Allergic rhinitis (AR) affects both the quality of life and daily functioning of a patient. Carefully selected personalized therapy determines good management of disease symptoms. In the latest update of the ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines, the algorithm for therapeutic management is based on the assessment of a patient’s condition with the use of a Visual Analogue Scale (VAS), therefore adopting an approach which involves either escalation (step up) or reduction (step down) of treatment. First-line drugs include: second-generation antihistamines, intranasal corticosteroids (INCS) and a combination of INCS with azelastine. Since the combination of INCS with intranasal H1 antihistamine drugs allows patients to benefit from therapeutic advantages of both drug categories, it is considered to be a universal treatment strategy. The combination of mometasone furoate with olopatadine hydrochloride is the latest therapeutic option in this drug category. These drugs prove highly effective and demonstrate a favorable safety profile.
Introduction: Allergic rhinitis concerns nearly 25% of the Polish population. Among pollen allergens, the most common reasons for allergic rhinitis are: grass, birch and mugwort. Knowledge of the characteristics of pollen seasons is necessary in diagnostics, monitoring of therapy and prevention of allergic rhinitis. Purpose: This work aims to analyze pollen seasons of the most allergenic plants in the Polish population; grass, birch and mugwort in the years 2003–2017 in Warsaw. Material and methods: Measurements of pollen concentration were carried out using Burkard volumetric spore trap operating in continuous mode. Analysis of pollen seasons was conducted based on the following characteristics: beginning, end, and length of season, the seasonal pollen index (SPI), defined as the sum of average daily pollen concentrations over the year, maximum daily concentration, number of days with maximum and threshold concentration. Linear regression together with the Pearson correlation coefficient were used in statistical analysis to study the relationship between variables; furthermore, descriptive characteristics of distributions studied were determined. Results: The average beginning of the birch pollen season in the analyzed period is April 10th, and it belongs to seasons of medium length (47 days on average). Birch pollen count above 75 grains/m3, when most allergic people develop symptoms, was recorded for an average of 18 days. The highest daily birch pollen count reaching 6321 grains/m3 (2012) exceeded the lowest value of the maximum concentration by almost 20 times (2015). Among the taxa analyzed, the highest values of daily counts and annual sums were recorded for birch pollen. The average date for the beginning of grass pollination season is on May 13th. It is the longest pollen season (on average 134 days), and the period when concentration exceeded 50 grains/m3 covered an average of 26 days. The highest daily grass pollen counts reaching 496 grains/m3 (2007) exceeded the lowest value of maximum concentration by 3.5 times (2016). The average date of the beginning of mugwort pollen season is July 16th. The season lasts 65 days on average, when concentration exceeding 30 grains /m3 was registered for an average of 12 days. The highest daily mugwort pollen count reaching 154 grains/m3 (2007) exceeded the lowest value of maximum concentration by 4 times (2013). For all analyzed taxa, the strongest correlated variables are the sum of average daily pollen concentrations over the year (SPI ) and daily maximum concentration (correlation for birch pollen = 0.92, for grass pollen = 0.88, and for mugwort pollen = 0.91). Conclusions: Periods of pollen in the air show certain variation in the analyzed 15-year period. The maximum concentration in the pollen season for the analyzed taxa and the the sum of average daily pollen concentrations over the year show the highest variability, particularly strongly expressed in the case of birch pollen. There is a linear relationship between the sum of average daily pollen concentrations over the year and the maximum concentration value as well as the number of days with the threshold concentration for all analyzed taxa. Variability of parameters describing the dynamics of pollen seasons indicates the need to monitor, both by patients with hay fever and physicians, the current information on the concentration of pollen in the air during the pollen season.
The nasal allergen challenge (NAC) is used in the diagnosis of rhinitis. The primary use of NAC is to confirm allergy to a specific inhaled allergen. NAC reproduces the allergic reaction of the nasal mucosa under standardized and controlled conditions that occurs after direct intranasal administration of allergens. As the only used method for assessing the degree of allergy, it mimics the body’s natural response to the sensitizing factor in the early and late stages of an allergic reaction. NAC is used in the diagnosis of chronic, occupational and local rhinitis, as well as in the differential diagnosis of rhinitis and ophthalmic symptoms. Under conditions similar to natural exposure, it determines the relationship between the allergen and symptoms of allergic rhinitis, especially in the case of difficulties in interpreting the results of skin tests and the serum concentration of specific IgE. It is a truly valuable tool in determining the indications for immunotherapy and the selection of allergens for desensitization therapy. It also serves as a method of monitoring the effectiveness of immunotherapy and pharmacotherapy. For scientific purposes, NAC is used to study the mechanisms of an allergic reaction and the influence of various factors on its course. It is considered safe, but requires appropriate instruments and qualified personnel.
