Search

Allergic rhinitis (AR) is one of the most common chronic diseases in children. However, it remains underdiagnosed and undertreated. Its prevalence has increased in recent years and varies from 2 to 25 %. Symptoms include sneezing, itching, runny nose, and nasal congestion. A correct diagnosis and treatment of AR and its comorbidities such as rhinosinusitis with or without nasal polyposis, conjunctivitis, otitis media, bronchial asthma and respiratory tract infections, are important to reduce the negative impact on the quality of life of the patient and their relatives, and in medical costs. Specific allergen immunotherapy, in correctly selected patients, prevents new sensitizations and reduces bronchial hyperreactivity associated with AR. Taking into account all these reasons, the National Allergy Committee of the Sociedad Argentina de Pediatría proposes current evidence based recommendations., (Sociedad Argentina de Pediatría.)

Allergic rhinitis and asthma represent global problems of public health affecting all age groups; asthma and allergic rhinitis frequently coexist in the same patients. In Latin American prevalence of allergic rhinitis, although variable, is very high. Allergic rhinitis and its Impact on Asthma (ARIA) started during a workshop of the World Health Organization performed in 1999 and was published in 2001. ARIA proposed a new classification of allergic rhinitis in intermittent or persistent and mild or moderate-severe. This approach of classification reflects more nearly the impact of allergic rhinitis in patients. In its review of 2010 ARIA developed guidelines for diagnosis and treatment of allergic rhinitis and of clinical practices for management of comorbidities of allergic rhinitis and asthma based on GRADE (Grading of Recommendations, Development and Evaluation). ARIA has been spread and implemented in more than 50 countries. In Latin American an intense activity has been developed to spread these recommendations in almost all the countries of the region and it is important to record the obtained goals in the diffusion and implementation of ARIA, as well as to identify the unsatisfied needs from the clinical, research and implementation points of view. Final objective is to reinforce the priority that allergy and asthma should have, especially in children, in the programs of public health, as they have been prioritized in European Union in 2011.

Background: Allergic rinitis is the more common allergic disease, affecting to 25% of general population. Otitis media, sinusitis and other complications result from not controlled allergic rinitis. It has been reported that a low expression of FOXP3 marker on lymphocytes is associated with allergic diseases, and that allergen immunotherapy increases its synthesis., Objective: To compare CD4+ FOXP3+ T cell levels in patients with allergic rhinitis, with and without allergen immunotherapy., Methods: In this cross-sectional, observational and comparative study were included adult patients with allergic rinitis in two groups: one group with 29 patients under allergen immunotherapy for six months, and other group with 30 patients without immunotherapy. Lymphocyte markers CD3, CD4, CD8 y FOXP3 were determined in both groups, as well as serum immunoglobulins., Results: In the group treated with immunotherapy the mean age was 36.4 years, and 72% of them were women. In the other group the age average was 40.4 years and 63% were women. There were no significant differences in immunoglobulin levels among both groups; IgG4 had higher levels, but not significant, in the immunotherapy group (82.1 vs 72.4 mg/dL, p=0.67). Patients from the group without immunotherapy had higher number of FOXP3+ lymphocytes, but not significant (8.2 vs 7.9, p=0.57)., Conclusions: Patients treated with allergen immunotherapy had lower FOXP3+ lymphocytes number than those not treated. More studies are needed for considering FOXP3+ lymphocyte molecule as a useful marker in the follow-up of patients under immunotherapy.

Rhinitis is the most frequent respiratory disease in most countries of the world. It is estimated that 600 million people suffer this condition. Allergic rhinitis is a public health problem at global level. Patients who suffer allergic rhinitis have from mild to annoying nasal symptoms which affect quality of life, cause sleep disorders, scholar and workplace absenteeism, and health expenditure. Rhinitis is frequently associated to co-morbidities such as sinusitis, otitis media, and especially asthma. Rhinitis is under-diagnosed and under-treated worldwide and also in Latin American countries. ARIA is the very first evidence-based guideline for the diagnosis and treatment of rhinitis with focus in its co-morbidities (2001), especially asthma published in 2001. In 2008 an update was published. ARIA recommends an integrative approach for management; including anti-histamines (second generation), intra-nasal corticosteroids, anti-leukotrienes and immunotherapy. It also provides a questionnaire to evaluate asthma and its severity in those patients suffering rhinitis. The prevalence of allergic rhinitis is quite high in Latin American countries and in recent years a great insight on the burden of this condition has been gained.

