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Association Of Ige Serum Concentration, Total Eosinophil Count With Symptom Severity In Children With House Dust Mite Allergic Rhinitis
AB172 Abstracts
673
Perennial Allergen Skin Sensitivity As A Predictor Of Seasonal Allergic Rhinoconjunctivitis Severity P. Gomes1, M. B. Abelson2,3, K. Mandell1; 1Ora, Inc., Andover, MA, 2 Schepens Eye Research Institute, Boston, MA, 3Harvard University, Cambridge, MA. RATIONALE: To evaluate the relationship of perennial allergen skin sensitivity to seasonal allergic rhinoconjunctivitis. METHODS: A 4 week, environmental study was conducted during ragweed season in allergic rhinoconjunctivitis patients (N534). Subjects had a positive skin test reaction to seasonal (ragweed) and perennial (cockroach, dust mite, and cat/dog dander) allergens, and had a medical history of allergic conjunctivitis in ragweed season. An IRB (Alpha, San Clemente, CA) approved the protocol and informed consent form, and no treatment was allowed during the study. Subjects reported ocular (itching, redness, and lid swelling) and nasal (itching, sneezing, rhinorrhea, and nasal congestion) allergic symptoms in a diary 3 times daily for 27 days (0-4 scale). A composite nasal score of all individual nasal symptoms, the Total Nasal Symptom Score (TNSS), was then calculated (0-16 scale). A subset analysis was performed on the perennial-positive (N526) and perennial-negative (N58) subjects. Mean daily symptom scores were calculated, and differences compared using a two-tailed, student t-test. RESULTS: Nasal symptom scores were consistently more severe in the perennial-positive subjects. TNSS peaked on day 6 at 4.69 (63.58), compared to 2.75 (63.35) for perennial-negative subjects. On each of the 27 days, the mean average TNSS for perennial-positive subjects was higher, with statistically significant (p<0.05) differences between groups observed at 9 of the 27 days. Ocular scores were likewise numerically higher and exhibited strong trends. CONCLUSION: These data suggest that perennial allergen skin sensitivity can be a predictor for the severity of seasonal allergic rhinoconjunctivitis symptomatology.
674
MONDAY
Acetaminophen Use and Risk of Rhinitis and Eczema in Schoolchildren: A Meta-Analysis M. Desai, D. Axelrod; University of Medicine and Dentistry of New Jersey, Newark, NJ. RATIONALE: Acetaminophen use has increased alongside an increase in the global prevalence of allergic disorders. A meta-analysis was conducted to assess the relationship between acetaminophen use and risk of rhinitis and eczema in schoolchildren ages 6-7. METHODS: The literature was systematically searched using Medline, Cochrane, and Embase databases through August 2009 (keywords: acetaminophen, paracetamol, allergic rhinitis, eczema, asthma, wheeze, children). Observational studies that clearly defined acetaminophen use and included rhinitis and/or eczema outcomes were included. A random effects model was used to combine studies reporting symptoms at present and symptoms since birth. Analyses were performed using RevMan5 software. RESULTS: Five cross-sectional studies consisting of 220,209 subjects were included in the review. The pooled odds ratio (OR) of rhinitis in children aged 6-7 years who had received acetaminophen in the first year of life was 1.38 (95% CI 1.22-1.57). The risk of rhinitis in children who had used acetaminophen regularly in the year prior to study participation was 1.81 (95% CI 1.34-2.44). The risk of eczema in children participating in three of the studies who had received acetaminophen in the first year of life and in the past 12 months was elevated (1.34 [95% CI 1.26-1.44], 1.51 [95% CI 0.98-2.34], respectively). All studies used the validated, standardized ISAAC questionnaire. CONCLUSIONS: Meta-analysis of the literature suggests that children receiving acetaminophen may be at increased risk for developing rhinitis and eczema. Further studies are needed to confirm these results.
J ALLERGY CLIN IMMUNOL FEBRUARY 2010
675
Influence of Different Application Devices on Nasal Clearance Times of Mucoadhesive Saccharine Solution C. T. Tzachev1, A. Vladislavova2, T. A. Popov3, J. R. Farrar4, C. Efessiou5; 1Medical University - Sofia, Faculty of Pharmacy, Sofia, BULGARIA, 2Fifth City Hospital, Clinic of Ophthalmology, Sofia, BULGARIA, 3 Clinic of Allergy & Asthma, Alexander’s University Hospital, Sofia, BULGARIA, 4Editor-in-chief, LifeSciences Press, Washington, DC, 5 Strategic Pharmaceutical Advisors, Washington, DC. RATIONALE: We previously demonstrated the efficacy of a decongestant mounted on a muco-adhesive carrier (MucoAdä) in allergic-rhinitis patients, including prolongation of action. Here we address optimal application methods, comparing standard dropper devices (DD) and spraying devices (SD) with the ‘‘gold standard’’ precision pipette (PP). METHODS: Nasal clearance was evaluated by the saccharine method in 12 healthy volunteers at 3 visits 1 week apart. At each visit subjects received 50 and 100 mcL saccharine MucoAdä solution applied by PP, DD, or SD. Times to sweet flavor were measured, and device-related discomfort was assessed using visual-analogue scales (VAS). A separate experiment validated SDs releasing 50 and 100 mcL (SD50, SD100) for accuracy and repeatability of the delivered doses. RESULTS: Only delivery by PP achieved a high correlation of nasal clearance times for the saccharine-MucoAdä doses: 50mcL, 10.9 61.4 min; 100mcL, 8.561.2 min (r50.86, p<0.001). Clearance times for DD (50mcL, 10.960.7 min; 100mcL, 7.260.6 min) were similar to PP, but with no significant correlation between the doses. SD50 and SD100 had longer clearance times (11.660.8 and 11.761.2 min, respectively), but no dose response. The experiment assessing the weights of SD50 and SD100 delivered doses disclosed minimal differences between the isotonic, saline and MucoAdä solutions, despite distinctly different spraying patterns. Subjects reported mild discomfort using the PP; but not for either SD. CONCLUSIONS: Application of MucoAdä saccharine solution by PP provides the greatest precision of delivered dose, but, ot associated with any discomfort delivery by SD prolongs nasal clearance and has the least discomfort on application.
