The Experts below are selected from a list of 34278 Experts worldwide ranked by ideXlab platform

Jean Bousquet - One of the best experts on this subject based on the ideXlab platform.

  • next generation Allergic Rhinitis and its impact on asthma aria guidelines for Allergic Rhinitis based on grading of recommendations assessment development and evaluation grade and real world evidence
    The Journal of Allergy and Clinical Immunology, 2020
    Co-Authors: Jean Bousquet, C. Bachert, Holger J Schunemann, Akdis Togias, Martina Erhola, Peter Hellings, Ludger Klimek, Oliver Pfaar, Dana Wallace, Ignacio J Ansotegui
    Abstract:

    The selection of pharmacotherapy for patients with Allergic Rhinitis aims to control the disease and depends on many factors. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines have considerably improved the treatment of Allergic Rhinitis. However, there is an increasing trend toward use of real-world evidence to inform clinical practice, especially because randomized controlled trials are often limited with regard to the applicability of results. The Contre les Maladies Chroniques pour un Vieillissement Actif (MACVIA) algorithm has proposed an Allergic Rhinitis treatment by a consensus group. This simple algorithm can be used to step up or step down Allergic Rhinitis treatment. Next-generation guidelines for the pharmacologic treatment of Allergic Rhinitis were developed by using existing GRADE-based guidelines for the disease, real-world evidence provided by mobile technology, and additive studies (allergen chamber studies) to refine the MACVIA algorithm.

  • interaction between air pollution and pollen seasons on Allergic Rhinitis control
    European Respiratory Journal, 2019
    Co-Authors: Annabelle Bedard, Jean Bousquet, Josep M Anto, Judith Garciaaymerich, Sylvie Arnavielhe, Daniel Laune, Mikhail Sofiev, Xavier Basagana
    Abstract:

    A few studies have suggested an interaction between air pollution and pollen exposure on allergy symptoms but more research is needed. As part of the POLLAR (Impact of Air Pollution in Asthma and Rhinitis) project, we investigated the associations between major air pollutants (ozone and PM2.5) and Allergic Rhinitis control, during grass and birch pollen seasons, using the Allergy Diary app (a validated mHealth tool for Allergic Rhinitis management). The daily impact of Allergic symptoms was recorded, using visual analogue scale (VAS), by 3,328 geolocated app users in 2017 and 2018 in Northern Europe, representing 36,523 VAS days. Uncontrolled Allergic Rhinitis was defined either as 1) VAS≥50, 2) VAS≥35 with intra-nasal corticosteroids or azelastine-fluticasone propionate use or 3) VAS≥20 and use of ≥3 Allergic Rhinitis medications. For each VAS recorded with geolocation, pollutants levels were assessed using the SILAM (System for integrated modelling of atmospheric composition) database, and pollen seasons were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for gender, age, treatment and country. Positive associations were found between ozone and uncontrolled Allergic Rhinitis during the grass pollen season only (ORs=1.25 [1.11-1.41] and 1.14 [1.04-1.25], per interquartile range increase in ozone, for 2017 and 2018 respectively). A similar trend was found for PM2.5 levels in 2017 while results for 2018 did not suggest any effect modification by pollen seasons. These results show the importance of air pollution and allergen concentrations, and their interaction, as predictors of Allergic Rhinitis control.

  • macvia aria sentinel network for Allergic Rhinitis mask Rhinitis
    2015
    Co-Authors: Jean Bousquet, P Demoly, C. Bachert, Thomas B Casale, Giorgio Walter Canonica, Holger J Schunemann, Joao Fonseca, Boleslaw Samolinski, Alvaro A Cruz, P W Hellings
    Abstract:

    Several unmet needs have been identified in Allergic Rhinitis: identification of the time of onset of the pollen season, optimal control of Rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-Rhinitis (MACVIA-ARIA Sentinel NetworK for Allergic Rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in Allergic Rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of Allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in Allergic diseases which will improve policies and standards.

