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      Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report

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          Abstract

          This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms, recommendations for diagnosis and treatment of AR, and to define the needs in this neglected area by a literature review. AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic oesophagitis (EoE), conjunctivitis, chronic middle ear effusions, rhinosinusitis, adenoid hypertrophy, olfaction disorders, obstructive sleep apnea, disordered sleep and consequent behavioural and educational effects. This report provides up-to-date usable information to: (1) improve the knowledge and skills of allergists, so as to ultimately improve the overall quality of patient care; (2) to increase interest in this area; and (3) to present a unique contribution to the field of upper inflammatory disease.

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          European Position Paper on Rhinosinusitis and Nasal Polyps 2012.

          The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed.
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            ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE).

            Esophageal eosinophilia and eosinophilic esophagitis (EoE) are increasingly recognized and prevalent conditions, which now represent common clinical problems encountered by gastroenterologists, pathologists, and allergists. The study of EoE has become a dynamic field with an evolving understanding of the pathogenesis, diagnosis, and treatment. Although there are limited data supporting management decisions, clinical parameters are needed to guide the care of patients with eosinophilic-esophageal disorders. In this evidence-based review, recommendations developed by adult and pediatric gastroenterologists are provided for the evaluation and management of these patients. New terminology is emphasized, particularly the concepts of esophageal eosinophilia and proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE) as entities distinct from EoE.
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              Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma.

