Trends in Specific Immunotherapy for Allergic Rhinitis: A Survey of Chinese ENT Specialists

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	Original Article  Open Access
	Allergy Asthma Immunol Res. 2014 Jul;6(4):296-303. English. Published online 2014 February 13.  http://dx.doi.org/10.4168/aair.2014.6.4.296  Copyright © 2014 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease Han Zhou,1 Qi-Lei Tao,1,2 Jun-Min Wei,3 Geng Xu,4 and Lei Cheng1,5 1Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China. 2Department of Otorhinolaryngology, Changzheng Hospital, The Second Military Medical University, Shanghai, China. 3Editorial Office, Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association, Beijing, China. 4Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou, China. 5International Centre for Allergy Research, Nanjing Medical University, Nanjing, China.  Correspondence to: Lei Cheng, MD, PhD, Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China. Tel: +86-(0)25-6813-6031; Fax: +86-(0)25-8378-0934; Email: jspent@126.com  Received June 24, 2013; Revised August 13, 2013; Accepted September 24, 2013. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.  This article has been cited by 1 article in    This article has been cited by Google Scholar. Abstract Purpose Specific immunotherapy (SIT) is a suitable but uncommon treatment option for allergic rhinitis (AR) in China. The current understanding and attitude of Chinese ENT (ear, nose, and throat) specialists in regards to SIT is unclear. This study investigates current trends in the awareness and application status of SIT among Chinese ENT specialists. Methods We performed a nationwide, cross-sectional survey with a specially designed questionnaire given to 800 ENT specialists in China. A member of the trained research group conducted face-to-face interviews with each respondent. Results Most of the respondents considered AR (96.0%) and allergic asthma (96.0%) the most suitable indications for SIT. Of all respondents, 77.0% recommended the application of SIT as early as possible; in addition, SIT was considered 'relatively controllable and safe' by most respondents (80.6%). The highest allergen-positive rate in AR was associated with house dust mite (47.7%) and obvious differences existed among geographical regions. Conventional subcutaneous immunotherapy was the most highly recommended treatment option (96.2%). 'The high cost of SIT' (86.6%) and 'lack of patient knowledge of SIT' (85.2%) were probably the main reasons for the lower clinical use of SIT in China. Conclusions Most cases showed that the opinions of Chinese ENT specialists appeared to be in agreement with recent SIT progress and international guidelines; however, many areas still need to enhance the standardization and use of SIT in China. Clinical guidelines for SIT require improvement; in addition, Chinese ENT specialists need continuing medical education on SIT. Keywords: Allergic rhinitis, specific immunotherapy, data collection, Chinese otolaryngologists. Formats: Article PubReader PDF Figures + Tables References Supplementary Materials

Epidemiology of allergic rhinitis in Quebec: from a 2008 population-based survey

M. Canuel, MSc; G. Lebel, MSc

Author references:

Institut national de santé publique du Québec (INSPQ), Québec, Quebec, Canada

Correspondence: Magalie Canuel, INSPQ, 945, avenue Wolfe, 4^eétage, Québec, QC G1V 5B3; Tel.: 418-650-5115, ext. 5224; Fax: 418-654-3144; Email: magalie.canuel@inspq.qc.ca

Abstract

Introduction: Our objective was to estimate the prevalence of symptoms and the proportion of a lifetime physician-based diagnosis of allergic rhinitis (AR) in the province of Quebec among people aged 15 years and older.

Methods: The 2008 Quebec Population Health Survey provided data on the prevalence of symptoms and proportion of lifetime physician-based diagnoses of AR. The prevalence of symptoms was defined as the proportion of individuals who, in the absence of a cold or the flu, had nasal and ocular symptoms in the 12 months before the survey.

Results: The reported prevalence of AR symptoms was 17%, although 9% did not have a diagnosed condition. Reported prevalence was lowest in those aged 65 years and older (12%) and was more common among women (19%) than men (15%). The estimated prevalence of lifetime physician-based diagnosis was 17%.

