In the (Sub)Tropics Allergic Rhinitis and Its Impact on Asthma Classification of Allergic Rhinitis is More Useful than Perennial–Seasonal Classification

Larenas‐Linnemann, Désirée; Michels, Alexandra; Dinger, Hanna; Arias-Cruz, Alfredo; Moreno, Marichuy Ambriz; Bedolla-Barajas, Martín; Javier, R Cerino; Prado, María de la Luz Cid del; Moreno, Manuel Alejandro Cruz; Vergara, Laura Diego; Almaráz, Roberto García; García-Cobas, Cecilia Yvonne; Imperial, Daniel Alberto García; Muñoz, Rosa Garcia; Colín, Dante Hernández; Zapien, Francisco Javier Linares; Luna-Pech, Jorge A.; Campos, Juan José Matta; Jiménez, Norma Martínez; Avalos, M.M.; Hernández, Alejandra Medina; Maldonado, Albero Monteverde; López, Doris N; Nazara, Luis J Pizano; Sanchez, Emanuel Ramirez; López, José Domingo Ramos; Rodríguez-Pérez, Noel; Ortiz, Pablo Gabriel Rodríguez; Shah‐Hosseini, Kija; Mösges, Ralph

doi:10.2500/ajra.2014.28.4035

Cited by 11 publications

(12 citation statements)

References 35 publications

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“…In the present article we describe how allergen sensitization is distributed over the whole country and how it is linked to allergic rhinitis phenotypes, age and climate zones. Detailed AR phenotype data will be presented in a separate manuscript [11]. …”

Section: Introductionmentioning

confidence: 99%

Allergen sensitization linked to climate and age, not to intermittent‐persistent rhinitis in a cross‐sectional cohort study in the (sub)tropics

Larenas‐Linnemann

Michels

Dinger

et al. 2014

Clinical & Translational All

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BackgroundAllergen exposure leads to allergen sensitization in susceptible individuals and this might influence allergic rhinitis (AR) phenotype expression. We investigated whether sensitization patterns vary in a country with subtropical and tropical regions and if sensitization patterns relate to AR phenotypes or age.MethodsIn a national, cross-sectional study AR patients (2-70 y) seen by allergists underwent blinded skin prick testing with a panel of 18 allergens and completed a validated questionnaire on AR phenotypes.Results628 patients were recruited. The major sensitizing allergen was house dust mite (HDM) (56%), followed by Bermuda grass (26%), ash (24%), oak (23%) and mesquite (21%) pollen, cat (22%) and cockroach (21%). Patients living in the tropical region were almost exclusively sensitized to HDM (87%). In the central agricultural zones sensitization is primarily to grass and tree pollen. Nationwide, most study subjects had perennial (82.2%), intermittent (56.5%) and moderate-severe (84.7%) AR. Sensitization was not related to the intermittent-persistent AR classification or to AR severity; seasonal AR was associated with tree (p < 0.05) and grass pollen sensitization (p < 0.01). HDM sensitization was more frequent in children (0-11 y) and adolescents (12-17 y) (subtropical region: p < 0.0005; tropical region p < 0.05), but pollen sensitization becomes more important in the adult patients visiting allergists (Adults vs children + adolescents for tree pollen: p < 0.0001, weeds: p < 0.0005).ConclusionsIn a country with (sub)tropical climate zones SPT sensitization patterns varied according to climatological zones; they were different from those found in Europe, HDM sensitization far outweighing pollen allergies and Bermuda grass and Ash pollen being the main grass and tree allergens, respectively. Pollen sensitization was related to SAR, but no relation between sensitization and intermittent-persistent AR or AR severity could be detected. Sensitization patterns vary with age (child HDM, adult pollen). Clinical implications of our findings are dual: only a few allergens –some region specific- cover the majority of sensitizations in (sub)tropical climate zones. This is of major importance for allergen manufacturers and immunotherapy planning. Secondly, patient selection in clinical trials should be based on the intermittent-persistent and severity classifications, rather than on the seasonal-perennial AR subtypes, especially when conducted in (sub)tropical countries.

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Section: Introductionmentioning

confidence: 99%

Allergen sensitization linked to climate and age, not to intermittent‐persistent rhinitis in a cross‐sectional cohort study in the (sub)tropics

Larenas‐Linnemann

Michels

Dinger

et al. 2014

Clinical & Translational All

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“…The only exception is the central part of the country, where agriculture is one of the main income sources and grass pollen is the prime sensitizer [1]. In this epidemiological study, children had mostly intermittent moderate-severe, perennial allergic rhinitis and asthma was a comorbid condition in more than half of the children [2].…”

Section: Allergic Sensitization and Avoidancementioning

confidence: 98%

“…Moreover, in these children, allergic rhinitis is often of the perennial, intermittent type. Also, it is accompanied in more than half of the children by allergic, mild-moderate asthma [2].…”

Section: Introductionmentioning

confidence: 99%

Allergic Sensitization and Rhinitis in Children: What Is New?