              Adult patients with nasal polyps often have comorbid asthma, adding to the serious effect on the quality of life of these patients. Nasal polyps and asthma might represent a therapeutic challenge; inflammation in both diseases shares many features, such as airway eosinophilia, local IgE formation, and a T(H)2 cytokine profile. Omalizumab is a human anti-IgE mAb with proved efficacy in patients with severe allergic asthma. Omalizumab could be a treatment option for patients with nasal polyps and asthma. The goal of this study was to investigate the clinical efficacy of omalizumab in patients with nasal polyps and comorbid asthma. A randomized, double-blind, placebo-controlled study of allergic and nonallergic patients with nasal polyps and comorbid asthma (n = 24) was conducted. Subjects received 4 to 8 (subcutaneous) doses of omalizumab (n = 16) or placebo (n = 8). The primary end point was reduction in total nasal endoscopic polyp scores after 16 weeks. Secondary end points included a change in sinus computed tomographic scans, nasal and asthma symptoms, results of validated questionnaires (Short-Form Health Questionnaire, 31-item Rhinosinusitis Outcome Measuring Instrument, and Asthma Quality of Life Questionnaire), and serum/nasal secretion biomarker levels. There was a significant decrease in total nasal endoscopic polyp scores after 16 weeks in the omalizumab-treated group (-2.67, P = .001), which was confirmed by means of computed tomographic scanning (Lund-Mackay score). Omalizumab had a beneficial effect on airway symptoms (nasal congestion, anterior rhinorrhea, loss of sense of smell, wheezing, and dyspnea) and on quality-of-life scores, irrespective of the presence of allergy. Omalizumab demonstrated clinical efficacy in the treatment of nasal polyps with comorbid asthma, supporting the importance and functionality of local IgE formation in the airways. Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Contributors
                +90 532 2676616 , ccingi@gmail.com
                philippe.gevaert@ugent.be
                ralph@moesges.de
                carmenrs61@gmail.com
                valerie.hox@med.kuleuven.be
                rudenko_michael@yahoo.com
                nbayarmuluk@yahoo.com
                g.scadding@ucl.ac.uk
                felimanole@yahoo.com
                cloe.hupin@uclouvain.be
                w.j.fokkens@amc.uva.nl
                akdisac@siaf.uzh.ch
                claus.bachert@ugent.be
                pascal.demoly@inserm.fr
                jmullol@clinic.ub.es
                muraro@centroallergiealimentari.eu
                ngpallergy@gmail.com
                pawankar.ruby@gmail.com
                philippe.rombaux@uclouvain.be
                elina.toskala@tuhs.temple.edu
                kalogjera@sfzg.hr
                eprokopakis@gmail.com
                peter.hellings@med.kuleuven.ac.be
                jean.bousquet@orange.fr
                Journal
                Clin Transl Allergy
                Clin Transl Allergy
                Clinical and Translational Allergy
                BioMed Central (London )
                2045-7022
                1 June 2017
                1 June 2017
                2017
                : 7
                : 17
                Affiliations
                [1 ]ISNI 0000 0004 0596 2460, GRID grid.164274.2, Department of Otorhinolaryngology, , Eskisehir Osmangazi University School of Medicine, ; Eskisehir, Turkey
                [2 ]ISNI 0000 0004 0626 3303, GRID grid.410566.0, Upper Airway Research Laboratory, , Ghent University Hospital, ; Ghent, Belgium
                [3 ]ISNI 0000 0000 8580 3777, GRID grid.6190.e, Institute of Medical Statistics, Informatics, and Epidemiology, Medical Faculty, , University of Köln, ; Cologne, Germany
                [4 ]ISNI 0000 0001 2298 7828, GRID grid.10215.37, Allergy Unit, IBIMA, Regional University Hospital of Malaga, , UMA, ; Malaga, Spain
                [5 ]ISNI 0000 0004 0626 3338, GRID grid.410569.f, Clinical division of Otorhinolaryngology, Head and Neck Surgery, , University Hospitals Leuven, ; Louvain, Belgium
                [6 ]London Allergy and Immunology Centre, London, UK
                [7 ]ISNI 0000 0004 0595 9528, GRID grid.411047.7, ENT Department, Faculty of Medicine, , Kirikkale University, ; Kirikkale, Turkey
                [8 ]GRID grid.439342.b, , Royal National Throat, Nose and Ear Hospital, ; London, UK
                [9 ]ISNI 0000 0001 1087 4092, GRID grid.19723.3e, Faculty of Medicine, ENT Department, , University of Oradea, ; Oradea, Romania
                [10 ]ISNI 0000 0001 2294 713X, GRID grid.7942.8, Institut de Recherche Expérimentale et Clinique (IREC), Pole de Pneumologie, ORL & Dermatologie, , Université catholique de Louvain, ; Louvain-la-Neuve, Belgium
                [11 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Otorhinolaryngology, Head and Neck Surgery, , Academic Medical Centre (AMC), ; Amsterdam, The Netherlands
                [12 ]ISNI 0000 0004 1937 0650, GRID grid.7400.3, Christine Kuhne-Center for Allergy Research and Education, Swiss Institute of Allergy and Asthma Research, , University of Zurich, ; Davos, Switzerland
                [13 ]ISNI 0000 0000 9961 060X, GRID grid.157868.5, Hôpital Arnaud de Villeneuve, , University Hospital of Montpellier, ; Montpellier, France
                [14 ]ISNI 0000 0000 9635 9413, GRID grid.410458.c, Unitat de Rinologia i Clinica de l’Olfacte, Servei d’Otorinolaringologia, , Hospital Clínic, ; Barcelona, Catalonia Spain
                [15 ]ISNI 0000 0004 1757 3470, GRID grid.5608.b, The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, , University of Padua, ; Padua, Italy
                [16 ]ISNI 0000 0001 2155 0800, GRID grid.5216.0, Allergy Department, 2nd Pediatric Clinic, , University of Athens, ; Athens, Greece
                [17 ]ISNI 0000 0001 2173 8328, GRID grid.410821.e, , Nippon Medical School, ; Tokyo, Japan
                [18 ]ISNI 0000 0004 0461 6320, GRID grid.48769.34, Service d’ORL, , Cliniques Universitaires St-Luc, ; Brussels, Belgium
                [19 ]ISNI 0000 0001 2248 3398, GRID grid.264727.2, Department of Otorhinolaryngology-Head and Neck Surgery, , Temple University, ; Philadelphia, PA USA
                [20 ]ISNI 0000 0000 9336 4196, GRID grid.412488.3, Department of Otorhinolaryngology and Head and Neck Surgery, , University Hospital Sestre milosrdnice, ; Zagreb, Croatia
                [21 ]GRID grid.412481.a, Department of Otorhinolaryngology, , University Hospital of Crete, ; Crete, Greece
                Article
                153
                10.1186/s13601-017-0153-z
                5452333
                28572918
                afd0da5b-ffa7-4667-b50d-10aedc5c7d3d
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 February 2017
                : 12 May 2017
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Immunology
                adenoid hypertrophy,allergic rhinitis (ar),asthma,chronic middle ear effusions,comorbidities,disordered sleep,eczema,eosinophilic oesophagitis (eoe),conjunctivitis,food allergies,obstructive sleep apnea,olfaction disorders,rhinitis,rhinosinusitis

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