allergic rhinitis

Asthma and Allergic rhinitis (AR) are frequently concurrent diseases. Epidemiological, immunological, and clinical studies reported increasing evidence of the links between AR and asthma. Epidemiologically, up to 40% of patients with AR also have asthma, and up to 80% of patients with asthma experience nasal symptoms. Furthermore, patients with AR are at three times the risk of developing asthma compared with those without AR.

This cross-sectional study was carried out during one year from all patients between 0-16 years who were referred to allergy and ENT clinics with symptoms of chronic cough (more than four weeks) or upper respiratory tract symptoms such as sneezing, runny nose, and nasal congestion. Data and diagnosis were classified according to the Global Initiative for Asthma (GINA) and the AR criteria and its Impact on Asthma guidelines (ARIA), respectively.

190 (120 individuals with asthma and 70 individuals with AR) were enrolled in the study. The mean age of patients with asthma was 9.14±3.13, and 43.3% were female. The severity of asthma was classified as mild (20%), moderate (70.8%), and severe (9.2%). The mean age of patients with rhinitis was 10.13±3.45 years, and 35.7% were female. Rhinitis was classified as intermittent (40%) and persistent (60%). The prevalence of AR in the asthma group was 42 individuals (35%). Twenty-nine cases of them (24.2%) had intermittent AR, and 13 (10.8%) cases had persistent AR. The prevalence of asthma in AR was 18 cases (25.7%) 3 cases (4.3%) had mild asthma, 12 cases (17/1%) had moderate asthma, and 3 cases (4.3%) had severe asthma. A significant correlation was found ( P<0.0001) between the severity of AR and asthma.

Based on the findings of our study, there is a significant relationship between the severity of asthma and AR in patients with asthma and AR. The results show that asthma prevalence is high in patients with AR. Also, the frequency of AR in patients with asthma is significantly higher.

Asthma and allergic rhinitis are prevalent respiratory conditions influenced by genetic, environmental, and immunological factors. Understanding the distribution of these conditions and their associated allergens is essential for effective management and prevention strategies.This study aimed to investigate the prevalence of asthma, allergic rhinitis, and their co-occurrence in a specific population, with a focus on allergen sensitivity patterns.

A retrospective analysis was conducted on patients diagnosed with asthma, allergic rhinitis, or both. Allergen sensitivity was assessed using skin prick tests for common environmental allergens, including weeds, mites, cockroaches, and mixed allergens. Data analysis included prevalence rates, allergen distribution, and a heatmap visualization of allergen-patient associations.

Males demonstrated a higher prevalence of asthma (68.8%), allergic rhinitis (64.4%), and combined conditions (67.0%) compared to females. Weeds were the most common allergen among asthma patients (40.0%), while mixed allergens were predominant among allergic rhinitis (45.7%) and coexisting conditions (50.0%). Heatmap analysis revealed strong associations between mites, cockroaches, and respiratory conditions, reinforcing their role as significant allergens. The high prevalence of mixed allergens in patients with both conditions suggests the need for comprehensive allergy management approaches.

This study highlights a male predominance in asthma and allergic rhinitis cases and underscores the role of environmental allergens in disease manifestation. The findings support targeted allergen avoidance and personalized immunotherapy strategies for optimal respiratory disease management.

