Different serum soluble Fas levels in patients with allergic rhinitis and bronchial asthma

BACKGROUND: The pathogeneses of allergic rhinitis and bronchial asthma are believed to be closely mutually related because of the similar dynamics of allergy-inducing cells and molecules and clinical overlap. In this study, we compared these diseases in the dynamics of cell apoptosis-regulating molecules. METHODS: Allergic rhinitis patients (n=36), bronchial asthma patients (n=22), and healthy subjects (n=32) were subjected to measurement of serum (soluble Fas) (sFas) levels during the stable and attack disease phases by a sandwich enzyme-linked immunosorbent assay. RESULTS: Serum sFas levels in patients with allergic rhinitis during the attack phase were significantly lower (P<0.0001) than those in healthy individuals. There were no differences between them during the attack and stable disease phases. In contrast, serum sFas levels in patients with bronchial asthma during the attack phase were higher (P<0.0005) than those in healthy individuals. Interestingly, the levels during the attack phase were lower (P<0.002) than those during the stable phase. CONCLUSIONS: Our results suggest a different pathogenesis for allergic rhinitis and bronchial asthma at the cell apoptosis-linked step.     

The natural course of allergic rhinitis during 12 years of follow-up

As symptoms of allergic rhinitis are generally thought to disappear with increasing age, we decided to follow up our allergic rhinitis patients to ascertain whether their disease had regressed or progressed, and whether they had developed respiratory symptoms. At our department, between 1979 and 1982, allergic rhinitis was diagnosed in 108 patients. In 1993, 82 of the patients (40 women, 42 men; mean age 36 years), none of whom had received immunotherapy, answered a questionnaire concerning the status of their allergic rhinitis, and any development of the disease during the interim. Of the 82 patients, one was free of allergic symptoms and 39% had become better; symptoms were unchanged in 39% of cases, and worse in 21%. Six percent had suffered from asthma at presentation, 6% had developed asthma in the interim, and 34% reported other lower airways symptoms. Neither sex nor age at diagnosis was a determinant of the course of allergic rhinitis. Thus, in contrast to findings in other studies, the severity of allergic rhinitis seems to have increased among our patients.     

Increase of asthma, allergic rhinitis and eczema in Swedish schoolchildren between 1979 and 1991

Background: A previous study has shown a twofold increase in prevalence of asthma and allergic rhinitis (AR) in Swedish recruits during the 1970s. The increase was higher in more northerly colder regions. Objectives To follow up the previously found trend to increasing prevalences with time as well as the climatic variations within the country. Methods: The prevalences of asthma, allergic rhinitis and eczema were assessed using two questionnaire studies, 12 years apart (1979 and 1991) with identical questions about the diseases. The study comprised representative samples of children from the Göteborg area on the south-western coast (in 1979: 7-year-olds, n= 4255, in 1991: 7-year-olds, n= 1649) and in Kiruna, a mining town in the northernmost inland mountains (in 1979: 7-year-olds, n= 427, in 1991: 7-9-year-olds, n= 832). In 1991 there was also a personal interview and a skin-prick test (SPT) on subsamples. Results: The prevalence of all these diseases present over the last year had roughly doubled over the 12-year period. On both occasions, most symptoms were more prevalent in the northern area. In 1991, the prevalence of one or more symptoms in Goteborg was 23.8% and 32.5% and in Kiruna 29.9% and 44.8% in the questionnaire and the interview, respectively. Conclusion: Asthma, AR and eczema increase continuously in prevalence in Sweden and the climatic distribution of the prevalences suggests possible major risk factors to be found in a closed indoor climate.     

Comparison of allergen-induced changes in bronchial hyperresponsiveness and airway inflammation between mildly allergic asthma patients and allergic rhinitis patients

