WHAT YOU SHOULD HAVE READ BUT….2012                 rhinitisAttilio BonerUniversity ofVerona, Italy
Validation of a self-questionnaire for assessing the   control of allergic rhinitis. Demoly CEA 2011;41:860               ...
Validation of a self-questionnaire for assessing the   control of allergic rhinitis. Demoly CEA 2011;41:860               ...
Validation of a self-questionnaire for assessing the control of allergic rhinitis. Demoly CEA 2011;41:860
•Rhinitis prevalence
Can early household exposure influence the developmentof rhinitis symptoms in infancy? Findings from the PARISbirth cohort...
Can early household exposure influence the developmentof rhinitis symptoms in infancy? Findings from the PARISbirth cohort...
Can early household exposure influence the developmentof rhinitis symptoms in infancy? Findings from the PARISbirth cohort...
Natural course and comorbidities of allergic and          nonallergic rhinitis in children                Westman JACI 201...
Natural course and comorbidities of allergic and          nonallergic rhinitis in children               Westman JACI 2012...
Natural course and comorbidities of allergic and          nonallergic rhinitis in children                Westman JACI 201...
Natural course and comorbidities of allergic and          nonallergic rhinitis in children               Westman JACI 2012...
Natural course and comorbidities of allergic and          nonallergic rhinitis in children                Westman JACI 201...
Natural course and comorbidities of allergic and         nonallergic rhinitis in children               Westman JACI 2012;...
Trends in the prevalence of asthma and allergic        rhinitis in Italy between 1991 and 2010              R. de Marco, E...
Trends in the prevalence of asthma and allergic        rhinitis in Italy between 1991 and 2010              R. de Marco, E...
The protective effect of farm milk consumption on   childhood asthma and atopy: the GABRIELA study                     Los...
The protective effect of farm milk consumption on   childhood asthma and atopy: the GABRIELA study                      Lo...
The protective effect of farm milk consumption on   childhood asthma and atopy: the GABRIELA study                      Lo...
The protective effect of farm milk consumption on   childhood asthma and atopy: the GABRIELA study                     Los...
The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study                    Loss J...
The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study                   Loss JA...
House dust mite sensitization in toddlers predicts current     wheeze at age 12 years Lodge JACI 2011;128:782             ...
House dust mite sensitization in toddlers predicts current     wheeze at age 12 years Lodge JACI 2011;128:782             ...
House dust mite sensitization in toddlers predicts current     wheeze at age 12 years Lodge JACI 2011;128:782             ...
House dust mite sensitization in toddlers predicts current     wheeze at age 12 years Lodge JACI 2011;128:782             ...
House dust mite sensitization in toddlers predicts current     wheeze at age 12 years Lodge JACI 2011;128:782             ...
Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study-      an in...
Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study-      an in...
Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study-      an in...
Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study-      an in...
Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study-      an in...
•Rhinitis   •risk factors•Protective factors
The influence of gender and atopy on the natural     history of rhinitis in the first 18 years of life                 Kur...
The influence of gender and atopy on the natural     history of rhinitis in the first 18 years of life                Kuru...
The influence of gender and atopy on the natural     history of rhinitis in the first 18 years of life                 Kur...
Gestational age at birth and risk of allergic rhinitis  in young adulthood. Crump JACI 2011;127:1173                      ...
Gestational age at birth and risk of allergic rhinitis  in young adulthood. Crump JACI 2011;127:1173     These findings su...
Staphylococcal enterotoxin B compromises   the immune tolerant status in the airway mucosa.                 Liu T, Clin Ex...
Staphylococcal enterotoxin B compromises   the immune tolerant status in the airway mucosa.                 Liu T, Clin Ex...
Staphylococcal enterotoxin B compromises    the immune tolerant status in the airway mucosa.                 Liu T, Clin E...
Staphylococcal enterotoxin B compromises    the immune tolerant status in the airway mucosa.                Liu T, Clin Ex...
Adaptative immune responses in Staphylococcus aureus      biofilm-associated chronic rhinosinusitis                Foreman...
Adaptative immune responses in Staphylococcus aureus      biofilm-associated chronic rhinosinusitis                 Forema...
Adaptative immune responses in Staphylococcus aureus      biofilm-associated chronic rhinosinusitis                 Forema...
Adaptative immune responses in Staphylococcus aureus       biofilm-associated chronic rhinosinusitis                      ...
Early protective and risk factors for allergic rhinitis at     age 4½ yr Alm Pediat Allergy Immunol 2011;22:398           ...
Early protective and risk factors for allergic rhinitis at     age 4½ yr Alm Pediat Allergy Immunol 2011;22:398 1.5 – 1.0 ...
Early protective and risk factors for allergic rhinitis at     age 4½ yr Alm Pediat Allergy Immunol 2011;22:398 1.5 – 1.0 ...
High-Dose Docosahexaenoic Acid Supplementation of  Preterm Infants: Respiratory and Allergy Outcomes                 Manle...
•Rhinitisetiopathogenesis
Protease-activated receptor 2-dependent fluid secretion   from airway submucosal glands by house dust mite    Quantitative...
Protease-activated receptor 2-dependent fluid secretion   from airway submucosal glands by house dust mite              ex...
Protease-activated receptor 2-dependent fluid secretion   from airway submucosal glands by house dust mite              ex...
Protease-activated receptor 2-dependent fluid secretion   from airway submucosal glands by house dust mite              ex...
Protease-activated receptor 2-dependent fluid secretion   from airway submucosal glands by house dust mite              ex...
Protease-activated receptor 2-dependent fluid secretion   from airway submucosal glands by house dust mite              ex...
Protease-activated receptor 2-dependent fluid secretion   from airway submucosal glands by house dust mite              ex...
Luminal decoration of blood vessels by activated     perivasal mast cells in allergic rhinitis           Schaefer, Allergy...
Luminal decoration of blood vessels by activated     perivasal mast cells in allergic rhinitis           Schaefer, Allergy...
Luminal decoration of blood vessels by activated         perivasal mast cells in allergic rhinitis                  Schaef...
Luminal decoration of blood vessels by activated          perivasal mast cells in allergic rhinitis                    Sch...
Nasal allergen provocation test with multiple          aeroallergens detects polysensitization in local             allerg...
Nasal allergen provocation test with multiple           aeroallergens detects polysensitization in local              alle...
Nasal allergen provocation test with multiple           aeroallergens detects polysensitization in local              alle...
Nasal allergen provocation test with multiple      aeroallergens detects polysensitization in local         allergic rhini...
Nasal allergen provocation test with multiple      aeroallergens detects polysensitization in local         allergic rhini...
Nasal allergen provocation test with multiple       aeroallergens detects polysensitization in local          allergic rhi...
Nasal allergen provocation test with multiple       aeroallergens detects polysensitization in local          allergic rhi...
Comparative evaluation of nasal blood flow and airflow     in the decongestant response to oxymetazoline       Vaidyanatha...
Comparative evaluation of nasal blood flow and airflow     in the decongestant response to oxymetazoline       Vaidyanatha...
Comparative evaluation of nasal blood flow and airflow     in the decongestant response to oxymetazoline       Vaidyanatha...
Comparative evaluation of nasal blood flow and airflow     in the decongestant response to oxymetazoline       Vaidyanatha...
Thermographic imaging during nasal peanut challenge may     be useful in the diagnosis of peanut allergy.                 ...
Thermographic imaging during nasal peanut challenge may     be useful in the diagnosis of peanut allergy.                 ...
Thermographic imaging during nasal peanut challenge may     be useful in the diagnosis of peanut allergy.                 ...
Thermographic imaging during nasal peanut challenge may     be useful in the diagnosis of peanut allergy.                 ...
Rhinitis and asthma
Comparison of bronchodilator response in patients with  asthma and healthy subjects using spirometry and oscillometry. Nai...
Comparison of bronchodilator response in patients with  asthma and healthy subjects using spirometry and oscillometry. Nai...
Comparison of bronchodilator response in patients with  asthma and healthy subjects using spirometry and oscillometry. Nai...
Relationship between bronchial hyperreactivity and  bronchodilation in patients with allergic rhinitis      Ciprandi Ann A...
Relationship between bronchial hyperreactivity and    bronchodilation in patients with allergic rhinitis       Ciprandi An...
Relationship between bronchial hyperreactivity and    bronchodilation in patients with allergic rhinitis       Ciprandi An...
Relationship between bronchial hyperreactivity and    bronchodilation in patients with allergic rhinitis       Ciprandi An...
Validating childhood symptoms     with physician-diagnosed allergic rhinitis      Kim, Ann Allergy Asthma Immunol 2012;108...
Validating childhood symptoms          with physician-diagnosed allergic rhinitis           Kim, Ann Allergy Asthma Immuno...
Validating childhood symptoms      with physician-diagnosed allergic rhinitis       Kim, Ann Allergy Asthma Immunol 2012;1...
Validating childhood symptoms      with physician-diagnosed allergic rhinitis       Kim, Ann Allergy Asthma Immunol 2012;1...
Validating childhood symptoms      with physician-diagnosed allergic rhinitis       Kim, Ann Allergy Asthma Immunol 2012;1...
Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan                    Ohta, ...
Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan                    Ohta, ...
Bronchodilation test in patients with allergic rhinitis                  Ciprandi, Allergy 2011;66:694                    ...
Bronchodilation test in patients with allergic rhinitis                  Ciprandi, Allergy 2011;66:694                    ...
Bronchodilation test in patients with allergic rhinitis                  Ciprandi, Allergy 2011;66:694                    ...
Bronchodilation test in patients with allergic rhinitis                  Ciprandi, Allergy 2011;66:694                    ...
Effect of an intranasal corticosteroid on exercise    induced bronchoconstriction in asthmatic children                Ker...
Effect of an intranasal corticosteroid on exercise    induced bronchoconstriction in asthmatic children               Kers...
Effect of an intranasal corticosteroid on exercise    induced bronchoconstriction in asthmatic children               Kers...
Effect of an intranasal corticosteroid on exerciseinduced bronchoconstriction in asthmatic children            Kersten Ped...
