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Indian Journal of Otolaryngology and... Jun 2024To detect proportion and surgical outcome of adult patients with allergic rhinitis non-responsive to medical treatment. To identify clinical candidacy for submucous...
To detect proportion and surgical outcome of adult patients with allergic rhinitis non-responsive to medical treatment. To identify clinical candidacy for submucous turbinoplasty of inferior turbinate resection or soft tissue reduction. A prospective descriptive study of adults with clinical allergic rhinitis was done. Non-responders to medical therapy were identified and outcome of surgical intervention analyzed. There were 393 patients. Eighty-one patients (21%) were refractory to medical therapy. Presenting symptoms were sneezing with watery rhinorrhea among 72% and nasal obstruction in 28% patients All patients in the latter group had hypertrophied inferior turbinates with associated deviated nasal septum in 36.6%. Bony and mucosal inferior turbinate hypertrophy among 73.3% and mucosal hypertrophy among 26.7% were identified by a negative or positive response to on-table local vasoconstrictor application respectively. Submucosal inferior turbinoplasty with turbinate resection in the former and soft tissue reduction in the latter group were done, along with septoplasty among 36%. All patients revealed significant reduction in postoperative SNOT score. Crusting was more during early postoperative period among those with soft tissue reduction and simultaneous septoplasty, necessitating meticulous endoscopic follow-up. Adult allergic rhinitis presenting predominantly with nasal obstruction ('stuffy nose'), could be non-responsive to medical therapy unlike sneezy, runny nose, especially when obstructive symptoms are more than two years among older patients, suggesting presence of hypertrophied inferior turbinates. On-table response to vasoconstrictors is a reliable clinical indicator for submucous inferior turbinoplasty: negative and positive response suggesting turbinate resection among majority and soft tissue reduction among minority respectively.
PubMed: 38883460
DOI: 10.1007/s12070-023-04404-x -
ClinicoEconomics and Outcomes Research... 2024In Sweden, allergy immunotherapy (AIT) is available as either subcutaneous immunotherapy (SCIT) injections or sublingual immunotherapy (SLIT) tablets and is used to...
AIM
In Sweden, allergy immunotherapy (AIT) is available as either subcutaneous immunotherapy (SCIT) injections or sublingual immunotherapy (SLIT) tablets and is used to treat moderate-severe allergic rhinitis (AR). This study sought to determine direct and indirect annual costs stemming from treatment-related travel, appointments, waiting times and medication costs, before exploring likely CO emission-related cost-savings for 20,330 patients receiving SCIT or SLIT-tablets in Sweden.
METHODS
A model was developed in Python to capture each category of costs in the target patient population. Absenteeism costs arising from treatment-related travel were determined by obtaining average hourly pay data from Swedish Government sources. Absenteeism costs were also calculated for 30-minute post-dose observation times, which occurred during one clinical appointment for SLIT patients, and all clinical appointments for SCIT patients. Clinical appointment costs were obtained from healthcare price lists for Sweden. Medication costs were retrieved from the Pharmaceutical Specialities in Sweden (Fass) website, and treatment doses required for SCIT and SLIT-tablets were determined based on product labels and previously-calculated dosage regimes. High-cost protection and reimbursement scheme payment caps were applied when determining patient appointment and medication costs, respectively, and when identifying financial burdens for individual payers.
RESULTS
Mean total annual costs for SCIT were Swedish Krona (SEK) 604.1 million (m), with clinical appointments contributing the largest share of these costs (52.7%), followed by medication (34.4%), travel-related absenteeism (8.9%), waiting time-related absenteeism (2.7%) and private transportation (1.3%). Mean total annual costs for SLIT-tablets were SEK 336.2m. Medication contributed the most to these costs (72.3%), followed by clinical appointments (22.7%), travel-related absenteeism (3.8%), waiting time-related absenteeism (0.6%) and private transportation (0.6%).
CONCLUSION
For patients with moderate-severe AR receiving AIT in Sweden, SLIT-tablets displayed large potential cost savings to patients, the healthcare system, and the government, whilst possessing reduced societal costs of carbon emissions relative to SCIT.
PubMed: 38882235
DOI: 10.2147/CEOR.S462698 -
International Journal of Pediatric... May 2024Otitis media with effusion (OME) is a prevalent and costly disease, especially in children. This article analyzed the expression patterns and clinical significance of T...