Larenas‐Linnemann

2015

Curr Treat Options Allergy

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Allergic rhinitis I Pediatric I House dust mite I Pollens I Skin prick test I Immunotherapy Opinion statement In children with nasal symptoms during several months, oftentimes with a chronically relapsing course, allergic rhinitis is one of the most probable diagnoses. This is often complicated with recurrent respiratory infections, as there is a circular causal loop between allergic rhinitis that increases the frequency of respiratory infections and the infections that exacerbate the allergic disease. As a consequence, in these children, the physician should intentionally search for allergic sensitization, in serologic specific IgE testing and/or with skin prick testing. If a possible allergic diathesis is further suspected because of a personal (atopic dermatitis) or a family history of allergic diseases, the search for allergic sensitization should begin at an even earlier age; in several cases, allergic sensitization can already be shown even before the age of two. In my opinion, in highly atopic children as soon as a specific allergic sensitization can be documented that coincide with the presence of symptoms on possible exposure, as obtained from the detailed history, allergen immunotherapy should be offered as an integral part of the treatment. It is very well plausible that the earlier in the development of the allergic disease, we can redirect the immune system, the better the results. However, in these young allergic children, I only choose sublingual immunotherapy (SLIT), being the option with the best safety profile. In our clinic, we have looked for several ways to improve adherence, which is an issue especially in SLIT. Among the several strategies we implemented are written information on the treatment and the administration schedule with a 20 min explanation by a specialized nurse at start, a flexible, 1-month up-dosing phase to reduce the frequency and intensity of local side effects and reduce the frequently seen flare in nasal symptoms, morning dosing, up-dosing under the cover of an antihistamine and a topical corticosteroid in the evening for 6 weeks, a close follow-up of the children by phone contacts, and an initial follow-up visit at 6 weeks.

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“…98,99,100,101 Un estudio con 529 pacientes con rinitis alérgica diagnosticados por alergólogos en 26 centros mexicanos mostró que 36.2 % padecía asma, con variaciones entre 20 y 25 % en zonas secas del norte de México hasta 50 % en la zona tropical de Tabasco. 102 En pacientes con rinosinusitis crónica se ha estimado un riesgo 3.5 veces mayor de padecer asma, y cerca de la mitad de los pacientes con poliposis nasosinusal tienen asma.…”

Section: Frecuenciaunclassified

Guía Mexicana del Asma: GUIMA 2017

Larenas-Linnemann¹,

Salas-Hernández²,

Vázquez-García³

et al. 2017

RAM

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Este artículo debe citarse como: Larenas-Linnemann D, Salas-Hernández J, Vázquez-García JC, Ortiz-Aldana I, Fernández-Vega M, Del Río-Navarro BE, et al. Guía Mexicana del Asma 2017. Rev Alerg Mex. 2017;64 Supl 1:s11-s128. AbstractBackground: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. Conclusion: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.Keywords: Clinical practice guideline; Asthma; Asthmatic exacerbation; Bronchodilator; Inhaled corticosteroid; Spirometry; Immunotherapy. IntroducciónLa presentación de este documento muestra la importancia del asma en México por su alta prevalencia, pero también por su subdiagnóstico y tratamiento deficiente, que propician un mal control de los pacientes con asma, crisis más frecuentes y sintomatología activa. En consecuencia, el asma tiene un impacto socioeconómico considerable para el paciente y la sociedad en su conjunto, al igual que afecta la calidad de vida del paciente y su familia. En México, el paciente con asma puede recibir atención médica en los ámbitos pú-blico o privado, en los diferentes niveles de salud y por múltiples especialidades. Todas estas particularidades de la situación nacional indican la necesidad de un documento guía actualizado, con base amplia en múltiples gremios médicos, tanto de primer nivel de atención como de especialidad.El objetivo de la GUIMA 2017 es facilitar la reducción de la morbimortalidad por asma en México, no solo al mejorar el conocimiento acerca de esta patología, sino también al ayudar a la parte administrativa del Sector Salud a gestionar la selección y adquisición más precisa de los medicamentos necesarios para su tratamiento a nivel de la salud pública. Para tal fin se ofrecen lineamientos par...

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In the (Sub)Tropics Allergic Rhinitis and Its Impact on Asthma Classification of Allergic Rhinitis is More Useful than Perennial–Seasonal Classification

Cited by 11 publications

References 35 publications

Allergen sensitization linked to climate and age, not to intermittent‐persistent rhinitis in a cross‐sectional cohort study in the (sub)tropics

Allergen sensitization linked to climate and age, not to intermittent‐persistent rhinitis in a cross‐sectional cohort study in the (sub)tropics

Allergic Sensitization and Rhinitis in Children: What Is New?

Guía Mexicana del Asma: GUIMA 2017

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