Introduction: Allergic rhinitis concerns nearly 25% of the Polish population. Among pollen allergens, the most common reasons for allergic rhinitis are: grass, birch and mugwort. Knowledge of the characteristics of pollen seasons is necessary in diagnostics, monitoring of therapy and prevention of allergic rhinitis. Purpose: This work aims to analyze pollen seasons of the most allergenic plants in the Polish population; grass, birch and mugwort in the years 2003–2017 in Warsaw. Material and methods: Measurements of pollen concentration were carried out using Burkard volumetric spore trap operating in continuous mode. Analysis of pollen seasons was conducted based on the following characteristics: beginning, end, and length of season, the seasonal pollen index (SPI), defined as the sum of average daily pollen concentrations over the year, maximum daily concentration, number of days with maximum and threshold concentration. Linear regression together with the Pearson correlation coefficient were used in statistical analysis to study the relationship between variables; furthermore, descriptive characteristics of distributions studied were determined. Results: The average beginning of the birch pollen season in the analyzed period is April 10th, and it belongs to seasons of medium length (47 days on average). Birch pollen count above 75 grains/m3, when most allergic people develop symptoms, was recorded for an average of 18 days. The highest daily birch pollen count reaching 6321 grains/m3 (2012) exceeded the lowest value of the maximum concentration by almost 20 times (2015). Among the taxa analyzed, the highest values of daily counts and annual sums were recorded for birch pollen. The average date for the beginning of grass pollination season is on May 13th. It is the longest pollen season (on average 134 days), and the period when concentration exceeded 50 grains/m3 covered an average of 26 days. The highest daily grass pollen counts reaching 496 grains/m3 (2007) exceeded the lowest value of maximum concentration by 3.5 times (2016). The average date of the beginning of mugwort pollen season is July 16th. The season lasts 65 days on average, when concentration exceeding 30 grains /m3 was registered for an average of 12 days. The highest daily mugwort pollen count reaching 154 grains/m3 (2007) exceeded the lowest value of maximum concentration by 4 times (2013). For all analyzed taxa, the strongest correlated variables are the sum of average daily pollen concentrations over the year (SPI ) and daily maximum concentration (correlation for birch pollen = 0.92, for grass pollen = 0.88, and for mugwort pollen = 0.91). Conclusions: Periods of pollen in the air show certain variation in the analyzed 15-year period. The maximum concentration in the pollen season for the analyzed taxa and the the sum of average daily pollen concentrations over the year show the highest variability, particularly strongly expressed in the case of birch pollen. There is a linear relationship between the sum of average daily pollen concentrations over the year and the maximum concentration value as well as the number of days with the threshold concentration for all analyzed taxa. Variability of parameters describing the dynamics of pollen seasons indicates the need to monitor, both by patients with hay fever and physicians, the current information on the concentration of pollen in the air during the pollen season.
Introduction: Migraine and allergies are common occurrences. The aim of this study was to investigate the relationship between respiratory allergy and cephalalgic migraine in childhood. Materials and Methods: We screened 800 children for headache and its characteristics. After that we investigated the presence of allergy performing prick tests, rhinoscopy, endoscopy, rhinomanometry, nasal cytology and mucociliary clearance tests. Results: Out of 800 children screened, 96 suffered from headache. Among these, 67 resulted to suffered from both headache and allergy. We found a significant correlation between allergy and headache onset in the morning and headache onset in the evening in non-allergic subjects. The average duration of the a headache attack was independent from the presence of allergy, as well as the frequency of the cephalalgy attacks, and the localization of the pain. Prodromal symptoms connected with headache were reported to be: dizziness, aurea, sparkling scotoma, nausea and vomiting, and they were associated with absence of allergy. We also found a relationship between female gender and headache onset, but in teen-agers only. Paracetamol or FANS were used in the majority of cases, but antihistaminic therapy and/or nasal topical sprays were also reported. Discussion: For an effective diagnostic and therapeutic approach to migraine, the pediatrician should take into account atopy and its related allergic manifestations requiring a consultation with an otolaryngologist or allergist, if necessary. Our findings also stress the potential role of medicines that are not usually utilized for migraine attacks, such as antihistamines or decongestionant nasal sprays.
Exposure to airborne pollen allergens results in allergic symptoms in subjects who are sensitized. The paper presents diurnal variation in the counts of airborne allergenic pollen of selected trees (Betula L., Alnus Mill., Corylus L., Fagus L. and Ulmus L.) in two localities differing in the degree of urbanization: the city of Szczecin (urban) and the village of Gudowo, West Pomerania in northwest Poland (rural) in the years 2012–2014. The measurements were made by the volumetric method using a Burkardtype sampler operating in a continuous mode. The greatest similarities in the beginning of the main pollen season between the two sites studied were observed for birch and elm trees, while in the length of the main pollen season, for birch and alder trees. Pollen counts of alder and hazel reached higher levels in the rural area, while the levels of ash tree pollen counts were higher in the urban area. The level of birch tree pollen counts was similar in the two sites studied. For the majority of taxons observed in the urban and rural areas the dynamics of hourly changes in tree pollen counts were similar. The pollination peak was noted in the daytime, usually in the afternoon. For ash and elm trees increased pollen counts were observed at nighttime, while the birch tree pollen counts were at a high level for most of the 24 h cycle. The knowledge of seasonal and diurnal variations in tree pollen counts is crucial for prevention in patients with allergic rhinitis, sensitized to tree pollen allergens.
