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Purpose: To evaluate the association between allergic sensitivity and pollen counts in patients with allergic respiratory disease (ARD) and its relationship with atmospheric pollutants. Methods: From 2012 to 2018, we evaluated the sensitivity by skin prick test in ARD patients. The pollen counts were analyzed according to international guidelines (2014-2018). The pollutant and meteorological data were obtained at the same time from AIRE-CDMX websites. We analyzed the association between allergic sensitivity and pollen counts using the χ2 test and stratified by disease allergic rhinitis (AR) and AR with asthma (ARwA), periods (before/after 2015), and pollination seasons (S1:2014-2015), (S2:2015-2016), (S3:2016-2017), (S4:2017-2018). Likewise, we correlated the pollen counts with the concentrations of pollutants using Pearson's correlation. For all analyses, we used SPSS v.21 software, and a p-value <0.05 was considered significant. Results: A total of 520 patients were enrolled, of whom 67.3% had ARwA and 33.7% had AR (p<0.05). The frequency of patients allergic to at least one pollen was higher compared with patients sensitive to indoor allergens (55.3% vs 44.6%, p<0.001). A total of 46.8% of the patients were only sensitive to trees in comparison to other outdoor allergens (p<0.001). The Fraxinus sp. and the Cupressaceae family allergens were approximately two times more frequent than the other tree allergens in both diseases (p<0.05). These pollens doubled their counts since 2015 (p<0.001), which was associated with increases in sensitivity for Fraxinus sp. and the Cupressaceae family compared to previous years (p<0.001). Regarding pollutants, the most significant correlations were with PM10, NO2, PMCO for Fraxinus sp. pollen concentrations in all seasons (p≤0.02). Conclusion: The high increases in pollen counts of the Fraxinus sp. and Cupressaceae family were associated with increases in the frequency of sensitization to these species, and this phenomenon correlated with increases in PM10, NO2, and PMCO.

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ABSTRACT Allergic conjunctivitis is an increasingly frequent condition with a higher prevalence in children. It can be debilitating and is responsible for a great economic burden. These guidelines were developed on the basis of the medical literature (PubMed/Medline database) and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology, the Brazilian Council of Ophthalmology, the Brazilian Society of Pediatrics, and the Brazilian Association of Allergy and Immunology. Allergic conjunctivitis is considered to be controlled when the ocular symptoms are not uncomfortable or are present, at most, on 2 days a week; the visual analog scale score is below 5; and the degree of conjunctival hyperemia is graded 0 or 1 on the Efron scale. Allergic conjunctivitis should be classified as mild, moderate, severe, and vision-threatening for adequate treatment and monitoring of frequency. The present document is a guideline for diagnosing, treating, and monitoring pediatric allergic conjunctivitis considering the clinical and demographic aspects of allergic conditions in Brazil.

RESUMO A conjuntivite alérgica (CA) é uma condição frequente, debilitante e responsável por grande impacto econômico, proporcionalmente maior quando acomete crianças. Essas diretrizes foram desenvolvidas com base na literatura científica (PubMed/Medline) e na experiência de um Comitê de Especialistas composto por membros da Sociedade Brasileira de Oftalmologia Pediátrica, do Conselho Brasileiro de Oftalmologia, da Sociedade Brasileira de Pediatria e da Associação Brasileira de Alergia e Imunologia. A conjuntivite alérgica é considerada controlada quando os sintomas não são desconfortáveis ou estão presentes por dois dias na semana; o escore visual pela escala analógica é inferior a 5 e o grau de hiperemia conjuntival é de 0-1 pela escala de Efron. A conjuntivite alérgica deve ser classificada em leve, moderada, grave e com risco de perda visual para tratamento e frequência de monitoramento adequados. Esta diretriz orienta o diagnóstico, tratamento e monitoramento da conjuntivite alérgica pediátrica, considerando aspectos clínicos e demográficos das condições alérgicas no Brasil.

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Introdução: A rinite alérgica (RA) é uma doença não infecciosa da mucosa nasal mediada por IgE após o contato com alérgenos. Objetivo: Investigar as células Th17 periféricas e CD4 + CD25 + Foxp3 + células T reguladoras (Treg) e a expressão sérica de citocinas em pacientes com RA. Métodos: De março a maio de 2012, foi coletado o sangue periférico de 14 pacientes com RA (grupo RA) e seis indivíduos saudáveis (grupo controle). A detecção das células Th17 e células Treg foi realizada através da citometria de fluxo e os níveis séricos de IL -17 e TGF- β1. Foram medidos por ELISA. Resultados: A percentagem de células Th17 no grupo RA foi bem maior do que no grupo controle (p < 0,01). A proporção de células Treg no grupo RA também foi drasticamente menor quando comparada ao grupo controle (p < 0,01). No grupo RA, o nível sérico de IL-17 foi significativamente maior do que no grupo controle (p < 0,01). Conclusão: O desequilíbrio de células Th17/Treg periféricas desempenha um papel importante na patogênese da RA. .