Nasal irrigation, a nonpharmacological intervention for alleviating nasal symptoms, has yet to gain widespread acceptance among caregivers due to procedural ambiguities and the absence of a standardized protocol. This study aimed to evaluate the efficacy of normal saline nasal irrigation in managing allergic rhinitis among children aged 6 to 12 years.This prospective, randomized, single-blind trial enrolled children aged 6 to 12 with allergic rhinitis. Patients were randomly assigned to receive either standard care (oral antihistamine and intranasal corticosteroid) or standard care plus nasal irrigation with saline solution. Symptom severity, assessed using the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) at baseline, 1, and 3 months, included rhinorrhea, nasal congestion, sneezing, pruritus, ocular symptoms, and functional impairment.The intervention group demonstrated statistically significant improvements in several domains post-intervention. Specifically, a marked reduction in sneezing frequency and nasal cleansing requirements was observed. Moreover, this group reported significantly lower ocular symptoms, including irritation, itching, and watering, relative to the control group. Although overall PRQLQ scores did not differ significantly between groups, the intervention group exhibited lower scores at the 1- and 3-month follow-ups, indicative of enhanced quality of life. These findings suggest a potential beneficial effect of the intervention on participant well-being.The findings of this study indicate that nasal irrigation with 0.65% saline solution 4 times daily may serve as an effective adjunct treatment for children with allergic rhinitis. This regimen was associated with significant enhancements in both nasal symptom severity and quality of life.

Propofol, a quick‑acting systemic anesthetic agent widely used in general anesthesia, can alleviate airway T-helper 2 (TH2) inflammation. Group 2 innate lymphoid cells (ILC2s) are a newly discovered group of lymphoid cells and play key roles in allergic rhinitis (AR). We aimed to investigate the regulation of ILC2s treated with propofol and its possible mechanisms in a mouse model. An ovalbumin (OVA)-sensitized and challenged mouse model was established. Nasal lavage fluid (NLF) and tissue samples were collected for the detection of inflammatory cells, type II cytokines, and ILC2s using Giemsa staining, enzyme-linked immunosorbent assay, and flow cytometry. CD4+ T cells and ILC2s were cocultured and detected by flow cytometry to confirm the proportion of TH2 cells. Compared with OVA-sensitized and challenged mice, propofol-treated model mice presented decreased type II cytokine levels and total numbers of cells, eosinophils, neutrophils, and macrophages in NLF.  Mice treated with propofol presented decreased nasal ILC2 frequency. Moreover, the nasal expression of GATA binding protein 3 (GATA3) and retinoid-related orphan receptor α (RORα),  as well as the levels of IL-5 and IL-13, were significantly inhibited after propofol treatment. Compared with those cultured alone, cocultures of ILC2s and CD4+ T cells resulted in significantly more TH2 cells. When propofol was added, the percentage of TH2 cells significantly decreased. This effect was alleviated when anti-major histocompatibility complex class II (anti-MHC II) protein was added.  Our study provides preliminary evidence that propofol can play an inhibitive role in AR by regulating innate and adaptive immunity.

Extended endoscopic sinus surgery (EESS) can reduce the recurrence rate of chronic rhinosinusitis (CRS). The purpose of this study was to investigate the effect of the application of modified “protective middle turbinate-EESS” (mEESS) on patients with CRS with nasal polyps (CRSwNP) and allergic rhinitis (AR). Forty-three patients with CRSwNP and AR were classified into 2 groups, the mEESS group (n=23) and the functional endoscopic sinus surgery (FESS) group (n=20), and were followed up for 6 months and 1 year after surgery. The disease severity was assessed by the Lund-Mackay score, the Lund-Kennedy score, and the visual analog scale (VAS) score. The patency rate of the frontal sinus was evaluated by endoscopy. Patient satisfaction was also followed up. No preoperative differences or postoperative complications were found between the 2 groups. The VAS score and Lund-Kennedy score of the 2 groups were lower at 6 months and 1 year after surgery. The olfactory function of the mEESS group was significantly better than that of the FESS group at 6 months post-operative. The patency rate of the frontal sinus orifice in the mEESS group was significantly higher than that in the FESS group at 6 months and 1 year post-operative. Patient satisfaction in the mEESS group was relatively higher than that in the FESS group. mEESS improves frontal sinus drainage, olfactory sense, and patient satisfaction in the short term.

