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December 10, 1997, Vol 278, No. 22 >
ARTICLE | December 10, 1997

Rhinitis and Inhalant Allergens FREE

Robert Naclerio, MD; William Solomon, MD
JAMA. 1997;278(22):1842-1848. doi:10.1001/jama.1997.03550220048008
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References

Allergic rhinitis affects about 20% of the US population. The diagnosis is based on patterns of symptoms, physical examination, and assessment of IgE antibodies by skin or in vitro testing. The most common offending allergens are pollens of grasses, trees, and weeds; fungi; animal allergens; and dust mites. In an individual with nasal allergy, exposure leads to rapid release of mast cell—derived mediators. This immediate response is followed by a cell-dominated response, including eosinophils and lymphocytes. Cytokines from TH2 lymphocytes, such as interleukin 4 and interleukin 5, orchestrate allergic inflammation. Resulting tissue changes produce symptoms of the disease and augment responses on subsequent exposure to allergens and irritants. Strategies for avoiding offending agents are important in management. In intermittent disease, antihistamines and/or decongestants are first prescribed. More continuous symptoms may mandate intranasal steroids. lmmunotherapy is often helpful for patients who respond poorly to pharmacotherapy and avoidance.

REFERENCES

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Evans R.  Epidemiology and natural history of asthma, allergic rhinitis, and atopic dermatitis . In: Middleton E Jr, Reed C, Ellis E, et al, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: CV Mosby; 1993;:1109-1136.
2 +
Young T, Finn L, Kim H.  Nasal obstruction as a risk factor for sleep-disordered breathing . J Allergy Clin Immunol . 1997;;99( (suppl) ):757-762.
3 +
Settipane RJ, Hagy GW, Settipane GA.  Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students . Allergy Asthma Proc . 1994;;15:21-25.
4 +
Maternowski CJ, Mathews KP.  The prevalence of ragweed pollinosis in foreign and native students at a midwestern university and its implications concerning methods for determining the inheritance of atopy . Allergy . 1962;;33:130-140.
5 +
Takenaka H, Zhang K, Diaz-Sanchez D, Tsien A, Saxon A.  Enhanced human IgE production results from exposure to the aromatic hydrocarbons from diesel exhaust . J Allergy Clin Immunol . 1995;;95:103-115.
6 +
Malone DC, Lawson KA, Smith DH, Arrighi HM, Battista C.  A cost of illness study of allergic rhinitis in the United States . J Allergy Clin Immunol . 1997;;99:22-27.
7 +
Huang S-K, Marsh DG.  Genetics of allergy . Ann Allergy Asthma Immunol . 1993;;70:347-359.
8 +
Doty R, Bartoshuk L, Snow J.  Causes of olfactory and gustatory disorders . In: Getchell TV, Doty R, Bartoshuk L, Snow J, eds. Smell and Taste in Health and Disease . New York, NY: Raven Press; 1991;: 449-462.
9 +
King TP, Hoffman D, Lowenstein H, Marsh DG, Platts-Mills TAE, Thomas W.  Allergen nomenclature . Int Arch Allergy Immunol . 1994;;105:224-233.
10 +
Platts-Mills TAE, Chapman MD, Heymann PW, Luczynska CM.  Measurement of airborne allergen using immunoassays . Immunol Allergy Clin North Am . 1989;;9:269-283.
11 +
Burge HA, Solomon WR, Muilenberg ML.  Evaluation of indoor plantings as allergen exposure sources . J Allergy Clin Immunol . 1982;;70:101-108.
12 +
AAAI Executive Committee.  Position statement: candidiasis hypersensitivity syndrome . J Allergy Clin Immunol . 1986;;78:271-273.
13 +
Spieksma F. ThM.  Domestic mites: their role in respiratory allergy . Clin Exp Allergy . 1991;;21:655-660.
14 +
deBlay F, Pauli G, Velten M, Bessot JC.  Influence of mite exposure on symptoms of mite-sensitive patients with asthma . J Allergy Clin Immunol . 1994;;93:136-138.
