Different medications for seasonal allergic rhinitis in adults:A systematic review and meta-analysis

BACKGROUND While the efficacy of medications such as fluticasone furoate(FF),fluticasone propionate(FP),and azelastine-fluticasone(AF)has been substantiated in comparison to their respective placebo controls,uncertainties persist regarding the comparative effectiveness of different intranasal agents.AIM To evaluate the efficacy of FP,FF,and AF in the treatment of adult patients with seasonal allergic rhinitis(SAR)using a meta-analytic approach.METHODS A computer search was conducted in Cochrane Library,PubMed,and EMBASE databases to identify randomized controlled trials assessing the effectiveness and safety of FF,FP,and AF in treating SAR.Data on treatment safety and efficacy were extracted and analyzed through meta-analysis.RESULTS A total of 20 studies were included,comprising 10590 participants.The results of the direct meta-analysis indicated that,compared to placebo,both relative Total Nasal Symptom Score(rTNSS)and relative Total Ocular Symptom Score(rTOSS)significantly decreased post-intervention[mean difference(MD)=-1.48,95%confidence interval(CI):-1.73 to-1.22;MD=-0.66,95%CI:-0.82 to-0.49],with similar findings observed across the FF,FP,and AF subgroups.The network meta-analysis results showed that for improving rTNSS and rTOSS,the SUCRA values ranking from highest to lowest were AF,FP,FF,and placebo.Improvements in rTNSS and rTOSS with FP,FF,and AF were all significantly greater than those observed with placebo,with AF demonstrating superior efficacy compared to both FP and FF.No statistically significant difference in rTNSS improvement was found between FP and FF,although FP exhibited significantly greater improvement in rTOSS compared to FF.CONCLUSION In adult patients with SAR,the combination of azelastine and fluticasone shows a significant effect in improving nasal and ocular symptoms,with FP demonstrating marked improvement in ocular symptoms compared to FF.

Epidemiological Features of Allergic Rhinitis in Four Major Cities in Western China

Allergic rhinitis（AR）,with an increasing uptrend of the prevalence in many developed and developing countries,is a global health problem that affects people of all ages and ethnic groups.However,data on the prevalence of self-reported AR in western China are rare.This study investigated the epidemiological features of self-reported AR in western China.In the cross-sectional,population-based study,a validated questionnaire survey on self-reported AR was carried out in 4 major cities in western China by multistage,stratified and cluster sampling,from January to December 2008.The total prevalence rate was 34.3%,with 32.3%（Chongqing）,34.3%（Chengdu）,37.9%（Urumqi）,30.3%（Nanning）,respectively.The prevalence presented to increase with age before 30 years old while decrease with age after 30 years old,and the highest prevalence was in 19-30 years group in Chongqing,Chengdu and Nanning which significantly showed ＂persistent and moderate-severe＂ type（P0.0001）;In Urumqi,there wasn＇t a significant increasing or decreasing trend of prevalence rate with age but with an ＂intermittent and mild＂predominance（P0.0001）.There were no distinct sexual differences in prevalence rates in the 4 cities.The morbidity was positively related to monthly average temperature and sunshine（r=0.76645,P=0.0036;r=0.67303,P=0.0165）,but negatively associated with relative humidity（r=-0.64391,P=0.0238） in Urumqi.Interestingly,the monthly morbidity was negatively associate with average temperature,sunshine and precipitation in Nanning（r=-0.81997,P=0.0011;r=-0.60787,P=0.0360;r=-0.59443,P=0.0415）.Self-reported AR is becoming common in western China with a rapid development in recent years,affecting about three persons out of ten.The climatic factors may have an indirect impact on the prevalence rate through the effects on the local allergens.