Melittin is a natural toxin used in traditional medicine as an anti-inflammatory drug. It seems that the anti-inflammatory properties of melittin are caused by suppressing the expression of inflammatory genes and inhibiting signaling pathways. However, the use of melittin is limited due to instability, rapid degradation, and impurity. The aim of this study was to investigate the intranasal administration of a melittin-encoded plasmid as a new melittin delivery method for allergic diseases. After the induction of a mouse model of allergic rhinitis, mice received intranasal melittin plasmid. After the final challenge with allergen and allergic symptom assessment, the required samples were collected and transforming growth factor-beta (TGF-β), interferon-gamma (IFN-γ), and interleukin-4 (IL-4) cytokine levels, serum levels of ovalbumin-specific immunoglobulin (Ig) E, and histopathological changes were assessed. In addition to investigating the immune response, the effect of melittin on the expression level of genes involved in apoptosis was also investigated. The melittin plasmid significantly improved nasal symptoms and decreased eosinophil infiltration into the nasal mucosa. Moreover, melittin decreased the expression levels of IL-4 and TGF-β in nasal lavage fluid, while IFN-γ expression was increased. Regarding the expression level of genes involved in apoptosis, melittin led to an increase in BAX mRNA expression. These results suggest intranasal administration of a plasmid encoding melittin can suppress nasal symptoms, eosinophil infiltration, and immunomodulation of the immune response, which can be considered a promising approach in the treatment of inflammatory diseases.

Allergic rhinitis is a common childhood disease. Although various drugs have been used to treat allergic rhinitis, including nasal corticosteroids, antileukotrienes, and antihistamines, there is still controversy about the optimal dose and the best combination with the highest efficacy. Higher doses of antihistamines are recommended for better control of urticaria, but there is insufficient evidence regarding the efficacy of increased doses of antihistamines in allergic rhinitis. The aim of the study was to evaluate the effectiveness of different drug combinations in the treatment of children with allergic rhinitis. Sixty-four children with persistent moderate to severe allergic rhinitis were enrolled and randomly divided into 4 groups. All children received mometasone furoate nasal spray once daily. In addition to mometasone, each group received one of the following drugs or drug combinations: daily desloratadine, twice daily desloratadine, montelukast, or a combination of desloratadine and montelukast. The severity of symptoms before and after the intervention was evaluated based on the total nasal symptoms score, including sneezing, nasal congestion, nasal itching, and rhinorrhea. Sixty patients completed the study. The reduction of nasal congestion score and total nasal symptoms score in the groups receiving desloratadine twice a day and desloratadine plus montelukast was superior to the daily desloratadine group and daily montelukast groups. According to this work, the treatment of allergic rhinitis with mometasone nasal spray with desloratadine twice a day or with the combination of desloratadine and montelukast was more effective than other treatment regimens.

Allergic and non-allergic rhinitis are chronic upper airway inflammatory diseases. Iota carrageenan is an herbal extract of red algae used as a prophylactic treatment for rhinitis in the common cold and other viral infections. This study was designed to evaluate the clinical efficacy of Iota carrageenan in the treatment of allergic and non-allergic rhinitis. 

60 patients with allergic and non-allergic rhinitis clinical symptoms were randomly divided into carrageenan and placebo (control) groups. The Standard Sino-Nasal Outcome Questionnaire 22 (SNOT-22) and Rhino Juniper Mini Conjunctivitis Quality of Life Questionnaire (Mini-RQLQ) were completed for each patient before and after receiving the drug. Smear of nasal secretions and rhinomanometry were also performed for all studied participants. 

The mean score of SNOT-22 in the study group was 43.3 and 23.7 in the first and fourth weeks after therapy. The mean score of Mini RQLQ was 36.3 and 19.3 at the same time points (P< 0.001). SNOT-22 (P= 0.002) and Mini RQLQ (P= 0.005) scores showed a statistically significant decrease in the study group compared to the control group. The decrease in the eosinophil count and rhinomanometry results following treatment in both groups was statistically insignificant. 

Our findings showed a positive effect for carrageenan over placebo in the management of both non-allergic and allergic rhinitis in symptom control. However, non-allergic rhinitis patients’ symptoms may improve better with this drug.

