Rinitis Alergica

1. Ann Allergy Asthma Immunol. 2015 Aug;115(2):137-42.
doi:
10.1016/j.anai.2015.05.019.
No hypothalamic-pituitary-adrenal function effect with beclomethasone
dipropionate nasal aerosol, based on 24-hour serum cortisol in pediatric allergic
rhinitis.
Hampel FC Jr(1), Nayak NA(2), Segall N(3), Small CJ(4), Li J(4), Tantry SK(4).
Author information:
(1)Central Texas Health Research, New Braunfels, Texas. Electronic address:
fchampel@aol.com. (2)Sneeze, Wheeze, and Itch Associates, LLC, Normal, Illinois.
(3)Georgia Allergy and Respiratory, Atlanta, Georgia. (4)Teva Branded
Pharmaceutical Products R&D, Inc, Frazer, Pennsylvania.
BACKGROUND: Intranasal corticosteroids are the mainstay of allergic rhinitis (AR)
treatment. Their potential to suppress the hypothalamic-pituitary-adrenal axis
should be evaluated, especially after long-term daily use in children.
OBJECTIVE: To evaluate the effects of treatment with non-aqueous beclomethasone
dipropionate (BDP) nasal aerosol on hypothalamic-pituitary-adrenal axis function
in children with perennial AR.
METHODS: In this double-blinded, placebo-controlled, parallel-group study,
patients (6-11 years old) with perennial AR were randomized (2:1) to BDP nasal
aerosol at 80 g/day (n = 67) or placebo (n = 32). The primary end point was
change from baseline in 24-hour serum cortisol (SC) weighted mean for BDP nasal
aerosol and placebo after 6 weeks of treatment, which was analyzed in the
per-protocol population.
RESULTS: The per-protocol population included 97 patients (BDP nasal aerosol, n =
66; placebo, n = 31). Baseline geometric mean SC weighted mean values were
similar in the 80-g/day BDP nasal aerosol and placebo groups (5.97 and 6.47
g/dL, respectively). After 6 weeks' treatment, geometric mean values were 6.19
and 7.13 g/dL, respectively, with no decrease from baseline in either group.
Geometric mean SC ratio of BDP nasal aerosol at 80 g/day to placebo was 0.91
(95% confidence interval 0.81-1.03), indicating predefined noninferiority. SC
concentration-time profiles were similar for the placebo and 80-g/day BDP nasal
aerosol groups at baseline and week 6. BDP nasal aerosol at 80 g/day was
generally well tolerated.
CONCLUSION: In pediatric patients with perennial AR, 24-hour SC profiles were
comparable for BDP nasal aerosol and placebo, indicating that once-daily BDP
nasal aerosol treatment did not significantly affect
hypothalamic-pituitary-adrenal axis function.
TRIAL REGISTRATION: ClinicalTrials.gov; NCT01697956.
Copyright 2015 American College of Allergy, Asthma & Immunology. Published by
Elsevier Inc. All rights reserved.
PMID: 26250771
[PubMed - indexed for MEDLINE]
2. Ann Allergy Asthma Immunol. 2015 Aug;115(2):130-6. doi:

10.1016/j.anai.2015.05.012. Epub 2015 Jun 24.
Efficacy and safety of beclomethasone dipropionate nasal aerosol in children with
perennial allergic rhinitis.
Berger WE(1), Jacobs RL(2), Amar NJ(3), Tantry SK(4), Li J(4), Small CJ(4).
Author information:
(1)Allergy and Asthma Associates of Southern California, Mission Viejo,
California. Electronic address: weberger@uci.edu. (2)Biogenics Research
Institute, San Antonio, Texas. (3)Allergy Asthma Research Institute, Waco, Texas.
(4)Teva Branded Pharmaceutical Products R&D, Inc, Frazer, Pennsylvania.
BACKGROUND: Beclomethasone dipropionate (BDP) nasal aerosol (non-aqueous) is

approved for management of seasonal and perennial allergic rhinitis (PAR) in
adolescents and adults.
OBJECTIVE: To evaluate the efficacy and safety of BDP nasal aerosol at 80 g/day
in children with PAR.
METHODS: This 12-week, phase 3, double-blinded, placebo-controlled,
parallel-group study randomized 547 children (4-11 years old) with PAR to
once-daily BDP nasal aerosol at 80 g/day or placebo. The primary end point was
change from baseline in average morning and evening reflective total nasal
symptom score (rTNSS) during the first 6 weeks of treatment in patients 6 to 11
years old. Changes from baseline in average morning and evening instantaneous
TNSS (iTNSS) in children 6 to 11 years old and average rTNSS and iTNSS in
children 4 to 11 years old were assessed during the first 6 weeks of treatment.
RESULTS: Improvements were significantly greater with BDP nasal aerosol than with
placebo during the first 6 weeks of treatment in children 6 to 11 years old in
average morning and evening rTNSS and iTNSS (mean treatment difference -0.66 [P =
.002] and -0.58 [P = .004], respectively). Improvements in average morning and
evening rTNSS and iTNSS also were significantly greater in patients 4 to 11 years
receiving BDP nasal aerosol than with placebo during the first 6 weeks of
treatment (P = .002 and P = .004, respectively). Similar improvements were seen
during 12 weeks of treatment. The safety profile of BDP nasal aerosol was
comparable to that of placebo.
CONCLUSION: The BDP nasal aerosol at 80 g/day in children 4 to 11 years old was
well tolerated and effective in controlling nasal symptoms of PAR.
TRIAL REGISTRATION: www.clinicaltrials.gov, identifier NCT01783548.
PMID: 26115578
3. Arch Dis Child. 2015 Jun;100(6):576-82. doi: 10.1136/archdischild-2014-306300.

Epub 2015 Apr 2.
Optimal management of allergic rhinitis.
Scadding GK.
Allergic rhinitis (AR), the most common chronic disease in childhood is often
ignored, misdiagnosed and/or mistreated. Undertreated AR impairs quality of life,
exacerbates asthma and is a major factor in asthma development. It can involve
the nose itself, as well as the organs connected with the nose manifesting a
variety of symptoms. Evidence-based guidelines for AR therapy improve disease
control. Recently, paediatric AR guidelines have been published by the European
Academy of Allergy and Clinical Immunology and are available online, as are a
patient care pathway for children with AR and asthma from the Royal College of
Paediatrics and Child Health. Management involves diagnosis, followed by
avoidance of relevant allergens, with additional pharmacotherapy needed for most
sufferers. This ranges, according to severity, from saline sprays, through
non-sedating antihistamines, oral or topical, with minimally bioavailable
intranasal corticosteroids for moderate/severe disease, possibly plus additional
antihistamine or antileukotriene. The concept of rhinitis control is emerging,
but there is no universally accepted definition. Where pharmacotherapy fails,
allergen-specific immunotherapy, which is uniquely able to alter long-term
disease outcomes, should be considered. The subcutaneous form (subcutaneous
immunotherapy) in children has been underused because of concerns regarding
safety and acceptability of injections. Sublingual immunotherapy is both
efficacious and safe for grass pollen allergy. Further studies on other allergens
in children are needed. Patient, carer and practitioner education into AR and its
treatment are a vital part of management.
Published by the BMJ Publishing Group Limited. For permission to use (where not
already granted under a licence) please go to

http://group.bmj.com/group/rights-licensing/permissions.
PMCID: PMC4514979
PMID: 25838332 [PubMed - indexed for MEDLINE]
4. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43. doi:
10.1177/0194599814561600.
Clinical practice guideline: Allergic rhinitis.
Seidman MD(1), Gurgel RK(2), Lin SY(3), Schwartz SR(4), Baroody FM(5), Bonner
JR(6), Dawson DE(7), Dykewicz MS(8), Hackell JM(9), Han JK(10), Ishman SL(11),
Krouse HJ(12), Malekzadeh S(13), Mims JW(14), Omole FS(15), Reddy WD(16), Wallace
DV(17), Walsh SA(18), Warren BE(18), Wilson MN(19), Nnacheta LC(20); Guideline
Otolaryngology Development Group. AAO-HNSF.
Author information:
(1)Department of Otolaryngology-Head and Neck Surgery, Henry Ford West Bloomfield
Hospital West Bloomfield, Michigan, USA mseidma1@hfhs.org. (2)Department of
Surgery Otolaryngology-Head and Neck Surgery University of Utah, Salt Lake City,
Utah, USA. (3)Johns Hopkins School of Medicine, Department of Otolaryngology-Head
and Neck Surgery, Baltimore, Maryland, USA. (4)Virginia Mason Medical Center,
Seattle, Washington, USA. (5)University of Chicago Medical Center, Department of
Otolaryngology, Chicago, Illinois, USA. (6)Birmingham VA Medical Center,
Birmingham, Alabama, USA. (7)Otolaryngology, Private Practice, Muscatine, Iowa,
USA. (8)Department of Internal Medicine, St Louis University School of Medicine,
St Louis, Missouri, USA. (9)Pomona Pediatrics, Pomona, New York, USA. (10)Eastern
Virginia Medical School, Norfolk, Virginia, USA. (11)Cincinnati Children's
Hospital Medical Center, Cincinnati, Ohio, USA. (12)Wayne State University,
Philadelphia, Pennsylvania, USA. (13)Georgetown University Hospital, Washington,
DC, USA. (14)Wake Forest Baptist Health, Winston Salem, North Carolina, USA.
(15)Morehouse School of Medicine, East Point, Georgia, USA. (16)Acupuncture and
Oriental Medicine (AAAOM), Annandale, Virginia, USA. (17)Florida Atlantic
University, Boca Raton, Florida and Nova Southeastern University, Davie, Florida,
USA. (18)Consumers United for Evidence-based Healthcare, Fredericton, New
Brunswick, Canada. (19)Louisiana State University School of Medicine, New
Orleans, Louisiana, USA. (20)Department of Research and Quality, American Academy
of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.
Comment in
Otolaryngol Head Neck Surg. 2015 Feb;152(2):193-4.
OBJECTIVE: Allergic rhinitis (AR) is one of the most common diseases affecting
adults. It is the most common chronic disease in children in the United States
today and the fifth most common chronic disease in the United States overall. AR
is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5
billion in direct health expenditures annually. It can impair quality of life
and, through loss of work and school attendance, is responsible for as much as $2
to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic
tests and treatments are used in managing this disorder, yet there is
considerable variation in their use. This clinical practice guideline was
undertaken to optimize the care of patients with AR by addressing quality
improvement opportunities through an evaluation of the available evidence and an
assessment of the harm-benefit balance of various diagnostic and management
options.
PURPOSE: The primary purpose of this guideline is to address quality improvement
opportunities for all clinicians, in any setting, who are likely to manage
patients with AR as well as to optimize patient care, promote effective diagnosis
and therapy, and reduce harmful or unnecessary variations in care. The guideline
is intended to be applicable for both pediatric and adult patients with AR.
Children under the age of 2 years were excluded from the clinical practice
guideline because rhinitis in this population may be different than in older

patients and is not informed by the same evidence base. The guideline is intended
to focus on a limited number of quality improvement opportunities deemed most
important by the working group and is not intended to be a comprehensive
reference for diagnosing and managing AR. The recommendations outlined in the
guideline are not intended to represent the standard of care for patient
management, nor are the recommendations intended to limit treatment or care
provided to individual patients.
ACTION STATEMENTS: The development group made a strong recommendation that
clinicians recommend intranasal steroids for patients with a clinical diagnosis
of AR whose symptoms affect their quality of life. The development group also
made a strong recommendation that clinicians recommend oral
second-generation/less sedating antihistamines for patients with AR and primary
complaints of sneezing and itching. The panel made the following recommendations:
(1) Clinicians should make the clinical diagnosis of AR when patients present
with a history and physical examination consistent with an allergic cause and 1
or more of the following symptoms: nasal congestion, runny nose, itchy nose, or
sneezing. Findings of AR consistent with an allergic cause include, but are not
limited to, clear rhinorrhea, nasal congestion, pale discoloration of the nasal
mucosa, and red and watery eyes. (2) Clinicians should perform and interpret, or
refer to a clinician who can perform and interpret, specific IgE (skin or blood)
allergy testing for patients with a clinical diagnosis of AR who do not respond
to empiric treatment, or when the diagnosis is uncertain, or when knowledge of
the specific causative allergen is needed to target therapy. (3) Clinicians
should assess patients with a clinical diagnosis of AR for, and document in the
medical record, the presence of associated conditions such as asthma, atopic
dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and
otitis media. (4) Clinicians should offer, or refer to a clinician who can offer,
immunotherapy (sublingual or subcutaneous) for patients with AR who have
inadequate response to symptoms with pharmacologic therapy with or without
environmental controls. The panel recommended against (1) clinicians routinely
performing sinonasal imaging in patients presenting with symptoms consistent with
a diagnosis of AR and (2) clinicians offering oral leukotriene receptor
antagonists as primary therapy for patients with AR. The panel group made the
following options: (1) Clinicians may advise avoidance of known allergens or may
advise environmental controls (ie, removal of pets; the use of air filtration
systems, bed covers, and acaricides [chemical agents formulated to kill dust
mites]) in patients with AR who have identified allergens that correlate with
clinical symptoms. (2) Clinicians may offer intranasal antihistamines for
patients with seasonal, perennial, or episodic AR. (3) Clinicians may offer
combination pharmacologic therapy in patients with AR who have inadequate
response to pharmacologic monotherapy. (4) Clinicians may offer, or refer to a
surgeon who can offer, inferior turbinate reduction in patients with AR with
nasal airway obstruction and enlarged inferior turbinates who have failed medical
management. (5) Clinicians may offer acupuncture, or refer to a clinician who can
offer acupuncture, for patients with AR who are interested in nonpharmacologic
therapy. The development group provided no recommendation regarding the use of
herbal therapy for patients with AR.
American Academy of OtolaryngologyHead and Neck Surgery Foundation 2014.
PMID: 25644617
5. Curr Med Res Opin. 2015 Mar;31(3):391-6. doi: 10.1185/03007995.2015.1009532.

Epub
2015 Feb 9.
Intranasal budesonide in children affected by persistent allergic rhinitis and
its effect on nasal patency and Nasal Obstruction Symptom Evaluation (NOSE)
score.
Zicari AM(1), Occasi F, Montanari G, Indinnimeo L, De Castro G, Tancredi G, Duse
M.
Author information:
(1)'Sapienza' University of Rome, Department of Pediatrics , Rome , Italy.
Erratum in
Curr Med Res Opin. 2015;31(7):1449. Giulia, Montanari [corrected to
Montanari,
Giulia].
BACKGROUND: Intranasal steroids are recognized as an effective treatment for
allergic rhinitis (AR) although their effect on nasal patency has never been
evaluated with an objective instrument such as anterior rhinomanometry in
children. Moreover this effect has been widely assessed with total Nasal Symptom
Scores (NSS) including all symptoms of allergic rhinitis and not with scores
specifically focused on nasal obstruction such as the Nasal Obstruction Symptom
Evaluation score (NOSE).
MATERIALS AND METHODS: Sixty children (42 males and 18 female) aged 6-10 years,
affected by persistent AR, were randomized and divided in two groups of 30
children to be included in an unblinded trial: one group treated with intranasal
budesonide and isotonic nasal saline for 2 weeks and the other group treated only
with isotonic nasal saline for 2 weeks. Each child underwent rhinomanometry and
completed the NSS and the NOSE scores before and after treatment.
RESULTS: At the baseline nasal patency and NSS total score, NOSE total scores
were correlated (r=-0.29, p<0.001; r=-60, p<0.001). After 2 weeks of treatment
improvements in nasal patency, NSS and NOSE were seen ( NSS 4.13 1.38 vs 1.33
1.93, p<0.001; NOSE 34 17.97 vs 9 18.21, p<0.001; nasal patency -26.13
25.25 vs -11.83 11.31, p<0.001). Correlations were found between rhinitis
duration and nasal patency and NOSE (r=-0.84, p<0.001; r=0.43, p<0.01).
CONCLUSION: Intranasal budesonide is effective in increasing nasal patency in
children. Moreover the NOSE score was strongly correlated with nasal flow and,
hence, this score should be regarded as a valid and reliable instrument in
children.
PMID: 25629793
6. Ann Allergy Asthma Immunol. 2015 Feb;114(2):141-7. doi:

10.1016/j.anai.2014.11.012.
Efficacy of daily intranasal fluticasone propionate on ocular symptoms associated
with seasonal allergic rhinitis.
Ratner P(1), Van Bavel J(2), Mohar D(3), Jacobs RL(4), Hampel F(5), Howland W(6),
Karwal R(7).
Author information:
(1)Sylvana Research Associates, San Antonio, Texas. Electronic address:
pratner@sylvanaresearch.com. (2)Isis Clinical Research, Austin, Texas.
(3)Kerville Research Associates, Kerrville, Texas. (4)Biogenics Research
Institute, San Antonio, Texas. (5)Central Texas Health Research, New Braunfels,
Texas. (6)Sirius Clinical Research, Austin, Texas. (7)GlaxoSmithKline Consumer
Healthcare, Parsippany, New Jersey.
BACKGROUND: Allergic rhinitis (AR) is an inflammatory condition of the nasal
mucosa characterized by symptoms of nasal discharge, itching, sneezing, and
congestion. Ocular symptoms are commonly associated with AR and include itching
or burning, tearing or watering, and redness. Intranasal corticosteroids are a
mainstay of treatment, and their effect on nasal symptoms is well described.
OBJECTIVE: To demonstrate that a 14-day course of 200 g/d of nasal fluticasone
propionate is superior to placebo in relieving ocular symptoms associated with
AR.
METHODS: This was a randomized, double-blind, parallel group, multicenter study
comparing 200 g/d of fluticasone propionate with placebo in patients with

seasonal allergic rhinitis. The primary end point was mean change from baseline
in patient-rated reflective total ocular symptom score (rTOSS). Key secondary end
points included mean change from baseline in the morning and evening rTOSS,
end-of-treatment assessment of response, and effect on activities of daily
living. The primary analysis was performed using analysis of covariance with a
linear fixed-effects model.
RESULTS: Fluticasone was statistically significantly more efficacious in reducing
the ocular symptoms of AR than placebo. The least squares mean difference in the
change from baseline of rTOSS was -0.36 (P = .002). A statistically significant
difference in mean change from baseline was observed in favor of fluticasone for
morning and evening rTOSS. Significantly more patients taking fluticasone
achieved an overall response compared with placebo. Fluticasone had a
significantly greater effect on daily living activities and was well tolerated.
CONCLUSION: This study supports the efficacy of fluticasone in treating ocular
symptoms associated with AR.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01817790.
PMID: 25624132
7. Ann Allergy Asthma Immunol. 2015 Feb;114(2):134-40. doi:

