Allergic rhinitis in young children: clinical and allergological correlations, risk factors, sensitization patterns and major allergens

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Allergen immunotherapy (AIT) is the only etiological treatment for allergic rhinitis (AR) patients, yet the impact of allergen sensitization patterns on AIT efficacy remains unclear. This study aimed to assess the effectiveness of subcutaneous immunotherapy (SCIT) using a native house dust mite (HDM) allergen extract in Chinese AR patients with diverse HDM sensitization patterns. This prospective multicenter study across three allergy centers in China enrolled patients aged 5-65 diagnosed with HDM-induced AR. Serum-specific IgE testing for nine HDM components (Der p1, Der p2, Der p23, Der f1, Der f2, Der p5, Der p7, Der p10, Der p21) categorized patients into two groups: Group A with sensitization limited to major allergen components and Group B with sensitization to minor components with or without major components. Both groups underwent 1 year of HDM SCIT (Allergopharma, Germany), whose efficacy was assessed using the visual analogue scale (VAS) and combined symptom medication scores (CSMS). Serum IgE and IgG4 levels against the nine HDM components were measured pre- and post-treatment, and SCIT-related adverse reactions were recorded. The study enrolled 168 patients, with 75 in Group A and 93 in Group B. Group B patients had higher asthma prevalence and elevated baseline HDM sIgE and total IgE levels. After 1 year, Group B showed significantly greater CSMS reduction (67.70% vs. 59.09%, p = 0.03) and VAS improvement (66.67% vs. 50.00%, p = 0.01) compared to Group A. Group A had increased new sensitization risk to minor allergens (Der p5, Der p7, Der p21). No significant difference in SCIT efficacy was observed between patients with and without new sensitization. Both groups exhibited increased sIgG4 levels against all nine HDM allergens, with a more pronounced elevation of sIgG4 levels to Der p21 observed in Group B compared to Group A (p = 0.02). SCIT-related adverse reactions were comparable (p > 0.05). The native HDM allergen extract demonstrates efficacy in Chinese AR patients with varying sensitization patterns. It offers enhanced benefits for patients sensitized to minor allergens with or without major allergens of HDM, positioning it as the preferred option for individuals with AR. Chinese Clinical Trial Registry identifier: ChiCTR2300078642.

Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence

To evaluate the invivo and invitro responses to nOle e 1 in allergic rhinitis (AR) and local allergic rhinitis (LAR) patients sensitized to olive tree pollen (OL) confirmed by nasal allergen provocation test (NAPT). Twelve subjects with AR, 12 with LAR and 12 subjects as control group (CG) were selected. Skin testing and NAPT with nOle e 1 were performed. Eosinophilic cationic protein (ECP) and tryptase were measured in nasal lavages before and after NAPT. Serum IgE to OL allergens was measured by ELISA. Basophil activation tests (BAT) with OL and nOle e 1 and dendritic cell maturation/proliferation studies were carried out. All AR (12/12) and 10/12 (83%) of LAR had a +NAPT to nOle e 1. ECP levels in nasal lavages were significantly increased after NAPT in both AR and LAR compared with CG at 15min (P<0.05). Serum IgE was positive only in AR. All AR had +BAT responses to OL and 10/12 to nOle e 1 (83%); 8/12 LAR (66.6%) had a +BAT to OL and 4/12 (33%) to nOle e 1, with only one subject of the CG with a +BAT to both OL and nOle e 1 (8%). Dendritic cell proliferation to nOle e 1 was increased in AR compared to LAR and CG (P=0.019 and P=0.001, respectively). Both AR and LAR had a similar invivo response to nOle e 1 with release of inflammatory mediators. Specific basophil activation with OL and nOle e 1 was observed in LAR confirming previous data obtained with dust mites.