OBJECTIVE
Otitis media with effusion (OME) is a prevalent and costly disease, especially in children. This article analyzed the expression patterns and clinical significance of T helper-1 (Th1)/Th2 cytokines in the peripheral blood of children with OME and allergic rhinitis (AR).
METHODS
Subjects were assigned to the OME + AR group and the Control group (children with OME), with their clinical baseline data documented. The correlations between Th1/Th2 cytokines and between the total nasal symptom score (TNSS) and Th1/Th2 cytokines were analyzed. The risk factors and the predictive value of Th1/Th2 cytokines for OME + AR were analyzed using logistics multivariate regression analysis and receiver operating characteristic curve.
RESULTS
Significant differences were observed in tympanic pressure/speech frequency/air conduction valve/TNSS score/immunoglobulin E (IgE) level between both groups. The OME + AR children exhibited evidently elevated interleukin-2 (IL-2)/tumor necrosis factor-α (TNF-α)/IL-4/IL-10/IL-6 levels and no significant difference in interferon-γ (IFN-γ) level. Th1/Th2 cytokines were remarkably positively-correlated with the TNSS score. IL-2/TNF-α/IL-4/IL-6 were risk factors for OME with AR. The area under the curves (AUCs) of IL-6/IL-2/IL-4/TNF-α levels in predicting the occurrence of OME + AR were 0.805/0.806/0.775/0.781, with sensitivities of 75.76 %/89.39 %/72.21 %/72.73 % and specificities of 74.29 %/61.34 %/72.86 %/70.00 %, and the cut-off values were 239.600/20.300/29.880/34.800 (pg/mL). The AUC of their combination in predicting OME + AR was 0.955 (93.94 % sensitivity, 85.71 % specificity).
CONCLUSION
Th1/Th2 cytokine levels were imbalanced and obviously positively-correlated with the TNSS score in OME + AR children. IL-2, TNF-α, IL-4, and IL-6 levels had auxiliary predictive value in the occurrence of OME + AR.
PubMed: 38879907
DOI: 10.1016/j.ijporl.2024.111996 -
International Journal of Pediatric... Jun 2024The purpose of this study was to investigate the prevalence of otitis media and other otolaryngologic disorders in children with Obstructive Sleep Apnea (OSA) compared...
INTRODUCTION
The purpose of this study was to investigate the prevalence of otitis media and other otolaryngologic disorders in children with Obstructive Sleep Apnea (OSA) compared to those without OSA in a large cohort.
METHODS
A retrospective cohort study was carried within the US Collaborative Network within TriNetX. The OSA group was defined by ICD-10 code G47.33 and non-OSA group excluded patients with OSA. Both groups were required to have a CPT code for an outpatient visit to act as a control: 99202-99215. Propensity score matching for age, sex, and race was performed. Prevalence of otitis media (ICD-10H65, H66), chronic otitis media (ICD-10H66.1, H66.2, H66.3, H65.2, H65.3, and H65.4), tympanostomy (CPT 69433, 69436), adenoidectomy (CPT 42830, 42831), tonsillectomy (CPT 42825, 42826), adenotonsillectomy (CPT 42820, 42821), and allergic rhinitis (ICD-10 J30.9) were compared in this cohort.
RESULTS
Propensity score matching yielded 165,665 (M = 95949, F = 69901) patients with a mean age of 10.7 (SD = 4.07) for each cohort. Children with OSA were 1.27x and 3.86x more likely to be diagnosed with otitis media and chronic otitis media, respectively (P<.0001). They were 3.81x more likely to undergo a tympanostomy (P<.0001). Children with OSA were 4.1x, 18.2x, and 24.7x more likely undergo an adenoidectomy, tonsillectomy, and adenotonsillectomy, respectively (P<.0001). Children with OSA were also 2.03x as likely to have a diagnosis of allergic rhinitis (P<.0001).
CONCLUSION
Children with OSA experience otitis media and related surgical intervention more than children without OSA. Since allergic rhinitis and adenoid hypertrophy are contributors to both OSA and AOM, their increased prevalence in children with OSA may explain their increased frequency of AOM.
PubMed: 38878449
DOI: 10.1016/j.ijporl.2024.112014 -
Archives of Dermatological Research Jun 2024
Topics: Humans; Dermatitis, Atopic; Keloid; Female; Male; Comorbidity; Adult; United States; Databases, Factual; Middle Aged; Adolescent; Young Adult; Risk Factors; Child
PubMed: 38878188
DOI: 10.1007/s00403-024-03145-3 -
Journal of the American Academy of... Jun 2024Dupilumab effectively treats atopic dermatitis (AD); however, its role in halting the atopic march remains uncertain.