10.1016/j.anai.2014.11.015.
SQ house dust mite sublingually administered immunotherapy tablet (ALK) improves
allergic rhinitis in patients with house dust mite allergic asthma and rhinitis
symptoms.
Mosbech H(1), Canonica GW(2), Backer V(3), de Blay F(4), Klimek L(5), Broge L(6),
Ljrring C(6).
Author information:
(1)Allergy Clinic, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Electronic address: hmos0006@geh.regionh.dk. (2)Allergy and Respiratory Disease
Clinic, University of Genova-IRCCS AOU San Martino, San Martino, Italy.
(3)Bispebjerg University Hospital, Copenhagen, Denmark. (4)Chest Diseases
Department, Strasbourg University Hospital, University of Strasbourg, Strasbourg,
France. (5)Center for Rhinology and Allergology, Wiesbaden, Germany. (6)ALK,
Hrsholm, Denmark.
BACKGROUND: House dust mite (HDM) allergy is associated with persistent allergic
rhinitis (AR) and allergic asthma.
OBJECTIVE: To investigate the efficacy and safety of a SQ HDM sublingually
administered immunotherapy tablet (ALK, Hrsholm, Denmark) in adults and
adolescents with HDM respiratory allergic disease and report the AR results.
METHODS: Six hundred four subjects at least 14 years old with HDM AR and mild to
moderate HDM allergic asthma were randomized 1:1:1:1 to double-blinded daily
treatment with 1, 3, 6 SQ-HDM or placebo. End-of-treatment rhinoconjunctivitis
symptoms and medication score were predefined extrapulmonary end points. A
subgroup analysis was conducted post hoc in subjects with a total combined
rhinitis score (TCRS) > 0 (ie, with AR symptoms and/or AR medication use during
the 4-week baseline period). The subgroup was comprised of 498 subjects (82%).
RESULTS: In the subgroup, the absolute difference in end-of-treatment TCRS
between 6 SQ-HDM and placebo was -0.78 (95% confidence interval -1.47 to -0.07,
relative difference 28.8%, P = .0357). Furthermore, a significant difference was
found for the total score of the Rhinitis Quality of Life Questionnaire with
Standardized Activities RQLQ(S) and for the individual domains: activities,
sleep, non-nose and non-eye symptoms, and nasal symptoms. For the TCRS and
Rhinitis Quality of Life Questionnaire score, a dose response was seen, with
numerically lower, nonsignificant differences for 1 and 3 SQ-HDM. The predefined
analysis for the entire trial population showed no statistically significant

difference between the placebo and actively treated groups. No safety concerns
were observed.
CONCLUSION: Efficacy in mild to severe AR of 6 SQ-HDM compared with placebo was
demonstrated by statistically significant improvements in TCRS and Rhinitis
Quality of Life Questionnaire score in subjects with AR present at baseline. The
treatment was well tolerated.
TRIAL REGISTRATION: EudraCT, no 2006-001795-20; ClinicalTrials.gov, identifier
NCT00389363.
PMID: 25624131
8. Allergy. 2015 Mar;70(3):302-9. doi: 10.1111/all.12560. Epub 2015 Jan 14.

Safety of sublingual immunotherapy Timothy grass tablet in subjects with allergic
rhinitis with or without conjunctivitis and history of asthma.
Maloney J(1), Durham S, Skoner D, Dahl R, Bufe A, Bernstein D, Murphy K, Waserman
S, Berman G, White M, Kaur A, Nolte H.
Author information:
(1)Merck & Co., Inc., Whitehouse Station, NJ, USA.
BACKGROUND: Patients with asthma may be more susceptible to adverse events (AEs)
with sublingual immunotherapy tablet (SLIT-tablet) treatment, such as severe
systemic reactions and asthma-related events. Using data from eight trials of
grass SLIT-tablet in subjects with allergic rhinitis with/without conjunctivitis
(AR/C), AE frequencies were determined in adults and children with and without
reported asthma.
METHODS: Data from randomized, double-blind, placebo-controlled trials of Timothy
grass SLIT-tablet MK-7243 (2800 BAU/75 000 SQ-T, Merck/ALK-Abell) were pooled
for post hoc analyses. Subjects with uncontrolled and severe asthma were excluded
from the trials. Frequencies for treatment-emergent AEs (TEAEs), local allergic
swelling (mouth or throat), systemic allergic reactions, and asthma-related
treatment-related AEs (TRAEs) were calculated.
RESULTS: Among adults (n = 3314) and children (n = 881), 24% and 31%,
respectively, had reported asthma. No serious local allergic swellings or serious
systemic allergic reactions occurred in subjects with asthma treated with
SLIT-tablet. There was no evidence of increased TEAEs, systemic allergic
reactions, or severe local allergic swellings in adults or children with asthma
treated with grass SLIT-tablet versus subjects without asthma in or outside of
pollen season. There were 6/120 asthma-related TRAEs assessed as severe with
grass SLIT-tablet and 2/60 with placebo, without a consistent trend among
subjects with and without asthma (5 and 3 events, respectively).
CONCLUSIONS: In the AR/C subjects with reported well-controlled mild asthma
included in these studies, grass SLIT-tablet did not increase TEAE frequency,
severe local allergic swelling, or systemic allergic reactions versus subjects
without asthma. There was no indication that treatment led to acute asthma
worsening.
2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PMID: 25495666
9. Immunol Allergy Clin North Am. 2015 Feb;35(1):185-98. doi:

10.1016/j.iac.2014.09.003. Epub 2014 Oct 18.
Pediatric allergic rhinitis.
Tharpe CA(1), Kemp SF(2).

Author information:
(1)Division of Clinical Immunology and Allergy, Department of Medicine, The
University of Mississippi Medical Center, 768 Lakeland Drive, Building LJ,
Jackson, MS 39216, USA. (2)Division of Clinical Immunology and Allergy,
Department of Medicine, The University of Mississippi Medical Center, 768
Lakeland Drive, Building LJ, Jackson, MS 39216, USA. Electronic address:
skemp@umc.edu.
Allergic rhinitis is a common pediatric problem with significant comorbidities
and potential complications. This article is an overview of the epidemiology,
pathophysiology, and current therapeutic strategies. Allergic rhinitis management
in a specific child is age dependent and influenced by the severity and frequency
of the symptoms and the presence of any concurrent conditions. Current strategies
permit symptomatic control and improved quality of life for most patients.
Copyright 2015 Elsevier Inc. All rights reserved.
PMID: 25459584
10. Am J Rhinol Allergy. 2014 Nov-Dec;28(6):471-6. doi:

10.2500/ajra.2014.28.4112.
Epub 2014 Oct 20.
300IR 5-Grass pollen sublingual tablet offers relief from nasal symptoms in
patients with allergic rhinitis.
Serrano E(1), Wahn HU, Didier A, Bachert C.
Author information:
(1)Ear, Nose and Throat Department, Larrey Hospital, Toulouse, France.
BACKGROUND: 300IR 5-grass pollen sublingual immunotherapy tablets have been
approved for the treatment of allergic rhinitis (AR) with or without
conjunctivitis in adults and children >5 years with grass pollen allergy. This
study was designed to review data on nasal symptoms with 300IR 5-grass pollen
sublingual tablets in adults and children.
METHODS: We reviewed data from four double-blind, placebo-controlled, randomized
clinical trials. Two groups of patients who received a daily dose of either
placebo or 300IR 5-grass pollen sublingual tablets starting 4 months before the
expected start of the pollen season and continuing through the season were
compared (analysis of covariance) for scores of sneezing, rhinorrhea, nasal
pruritus, nasal congestion, total nasal symptom score (TNSS), and adult
Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores.
RESULTS: Data for 266 children (one pediatric trial) and 1036 adults (three
trials) were analyzed. Compared with the placebo groups, mean TNSS in the 300IR
groups was lower by 22% in children and 19-36% in adults. Among the four nasal
symptoms, the lowest scores relative to placebo were for nasal congestion in
children (31%) and adults (43%). Mean adult RQLQ scores were 21-31% lower in the
300IR group than in the placebo group.
CONCLUSION: Allergen immunotherapy with 300IR 5-grass pollen sublingual tablets
was consistently associated with AR symptom relief in adults and children and
provided a clinically meaningful improvement in quality of life.
PMID: 25335122
11. Curr Opin Otolaryngol Head Neck Surg. 2014 Dec;22(6):487-94. doi:
10.1097/MOO.0000000000000101.
Specific immunotherapy for allergic rhinitis in children.

Wang C(1), Zhang L.
Author information:
(1)aDepartment of Otolaryngology, Head and Neck Surgery, Beijing Tongren
Hospital, Capital Medical University bBeijing Key Laboratory of Nasal Diseases,
Beijing Institute of Otolaryngology, Beijing, People's Republic of China.
PURPOSE OF REVIEW: Allergic rhinitis is a highly prevalent inflammatory disease
affecting 20-40% of the children worldwide. Allergen-specific immunotherapy (SIT)
is an effective treatment for allergic rhinitis. This article reviews the recent
advances in SIT for children.
RECENT FINDINGS: In current clinical practice, immunotherapy is delivered as
either subcutaneous immunotherapy or sublingual immunotherapy (SLIT). Most
meta-analyses and reviews concluded a trend that subcutaneous immunotherapy was
better than SLIT in reducing symptoms of allergic rhinitis and rescue medication
use, however, SLIT has a better safety profile than subcutaneous immunotherapy.
Additionally, the absence of pain on administration of therapy is a character of
SLIT, which is well suited for children. T regulatory cells, especially Tr1 cells
that secrete interleukin-10 and induce production of immunoglobulin G4, play a
role during SIT.
SUMMARY: Although there is substantial evidence for effectiveness of both
subcutaneous immunotherapy and SLIT, safer and more effective SIT approaches are
needed. New approaches to improve SIT include omalizumab pretreatment, use of
recombinant allergens, and alternate routes of administration.
PMID: 25207858
12. Pediatr Allergy Immunol. 2014 Nov;25(7):724-8. doi: 10.1111/pai.12279.

Resveratrol plus carboxymethyl--glucan may affect respiratory infections in
children with allergic rhinitis.
Miraglia Del Giudice M(1), Maiello N, Decimo F, Capasso M, Campana G, Leonardi S,
Ciprandi G.
Author information:
(1)Department of Pediatrics, Second University of Naples, Naples, Italy.
PMID: 25199647
13. Allergol Int. 2014 Sep;63(3):357-75. doi: 10.2332/allergolint.14-RAI-0768.

Japanese Guideline for Allergic Rhinitis 2014.
Okubo K(1), Kurono Y(2), Fujieda S(3), Ogino S(4), Uchio E(5), Odajima H(6),
Takenaka H(7); Japanese Society of Allergology.
Author information:
(1)Department of Otorhinolaryngology, Nippon Medical School, Tokyo, Japan.
(2)Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of
Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. (3)Division
of Otorhinolaryngology Head & Neck Surgery, Department of Sensory and Locomotor
Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan.
(4)School of Allied Health Sciences, Osaka University Graduate School of
Medicine, Osaka, Japan. (5)Department of Ophthalmology, Fukuoka University
Hospital, Fukuoka, Japan. (6)Department of Pediatrics, National Hospital
Organization, Fukuoka National Hospital, Fukuoka, Japan. (7)Osaka Medical
College, Osaka, Japan.
Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but
of the three, it is the only type I allergic disease. Allergic rhinitis includes
pollinosis, which is intractable and reduces quality of life (QOL) when it
becomes severe. A guideline is needed to understand allergic rhinitis and to use
this knowledge to develop a treatment plan. In Japan, the first guideline was
prepared after a symposium held by the Japanese Society of Allergology in 1993.
The current 7th edition was published in 2013, and is widely used today. To
incorporate evidence based medicine (EBM) introduced from abroad, the most recent
collection of evidence/literature was supplemented to the Practical Guideline for
the Management of Allergic Rhinitis in Japan 2013. The revised guideline includes
assessment of diagnosis/treatment and prescriptions for children and pregnant
women, for broad clinical applications. An evidence-based step-by-step strategy
for treatment is also described. In addition, the QOL concept and cost benefit
analyses are also addressed. Along with Allergic Rhinitis and its Impact of
Asthma (ARIA), this guideline is widely used for various clinical purposes, such
as measures for patients with sinusitis, childhood allergic rhinitis, oral
allergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regarding
allergic rhinitis in Japan was added to the end of this guideline.
PMID: 25178177
14. Pediatr Ann. 2014 Aug;43(8):e192-200. doi: 10.3928/00904481-20140723-09.

New developments in the treatment of pediatric allergic rhinitis and
conjunctivitis.
Lierl MB.
The primary care physician is the first line of treatment for allergic rhinitis,
which affects approximately one-fourth of children in the United States. There is
an increasing trend toward self-management by patients or parents due to
high-deductible insurance plans and the over-the-counter availability of allergy
medications. The primary care physician can offer guidance on appropriate
selection of medications and potential adverse effects. Vitamin D deficiency has
been proposed as a potential contributing factor in patients with allergic
diseases, and studies are underway to determine whether supplementation with
vitamin D is helpful for these conditions. Sublingual immunotherapy has recently
received US Food and Drug Administration approval for grass and ragweed
allergens; many children will be interested in this alternative to allergy shots.
The relative advantages and disadvantages of sublingual vs subcutaneous
immunotherapy are discussed.
Copyright 2014, SLACK Incorporated.
PMID: 25102489
15. Allergol Int. 2014 Dec;63(4):543-51. doi: 10.2332/allergolint.14-OA-0688.

Epub
2014 Jul 25.
Efficacy and safety of fluticasone furoate nasal spray in Japanese children with
perennial allergic rhinitis: a multicentre, randomized, double-blind,
placebo-controlled trial.
Okubo K(1), Okamasa A(2), Honma G(2), Komatsubara M(2).
Author information:
(1)Department of Head & Neck and Sensory Organ Science, Graduate School of
Medicine, Nippon Medical School, Tokyo, Japan. (2)Development and Medical Affairs
Division, GlaxoSmithKline K.K., Tokyo, Japan.
BACKGROUND: Fluticasone furoate nasal spray (FFNS) is a glucocorticoid developed

for the treatment of allergic rhinitis (AR). This is the first randomized
clinical trial to assess the efficacy and safety of FFNS in Japanese children
with perennial AR (PAR).
METHODS: In this multicentre, randomized, double-blind, placebo-controlled,
parallel-group, phase III study, 261 children aged 6 to <15 years were treated
with FFNS 55g, once daily or placebo for two weeks. Nasal and ocular symptoms
were rated by parents/guardians/patients in the patient daily diary. The primary
endpoint was the mean change from baseline in the three total nasal symptom score
(3TNSS). In addition, rhinoscopic findings were rated by the investigators as an
efficacy measure. As a safety measure, adverse events and clinical chemistry and
hematology were evaluated.
RESULTS: Mean change from baseline over the entire treatment period in 3TNSS was
greater in the FFNS 55g group compared with placebo, and the difference was
statistically significant (p < 0.001). Significant improvements in rhinoscopic
findings of swelling of inferior turbinate mucosa and quantity of nasal discharge
were also observed. The total ocular symptom score (TOSS) was reduced
significantly in the FFNS 55g group, compared with placebo, in the second week
in a subgroup of patients with baseline TOSS > 0. The incidence of adverse events
was similar between FFNS 55g(18%) and placebo (19%).
CONCLUSIONS: Two-week treatment with FFNS 55g, once daily is effective and
tolerable in Japanese children aged 6 to <15 years with PAR.
PMID: 25056227
16. Kulak Burun Bogaz Ihtis Derg. 2014 Jul-Aug;24(4):217-24. doi:

10.5606/kbbihtisas.2014.48108.
Quality of life in patients with persistent allergic rhinitis treated with
desloratadine monotherapy or desloratadine plus montelucast combination.
Erdoan BA(1), Sanl A, Paksoy M, Altn G, Aydn S.
Author information:
(1)Department of Otolaryngology, Dr. Ltfi Krdar Kartal Training and Research
Hospital, 34890 Cevizli, Kartal, stanbul, Turkey. banuatalay81@gmail.com.
OBJECTIVES: This study aims to compare the effectiveness of desloratadine
monotherapy and desloratadine plus montelukast combination therapy on quality of
life in patients with persistent allergic rhinitis.
PATIENTS AND METHODS: This study consists of 40 patients (28 females, 12 males,
mean age 29.8 years; range 17 to 44 years) referred to ear, nose, and throat
outpatient clinic between May 2010 and September 2010. A six-week randomized,
double-blind, cross-sectional study was performed in two arms: In group 1, 20
patients received desloratadine (5 mg/d) alone; in group 2, 20 patients received
desloratadine (5 mg) plus montelukast (10 mg) combination therapy. Quality of
life was assessed on the day before starting treatment and on the last day of
each treatment period using the Rhinoconjunctivitis Quality of Life Questionnaire
and Nighttime Symptom Scores.
RESULTS: In group 1, the mean quality of life scores before and after treatment
were 3.17 and 2.43, respectively. In group 2, the mean quality of life scores
before and after treatment were 2.94 and 1.73, respectively.
CONCLUSION: Desloratadine plus montelukast combination therapy may have a
positive impact on quality of life, sleep symptoms in particular.
PMID: 25046070
17. J Allergy Clin Immunol Pract. 2014 Jul-Aug;2(4):421-7. doi:

10.1016/j.jaip.2014.04.008. Epub 2014 May 21.
Growth velocity reduced with once-daily fluticasone furoate nasal spray in
prepubescent children with perennial allergic rhinitis.

