Allergic rhinitis represents a global health issue affecting 10% to 25% of the population worldwide. Over the years, studies have found that allergic diseases, including allergic rhinitis, are associated with immunological responses to antigens driven by a Th2-mediated immune response. Because Toll-like receptors (TLRs) are involved in both innate and adaptive immune responses to a broad variety of antigens, the association between polymorphisms of TLRs and allergic diseases has been the focus in many animal and human studies. Although the etiology of allergic rhinitis is still unknown, extensive research over the years has confirmed that the underlying causes of allergic diseases are due to many genetic and environmental factors, along with the interactions among them, which include gene-environment, gene-gene, and environment-environment interactions. Currently, there is great inconsistency among studies mainly due to differences in genetic background and unique gene-environment interactions. This paper reviews studies focusing on the association between TLR polymorphisms and allergic diseases, including allergic rhinitis, which would help researchers better understand the role of TLR polymorphisms in the development of allergic rhinitis, and ultimately lead to more efficient therapeutic interventions being developed.

BACKGROUND:

Several studies have demonstrated that medication is commonly used off-label in children with allergic diseases. The aim of this study was to characterise off-label use of prescriptions for allergic diseases in pre-school children from an allergology outpatient unit.

METHODS:

The clinical files of children aged ≤6 years seen in a reference allergology consultation with asthma, allergic rhinitis, and/or atopic eczema were reviewed. A total of 500 patients were consecutively observed from January to June 2012. The data collected included gender, age, diagnosis, and prescriptions with the respective daily dosage.

RESULTS:

A total of 1224 prescriptions were registered. The most prescribed medications were oral antihistamines (34.6%), antileukotrienes (22.6%), topical nasal corticosteroids (20.3%), and inhaled corticosteroids (17.7%). From all prescriptions, 422 (34.5%) were considered off-label for age (62.6%), dosage (31.7%), or clinical indication (5.7%). Off-label use was more frequent in children aged <2 years, with 73.5% prescribed for children of this age.

CONCLUSIONS:

Off-label use of drugs for the treatment of paediatric allergic diseases is high. However, these prescriptions are not necessarily wrong, and are recommended in many guidelines. Randomised controlled studies are limited by methodological difficulties creating the need for more observational studies in order to further evaluate the safety and efficacy of drugs used in children.

With the aim to better understand the association between asthma/allergy and psychological distress, it was hypothesized that levels of stress, exhaustion, anxiety, depression, and health worries for environmental pollution would be higher in allergic asthma, allergic rhinitis, and atopic dermatitis than in non-allergic asthma and in referents without asthma or allergy. Taking part in the population-based Västerbotten Environmental Health Study (aged 18-79 years), 76 respondents reported a physician-based diagnosis of allergic asthma, 86 reported non-allergic asthma, 190 reported allergic rhinitis, and 46 reported atopic dermatitis as the only form of asthma/allergy. A group of 2876 respondents without an asthma/allergy diagnosis constituted as referents. The participants responded to the Perceived Stress Scale, the Shirom-Melamed Burnout Questionnaire, the Hospital Anxiety and Depression Scale, and the Environmental Pollution subscale of the Modern Health Worries Scale. Levels of stress, exhaustion, and anxiety were higher in allergic asthma and atopic dermatitis than in non-allergic asthma, allergic rhinitis, and among referents, and there was a strong tendency of such group differences for depression and health worries. The results imply that stress reduction and treatment of negative affect may in certain cases be fruitful interventions in patients with atopy.

Allergic rhinitis (AR) is a global disease affecting hundreds of millions internationally. Substantial pharmacologic gains have been made in the treatment of allergy, including antihistamines, steroids, and leukotriene inhibitors. Pharmacology and immunotherapy are the 2 primary choices in an otolaryngologist's armamentarium of allergy treatment. Outside of these options lie complementary and integrative medicine, including various herbs and supplementation along with acupuncture. Some of these methods have shown great efficacy in treating AR and others have failed to show any improvement. This article reviews AR and some of the more common therapies used to care for the disease.

