early-life supplementation with probiotics did not change allergic outcomes at 5 years of age.

Multivalent paediatric allergy vaccines protect against allergic anaphylaxis in mice.

BACKGROUND: Almost a quarter of the world population suffers from IgE-mediated allergies. T cells and IgG-producing B cells can produce protection, but treatment for disease is laborious with unsatisfactory patient compliance. OBJECTIVE: We sought to identify whether paediatric allergy vaccines affected later allergen sensitization and onset of disease when used prophylactically. METHODS: A murine model of anaphylaxis was applied. Mice were first immunized with monovalent or multivalent allergy vaccines that also contained aluminium hydroxide and CpG oligodeoxynucleotide as adjuvants. Later, the mice were sensitized by multiple low-dose injections of aluminium-adsorbed allergen. After a dormant period, the mice were challenged systemically with high-dose allergen, and the clinical signs of anaphylaxis were recorded. Throughout the immunization and sensitization periods, blood was collected for serological testing. RESULTS: Immunization with allergy vaccines produced antigen-specific protection against sensitization as measured by systemic anaphylaxis in mice. The long-term effect was observed both after juvenile (5-6 weeks) and neonatal (7 days) vaccination. Monovalent and pentavalent vaccines were protective to a similar level. Protection was associated with increased secretion of IgG2a and production of IFN-γ. Protection could also be transferred to sensitized mice via serum or via CD25-positive CD4 T cells. CONCLUSION AND CLINICAL RELEVANCE: Prophylactic and multivalent allergy vaccines in juvenile and neonatal mice protected against later sensitization and anaphylaxis. Such treatment may provide a rational measure for future management of allergen-related diseases and their strong socio-economic impact on daily life.

Knockdown of neurokinin-1 receptor expression by small interfering RNA prevents the development of allergic rhinitis in rats.

OBJECTIVE AND DESIGN: This study is aimed at exploring the role of neurokinin-1 receptor (NK-1R) in the development of allergic rhinitis (AR) in rats. METHODS: Sprague-Dawley rats were sensitized and challenged with ovalbumin to induce AR. The rats were treated intranasally with saline, control, or NK-1R-specific small interfering RNA (siRNA) before and during the challenge period. The numbers of sneezes and nose rubs and amount of nasal secretion in individual rats were measured. The levels of NK-1R expression in the nasal mucosal tissues after the last challenge were determined. The numbers of eosinophils in the collected nasal lavage fluid and the levels of serum interleukin (IL)-5 in individual rats were determined. RESULTS: The levels of NK-1R expression in the nasal mucosal tissues of the AR rats that had been treated with saline or control siRNA were significantly higher than those in the healthy controls and the rats treated with NK-1R-specific siRNA, demonstrating NK-1R silencing. Furthermore, knockdown of NK-1R expression significantly reduced the amounts of sneezing, nose rubbing, and nasal secretions in AR rats. Knockdown of NK-1R expression also significantly eliminated eosinophil infiltration in the nasal tissues and reduced the levels of serum IL-5 in rats. CONCLUSIONS: Knockdown of NK-1R expression decreased allergic inflammation in nasal mucosal tissues and alleviated the allergic rhinitis symptoms, suggesting that NK-1R may be a critical mediator of the development of AR.

DermAll nanomedicine for allergen-specific immunotherapy.

Allergen-specific immunotherapy (ASIT) the only disease-modifying treatment for IgE-mediated allergies is characterized with long treatment duration and high risk of side effects. We investigated the safety, immunogenicity and efficacy of a novel ASIT, called DermAll, in an experimental allergic rhinitis model. We designed and characterized DermAll-OVA, a synthetic plasmid pDNA/PEIm nanomedicine expressing ovalbumin (OVA) as model allergen. DermAll-OVA was administered topically with DermaPrep device to target Langerhans cells. To detect the clinical efficacy of DermAll ASIT we quantified the nasal symptoms and characterized the immunomodulatory activity of DermAll ASIT by measuring cytokine secretion after OVA-stimulation of splenocytes and antibodies from the sera. In allergic mice DermAll ASIT was as safe as Placebo, balanced the allergen-induced pathogenic TH2-polarized immune responses, and decreased the clinical symptoms by 52% [32%, 70%] compared to Placebo. These studies suggest that DermAll ASIT is safe and should significantly improve the immunopathology and symptoms of allergic diseases. FROM THE CLINICAL EDITOR: A novel allergen-specific immunotherapy for IgE-mediated allergies is presented in this paper, using an experimental allergic rhinitis model and a synthetic plasmid pDNA/PEIm nanomedicine expressing ovalbumin as model allergen. Over 50% reduction of symptoms was found as the immune system's balance was favorably altered toward more TH2-polarized immune responses.

[Construction of recombinant house dust mite group 1 allergen vaccine and study on immune response induced by nasal immunization].