  • Allergic Rhinitis and its impact on asthma aria guidelines 2010 revision
    The Journal of Allergy and Clinical Immunology, 2010
    Co-Authors: Jan Brozek, Jean Bousquet, Thomas B Casale, Carlos E Baenacagnani, S Bonini, Walter G Canonica, Roy Gerth Van Wijk, Ken Ohta, Torsten Zuberbier, Holger J Schunemann
    Abstract:

    BACKGROUND: Allergic Rhinitis represents a global health problem affecting 10% to 20% of the population. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines have been widely used to treat the approximately 500 million affected patients globally. OBJECTIVE: To develop explicit, unambiguous, and transparent clinical recommendations systematically for treatment of Allergic Rhinitis on the basis of current best evidence. METHODS: The authors updated ARIA clinical recommendations in collaboration with Global Allergy and Asthma European Network following the approach suggested by the Grading of Recommendations Assessment, Development and Evaluation working group. RESULTS: This article presents recommendations about the prevention of Allergic diseases, the use of oral and topical medications, allergen specific immunotherapy, and complementary treatments in patients with Allergic Rhinitis as well as patients with both Allergic Rhinitis and asthma. The guideline panel developed evidence profiles for each recommendation and considered health benefits and harms, burden, patient preferences, and resource use, when appropriate, to formulate recommendations for patients, clinicians, and other health care professionals. CONCLUSION: These are the most recent and currently the most systematically and transparently developed recommendations about the treatment of Allergic Rhinitis in adults and children. Patients, clinicians, and policy makers are encouraged to use these recommendations in their daily practice and to support their decisions.

  • efficacy of desloratadine in persistent Allergic Rhinitis a ga len study
    International Archives of Allergy and Immunology, 2010
    Co-Authors: Jean Bousquet, J. Mullol, C. Bachert, Giorgio Walter Canonica, Paul Van Cauwenberge, Carsten Bindslev Jensen, W J Fokkens, Johannes Ring, Paul K Keith, Gokul Gopalan
    Abstract:

    Background: The ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines proposed a classification for Allergic Rhinitis based on the duration of symptoms (intermittent or persistent) rather than on the time of allergen exposure (seasonal or perennial). There had been no placebo-controlled, randomized, clinical trial of desloratadine (DL) in patients with persistent Allergic Rhinitis to date. Objectives: To assess the efficacy and safety of DL in patients with persistent Allergic Rhinitis based on the ARIA classification. Methods: Patients 12 years of age and older with persistent Allergic Rhinitis were assessed over 85 days of treatment with DL 5 mg once daily (n = 360) or placebo (n = 356). The primary endpoint was the AM/PM reflective total 5-symptom score (T5SS) averaged over days 1–29. Secondary endpoints included AM/PM instantaneous T5SS and individual symptoms, therapeutic response, symptom severity assessed by a visual analogue scale and quality of life. Results: The mean reduction in AM/PM reflective T5SS was significantly greater with DL than placebo over days 1–29 (–3.76 vs. –2.87, p Conclusions: This study showed DL to be effective and safe in the treatment of persistent Allergic Rhinitis.

Stephen R Durham - One of the best experts on this subject based on the ideXlab platform.

  • Allergic Rhinitis and its impact on asthma update allergen immunotherapy
    The Journal of Allergy and Clinical Immunology, 2007
    Co-Authors: Giovanni Passalacqua, Stephen R Durham
    Abstract:

    The Allergic Rhinitis and its Impact on Asthma document was first published in 2001. Since then, new data on specific immunotherapy have appeared. This review is intended as an update to the original document. MedLine (2001 to June 2006) was searched with appropriate key words, and panelists were asked to identify further relevant articles. Randomized controlled trials were considered for the evaluation of efficacy. For the evaluation of safety and additional effects, studies with lower grades of evidence were included. The clinical efficacy of injection immunotherapy in Rhinitis and asthma was confirmed, as well as the safety, provided that recommendations are followed. Studies have demonstrated the long-term efficacy and the preventive effect of immunotherapy in reducing the onset of new sensitizations. One randomized open trial demonstrated that in children with Allergic Rhinitis, injection immunotherapy may reduce the risk of developing asthma. There is strong evidence that sublingual immunotherapy is effective in Allergic Rhinitis in adults. Recent meta-analyses demonstrated its efficacy in Allergic Rhinitis in children and in asthma, although more definitive trials are required. Current data indicate that sublingual immunotherapy is safe and the rate of adverse reactions is not greater below 5 years of age. One randomized open trial showed that in children with Allergic Rhinitis, sublingual immunotherapy reduced the onset of asthma. Further studies are needed to identify the optimal maintenance dose and to elucidate the mechanism of action. Novel approaches for immunotherapy are currently under evaluation, including the use of adjuvants, peptides, and DNA-conjugated and recombinant allergens.