Introduction: Up to 30% of the Japanese population suffers from Japanese cedar pollinosis, and some of these patients also have severe perennial allergies or other pollen allergies. Posterior nasal neurectomy has recently been reported as effective treatment for severe perennial allergic and intrinsic rhinitis. However, the efficacy of this surgery for seasonal allergic rhinitis has not been shown. In this study, the effectiveness of posterior nasal neurectomy combined with inferior turbinate surgery for patients with Japanese cedar pollinosis with concomitant intractable perennial allergies was evaluated with a questionnaire. Subjects and

Methods:

Nine patients with Japanese cedar pollinosis, who also had perennial allergies, and undergone posterior nasal neurectomy combined with inferior turbinate surgery from April in 2005 to July in 2008, were enrolled. A numeric rating scale (NMR) was used to evaluate clinical symptoms in the pre- and post-surgery periods. The frequency of medication (oral administration and nasal spray) during the cedar pollinosis season was also evaluated.

Results:

The NMR scores for all nasal and eye symptoms during cedar pollinosis season were significantly reduced after the surgery. The frequency of medication during the season was dramatically decreased after surgery.

Conclusion:

The present study demonstrates that posterior nasal neurectomy combined with inferior turbinate surgery is a highly effective treatment for Japanese cedar pollinosis. Since the Japanese cedar pollinosis season is limited to 2 to 3 months, such surgery is indicated for patients who suffer from severe perennial allergies and are also sensitized to some allergens such as Japanese cedar and ragweed pollen.

Allergen-specific immunotherapy (ASIT) the only disease-modifying treatment for IgE-mediated allergies is characterized with long treatment duration and high risk of side effects. We investigated the safety, immunogenicity and efficacy of a novel ASIT, called DermAll, in an experimental allergic rhinitis model. We designed and characterized DermAll-OVA, a synthetic plasmid pDNA/PEIm nanomedicine expressing ovalbumin (OVA) as model allergen. DermAll-OVA was administered topically with DermaPrep device to target Langerhans cells. To detect the clinical efficacy of DermAll ASIT we quantified the nasal symptoms and characterized the immunomodulatory activity of DermAll ASIT by measuring cytokine secretion after OVA-stimulation of splenocytes and antibodies from the sera. In allergic mice DermAll ASIT was as safe as Placebo, balanced the allergen-induced pathogenic TH2-polarized immune responses, and decreased the clinical symptoms by 52% [32%, 70%] compared to Placebo. These studies suggest that DermAll ASIT is safe and should significantly improve the immunopathology and symptoms of allergic diseases.

Background:

Thymic stromal lymphopoietin (TSLP) is a cytokine implicated in the pathogenesis of allergic diseases such as asthma, atopic dermatitis and allergic rhinitis. Curcumin has various effects such as antidepressant, antioxidant, antihyperglycemic, antitumor and anti-inflammatory. However, the effect of curcumin on the production of TSLP has not been clarified. Thus, we investigated how curcumin inhibits the expression and production of TSLP in the human mast cell line, HMC-1 cells.

Methods:

We used enzyme-linked immunosorbent assay, reverse transcription-polymerase chain reaction, luciferase assay, and caspase-1 assay to investigate the effects of curcumin.

Results:

The results show that curcumin inhibited the production and mRNA expression of TSLP in HMC-1 cells: the maximal inhibition rate of TSLP production by curcumin (50 μM) was 59.16 ± 4.20%. In addition, curcumin suppressed the nuclear factor-κB luciferase activity induced by phorbol myristate acetate plus A23187. In the activated HMC-1 cells, caspase-1 activity was increased, whereas caspase-1 activity was decreased by pretreatment with curcumin.

Conclusion:

These results suggest that curcumin can be used to treat inflammatory and atopic diseases through the suppression of TSLP.

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.