Allergen-specific immunotherapy is the only disease-modifying treatment for IgE-mediated allergic disorders. Intra lymphatic immunotherapy (ILIT) is an efficacious and time-saving alternative to subcutaneous immunotherapy (SCIT). This study aimed to evaluate the effects and safety of ILIT in patients with moderate to severe allergic rhinitis. In this clinical trial, patients between 18 and 65 years old with moderate to severe allergic rhinitis were enrolled. They received monthly intra-lymphatic inguinal injections of an active allergen (1000 SQ-U Salsola kali pollen). Their clinical symptoms were assessed before and four weeks after treatments. The clinical signs were also evaluated during two consecutive pollination seasons and the following non-pollination season in April. No moderate or severe reactions were recorded following ILIT treatment. Lymph node enlargement, angioedema/urticaria, and local itching were seen instantly after injection. Patients who received ILIT experienced a significant clinical improvement in self-recorded seasonal allergic symptoms after the treatments, compared to themselves before ILIT. Furthermore, their quality of life significantly improved. This study suggests ILIT with Salsola-pollen extract may decrease symptoms of allergic rhinitis. It was safe and did not cause any crucial complications.

Allergen-specific immunotherapy (AIT) has confirmed its efficacy in improving the symptoms of allergic rhinitis. However, no reliable biomarkers have been identified to predict the efficacy of AIT were found. We aimed to find clinical and immunological markers to predict efficacy in children after 2 years of sublingual immunotherapy (SLIT). A total of 285 children diagnosed with allergic rhinitis were recruited. The clinical efficacy was evaluated by comparing endpoint and baseline symptom and medication scores (SMS). Baseline clinical and immunological markers (serum total and specific immunoglobulin [Ig]E) and their correlation with clinical efficacy were analyzed. Of the 285 children recruited, 249 completed the 2-year SLIT program. After 2 years of SLIT, 68.3% of the children showed a significant response. Children in the Remarkable Response Group had the highest baseline SMS and most extended disease duration, followed by the Effective Relief and Unresponsive Group. Correlation analysis demonstrated that SMS improvement was positively correlated with baseline SMS (r=0.67) and disease duration (r=0.35). SMS improvement was not correlated with age, body mass index, total or specific IgE levels, or their ratios. Our results show that baseline SMS and disease duration can predict the efficacy of SLIT. Our study can guide the selection of suitable candidates for SLIT.

  Allergicrhinitis (AR) is an inflammatory disorder of the nasal mucosa, caused by exposure to environmental allergens. It is known that 15-lipoxygenase (15-LOX) is involved in the biosynthetic pathways of anti-inflammatory lipid mediators, including resolvins and protectins.

In this study, which was performed on 130 AR patients and 130 healthy controls, we aimed to investigate the association of susceptibility to AR with two selected single-nucleotide polymorphisms (SNPs), that is, rs2619112:A>G and rs7217186:C>T, in the intron regions of arachidonic acid 15-LOX (ALOX15) gene, using SNPinfo and Regulome DB tools.

The results showed that the CT genotype of rs7217186: C>T was significantly associated with the increased risk of AR compared to the CC genotype (P= 0.037, OR=1.943, CI: 1.038-0.638). However, there was no strong evidence of the association of rs2619112: A>G with susceptibility to AR (P> 0.05).

The present results indicated that rs7217186 polymorphism of ALOX15 gene might be a potential biomarker for susceptibility to AR.

As a common disease among people of almost any age, allergic rhinitis has many adverse effects such as lowering the quality of life and efficiency at work or school. Considering these conditions and the collection of large amounts of data, the present research was conducted on allergic rhinitis and asthma patients' data to extract the common symptoms of these diseases using cluster analysis and the k-means algorithm.