Objective: To clarify the roles of 11 beta-HSD in resistance to glucocorticoid therapy for allergic rhinitis, a case series study was conducted. Methods: The patient group consisted of 20 subjects with allergic rhinitis, aged from 21 to 46 years (mean age 26.5), who showed persistent GC resistance necessitating surgical removal of the inferior turbinate after 6 months’ GC treatment. The patients with poor response to GC treatment for 6 months’ were defined as GC resistance. The control group consisted of 10 subjects aged from 16 to 39 years (mean age 24.5) who underwent maxillofacial surgery, from whom nasal tissues were taken and who did not receive GC treatment. Nasal mucosal tissues from patients and cntorol subjects were examined immunohistochemically. The sections were washed with 0.01 M phosphate-buffered saline (PBS; pH 7.2) containing 0.15 M NaCl and 0.01% Triton X-100, and incubated for 2 h with rabbit polyclonal anti-11 beta HSD1 and 11 beta-HSD2 antibody (Santa Cruz Biotechnology, Inc., Santa Cruz, CA, USA), each diluted 1:200 in PBS containing 0.1% bovine serum albumin. Immunostained sections were assessed under an Olympus microscope with an eyepiece reticule at 200 X magnification. Cell counts are expressed as means per high-power field (0.202 mm2). Control group means (arithmetic mean ± SD) were compared with patient group means by Mann–Whitney U-test at P = 0.05. Results: Although 11 beta-HSD1 was expressed to a similar extent in patients and controls, 11 beta-HSD2 was expressed significantly more in patients with severe allergic rhinitis, resulting in a increased HSD-1/HSD-2 ratio. The significantly increased expression of 11 beta-HSD2 in the nasal epithelium and submucosal inflammatory cells of patients with severe nasal allergy were observed in the present study. Conclusion: Our findings suggest that 11 beta-HSD2 plays an important role in resistance to glucocorticoid therapy for allergic rhinitis, and its expression might be used as an additional parameter indicating steroid resistance in allergic rhinitis.
Introduction: Migraine and allergies are common occurrences. The aim of this study was to investigate the relationship between respiratory allergy and cephalalgic migraine in childhood. Materials and Methods: We screened 800 children for headache and its characteristics. After that we investigated the presence of allergy performing prick tests, rhinoscopy, endoscopy, rhinomanometry, nasal cytology and mucociliary clearance tests. Results: Out of 800 children screened, 96 suffered from headache. Among these, 67 resulted to suffered from both headache and allergy. We found a significant correlation between allergy and headache onset in the morning and headache onset in the evening in non-allergic subjects. The average duration of the a headache attack was independent from the presence of allergy, as well as the frequency of the cephalalgy attacks, and the localization of the pain. Prodromal symptoms connected with headache were reported to be: dizziness, aurea, sparkling scotoma, nausea and vomiting, and they were associated with absence of allergy. We also found a relationship between female gender and headache onset, but in teen-agers only. Paracetamol or FANS were used in the majority of cases, but antihistaminic therapy and/or nasal topical sprays were also reported. Discussion: For an effective diagnostic and therapeutic approach to migraine, the pediatrician should take into account atopy and its related allergic manifestations requiring a consultation with an otolaryngologist or allergist, if necessary. Our findings also stress the potential role of medicines that are not usually utilized for migraine attacks, such as antihistamines or decongestionant nasal sprays.
Objective: To clarify the roles of 11 beta-HSD in resistance to glucocorticoid therapy for allergic rhinitis, a case series study was conducted. Methods: The patient group consisted of 20 subjects with allergic rhinitis, aged from 21 to 46 years (mean age 26.5), who showed persistent GC resistance necessitating surgical removal of the inferior turbinate after 6 months’ GC treatment. The patients with poor response to GC treatment for 6 months’ were defined as GC resistance. The control group consisted of 10 subjects aged from 16 to 39 years (mean age 24.5) who underwent maxillofacial surgery, from whom nasal tissues were taken and who did not receive GC treatment. Nasal mucosal tissues from patients and cntorol subjects were examined immunohistochemically. The sections were washed with 0.01 M phosphate-buffered saline (PBS; pH 7.2) containing 0.15 M NaCl and 0.01% Triton X-100, and incubated for 2 h with rabbit polyclonal anti-11 beta HSD1 and 11 beta-HSD2 antibody (Santa Cruz Biotechnology, Inc., Santa Cruz, CA, USA), each diluted 1:200 in PBS containing 0.1% bovine serum albumin. Immunostained sections were assessed under an Olympus microscope with an eyepiece reticule at 200 X magnification. Cell counts are expressed as means per high-power field (0.202 mm2). Control group means (arithmetic mean ± SD) were compared with patient group means by Mann–Whitney U-test at P = 0.05. Results: Although 11 beta-HSD1 was expressed to a similar extent in patients and controls, 11 beta-HSD2 was expressed significantly more in patients with severe allergic rhinitis, resulting in a increased HSD-1/HSD-2 ratio. The significantly increased expression of 11 beta-HSD2 in the nasal epithelium and submucosal inflammatory cells of patients with severe nasal allergy were observed in the present study. Conclusion: Our findings suggest that 11 beta-HSD2 plays an important role in resistance to glucocorticoid therapy for allergic rhinitis, and its expression might be used as an additional parameter indicating steroid resistance in allergic rhinitis.
