BACKGROUND: Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real-life studies. OBJECTIVE: To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK-air® app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. METHODS: We assessed the MASK-air® data of European users with self-reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales-VASs), and a combined symptom-medication score (CSMS). We applied Bayesian mixed-effects models, with clustering by patient, country and pollen season. RESULTS: We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT-tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = -12.1;-2.8), lower VAS Work (average difference = 5.0; 95%CrI = -8.5;-1.5), and a lower CSMS (average difference = 3.7; 95%CrI = -9.3;2.2). When compared to SCIT, SLIT-tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = -17.2;-2.8), lower VAS Work (average difference = 7.8; 95%CrI = -15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = -18.5;0.2). CONCLUSION: In patients with grass pollen allergy, SLIT-tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally-harmonised standards for performing and reporting real-world data in AIT are needed to better understand its 'real-world' effectiveness.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. METHODS: We analysed 2015-2020 MASK-air® European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. RESULTS: We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H1 -antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. CONCLUSIONS: Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.
- MeSH
- alergická rýma * farmakoterapie epidemiologie MeSH
- antihistaminika terapeutické užití MeSH
- lidé MeSH
- rinitida * farmakoterapie MeSH
- zvyky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- angiotensin konvertující enzym 2 fyziologie MeSH
- bronchiální astma komplikace farmakoterapie MeSH
- COVID-19 etiologie MeSH
- lidé MeSH
- SARS-CoV-2 * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. METHODS: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis. RESULTS: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p < .001). CONCLUSIONS: This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.
- MeSH
- alergická rýma * diagnóza MeSH
- bronchiální astma * MeSH
- COVID-19 * MeSH
- konsensus MeSH
- lidé MeSH
- nachlazení * MeSH
- SARS-CoV-2 MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
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.
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
- MeSH
- alergeny aplikace a dávkování imunologie MeSH
- alergická rýma epidemiologie imunologie terapie MeSH
- analýza nákladů a výnosů MeSH
- biologické markery MeSH
- bronchiální astma epidemiologie imunologie terapie MeSH
- desenzibilizace imunologická * škodlivé účinky metody MeSH
- individualizovaná medicína metody MeSH
- klinické rozhodování MeSH
- komorbidita MeSH
- kritické cesty * MeSH
- lidé MeSH
- management nemoci MeSH
- náchylnost k nemoci MeSH
- osobní újma zaviněná nemocí MeSH
- postoj zdravotnického personálu MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- výsledek terapie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Suchý kašel během dne, záchvaty kašle v noci a pískoty při dýchání – téměř 10 % obyvatel Německa trpí bronchiálním astmatem. Pacienti s mírnou formou onemocnění mohou být v péči praktického lékaře a není nutno, aby vyhledali specialistu. Pokud však dosavadní léčba není dostatečně účinná, pneumologové mají k dispozici různé další metody k medikamentózní kontrole astmatu.
Trockener Husten am Tag, Hustenanfälle in der Nacht und ein pfeifendes Atemgeräusch – fast 10 % der Deutschen leiden an Asthma bronchiale. Wer nur von einer milden Form betroffen ist, kann sich von seinem Hausarzt behandeln lassen und muss nicht unbedingt einen Facharzt aufsuchen. Spricht die Therapie jedoch nicht an, verfügen Pneumologen über viele Möglichkeiten, die Krankheit medikamentös zu kontrollieren.
Pacienti alergičtí na pyly trav jsou prirozeně exponováni a senzibilizováni četnými pyly z různých druhů podčeledi Pooideae. Vzniká otázka, zda by takoví pacienti měli být desenzibilizováni extrakty na základě jednoho pylu nebo směsi pylů. Ani konvenční diagnostika založená na reaktivitě IgE ani sčítání pylu neumožňují identifikaci druhů trav, které se účastní senzibilizace pacienta. Mezi alergeny z pylů podčeledi Pooideae lze pozorovat významnou zkříženou imunogenicitu následkem jejich prirozených aminokyselinových sekvencí (například > 90 % pro skupinu 1, 55-80 % pro skupinu 5, 30-60 % pro ostatní alergeny včetně minoritních alergenů. Nicméně pylové alergeny rovněž obsahují druhově specifické epitopy T- nebo B-lymfocytů a existuje důkaz, že alespoň 50 % alergických pacientů je senzibilizováno vůči těmto konkrétním epitopům. Navíc existují podstatné kvantitativní rozdíly mezi obsahy alergenů (například skupiny 1, 2/3, 4, 5, 6, 10, 13) v pylech obdržených z jednotlivých druhů trav. V této souvislosti doporučujeme vakcínu složenou z kombinace pylů z pěti běžných a dobře charakterizovaných trav podčeledi Pooideae zahrnující Anthoxanthum odoratum, Dactylis glomerata, Lolium perenne, Phleum pratense a Poapratensis pro účely desenzibilizace. Tato směs pěti trav se doporučuje, protože (i) byla validována ve smyslu bezpečnosti a účinnosti v zavedené klinické praxi; (ii) lépe odráží přirozené podmínky expozice a senzibilizace na molekulární úrovni ve srovnání s jednotlivým pylem; a (iii) poskytuje konzistentní a dobře vyvážené složení kritických alergenů při rozšiřování repertoáru epitopů T- a B-lymfocytům.
Grass pollen. allergic patients are naturally exposed and sensitized to multiple pollens from various Pooideae species. The que stion arises as to whether such patients should be desensitized with extracts based on a single pollen or a pollen mixture. Neither conventional d iagnosis based on IgE reactivity nor pollen counts enable the identification of which grass species are involved in patient sensitization. Significan t cross-immunogenicity is observed between aller gens from Pooideae pollens due to their conserved amino acid sequences (e.g. > 90% for group 1, 55–80% for group 5, 30–60% for other allergens, including minor allergens). Nevertheless, pollen allergens also contain species-specific T or B c ell epitopes, and there is evidence that at least 50% of allergic patients are sensitized to such distinct epitopes. In addition, substantial quantitat ive differences exist in the allergen (e.g. group 1, 2/3, 4, 5, 6, 10, 13) content of pollens obtained from distinct grass species. In this context, we reco mmend a vaccine con- sisting of a combination of pollens from five common and well characterized Pooideae including Anthoxanthum odoratum, Dactylis glomerata, Lolium perenne, Phleum pratense and Poa pratensis for desensitization purposes. This 5-grass mixture is recommended because, (i) it has been validated, in terms of safety and efficacy, by established clinical practice; (ii) it better reflects natural exposure and sensitization conditions at the molecular level than a single pollen; and (iii) it provides a consistent a nd well-balanced composition of critical allergens, w hile extending the repertoire of T a nd B cell epitopes.
- MeSH
- antigeny rostlinné MeSH
- Dactylis škodlivé účinky MeSH
- desenzibilizace imunologická MeSH
- jílek škodlivé účinky MeSH
- lidé MeSH
- lipnicovité škodlivé účinky MeSH
- Phleum škodlivé účinky MeSH
- Poa škodlivé účinky MeSH
- pyl škodlivé účinky MeSH
- rostlinné extrakty imunologie terapeutické užití MeSH
- vakcíny imunologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
