Assessment of sensory perceptions and patient preference for intranasal corticosteroid sprays in allergic rhinitis

BACKGROUND: Long-term intranasal corticosteroid sprays (INCSs), the mainstay of therapy in allergic rhinitis, differ little in efficacy and safety. Compliance to therapy is strongly influenced by patients' perceptions and preferences. We evaluated the acceptability, based on sensory perceptions, of beclomethasone, budesonide, fluticasone propionate (FP), and mometasone furoate (MF) nasal sprays. METHODS: A single-blind (patient), crossover study was performed; 114 patients with allergic rhinitis, categorized as "sneezers and runners" (group 1) and "blockers" (group 2) were assessed for their sensory perceptions (nasal spray evaluation questionnaire, 14 sensory attributes, and 100-point scale). RESULTS: Significantly more patients preferred MF because of its less irritation, liking of odor, more moistness, and less aftertaste. FP rated significantly higher odor strength and amount of irritation. Seventy-two (63%) patients were in group 1 and 42 (37%) patients were in group 2. MF was the most preferred drug in both group 1 (40 patients, 56%; p < 0.05) and group 2 (21 patients, 50%). Liking the odor was the strongest attribute that affected choice in group 1 (52 patients, 58%), and strength of aftertaste in group 2 (13 patients, 31%). Significantly more patients in group 1 (55 patients, 76%) could appreciate differences in attributes than in group 2 (27 patients, 64%). Ninety-one (80%) patients predicted a better compliance with their preferred drug. CONCLUSION: MF was the most preferred INCS in our patients. This was ascribed to less irritation, odor, and aftertaste along with superior moistness. "Sneezers and runners" appreciated significant differences in INCS. In patients with allergic rhinitis, assessment of sensory perceptions could play a crucial role in promoting compliance with therapy.     

治疗变应性鼻炎对小气道功能的影响

目的　针对伴有小气道功能异常的变应性鼻炎患者,给予正规鼻用糖皮质激素治疗,观察其对小气道功能的影响。方法　筛选具有小气道功能异常的变应性鼻炎患者,给予鼻用糖皮质激素喷鼻治疗12周。治疗前予鼻部症状视觉模拟量表评分及鼻结膜炎相关生活质量问卷评分、肺通气功能检查;治疗后4、8、12周再次评估鼻部症状评分,4、12周时复查肺功能指标,观察肺功能的变化。结果　经过12周治疗,患者主观症状均有显著改善（P <0.01）,肺功能指标：第1秒用力呼气容积占预计值百分比（FEV1pred%）、第1秒用力呼气容积占肺活量比值（FEV1/FVC%）、最大呼气中段流量占预计值百分比（MMEFpred%）、用力呼出75%肺活量的呼气流量占预计值百分比（MEF75pred%）、用力呼出50%肺活量的呼气流量占预计值百分比（MEF50pred%）、用力呼出25%肺活量的呼气流量占预计值百分比（MEF25pred%）均较 治疗前明显提高（P <0.05）,其中代表小气道功能的指标MMEFpred%、MEF75pred%、MEF50pred%的改善具有统计学非常显著性差异（P <0.01）。结论　鼻用糖皮质激素治疗小气道损伤的变应性鼻炎患者可以明显改善其小气道功能,这对于预防变应性鼻炎发展为哮喘具有积极的意义。     

The efficacy and safety of ciclesonide for the treatment of perennial allergic rhinitis: a systematic review and meta-analysis

IntroductionAllergic rhinitis is a chronic inflammatory disease which affects 1 out of 6 individuals. Perennial allergic rhinitis accounts for 40% of AR cases. Ciclesonide is one of the relatively new intranasal steroid for allergic rhinitis.ObjectiveThe purpose of this study was to evaluate the efficacy and safety of ciclesonide in the treatment of perennial allergic rhinitis.MethodsWe searched Pubmed, Scientific Citation Index, Embase, Clinical Trial Registries for randomized controlled trials and Cochrane Central Register of Controlled Trials to find out the randomized controlled Trial comparing ciclesonide with placebo for PAR.ResultsEight studies were included. In comparison with placebo groups, ciclesonide groups significantly decreased Reflective Total Nasal Symptom Score (MD = ?0.56; 95% CI ?0.72 to 0.39, p < 0.00001) with heterogeneity (p = 0.19, I² = 24%), Instantaneous Total Nasal Symptom Score (MD = ?0.57; 95% CI ?0.75 to ?0.39, p < 0.00001) with heterogeneity (p = 0.34, I² = 11%). A significant effect for Reflective Nasal Symptom Score Subtotal (MD = ?0.15; 95% CI ?0.18 to ?0.13, p < 0.00001) with heterogeneity (p = 0.12, I² = 24%) was also demonstrated. Rhinoconjunctivitis quality of life questionnaire score (RQLQs) (MD = ?0.27; 95% CI ?0.39 to ?0.15, p < 0.00001) with heterogeneity (p = 0.58, I² = 0%) in the treatment of ciclesonide was also significantly reduced. In addition, the difference in Treatment-Emergent Adverse Events between the two groups was not significant.ConclusionCiclesonide can improve perennial allergic rhinitis without increasing adverse events. Ciclesonide may be another valuable choice for perennial allergic rhinitis in the future.     