Background: Educational strategies look for the increase of knowledge in physicians; they are a useful resourse for the diffusion among physicians of guides GINA and ARIA., Objective: To evaluate a course shop-like for physicians as an educative strategy., Participants and Methods: A transversal study was performed, where knowledge was evaluated to primary contact physicians about recent currents of guides of GINA and ARIA 2006., Results: There was a participation of 69 primary contact physicians who applied a questionnaire of 30 questions: 20 about asthma (GINA) and 10 about allergic rhinitis (ARIA) before and after a course shop-like for physicians; there was improvement on calification after educative strategy on knowledge about asthma and allergic rhinitis with a p = < 0.05., Conclusion: The educative strategy proposed as course shop-like for primary contact physicians is effective for teaching the guides of GINA and ARIA 2006.

Background: More than 10 years ago prick tests have been applied to children from the age of 12 months and a lot of them were given sublingual immunotherapy with significant acceptance from family and without undesirable reactions., Objective: To assess the efficacy and safety of sublingual immunotherapy in children., Patients and Methods: A clinical trial was done in 138 children with asthma or rhinitis and positive prick test to Dermatophagoides pteronyssinus, D. siboney and Blomia tropicalis. Randomly 69 received sublingual immunotherapy, applying two drops in growing concentrations of 500, 1,000, 2,000, 10,000 and 20,000 biological units. The concentration of 20,000 was left as maintenance till completes the scheme., Results: Out of the 138 children included in the study 69, who received sublingual immunotherapy, showed a difference in variables in relation to control group, and the attendance to emergency services was lower in the study group than in the control one for a relative risk of 0.39 with a 95% confidence interval of 0.19, 0.81. Corticosteroid consumption was lower in patients treated for a relative risk of 0.37 and 95% confidence interval of 0.14, 0.79. Out of the 69 patients, 11 had mild (8.6%) and moderate (7.2%) adverse reactions., Conclusions: 84% did not have any reaction, thus, sublingual immunotherapy with allergenic extracts of acarus is effective and safe in the treatment of asthma and allergic rhinitis.

Background: The methimazole has long been used for treating Graves' disease to decrease thyroid hormone production and obtain a thyroid normofunction, but this drug has also immunosuppressive and immunomodulation effects., Objective: To analyze in patients with Graves' disease treated with methimazole and allergic rhinitis, the clinical evolution of the allergic rhinitis with the immunosuppressive and immunomodulation effects of the methimazole., Patients and Methods: A comparative and observational study was done in the Mexico's General Hospital, in twenty-six patients with Graves' disease treated with methimazole 10 mg, thyroid profile was done, and when subjects obtained a thyroid normofunction continued with the same doses of methimazole and received also 12.5 mcg/day of levothyroxine. All the patients were diagnosed with allergic rhinitis, and they were divided into two groups (11 females and 2 males each). Both groups continued with the same treatment of methimazole and levothyroxine, but group II was given also antihistamines H1 of second-generation (loratadine) daily, and specific immunotherapy during six months. We described and compared the clinical evolution of the allergic rhinitis of the two groups with the treatment., Results: In the group I, changes in the clinical evolution of the allergic rhinitis after six months were not observed. In the group II, by week 10 the symptoms of the allergic rhinitis were controlled in 80% of the patients, and by week 14 all the patients of this group were asymptomatic., Conclusions: In patients with allergic rhinitis and Graves' diseases with methimazole-thyroid normofunction we observed that there is not influence of methimazole on clinical evolution of the allergic rhinitis.

Among the aeroallergens associated to asthma and allergic rhinitis, the fungi are a common cause of diagnostic and therapeutic problems. The wide variety and distribution of fungal species and the complex characterization of their allergenicity, is a complex item. The fungus extracts used to diagnose and treat sensitizations are frequently non effective, and different varieties of extracts are globally distributed. The standardization of commercial fungi extracts results extremely important as diagnostic procedure as well as to decide an efficacious and safe immunotherapy. This paper reviews important methodological steps to the standardization of fungi extracts, and finally the clinical use of these extracts.