15 +
Leitermann K, Ohman JL.  Cat allergen, I . J Allergy Clin Immunol . 1984;;74:147-153.
16 +
Slater JE.  Latex allergy . J Allergy Clin Immunol . 1994;;94:139-149.
17 +
Kang BC.  Cockroach allergy . Clin Rev Allergy Immunol . 1990;;8:87-98.
18 +
Edwards AM.  Food-allergic disease . Clin Exp Allergy . 1995;;25( (suppl 1) ):16-19.
19 +
Naclerio RM.  Allergic rhinitis . N Engl J Med . 1991;;325:860-869.
20 +
Schwartz L, Huff T.  Biology of mast cells and basophils . In: Middleton E Jr, Reed C, Ellis E, et al, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: CV Mosby; 1993;:135-168.
21 +
Lim MC, Taylor RM, Naclerio RM.  The histology of allergic rhinitis and its comparison to nasal lavage . Am J Respir Crit Care Med . 1995;;151:136-144.
22 +
Shirakawa T, Enomoto T, Shimazu S, Hopkin JM.  The inverse association between tuberculin responses and atopic disorders . Science . 1997;;9:275-277.
23 +
Nelson HS, Oppenheimer J, Buchmeier A, Kordash TR, Freshwater LL.  An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass . J Allergy Clin Immunol . 1996;;97:1193-201.
24 +
van der Zee JS, de Groot H, van Sweiten P, et al.  Discrepancies between the skin tests and IgE antibody assays . J Allergy Clin Immunol . 1988;;82:270-281.
25 +
Solomon WR.  Fungus aerosols arising from cold-mist vaporizers . J Allergy Clin Immunol . 1974;;54:222-228.
26 +
Platts-Mills TAE, Chapman MD.  Dust mites: immunology, allergic disease, and environmental control . J Allergy Clin Immunol . 1987;;80:755-775.
27 +
Klucka CV, Ownby DR, Green J, Zoratti E.  Cat shedding of Fel d /is not reduced by washings, Allerpet-C spray, or acepromazine . J Allergy Clin Immunol . 1995;;95:1164-1171.
28 +
Dreborg SKG, Munir MD, Einarrson R.  The level of Fel d I in school dust is sufficiently high to induce symptoms in asthmatics . J Allergy Clin Immunol . 1991;;87:169.
29 +
Simons FE. Histamine and H-1 Receptor Antagonists in Allergic Disease . New York, NY: Marcel Dekker Inc; 1996;.
30 +
Fraser CM, Potter P, Venter JC.  Adrenergic agents, I:  In: Middleton E Jr, Reed CE, Ellis E, et al, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: CV Mosby; 1993;;1:636.
31 +
Welsh PW, Stricker WE, Chu-Pin C, et al.  Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy . Mayo Clin Proc . 1987;;62:125-134.
32 +
Naclerio RM, Mygind N.  Intranasal steroids . In: Mygind N, Naclerio RM, eds. Allergic and Non-allergic Rhinitis: Clinical Aspects . Copenhagen, Denmark: Munksgaard; 1993;:114-122.
33 +
Juniper EF, Kline PA, Hargreave F, et al.  Comparison of beclomethasone diproprionate aqueous nasal spray, astemizole and the combination in the prophylactic treatment of ragweed pollen-induced rhinoconjunctivitis . J Allergy Clin Immunol . 1989;;83:627-637.
34 +
Siegel SC, Katz R, Rachelefsky G, et al.  Multicenter study of beclomethasone dipropionate in adults with seasonal allergic rhinitis . J Allergy Clin Immunol . 1982;;69:345-353.
35 +
Dolovich J, Kennedy RN, Vickerson F, et al.  Control of the hypersecretion of vasomotor rhinitis by topical ipratropium bromide . J Allergy Clin Immunol . 1987;;80:274-278.
