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Cureus May 2024A 12-year-old boy with underlying severeand poorly controlled atopic dermatitis (AD) associated with atopic conjunctivitis and rhinitis presented with a right...
A 12-year-old boy with underlying severeand poorly controlled atopic dermatitis (AD) associated with atopic conjunctivitis and rhinitis presented with a right painless blurring of vision for two weeks. On examination, his right eye visual acuity was 1/60,with grade 1 relative afferent pupillary defect (RAPD). Anterior segment examination revealed anterior uveitis with dense posterior subcapsular cataract and hazy fundus view. B-scan ultrasound suggested a shallow total retinal detachment. Intraoperatively, a large retinal dialysis was found. This paper highlights the need for a high index of suspicion of retinal dialysis in a child with underlying AD and the importance of good control of this systemic condition to prevent ocular morbidity.
PubMed: 38899264
DOI: 10.7759/cureus.60660 -
Clinical and Translational Allergy Jun 2024Rhinitis encompasses diverse forms. Each form has distinct pathophysiology and clinical manifestations and may be influenced by differential risk factors. The...
BACKGROUND
Rhinitis encompasses diverse forms. Each form has distinct pathophysiology and clinical manifestations and may be influenced by differential risk factors. The association between socioeconomic status (SES) and different forms of rhinitis remains poorly understood. Our aim was to examine SES variations in allergic rhinitis, chronic rhinitis, and chronic rhinosinusitis in adults.
METHODS
Based on a 2016 postal questionnaire survey within the West Sweden Asthma Study, we analyzed data from 36,213 subjects aged 16-75 years. The measures of SES were levels of education and occupation. Adjusted logistic regression was used to examine associations between SES and the rhinitis outcomes.
RESULTS
Attaining a secondary school and tertiary education, compared to a primary school, were associated with increased risk of allergic rhinitis (secondary OR 1.33, 95% CI 1.22-1.45; tertiary 1.54, 1.41-1.69) and chronic rhinitis (secondary 1.18, 1.08-1.29; tertiary 1.17, 1.06-1.28). The influence of occupation was consistent with respect to allergic rhinitis. For instance, compared to the lowest occupational skill level, the highest level (OR 1.24, 95% CI 1.04-1.48) and the lower high occupation levels (1.24, 1.04-1.49) were associated with an increased risk of allergic rhinitis. No significant link was found between education and chronic rhinosinusitis or between occupation levels and risk of either chronic rhinitis or chronic rhinosinusitis.
CONCLUSION
Individuals with higher education and those at higher occupational levels may be at higher risk of having different forms of rhinitis than those at lower education and occupation levels. Assessment of rhinitis burden via SES can be one strategy to develop preventive strategies.
PubMed: 38898553
DOI: 10.1002/clt2.12374 -
Annals of Allergy, Asthma & Immunology... Jun 2024The development of monoclonal antibodies that selectively target IgE and type 2 immunity has opened new possibilities in the treatment of allergies. Although they have... (Review)
Review
The development of monoclonal antibodies that selectively target IgE and type 2 immunity has opened new possibilities in the treatment of allergies. Although they have been used mainly as single therapies that have shown efficacy in the management of asthma and other T2-mediated diseases, there is a growing interest in using these monoclonal antibodies in combination with allergen immunotherapy (AIT). AIT has transformed the treatment of allergic diseases by aiming to modify the underlying immune response to allergens rather than just providing temporary symptom relief. Despite the proven efficacy and safety of AIT, unmet needs call for further research and innovation. Combination strategies involving biologics and AIT exhibit potential in improving short-term efficacy, reducing adverse events, and increasing immunological tolerance. Anti-IgE emerges as the most promising therapeutic strategy, not only enhancing AIT's safety and tolerability but also providing additional evidence of efficacy compared to AIT alone. Anti-IL-4 receptor offers a reduction in side effects and an improved immunological profile when combined with AIT, however its impact on short-term efficacy appears limited. The combination of cat dander subcutaneous immunotherapy with anti-TSLP was synergistic with enhanced efficacy and altered immune responses that persisted for one year after discontinuation compared to AIT alone. Long-term studies are needed to evaluate the sustained benefits and safety profiles of combination strategies.
