phenylephrine-hydrochloride and Rhinitis--Allergic--Perennial

Allergic rhinitis, particularly seasonal allergic rhinitis, is considered a classic Th2-mediated disease, with important contributions to pathology by interleukins 4, 5 and 13. As such, allergic rhinitis is an excellent model for studying allergic inflammation, with findings potentially relevant to the mechanism of lower airways inflammation seen in allergic asthma. However, recent evidence has revealed roles for additional non-Th2 cytokines in asthma, including IL-17 family cytokines and epithelial-derived cytokines. Additionally, putative roles for epithelial-derived cytokines and innate lymphoid cells have been described in chronic rhinosinusitis with nasal polyps. Here, evidence for the involvement of different cytokines and cytokine groups in allergic rhinitis is considered.

Topics: Animals; Chronic Disease; Cytokines; Epithelial Cells; Humans; Nose; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; T-Lymphocytes, Helper-Inducer

To evaluate the treatment outcomes of leukotriene receptor antagonists (LTRA) as monotherapy or combined with the second-generation oral H1-histamines in the treatment of allergic rhinitis (AR), and to provide a basis for optimizing clinical therapeutic strategies.. PubMed,EMBASE, CBMdisc and CJFD databases, retrieving randomized controlled trials (RCTs) of AR therapy literatures were searched. Based on the literature inclusion and exclusion criteria, the related literatures were selected and the quality was evaluated by using the Jadad scale. Meta-analysis was performed by Stata 12.1 software.For continuous outcomes, the weighted mean difference (WMD) and its 95% confidence intervals (CI) were calculated. The forest plots were drawn. The treatment outcomes included daytime nasal symptom scores (DNSS), nighttime symptom scores (NSS), composite symptom scores (CSS), daytime eye symptom scores (DESS), and the rhinoconjunctivitis quality of life questionnaire (RQLQ) were used to evaluate the therapeutic effects of LTRA on seasonal and perennial AR.. Eleven of clinical RCTs including 14 809 cases of AR patients, aged 15 to 85 years old, were available for Meta-analysis. Montelukast, a drug of LTRA, was primarily evaluated in the study. The results of Meta-analysis showed: (1) Compared with the placebo, montelukast statistically significantly reduced the DNSS,NSS, CSS, and RQLQ scores in patients with seasonal and perennial AR, as well as the DESS in patients with seasonal AR.(2) There were no statistical differences in the improvement of the CSS,DESS, and RQLQ scores in patients with seasonal AR after the treatment by montelukast compared with loratadine, a second-generation oral H1-histamine.(3) Montelukast statistically significantly reduced the NSS, but not DNSS, in patients with seasonal AR compared with loratadine.(4) The combination therapy of montelukast and loratadine statistically significantly improved the CSS compared with either montelukast or loratadine monotherapy.. Montelukast, a representative drug of LTRA, can be used as first-line therapy for AR, with comprehensive improvement of the nasal and ocular symptoms and the quality of life in AR patients. Montelukast combined with loratadine can significantly improve the diurnal and nocturnal symptoms for patients with seasonal AR, and the curative effect is better than the single use of montelukast or loratadine.

Topics: Acetates; Cyclopropanes; Drug Therapy, Combination; Humans; Leukotriene Antagonists; Loratadine; Nose; Quality of Life; Quinolines; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sulfides; Surveys and Questionnaires; Treatment Outcome

Snoring and obstructive sleep apnoea are both due to multilevel anatomical obstruction, and the nose and nasal pathology both contribute in many cases. This paper addresses some of the issues surrounding the problem and briefly discusses the role of medication and nasal dilators and in more detail the implication of nasal surgery in various aspects of sleep related breathing disorders (SRBD). Nasal obstruction leads to mouth breathing, which destabilises the upper airway and aggravates SRBD.

Topics: Continuous Positive Airway Pressure; Humans; Nose; Quality of Life; Rhinitis, Allergic, Perennial; Sleep Apnea, Obstructive; Sleep Wake Disorders; Snoring

The effects of aging on the nose include structural, hormonal, mucosal, olfactory, and neural changes. As the US population ages and remains in overall better health, we will have more patients with rhinologic problems related to aging. In this manuscript, we review the available evidence on the structural and physiologic changes of the nose caused by aging, and we briefly describe management of common causes of rhinitis in the elderly.

Topics: Aged; Aging; Humans; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Smell

During the past few decades, the incidence of sensitization to inhaled allergens as well as allergic airways disease has grown steadily. Genetic and environmental factors are recognized as etiologic factors in the development of allergic airway disease, with allergic rhinitis often preceding the development of asthma. Allergic rhinitis is considered a risk factor for the development of asthma, and almost all allergic asthmatic patients have rhinitis. Insight into the risk factors responsible for allergic airways disease and the interaction between the involved organs results in a better diagnostic and therapeutic approach in global airway allergy syndrome.. Recent studies have shown that local tissue factors, such as microbial stimuli and systemic inflammatory mechanisms, play a role in the clinical expression of the allergic airway syndrome. In addition, impaired nasal function affects the lower airways of asthmatic patients via different pathways. To date, most human and animal data point towards a systemic pathway linking the upper and lower airways, involving both bloodstream and bone marrow. Recent clinical trials and current guidelines underline the importance of an integrated treatment strategy involving both ends of the respiratory tract.. This review provides an overview of recent epidemiological and immunopathologic evidence concerning the link between upper and lower airways in allergic disease and its therapeutic implications.

Topics: Asthma; Bronchi; Humans; Nose; Respiratory Hypersensitivity; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Allergic rhinitis is a frequent immunological disease affecting about 10-25% of the total population. The pathogenesis of allergic rhinitis is presumed to involve an IgE-mediated mechanism. Careful patient history, together with the skin prick test or RAST, usually allows an easy diagnosis of allergic rhinitis. In other cases it may be necessary to confirm diagnosis by the nasal provocation test. Different methods of provocation and measurement of nasal responses have been used in recent years. Scoring of the severity of clinical symptoms is too subjective to be clinically useful and should therefore be supplemented by one of the objective measurement techniques, such as anterior rhinomanometry. Additional analysis of nasal cytologic findings and determination of biomarkers in nasal secretions can be a critical tool in the evaluation of pathophisiology of allergic rhinitis. We critically discuss indications and contraindications for nasal challenges and review current techniques of provocation. We also provide various methods of assessment of nasal responses. The included examples of nasal provocation tests protocols may be helpful in introducing nasal provocation tests into everyday clinical practice.

Topics: Administration, Intranasal; Allergens; Contraindications; Humans; Nasal Provocation Tests; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Skin Tests

Levocetirizine and desloratadine are newer antihistamines indicated for the treatment of allergic rhinitis and chronic idiopathic urticaria.. This article discusses the pharmacokinetics and pharmacodynamics of levocetirizine and desloratadine and reviews studies that have directly compared the effects of these 2 drugs in allergic rhinitis and urticaria.. Relevant articles were identified through a search of MEDLINE from 1999 through 2004 using the main search terms levocetirizine and desloratadine.. Levocetirizine is absorbed rapidly and reaches a steady-state plasma concentration more quickly than does desloratadine. It is also metabolized to a lesser extent than desloratadine, has a lower V(d), and has higher specificity for histamine(1) receptors. Eight well-controlled trials were identified that directly compared the effects of levocetirizine and desloratadine in the skin and nose of healthy individuals and patients with allergic rhinitis. Drug activity was measured in terms of wheal, flare, and itch reactions; nasal symptoms or symptom scores; increases in concentrations of inflammatory markers; or facial thermography. In most of these trials, levocetirizine had a faster onset and greater consistency of effect than desloratadine. The differences in the pharmacokinetic and pharmacodynamic profiles of the 2 drugs may partially explain these clinical findings.. Levocetirizine may be preferred to desloratadine as a treatment option for allergic rhinitis because of its faster onset of action and greater consistency of effect. Although comparative studies in chronic idiopathic urticaria are not available, data from histamine-induced wheal and flare studies in healthy volunteers suggest that levocetirizine may be more effective in preventing itching than desloratadine.

Topics: Cetirizine; Histamine Antagonists; Humans; Loratadine; Nose; Piperazines; Quality of Life; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Skin; Urticaria

The upper airway, including nasal cavities, naso-, oro-, and hypopharynx, is the portal of entry for air pollutants. Upper airway (as well as eye) irritation figures prominently in symptom reporting in so-called problem buildings and with exposure to environmental tobacco smoke. Large particles and water-soluble gases and vapors are likely to have their initial irritant effects in the mucous membranes of the upper airway and eyes, giving warning to the exposed individual to minimize further exposure. The spectrum of irritant-related upper airway health effects is reviewed in this article.

Topics: Animals; Environmental Exposure; Humans; Irritants; Nose; Occupational Diseases; Reflex; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sensation

The vast majority of patients with asthma have rhinitis, and rhinitis is a major independent risk factor for asthma in cross-sectional and longitudinal studies. The relationships between rhinitis and asthma can be viewed under the concept that the 2 conditions are manifestations of one syndrome, the chronic allergic respiratory syndrome, in 2 parts of the respiratory tract. At the low end of the syndrome's severity spectrum, rhinitis appears to be the sole manifestation, although pathologic abnormalities in the lower airways are already present. At the higher end, rhinitis is worse, and the lower airways disease becomes clinically evident. Once manifested, the 2 conditions track in parallel in terms of severity. This parallel relationship is influenced by many interactions between the nasal and the lower airways: some interactions stem from the fact that the nasal passages play a major homeostatic role by conditioning inhaled air, but perhaps even more important is the bidirectional interaction that results from the systemic inflammation that is produced after local allergic reactions. Successful management of the chronic allergic respiratory syndrome requires an integrated view of the airways and an understanding of their interactions.

Topics: Asthma; Humans; Lung; Models, Biological; Nose; Respiratory System; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Syndrome

Afferent nerves, derived from the trigeminal ganglion, and postganglionic autonomic nerves, derived from sympathetic and parasympathetic ganglia expressing many different neurotransmitters, innervate the nose. Reflexes that serve to optimize the air-conditioning function of the nose by altering sinus blood flow, or serve to protect the nasal mucosal surface by mucus secretion, vasodilatation, and sneezing, can be initiated by a variety of stimuli, including allergen, cold air, and chemical irritation. Activation of nasal afferent nerves can also have profound effects on respiration, heart rate, blood pressure, and airway caliber (the diving response). Dysregulation of the nerves in the nose plays an integral role in the pathogenesis of allergic rhinitis. Axon reflexes can precipitate inflammatory responses in the nose, resulting in plasma extravasation and inflammatory cell recruitment, while allergic inflammation can produce neuronal hyper-responsiveness. Targeting the neuronal dysregulation in the nose may be beneficial in treating upper airway disease.

Topics: Animals; Humans; Inflammation; Nasal Mucosa; Neurons, Afferent; Neurons, Efferent; Neurotransmitter Agents; Nose; Reflex; Respiratory System; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Vasomotor System

The link between upper and lower respiratory tracts has been repeatedly observed in the past 50 years but only carefully investigated during the past decade. Several clinical and experimental observations suggested the hypothesis of the unity of upper and lower airways (allergic rhinobronchitis or united airways disease). The relationships between rhinitis (and sinusitis) and asthma also include non-epidemiological aspects such as viral infections and bronchial hyperreactivity. The hypotheses have been confirmed by means of epidemiological observations, functional and immunological evidence and, indirectly, by observing the effects of drugs used mainly for rhinitis on asthma symptoms. In this article, therefore, we collected and reviewed the most relevant experimental results available to support the hypothesis for united airways disease and the studies conducted on the possible mechanisms of nose-lung interaction.

Topics: Asthma; Humans; Lung; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Topics: Cytokines; Histamine; Humans; Nasal Mucosa; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Topics: Cell Adhesion Molecules; Humans; Inflammation Mediators; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Efficacy monitoring of immunotherapy (IT) is performed to adjust the therapy according to the patient's reactions, to collect data for scientific studies and to evaluate the efficacy of IT. A decrease of allergy symptoms and of drug use are the main parameters. For this, allergy diaries are most suitable. Pollen exposition should be monitored with Burkhard traps. Wheal and flare reactions in skin tests can be measured by visual inspection with quantification of the diameter on transparent foils or by means of laser scanners. Nasal provocation testing leads to subjective and objective (rhinomanometry, acoustic rhinometry) results. A change in the threshold concentration of allergen, which is needed to provoke a positive test reaction, can be used to evaluate the success of an IT. Additionally, systemic or local side-effects should be carefully revealed. Cytologic measures can be achieved by nasal lavages. Cotton samplers, cytology brushes and suction techniques are used to collect cells and nasal secretions. Early and late allergic reactions can be evaluated. Specific cell activation markers like ECP or tryptase are useful parameters in nasal secretions. T-lymphocyte subpopulations and T-cell-lymphokine-profiles can be detected. During IT, a change from a dominating TH2-cytokine-profile to a dominating TH1-cytokine-profile can be seen. For the reason of their expense, those methods are restricted to scientific investigations and only rarely used for routine diagnostics.

Topics: Biomarkers; Humans; Immunotherapy; Monitoring, Immunologic; Nasal Provocation Tests; Nose; Rhinitis, Allergic, Perennial; T-Lymphocyte Subsets; Therapeutic Irrigation

Perennial rhinitis and asthma are clinical syndromes representing a range of overlapping pathologies; accurate classification should therefore precede any comparison. Although the sinonasal cavities, trachea and bronchi have a common respiratory mucosa, there are also anatomical differences. For example, the nose has a capacitance vessel network and the lower airways possess smooth muscle, both of which are responsive to neurohumoral influences. The prevalence of rhinitis and asthma has increased over the last three decades. Rhinitis occurs in around 75% of allergic asthmatics while 20% of perennial allergic rhinitics develop asthma. Eosinophils, and their associated proteins and cytokines, may play a central role in both perennial rhinitis and asthma with and without atopy. The characteristic pathology of asthma can be summarized as a chronic, desquamating, eosinophilic bronchitis. Non-allergic rhinitis with eosinophilia is recognized, but without consistent evidence of epithelial damage. Eosinophils are also present in rhinosinusitis with polyposis, particularly in patients with aspirin sensitivity, in whom asthma also often occurs. Increased mast cell activation and mediator release is evident in both perennial rhinitis and asthma following allergen challenge. The importance of mast cells in non-atopic asthma and polyposis is also recognized. Adhesion molecules may also be upregulated, with an increased number and activation of TH2 lymphocytes. However, allergen-resultant T-cell activation may be less marked in the nose than in the lung. Autonomic imbalance also plays a role in both conditions via changes in neural tone to effector tissues, release of neuropeptides, and interplay with cellular recruitment. Pharmacological manipulation of rhinitis and asthma also illustrates the pathological similarities and differences.