  • allergen injection immunotherapy for seasonal Allergic Rhinitis
    Cochrane Database of Systematic Reviews, 2007
    Co-Authors: Moises A Calderon, M R Jacobson, Bernadette Alves, Brian Hurwitz, Aziz Sheikh, Stephen R Durham
    Abstract:

    Background Allergic Rhinitis is the most common of the Allergic diseases. Despite improved understanding of the pathophysiology of Allergic Rhinitis and advances in its pharmacological treatment, its prevalence has increased worldwide. For patients whose symptoms remain uncontrolled despite medical treatment, allergen injection immunotherapy is advised. An allergen-based treatment may reduce symptoms, the need for medication and modify the natural course of this disease. Objectives To evaluate the efficacy and safety of subcutaneous specific allergen immunotherapy, compared with placebo, for reducing symptoms and medication requirements in seasonal Allergic Rhinitis patients. Search methods We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2006), MEDLINE (1950 to 2006), EMBASE (1974 to 2006), Pre-MEDLINE, KOREAMED, INDMED, LILACS, PAKMEDINET, Scisearch, mRCT and the National Research Register. The date of the last search was February 2006. Selection criteria All studies identified by the searches were assessed to identify randomised controlled trials involving participants with symptoms of seasonal Allergic Rhinitis and proven allergen sensitivity, treated with subcutaneous allergen specific immunotherapy or corresponding placebo. Data collection and analysis Two independent authors identified all studies reporting double-blind, placebo controlled randomised trials of specific immunotherapy in patients with seasonal Allergic Rhinitis due to tree, grass or weed pollens. Two authors independently performed quality assessment of studies. Data from identified studies were abstracted onto a standard extraction sheet and subsequently entered into RevMan 4.2.8. Analysis was performed using the Standardised Mean Difference (SMD) method and a random-effects model; P values < 0.05 were considered statistically significant. The primary outcome measures were symptom scores, medication use, quality of life and adverse events. Main results We retrieved 1111 publications of which 51 satisfied our inclusion criteria. In total there were 2871 participants (1645 active, 1226 placebo), each receiving on average 18 injections. Duration of immunotherapy varied from three days to three years. Symptom score data from 15 trials were suitable for meta-analysis and showed an overall reduction in the immunotherapy group (SMD -0.73 (95% CI -0.97 to -0.50, P < 0.00001)). Medication score data from 13 trials showed an overall reduction in the immunotherapy group (SMD of -0.57 (95% CI -0.82 to -0.33, p<0.00001)). Clinical interpretation of the effect size is difficult. Adrenaline was given in 0.13% (19 of 14085 injections) of those on active treatment and in 0.01% (1 of 8278 injections) of the placebo group for treatment of adverse events. There were no fatalities. Authors' conclusions This review has shown that specific allergen injection immunotherapy in suitably selected patients with seasonal Allergic Rhinitis results in a significant reduction in symptom scores and medication use. Injection immunotherapy has a known and relatively low risk of severe adverse events. We found no long-term consequences from adverse events.

  • prevalence and rate of diagnosis of Allergic Rhinitis in europe
    European Respiratory Journal, 2004
    Co-Authors: Vincent Bauchau, Stephen R Durham
    Abstract:

    To measure the prevalence of Allergic Rhinitis among European adults and the proportion of undiagnosed subjects, a two-step, cross-sectional, population-based survey in Belgium, France, Germany, Italy, Spain, and the UK was undertaken. Step one of the study involved screening for Allergic Rhinitis by telephone interview, based on history of symptoms and/or self-awareness of the condition. Step two undertook confirmation of Allergic Rhinitis in a subset of the subjects screened positive; this was performed by a clinical diagnosis conducted in three to five clinical centres per country, including specific immunoglobulin E tests and a disease-specific questionnaire. A total of 9,646 telephone interviews were conducted between February and April 2001. Self-awareness of Allergic Rhinitis was reported by 19% of the subjects. Physician-based diagnosis of Allergic Rhinitis was reported by 13% of the subjects. In step two, 725 clinical assessments were conducted between May and August 2001. A total of 411 of patients, who underwent step two, had investigator-confirmed Allergic Rhinitis. Among patients with investigator-confirmed Allergic Rhinitis, 45% had not reported a previous diagnosis by a physician. Prevalence of subjects with clinically confirmable Allergic Rhinitis estimated by combining step one and step two data ranged from 17% in Italy to 29% in Belgium with an overall value of 23%. This large-scale study confirms that Allergic Rhinitis has a high prevalence in western Europe and is frequently undiagnosed.