•Rhinitis treatmentgeneral considerations
Chronic rhinosinusitis: epidemiology and medical        management Hamilos JACI 2011;128:693            • Chronic rhinosin...
Chronic rhinosinusitis: epidemiology and medical     management Hamilos JACI 2011;128:693            Current consensus def...
Chronic rhinosinusitis: epidemiology and medical        management Hamilos JACI 2011;128:693         • Evaluation and medi...
A new instrument for the assessment of patient-defined      benefit in the treatment of allergic rhinitis                F...
A new instrument for the assessment of patient-defined      benefit in the treatment of allergic rhinitis                F...
•Rhinitis treatment  anti-histamines
Petasol butenoate complex (Ze 339) relieves allergic   rhinitis–induced nasal obstruction more effectively     than deslor...
Petasol butenoate complex (Ze 339) relieves allergic     rhinitis–induced nasal obstruction more effectively       than de...
Petasol butenoate complex (Ze 339) relieves allergic  rhinitis–induced nasal obstruction more effectively    than deslorat...
Petasol butenoate complex (Ze 339) relieves allergic rhinitis–induced nasal obstruction more effectively   than desloratad...
Mometasone furoate nasal spray increases the number of      minimal-symptom days in patients with acuterhinosinusitis Melt...
Mometasone furoate nasal spray increases the number of      minimal-symptom days in patients with acuterhinosinusitis Melt...
Mometasone furoate nasal spray increases the number of      minimal-symptom days in patients with acuterhinosinusitis Melt...
Mometasone furoate nasal spray increases the number of      minimal-symptom days in patients with acuterhinosinusitis Melt...
Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis              ...
Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis              ...
Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis              ...
Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis              ...
Ocular symptoms in nonspecific conjunctival hyperreactivity         Mourão Ann Allergy Asthma Immunol 2011;107:29  Backgro...
Ocular symptoms in nonspecific conjunctival hyperreactivity          Mourão Ann Allergy Asthma Immunol 2011;107:29        ...
Ocular symptoms in nonspecific conjunctival hyperreactivity            Mourão Ann Allergy Asthma Immunol 2011;107:29Hypero...
Ocular symptoms in nonspecific conjunctival hyperreactivity           Mourão Ann Allergy Asthma Immunol 2011;107:29       ...
Allergic Conjunctivitis and Dry Eye Syndrome            Hom, Ann Allergy Asthma Immunol 2012;108:1631. Allergic Conjunctiv...
Allergic Conjunctivitis and Dry Eye Syndrome          Hom, Ann Allergy Asthma Immunol 2012;108:163                  Subjec...
Allergic Conjunctivitis and Dry Eye Syndrome          Hom, Ann Allergy Asthma Immunol 2012;108:163                        ...
Allergic Conjunctivitis and Dry Eye Syndrome            Hom, Ann Allergy Asthma Immunol 2012;108:163                      ...
Allergic Conjunctivitis and Dry Eye Syndrome          Hom, Ann Allergy Asthma Immunol 2012;108:163 Self-reported  - itchi...
Allergic Conjunctivitis and Dry Eye Syndrome   Hom, Ann Allergy Asthma Immunol 2012;108:163 Itch & Redness                ...
Allergic Conjunctivitis and Dry Eye Syndrome    Hom, Ann Allergy Asthma Immunol 2012;108:163  Itch & Redness              ...
Conjunctival provocation with airborne allergen     in patients with atopic keratoconjunctivitis            Nivenius, Clin...
Conjunctival provocation with airborne allergen         in patients with atopic keratoconjunctivitis                    Ni...
Conjunctival provocation with airborne allergen        in patients with atopic keratoconjunctivitis                Niveniu...
Conjunctival provocation with airborne allergen        in patients with atopic keratoconjunctivitis                Niveniu...
Conjunctival provocation with airborne allergen        in patients with atopic keratoconjunctivitis                Niveniu...
Conjunctival provocation with airborne allergen        in patients with atopic keratoconjunctivitis                Niveniu...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
Topical cyclosporine prevents seasonal recurrences of  vernal keratoconjunctivitis in a randomized, double-            mas...
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
What 2012 rhinitis & sinusitis & poliposis
Upcoming SlideShare
Loading in...5
×

What 2012 rhinitis & sinusitis & poliposis

5,596

Published on

0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
5,596
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

What 2012 rhinitis & sinusitis & poliposis

  1. 1. WHAT YOU SHOULD HAVE READ BUT….2012  rhinitisAttilio BonerUniversity ofVerona, Italy
  2. 2. Validation of a self-questionnaire for assessing the control of allergic rhinitis. Demoly CEA 2011;41:860 Improvement of impact of allergic rhinitis on sleep and work life (on a numeric scale from 0 for ‘no signs’ to 10 for ‘very intense’) A self-assessment at inclusion and day 15 after treatment. global score for allergic rhinitis control (five items scored from 1 to 5 assessing the rhinitis over the 2 previous weeks). 902 patients.
  3. 3. Validation of a self-questionnaire for assessing the control of allergic rhinitis. Demoly CEA 2011;41:860 Improvement of impact of allergic rhinitis on social and physical activities (on a numeric scale from 0 for ‘no signs’ to A self-assessment 10 for ‘very intense’) at inclusion and day 15 after treatment. global score for allergic rhinitis control (five items scored from 1 to 5 assessing the rhinitis over the 2 previous weeks). 902 patients.
  4. 4. Validation of a self-questionnaire for assessing the control of allergic rhinitis. Demoly CEA 2011;41:860
  5. 5. •Rhinitis prevalence
  6. 6. Can early household exposure influence the developmentof rhinitis symptoms in infancy? Findings from the PARISbirth cohort. Herr Ann Allergy Asthma Immunol 2011;107:303 Prevalence at age 18 months of 6.0 – Infants at age 18 months. 5.4% 5.0 – Presence of rhinitis 4.0 – symptoms (runny nose, blocked nose, sneezing 3.0 – 3.8% in the absence of a cold) 2.0 – combined with biological 1.0 – atopy. 0 0 Allergic rhinitis Nonallergic rhinitis
  7. 7. Can early household exposure influence the developmentof rhinitis symptoms in infancy? Findings from the PARISbirth cohort. Herr Ann Allergy Asthma Immunol 2011;107:303 OR for allergic rhinitis 4.0 – Infants at age 18 months. 3.0 – Presence of rhinitis 3.15 symptoms (runny nose, 2.0 – blocked nose, sneezing in the absence of a cold) 1.0 – combined with biological atopy. 0 0 Presence of cockroaches in the home
  8. 8. Can early household exposure influence the developmentof rhinitis symptoms in infancy? Findings from the PARISbirth cohort. Herr Ann Allergy Asthma Immunol 2011;107:303 OR for nonallergic rhinitis 2.0 – Infants at age 18 months. 1.5 – 1.87 Presence of rhinitis symptoms (runny 1.0 – nose, blocked nose, sneezing in the 0.5 – absence of a cold) combined with biological 0 0 Presence of particle-board atopy. furniture less than 12 months old in the childs bedroom
  9. 9. Natural course and comorbidities of allergic and nonallergic rhinitis in children Westman JACI 2012;129:403 Proportion of children % pts with allergic rhinitis* 20 –Birth cohort of 2024 children. 15 – 14%IgEs against 8 common 10 – inhaled allergens was available. 05 –Age 4 and 8 yrs. 5% 0 4 years 8 years *allergic rhinitis = rhinitis with sensitization to allergens.
  10. 10. Natural course and comorbidities of allergic and nonallergic rhinitis in children Westman JACI 2012;129:403 Proportion of children % pts with allergic rhinitis* Of the children with 20 –Birth cohort of allergic rhinitis 2024 children. when they were 15 – 14% 4 againstIgEs years old, 8 common 12% underwent 10 – inhaled allergens was remission available. 05 – by the time 4 and 8 yrs.Agethey were 5% 0 8 years old. 4 years 8 years *allergic rhinitis = rhinitis with sensitization to allergens.
  11. 11. Natural course and comorbidities of allergic and nonallergic rhinitis in children Westman JACI 2012;129:403 Proportion of children % pts with nonallergic rhinitis* 20 –Birth cohort of 2024 children. 15 –IgEs against 8 common 10 – inhaled allergens was available. 05 – 8% 6%Age 4 and 8 yrs. 0 4 years 8 years *nonallergic rhinitis = rhinitis without sensitization to allergens.
  12. 12. Natural course and comorbidities of allergic and nonallergic rhinitis in children Westman JACI 2012;129:403 Proportion of children % pts with nonallergic rhinitis* Of the children 20 – withBirth cohort ofnonallergic rhinitis 2024 children. 15 –IgEs against were when they 8 common old, 4 years 10 – 73% underwent inhaled allergens was remission available. 05 – 8% 6%Age 4 and 8 period during the yrs. of development. 0 4 years 8 years *nonallergic rhinitis = rhinitis without sensitization to allergens.
  13. 13. Natural course and comorbidities of allergic and nonallergic rhinitis in children Westman JACI 2012;129:403 % children with ORAL ALLERGY SYNDROMEBirth cohort of 30 – 2024 children.IgEs against 20 – 25% 8 common inhaled allergens 10 – was available.Age 4 and 8 yrs. 0 If allergic rhinitis at the age of 8 years
  14. 14. Natural course and comorbidities of allergic and nonallergic rhinitis in children Westman JACI 2012;129:403ConclusionsFewer preschool-age children with allergic rhinitisundergo remission than do those with nonallergic rhinitis.Sensitization to inhaled allergens at an early age (4 years)precedes the development of allergic rhinitis, whereassymptoms of rhinitis do not.Oral allergy syndrome is common among 8-year-olds withallergic rhinitis.