Bronchial eosinophilic inflammation and bronchial hyperresponsiveness (BHR) are the main features of allergic asthma (AA), but they have also been demonstrated in allergic rhinitis (AR), suggesting a continuity between both diseases. In spite of not fully reproducing natural allergenic exposure, the allergen bronchial provocation test (A-BPT) has provided important knowledge of the pathophysiology of AA. Our aim was to verify the existence of a behavior of AA and AR airways different from the allergen bronchial challenge-induced airway eosinophilic inflammation and BHR changes. We studied a group of 31 mild and short-evolution AA and 15 AR patients, sensitized to Dermatophagoides pteronyssinus. The A-BPT was performed with a partially biologically standardized D. pteronyssinus extract, and known quantities of Der p 1 were inhaled. Peripheral blood (eosinophils and ECP) and induced sputum (percentage cell counts, ECP, albumin, tryptase, and interleukin [IL]-5) were analyzed, before and 24 h after A-BPT. Methacholine BHR, assessed before and 32 h after the A-BPT, was defined by M-PD20 values and, when possible, by maximal response plateau (MRP). The A-BPT was well tolerated by all the patients. AA presented a lower Der p 1 PD20 and a higher occurrence of late-phase responses (LPR). M-PD20 values decreased in AA, but not in AR, patients. MRP values increased in both groups. Eosinophils numbers and ECP levels increased in blood and sputum from both AA and AR, but only the absolute increment of sputum ECP levels was higher in AA than AR patients (P = 0.025). The A-BPT induced no change in sputum albumin, tryptase, or IL-5 values. We conclude as follows: 1) In spite of presenting a lower degree of bronchial sensitivity to allergen, AR patients responded to allergen inhalation with an eosinophilic inflammation enhancement very similar to that observed among AA. 2) MRP levels increased in both AA and AR patients after allergen challenge; however, M-PD20 values significantly changed only in the AA group, suggesting that the components of the airway response to methacholine were controlled by different mechanisms. 3) It is possible that the differences between AR and AA lie only in the quantitative bronchial response to allergen inhalation.     

Comparison of biomarkers between allergic rhinitis only and allergic rhinitis with concomitant asthma

This post hoc analysis suggests distinct immunologic profiles in the allergic rhinitis (AR)‐only and the AR & AA phenotypes.     

Allergy screening in asthma and allergic rhinitis

To detect atopy by a screening method employing skin prick testing with a limited number of allergens, the test results of 939 patients with allergic airways diseases were analysed. It was found that an allergen panel consisting of cat, timothy and house dust mite could detect 85% of atopic patients with asthma and/or rhinitis. For subgroups of patients the results were even more favourable. Thus 98% of atopic patients with seasonal allergic rhinitis were detected by an allergen panel consisting of timothy, birch and mugwort. It is concluded that screening methods using only three of four allergens could be used for detecting atopy in patients with airways diseases. The method should be most valuable for in vitro tests used in combination with standardized questionnaires.     

The use of a feather quilt, childhood asthma and allergic rhinitis: a prospective cohort study

BACKGROUND: Feather bedding has long been considered as a potential source of allergen exposure and thus a potential risk factor for allergic diseases. However, recent cross-sectional studies have reported a higher risk of allergic diseases among users of synthetic bedding compared with feather-bedding users. OBJECTIVE: To explore associations between early life exposure to feather bedding and the risk of developing asthma allergic rhinitis in childhood. METHODS: We assessed the association between early life exposure to feather quilts and the risk of bronchial obstruction during the first 2 years of life and asthma and allergic rhinitis in a prospective 4-year cohort study of 2531 Norwegian children. RESULTS: At the age of 6 months, 24% of the children had a quilt with feathers, decreasing to 20% at the age of 2 years. The adjusted odds ratio for bronchial obstruction 0 to 2 years by exposure to a feather quilt at the age of 6 months was 0.59, 95% confidence interval 0.41 to 0.86, for asthma at the age of 4 years 0.38, 0.23 to 0.64 and for allergic rhinitis at the age of 4 years 0.73, 0.43 to 1.18. CONCLUSION: The use of a feather quilt in early life does not seem to increase the risk of asthma and allergic rhinitis later in childhood.     

High incidence of sensitization to ornamental plants in allergic rhinitis

BACKGROUND: A few indoor plants have been described as potential allergens, in single case reports of allergic rhinitis. There is no data evaluating the prevalence of allergic sensitization to these plants. AIM: The relationship between owning indoor ornamental plants with the risk to be sensitized has been evaluated in atopic rhinitis. METHODS: A group of 59 patients with allergic rhinitis were submitted to skin prick tests (SPT) using both the leafs of their own plant and commercial extracts of the most frequent airborne allergens. A control group of 15 healthy subjects was tested with the same allergens. RESULTS: While no subject from the control group developed a significant SPT to any of the tested plants, 78% of allergic rhinitis had positive SPT to at least one plant, the most frequent sensitization being Ficus benjamina, yucca, ivy and palm tree. CONCLUSION: In allergic rhinitis, indoor plants should be considered as potential allergens.     

