Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.

In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.

This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.

The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.

Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.

The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.

/pdf/allergic-rhinitis-and-its-impact-on-asthma-aria-2008-update-13eqfzaw4u.pdf

Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Authors Jan L. Brozek, MD, PhD – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada Jean Bousquet, MD, PhD – Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France, INSERM, CESP U1018, Respiratory and Environmental Epidemiology Team, France, and WHO Collaborating Center for Rhinitis and Asthma Carlos E. Baena-Cagnani, MD – Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina Sergio Bonini, MD – Institute of Neurobiology and Molecular Medicine – CNR, Rome, Italy and Department of Medicine, Second University of Naples, Naples, Italy G. Walter Canonica, MD – Allergy & Respiratory Diseases, DIMI, Department of Internal Medicine, University of Genoa, Genoa, Italy Thomas B. Casale, MD – Division of Allergy and Immunology, Department of Medicine, Creighton University, Omaha, Nebraska, USA Roy Gerth van Wijk, MD, PhD – Section of Allergology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands Ken Ohta, MD, PhD – Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan Torsten Zuberbier, MD – Department of Dermatology and Allergy, Charite Universitatsmedizin Berlin, Berlin, Germany Holger J. Schunemann, MD, PhD, MSc – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada

/pdf/allergic-rhinitis-and-its-impact-on-asthma-20b4c7y0pr.pdf

Allergic Rhinitis and Its Impact on Asthma

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

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.

/pdf/allergic-rhinitis-and-its-impact-on-asthma-aria-guidelines-3pawic20n9.pdf

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision

Clinical practices. Scabies.

Background Maintaining a relative humidity (RH) of less than 50% is one recommendation for reducing numbers of house dust mites and their allergens in homes. Objective The purpose of this study was to determine whether, in a humid temperate climate, indoor RH could be sufficiently lowered to control dust mites and their allergens. Methods During a period spanning 2 humid summers (May 1998 to October 1999), dust mite and allergen densities were determined in 3 groups of homes. One group (low RH group, n = 23) maintained an RH of less than 51%. Most of these homes used a high-efficiency dehumidifier and air conditioning. A second group of homes (group A) used air conditioning only (n = 19) or air conditioning and dehumidification (n = 5) but did not maintain an RH of less than 51%. A third group of homes (group C, n = 24) controlled climate by opening windows and had an RH of greater than 51%. Normal housecleaning was maintained in all homes during the study. Results The low RH group homes started in June with a mean +/- SE of 401 +/- 124 live mites and 17 +/- 3 microg of total Der 1 allergen per gram of dust. After 17 months of maintaining an RH of less than 51%, these declined significantly to 8 +/- 3 live mites per gram (P =. 004) and 4 +/- 1 microg of Der 1 per gram of dust (P Conclusion This study showed that it is practical to maintain an indoor RH of less than 51% during the humid summer season in a temperate climate, and this resulted in significant reductions in mite and allergen levels.

Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates

This study determined the prevalence of Sarcoptes scabiei in the home environment of 37 confirmed cases of scabies and in five nursing homes with scabietic patients. Dust samples from 44% of infested patients' homes contained scabies mites. Live mites at the time the dust samples were analyzed were present in 64% of these homes. Live mites were recovered most often from bedroom floors or overstuffed chairs and couches. The density of live and dead mites ranged from 1 to 5 mites/0.1 gm of dust or 1 to 9 mites/m2 of surface area sampled. The presence of mites in fomites coupled with survival and host-seeking behavior indicate that it is possible for a person to become infested by dislodged mites in contaminated home, school, and work environments. By contrast, only a small number of mites were recovered from beds, furniture, and floors of scabies-infested nursing homes. Mite-contaminated fomites may be less important in the transmission of scabies in nursing homes than in private homes.

https://www.jaad.org/article/S0190-9622(88)70237-6/pdf

Prevalence of Sarcoptes scabiei in the homes and nursing homes of scabietic patients