  15. 15. Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010 R. de Marco, Eur Respir J 2012;39:883 Overall mean prevalence The same screening questionnaire by mail or phone. Random samples of the general population (age 20–44 yrs). (1991–1993; n=6,031) (1998–2000; n=18,873) (2007–2010; n=10,494)
  16. 16. Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010 R. de Marco, Eur Respir J 2012;39:883 Overall mean prevalence The same screening The asthma epidemic questionnaire by mail or is not over in Italy. phone. During the past 20 yrs, asthma prevalence has Random samples of the increased by 38%, general population (age 20–44 with a similar in parallel yrs). increase in asthma-like symptoms and (1991–1993; n=6,031) allergic rhinitis. (1998–2000; n=18,873) (2007–2010; n=10,494)
  17. 17. The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study Loss JACI 2011;128:766 OR for asthma 1.0 – Farm milk consumption. 8334 school-aged children. 0.59 0.5 – 800 cow’s milk samples collected at the participants’ homes, viable bacterial counts, whey protein 0 levels and total fat For raw milk content. consumption
  18. 18. The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study Loss JACI 2011;128:766 OR for asthma 1.0 – Farm milk consumption. 8334 school-aged children. farm milk Boiled 800 did not show a 0.59 0.5 – cow’s milk samples protective collected at the effect. participants’ homes, viable bacterial counts, whey protein levels and 0 total fat content. For raw milk consumption
  19. 19. The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study Loss JACI 2011;128:766 OR for hay fever 1.0 – Farm milk consumption. 8334 school-aged children. 0.5 – 800 cow’s milk samples collected at the participants’ homes, 0.51 viable bacterial counts, whey protein levels and 0 total fat content. For raw milk consumption
  20. 20. The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study Loss JACI 2011;128:766 OR for hay fever 1.0 – Farm milk consumption. 8334 school-aged children. farm milk Boiled 800 did not show a cow’s milk samples 0.5 – protective collected at the effect. participants’ 0.51 homes, viable bacterial counts, whey protein 0 levels and total fat For raw milk content. consumption
  21. 21. The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study Loss JACI 2011;128:766 Total viable bacterial counts and total fat content of milk were not significantly related to asthma or atopy. Increased levels of the whey proteins BSA (aOR for highest vs lowest levels and asthma, 0.53; 95% CI 0.30- 0.97), α-lactalbumin (aOR for interquartile range and asthma, 0.71; 95% CI, 0.52-0.97), and β-lactoglobulin (aOR for interquartile range and asthma, 0.62; 95% CI, 0.39- 0.97), however, were inversely associated with asthma but not with atopy.
  22. 22. The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study Loss JACI 2011;128:766 Total viable bacterial counts and total fat content of milk were not significantly related to asthma raw milk The protective effect of or atopy. consumption on asthma might be associated with BSA Increased levels of the whey proteins the (aOR for highest vs lowest levels and asthma, 0.53; 95% CI 0.30- 0.97), whey protein(aOR for interquartile range and α-lactalbumin fraction of milk. asthma, 0.71; 95% CI, 0.52-0.97), and β-lactoglobulin (aOR for interquartile range and asthma, 0.62; 95% CI, 0.39- 0.97), however, were inversely associated with asthma but not with atopy.
  23. 23. House dust mite sensitization in toddlers predicts current wheeze at age 12 years Lodge JACI 2011;128:782 Prevalence of sensitization (and 95% CI) at age 6 months (n=560), 1 year (n=551), Birth cohort of 620 and 2 years (n=459). children oversampled for familial allergy. SPTs to 6 allergens at ages 6, 12, and 24 mo. Wheeze and eczema recorded during the first 2 yrs. Current wheeze recorded at age 12 yrs.
  24. 24. House dust mite sensitization in toddlers predicts current wheeze at age 12 years Lodge JACI 2011;128:782 7 – OR for wheeze at 12 yrs 6 – 6.37 Birth cohort of 620 5 – children oversampled for 4 – familial allergy. SPTs to 6 allergens at 3 – ages 6, 12, and 24 mo. 3.31 2 – Wheeze and eczema recorded during 1 – the first 2 yrs. 0 Current wheeze recorded Age 1 yr Age 2 yrs at age 12 yrs. SPT (+) for mite dust
  25. 25. House dust mite sensitization in toddlers predicts current wheeze at age 12 years Lodge JACI 2011;128:782 80 – % children wheezing at age 12 yrs 75% 70 – 60 – Birth cohort of 620 children oversampled for 50 – familial allergy. 40 – SPTs to 6 allergens at ages 6, 12, and 24 mo. Wheeze and eczema 30 – 20 – 36% recorded during 10 – the first 2 yrs. 0 Current wheeze recorded Sensitized Not Sensitized at age 12 yrs. Wheezing at age 1
  26. 26. House dust mite sensitization in toddlers predicts current wheeze at age 12 years Lodge JACI 2011;128:782 80 – % children wheezing at age 12 yrs 70 – Birth cohort of 620 children oversampled for 60 – 50 – 67% familial allergy. 40 – SPTs to 6 allergens at 35% 30 – ages 6, 12, and 24 mo. Wheeze and eczema 20 – recorded during 10 – the first 2 yrs. 0 Current wheeze recorded SPT (+) SPT (-) at age 12 yrs. Eczema at age 1 and mite
  27. 27. House dust mite sensitization in toddlers predicts current wheeze at age 12 years Lodge JACI 2011;128:782 80 – % children wheezing at age 12 yrs 70 – HDM sensitization Birthat age 1 or 2 yrs cohort of 620 in wheezing and children oversampled for 60 – 50 – 67% familial allergy. children eczematous 40 – at increased familial SPTs to 6 allergens at 35% 30 – allergy risk ages 6, 12, and 24 mo. predicts asthma Wheeze and eczema 20 – recorded duringinform and may 10 – themanagement of these first 2 yrs. 0 Current wheeze group. high-risk recorded SPT (+) SPT (-) at age 12 yrs. Eczema at age 1 and mite
  28. 28. Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study- an international population-based cohort study Matheson JACI 2011;128:816 HR for women developing rhinitis compared to men 1992-1994 community- based samples 1.0 – 1.36 of 20-44 yr-old people. 0.63 0.5 – 48 centers in 22 countries. 8486 participants. 0 Childhood Adulthood During
  29. 29. Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study- an international population-based cohort study Matheson JACI 2011;128:816 Cumulative probability of Cumulative probability of rhinitis by gender in rhinitis by gender in subjects who are atopic. subjects who are non atopic.
  30. 30. Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study- an international population-based cohort study Matheson JACI 2011;128:816 HR for developing rhinitis 1.0 – 0.84 1992-1994 community- based samples of 20-44 yr-old people. 0.5 – 48 centers in 22 countries. 0 8486 participants. Early contact with children in the family or day care before age 5 yrs.
  31. 31. Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study- an international population-based cohort study Matheson JACI 2011;128:816 HR for developing rhinitis 1.0 – 0.5 1992-1994 community- based samples of 20-44 yr-old people. 0.5 – 48 centers in 22 countries. 0 8486 participants. Early childhood pets or growing up on a farm.
  32. 32. Early-life risk factors and incidence of rhinitis: resultsfrom the European Community Respiratory Health Study- an international population-based cohort study Matheson JACI 2011;128:816 HR for developing rhinitis Protective effects 1.0 – of early contact with 0.5 1992-1994 and animals children community- based samples were suggested offor incident rhinitis, 20-44 yr-old people. 0.5 – 48 with risk patterns centers in 22 countries. age window varying by and atopic status 8486 participants. . 0 Early childhood pets or growing up on a farm.
  33. 33. •Rhinitis •risk factors•Protective factors
  34. 34. The influence of gender and atopy on the natural history of rhinitis in the first 18 years of life Kurukulaaratchy CEA 2011;41:851 Changes in atopic and non-atopic rhinitis prevalence for boys and girls over the first 18 years of life Natural history of rhinitis up to 18 years of age. Isle of Wight birth cohort recruited in 1989 (n = 1456). Questionnaire and skin prick tests.
  35. 35. The influence of gender and atopy on the natural history of rhinitis in the first 18 years of life Kurukulaaratchy CEA 2011;41:851 Changes in atopic and non-atopic rhinitis prevalence for boys and girls over the first 18 years of life Natural history Atopic rhinitis of rhinitis up to becomes 18 years of age. increasingly common as children grow Isle of Wight birth into cohort recruited in adolescents, with 1989 (n = 1456). stronger Questionnaireto male associations and gender. skin prick tests.
  36. 36. The influence of gender and atopy on the natural history of rhinitis in the first 18 years of life Kurukulaaratchy CEA 2011;41:851 Changes in atopic and non-atopic rhinitis prevalence for boys and girls over the first 18 years of life Natural history ofNon-atopic to rhinitis up rhinitis shows a female 18 years of age. predominance at 18 Isle of Wight birth years as girls „grow cohort it more during into‟ recruited in (n = 1456). 1989 adolescence. Questionnaire and skin prick tests.
  37. 37. Gestational age at birth and risk of allergic rhinitis in young adulthood. Crump JACI 2011;127:1173 For subjects born extremely preterm (23-28 weeks) OR for 630,090 infants born in Sweden including 27,953 1.0 – born preterm (<37 wks). Prescription of nasal 0.5 – 0.70 corticosteroids and oral 0.45 antihistamines 0.0 Nasal Both nasal age, 25.5-37.0 yrs. corticosteroid corticosteroid prescription and oral antihistamine prescription
  38. 38. Gestational age at birth and risk of allergic rhinitis in young adulthood. Crump JACI 2011;127:1173 These findings suggest that low gestational age For subjects born extremely at birth independent preterm (23-28 weeks) OR for 630,090 infants born in of fetal growth is Sweden including 27,953 1.0 – associated with a born preterm (<37 wks). decreased risk of Prescription of nasal young 0.5 – allergic rhinitis in 0.70 corticosteroids and oral adulthood, possibly 0.45 antihistaminesa protective 0.0 because of Nasal Both nasal effect of earlier age, 25.5-37.0 yrs. corticosteroid corticosteroid exposure to pathogens. prescription and oral antihistamine prescription
  39. 39. Staphylococcal enterotoxin B compromises the immune tolerant status in the airway mucosa. Liu T, Clin Exp Allergy 2012;42:3751) Staphylococcal enterotoxin B (SEB) is an enterotoxin produced by the bacterium Staphylococcus aureus. SEB may contaminate ingested food and induce gastrointestinal dysfunction. SEB interferes with the function of the immune system in the airway mucosa, such as to be involved in the pathogenesis of airway allergy.2) Integrin alphavbeta6 (avb6) is produced by epithelial cells in response to external stimuli, such as wound and inflammation. Our recent study data also show that intestinal epithelial cells express detectable avb6 that has protelytic activity and can convert the precursor of transforming growth factor (TGF)β into the active form of TGFβ. TGFβ plays a critical role in the Treg development. Tolergenic DCs (TolDC) express TGFβ and aldehyde dehydrogenase (ALDH) that can induce CD4+ CD25- T cells to Foxp3+ Tregs.