Topics: Asthma; Autonomic Nervous System; Bronchi; Bronchial Hyperreactivity; Eosinophils; Glucocorticoids; Humans; Inflammation; Lung; Nose; Rhinitis, Allergic, Perennial; Sinusitis; Trachea

Topics: Biomarkers; Cystic Fibrosis; Diagnosis, Differential; Diagnostic Imaging; Humans; Immunologic Deficiency Syndromes; Mucociliary Clearance; Nasal Cavity; Nose; Pressure; Pulmonary Ventilation; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sinusitis; Smell; Sound

No ancillary or laboratory study can replace the medical history and physical examination, in the diagnosis of allergic diseases. It is mandatory to know the wide diversity of clinical manifestations to make an accurate diagnosis and select its best treatment.

Topics: Chronic Disease; Humans; Medical History Taking; Nose; Physical Examination; Rhinitis; Rhinitis, Allergic, Perennial; Sinusitis

Nasal provocative testing is the introduction of a specific factor into the nose and the subsequent assessment of the pathophysiologic changes induced by the challenge. The provocative test primarily affects the nasal airway but also may affect the adjacent organs, including the eustachian tube, middle ear, sinuses, and lower respiratory tract. Recent advances in the measurement of nasal airway resistance with microcomputer-assisted rhinomanometry have improved the objective assessment of nasal airway obstruction. Eustachian tube obstruction has been shown after nasal provocation by a new procedure, sonotubometry, which can be performed in series with rhinomanometry and pulmonary spirometry. As will be described these procedures have helped elucidate the extent and pathophysiology of diseases affecting the upper airway, especially allergic rhinitis. At present, nasal provocation is primarily a clinical investigative test. It is anticipated that with further development and refinement, it can be used to a greater extent in the diagnosis and management of nasal diseases.

Topics: Allergens; Animals; Eustachian Tube; Haplorhini; Humans; Manometry; Nasal Provocation Tests; Nose; Rhinitis, Allergic, Perennial

Rhinitis is a common affliction of humans that can cause significant morbidity. Distinction between allergic and nonallergic varieties has important prognostic and therapeutic implications. Newer, nonsedating antihistamines and intranasal steroid preparations have greatly enhanced the treatment of these disorders. Distinguishing factors of viral and bacterial rhinitis have been reviewed. Early recognition of nasal cellulitis and mucormycosis with aggressive therapy is necessary to prevent serious complications. Multiple processes, including structural and drug-induced reactions, can mimic rhinitis. An orderly approach, including a good history and physical examination, coupled with use of the nasal smear, will allow the emergency physician to master this frequent complaint.

Topics: Emergencies; Histamine H1 Antagonists; Humans; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Rhinitis, Vasomotor; Sympathomimetics

Topics: Allergens; Humans; Nasal Mucosa; Nasal Polyps; Nose; Pollen; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sinusitis; SRS-A

Topics: Adrenergic alpha-Agonists; Adrenergic beta-Agonists; Airway Resistance; Calcium Channel Blockers; Chemotactic Factors, Eosinophil; Cholinergic Antagonists; Cromolyn Sodium; Glucocorticoids; Histamine; Histamine H1 Antagonists; Histamine H2 Antagonists; Humans; Hydroxyeicosatetraenoic Acids; Leukotriene B4; Nasal Mucosa; Nasal Provocation Tests; Nose; Prostaglandins; Rhinitis, Allergic, Perennial; Thromboxanes

Topics: Ephedrine; Histamine H1 Antagonists; Humans; Immunotherapy; Nose; Phenylpropanolamine; Pollen; Radioallergosorbent Test; Respiratory Tract Diseases; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Skin Tests

Topics: Adolescent; Adult; Allergens; Child; Child, Preschool; Complement Fixation Tests; Cromolyn Sodium; Desensitization, Immunologic; Histamine H1 Antagonists; Humans; Immunoglobulin A; Immunoglobulin A, Secretory; Immunoglobulin E; Infant; Medical History Taking; Middle Aged; Mucous Membrane; Nasal Provocation Tests; Nose; Pollen; Prognosis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Skin Tests; Steroids; Vasodilator Agents

Many studies have shown the potential therapeutic effect of acupuncture on allergic rhinitis. Most of these studies were limited by low-quality evidence. Preliminary experiments showed that the use of acupuncture at three nasal acupoints plus acupoint application (AAP) achieves a more persistent effect in the treatment of perennial allergic rhinitis than acupuncture alone. In this study, a multicenter, single-blind, randomized controlled trial will be performed, in which acupuncture at nonmeridian acupoints and sham AAP will be used as the control group to evaluate the effect of AAP through long-term observation.. The trial is designed on the basis of the Consolidated Standards of Reporting Trials 2010 guidelines and Standards for Reporting Interventions in Controlled Trials of Acupuncture. A total of 120 participants with perennial allergic rhinitis will be randomly assigned to a treatment or control group. A specially appointed investigator will be in charge of randomization. The participants in the treatment group will be treated with acupuncture at EX-HN3, LI20, and EX-HN8 thrice per week for a total of 12 sessions. In addition, they will undergo AAP at DU14, BL13, EX-BI, and RN22. The participants in the control group will be treated with sham AAP. The primary outcome will be the change in the Total Nasal Symptom Score from baseline to the completion of 4-week treatment. Secondary outcomes include changes in visual analog scale and total non-nasal symptom scores from baseline to the second and fourth weeks of treatment, as well as 1, 3, and 6 months after the completion of treatment. Peripheral blood IL-4, IL-5, IL-6, IL-8, and IL-10 levels will be measured, and any side effects related to treatment will be observed and recorded.. It is expected that this randomized clinical trial will provide evidence to determine the effects of AAP compared with acupuncture at nonmeridian acupoints and sham AAP, particularly the long-term effect. These findings will help improve the clinical application of this technique.. Acupuncture-Moxibustion Clinical Trial Registry AMCTR-ICR-18000179. Registered on 12 April 2018.

Topics: Acupuncture Points; Acupuncture Therapy; Cytokines; Drugs, Chinese Herbal; Humans; Nose; Ointments; Rhinitis, Allergic, Perennial; Single-Blind Method; Treatment Outcome

In the clinic, approximately 30% of children with adenoid hypertrophy (AH) concomitant with allergic rhinitis (AR) report poor responses to intranasal steroids. To determine whether the combination of mometasone furoate (MF) and oxymetazoline (OXY) is more effective than either agent alone, we performed a two-stage, parallel, randomized, double-blind, double-dummy, clinical trial with 240 AH children with concomitant perennial AR. During the first stage, all children were randomly assigned to the MF or control group for six weeks of treatment. During the second stage, the non-responders from stage one were randomly assigned to 4 groups for 8 weeks of treatment that involved receiving the following treatments: MF/OXY, MF/placebo, placebo/OXY, or placebo/placebo. During the first stage of treatment, 39% of the responders treated with MF achieved greater reductions in total and individual symptom scores than did those on placebo. During the second stage of treatment, the nasal congestion scores of the MF/OXY group significantly decreased. The adenoid/choana ratio of the MF/OXY-treated group decreased and the nasal volume increased significantly. Our results suggest that the combination of OXY and MF is effective and safe for the treatment of AH children with concomitant AR and has a rapid onset of action.

Topics: Adenoids; Case-Control Studies; Child; Demography; Female; Humans; Hypertrophy; Male; Mometasone Furoate; Nose; Oxymetazoline; Patient Compliance; Rhinitis, Allergic, Perennial

To compare the difference in the clinical efficacy on perennial allergic rhinitis between three nasal points acupuncture therapy and the oral administration of loratadine so as to provide the better acupuncture program in clinical treatment.. Sixty cases were randomized into an acupuncture group (30 cases) and a medication group (30 cases). In the acupuncture group, acupuncture was applied to three nasal points [Yingxiang (LI 20), Yintang (EX-HN 3), Bitong (Extra)] and acupoints selected by syndrome differentiation. Acupuncture was given once every two days, three times a week, for 4 weeks totally. In the medication group, loratadine was prescribed for oral administration, 10 mg every day, for 4 weeks. The symptom and physical sign scores before and after treatment, as well the short-term and long-term efficacy were compared between the two groups.. The total effective rate was 96.7% (29/30) in the acupuncture group and was 93.3% (28/30) in the medication group after treatment. The efficacy was similar between the two groups (P>0.05). In follow-up, the total effective rate was 86.7% (26/30) in the acupuncture group, which was better than 56.7% (17/30, P<0.05) in the medication group. The scores of symptoms and physical signs after treatment and in follow-up were all reduced apparently as compared with those before treatment in the patients of the two groups (all P<0.05). The scores of symptoms and physical signs were reduced more apparently in the acupuncture group as compared with those in the medication group in follow-up (all P<0.05).. The acupuncture at three nasal points and the acupoints selected by syndrome differentiation achieves the similar short-term efficacy on perennial allergic rhinitis as compared with the oral administration of loratadine. The acupuncture therapy presents the obvious advantages on long-term efficacy.

Topics: Acupuncture Points; Acupuncture Therapy; Adult; Female; Humans; Male; Middle Aged; Nose; Rhinitis, Allergic, Perennial; Young Adult

Probiotics are defined as 'living micro-organisms that when administered in adequate amounts confer a health benefit to the host'. Different probiotic strains have been investigated for beneficial effects on allergic disorders. The purpose of the current study was to evaluate the effect of orally administering the probiotic Nestlé culture collection (NCC)2818 Bifidobacterium lactis strain on immune parameters and nasal symptom scores in subjects suffering from seasonal allergic rhinitis (SAR).. The study was a double-blinded, parallel, randomized placebo-controlled trial conducted during the peak of the pollen season. Adult subjects with clinical history of SAR and positive skin prick test to grass pollen were recruited. The subjects received B. lactis NCC2818 or placebo for 8 weeks and completed symptom questionnaires every week. Whole blood was collected at baseline (V1), 4 weeks (V2) and 8 weeks (V3) to measure immune parameters.. Concentrations of Th-2 cytokines, secreted by stimulated blood lymphocytes, were significantly lower in the probiotic group compared with the placebo group at V3 (interleukin (IL)-5, P=0.016; IL-13, P=0.005). Total nasal symptom scores were significantly lower in the second month of the study (weeks 5-8) in the probiotic group compared with the placebo group (P=0.03). Also, percentages of activated CD63 expressing basophils were significantly lower in the probiotic group at V2 (P=0.02).. Oral administration of the probiotic NCC2818 mitigates immune parameters and allergic symptoms during seasonal exposure. These promising results warrant that B. lactis NCC2818 be investigated further in large-scale trials for management of respiratory allergy.

Topics: Adult; Basophils; Bifidobacterium; Double-Blind Method; Female; Humans; Immunologic Factors; Interleukin-13; Interleukin-5; Interleukins; Leukocytes; Lymphocytes; Male; Nose; Poaceae; Pollen; Probiotics; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Seasons; Species Specificity; Surveys and Questionnaires; Tetraspanin 30; Th2 Cells

House dust mites are a major source of aeroallergens for patients with allergic rhinitis and asthma. Most patients with allergic rhinitis are simultaneously sensitized by Dermatophagoides pteronyssinus (Dp) and Tyrophagus putrescentiae (Tp). Dp and Tp allergy in allergic rhinitis can be caused by cross-reactivity, and the group 2 mite allergens appear to be the major cross-reactive allergens in mites. We previously demonstrated that local nasal immunotherapy (LNIT) with Dp-coated strips could modulate the serum levels of Dp-specific IgE. The aim of this study was to investigate whether Tp allergy could be modulated by LNIT with Dp.. Both Tyr p2-specific IgE in the sera and its effect on Tyr p2-triggered basophil histamine release (BHR) were measured to evaluate the Tp-mediated allergic reaction before and after LNIT.. The results showed that not only was Tyr p2-specific IgE reduced, but also Tyr p2-triggered histamine release in the sera after LNIT with Dp allergen strips. There was a significant reduction of Tyr p2-specific IgG1 and upregulation of IgG4 after LNIT with Dp allergen strips. When the amounts of histamine were compared between the two groups, rDer p2-triggering or rTyr p2-triggering histamine release was significantly reduced in the Dp treatment group compared with the normal saline treatment group. No matter in the rDer p2-triggering or rTyr p2-triggering histamine release, differences between before LNIT and after LNIT were statistically significant in the Dp group.. Our study demonstrated that not only was Tyr p2-specific IgE reduced in the sera, but also its biological activity of Tyr p2-triggered BHR after LNIT with Dp strips. It is conceivable that the clinical effectiveness of Tp allergy by LNIT with Dp allergen strips may exist.