Background: In order to determine the impact of allergic rhinitis on the quality of life of the patients, standardized and validated questionnaires have been developed. The quality of life is the perception of the patient of the functional effects of his illness and its therapeutics consequences., Objective: To determine the modification of index the quality of life on the patients with allergic rhinitis attended at the external consultation of the service of allergy and clinical immunology of the Hospital Universitario de Puebla when they were submitted to integral allergologic treatment., Patients and Methods: It was carried out a longitudinal, prospective, experimental and prolective study in patients of both sexes, older than 18 years with diagnosis of allergic rhinitis, a validated and standardized questionnaire was applied to assess the quality of life index every 14 days during 6 months. It was measured severity degree at the beginning and the end of the study. It was assessed the sample size considering a reasonable size of the effect 1 and a variability of 0.8 for usual techniques. The severity degree was compared with RIDIT analysis and the mean with variance, a value of p smaller than 0.05 was considered significant., Results: Sixteen patients were included, 75% were women. The average age was 34.2 years old. When the severity degrees were compared it was an average RIDIT of 0.014 with a "z" of -5.0 that implicated a value of p < 0.001. The comparison among the initial quality of life and the subsequently visits mean was significantly different since third visit., Conclusion: The integral allergologic treatment modifies the quality of life and the severity degree in the patients with allergic rhinitis.

Background: It has been demonstrated that specific immunotherapy, in addition to its preventive properties, is an effective and safe therapeutic resource for allergic asthma, allergic rhinitis and allergy to insect's venom; however, its use in patients younger than five years has been limited due to the risk of systemic reactions., Objectives: To know the frequency and severity of systemic reactions in children younger than five years and to know if a greater risk of systemic reactions in this group of age is real., Patients and Methods: We included 239 patients from one to five years of age with diagnosis of allergic disease and verified its specific sensitivity with skin tests or RAST and were treated with specific immunotherapy. A detailed registry of the application of specific immunotherapy was kept from every patient, with special attention to any symptom present during the first 30 minutes post application of specific immunotherapy or skin test., Results: From January 1996 to June 2005, 6,689 injections were applied to 239 patients. Only one patient of 36 months of age presented with a delayed systemic reactions characterized by generalized hives, itching, runny nose, water eyes, 90 minutes post injection. The patient was under treatment with Dermatophagoides farinae and pteronissinus (house dust mites) with a dose of 1AU for allergic rhinitis. The systemic reactions were treated easily and without complications with a single dose of intramuscular epinephrine (0.15cc, 1:1000) and oral antihistamine., Conclusion: Patients younger than five years are not in greater risk of systemic reactions from specific immunotherapy or skin tests than the older children or adults and the treatment of those systemic reactions does not imply greater difficulty. Because of its preventive properties, safety and effectiveness in lowering the severity of symptoms of allergic diseases, we concluded that specific immunotherapy should be considered at early age, prescribed and administered only by specialist in pediatric allergy and in optimal conditions of safety.

Background: The incidence of asthma is high, especially in young people, a population group that includes women of reproductive age. We reviewed recent publications on asthma control during pregnancy to avoid undesired effects on both the mother and fetus. The prevalence of rhinoconjunctivitis is also high, although this disease is often under-treated by physicians. The use of beta2-agonists, corticoids (systemic/inhaled/nebulized), epinephrine and specific allergen immunotherapy is discussed., Methods: We reviewed recent publications on asthma during pregnancy as well as other articles of interest. Articles providing data on drug therapy, overall strategies and patient education were selected. Sufficient drugs are available for the management of this disease and under-treatment cannot be justified., Conclusions: Pregnancy is not a disease, but constitutes a period when special care must be taken with underlying diseases. The aim of asthma treatment during pregnancy is to prevent fetal complications due to the effects of medication and asthma crises by keeping the mother symptom free and preventing possible exacerbations. Almost all authors agree that asthma crises in pregnant women should be treated no differently from those in non-pregnant women. Treatment of rhinoconjunctivitis should not be stopped during pregnancy since a wide variety of FDA category B drugs is available. Specific allergen immunotherapy should not be suspended during pregnancy as it is not contraindicated. However, this therapy should not be initiated during pregnancy.