Recent developments in immunotherapy approaches for allergic rhinitis

Allergic rhinitis(AR)poses a significant global health burden,with the potential to progress to asthma,thereby impacting patients’quality of life.Immunotherapy has demonstrated effectiveness in mitigating clinical symptoms by altering the underlying disease mechanisms of AR.This article provides a thorough review of the current state of immunotherapy for AR,encompassing various facets of immunotherapeutic strategies,elucidating their mechanisms and clinical implications.By presenting a nuanced understanding of the present landscape of immunotherapy for AR,this review aims to serve as a valuable reference for informing clinical treatment strategies.The subsequent analysis of diverse immunotherapeutic pathways offers a comprehensive understanding of their mechanisms and clinical implications.A meticulous examination is conducted on subcutaneous immunotherapy,sublingual immunotherapy,oral immunotherapy,intralymphatic immunotherapy,and innovative intravenous gold-induced autologous serum injection therapy.Each pathway is systematically elucidated,with its distinctive features and potential contributions to managing AR emphasized.In conclusion,synthesizing epidemiological insights,immunotherapeutic nuances,and pathway-specific analyses encapsulates a profound understanding of immunotherapy for AR.

Overview of Research on the Clinical Treatment of Allergic Rhinitis

Three kinds of treatment for allergic rhinitis(Western medicine,traditional Chinese medicine and their combination)were described respectively,and the different treatment methods of AR and their characteristics were analyzed.This study will help to further improve the diagnosis and treatment of the disease and promote the early recovery of patients.

Progress in the Application of Mendelian Randomization Analysis in Allergic Rhinitis

Allergic rhinitis (AR) is a non-infectious chronic inflammatory disease of the nasal mucosa mediated mainly by immunoglobulin E (IgE) in atopic individuals after exposure to allergens, with the typical symptoms of paroxysmal sneezing, watery runny nose, itchy nose and nasal congestion. Mendelian randomization (MR), an innovative epidemiological approach that uses common genetic variants as instrumental variables for exposure, thus enabling prediction of their causal relationship with outcomes, has been widely used in recent years in studies related to AR. This paper provides a review of the method and its progress in the field of allergic rhinitis research.

Establishment and Evaluation of a Mouse Model of Allergic Rhinitis

[Objectives]To explore a new method for induction of allergic rhinitis in mice,and compare and evaluate it with common modeling methods.[Methods]36 mice were randomly divided into the control group,blank group and experimental group,and there were 12 mice in each group.The mice in the control group were conventionally induced.That is,the mice were first injected intraperitoneally with the mixture composed of OVA 50μg,[Al(OH)3]5 mg and 1ml of normal saline once every other day,and then since the 15 th d,20μL of 5%OVA solution was dropped into each nasal cavity once a day,which lasted for 7 d.The blank group was treated with the same amount of normal saline according to the control group,and received intraperitoneal injection and bilateral nasal drip respectively.In the experimental group,mice were first given intraperitoneal injection of the mixture composed of ovalbumin(OVA)75μg,aluminum hydroxide gel[Al(OH)3]8 mg and normal saline 1.5 mL for basic sensitization.On the 26 th d,20μL of 3%OVA solution was dropped into each nasal cavity once a day,which lasted for 10 d.The number of sneezes,the number of nose scratching,the amount of nasal discharge,and the activity of mice in each group were observed,and the behavior of allergic reaction was scored.Meanwhile,the number of eosinophils in the nasal discharge of mice and the IgE content in serum were measured.[Results]The score of nasal stimulation symptoms,the number of eosinophils and serum IgE level of mice in the control group and the experimental group were higher than those in the blank group(P<0.05),and there was no statistical significance between the two groups in the three indicators(P>0.05).[Conclusions]The modeling method was more suitable for the development of allergic rhinitis patients condition,and reduced the probability of death of mice due to modeling,and simplified the experimental operation.