Topics: Administration, Topical; Adult; Allergens; Animals; Dermatophagoides pteronyssinus; Desensitization, Immunologic; Double-Blind Method; Female; Humans; Male; Nose; Proteins; Rhinitis, Allergic, Perennial

The aim of this study is pursue the effect of herbal point-patch treatment on allergic rhinitis patients by investigation of the changes of serum total IgE (T-IgE) and eosinophile cationic protein (ECP) levels and through assessment of the results of SF-36 and rhinitis severity questionnaires. A prospective, randomized, single-blind, parallel, controlled study was used. Forty- three eligible participants were selected from outpatients of the Dept. of Ear, Nose, and Throat and Chinese medicine clinic, and 33 eligible participants completed the treatment satisfactorily. Participants used a Chinese herbal point-patch or a placebo patch once a week, for three hours at a time, after being randomly assigned to a control or an experimental group. Each treatment course was three weeks in duration, and each participant underwent two courses of treatment. Before and after each course, participants evaluated the effectiveness of the treatment by completing a questionnaire, and blood samples were collected for T-IgE and ECP analysis. The data revealed that the acupoint herbal patch is a valuable treatment for allergic rhinitis, especially in the symptoms of sneezing, running and itchy nose. The results of the SF-36 indicate a distinct improvement in GH (general health) and VT (vitality) in patients treated with acupoint herbal patches. This study supports the belief that the acupoint herbal patch is an effective treatment for allergic rhinitis and can significantly improve general health, social life and vitality in quality of life.

Topics: Acupuncture Points; Administration, Cutaneous; Adolescent; Adult; Child; Drugs, Chinese Herbal; Eosinophil Cationic Protein; Female; Humans; Immunoglobulin E; Magnoliopsida; Male; Nasal Mucosa; Nose; Phytotherapy; Quality of Life; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Single-Blind Method; Sneezing; Surveys and Questionnaires; Treatment Outcome; Young Adult

End-organ hyperreactivity is an important feature of the allergic airway. There are no data directly comparing the responsiveness to treatment of different nasal provocation tests (NPT).. We compared the effect of levocetirizine on nasal adenosine 5'-monophosphate (AMP) with specific allergen challenge in patients with intermittent and persistent allergic rhinitis (AR).. Patients with AR were randomized in double-blind cross-over fashion to receive single doses of levocetirizine 5 mg or identical placebo, with nasal challenge performed 12 h after dosing. Sixteen participants completed per protocol. Nasal AMP or allergen challenge was conducted on separate days with 1- and 2-week washout periods in between, respectively. Measurements of peak nasal inspiratory flow (PNIF) were made over 60 min after each challenge. The primary end-point was the provocative concentration of AMP or allergen causing a 20% drop in the PNIF (PC(20)).. The time-profile for PNIF recovery [area under the 60 min time-response curve as % PNIF change (min)] were significantly attenuated for AMP challenge, as mean difference [95% confidence interval (CI)]: 11.57 (3.87, 19.25), P=0.005 and for allergen challenge: 17.82 (0.11, 35.53), P=0.04. A highly significant correlation was shown between methods for the area under the curve: (R=0.86, P<0.001). A statistically significant correlation was also seen for the PC(20): (R=0.94, P<0.001). PC(20) improvement amounted to a 1.26 (95% CI 0.16, 2.35) and 0.16 (95% CI -0.41, 0.73) doubling-dilution shifts for allergen and AMP challenges, respectively. Bland-Altman plots confirmed good agreement between methods.. A high correlation and statistical agreement has been demonstrated between AMP and allergen challenge for all outcome measures. In particular, the recovery profile after NPT is a sensitive and discriminatory measure of anti-allergic treatment.

Topics: Adenosine Monophosphate; Adult; Aged; Allergens; Area Under Curve; Cetirizine; Cross-Over Studies; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Provocation Tests; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Treatment Outcome; Young Adult

There is an increasing knowledge that the severity of perennial allergic rhinitis is associated with nasal carriage of Staphylococcus aureus (S. aureus). The aim of this study was to evaluate the rate of bacterial colonization with S. aureus in the nose of subjects with and without chronic rhinosinusitis (CRS) and to correlate these findings with the severity of symptoms and the extent of the disease.. Open, prospective controlled trial.. 190 subjects with CRS and 42 subjects with septal deviation without sinusitis (control subjects) were included in this study. Swabs were taken endoscopically from the middle meatus and bacteria were cultured and identified. Airway symptoms were assessed by subjects in standardized questionnaires and frequencies of respiratory tract infections were noted. The rhinosinusitis extent was graded by CT scan assessment. Analysis of variance, chi-square test, and Pearson's correlation test were applied for statistical analyses.. The S. aureus carriage rate was 25.5% in CRS and 31.4% in control subjects. Further facultative pathogens were cultured in 20.6% of subjects with CRS and in 8.5% of controls. 73.8% of S. aureus were ampicillin-resistant, multiresistant strains were cultured in 5.8%. Most airway symptoms and the frequencies of respiratory tract infections were significantly higher in the CRS group compared with control subjects. In post hoc comparison between the subgroups with and without S. aureus colonization, no significant differences were found between the extent of rhinosinusitis and the severity of airway symptoms.. Facultative pathogens were detected in more than 40% of CRS patients without acute respiratory tract infections. In contrast to the findings in atopic dermatitis and perennial allergic rhinitis, the colonization rate with S. aureus is not increased and S. aureus carriage is not a risk factor for the severity or the extent of rhinosinusitis.

Topics: Adult; Chronic Disease; Female; Humans; Hypersensitivity; Male; Middle Aged; Nose; Prospective Studies; Rhinitis, Allergic, Perennial; Severity of Illness Index; Sinusitis; Staphylococcus aureus

Using conventional methods, it has been difficult to show differences in efficacy between intranasal corticosteroids in perennial rhinitis.. To compare the effects of budesonide and mometasone on nasal symptoms and nasal airflow in perennial allergic rhinitis.. Four hundred thirty-eight patients (age > 18 years old) were randomized to budesonide, 256 microg or 128 microg, mometasone furoate 200 microg, or placebo, once daily for 4 weeks. Efficacy was evaluated by nasal index score (NIS; the sum of scores for blocked nose, runny nose, and itchy nose/sneezing) and peak nasal inspiratory flow (PNIF).. All three active treatments significantly reduced the NIS compared with placebo. There was no significant difference between the treatments, although the effect of budesonide, 256 microg, tended to be greater than that of the other regimens. PNIF was significantly improved with all three active treatments: the effect of budesonide 256 microg on morning and evening PNIF was significantly greater than that of mometasone furoate and 128 microg budesonide. Budesonide had a rapid onset of action, showing a significantly greater effect on evening PNIF than mometasone furoate during the first 10 days. For all active treatments, significant improvements in NIS were seen within 4 hours of the first dose. All three treatments were well tolerated.. The objective parameter PNIF was capable of demonstrating greater efficacy of budesonide 256 microg compared with budesonide 128 microg and mometasone furoate 200 microg, whereas the combined nasal symptom score could only distinguish active treatment from placebo.

Topics: Administration, Intranasal; Adult; Aged; Budesonide; Female; Humans; Hungary; Inspiratory Capacity; Male; Middle Aged; Mometasone Furoate; Nose; Portugal; Pregnadienediols; Rhinitis, Allergic, Perennial; Spain; Sweden

Nonsedating H1 antihistamines such as terfenadine, loratadine, and astemizole are widely prescribed for the treatment of allergic rhinitis. The comparative efficacy of these agents has not been thoroughly studied. We studied 14 subjects in an open-label four-way crossover trial. Patients were recruited from an outpatient allergy clinic. Inclusion criteria were documented rhinitis symptoms for at least 2 years before the study and skin-test positivity in response to perennial allergens. Each subject underwent sequential 2-week trials of each of four H1 antihistamines: terfenadine, loratadine, astemizole, and chlorpheniramine. No placebo was included. Outcome measures were subjective rhinitis symptom scores, overall efficacy scores, and concomitant pseudoephedrine use. In addition, nasal-examination scores were obtained by way of physician assessment at the end of each 2-week trial, and side effects were tabulated. Nasal-examination scores for each of the four H1 antihistamines were significantly better than the baseline scores (p < 0.05). No statistically significant differences in rhinitis symptom scores, overall efficacy scores, or concomitant pseudoephedrine use were noted. We detected no clinically significant differences in efficacy among terfenadine, loratadine, astemizole, and chlorpheniramine in the treatment of perennial allergic rhinitis.

Topics: Adrenergic Agents; Allergens; Ambulatory Care; Analysis of Variance; Anti-Allergic Agents; Astemizole; Bronchodilator Agents; Chlorpheniramine; Confidence Intervals; Cross-Over Studies; Ephedrine; Female; Histamine H1 Antagonists; Humans; Loratadine; Male; Nasal Mucosa; Nose; Rhinitis, Allergic, Perennial; Skin Tests; Terfenadine; Treatment Outcome

Acoustic rhinometry (AR) was used for objective measurements of nasal cavity dimensions in conjunction with a 100-mm horizontal visual analogue scale (VAS) for simultaneous subjective assessments of nasal sensations of airflow. Studies were conducted on 45 patients with perennial allergic rhinitis before, during and after a 2-week period of treatment with oral emedastine difumarate, azelastine hydrochloride, and xiao qing long tang (a homeopathic decongestant), as well as intranasal fluticasone propionate aqueous nasal spray. During the treatment period, there was a significant increase in the right and left minimum cross-sectional areas (MCA) of the nose and/or nasal cavity volumes (NCV) in all groups. The average increase in MCA ranged from 21-39% after 1 week of treatment and 16-39% after 2 weeks, whereas that in the NCV ranged from 16-24% and 19-24%, respectively. Post-treatment measurements were not significantly different from the corresponding pre-treatment ones. These findings were in close agreement with that obtained with VAS, demonstrating that AR can be used to validate the application of VAS in the evaluation of nasal airflow during medical therapy.

Topics: Acoustics; Administration, Intranasal; Administration, Oral; Adult; Androstadienes; Anti-Allergic Agents; Benzimidazoles; Evaluation Studies as Topic; Female; Fluticasone; Follow-Up Studies; Histamine H1 Antagonists; Homeopathy; Humans; Imidazoles; Male; Middle Aged; Naphazoline; Nasal Cavity; Nasal Decongestants; Nasal Obstruction; Nose; Phthalazines; Pulmonary Ventilation; Reproducibility of Results; Rhinitis, Allergic, Perennial

Topical sodium cromoglycate is used to treat allergic diseases of the upper and lower airways. To investigate its mechanisms of action, intranasal histamine challenge was used in nine subjects with perennial allergic rhinitis. After a preliminary day where subjects' reactivity thresholds (D100) for histamine were determined, intranasal sodium cromoglycate was administered in a double-blind, placebo-controlled fashion. Graded (D100/3, D100, D100X3), sequential challenges were performed on days 1 and 21 of each course, and responses measured by changes in nasal airway resistance, sneezes, secretion volume and secretion content: total protein, lysozyme and mucin. After a single dose of sodium cromoglycate, there was no change in resistance, but secretion volumes fell significantly (3.12 ml/5 min c.i. 2.83-3.4; placebo 3.61, c.i. 3.32-3.90: P = 0.026). After a 3-week-course, there was a significant fall in resistance (4.29 cm H2O/l/s, c.i. 3.85-4.72; placebo 5.45, c.i. 5.01-5.88: P < 0.0001). No change in other parameters was observed. Thus, in perennial allergic rhinitis, intranasal sodium cromoglycate has both short- and long-term effects on nasal reactivity to histamine challenge. Acutely, there is a reduction in nasal lavage fluid volume which may be the result of reduced irritant receptor activity. After a 3-week course, there is a reduction in nasal resistance responses, a possible anti-inflammatory effect.

Topics: Administration, Intranasal; Adult; Aged; Airway Resistance; Anti-Inflammatory Agents; Cromolyn Sodium; Double-Blind Method; Female; Histamine; Humans; Male; Middle Aged; Mucins; Muramidase; Nasal Lavage Fluid; Nasal Mucosa; Nasal Provocation Tests; Nose; Placebos; Proteins; Rhinitis, Allergic, Perennial; Sneezing

Local nasal hyperthermia or inhalation of heated water vapor is often recommended as a home remedy for various rhinitis disorders such as the common cold and allergic rhinitis. Inhaled heated vapor treatments and simple saline solution nasal irrigation were investigated for their effect on inflammatory mediator production in nasal secretions.. Three treatments were given for nasal irrigation: heated water particles (large particle water vapor) at 43 degrees C, heated molecular water vapor (molecular water vapor) at 41 degrees C, and simple saline solution nasal irrigation. Nasal washes were done before each treatment (baseline), immediately after treatments, and at 30 min, 2, 4, and 6 h. Histamine, prostaglandin D2, and leukotriene C4 (LTC4) concentrations were measured in nasal secretions and compared with baseline values.. Thirty symptomatic patients with active perennial allergic rhinitis underwent three treatments at weekly intervals.. Nasal histamine concentrations fell substantially with the nasal irrigation (p < 0.01 immediately posttreatment and at 30 min; p < 0.05 at 2, 4, and 6 h). Large particle vapor also reduced histamine concentrations for up to 4 h posttreatment compared with baseline values (p < 0.05). Alternatively, molecular water vapor did not alter nasal histamine concentrations. Surprisingly, the three treatments did not alter prostaglandin D2 concentrations over the 6 h. Leukotriene C4 concentrations fell briefly after the large particle treatment but did not with the molecular water vapor. With saline solution irrigation, LTC4 concentrations in nasal secretions were lower than baseline at 30 min to 4 h after a treatment (p < 0.05).. This study demonstrated the usefulness of large particle vapor treatment and saline solution irrigation in reducing inflammatory mediators in nasal secretions and indirectly supports the clinical efficacy of these treatments for chronic rhinitis.

