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

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Allergic Rhinitis and Its Impact on Asthma

Background In early life, the innate immune system can recognize both viable and nonviable parts of microorganisms. Immune activation may direct the immune response, thus conferring tolerance to allergens such as animal dander or tree and grass pollen. Methods Parents of children who were 6 to 13 years of age and were living in rural areas of Germany, Austria, or Switzerland where there were both farming and nonfarming households completed a standardized questionnaire on asthma and hay fever. Blood samples were obtained from the children and tested for atopic sensitization; peripheral-blood leukocytes were also harvested from the samples for testing. The levels of endotoxin in the bedding used by these children were examined in relation to clinical findings and to the cytokine-production profiles of peripheral-blood leukocytes that had been stimulated with lipopolysaccharide and staphylococcal enterotoxin B. Complete data were available for 812 children. Results Endotoxin levels in samples of dust from th...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa020057

Environmental exposure to endotoxin and its relation to asthma in school-age children.

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

The allergenic content of the atmosphere varies according to climate, geography and vegetation. Data on the presence and prevalence of allergenic airborne pollens, obtained from both aerobiological studies and allergological investigations, make it possible to design pollen calendars with the approximate flowering period of the plants in the sampling area. In this way, even though pollen production and dispersal from year to year depend on the patterns of preseason weather and on the conditions prevailing at the time of anthesis, it is usually possible to forecast the chances of encountering high atmospheric allergenic pollen concentrations in different areas. Aerobiological and allergological studies show that the pollen map of Europe is changing also as a result of cultural factors (for example, importation of plants such as birch and cypress for urban parklands), greater international travel (e.g. colonization by ragweed in France, northern Italy, Austria, Hungary etc.) and climate change. In this regard, the higher frequency of weather extremes, like thunderstorms, and increasing episodes of long range transport of allergenic pollen represent new challenges for researchers. Furthermore, in the last few years, experimental data on pollen and subpollen-particles structure, the pathogenetic role of pollen and the interaction between pollen and air pollutants, gave new insights into the mechanisms of respiratory allergic diseases.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1398-9995.2007.01393.x

Allergenic pollen and pollen allergy in Europe

How many systemic reactions to skin prick tests could be preventable in defined conditions

BACKGROUND The major cat allergen, Fel d 1, is ubiquitous, and clothes of cat owners are important vehicles for its distribution and dispersal in cat-free environments. OBJECTIVE We assessed the efficiency of a standard vacuum-cleaning in removing the cat allergen from cotton fabrics, experimentally contaminated by a prolonged contact with cats. METHODS Fifteen rectangles (80 x 100 cm) of a widely used cotton material were kept in baskets of male cats for 1 week. Afterwards, the squares were cut in half. One half was immediately sampled for cat allergen, and the other half was vacuum-cleaned for 15 minutes by a commercially available device before sampling. Five identical cotton rectangles not exposed to cats served as controls. Samples were collected with a high-volume vacuum air-sampler. Particulate material was harvested onto filters with 25-mm diameter and 2 microm pore size, extracted in phosphate buffer with BSA and then assayed for the Fel d 1 allergen with an ELISA method. The results were expressed as micrograms of allergen per filter. RESULTS After vacuum-cleaning the amounts of Fel d 1 extracted from cat-exposed fabrics were not significantly reduced ( t = 3.118; P > 0.005), with respect to the non vacuum-cleaned tissues. No Fel d 1 was found in control fabrics. CONCLUSIONS Our study suggest that vacuum-cleaning by using a commercially available device is not able to remove significant amounts of cat allergen from cotton fabrics exposed to cats.

Effectiveness of vacuum-cleaning in removing Fel d 1 allergen from cotton fabrics exposed to cats.

Relationship between oxytocin/vasopressin and latex in obstetric surgery: how to recognize (and prevent) allergic reactions and differentiate them from side effects?

Eruca sativa (Arugula, Rocket, Roquette; Cruciferae family) is a spontaneous or cultivated plant native to Mediterranean countries (Italy, France, Spain, and Greece), but it is becoming more popular in the United States. This vegetable constitutes a typical Mediterranean food because it is widely used as an uncooked ingredient in many dishes such as salads, pizza, and pasta. Reactions to fresh E. sativa were considered very uncommon in comparison with reaction to other vegetables, even among subjects with pollen allergy. The few available studies show that sensitization to E. sativa1 or other Cruciferae plant allergens2, 3 is able to induce especially cutaneous or systemic manifestations (e.g., contact urticaria and anaphylactic shock). In this report we describe an unusual case of E. sativa sensitization with only intraoral and respiratory symptoms in a subject with pollen allergy.

https://www.jacionline.org/article/S0091-6749(98)70407-5/pdf

Gennaro Liccardi

Papers

How many systemic reactions to skin prick tests could be preventable in defined conditions

Effectiveness of vacuum-cleaning in removing Fel d 1 allergen from cotton fabrics exposed to cats.

Relationship between oxytocin/vasopressin and latex in obstetric surgery: how to recognize (and prevent) allergic reactions and differentiate them from side effects?

Intraoral and respiratory allergy to Eruca sativa (Cruciferae family) in a subject with sensitization to pollen allergens.

Chronic cat allergen exposure and low sensitization: Possible limitations in patient selection?