Asia Pac Allergy.  2018 Jan;8(1):e7. 10.5415/apallergy.2018.8.e7.

The International Study of the Allergic Rhinitis Survey: outcomes from 4 geographical regions

• Passali D
• Cingi C
• Staffa P
• Passali F
• Muluk NB
• Bellussi M

• KMID: 2428874
• DOI: http://doi.org/10.5415/apallergy.2018.8.e7

Abstract

BACKGROUND
Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea.
OBJECTIVE
We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions.
METHODS
In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions"”Asia, Europe, the Americas, and Africa.
RESULTS
The prevalence of AR was reported to be 15%-25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H₁-antihistamines (82.69%).
CONCLUSION
A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

Keyword

Allergic rhinitis; Allergens; Treatment; Allergen specific immunotherapy; Sublingual immunotherapy; Subcutaneous immunotherapy

MeSH Terms

Adolescent
Adrenal Cortex Hormones
Africa
Allergens
Americas
Animals
Asthma
Child
Comorbidity
Conjunctivitis
Cross-Sectional Studies
Dander
Diagnosis
Epidemiology
Estrogens, Conjugated (USP)
Europe
Global Health
Humans
Immunotherapy
Mites
Pollen
Prevalence
Pruritus
Rhinitis, Allergic*
Seasons
Sinusitis
Sneezing
Sublingual Immunotherapy
Young Adult
Adrenal Cortex Hormones
Allergens
Estrogens, Conjugated (USP)

Reference

References

1. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol. 2001; 108(1 Suppl):S2–8.

2. Clinical practice guideline: allergic rhinitis [Internet]. Alexandria (VA): American Academy of Otolaryngology – Head and Neck Surgery;c2018. [cited 2015 May 4]. Available from:. http://www.entnet.org/content/clinical-practice-guideline-allergic-rhinitis.

3. Bousquet J, Van Cauwenberge P, Khaltaev N. Aria Workshop Group; World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001; 108(5 Suppl):S147–334.

4. Leuschner RM. Pollen. Experientia. 1993; 49:931–42.

5. D'Amato G, Lobefalo G. Allergenic pollens in the southern Mediterranean area. J Allergy Clin Immunol. 1989; 83:116–22.

6. Ariano R, Panzani RC, Chiapella M, Augeri G. Pollinosis in a Mediterranean area (Riviera Ligure, Italy): ten years of pollen counts, correlation with clinical sensitization and meteorological data. J Investig Allergol Clin Immunol. 1994; 4:81–6.

7. Mims JW. Epidemiology of allergic rhinitis. Int Forum Allergy Rhinol. 2014; 4(Suppl 2):S18–20.

8. Barnes KC, Marsh DG. The genetics and complexity of allergy and asthma. Immunol Today. 1998; 19:325–32.

9. Strachan DP. Is allergic disease programmed in early life? Clin Exp Allergy. 1994; 24:603–5.

10. Sibbald B, Strachan D. Epidemiology of rhinitis. In: Busse W, Holgate ST, editors. Asthma and rhinitis. London: Blackwell Scientific Publications;1995. p. 32–43.

11. Bolte G, Schmidt M, Maziak W, Keil U, Nasca P, von Mutius E, Weiland SK. The relation of markers of fetal growth with asthma, allergies and serum immunoglobulin E levels in children at age 5-7 years. Clin Exp Allergy. 2004; 34:381–8.

12. McKeever TM, Lewis SA, Smith C, Collins J, Heatlie H, Frischer M, Hubbard R. Siblings, multiple births, and the incidence of allergic disease: a birth cohort study using the West Midlands general practice research database. Thorax. 2001; 56:758–62.

13. Renz-Polster H, David MR, Buist AS, Vollmer WM, O'Connor EA, Frazier EA, Wall MA. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005; 35:1466–72.