Topics: Adolescent; Adult; Aged; Cross-Over Studies; Humans; Hyperthermia, Induced; Inflammation Mediators; Middle Aged; Nasal Lavage Fluid; Nose; Radioimmunoassay; Rhinitis, Allergic, Perennial; Therapeutic Irrigation; Time Factors

Nasal lavage and challenge studies in allergic rhinitis implicate prostaglandin (PG) D2 in the genesis of nasal blockage. PG D2 is known to act via at least two receptors, the thromboxane prostanoid receptor and the PG D2 prostanoid (DP) receptor; the lower airway effects are mediated chiefly by the TP receptor. The receptor involved in the genesis of PG D2-induced nasal blockage is unknown. BAY u 3405 is a potent selective competitive TP receptor antagonist, which inhibits the lower airway response to PG D2, and shifts the dose-response curve to the right by up to 16-fold.. The efficacy of a single oral dose of 20 mg of BAY u 3405 was examined in comparison with PG D2 nasal insufflation in a randomized, double-blind, placebo-controlled crossover study, with objective measurement of nasal resistance by active posterior rhinomanometry.. BAY u 3405 afforded no protection against PG D2-induced nasal blockage.. This suggests that PG D2-induced nasal blockage may be mediated by the DP receptor rather than the TP receptor and that TP receptor antagonists are unlikely to be of benefit in the treatment of allergic rhinitis. In vivo investigation with specific potent DP receptor antagonists is awaited.

Topics: Adult; Aged; Airway Resistance; Carbazoles; Dose-Response Relationship, Drug; Double-Blind Method; Humans; Male; Middle Aged; Nasal Provocation Tests; Nose; Prostaglandin D2; Receptors, Thromboxane; Rhinitis, Allergic, Perennial; Sulfonamides

The effect of azelastine 2 mg b.d. p.o. for 10 days on grass pollen-induced nasal responses in 16 patients with grass pollen allergic rhinitis has been assessed. The study was a double blind, randomized, placebo controlled, crossover trial, with a 10-14 day wash-out period. Patients were challenged with grass pollen before and after placebo and azelastine. The response was assessed by measurement of nasal resistance using active posterior rhinomanometry, by weighing nasal secretions, and by counting sneezes. The sensation of nasal obstruction was assessed with a visual analogue scale. After measurement of baseline total nasal resistance, doubling doses of allergen were sprayed into both nostrils at 15 min intervals until the nasal resistance was doubled. Cumulative doses of allergen that doubled prechallenge nasal resistance, numbers of sneezes and the amounts of nasal secretions were similar before azelastine as well as before and after placebo (cumulative dose, mean, (microgram): 2.3, 4.2 and 2.1 respectively, N.S.). After azelastine, the cumulative dose of allergen was increased (7.3 micrograms), and nasal secretions and the number of sneezes were decreased. The visual analogue scores were similar before and after azelastine as well as before and after the placebo. It is concluded that azelastine reduced the allergen-induced nasal responses.

Topics: Adult; Airway Resistance; Allergens; Female; Histamine H1 Antagonists; Humans; Male; Nose; Phthalazines; Pollen; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Time Factors

A new formulation of intranasal flunisolide containing less propylene glycol was compared with the original formulation for efficacy and acceptability in more than 200 patients with symptoms of perennial allergic rhinitis. In this multicenter, randomized, double-blind, parallel group study, symptomatic patients were treated with either the new or the original formulation of 0.025% solution of intranasal flunisolide for 4 weeks to provide 200 micrograms flunisolide daily. Both formulations were highly effective in decreasing symptom scores as evident from patient diary reports before and after treatment (P less than .001). Similarly, nasal airflow was improved with each treatment as measured by anterior rhinomanometry (P less than .0002) and the number of patients with nasal eosinophilia decreased (P less than .01). Finally, fewer patients using the new formulation reported nasal burning or stinging and the acceptability rating of the new formulation was higher.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Dosage Forms; Double-Blind Method; Fluocinolone Acetonide; Humans; Middle Aged; Multicenter Studies as Topic; Nose; Patient Acceptance of Health Care; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial

A study of 18 patients with chronic rhinitis who underwent anterior or radical trimming of the inferior turbinates is presented. Radical trimming produced a significant decrease in both total nasal resistance to airflow and subjective nasal obstruction (P less than 0.005). Anterior trimming produced a significant decrease in total nasal resistance to airflow (P less than 0.05), but had no significant effect on subjective nasal obstruction. These results suggest that the main site of nasal resistance in patients with chronic rhinitis is the same as in the normal nose. On the basis of this study, adoption of anterior trimming in place of radical trimming of the inferior turbinates cannot be recommended.

Topics: Adolescent; Adult; Airway Resistance; Female; Humans; Male; Middle Aged; Nose; Random Allocation; Rhinitis, Allergic, Perennial; Rhinitis, Vasomotor; Turbinates

The influence of mouth breathing on craniofacial development has previously been demonstrated. Recent investigations do indicate, however, that head posture also might be related to craniofacial morphology. The aim of the present study was to analyze the effect of a topical steroid spray (Budesonide) on nasal respiratory resistance and head posture in children with asthma and nasal obstruction. Thirty-seven children, 8 to 15 years of age, with bronchial asthma, perennial allergic rhinitis, and subjectively assessed mouth breathing were selected for the study. Rhinomanometric and cephalometric analyses were performed. Head posture was defined as the position of the head relative to the cervical column and to the true vertical. After the first examination the children were randomly allocated to two groups, of which one group was treated intranasally with Budesonide (N = 18) and the other with placebo (N = 19), for a double-blind study. After one month of treatment, there was a statistically significant decrease in nasal resistance (p less than 0.001) and an increased flexing of the head (p less than 0.01) (paired t tests) in the children under active treatment. No significant changes were seen in the placebo group. The results indicate that Budesonide nasal spray is capable of reducing nasal obstruction in allergic children and that a reduced nasal resistance leads to a decrease in craniocervical angulation. The clinical importance of these results is yet to be clarified.

Topics: Adolescent; Airway Resistance; Asthma; Budesonide; Cephalometry; Child; Double-Blind Method; Female; Head; Humans; Male; Nose; Pregnenediones; Rhinitis, Allergic, Perennial

Nitric oxide (NO) is a potential marker in the diagnosis and monitoring of treatment for the management of patients with allergic rhinitis (AR). The study aimed to determine the value of nasal fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment response of AR patients.. The participants were divided into control and allergic rhinitis groups based on the clinical symptoms and skin prick tests. The AR group was treated with intranasal corticosteroid after the diagnosis. The nasal fractional exhaled nitric oxide (FENO) levels were compared between control and AR groups. In the AR group, the visual analogue scale (VAS), Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, and nasal fractional exhaled nitric oxide (FeNO) were assessed pre- and post-treatment.. One hundred ten adults were enrolled. The nasal FeNO level was significantly higher in AR compared to control (. Nasal FeNO level is significantly higher in AR compared to control group with significant difference pre- and post-treatment. The findings suggest nasal FeNO can serve as an adjunct diagnostic tool together with the monitoring of treatment response in AR.

Topics: Adult; Breath Tests; Fractional Exhaled Nitric Oxide Testing; Humans; Nasal Obstruction; Nitric Oxide; Nose; Rhinitis, Allergic; Rhinitis, Allergic, Perennial

Acanthosis nigricans (AN) is a well-known cutaneous condition that is most commonly associated with insulin resistance and obesity when present in a pediatric patient. We present a unique presentation of AN in an adolescent African American girl with a history of perennial allergic rhinitis. She presented with AN affecting the neck, axillae, as well as the transverse nasal crease, a consequence of habitual pushing of the nasal tip upward due to chronic obstruction and itching from allergic rhinitis known as the "allergic salute." All providers should be aware of this rare presentation, as the presence of AN should prompt additional evaluation to determine the underlying cause and effect of appropriate treatment.

Topics: Acanthosis Nigricans; Child; Female; Humans; Nasal Obstruction; Nose; Pediatric Obesity; Rhinitis, Allergic, Perennial

Allergic rhinitis (AR) is a very common, chronic and global health problem. In the last two decades, the efficiency of barrier-enforcing measures in AR has been investigated. In this study, we aimed to evaluate the effect of allergen-blocker mechanical barrier gel (MBG) (AlerjiSTOP. A single-center, prospective study was conducted between January 2017 and May 2018. Patients diagnosed with allergic rhinitis with a visual analogue scale (VAS) of 5 or higher (moderate/severe) were enrolled in the study. Patients were evaluated in terms of VAS, nasal symptom score (NSS), ocular symptom score (OSS), total symptom score (TSS) and QoLS at baseline, 1 week and 1 month of MBG treatment.. A total of 83 patients with AR were enrolled in the study. Clinical and laboratory examinations showed that 50 (60.2%) patients were mono-sensitized. Allergen-blocker mechanical barrier gel treatment was performed as monotherapy in 22 (26.5%) patients. Median VAS, NSS, OSS and TSS decreased from 7 to 4, 8 to 3, 4 to 0 and 12 to 4, respectively (p < 0.0001). Correlation analysis revealed positive correlations between lower pediatric rhinoconjunctivitis quality of life questionnaire scores for patients under 12 years of age and decrease in VAS, NSS and TSS (r = 0.380, p = 0.008; r = 0.544, p < 0.0001; r = 0.543, p < 0.0001). Positive correlations were detected between lower rhinoconjunctivitis quality of life questionnaire (self-administered) scores for patients ≥ 12 years of age and decrease in VAS, NSS, OSS and TSS (r = 0.703, p < 0.0001; r = 0.465, p = 0.005; r = 0.526, p = 0.001; r = 0.624, p < 0.0001).. In conclusion, we found significant decrease in all symptom scores and improvement in QoLS of patients treated with MBG as monotherapy and combination therapy.

Topics: Administration, Intranasal; Adolescent; Allergens; Child; Conjunctivitis, Allergic; Female; Gels; Humans; Male; Nose; Prospective Studies; Quality of Life; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Surveys and Questionnaires; Visual Analog Scale

To determine whether findings on fiberoptic nasolaryngoscopy beyond the nasal cavity can aid in diagnosis of atopy.. Case control analysis of patients undergoing fiberoptic nasolaryngoscopy and allergy testing at a single academic institution.. Patients who underwent flexible nasolaryngoscopy for either laryngeal or nasal symptoms and allergy testing by in vitro methods were divided into an atopic group and a nonatopic control group based on results of allergy testing. Three board-certified otolaryngologists who were blinded to the atopic status and symptoms viewed 88 patient videos and filled out an 8-item endoscopic rating questionnaire for each. Correlation between rater scores, endoscopic findings, and atopic status was calculated using Randolph's multirater kappa values and Mann-Whitney test.. Intrarater reliability was moderate to perfect for all physicians on all questions (kappa 0.545-1.0). Inter-rater reliability was slight to fair (kappa 0.143-0.399) for all questions and the overall impression of atopic disease. Abnormalities of the torus tubarius (P = .007) and increased nasopharyngeal secretions (P = .038) were predictive of atopic disease, whereas the presence of an adenoid (P = .08) and impression of atopic disease (P = .15) approached significance. All other endoscopic measures were not predictive of atopic status.. Fiberoptic nasolaryngeal findings within the nasopharynx rather than the larynx are predictive of a positive atopic status.. 3b.

Topics: Adult; Case-Control Studies; Fiber Optic Technology; Humans; Immunoglobulin E; Laryngoscopy; Male; Nose; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Rhinitis, Allergic, Perennial

Optimal medication should be characterized by good bioavailability, rapid onset of action, a long period of therapeutic activity, with preserved high safety profile and the lowest possible risk of side effects. Therefore, in addition to traditional drug administration routes, such as oral or injection, novel methods for drug applications, for example in the form of a nasal application have been developed. Because of the anatomy of the nose, drugs administered intranasally can be rapidly absorbed and, depending on the nature of the active substance, may act locally on the mucosa or can have a significant systemic effect. Most nasal drugs are developed in the form of solution administered as aerosol. In some cases, these solutions are thixotropic. They are able to change their physical properties under agitation to facilitate supply of the drug and its adhesion to the mucosa. Intranasal corticosteroids represent the mainstay of treatment for any form of chronic allergic rhinitis (AR) and moderate to severe periodic AR, especially with impaired nasal obstruction and frequent occurrence of symptoms. The article discusses the rheological properties of intranasal corticosteroids, their role in therapy and efficacy in the everyday clinical practice.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Humans; Nasal Sprays; Nose; Rhinitis, Allergic, Perennial

Allergic rhinitis is a major chronic respiratory disease which more than 500 million people suffer from around the world. It is considered to be an immuno-neuronal disorder, but little is known about the part played by the neural system in nasal allergic reaction. This is due mainly to the lack of objective measurement techniques producing accurate, reliable and continuous measurement data about the dynamic changes in nasal respiratory function. Here, a method to assess the association of nasal airflow resistance and the underlying function of autonomic nervous system (ANS) is presented and used during the birch pollen provocation test. Ten allergic volunteers were challenged with allergen. Continuous nasal airflow resistance and spectral heart rate variability parameters were computed and analyzed for the dynamic changes. The derived signals show in detail the timing and intensity differences in subjects' reactions. After the provocation, the nasal airflow resistance rose gradually, whereas LF power and LF/HF ratio decreased gradually for all subjects. This implies gradually increasing sympathetic withdrawal in allergic patients during the provocation with allergen. The proposed method opens entirely new possibilities to assess accurately the dynamic and short-term changes in non-stationary nasal function and could increase the accuracy and reliability of diagnostics and assessment of the effect of nasal treatments.

Topics: Adult; Algorithms; Allergens; Autonomic Nervous System; Betula; Female; Heart Rate; Humans; Male; Nasal Provocation Tests; Nose; Pollen; Reproducibility of Results; Respiration; Rhinitis, Allergic, Perennial; Young Adult

The aim of the present study was to evaluate the effect of allergic rhinitis (AR) on the nasal flora and colonization rates of resistant microorganisms in comparison to healthy individuals. This colonization may be important in terms of AR-related disorders, the resistant microorganisms' carriage, and its complications and co-morbidities. The study was performed with two groups. The study group was composed of 54 adult patients with AR. The control group was composed of 50 healthy individuals. None of the individuals in both groups have used any antibiotics, local or systemic steroid within the last month. Composition of bacterial nasal flora and carriage rates of methicillin-resistant Staphylococcus aureus (MRSA) were evaluated with conventional methods by taking nasal smears with a swab. In the study group, methicillin-sensitive coagulase-negative staphylococci (MRCNS) were detected in 30%; whereas diphtheroids in 25%, methicillin-resistant coagulase-negative staphylococci in 13%, methicillin-sensitive S. aureus in 9%, methicillin-resistant S. aureus in 3.7%, and extended-spectrum beta lactamases-positive gram-negative bacilli (GR-ESBL+) in 3.7% were detected. In the control group, methicillin-sensitive coagulase-negative staphylococci were detected in 54%; whereas diphtheroids in 21%, methicillin-resistant coagulase-negative staphylococci in 1.5%, methicillin-sensitive S. aureus in 16%, methicillin-resistant S. aureus in 1.5%, Gr-ESBL(-) in 4%, and viridians streptococci in 3% were detected. It is found that the MRSA and MRCNS colonization is higher in patients with AR. This colonization may be important in terms of AR-related disorders, the resistant microorganisms' carriage, and its complications and co-morbidities in comparison to healthy subjects.