  40. 40. Staphylococcal enterotoxin B compromises the immune tolerant status in the airway mucosa. Liu T, Clin Exp Allergy 2012;42:3751) Staphylococcal enterotoxin B (SEB) is an enterotoxin produced by the bacterium Staphylococcus aureus. SEB may contaminate ingested food and induce gastrointestinal dysfunction. in avb6 The increases in SEB and decreases SEB interferes with the function of the immune system in the airway mucosa, such as to be involvedassociated in nasal epithelium are in the pathogenesis of airway allergy. compromises of immune tolerance with the in the nasal mucosa.2) Integrin alphavbeta6 (avb6) is produced by epithelial cells in response SEB has stimuli,ability wound and inflammation. to external the such as to suppress Our recent study data also show that intestinal epithelial cells express detectable avb6 that has protelyticavb6 and can convert the expression of activity in nasal epithelial cells. the precursor of transforming growth factor (TGF)β into the active form of TGFβ. TGFβ plays a critical role in the Treg development. Tolergenic DCs (TolDC) express TGFβ and aldehyde dehydrogenase (ALDH) that can induce CD4+ CD25- T cells to Foxp3+ Tregs.
  41. 41. Staphylococcal enterotoxin B compromises the immune tolerant status in the airway mucosa. Liu T, Clin Exp Allergy 2012;42:375 Avb6 expression is suppressed in the allergic rhinitis (AR) nasal epithelium• The immune tolerant components, tolerogenic dendritic cells (TolDC) P<0.01 & regulatory T cells (Treg), were assessed in the surgically removed nasal mucosa from patients with allergic rhinitis (AR) Staphylococcal enterotoxin B (SEB) or non-AR chronic rhinitis. levels are increased in the allergic rhinitis nasal epithelium.• Contents of Staphylococcal enterotoxin B & integrin alphavbeta6 P<0.01 (avb6) in the nasal epithelium assessed using enzyme-linked immunoassay.
  42. 42. Staphylococcal enterotoxin B compromises the immune tolerant status in the airway mucosa. Liu T, Clin Exp Allergy 2012;42:375 Avb6 expression is suppressed in the allergic rhinitis (AR) nasal epithelium• The immune tolerant components, components The tolerogenic dendritic P<0.01 cells (TolDC) & regulatory T cells of immune tolerance (Treg), were assessed in the surgically machinery, mucosa removed nasal from patients & Tregs TolDCs with Staphylococcal enterotoxin B (SEB) allergic rhinitis (AR) were suppressed levels are increased in the allergic or non-AR chronic rhinitis. rhinitis nasal epithelium. in the AR• Contents of Staphylococcal nasal mucosa. P<0.01 enterotoxin B & integrin alphavbeta6 (avb6) in the nasal epithelium assessed using enzyme-linked immunoassay.
  43. 43. Adaptative immune responses in Staphylococcus aureus biofilm-associated chronic rhinosinusitis Foreman, Allergy 2011;66:1449Background: The etiopathogenesis of chronic rhinosinusitis (CRS)is currently an area of intense debate. Recently, biofilms havebeen proposed as a potential environmental trigger in thisdisease. In particular, Staphylococcus aureus biofilms appear tobe a predictor of severe disease recalcitrant to currenttreatment paradigms.However, direct causal links between biofilms and host immuneactivation are currently lacking. This study aimed to documentboth the adaptive immune responses that characterize S. aureusbiofilm–associated CRS and the relative contributions ofstaphylococcal superantigens and S. aureus biofilms in theinflammatory make-up of this disease.
  44. 44. Adaptative immune responses in Staphylococcus aureus biofilm-associated chronic rhinosinusitis Foreman, Allergy 2011;66:1449 Staphylococcus aureus biofilms and 53 disease subjects; superantigens are 15 controls; significantly associated Sinonasal mucosa for in CRS S.aureus and Haemophilus patients, suggesting influenzae biofilms; the biofilm may be a Presence of total and nidus for superantigen-specific IgE superantigen-eluting bacteria.
  45. 45. Adaptative immune responses in Staphylococcus aureus biofilm-associated chronic rhinosinusitis Foreman, Allergy 2011;66:1449 Staphylococcus aureus biofilms and 53 The presence of disease subjects; S. aureus superantigens are biofilms is 15 controls; significantly associated with associated Sinonasal mucosa for eosinophilic in CRS S.aureus and Haemophilus inflammation, patients, suggesting influenzae biofilms; across the the biofilm may be a spectrum of CRS nidus for Presence of total and superantigen-specific IgE superantigen-eluting bacteria.
  46. 46. Adaptative immune responses in Staphylococcus aureus biofilm-associated chronic rhinosinusitis Foreman, Allergy 2011;66:1449 Representative images of bacterial biofilms on sinus mucosa using a FISH(Fluorescence in situ Hybridization) protocol, imaged on the confocal scanning laser microscope. Both images demonstrate brightly fluorescing bacterial-sized dots surrounded by a less-intense fluorescing blush, thought to represent the matrix. (A) H.influenza (B) Staphylococcus FISH probe aureus FISH probe tagged with Cy3 tagged with Alexa488 fluorophore fluorophore
  47. 47. Early protective and risk factors for allergic rhinitis at age 4½ yr Alm Pediat Allergy Immunol 2011;22:398 % children reporting A prospective, longitudinal symptoms of allergic study of a cohort of rhinitis during the least children born in the region year at age 4 ½ yrs of western Sweden in 2003. 6 – 8,176 families. 5 – 4 – 5.5% Questionnaires at 3 – 6 and 12 months 2 – and at 4½ yr of age. 1 – 0
  48. 48. Early protective and risk factors for allergic rhinitis at age 4½ yr Alm Pediat Allergy Immunol 2011;22:398 1.5 – 1.0 – 10.21 OR for allergic rhinitis 0 9 – 0 8 – 0 7 – 0 6 – 0 5 – 0 4 – 0 3 – 3.3 0 2 – 2.72 2.21 0 1 – 1.97 0 0 Sensitisation Recurrent Doctor- Parental Eczema to food wheeze diagnosed rhinitis first year allergens eczema
  49. 49. Early protective and risk factors for allergic rhinitis at age 4½ yr Alm Pediat Allergy Immunol 2011;22:398 1.5 – 1.0 – 10.21 OR for allergic rhinitis 0 9 – 0 8 – 0 7 – The risk was reduced with 0 6 – fish introduction before 0 5 – 0 4 – 9 months 0 3 – 3.3 0 2 – 2.72 2.21 0 1 – 1.97 0 0 Sensitisation Recurrent Doctor- Parental Eczema to food wheeze diagnosed rhinitis first year allergens eczema
  50. 50. High-Dose Docosahexaenoic Acid Supplementation of Preterm Infants: Respiratory and Allergy Outcomes Manley Pediatrics 2011;128:e71 657 preterm infants 33 RR of reported hay fever weeks’ gestation who in all infants at either consumed expressed breast 12 or 18 months 1.0 – milk from mothers taking 0.9 – either tuna oil 0.8 – (high-DHA diet) or soy oil 0.7 – (standard-DHA) capsules. 0.6 – 0.5 – 0.4 – Incidence of bronchopulmonary dysplasia 0.3 – 0.2 – 0.41 (BPD) and parental reporting 0.1 – p=0.03 of atopic conditions over the 0 first 18 months of life. DHA diet
  51. 51. •Rhinitisetiopathogenesis
  52. 52. Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite Quantitative extract Cho JACI 2012;129:529 measurement of glandular secretion.A. Harvest of nasal mucosa from the inferior nasal turbinate.B. Experimental setup.C. Mucus bubbles from glands under oil are visualized by using bright-field microscopy and side-light illumination.D. Example of mucus bubbles formed on the surface of nasal turbinates 30 minutes after stimulation with HDM extract.
  53. 53. Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite extract Cho JACI 2012;129:529BackgroundThe submucosal gland (SMG) is important in the control of airwaysurface fluid.Protease-activated receptor (PAR) 2 contributes to the pathophysiologyof allergies in response to nonspecific allergens bearing proteases andanion secretion.House dust mites (HDMs) have abundant proteases that can activatePAR2, but little is known about the direct effect of HDM on SMGsecretion.ObjectiveTo investigate the effect of HDMs on glandular secretion and itsmechanism in allergic patients, patients with chronic rhinosinusitis(CRS), or both.
  54. 54. Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite extract Cho JACI 2012;129:529Inferior nasal 1) HDM induced a turbinates. significantly higher55 patients classified secretion rate into four groups: and number of 1. the control, 2. allergic rhinitis (AR), responding glands 3. chronic rhinosinusitis (CRS), in the AR and 4. AR + CRS. AR+CRS groupsMucus bubbles from than in the individual submucosal control group. gland (SMGs).
  55. 55. Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite extract Cho JACI 2012;129:529Inferior nasal 2) Patients in the turbinates. CRS group, who had no55 patients classified HDM-specific IgE, into four groups: showed a 1. the control, higher response 2. allergic rhinitis (AR), than the control group, 3. chronic rhinosinusitis (CRS), and its response 4. AR + CRS. was suppressed byMucus bubbles from a PAR2-selective individual submucosal antagonist. gland (SMGs).