14. Bråbäck L, Hedberg A. Perinatal risk factors for atopic disease in conscripts. Clin Exp Allergy. 1998; 28:936–42.

15. Savilahti E, Siltanen M, Pekkanen J, Kajosaari M. Mothers of very low birth weight infants have less atopy than mothers of full-term infants. Clin Exp Allergy. 2004; 34:1851–4.

16. Katz KA, Pocock SJ, Strachan DP. Neonatal head circumference, neonatal weight, and risk of hayfever, asthma and eczema in a large cohort of adolescents from Sheffield, England. Clin Exp Allergy. 2003; 33:737–45.

17. Lim R, Fedulov AV, Kobzik L. Maternal stress during pregnancy increases neonatal allergy susceptibility: role of glucocorticoids. Am J Physiol Lung Cell Mol Physiol. 2014; 307:L141–8.

18. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. World Health OrganizationGA(2)LEN; AllerGen. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; 63(Suppl 86):8–160.

19. Sih T, Mion O. Allergic rhinitis in the child and associated comorbidities. Pediatr Allergy Immunol. 2010; 21(1 Pt 2):e107–13.

20. Lack G. Pediatric allergic rhinitis and comorbid disorders. J Allergy Clin Immunol. 2001; 108(1 Suppl):S9–15.

21. Matsuzaki Z, Okamoto Y, Sarashina N, Ito E, Togawa K, Saito I. Induction of intercellular adhesion molecule-1 in human nasal epithelial cells during respiratory syncytial virus infection. Immunology. 1996; 88:565–8.

22. Hellings PW, Fokkens WJ. Allergic rhinitis and its impact on otorhinolaryngology. Allergy. 2006; 61:656–64.

23. Braunstahl GJ, Hellings PW. Allergic rhinitis and asthma: the link further unraveled. Curr Opin Pulm Med. 2003; 9:46–51.

24. Hannaway PJ, Hopper GD. Cough variant asthma in children. JAMA. 1982; 247:206–8.

25. Gerth van Wijk RG, de Graaf-in't Veld C, Garrelds IM. Nasal hyperreactivity. Rhinology. 1999; 37:50–5.

26. Boulet LP, Turcotte H, Laprise C, Lavertu C, Bédard PM, Lavoie A, Hébert J. Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma. Clin Exp Allergy. 1997; 27:52–9.

27. Braun-Fahrländer C, Wüthrich B, Gassner M, Grize L, Sennhauser FH, Varonier HS, Vuille JC. International Study of Asthma and Allergies in Childhood. Validation of a rhinitis symptom questionnaire (ISAAC core questions) in a population of Swiss school children visiting the school health services. SCARPOL-team. Swiss Study on Childhood Allergy and Respiratory Symptom with respect to Air Pollution and Climate. Pediatr Allergy Immunol. 1997; 8:75–82.

28. Gergen PJ, Turkeltaub PC. The association of individual allergen reactivity with respiratory disease in a national sample: data from the second National Health and Nutrition Examination Survey, 1976-80 (NHANES II). J Allergy Clin Immunol. 1992; 90(4 Pt 1):579–88.

29. Spieksma FT. Domestic mites from an acarologic perspective. Allergy. 1997; 52:360–8.

30. Platts-Mills TA, Vervloet D, Thomas WR, Aalberse RC, Chapman MD. Indoor allergens and asthma: report of the Third International Workshop. J Allergy Clin Immunol. 1997; 100(6 Pt 1):S2–24.

31. Salvaggio J, Seabury J, Schoenhardt FA. New Orleans asthma. V. Relationship between Charity Hospital asthma admission rates, semiquantitative pollen and fungal spore counts, and total particulate aerometric sampling data. J Allergy Clin Immunol. 1971; 48:96–114.

32. Atkinson RW, Strachan DP, Anderson HR, Hajat S, Emberlin J. Temporal associations between daily counts of fungal spores and asthma exacerbations. Occup Environ Med. 2006; 63:580–90.