36 +
Donnelly AL, Glass M, Minkwitz MC, Casale TB.  The leukotriene D4-receptor antagonist, ICI 204,219, relieves symptoms of acute seasonal allergic rhinitis . Am J Respir Crit Care Med . 1995;;151:1734-1739.
37 +
Pastuszak A, Schick B, D'Alimonte D, et al.  The safety of astemizole in pregnancy . J Allergy Clin Immunol . 1996;;98:748-750.
38 +
Torfs CP, Katz EA, Bateson TF, et al.  Maternal medications and environmental exposures as risk factors for gastroschisis . Teratology . 1996;;54:84-92.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Evans R.  Epidemiology and natural history of asthma, allergic rhinitis, and atopic dermatitis . In: Middleton E Jr, Reed C, Ellis E, et al, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: CV Mosby; 1993;:1109-1136.
2 +
Young T, Finn L, Kim H.  Nasal obstruction as a risk factor for sleep-disordered breathing . J Allergy Clin Immunol . 1997;;99( (suppl) ):757-762.
3 +
Settipane RJ, Hagy GW, Settipane GA.  Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students . Allergy Asthma Proc . 1994;;15:21-25.
4 +
Maternowski CJ, Mathews KP.  The prevalence of ragweed pollinosis in foreign and native students at a midwestern university and its implications concerning methods for determining the inheritance of atopy . Allergy . 1962;;33:130-140.
5 +
Takenaka H, Zhang K, Diaz-Sanchez D, Tsien A, Saxon A.  Enhanced human IgE production results from exposure to the aromatic hydrocarbons from diesel exhaust . J Allergy Clin Immunol . 1995;;95:103-115.
6 +
Malone DC, Lawson KA, Smith DH, Arrighi HM, Battista C.  A cost of illness study of allergic rhinitis in the United States . J Allergy Clin Immunol . 1997;;99:22-27.
7 +
Huang S-K, Marsh DG.  Genetics of allergy . Ann Allergy Asthma Immunol . 1993;;70:347-359.
8 +
Doty R, Bartoshuk L, Snow J.  Causes of olfactory and gustatory disorders . In: Getchell TV, Doty R, Bartoshuk L, Snow J, eds. Smell and Taste in Health and Disease . New York, NY: Raven Press; 1991;: 449-462.
9 +
King TP, Hoffman D, Lowenstein H, Marsh DG, Platts-Mills TAE, Thomas W.  Allergen nomenclature . Int Arch Allergy Immunol . 1994;;105:224-233.
10 +
Platts-Mills TAE, Chapman MD, Heymann PW, Luczynska CM.  Measurement of airborne allergen using immunoassays . Immunol Allergy Clin North Am . 1989;;9:269-283.
11 +
Burge HA, Solomon WR, Muilenberg ML.  Evaluation of indoor plantings as allergen exposure sources . J Allergy Clin Immunol . 1982;;70:101-108.
12 +
AAAI Executive Committee.  Position statement: candidiasis hypersensitivity syndrome . J Allergy Clin Immunol . 1986;;78:271-273.
13 +
Spieksma F. ThM.  Domestic mites: their role in respiratory allergy . Clin Exp Allergy . 1991;;21:655-660.
14 +
deBlay F, Pauli G, Velten M, Bessot JC.  Influence of mite exposure on symptoms of mite-sensitive patients with asthma . J Allergy Clin Immunol . 1994;;93:136-138.
15 +
Leitermann K, Ohman JL.  Cat allergen, I . J Allergy Clin Immunol . 1984;;74:147-153.
16 +
Slater JE.  Latex allergy . J Allergy Clin Immunol . 1994;;94:139-149.
17 +
Kang BC.  Cockroach allergy . Clin Rev Allergy Immunol . 1990;;8:87-98.
18 +
Edwards AM.  Food-allergic disease . Clin Exp Allergy . 1995;;25( (suppl 1) ):16-19.