Introduction: Allergic rhinitis (AR) is an IgE-mediated non-infectious disease of the nasal mucosa following contact with allergens. Objective: To investigate the peripheral Th17 cells and CD4 + CD25 + Foxp3 + regulatory T (Treg) cells and the expression of cytokines in the serum of AR patients. Methods: The peripheral blood of 14 patients with AR (AR group) and six healthy subjects (control group) was collected from March to May of 2012. Flow cytometry was performed to detect the Th17 cells and Treg cells, and enzyme-linked immunosorbent assay (ELISA) to measure the serum levels of IL-17 and TGF-β1. Results: The proportion of Th17 cells in the AR group was markedly higher than that in the control group (p < 0.01). The proportion of Treg cells in the AR group was also dramatically reduced when compared with the control group (p < 0.01). In the AR group, serum IL-17 levels were markedly higher than those in the control group (p < 0.01). In the AR group, serum TGF-β1 levels were significantly lower than those in the control group (p < 0.01). Conclusion: The imbalance of peripheral Th17/Treg cells plays an important role in the pathogenesis of AR. .

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OBJECTIVE: The aim of this study was to verify if ABO phenotypes are associated with allergic rhinitis. METHODS: 168 patients with allergic rhinitis and 168 control individuals from the same geographical region and paired by gender and age were enrolled in the study. ABO phenotypes were identified in red blood cells using the hemagglutination technique. The Fisher exact and chi-squared tests were employed to compare proportions. Statistical significance was set for an alpha error of 5 percent (p-value < 0.05). RESULTS: The overall differences in the frequencies of the ABO phenotypes of patients and controls were marginal (χ2: 7.569; degrees of freedom (DF): 3; p-value = 0.055) however the O blood group was associated with allergic rhinitis (χ2: 5.764; DF: 1; p-value = 0.016; OR: 1.735; CI 95 percent: 1.127-2.673). The differences in the frequencies of the O phenotype in patients and controls were statistically different for men (χ2: 8.520; DF: 1; p-value = 0.003) but not for women (χ2: 0.6375; DF: 1; p-value = 0.4246). The A phenotype was associated with protection (OR: 0.4385; CI 95 percent: 0.2043-0.9415; p-value = 0.049) and the O phenotype was associated with susceptibility (OR = 2.789; CI 95 percent: 1.385-5.616; p-value = 0.005) to allergic rhinitis only for men. CONCLUSION: The O blood group phenotype is associated with allergic rhinitis in male but not in female patients.

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OBJECTIVE: The aim of this study was to verify if ABO phenotypes are associated with allergic rhinitis. METHODS: 168 patients with allergic rhinitis and 168 control individuals from the same geographical region and paired by gender and age were enrolled in the study. ABO phenotypes were identified in red blood cells using the hemagglutination technique. The Fisher exact and chi-squared tests were employed to compare proportions. Statistical significance was set for an alpha error of 5% (p-value < 0.05). RESULTS: The overall differences in the frequencies of the ABO phenotypes of patients and controls were marginal (χ(2): 7.569; degrees of freedom (DF): 3; p-value = 0.055) however the O blood group was associated with allergic rhinitis (χ(2): 5.764; DF: 1; p-value = 0.016; OR: 1.735; CI 95%: 1.127-2.673). The differences in the frequencies of the O phenotype in patients and controls were statistically different for men (χ(2): 8.520; DF: 1; p-value = 0.003) but not for women (χ(2): 0.6375; DF: 1; p-value = 0.4246). The A phenotype was associated with protection (OR: 0.4385; CI 95%: 0.2043-0.9415; p-value = 0.049) and the O phenotype was associated with susceptibility (OR = 2.789; CI 95%: 1.385-5.616; p-value = 0.005) to allergic rhinitis only for men. CONCLUSION: The O blood group phenotype is associated with allergic rhinitis in male but not in female patients.