Effect of Centipeda Herba Volatile Oil on Allergic Rhinitis by Nasal Sniffing

[Objectives] To explore the efficacy of different concentrations of Centipeda Herba volatile oil in the treatment of allergic rhinitis (AR) by nasal sniffing and the optimal drug concentration.[Methods] Forty-eight mice were randomly divided into control group, blank group, alcohol treatment group, low concentration group, medium concentration group and high concentration group, with 8 mice in each group. Except for the blank group, each mouse in the other groups was intraperitoneally injected with 1 mL of a mixture of 50 μgOVA+5 mg [Al(OH) 3] +1 mL of normal saline for 14 d. The allergic rhinitis mouse model was successfully established by intranasal instillation of 5% OVA solution on both sides (20 μL per side, once a day) from the 15 th day after stimulation for 7 d. The blank group was treated with the same amount of saline as above. The volatile oil of Centipeda Herba was obtained by steam distillation and petroleum ether extraction, and then was made into 1.25%, 2.5% and 5% volatile oil of Centipeda Herba with 75% alcohol. The control group was stimulated once every other day with reagent 2 after 7 d of stimulation (maintenance) until the end of treatment. The blank group was treated with 5 mL saline by nasal sniffing for 30 d, twice in the morning and evening, 30 min each time. The alcohol treatment group was treated with 5 mL of 75% alcohol, and the low concentration group, the medium concentration group and the high concentration group were treated with 5 mL of 1.25%, 2.5% and 5% Centipeda Herba volatile oil, respectively. The treatment time was the same as that of the blank group, and the treatment process was carried out in their respective closed contamination boxes. Before and after the treatment, the frequency of sneezing, the frequency of scratching nose, the amount of nasal discharge, activity and other general characteristics of the mice were observed, and the allergic behavior score was carried out. Besides, the IgE content in the serum of the mice was determined, and the eosinophils in the nasal discharge were counted.[Results] The scores of mice before and after treatment showed that there was no significant difference in the alcohol treatment group before and after treatment ( P >0.05), and there was significant difference in the low, medium and high concentration groups before and after treatment ( P <0.05), except that there was no significant difference between the control group and the alcohol treatment group ( P >0.05), and there was significant difference among the other groups ( P <0.05). The levels of IgE and the number of eosinophils in peripheral serum of mice in the control group, alcohol treatment group, low concentration group, medium concentration group and high concentration group were higher than those in the blank group ( P <0.05), and there was no significant difference between the two groups ( P >0.05).[Conclusions] Volatile oil of Centipeda Herba can be used to treat allergic rhinitis by nasal sniffing, and 5% volatile oil of Centipeda Herba has the best effect. During the treatment, sneezing and runny nose in mice were reduced. The results showed that nasal sniffing was less irritating to the nasal cavity and not easy to produce discomfort, the utilization rate of drugs was higher than that of traditional therapy, and the volatile oil could be preserved longer than that of traditional Chinese medicine.

Study on Cytokines IL-2,IL-6,IL-10 in Patients of Chronic Allergic Rhinitis Treated with Acupuncture

OBJECTIVES: To observe the plasmatic concentration of IL-6, IL-10 and IL-2 in the patient of chronic allergic rhinitis before and after acupuncture therapy. METHODS: Cytokine levels were determined before and after treatment in 30 healthy volunteers (Group A) and 90 patients of chronic allergic rhinitis (Group B) with an increased plasma IL-10 level. Group B was then divided into 3 subgroups: 30 patients treated with real acupuncture (Group B1); 30 patients treated with sham acupuncture (Group B2); 30 non-treated patients (Group B3). RESULTS: The allergic subjects of group B1, compared with controls, showed a significant reduction of IL-10 after a specific treatment with acupuncture (P

Clinical Research into Ke Min Yin for Treatment of Persistent Allergic Rhinitis in Patients with Qi Deficiency and Blood Stasis

Persistent allergic rhinitis (PAR) is one of the common diseases at ear-nose-throat department. From August 1998 to May 2001, we randomly selected 60 cases of PAR with qi deficiency and blood stasis for a clinical observation. 30 patients in the treatment group were treated with Ke Min Yin (克敏饮), a herbal medicine, to supplement qi, expel wind, nourish blood and promote blood circulation; and the other 30 cases in the control group were treated with cetrine. Through systematic observation and statistical processing, the clinical research is summarized and reported in the following.