676
Association Of Ige Serum Concentration, Total Eosinophil Count With Symptom Severity In Children With House Dust Mite Allergic Rhinitis Y. Rha1, S. Choi2; 1Kyung Hee Medical Center, Seoul, REPUBLIC OF KOREA, 2Kyung Hee East-West Neo Medical Center, Seoul, REPUBLIC OF KOREA. RATIONALE: Elevated levels of serum total immunoglobulin E (IgE), serum allergen-specific IgE, blood eosinophil count are considered to be associated with allergic rhinitis (AR), but the relationships between these allergic inflammatory markers and the clinical severity of AR remain controversial. METHODS: Ninety-two children aged 4 to 16 years old were selected, including 70 with HDM AR and 22 with non-AR as controls. The total nasal symptom score was calculated for each patient from a questionnaire and was analyzed for association with blood total eosinophil count(TEC), total serum IgE, and serum allergen-specific IgE. RESULTS: Levels of all allergic inflammatory markers in children with HDM AR were significantly different from those in non-allergic children. All of the markers were related to the severity of HDM AR in bivariate correlation analysis. On multiple linear regression analysis, TEC (p<0.05) and serum allergen-specific IgE (p50.001) were independent predictors. CONCLUSIONS: These results suggest that TEC and serum allergenspecific IgE, systemic allergic inflammatory marker, are correlated with the severity of HDM AR in children. Our data suggest that TEC and specific IgE can be used as a parameter for severity of symptoms of AR in children. Further study in larger populations is needed to confirm our findings.
673
Perennial Allergen Skin Sensitivity As A Predictor Of Seasonal Allergic Rhinoconjunctivitis Severity P. Gomes1, M. B. Abelson2,3, K. Mandell1; 1Ora, Inc., Andover, MA, 2 Schepens Eye Research Institute, Boston, MA, 3Harvard University, Cambridge, MA. RATIONALE: To evaluate the relationship of perennial allergen skin sensitivity to seasonal allergic rhinoconjunctivitis. METHODS: A 4 week, environmental study was conducted during ragweed season in allergic rhinoconjunctivitis patients (N534). Subjects had a positive skin test reaction to seasonal (ragweed) and perennial (cockroach, dust mite, and cat/dog dander) allergens, and had a medical history of allergic conjunctivitis in ragweed season. An IRB (Alpha, San Clemente, CA) approved the protocol and informed consent form, and no treatment was allowed during the study. Subjects reported ocular (itching, redness, and lid swelling) and nasal (itching, sneezing, rhinorrhea, and nasal congestion) allergic symptoms in a diary 3 times daily for 27 days (0-4 scale). A composite nasal score of all individual nasal symptoms, the Total Nasal Symptom Score (TNSS), was then calculated (0-16 scale). A subset analysis was performed on the perennial-positive (N526) and perennial-negative (N58) subjects. Mean daily symptom scores were calculated, and differences compared using a two-tailed, student t-test. RESULTS: Nasal symptom scores were consistently more severe in the perennial-positive subjects. TNSS peaked on day 6 at 4.69 (63.58), compared to 2.75 (63.35) for perennial-negative subjects. On each of the 27 days, the mean average TNSS for perennial-positive subjects was higher, with statistically significant (p<0.05) differences between groups observed at 9 of the 27 days. Ocular scores were likewise numerically higher and exhibited strong trends. CONCLUSION: These data suggest that perennial allergen skin sensitivity can be a predictor for the severity of seasonal allergic rhinoconjunctivitis symptomatology.