Lee LA(1), Sterling R(2), Mspero J(3), Clements D(4), Ellsworth A(4), Pedersen
S(5).
Author information:
(1)Respiratory Research and Development, GlaxoSmithKline, Research Triangle Park,
NC. Electronic address: laurie.a.lee@gsk.com. (2)Department of Otolaryngology
Carolina Research, Orangeburg, SC. (3)Allergy and Respiratory Research Unit,
Fundacion CIDEA, Buenos Aires, Argentina. (4)Respiratory Research and
Development, GlaxoSmithKline, Research Triangle Park, NC. (5)Pediatric Research
Unit, Kolding Hospital, Kolding, Denmark.
BACKGROUND: The effect of fluticasone furoate nasal spray (FFNS) on growth in
prepubescent children has not been evaluated.
OBJECTIVE: To characterize the difference in mean prepubescent growth velocities,
as determined by stadiometry, between patients treated continuously for 1 year
with FFNS 110 mcg once daily and placebo nasal spray.
METHODS: This was a multicenter, randomized, double-blind, placebo-controlled,
parallel-group 76-week safety study. Nasal symptom assessments were used as a
measure of adherence. Eligible patients were ages 5 to <8.5 years at screening
and had at least a 1-year clinical history and diagnosis of perennial allergic
rhinitis, including a positive skin test or specific IgE to an appropriate
perennial allergen within the past year.
RESULTS: One hundred eighty-six patients in the FFNS group and 187 patients in
the placebo group completed the entire 52-week treatment period. During
treatment, the least squares mean growth velocity was 5.19 cm/y for the FFNS
group and 5.46 cm/y for the placebo group; mean difference, -0.270 cm/y (95%
CI, -0.48 to -0.06 cm/y). Other safety assessments, including 24-hour urinary
cortisol excretion, were comparable between the treatment groups. Daily
reflective total nasal symptom scores declined similarly in both the FFNS and
placebo groups.
CONCLUSION: Once-daily treatment with FFNS over 52 weeks in prepubescent children
resulted in a small reduction in growth velocity compared with placebo.
Clinicians will need to balance the reduction in growth observed with FFNS to its
potential for clinical benefit.
Copyright 2014 American Academy of Allergy, Asthma & Immunology. Published by
PMID: 25017530
18. Asian Pac J Allergy Immunol. 2014 Jun;32(2):166-70. doi:

10.12932/AP0339.32.2.2013.
Evaluation of animated cartoon-aided teaching of intranasal corticosteroid
administration technique among Thai children with allergic rhinitis.
Indradat S(1), Jirapongsananuruk O, Visitsunthorn N.
Author information:
(1)Division of Allergy and Immunology, Department of Pediatrics, Faculty of
Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand 10700.
BACKGROUND: Correct use of intranasal corticosteroid (INCS) and compliance with
treatment is very important for the treatment of allergic rhinitis (AR). An
animated cartoon-aided teaching method for INCS administration was created to
decrease the workload of health care professionals. The aim of this study was to
compare the performance of children with AR in using INCS between a group who
were instructed using animated cartoon-aided teaching and those receiving only an
oral presentation without demonstration.
METHODS: The study was a prospective randomized controlled trial in children aged
5-16 years with moderate to severe intermittent or persistent AR who had never
used INCS. The patients were randomly divided into 2 groups; 1) those receiving
teaching about how to use INCS by an oral presentation without demonstration and
2) by animated cartoon-aided teaching. The performance of the children was
recorded after the initial training using a five-point checklist. If they were
unable to use the INCS correctly after the first teaching session, the same
instructions were repeated and a second assessment was performed.
RESULTS: A total of 80 patients, 40 each group, underwent randomization. The rate
of achieving competency for the patients after the first instruction using the
animated cartoon-aided teaching group was significantly higher than that for the
oral presentation group (57.5% VS 27.5%; P = 0.007). The cumulative success rate
for the second assessment of the animated cartoon-aided group was also
significantly higher than for those receiving only an oral presentation (95% VS
60%, P = 0.004).
CONCLUSION: With regard to mastering the correct method for INCS usage,
instruction using animated cartoon-aided teaching is better than oral
presentation without demonstration. However, the best method for teaching
patients how to use INCS is a combination of oral explanation and demonstration
by cartoon-aided teaching. The teaching should be repeated periodically to remind
patients of the correct method for INCS usage.
PMID: 25003731
19. BMJ. 2014 Jul 1;349:g4153. doi: 10.1136/bmj.g4153.

Allergic rhinitis in children.
Barr JG(1), Al-Reefy H(2), Fox AT(2), Hopkins C(2).
Author information:
(1)Department of ENT surgery, Guy's and St Thomas' Hospitals NHS Foundation
Trust, London SE1 9RT, UK jgbarr85@gmail.com. (2)Department of ENT surgery, Guy's
and St Thomas' Hospitals NHS Foundation Trust, London SE1 9RT, UK.
Erratum in
BMJ. 2014;349:4923.
PMID: 24986886
20. Curr Med Res Opin. 2014 Oct;30(10):1931-5. doi: 10.1185/03007995.2014.938731.

Epub 2014 Jul 7.
Resveratrol plus carboxymethyl--glucan reduces nasal symptoms in children with
pollen-induced allergic rhinitis.
Miraglia Del Giudice M(1), Maiello N, Capristo C, Alterio E, Capasso M, Perrone
L, Ciprandi G.
Author information:
(1)Department of Women and Children and General and Specialized Surgery, Second
University of Naples , Naples , Italy.
OBJECTIVE: Allergic rhinitis (AR) is caused by an IgE-mediated inflammatory
reaction consequent to the exposure to causal allergen. Resveratrol is a natural
non-flavonoid polyphenol, exerting anti-inflammatory activity; -glucan is a
polysaccharide with immuno-modulatory properties. Thus, this study aimed to
investigate whether these combined compounds are able of relieving nasal symptoms
in children with AR due to pollen allergy.
RESEARCH DESIGN AND METHODS: The present study was conducted as
placebo-controlled, double-blinded, and randomized. Globally, 68 children (36
males; mean age 7.9 years) were treated with resveratrol plus -glucan or placebo
(the diluent of active drug) two sprays (100L/spray) in each nostril three
times/day for 2 months. Nasal symptoms, including itching, sneezing, rhinorrhea,
and obstruction, were assessed at baseline and after treatment. Use of rescue
medication, such as cetirizine syrup, was also evaluated.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID NCT02130440.
RESULTS: Children treated with active drug achieved a significant reduction in
all nasal symptoms: itching (p=0.0001), sneezing (p=0.0009), rhinorrhea
(p=0.009), and obstruction (0.002) as well as antihistamine use (p=0.003).
Placebo did not affect nasal complaints and cetirizine use. The intergroup
analysis showed that active treatment was significantly superior to placebo about
reduction of AR symptoms and rescue medication use.
CONCLUSIONS: The present preliminary study firstly showed that intranasal
resveratrol plus carboxymethyl--glucan is capable of significantly improving
nasal symptoms in children with pollen-induced AR.
PMID: 24983742
21. Rhinology. 2014 Jun;52(2):133-6. doi: 10.4193/Rhin.

Application of Peak Nasal Inspiratory Flow reference values in the treatment of
allergic rhinitis.
de Souza Campos Fernandes S, Ribeiro de Andrade C, da Cunha Ibiapina C.
Comment in
Rhinology. 2014 Dec;52(4):444.
Rhinology. 2014 Dec;52(4):444.
OBJECTIVE: To assess the applicability of the Peak Nasal Inspiratory Flow (PNIF)
curves in follow-up of children in the treatment of allergic rhinitis.
METHODS: Prospective study of 40 patients with AR, grouped in corticosteroid
spray versus physiological saline solution use. Follow up for 10 weeks through
clinical score and PNIF percentages in relation to the reference curves, with
was-out at week 8. Statistical assessment of the effect of treatment on variation
of PNIF and clinical score was calculated by ANOVA model and Multiple Comparison
of Means Test - Least Significant Difference.
RESULTS: There was a statistically significant influence of the group, time and
interaction between time and group on PNIF percentages. Throughout follow up,
patients from the treatment group had mean PNIF percentages significantly higher
than the placebo group. Clinical score results also demonstrated a statistically
significant influence between the groups, time and interaction between time and
group.
CONCLUSION: Increase in PNIF percentage values observed in children treated with
intranasal corticosteroids revealed the applicability of PNIF curves in their
follow up.
PMID: 24932624
22. NPJ Prim Care Respir Med. 2014 Jun 5;24:14012. doi: 10.1038/npjpcrm.2014.12.
Adolescent seasonal allergic rhinitis and the impact of health-care professional
training: cluster randomised controlled trial of a complex intervention in
primary care.
Hammersley VS(1), Elton RA(1), Walker S(1), Hansen CH(2), Sheikh A(3).
Author information:
(1)Allergy and Respiratory Research Group, Centre for Population Health Sciences,
The University of Edinburgh, Edinburgh, UK. (2)School of Molecular and Clinical
Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, UK.
(3)1] Allergy and Respiratory Research Group, Centre for Population Health
Sciences, The University of Edinburgh, Edinburgh, UK [2] Division of General

Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical
School, Boston, MA, USA.
BACKGROUND: Seasonal allergic rhinitis is typically poorly managed, particularly
in adolescents, in whom it is responsible for considerable morbidity. Our
previous work has demonstrated that if poorly controlled this can impair
educational performance.
AIM: The primary aim of this trial was to assess the impact of a primary
care-based professional training intervention on clinical outcomes in adolescents
with seasonal allergic rhinitis.
METHODS: Cluster trial in which UK general practice staff were randomised to a
short, intensive workshop on the evidence-based management of seasonal allergic
rhinitis. The primary outcome measure was the change in the validated
Rhinoconjunctivitis Quality of Life Questionnaire with Standardized Activities
(RQLQ(S)) score between baseline and 6 weeks post intervention (minimal
clinically important difference=0.5). Secondary outcome measures of interest
included health-care professionals' knowledge and confidence in managing seasonal
allergic rhinitis, number of seasonal allergic rhinitis-related consultations,
relevant treatments prescribed and symptom scores.
RESULTS: Thirty-eight general practices were randomised (20 in the intervention
arm) and 246 patients (50.2% males, mean age 15 years) were included in the
primary outcome analysis. Health-care professionals' knowledge and confidence of
the clinical management of seasonal allergic rhinitis improved. This did not,
however, result in clinically or statistically significant improvements in
RQLQ(S): -0.15, (95% confidence interval, -0.5 to +0.2). There were no
differences in consultation frequency, treatments issued for seasonal allergic
rhinitis or symptom scores.
CONCLUSIONS: Although associated with increases in professionals' self-assessed
confidence and understanding of seasonal allergic rhinitis management, this
intensive training workshop did not translate into improvements in adolescents'
disease-specific quality of life or a reduction in rhinitis symptoms.
PMCID: PMC4373308
23. Allergy Asthma Proc. 2014 Jul-Aug;35(4):332-7. doi: 10.2500/aap.2014.35.3770.
Epub 2014 May 27.
Comparative safety and efficacy of two formulations of mometasone nasal spray in
adult seasonal allergic rhinitis.
Kuna P(1), Wasiak W, Jones S, Kreft KZ.
Author information:
(1)Division of Internal Medicine, Asthma and Allergy, Barlicki University
Hospital, Medical University of Lodz, Lodz Poland.
Mometasone furoate as a nasal spray is an effective treatment for seasonal
allergic rhinitis (SAR). An aqueous mometasone nasal spray containing the same
active substance and excipients as the originator product (reference mometasone)
has been developed. This study was designed to establish therapeutic equivalence
of test mometasone to reference mometasone and superiority over placebo for the
treatment of SAR in adults. In this multicenter, randomized, double-blind,
placebo- and active-controlled, fixed-dose study, patients aged 18 years with
SAR were randomized 2:2:1 to reference mometasone, test mometasone, or placebo
for 28 days. Patients recorded nasal and ocular symptoms daily. The primary end
point was change from baseline in the pooled 24-hour reflective total nasal
symptom score (rTNSS). Safety and tolerability included evaluation by adverse
events (AEs), physical (including nasal) examinations, vital signs assessments,
laboratory evaluations, and change in concomitant medications. Four hundred two
patients received reference mometasone (n = 156), test mometasone (n = 163), or
placebo (n = 83). The intent-to-treat population (ITT) comprised 399 patients,

and the per-protocol (PP) population comprised 327 patients. The 95% confidence
intervals for the treatment difference (reference minus test mometasone) in
change from baseline in pooled 24-hour rTNSS were within prespecified equivalence
limits for the PP and ITT populations. Both active treatments showed superiority
over placebo (p = 0.0019-0.0087). No significant difference was seen between test
mometasone and reference mometasone for any secondary efficacy variables.
Treatment-emergent AE incidence was low. No deaths or serious AEs were reported.
The test mometasone is efficacious in the treatment of SAR in adults and shows a
favorable safety profile. The results indicate that the test mometasone is
therapeutically equivalent to the reference mometasone.
PMID: 24871808
24. Int Arch Allergy Immunol. 2014;163(4):313-8. doi: 10.1159/000360734. Epub

2014
Apr 29.
A nasally applied cellulose powder in seasonal allergic rhinitis in adults with
grass pollen allergy: a double-blind, randomized, placebo-controlled,
parallel-group study.
berg N(1), Ospanova ST, Nikitin NP, Emberlin J, Dahl .
Author information:
(1)Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden.
BACKGROUND: A nasally applied cellulose powder is increasingly used in many
countries as a remedy for allergic rhinitis. In 2009, a 4-week study in birch
pollen-allergic children showed a reduction in nasal symptoms. The best effect
occurred on days with lower pollen counts. The present study in grass
pollen-allergic adults used the same basic design.
METHODS: In May 2013, a double-blind, placebo-controlled study was conducted in
108 patients with allergic rhinitis due to grass pollen (18-40 years of age). SMS
on mobile phones were used as reminders of treatment and reporting of symptom
scores.
RESULTS: We found significant reductions in severity scores for sneezing, runny
nose, stuffy nose and symptoms from eyes and lower airways, both separately and
together (all p < 0.001). Reflective opinion of effect and guess on treatment at
follow-up visits (both p < 0.001) confirmed a high efficacy. No clinically
significant adverse effects were reported.
CONCLUSIONS: The product provided significant protection against all seasonal
allergic rhinitis symptoms from both upper and lower airways during the grass
pollen season in an adult population. The magnitude and scope of efficacy support
the use of the product as an early choice in the treatment of allergic rhinitis.
2014 S. Karger AG, Basel.
PMID: 24852424
25. Allergy. 2014 Jul;69(7):828-33. doi: 10.1111/all.12413. Epub 2014 May 12.
Is chronic rhinosinusitis related to allergic rhinitis in adults and children?
Applying epidemiological guidelines for causation.
Georgalas C(1), Vlastos I, Picavet V, van Drunen C, Garas G, Prokopakis E.
Author information:
(1)Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the
Netherlands.
The relationship between allergic rhinitis and chronic rhinosinusitis has been
assessed in a number of observational and experimental studies. In this review,
we attempt their synthesis and evaluation using the modified Bradford Hill
guidelines for causation. Although there is no proof of causation, especially in
the pediatric literature, an evaluation of underlying allergies is recommended at
least as an initial measure of symptoms relief.
2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PMID: 24815699
26. J Allergy Clin Immunol Pract. 2014 May-Jun;2(3):332-40.e1. doi:

10.1016/j.jaip.2014.02.001.
Omalizumab for the treatment of inadequately controlled allergic rhinitis: a
systematic review and meta-analysis of randomized clinical trials.
Tsabouri S(1), Tseretopoulou X(2), Priftis K(3), Ntzani EE(4).
Author information:
(1)Department of Paediatrics, University of Ioannina School of Medicine,
Ioannina, Greece. (2)Evidence-based Medicine Unit, Department of Hygiene and
Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
(3)Third Department of Paediatrics, University of Athens School of Medicine,
Attikon University Hospital, Athens, Greece. (4)Evidence-based Medicine Unit,
Department of Hygiene and Epidemiology, University of Ioannina School of
Medicine, Ioannina, Greece. Electronic address: entzani@cc.uoi.gr.
BACKGROUND: Patients with moderate-to-severe allergic rhinitis who are
inadequately controlled despite treatment according to current rhinitis
management guidelines have a significant unmet medical need. Such patients have a
negative impact on daily functioning and are at risk of developing serious
comorbidities, such as asthma and chronic rhinosinusitis.
OBJECTIVE: To assess the efficacy and safety of omalizumab in poorly controlled
allergic rhinitis under a meta-analysis framework.
METHODS: MEDLINE and the Cochrane Central Register of Controlled Trials were
searched through September 2013. Studies on the efficacy of omalizumab in
allergic rhinitis that assessed clinical outcomes were selected. Descriptive and
quantitative information was extracted; mean differences and relative risk
estimates were synthesized under a fixed or random effects model. Heterogeneity
was assessed by using the Q statistic and the I(2) metric. Subgroup analyses were
performed for the presence of specific immunotherapy treatment.
RESULTS: Of the 352 citations retrieved, 11 studies of 2870 patients were finally
included. A statistically significant reduction in the daily nasal symptom
severity score (standardized mean difference -0.67 [95% CI, -1.3 to -0.31]; P <
.0001; I(2), 92%) and a statistically significant reduction in daily nasal rescue
medication score (-0.22 [95% CI, -0.39 to -0.05; P = .01; I(2), 58%) were
observed. There was not a statistically significant difference in the occurrence
of any adverse event (relative risk 1.06 [95% CI, 0.94-1.19; I(2), 55%).
CONCLUSIONS: Omalizumab is statistically significantly associated with symptom
relief, decreased rescue medication use, and improvement of quality of life in
patients with inadequately controlled allergic rhinosinusitis.
PMID: 24811026
27. Int J Pediatr Otorhinolaryngol. 2014 Jul;78(7):1115-8. doi:

