Maternal tobacco exposure during pregnancy and allergic rhinitis in offspring: A systematic review and meta-analysis

Background:Maternal tobacco exposure during pregnancy is known to cause a potential hazard to the offspring''s health. So far, published studies have shown no consistent results with whether tobacco exposure in utero is causally linked to the development of allergic rhinitis in offspring. The aim of this study was to comprehensively evaluate the association between maternal tobacco exposure during pregnancy and allergic rhinitis in offspring by meta-analysis and to provide reference for clinical work.Methods:Literatures were searched in CNKI, Wanfang Data, VIP, SinoMed, PubMed, Web of science and Embase up to September 30,2020. Screening, inclusion, quality assessment, data extraction and data analysis of the literatures were conducted. Meta-analysis was performed with Revman 5.3 and State15.1 software. Odds ratio (OR) and 95%CI were used as observation indicators.Results:We had retrieved 16 articles with 22 independent datasets and 11,49,879 sample size. When all the studies were analyzed together, the results showed that maternal smoking exposure during pregnancy would increase the risk of allergic rhinitis in offspring (OR = 1.13, 95%CI:1.02–1.26), especially maternal passive smoking during pregnancy (OR = 1.39, 95%CI:1.05–1.84). But subgroup analysis showed that maternal active smoking during pregnancy was only significantly associated with offspring allergic rhinitis in cross-sectional studies (OR = 1.24, 95%CI:1.07–1.45) and study done in America study (OR = 1.22, 95%CI:1.05–1.42).Conclusions:Tobacco exposure during pregnancy could increase the risk of allergic rhinitis in offspring. The importance of avoiding prenatal tobacco exposure should be emphasized more for the health of next generation in the public.     

�����Լ�������������������

过敏性鼻炎是体外环境中的过敏原作用于特应性个体(atopy)后出现IgE介导的鼻腔黏膜Th2免疫反应占优的过敏性炎症,与下呼吸道关系密切。在社会群体中的患病率较高,已成为耳鼻咽喉头颈外科门诊的主要疾病。过敏原特异性免疫治疗是惟一可能通过免疫调节机制改变过敏性疾病自然进程的治疗方式,在过敏性鼻炎治疗体系中占有特殊重要的地位。     

Efficacy and safety of Tian moxibustion in treating allergic rhinitis: A protocol for a systematic review and meta-analysis

Background:Allergic rhinitis, abbreviated AR, modern medicine considers AR to be a chronic inflammatory reactive disease of the nasal mucosa mediated by exposure to allergens such as pollen and mites immunoglobulin E. AR not only affects patients’ daily life, sleep, work, and study, but also brings huge economic burden to patients and society. At present, desensitization therapy, antiallergic drugs, antihistamines, hormones, and other drugs are used to improve symptoms or immune regulation, but the clinical short-term and long-term efficacy is general, the symptoms are easy to be repeated after drug withdrawal, and the long-term toxicity and side effects of drugs are obviously insufficient. Tian moxibustion therapy has a good effect on AR. Therefore, this paper will carry out a systematic evaluation and meta-analysis of the efficacy and safety of moxibustion in the treatment of allergic rhinitis.Methods:Eight electronic databases will be searched, including PubMed, Embase, Web of Science, Cochrane Library, the China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Database (WF), and Chinese Biomedical Literature Database (CBM). We will search above electronic databases from the beginning to November 2020, without any language restriction, but involving only the human subjects. Clinical efficacy, including total effective rate or cure rate, and recurrence rate will be accepted as the primary outcomes. The Rhinoconjunctivitis quality of life questionaire (RQLQ) score, symptom score (nasal congestion, snot, continuous sneezing) will be used as secondary outcomes. The Cochrane Handbook of Systematic Review (5.3.0) randomized controlled trials (RCT) risk assessment tool will be used to evaluate the risk of bias by 2 independent researchers.Results:After the completion of this study, the results will be reported, so it is not possible to give accurate results at present.Conclusions:The results of this study will provide reliable evidence for the efficacy and safety of Tian moxibustion in the treatment of allergic rhinitis.Ethics and dissemination:This paper does not need to be approved by the Ethics Committee, because this paper is a systematic review and quality evaluation of relevant literature. The results of this study will be disseminated in the form of a paper to help better guide the clinical practice of Tian moxibustion in the treatment of allergic rhinitis.INPLASY Registration number:INPLASY2020110058.     

Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regard to the inflammatory response

Background and Aims: Seasonal allergy is an interesting model to study the pathophysiological mechanisms involved in allergic inflammation. However, experimental allergen exposure is easier to perform and standardise. The primary aim of this study was to compare the inflammatory responses to high‐dose bronchial challenge and natural exposure during birch pollen season. The second aim was to compare the responses of patients with allergic rhinitis and allergic asthma, respectively to both types of allergen exposure. Methods: Fifteen birch pollen‐allergic patients (seven with asthma and eight with rhinitis) and five healthy individuals were studied during pollen season and after challenge with birch allergen. Symptoms, medication and peak expiratory flow rate (PEFR) were recorded, and blood samples, spirometry and induced sputum were analysed during season and after challenge. Results: Patients with allergic asthma demonstrated a greater bronchial responsiveness to bronchial provocation with birch allergen than patients with rhinitis (P = 0.04) whereas no difference was found regarding nasal challenge. No significant association was found between the level of responsiveness and the inflammatory response after seasonal exposure. Seasonal exposure was related to a more marked systemic inflammatory blood–eosinophil increase than bronchial challenge [(median) (0.25 vs 0.11 × 109/L, P = 0.03)] and after nasal challenge, respectively [(median) (0.25 vs 0.04 × 109/L, P = 0.003)]. A significant correlation in eosinophil cationic protein in induced sputum was found between the experimental and seasonal exposure (rho = 0.62, P = 0.02). Conclusions: Bronchial allergen challenge with inhalation of birch pollen gives a similar inflammatory response in the airway but less systemic inflammation than seasonal exposure in birch pollen allergic patients with asthma and rhinitis. Please cite this paper as: Kämpe M, Janson C, Stålenheim G, Stolt I and Carlson M. Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regard to the inflammatory response. The Clinical Respiratory Journal 2009; DOI:10.1111/j.1752‐699X.2009.00140.x.     

Yu ping feng san for pediatric allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials

Background:The potential treatment effects and safety of Yu ping feng san (YPFS) for pediatric allergic rhinitis (PAR) patients have yet to be studied systematically.Objectives:To assess the effects and safety of YPFS for treat pediatric patients, allergic rhinitis.Methods:We systematically searched PubMed, EMBASE (Excerpta Medical Database), Cochrane library, Chinese Cochrane Centre''s Controlled Trials Register platform, Wanfang Chinese Digital Periodical and Conference Database, China National Knowledge Infrastructure Database, and VIP Chinese Science, from inception dates to November 1, 2019. Randomized controlled trials (RCTs) were included. The risk of bias in the trials was assessed in accordance with the Cochrane Handbook, version 5.1.0. RevMan 5.3 software was used to perform a meta-analysis. Grading of Recommendations Assessment, Development and Evaluation methodology was applied to evaluate the evidence quality for each outcome. The quality of evidence for each outcome measurement was low for 4 outcomes and very low for 5 outcomes.Results:A total of 10 RCTs involving 1069 participants (3–15 years old) fulfilled the inclusion criteria. After exclusion, 8 RCTs were pooled for efficacy assessment. The overall efficacy evaluation result did not show benefit for the experimental group (relative risk 0.32, CI 95% 0.24–0.45; P = .98;) Investigation of variation of serum IgA, immunoglobulin E, IgG in three studies in 2 groups returned no statistical significance. YPFS gave relatively better safety (relative risk 0.29, CI 95% 0.14–0.58; P = .0005; Fig. S8 and lower recurrence rates than did Western medical therapy.Conclusions:Current evidence cannot support the routine use of YPFS for treatment of PAR. This may be due to poor-quality study-design limitations of the included YPFS studies. Our data showed that the use of YPFS for PAR is relatively safe compared to Western medical therapy, but a conclusion could not be drawn because only 5 studies were analyzed. Every study suffered from some methodological limitation. Therefore, further large, rigorously-designed studies are necessary to determine conclusively the utility of YPFS in PAR.     

Effects of H1 antihistamine addition to intranasal corticosteroid for allergic rhinitis: a systematic review and meta‐analysis

Background

A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commonly prescribed to patients with allergic rhinitis (AR) who have an inadequate response to monotherapy. In this systematic review we aimed to determine the effects of AH combined with INCS (AH‐INCS) for treating AR.