ACUPUNCTURE TREATMENT OF ALLERGIC RHINITIS

Case HistoryName:Kerstin Wiest;Sex:female;Age:46 years;Occupation:teacher;Date of firstvisit:April,1996.Chief complaint:Allergic rhinitis for fiveyears.The patient stated that five years before,she got the sensation of weakness and lassitudeafter undergoing a uterectomy,which

A CLINICAL OBSERVATION ON THERAPEUTIC EFFECTS OF ACUPUNCTURE FOR ALLERGIC RHINITIS

The author applied acupuncture to treat52 cases of allergic rhinitis with certaintherapeutic effectiveness confirmed by afollowing-up for one year and more.The resultis reported as follows.

Effects of lysedEnterococcus faecalis FK-23 on experimental allergic rhinitis in a murine model

In the current study, we sought to investigate whether lysed Enterococcus faecalis FK-23 （LFK）, a heat-killed probiotic preparation, attenuated eosinophil influx into the upper airway and had immunomodulatory activity in a murine allergic rhinitis model. Eighteen BALB/c mice were divided into three groups; the ovalbumin （OVA）-sen- sitized/challenged group, which received saline orally for 6 weeks （OVA group）, the OVA-sensitized/challenged group, which received LFK orally for 6 weeks （LFK-fed group）, and the non-sensitized group, which received saline for 6 weeks （saline control group）. Nasal rubbing and sneezing were monitored during the study. After the final challenge, interleukin （IL）-4, interferon （IFN）-y, and OVA-specific IgE levels in the sera and splenocyte culture supernatants were determined, eosinophilic infiltrate into the upper airway was quantified, and splenic CD4~CD25＋ regulatory T cells （Tregs） were examined by flow cytometry. We found that nasal rubbing was sig- nificantly reduced in LFK-fed mice compared to the OVA group on d 27 and 35, and sneezing was significantly inhibited by LFK administration for 35 d. LFK-fed mice had significantly less eosinophil influx into the nasal mucosa than the OVA group. There were no significant differences between the LFK-fed group and OVA group in the serum and splenocyte culture supernatant levels of IL-4, IFN-y, and OVA-specific IgE. Interestingly, the LFK-fed mice had a significantly greater percentage of splenic CD4＋CD25＋ Tregs than OVA group. Our results indicate that oral administration of LFK may alleviate nasal symptoms, reduce nasal eosinophilia, and increase the percentage of CD4＋CD25＋ Tregs in experimental allergic rhinitis.

Effect of RNA interference therapy on the mice eosinophils CCR3 gene and granule protein in the murine model of allergic rhinitis

Objective:To observe the clinical manifestations of allergic rhinitis mice and the expression changes of the eosinophils CCR3 and the granule protein rnRNA in the bone marrow,peripheral blood and nasal lavage fluid.Mctliods:Twenty-four BALB/c mice were randomly divided into the control group.PBS therapy group.siKNA therapy group and the CCR3 siRNA therapy group(n=6).Allergic rhinitis model were sensitized and stimulated by ovalbunfin,and CCR3 siKNA therapy group were administered with CCH3 transnasally before stimulated.The levels of the eosinophils CCR3.MBP.ECP and EPO in bone marrow,peripheral blood and nasal lavage fluid were detected by RT-PCR.Results:Compared to the control group and CCR3 siR.NA therapy group,the nasal mucosa of the PBS therapy group and siRNA therapy group developed epithalaxy.goblet cells hyperplasia,squamous epithelium metaplasia,epithelium necrosis,lamina propria and submucosa gland hyperplasia,vasodilatation,tissue edema,and the characterized eosinophil infiltration.RT-PCR indicated that the CCR3 rnRNA,MBP.ECP and EPC)expression in bone marrow,peripheral blood and nasal lavage fluid of the CCR3 siKNA therapy group was lower than the PBS therapy group and siR.NA therapy group(P<0.05).Conclusions:The RNA interference therapy to CCR3 by local administration pernasal can suppress the process of the development,migration and invasion of the allergic rhinitis eosinophil,thus can reduce the effect of eosinophils and then reduce the inflammation effect of the allergic rhinitis.It may be a new treatment for respiratory tract allergic inflammation.