BACKGROUND
Dupilumab effectively treats atopic dermatitis (AD); however, its role in halting the atopic march remains uncertain.
OBJECTIVE
To investigate dupilumab's effect on atopic march in pediatric AD patients versus conventional immunomodulators.
METHODS
This retrospective cohort study utilized data from the TriNetX US Collaborative Network (2011-2024). Pediatric AD patients (≤18 years) were categorized into DUPI-cohort (newly prescribed dupilumab) or CONV-cohort (prescribed conventional immunomodulators without dupilumab). After 1:1 propensity-score matching, we analyzed atopic march progression, defined by the incident asthma or allergic rhinitis (AR). Cumulative incidence was plotted using Kaplan-Meier, with risk assessment via Cox regression.
RESULTS
The study included 2192 patients in each cohort. The 3-year cumulative incidence of atopic march progression was lower in the DUPI-cohort than the CONV-cohort (20.09% vs 27.22%; P < .001). The DUPI-cohort demonstrated significant risk reduction in atopic march progression (hazard ratio [HR] 0.68, 95% CI 0.55-0.83), individual asthma (HR 0.60, 0.45-0.81), and individual AR (HR 0.69, 0.54-0.88). Younger patients on dupilumab exhibited a greater risk reduction for atopic march progression and individual asthma, contrasting with the opposite age-related pattern for individual AR.
LIMITATIONS
Observational study.
CONCLUSION
Among pediatric AD patients, dupilumab was associated with reduced risk of atopic march progression compared with conventional therapies.
PubMed: 38878041
DOI: 10.1016/j.jaad.2024.05.029 -
Briefings in Bioinformatics May 2024One of the prevalent chronic inflammatory disorders of the nasal mucosa, allergic rhinitis (AR) has become more widespread in recent years. Acupuncture pterygopalatine...
Mechanistic study of acupuncture on the pterygopalatine ganglion to improve allergic rhinitis: analysis of multi-target effects based on bioinformatics/network topology strategie.
One of the prevalent chronic inflammatory disorders of the nasal mucosa, allergic rhinitis (AR) has become more widespread in recent years. Acupuncture pterygopalatine ganglion (aPPG) is an emerging alternative therapy that is used to treat AR, but the molecular mechanisms underlying its anti-inflammatory effects are unclear. This work methodically demonstrated the multi-target mechanisms of aPPG in treating AR based on bioinformatics/topology using techniques including text mining, bioinformatics, and network topology, among others. A total of 16 active biomarkers and 108 protein targets related to aPPG treatment of AR were obtained. A total of 345 Gene Ontology terms related to aPPG of AR were identified, and 135 pathways were screened based on Kyoto Encyclopedia of Genes and Genomes analysis. Our study revealed for the first time the multi-targeted mechanism of action of aPPG in the treatment of AR. In animal experiments, aPPG ameliorated rhinitis symptoms in OVA-induced AR rats; decreased serum immunoglobulin E, OVA-sIgE, and substance P levels; elevated serum neuropeptide Y levels; and modulated serum Th1/Th2/Treg/Th17 cytokine expression by a mechanism that may be related to the inhibition of activation of the TLR4/NF-κB/NLRP3 signaling pathway. In vivo animal experiments once again validated the results of the bioinformatics analysis. This study revealed a possible multi-target mechanism of action between aPPG and AR, provided new insights into the potential pathogenesis of AR, and proved that aPPG was a promising complementary alternative therapy for the treatment of AR.
Topics: Rhinitis, Allergic; Animals; Computational Biology; Acupuncture Therapy; Rats; Ganglia, Parasympathetic; Male; Humans; Protein Interaction Maps; Cytokines
PubMed: 38877888
DOI: 10.1093/bib/bbae287 -
Asian Pacific Journal of Allergy and... Jun 2024COA number for ethical approval should be included in Methods part as follows: Methods Patients The study was approved by the Institutional Review Board, Siriraj...
Erratum: Request to Include COA Number Beta-Expansin of Bermuda, Johnson, and Para grass pollens, is a major cross-reactive allergen for allergic rhinitis patients in subtropical climate.