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O objetivo desta revisão foi apresentar evidências da relação entre rinite alérgica e redução da qualidade de vida. As fontes de dados foram artigos originais, revisões e consensos indexados nos bancos de dados Medline e LILACS entre 1997 e 2008. As palavras de busca foram "rinite alérgica", "qualidade de vida" e "distúrbios do sono". Os pacientes com rinite alérgica frequentemente têm redução na qualidade de vida causada pelos sintomas clássicos da doença (espirros, prurido, coriza e obstrução). Além disso, a fisiopatologia da rinite alérgica, com frequência, interrompe o sono, ocasionando fadiga, irritabilidade, déficits de memória, sonolência diurna e depressão. A carga total da doença recai não apenas no funcionamento social e físico prejudicados, mas também no impacto financeiro, que se torna maior quando se consideram as evidências de que a rinite alérgica é um possível fator casual de comorbidades, tais como a asma e a sinusite. A obstrução nasal, o mais proeminente dos sintomas, está associada a eventos respiratórios relacionados aos distúrbios do sono, uma condição que tem profundo efeito sobre a saúde mental, o aprendizado, o comportamento e a atenção. Finalmente, a rinite alérgica - doença crônica que afeta crianças, adolescentes e adultos - frequentemente é subdiagnosticada ou inadequadamente tratada. O impacto deletério dos distúrbios do sono associados à rinite alérgica sobre a habilidade para realizar as atividades de vida diária dos pacientes é um importante componente da morbidade da doença. Com um diagnóstico acurado, existem vários tratamentos disponíveis que podem reduzir a carga associada à rinite alérgica.

The objective of this review was to present evidence of the relationship between allergic rhinitis and impairment of quality of life. The data sources were original articles, reviews and consensus statements entered into the Medline and LILACS databases between 1997 and 2008. The following search terms were used: "allergic rhinitis"; "quality of life"; and "sleep disorders". Quality of life is often impaired in patients with allergic rhinitis, due to the classic symptoms of the disease (sneezing, pruritus, rhinorrhea and nasal obstruction). In addition, the pathophysiology of allergic rhinitis often disrupts sleep, leading to fatigue, irritability, memory deficits, daytime sleepiness and depression. The total burden of this disease goes beyond impairment of physical and social functioning. It has also a financial impact, which becomes greater when we consider the evidence that allergic rhinitis is a possible causal factor of comorbidities, such as asthma and sinusitis. Nasal obstruction, the most prominent symptom, is associated with sleep disorders, which can have a profound effect on mental health, learning, behavior and attention. Finally, allergic rhinitis-a chronic condition that affects adults, adolescents and children-is often underdiagnosed or inadequately treated. The deleterious impact that allergic rhinitis-related sleep disorders have on patient capacity to perform activities of daily living is an important component of the morbidity of the disease. With an accurate diagnosis, there are various available treatments that can reduce the burden of allergic rhinitis.

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Objetivo. Establecer la equivalencia clínica de un rociador nasal de propionato de fluticasona (RNF) genérico comparadocon dos formulas farmacéuticas comerciales del mismo producto (Flonase® y Flixonase®) durante la estación de polinización del cedro de montaña (Juniperus ashei) en Texas, EEUU. Materiales y métodos. Estudio multicéntrico, aleatorizado, doble ciego, controlado con placebo, en grupos paralelos diseñado para investigar la seguridad y eficacia de RNF (200 mcg una vez al día), Flonase® (200 mcg una vez al día) y Flixonase® (200 mcg una vez al día), comparados con placebo, administrados por 13 a 15 días. Los pacientes registraron diariamente, en la mañana y en la tarde, sus síntomas nasales totales (SNT). La variable de desenlace primaria fue la suma de SNT en la mañana y tarde + 1. Las variables de desenlace secundarias fueron los SNT AM + 1 y SNT PM + 1, y la evaluación de seguridad. Resultados. No se observó diferencia estadísticamente significativa en ningún día de estudio, ni en todo el periodo de tratamiento, ni al punto de final entre SNT promedio tanto de Flonase® como Flixonase® y RNF. La equivalencia clínica entre RNF yFlonase® (cociente= 0,98; intervalo de confianza [IC] al 90 por ciento, 0,91 a 1,06), y entre RNF y Flixonase® (cociente= 1,02; IC 90 por ciento, 0,94 a 1,10) fue demostrada tanto para la variable de desenlace primaria como para las otras variables de eficacia. Conclusiones. Estos resultados respaldan la equivalencia clínica entre RNF 200 mcg una vez al día tanto con Flonase®como Flixonase® en el tratamiento de rinitis alérgica estacional.