Association between Promoter Polymorphisms of Interleukin-4 Gene and Allergic Rhinitis Risk: a Meta-analysis

Summary： The relationship of interleukin-4 （IL-4） C-33T and C-590T （C-589T） gene polymorphisms with allergic rhinitis was analyzed. Data about the case control studies of IL-4 gene promoter polymorphisms [C-33T and C-590T （C-589T）] and their association with allergic diseases and correlation between serum IL-4 levels and allergic rhinitis were retrieved. The Stata 12.0 statistical soitvcare was applied to analyze the correlation between IL-4 gene polymorphisms and allergic rhinitis. The meta-analysis result of TT/CC genotype of -590 （-589） polymorphism showed a significant association with allergic diseases [OR=1.93, 95% CI （1.61 2.31）, P=0.00]. Meta-analysis of the TT＋TC versus CC genotype of IL-4 C-33/T polymorphism revealed significant associations with allergic diseases [OR=3.23, 95% CI （1.13-9.25）, P=0.03]. Meanwhile, there was a significant correlation between serum IL-4 levels and allergic rhinitis [OR=2.52, 95% CI-（1.80-3.23）, P=0.00]. IL-4 gene -590 TT genotype may increase the risk of allergic rhinitis and the T allele mutation of -33 might be correlated with aller- gic rhinitis.

p38 MAPK Regulates Th2 Cytokines Release in PBMCs in Allergic Rhinitis Rats

Th2 cytokines play a pivotal role in the pathogenesis of allergic rhinitis. To investigate the effect of p38 mitogen-activated protein kinase （MAPK） on the production of Th2 cytokines such as IL-4 and IL-5 in allergic rhinitis, a model of allergic rhinitis was established in SD rats. The expression level of p38 MAPK mRNA in PBMCs was detected by means of real time quantitative RT-PCR. The p38 MAPK activity in PBMCs was detected by Western blotting. PBMCs were cultured with various concentrations of p38 MAPK inhibitor SB 239063 or without the treatment, and then IL-4, IL-5 levels of the supernatant were determined by using sandwich ELISA. The results showed that mRNA expression and activity of p38 MAPK in PBMCs were significantly higher in allergic rhinitis rats than in control rats （P〈0.05）. The p38 MAPK inhibitor SB 239063 decreased the production of IL-4 and IL-5 in a dose-dependent manner. It is concluded that p38 MAPK plays an important role in the pathogenesis of allergic rhinitis which is associated with Th2 cytokines release.

Single-allergen Sublingual Immunotherapy versus Multi-allergen Subcutaneous Immunotherapy for Children with Allergic Rhinitis

