Management of patients with asthma and allergic rhinitis

Asthma and allergic rhinitis are two of the most common manifestations of allergy. The conditions have similar aetiologies, and genetic and environmental influences. There is increasing evidence that asthma and allergic rhinitis frequently co-exist, this article discusses the pharmacological management of these conditions, whether they exist independently or simultaneously. Correct use of inhaler devices and nasal sprays is also outlined.     

Pharmacotherapy of asthma and allergic rhinitis

It has become easier to treat and control the symptoms of asthma, while the treatment of allergies remains directed toward the prevention and blockade of histamine-induced symptoms. This article details treatment options, including beta-2 selective sympathomimetic agonists, methods of delivery, theophylline, cromolyn, corticosteroids, antihistamines, decongestants, and intranasal steroids.     

Management of allergic rhinitis

Rhinitis is characterised by the presence of two or more of the following symptoms: nasal blockage, sneezing, rhinorrhoea (a persistent watery mucous discharge from the nose) and nasal itching which last for an hour or more on most days. Allergy is the commonest cause of chronic symptoms. Patients with allergic rhinitis often have a clear relationship between symptoms and allergen exposure, for example, during the tree/grass pollen season. Viral or bacterial infection is the commonest acute cause of symptoms and is usually self-limiting.     

Management of allergic rhinitis

Allergic rhinitis, including hay fever, can have a major effect on patients' quality of life. This article outlines the assessment and management of this common condition, which nurses are ideally placed to carry out.     

Month of birth in asthma and allergic rhinitis

The distribution by month of birth among 7796 patients, who consulted Danish general practitioners during a one year period 1977-78 because of asthma and/or allergic rhinitis is presented. Among allergic rhinitis patients births in March and April were significantly overrepresented, and July underrepresented. As a whole February-May were overrepresented and July-January underrepresented. The distribution of month of birth of asthma patients did not differ from the distribution of the total Danish population. Patients suffering from both asthma and allergic rhinitis presented a pattern similar to that of allergic rhinitis patients. Families with a high prevalence of allergy may take advantage of this knowledge when planning child births, as the findings may be explained partly by exposure to pollen during infancy.     

Caring for patients with allergic rhinitis

PURPOSE: Allergic rhinitis (AR) affects up to 40 million Americans, with an estimated cost of $2.7 billion per annum. This review discusses several therapeutic options that reduce the symptoms of AR, including allergen avoidance, antihistamines, intranasal corticosteroids (INS), leukotriene receptor antagonists, and immunotherapy. DATA SOURCES: The articles included in this review were retrieved by a search of Medline literature on the subjects of AR, antihistamines, INS, leukotriene antagonists, and immunotherapy, as well as current published guidelines for the treatment of AR. CONCLUSIONS: Allergen avoidance is recommended for all patients prior to pharmacologic therapy. Oral and nasal H(1)-antihistamines are recommended to alleviate the mild and intermittent symptoms of AR, and INS are recommended as the first-line treatment choice for mild persistent and more moderate-to-severe persistent AR. IMPLICATIONS FOR PRACTICE: There are a number of different types of therapy for the management of AR; with so many options available, successful tailoring of treatment to suit individual requirements is realistically achievable.     

过敏性哮喘和鼻炎患儿的临床免疫治疗研究

目的：探讨过敏性哮喘和鼻炎患儿的特异性免疫治疗的临床应用。方法采用体外特异性过敏原检测系统对儿童医院门诊患儿进行血清过敏原特异性 lgE（SlgE）抗体和总 lgE 进行检测,对尘螨过敏患儿进行分组治疗,免疫治疗组采用粉尘螨滴剂舌下脱敏治疗,对照组按普通药物抗过敏治疗,治疗6个月、12个月给予临床控制指标评分,同时观察患儿血清中 SIgE 的改变。结果218例过敏患儿吸入性过敏114例（52．4％）,食入性过敏101例（46．3％）。98例尘螨过敏患儿占总过敏者和吸入性过敏者的44．95％和85．96％。免疫治疗组与对照组比较差异有统计学意义（P ＜0．05）;脱敏治疗患儿 SIgE 阳性率有所下降,但差异无统计学意义（P ＞0．05）。结论218例过敏患儿的特异性过敏原检测中尘螨过敏者最多;舌下特异性免疫治疗过敏性哮喘和鼻炎效果显著。     