Topics: Adult; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Rhinitis, Allergic, Perennial; Young Adult

Until recently, Vidian neurectomy had been applied mainly in intractable vasomotor rhinitis and severe perennial allergic rhinitis. Although the results were excellent, the operation has not been applied recently because of the adverse events such as xerophthalmia and trigeminal neuralgia. To resolve these problems, a new surgical technique, posterior nasal neurectomy, was developed. In this report, we examined the effectiveness of posterior nasal neurectomy combined with the inferior turbinate surgery for severe perennial allergic rhinitis and intrinsic rhinitis by questionnaire.. Twenty patients who had undergone posterior nasal neurectomy combined with the inferior turbinate surgery between April in 2005 and March in 2009 were enrolled. Numeric Rating Scale was used to evaluate clinical symptoms and quality of life (QOL) of pre- and postsurgery. Frequency of medication (oral administration and nasal spray) was also evaluated.. Questionnaires were collected from 17 patients. As for all patients but one, the surgery significantly reduced rhinorrhea, nasal obstruction, and sneezing. Furthermore, QOL for many symptoms such as sleep disorder and malaise/feebleness was also significantly improved after the surgery. Eighty-one percent of patients were satisfied with the surgery.. Posterior nasal neurectomy combined with the inferior turbinate surgery is effective in alleviating clinical symptoms and improving QOL in the patients with severe perennial allergic rhinitis and intrinsic rhinitis, although a longer follow-up is needed.

Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Nasal Surgical Procedures; Nose; Quality of Life; Rhinitis, Allergic, Perennial; Rhinitis, Vasomotor; Surveys and Questionnaires; Treatment Outcome; Turbinates

Patients with nonallergic irritant rhinitis (NAIR) have symptoms of nasal congestion, nasal irritation, rhinorrhea, and sneezing in response to nasal irritants. We currently have no reliable objective means to quantify these patients' subjective symptoms. In this study, we used the transient receptor potential vanilloid receptor (TRPV1) receptor agonist, capsaicin, as an intranasal challenge while comparing the changes in blood flow with optical rhinometry between subjects with NAIR and healthy controls (HCs).. Six HCs and 6 NAIR subjects were challenged intranasally with saline solution followed by increasing concentrations of capsaicin (0.005 mM, 0.05 mM, and 0.5 mM) at 15-minute intervals. We recorded maximum optical density (OD) and numeric analog scores (NAS) for nasal congestion, nasal irritation, rhinorrhea, and sneezing for each subject after each challenge. Correlations between NAS and maximum OD were calculated.. Maximum OD increased with increasing concentrations of intranasal capsaicin in NAIR subjects. There were significant differences in maximum OD obtained for 0.05 mM and 0.5 mM capsaicin between NAIR subjects and HCs. Significant differences were found in the NAS for nasal irritation at 0.005 mM, 0.05 mM, and 0.5 mM, and nasal congestion at 0.5 mM. Correlation between maximum OD and mean NAS was most significant for 0.05 mM capsaicin.. Optical rhinometry with intranasal capsaicin challenge could prove a viable option in the diagnosis of NAIR. Further studies will investigate its use to monitor a patient's response to pharmacologic therapy and provide further information about the underlying mechanisms of NAIR.

Topics: Adolescent; Adult; Aged; Blood Flow Velocity; Capsaicin; Diagnostic Techniques, Respiratory System; Female; Humans; Irritants; Male; Middle Aged; Nose; Optics and Photonics; Rhinitis, Allergic, Perennial; Young Adult

Topics: Adult; Denervation; Female; Humans; Male; Middle Aged; Nasal Provocation Tests; Nose; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Treatment Outcome; Young Adult

CME EDUCATIONAL OBJECTIVES1.Recognize the transverse nasal crease and its association.2.Identify treatment options for milia in the nasal crease.3.Identify cutaneous findings associated with atopy in children. An 8-year-old male presented for evaluation of a lesion across his nasal bridge. This had been worsening and getting more prominent over the last 6 months. He frequently rubbed his nose with the palm of his hand due to rhinitis. His medical history was significant for asthma, allergic rhinitis, conjunctivitis, and resolved peanut allergy. He lived with his parents and was the youngest of five children. The boy's family history was significant for atopy in parents, and a sister with anaphylaxis to tree nuts. There was no family history of severe or scarring acne vulgaris. Review of systems was normal.

Topics: Child; Facial Dermatoses; Humans; Male; Nose; Rhinitis, Allergic, Perennial

The aim of the study was to evaluate the usefulness of PNIF in assessing nasal airway patency based on test results. The sample in the study was a group of 4 674 subjects, including 1291 people aged 6-7 years (woman 643, men 648), 1293 people aged 13-14 years (woman 625, men 668) and 2090 adults (woman 1284, men 806). The research method employed in the study was the measurement of peak nasal inspiratory flow using a peak flow meter with a suitable mask as used in rhinomanometry tests and with a flow rate ranging from 20 to 350 l/min. The study was conducted in 2006-2008 at the following centres: Katowice, Wroclaw, Krakow, Lublin, Warszawa, Bydgoszcz, Gdansk and in the rural areas of the former province of Zamosc.. For the purposes of the study, the average values for the subjects were calculated for a number of criteria: - subject age: The average PNIF value was 52,41/min for subjects aged 6-7 years(n=1291), 94.7 l/min for subjects aged 13-14 (n=1293) and 108.0 l/min for the adults (n=2090). Indeed statistical dependences for all aged groups were observed on level p<0,0005. -diagnosis: The average PNIF value for healthy was 52,3 l/min p=0,338 for subjects aged 6-7 years (n=680), 97,3 l/min p=0,279 for subjects aged 13-14 (n=640) and 111,7 l/min p=0,438 for the adults (n=1035) and for allergic rhinitis PNIF value was 50,41/min p=0,028 for subjects aged 6-7 years(n=310), 93,3 l/min p=0,299 for subjects aged 13-14 (n=389) and 107,71 1/min p=0,276 for the adults (n=623) and asthma PNIF value was 51,6/min for subjects aged 6-7 years(n=149) 87,3 l/min p=0,062 for subjects aged 13-14 (n=145) p=0,097 and 105,3 l/min p=0,13 for the adults (n=198) -exposure to tobacco smoke (adults): passive smoking - 105,311 min (n=1202) p=0,017, active smoking-119.1 l/min(n=885) p=0,108.. PINF is important investigative tool thanks which we can: to differentiate in dependence the functional state of nose from: put the recognition (the patients with allergic rhinitis, the bronchial asthma), the age and the studied sexes.

Topics: Adolescent; Adult; Age Distribution; Child; Comorbidity; Female; Humans; Inspiratory Capacity; Male; Middle Aged; Nasal Obstruction; Nose; Poland; Reference Values; Respiratory Function Tests; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Rhinomanometry; Smoking; Tobacco Smoke Pollution; Young Adult

Transnasal resection of the posterior nasal nerve (TRPN) is the surgical procedure for drug therapy-resistant, intractable allergic rhinitis (AR). Submucous inferior turbinectomy also improves nasal symptoms in severe AR. Surgical injury to this peripheral nerve fibre may be the major cause of the decrease in allergic symptoms. During submucous turbinectomy, we have identified the peripheral branches of the posterior nasal nerve in the inferior turbinate and resected them (SRPN). The aim of this study was to evaluate the therapeutic effects of turbinoplasty with SRPN in severe AR.. Improvements in subjective symptoms were compared between 13 patients who underwent SRPN with turbinoplasty (Group 1) and 11 who underwent TRPN combined with turbinoplasty and SRPN (Group 2) by retrospective chart review. Pre- and postoperative sneezing, rhinorrhea, and nasal obstruction were evaluated with questionnaires. Postoperative complications and drug therapy before and after surgery were investigated.. All symptoms improved postoperatively in both groups, with no significant differences in the improvements in nasal symptom scores between the groups.. SRPN combined with submucosal turbinectomy was shown to be a safe, useful, and efficient approach to patients with AR unresponsive to medical therapy. Although this is a short-term study, the results of this study suggest that SRPN represents one of the treatment options for intractable AR.

Topics: Adult; Denervation; Endoscopy; Female; Humans; Male; Nasal Mucosa; Nasal Obstruction; Nasal Surgical Procedures; Nose; Retrospective Studies; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Sneezing; Treatment Outcome; Turbinates

To test the immunoglobulin free light chain (FLC) from nasal secretion(s) and serum of patients with allergic rhinitis and non-allergic rhinitis for the purpose of exploring the possible immunological mechanism.. Sixty consecutive patients were selected between September and December in 2009, involving 30 patients with allergic rhinitis and 30 patients with non-allergic rhinitis, diagnosed by symptoms, signs, SPT and sIgE. Thirty volunteers was chosen as health control (HC). ELISA was used to detect the total IgE, eosinophil cationic protein (ECP), mast cell tryptase (MCT), κFLC, λFLC in nasal secretion and serum. The data was statistically analyzed by SPSS 17.0 software.. According to the VAS scores, the nasal symptoms of AR and NAR, including sneeze, nasal discharge, nasal obstruction and nasal itching were compared. There was no statistical difference (t value was 1.189, 0.741, 0.758, 0.797, respectively, P < 0.5); In serum, κFLC, λFLC, IgE, ECP & MCT were increased in NAR compared to HC (P < 0.05); λFLC was increased in NAR compared to AR group (P < 0.05), κFLC and ECP were increased in AR. There was no significant difference between AR and NAR (P < 0.05); In nasal secretion, κFLC, λFLC, IgE, ECP and MCT were increased in AR and NAR compared to HC, and the ECP and IgE were significantly increased in AR compared to NAR (P < 0.05). ; In nasal secretion, the FLCs revealed a significantly higher correlation with MCT (r value was 0.518 and 0.484, P < 0.01), and in serum revealed a significant correlation with ECP (r value was 0.343 and 0.342, P < 0.01).. Immunoglobulin free light chain takes part in the path of physiological process of allergic rhinitis and non-allergic rhinitis with the immunological mechanism.

Topics: Adolescent; Adult; Bodily Secretions; Case-Control Studies; Eosinophil Cationic Protein; Female; Humans; Immunoglobulin E; Immunoglobulin Light Chains; Male; Middle Aged; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Tryptases; Young Adult

The literature documents the fact that UV irradiation of cutaneous Langerhans cells (LC) in vivo prevents the development of contact allergy and produces long-lasting immunosuppression. However, not much is known about the effect of UV irradiation on the LC of the nasal mucosa and their connection with clinical scores. Local antigen presentation may be necessary for both primary and recall T cell responses to birch pollen in patients with hay fever. Endonasal phototherapy combination of UVB (5%), UVA (25%) and visible light (70%) utilises the immunosuppressive effects of UV irradiation. The aim of this study was to correlate clinical symptom scores with possible changes in the LC of the nasal mucosa induced by UV radiation. The clinical effectiveness of this form of treatment is discussed. Nasal biopsies were obtained from ten birch pollen-sensitive patients with seasonal rhinitis before and after endonasal phototherapy. All patients showed a significant clinical benefit post-treatment as assessed by standardised instruments, including total nasal symptom score, nasal congestion score, nasal itching score, sneezing score, nasal secretion score and impairment-to-health score. However, we found no significant morphological changes, to, or quantitative differences in, the CD1a+, CD4, CD8 or CD31 cells before and 14 days after treatment. Despite the positive clinical effect, the study revealed no effect of UV irradiation on the LC and other analysed cells of the nasal mucosa immune system. Possible reasons for this are discussed.

Topics: Adolescent; Adult; Biopsy; Endoscopy; Female; Follow-Up Studies; Humans; Immunity, Cellular; Male; Middle Aged; Nasal Mucosa; Nose; Phototherapy; Pollen; Rhinitis, Allergic, Perennial; T-Lymphocytes; Young Adult

Allergic rhinitis is a global public health issue. Peak nasal inspiratory flow (PNIF) can help in the assessment of patients with allergic rhinitis. However, reference values in the literature for PNIF in school children and adolescents are limited. THE AIM OF THIS STUDY was to identify reference values of PNIF among children and adolescents.. We conducted a cross-sectional study to identify reference values of PNIF among healthy school children and adolescents aged from eight to fifteen years old, selected from 14 randomly selected public schools. Participants performed measurements of PNIF using the In-check-inspiratory flow meter (Clement Clarke, Harlow, England). PNIF values were correlated to gender, age, height, weight and body mass index.. A total of 526 subjects participated in the study. The final linear regression model for PNIF allowed obtaining the following equation for subjects aged from eight to 15 years old: PNIF (l/m) = height (centimeters) x 0.7 + 11.2, for boys and PNIF (l/m) = height (centimeters) x 0.7, for girls.. the equations of the final regression model resulted in a simple formula to obtain reference values of PNIF for subjects aged from 8 to 15 years old.