OBJECTIVE: To study the preparation of recombinant house dust mite group 1 allergen vaccine (chitosan-pVAX1-Derp1 nanoparticles, pVAX1-Derp1/CS) and to investigate the efficacy and mechanism of intranasally given chitosan-pVAX1-Derp1 nanoparticles on mouse model with allergic rhinitis (AR). METHODS: The chitosan-pVAX1-Derp1 nanoparticles was prepared by complex coacervation, and its nature was identified and analysed. A total of 40 BALB/c rats were randomly divided into 5 groups: the normal group (group A), the AR model group (group B), the chitosan (CS) prevention group (group C), the pVAX1-Derp1 prevention group (group D), and the pVAX1-Derp1/CS prevention group (group E). The nasal cavity of rats in the group B, C, D and E were dripped with phosphate buffered saline (20 µl), CS (20 µl), pVAX1-Der p1 (20 µl), pVAX1-Derp1/CS nanoparticles (20 µl) on the first day and day 8, once daily. Rats in the latter 4 group were sensitized with Der p1 and Al(OH)3 in day 15 and day 22, and challenged with Der p1 to establish AR model from day 36 to day 43, while rats in group A were treated with PBS. Then the level of cytokines in serum was assayed by ELISA, inflammatory reactions in nasal mucosa were analyzed by haematoxylin and eosin staining. RESULTS: pVAX1-Derp1/CS nanoparticles was successfully constructed, the mean grain size of pVAX1-Derp1/CS was (205.3 ± 12.8) nm, and the zeta potential was (30.5 ± 5.6) mV. In nasal mucosa tissue, group B and C showed significant allergic inflammation, while group D and E showed lighter allergic inflammation. Compared with the group B, the group D and E could effectively reduced serum IgE level and IL-4 level [group B: (120.0 ± 8.8) ng/ml, (248.7 ± 10.6) pg/ml; group D: (109.6 ± 14.5) ng/ml, (192.5 ± 10.2) pg/ml; group E: (88.1 ± 8.3) ng/ml, (165.7 ± 9.7) pg/ml; IgE: t value were 3.5, 6.9, all P < 0.01; IL-4: t value were 10.0, 15.2, all P < 0.01], and increased IFN-γ level [group B: (709.0 ± 26.5) pg/ml; group D: (856.3 ± 37.4) pg/ml; group E: (904.8 ± 37.7) pg/ml; t value were 8.2, 10.8, all P < 0.01)]. IL-10 level of group D [(129.9 ± 16.1) pg/ml] and E [(107.1 ± 11.8) pg/ml] was lower than IL-10 level of group B [(160.6 ± 24.2) pg/ml]. The difference were significantly (t value were 2.9, 5.5, all P < 0.05). CONCLUSIONS: Chitosan can effectively encapsulate pVAX1-Derp 1 and inhibit nuclease degradation of the plasmid, the DNA vaccine has some preventive effect on AR animal model by nasal immunization.

A cross sectional assessment of allergic rhinitis and asthma control at an immunoallergology outpatient hospital setting using CARAT10 questionnaire.

INTRODUCTION: The most recent guidelines on asthma and rhinitis management recommend the optimal control of both diseases as the primary goal of treatment. CARAT10 is a recently developed and validated Portuguese questionnaire, which permits the simultaneous assessment of allergic rhinitis and asthma (ARA) control. There is no published data about the use of this tool. AIMS: To assess ARA control using CARAT10 in an Immunoallergology hospital setting; METHODS: Patients with diagnosis of allergic rhinitis with or without asthma (positive aeroallergens prick-tests and/or positive specific IgE) were sequentially enrolled and asked to fill in CARAT10 questionnaire at their first appointment. RESULTS: Two hundred patients were included, mostly female (n=142) with an average age of 33.6±12.3 years. ARA was present in 86 patients while 114 had isolated allergic rhinitis. In ARA group, 86% scored CARATtotal ≤ 24, meaning poor control. Subscores revealed that 83% had poorly controlled rhinitis (CARATr ≤ 8) and 74% had poorly controlled asthma (CARATa < 16). There were no age or gender related differences in ARA control. In allergic rhinitis group (n=114), 89% were poorly controlled. CONCLUSIONS: Only 14% of patients presenting rhinitis and asthma had both diseases controlled.

Probiotic effects in allergic disease.

The increasing prevalence of allergic disease has been linked to reduced microbial exposure in early life. Probiotics have recently been advocated for the prevention and treatment of allergic disease. This article summarises recent publications on probiotics in allergic disease, focusing on clinical studies of prevention or treatment of allergic disease. Studies employing the combined administration of pre-natal and post-natal probiotics suggest a role for certain probiotics (alone or with prebiotics) in the prevention of eczema in early childhood, with the pre-natal component of treatment appearing to be important for beneficial effects. On the other hand, current data are insufficient to support the use of probiotics for the treatment of established allergic disease, although recent studies have highlighted new hope in this area. Probiotic bacteria continue to represent the most promising intervention for primary prevention of allergic disease, and well-designed definitive intervention studies should now be a research priority.

Efficacy of environmental controls for inhalant allergies.

PURPOSE OF REVIEW: This review examines the efficacy of environmental controls as part of the management for inhalant allergic disease (allergic rhinitis and allergic asthma). RECENT FINDINGS: Evidence of efficacy of environmental controls for allergic disease can be categorized into two types of studies: environmental controls reducing measured allergen levels and environmental controls affecting clinical outcomes (e.g., symptom scores, medication use, or measured lung function). Multiple environmental control strategies have demonstrated efficacy in reducing allergen levels; however, clinical benefit secondary to allergen reduction has been variable. Clinical benefit is seen more consistently in studies that remove the allergic patient from a high allergen environment, than in studies that attempt to reduce the allergen level within the home. Prevention of sensitization using environmental controls in the prenatal and infant periods has been studied, but it has been difficult to demonstrate a consistent reduction in the development of allergic disease or decrease symptom severity. Allergen exposure early in life may paradoxically promote tolerance in some populations and sensitizations in others. SUMMARY: Although many studies evaluating a single environmental control strategy fail to show an improvement in clinical outcomes, comprehensive environmental controls may provide some benefit. Additionally, studies that relocate patients to low allergen environments tend to demonstrate clinical improvement.