Allergic rhinitis (AR) is the most common form of allergy, which - as epidemiological research has shown - applies to nearly 25% of the population. AR significantly affects the quality of life of the patient, and the more severe the disease, the greater the risk of developing bronchial asthma. One of the factors affecting the severity of symptoms and the degree of their control is air pollution. In some patients, despite proper treatment, persistence or only partial remission of symptoms (uncontrolled allergic rhinitis) is observed. This can lead to an increase in comorbidities - inflammation of the paranasal sinuses, otitis media and asthma - both in children and in adults. The treatment of allergic rhinitis, in accordance with the standards, consists in: education of the patient, elimination of the allergen from the environment and factors intensifying the course of the disease, selection of proper pharmacotherapy and specific allergen immunotherapy. Many factors influence the selection of the antihistamine used, e.g., the opportunity of safe increase of the dosage.
Allergic rhinitis (AR) is the most common form of allergy, which - as epidemiological research has shown - applies to nearly 25% of the population. AR significantly affects the quality of life of the patient, and the more severe the disease, the greater the risk of developing bronchial asthma. One of the factors affecting the severity of symptoms and the degree of their control is air pollution. In some patients, despite proper treatment, persistence or only partial remission of symptoms (uncontrolled allergic rhinitis) is observed. This can lead to an increase in comorbidities - inflammation of the paranasal sinuses, otitis media and asthma - both in children and in adults. The treatment of allergic rhinitis, in accordance with the standards, consists in: education of the patient, elimination of the allergen from the environment and factors intensifying the course of the disease, selection of proper pharmacotherapy and specific allergen immunotherapy. Many factors influence the selection of the antihistamine used, e.g., the opportunity of safe increase of the dosage.
Rhinitis (RN) is inflammation of the nasal mucous membrane, manifested by impaired patency, pruritus, sneezing and the presence of secretions. Depending on the mechanism of creation of an inflammatory reaction, RN is divided into: (1) allergic rhinitis (AR) and (2) nonallergic rhinitis (NAR), and in case of their overlap, it is said to be (3) mixed (MR). The basis for the diagnosis of NN are: physical examination and interview (including ENT) and properly selected auxiliary research. The fundamental approach in RN in children is: education of patients and their parents, avoiding exposure to irritants (including allergens), nasal irrigation, air humidification and proper hydration of the child, and pharmacotherapy, and in selected cases of ARN, also allergen specific immunotherapy. The basis of pharmacotherapy in RN are intranasal glucocorticoids (dnGKS) and second-generation antihistamines, although their efficacy in NAR is lower than in AR. Due to the high incidence and adverse consequences, such as: decreased quality of life, sleep and mood disorders, deterioration in school education and relationship with other diseases, including: asthma, adenoid hypertrophy, conjunctivitis, chronic inflammation of paranasal sinuses and otitis media, RN is an important clinical problem. It is necessary to further investigate the issue to better understand this problem and to avoid its negative consequences, especially in the paediatric population.
Allergic rhinitis (AR) is the most common allergic disease in the world. Frequently it coexists with other allergic diseases such as asthma, allergic conjunctivitis or allergic dermatitis. It is inflammatory disease with immunological background, and it is caused by IgE-dependent reaction of the nasal mucous membrane to allergen. If time of symptoms duration is taken into account AR can be classified into intermittent or perennial, and severity of symptoms classifies it into mild or moderate/severe. Allergic rhinitis is a disease that depends of many factors. Interactions of environmental and genetic factors are responsible for its development. Environmental factors include airborne outdoor and indoor allergens (pollen, mold spores, house dust mites, animals fur and dander, insects), occupational allergens and atmospheric air pollution. Genetic factors are atopy and particular genetic polymorphisms coexistence. Symptoms of AR are itching, sneezing, clear nasal discharge, nasal congestion and loss of smell ability. Recognition of AR bases on compliance of symptoms and results of skin prick tests or the presence of specific IgE antibodies in blood. Assessment of amount of total IgE is not helpful in diagnostic process, while nasal provocation tests are more useful in scientific researches than clinical practice. Therapeutic process consists of patients education, exposure to allergens reduction, pharmacological treatment and specific immunotherapy. In pharmacological treatment are used systemic or topical antihistamine drugs, systemic or topical glucocorticoids, topical decongestants, pyłmontelukast, cromoglicas, and ipratropium bromide. Specific immunotherapy is indicated in selected groups of patients and it influences natural history of allergic diseases.