Topics: Adolescent; Brazil; Child; Cross-Sectional Studies; Female; Humans; Inspiratory Capacity; Linear Models; Male; Nose; Reference Values; Rhinitis, Allergic, Perennial

Recently, a new set of pattern-recognition receptors, the nucleotide-binding oligomerization domain (Nod)-like receptors (NLRs), have emerged. Their activation, either by allergens or microbes, triggers an inflammatory response. The knowledge about NLRs in human airways is limited.. To investigate presence of NLRs in the human nose of healthy individuals and patients with intermittent allergic rhinitis outside and during pollen season.. The expression of Nod1, Nod2, and Nalp3 in nasal biopsies was determined with real-time RT-PCR and immunohistochemistry. Cultured primary human nasal epithelial cells (HNECs) were analyzed using real-time RT-PCR and flow cytometry to further verify the presence of NLRs in the epithelium.. Immunohistochemical analysis revealed presence of Nod1, Nod2, and Nalp3 in the nasal epithelium. This was corroborated in cultured HNECs. Patients suffering from symptomatic allergic rhinitis exhibited lower Nod1 and Nalp3 mRNA levels than both controls and patients during pollen season. Nod2 expression was found in all specimens tested, but no differences were seen between the three groups.. Nod1, Nod2, and Nalp3 receptors were found to be present in the human nose. The expression of Nod1 and Nalp3 were down-regulated during pollen season among patients with allergic rhinitis. This opens up for new insights and novel therapeutic strategies in inflammatory airway disease.

Topics: Carrier Proteins; Case-Control Studies; Cells, Cultured; Down-Regulation; Drug Delivery Systems; Epithelial Cells; Humans; NLR Family, Pyrin Domain-Containing 3 Protein; Nod1 Signaling Adaptor Protein; Nod2 Signaling Adaptor Protein; Nose; Receptors, Pattern Recognition; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Seasons

The concept of a sinus headache is problematic from neurology, allergology, and rhinology perspectives. It may be considered the final neurological diagnosis of exclusion when criteria for other craniofacial pain syndromes are not met. The International Headache Society definition implicates the presence of acute sinusitis, but this requirement is often not met in practice or with a patient's perception of the term. Otorhinolaryngologists have a similar exasperation with this cephalgia but tend to attribute idiopathic, nonallergic rhinopathy as the cause. Allergists often see patients who claim to have a sinus headache but instead have perennial allergic rhinitis or nonallergic rhinitis. A fresh perspective is required to determine the characteristics, differential diagnosis, and veracity of the sinus headache. We recommend using the term with caution only if the clinical picture meets the criteria for acute sinusitis-induced headache.

Topics: Diagnosis, Differential; Facial Neuralgia; Facial Pain; Headache; Humans; Neurology; Nose; Otolaryngology; Rhinitis, Allergic, Perennial; Sinusitis

Topics: Anti-Allergic Agents; Histamine Antagonists; Humans; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

We studied the effect of Brazilian propolis on sneezing and nasal rubbing in experimental allergic rhinitis of mice. A single administration of propolis caused no significant effect on both antigen-induced nasal rubbing and sneezing at a dose of 1000 mg/kg, but a significant inhibition was observed after repeated administration for 2 weeks at this dose. Propolis caused no significant inhibitory effect on the production of total IgE level after repeated administration of 1000 mg/kg. The drug also caused no significant inhibition of histamine-induced nasal rubbing and sneezing at a dose of 1000 mg/kg. On the other hand, propolis significantly inhibited histamine release from rat mast cells induced by antigen and compound 48/80 at a concentration of more than 10 microg/ml. These results clearly demonstrated that propolis may be effective in the relief of symptoms of allergic rhinitis through inhibition of histamine release.

Topics: Allergens; Animals; Brazil; Histamine; Immunoglobulin E; Male; Mice; Mice, Inbred BALB C; Nose; Propolis; Pruritus; Rats; Rhinitis, Allergic, Perennial; Sneezing

Because both allergic rhinitis and asthma are caused by eosinophilic airway inflammation, using the same method to measure the eosinophilic inflammation of both the upper and lower airway would be advantageous. The levels of nitric oxide in exhaled air (FeNO) and nasal air (nNO) are useful as noninvasive markers of eosinophilic airway inflammation. Although the off-line method of measuring these parameters is easier and more useful than the on-line method, studies using the off-line method are rare in Japan.. In Study 1, we measured the levels of nNO and FeNO in 9 healthy controls and 9 subjects with allergic rhinitis, to validate the methodology for using the off-line method to measure nNO. In Study 2, we measured the nNO and FeNO levels of and performed spirometry on 69 stable asthmatics treated with inhaled corticosteroid.. In Study 1, nNO levels were significantly increased in patients with allergic rhinitis compared with healthy subjects (31.0 [20.8 to 41.2] versus 7.4 [0.0 to 14.8] ppb {median [95% confidence interval]}, p=0.018). The 69 patients with asthma that comprised the study population in Study 2 were classified as asthmatics with rhinitis (treatment-naïve, n=14; treated with antiallergic drugs, n=11; treated with intranasal corticosteroid, n=19) and asthmatics without rhinitis (n=15). Although FeNO did not differ among groups, nNO was significantly increased in treatment-naïve asthmatics with rhinitis compared with patients with asthma only (26.5 [17.1 to 35.9] versus 8.0 [-1.1 to 17.1] ppb, p=0.033).. nNO levels measured by the off-line method are useful markers of allergic rhinitis.

Topics: Adult; Air; Asthma; Female; Humans; Male; Middle Aged; Nitric Oxide; Nose; Rhinitis, Allergic, Perennial; Spirometry

We aimed to study the reproducibility of several biomarkers of allergic rhinitis to investigate their potential as outcome measures in clinical intervention trials. Furthermore, we investigated the kinetics of the biomarkers studied in nasal lavage and brush material following a placebo-controlled nasal allergen challenge.. We performed a skin prick test and measured serum specific immunoglobulin (Ig) E levels and inflammatory biomarkers in nasal lavage and brush material in 20 patients with allergic rhinitis on 2 separate days (washout, 14-21 days). The patients were then randomly assigned to undergo an intranasal challenge with a relevant allergen (n=10) or diluent (n=10) in order to assess the kinetics of several biomarkers of allergic airway inflammation in nasal lavage and brush samples.. Baseline serum IgE levels and skin wheal sizes were highly reproducible measurements, with a coefficient of variation (CV) of 13.4% and 18.2%, respectively. This was not the case with the majority of inflammatory biomarkers, whose CV varied considerably (range, 6.1%-224.1%). The nasal allergen challenge induced an increase in composite symptom scores in all patients. Compared to placebo, tryptase (P=.004), eosinophilic cationic protein (ECP) (P=.03) and alpha2-macroglobulin (P=.002) were increased in nasal lavage at 20 minutes post allergen. Nasal lavage ECP levels and nasal brush eosinophils were still significantly increased at 7 hours (P=.03 and P=.04), but all statistical significance had been lost at 24 hours post challenge.. Serum specific IgE assays and skin prick tests exhibited good reproducibility in patients with clinically stable allergic rhinitis. We were also able to investigate the kinetics of allergen-induced upper airway inflammatory markers in nasal lavage and brush material. Hence, nasal allergen challenge, when used in combination with nasal lavage and brush sampling, is a suitable research tool for early drug development.

Topics: Adult; Allergens; Anti-Inflammatory Agents; Biomarkers; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Lavage Fluid; Nasal Provocation Tests; Nose; Reproducibility of Results; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Skin Tests

We examined the role of prostanoid DP receptor in nasal blockage in an experimental allergic rhinitis model in guinea pigs. Local inhalation of prostaglandin D(2) (PGD(2)) to the nasal cavity resulted in an increase in intranasal pressure in guinea pigs actively sensitized by repeated antigen exposure but not in non-sensitized guinea pigs. Nasal hyperresponsiveness was observed when the guinea pigs were exposed to histamine and U-46619 (11alpha, 9alpha-epoxymethano-PGH(2); a thromboxane (TX) A(2) mimetic) after repeated antigen exposure. S-5751 ((Z)-7-[(1R,2R,3S,5S)-2-(5-hydroxybenzo[b]thiophen-3-ylcarbonylamino)-10-norpinan-3-yl]hept-5-enoic acid), a prostanoid DP receptor antagonist, inhibited not only PGD(2)-induced nasal blockage but also nasal hyperresponsiveness to histamine and U-46619 in sensitized guinea pigs. Combined exposure of the nasal cavity of guinea pigs to an aerosol of PGD(2) with histamine or U-46619 at sub-threshold concentrations synergistically caused a marked increase in intranasal pressure. These responses were significantly suppressed by S-5751. These results suggest that PGD(2) plays a critical role in the increase in intranasal pressure via prostanoid DP receptor, probably through synergistically enhancing the nasal response with other chemical mediators released from mast cells and other inflammatory cells activated by allergens.

Topics: 15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid; Administration, Intranasal; Allergens; Animals; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Synergism; Guinea Pigs; Histamine; Male; Nasal Mucosa; Nasal Obstruction; Nose; Ovalbumin; Pressure; Prostaglandin D2; Receptors, Immunologic; Receptors, Prostaglandin; Rhinitis, Allergic, Perennial; Thiophenes; Time Factors

There is no uniform consensus on how to grow fungi from sinus aspirates in the Canadian setting. Protocols vary between institutions, and the positivity rate for fungal cultures ranges between 10 and 20% even when endoscopically obvious allergic mucin is being sent to the laboratory. The aim of this study was to compare the occurrence of positive fungal cultures obtained by our institution's fungal culture method with the occurrence obtained by the Mayo Clinic's fungal culture method. The ultimate aim was to propose a modified, feasible, standardized protocol for culturing fungi from sinus aspirates in the Canadian laboratory setting.. Twenty-five allergic mucin aspirates were collected in 23 consecutive patients meeting the clinical diagnosis of allergic fungal rhinosinusitis. These samples were sent to the microbiology laboratory, where half of them were subject to our conventional laboratory protocol and the other half to the modified Mayo Clinic protocol.. Positive fungal cultures were obtained in 16 of 25 (64%) specimens when the modified Mayo Clinic culture technique was used, with 12 cultures (48%) growing pathogenic fungus. Using our standard culture technique, 4 of 25 (16%) specimens resulted in a positive fungal culture, of which 3 grew pathogenic fungus (12%). A significantly greater fungal culture yield was obtained by the modified Mayo Clinic fungal culture technique than with our culturing technique.. The modified Mayo Clinic fungal culture technique, although more costly, is a highly sensitive and effective technique for growing fungi from nasal specimens when compared with our traditional culture technique.

Topics: Canada; Clinical Protocols; Female; Humans; Male; Middle Aged; Nose; Prospective Studies; Rhinitis, Allergic, Perennial; Sinusitis

Submucous resection of the inferior turbinate is one of the recommended methods to alleviate nasal symptoms in patients with severe allergic rhinitis patients in terms of postoperative results and preservation of nasal function. Posterior nasal neurectomy, recently developed by Kikawada, is a novel method to selectively cut the neural bundles out from the sphenopalatine foramen and to diminish the complaints of hypersecretion. This study was carried to examine the clinical effectiveness and changes in local cytokine levels of this combined surgical procedure.. Twenty-three patients with severe perennial allergic rhinitis underwent submucous turbinectomy combined with posterior nasal neurectomy under general anesthesia. The patients' subjective nasal symptoms were examined at each visit. The levels of interleukin-5 (IL-5), eotaxin and regulated on activation, normal T cell expressed and secreted (RANTES) in nasal lavages were measured before and 6 month after surgery. Nasal mucosa of the inferior turbinate was also obtained for histopathological examination in some cases.. The mean symptom scores for sneeze, rhinorrhea, nasal obstruction, and total severity were all statistically decreased after surgery. Therapeutic effects continued to be apparent as long as 3 years after surgery. The mean levels of both IL-5 and eotaxin significantly decreased after surgery, but that of RANTES remained unchanged. Histopathological examination revealed that the number of inflammatory cells and nasal glands markedly reduced in lamina propria and the epithelial layer became covered with stratified columnar cells.. Submucosal turbinectomy with posterior nasal neurectomy has remarkably improved subjective nasal symptoms in patients with severe allergic rhinitis on a long-term follow-up basis. The present study also demonstrates that the clinical effectiveness of the procedure is accompanied by decreases in local inflammatory cell infiltration and the related cytokine production.

Topics: Adolescent; Adult; Chemokine CCL11; Chemokine CCL5; Chemokines, CC; Denervation; Electrocoagulation; Endoscopy; Female; Follow-Up Studies; Humans; Interleukin-5; Male; Middle Aged; Nasal Lavage Fluid; Nasal Mucosa; Nose; Rhinitis, Allergic, Perennial; Turbinates

Vasoconstrictor drugs reduce nitric oxide (NO) production in vitro by inhibiting the enzyme involved in the regulation of inducible and constitutive NO synthases (iNOS and cNOS). Intranasal vasoconstrictors also decrease nasal NO concentration in vivo. It is as yet unclear if this last finding is due to the effects of the drug on the enzyme or on the vessels. Physical exercise also induces nasal vasoconstriction and reduces nasal resistance.. The aim of this study was to clarify the mechanisms involved in xylometazoline-induced reduction of nasal NO concentration.. We compared 2 randomized groups of patients with moderate--severe persistent allergic rhinitis. The first group (n = 24) underwent a physiological nasal vasoconstrictor stimulus (exercise) whereas the second group (n = 29) was treated with a nasal vasoconstrictor drug (topical xylometazoline). Nasal volume and NO were determined at baseline and 15 to 20 minutes after the end of each stimulus using acoustic rhinometry and chemiluminescence, respectively.. Baseline values of nasal volume and NO did not differ between the 2 groups. Nasal volume increased by 57% (P = .0001) after exercise and 71% (P = .0001) after xylometazoline. Nasal NO decreased (25%, P = .001) after xylometazoline, but not after exercise.. Physical exercise and topical xylometazoline cause vasoconstriction and similar effects on nasal volume. In contrast nasal NO decreased with xylometazoline but not after exercise. These findings suggest that vasoconstrictor drugs reduce nasal NO by mechanisms other than vasoconstriction.