  56. 56. Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite extract Cho JACI 2012;129:529 Responses to HDM. Plots of averaged secretion rates versus time for each group.Inferior nasal *p < 0.05 turbinates.55 patients classified into four groups: 1. the control, 2. allergic rhinitis (AR), 3. chronic rhinosinusitis (CRS), 4. AR + CRS.Mucus bubbles from individual submucosal gland (SMGs).
  57. 57. Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite extract Cho JACI 2012;129:529 Responses to HDM. Plots of averaged secretion rates versus time for each group.Inferior nasal *p < 0.05 Interestingly, patients in turbinates. the CRS group, who had55 patients classified IgE no HDM-specific into four groups: antibody, showed a 1. the control, higher response than the 2. allergic rhinitis (AR), its control group, and 3. chronic rhinosinusitis (CRS), response was suppressed 4. AR + CRS. by a PAR2-selective antagonist.Mucus bubbles from individual submucosal gland (SMGs).
  58. 58. Protease-activated receptor 2-dependent fluid secretion from airway submucosal glands by house dust mite extract Cho JACI 2012;129:529 Conclusions HDM allergens can induce glandular secretion in patients with AR, CRS, or both, and PAR2 represents a possible mechanism for nonspecific hyperreactivity in inflammatory airway diseases.
  59. 59. Luminal decoration of blood vessels by activated perivasal mast cells in allergic rhinitis Schaefer, Allergy 2012;67:510 (A) Tissue accumulation of mast cells (b- tryptase, brown, on hematoxylin background staining) in allergic rhinitis patient (AR, right) & healthy control (left). (B) Activated mast cells co-localize with peripheral blood vessels in AR nasal mucosa. Asterisks indicate capillary lumen.
  60. 60. Luminal decoration of blood vessels by activated perivasal mast cells in allergic rhinitis Schaefer, Allergy 2012;67:510 (C) Confocal laser scanning microscopy of AR nasal mucosa stained with DAPI (nuclei, blue), anti CD31 (endothelial cells, green), & anti CD63var (red). Arrows indicate fluorescence signal transfer from degranulating mast cells into the lumen of microcapillaries across the juxtapositioned endothelial cells.
  61. 61. Luminal decoration of blood vessels by activated perivasal mast cells in allergic rhinitis Schaefer, Allergy 2012;67:510• Mast cells can discharge exosomes, which are complete, membrane-covered vesicles, able to travel long distances with the help of the lymphatic system.• Another novel way: upon triggering, granular membrane factors directly traverse from the activated mast cell onto an acceptor cell.• Detected epitope transfer from activated mast cells onto neighboring cells by following the localization of CD63var, which is a specific molecular marker of human mast cell granuli.• The new transport mode requires an intimate cellular coupling.
  62. 62. Luminal decoration of blood vessels by activated perivasal mast cells in allergic rhinitis Schaefer, Allergy 2012;67:510• In conclusion, we describe details of a novel intercellular communication mechanism, wherein granulated cells can select distinguished acceptor cells via receptor–ligand interactions and then transfer a set of their own molecules onto them.• This way mast cells can control, modify or even reprogram selected bystander cells and may fundamentally reshape their microenvironment in case of an allergic challenge. As mast cells frequently co-localize with blood vessels in situ, we propose that via this transcytotic channeling, mast cells instantly modulate the membrane composition of neighboring endothelium.
  63. 63. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Rondon, JACI 2011;128:1192Background:Patients previously given a diagnosis of non-allergic rhinitis (NAR)might have a new form of local allergic rhinitis (LAR) withlocal production of specific IgE antibodies and a positive responseto a nasal allergen provocation test (NAPT).Objective:We evaluated an NAPT protocol using multiple aeroallergens(NAPT-M) for the detection of polysensitizationto several aeroallergens in patients with LAR. LAR: Local allergic rhinitis; NAPT-M: Nasal allergen provocation test with multiple allergens; NAPT-S: Nasal allergen provocation test with a single aeroallergen; NAR: Non-allergic rhinitis; VAS: Visual analog scale; VOL2-6 cm : Volume of the nasal cavity from 2 to 6 cm.
  64. 64. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Rondon, JACI 2011;128:1192 25 adult patients with Local allergic rhinitis (LAR); 25 adult patients with Non-allergic rhinitis (NAR). All the patients had a history of at least 2 yrs of persistent rhinitis with negative skin prick test (SPT) responses and serum sIgE levels to the most prevalent aeroallergens. - LAR was diagnosed by the presence of a positive response to ≥ 1 NAPT-Ss with D pteronyssinus, Alternaria alternata, Olea europea, or grass pollen ; - NAR by a negative NAPT response. LAR: Local allergic rhinitis; NAPT-M: Nasal allergen provocation test with multiple allergens; NAPT-S: Nasal allergen provocation test with a single aeroallergen; NAR: Non-allergic rhinitis; VAS: Visual analog scale; VOL2-6 cm : Volume of the nasal cavity from 2 to 6 cm.
  65. 65. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Rondon, JACI 2011;128:1192NAPT-M: Nasal allergen provocation test with multiple allergens• Symptom-free patients (total VAS <60 mm) were challenged intranasally with 2 puffs (100 mL) of saline in each nostril to exclude nasal hyperreactivity. If the result was negative, 15 minutes after NAPT-M, we began administrating 4 consecutive and different reconstituted freeze-dried allergen solutions of D pteronyssinus (4 µg/mL), A alternata (0.25 µg/mL), O europea (0.6 µg/mL), and grass pollen (0.1 µg/mL; ALK-Abello) at 15-minute intervals. 2 puffs (100 mL) of the solution at room temperature were applied in each nostril.• The response to nasal challenge was evaluated based on subjective (VAS of nasal-ocular symptoms) and objective (VOL2-6 cm) parameters.• A positive NAPT-M response was considered to be: 1) an increase of ≥ 30% in the total VAS score 2) a decrease of ≥ 30% in the sum of VOL2-6 cm from both nasal cavities. LAR: Local allergic rhinitis; NAPT-M: Nasal allergen provocation test with multiple allergens; NAPT-S: Nasal allergen provocation test with a single aeroallergen; NAR: Non-allergic rhinitis; VAS: Visual analog scale; VOL2-6 cm : Volume of the nasal cavity from 2 to 6 cm.
  66. 66. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Rondon, JACI 2011;128:1192Nasal levels of tryptase and ECP in patients with LAR after NAPT-Ms. * * * * * ** Significant differences (p < 0.05) between baseline and 15 minutes and 1, 2, and 24 hours after challenge.LAR: Local allergic rhinitis; NAPT-M: Nasal allergen provocation test with multiple allergens;
  67. 67. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Rondon, JACI 2011;128:1192Nasal levels of tryptase and ECP in patients with LAR after NAPT-Ms. * * * * * * There is a clinically relevant polysensitization* Significant differences (p <aeroallergens and 15 minutes and 1, 2, and 24 hours to 0.05) between baseline in patients after challenge. with LAR.LAR: Local allergic rhinitis; NAPT-M: Nasal allergen provocation test with multiple allergens;
  68. 68. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Rondon, JACI 2011;128:1192 Number of visits required for the final diagnosis in NAPT-Ms and NAPT-Ss. LAR: Local allergic rhinitis; NAPT-M: Nasal allergen provocation test with multiple allergens;NAPT-S: Nasal allergen provocation test with a single aeroallergen; NAR: Non-allergic rhinitis; VAS: Visual analog scale; VOL2-6 cm : Volume of the nasal cavity from 2 to 6 cm.
  69. 69. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. Rondon, JACI 2011;128:1192 Number of visits required for the final diagnosis in NAPT-Ms and NAPT-Ss. NAPT-M is a useful, specific, sensitive, reproducible, and less time-consuming in vivo diagnostic test for the screening of patients with LAR. LAR: Local allergic rhinitis; NAPT-M: Nasal allergen provocation test with multiple allergens;NAPT-S: Nasal allergen provocation test with a single aeroallergen; NAR: Non-allergic rhinitis; VAS: Visual analog scale; VOL2-6 cm : Volume of the nasal cavity from 2 to 6 cm.
  70. 70. Comparative evaluation of nasal blood flow and airflow in the decongestant response to oxymetazoline Vaidyanathan, Ann Allergy Asthma Immunol 2012;108:77 19 healthy adults. Decongestive response in nasal blood flow (NBF) Doubling doses of oxymetazoline of 25µg, P<0.001 P<0.001 50µg, 100µg, and 200µg at 20 minute intervals. Peak nasal inspiratory flow (PNIF) and nasal airway resistance (NAR) at baseline and after each successive dose. 1 visit 2 visit Nasal blood flow (NBF) using laser Doppler Flowmetry.
  71. 71. Comparative evaluation of nasal blood flow and airflow in the decongestant response to oxymetazoline Vaidyanathan, Ann Allergy Asthma Immunol 2012;108:77 19 healthy adults. Peak nasal inspiratory flow (PNIF) Doubling doses of oxymetazoline of 25µg, 50µg, 100µg, and 200µg at P<0.001 P<0.003 20 minute intervals. Peak nasal inspiratory flow (PNIF) and nasal airway resistance (NAR) at baseline and after each successive dose. 1 visit 2 visit Nasal blood flow (NBF) using laser Doppler Flowmetry.