  • cellular infiltration and cytokine mrna expression in perennial Allergic Rhinitis
    Allergy, 1999
    Co-Authors: Eva Maria Varga, M R Jacobson, Stephen J Till, K Masuyama, F Obrien, Valerie J Lund, Glenis K Scadding, Qutayba Hamid, Stephen R Durham
    Abstract:

    Background: Allergen challenge in Allergic Rhinitis patients leads to local eosinophilia and Th2-type cytokine expression. Natural exposure to grass pollen is additionally characterized by epithelial mast-cell infiltration. We hypothesized that perennial Allergic Rhinitis is also associated with T-cell and eosinophil infiltration of the nasal mucosa, local Th2-type cytokine expression, and increased numbers of nasal epithelial mast cells. Methods: Nasal biopsies from perennial Allergic Rhinitis patients and controls were analysed by immunocytochemistry for different cell populations and in situ hybridization for cytokine mRNA-expressing cells. Results: Perennial Allergic Rhinitis was associated with increased numbers of submucosal CD3+ T cells (P=0.05), EG2+ activated eosinophils (P=0.01), and CD68+ macrophages (P=0.01) compared to controls. Epithelial, but not submucosal, tryptase-positive mast cells were also elevated in rhinitics compared to controls (P=0.01). The numbers of cells expressing interleukin (IL)-5 were higher (P=0.01) and the numbers of cells expressing IL-2 were lower (P=0.04) in rhinitic patients than controls. There were no significant differences for either IL-4 or interferon-gamma between the groups. Conclusions: Perennial Allergic Rhinitis is characterized by mast-cell migration into the epithelium; submucosal infiltration by T cells, eosinophils, and macrophages; and an imbalance in local T-cell cytokine production in favour of enhanced IL-5 and reduced IL-2 expression.

Philip Fireman - One of the best experts on this subject based on the ideXlab platform.

  • otitis media and eustachian tube dysfunction connection to Allergic Rhinitis
    The Journal of Allergy and Clinical Immunology, 1997
    Co-Authors: Philip Fireman
    Abstract:

    Otitis media and otitis media with effusion are among the most common childhood illnesses and contribute a great deal to health care costs. The cause of otitis media is multifactorial. Eustachian tube dysfunction, bacterial or viral infection of the middle ear, and nasal inflammation resulting from Allergic Rhinitis or upper respiratory infection are acknowledged contributing factors. Data from epidemiology studies indicate that 25% to 40% of upper respiratory infections in children younger than 3 years are accompanied by an episode of otitis media, 40% to 50% of children older than 3 years with chronic otitis media have confirmed Allergic Rhinitis. Studies of the pathogenesis of otitis media have identified interactions among infection, Allergic reactions, and eustachian tube dysfunction. Nasal inflammation due to allergen challenge results in classic signs and symptoms of Allergic Rhinitis and eustachian tube dysfunction. Eustachian tube dysfunction leads to increased negative pressure in the middle ear and improper ventilation. Both viral upper respiratory infection and nasal Allergic reaction provoke nasal inflammation, eustachian tube dysfunction, and enhanced nasal protein transudation and secretion, which is likely to be sustained and modulated by inflammatory mediators and cytokines. In a study of experimental infection with influenza A virus, histamine release increased from peripheral blood basophils of patients with Allergic Rhinitis. These data support an interaction between viral infection and nasal allergy in enhancing certain pathophysiologic responses. Viral upper respiratory infections may promote secondary bacterial infections by altering bacterial adherence, modulating host immune and inflammatory responses, and impairing eustachian tube function. In acute otitis media, bacteria are cultured front approximately 70% of middle ear effusions with Streptococcus pneumoniae being the most common organism. Initial management of otitis media consists of appropriate antimicrobial therapy. In the presence of Allergic Rhinitis, antiAllergic therapies may be used to augment symptom resolution and therapeutic response. Surgical insertion of tympanostomy or ventilation tubes to promote drainage of unresolved effusions has become common. Further delineation of the pathogenesis of otitis media and otitis media with effusion will guide appropriate medical management and may decrease the need and frequency of surgical procedures.

Peter Smith - One of the best experts on this subject based on the ideXlab platform.

  • identifying the hidden burden of Allergic Rhinitis ar in community pharmacy a global phenomenon
    Asthma Research and Practice, 2017
    Co-Authors: Rachel Tan, Peter Smith, Biljana Cvetkovski, Vicky Kritikos, D Price, Kwok Yan, Sinthia Bosnicanticevich
    Abstract:

    Patients with Allergic Rhinitis often trivialise their condition, self-manage inappropriately, and would benefit from health care intervention. The primary point of health care contact for these self-managing Allergic Rhinitis patients is the community pharmacy. With the majority of Allergic Rhinitis treatments being available for purchase over the counter, without health care professional contact, we know little about how the patients self-manage. This study aims to identify the burden of Allergic Rhinitis in the community pharmacy and to identify key opportunity for intervention. Pharmacy customers, who purchased nasal treatment in a community pharmacy, were approached with a research-administered questionnaire that collected data on medical history, symptoms and products purchased for the treatment of nasal symptoms. Of the 296 participants, 69.9% self-managed with over-the-counter medications; with 68% experiencing Allergic Rhinitis symptoms and only 44.3% of this subgroup had a doctor’s diagnosis. Nasal congestion (73.6%) was most commonly experienced and oral antihistamines were most commonly purchased (44.3%), indicating a pattern of suboptimal management. A third of participants (36.5%) experienced moderate-severe symptoms, persistently, which impacted on their daily living. Medication selection was mainly based on pharmacy customers’ perceptions of medication effectiveness (47.6%). A majority of participants that self-selected over-the-counter medications have symptoms consistent with Allergic Rhinitis, with almost half not having received a diagnosis. Medication purchasing patterns suggest that sub-optimal therapeutic decisions made by participants, even when they are experiencing significant symptoms. This study uncovers the hidden burden of Allergic Rhinitis in the community pharmacy and a missed opportunity to intervene and refer if necessary. Patients need to be guided through appropriate treatment as this study showed that many should be referred to a medical practitioner.

  • recognition of Allergic conjunctivitis in patients with Allergic Rhinitis
    World Allergy Organization Journal, 2013
    Co-Authors: Daniel Williams, Gabrielle Edney, Bianca Kathleen Maiden, Peter Smith
    Abstract:

    Aims To identify the incidence of Allergic conjunctivitis in patients with Allergic Rhinitis.

Cemal Cingi - One of the best experts on this subject based on the ideXlab platform.

  • Role of Leukotriene Antagonists and Antihistamines in the Treatment of Allergic Rhinitis
    Current allergy and asthma reports, 2013
    Co-Authors: Bengü Çobanoğlu, Elina Toskala, Ahmet Ural, Cemal Cingi
    Abstract:

    Allergic Rhinitis is the most common atopic disorder seen in ENT clinics. It is diagnosed by history, physical exam and objective testing. Patient education, environmental control measures, pharmacotherapy, and allergen-specific immunotherapy are the cornerstones of Allergic Rhinitis treatment and can significantly reduce the burden of disease. Current treatment guidelines include antihistamines, intranasal corticosteroids, oral and intranasal decongestants, intranasal anticholinergics, intranasal cromolyn, and leukotriene receptor antagonists. In the mechanism of Allergic Rhinitis, histamine is responsible for major Allergic Rhinitis symptoms such as rhinorrhea, nasal itching and sneezing. Its effect on nasal congestion is less evident. In contrast, leukotrienes result in increase in nasal airway resistance and vascular permeability. Antihistamines and leukotriene receptor antagonists are commonly used in the treatment of Allergic Rhinitis. The published literature about combined antihistamines and leukotriene antagonists in mono- or combination therapy is reviewed and presented.

  • Efficacy of leukotriene antagonists as concomitant therapy in Allergic Rhinitis
    The Laryngoscope, 2010
    Co-Authors: Cemal Cingi, Kivanc Gunhan, Linda Gage-white, H. Halis Ünlü
    Abstract:

    Objectives/Hypothesis: The symptoms of Allergic Rhinitis result from an immunoglobulin E-dependent mast cell activation cascade, marked by the release of inflammatory mediators, including histamine. Patients with perennial Allergic Rhinitis also have elevated levels of cysteinyl leukotrienes (CysLTs) in nasal lavage fluid. Histamine and CysLTs produce different responses in the pathogenesis of Allergic Rhinitis, and this study tested the hypothesis that the effects of combined antihistamine and leukotriene antagonist therapy would be more effective than antihistamine alone. Study Design: Multicentered, prospective, randomized, placebo-controlled, parallel-group. Methods: Three groups totaling 275 patients using: 1) fexofenadine alone, 2) fexofenadine with montelukast, or 3) fexofenadine with placebo, participated in a 21-day trial conducted during the spring pollen season. Objective analysis included pre- and poststudy physical examination findings and nasal resistance measurements. Subjective data gathered included a daily patient diary and pre- and poststudy patient satisfaction measurements. Results: The group using both fexofenadine and montelukast showed significantly better control of nasal congestion both subjectively, using patient diary and visual analog scale evaluations, and objectively, using rhinomanometry and physical examination, compared to groups using antihistamine alone or with placebo. Conclusions: Our data provided both objective and subjective evidence that leukotriene receptor antagonist-antihistamine combination therapy is more effective than antihistamine alone in the control of Allergic Rhinitis symptoms. Laryngoscope, 2010