Topics: Exercise; Female; Humans; Imidazoles; Male; Nasal Decongestants; Nitric Oxide; Nose; Rhinitis, Allergic, Perennial; Vasoconstriction

To correlate subjective and objective clinical features with nasal smear cytology findings in noninfectious chronic rhinitis.. An analysis of prospectively collected data of consecutive patients with non-infectious seasonal and perennial rhinosinusitis seen at a tertiary health institution.. Clinical assessments including Visual Analog Scale (VAS) scoring of presenting symptoms of 45 patients suffering from non-infectious chronic rhinosinusitis are measured. Subjects had a medical questionnaire regarding presence and duration of symptoms, family history of atopy or allergy, occupational exposure to allergens, provocative agents, and medication usages. Subjects had detail Ear, Nose, and Throat assessment, and nasal secretions were analyzed for eosinophils counts and statistically correlated with clinical parameter.. A total of 45 patients were recruited. Age range was 13 to 71 years (SD 11.516). 73% (n=33) were females while 27% (n=12) were males. The modal occupation was homemaking (24%, n=11). 38% (n=17) had family history of atopy, while 13% (n=6) had family history of allergy. Symptoms were perennial in 62% (n=28) and seasonal in 38% (n=17). 9% (n=4) of the subjects keep pets at home, while 40% (n=18) grow flowers or trees around the house. All subjects gave a history of identifiable provocative agents. There is positive correlation of itchy nose with total symptom score. There was negative history of occupational exposure to allergens in all subjects. The average subjective symptom score are Sneezing (6.3), Itchy nose (6.1), Nasal obstruction (6.2) and Runny nose (6.7). There is a high positive correlation of sneezing with runny nose (r = 0.51), but poor correlation with nasal obstruction (r = 0.15). There is negative correlation of total individual symptom score with keeping of pets (r = -0.24) or growing of flowers or trees around house (r = -0.039). There is also low correlation of total symptom score with family history of atopy (r = 0.06). There is positive correlation of total symptom score with number of provocative agents identified (r = 0.34). There is low positive correlation of nasal smear eosinophilia with total symptom score (r = 0.030) and itchy nose score (r = 0.038). Nasal smear eosinophilia show negative correlation with sneezing score (r= -0.076).. The best predictors of nasal smear eosinophilia in non-infectious chronic rhinosinusitis are itchy nose score and Individual Total Symptom (ITS) score.

Topics: Adolescent; Adult; Aged; Chronic Disease; Eosinophilia; Female; Health Status Indicators; Humans; Male; Middle Aged; Nose; Occupational Exposure; Pilot Projects; Rhinitis, Allergic, Perennial; Severity of Illness Index; Sinusitis

The decongestion test involves spraying an intranasal vasoconstrictor drug to evaluate the recovery of nasal airflow.. The aim of this study was to assess the relationship between pulmonary function (assessed by spirometry and methacholine challenge) and nasal airflow recovery after a topical vasoconstrictor had been administered in patients with allergic rhinitis (perennial, seasonal, or mixed allergic rhinitis).. A total of 150 subjects were studied. The total symptom score, sensitization, and pulmonary function were all assessed. All subjects underwent rhinomanometry and the decongestion test.. Univariate analysis revealed that nasal symptoms and spirometric parameters (except FEF(25-75) in subjects with seasonal allergic rhinitis) were not. Only bronchial hyperreactivity, assessed by methacholine challenge, proved to be significantly (and independently) associated with outcome (OR 1.45, P = 0.025).. This study provides the first evidence of an association between a positive response to the decongestion test and bronchial hyperreactivity, assessed by methacholine challenge, in patients with allergic rhinitis.

Topics: Adult; Bronchial Hyperreactivity; Bronchial Provocation Tests; Humans; Male; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Spirometry

The aims of the current study were to ascertain the prevalence of asthma and allergic rhinoconjunctivitis symptoms in Cairo, Egypt (northern Africa), and to elucidate the socioeconomic factors associated with symptom prevalence and severity. A translated and adapted version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was distributed to a sample of 2,645 11-15-yr-olds in state and fee-paying schools in Cairo. The overall prevalences of wheeze ever, wheeze during the last year and physician-diagnosed asthma were 26.5% (697 out of 2,631), 14.7% (379 out of 2,570) and 9.4% (246 out of 2,609), respectively. The prevalence of rhinoconjunctivitis was 15.3% (399 out of 2,616). Asthma symptoms were independently associated with attendance at a state school, parental asthma, age, history of rhinitis and owning a pet cat. Rhinoconjunctivitis was independently associated with attendance at a state school, father's education, parental history of asthma, asthma symptoms and owning a pet cat. In spite of a higher prevalence of severe asthma symptoms in state schools prevalence of physician diagnosis of asthma was the same in both school types, suggesting inequalities in access to healthcare. In conclusion, the prevalence of physician-diagnosed asthma in Cairo was 9.4%, while the prevalence of rhinoconjunctivitis was 15.3%. There is a higher prevalence and increased severity of asthma symptoms in children of lower socioeconomic groups, as defined by state school attendance in Cairo.

Topics: Adolescent; Asthma; Child; Egypt; Eye; Humans; Lung; Nose; Prevalence; Respiratory Sounds; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Socioeconomic Factors

The objective of this study was to evaluate the role of p38 MAP-kinase (MAPK) pathway on CLC-3 expression after interleukin-4 (IL-4) induction in primary cultured human nasal epithelial cells (HNECs) from patients with allergic rhinitis (AR).. Cultured HNECs from five patients with AR were treated with IL-4 (20 ng/mL) with or without SB203580, a selective inhibitor of p38 MAPK, at different concentrations and durations. CLC-3 was detected in HNECs by immunohistochemistry and real-time quantitative reverse transcription-polymerase chain reaction. p38 MAPK and phosphorylated p38 MAPK (pp38 MAPK) was examined by Western blotting.. After exposure to SB203580, CLC-3 expression induced by IL-4 was downregulated in HNECs in a concentration and time-dependent manner. This downregulation was associated with a decrease in pp38 MAPK.. These results confirmed that IL-4 can induce CLC-3 production in HNECs with AR through a p38 MAPK-dependent pathway. Inhibitors of p38 MAPK may become an important strategy for the treatment of AR.

Topics: Adult; Cells, Cultured; Chloride Channels; Down-Regulation; Enzyme Inhibitors; Epithelial Cells; Female; Humans; Imidazoles; Immunohistochemistry; Interleukin-4; Male; Middle Aged; Muscle Proteins; Nose; p38 Mitogen-Activated Protein Kinases; Pyridines; Reverse Transcriptase Polymerase Chain Reaction; Rhinitis, Allergic, Perennial

Humming greatly increases nasal nitric oxide (NO) in healthy people by causing a rapid washout of NO from the sinuses. This increase is abolished in patients with complete sinus ostial obstruction.. Allergic rhinitis is a risk factor for development of sinusitis and we wanted to study whether nasal NO measurement during humming could be used to detect sinus abnormalities in this disorder.. Fifty-nine consecutive subjects with mild to moderate allergic rhinitis were studied. Their present nasal symptoms were recorded. Then NO levels were measured by chemiluminescence during quiet single-breath nasal exhalations and humming exhalations at a fixed exhalation flow of 0.2 L s(-1). Based on the NO results the patients were divided into two groups: those with a great increase in nasal NO during humming (humming responders, n = 46) and those without a significant increase (humming nonresponders, n = 13). In 11 of the nonresponders and in 22 of the responders the passage to the osteomeatal complex area was assessed and scored by nasal endoscopy. This was carried out by an oto-rhino-laryngologist unaware of the NO results.. Among the nonresponders nine of 11 patients (80%) had endoscopic signs of bilateral sinus obstruction, compared with one of the 22 (< 5%) humming responders. Baseline nasal symptom score and NO levels during quiet exhalation were not significantly different between the groups. Absence of a nasal NO peak during humming is associated with endoscopic findings suggestive of sinus ostial obstruction in subjects with allergic rhinitis. Measurement of nasal NO during humming may be a simple method to detect sinus abnormalities in these patients.

Topics: Acoustic Stimulation; Adolescent; Adult; Exhalation; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nitric Oxide; Nose; Paranasal Sinuses; Pilot Projects; Rhinitis, Allergic, Perennial; Sinusitis

Allergic rhinitis and asthma are frequently associated and are characterized by TH2-dependent inflammation. Nasal and bronchial obstruction largely depend on allergic inflammation.. To evaluate the relationships among nasal eosinophil counts, interleukin 4 (IL-4) and interferon-gamma (IFN-gamma) levels, nasal airflow, and forced expiratory volume in 1 second (FEV1) in patients with perennial allergic rhinitis and asthma.. Eight men and 7 women (mean +/- SD age, 24.8 +/- 4.7 years) with perennial allergic rhinitis and asthma were evaluated. All 15 patients had a moderate-to-severe grade of nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, nasal scraping, and spirometry were evaluated in all patients. Eosinophils were counted using conventional staining; IL-4 and IFN-gamma levels were measured by immunoassay in fluids recovered from nasal lavage.. Significant positive relationships were demonstrated between eosinophil infiltration and IL-4 levels, nasal airflow and IFN-gamma levels, FEV1 and IFN-gamma levels, and nasal airflow and FEV1 (P < .001 for all). Significant negative relationships were demonstrated between eosinophil infiltration and IFN-gamma levels, IL-4 and IFN-gamma levels, eosinophil infiltration and nasal airflow, IL-4 values and nasal airflow, nasal eosinophil counts and FEV1, and IL-4 values and FEV1 (P < .001 for all).. There is a close association between TH2 cytokines and eosinophil infiltration in the nose. There is also clear evidence concerning the relationships among eosinophil infiltration, IL-4 and IFN-gamma levels, and nasal airflow. Nasal eosinophil, IL-4, and IFN-gamma levels correlate with FEV1. Finally, nasal airflow is related to FEV1. These findings constitute the first evidence of a relationship between TH2-related nasal inflammation and nasal and bronchial airflow in patients with perennial allergic rhinitis and asthma.

Topics: Adult; Asthma; Cytokines; Eosinophilia; Female; Forced Expiratory Volume; Humans; Inflammation; Male; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Perennial

Analysis of exhaled breath condensate is a method for noninvasive assessment of the lung. Condensate can be collected with a nose clip (subjects inhale and exhale via the mouth) or without it (subjects inhale via the nose and exhale via the mouth), but the mode of inhalation may influence condensate volume and mediator levels. We compared condensate volume and adenosine, ammonia, and thromboxane B2 levels in young healthy volunteers (n = 25) in samples collected for 10 minutes from subjects with or without a nose clip. Patients with allergic rhinitis (n = 8) were also studied to assess the effect of upper airway inflammation on mediator levels. Adenosine, ammonia, and thromboxane B2 levels were determined by HPLC, spectrophotometry, and radioimmunoassay, respectively. Volume of condensate was significantly higher without nose clip than that with nose clip (mean +/- SD, 2321 +/- 736 microl and 1746 +/- 400 microl, respectively; p = 0.0001). We found no significant difference in any mediator levels between these two collection modes in healthy volunteers, but adenosine showed a tendency to differ between oral and nasal inhalation in patients with allergic rhinitis. Our data indicate that whereas a greater volume of condensate can be obtained when subjects inhale through their noses, the mode of inhalation does not influence mediator levels in young healthy volunteers, but may affect these levels in patients with allergic rhinitis.

Topics: Adenosine; Adult; Ammonia; Bias; Breath Tests; Case-Control Studies; Constriction; Female; Forced Expiratory Volume; Humans; Inflammation Mediators; Inhalation; Linear Models; Male; Mouth; Nose; Rhinitis, Allergic, Perennial; Specimen Handling; Thromboxane B2; Tidal Volume; Time Factors; Vital Capacity

We sought to investigate the pattern, duration, and amplitude of nasal cycle and its response to nasal decongestant.. Ten adult volunteers attended 2 sessions (with and without nasal spray of 0.1% xylometazoline) for consecutive examinations by rhinomanometry and acoustic rhinometry every 10 minutes over 6 hours.. A spontaneous fluctuation in nasal minimum cross-sectional area, volume, and nasal resistances (inspiration and expiration) could be observed in every consecutive measurement. A significant negative correlation (r = -0.33 to -0.70, P < 0.05) between both nasal passages was shown in 5 subjects by rhinomanometry and in 2 subjects by acoustic rhinometry but was not detectable after nasal spray with 0.1% xylometazoline.. A spontaneous fluctuation in nasal patency can be documented every 10 minutes with irregular pattern, frequency, and amplitude. Classic nasal cycle is not a universal phenomenon, which can be abolished by the application of decongestant.

Topics: Adolescent; Adult; Female; Humans; Male; Nasal Decongestants; Nose; Rhinitis, Allergic, Perennial; Rhinomanometry; Rhinometry, Acoustic

It remains to be established which factors contribute to the occurrence of asthma in allergic individuals. We hypothesized that differences in the late allergic inflammatory reaction to allergen between asthmatic and non-asthmatic house dust mite-allergic individuals might contribute to the difference in the clinical presentation of allergy.. To compare allergen-induced changes in parameters for cellular inflammation during the phase of the late allergic reaction in the skin and nose, in house dust mite-allergic individuals with or without asthma.. Nasal and dermal allergen challenges with house dust mite (Dermatophagoides pteronyssinus) extract were performed in 52 house dust mite-allergic individuals, of whom 26 had mild to moderate persistent asthma and 26 had perennial rhinitis without current or past asthmatic symptoms. Serial nasal lavage samples were analyzed for the presence of inflammatory cells (eosinophils and neutrophils) and soluble markers associated with cellular inflammation [interleukin-5 (IL-5), interleukin-8 (IL-8), eosinophil cationic protein (ECP) and myeloperoxidase (MPO)]. Macroscopic late phase skin reactions were studied after intracutaneous skin tests with house dust mite extract.. Fixed dose nasal allergen provocation elicited a similar degree of immediate allergic reaction as judged by plasma protein exudation and histamine concentrations in asthma and non-asthmatic rhinitis. Subsequently, no differences between groups were found during the phase of the late allergic reaction (4-24 h) in inflammatory cell influx, plasma protein leakage, ECP or MPO. Likewise, there were no differences in levels of chemotactic cytokines IL-5 and IL-8. In agreement with the results of nasal challenge, the late skin reaction after dermal challenge with a fixed allergen dose and after an allergen dose 10,000 times above the skin threshold for an early skin reaction did not differ between the groups.. House dust mite-allergic patients with or without asthma have very similar late allergic inflammatory reactions in the skin and in the nose after allergen challenge. Hence, it is unlikely that the occurrence of pulmonary symptoms in asthma is explained by a general tendency of asthmatics to have an enhanced late allergic cellular inflammatory response. Nasal and dermal allergen provocations are adequate models to study allergen-induced inflammation but probably lack the pivotal link which is essential for the development of asthma.