淋巴结内特异性免疫治疗变应性鼻炎疗效和安全性的Meta分析

目的 系统评价淋巴结内特异性免疫治疗(ILIT)草花粉诱导的变应性鼻炎(AR)的临床疗效和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、CNKI、VIP等电子数据库,纳入诊断为草花粉诱导的AR患者,并接受淋巴结内免疫治疗的随机对照试验。主要结局包括症状评分、药物评分、症状和药物综合评分、视觉模拟量表。次要结局包括不良事件、生活质量、血清特异性IgE、血清特异性IgG4、皮肤点刺试验和鼻腔激发试验,采用RevMan 5.3软件进行 Meta 分析。结果 纳入9项研究269名受试者,所有研究都包括草花粉过敏原,其中5项研究还包括草和/或桦树花粉过敏原。除1项研究注射间隔时间为2周外,其余均为4周。与安慰剂对照组相比,ILIT组显著改善视觉模拟量表(P＜0.05),而症状评分、药物评分、症状和药物综合评分、杜松鼻结膜炎生活质量问卷均显示差异无统计学意义(P均＞0.05),其中症状和药物综合评分表现出中度异质性(I²=60%)。每4周注射1次过敏原是改善症状和药物联合评分的最佳间隔时间,而加强注射或增加剂量是否能改善临床效果尚无定论。结论 Meta分析显示,ILIT总体上是安全的,但增加注射剂量可能出现严重并发症,应谨慎。ILIT对草花粉诱导的AR视觉模拟量表有显著改善,仍需要更大规模和更长期的试验来标准化治疗方案。ILIT可能在未来的AR治疗中发挥重要作用。     

Ear-acupressure for allergic rhinitis: a systematic review

Clin. Otolaryngol. 2010, 35 , 6–12. Background: Allergic rhinitis affects 10–40% of the population globally with a substantial health and economic impact on the community. Objective of review: To assess the effectiveness and safety of ear-acupuncture or ear-acupressure for the treatment of allergic rhinitis by reviewing randomised controlled trials and quasi-randomised controlled trials. Type of review: This review followed the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions. Search strategy: A total of 21 electronic English and Chinese databases were searched from their respective inceptions to April 2008. Key words used in the search included the combination of ear, auricular, acupuncture, acupressure, acupoint, allergic, allergy, rhinitis, hayfever, randomised clinical trial and their synonyms. Evaluation method: The methodological quality was assessed using Jadad’s scale. The effect size analysis was performed to explore the difference between interventional groups. Results: Ninety-two research papers were identified and seven of them referring to five studies met the inclusion criteria. All included studies involved ear-acupressure treatment. These studies mentioned randomisation, but no details were given. None of the five studies used blinding or intention-to-treat analysis. Ear-acupressure was more effective than herbal medicine, as effective as body acupuncture or antihistamine for short-term effect, but it was more effective than anti-histamine for long-term effect. Conclusions: The benefit of ear-acupressure for symptomatic relief of allergic rhinitis is unknown due to the poor quality of included studies.     

特异性免疫治疗变应性鼻炎的疗效及安全性临床分析

目的评价特异性免疫治疗变应性鼻炎的疗效及安全性。方法对65例变应性鼻炎患者进行1～3年特异性免疫治疗后,通过患者的症状评估进行临床疗效及安全性的分析。结果 65例患者中3例中途退出(治疗未满1年),其余62例经过1～3年特异性免疫治疗,多数患者症状均有不同程度好转。治疗结束时显效25例(40.32%),有效18例(29.03%),无效19例(30.65%),总有效率69.35%。其中25例治疗满1年,显效7例(28%),有效7例(28%),无效11例(44%),有效率56%;2 1例满2年,显效1 0例(4 7.6 2%),有效5例(2 3.8 1%),无效6例(2 8.5 7%),有效率7 1.4 3%;1 6例满3年,显效8例(5 0%),有效6例(3 7.5%),无效2例(1 2.5%),有效率8 7.5%。所有患者均未发生严重不良反应。结论特异性免疫治疗对于变应原明确的变应性鼻炎患者,是一种有效、安全可靠的治疗方法。     