Background: Allergic rhinitis is the most common atopic reaction to allergens and may persist for many years if not treated. It is never lethal, though it may cause morbidity. The IgE synthesis is regulated by inheritance, antigen exposition and cytokines; specially Th2 cells, through secretions of the IL4 e IL5 that favor IgE production and inflammation rich in eosinophils., Objective: To determine the difference of IgG4 serum levels, gamma interferon, and interleukins of patients with allergic rhinitis, with and without immunotherapy, and healthy patients., Material and Methods: In an observational, transversal, prospective, comparative and open study 82 (100%) patients were recruited and divided into three groups. Group 1 included 15 patients with allergic rhinitis diagnosis and positive skin tests without immunotherapy; group 2, 15 patients with allergic rhinitis diagnosis and positive skin tests with immunotherapy; group 3, 52 healthy patients., Results: IL-4, IL-5, IL-6 and IL-12 values were higher in both groups of allergic rhinitis, compared with healthy group. There were differences in the IL-5 concentrations that were less in patients with allergic rhinitis and vaccine than in those without vaccine. The values of IgG4 and gamma interferon did not vary and were not found in the studied groups., Conclusion: The present study proved the existence of significant differences, showed increments in the interleukin values among healthy and allergic patients, despite allergic rhinitis is a local phenomenon. It is probable that the above is related to the genetic tendency to produce a Th2 cytokines pattern which is a characteristic of allergy. Allergen immunotherapy modified significantly the IL-5 levels as well as the other studied interleukins.

Background: Rhinitis is the most frequent allergic disease in children. Symptoms may affect importantly life quality. Measures to avoid allergens when possible and the use of drugs are an important part of the treatment; however, specific immunotherapy is the only treatment altering the natural course of the disease., Objective: To assess if specific immunotherapy improves life quality in children with allergic rhinitis., Material and Methods: Patients who attended to the allergy department during August and September 2002, and who fulfilled the inclusion criteria, were included. Two groups of treatment were formed: group A received specific immunotherapy with standardized allergenic extracts, from IPI ASAC Mexico. They started with a concentration of 0.07 bioequivalent units (BEU), with twice-a-week-application with increases of 10 (0.7, 7 and 80 BEU) each seven weeks up to maintenance dose of 700 BEU at six months. Group B only was given pharmacological treatment. Paediatric Rhinoconjunctivitis Quality of Life Questionnaires, specific to children with allergic rhinoconjunctivitis, validated for its use in Spanish in Mexican children by the department of Clinical Epidemiology and Biostatistics of Mc Master University, were applied to all patients., Results: Twenty-seven patients were included in each group, 14 males, adjusted for age with a correlation coefficient (r2) = 0.9799. In both groups, mean age was of 11 years 6 months (group A: 7 to 16 years, group B: 7 to 17 years). Eighteen (44.4%) and fifteen patients (33.3%), of groups A and B respectively, had persistent mild rhinitis, and 9 (55.6%) and 12 cases (66.7%) of groups A and B, respectively, had moderate persistent rhinitis. All of them were sensitized to domiciliary allergens. As to life quality a high odds ratio (OR) was found when assessing patients six months after treatment, especially in nasal symptoms such as pruritus (OR = 6.8) and obstruction (OR = 5.9). Also for practical symptoms the OR was high: carving eyes and nose (OR = 7), blowing the nose (OR = 4.8) and carrying disposable tissues (OR = 4.7). OR for other symptoms was as follows: thirst and throatitch, OR = 4; irritability, OR = 6.2, and ocular pruritus, OR = 3.1. Patients without immunotherapy were likely to use more drugs (OR = 6.4) than those receiving immunotherapy., Conclusion: We did not find controlled studies on life quality with the use of immunotherapy in children. In this study, specific immunotherapy was found to improve life quality in children with allergic rhinoconjunctivitis, especially in nasal symptoms, such as pruritus and obstruction, as well as in practical symptoms. These results are similar to those by Fell, who found that 92% patients referred an improvement of nasal symptoms, a better labor performance and a lesser use of drugs after four months of using immunotherapy.

Allergic rhinitis is the commonest chronic respiratory disorder in children and young adults having an important impact for those suffering this condition, as well as for the public health. Allergic rhinitis is frequently associated to other co-morbidities, particularly asthma and conjunctivitis but, also, sinusitis and otitis media. Most of patients suffering rhinitis are cared by GPs and pediatricians and there are evidences that allergic rhinitis is undertreated, particularly the moderate/severe persistent forms. Clinical guidelines have become an important tool providing recommendations for diagnosis and treatment of different medical conditions. They help the process of decision making for GPs and pediatricians, and many of them, contain an update on basic science and epidemiology. In respiratory medicine, guidelines on asthma and rhinitis are available; however, they do not look at the patients globally and focus the disorder on an organ-specific basis without recommendations on co-morbidities. ARIA, Allergic rhinitis and its impact on asthma, has not been developed only to update specialists in allergy/immunology, otorhinolaryngology and neumology on rhinitis and its comorbidities but, also, to provide recommendations for non-specialists. A new classification and severity of allergic rhinitis is proposed replacing the classic perennial and seasonal forms for persistent and intermittent, mild to moderate/severe. ARIA is an initiative in collaboration with the World Health Organization and the master document has been endorsed by many national and international scientific societies and organizations. ARIA is an evidence-based document also stressing on pediatric aspects and providing recommendations for low-income countries.