10.1016/j.ijporl.2014.04.026. Epub 2014 May 5.
The effectiveness of nasal saline irrigation (seawater) in treatment of allergic

rhinitis in children.
Chen JR(1), Jin L(1), Li XY(2).
Author information:
(1)Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's
Hospital, Shanghai Jiaotong University, Shanghai, China. (2)Department of
Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai
Jiaotong University, Shanghai, China. Electronic address: chhshent@163.com.
OBJECTIVE: To evaluate the effect of nasal saline irrigation in the treatment of
allergic rhinitis (AR) in children and to assess whether nasal saline irrigation
could be used as a complementary therapy for AR in children in combination with
the intranasal corticosteroids (INS).
METHOD: In total, 61 children with AR were divided into three groups: the nasal
irrigation, intranasal corticosteroid, and combined treatment groups. Symptoms
and signs of AR and eosinophils (EOS) in the nasal secretions were evaluated
after 4 weeks, 8 weeks, and 12 weeks of treatment.
RESULTS: In AR children treated with nasal irrigation and a decreased the INS
dose, a significant improvement in symptoms and signs and a significant decrease
in the mean EOS count in nasal secretions were observed at week 12.
CONCLUSION: Nasal saline irrigation with physiological seawater is well tolerated
and benefits the patients with AR, and can thus be considered a good adjunctive
treatment option to maintain the effectiveness of the INS at a lower dose, thus
resulting in reduced side effects and a decreased economic burden.
Copyright 2014 Elsevier Ireland Ltd. All rights reserved.
PMID: 24809770
28. Am J Rhinol Allergy. 2014 Mar-Apr;28(2):131-9. doi:

10.2500/ajra.2014.28.4006.
Efficacy and safety of sublingual immunotherapy in children aged 3-13 years with
allergic rhinitis.
Shao J(1), Cui YX, Zheng YF, Peng HF, Zheng ZL, Chen JY, Li Q, Cao LF.
Author information:
(1)Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University
School of Medicine, Shanghai, China.
BACKGROUND: Sublingual immunotherapy (SLIT) is recommended for allergic diseases.
However, clinical studies containing evidence-based data of this treatment in
young children, which is rarely reported in the literature, are needed. This
study was designed to assess the efficacy and safety of SLIT in children,
including very young children.
METHODS: Two hundred sixty-four children aged 3-13 years old (133 children, 3-5
years old) with Dermatophagoides farinae-induced allergic rhinitis with or
without asthma treated by standard pharmacotherapy had randomly received either
SLIT (SLIT group) or no SLIT (control group) for 12 months. Symptoms,
medications, visual analog scale (VAS) and presence of adverse events (AEs) were
assessed at monthly visits. Skin-prick test and Dermatophagoides farinae-specific
IgE and IgG4 were measured before and after treatment.
RESULTS: Both treatments were effective in the global clinical scores during the
first seven visits when compared with baseline (all, p < 0.01), and SLIT showed
lower symptoms scores and VAS scores throughout this period (all, p < 0.01).
These improvements continued until the later visits only in the SLIT group. Also,
the asthma medication consumption was decreased by SLIT treatment only at the end
of study (p < 0.01). The specific IgG4 was significantly increased after SLIT
treatment when compared with the control group, but no significant change of
specific IgE was observed in either groups. In the SLIT group, there was no
significant difference between children less than or more than 5 years old in
terms of clinical efficacy, onset of action, immunologic parameters, and safety.
No severe systemic AEs were reported.
CONCLUSION: SLIT is effective and well-tolerated in children with allergic
rhinitis 3-13 years old.
PMID: 24717951
29. Am J Rhinol Allergy. 2014 Mar-Apr;28(2):e107-14. doi:

10.2500/ajra.2014.28.4040.
Prevalence, risk factors and comorbidities of allergic rhinitis in South Korea:
The Fifth Korea National Health and Nutrition Examination Survey.
Rhee CS(1), Wee JH, Ahn JC, Lee WH, Tan KL, Ahn S, Lee JH, Lee CH, Cho YS, Park
KH, Lee KH, Kim KS, Lee A, Kim JW.
Author information:
(1)Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National
University Bundang Hospital, Seoul National University College of Medicine,
Seongnam, South Korea.
BACKGROUND: There has been no nationwide epidemiological investigation of
allergic rhinitis (AR) that was diagnosed by both questionnaires and laboratory
tests in Korea. This study investigated the prevalence, risk factors, and
comorbidities of AR in South Korea.
METHODS: The Korean National Health and Nutritional Examination Survey examined a
representative sample of the Korean population. A total of 2305 participants
underwent immunoradiometric assay for specific IgE antibodies against common
indoor allergens. Healthy, atopy only, and AR groups were defined according to
the results of allergen test. The weighted prevalence for each group was
calculated. Risk factors including food and comorbidities were identified using
univariate or multivariate analyses. The patients were also categorized into four
subgroups according to the Allergic Rhinitis and Its Impact on Asthma (ARIA)
classification and associated comorbidities were analyzed.
RESULTS: The prevalence of atopy only and AR was 30.0 1.2% and 16.2 1.0%,
respectively. The multivariate analysis showed that the prevalence was influenced
by sex (p < 0.01) for atopy only and sex (p = 0.09), age (p = 0.02), marital
status (p = 0.24), and stress level (p = 0.30) for AR. Compared with the healthy
group, asthma (odds ratio [OR] = 4.77), nasal polyp (NP; OR = 3.44), chronic
rhinosinusitis (OR = 13.93), and olfactory dysfunction (OR = 4.88) were more
prevalent in the AR group. Based on the ARIA guideline, intermittent mild
rhinitis was most common (58.1%). Asthma was correlated to severity and atopic
dermatitis and NPs was associated with persistency. Daily intake of less mackerel
and more carrots, bread, and bean curd were associated with the increased risk of
AR.
CONCLUSION: Prevalence, risk factors, and comorbidities of AR were evaluated in
the general Korean population, which will contribute to prevention and treatment
of AR and its comorbidities in Koreans.
PMID: 24717946
30. Allergy Asthma Proc. 2014 Mar-Apr;35(2):163-70. doi:

10.2500/aap.2014.35.3728.
Effect of intranasal triamcinolone acetonide on basal
hypothalamic-pituitary-adrenal axis function in children with allergic rhinitis.
Georges G(1), Kim KT, Ratner P, Segall N, Qiu C.
Author information:
(1)GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
Intranasal corticosteroids are the most effective medication class for
controlling allergic rhinitis (AR) symptoms. However, limited data are available
on their effects on basal hypothalamic-pituitary-adrenal (HPA) axis function in
children. This study was designed to determine the effect of 6-week triamcinolone
acetonide aqueous (TAA-AQ) nasal spray treatment on HPA axis function by
measuring 24-hour serum cortisol area under the curve (AUC(0-24h)) in children
with AR aged 2-11 years. This phase 4, multicenter, double-blind,
placebo-controlled, parallel-group study randomized children with AR to receive
TAA-AQ (110 g, 2-11 years old, or 220 g, 6-11 years old) or placebo. At preand posttreatment domiciled visits, 24-hour serum cortisol and reflective total
nasal symptom scores (rTNSSs) were assessed. Safety assessment included
treatment-emergent adverse events (TEAEs) at each visit and trough levels of
24-hour serum cortisol. A total of 140 subjects (mean age, 7.2 years; males, 59%)
were randomized; 66 from each group completed treatment. The ratio of TAA-AQ to
placebo for change from baseline in serum cortisol AUC(0-24h) was 0.966 (95%
confidence interval, 0.892-1.045). Reduction from baseline in mean rTNSS was
significantly greater in the TAA-AQ than in the placebo group (difference: least
square mean SE = -0.85 0.24; p = 0.0007). The safety profile was similar
(TEAEs, TAA-AQ, 27.5%; placebo, 25.4%), and so was the mean change in serum
cortisol trough level (TAA-AQ, -0.4 g/dL; placebo, -0.1 g/dL; p = 0.1818 for
treatment difference) from pre- to posttreatment. TAA-AQ was safe, well
tolerated, and not associated with clinically meaningful suppression of serum
cortisol AUC(0-24h) in children with AR. Clinical trial NCT01154153,
www.clinicaltrials.gov.
PMID: 24717794
31. BMC Complement Altern Med. 2014 Apr 6;14:128. doi: 10.1186/1472-6882-14-128.
A randomised multicentre trial of acupuncture in patients with seasonal allergic
rhinitis--trial intervention including physician and treatment characteristics.
Ortiz M(1), Witt CM, Binting S, Helmreich C, Hummelsberger J, Pfab F, Wullinger
M, Irnich D, Linde K, Niggemann B, Willich SN, Brinkhaus B.
Author information:
(1)Institute of Social Medicine, Epidemiology and Health Economics,
Charit-Universittsmedizin Berlin, Berlin, Germany. miriam.ortiz@charite.de.
BACKGROUND: In a large randomised trial in patients with seasonal allergic
rhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue
medication. The aim of this paper is to describe the characteristics of the
trial's participating physicians and to describe the trial intervention in
accordance with the STRICTA (Standards for Reporting Interventions in Controlled
Trials of Acupuncture) guidelines, to make details of the trial intervention more
transparent to researchers and physicians.
METHODS: ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) was a three-armed,
randomised, controlled multicentre trial. 422 SAR patients were randomised to
semi-standardised acupuncture plus rescue medication (RM, cetirizine), sham
acupuncture plus RM or RM alone. We sent a questionnaire to trial physicians in
order to evaluate their characteristics regarding their education about and
experience in providing acupuncture. During the trial, acupuncturists were asked
to diagnose all of their patients according to Chinese Medicine (CM) as a basis
for the semi-standardised, individualized intervention in the acupuncture group.
Every acupuncture point used in this trial had to be documented after each
session
RESULTS: Acupuncture was administered in outpatient clinics by 46 (mean age
4710 years; 24 female/ 22 male) conventionally-trained medical doctors (67%
with postgraduate specialization such as internal or family medicine) with
additional extensive acupuncture training (median 500 hours (1st quartile 350,
3rd quartile 1000 hours with 73% presenting a B-diploma in acupuncture training
(350 hours)) and experience (mean 14 years in practice). The most reported
traditional CM diagnosis was 'wind-cold invading the lung' (37%) and 'wind-heat
invading the lung' (37%), followed by 'lung and spleen qi deficiency' (9%). The
total number of needles used was higher in the acupuncture group compared to the
sham acupuncture group (15.7 2.5 vs. 10.0 1.6).
CONCLUSIONS: The trial interventions were provided by well educated and
experienced acupuncturists. The different number of needles in both intervention
groups could be possibly a reason for the better clinical effect in SAR patients.
For future trials it might be more appropriate to ensure that acupuncture and
sham acupuncture groups should each be treated by a similar number of needles.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT00610584.
PMCID: PMC3983860
32. PLoS Med. 2014 Mar 11;11(3):e1001611. doi: 10.1371/journal.pmed.1001611.
eCollection 2014.
Active or passive exposure to tobacco smoking and allergic rhinitis, allergic
dermatitis, and food allergy in adults and children: a systematic review and
meta-analysis.
Saulyte J(1), Regueira C(1), Montes-Martnez A(1), Khudyakov P(2), Takkouche
B(1).
Author information:
(1)Department of Preventive Medicine, University of Santiago de Compostela,
Santiago de Compostela, Spain; Centro de Investigacin Biomdica en Red de
Epidemiologa y Salud Pblica (CIBER-ESP), Barcelona, Spain. (2)Departments of
Epidemiology and Biostatistics, Harvard School of Public Health, Boston,
Massachusetts, United States of America.
BACKGROUND: Allergic rhinitis, allergic dermatitis, and food allergy are
extremely common diseases, especially among children, and are frequently
associated to each other and to asthma. Smoking is a potential risk factor for
these conditions, but so far, results from individual studies have been
conflicting. The objective of this study was to examine the evidence for an
association between active smoking (AS) or passive exposure to secondhand smoke
and allergic conditions.
METHODS AND FINDINGS: We retrieved studies published in any language up to June
30th, 2013 by systematically searching Medline, Embase, the five regional
bibliographic databases of the World Health Organization, and ISI-Proceedings
databases, by manually examining the references of the original articles and
reviews retrieved, and by establishing personal contact with clinical
researchers. We included cohort, case-control, and cross-sectional studies
reporting odds ratio (OR) or relative risk (RR) estimates and confidence
intervals of smoking and allergic conditions, first among the general population
and then among children. We retrieved 97 studies on allergic rhinitis, 91 on
allergic dermatitis, and eight on food allergy published in 139 different
articles. When all studies were analyzed together (showing random effects model
results and pooled ORs expressed as RR), allergic rhinitis was not associated
with active smoking (pooled RR, 1.02 [95% CI 0.92-1.15]), but was associated with
passive smoking (pooled RR 1.10 [95% CI 1.06-1.15]). Allergic dermatitis was
associated with both active (pooled RR, 1.21 [95% CI 1.14-1.29]) and passive
smoking (pooled RR, 1.07 [95% CI 1.03-1.12]). In children and adolescent,
allergic rhinitis was associated with active (pooled RR, 1.40 (95% CI 1.24-1.59)
and passive smoking (pooled RR, 1.09 [95% CI 1.04-1.14]). Allergic dermatitis was
associated with active (pooled RR, 1.36 [95% CI 1.17-1.46]) and passive smoking
(pooled RR, 1.06 [95% CI 1.01-1.11]). Food allergy was associated with SHS (1.43
[1.12-1.83]) when cohort studies only were examined, but not when all studies
were combined. The findings are limited by the potential for confounding and bias
given that most of the individual studies used a cross-sectional design.
Furthermore, the studies showed a high degree of heterogeneity and the exposure
and outcome measures were assessed by self-report, which may increase the
potential for misclassification.
CONCLUSIONS: We observed very modest associations between smoking and some
allergic diseases among adults. Among children and adolescents, both active and
passive exposure to SHS were associated with a modest increased risk for allergic
diseases, and passive smoking was associated with an increased risk for food
allergy. Additional studies with detailed measurement of exposure and better case
definition are needed to further explore the role of smoking in allergic
diseases.
PMCID: PMC3949681
33. J Laryngol Otol. 2014 Mar;128(3):242-8. doi: 10.1017/S002221511400036X. Epub
2014
Mar 11.
Quality of life assessment in patients with moderate to severe allergic rhinitis
treated with montelukast and/or intranasal steroids: a randomised, double-blind,
placebo-controlled study.
Goh BS(1), Ismail MI(2), Husain S(1).
Author information:
(1)Department of Otorhinolaryngology Head and Neck Surgery, Universiti Kebangsaan
Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur,
Malaysia. (2)Department of Otorhinolaryngology, Hospital Melaka, Malacca,
Malaysia.
OBJECTIVE: This study investigated improvements in quality of life associated
with eight weeks of montelukast and/or intranasal steroid treatment for moderate
to severe allergic rhinitis.
METHODS: A single-centre, prospective, randomised, double-blind,
placebo-controlled study was carried out. Assessments were made using the
Rhinoconjunctivitis Quality of Life Questionnaire and symptom scales.
RESULTS: A total of 128 patients (aged 13-51 years) were randomly assigned to one
of two groups. In the montelukast group, patients were treated with montelukast
tablets and fluticasone propionate nasal spray (n = 64). In the placebo group,
treatment comprised a placebo and fluticasone propionate. The results showed
significant improvements in symptom scores and quality of life scores for both
groups after one month and two months of treatment, compared with baseline
values; these improvements were significantly greater for the montelukast group
compared with the placebo group. The mean number of loratadine tablets taken by
each patient during the study period was only 0.73 for the montelukast group
compared with 9 for the placebo group.
CONCLUSION: The combination of montelukast tablets and fluticasone propionate
nasal spray improved symptom control and overall quality of life for moderate to
severe allergic rhinitis patients.
PMID: 24618303
34. Int Forum Allergy Rhinol. 2014 Jan;4(1):43-8.