Background: Allergic rhinitis (AR) is a common allergic disease in children, characterized by an immune response to various environmental and food allergens. The distribution and prevalence of allergen-specific IgE (sIgE) play a crucial role in understanding the pathophysiology and management of AR. In Shenzhen, the profile of common allergens in children with AR has not been extensively studied, particularly in relation to seasonal variations, gender, and age differences. Objective: To investigate the distribution of allergen-specific IgE (sIgE) in children with allergic rhinitis (AR) in Shenzhen, focusing on 28 allergens. Methods: A total of 3901 children with AR, aged 0 to 14 years, were selected from the outpatient clinic of Longgang District Maternal and Child Health Hospital. The distribution of sIgE positivity across 28 allergens was compared by season, gender, and age group. Results: Among inhalant allergens, the three most common with the highest positive rates were house dust mites, dog dander, and cat dander. In the food allergen group, the top three were milk, egg white, and beef. Dust mites exhibited the highest positive rate across all four seasons. Statistically significant differences (P P P P P Conclusion: House dust mites and dog dander are the most prevalent inhalant allergens for children with AR across all seasons, genders, and age groups in Shenzhen. Milk and egg white are the primary food allergens. The positive rate for inhalant allergens generally increases with age, while food allergens such as milk and egg white show a decreasing trend. Milk retains a relatively higher positive rate beyond 3 years of age, accompanied by a higher proportion of strong positive sensitization.

Background: Enterotoxins produced by Staphylococcus aureus and their specific IgE antibodies were thought to be important in worsening atopic dermatitis. However, few studies have documented an association between S. aureus or its exotoxins and exacerbations of upper airway/nasal disease. In the current study, we determined the prevalence of serum-specific IgE towards staphylococcal enterotoxin A, B, C, D (SEA, SEB, SEC, SED) and toxic shock syndrome toxin 1 (TSST-1) in patients suffering from rhinitis and/or asthma due to allergy. Therefore, we examined whether SEA, SEB, SEC, SED and TSST-1 were important in worsening the clinical status of patients allergic to house dust mites by means of assessing serum eosinophil cationic protein (ECP), which is thought to be a reliable marker of asthma and rhinitis severity. Methods: 198 patients with persistent allergic rhinitis and/or asthma due to house dust mites were evaluated. Specific IgE towards SEA, SEB, SEC, SED, TSST-1, timothy grass and birch pollen recombinant allergens, and other aeroallergen extracts from common allergen sources were evaluated by the Pharmacia CAP System. Serum ECP was assessed, too. Results: The percentages of sensitization to staphylococcal enterotoxins of 198 house dust mite-allergic patients were as follows: TSST-1-specific IgE 24.7% (n = 49), SEC-specific IgE 22.2% (n = 44), SEB-specific IgE 15.1% (n = 30), SEA-specific IgE 9.1% (n = 18), and SED-specific IgE 5.5% (n = 11). Out of 198 individuals allergic to house dust mites 136 patients suffering from persistent rhinitis were subdivided into two subgroups: 53 patients with serum-specific IgE to at least one staphylococcal enterotoxin and 83 patients without specific IgE towards staphylococcal enterotoxins. Patients sensitive to staphylococcal enterotoxins had higher serum ECP levels than patients lacking specific IgE to SEA, SEB, SEC, SED and TSST-1(geometric mean 24.3 vs. 16.6 µg/100 ml; p = 0.029), as well as total IgE levels (geometric mean 564 vs. 161 kU/l, p = 0.00063) and specific IgE to Dermatophagoides pteronyssinus (geometric mean 16.7 vs. 6.6 kU/l; p = 0.0235) and Dermatophagoides farinae (geometric mean 18.6 vs. 7.8 kU/l; p = 0.0246). Conclusion: A status of sensitization to staphylococcal enterotoxins seems to be a factor increasing serum ECP, which is thought to be a reliable marker of clinical severity of allergic disease. Therefore, the evaluation of SEA, SEB, SEC, SED and TSST-1-specific IgE antibodies may have additional significance for the prognosis of persistent allergic diseases of the upper airway.

