Clinical Efficacy of Complex Therapy for Mixed Allergic and Non-allergic Rhinitis in Immunocompromised Patients with Recurrent Viral–Bacterial Infections - European Medical Journal

Clinical Efficacy of Complex Therapy for Mixed Allergic and Non-allergic Rhinitis in Immunocompromised Patients with Recurrent Viral–Bacterial Infections

2 Mins
Allergy & Immunology
EMJ Allergy & Immunology 6.1 Feature Image
*Irina Nesterova,1 Evgeniya Khalturina,2 Nataliya Garskova3

The authors have declared no conflicts of interest.

EMJ Allergy Immunol. ;6[1]:37-38. Abstract Review No. AR3.
Allergic rhinitis, immunocompromised, infection, non-allergic rhinitis.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


It is known that acute viral infections cause exacerbation of IgE-dependent allergic diseases. In this regard, the treatment of immunocompromised patients suffering from mixed allergic and non-allergic rhinitis (MANAR) with frequent exacerbations despite adequate therapy is difficult.1,2 Episodes of repeated acute respiratory viral–bacterial (RAVBRI) and recurrent herpes virus infections (RHVI) caused by HSV1/2, which are immunocompromising clinical signs, have induced exacerbations of MANAR.3


Twenty-one patients of both sexes were observed, aged 23–60 years, affected by MANAR associated with RAVBRI and RHVI caused by HSV1/2. The diagnostic assessment included complaints, anamnesis, physical examination, and assessment of MANAR symptoms on the visual analogue scale. Laboratory research included total IgE, specific IgE to exoallergens, and an evaluation of the IFN system examined by ELISA. HVI were tested by polymerase chain reaction and serodiagnostic testing; bacteria were tested by cultivation.


Symptoms of MANAR on the visual analogue scale were 3.19 points, which corresponded to an average–severe or severe stage. The level of total IgE was increased in all patients. Sensitisation to household allergens occurred in 48%, to epidermal in 32%, and to fungal in 40%
(Figure 1). The frequency of episodes of RAVBRI was 7.45 (5.75–10.0) and of RHVI was 7.89 (4.75–11.0) per year.

Figure 1 Sensitisation spectrum

Figure 1: Sensitisation spectrum.

Disorders of induced IFNα production were detected in 100% of cases. The programme of complex therapy was developed, which included basic MANAR treatment using systemic antihistamines and intranasal glucocorticosteroids. Continuous local and systemic therapy with rIFNα2b, in combination with antioxidants and immunotherapy with glucosaminylmuramylpeptide alternated with arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine, were used to restore anti-infection protection.4

After 3.5 months of therapy, the authors
observed a decrease of the frequency of acute respiratory viral infections to 4.28 (3.0–4.25),
after 6–8 months to 2.45 (2.0–3.0), and a reduction of RHVI frequency to 3.38 (1.38–5.0) and to 2.1 (1.0–3.0) episodes per year, respectively.

The restoration of induced IFNα production occurred in 42.8% of patients. The MANAR symptoms decreased to 1.62 points.

Nesterova IV et al. Interferon and Immunotherapy in the Treatment of Atypical Infectious and Inflammatory Diseases in Children and Adults (2020) Russia: Capricorn Publishing. Nesterova IV et al. New tactics of prolonged local and systemic interferon therapy in optimization of treatment of immunocompromised young children having viral coinfections. IJPR. 2020;12(Suppl 1):950-61. Nesterova IV et al. “Unfavorable Impact of the Urbanization on the Immune Antiviral Protection in Children: The Relationship with Recurrent Respiratory Infections,” Vasenev V et al. (eds), Advanced Technologies for Sustainable Development of Urban Green Infrastructure (2021) 1st edition, Switzerland: Springer Nature, pp.171-84. Nesterova IV et al. Congenital and acquired interferonopathies: differentiated approaches to interferon therapy. IntechOpen. 2020;DOI:10.5772/intechopen.91723. Khalturina EO et al, “Comprehensive Treatment Program for Allergic Rhinitis Associated with Return Respiratory and Chronic Herpes Virus Co-Infections,” Sepiashvili R (ed.) Allergy, Asthma, COPD, Immunophysiology & Immunorehabilitology: Innovative Technologies (2017) Bologna: Filodiritto, pp.53-61.

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