PL
Alergiczny nieżyt nosa (ANN) jest najczęstszą chorobą alergiczną na świecie. Często współistnieje z innymi chorobami alergicznymi, np. astmą, alergicznym zapaleniem spojówek lub atopowym zapaleniem skóry. Jest chorobą zapalną o podłożu immunologicznym, wywołaną IgE-zależną reakcją błony śluzowej nosa na alergen. Biorąc pod uwagę czas utrzymywania się objawów, ANN można podzielić na okresowy i przewlekły – ich przebieg może być łagodny oraz umiarkowany lub ciężki. Alergiczny nieżyt nosa jest chorobą zależną od wielu czynników. Za jego rozwój odpowiadają interakcje czynników środowiskowych i genetycznych. Do czynników środowiskowych zalicza się alergeny powietrznopochodne zewnętrzne i domowe (pyłki roślin, zarodniki grzybów pleśniowych, roztocze kurzu domowego, naskórki i sierści zwierząt, owady), alergeny zawodowe i zanieczyszczenia powietrza atmosferycznego. Czynniki genetyczne to atopia i współistnienie określonych polimorfizmów genów. Objawami ANN są świąd, kichanie, surowicza wydzielina nosowa, niedrożność nosa, utrata powonienia. Rozpoznanie ANN opiera się na wykazaniu zgodności pomiędzy objawami i wynikami punktowych testów skórnych lub obecnością we krwi swoistych IgE. Pomiar całkowitego IgE nie jest przydatny w rozpoznaniu ANN, a donosowe próby prowokacyjne są wykorzystywane głównie w badaniach naukowych, rzadziej w praktyce klinicznej. Postępowanie terapeutyczne obejmuje edukację pacjenta, zmniejszenie narażenia na alergeny, leczenie farmakologiczne oraz immunoterapię swoistą. W leczeniu farmakologicznym stosujemy leki przeciwhistaminowe doustne i donosowe, glikokortykosteroidy donosowe i systemowe, leki obkurczające naczynia błony śluzowej nosa, montelukast, bromek ipratropium i kromony. Immunoterapia swoista jest stosowana w leczeniu wybranych grup chorych i wpływa na naturalny przebieg chorób alergicznych.
Allergic rhinitis is currently considered the most common allergic condition. The ECAP (Epidemiology of Allergic Disorders in Poland) study, which was conducted in Poland between 2006 and 2008, found that allergic rhinitis affects 23.6% of children aged 6–7 years, 24.6% of children aged 13–14 years and 21.0% of adults aged 35–44 years. It was shown that allergic rhinitis causes a nine-fold increase in the risk of allergic asthma. The aim of the study was to assess the risk of asthma in children with allergic rhinitis based on spirometric identification of bronchial obstruction. A three-year follow-up was conducted in a group of 60 children, including 37 study patients with diagnosed allergic rhinitis and 23 controls. Three (8.1%) children in the study group developed asthma. Despite normal spirometry findings in the three asthmatic children with allergic rhinitis, comparison analyses indicated statistically significant differences in FEV1 and FVC values between the study group with allergic rhinitis and asthma and the controls. Normal spirometry results in most monitored children, suggesting the absence of lower respiratory inflammation, may be associated with an adequate control of allergic rhinitis as a result of proper treatment.
PL
Alergiczny nieżyt nosa jest obecnie uważany za najczęściej występującą chorobę alergiczną. W Polsce w przeprowadzonym w latach 2006–2008 badaniu ECAP (Epidemiologia Chorób Alergicznych w Polsce) stwierdzono, że na alergiczny nieżyt nosa choruje 23,6% dzieci w wieku 6–7 lat, 24,6% w wieku 13–14 lat i 21,0% dorosłych w wieku 35–44 lat. Wykazano, że rozpoznanie alergicznego nieżytu nosa zwiększa ryzyko rozwoju astmy alergicznej aż dziewięciokrotnie. Celem prezentowanej pracy była ocena ryzyka rozwoju astmy u dzieci chorujących na alergiczny nieżyt nosa poprzez określenie, czy występują u nich cechy obturacji oskrzeli w badaniu spirometrycznym. Trzyletniej obserwacji poddano grupę 60 dzieci: 37 stanowiło grupę badaną z rozpoznanym alergicznym nieżytem nosa, a 23 – grupę kontrolną. W badanej grupie 3 dzieci rozwinęło astmę, co stanowiło 8,1%. Wyniki badań spirometrycznych u 3 dzieci z alergicznym nieżytem nosa, u których rozwinęła się astma, były prawidłowe, ale analizy porównawcze wskazywały na statystycznie znamienną różnicę wartości FEV1 i FVC pomiędzy grupą badaną z alergicznym nieżytem nosa i astmą a grupą referencyjną. Prawidłowe wyniki badań spirometrycznych u większości obserwowanych dzieci, sugerujące brak toczenia się procesu zapalnego w dolnych drogach oddechowych, mogą być związane z dobrą kontrolą alergicznego nieżytu nosa w wyniku poprawnie prowadzonego leczenia.