  72. 72. Comparative evaluation of nasal blood flow and airflow in the decongestant response to oxymetazoline Vaidyanathan, Ann Allergy Asthma Immunol 2012;108:77 19 healthy adults. Nasal airway resistance (NAR) Doubling doses of oxymetazoline of 25µg, 50µg, 100µg, and P<0.002 200µg at 20 minute P<0.001 intervals. Peak nasal inspiratory flow (PNIF) and nasal airway resistance (NAR) at baseline and after each successive 1 visit 2 visit dose. Nasal blood flow (NBF) using
  73. 73. Comparative evaluation of nasal blood flow and airflow in the decongestant response to oxymetazoline Vaidyanathan, Ann Allergy Asthma Immunol 2012;108:77 19 healthy adults. Nasal airway resistance (NAR) Doubling doses offlow using Nasal blood oxymetazoline of laser Doppler flowmetry 25µg, 50µg, 100µg, and 200µg at 20 minute and is a sensitive P<0.002 P<0.001 reproducible outcome to intervals. decongestion with Peak nasal inspiratory flow oxymetazoline, similar (PNIF) and nasal airway to nasal patency resistance (NAR) at baseline and symptoms. and after each successive 1 visit 2 visit dose. Nasal blood flow (NBF) using
  74. 74. Thermographic imaging during nasal peanut challenge may be useful in the diagnosis of peanut allergy. Clark, Allergy 2012;67:574Background: Double-blinded challenges are widely used for diagnosingfood allergy but are time-consuming and cause severe reactions.Outcome relies on subjective interpretation of symptoms, which leadsto variations in outcome between observers.Facial thermography combined with nasal peanut challenge wasevaluated as a novel objective indicator of clinical allergy.
  75. 75. Thermographic imaging during nasal peanut challenge may be useful in the diagnosis of peanut allergy. Clark, Allergy 2012;67:574 Change in mean nasal temperature from baseline (Δt) over time (min) for placebo and active peanut nasal 16 children with positive challenge arms. peanut challenge. Nasal challenge with 10 μg peanut protein or placebo. Mean skin temperatures recorded from the mouth & nose using infrared thermography over 18 min.
  76. 76. Thermographic imaging during nasal peanut challenge may be useful in the diagnosis of peanut allergy. Clark, Allergy 2012;67:574 Change in mean nasal temperature The area under curve from baseline (Δt) over time (min) of nasal skin temperature for placebo and active peanut nasal 16 children with elevated was significantly positive challenge arms. peanut peanut vs placebo after challenge. (18.2 vs 4.8°Cmin). Nasal maximum increase μg The challenge with 10 peanut protein or placebo. in temperature was also significantly greater Mean aftertemperatures skin peanut: recorded from +0.9°C. mean difference the mouth & nose using infrared thermography over 18 min.
  77. 77. Thermographic imaging during nasal peanut challenge may be useful in the diagnosis of peanut allergy. Clark, Allergy 2012;67:574 Change in mean nasal temperature Thermography from baseline (Δt) over time (min) can detect inflammation for placebo and active peanut nasal caused by nasal challenges 16 children with positive whilst employing 1000-fold challenge arms. peanutpeanut than an oral less challenge. challenge. Nasal challenge with 10 μg This novel technique could peanut protein or placebo. be developed to provide a rapid, safe Mean skin temperatures recorded from clinical and objective allergy test. the mouth & nose using infrared thermography over 18 min.
  78. 78. Rhinitis and asthma
  79. 79. Comparison of bronchodilator response in patients with asthma and healthy subjects using spirometry and oscillometry. Nair Ann Allergy Asthma Immunol 2011;107:317 Linear Regression with 95.00% Mean Prediction Interval Impulse oscillometry (IOS) is an effort-independent pulmonary function technique. Spirometry. Reversibility after 400 μg salbutamol. 95 asthmatic and 61 healthy subjects. Correlation between percent predicted FEV1 and resistance at 5 Hz (R5) at baseline in patients with asthma
  80. 80. Comparison of bronchodilator response in patients with asthma and healthy subjects using spirometry and oscillometry. Nair Ann Allergy Asthma Immunol 2011;107:317 Linear Regression with 95.00% Mean Prediction Interval Impulse oscillometry (IOS) is an effort-independent Low-frequency pulmonary function technique. as R5 and IOS spirometry as Spirometry. FEV1 correlate in Reversibility after patients with 400 μg salbutamol. asthma. 95 asthmatic and 61 healthy subjects. Correlation between percent predicted FEV1 and resistance at 5 Hz (R5) at baseline in patients with asthma
  81. 81. Comparison of bronchodilator response in patients with asthma and healthy subjects using spirometry and oscillometry. Nair Ann Allergy Asthma Immunol 2011;107:317 Linear Regression with 95.00% Mean Prediction Interval Correlation between percent predicted Correlation of the bronchodilator response FEV1 and and R5 post bronchodilator in measured as a percentage of predicted change patients with asthma in FEV1 and R5 in patients with asthma.
  82. 82. Relationship between bronchial hyperreactivity and bronchodilation in patients with allergic rhinitis Ciprandi Ann Allergy Asthma Immunol 2011;106:460BackgroundAllergic rhinitis may be considered a risk factor for the onset ofasthma. Recently, it has been reported that forced expiratoryflow between 25% and 75% of vital capacity (FEF25%−75%) maypredict a positive response to bronchodilation test in asthmaticchildren. Moreover, bronchial hyperreactivity (BHR) is frequentlydetected in AR patients.ObjectiveTo evaluate the possible relationship between the response tobronchodilation test and methacholine challenge, also consideringthe FEF25%−75% values in a large group of patients with persistentallergic rhinitis.
  83. 83. Relationship between bronchial hyperreactivity and bronchodilation in patients with allergic rhinitis Ciprandi Ann Allergy Asthma Immunol 2011;106:460 % AHR patients with ”positive” results for 365 consecutive bronchodilation test AR patients. 70 – 60 – Spirometry, methach oline, bronchial 50 – 66% challenge, and 40 – bronchodilation (+ if 30 – FEV1 > 12% after 400 20 – mcg salbutamol). 10 – 00
  84. 84. Relationship between bronchial hyperreactivity and bronchodilation in patients with allergic rhinitis Ciprandi Ann Allergy Asthma Immunol 2011;106:460 % AHR patients with severe BHR 365 consecutive AR patients. 25 – (PC20 < 1mg/mL) 20 – Spirometry, methach oline, bronchial 15 – 20.8% challenge, and 10 – bronchodilation (+ if FEV1 > 12% after 400 05 – mcg salbutamol). 00
  85. 85. Relationship between bronchial hyperreactivity and bronchodilation in patients with allergic rhinitis Ciprandi Ann Allergy Asthma Immunol 2011;106:460 Boxplot for duration of rhinitis grouped by grade of severity of BHR 365 consecutive AR patients. Spirometry, methach oline, bronchial challenge, and bronchodilation (+ if FEV1 > 12% after 400 mcg salbutamol).
  86. 86. Validating childhood symptoms with physician-diagnosed allergic rhinitis Kim, Ann Allergy Asthma Immunol 2012;108:231Background: Multiple population-based andhigh-risk cohort studies use parental questionnaireresponses to define allergic rhinitis (AR) in children.Individual questionnaire items have not been validatedby comparison with physician-diagnosed AR (PDAR).Objective: To identify routine clinical questions thatbest agree with a physician diagnosis of AR and can beused for early case identification.
  87. 87. Validating childhood symptoms with physician-diagnosed allergic rhinitis Kim, Ann Allergy Asthma Immunol 2012;108:231 Longitudinal birth cohort study. 531 children at ages 1 through 4 and 7. Questionnaires, physical examinations, skin prick tests (SPT). Rhinitis- specific Rhinitis specific questionnaire questionnaire items: 3 stem questions and 4 sub-questions.
  88. 88. Validating childhood symptoms with physician-diagnosed allergic rhinitis Kim, Ann Allergy Asthma Immunol 2012;108:231Percent agreement, sensitivity and specificity ofindividual questionnaire items compared withphysician-diagnosed allergic rhinitis (PDAR)
  89. 89. Validating childhood symptoms with physician-diagnosed allergic rhinitis Kim, Ann Allergy Asthma Immunol 2012;108:231Percent agreement, sensitivity and specificity ofindividual questionnaire items compared withphysician-diagnosed allergic rhinitis (PDAR)
  90. 90. Validating childhood symptoms with physician-diagnosed allergic rhinitis Kim, Ann Allergy Asthma Immunol 2012;108:231Percent agreement, sensitivity and specificity ofindividual questionnaire items compared withphysician-diagnosed allergic rhinitis (PDAR) Responses to hayfever and ocular symptoms had better specificity and percent agreement with PDAR than the ISAAC-validated questionnaire item. Combining 2 rhinitis questions sharply increases specificity and may improve diagnostic accuracy of clinical questions.
  91. 91. Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan Ohta, Allergy 2011;66:1287 % of patients with rhinitis 80– 70– 1910 physician. 60– 68.5% 66.2% 29 518 asthmatics. 50– 40– Questionnaires on rhinitis and asthma based on ARIA 30– (Allergic Rhinitis and its 20– Impact on Asthma) and 10– Global Initiative for Asthma (GINA); 0 Self-administered Patients with questionnaires physicians- administered
  92. 92. Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan Ohta, Allergy 2011;66:1287 % of patients with uncontrolled asthma as defined by GINA 70– 1910 physician. 60– 50– 29 518 asthmatics. 40– Questionnaires on rhinitis 30– P<0.05 and asthma based on ARIA (Allergic Rhinitis and its 20– 25.4% Impact on Asthma) and 10– 18% Global Initiative for Asthma (GINA); 0 YES NO Physician‟s diagnosis of rhinitis
  93. 93. Bronchodilation test in patients with allergic rhinitis Ciprandi, Allergy 2011;66:694 % patients with impaired FEF25-75 values (≤ 65% of predicted) 30 – 1469 consecutive patients suffering 20 – from persistent AR. 10 – 18% Spirometry and bronchodilation test in all patients. 0
  94. 94. Bronchodilation test in patients with allergic rhinitis Ciprandi, Allergy 2011;66:694 % patients with FEV1 ≥ 12% post salbutamol 80 – 70 – 63% 1469 consecutive 60 – patients suffering 50 – from persistent 40 – AR. 30 – Spirometry and 20 – bronchodilation 10 – test in all patients. 0
  95. 95. Bronchodilation test in patients with allergic rhinitis Ciprandi, Allergy 2011;66:694 % patients with FEV1 ≥ 12% post salbutamol 80 – 70 – 63% 1469 consecutive 60 – patients suffering 50 – from persistent 40 – AR. 30 – Spirometry and 20 – at risk of bronchodilation asthma 10 – test in all patients. development 0
  96. 96. Bronchodilation test in patients with allergic rhinitis Ciprandi, Allergy 2011;66:694 OR for reversibility 20 – 1469 consecutive patients suffering from persistent AR. 10 – 11.3 Spirometry and bronchodilation test in all patients. 0 Impaired FEF25-75 values and longer rhinitis duration
  97. 97. Effect of an intranasal corticosteroid on exercise induced bronchoconstriction in asthmatic children Kersten Pediatr Pulmonol 2012;47:27 Subjects aged 12–17 years, with mild-to- moderate asthma, intermittent allergic rhinitis and ≥10% fall in FEV1 at a screening exercise challenge. 22 ± 3 days treatment with Exercise induced fall in FEV1 (%) before and intranasal fluticasone after treatment with placebo or fluticasone furoate or placebo. furoate. Data expressed as individual fall in FEV1 and mean fall in FEV1.