674
MONDAY
Acetaminophen Use and Risk of Rhinitis and Eczema in Schoolchildren: A Meta-Analysis M. Desai, D. Axelrod; University of Medicine and Dentistry of New Jersey, Newark, NJ. RATIONALE: Acetaminophen use has increased alongside an increase in the global prevalence of allergic disorders. A meta-analysis was conducted to assess the relationship between acetaminophen use and risk of rhinitis and eczema in schoolchildren ages 6-7. METHODS: The literature was systematically searched using Medline, Cochrane, and Embase databases through August 2009 (keywords: acetaminophen, paracetamol, allergic rhinitis, eczema, asthma, wheeze, children). Observational studies that clearly defined acetaminophen use and included rhinitis and/or eczema outcomes were included. A random effects model was used to combine studies reporting symptoms at present and symptoms since birth. Analyses were performed using RevMan5 software. RESULTS: Five cross-sectional studies consisting of 220,209 subjects were included in the review. The pooled odds ratio (OR) of rhinitis in children aged 6-7 years who had received acetaminophen in the first year of life was 1.38 (95% CI 1.22-1.57). The risk of rhinitis in children who had used acetaminophen regularly in the year prior to study participation was 1.81 (95% CI 1.34-2.44). The risk of eczema in children participating in three of the studies who had received acetaminophen in the first year of life and in the past 12 months was elevated (1.34 [95% CI 1.26-1.44], 1.51 [95% CI 0.98-2.34], respectively). All studies used the validated, standardized ISAAC questionnaire. CONCLUSIONS: Meta-analysis of the literature suggests that children receiving acetaminophen may be at increased risk for developing rhinitis and eczema. Further studies are needed to confirm these results.
J ALLERGY CLIN IMMUNOL FEBRUARY 2010
675
Influence of Different Application Devices on Nasal Clearance Times of Mucoadhesive Saccharine Solution C. T. Tzachev1, A. Vladislavova2, T. A. Popov3, J. R. Farrar4, C. Efessiou5; 1Medical University - Sofia, Faculty of Pharmacy, Sofia, BULGARIA, 2Fifth City Hospital, Clinic of Ophthalmology, Sofia, BULGARIA, 3 Clinic of Allergy & Asthma, Alexander’s University Hospital, Sofia, BULGARIA, 4Editor-in-chief, LifeSciences Press, Washington, DC, 5 Strategic Pharmaceutical Advisors, Washington, DC. RATIONALE: We previously demonstrated the efficacy of a decongestant mounted on a muco-adhesive carrier (MucoAdä) in allergic-rhinitis patients, including prolongation of action. Here we address optimal application methods, comparing standard dropper devices (DD) and spraying devices (SD) with the ‘‘gold standard’’ precision pipette (PP). METHODS: Nasal clearance was evaluated by the saccharine method in 12 healthy volunteers at 3 visits 1 week apart. At each visit subjects received 50 and 100 mcL saccharine MucoAdä solution applied by PP, DD, or SD. Times to sweet flavor were measured, and device-related discomfort was assessed using visual-analogue scales (VAS). A separate experiment validated SDs releasing 50 and 100 mcL (SD50, SD100) for accuracy and repeatability of the delivered doses. RESULTS: Only delivery by PP achieved a high correlation of nasal clearance times for the saccharine-MucoAdä doses: 50mcL, 10.9 61.4 min; 100mcL, 8.561.2 min (r50.86, p<0.001). Clearance times for DD (50mcL, 10.960.7 min; 100mcL, 7.260.6 min) were similar to PP, but with no significant correlation between the doses. SD50 and SD100 had longer clearance times (11.660.8 and 11.761.2 min, respectively), but no dose response. The experiment assessing the weights of SD50 and SD100 delivered doses disclosed minimal differences between the isotonic, saline and MucoAdä solutions, despite distinctly different spraying patterns. Subjects reported mild discomfort using the PP; but not for either SD. CONCLUSIONS: Application of MucoAdä saccharine solution by PP provides the greatest precision of delivered dose, but, ot associated with any discomfort delivery by SD prolongs nasal clearance and has the least discomfort on application.
676
Association Of Ige Serum Concentration, Total Eosinophil Count With Symptom Severity In Children With House Dust Mite Allergic Rhinitis Y. Rha1, S. Choi2; 1Kyung Hee Medical Center, Seoul, REPUBLIC OF KOREA, 2Kyung Hee East-West Neo Medical Center, Seoul, REPUBLIC OF KOREA. RATIONALE: Elevated levels of serum total immunoglobulin E (IgE), serum allergen-specific IgE, blood eosinophil count are considered to be associated with allergic rhinitis (AR), but the relationships between these allergic inflammatory markers and the clinical severity of AR remain controversial. METHODS: Ninety-two children aged 4 to 16 years old were selected, including 70 with HDM AR and 22 with non-AR as controls. The total nasal symptom score was calculated for each patient from a questionnaire and was analyzed for association with blood total eosinophil count(TEC), total serum IgE, and serum allergen-specific IgE. RESULTS: Levels of all allergic inflammatory markers in children with HDM AR were significantly different from those in non-allergic children. All of the markers were related to the severity of HDM AR in bivariate correlation analysis. On multiple linear regression analysis, TEC (p<0.05) and serum allergen-specific IgE (p50.001) were independent predictors. CONCLUSIONS: These results suggest that TEC and serum allergenspecific IgE, systemic allergic inflammatory marker, are correlated with the severity of HDM AR in children. Our data suggest that TEC and specific IgE can be used as a parameter for severity of symptoms of AR in children. Further study in larger populations is needed to confirm our findings.