Objective. The primary objective of this study was to establish the clinic equivalence of a new Fluticasone Propionate Aqueous Nasal Spray (FANS) compared to two commercially available active treatments of fluticasone propionate nasal spray (Flonase® and Flixonase®) during the mountain cedar (Juniperus ashei) pollen season in Texas. Material and methods. This was a multicenter, randomized, double-blind, double-dummy, active-controlled and placebo-controlled, parallel group study designed to investigate the safety and efficacy of FANS (200 mcg QD), Flonase® and Flixonase® (200 mcg QD) compared to placebo administered for 13 to 15 days. Patients recorded the total nasal symptoms dcores (TNSS) in a diary in the morning and evening every day. The primary endpoint was the patient-rated am and pm TNSS +1. Other key efficacy endpoints were patient-rated AM TNSS+1, patient-rated PM TNSS+1, and safety. Results. Mean TNSS values for Flonase® and Flixonase® were not statistically significantly different from FANS during any study day, over the entire treatment period, or at endpoint. Bioequivalence between FANS and Flonase® (ratio= 0.98, 90 per cent CI 0.91 to 1.06) as well as FANS and Flixonase® (ratio=1.02, 90 per cent CI 0.94 to 1.10) was demonstrated for the primary endpoint [Patient-Rated am and pm TNSS +1] as well as for the other key efficacy endpoints. Conclusions. The findings from this study support that FANS 200 mcg QD is therapeutically bioequivalent to both Flonase® and Flixonase® in the control ofthe symptoms of seasonal allergic rhinitis.

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OBJETIVOS: Determinar la prevalencia de síntomas de rinitis alérgica en escolares de Mexicali, Baja California, México, y evaluar la influencia del medio ambiente rural sobre esta afección. MÉTODOS: Estudio transversal poblacional mediante la aplicación de un cuestionario estandarizado en una muestra aleatoria de 2 087 escolares de 6 a 7 años (1 078 niñas y 1 009 niños) residentes en la ciudad de Mexicali, Baja California, México. Se evaluó la asociación entre variables de exposición y antecedentes clínicos personales y familiares, y dos variables dependientes: síntomas nasales y síntomas nasales y oculares, en ausencia de catarro o gripe, con sus razones de posibilidades (OR, odds ratios) e intervalos de confianza de 95 por ciento (IC95 por ciento). El estudio, realizado entre febrero y julio de 2004, utilizó la metodología del Estudio Internacional de Asma y Alergia en la Infancia (ISAAC). RESULTADOS: Las prevalencias generales de síntomas nasales y síntomas nasales y oculares fueron de 25,0 por ciento y 10,5 por ciento, respectivamente. Los niños y las niñas que habían vivido en el campo o zona rural en algún momento presentaron menor probabilidad de padecer síntomas nasales (OR = 0,43; IC95 por ciento: 0,24 a 0,77) y síntomas nasales y oculares (OR = 0,39; IC95 por ciento: 0,16 a 0,93), después de ajustar por factores de confusión. CONCLUSIONES: El contacto con el medio rural en los primeros años de vida disminuyó el riesgo de presentar rinitis alérgica en la población estudiada, independientemente de los antecedentes familiares de asma.

OBJECTIVES: To assess the prevalence of allergic rhinitis symptoms among schoolchildren in Mexicali, Baja California, Mexico, and determine what impact a rural environment might have on this condition. METHODS: A population-based, cross-sectional study using a standardized questionnaire administered to a random sample of 2 087 schoolchildren 6-7 years of age (1 078 girls and 1 009 boys) living in the city of Mexicali, Baja California, Mexico. The study analyzed associations between exposure variables and personal and family health history, and two dependent variables-nasal symptoms and nasal and ocular symptoms, in the absence of a cold or flu-using odd ratios (OR) and 95 percent Confidence Intervals (95 percentCI). The study took place in February-July 2004 and followed the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: The general prevalence of nasal symptoms and nasal and ocular symptoms was 25.0 percent and 10.5 percent, respectively. The boys and girls who had ever lived on a farm or in a rural area had a lower probability, adjusted for confounding variables, of presenting nasal symptoms (OR = 0.43; 95 percentCI: 0.24-0.77), or nasal and ocular symptoms (OR = 0.39; 95 percentCI: 0.16-0.93). CONCLUSIONS: In the study population, exposure to a rural environment in early childhood decreased the risk of developing allergic rhinitis, regardless of a family history of asthma.

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