The present cross-sectional research was conducted in Mashhad city. The inclusion criteria were affliction with one or two respiratory allergy diseases diagnosed by an allergy specialist through clinical history taking and physical examination. A researcher-made checklist was used in the present study for data collection. Then, the K-means algorithm's cluster analysis model was conducted to extract clusters (WEKA software (3, 6, 9)).

Overall, 1,231 patients met the inclusion criteria. The result of the Cluster analysis consisted of  1: Cluster 1 in allergic rhinitis consisted of 702 patients, and cluster 2 consisted of 382 patients. 2: 46 asthma patients were assigned to cluster 1 and 23 to cluster 2. 3: Also, 60 asthma and allergic rhinitis patients were assigned to cluster 1 and 19 to cluster 2. The most common symptoms in all patients were rhinorrhea, sneezing, nasal congestion, and itchy nose.

Overall, Salsola kali was the most common allergen in allergic rhinitis and asthma patients. Also, the most common symptoms in patients are rhinorrhea, sneezing, itchy nose, and nasal congestion. This study can help physicians diagnose allergic rhinitis and asthma in geographical areas with a high prevalence of Salsola kali.

Allergic rhinitis (AR) is a chronic inflammatory disease involving the nasal mucosa. Leukocytes recruitment to the inflammation sites is controlled by chemokines, cytokines, and adhesion molecules. Retinoic acid (RA), a vitamin A metabolite, plays an essential role in mucosal immunity and the production of inflammatory cytokines and chemokines. This study intended to evaluate the serum levels of RA, CCL17, CCL22, CCL28, and the mRNA expression levels of α4, β1, and β7 integrins in AR patients compared to healthy subjects. Peripheral blood was collected from 37 patients with AR and 30 age- and gender-matched healthy individuals. Serum levels of RA, CCL17, CCL22, and CCL28 were measured by the enzyme-linked immunosorbent assay (ELISA) technique, and the mRNA expression levels for α4, β1, and β7 integrins were assessed using the quantitative real-time PCR method. Our results showed that the serum levels of CCL22 and CCL28 chemokines are significantly higher in the AR group compared to the healthy controls (P<0.01). However, the gene expression of the β1 integrin in the AR group was significantly lower than that of the control group (P<0.001). Besides, there was a positive association between serum RA and CCL17 levels in patients (P<0.0001, r=0.6). In conclusion, increased serum levels of CCL22 and CCL28 chemokines, as well as decreased gene expression of β1 integrin in AR patients, may contribute to the pathogenesis and/or exacerbation of AR.

Type 2 innate lymphoid cells (ILC2s) and NLRP3 inflammasome are related to allergic and inflammatory responses. NLRP3 inflammasome inhibitor MCC950 was demonstrated to ameliorate allergic rhinitis (AR) in animal models. To elucidate the effect of MCC950 on ILC2 responses in AR. NLRP3 inflammasome, ILC2s, IL-5+ILC2s, IL-13+ILC2s, and Th2-related factors were examined in 30 AR patients. ILC2s were identified as Lin-CRTH2+CD127+lymphocytes. ILC2s isolated from PBMCs were stimulated with LPS plus ATP. The effect of MCC950, IL-1β, and IL-18 on ILC2 responses was detected by flow cytometry. AR models were established in 60 BALB/c mice. Nasal symptoms and ILC2 responses in the AR models after MCC950 treatment were detected. Human nasal epithelial cells were stimulated with IL-13 (10 ng/mL) and treated with MCC950 (10 μM). AR patients showed activated NLRP3 inflammasome and increased ILC2 responses compared to controls. NLRP3 inflammasome levels in the AR patients were positively related to the proportion of ILC2s, IL-5+ILC2s, and IL-13+ILC2s in total PBMCs. MCC950 treatment or IL-1β/IL-18 suppression inhibited ILC2 proliferation and Th2-related factors (GATA3, RORα, IL-5, and IL-13). MCC950 administration alleviated frequencies of nasal rubbing and sneezes in the AR models. ILC2s, IL-5+ILC2s, and IL-13+ILC2s in mice were reduced by MCC950. MCC950 inhibited NLRP3 inflammasome in the in vitro models of AR. MCC950 inhibited ILC2 responses in AR and mice models, suggesting that blocking NLRP3 inflammasome may be a promising target for AR clinical treatment.