Anti-IgE in allergic asthma and rhinitis: an update

Allergic asthma and rhinitis imposes a huge burden in terms of treatment costs, productivity loss and hospital admissions. IgE plays a significant role in the manifestation of these conditions and the identification of a monoclonal antibody that binds to IgE provides clinicians another therapeutic strategy in the management of these conditions. Blocking the effects of IgE by omalizumab, a recombinant humanised monoclonal antibody that selectively binds to IgE has been shown to be a useful adjunct in the treatment of allergic asthma and rhinitis. Omalizumab is effective as a steroid reducing agent in patients with severe asthma and is successful in decreasing asthma exacerbations. Omalizumab was well tolerated in clinical trials, however, the potential long-term side effects need careful monitoring. The high cost of the molecule could make this a therapeutic option in a small proportion of patients in whom there is a large unmet need.     

Anti-IgE in allergic asthma and rhinitis: an update

Allergic asthma and rhinitis imposes a huge burden in terms of treatment costs, productivity loss and hospital admissions. IgE plays a significant role in the manifestation of these conditions and the identification of a monoclonal antibody that binds to IgE provides clinicians another therapeutic strategy in the management of these conditions. Blocking the effects of IgE by omalizumab, a recombinant humanized monoclonal antibody that selectively binds to IgE has been shown to be a useful adjunct in the treatment of allergic asthma and rhinitis. Omalizumab is effective as a steroid reducing agent in patients with severe asthma and is successful in decreasing asthma exacerbations. Omalizumab was well tolerated in clinical trials, however, the potential long-term side effects need careful monitoring. The high cost of the molecule could make this a therapeutic option in a small proportion of patients in whom there is a large unmet need.     

南京地区支气管哮喘患者合并过敏性鼻炎的现状及其临床表现相关性

背景:过敏性鼻炎和支气管哮喘均为呼吸道炎性疾病,它们常并存于同一患者。目的:了解南京地区支气管哮喘患者中过敏性鼻炎的发生率,并分析过敏性鼻炎与支气管哮喘在临床表现方面的相关性。设计:问卷调查。单位:解放军南京军区南京总医院耳鼻咽喉-头颈外科及呼吸内科。对象:纳入2001-02/2005-04解放军南京军区南京总医院确诊为支气管哮喘的患者134例,男73例,女61例;年龄3～72岁。参照全球哮喘防治创议(Global initiative for asthma,GINA)方案进行哮喘严重程度分级;过敏性鼻炎的诊断标准参照1997-11"海口会议"的修订标准;所有患者均同意参与问卷调查。方法:通过问卷调查,详细了解134例支气管哮喘患者中患支气管哮喘、过敏性鼻炎患者的年龄、症状分型及严重程度、治疗状况、家族史等临床资料。应用统计学描述和两个独立样本的t检验,并计算支气管哮喘合并过敏性鼻炎的发生率,比较支气管哮喘和过敏性鼻炎患者的年龄、发病年龄及病程的差异有无显著性。应用Spearman等级相关分析进行两者严重程度相关性分析。主要观察指标:支气管哮喘患者中过敏性鼻炎的发生率,以及过敏性鼻炎与支气管哮喘在临床表现方面的相关性。结果:支气管哮喘患者134例中82例(61.2%,82/134)并发过敏性鼻炎,其中男45例,女37例。此82例患者中,哮喘严重程度一级(轻度间歇)56例,二级(轻度持续)21例,三级(中度持续)4例,四级(重度持续)1例。其过敏性鼻炎分型,间歇性65例,持续性17例;按严重程度分级,轻度63例,中-重度19例。过敏性鼻炎与支气管哮喘严重程度呈明显正相关(r=0.689,P<0.01)。结论:南京地区支气管哮喘合并过敏性鼻炎的发生率较高;过敏性鼻炎与支气管哮喘严重程度具有高度相关性。     