Objective: To evaluate improvement in therapeutic management of allergic rhinitis., Design: Study of level of quality (longitudinal, prospective, intervention)., Setting: Primary care., Patients and Others Participants: First evaluation (second quarter of 1995): 73 out of 305 patients were sampled (confidence 5%, accuracy 10%). Second evaluation (second quarter of 1996). Sample of 51 patients from a total of 210., Interventions: Explicit criteria and standard procedure, based on consensus, for rhinitis treatment and an overall indicator of the general quality of rhinitis management were analysed. Criterion 1 (C1): correctly scaled treatment; criterion 2 (C2): initial treatment of choice with inhaled corticoids; criterion 3 (C3): correct use of oral corticoids or immunotherapy; criterion 4 (C4): coadjutant therapy according to predominant symptoms. Corrective measures: ongoing training and routine use of guide to practice., Statistics: index of compliance with criteria, Chi squared and Fisher's Z tests of a tail to compare both evaluations., Measurements and Main Results: First evaluation: index of compliance with C1 = 59% (CI +/- 11), C2 = 41% (CI +/- 11), C3 = 90% (CI +/- 6) and C4 = 83% (CI +/- 8). Criteria and summary indicator obtained better results in patients attended by allergists. Second evaluation with overall improvement: C1 = 68.6% (CI +/- 13), C2 = 57% (CI +/- 13), C3 = 94% (CI +/- 6), C4 = 98% (CI +/- 3). Significant differences for C4 and C2 (p < 0.05). Overall quality and quality of criteria improved for patients attended in our environment. The summary indicator went up from 35.6% to 57% (p = 0.019), with the quality levels (C1-C4) becoming the same as those of the patients with allergy attended and with significant differences in the first evaluation disappearing., Conclusions: Ongoing training and routine use of guides to practice enables the therapeutic management of allergic rhinitis in primary care to be improved.

Because cats are a common pet in many houses and tourist complexes in the Canary Islands, sensitization to cat epithelium is a frequent problem. A total of 19.2% of patients with intrinsic asthma are sensitized to cat epithelium. In the Canary Islands, the percentage of sensitization among patients with a household cat is 18.1%, which higher is higher than in the rest of Spain (11.9). Many patients with extrinsic asthma sensitized to house dust mites undergo conventional subcutaneous immunotherapy but evolution is unsatisfactory due to sensitization to cat epithelium (whether a cat is present or not). The aim of this study was to evaluate the clinical effectiveness of sublingual immunotherapy with extract of cat epithelium in monosensitized patients with perennial allergic rhinitis and/or bronchial asthma. Forty patients monosensitized to cat epithelium were selected. Of these, 20 were administered sublingual immunotherapy and another 20 received placebo. The following evaluation was carried out in both groups: in vivo and in vitro: symptom score, skin tests, nasal challenge with cat epithelium, specific IgE determination, specific IgG4 and eosinophilic cationic protein. After 1 year of treatment the cumulative dose was 3.6 micrograms of Fe ld I, equivalent to 10 ng/drop. Duration of treatment was 365 days. Our conclusions, based on our patients in the Canary Islands, were the following: 1. Sublingual Fel d I therapy is effective after 1 year of treatment. 2. There were no modifications in IgE, eosinophilic cationic protein or skin tests. 3. An increase in IgG4 occurred which was related to clinical improvement. 4. In general, tolerance was good, except in one patient who presented urticaria and sublingual pruritus. 5. In polysensitized patients, sublingual immunotherapy to cat epithelium is complementary to immunotherapy to dermatophagoides.