On histopathological examination, nasal polyps and nasal mucosa in allergic rhinitis show different forms of pseudostratified respiratory epithelium, whereas the dominant characteristic of lamina propria is an eosinophilic infiltration. The aim of this study was to compare interleukin (IL)-5 and eosinophilic cationic protein (ECP) levels in the nasal fluid of 42 patients: 12 with allergic rhinitis and nasal septal deviation, 17 non-atopic patients with nasal polyposis, and 13 atopic nasal polyp patients were enrolled in this cross-sectional study. Nasal secretion samples were collected a few days before surgery. The levels of IL-5 were measured using flow cytometry and the ECP using a commercial ELISA kit. In addition, we counted eosinophils in hematoxylin-and-eosin-stained sections of all nasal polyp and all nasal mucosa samples taken from the inferior nasal turbinates during septoplasty. A significantly higher concentration of IL-5 was found in the nasal fluid of atopic patients with nasal polyposis than in non-atopic nasal polyp patients (p=0.025) and patients with allergic rhinitis (p=0.05). ECP was higher in atopic nasal polyp patients than in patients with allergic rhinitis (p<0.0001) and than in non-atopic nasal polyp patients (p<0.0001). Polyp eosinophils were higher in atopic' than in non-atopic patients (p<0.0001) and higher than in the mucosa of patients with allergic rhinitis (p<0.0001). These however had significantly more mucosal eosinophils than was found in the polyps of non-atopic patients' (p=0.025). ECP levels in nasal fluid and eosinophil counts in tissue specimens correlated well in all three groups of patients. Our study has shown that atopic nasal polyp patients have a higher level of eosinophilic inflammation than non-atopic patients with nasal polyps and patients with allergic rhinitis.

Despite a significant rise in asthma globally as well as in Sri Lanka, data regarding allergen sensitization patterns and other risk factors for asthma are not available. Therefore, we set out to determine the allergen sensitization patterns in children with asthma in Sri Lanka. Skin prick testing for common indoor aeroallergens (cockroach, cat, dog, house dust mite, moulds) were carried out in 156 children with bronchial asthma at Lady Ridgeway Hospital for Children. 49.1% of the patients were sensitized to at least one allergen and 6.4% were sensitized to three or more allergens. Of the children 37.8% tested positive to house dust mite, 23.7% to cockroach, 5.8% to indoor moulds, 12.2% to cats and 8.9% to dogs. Allergen sensitization was significantly less in children aged four years or younger than in older children (p<0.0001). A family history of asthma or allergic rhinitis (AR) was a significant risk factor (p<0.0001) for allergen sensitization (OR 10.9, 95% CI 3.9 to 30.1). Frequency of symptoms was significantly higher in those who used firewood alone compared to those who used other fuels (OR 2.5, 95% CI 1.1 to 5.8). Sensitization to aero-allergens was seen in a majority of children with asthma. Sensitization was significantly more in children above 4 years of age. Patients with more frequent symptoms and with AR were more likely to be sensitized to allergens.

Background: Allergic rhinitis (AR) is increasing in prevalence among children globally and in India. Allergens are factors which trigger allergic rhinitis. Skin prick test (SPT) is a rapid, sensitive and cost effective test to detect IgE- mediated allergic diseases. Identification of common aeroallergens in an area is necessary, in order to educate the patient on what allergens to avoid and also help find the best formulation of allergen immunotherapy for effective AR treatment. This study was done to find the clinical profile and skin sensitivity to common allergens by skin prick test in children with allergic rhinitis between six and fifteen years.Methods: This cross-sectional study was conducted for a period of one year from January 2016 to December 2016. All children between 6 to 15 years with allergic rhinitis were included in the study. Skin prick test was done with seven most common allergens.Results: A total of 60 children with allergic rhinitis were studied and 42 patients (70%) tested positive for SPT. The major symptoms were persistent sneezing (68%), nasal itching (33%), rhinorrhea (85%) and nasal congestion (42%). The proportion of sneezers-runners was higher than blockers (64% versus 36). We tested seven common allergens and house dust mite allergen yielded the highest number of positive responses (33%) followed by cockroach (25%), alternaria (16.66%), parthenium (10%), cat dander (8.35%), sorghum (5%) and dog dander (5%). Among patients with SPT positivity; eight were positive to one allergen, thirteen were positive to two allergens, sixteen to three allergens and five to four allergens.Conclusions: Allergic Rhinitis with a number of allergic co morbidities has a significant impact on the quality of life and scholastic performance in children. Skin prick test which is a standardized, most rapid, sensitive and cost-effective test to detect IgE-mediated allergic diseases is helpful in identifying the common allergens. House dust mite is the commonest allergen tested positive in our study in children.