This study represents the first attempt in understanding the prevalence of common allergens in Kashan, based on the clinical data i.e., demographic statistics and available SPTs collected.

In a retrospective cross-sectional study on 10,000 patients referred to Kashan Asthma and Allergy Clinic from 2006 to 2016, clinical information was extracted through electronic records. Considering risk factors including a family history of atopy, symptoms, smoking, and suitability of sleeping materials, sensitization to 17 aeroallergens was evaluated using SPT.

About 44.6% of patients had simultaneous allergic rhinitis and asthma, while 21.2% suffered concurrently from ocular allergy. The most prevalent outdoor sensitization was against weed pollens (62.3%), specially Salsola kali (69.9%), mixed extracts of Chenopodium album and Amaranthus retroflexus (58.3%) from Chenopodiaceae family, followed by grasses (44.6%), and trees (35.5%). For indoor allergens, cockroach (32.5%) was the most prevalent aeroallergen, followed by mites (27.1%), mold (23.4%), and animal dander (20.64%).

The study showed that reaction to SPT is generally high in Kashan, especially towards weed pollens of the Chenopodiaceae family. Despite her dry climate, the living style in Kashan has traditionally been inclined to keep indoor spaces humid throughout the year and therefore more prone to such indoor aeroallergens as cockroaches, mites, and fungi infestations.

 Allergic rhinitis is a very common disease which its clinical symptoms can reduce the patient’s quality of life. This study aimed to compare the effects and side effects of desloratadine with fexofenadine on allergic rhinitis.

 The present study is a clinical trial on 68 patients with allergic rhinitis who were randomly divided into two groups named A and B. In the A group, patients used 120 mg of fexofenadine for 4 weeks and in the B group, patients received 5 mg of desloratadine for 4 weeks. After two weeks of rest, patients in the A group received desloratadine, and patients in the B group received fexofenadine for 4 weeks. Then, the clinical conditions and efficiency of the drugs in both groups were compared.

 The severity of symptoms significantly decreased in the A and B groups before and after the treatment (p<0.001 and p=0.007, respectively). The severity of symptoms after taking the first and second drugs in the A group was lower than in the B group. In the A group, the changes in symptom severity after taking the first and second drugs were significantly greater than in the B group. Other symptoms were not significantly different between the two treatment groups (p>0.05 in all cases(. 

 In patients with allergic rhinitis, the use of fexofenadine compared to desloratadine can more effectively reduce the severity of the symptoms of the disease and can be prescribed as a suitable treatment option for these patients.

Antihistamines are the most common drugs used for treating allergic rhinitis. They, significantly, reduce nasal symptoms by blocking the action of a chemical cytokine called histamine.  This study aimed to compare cetirizine and desloratadine's efficacy and adverse effects in children with allergic rhinitis.

This randomized single-blinded clinical trial was conducted on 400 children with allergic rhinitis, aged 6-12 between February and September 2022. The patients were randomized to receive cetirizine or desloratadine for four weeks. We recorded the symptoms and adverse effects at the baseline and four weeks after starting the intervention.

A total of 248 patients completed the study: 109 patients (47 female, 62 male) in the cetirizine group and 139 patients (53 female, 86 male) in the desloratadine group. The scores related to symptoms of allergic rhinitis before starting the drugs and after 4-week therapy were not significantly different between the two treatment groups (p= 0.1, p= 0.7, respectively). Cetirizine had more side effects than desloratadine in the treated patients (p = 0.02).

This study showed that cetirizine and desloratadine improved symptoms of children with allergic rhinitis; however, there was no significant difference in the efficacy of these two drugs.  Desloratadine caused fewer side effects in patients after 4 weeks of treatment.