A pilot study of the effects of intranasal budesonide delivered by NasoNeb on
patients with perennial allergic rhinitis.
Brown K, Lane J, Silva MP, DeTineo M, Naclerio RM, Baroody FM.
BACKGROUND: We investigated whether nebulization of budesonide via a NasoNeb

device would treat perennial allergic rhinitis.
METHODS: We performed a parallel, randomized, double-blind, placebo-controlled,
pilot study in subjects (n = 40) with perennial allergic rhinitis. After
recording baseline symptoms, subjects were randomized to budesonide respules
(0.25 mg) or an equivalent placebo for 26 days. Nasal peak inspiratory flow
(NPIF) and nasal symptoms (graded on a 03 scale) were recorded by the subjects
twice daily. Rhinoconjunctivitis quality of life (RQOL) as well as nasal volume,
measured by acoustic rhinometry, was obtained at baseline, after 2 weeks, and at
the end of treatment.
RESULTS: The average change from baseline in symptoms over the treatment period
was greater for the group on budesonide (3.33) compared to placebo (1.98) (p =
0.45). When the average change from baseline over the treatment period was
compared between the groups, budesonide resulted in higher NPIF (36.4 L/min) than
placebo (18.7 L/min), p = 0.094. QOL improved in both groups compared to baseline
with no significant difference between the groups. Although acoustic rhinometry
indicated a larger volume in the group treated with budesonide on the last trial
visit, the differences between the groups were not significant when accounting
for the baseline values.
CONCLUSION: Compared to placebo, administration of nebulized budesonide in
subjects with perennial allergic rhinitis resulted in improvements in symptoms
and objective measures of nasal congestion which approached but did not achieve
statistical significance. A higher dose of active agent, a less effective placebo
and a larger number of subjects might have improved statistical significance.
PMID: 24574125
35. J Allergy Clin Immunol Pract. 2013 May-Jun;1(3):214-26; quiz 227. doi:
10.1016/j.jaip.2013.03.012. Epub 2013 Apr 29.
Current and future directions in pediatric allergic rhinitis.
Gentile D(1), Bartholow A(1), Valovirta E(2), Scadding G(3), Skoner D(4).
Author information:
(1)Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny
General Hospital, Pittsburgh, Pa. (2)Turku Allergy Center, Turku, Finland. (3)The
Royal National Throat, Nose and Ear Hospital, London, United Kingdom. (4)Division
of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General
Hospital, Pittsburgh, Pa. Electronic address: dskoner@wpahs.org.
BACKGROUND: Allergic rhinitis (AR) is a common pediatric problem that
significantly affects sleep, learning, performance, and quality of life. In
addition, it is associated with significant comorbidities and complications.
OBJECTIVE: The aim was to provide an update on the epidemiology, comorbidities,
pathophysiology, current treatment, and future direction of pediatric AR.
METHODS: Literature reviews in each of these areas were conducted, and the
results were incorporated.
RESULTS: The prevalence of AR is increasing in the pediatric population and is
associated with significant morbidity, comorbidities, and complications. The
mainstay of current treatment strategies includes allergen avoidance,
pharmacotherapy, and allergen specific immunotherapy.
CONCLUSIONS: In the future, diagnosis will be improved by microarrayed
recombinant allergen testing and therapy will be expanded to include emerging
treatments such as sublingual immunotherapy and combination products.
PMID: 24565478
36. Int Forum Allergy Rhinol. 2014 Feb;4(2):110-6. doi: 10.1002/alr.21246. Epub
2013
Nov 4.
The role of secondhand smoke in allergic rhinitis: a systematic review.
Hur K(1), Liang J, Lin SY.
Author information:
(1)Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University,
Baltimore, MD.
BACKGROUND: The objective of this work was to systematically review existing
literature on the association between allergic rhinitis (AR) and secondhand
smoking (SHS) in children and adults.
METHODS: We performed a literature search encompassing the last 25 years in
PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL),
Cochrane CENTRAL, Web of Science, Scopus, and EMBASE. Inclusion criteria included
English language papers containing original human data with greater than 6
subjects. Data was systematically collected on study design, patient
demographics, clinical characteristics/outcomes, and level-of-evidence (Oxford
Center of Evidence-Based Medicine). Quality assessment of the studies was
performed using the Newcastle-Ottawa scale. Two investigators independently
reviewed all manuscripts.
RESULTS: The initial search yielded 590 abstracts, of which 40 articles were
included. 12 (37.5%) of the 32 articles studying children and 5 (62.5%) of the 8
articles studying adults showed a statistically significant association between
AR and SHS. One article was a prospective cohort study (Level 2b) and all other
articles were case-control studies (Level 3b). For characterizing AR, 10 (25%)
studies included skin-prick testing and 5 (12.5%) used in vitro testing. For
determining presence of SHS, 39 (97.5%) of the studies used questionnaires and 1
article used a cotinine/creatinine ratio.
CONCLUSION: This review demonstrated a majority of adult studies vs a minority of
children studies found a significant association between AR and SHS. However, the
percent difference between age groups was not statistically significant. Further
higher-quality studies with validated methods for diagnosing AR and quantifying
SHS exposure should be performed to better evaluate the relationship between AR
and SHS in adults and children.
2013 ARS-AAOA, LLC.
PMID: 24493468
37. Curr Med Res Opin. 2014 Jun;30(6):1131-7. doi: 10.1185/03007995.2014.882299.

Epub
2014 Jan 30.
Barrier-enforcing measures as treatment principle in allergic rhinitis: a
systematic review.
Andersson M(1), Greiff L, Ojeda P, Wollmer P.
Author information:
(1)Department of Otorhinolaryngology, Skne University Hospital , Sweden.
BACKGROUND AND OBJECTIVES: Barrier-enforcing measures have been suggested as
treatment options for allergic rhinitis. This review identifies and describes the
literature on the subject.
METHODS: Relevant publications were searched for in the PubMed database (search
entries: 'allergic rhinitis' and 'treatment'). The evaluation comprised condition
(seasonal or perennial allergic rhinitis), type of intervention, duration of
treatment, study design, peer review status or not, number of test subjects, type
of allergen exposure, and outcome in terms of effects or not on nasal symptoms of

allergic rhinitis.
RESULTS: Fifteen studies were either identified in the PubMed database search or
from the reference lists of identified publications. Seven were
placebo-controlled, randomized, and peer-reviewed, and symptom-reducing effects
were reported by all of these reports. Limitations of this review reflect that
the remainder of the studies had inferior designs, particularly lack of placebo
control.
CONCLUSIONS: Barrier-enforcing measures as achieved by nasal administrations of
cellulose powder and microemulsions, respectively, have symptom-reducing effects
in allergic rhinitis.
PMID: 24405331
38. Ann Pharmacother. 2013 Sep;47(9):1175-81. doi: 10.1177/1060028013503125.

Effect of inhaled corticosteroids on long-term growth in pediatric patients with
asthma and allergic rhinitis.
Hoover RM(1), Erramouspe J, Bell EA, Cleveland KW.
Author information:
(1)Department of Pharmacy Practice and Administrative Sciences, College of
Pharmacy, Idaho State University, Pocatello, ID, USA.
OBJECTIVE: To evaluate the effect of orally and nasally inhaled corticosteroids
(ICS) on final adult height in pediatric patients with mild to moderate
persistent asthma and allergic rhinitis.
DATA SOURCES: MEDLINE (1975-April 2013), Cochrane Library (through 2012), and
International Pharmaceutical Abstracts (1975-April 2013) were searched for
prospective clinical trials assessing the effects of orally or intranasally ICS
use on growth in pediatric patients with asthma or allergic rhinitis using the
terms inhaled/intranasal corticosteroid, linear growth, height, and asthma or
allergic rhinitis.
STUDY SELECTION AND DATA EXTRACTION: Eligible articles included double-blind,
randomized, placebo-controlled studies of at least 1 year with growth velocity or
height as the primary outcome.
DATA SYNTHESIS: Seven trials and 1 follow-up study analyzing the effects of
orally ICSs were examined. Of these studies, 4 found a delay in growth in at
least 1 subset of its participants of approximately 1 cm, 1 study found a
decrease in final adult height of 1.2 cm, and 3 studies found no effect. Of the 4
studies examining nasally ICS, 1 found evidence of growth delay in a subgroup
using supratherapeutic dosing. There are conflicting data on whether ICS use
causes long-term growth reduction in pediatric patients. The concern surrounding
their long-term use including a potential delay or decrease in growth may result
in underuse and potential mismanagement of persistent asthma and/or allergic
rhinitis. Patients should be treated with the lowest effective corticosteroid
dose to achieve symptomatic control while minimizing excessive systemic effects.
Orally ICS use may cause a delay in growth, but a decrease in final adult height
(1.2 cm) has been documented in only one study. This single report should not
preclude daily use of inhaled corticosteroids if needed to decrease the morbidity
and mortality associated with pediatric reactive airway disease.
CONCLUSIONS: Continued studies on the systemic effects of ICS are required before
truly understanding the class's effect on growth in pediatric patients with
asthma and allergic rhinitis. What is understood, however, is the detriment and
potential danger of mismanaged asthma care.
PMID: 24259733
39. Otolaryngol Head Neck Surg. 2014 Jan;150(1):22-7. doi:

10.1177/0194599813510892.
Epub 2013 Nov 14.

Inconclusive evidence for allergic rhinitis to predict a prolonged or chronic
course of acute rhinosinusitis.
Frerichs KA(1), Nigten G, Romeijn K, Kaper NM, Grolman W, van der Heijden GJ.
Author information:
(1)Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
OBJECTIVE: To systematically review the evidence on allergic rhinitis as a
predictor for a prolonged or chronic course in adult patients with acute
rhinosinusitis.
DATA SOURCES: Pubmed, EMBASE, and the Cochrane library.
REVIEW METHODS: A systematic literature search was performed on March 15, 2013.
During screening of title and abstract, 3 authors independently selected studies
on allergic rhinitis as a predictor for the course of acute rhinosinusitis in
adults. The reported study design was assessed for directness of evidence and
risk of bias. We aimed to extract prior and posterior probabilities for a
prolonged or chronic course of acute rhinosinusitis.
RESULTS: Of 13,202 retrieved articles, 2 articles were eligible for study
assessment. They provided a high directness of evidence but carried a high risk
of bias. The studies showed an incidence of a prolonged and chronic course of,
respectively, .19 (95% confidence interval [CI] .16-.23) and .05 (95% CI,
.02-.13). In patients with allergic rhinitis, the incidence was .25 (95% CI,
.18-.35) and .14 (95% CI, .04-.34), so the added value of allergic rhinitis to
predict a prolonged course is 6% and to predict a chronic course 8%.
CONCLUSION AND RECOMMENDATION: While the 2 included studies suggest that allergic
rhinitis adds little to the prediction of a prolonged or chronic course in
patients with acute rhinosinusitis, they carry a high risk of bias. As the
available evidence does not provide grounds for different management of patients
with and without allergic rhinitis, namely, according to clinical practice
guidelines, both can be managed with expectant observation and symptomatic
treatment.
PMID: 24233061
40. Int J Pediatr Otorhinolaryngol. 2013 Dec;77(12):1922-4. doi:

10.1016/j.ijporl.2013.10.006. Epub 2013 Oct 19.
Effectiveness of montelukast in pediatric patients with allergic rhinitis.
Yilmaz O(1), Altintas D, Rondon C, Cingi C, Oghan F.
Author information:
(1)Celal Bayar University Medical Faculty, Department of Pediatric Allergy and
Pulmonology, Manisa, Turkey. Electronic address: oyilmaz_76@hotmail.com.
Allergic rhinitis (AR) is one of the most common chronic diseases of childhood
and carries significant morbidity as well as physical and psychosocial
consequences. Therapy aims to alleviate clinical symptoms, prevent complications
and improve psychosocial consequences. Leukotrienes which are amongst the main
mediators in pathogenesis of AR have chemotactic properties and lead to increased
vascular permeability. Thus, leukotriene antagonism may be an effective
therapeutic option in treatment of allergic diseases, specifically AR.
Montelukast which is a leukotriene receptor type I inhibitor has variable
efficacy in children with AR and the guidelines recommend its use in children
with seasonal AR aged six years and above. Although its efficacy is inferior to
anti-histamines and intranasal corticosteroids, combination treatment may warrant
clinical efficacy. Therefore, montelukast may be considered to be a
well-tolerated therapeutic option for children with AR with minor side effects
though long term results need to be assessed. In conclusion, larger scale

research enrolling pediatric cases with seasonal and persistent AR are required
before concise recommendations about montelukast use in pediatric AR can be made.
PMID: 24210867
41. J Pharm Sci. 2013 Dec;102(12):4213-29. doi: 10.1002/jps.23720. Epub 2013 Nov
1.
An overview of the pediatric medications for the symptomatic treatment of
allergic rhinitis, cough, and cold.
Fan Y(1), Ji P, Leonard-Segal A, Sahajwalla CG.
Author information:
(1)Division of Clinical Pharmacology II, Office of Clinical Pharmacology, U.S.
Food and Drug Administration, Silver Spring, Maryland, 20993.
Upper respiratory infections and allergic rhinitis are common diseases in
children. In recent years, U.S. Food and Drug Administration has been promoting
pediatric drug development with marketing exclusivity incentives and
requirements. The assessment of clinical pharmacology, efficacy, and safety data
has facilitated pediatric drug development and provided appropriate labeling for
pediatric use. Regulatory decision making involves multiple evaluation processes,
including drug exposure comparison between adult and pediatric population,
formulation bridging, dose selection, and evaluation of efficacy and safety in
pediatric patients. This article reviews the pediatric drugs indicated for cough,
cold, and allergic rhinitis, focusing on the utility of clinical pharmacology,
safety, and efficacy data in determining the pediatric dosing regimen and the
approaches taken for regulatory decision making.
2013 Wiley Periodicals, Inc. and the American Pharmacists Association.
PMID: 24185951
42. Ann Allergy Asthma Immunol. 2013 Nov;111(5):408-414.e1. doi:

10.1016/j.anai.2013.07.033. Epub 2013 Aug 28.
Efficacy and safety of beclomethasone dipropionate nasal aerosol in pediatric
patients with seasonal allergic rhinitis.
Storms WW(1), Segall N, Mansfield LE, Amar NJ, Kelley L, Ding Y, Tantry SK.
Author information:
(1)William Storms Allergy Clinic, Colorado Springs, Colorado. Electronic address:
wstorms@stormsallergy.com.
BACKGROUND: Aerosolized intranasal corticosteroid formulations are desirable for
many patients with allergic rhinitis (AR), especially children, who wish to avoid
the "wet feeling" and "drip down the throat" associated with aqueous
formulations. Beclomethasone dipropionate (BDP) hydrofluoroalkane nasal aerosol
has been shown to be safe and effective in adolescents and adults with AR.
OBJECTIVE: To evaluate the efficacy and safety of BDP nasal aerosol in pediatric
patients with moderate to severe seasonal AR.
METHODS: In this double-blinded, placebo-controlled study, children (6-11 years
of age) with seasonal AR were randomized to once-daily treatment with BDP nasal
aerosol 80 g (n = 239) or 160 g (n = 242) or placebo (n = 234). The primary end
point was change from baseline in average morning and evening reflective total
nasal symptom score over the 2-week treatment period.
RESULTS: Treatment with BDP nasal aerosol showed significantly greater

improvements in average morning and evening reflective total nasal symptom score
vs placebo (80 g, -0.71; 160 g, -0.76; P < .001 for the 2 comparisons).
Similarly, significantly greater improvements in average morning and evening
instantaneous total nasal symptom score were seen with BDP nasal aerosol vs
placebo (80 g, -0.63; 160 g, -0.73; P < .001 for the 2 comparisons). The
incidence of adverse events from BDP nasal aerosol was comparable to that from
placebo.
CONCLUSION: BDP nasal aerosol (80 or 160 g/d) provided significant and
clinically meaningful nasal symptom relief and an established overall safety
profile similar to that of placebo, suggesting that it is an effective and
well-tolerated treatment option for pediatric patients with moderate to severe
seasonal AR.
PMID: 24125150
43. Expert Opin Biol Ther. 2013 Nov;13(11):1543-56. doi:

10.1517/14712598.2013.844226. Epub 2013 Oct 8.
Allergen immunotherapy for house dust mite: clinical efficacy and immunological
mechanisms in allergic rhinitis and asthma.
Eifan AO(1), Calderon MA, Durham SR.
Author information:
(1)Imperial College London, Allergy and Clinical Immunology , NHLI, London, SW7
2AZ , UK a.eifan@imperial.ac.uk.
INTRODUCTION: There is an increasing prevalence of atopic diseases such as
allergic rhinitis and asthma with house dust mite (HDM) being the common allergen
that is highly associated with allergic rhinitis and asthma. Allergen avoidance
and pharmacotherapy are part of treatment but it has proved difficult to change
the course of HDM-related allergic diseases. Allergen immunotherapy (AIT) has
been in use for the past century and has been shown to be effective in the
treatment of allergic respiratory disease.
AREAS COVERED: This review exclusively focuses on HDM-AIT and discusses the
differences in clinical efficacy and safety, long-term effect after
discontinuation and immunological changes observed in both HDM-subcutaneous
immunotherapy (SCIT) and HDM-sublingual immunotherapy (SLIT) in the treatment of
allergic rhinitis and asthma in both pediatric and adult populations.
EXPERT OPINION: The majority of studies involved small numbers of patients,
variable doses of major allergens and are of variable quality. There is good
evidence for HDM-SCIT efficacy and its long-term effect in adults and children,
whereas at the present time, evidence for HDM-SLIT is unconvincing, particularly
in children. In carefully selected patients, HDM-SCIT is effective and safe. More
definitive trials are needed before HDM-SLIT can be recommended in routine
practice for rhinitis and/or asthma.
PMID: 24099116
44. Allergy Asthma Proc. 2013 Nov-Dec;34(6):551-7. doi: 10.2500/aap.2013.34.3715.

Epub 2013 Sep 27.
Validation of the allergic rhinitis treatment satisfaction and preference scale.
Turner RR(1), Testa MA, Hayes JF, Su M.
Author information:
(1)Phase V Technologies, Inc., Wellesley Hills, Massachusetts, USA.
Allergic rhinitis (AR) affects 7.8% of U.S. adults and 10-30% of the population
worldwide. AR symptoms (rhinorrhea, congestion, sneezing, nasal/ocular pruritus,
and postnasal drainage) significantly impact sleep and reduce cognitive and
emotional functioning affecting work and school productivity. Although effective,
intranasal corticoid (INS) steroid delivery systems are often associated with
adverse sensory attributes, affecting patient adherence and reducing efficacy.
Patient satisfaction with treatment characteristics predicts adherence levels
that can better inform treatment decisions. This study was designed to evaluate
psychometric evidence for the self-administered Allergic Rhinitis Treatment
Satisfaction and Preference (ARTSP) scale as a patient-reported outcomes measure
for use in clinical research. Analytic methods included qualitative analysis of
patient focus groups and psychometric analysis of scale data collected from 185
AR subjects enrolled in a randomized, 2-week, crossover, comparative U.S.
clinical trial. Qualitative analysis conceptually supported nine treatment
satisfaction subscales. Reliability by Cronbach alpha met accepted standards.
Evidence was found for construct validity using structural equation modeling,
criterion validity from correlation patterns between treatment satisfaction and
health-related quality of life scales, and discriminant validity analysis based
on AR symptom-defined groups. Responsiveness was shown by significant change in
treatment satisfaction subscales among AR symptom change groups. Scores on
treatment preference items discriminated between the aqueous and aerosol INS
formulations. The ARTSP scale is a conceptually sound, reliable, valid, and
responsive measure of patient evaluations of alternative therapies, providing
detailed information about treatment characteristics that are likely to influence
adherence levels and subsequent AR clinical control.
PMID: 24079817
45. Paediatr Drugs. 2013 Dec;15(6):431-40. doi: 10.1007/s40272-013-0043-3.