Skin prick tests are one of the most commonly used diagnostic method in modern allergology through which we recognize the immediate allergy, i.e. IgE-mediated allergy. Allergens are being administered in form of a standardized solutions. Then, the wheal diameter is measured and evaluated in relation to the positive and negative control. The thesis presents the results of skin prick tests carried out among 225 children with symptoms of allergy such as asthma, allergic rhinitis (ANN) and atopic dermatitis (AZS). Evaluation embraced a relationship between the types of allergies and a predisposition to the development of atopic disease and child’s age. The most common sensitising allergen in the whole group were house dust mites found in 81% of patients. The second most common allergy was allergy to grass pollen (43%), then to trees (33%) and cat dander allergens (27%). This order differs in studied age groups. The most frequently observed allergens in the youngest group were molds (54.3%), then equally dust mites and grass pollen (43.5%). The dominant allergen in the group between 5 and 12 years was dust mite (90.7%), then molds (50.4%) and grass allergens (36%). In the oldest age group the allergens of dust mite were also dominant (92%), less often grass pollen (58%) and molds (58%). The most common clinical manifestation was the co-occurrence of asthma and rhinitis, then asthma symptoms, less often symptoms of rhinitis and a co-occurrence of asthma and atopic dermatitis. The smallest group were children with atopic dermatitis. Distribution of most common allergens in relation to the manifestation of atopic disease showed that the allergen of dust mine is playing crucial role in patient with symptoms of asthma and co-occurrence of asthma and allergic rhinitis. These results are consistent with reports of other cited authors. However, due to the nature of studied group of patients, we can suppose that the results for whole paediatric population can be a bit different.
PL
Punktowe testy skórne to jedna z najpowszechniej stosowanych metod diagnostycznych we współczesnej alergologii, dzięki niej rozpoznajemy alergię natychmiastową, IgE-zależną. Diagnostycznie alergeny są stosowane w postaci standaryzowanych roztworów. Oceniana jest średnica powstałych bąbli, a także ich wielkość względem kontroli dodatniej i ujemnej. W prezentowanej pracy przedstawiono wyniki punktowych testów skórnych przeprowadzonych w grupie 225 dzieci z objawami alergii w postaci astmy, alergicznego nieżytu nosa (ANN) oraz atopowego zapalenia skóry (AZS). Oceniano związek pomiędzy typem alergenu a chorobą atopową oraz wiekiem dziecka. Najczęściej uczulającym alergenem w całej badanej grupie były roztocza kurzu domowego, stwierdzone u 81% pacjentów. Drugą co do częstości występowania alergię stanowiło uczulenie na pyłki traw (u 43%). W dalszej kolejności uczulały pyłki drzewa (33%) i alergeny sierści kota (27%). Kolejność ta zmienia się w poszczególnych grupach wiekowych. Dla najmłodszej grupy pacjentów najczęściej stwierdzanym alergenem były pleśnie (54,3%), rzadziej odnotowywano – w równym stopniu – roztocza kurzu domowego oraz alergeny traw (po 43,5%). W grupie między 5. a 12. rokiem życia dominującym alergenem były roztocza kurzu domowego (90,7%), następnie pleśnie (50,4%) i trawy (36%). U dzieci powyżej 12. roku życia również dominowały roztocza kurzu domowego (92%), rzadziej stwierdzano uczulenie – w równym stopniu – na trawy i pleśnie (po 58%). Najczęstszą manifestacją kliniczną był zespół współwystępowania astmy i ANN, rzadziej występowały objawy astmy, a jeszcze rzadziej objawy ANN oraz zespół współwystępowania astmy i AZS. Najmniej liczną grupę stanowiły dzieci z objawami AZS. Rozkład najczęściej występujących alergenów w odniesieniu do manifestacji choroby atopowej wykazał, że wśród pacjentów z astmą oraz współistniejącymi astmą i ANN dominującą rolę odgrywają roztocza kurzu domowego. W grupie dzieci z ANN równie często obserwuje się też alergie na pyłki traw. Powyższe wyniki są zgodne z doniesieniami innych cytowanych autorów. Jednakże ze względu na specyfikę badanej grupy pacjentów można przypuszczać, że uzyskane wyniki mogą być nieco inne dla ogółu populacji dziecięcej.
Allergic rhinitis (AR) is the most common allergic disease in the world. Frequently it coexists with other allergic diseases such as asthma, allergic conjunctivitis or allergic dermatitis. It is inflammatory disease with immunological background, and it is caused by IgE-dependent reaction of the nasal mucous membrane to allergen.If time of symptoms duration is taken into account AR can be classified into intermittent or perennial, and severity of symptoms classifies it into mild or moderate/severe. Allergic rhinitis is a disease that depends of many factors. Interactions of environmental and genetic factors are responsible for its development. Environmental factors include airborne outdoor and indoor allergens (pollen, mold spores, house dust mites, animals fur and dander, insects), occupational allergens and atmospheric air pollution. Genetic factors are atopy and particular genetic polymorphisms coexistence. Symptoms of AR are itching, sneezing, clear nasal discharge, nasal congestion and loss of smell ability. Recognition of AR bases on compliance of symptoms and results of skin prick tests or the presence of specific IgE antibodies in blood. Assessment of amount of total IgE is not helpful in diagnostic process, while nasal provocation tests are more useful in scientific researches than clinical practice. Therapeutic process consists of patients education, exposure to allergens reduction, pharmacological treatment and specific immunotherapy. In pharmacological treatment are used systemic or topical antihistamine drugs, systemic or topical glucocorticoids, topical decongestants, montelukast, cromo - glicas, and ipratropium bromide. Specific immunotherapy is indicated in selected groups of patients and it influences natural history of allergic diseases.