Allergen specific immunotherapy has been shown to be effective in rigorous double-blind placebo-controlled clinical trials in both children and adults A recent WHO position paper stated that immunotherapy is an effective treatment for patients with allergic rhinitis/conjunctivitis, allergic asthma and allergic reactions from stinging insects and is thought to be more effective in children than in adults. When speaking about children there are several questions that are important regarding the natural course of the disease. One of the most important is whether immunotherapy can prevent asthma, either by preventing sensitisation to allergens related to the development of asthma or by preventing the inflammation in the lungs caused by allergen exposure. Another point could be to establish the differences in the long term outcome of those patients treated with immunotherapy and medication during childhood, compared to the long term outcome of those with comparable asthma features who received only antiasthmatic medication The PAT study is a European multi-center study. The end-point is to show in what capacity allergen specific subcutaneous immunotherapy can prevent the development of asthma in children who only have rhinoconjunctivitis secondary to grass or birch pollen sensitisation. Two hundred and ten children aged from 5 to 13 years were included in the study. Children were randomised to the active treatment group receiving allergen specific immunotherapy with birch and/or timothy pollen allergen extract or to the control group receiving only pharmacotherapy. It is important to highlight that the main criteria to be included was that the children should never have had any asthmatic symptom. Immunotherapy has been effective in terms of decreasing significantly the amount of symptoms in the active group compared to the control one. It was safe with no serious adverse reactions and reduced the risk of the onset of asthma. After two years of treatment more children in the control group developed clinical asthma than in the active group: p = 0.004. Des Roches et al reported the results of a prospective non randomised trial of immunotherapy with Dermatophagoides pteronyssinus in 44 asthmatic children younger than six years of age who were sensitive only to dust mites. The purpose of the study was to assess whether immunotherapy could reduce the development of new sensitisation during a period of three years of follow up. Specific immunotherapy was given with only D. Pteronyssinus extract. All 22 children in the control group developed new sensitivities as determined by skin testing and in vitro tests, while 10 (45%) of 22 children who received mite immunotherapy did not develop additional sensitivities. The findings of this study suggests that immunotherapy may alter the natural course of the allergic sensitisation reducing the risk of developing new sensitisation in mono sensitive children. A limited number of studies have examined the long terms effects of immunotherapy on the clinical presentation of asthma and rhinoconjunctivitis, and have shown a long lasting efficacy decreasing the amount of symptoms 6-10 years after termination. In a retrospective study of children treated with immunotherapy during childhood for at least three years, that were re-evaluated in early adulthood, the control patients who were treated with medication and no immunotherapy suffered almost 3.5 times more symptoms than the active group treated with immunotherapy. The current findings suggest that immunotherapy should be considered earlier in the course of allergic disease to prevent progression or to prevent the development of new sensitisation. Further studies with long term follow up particularly in children could address this possibility.

The value of immunotherapy (IT) in allergic rhinitis is debated. The results of a retrospective study of 67 patients treated with IT from 1985 to the end of 1995 are reported. Patients were classified as cured, improved, or not improved. Variables such as age, number and type of allergens, improvement, release, duration of evolution, and initial and final IgE levels were analyzed. Response to IT was favorable in 81.1% of cases. Improvement and cure were age-dependent, with the cure rate being significantly higher in patients over 30.

The present study was done in order to determine the clinical benefit and results of treatment in 40 patients with chronic nasal obstruction due to perennial allergic rhinitis. These patients were separated in two groups in order to compare clinical results: one group treated with local electrocauthery over turbinate processes alone, and other group with electrocauthery plus immunotherapy. Two patients in each group abandoned treatment. The clinical results in the patients treated were seemingly better in the group that the combined treatment (electrocauthery plus immunotherapy) was employed with significant clinical improvement.

A group of patients with Dermatophagoides allergy was estudy analyze the behavior of blocking antibodies (Ab E: total IgG, IgG1 and IgG4) directed against complete allergen extract (CE) and against the major allergens, Der pI and Der pII, and its relation with the clinical results of desensitizing treatment. A group of 36 patients received specific immunotherapy (IT) and conventional treatment alone. Over a 12-month period, four follow-up studies were made to evaluate the patient's clinical situation (symptom score) and to determine total IgG and IgG subclasses directed against CE, DER pI, and DER pII. In the group treated with IT, the levels of all IgG subclasses increased subjectively, but in the group without It, igG levels did not change. There was no significant improvement in ocular on pulmonary symptoms in either group. Nasal symptoms had a more favorable evolution in the IT group.

The authors have partially reviewed the literature related to allergic rhinitis. Reviewed are those aspects related with its classification, physiopathology, clinical history, clinical and differential diagnosis and corresponding treatment. Allergic rhinitis is a recurrent illness, with symptoms which depend on the exposure to the environment and the intrinsic response of the host.

We analyzed 100 patients with allergic rhinitis during a twelve month period. Youngsters represented 59% of the population. There was no sex predominance. 69% of the patients had a positive history of familial atopy and relation with other allergic condition was found in 74%. The nasal eosinophilia and skin tests were important diagnostic tools, not being necessary the measurement of IgE in plasma. Immunotherapy was effective in 88% of the patients.