Methods

Literature searches were performed using Medline and Embase. Randomized, controlled trials that studied the effects of AH‐INCS vs INCS monotherapy for treating patients with AR were included. The primary outcomes were total nasal symptom scores, total ocular symptom scores, and disease‐specific quality of life. The secondary outcomes were objective tests for nasal patency and adverse events.

Results

Sixteen studies (4026 patients) met the inclusion criteria. Compared with INCS, AH‐INCS decreased total nasal symptom scores (standardized mean difference [SMD], ?0.13; 95% confidence interval [CI], ?0.19 to ?0.06; p < 0.001; 10 trials, 3348 patients) and total ocular symptom scores (SMD, ?0.12, 95% CI, ?0.20 to ?0.04; p = 0.003; 6 trials, 2378 patients). Subgroup analysis indicated no benefit with the oral AH‐INCS combination but did show benefit with intranasal AH‐INCS (SMD, ?0.18; 95% CI, ?0.27 to ?0.09; p < 0.001). There were no significant differences with regard to disease‐specific quality of life (SMD, ?0.07; 95% CI, ?0.16 to 0.02; p = 0.12; 6 trials, 1981 patients), nasal inspiratory flow (MD, ?0.03 L/min; 95% CI, ?0.57 to 0.50; p = 0.91; 1 trial, 54 patients), or adverse events.

Conclusion

Intranasal AH‐INCS has benefit over INCS on nasal and ocular symptom improvement for treating AR. Oral AH‐INCS is not recommended.

     

Clinical acupuncture therapy for children with allergic rhinitis: A protocol for systematic review and meta analysis

Background:Allergic rhinitis (AR) in children has become a common clinical allergic disease, the incidence of which is increasing in pediatric. The side effects of the drug cause parents to worry about the health of their child. However, a large number of current clinical studies have shown that acupuncture therapy is effective in treating children with AR. Therefore, this systematic review aims to explore the safety and effectiveness of acupuncture in the treatment of AR in children.Methods:We will conduct a comprehensive literature search in Medline, PubMed, Cochrane Database of Systematic Reviews, Embase, Chinese Biomedical Literatures Database (CBM), China National Knowledge Infrastructure (CNKI), Wang Fang Database (WF), Chinese Scientific Journal Database (VIP) from inception to November 2020 without any language restriction. In addition, we will retrieve the unpublished studies and the references of initially included literature manually. Reviewers will identify studies, extract data, and assess the quality independently. The outcomes of interest include: total effective rate; the total nasal symptom score; Rhinitis quality of life questionnaire (RQLQ); Visual Analog Scale (VAS); Laboratory inspection indicators: the level of IgE, IL6, IL10 or TNF-α; Recurrence rate; adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test will be conducted between the studies, P < .1 and I² > 50% are the thresholds for the tests. We will utilize the fixed effects model or the random effects model according to the size of heterogeneity.Results:The results of this systematic review will provide a synthesis of current evidence of AR in children. We will report this result shortly.Conclusion:This study will explore whether or not acupuncture therapy can be used as one of the non drug therapies to prevent or treat allergic rhinitis in children.Trial registration number:INPLASY2020110053.     

The effectiveness and safety of sanfu acupoint herbal patching for treating allergic rhinitis: A protocol for systematic review and meta-analysis

Background:Allergic rhinitis (AR) is one of the most common chronic disease of the nasal mucosa globally. Several clinical studies have shown that sanfu acupoint herbal patching (SAHP) has obvious advantages in treating AR. Therefore, the purpose of this systematic review is to evaluate the effectiveness and safety of SAHP for treating AR.Method:The following 9 electronic databases will be searched from January 2010 to October 2020: PubMed/Medline, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure, VIP Database, WANFANG Database, China Biology Medicine disc. The selection of the studies and the extraction of the data are independently completed by 2 reviewers. The qualities of the studies are evaluated by Cochrane risk-of-bias tool. The main outcome of included studies is total effective rate. Secondary outcomes are Total Nasal Symptom Score, recurrence rate, Rhinitis Quality of Life Questionnaire, adverse events and laboratory indicators: serum immunoglobulin E (IgE). And the STATA 14.0 software will be implemented for data synthesis and meta-analysis.Results:The review is ongoing, no results can be reported.Conclusions:The systematic review will provide a better option for patients to treat AR.Registration number:INPLASY2020100101.