PubMed: 38897405
DOI: 10.1016/j.anai.2024.06.016 -
Journal of Clinical Medicine May 2024Allergen immunotherapy (AIT) is a well-established and efficient method of causative treatment for allergic rhinitis, asthma and insect venom allergy. Traditionally, a...
Allergen immunotherapy (AIT) is a well-established and efficient method of causative treatment for allergic rhinitis, asthma and insect venom allergy. Traditionally, a recent history of malignant neoplasm is regarded as a contraindication to AIT due to concerns that AIT might stimulate tumor growth. However, there are no data confirming that the silencing of the Th2 response affects prognosis in cancer. The aim of this study was to investigate frequency of malignant tumors in patients undergoing AIT and the association between AIT and cancer-related mortality. A group of 2577 patients with insect venom allergy undergoing AIT in 10 Polish allergology centers was screened in the Polish National Cancer Registry. Data on cancer type, diagnosis time and patients' survival were collected and compared with the general population. In the study group, 86 cases of malignancies were found in 85 patients (3.3% of the group). The most common were breast (19 cases), lung (9 cases), skin (8 cases), colon and prostate cancers (5 cases each). There were 21 cases diagnosed before AIT, 38 during and 27 after completing AIT. Laplace's crude incidence rate was 159.5/100,000/year (general population rate: 260/100,000/year). During follow-up, 13 deaths related to cancer were revealed (15% of patients with cancer). Laplace's cancer mortality rate was 37.3/100,000/year (general population rate: 136.8/100,000/year). Malignancy was found in patients undergoing immunotherapy less often than in the general population. Patients with cancer diagnosed during or after AIT did not show a lower survival rate, which suggests that AIT does not affect the prognosis.
PubMed: 38892863
DOI: 10.3390/jcm13113152 -
Journal of Otolaryngology - Head & Neck... 2024To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores.
BACKGROUND
To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores.
METHODS
This prospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between November 2021 and June 2022 and included adult patients (≥14 years) with CRS. The validated Arabic or English Sinonasal Outcome Test (SNOT-22) and Patient Health Questionnaire-9 (PHQ-9) were used before treatment and 3 to 6 months after surgery and maximal medical treatment. PHQ-9 scores were compared at baseline and follow-up visits. The relationship between changes in SNOT-22 and PHQ-9 scores were assessed using Spearman's correlation and simple linear regression.
RESULTS
Overall, 38 participants with a mean ± SD age of 32.7 ± 12 years were enrolled. CRS with nasal polyps (55.26%) was the most frequently seen condition, followed by allergic fungal CRS (31.58%) and CRS without nasal polyps (13.16%). Six patients (15.7%) had PHQ-9 scores ≥10, indicating they had major depressive disorder. PHQ-9 and SNOT-22 scores improved significantly after treatment (3.7 ± 5.8 vs 6.5 ± 6.9 pretreatment, = .001; 20.7 ± 20.5 vs 45.6 ± 28.9 pretreatment, < .0001, respectively). Mean ± SD change in PHQ-9 and SNOT-22 scores was -2.7 ± 7 and -24.9 ± 29.8, respectively. SNOT-22 and PHQ-9 scores were positively correlated ( = .522, < .001). PHQ-9 score change was significantly associated with SNOT-22 score change (β = .178, 95% confidence interval 0.12-0.23, < .0001).
CONCLUSION
CRS affects the quality of life and psychological well-being of patients. Patient-centered care with maximal medical and surgical treatment help overcome its deleterious consequences.