Conclusion: AR prevalence is high in Quebec with about 1 in 6 people experiencing symptoms. The condition is underdiagnosed and might also be undertreated.

Keywords: adult, allergic rhinitis, allergy, diagnosis, prevalence, rhinoconjunctivitis, symptoms

Chronic Diseases and Injuries in Canada

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Efficacy and safety of fluticasone furoate 100 mug and 200 mug once daily in the treatment of moderate-severe #asthma in adults and adolescents: a 24-week randomised study

Research article

Ashley Woodcock, Jan Lötvall, William W Busse, Eric D Bateman, Sally Stone, Anna Ellsworth and Loretta Jacques

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BMC Pulmonary Medicine 2014, 14:113  doi:10.1186/1471-2466-14-113

Published: 9 July 2014

Abstract (provisional)

Background

Inhaled corticosteroids are a mainstay of therapy for persistent asthma, but suboptimal adherence with twice-daily use is widespread. Fluticasone furoate (FF) is a new inhaled corticosteroid (ICS) suitable for once-daily dosing in asthma. This study was performed to descriptively assess the efficacy and safety of two doses of FF, with no planned formal statistical hypothesis testing.

Methods

This was a 24-week double-blind, multicentre, parallel-group study (NCT01431950). Patients aged >=12 years with moderate-severe persistent asthma and uncontrolled on mid-high dose ICS were stratified by baseline FEV1 and randomised (1:1) to treatment with FF 100mug or 200mug once daily in the evening. The primary endpoint was change from baseline trough FEV1 after 24 weeks; secondary and other endpoints included peak expiratory flow (PEF) and rescue- and symptom-free 24-hour periods over Weeks 1-24, and Asthma Control TestTM (ACT) score at Week 24. A pre-specified subgroup analysis of patients by randomisation strata was performed for the primary and selected secondary and other endpoints. Safety assessments included adverse events, laboratory and vital sign measurements, and change from baseline in 24-hour urinary cortisol at Week 24.

Results

With FF 100mug and 200mug, least squares mean trough FEV1 improved from baseline by 208mL and 284mL respectively at Week 24; treatment difference: 77mL (95% CI: -39, 192). Similar improvements from baseline in rescue- and symptom-free periods, and morning and evening PEF were observed in both groups. Patients were 42% more likely to be well-controlled (ACT score >=20) with FF 200mug than with FF 100mug. Slightly more patients receiving FF 200mug vs. FF 100mug reported adverse events (63% vs. 59%) and events deemed treatment related (5% vs. -1%). Seven serious adverse events (FF 200mug 4; FF 100mug 3) were reported, none of which were deemed treatment related. No clinically relevant effects of either dose on 24-hour urinary cortisol were observed.

Conclusion

Improvements from baseline in trough FEV1 were observed after 24 weeks of treatment with both doses of FF, with a numerically greater improvement in FEV1 observed in patients receiving FF 200mug. Secondary endpoint findings were similar between groups. No safety concerns were identified during the study.

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Anaphylaxis avoidance and management: educating patients and their caregivers

Journal of Asthma and Allergy

Review

Authors: Järvinen KM, Celestin J

Published Date July 2014 Volume 2014:7 Pages 95 - 104

DOI: http://dx.doi.org/10.2147/JAA.S48611

Received:	27 February 2014
Accepted:	12 April 2014
Published:	10 July 2014

Kirsi M Järvinen, Jocelyn Celestin

Division of Allergy and Immunology, Department of Medicine, Albany Medical College, Albany, NY, USA

Abstract: Anaphylaxis is an increasingly prevalent problem in westernized countries. Therefore, it is of utmost importance that the increasing numbers of patients at risk for anaphylaxis receive proper education on the etiology and risk factors as well as appropriate treatment of anaphylaxis with epinephrine. The physician's role is crucial in order to educate the patients and care takers on effective measures to prevent anaphylaxis and empower them to take charge of early recognition and proper management of an anaphylactic reaction to prevent poor outcomes. This review summarizes the clinical presentation, triggers, avoidance, and management of anaphylaxis.