Pediatric allergic rhinitis and asthma: can the march be halted?
Tsilochristou OA(1), Douladiris N, Makris M, Papadopoulos NG.
Author information:
(1)Allergy Unit "D. Kalogeromitros," Medical School, "Attikon" University
Hospital, 1, Rimini str, 124 62, Chaidari, Athens, Greece,
ol.tsilochristou@gmail.com.
The strong epidemiologic and pathophysiologic link between allergic rhinitis (AR)
and asthma has led to the concept of 'united airways disease' or 'respiratory
allergy', implying that allergy, in its widest sense, underlies this clinical
syndrome. Progression from AR to asthma is frequent and part of the 'atopic
march'. Since pediatric immune responses are more adaptable and therefore may be
more amenable to treatment, interventions at early childhood are characterized by
a higher chance to affect the natural history of respiratory allergy. Although
current treatments are quite effective in alleviating respiratory allergy
symptoms, it has proven much more difficult to confirm any influence on the
progression of the disease. Much more promising is the field of specific allergen
immunotherapy, where current evidence, although not yet of ideal robustness,
points towards a disease-modifying effect. In addition, newer or emerging,
possibly more effective or more targeted interventions are promising in the
preventive sense.
PMID: 23955538
46. Am J Rhinol Allergy. 2013 Jul-Aug;27(4):299-303. doi:

10.2500/ajra.2013.27.3923.
Randomized double-blind placebo-controlled crossover study of efficacy of pollen

blocker cream for perennial allergic rhinitis.
Li Y(1), Wang D, Liu Q, Liu J.
Author information:
(1)Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan
University, Shanghai, China.
BACKGROUND: This study evaluates the efficacy and safety of a pollen blocker
cream in treatment of perennial allergic rhinitis (PAR) in a Chinese population.
METHODS: A randomized double-blind placebo-controlled, crossover trial was
conducted in the Outpatient Department of the Eye, Ear, Nose, and Throat
Hospital, Fudan University, Shanghai, China. Patients diagnosed with PAR were
randomly assigned to receive pollen blocker cream or placebo, which was applied
and evenly distributed to the lower internal nose region three times daily for a
total of 30 days. The primary outcome measures for efficacy were nasal symptom
scores (NSSs) and quality of life scores (QoLSs). Medication scores and adverse
events were also monitored.
RESULTS: After application of pollen blocker, the mean NSS fell from 23.1 to 12.4
points, and the QoLSs fell from 83.9 to 53.2 points (p < 0.001). The decrease in
NSSs of pollen blocker (10.7) was highly significant compared with the placebo
(3.6; p < 0.001). The decrease in QoLSs of pollen blocker was 30.7 compared with
7.1 in the placebo group, and the difference was also significant (p < 0.05).
Interestingly, the mean NSS of the placebo group also decreased from 23.7 to 20.1
(p < 0.05). Additionally, the efficacy of pollen blocker was superior to the
placebo both in adults and in children. However, there was no significant
difference for individual symptoms of rhinorrhea, nasal itching, sneezing, and
nasal congestion between the pollen blocker group and placebo group (p > 0.05).
Only one mild epistaxis was reported.
CONCLUSION: The pollen blocker was significantly more effective than the placebo
in relieving allergy symptoms and improving life quality of PAR in 30 Chinese
people.
PMID: 23883812
47. Recent Pat Inflamm Allergy Drug Discov. 2013 Sep;7(3):223-8.

New patents of fixed combinations of nasal antihistamines and corticosteroids in
allergic rhinitis.
Wolthers OD(1).
Author information:
(1)Asthma and Allergy Clinic, Children's Clinic Randers, Dytmrsken 9, 8900
Randers, Denmark. akk.odws@dadlnet.dk
During the last few years, fixed combinations of intranasal antihistamines and
corticosteroids have been introduced for treatment of allergic rhinitis. The aim
of this systematic review was to assess recent patents and clinical evidence for
fixed combinations of intranasal antihistamines and intranasal corticosteroids in
allergic rhinitis. Data base searches revealed that intranasal combinations of
the antihistamine azelastine with the corticosteroids mometasone furoate,
ciclesonide and fluticasone propionate, respectively, have been patented. Four
randomized, double-blinded, parallel-group, placebo-controlled, multicenter
trials sponsored by the manufacturer evaluated the fixed combination of
intranasal azelastine 125 g and fluticasone propionate 50 g administered as one
dose per nostril b.i.d. in patients with moderate-to-severe symptomatic allergic
rhinitis 12 years of age. Three of the studies were published as a
meta-analysis which found the fixed combination of azelastine and fluticasone
propionate statistically significantly more efficacious in reducing baseline
total nasal symptom score by 5.7 as compared to azelastine (4.4; P < 0.001),
fluticasone propionate (5.1; P < 0.001) and placebo (3.0; P < 0.001). The
findings were supported by secondary assessments of scores of specific nasal and
ocular symptoms. Pharmacokinetic studies have revealed no drug-drug interactions
but a discrete increase in bioavailability of fluticasone propionate which was
considered clinically unimportant. Further efficacy and quality-of-life studies
of combination products of nasal antihistamines and corticosteroids are needed,
especially, in primary care settings and in children before fixed combination
treatment can be considered first line therapy in allergic rhinitis. Fixed
combination treatment of azelastine and fluticasone propionate may offer
additional benefit to selected populations of adolescents and adults with
moderate-to-severe symptoms.
PMID: 23862774
48. Asian Pac J Allergy Immunol. 2013 Jun;31(2):142-7. doi:

10.12932/AP0262.31.2.2013.
The effect of six-weeks of sauna on treatment autonomic nervous system, peak
nasal inspiratory flow and lung functions of allergic rhinitis Thai patients.
Kunbootsri N(1), Janyacharoen T, Arrayawichanon P, Chainansamit S, Kanpittaya J,
Auvichayapat P, Sawanyawisuth K.
Author information:
(1)School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand.
BACKGROUND: Allergic rhinitis is a chronic respiratory disease. Sympathetic
hypofunction has been identified in allergic rhinitis patients.
OBJECTIVE: To investigate the effects of six weeks of repeated sauna treatment on
the autonomic nervous system, peak nasal inspiratory flow (PNIF) and lung
functions in Thai patients with allergic rhinitis.
METHODS: Subjects were diagnosed with allergic rhinitis clinically by an
attending physician based on history, physical examination and positive reactions
to a skin prick test. Subjects were randomly assigned to two groups.
Controlsubjects received education and maintained a normal life. The sauna group
received sauna treatment over a six-week period, 3 days per week, with 6 sets of
5 minutes per set per day, totaling 30 minutes. Each 5 minute set alternated with
a 5 minute period of rest. Heart rate variability (HRV), peak nasal inspiratory
flow and lung function were measured at the beginning and after three and six
weeks of sauna treatment. The HRV measurement is composed of three components,
including low frequency (indicating sympathetic function in normal units or
n.u.), high frequency (indicated parasympathetic function in n.u.), and the ratio
of LF/HF (indicating the balance of the autonomic system).
RESULTS: Twenty-six allergic rhinitis patients, 12 males and 14 females
participated in this study, 13 in the control group and 13 in the sauna treatment
group; there were 6 males in each group. Baseline characteristics for the control
and sauna treatment groups were comparable. There were significant changes in the
HRV after six weeks of sauna treatment. The high frequency component was
significantly lower in sauna treatment group (51.8 vs 35.4), while the low
frequency component and LF/HF ratio were significantly higher in sauna treatment
group than in the control group (48.1 vs 64.5 and 0.9 vs 2.5, respectively). The
PNIF and the forced expiratory volume in one second, or FEV1, were also
significantly higher in sauna treatment group (103.0 vs 161.9 and 80.1 vs 95.6,
respectively).
CONCLUSION: The six weeks of repeated sauna treatment can increase sympathetic
activity, PNIF, and FEV1 in Thai patients with allergic rhinitis.
PMID: 23859414
49. Health Technol Assess. 2013 Jul;17(27):vi, xi-xiv, 1-322. doi:

10.3310/hta17270.
A systematic review and economic evaluation of subcutaneous and sublingual
allergen immunotherapy in adults and children with seasonal allergic rhinitis.
Meadows A(1), Kaambwa B, Novielli N, Huissoon A, Fry-Smith A, Meads C, Barton P,
Dretzke J.
Author information:
(1)Department of Public Health, Epidemiology and Biostatistics, University of
Birmingham, Birmingham, UK.
BACKGROUND: Severe allergic rhinitis uncontrolled by conventional medication can
substantially affect quality of life. Immunotherapy involves administering
increasing doses of a specific allergen, with the aim of reducing sensitivity and
symptomatic reactions. Recent meta-analyses have concluded that both subcutaneous
immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are more effective than
placebo in reducing symptoms. It is uncertain which route of administration is
more effective and whether or not treatment is cost-effective.
OBJECTIVE: To determine the comparative clinical effectiveness and
cost-effectiveness of SCIT and SLIT for seasonal allergic rhinitis in adults and
children.
DATA SOURCES: Electronic databases {MEDLINE, EMBASE, The Cochrane Library
[Cochrane Central Register of Controlled Trials (CENTRAL)], NHS Economic
Evaluation Database (NHS EED)} and trial registries (from inception up to April
2011).
REVIEW METHODS: Standard systematic review methods were used for study selection,
data extraction and quality assessment. Double-blind randomised,
placebo-controlled trials of SCIT or SLIT, or of SCIT compared with SLIT, and
economic evaluations were included. Meta-analysis and indirect comparison
meta-analysis and meta-regression were carried out. A new economic model was
constructed to estimate cost-utility.
RESULTS: Meta-analyses found statistically significant effects for SCIT and SLIT
compared with placebo across a number of outcome measures and for the vast
majority of subgroup analyses (type and amount of allergen, duration of
treatment). There was less evidence for children, but some results in favour of
SLIT were statistically significant. Indirect comparisons did not provide
conclusive results in favour of either SCIT or SLIT. Economic modelling suggested
that, when compared with symptomatic treatment (ST), both SCIT and SLIT may
become cost-effective at a threshold of 20,000-30,000 per quality-adjusted
life-year (QALY) from around 6 years, or 5 years for SCIT compared with SLIT (NHS
and patient perspective).
LIMITATIONS: It is uncertain to what extent changes in the outcome measures used
in the trials translate into clinically meaningful benefits. Cost-effectiveness
estimates are based on a simple model, limited data and a number of assumptions,
and should be seen as indicative only.
CONCLUSIONS: A benefit from both SCIT and SLIT compared with placebo has been
consistently demonstrated, but the extent of this effectiveness in terms of
clinical benefit is unclear. Both SCIT and SLIT may be cost-effective compared
with ST from around 6 years (threshold of 20,000-30,000 per QALY). Further
research is needed to establish the comparative effectiveness of SCIT compared
with SLIT and to provide more robust cost-effectiveness estimates.
FUNDING: The National Institute for Health Research Health Technology Assessment
programme.
PMID: 23827204
50. Curr Med Res Opin. 2013 Oct;29(10):1329-40. doi:

10.1185/03007995.2013.821055.
Epub 2013 Aug 6.
Efficacy, safety, and optimal dose selection of beclomethasone dipropionate nasal

aerosol for seasonal allergic rhinitis in adolescents and adults.
Raphael GD(1), Berger WE, Prenner BM, Finn AF Jr, Kelley L, Tantry SK.
Author information:
(1)Bethesda Allergy, Asthma and Research Center, LLC , Bethesda, MD , USA.
OBJECTIVE: Some patients with allergic rhinitis (AR) may prefer nonaqueous
intranasal corticosteroid aerosols because of unwanted attributes of aqueous
formulations. The mandatory removal of chlorofluorocarbon-propelled nonaqueous
aerosols from the market limited available treatment options. To fulfill this
unmet need, a nonaqueous, hydrofluoroalkane-propelled beclomethasone dipropionate
(BDP) nasal aerosol was developed and approved for treatment of AR nasal
symptoms. As part of the development program, this dose-ranging study evaluated
three doses of BDP nasal aerosol to determine the optimally safe and effective
dose for adolescent and adult patients (12 years old) with seasonal AR (SAR).
METHODS: After a 7 to 21 day placebo run-in period, eligible patients with SAR
were randomly assigned to once-daily BDP nasal aerosol 80g, 160g, 320g, or
placebo. The primary endpoint was the change from baseline in average a.m. and
p.m. patient-reported reflective total nasal symptom scores (rTNSS) over 2 weeks.
Safety and tolerability were also assessed. A potential study limitation could be
lack of objective assessment of AR symptoms.
RESULTS: Significant improvements were seen in average a.m. and p.m. rTNSS (least
squares [LS] mean treatment difference, -0.63; 95% CI: -1.13, -0.13; p=0.013)
as well as in average a.m. and p.m. instantaneous TNSS (iTNSS; LS mean treatment
difference, -0.60; 95% CI: -1.09, -0.11; p=0.016) with BDP nasal aerosol
320g/day compared with placebo. Although there were numerical improvements from
baseline in patient-reported rTNSS and iTNSS with BDP nasal aerosol 80g and
160g, these doses did not achieve statistical significance compared with
placebo. BDP nonaqueous nasal aerosol was well tolerated at all doses tested,
with a safety profile comparable to that of placebo.
CONCLUSIONS: These data indicate that 320g/day of BDP nasal aerosol is the
optimally safe and effective dose for the treatment of SAR in adolescent and
adult patients. Trial registration NCT: #NCT00854360.
PMID: 23815103
51. Ann Allergy Asthma Immunol. 2013 Jul;111(1):56-63. doi:

10.1016/j.anai.2013.04.008. Epub 2013 May 3.
Cost-effectiveness for acupuncture in seasonal allergic rhinitis: economic
results of the ACUSAR trial.
Reinhold T(1), Roll S, Willich SN, Ortiz M, Witt CM, Brinkhaus B.
Author information:
(1)Institute for Social Medicine, Epidemiology and Health Economics, Charit University Medical Center, Berlin, Germany. thomas.reinhold@charite.de
BACKGROUND: Allergic rhinitis (AR) is a frequent allergic disorder with a
significant economic effect on health care costs and productivity.
OBJECTIVE: To assess the cost-effectiveness of acupuncture for patients with
seasonal AR (SAR) in Germany.
METHODS: The present analysis was part of the Acupuncture in Seasonal Allergic
Rhinitis (ACUSAR) trial, a 3-arm randomized, controlled, multicenter trial in
patients with SAR, comparing acupuncture plus rescue medication (RM), penetrating
sham acupuncture plus RM, and a control group receiving RM alone. Measures for
health economic analyses were costs and health-related quality of life.
Incremental cost-effectiveness ratio was calculated for different scenarios on
the duration of acupuncture effects and was expressed as costs per
quality-adjusted life-year gained. The study was conducted from society's and
from a third-party payer's perspective.

RESULTS: From 422 initially randomized patients, a total of 364 patients with
complete data on costs and quality of life were included in the health economic
evaluation. Patients receiving acupuncture or sham acupuncture caused higher
costs than patients in the RM group. Patients in the acupuncture group gained
significantly more quality-adjusted life-years compared with the RM group.
Depending on different scenarios, the incremental cost-effectiveness ratio for
acupuncture patients was between 31,241 (approximately US $38.569) and 118,889
(approximately US $146,777) from society's perspective and between 20,807
(approximately US $25,688) and 74,585 (approximately US $92.080) from a
third-party payer's perspective.
CONCLUSION: Acupuncture is an effective intervention that results in improved
quality of life in patients with SAR. However, in times of limited resources for
health care, acupuncture for AR may not be a cost-effective intervention.
PMID: 23806461
52. Ann Allergy Asthma Immunol. 2013 Jul;111(1):45-50. doi:

10.1016/j.anai.2013.04.013. Epub 2013 May 12.
Ocular safety of fluticasone furoate nasal spray in patients with perennial
allergic rhinitis: a 2-year study.
LaForce C(1), Journeay GE, Miller SD, Silvey MJ, Wu W, Lee LA, Chylack LT Jr.
Author information:
(1)North Carolina Clinical Research, Raleigh, North Carolina, USA.
BACKGROUND: This is the first study, to our knowledge, to evaluate the ocular
effects of an intranasal corticosteroid during 2 years of treatment for perennial
allergic rhinitis (PAR).
OBJECTIVE: To assess ocular safety in adult and adolescent patients 12 years and
older with PAR after 2 years of continuous treatment with fluticasone furoate
nasal spray (FFNS), 110 g once daily, and placebo.
METHODS: This was a 2-year, randomized, double-blind, placebo-controlled study of
once-daily FFNS, 110 g, and placebo in 548 patients 12 years and older with PAR.
The primary ocular safety end points were time to first occurrence of an event
for the Lens Opacities Classification System, Version III (LOCS III), posterior
subcapsular opacity (PSO) and time to first occurrence of an event for
intraocular pressure (IOP).
RESULTS: On the basis of survival analyses, the difference between the treatment
groups for time to first occurrence of a LOCS III PSO and time to first
occurrence of an IOP event was not statistically significant (P = .39 and P =
.34, respectively). Changes from baseline in visual acuity, LOCS III PSO,
cortical opacity, LOCS III nuclear opacity and nuclear color, IOP, and horizontal
cup-to-disc similar between treatment groups. There were no ophthalmic-related
adverse events of LOCS III PSO or IOP that led to early withdrawal. The most
common drug-related adverse event was epistaxis (FFNS, 28%; placebo, 14%).
CONCLUSION: These data neither support nor negate current recommendations for
regular ophthalmic monitoring in patients treated with intranasal
corticosteroids.
PMID: 23806459
53. Mediators Inflamm. 2013;2013:345217. doi: 10.1155/2013/345217. Epub 2013 Apr