Topics: Humans; Sinusitis; Rhinitis; Male; Female; Chronic Disease; Prospective Studies; Adult; Saudi Arabia; Depression; Middle Aged; Sino-Nasal Outcome Test; Rhinosinusitis
PubMed: 38888948
DOI: 10.1177/19160216241248668 -
Immunotherapy Jun 2024Sublingual immunotherapy (SLIT) changes history of allergic respiratory disease (ARD). However, adherence is a barrier for optimal outcomes. In the QUALI study, 859...
Sublingual immunotherapy (SLIT) changes history of allergic respiratory disease (ARD). However, adherence is a barrier for optimal outcomes. In the QUALI study, 859 patients with house-dust mite (HDM) and/or pollen induced ARD uncontrolled with symptomatic treatment and undergoing SLIT for at least 6 months or including one pre-coseason (pollen) were collected. SLIT significantly improved allergic rhinoconjunctivitis (ARC) and asthma symptom control, leading to reduced medication, meaningful health-related quality of life gain, improved nasal, ocular and bronchial symptoms and everyday life activities. Patients were highly satisfied and most of them adhered to SLIT, being forgetfulness the main non-adherence motive. SLIT is a quick effective treatment against persistent moderate-to-severe symptoms in ARC and asthma but it should been improve forgetfulness, as non-adherence reason.
PubMed: 38888502
DOI: 10.1080/1750743X.2024.2347828 -
Frontiers in Pharmacology 2024We describe the case of a 10-year-old boy with asthma (AS), accompanied by allergic rhinitis (AR), food allergy (FA), and combined attention-deficit/hyperactivity...
Omalizumab in combination with subcutaneous immunotherapy for the treatment of multiple allergies associated with attention-deficit/hyperactivity disorder: a case report and a literature review.
We describe the case of a 10-year-old boy with asthma (AS), accompanied by allergic rhinitis (AR), food allergy (FA), and combined attention-deficit/hyperactivity disorder (ADHD), who was treated at Shanghai Renji Hospital on 11 July 2020. The efficiency of the previous treatment with salmeterol/ticlosone was poor. Treatment with montelukast sodium resulted in development of neurological symptoms. Treatment with omalizumab in combination with subcutaneous immunotherapy (SCIT) was then initiated in our department based on anti-asthmatic therapy. Symptoms of asthma were completely controlled, and FA and AR symptoms improved. The treatment regimen led to a significant improvement in ADHD symptoms and the overall quality of life of the patient. The literature search was done in the PubMed database using "attention deficit/hyperactivity disorder/ADHD" and "asthma" as keywords, and we identified 47 relevant articles. In conclusion, our results show that treating asthma with omalizumab in combination with salmeterol/ticlosone and SCIT is efficient in controlling symptoms of multiple allergies and may lead to the improvement in ADHD symptoms and the overall quality of life of pediatric patients with ADHD. While current studies suggest that allergic diseases are closely related to ADHD, there is still a lack of studies or case reports of complete treatment protocols to provide clinical clues for management of the disease.
PubMed: 38887551
DOI: 10.3389/fphar.2024.1367551 -
The Journal of Asthma : Official... Jun 2024Eosinophil-derived neurotoxin (EDN) is an important biomarker of eosinophilic inflammation.
BACKGROUND
Eosinophil-derived neurotoxin (EDN) is an important biomarker of eosinophilic inflammation.
METHODS
This study evaluated Montelukast treatment response according to EDN concentration in children with perennial allergic rhinitis (PAR). Fifty-two children with PAR were recruited and took a combination of Montelukast (5mg) and Levocetirizine (5mg) "Mont/Levo Group" or only Montelukast (5mg) "Mont Group" for 4 weeks. All caregivers were instructed to record rhinitis symptoms for 4 weeks. EDN was measured before and after treatment.