标准化尘螨变应原疫苗治疗应性鼻炎一年的疗效和安全性研究

目的 评价标准化尘螨变应原免疫治疗变应性鼻炎的疗效及安全性.方法 60例螨过敏变应性鼻炎患者随机分为免疫治疗组30例和药物治疗组30例.通过症状评分、药物评分、鼻炎相关生活质量评分和不良反应分级评价免疫治疗的疗效和安全性.结果 经过1年治疗后,免疫治疗组症状评分和药物评分较治疗前均明显减少(P＜0.01),与药物治疗组相比亦有显著性差异(P＜0.01).同时,免疫治疗组患者的鼻炎相关生活质量明显改善.所有免疫治疗病例未出现严重不良反应.结论 标准化螨变应原免疫治疗可安全有效地治疗变应性鼻炎.     

安脱达标准化尘螨疫苗治疗变应性鼻炎的疗效和安全性评价

目的:评价安脱达标准化尘螨疫苗免疫治疗变应性鼻炎的疗效及安全性。方法:对68例尘螨变应性鼻炎(AR)患者进行特异性免疫治疗前及治疗2年后的症状和体征评分,比较其治疗效果,同时计算不良反应发生率。通过症状评分、鼻炎相关生活质量评分和不良反应分级评价免疫治疗的疗效和安全性。结果:经过2年治疗后,特异性免疫治疗患者症状评分和药物评分较治疗前均明显减少(P<0.01)。同时,免疫治疗组患者的鼻炎相关生活质量明显改善。所有免疫治疗患者未出现严重不良反应。结论:标准化特异性免疫治疗可以安全有效地治疗变应性鼻炎。     

地氯雷他定治疗季节性变应性鼻炎疗效及安全性观察

目的:评价地氯雷他定治疗季节性变应性鼻炎(SAR)的疗效及安全性.方法:采用随机、对照方法,治疗组40例,口服地氯雷他定5 mg/d;对照组35例,口服氯雷他定10 mg/d,疗程12 d;分别分析、评估其疗效及安全性.结果:治疗组总有效率为92.50%,对照组总有效率为85.71%,两组总有效率比较差异有统计学意义(P＜0.05);与治疗前比较,治疗组SAR患者服用地氯雷他定后鼻塞程度减轻,差异有统计学意义(P＜0.05);治疗组不良反应发生率为2.50%.结论:地氯雷他定能有效缓解SAR患者包括鼻塞在内的鼻部和非鼻部症状,安全性好.     

地洛他定片治疗变应性鼻炎有效性及安全性的临床研究

目的　探讨地洛他定片治疗变应性鼻炎的有效性及安全性并作出初步评价 ,同时推荐临床给药剂量。方法　采用随机盲法、多中心、氯雷他定平行对照的临床研究。结果　共有 2 2 5例病人入组 ,地洛他定片可明显改善病人的临床症状。地洛他定组与氯雷他定组总有效率差别无统计学意义 (P >0 .0 5 )。未发现地洛他定片有严重的不良反应。副作用发生率为 1 3.3%,以口干居多 ,嗜睡、头晕其次 ,不良反应发生率两组比较差别无统计学意义 (P >0 .0 5 )。结论　两种药物治疗变应性鼻炎疗效和不良反应相似 ,国产地洛他定片治疗变应性鼻炎疗效可靠、安全性好。     

Cetirizine and astemizole in allergic rhinitis a comparative study

The efficacy, safety and side effects of Cetirizine and Astemizole were compared with Pheniramine maleate in sixty cases of allergic rhinitis. All medications were stopped one week prior to treatment. Cetirizine, Astemizole or Pheniramine maleate were given as a single daily dose for 15 days. On completion of treatment results were evaluated subjectively as well as objectively, Cetirizine and Astemizole were found to be more effective than Pheniramine maleate. The side effects were minimum with Cetirizine.     