Keywords: food allergy, drug allergy, Hymenoptera, latex


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Transcription factor IRF4 drives dendritic cells to promote Th2 differentiation

• NIHPA Author Manuscripts
• PMC4003872

Nat Commun. Author manuscript; available in PMC Apr 29, 2014.

Published in final edited form as:

Nat Commun. 2013; 4: 2990.

doi:  10.1038/ncomms3990

PMCID: PMC4003872

NIHMSID: NIHMS565877

Jesse W. Williams,1 Melissa Y. Tjota,2,3 Bryan S. Clay,2 Bryan Vander Lugt,4 Hozefa S. Bandukwala,2 Cara L. Hrusch,6 Donna C. Decker,6 Kelly M. Blaine,6 Bethany R. Fixsen,6 Harinder Singh,4 Roger Sciammas,5 and Anne I. Sperling1,2,6

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Abstract

Atopic asthma is an inflammatory pulmonary disease associated with Th2 adaptive immune responses triggered by innocuous antigens. While dendritic cells (DCs) are known to shape the adaptive immune response, the mechanisms by which DCs promote Th2 differentiation remain elusive. Herein we demonstrate that Th2-promoting stimuli induce DC expression of IRF4. Mice with conditional deletion of Irf4 in DCs show a dramatic defect in Th2-type lung inflammation, yet retain the ability to elicit pulmonary Th1 anti-viral responses. Using loss- and gain-of-function analysis, we demonstrate that Th2 differentiation is dependent on IRF4 expression in DCs. Finally, IRF4 directly targets and activates the Il10 and Il33 genes in DCs. Reconstitution with exogenous IL-10 and IL-33 recovers the ability of Irf4 deficient DCs to promote Th2 differentiation. These findings reveal a regulatory module in DCs by which IRF4 modulates IL-10 and IL-33 cytokine production to specifically promote Th2 differentiation and inflammation.

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Abstract

Atopic asthma is an inflammatory pulmonary disease associated with Th2 adaptive immune responses triggered by innocuous antigens. While dendritic cells (DCs) are known to shape the adaptive immune response, the mechanisms by which DCs promote Th2 differentiation remain elusive. Herein we demonstrate that Th2-promoting stimuli induce DC expression of IRF4. Mice with conditional deletion of Irf4 in DCs show a dramatic defect in Th2-type lung inflammation, yet retain the ability to elicit pulmonary Th1 anti-viral responses. Using loss- and gain-of-function analysis, we demonstrate that Th2 differentiation is dependent on IRF4 expression in DCs. Finally, IRF4 directly targets and activates the Il10 and Il33 genes in DCs. Reconstitution with exogenous IL-10 and IL-33 recovers the ability of Irf4 

An Overview of Parabens and Allergic Contact Dermatitis

Skin Therapy Letter .com

Farhaan Hafeez, BA, MS and Howard Maibach, MD 

Dermatology of Department, University of California San Francisco, San Francisco, CA, USA

ABSTRACT

Esters of p-hydroxybenzoic acid (parabens) are the most widely used preservatives in cosmetic, pharmaceutical, and industrial products. However, since the 1960s, controversy has surrounded its use and safety as a potential cause of allergic contact dermatitis. Despite the cloud of suspicion that has hovered over parabens ever since, these ubiquitous compounds have withstood four decades of extensive skin testing conducted by a variety of organizations, both North American and European, and now, it seems parabens have shown to be one of the least sensitizing preservatives in commercial use. Of the very limited reports of paraben-induced allergic contact dermatitis, these cases are often attributable to the application of parabens on damaged skin. 