It has always been controversial whether a single allergen performs better than multiple allergens in polysensitized patients during the allergen-specific immunotherapy. This study aimed to examine the clinical efficacy of single-allergen sublingual immunotherapy(SLIT) versus multi-allergen subcutaneous immunotherapy(SCIT) and to discover the change of the biomarker IL-4 after 1-year immunotherapy in polysensitized children aged 6–13 years with allergic rhinitis(AR) induced by house dust mites(HDMs). The AR polysensitized children(n=78) were randomly divided into two groups: SLIT group and SCIT group. Patients in the SLIT group sublingually received a single HDM extract and those in the SCIT group were subcutaneously given multiple-allergen extracts(HDM in combination with other clinically relevant allergen extracts). Before and 1 year after the allergen-specific immunotherapy(ASIT), the total nasal symptom scores(TNSS), total medication scores(TMS) and IL-4 levels in peripheral blood mononuclear cells(PBMCs) were compared respectively between the two groups. The results showed that the TNSS were greatly improved, and the TMS and IL-4 levels were significantly decreased after 1-year ASIT in both groups(SLIT group: P<0.001; SCIT group: P<0.001). There were no significant differences in any outcome measures between the two groups(for TNSS: P>0.05; for TMS: P>0.05; for IL-4 levels: P>0.05). It was concluded that the clinical efficacy of single-allergen SLIT is comparable with that of multi-allergen SCIT in 6–13-year-old children with HDM-induced AR.

Sublingual immunotherapy for pediatric allergic rhinitis: The clinical evidence

Allergic rhinitis affect 10%-20% of pediatric population and it is caused by the Ig E-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient's daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy(SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness.

A cross-sectional study into the correlation of common household risk factors and allergic rhinitis in Taiwan's tropical environment

Objective:To discuss the effect of lesser-known potential risk factors,such as bedroom showers,on the prevalence of allergic rhinitis.Methods:A cross-sectional,population-based study was performed using both survey and fungal culturing in southern Taiwan.There were 998 participants enrolled in the survey,and 513 sets of fungal culture obtained.With score for allergic rhinitis(SFAR) more than 7,the patient was defined to have allergic rhinitis.Risks of allergic rhinitis were calculated as odds ratios for various predicted risk factors by logistic regression.Correlation between predicted risk factors and fungal level were examined with linear regression.Results:The adjusted odds ratio of frequently using bedroom shower to having allergic rhinitis was 1.572(95% confidence interval:1.090-2.265),and 0.962 for people with older age to have AR(95% confidence interval:0.949-0.976).As to the 24-hour fungal level,the standardized coefficient was 0.254 for frequent use of bedroom shower,and 0.106 for window open hours.Conclusions:Use of bedroom shower is a potential risk factor for allergic rhinitis development.

Clinical Observation of Warm Needling Moxibustion for Seasonal Allergic Rhinitis

Objective： To observe the clinical therapeutic effects of warm needling moxibustion for seasonal allergic rhinitis. Methods： One hundred and eighty cases of the patients with seasonal allergic rhinitis were randomly divided into two groups, 90 cases in the warm needling group, treated by acupuncture plus warm needling moxibustion, and 90 cases in the acupuncture group, treated by acupuncture only, to observe the therapeutic effects after one course of the treatments. Results： The total effective rate was 95.6% in the warm needling group and 85.6% in the acupuncture group, with significant statistical difference in comparison between the two groups. Conclusion： The total effective rate of the warm needling moxibustion is better than that of the acupuncture treatment in the treatment of seasonal allergic rhinitis.

Serum IL-10 Level in Allergic Rhinitis Patients and Its Effect on Serum Total IgE

To investigate the level of serum IL-10 in allergic rhinitis patients and the correlation between IL-10 and serum total IgE （TIgE）. 50 allergic rhinitis patients and 30 normal subjects were involved in the study. The levels of serum IL-10 and TIgE were measured by enzyme-linked immunosorbent assay （ELISA）, and the correlation between serum IL-10 and TIgE was analyzed. In the allergic rhinitis group, the levels of serum IL-10 and TIgE were 8.34±2.48 pg/mL and 142.6± 28.2 KUA/L. In the normal control group, they were 12.86±.88 pg/mL and 47.2±12.2 KUA. There were significant differences between the two groups （P〈0. 01）; and the level of serum TIgE in the patients was negatively correlated with that of IL-10 （r= -0.46, P=0. 02）. The level of serum IL-10 was significantly decreased in allergic rhinitis patients, which was beneficial to the synthesization of IgE. IL-10 plays an important role in the episode of allergic rhinitis.