Chapter 20 Allergen immunotherapy and standardization and stability of allergen extracts

Towards prevention

Analysis of 1175 Korean adults in the 2019 KNHANES study found that sensitization to house dust mites and birch pollen significantly increased glaucoma risk, while oak pollen sensitization showed a protective effect. The relationship between allergen sensitization and glaucoma remains poorly understood. This study investigated the association between specific allergen sensitization patterns and glaucoma risk using data from the 2019 Korea National Health and Nutrition Examination Survey. In this population-based cross-sectional study, we analyzed 1175 adult participants (≥19y) who completed ophthalmologic examinations and allergen sensitization assessments. Glaucoma diagnosis was based on International Society of Geographical and Epidemiological Ophthalmology criteria. Specific IgE antibodies against 7 common allergens were measured using ImmunoCAP assays, with significant sensitization defined as IgE ≥3.5kU/L. We employed the Synthetic Minority Over-sampling Technique to address class imbalance. Multiple logistic regression models were employed to evaluate associations between allergen sensitization and glaucoma, adjusting for demographic and clinical factors. Among the participants, 50 (4.3%) were diagnosed with glaucoma. Analysis of allergen sensitization patterns revealed house dust mites as the most prevalent allergen (11.7% overall), with comparable rates between the glaucoma (12.0%) and non-glaucoma groups (11.7%). Birch pollen sensitization followed at 4.1% and 4.0% in the glaucoma and non-glaucoma groups, respectively. Multivariate logistic regression analysis, after adjusting for confounders, identified house dust mite sensitization as having the strongest positive association with glaucoma (OR: 3.08, 95% CI: 1.40-6.77, P =0.005), followed by birch pollen (OR: 2.69, 95% CI: 1.02-7.12, P =0.046). Interestingly, oak pollen sensitization demonstrated a protective effect (OR: 0.24, 95% CI: 0.07-0.81, P =0.022). Our findings suggest a complex relationship between allergen sensitization and glaucoma, with different allergens showing varying associations with disease risk.

Major allergen content consistency of SQ house dust mite sublingual immunotherapy tablets and relevance across geographic regions

Comparison of rush-subcutaneous and sublingual immunotherapy with house dust mite extract for pediatric allergic rhinitis: A prospective cohort study

BackgroundAsthma and allergic rhinitis are a global health burden. Inhalant allergens worsen the symptoms and clinical manifestations of asthma and allergic rhinitis. Skin prick test is the gold standard for diagnosing allergen sensitization but is associated with some limitations. In contrast, in vitro serum-specific immunoglobulin E (SSIgE) test is convenient and is not associated with an anaphylactic risk.ObjectiveThe present study compared the accuracy of the SSIgE test by using microfluidic array enzyme-linked immunosorbent assay (ELISA) with that of the skin prick test for diagnosing inhalant allergen sensitization in patients with asthma and/or allergic rhinitis.MethodsThis diagnostic study included patients with asthma and/or allergic rhinitis. Of these, 100 patients underwent the SSIgE test for diagnosing sensitization to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis), dog dander, cat dander, and cockroach allergen. All the patients also underwent the skin prick test for diagnosing allergen sensitization. The sensitivity, specificity, predictive value, and likelihood ratio (LR) of the SSIgE test were evaluated for each allergen.ResultsSensitivity of the SSIgE test for diagnosing house dust mite sensitization was 48%–77%, with the highest sensitivity (77%) observed for diagnosing D. farinae sensitization. Specificity of the SSIgE test for diagnosing house dust mite sensitization was 64%–95%, with the highest specificity (95%) observed for diagnosing B. tropicalis sensitization. Although the SSIgE test showed high specificity and LR+ for diagnosing cockroach allergen sensitization, it showed low sensitivity (12%). Moreover, the SSIgE test showed high specificity (89%) but low sensitivity (3%) for diagnosing dog dander sensitization and high specificity (88%) but low sensitivity (10%) for diagnosing cat dander sensitization.ConclusionThe SSIgE test using microfluidic array ELISA shows moderate accuracy for diagnosing house dust mite sensitization and low accuracy for diagnosing cockroach allergen and dog and cat dander sensitization.