PL
Alergiczny nieżyt nosa (ANN) jest najczęstszą chorobą alergiczną na świecie. Często współistnieje z innymi chorobami alergicznymi, np. astmą, alergicznym zapaleniem spojówek lub atopowym zapaleniem skóry. Jest chorobą zapalną o podłożu immunologicznym, wywołaną IgE-zależną reakcją błony śluzowej nosa na alergen. Biorąc pod uwagę czas utrzymywania się objawów, ANN można podzielić na okresowy i przewlekły – ich przebieg może być łagodny oraz umiarkowany lub ciężki. Alergiczny nieżyt nosa jest chorobą zależną od wielu czynników. Za jego rozwój odpowiadają interakcje czynników środowiskowych i genetycznych. Do czynników środowiskowych zalicza się alergeny powietrznopochodne zewnętrzne i domowe (pyłki roślin, zarodniki grzybów pleśniowych, roztocze kurzu domowego, naskórki i sierści zwierząt, owady), alergeny zawodowe i zanieczyszczenia powietrza atmosferycznego. Czynniki genetyczne to atopia i współistnienie określonych polimorfizmów genów. Objawami ANN są świąd, kichanie, surowicza wydzielina nosowa, niedrożność nosa, utrata powonienia. Rozpoznanie ANN opiera się na wykazaniu zgodności pomiędzy objawami i wynikami punktowych testów skórnych lub obecnością we krwi swoistych IgE. Pomiar całkowitego IgE nie jest przydatny w rozpoznaniu ANN, a donosowe próby prowokacyjne są wykorzystywane głównie w badaniach naukowych, rzadziej w praktyce klinicznej. Postępowanie terapeutyczne obejmuje edukację pacjenta, zmniejszenie narażenia na alergeny, leczenie farmakologiczne oraz immunoterapię swoistą. W leczeniu farmakologicznym stosuje się leki przeciwhistaminowe doustne i donosowe, glikokortykosteroidy donosowe i systemowe, leki obkurczające naczynia błony śluzowej nosa, montelukast, bromek ipratropium i kromony. Immunoterapia swoista jest stosowana w leczeniu wybranych grup chorych i wpływa na naturalny przebieg chorób alergicznych.
Asthma, allergic rhinitis and idiosyncrasy to aspirin stand for an increasing epidemiologic. In Poland an epidemiological study has been carried out in 11 centres, showing the occurrence of asthma at 5.4% of general population, for allergic rhinitis and idiosyncrasy – 8.5% and 0.5%, respectively. Some publications suggest more often presentation of idiosyncrasy in atopic patients. Taking under consideration high and increasing occurrence of allergy and massive use of non-steroid anti inflammatory drugs, their coincidence is quite important and we decided to investigate it. In a retrospective analysis of patients diagnosed at the Department of Internal Medicine and Allergology, Wrocław Medical University, we determined a group of 1 557 patients suffering from at least of one of these conditions. Asthma has been recognized in 1 015 patients (65%), allergic rhinitis and aspirin idiosyncrasy in 495 (32%) and 363 (23%), respectively. Coincidence of asthma and allergic rhinitis has been reported in 255 patients, and coincidence of asthma or rhinitis and idiosyncrasy – in 3% and 6%, respectively. We conclude that asthma and allergic rhinitis coexist very frequently, confirming a mutual pathophysiologic background and the concept of united airways disease. Further, idiosyncrasy appears 10 times more often in allergic patients than in general population.
PL
Astma, alergiczny nieżyt nosa i nadwrażliwość na aspirynę stanowią coraz istotniejszy problem epidemiologiczny. W Polsce, pod kierunkiem Kliniki Chorób Wewnętrznych i Alergologii Akademii Medycznej we Wrocławiu przeprowadzono badanie epidemiologiczne w 11 ośrodkach. Wynika z niego, że częstość występowania tych problemów klinicznych stale wzrasta. Obecnie na astmę choruje 5,4% populacji, na ANN – 8,5%, a nadwrażliwość na aspirynę dotyczy ok. 0,5% populacji. Inne doniesienia mówią o częstszym występowaniu nadwrażliwości na aspirynę u chorych z atopią. W związku z tak dużym rozpowszechnieniem schorzeń o podłożu alergicznym i szerokim zastosowaniem w leczeniu innych schorzeń kwasu acetylosalicylowego oraz innych leków z grupy niesteroidowych leków przeciwzapalnych, problem częstości współwystępowania tych chorób wydaje się być istotny i jest przedmiotem niniejszej pracy. W analizie retrospektywnej zidentyfikowano wśród pacjentów Kliniki Chorób Wewnętrznych i Alergologii AM we Wrocławiu w latach 1999-2003 grupę 1 557 chorych z co najmniej jednym z rozpoznań: astmy, alergicznego nieżytu nosa lub nadwrażliwości na aspirynę. Astmę zdiagnozowano u 1 015 pacjentów, alergiczny nieżyt nosa u 495, natomiast nadwrażliwość na aspirynę u 363 chorych, co stanowiło odpowiednio: 65%, 32% i 23% grupy. Współwystępowanie astmy i alergicznego nieżytu nosa stwierdzono u 255 pacjentów. Współwystępowanie którejś z powyższych chorób i idiosynkrazji aspirynowej zaobserwowano odpowiednio u 3 i 6% grupy. Wnioskujemy, że alergiczny nieżyt nosa i astma współwystępują z dużą częstością, co świadczy o wspólnym podłożu patogenetycznym tych chorób i potwierdza koncepcję united airways disease. Częstość występowania idiosynkrazji aspirynowej w grupie chorych z atopią jest 10-krotnie większa w porównaniu z populacją ogólną.