Nasal obstruction as a key symptom in allergic rhinitis: efficacy and safety of a medical device in children

BackgroundAllergic rhinitis (AR) is a global health problem that has increased rapidly in prevalence over the past few decades. Nasal congestion, which represents a cardinal symptom of AR, appears to be difficult to treat and, especially for pediatric population, therapies that are both well tolerated and effective in relieving nasal congestion are needed. The aim of the present study was to evaluate the safety and clinical effectiveness of the medical device (lactoferrin, carboximetil β-glucan, D-panthenol, dipotassium glycyrrhizinate) in reducing the allergic rhinitis symptoms.MethodsA multicenter prospective study with a pre-post design was performed consecutively enrolling 100 pediatric patients of both genders affected by persistent AR. Patients received 2 puffs into each nostril 2 times a day over the course of 4 weeks. The severity of AR symptoms, as measured by VAS score, was assessed before and after treatment. The main outcomes were improvement in each symptom score and in overall symptom burden (as measured by average symptom scores). Differences in symptoms scores measured before and after treatment were compared using paired-sample Wilcoxon signed rank test. The proportion of participants with adverse effects attributed to the treatment was also computed.ResultsAll considered symptoms, including nasal congestion, significantly improve after treatment (p < 0.001), while only 9 patients suffered adverse effects (itch, burning sensation, dryness).ConclusionThese results confirm the efficacy and safety of this medical device in pediatric population     

变应性鼻炎和哮喘患者变应原类型及免疫治疗疗效的比较

目的 比较单纯性变应性鼻炎患者和哮喘患者变应原阳性率及变应原免疫治疗情况,分析机体对变应原反应程度与疾病的发生、发展及免疫治疗的关系.方法 对100例单纯性变应性鼻炎和100例哮喘患者行皮肤点刺试验,根据变应原类型从中挑选各30名符合混合螨免疫治疗条件者进行变应原免疫治疗.标准化皮肤点刺液和脱敏制剂均由阿罗格公司提供.结果 单纯变应性鼻炎组的主要吸入性变应原和摄入性变应原阳性率均显著低于哮喘组,且主要吸入性变应原屋尘螨和粉尘螨的强阳性率亦明显低于哮喘组.变应原免疫治疗则无显著差异.结论 机体对变应原的反应程度与疾病的发生、发展可能存在一定的关系.对变应性鼻炎的早期干预是必要的.     

Clinical efficacy and safety of cervical intralymphatic immunotherapy for house dust mite allergic rhinitis: A pilot study

BackgroundPrevious studies have demonstrated that intralymphatic immunotherapy (ILIT), a less time-consuming alternative to conventional subcutaneous immunotherapy (SCIT), is safe and effective. However, because of the private location of inguinal lymph nodes, inguinal ILIT is relatively inconvenient. We proposed a novel form of ILIT that involves 3 injections of allergen into cervical lymph nodes. The aim of this study is to determine the clinical efficacy and safety of cervical ILIT on house dust mite induced allergic rhinitis (AR) in adults.MethodsIn this study, we performed a prospective cohort study to determine the clinical efficacy and safety of cervical ILIT on house dust mite induced AR in adults, by comparing the symptom scores, quality-of-life scores (QOLS) and drug scores (use of rescue medication) before and after treatment. Meanwhile, side events were also recorded.ResultsCervical ILIT elicited no moderate-severe adverse events. Patients receiving cervical ILIT experienced a significant improvement in nasal symptoms, eye symptoms and quality of life, as compared to baseline (P all <0.001). A reduction in the use of rescue medication was also demonstrated (P < 0.001).ConclusionsIn this first-in-human clinical study, cervical ILIT was demonstrated safe and induced allergen tolerance after 3 injections.     

Efficacy of intranasal steroid spray (mometasone furoate) on treatment of patients with seasonal allergic rhinitis: Comparison with oral corticosteroids

Objective

Intranasal corticosteroids are effective for allergic rhinitis and broadly used in daily clinical practice. Systemic oral corticosteroids are also known to be effective for treatment of allergic rhinitis. These topical and systemic corticosteroids are both effective formulations for allergic rhinitis, and both drugs have some side effects. When treatment formulations for allergic rhinitis are selected based on side effects, topical corticosteroids are more commonly selected than systemic steroids. Systemic corticosteroids, on the other hand, have traditionally been believed to have higher and more instantaneous therapeutic effects than those of topical corticosteroids. However, there have been few reports of direct comparisons between topical corticosteroid and systemic corticosteroid efficacy. The purpose of this study was to evaluate the subjective outcomes of nasal symptom management using topical intranasal corticosteroid therapy or systemic oral corticosteroid therapy in patients with seasonal allergic rhinitis. We compared the efficacy of mometasone furoate nasal spray (MFNS) to betamethasone oral tablets (BOT) for the treatment of patients with seasonal allergic rhinitis.

Methods

In an open label study, patients with seasonal allergic rhinitis who had intermediate-to-severe symptoms and who visited the hospital without prior treatment were allocated to 1 of 3 treatment groups (noncorticosteroid group, topical corticosteroid group, and oral corticosteroid group). Evaluation was conducted using allergy diaries that consisted of patient questionnaires. The Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ) was used in this study.