特应性舌下免疫治疗儿童哮喘并变应性鼻炎的临床研究

目的 探讨舌下含服尘螨变应原疫苗治疗儿童哮喘的临床疗效和免疫指标变化.方法 选取年龄4～13岁哮喘缓解期伴变应性鼻炎患儿300例为免疫治疗对象,完成包括粉尘螨在内的10种常见过敏原皮肤点刺实验,点刺试验结果呈阳性反应.全部患者肺功能检查在个人预计值正常值范围.应用粉尘螨滴剂进行临床免疫治疗,记录治疗前后症状和体征评分和不良反应.采用夹心酶联免疫吸附测定方法检测治疗前后血清尘螨免疫球蛋白E(slgE)和特异性IgG4.结果 进入治疗的300例儿童哮喘并变应性鼻炎患儿坚持完成1年治疗的有221例,治疗总有效率为71.0%,有效病例中平均起效时间为6.8月(中位时间6个月).与用药相关的皮疹,鼻咽痒和哮喘发作的不良反应发生率21.7%(48/221),未出现过敏性休克的严重不良反应.儿童哮喘并变应性鼻炎患者血清slgE治疗前(125.21±96.70)kU/L,治疗后(121.19±87.01)kU/L,治疗前后比较无明显变化(t=0.913,P>0.05);血清特异性IgG4治疗后(894.2±687.1)ku/L比治疗前(696.7±452.8)ku/L明显升高(t=3.519,P<0.01).结论 特应性舌下免疫治疗方法安全有效,是治疗儿童变应性疾病的重要措施之一.     

The Fc gammaRIIa polymorphism in Turkish children with asthma bronchial and allergic rhinitis

OBJECTIVE: The aim of the present study was to evaluate the Fc gammaRIIa polymorphism in Turkish children with atopic asthma and allergic rhinitis. DESIGN AND METHODS: In this study, 372 atopic children (192 asthma bronchial, 180 allergic rhinitis) between ages of 5 and 16 years old (11.3+/-2.9) who were followed at Aegean University Paediatric Allergy and Pulmonology Outpatient Clinics and 234 healthy subjects as the control group were included. The evaluation of subjects included routine biochemical blood analysis and allergic workup based on the following laboratory determinants. The Fc gammaRIIa polymorphism was determined using the polymerase chain reaction method. RESULTS: Distribution of R131R genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 2.64 95%CI: 1.22-5.79, p=0.006; for allergic rhinitis OR: 2.58 95%CI: 1.18-5.71, p=0.009). Frequency of 131R allele was significantly different among patient groups compared to controls (for asthmatic children OR: 1.66 95%CI: 1.22-2.26, p=0.0007; for allergic rhinitis OR: 1.93 95%CI: 1.42-2.63, p=0.00001). CONCLUSION: This study shows that Fc gammaRIIa gene 131R allele represents an important genetic risk factor for bronchial asthma and allergic rhinitis susceptibility.     

某院哮喘合并变应性鼻炎的流行病学调查

目的调查西南医院门诊哮喘合并变应性鼻炎(AR)患者的分布情况,分析二者在临床表现方面的相关性及患者对AR的认知程度和治疗现状。方法选取2013年1~9月西南医院收治的哮喘患者250例进行面对面的问卷调查,了解其哮喘病史、严重程度分级、哮喘控制测试(ACT)评分和鼻炎情况,并建立个人数据档案。结果 250例哮喘患者中,161例(64.4%)合并AR,单纯哮喘组(A组)和哮喘合并AR组(B组)在年龄、性别、病程等方面差异无统计学意义(P0.05)。B组中轻度持续、中度持续、重度持续例数均高于A组,差异有统计学意义(P0.05);ACT评分显示完全控制、一般控制例数均低于A组,差异有统计学意义(P0.05);未控制哮喘高于A组,差异有统计学意义(P0.05)。AR起病早于哮喘占58.3%,两者同时起病占12.7%。32.8%患者曾经检测过敏原,22.6%患者使用药物治疗鼻炎。结论重庆地区哮喘合并AR发生率高,认知程度较低,治疗现状不容乐观。