Oxygen is a biogenic element which determines the course of basic biochemical processes to ensure the survival of the cell. Unfortunately, in particular circumstances, the highly reactive oxygen species (ROS) may cause a toxic effect on the body. Small amounts of ROS are essential for the proper functioning of cells, however, the excessive production of them, which transcend the effectiveness of antioxidant systems – defined as oxidative stress – promotes structural and functional disorders of cells and tissues. Nowadays, the significant participation of oxidative stress is increasingly more frequently indicated in the course and/or etiology of chronic inflammatory diseases, which include atopic diseases such as bronchial asthma, atopic dermatitis, or allergic rhinitis.
PL
Tlen jako pierwiastek biogenny warunkuje przebieg podstawowych procesów biochemicznych gwarantujących przeżycie komórki. Niestety, w szczególnych warunkach wysoce reaktywne formy tlenu (RFT) mogą wywierać toksyczny efekt na organizm. W niewielkich ilościach RFT są niezbędne do prawidłowego funkcjonowania komórki, jednak ich nasilone wytwarzanie, przekraczające skuteczność działania systemów antyoksydacyjnych, określane mianem stresu oksydacyjnego, sprzyja zaburzeniom struktury i funkcji komórek oraz tkanek. Współcześnie coraz częściej wskazuje się na istotny udział stresu oksydacyjnego w przebiegu i/lub etiologii przewlekłych chorób zapalnych, do których zalicza się m.in. choroby atopowe, takie jak astma oskrzelowa, atopowe zapalenie skóry czy alergiczny nieżyt nosa.
Second generation antihistamines have been commonly used in treatment of allergic disorders for decades, especially in allergic rhinitis, urticaria, atopic dermatitis and allergic conjunctivitis. They are frequently used in everyday clinical practice, mainly because of high efficacy and excellent safety profile. In allergic disorders we use the potency of antihistamines to bind to histamine receptors, while in other diseases we use them because of their possible anti‑inflammatory mechanisms. Antihistamines are usually administered in monotherapy, however, in some cases we combine them with other agents. Certain antihistamines drugs have similar mechanisms of action, however, we can find distinct differences between the drugs. This is the reason why in case of no significant clinical improvement it is possible to add one antihistamine drug to another in order to enhance efficacy, it is also possible to increase a single therapeutic dose even up to four times. These observations based on clinical experience are the reason why it is necessary to conduct further studies on schemes of antihistamines drugs’ administration. In the article frequently used drugs are presented, especially their clinical efficacy and safety. Results of chosen clinical trials are also reported. Some controversial topics are mentioned, especially combined use of certain drugs and the possibility of applying higher daily doses.
PL
Leki przeciwhistaminowe II generacji stosowane są od wielu lat w leczeniu chorób alergicznych, szczególnie alergicznego nieżytu nosa, pokrzywki, atopowego zapalenia skóry i alergicznego zapalenia spojówek. Należą do najczęściej przepisywanych leków w codziennej praktyce lekarskiej, głównie ze względu na wysoką skuteczność terapeutyczną i dobry profil bezpieczeństwa. W chorobach alergicznych istotny jest ich efekt wiązania z receptorami histaminowymi, natomiast w innych jednostkach opieramy się na własnym doświadczeniu i wykorzystujemy ich potencjalne działanie przeciwzapalne. Leki przeciwhistaminowe często stosowane są w monoterapii, niekiedy w skojarzeniu z innymi lekami. Poszczególne leki, mimo że mechanizm ich działania jest podobny, nieznacznie różnią się od siebie. Z tego względu przy braku efektu klinicznego zawsze warto zamienić lek antyhistaminowy na inny lub dołączyć inny preparat w dowolnym schemacie. Można również manipulować dawkami, podwyższając je nawet czterokrotnie w stosunku do dawek zarejestrowanych. Chociaż leki przeciwhistaminowe stosuje się od wielu lat, konieczne są zatem dalsze badania, mające na celu optymalizację schematów postępowania, ze szczególnym uwzględnieniem łączenia poszczególnych preparatów i stosowania zróżnicowanych dawek. W artykule omówiono najczęściej stosowane leki przeciwhistaminowe, ich skuteczność terapeutyczną i bezpieczeństwo ich stosowania. Przedstawiono wyniki wybranych badań klinicznych oraz poruszono zagadnienia kontrowersyjne, takie jak łączenie oraz stosowanie poszczególnych preparatów w wyższych dawkach dziennych.
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