Results

Compared to only loratazine nonsteroid therapy, both MFNS 200 μg once daily and BOT 0.25 mg twice daily significantly reduced the total and individual symptom scores for sneezing, nasal obstruction, watery nasal discharge, and nasal itching (P < 0.05). Scores for itching of the eyes were reduced slightly more in the MFNS group than in the noncorticosteriod treatment group, but the difference was not significant.

Conclusion

MFNS and BOT have virtually equivalent effects on nasal symptoms in patients with seasonal allergies. Our study was the first direct comparison between an intranasal corticosteroid spray and a systemic oral corticosteroid for seasonal allergic rhinitis. No significant differences were found in the therapeutic effects of the topical and systemic corticosteroids tested, suggesting that topical corticosteroids are expected to sufficiently improve nasal symptoms without administration of oral corticosteroids. Treatment with intranasal corticosteroid spray is more strongly recommended than treatment with systemic corticoid steroids, due to the side effects associated with each treatment.     

鼻腔冲洗联合鼻用糖皮质激素对AR患者FeNO、肺功能及生活质量的影响

目的 探讨变应性鼻炎(AR)患者采用鼻腔冲洗联合鼻用糖皮质激素治疗对呼出气一氧化氮(FeNO)、肺功能及生活质量的影响。 方法 选取我院2016年3月至2017年3月收治的AR患者120例,采用随机数字表法分为观察组和对照组各60例,对照组采用布地奈德喷雾剂治疗,60 μg,每侧1次,每日早晚1次,连续治疗3个月;观察组早晚各采用100 mL生理盐水冲洗治疗,每侧早晚各冲洗1次,冲洗后采用布地奈德鼻喷雾剂治疗,连续治疗3个月。对比两组的FeNO、用力肺活量占预计值的百分比(FVC%)、第1秒用力肺活量占预计值的百分比(FEV₁%)、最高呼气流速(PEF)、平静呼气肺活量(VC%)占预计值的百分比及鼻-结膜炎相关生活质量问卷(RQLQ)评分。 结果 治疗后观察组与对照组FeNO水平分别为(750.2±89.4)×10^-10mol/L、(816.3±92.7)×10^-10mol/L,两组FeNO水平比较差异有统计学意义(t=-3.976, P<0.001)。治疗后,观察组FVC%、FEV₁%、PEF%、VC%水平高于对照组(t分别为3.207、4.211、2.780、3.272, P分别为0.002、<0.001、0.006、0.001)。治疗后观察组与对照组RQLQ评分分别为(29.0±6.4)、(34.4±7.0)分,两组比较差异有统计学意义(t=-4.410, P<0.001)。 结论 采用鼻腔冲洗联合鼻用糖皮质激素治疗AR能降低患者FeNO,在一定程度上改善患者肺功能,提高患者的生活质量。     

舌下含服粉尘螨滴剂联合鼻用激素治疗变应性鼻炎疗效观察

目的 评估舌下特异性免疫治疗联合鼻用激素治疗变应性鼻炎的疗效。方法 将能坚持治疗并定期随访的90例对粉尘螨过敏的变应性鼻炎患者资料纳入研究,随机分为两组,其中60例接受舌下免疫治疗(SLIT)联合鼻用激素治疗,另30例只用鼻用激素治疗,分别记录两组患者治疗前及治疗后6、12个月的症状评分(鼻痒、喷嚏、流涕、鼻塞症状评分)和症状总评分。结果 两组治疗后鼻炎症状均有显著改善,差异有统计学意义(P<0.05);联合治疗组12个月后较治疗6个月后鼻炎症状改善更显著(P<0.05),而单用激素组未再有明显改善(P>0.05);联合治疗组较单用激素组无论6个月后还是12个月后症状改善均更为显著(P<0.05)。结论 舌下特异性免疫治疗联合鼻用激素治疗变应性鼻炎较单用激素更为有效。     

鼻内镜下射频热凝筛前神经治疗常年性变应性鼻炎

目的:探讨提高常年性变应性鼻炎(PAR)疗效的治疗方法。方法:利用鼻内镜行前筛开放术,暴露并用射频热凝筛前神经鼻内支治疗22例PAR患者。结果:随访1年,显效18例(81.82％),有效3例(13.64％),无效1例(4.54％),总有效率95.46％,无严重并发症发生。结论:鼻内镜前筛开放术射频热凝筛前神经治疗PAR具有疗效显著,治疗部位精确等优点,有较好临床应用价值。