27.
Evaluation of clinical and immunological responses: a 2-year follow-up study in
children with allergic rhinitis due to house dust mite.
Moed H(1), Gerth van Wijk R, Hendriks RW, van der Wouden JC.
Author information:
(1)Department of General Practice, Erasmus MC-University Medical Center
Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. h.moed@erasmusmc.nl
Background. Allergic rhinitis is a disease with polarization towards Th2 and a
defect of regulatory T cells. Immunological changes have been reported after
immunotherapy treatment. However, there is not much known about the natural
course of allergic rhinitis with respect to clinical manifestation and the
relation with immunological responses. Objective. To evaluate clinical symptoms
of allergic rhinitis, in relation to in vivo allergen-specific skin responses and
in vitro allergen-specific effector and regulatory T cells determined at baseline
and after two years. Methods. From a large trial, 59 children were randomly
selected. The following variables were compared: clinical symptoms, allergen skin
tests, specific IgE, T-cell proliferation, IL-5, IL-13, IFN-gamma, IL-10,
TGF-beta, CD4(+)CD25(hi) cells, and Foxp3 expression. Results. Allergic symptoms
had decreased after two years. Whereas skin test reactions correlated between
years 0 and 2, there was no change in the size of the reaction. Also,
proinflammatory reactions did not change after two years, with a positive
correlation between years 0 and 2. No relevant changes were observed with respect
to regulatory cells. Conclusion. Whereas, comparable to immunotherapy, allergic
complaints decrease, the immunological changes of specific T-cell activity (both
effector cells and regulator cells) which are observed after immunotherapy, do
not change.
PMCID: PMC3655673
54. J Negat Results Biomed. 2013 Jun 1;12:10. doi: 10.1186/1477-5751-12-10.
A phase 3 trial assessing the efficacy and safety of grass allergy immunotherapy
tablet in subjects with grass pollen-induced allergic rhinitis with or without
conjunctivitis, with or without asthma.
Murphy K, Gawchik S, Bernstein D, Andersen J, Pedersen MR.
BACKGROUND: Design and execution of immunotherapy trials for seasonal allergies
may be complicated by numerous factors including variable allergy testing
methods, pollen levels, and timing and intensity of other seasonal allergens. We
evaluated grass allergy immunotherapy tablet (AIT) treatment in North American
adults with grass pollen-induced allergic rhinitis with or without conjunctivitis
(AR/C), with/without asthma.
METHODS: Subjects age 18-65 with clinical history of grass pollen-induced AR/C,
with/without asthma were randomized 1:1 to once-daily 2800 BAU Timothy grass AIT
(oral lyophilisate, Phleum pratense, 75,000 SQ-T, containing approximately 15 g
of Phl p 5) or placebo. The AR/C symptom and medication scores were recorded
daily. The primary end point was the average AR/C daily symptom score (DSS)
during the entire grass pollen season (GPS). Ranked key secondary end points were
Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, daily medication
score (DMS), and percentage of well days, all over entire GPS. Safety was
monitored through adverse event reporting.
RESULTS: Efficacy analysis included 289 subjects. Over the entire GPS, mean DSS
was 6% lower with AIT versus placebo (5.69 vs. 6.06), but this difference was not
statistically significant (p=0.3475) despite significantly higher immunological
response in the grass AIT group. No significant between-group differences were

seen for key secondary end points. In general, DSS was high before GPS began and
no clear relationship between DSS and grass pollen counts was seen during GPS. In
post hoc analysis of subjects with pre-seasonal DSS 3, mean DSS and DMS were
both significantly lower with grass AIT versus placebo (27%; p=0.0327 and 68%;
p=0.0060, respectively). In this subgroup a relationship between DSS and grass
pollen counts was observed. Grass AIT was generally well tolerated, with no
events of anaphylactic shock or respiratory compromise.
CONCLUSIONS: In this trial, 2800 BAU grass AIT did not demonstrate significant
symptom improvement versus placebo. Lack of relationship between pollen count and
symptom score in the study population, and post hoc findings among subjects with
low pre-seasonal symptoms, suggest that the symptoms reported in this study were
not primarily reflective of the effects of grass pollen exposure.
TRIAL REGISTRATION: NCT00421655.
PMCID: PMC3689082
55. Laryngoscope. 2013 Dec;123(12):2945-9. doi: 10.1002/lary.24215. Epub 2013 Jun
3.
Efficacy of intra- and extraturbinal microdebrider turbinoplasty in perennial
allergic rhinitis.
Lee JY(1).
Author information:
(1)Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang
University College of Medicine, Bucheon Hospital, Bucheon, South Korea.
OBJECTIVES/HYPOTHESIS: Microdebrider-assisted inferior turbinoplasty (MAIT) has
become a popular method for relieving symptoms of allergic rhinitis and can be
performed intraturbinally or extraturbinally. The objective of this study was to
evaluate and compare the long-term efficacy of these two methods.
STUDY DESIGN: Prospective randomized study.
METHODS: Sixty patients diagnosed with perennial allergic rhinitis were selected.
Thirty patients were treated with intraturbinal MAIT (group 1) and 30 patients
were treated with extraturbinal MAIT (group 2). Postoperative changes in nasal
obstruction, rhinorrhea, sneezing, nasal itching, and postnasal drip were
evaluated 3, 6, and 12 months postoperatively. The cross-sectional area of the
second notch and nasal cavity volume were compared at 12 months. The operation
time, duration of crust formation, and postoperative bleeding were also compared.
RESULTS: All symptoms improved significantly in both groups at 3, 6, and 12
months. However, when improvement of rhinorrhea, sneezing, and nasal itching was
compared, improvement was statistically significant in group 2 at 12 months.
Acoustic rhinometry demonstrated a significant increase in the cross-sectional
area of the second notch and nasal cavity volume in both groups, which did not
differ significantly between the two groups at 12 months. The operation time and
duration of crust formation were longer in groups 1 and 2, respectively. The
incidence of postoperative bleeding was higher in group 2.
CONCLUSION: Although both methods showed significant improvement, extraturbinal
MAIT seemed more effective for long-term relief of allergic symptoms. However,
the advantages and disadvantages of each method should be considered before
choosing the surgical technique.
Copyright 2013 The American Laryngological, Rhinological and Otological
Society, Inc.
PMID: 23712736
56. Allergy Asthma Proc. 2013 May-Jun;34(3):283-91. doi:

10.2500/aap.2013.34.3662.
An integrated analysis of the efficacy of fluticasone furoate nasal spray versus
placebo on the nasal symptoms of perennial allergic rhinitis.
Wu W(1), Walters RD, Nadeau GA, Botnick W, Broughton N.
Author information:
(1)Clinical Statistics, Quantitative Sciences Division, Medicines Discovery and
Development, Research and Development, GlaxoSmithKline, Research Triangle Park,
NC, USA.
Intranasal corticosteroids are widely prescribed for the treatment of perennial
allergic rhinitis (PAR). The aim of this analysis was to determine whether the
beneficial effects of once-daily (q.d.) fluticasone furoate nasal spray (FFNS)
effectively improved individual nasal symptoms of PAR. An integrated analysis was
performed on data from three randomized, double-blind, placebo-controlled,
parallel-group trials designed to evaluate the efficacy and safety of FFNS at 110
micrograms, q.d. in subjects with PAR. The analysis included 460 subjects who
received FFNS and 459 who received placebo for 4 weeks. All subjects evaluated
the severity of individual nasal symptoms of nasal congestion, nasal itching,
rhinorrhea, and sneezing on a four-point categorical scale. The main efficacy
measures included change from baseline in daily reflective total nasal symptom
score (rTNSS), reflective daily scores for each individual symptom, and predose
instantaneous TNSS (iTNSS). Over 4 weeks of treatment, FFNS significantly
improved rTNSS, iTNSS, and the reflective scores for each individual symptom
compared with placebo. The least squares (LS) mean treatment difference over
weeks 1-4 between FFNS and placebo for rTNSS was -0.93, ranging from -0.20 to
-0.28 for the individual nasal symptoms (p < 0.001 for all versus placebo). For
the iTNSS, the LS mean treatment difference between FFNS and placebo over weeks
1-4 was -0.95 (95% CI,-1.24, -0.66; p < 0.001). FFNS at 110 micrograms q.d.
effectively relieved all nasal symptoms of PAR including nasal congestion over a
24-hour period.
PMID: 23676578
57. Allergy Asthma Proc. 2013 May-Jun;34(3):274-82. doi:

10.2500/aap.2013.34.3668.
Randomized controlled trial of desloratadine for persistent allergic rhinitis:
correlations between symptom improvement and quality of life.
Bousquet J(1), Zuberbier T, Canonica GW, Fokkens WJ, Gopalan G, Shekar T.
Author information:
(1)Hpital Arnaud de Villeneuve, Montpellier, France. jean.bousquet@inserm.fr
Allergic rhinitis (AR) symptoms can impart emotional, quality of life (QOL), and
work productivity burdens, especially in persistent AR (PER). Desloratadine, an
H1-receptor antagonist, has been shown to be effective against nasal and nonnasal
AR symptoms and to improve QOL. Exploratory analyses were conducted to evaluate
whether desloratadine-mediated symptom improvement correlated with improvements
in QOL and productivity. The Aerius Control: Clinical and Evaluative Profile of
Treatment 2 (NCT00405964) study was a 12-week, multinational, randomized,
placebo-controlled prospective study of once-daily desloratadine at 5 mg in
subjects with moderate-to-severe PER. Assessments included twice-daily symptom
severity ratings (0 = none to 3 = severe; total and individual symptoms), sleep
interference (morning [A.M.]), interference with activities of daily living (ADL;
evening [P.M.]), the Rhinoconjunctivitis Quality of Life
Questionnaire-Standardized version (baseline and days 29 and 85), and the Work
Productivity and Activity Impairment-Allergy-Specific questionnaire (baseline and
weekly). Pearson product-moment correlation statistics (r) were determined to

assess correlations between symptom score improvements and QOL factors. All
desloratadine-treated patients (n = 360) were included in this exploratory
analysis. In the desloratadine-treated patients, all correlations tested were
positive (all p < 0.0001). The highest coefficients were seen for the
correlations between A.M./P.M. PRIOR total five-symptom score and interference
with ADL (r = 0.72) and between A.M. NOW congestion and ADL interference (r =
0.69). Continuous daily treatment of moderate-to-severe PER with desloratadine at
5 mg/day significantly improved symptoms, which correlated positively, albeit
moderately, with QOL benefits and reversal of functional impairments caused by
PER.
PMID: 23676577
58. Laryngoscope. 2013 Jun;123(6):1334-40. doi: 10.1002/lary.23935. Epub 2013 Apr

24.
Fast onset of action of sublingual immunotherapy in house dust mite-induced
allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled
trial.
Wang DH(1), Chen L, Cheng L, Li KN, Yuan H, Lu JH, Li H.
Author information:
(1)Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai,
People's Republic of China.
OBJECTIVES/HYPOTHESIS: To investigate how quickly an allergic rhinitis (AR)
patients' symptoms will improve with sublingual immunotherapy (SLIT).
STUDY DESIGN: Double-blind placebo study.
METHODS: This is a multicenter, randomized, double-blind, placebo-controlled
study of SLIT used to treat house dust mite-induced AR. A total of 120 AR
patients, aged 4 to 60 years, were treated for 6 months and randomized into two
groups: 1) SLIT with Dermatophagoides pteronyssinus (D.p.) and Dermatophagoides
farina (D.f.) extract (n = 60) ; and 2) matched placebo controls (n = 60).
Symptom, medications received, and a visual analog scale score were recorded
during the whole study. Serum-specific IgE and IgG4 to D. p. and D. f. were
assessed before and after the treatment.
RESULTS: Eighty-five patients (70.8%) completed the study. Twelve patients (20%)
chose to withdraw from the SLIT group, but none because of serious adverse
effects. The total symptom and visual analog scores VAS in the SLIT group
decreased significantly when compared to the placebo controls (P <0.05) after
week 14, as well as for the significant (P <0.05) improvement of all individual
AR symptoms in the SLIT group (e.g., sneezing, nasal discharge, itching, and
nasal obstruction) after week 22. There was a significant (P <0.05) increase of
IgG4 to both D.f. and D.p. in the SLIT, but not in the placebo group after
treatment.
CONCLUSION: SLIT with a mixture of D.f. and D.p. extract is an effective and safe
treatment for patients with house dust mite-induced AR. Its onset of action can
be observed as early as 14 weeks after treatment.
Copyright 2012 The American Laryngological, Rhinological and Otological
Society, Inc.
PMID: 23616386
59. Allergol Int. 2013 Jun;62(2):245-9. doi: 10.2332/allergolint.12-OA-0510. Epub

2013 Apr 25.
Comparing the effects of Botulinum Toxin-A and cetirizine on the treatment of
allergic rhinitis.
Hashemi SM(1), Okhovat A, Amini S, Pourghasemian M.

Author information:
(1)Department of Otorhinolaryngology Head and Neck Surgery, Isfahan University of
Medical Sciences, Isfahan, Iran.
BACKGROUND: There are few reports on the effects of intranasal Botulinum Toxin-A
(BTX-A) as a treatment of allergic rhinitis (AR). In this study, we compared the
efficacy of intranasal BTX-A to cetirizine in the treatment of AR.
METHODS: Fifty AR patients at the age of 26.2 9.1 years (64% females), were
recruited to the trial according to the Allergic Rhinitis and its Impact on
Asthma (ARIA) criteria. Participants randomly received either intranasal
injection of BTX-A (75IU Dysport) or cetirizine (10mg/day). Symptoms (based on
the ARIA) and side effects were assessed every two weeks for two months. Quality
of life was evaluated before and after the study using the Rhinasthma
questionnaire.
RESULTS: Total symptom severity score of patients significantly decreased (P <
0.001) and quality of life significantly improved (P < 0.001) at the same level
in both groups. Side effects included nasal dryness (4%) and epistaxis (4%) in
the BTX-A group. In the cetirizine group 44% sleepiness and 4% blurred vision was
reported.
CONCLUSIONS: Nasal injection of BTX-A shows the same therapeutic effects as
cetirizine in the management of AR. Since BTX is expensive, we do not suggest it
in the first line of treatment for AR. However, BTX-A is a potential treatment
for patients who are resistant or not compliant to the routine medications of AR.
Further studies are required to investigate implications and limitations of BTX-A
in the treatment of AR.
PMID: 23612494
60. Pediatr Neonatol. 2013 Aug;54(4):239-45. doi: 10.1016/j.pedneo.2013.01.007.

Epub
2013 Mar 5.
Comparison of mometasone furoate monohydrate (Nasonex) and fluticasone propionate
(Flixonase) nasal sprays in the treatment of dust mite-sensitive children with
perennial allergic rhinitis.
Mak KK(1), Ku MS, Lu KH, Sun HL, Lue KH.
Author information:
(1)Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung
Shan Medical University Hospital, Taichung, Taiwan.
BACKGROUND: Various studies have investigated the efficacies of mometasone
furoate monohydrate (MFM) and fluticasone propionate (FP) nasal sprays for
adults. However, research on their effectiveness for children is limited. This
study compares the efficacies of MFM and FP nasal sprays in pediatric patients
with perennial-allergic rhinitis.
MATERIALS AND METHODS: For this study, 94 perennial allergic rhinitis patients
aged 6-12 years were randomly assigned to two treatment groups: an MFM group and
an FP group. Treatment was provided for 4 weeks. The effects of the two agents
were compared using the Pediatric Rhinoconjunctivitis Quality of Life
Questionnaire and total symptom scores (TSSs). Nasal-peak expiratory flow rates
and eosinophil percentage in nasal smears were also compared between the two
groups.
RESULTS: Patients in the MFM group exhibited significant improvement in their TSS
(t = -2.65, p < 0.05). A detailed TSS analysis showed MFM to be more effective
for relieving nasal symptoms, whereas FP was more effective for relieving
non-nasal symptoms. Patient questionnaire scores suggested a significant
reduction in symptoms for both the MFM (t = -7.23, p < 0.01) and FP (t = -5.43,
p < 0.01) groups. The flow rate test results indicated significant improvements
in the MFM group (t = 2.27, p < 0.05).
CONCLUSION: Following the 4-week therapy, MFM provided greater improvement
compared to FP for symptoms of childhood perennial-allergic rhinitis. Based on
their TSSs, the MFM group experienced more effective relief of nasal symptoms,
whereas the FP group experienced more effective relief of non-nasal symptoms.
Copyright 2013. Published by Elsevier B.V.
PMID: 23597528
61. Arch Immunol Ther Exp (Warsz). 2013 Aug;61(4):327-32. doi:

10.1007/s00005-013-0224-3. Epub 2013 Apr 7.
Increased cys-leukotrienes in exhaled breath condensate and decrease of PNIF
after intranasal allergen challenge support the recognition of allergic rhinitis
in children.
Zagrska W(1), Grzela K, Kulus M, Sobczyski M, Grzela T.
Author information:
(1)Department of Pediatrics, Pneumonology and Allergology, Medical University of
Warsaw, Warsaw, Poland.
Exhaled breath condensate (EBC) contains various mediators of inflammation. Since
their concentrations correlate with severity of inflammatory response, EBC
assessment allows non-invasive detection of various respiratory tract diseases
and enables monitoring of their progression or treatment effectiveness. In this
study, authors evaluate the usefulness of cysteinyl leukotrienes (cysLT)
measurement in EBC, as non-invasive diagnostic markers of allergic rhinitis in
children. It has been found that the assessment of cysLT in EBC, when performed
out of the natural allergen exposure, can discriminate between healthy and
allergic rhinitis individuals, with sensitivity 87.8% and specificity 76.4%, at
the threshold level 39.05 pg/ml. The change of peak nasal inspiratory flow
(PNIF), measured before and after intranasal allergen challenge allowed
recognition of healthy/allergic rhinitis-suffering individuals with sensitivity
76.8% and specificity 78.6%, at the threshold level of -3.2 l/min. When PNIF
assessment was combined with the measurement of cysLT in EBC, the sensitivity of
such diagnostic approach reached 100% and its specificity increased up to 84.6%.
The proposed algorithm was found to sufficiently discriminate between allergic
rhinitis-suffering and healthy children, however, its clinical usefulness
especially in young children requires further studies.
PMID: 23563863
62. Am J Rhinol Allergy. 2013 Mar-Apr;27(2):102-8. doi:

10.2500/ajra.2013.27.3864.
Mometasone furoate nasal spray plus oxymetazoline nasal spray: short-term
efficacy and safety in seasonal allergic rhinitis.
Meltzer EO(1), Bernstein DI, Prenner BM, Berger WE, Shekar T, Teper AA.
Author information:
(1)Allergy & Asthma Medical Group & Research Center, San Diego, California 92123,
USA. eomeltzer@aol.com
BACKGROUND: Allergic rhinitis (AR) and associated congestion adversely affect
patients' lives. The intranasal corticosteroid mometasone furoate nasal spray
(MFNS) is effective for AR symptoms including nasal congestion, and the
intranasal decongestant oxymetazoline (OXY) is effective against nasal
congestion, but the combination has not been fully studied. This study was
designed to assess the efficacy of the combination of MFNS and OXY for the relief
of seasonal allergic rhinitis (SAR) symptoms.
METHODS: This phase 2 controlled clinical trial randomized adolescent and adult
subjects (12 years; 2-year SAR) to MFNS q.d. (200 g) + 3 sprays/nostril of OXY
0.05% (MFNS + OXY3); MFNS q.d. + 1 spray/nostril of OXY (MFNS + OXY1); MFNS q.d.;
OXY b.i.d.; or placebo for 15 days, with 1-week follow-up. Coprimary end points
were change from baseline in morning/evening (A.M./P.M.) instantaneous (NOW)
total nasal symptom score (TNSS) over days 1-15 and AUC (AUC[0-4 hr]) change from
baseline in day 1 congestion.
RESULTS: In 705 subjects, both combinations reduced A.M./P.M. NOW TNSS over days
1-15 significantly more than OXY b.i.d. or placebo (p 0.002). Mean standardized
AUC(0-4 hr) day 1 congestion change from baseline was significantly greater in
combination and OXY b.i.d. groups (MFNS + OXY3, -0.92; MFNS + OXY1, -0.80; OXY
b.i.d., -1.06) versus placebo (-0.57) and MFNS q.d. (-0.63). Combinations and
MFNS q.d. were significantly effective for A.M./P.M. NOW TNSS over each weekly
period; OXY b.i.d. was superior to placebo in week 1. Adverse events (AEs) were
few and similar across treatments; one MFNS q.d. and one placebo subject
experienced a serious AE, with neither considered treatment related.
CONCLUSION: Combining MFNS with OXY relieves SAR symptoms, including congestion,
with faster onset of action than MFNS q.d. and better sustained efficacy than OXY
b.i.d.
PMID: 23562197
63. J Allergy Clin Immunol. 2013 May;131(5):1361-6. doi:

10.1016/j.jaci.2013.02.013.
Epub 2013 Apr 1.
Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: a
systematic review and indirect comparison.
Dretzke J(1), Meadows A, Novielli N, Huissoon A, Fry-Smith A, Meads C.
Author information:
(1)Department of Public Health, Epidemiology & Biostatistics, University of
Birmingham, Birmingham, United Kingdom. j.dretzke@bham.ac.uk
Comment in
J Allergy Clin Immunol. 2015 Jan;135(1):293-4.
J Allergy Clin Immunol. 2014 Mar;133(3):936.
BACKGROUND: Severe allergic rhinitis uncontrolled by pharmacotherapy can
adversely affect quality of life. Both subcutaneous immunotherapy (SCIT) and
sublingual immunotherapy (SLIT) have demonstrated effectiveness in this patient
group; however, it remains uncertain which route of administration is more
effective.
OBJECTIVES: We sought to update existing systematic reviews on the clinical
effectiveness of SCIT and SLIT versus placebo, to undertake a systematic review
of head-to-head trials, and to compare the relative effectiveness of SCIT and
SLIT in an adjusted indirect comparison.
METHODS: Standard systematic review methods aimed at minimizing bias were used.
Double-blind, randomized, placebo-controlled trials of SCIT or SLIT or trials of
SCIT versus SLIT were included. Meta-analysis and indirect comparison
meta-analysis with meta-regression were performed.
RESULTS: Updated meta-analyses confirmed statistically significant benefits for
SCIT and SLIT compared with placebo in adults and, to a lesser extent, in
children. Only 1 head-to-head trial met the inclusion criteria; both this and the
indirect comparisons did not provide conclusive results in favor of either SCIT
or SLIT based on symptom-medication or quality-of-life scores. There was a trend
toward favoring SCIT for symptom and medication scores.
CONCLUSIONS: Although there is clear evidence of effectiveness of both SCIT and
SLIT, superiority of one mode of administration over the other could not be
consistently demonstrated through indirect comparison, and further research is
needed to establish the comparative effectiveness of SCIT versus SLIT.
Mosby, Inc. All rights reserved.
PMID: 23557834
64. Immunotherapy. 2013 Mar;5(3):257-64. doi: 10.2217/imt.12.157.

Sublingual immunotherapy for allergic rhinitis and conjunctivitis.
Passalacqua G(1), Garelli V, Sclif F, Canonica GW.
Author information:
(1)Allergy & Respiratory Diseases, IRCCS San Martino-IST-University of Genoa,
Padiglione Maragliano, L.go R. Benzi 10, 16132 Genoa, Italy. passalacqua@unige.it
Sublingual immunotherapy (SLIT) for allergic respiratory diseases was first
described in 1986 and immediately appeared as a viable alternative to the
traditional subcutaneous route. Since then, more than 60 randomized controlled
trials have been published, almost all with very favorable results. The average
improvement over placebo in symptom score and medication use was always greater
than 20%. The results of the clinical trials were pooled in several
meta-analyses, which consistently confirmed the efficacy of the treatment. SLIT
is characterized by a satisfactory safety profile, its side effects being mainly
limited to oral discomfort. Only six anaphylaxes and no fatalities have been so
far reported. Due to the good risk:benefit ratio, SLIT is currently being
investigated in diseases other than respiratory allergy, such as food allergy and
atopic dermatitis.
PMID: 23444955
65. JAMA Pediatr. 2013 Apr;167(4):380-6. doi: 10.1001/jamapediatrics.2013.623.

A control model to evaluate pharmacotherapy for allergic rhinitis in children.
Rachelefsky G(1), Farrar JR.
Author information:
(1)Executive Care Center for Asthma, Allergy, and Respiratory Diseases, Geffen
School of Medicine at the University of California, Los Angeles, 1131 Wilshire
Blvd, Ste 202, Santa Monica, CA 90401, USA.
IMPORTANCE: Although the question of whether early diagnosis and treatment of
pediatric allergic rhinitis (AR) improve disease control is important, a more
crucial question is whether we can evaluate the effect of treatment on disease
control using an impairment-risk model.
OBJECTIVE: To conduct a systematic review evaluating application of a control
model based on domains of impairment and risk (similar to that used for asthma)
in pharmacotherapy for children with AR.
EVIDENCE ACQUISITION: We searched the MEDLINE and EMBASE databases (January 1,
1996, through May 31, 2012) for controlled studies lasting 2 weeks or longer in
children with confirmed diagnoses of AR, including measures assessing impairment
and/or risk of comorbid conditions.
RESULTS: Sixteen controlled clinical trials, including more than 3000 children
(aged 2-18 years) with AR (seasonal, n = 2290; perennial, n = 800), met the study
criteria. All medication classes improved impairment related to AR, but
between-treatment comparisons were limited because of different assessments.
Intranasal steroids improved risk outcomes associated with asthma and obstructive
sleep apnea. Small single studies suggested possible effects of oral

antihistamines on asthma and sleep-disordered breathing. No risk data were
available for nasal antihistamines or montelukast sodium.
CONCLUSIONS: Treatment of AR, particularly with intranasal steroids, improves
disease control in children by reducing disease-associated impairment and risk.
All AR medications with proved efficacy probably improve impairment, paralleling
symptom reduction. Intranasal steroids may reduce the likelihood of comorbidities
that increase health care use. These observations, although limited by different
protocols and outcomes measures among studies, support current practice
recommendations. Studies that use standardized measures of impairment to permit
better comparison and appropriate protocols for risk evaluation are needed.
PMID: 23440263
66. Int J Pediatr Otorhinolaryngol. 2013 May;77(5):658-65. doi:

10.1016/j.ijporl.2013.01.006. Epub 2013 Feb 8.
Comparative study in the management of allergic rhinitis in children using LED
phototherapy and laser acupuncture.
Moustafa Y(1), Kassab AN, El Sharnoubi J, Yehia H.
Author information:
(1)Otorhinolaryngology Unit, Department of Medical Laser Applications, National
Institute of Laser Enhanced Sciences, Cairo University, Egypt.
OBJECTIVE: The objective of this study was to compare the outcomes of LED
phototherapy and laser acupuncture treatment on allergic rhinitis in children.
METHODS: 40 patients with perennial allergic rhinitis were divided randomly into
two groups. Patient's ages ranged from 7 to 18 years. One group was subjected to
LED phototherapy and the other group was managed by laser acupuncture .The
patients were followed-up for 1 year.
RESULTS: There was a significant improvement in the severity score symptoms in
both groups through and by the end of the follow up period.
CONCLUSION: This led to the conclusion that both techniques are equally safe,
reliable, non invasive and successful.
PMID: 23394792
67. Pediatr Allergy Immunol. 2013 Mar;24(2):144-50. doi: 10.1111/pai.12036. Epub

2013
Feb 6.
Rupatadine oral solution in children with persistent allergic rhinitis: A
randomized, double-blind, placebo-controlled study.
Potter P(1), Maspero JF, Vermeulen J, Barkai L, Nmeth I, Baillieau RA, Garde JM,
Giralt J, Domnech A, Izquierdo I, Nieto A.
Author information:
(1)Allergy Diagnostic and Clinical Research Unit, Department of Medicine,
University of Cape Town, Cape Town, South Africa.
BACKGROUND: Allergic rhinitis (AR) is one of the most common chronic diseases in
childhood. No large, multicentre clinical trials in children with persistent
allergic rhinitis (PER) have previously been performed. Rupatadine, a newer
second-generation antihistamine, effective and safe in adults, is a promising
treatment for children with AR. The aim of the present study was to evaluate the
efficacy and safety of a new rupatadine oral solution in children aged 6-11 yr
with PER.
METHODS: A multicenter, randomized, double-blind, placebo-controlled study was
carried out worldwide. Patients between 6 and 11 yr with a diagnosis of PER
according to ARIA criteria were randomized to receive either rupatadine oral
solution (1 mg/ml) or placebo over 6 wk. The primary efficacy end-point was the
change from baseline of the total nasal symptoms score (T4SS) after 4 wk of
treatment.
RESULTS: A total of 360 patients were randomized to rupatadine (n = 180) or
placebo (n = 180) treatment. Rupatadine showed statistically significant
differences vs. placebo for the T4SS reduction both at 4 (-2.5 1.9 vs.
-3.1 2.1; p = 0.018) and 6 wk (-2.7 1.9 vs. -3.3 2.1; p = 0.048).
Rupatadine also showed a statistically better improvement in the children's
quality of life compared with placebo. Adverse reactions were rare and
non-serious in both treatment groups. No QTc or laboratory test abnormalities
were reported.
CONCLUSIONS: Rupatadine oral solution (1 mg/ml) was significantly more effective
than placebo in reducing nasal symptoms at 4 and 6 wk and was well tolerated
overall. This is the first large clinical report on the efficacy of an H1
receptor antagonist in children with PER in both symptoms and quality of life.
2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.
PMID: 23384091
68. Int Forum Allergy Rhinol. 2013 Jun;3(6):504-9. doi: 10.1002/alr.21123. Epub
2013
Jan 10.
The association between allergic rhinitis and sleep-disordered breathing in
children: a systematic review.
Lin SY(1), Melvin TA, Boss EF, Ishman SL.
Author information:
(1)Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore,
MD 21287, USA. slin@jhmi.edu
BACKGROUND: The objective of this work was to systematically review existing
literature on the association between allergic rhinitis (AR) and sleep-disordered
breathing (SDB) in children.
METHODS: We performed a literature search encompassing the last 25 years in
PubMed, EMBASE, and Cochrane CENTRAL. Inclusion criteria included
English-language papers containing original human data, number of subjects 7,
and age <18 years old. Data was systematically collected on study design, patient
demographics, clinical characteristics/outcomes, and level-of-evidence. Two
investigators independently reviewed all articles.
RESULTS: The initial search yielded 433 abstracts, of which 18 articles were
included. Twelve (67%) of the 18 articles showed a statistically significant
association between AR and SDB. All articles were either case-series or
case-control studies. Based on the Newcastle-Ottawa scale, the quality of the
articles was determined to be fair to good. For characterizing AR, 7 (39%)
studies included skin-prick testing and/or in vitro testing. For determining
presence of SDB, 7 (39%) of the studies used polysomnographic data, of which 1
study incorporated data from a home polysomnogram. Habitual snoring was the most
common form of SDB studied, in 10 (56%) of the articles. Obstructive sleep apnea
was studied in 6 (33%) articles.
CONCLUSION: Although the majority of the studies included in this review showed a
significant association between AR and SDB, all of the studies were evidence
level 3b and 4, for an overall grade of B- evidence (Oxford Evidence-Based
Medicine Center). Further higher-quality studies should be performed in the
future to better evaluate the relationship between AR and SDB in children.
2013 ARS-AAOA, LLC.

PMID: 23307785
69. Curr Allergy Asthma Rep. 2013 Apr;13(2):142-51. doi: 10.1007/s11882-012-0331y.

Comparative analysis of allergic rhinitis in children and adults.
Izquierdo-Domnguez A(1), Valero AL, Mullol J.
Author information:
(1)Department of Allergology, Hospital Quirn, Barcelona, Catalonia, Spain.
adrianaeizquierdo@hotmail.com
Allergic rhinitis (AR) is a worldwide health problem that generates a significant
healthcare burden in adults, adolescents, and children. Epidemiological studies
have indicated that the prevalence of AR has progressively increased over the
last three decades in developed and industrialized countries. AR currently
affects up to 40 % of the worldwide population, with differences between adults
and children and different countries of the World. Although not life-threatening,
AR symptoms are frequently bothersome, adversely affecting work and quality of
life of the affected patients, and causing a significant burden on both the
individual and society. The symptoms have the potential to lead to both physical
and mental complications, with sleep-disordered breathing in childhood and
adolescence being associated with disorders in learning performance, behavior,
and attention. Clinical features and comorbidities are very important for the
"allergic march", and in both adults and children there is some evidence of
association between AR and asthma. ARIA classifications of both symptom duration
(intermittent, persistent) and severity (mild, moderate, severe) have been
validated in both adult and pediatric populations. Based on the duration and
severity of patient's disease, an appropriate treatment strategy has been issued
for both adults and children, which consists of patient's education, allergen
avoidance, and pharmacological as well as allergen-specific immunotherapy
treatment. The present review will attempt to compare the characteristics of AR
between children and adults, either in the epidemiology, clinical features,
impact on QOL, and management of the disease.
PMID: 23250586
70. Laryngoscope. 2013 Jan;123(1):53-6. doi: 10.1002/lary.23617. Epub 2012 Oct

15.
Comparison of buffered and nonbuffered nasal saline irrigations in treating
allergic rhinitis.
Chusakul S(1), Warathanasin S, Suksangpanya N, Phannaso C, Ruxrungtham S,
Snidvongs K, Aeumjaturapat S.
Author information:
(1)Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand. supinda.ent@gmail.com
OBJECTIVES/HYPOTHESIS: We aimed to study the effect of alkalinity of isotonic
nasal saline irrigation on nasal symptoms, mucociliary clearance, nasal patency,
and patient's preference in patients with allergic rhinitis (AR).
STUDY DESIGN: A double-blind, randomized, three-arm crossover study.
METHODS: Patients with AR were enrolled. Three kinds of isotonic nasal saline
irrigations: nonbuffered (pH 6.2-6.4), buffered with mild alkalinity (pH
7.2-7.4), and buffered with alkalinity (pH 8.2-8.4) were given one at a time, in
different orders. Patients rinsed their nose with 240 ml of one solution twice
daily for 10 days and then swapped to the others. The washout period was at least
5 days. Primary outcomes were nasal symptoms, mucociliary clearance time, and
nasal patency. Outcomes were compared between baseline and posttreatment and also
between various kinds of solution. Secondary outcomes were patients' preference
and adverse events.
RESULTS: Thirty-six subjects entered the study, and there were no dropouts.
Overall nasal symptom was significantly improved from baseline (P = 0.03) only by
buffered solution with mild alkalinity. Sneezing was significantly improved from
baseline (P = 0.04) only by buffered solution with alkalinity. No other
significant improvements were achieved by any solution. When comparing between
the three nasal irrigations, there were no differences in all parameters. The
patients significantly preferred the buffered solution with mild alkalinity (P =
0.02).
CONCLUSIONS: Buffered isotonic saline with some degree of alkalinity may improve
nasal symptoms. Isotonic saline irrigations, regardless of alkalinity, may not
improve mucociliary function and nasal patency. Buffered isotonic saline with
mild alkalinity is the most preferred.
Copyright 2012 The American Laryngological, Rhinological, and Otological
Society, Inc.
PMID: 23070939
71. Indian Pediatr. 2013 Feb;50(2):209-13. Epub 2012 Jun 10.

Effect of probiotics on allergic rhinitis in Df, Dp or dust-sensitive children: a
randomized double blind controlled trial.
Lin TY(1), Chen CJ, Chen LK, Wen SH, Jan RH.
Author information:
(1)Department of Laboratory Medicine, Buddhist Tzu Chi General Hospital, Hualien,
Taiwan.
Comment in
Indian Pediatr. 2013 Feb;50(2):195-6.
OBJECTIVE: To study, we examined the effect of Lactobacillus salivarius on the
clinical symptoms and medication use among children with established allergic
rhinitis (AR).
DESIGN: Double blind, randomized, controlled trial.
SETTING: Hualien Tzu-Chi General Hospital.
METHODS: Atopic children with current allergic rhinitis received 4x10(9) colony
forming units/g of Lactobacillus salivarius (n=99) or placebo (n=100) daily as a
powder mixed with food or water for 12 weeks. The SCORing Allergic rhinitis index
(specific symptoms scores [SSS] and symptom medication scores [SMS]), which
measures the extent and severity of AR, was assessed in each subject at each of
the visits--2 weeks prior to treatment initiation (visit 0), at the beginning of
the treatment (visit 1), then at 4 (visit 2), 8 (visit 3) and 12 weeks (visit 4)
after starting treatment. The WBC, RBC, platelet and, eosinophil counts as well
as the IgE antibody levels of the individuals were evaluated before and after 3
months of treatment.
RESULTS: The major outcome, indicating the efficacy of Lactobacillus salivarius
treatment, was the reduction in rhinitis symptoms and drug scores. No significant
statistical differences were found between baseline or 12 weeks in the probiotic
and placebo groups for any immunological or blood cell variables.
CONCLUSIONS: Our study demonstrates that Lactobacillus salivarius treatment
reduces rhinitis symptoms and drug usage in children with allergic rhinitis.
PMID: 22728633

Rinitis Alergica

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