33. Bush RK, Portnoy JM, Saxon A, Terr AI, Wood RA. The medical effects of mold exposure. J Allergy Clin Immunol. 2006; 117:326–33.

34. Luczynska CM, Li Y, Chapman MD, Platts-Mills TA. Airborne concentrations and particle size distribution of allergen derived from domestic cats (Felis domesticus). Measurements using cascade impactor, liquid impinger, and a two-site monoclonal antibody assay for Fel d I. Am Rev Respir Dis. 1990; 141:361–7.

35. Gordon S. Allergy to furred animals. Clin Exp Allergy. 1997; 27:479–81.

36. Poole JA, Rosenwasser LJ. The role of immunoglobulin E and immune inflammation: implications in allergic rhinitis. Curr Allergy Asthma Rep. 2005; 5:252–8.

37. Punnonen J, Aversa GG, Vandekerckhove B, Roncarolo MG, de Vries JE. Induction of isotype switching and Ig production by CD5+ and CD10+ human fetal B cells. J Immunol. 1992; 148:3398–404.

38. Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CC, Schuller D, Spector SL, Tilles SA. Joint Task Force on Practice; American Academy of Allergy; Asthma & Immunology; American College of Allergy; Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008; 122(2 Suppl):S1–84.

39. Bernstein IL, Storms WW. Practice parameters for allergy diagnostic testing. Joint Task Force on Practice Parameters for the Diagnosis and Treatment of Asthma. The American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1995; 75(6 Pt 2):543–625.

40. Adinoff AD, Rosloniec DM, McCall LL, Nelson HS. Immediate skin test reactivity to Food and Drug Administration-approved standardized extracts. J Allergy Clin Immunol. 1990; 86:766–74.

41. Gendo K, Larson EB. Evidence-based diagnostic strategies for evaluating suspected allergic rhinitis. Ann Intern Med. 2004; 140:278–89.

42. Noon L. Prophylactic inoculation against hay fever. Lancet. 1911; 177:1572–3.

43. Bousquet J, Lockey R, Malling HJ. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol. 1998; 102(4 Pt 1):558–62.

44. Bousquet J, Demoly P. Specific immunotherapy–an optimistic future. Allergy. 2006; 61:1155–8.

45. Van Metre TE Jr, Adkinson NF Jr, Amodio FJ, Lichtenstein LM, Mardiney MR Jr, Norman PS, Rosenberg GL, Sobotka AK, Valentine MD. A comparative study of the effectiveness of the Rinkel method and the current standard method of immunotherapy for ragweed pollen hay fever. J Allergy Clin Immunol. 1980; 66:500–13.

46. Smith PK, Collins J. Olopatadine 0.6% nasal spray protects from vasomotor challenge in patients with severe vasomotor rhinitis. Am J Rhinol Allergy. 2011; 25:e149–52.

47. Lieberman P, Meltzer EO, LaForce CF, Darter AL, Tort MJ. Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastine hydrochloride nasal spray 0.1% in patients with vasomotor rhinitis. Allergy Asthma Proc. 2011; 32:151–8.

48. Varricchio A, Capasso M, De Lucia A, Avvisati F, Varricchio AM, Bettoncelli G, Ciprandi G. Intranasal flunisolide treatment in patients with non-allergic rhinitis. Int J Immunopathol Pharmacol. 2011; 24:401–9.

49. LaForce CF, Carr W, Tilles SA, Chipps BE, Storms W, Meltzer EO, Edwards M. Evaluation of olopatadine hydrochloride nasal spray, 0.6%, used in combination with an intranasal corticosteroid in seasonal allergic rhinitis. Allergy Rhinol (Providence). 2010; 1:14.

50. Kaliner MA. A novel and effective approach to treating rhinitis with nasal antihistamines. Ann Allergy Asthma Immunol. 2007; 99:383–90. quiz 391-2, 418.