Background : Blomia tropicalis (BT) occurs in a significant percentage of homes in tropical and subtropical geographic regions of the United States and Europe and in countries in South America and Asia along with the pyroglyphid mites, Euroglyphus maynei (EM), Dermatophagoides pteronyssinus , and D farinae Blomia species may be major sources of allergens in house dust in addition to Dermatophagoides species and E maynei  Methods : Crossed immunoelectrophoresis and crossed radioimmunoelectrophoresis were used to identify the antigens and allergens of BT and to determine the cross-reactivity between BT and the house dust mites, D farinae, D pteronyssinus , and the stored product mite, Tyrophagus putrescentiae  Results : Homologous crossed immunoelectrophoresis of BT resulted in 27 antigen-antibody complexes Crossed radioimmunoelectrophoresis of these gels showed 21 different immunoglobulin E binding antigens when they were incubated in the sera from 14 patients with asthma whose radioallergosorbent test and skin test results were positive Heterologous crossed immunoelectrophoresis reactions with BT and rabbit D farinae body and feces, D pteronyssinus body and feces, and T putrescentiae body and feces antisera resulted in one to four precipitin lines BT extract, reacted with rabbit antisera produced against the bodies of D farinae, D pteronyssinus , and T putrescentiae , produced 3, 2, and 4 antigenic peaks, respectively; whereas crossed radioimmunoelectrophoresis of these gels with the sera of the 14 patients with asthma resulted in immunoglobulin E binding to 2, 2, and 4 peaks, respectively Conclusions : The results of this study indicated that BT contained multiple allergens of which most were species-specific There was a limited amount of cross-reactivity between BT and the two common house dust mite species and the stored product mite The amount of cross-reactivity appears to parallel the phylogenetic relatedness

https://www.jacionline.org/article/0091-6749(93)90218-5/pdf

Allergenicity of the mite, Blomia tropicalis

Background: Indoor relative humidity (RH) is the key factor that determines the survival and population development of the house dust mite Dermatophagoides farinae. Maintaining RH below 50% is one recommendation in a comprehensive plan to reduce house dust mites and mite allergen levels in homes. Even when mean daily RH is reduced below 50%, RH may rise above 50% intermittently for brief periods because of activities in the home (eg, cooking, bathing, and ventilation). Objective: The purpose of this study was to determine how brief daily periods of moist air alternating with long spells of low ambient RH (0% or 35%) influence population survival and growth of D farinae. Methods: Population growth was determined for D farinae at daily RH regimens of 2, 4, 6, and 8 hours at 75% or 85% RH alternating with 22, 20, 18, and 16 hours at 0% or 35% RH. Results: D farinae populations declined at daily regimens of 2 hours at 75% or 85% RH alternating with 22 hours at 0% or 35% RH. Daily regimens of 4, 6, and 8 hours at 75% RH alternating with 20, 18, and 16 hours, respectively, at 35% RH provided sufficient moisture for small growths in population size. These growths after 10 weeks were reduced by 98.2%, 98.0%, and 97.3% for daily regimens of 4, 6, and 8 hours, respectively, at 75% RH (with the remainder of the day at 35% RH) compared with the growth of populations continuously exposed to 75% RH. Continuous exposure to 85% RH inhibited population growth, but alternating daily regimens of 16, 18, and 20 hours at 35% RH allowed small populations to develop, although they were reduced by 99.4%, 98.8%, and 99.1% compared with population growth at a continuous 75% RH. Conclusion: This study indicates that maintaining mean daily RH below 50%, even when RH rises above 50% for 2 to 8 hours daily, effectively restricts population growth of these mites and thus the production of allergen. To completely prevent population growth of D farinae, RH must be maintained below 35% for at least 22 hours per day when the daily RH is 75% or 85% for the remainder of the day. (J Allergy Clin Immunol 1999;104:852-6.)

https://www.jacionline.org/article/S0091-6749(99)70298-8/pdf

Reducing relative humidity to control the house dust mite Dermatophagoides farinae.

Backgound: Human scabies is a debilitating skin disease caused by the ''itch mite'' Sarcoptes scabiei Ordinary scabies is commonly treated with topical creams such as permethrin, while crusted scabies is treated with topical creams in combination with oral ivermectin Recent reports of acaricide tolerance in scabies endemic communities in Northern Australia have prompted efforts to better understand resistance mechanisms and to identify potential new acaricides In this study, we screened three essential oils and four pure compounds based on eugenol for acaricidal properties Methodology/Principal Findings: Contact bioassays were performed using live permethrin-sensitive S scabiei var suis mites harvested from pigs and permethrin-resistant S scabiei var canis mites harvested from rabbits Results of bioassays showed that clove oil was highly toxic against scabies mites Nutmeg oil had moderate toxicity and ylang ylang oil was the least toxic Eugenol, a major component of clove oil and its analogues -acetyleugenol and isoeugenol, demonstrated levels of toxicity comparable to benzyl benzoate, the positive control acaricide, killing mites within an hour of contact Conclusions: The acaricidal properties demonstrated by eugenol and its analogues show promise as leads for future development of alternative topical acaricides to treat scabies

/pdf/acaricidal-activity-of-eugenol-based-compounds-against-48he4g5phs.pdf

DiAnn L. Vyszenski-Moher

Papers

Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates

Prevalence of Sarcoptes scabiei in the homes and nursing homes of scabietic patients

Allergenicity of the mite, Blomia tropicalis

Reducing relative humidity to control the house dust mite Dermatophagoides farinae.

Acaricidal Activity of Eugenol Based Compounds against Scabies Mites