Key Words: parabens, allergic contact dermatitis, sensitization, allergen, patch test

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Food Hypersensitivity in Mexican Adults at 18 to 50 Years of Age: A Questionnaire Survey

	Original Article  Open Access
	Allergy Asthma Immunol Res. 2014 Jul;6:e269. English. Published online 2014 July 09.  Copyright © 2014 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease Martín Bedolla-Barajas,1 Tonatiuh Ramses Bedolla-Pulido,2 Alan Salvador Camacho-Peña,2 Estefanía González-García,3 and Jaime Morales-Romero4 1Allergy and Clinical Immunology Service, The "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, México. 2Guadalajara Lamar University. Guadalajara, Jalisco, México. 3UTEG University. Guadalajara, Jalisco, México. 4Public Health Institute, University of Veracruz. Xalapa, Veracruz, México.  Correspondence to: Martín Bedolla-Barajas MD, Allergy and Clinical Immunology Service, Division of Internal Medicine, The "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, 2330-301 Eulogio Parra, Las Américas, Guadalajara, Jalisco 44650, México. Tel: (+52) (33) 33-42-89-16; Fax: (+52) (33) 33-42-89-16;Email: drmbedbar@gmail.com  Received September 28, 2013; Revised January 13, 2014; Accepted January 29, 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose There is limited epidemiological evidence of food hypersensitivity (FH) in the adult population. We aimed to determine the prevalence of FH in Mexican adults, their clinical features and to establish common food involved in its appearance. Methods We designed a cross-sectional study using a fixed quota sampling; 1,126 subjects answered a structured survey to gather information related to FH. Results The prevalence of FH in adults was 16.7% (95% CI, 14.5% to 18.8%), without statistical significant differences related to gender (women, 17.5% and men, 15.9%) or residential location. The most common clinical manifestations in adults with FH were oral allergy syndrome (70 of 1,126) and urticaria (55 of 1,126). According to category, fruits and vegetables were the most frequent foods to trigger FH (6.12%) and were individually related to shrimp (4.0%), and cow milk (1.5%). Adults under age 25 had a higher frequency of FH (OR, 1.39; 95% CI, 1.01 to 1.91, P -0.001). Personal history of any atopic disease was significantly associated with FH (P -0.0001). Conclusions The prevalence of FH is relatively high in Mexican adults, and FH is significantly associated with atopic diseases. Keywords: Food hypersensitivity, prevalence, adult, epidemiology, questionnaire. Formats: Abstract Article PubReader PDF Figures + Tables References

Current Specific Immunotherapy for Allergic Rhinitis: Perspectives from Otorhinolaryngologists

• Allergy Asthma Immunol Res
• v.6(4); Jul 2014
• PMC4077952

Allergy Asthma Immunol Res. Jul 2014; 6(4): 273–275.

Published online Jun 19, 2014. doi:  10.4168/aair.2014.6.4.273

PMCID: PMC4077952

Chae-Seo Rhee1,2,3,4,5

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Occupational asthma from exposure to rye flour in a Japanese baker

Case Report

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1. Chiyako Oshikata¹, 
2. Naomi Tsurikisawa^1,*,
3. Akemi Saito², 
4. Hiroshi Yasueda²and
5. Kazuo Akiyama¹

Article first published online: 14 JUL 2014

DOI: 10.1002/rcr2.63

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Keywords:

• Baker's asthma;
• bronchial provocation test;
• occupational asthma;
• rye flour;
• wheat flour

Abstract

Three years after beginning employment at a bakery, a 32-year-old Japanese man began experiencing acute asthma exacerbations after exposure to rye flour. Antigen-specific serum IgE antibodies were detected to the albumin and globulin, gliadin, prolamin, and glutenin protein fractions of rye flour purified from the crude antigen, but only to the albumin and globulin fraction of wheat flour. The histamine concentration producing one-half maximal effect was lower for all four rye flour fractions than for the wheat flour fractions. After inhalation of the albumin and globulin fraction of rye flour, forced expiratory volume in 1 sec decreased to 77.7% of that pre-provocation. To our knowledge, this is the first report of baker's asthma due to rye flour in Japan.

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