Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

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.

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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

National Asthma Education and Prevention Program.

Abstract Background The surface coating of iron oxide magnetic nanoparticle (MNPs) drives their intracellular trafficking and degradation in endolysosomes, as well as dictating other cellular outcomes. As such, we assessed whether MNP coatings might influence their biodistribution, their accumulation in certain organs and their turnover therein, processes that must be understood in vivo to optimize the design of nanoformulations for specific therapeutic/diagnostic needs. Results In this study, three different MNP coatings were analyzed, each conferring the identical 12 nm iron oxide cores with different physicochemical characteristics: 3-aminopropyl-triethoxysilane (APS), dextran (DEX), and dimercaptosuccinic acid (DMSA). When the biodistribution of these MNPs was analyzed in C57BL/6 mice, they all mainly accumulated in the spleen and liver one week after administration. The coating influenced the proportion of the MNPs in each organ, with more APS-MNPs accumulating in the spleen and more DMSA-MNPs accumulating in the liver, remaining there until they were fully degraded. The changes in the physicochemical properties of the MNPs (core size and magnetic properties) was also assessed during their intracellular degradation when internalized by two murine macrophage cell lines. The decrease in the size of the MNPs iron core was influenced by their coating and the organ in which they accumulated. Finally, MNP degradation was analyzed in the liver and spleen of C57BL/6 mice from 7 days to 15 months after the last intravenous MNP administration. Conclusions The MNPs degraded at different rates depending on the organ and their coating, the former representing the feature that was fundamental in determining the time they persisted. In the liver, the rate of degradation was similar for all three coatings, and it was faster than in the spleen. This information regarding the influence of coatings on the in vivo degradation of MNPs will help to choose the best coating for each biomedical application depending on the specific clinical requirements. Graphical Abstract 

https://jnanobiotechnology.biomedcentral.com/counter/pdf/10.1186/s12951-022-01747-5

Different coatings on magnetic nanoparticles dictate their degradation kinetics in vivo for 15 months after intravenous administration in mice

The rockrose Cistus ladanifer is a plant belonging to the Cistaceae family found in southwestern Europe (Spain, Portugal) and northwestern Africa (Morocco, Algeria). A 32-year-old engineer, with a previous history of atopic rhinitis due to housedust mite, developed dermatitis on both hands after beginning a new construction project in the countryside. He was also an amateur botanist, and after identifying the plants surrounding his working area, suspected that Cistus ladanifer could be the cause. On patch testing, TRUE TestTM (Pharmacia Upjohn, Hillerød, Denmark) was negative. Rockrose leaves were extracted at 10% (w/v) in 1.8% NaCl (90 min, 4 æC, magnetic stirring). After centrifuging, the supernatant was dialyzed against 1.8% NaCl (MW cut-off 3500 Da) and filtered through 0.22 mm. For prick testing, the rockrose extract was glycerinated at 50% (5% w/v). The prick test was weakly positive (wheal size 15 mm2) with a greater late response (30 mm2). Specific IgE determination by RAST, using activated paper discs with the dialyzed Cistus ladanifer extract, was negative. Patch tests with a rockrose leaf and with the C. ladanifer extract were applied for 2 days (D), and readings made at D2, D3 and D7. Both the leaf and the extract were clearly positive and were negative in non-atopic control subjects. Skin biopsy was compatible with contact dermatitis. An immunofluoresence study (anti-IgG, IgM, IgA, C3 complement component and fibrinogen) carried out on skin biopsies was negative. The patient no longer had symptoms after avoiding further contact with the plant. To our knowledge, this is the 1st case report of allergic contact dermatitis caused by Cistus ladanifer, though English & Cronin (1) reported a positive open test to a leaf of another rockrose, Cistus creticus, in a housewife whose dermatitis improved when the plant was removed from her garden (there is a fine colour plate of this plant in Lovell (2)). Involvement of a low-MW non-protein C. ladanifer component is being studied.

Cistus ladanifer contact dermatitis.

Background
In this work we analyzed the allergological importance of Tyrophagus putrescentiae (Tp) in Huelva (SE Spain). We studied the level of exposition and the grade of sensitization to Tp in a group of patients sensitized to Dermatophagoides pteronyssinus (Dpt). The allergenic cross-reactivity between Dpt and Tp was determined by RAST inhibition.

Exposición y sensibilización a Tyrophagus putrescentiae en una población de alérgicos a Dermatophagoides pteronyssinus en Huelva

Mites and their allergens

To the Editor In the study by Monsalve et al. (1), 45 individuals with allergic reactions to vespid stings and positive tests to vespid venoms were studied by measuring their IgE to single recombinant and natural allergens from Vespula and Polistes. The results showed that such component-resolved diagnosis (CRD) allowed to recognize the really causative venom in 31 cases (69%), while in 14, a double sensitization was apparent. However, among the patients identified by CRD as monosensitized, 22 (71%) were sensitized to Polistes venom and 9 (29%) were sensitized to Vespula venom. This is in striking contrast with what we know about entomological and clinical aspects of hypersensitivity to vespids. In fact, Vespula spp. is much more aggressive than Polistes spp., this making the former the culprit insect in most cases of allergic reactions to vespid venom (2). In the first study demonstrating by the RAST-inhibition technique that in most patients with double sensitization to Vespula and Polistes only one venom was really causative, Polistes venom was identified only in 4.3% of patients (3). One may consider that the geographic distribution of Polistes is especially relevant in Mediterranean areas including Spain (4), but in an epidemiologic study conducted in Spain, the percentage of subjects with a positive RAST for Vespula venom was more than double the percentage found for Polistes (5). The most likely explanation of the finding from Monsalve et al. is provided by the low number of patients and thus on the stochastic nature of the data. Had the authors examined a number of patients as predetermined by statistical calculation, the results would have been different. However, any other explanation from the authors will be useful to appraise the real role of CRD in Hymenoptera venom allergy.

Domingo Barber

Papers

Different coatings on magnetic nanoparticles dictate their degradation kinetics in vivo for 15 months after intravenous administration in mice

Cistus ladanifer contact dermatitis.

Exposición y sensibilización a Tyrophagus putrescentiae en una población de alérgicos a Dermatophagoides pteronyssinus en Huelva

Mites and their allergens

Can component-resolved diagnosis overturn the current knowledge on vespid allergy?