  98. 98. Effect of an intranasal corticosteroid on exercise induced bronchoconstriction in asthmatic children Kersten Pediatr Pulmonol 2012;47:27 Subjects aged 12–17 years, with mild-to- The activity limitation moderate domain score improved asthma, intermittent significantly within the allergic rhinitis and ≥10% fluticasone furoate fall in FEV1 at a screening group (P = 0.03). exercise challenge. 22 ± 3 days treatment with Exercise induced fall in FEV1 (%) before and intranasal fluticasone after treatment with placebo or fluticasone furoate or placebo. furoate. Data expressed as individual fall in FEV1 and mean fall in FEV1.
  99. 99. Effect of an intranasal corticosteroid on exercise induced bronchoconstriction in asthmatic children Kersten Pediatr Pulmonol 2012;47:27 Subjects aged 12–17 years, Treatment of allergic with mild-to-moderate rhinitis in asthmatic asthma, intermittent allergic rhinitiswith ≥10% children and an intranasal fall in FEV1 at a screening corticosteroid exercise challenge. reduces EIB and 22 ± 3tends treatment with days to improve quality of life. intranasal fluticasone Exercise induced fall in FEV1 (%) before and furoate or placebo. after treatment with placebo or fluticasone furoate. Data expressed as individual fall in FEV1 and mean fall in FEV1.
  100. 100. Effect of an intranasal corticosteroid on exerciseinduced bronchoconstriction in asthmatic children Kersten Pediatr Pulmonol 2012;47:27 Mean fall in FEV1 at each time point after exercise Before and after treatment Before and after treatment with placebo with fluticasone furoate
  101. 101. •Rhinitis treatmentgeneral considerations
  102. 102. Chronic rhinosinusitis: epidemiology and medical management Hamilos JACI 2011;128:693 • Chronic rhinosinusitis (CRS) affects 12.5% of the US population.• Some association has been found between CRS prevalence and air pollution, active cigarette smoking, secondhand smokeexposure, perennial allergic rhinitis, and gastroesophageal reflux. • The majority of pediatric and adult patients with CRS are immune competent.
  103. 103. Chronic rhinosinusitis: epidemiology and medical management Hamilos JACI 2011;128:693 Current consensus definitions subclassify CRS into: 1. CRS without nasal polyposis (CRSsNP), 2. CRS with nasal polyposis (CRSwNP), 3. allergic fungal rhinosinusitis (AFRS).
  104. 104. Chronic rhinosinusitis: epidemiology and medical management Hamilos JACI 2011;128:693 • Evaluation and medical management of CRS has been the subject of several recent consensus reports.• The highest level of evidence for treatment for CRSsNP exists for saline lavage, intranasal steroids, and long-term macrolide antibiotics.• The highest level of evidence for treatment of CRSwNP exists for intranasal steroids, systemic glucocorticoids, and topical steroid irrigations. • Sinus surgery followed by use of systemic steroids is recommended for AFRS.
  105. 105. A new instrument for the assessment of patient-defined benefit in the treatment of allergic rhinitis Franzke, Allergy 2011;66:665 Mean, standard deviation (SD) and percentage of afflicted patients and needs in allergic rhinitis
  106. 106. A new instrument for the assessment of patient-defined benefit in the treatment of allergic rhinitis Franzke, Allergy 2011;66:665 Mean, standard deviation (SD) and percentage of afflicted patients and needs in allergic rhinitis Needs are scaled from 0 “not important at all” to 4 “very important”
  107. 107. •Rhinitis treatment anti-histamines
  108. 108. Petasol butenoate complex (Ze 339) relieves allergic rhinitis–induced nasal obstruction more effectively than desloratadine. Dumitru JACI 2011;127:1515 Ze 339 is a carbon dioxide extract derived from the leaves of a special variety (Petzell) of Petasites hybridus registered at the European Community Plant Variety Office. In vitro studies show that Ze 339 blocks degranulation in activated immune cell populations and also inhibits leukotriene biosynthesis. 18 subjects with allergic rhinitis to grass pollen received Ze 339, desloratadine, and placebo for 5 days before nasal allergen challenge with grass pollen extract.
  109. 109. Petasol butenoate complex (Ze 339) relieves allergic rhinitis–induced nasal obstruction more effectively than desloratadine. Dumitru JACI 2011;127:1515 Ze 339 is a carbon dioxide extract derived from the leaves of a special variety (Petzell) of Petasites hybridus registered at the European Community Plant Nasal airflow Variety Office. improvement: In vitro studies show that Ze 339 Ze 339, 2.46 hours; blocks degranulation in activated immune cell populations and also desloratadine, 3.94 inhibits leukotriene biosynthesis. hours allergic rhinitis 18 subjects with [medians] to grass pollen received Ze 339, desloratadine, and placebo for 5 days before nasal allergen challenge with grass pollen extract.
  110. 110. Petasol butenoate complex (Ze 339) relieves allergic rhinitis–induced nasal obstruction more effectively than desloratadine. Dumitru JACI 2011;127:1515 Recovery of nasal obstruction Time to RTB value of the symptom of nasal Time to return to 90% of basal flow obstruction (means ± SEMs assessed by means (means ± SEMs assessed by means of of VAS: Ze 339, 3.2 ± 1.3 hours; placebo, rhinomanometry: Ze 339, 5.4 ± 1.6 hours; 8.3 ± 2.4 hours; desloratadine, 4.5 ± 1.2 hoursplacebo, 9.1 ± 2.3 hours; desloratadine, 10.7 ± 2.5 hours) RTB = return to baseline
  111. 111. Petasol butenoate complex (Ze 339) relieves allergic rhinitis–induced nasal obstruction more effectively than desloratadine. Dumitru JACI 2011;127:1515 Concentrations in picograms per milliliter per milligram of nasal secretion of IL-8 (A) and LTB4(B) in nasal secretions.
  112. 112. Mometasone furoate nasal spray increases the number of minimal-symptom days in patients with acuterhinosinusitis Meltzer, Ann Allergy Asthma Immunol 2012;108:275 Background: Acute rhinosinusitis (ARS) is triggered by viral or, uncommonly, bacterial infection, causing inflammatory symptoms for 12 weeks. Objective: To investigate effects of mometasone furoate nasal spray (MFNS) vs amoxicillin and placebo on minimal-symptom days.
  113. 113. Mometasone furoate nasal spray increases the number of minimal-symptom days in patients with acuterhinosinusitis Meltzer, Ann Allergy Asthma Immunol 2012;108:275 Double-blind, parallel- group, placebo- and active- % Minimal symptom days controlled 15-day study. 70 – P<0.004 Patients 12 years of age or older 60 – to MFNS 200 µg 2/daily, MFNS 62.69% 200 µg 1/daily, amoxicillin 500 50 – 50.33% 54.35% mg 3/daily, or placebo. 40 – 30 – Major symptom score (MSS; 20 – combined rhinorrhea, postnasal P<0.001 10 – drip, congestion, sinus 00 – headache, facial pain) of≥5 and ≤12 (maximum: 15) for 7 to 28 MFNS Placebo Amoxicillin 2/daily days.
  114. 114. Mometasone furoate nasal spray increases the number of minimal-symptom days in patients with acuterhinosinusitis Meltzer, Ann Allergy Asthma Immunol 2012;108:275 Double-blind, parallel-group, placebo- and active- µg MFNS 200 % Minimal symptom days 2/daily significantly controlled 15-day study. P<0.004 Patients increased or older 70 – 12 years of age 60 – minimal-symptom to MFNS 200 µg 2/daily, MFNS 62.69% 50 – 50.33% 54.35% days vs amoxicillin 200 µg 1/daily, amoxicillin 500 40 – mg 3/daily, or placebo. or placebo 30 – in patients Major symptom score (MSS; 20 – combined rhinorrhea, postnasal P<0.001 with ARS. drip, congestion, sinus headache, 10 – 00 – facial pain) of≥5 and ≤12 (maximum: 15) for 7 to 28 days. MFNS Placebo Amoxicillin 2/daily
  115. 115. Mometasone furoate nasal spray increases the number of minimal-symptom days in patients with acuterhinosinusitis Meltzer, Ann Allergy Asthma Immunol 2012;108:275 Results of this Double-blind, parallel-group, placebo- intranasal and active- % Minimal symptom days controlled 15-day study. corticosteroids (INS) 70 – P<0.004 Patients 12 years of age or it therapy indicate older 60 – to MFNS 200 µg 2/daily, MFNS 62.69% can improve 500 50 – 54.35% 200 µg 1/daily, amoxicillin 50.33% outcomes and mg 3/daily, or placebo. 40 – potentially reduce 30 – Major symptom score (MSS; inappropriate combined rhinorrhea, postnasal 20 – P<0.001 10 – antibiotic use. drip, congestion, sinus headache, 00 – facial pain) of≥5 and ≤12 (maximum: 15) for 7 to 28 days. MFNS Placebo Amoxicillin 2/daily
  116. 116. Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis Bielory, Allergy 2011;66:686  3132 patients.  A meta-analysis of 10 randomized, placebo-controlled.  Efficacy of MFNS 200 mcg daily in relieving ocular allergy symptoms, including itching/burning, redness, and tearing/watering in both with nasal symptoms of seasonal (SAR) and nasal symptoms of perennial (PAR).
