Professional Documents
Culture Documents
26-4-09
80
70
60
Cases 50 N=3355
per
1000 40
Children
30
20
10
0
Hay Fever Asthma Other Skin Digestive Cardiac Other
Respiratory Allergies Allergies Conditions Nonallergic
Allergies Conditions
*Patient assessment.
Adapted from Newacheck et al. J Pediatr. 1994;124:40.
Why do we have a nose?
Colds Asthma
Allergic
Rhinitis Sinus
Ear Infections
Infections
Nasal
Polyps
URI=upper respiratory infections.
Spector SL. J Allergy Clin Immunol. 1997;99:S773-S780. OME=otitis media with effusion.
Does Allergy Cause
Sinusitis?
7.9% 21%
60
58
56
54 *
52
50
48
46
44
42 (N=21) (Placebo Treated)
* P<0.007 (N=52)
40
N orm al Children A llergic R hinitis
Vuurman et al. Ann Allergy 1993,71:121
Questions
What is the relationship between allergic rhinitis
and asthma?
Atopic
sensitization
Phenotype
Genetic factors
Structural changes
Epidemiology
80-95% of asthmatic patients have rhinitis.
asthma
time
Togias, Allergy 1999
Bronchial asthma.
Symptom less state can be achieved for
most patients [Asthma bronchiale.
Beschwerdefreiheit fur Mehrzahl der
Patienten erreichbar.] Fortschr Med
1999 Mar 20;117(8):24-6, 28, 30
passim (ISSN: 0015-8178) Schmidt M
Medizinische Universitatsklinik Wurzburg.
Nasal inflammation and BHR
20
Nasal eosinophil number
10
0 PD20
22 3 11 12 methacholine
0 5
HC NANR RNA A+R HC NANR RNA A+R
n=16 n=8 n=18 n=19 n=16 n=8 n=18 n=19
25 25 25
20 20 20
15 15 15
10 10 10
5 5 5
0 0 0
controls rhinitis asthma controls rhinitis asthma controls rhinitis asthma
nose
lung
Nasal inflammation after SBP
MBP
FEV1
FEV1
B = baseline
R = frigid air
0 0 0
B R B R B R
P value 0.01 0.27 <0.001
60
IL-5 (pg/mL)
40
*
20
0
pre post pre post
Allergen Placebo
* p < 0.001
Beeh et al, Clin Exp Allergy, 2003
pg/mL cell x 106
50
IL-5 400
eosinophils
40
* 300
*
30
200
20
100
10
0 0
before after before after
control
Braunstahl GJ et al, AJRCCM, 2001 allergic
Summary
Allergen
Nose breathing
Ingestion
Aspiration
Neural reflex
Mouth
breathing
Lymph nodes
Circulation
GINA Guideline clearly states that THERE
IS NO CURE FOR ASTHMA, But
appropriate management most often
leading to CONTROL of asthma
Best cure for any illness is to
forget about it and enjoy
your present moment.
In collaboration with the World Health Organization
Needs for guidelines in the
management of allergic rhinitis
• Although it is not usually a severe disease,
rhinitis alters social life and affects school
performance and work productivity.
pharmacotherapy
pharmacotherapy immunotherapy
immunotherapy
safety
safety
effectiveness
effectiveness
AR
AR
effectiveness
effectiveness
specialist
specialistprescription
prescription
easy may
mayalter
alterthe
thenatural
natural
easyto
tobe
beadministered
administered course
courseofofthe
thedisease
disease
patient's
patient's
education
education
always
alwaysindicated
indicated
Treatment of allergic rhinitis (ARIA)
Allergic Rhinitis and its Impact on Asthma
moderate
severe
mild persistent
moderate persistent
severe
mild intermittent
intermittent intra-nasal steroid
local cromone
oral or local non-sedative H1-blocker
intra-nasal decongestant (<10 days) or oral decongestant
allergen and irritant avoidance
immunotherapy
Can Immunotherapy Treat
Asthma as Well as
Allergies?
Altersdisease process
Prevents allergic reactions
from occurring
Changes immune system
response and development
Birth:TH2
Still TH2
TH1 Allergies
No allergies
60
50
40
30
20
10
0
Before SIT After 3 Months After 12 Months
TH2 TH1
0
Total Studies Effective
No. of studies with children with children
Adults only 9 1 2 12
Children only 7 3 0 10
All Ages 1 0 1 2
TOTAL 17 4 3 24
Effectiveness of
Immunotherapy
3
2.87
2.76
2.5
2.00
1.81
2
1.5
improvement
Odds ratio of
1
Any odds ratio greater than
0.5
1.0 shows a positive effect
0
Reduced Reduced Reduced Improved
Asthma Bronchial Medication Pulmonary
Symptoms Challenge Use Function
When to Consider Immunotherapy
Moderate ± Severe ±
Mild conjunctivitis conjunctivitis
Consider
Considerimmunotherapy
immunotherapy
Moderate Severe
Intermittent Mild persistent persistent persistent
Pharmacotherapy
Consider immunotherapy
TSA
Take home messages
Allergic rhinitis often precedes asthma.
Allergic rhinitis and asthma characterized by
global airway inflammation.
There is a bi-directional influence between
upper and lower airways.
The systemic pathway plays an important role
in the interaction between nose and lung
Thank you.