Obtaining concomitant control of allergic rhinitis and asthma with a nasally inhaled corticosteroid

Allergic rhinitis (AR) and asthma coexist frequently and a dual treatment is recommended by prescribing topical nasal plus oral inhaled corticosteroids. The purpose of this study was to assess the efficacy of a nasally inhaled corticosteroid aiming at concomitant control of AR and asthma. A controlled trial was conducted among 60 patients with AR and asthma, aged 6-18 years, who were randomized into two groups. During 8 weeks, the experimental group (30 patients) received exclusively fluticasone propionate hydrofluoroalkane (FP-HFA) inhaled through the nose (mouth closed) using a large volume spacer attached to a face mask. The comparison group (30 patients) received a nasal spray of isotonic saline plus oral inhalation of FP-HFA through a mouthpiece attached to the same spacer. Clinical scores for AR and asthma, nasal inspiratory peak flow (NIPF), and spirometry were assessed by blinded observers. There was a significant improvement in AR scores and NIPF in the experimental group (P or= 0.20). Prebronchodilator FEV(1) (% predicted value) improved by 10% in both groups, comparing values at inclusion with those obtained at the end of follow up. Our results suggest that nasally inhaled FP-HFA through a spacer may control AR and asthma in children and adolescents. This approach is likely to result in higher compliance, lower costs, and fewer side effects.     

Trends in prevalence of asthma, allergic rhinitis and atopic dermatitis in 5-7-year old Swiss children from 1992 to 2001

BACKGROUND: Changing occurrence rates of asthma, allergic rhinitis and atopic dermatitis are of public health concern and require surveillance. Changes in prevalence rates of these atopic diseases were monitored during 10 years and their trend with time was determined taking into account the influence of personal and environmental risk factors. METHODS: Four cross-sectional surveys in 5-7-year old children were performed in seven different communities in Switzerland between 1992 and 2001. Prevalence of respiratory and allergic symptoms and of affecting risk factors including parental environmental concern were assessed using a standardized parental questionnaire. RESULTS: A total of 988 (74.1%), 1778 (79.0%), 1406 (82.6%) and 1274 (78.9%) children participated, respectively, in the 1992, 1995, 1998 and 2001 surveys. Prevalence rates of asthma and hay fever symptoms remained quite stable over time (wheeze/past year: 8.8%, 7.8%, 6.4% and 7.4%, sneezing attack during pollen season: 5.0%, 5.6%, 5.4% and 4.6%). Rates of reported atopic dermatitis symptoms (specific skin rash/past year: 4.6%, 6.5%,7.4% and 7.6%) showed an increase over time, but those of diagnosis of eczema did not show a clear pattern (18.4%, 15.7%, 14.0% and 15.2%). Stratified analysis by parental environmental concern and by parental atopy showed similar trends. Rates of atopic dermatitis symptoms showed significant increase in girls but stayed stable in boys. CONCLUSION: Results of these four consecutive surveys suggest that the increase in prevalence of asthma and hay fever in 5-7-year old children living in Switzerland may have ceased. However, symptoms of atopic dermatitis may still be on the rise, especially among girls.     

Prevalence of asthma, allergic rhinoconjunctivitis and allergic sensitization in Mongolia

BACKGROUND: Studies in countries, such as Mongolia, which are in transition from farming to industrial society permit evaluation of the impact of environmental change on atopic diseases. METHODS: In the screening study, questionnaire data were obtained from 9453 subjects aged 10-60 years. In the clinical study, a subsample of 869 subjects (participation rate 50.0%) was examined. A questionnaire-based interview, clinical examination, skin prick tests, spirometry and bronchodilation test or methacholine challenge test were used to define the clinical diagnoses. The prevalences of atopic diseases were evaluated at the population level using two-phase data and sampling weights. RESULTS: The prevalences of asthma, allergic rhinoconjunctivitis and allergic sensitization with 95% confidence intervals were 1.1% (0.3-2.0%), 9.3% (4.0-14.6%) and 13.6% (7.4-19.9%) in Mongolian villages, 2.4% (1.4-3.5%), 12.9% (8.2-17.7%) and 25.3% (17.1-33.6%) in rural towns and 2.1% (1.3-3.0%), 18.4% (13.3-23.4%) and 31.0% (24.5-37.5%) in Ulaanbaatar city, respectively. The prevalence of allergic rhinoconjunctivitis (P = 0.02) and allergic sensitization (P = 0.003) increased significantly with increasing urbanization. CONCLUSIONS: The prevalences of atopic diseases were low in rural Mongolia and increased with increasing urbanization suggesting that rural living environment protects against atopy.