  117. 117. Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis Bielory, Allergy 2011;66:686 Improvement in tearing, itching, and redness in patients with SAR trated with MFNS for 2 weeks
  118. 118. Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis Bielory, Allergy 2011;66:686 Improvement in tearing, itching, and redness in patients with PAR trated with MFNS for 30 days
  119. 119. Impact of mometasone furoate nasal spray on individual ocular symptoms of allergic rhinitis: a meta-analysis Bielory, Allergy 2011;66:686 Improvement in tearing, itching, and redness in patients with PAR trated with MFNS for 30 daysIn both SAR and PAR all individual ocular symptomswere reduced in patientstreated with MFNS.
  120. 120. Ocular symptoms in nonspecific conjunctival hyperreactivity Mourão Ann Allergy Asthma Immunol 2011;107:29 Background Ocular symptoms can be triggered by nonspecific environmental factors, characterizing conjunctival hyperreactivity (CHR). Objective To examine CHR in subjects with ocular symptoms by means of a hyperosmolar conjunctival provocation test (HCPT).
  121. 121. Ocular symptoms in nonspecific conjunctival hyperreactivity Mourão Ann Allergy Asthma Immunol 2011;107:29 Digital images of positive HCPT. 63 subjects with ocular complaints (A) Technicians analysis: number (itching, redness, or tearing) of red dots, 2521; number of blue dots, 8717. considered allergic if tests were (B) Technicians analysis: number positive to at least 1 allergen. of red dots, 2521; number of blue dots, 8717. Hyperosmolar Conjunctival Provocation Test (HCPT) with serial A diluted glucose concentrations was positive if it produced conjunctival hyperemia up to a 50% solution. Digital images were analyzed by B 2 observers who marked redness in the challenged eyes in red (GIMP 2.6.5 software).
  122. 122. Ocular symptoms in nonspecific conjunctival hyperreactivity Mourão Ann Allergy Asthma Immunol 2011;107:29Hyperosmolar conjunctival provocation Cumulative frequency of positive HCPTtest with serial glucose concentrations in allergic and nonallergic subjects in allergic and nonallergic subjects
  123. 123. Ocular symptoms in nonspecific conjunctival hyperreactivity Mourão Ann Allergy Asthma Immunol 2011;107:29 HCPT indentified CHR in allergic as well as inHyperosmolar conjunctival subjects. Allergic subjects exhibited non-allergic provocation Cumulative frequency of positive HCPTtest with serial glucose concentrations in allergic and nonallergic subjects more CHR than did non-allergic subjects. in allergic and nonallergic subjects
  124. 124. Allergic Conjunctivitis and Dry Eye Syndrome Hom, Ann Allergy Asthma Immunol 2012;108:1631. Allergic Conjunctivitis (AC) and Dry Eye Syndrome (DES) are 2 of the most common anterior inflammatory disorders of the eye.2. The prevalence of DES is 5%-35% of the population. Up to 40% of the general US population has reported ocular symptoms consistent with AC.3. Both conditions have a strong effect on quality of life. When measured with questionnaires reflecting quality of life, DES and AC can have the same effect on quality of life as moderate angina.
  125. 125. Allergic Conjunctivitis and Dry Eye Syndrome Hom, Ann Allergy Asthma Immunol 2012;108:163 Subjective evaluation of symptom of dryness or frequency of dryness score definitions. Self-reported - itchiness - dryness - redness. 689 patients 5-90 yrs.
  126. 126. Allergic Conjunctivitis and Dry Eye Syndrome Hom, Ann Allergy Asthma Immunol 2012;108:163 Clinically significant itch. Self-reported - itchiness - dryness - redness. 689 patients 5-90 yrs.
  127. 127. Allergic Conjunctivitis and Dry Eye Syndrome Hom, Ann Allergy Asthma Immunol 2012;108:163 Clinically significant itch. Self-reported - Clinically itchiness -significant dryness -itchiness redness. was found in 689 patients 28.2% 5-90 yrs. of patients.
  128. 128. Allergic Conjunctivitis and Dry Eye Syndrome Hom, Ann Allergy Asthma Immunol 2012;108:163 Self-reported - itchiness - dryness - redness. 689 patients 5-90 yrs.
  129. 129. Allergic Conjunctivitis and Dry Eye Syndrome Hom, Ann Allergy Asthma Immunol 2012;108:163 Itch & Redness Itch & DrynessDryness & Redness Itch, Dryness & Redness
  130. 130. Allergic Conjunctivitis and Dry Eye Syndrome Hom, Ann Allergy Asthma Immunol 2012;108:163 Itch & Redness Itch & Dryness Most patients with “itchy eyes” consistent with AC also have dry eyes and redness. Dryness & RednessThese results suggest that some symptomatic & Redness Itch, Dryness patients concomitantly have features of AC and DES.
  131. 131. Conjunctival provocation with airborne allergen in patients with atopic keratoconjunctivitis Nivenius, Clin Exp Allergy 2012;42:58Background Atopic keratoconjunctivitis (AKC)is a chronic eye disease with periods of exacerbations.Many patients experience no obvious seasonalvariation, althougha majority of patients are allergic to common airborneallergens.Objective To investigate the allergic reaction, toconjunctival provocation with airborne allergens, inpatients with AKC.
  132. 132. Conjunctival provocation with airborne allergen in patients with atopic keratoconjunctivitis Nivenius, Clin Exp Allergy 2012;42:58 11 patients with AKC and birch and/or grass pollen allergy Atopic keratoconjunctivitis patient, 5 patients with 10 min after provocation seasonal allergic conjunctivitis (SAC) with birch allergen in the right eye & 5 healthy subjects. and dilution buffer only in the left. Challenge in 1 eye with the allergen, to which the patient was reactive, & with dilution buffer in the other. Signs & symptoms from both eyes at 10 min, 8h and 48h. allergen Tear fluid for cytokine analyses at baseline and at 8h and 48h.
  133. 133. Conjunctival provocation with airborne allergen in patients with atopic keratoconjunctivitis Nivenius, Clin Exp Allergy 2012;42:58Total symptom score in the provoked eyes. Median linked by black line. Atopic Seasonal allergic Healthy
  134. 134. Conjunctival provocation with airborne allergen in patients with atopic keratoconjunctivitis Nivenius, Clin Exp Allergy 2012;42:58Total symptom score in the provoked eyes. Median linked by black line. A significant change from baseline was documented at 10 min for AKC & SAC patients, while no change was seen in healthy controls. Atopic Seasonal allergic Healthy
  135. 135. Conjunctival provocation with airborne allergen in patients with atopic keratoconjunctivitis Nivenius, Clin Exp Allergy 2012;42:58Total symptom score in the provoked eyes. Median linked by black line. In this single dose allergen provocation study, AKC patients responded with a typical IgE-mediated allergic reaction. Atopic Seasonal allergic Healthy
  136. 136. Conjunctival provocation with airborne allergen in patients with atopic keratoconjunctivitis Nivenius, Clin Exp Allergy 2012;42:58Total symptom score in the provoked eyes. Median linked by black line. An increase in cytokines at 48 h after the challenge was demonstrated and might, with further studies, give us a better understanding of the nature of inflammation in AKC. Atopic Seasonal allergic Healthy
  137. 137. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896• Vernal keratoconjunctivitis (VKC) is a severe allergic disease.• Treatment involves topical antiallergic agents, which are effective in patients with mild disease, whereas most patients with severe disease require some topical steroid therapy.• The physician’s primary objective with the patient with VKC is to prevent and minimize acute flare-ups, as well as to treat them when they do occur with the safest therapy available.
  138. 138. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896 Study design. Crossover 2 yr study. Efficacy and safety of 0.05% topical cyclosporine in patients with VKC. Ability of 0.05% cyclosporine to prevent flare-ups vs topical Ketotifen 0.025% AE; adverse event CsA; cyclosporine
  139. 139. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896 Crossover 2 yr study. Efficacy and safety of 0.05% topical cyclosporine in patients with VKC. Ability of 0.05% cyclosporine to prevent flare-ups vs topical Ketotifen 0.025%
  140. 140. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896 The number of recurrences was significantly reduced when patients were treated with Crossover 2 cyclosporine 0.05% yr study. Efficacy with safety of and respect 0.05% topical cyclosporine to 0.025% ketotifen. in patients with VKC. Ability of 0.05% cyclosporine to prevent flare-ups. The efficacy of a higher dose, 0.1%, was compared with 0.15% dexamethasone during acute relapses.
  141. 141. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896 The cyclosporine group had Crossover 2 yr study. significantly Efficacy and safety of 0.05% topical cyclosporine in patients periods free longer with VKC. of recurrences Ability of 0.05% cyclosporine to prevent the compared with flare-ups. Theketotifen higher efficacy of a group dose, 0.1%, was compared with 0.15% dexamethasone during acute relapses.
  142. 142. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896 Crossover 2 yr study. Efficacy and safety of 0.05% topical cyclosporine in patients with VKC. Ability of 0.05% cyclosporine to prevent flare-ups vs topical Ketotifen 0.025%
  143. 143. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896 Itching, photophobia, and conjunctival hyperemia scores showed Crossover 2 yr study. significant amelioration Efficacy and safety of 0.05%patients treated with in topical cyclosporine in patients with VKC. 0.05% cyclosporine eye Ability of 0.05% drops compared with those cyclosporine to prevent seen in patients treated flare-ups. The with 0.025% ketotifen efficacy of a higher dose, 0.1%,eye compared was drops. with 0.15% dexamethasone during acute relapses.
  144. 144. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double- masked, controlled 2-year study Lambiase JACI 2011;128:896 OR for recurrence 3 – p= 0.031 2.44 Crossover 2 yr study. 2 – Efficacy and safety of 0.05% topical cyclosporine in patients with VKC. 1  !

×