COA number for ethical approval should be included in Methods part as follows: Methods Patients The study was approved by the Institutional Review Board, Siriraj Hospital (SiEc 100/2012, COA no. Si 315/2012). Forty patients with history of AR were recruited. All patients signed an informed consent before SPT. Thirty-one of them were excluded due to mono -sensitization to grass allergen. Nine patients, aged 9-47 years old (mean 26.3 ± 4 years), were included in this study based on positive SPT (mean wheal diameter, MWD ≥ 3 mm) to protein extract from at least 2 of 3 BGP, JGP, and PGP. The SPT extracts were prepared as described previously.4 Determination of level of serum sIgE against extract of BGP and JGP was carried out by ImmunoCAP (Phadia, Uppsala, Sweden). However, there is no available test for PGP.
PubMed: 38877878
DOI: No ID Found -
Asian Pacific Journal of Allergy and... Jun 2024Allergic rhinitis (AR) represents a significant global health concern that can give rise to numerous diseases and result in labor productivity. T regulatory (Treg) cells...
BACKGROUND
Allergic rhinitis (AR) represents a significant global health concern that can give rise to numerous diseases and result in labor productivity. T regulatory (Treg) cells are pivotal players in the pathogenesis of AR, and their deficiencies are closely related to Prostaglandin E2 (PGE2). However, the downstream mechanisms of this relationship remain poorly understood.
OBJECTIVE
This study aims to investigate the inhibitory mechanisms through which PGE2 impacts the differentiation of Treg cells.
METHODS
We compared the differentiation of Treg cells from naïve CD4+ T cells of AR patients and healthy controls, with or without the presence of PGE2 by flow cytometry. Intracellular cAMP concentration, mRNA and protein levels of cyclic-AMP dependent protein kinase A (PKA), as well as their downstream target, Peroxisome Proliferator-Activated Receptor-γ (PPAR-γ) were examined in Treg cells from AR and healthy donors. AR mouse model was established by pollen administration.
RESULTS
PGE2 suppressed the differentiation of Treg cells from human naïve CD4+ T cells through the EP4 receptor. Furthermore, in AR patients and AR mouse, the expression of EP4 receptor were observed enhanced. The PGE2-EP4 signal was carried out by activating cAMP-PKA signaling pathway. Subsequently, phospholated PKA would suppress PPAR-γ expression. Treatment of Pioglitazone, a PPAR-γ agonist, was demonstrated to rescue the differentiation of Treg and help alleviate inflammation in the AR mouse model.
CONCLUSION
In AR disease, the PGE2-EP4 signaling exerts an inhibitory effect on Treg differentiation by influencing the cAMP-PKA pathway and its downstream target PPAR-γ.
PubMed: 38877848
DOI: 10.12932/AP-210923-1695 -
Asian Pacific Journal of Allergy and... Jun 2024Serum allergen-specific IgE (sIgE) detection is an important tool in the diagnosis of allergic diseases. However, the absence of international standards for sIgE...
BACKGROUND
Serum allergen-specific IgE (sIgE) detection is an important tool in the diagnosis of allergic diseases. However, the absence of international standards for sIgE detection systems raises questions about the comparability of different systems.
OBJECTIVE
This study aims to evaluate three common allergen sIgE detection systems, with a primary focus on detecting dust mite allergens.
METHODS
We recruited 85 children with rhinitis and 15 healthy control children. The subjects underwent testing with three different sIgE detection systems, including magnetic particle flow fluorescence, magnetic particle chemiluminescence, and protein chip, to detect sIgE levels to HDM extracts. In addition, skin prick testing (SPT) was conducted, and protein chip technology was performed to measure sIgE levels to component proteins.
RESULTS
Our findings reveal strong consistency between SPT and the three in vitro detection systems, with consistency exceeding 71.76% for dust mite allergens. Moreover, there was excellent consistency and RAST class consistency among the three in vitro detection systems, with scores exceeding 94.12% and 89.00%, respectively. And for the 13 additional allergens crude extracts sIgE simultaneously detected by systems 1 and 2, the results showed that the consistency of both systems was above 87.00%, and the RAST class consistency was above 82.00%.
CONCLUSION
The three serum sIgE detection systems exhibited an approximate 80% concordance rate with SPT in identifying dust mite allergens. Furthermore, these systems demonstrated excellent consistency and RAST class consistency among themselves. These findings suggest that the three assays introduced in this study are interchangeable in allergen diagnosis.
PubMed: 38877847
DOI: 10.12932/AP-290923-1702