Allergic rhinitis and dental-supporting tissue diseases in children

The etiology of dental-supporting tissue diseases in children is multi factorial and not merely related to oral hygiene. Therefore, in the present study, we investigated the relationship between children <18 years old with allergic rhinitis (AR) and the risk of dental-supporting tissue diseases.Data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective longitudinal cohort study. The study cohort comprised 378,160 patients with AR (AR group) and 378,160 patients without AR (non-AR group), who were selected through frequency matching based on age, sex, and the index year. The study patients were followed until dental-supporting tissue diseases occurrence, withdrawal from the National Health Insurance program, or December 31, 2013. Cox proportional hazards regression analysis was conducted to calculate the risk of dental-supporting tissue diseases in the AR group after adjustment for age, sex, and relative comorbidities.The adjusted HRs of periodontal, pulp, and periapical diseases in AR children were higher than those in the non-AR controls (1.51, 95% CI: 1.50 to 1.53; 1.06, 95% CI: 1.05 to 1.07, respectively). The AR to non-AR HRs of these inflammatory dental diseases were particularly higher in children <6 years old and in boys. The HRs of periodontal, pulp, and periapical diseases were greatest in those with >5 AR-related medical visits/year (5.57, 95% CI: 5.50 to 5.56; 4.06, 95% CI: 4.00 to 4.12, respectively).Children with AR had a greater risk of inflammatory dental-supporting tissue diseases, particularly those <6 years old with primary teeth, boys, and those with severe persistent AR.     

Lower airway inflammation and hyperresponsiveness in non-asthmatic patients with non-allergic rhinitis

Background

Potential associations between non-allergic rhinitis (NAR) and asthma have been verified epidemiologically, but these associations remain not very clear. It is necessary to further explore the possible implication of lower airway abnormities in NAR patients but without asthma. This study aims to determine lower airway hyperresponsiveness (AHR), inflammation and lung function in non-asthmatic patients with NAR.

Methods

We recruited 262 non-asthmatic patients with NAR, 377 with AR and 264 healthy subjects. All subjects were non-smokers who underwent meticulous history taking, nasal examination, allergen skin prick test (SPT), blood routine test, measurement of fractional exhaled nitric oxide (FeNO), methacholine bronchial challenge test and induced sputum eosinophil count, in this order.

Results

Compared with healthy subjects, non-asthmatic patients with NAR yielded markedly lower FEV₁/FVC, maximal mid-expiratory flow (MMEF), mid-expiratory flow when 50% of FVC has been expired (MEF_50%) and mid-expiratory flow when 75% of FVC has been expired (MEF_25%) (P<0.05). Differences in spirometry between group AR and NAR were unremarkable (P>0.05). Patients with NAR yielded higher rate of AHR and higher FeNO levels than healthy subjects but lower than those with AR. The proportion of lower airways disorders (sputum eosinophilia, high FeNO levels or AHR) was highest in group AR (70.8%), followed by NAR (53.4%) and healthy subjects (24.2%) (P<0.01). However, sputum eosinophils in NAR patients were not higher compared with healthy subjects (P>0.05). Sputum eosinophils and FeNO had significant correlation with positive AHR and MMEF in group AR but not in NAR.

Conclusions

Non-asthmatic patients with NAR harbor lower AHR, small airways dysfunction and inflammation, despite being less significant than those with AR. This offers clues to unravel the link between NAR and asthma.     

儿童过敏性鼻炎与支气管哮喘

很久以来一直认为儿童过敏性鼻炎与哮喘具有相关性。新近的流行病学研究证明,上、下呼吸道之间确实存在相互联系。而且,有多个学说解释过敏性鼻炎与哮喘的关系,两者具有相似的免疫学机制和病理生理学基础。越来越多的证据表明,过敏性鼻炎与哮喘具有共同的发病因素,且经常在同一个患者中并存,因此在制定治疗策略时应考虑完整气道的概念。     

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.     

Exhaled Nitric Oxide in Children with Allergic Rhinitis and/or Asthma: A Relationship with Bronchial Hyperreactivity

Background. Nowadays, the measure of the fractional concentration of exhaled nitric oxide (FeNO) enables to assess airway inflammation during an office visit and there is international consensus on this testing methodology. The aim of this study was to evaluate whether FeNO measurement is predictable for bronchial hyperreactivity (BHR) in children with allergic rhinitis, asthma, or both. Methods. Two hundred and eighty children with allergic rhinitis, allergic asthma, or both were evaluated. Bronchial function (FEV₁ and FEF_25–75), BHR (assessed by methacholine challenge), FeNO, and sensitizations were assessed. Results. Bronchial function, BHR, and FeNO were significantly different in the three groups (p < .001). A strong inverse correlation between FeNO and BHR was found in patients with asthma and with asthma and rhinitis (r?=??0.63 and r?=??0.61, respectively). A cutoff of 32 ppb of FeNO was a predictive factor for BHR. Conclusions. This study highlights the relevance of FeNO as possible marker for BHR in allergic children and underlines the close link between upper and lower airways.     

缓激肽在过敏性疾病发病机制中的作用

作为激肽释放酶-激肽系统的终末效应物质之一,缓激肽具有多种生物活性,如扩血管、增加血管通透性、诱导非血管平滑肌收缩等。近年来围绕缓激肽在过敏性哮喘、鼻炎等过敏性疾病中的作用开展了一些新的研究,并取得了一些进展。本文从激肽释放酶-激肽系统,缓激肽受体及受体后信号转导,缓激肽与过敏性疾病、血管性水肿的关系及以缓激肽为靶点的抗过敏药物研发等方面综述了缓激肽在过敏性疾病发病机制中的作用。     

Household mold exposure in association with childhood asthma and allergic rhinitis in a northwestern city and a southern city of China

BackgroundThe prevalence of asthma and allergic diseases has increased rapidly in Chinese cities over the past decades. Few studies have examined the potential role of household mold in asthma and allergies in Chinese cities.MethodsA cross-sectional survey in 4,691 school-age children was performed in Lanzhou and Wuhan. The two cities represent distinct climate conditions, as Lanzhou, located in northwestern China, has dry and cold winter and relatively cool summer whereas Wuhan, located in central-southern China, has hot and humid summer and mild winter temperatures. Two schools were randomly selected from a suburb and an urban area of each city, respectively. Data were collected using a modified Chinese version of the American Thoracic Society (ATS) standard respiratory health questionnaire for children, regarding asthma, substance allergy, allergic rhinitis, presence of mold in residence, and household characteristics. Logistic regression models were applied to identify the odds ratios of childhood asthma and allergies with regard to mold.ResultsThe prevalence rates of asthma, substance allergy, allergic rhinitis, and mold, were all higher in Wuhan than in Lanzhou. We observed significant associations of household mold with increased prevalence for both asthma [odds ratio (OR) =2.399, 95% confidence interval (95% CI): 1.309–4.398], substance allergy (OR =1.729, 95% CI: 1.282–2.332) and allergic rhinitis (OR =1.969, 95% CI: 1.491–2.600), with spatial heterogeneity across urban versus suburban schools. The mold effect was modified by age group and breast-feeding status.ConclusionsAcross two climatically distinct cities, household mold exposure was significantly associated with an increased risk for asthma and allergies. Younger children and children from the suburbs were more likely to be affected by mold. Whether breastfeeding enhanced or weakened the mold effects were inconsistent across the cities and across the health outcomes.