19 +
Naclerio RM.  Allergic rhinitis . N Engl J Med . 1991;;325:860-869.
20 +
Schwartz L, Huff T.  Biology of mast cells and basophils . In: Middleton E Jr, Reed C, Ellis E, et al, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: CV Mosby; 1993;:135-168.
21 +
Lim MC, Taylor RM, Naclerio RM.  The histology of allergic rhinitis and its comparison to nasal lavage . Am J Respir Crit Care Med . 1995;;151:136-144.
22 +
Shirakawa T, Enomoto T, Shimazu S, Hopkin JM.  The inverse association between tuberculin responses and atopic disorders . Science . 1997;;9:275-277.
23 +
Nelson HS, Oppenheimer J, Buchmeier A, Kordash TR, Freshwater LL.  An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass . J Allergy Clin Immunol . 1996;;97:1193-201.
24 +
van der Zee JS, de Groot H, van Sweiten P, et al.  Discrepancies between the skin tests and IgE antibody assays . J Allergy Clin Immunol . 1988;;82:270-281.
25 +
Solomon WR.  Fungus aerosols arising from cold-mist vaporizers . J Allergy Clin Immunol . 1974;;54:222-228.
26 +
Platts-Mills TAE, Chapman MD.  Dust mites: immunology, allergic disease, and environmental control . J Allergy Clin Immunol . 1987;;80:755-775.
27 +
Klucka CV, Ownby DR, Green J, Zoratti E.  Cat shedding of Fel d /is not reduced by washings, Allerpet-C spray, or acepromazine . J Allergy Clin Immunol . 1995;;95:1164-1171.
28 +
Dreborg SKG, Munir MD, Einarrson R.  The level of Fel d I in school dust is sufficiently high to induce symptoms in asthmatics . J Allergy Clin Immunol . 1991;;87:169.
29 +
Simons FE. Histamine and H-1 Receptor Antagonists in Allergic Disease . New York, NY: Marcel Dekker Inc; 1996;.
30 +
Fraser CM, Potter P, Venter JC.  Adrenergic agents, I:  In: Middleton E Jr, Reed CE, Ellis E, et al, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: CV Mosby; 1993;;1:636.
31 +
Welsh PW, Stricker WE, Chu-Pin C, et al.  Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy . Mayo Clin Proc . 1987;;62:125-134.
32 +
Naclerio RM, Mygind N.  Intranasal steroids . In: Mygind N, Naclerio RM, eds. Allergic and Non-allergic Rhinitis: Clinical Aspects . Copenhagen, Denmark: Munksgaard; 1993;:114-122.
33 +
Juniper EF, Kline PA, Hargreave F, et al.  Comparison of beclomethasone diproprionate aqueous nasal spray, astemizole and the combination in the prophylactic treatment of ragweed pollen-induced rhinoconjunctivitis . J Allergy Clin Immunol . 1989;;83:627-637.
34 +
Siegel SC, Katz R, Rachelefsky G, et al.  Multicenter study of beclomethasone dipropionate in adults with seasonal allergic rhinitis . J Allergy Clin Immunol . 1982;;69:345-353.
35 +
Dolovich J, Kennedy RN, Vickerson F, et al.  Control of the hypersecretion of vasomotor rhinitis by topical ipratropium bromide . J Allergy Clin Immunol . 1987;;80:274-278.
36 +
Donnelly AL, Glass M, Minkwitz MC, Casale TB.  The leukotriene D4-receptor antagonist, ICI 204,219, relieves symptoms of acute seasonal allergic rhinitis . Am J Respir Crit Care Med . 1995;;151:1734-1739.
37 +
Pastuszak A, Schick B, D'Alimonte D, et al.  The safety of astemizole in pregnancy . J Allergy Clin Immunol . 1996;;98:748-750.
38 +
Torfs CP, Katz EA, Bateson TF, et al.  Maternal medications and environmental exposures as risk factors for gastroschisis . Teratology . 1996;;54:84-92.

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