RESULTS
Daytime nasal symptom scores (DNSS) significantly decreased in both the Mont/Levo ( = 0.0001; = 20) and Mont Group ( < 0.0001; = 20), but there were no significant differences between the two groups. EDN concentration also significantly decreased after treatment in both groups ( < 0.0001 and < 0.001, respectively). For secondary analysis, children with a high initial EDN concentration (EDN ≥ 53 ng/mL) were placed in the "High EDN Group", while those with a lower initial EDN concentration (EDN < 53 ng/mL) were put in the "Low EDN Group". Both groups experienced significant reductions in DNSS after either treatment regimen ( < 0.0001 and = 0.0027, respectively) but the High EDN Group had greater reductions. EDN concentrations in the High EDN Group decreased significantly from either treatment ( < 0.0001).
CONCLUSION
We found that children with AR and a high serum EDN concentration may respond well to Montelukast treatment. A therapeutic strategy using EDN concentrations in patients with AR to evaluate therapeutic response may help improve quality of care.
PubMed: 38884630
DOI: 10.1080/02770903.2024.2370002 -
International Journal of General... 2024Allergic rhinitis is a prevalent allergic diseases and has a profound impact on physical well-being. In recent years, more and more people have changed to allergic... (Review)
Review
Allergic rhinitis is a prevalent allergic diseases and has a profound impact on physical well-being. In recent years, more and more people have changed to allergic diseases, such as allergic rhinitis, allergic asthma, allergic dermatitis and so on. In the incidence of allergic rhinitis, covering all ages. The common clinical treatment of allergic rhinitis are drugs and immunotherapy, but these therapies have certain limitations. Therefore, an effective and economical treatment for AR is urgently needed. Acupuncture are widely used in the clinical treatment of various diseases, but the effect of acupuncture in the treatment of allergic rhinitis (AR) is significant, and the mechanism of acupuncture in the treatment of AR is also a hot spot. Acupuncture is one of the traditional treatment methods of traditional Chinese medicine, which achieves therapeutic effect by pressing a needle or other means at a specific location on the skin to produce a special sensation. Among them, acupuncture, as a popular treatment method, has attracted more and more attention. In this review, we provide an overview of the current understanding of acupuncture and AR, as well as current studies investigating the efficacy and safety of acupuncture for AR.
PubMed: 38883703
DOI: 10.2147/IJGM.S470949 -
Indian Journal of Otolaryngology and... Jun 2024The cause of nasal obstruction in most of the patients is either nasal septal deviation or turbinate hypertrophy owing to vasomotor or perennial allergic rhinitis. Most...
The cause of nasal obstruction in most of the patients is either nasal septal deviation or turbinate hypertrophy owing to vasomotor or perennial allergic rhinitis. Most cases of hypertrophic turbinate are usually mild and respond to antihistamine therapy, local decongestions, or allergy desensitization; however, surgery is required in some cases. In our present study, three surgical methods were used for inferior turbinoplasty i.e. Sub-mucous Diathermy, Coblation and Micro-debrider and patients were divided randomly in these groups. The efficacy and outcomes of these methods was compared on the basis of subjective and objective relief of symptoms and their safety, recurrence and post-operative morbidity. Out of 45 patients, highest number of patients belonged to 20-40 years of age with the mean age of 28.7 years and male female ration 0.78:1. All the patients were evaluated on the basis of preoperative Endoscopic grading of inferior turbinate and SNOT22 symptom scores (Sino Nasal Outcome Test 22), intra-operative timing and bleeding and post-operative pain, crusting, SNOT22 scores (Sino Nasal Outcome Test 22) and Endoscopic grading improvement in inferior turbinate. On comparing all the above methods, we found that Coblation and Micro- debrider were more or less equally effective and better than Sub-mucous diathermy for inferior turbinoplasty. Submucous diathermy has least benefits, still most commonly used method because of its simplicity, conventionality and least cost factor while other two methods need capital investment and higher learning curve of the surgeon.
PubMed: 38883529
DOI: 10.1007/s12070-024-04501-5