Topics: Adolescent; Adult; Allergens; Animals; Asthma; Biomarkers; Female; Humans; Inflammation; Male; Nasal Lavage Fluid; Nose; Pyroglyphidae; Rhinitis, Allergic, Perennial; Skin

Nasal obstruction is a subjective complaint in patients with nasal disease. The ability to quantitate the nasal ventilation dysfunction would be useful for making the appropriate choice of nasal disease management. This cross-sectional study comprised of 200 adult subjects. They underwent assessment of relevant symptoms, nasal examination and investigations before undergoing active anterior rhinomanometry (AAR) assessment. A group of 88 normal subjects and 112 patients with nasal disease were included. The mean total nasal air resistance (NAR) was significantly higher in patients with nasal disease (0.33 Pa/cm(3)/s) as compared to normal subjects (0.24 Pa/cm(3)/s). There was no significant difference in total NAR between patients with symptoms of nasal obstruction and those without the symptoms (p = 0.42). It is concluded that AAR is a sensitive but not a specific tool for the detection of abnormalities in NAR and it failed to relate to the symptom of nasal obstruction.

Topics: Adolescent; Adult; Airway Resistance; Cross-Sectional Studies; Humans; Nasal Obstruction; Nasal Septum; Nose; Nose Diseases; Pressure; Rhinitis, Allergic, Perennial; Rhinomanometry

Rhinitis patients may have abnormal airway function as demonstrated by an obstruction in large or small airways and increased bronchial reactivity to inhaled nonspecific provocating agents. The nonspecific bronchial hyperreactivity (BHR) is particularly important in patients with rhinitis because they are more prone to develop asthma. However, the factors associated with BHR in rhinitis patients have not yet been explained. Therefore, we performed this study to determine the differences in airflow rates, and bronchial and nasal resistance between nonasthmatic rhinitis patients with or without BHR, and to evaluate the relationship between these parameters and bronchial reactivity to methacholine. A total of 66 patients with allergic rhinitis but not asthma were selected for the study and divided into two groups; Group 1 (40 patients with allergic rhinitis and negative mechacholine provocation test) and Group 2 (26 patients with allergic rhinitis and positive methacholine provocation test). Pulmonary function tests, methacholine provocation tests, anterior rhinomanometry, and skin prick tests were performed on the patients. The study groups were homogeneous with regard to gender, age, duration of illness, and smoking ratio. Expiratory airflow parameters including FVC, FEV1, PEFR, and FEF25 were similar in both groups, however FEV1/FVC, FEF25-75, FEF50, and FEF75 were significantly lower in Group 2. Additionally, sRaw was significantly higher in Group 2 and negatively correlated with the expiratory airflow parameters for small airways. Total nasal resistance was not different between the groups. There was no correlation between nasal resistance and BHR to methacholine or airway resistance. The present study suggests that nonasthmatic rhinitis patients with BHR may have mild but significant changes in the small airways. Clinical and functional follow-up of these patients should assess the long-term consequences of these parameters and their clinical importance.

Topics: Adolescent; Adult; Bronchial Hyperreactivity; Female; Forced Expiratory Flow Rates; Forced Expiratory Volume; Humans; Male; Manometry; Methacholine Chloride; Middle Aged; Nose; Peak Expiratory Flow Rate; Respiratory Function Tests; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Skin Tests; Vital Capacity

Topics: Adult; Aged; Dermatitis, Contact; Dose-Response Relationship, Immunologic; Female; Histamine; Humans; Male; Middle Aged; Nasal Mucosa; Nasal Provocation Tests; Nose; Rhinitis, Allergic, Perennial; Skin; Skin Tests

The purposes of this study were to clarify whether damage of the nasal epithelium exists in patients with nasal allergy, and how the morphology of the epithelium changes after topical allergen challenge. Electron microscopy revealed 2 characteristic features in the nasal epithelium of patients with perennial nasal allergy--an increase in the number of epithelial cells with cytoplasmic vacuoles, and markedly widened intercellular spaces--although these changes were unclear under light microscopy. The density of vacuolated cells significantly increased 24 hours after allergen challenge. Further, the number of eosinophils that were associated with vacuolated cells was significantly higher in patients with nasal allergy than in controls. These morphological changes, thus, were considered to be types of damage to the nasal epithelium associated with nasal allergy. Such changes may be among the causes of nasal hyperreactivity, which is an important feature of nasal allergy.

Topics: Administration, Topical; Adolescent; Adult; Allergens; Epithelium; Humans; Microscopy, Electron; Nose; Rhinitis, Allergic, Perennial

The authors examined 25 children with allergic rhinitis, who were sensitive to grass, weed and tree pollens. During the allergic season nasal lavage was performed then repeated after 4 weeks of loratadine treatment. Tryptase, IL-5, ECP, TNF-alpha and RANTES levels were measured from the nasal lavage fluid. Tryptase, IL-5, and ECP levels were decreased significantly while the decrease of RANTES and TNF-alpha levels was not significant. The authors emphasize that loratadine is an effective anti-inflammatory drug which affects the early and late phase of immediate hypersensitivity. In the moderate cases loratadine is enough to relieve the symptoms, while in the severe forms anti-allergic eye drops and nasal antihistamine or steroid spray has to be added.

Topics: Adolescent; Anti-Allergic Agents; Blood Proteins; Chemokine CCL5; Child; Child, Preschool; Eosinophil Granule Proteins; Female; Histamine H1 Antagonists; Humans; Inflammation Mediators; Interleukin-5; Loratadine; Male; Nose; Rhinitis, Allergic, Perennial; Ribonucleases; Serine Endopeptidases; Therapeutic Irrigation; Tryptases; Tumor Necrosis Factor-alpha

The economic impact and medical complication rate of viral upper respiratory infections are well documented, but many of the physiologic, inflammatory, and immune responses to respiratory viruses have only recently been investigated. A previous study demonstrated differential systemic immune and inflammatory responses in allergic rhinitis (AR) and nonallergic rhinitis (NAR) subjects during experimental infection with rhinovirus-39.. The purpose of this study was to compare selected systemic immune and inflammatory responses to experimental influenza A virus (FLU) challenge in seronegative AR and NAR subjects.. Peripheral blood was obtained at baseline (study day 0) and 3, 6, 18, and 31 days after intranasal FLU challenge and assayed for leukocyte histamine release, serum immunoglobulins, and plasma histamine.. All subjects were infected, as manifested by viral shedding in nasal secretions and/or seroconversion. FLU infection induced decreases in spontaneous leukocyte histamine release and increases in anti-immunoglobulin E-induced leukocyte histamine release, which were evident at least 1 month after infection, but caused no significant changes in serum immunoglobulins or plasma histamine. There were no differences between AR and NAR subjects for any of the study parameters.. The results show that intranasal challenge with FLU induces changes in leukocyte histamine release, but not other systemic immune and inflammatory responses.

Topics: Adolescent; Adult; Female; Histamine; Histamine Release; Humans; Immunoglobulin E; Influenza A virus; Influenza, Human; Male; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Virus Shedding

Allergic diseases are characterized by allergic complaints in the shock organ and specific immunoglobulin (Ig)E in serum. Literature data indicate that the nasal mucosa itself could produce at least a large part of the specific IgE in allergic rhinitis patients. In order to investigate this hypothesis, nasal mucosal biopsies from the inferior turbinate were taken from symptomatic grass pollen allergic rhinitis patients, symptomatic house dust mite allergic rhinitis patients and nonallergic healthy controls, confirmed by radioallergosorbent test and skin-prick test. Immunohistochemical double-staining was performed for B-cells (CD19) with IgE, plasma cells (CD138) with IgE and plasma cells with biotinylated allergens. Significantly more IgE-positive B-cells and IgE-positive plasma cells were found in the nasal mucosa of allergic patients than in that of nonallergic controls. Double staining with biotinylated allergens and plasma cells showed allergen-positive plasma cells in the nasal mucosa of allergic patients and no allergen-positive plasma cells in the nasal mucosa of nonallergic patients. Blocking experiments using polyclonal antibodies directed against IgE showed a significant reduction in the number of allergen-positive cells in contrast to experiments using polyclonal antibodies directed against IgG, IgA or IgM. This study describes new evidence that specific immunoglobulin E is produced locally in the nasal mucosa in patients with seasonal allergic rhinitis and perennial allergic rhinitis, but not in nonallergic controls.

Topics: Adolescent; Adult; B-Lymphocytes; Female; Humans; Immunoglobulin E; Immunohistochemistry; Male; Middle Aged; Nose; Plasma Cells; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

To test the hypothesis that rhinovirus (RV)-induced immune responses influence the outcome of RV infections, we inoculated 22 subjects with allergic rhinitis or asthma with RV16. Nasal secretions and induced sputum were repeatedly sampled over the next 14 d. RV16 infection increased nasal granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-8, which was accompanied by neutrophilia in blood and nasal secretions. Nasal G-CSF correlated closely with increased blood neutrophils (r(s) = 0.69, p < 0.005), whereas nasal neutrophils correlated with both G-CSF (r(s) = 0.87, p < 0.001) and IL-8 (r(s) = 0.75, p < 0.001). Although similar relationships were present in sputum, changes in sputum neutrophils and G-CSF with RV16 infection were relatively modest. In addition, virus-induced changes in the sputum interferon-gamma-to-IL-5 messenger RNA ratio were inversely related to both peak cold symptoms (r(s) = -0.60, p < 0.005) and the time to viral clearance (undetectable picornavirus RNA). These results indicate that airway IL-8 and G-CSF are closely associated with virus-induced neutrophilic inflammation during an experimental RV infection in atopic volunteers. In addition, the balance of airway T-helper cell type 1 (Th1)- and Th2-like cytokines induced by RV infection may help determine the clinical outcome of common cold infections, raising the possibility that the individual subject's immune response, rather than atopic status per se, is important in this regard.

Topics: Adolescent; Adult; Asthma; Base Sequence; Bronchi; Common Cold; Cytokines; Female; Humans; Male; Molecular Sequence Data; Nasal Lavage Fluid; Nose; Patient Selection; Reverse Transcriptase Polymerase Chain Reaction; Rhinitis, Allergic, Perennial; Rhinovirus; Sputum; Time Factors

We have previously shown that subjects with seasonal allergic rhinitis out of season had a reduced ability to warm and humidify air compared with normal subjects.. We sought to investigate whether allergic reactions induced by either seasonal exposure or nasal challenge with antigen would decrease the capacity of the nose to condition cold, dry air.. We performed two prospective studies comparing the effects of allergic inflammation, induced by either seasonal exposure or nasal challenge with antigen, on nasal conditioning capacity (NCC). The total water gradient (WG) across the nose was used to represent the NCC. In the first study, the NCC was measured and compared before and during the allergy season in 10 subjects with seasonal allergic rhinitis. In the second study, 20 subjects with seasonal allergic rhinitis were recruited outside of the allergy season. NCC was measured and compared before and 24 hours after challenge with antigen.. In the first study, seasonal allergic subjects in season showed a significant increase in NCC when compared with their preseason baseline (total WG in season: 2050 +/- 138 mg vs total WG preseason: 1524 +/- 100 mg; P <.01). In the second study, antigen challenge led to early-phase and late-phase responses. There was a statistically significant increase in NCC 24 hours after antigen challenge compared with that before antigen challenge (total WG after antigen challenge: 1938 +/- 101 mg vs total WG before antigen challenge: 1648 +/- 84 mg; P =.01).. Allergic reactions induced by either seasonal exposure or antigen challenge increase the ability of the nose to condition inspired air. We speculate that allergic inflammation increases this ability by changing the perimeter of the nasal cavity.

Topics: Adult; Allergens; Female; Hot Temperature; Humans; Humidity; Male; Nasal Provocation Tests; Nose; Prevalence; Prospective Studies; Respiration; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

The reported association of allergy and sinusitis varies greatly between study, and the exact role of allergy in predisposing to sinusitis is not clear. We attempted to determine whether patients with perennial allergic rhinitis are at greater risk of developing sinusitis with respect to a control group, and to determine whether there is a correlation between rhinomanometry, endoscopy, and nasal swab, and computed tomography (CT) findings.. Forty adult patients with perennial allergic rhinitis underwent CT scans of the paranasal sinuses, and the results were then compared to CTs of the paranasal sinuses of 30 control subjects. All allergic patients underwent nasal endoscopy, nasal swab, and active anterior rhinomanometry, and the results were studied in relation to the CT findings.. We found sinusitis in 67.5% of the allergic patients and in 33.4% of the controls, with a statistically significant difference between the two groups (P = 0.017). Twenty-three patients had a positive nasal swab; 22 showed increased nasal resistance on rhinomanometry, and 36 had positive endoscopy, but the association of CT findings with endoscopy, rhinomanometry, or nasal swab was not statistically significant (P = 0.583, P = 1.00, P = 0.506, respectively).. Allergic rhinitis is often associated with sinusitis, but the underlying mechanism has yet to be determined. Evidently, factors other than classical pathogen growth and mechanical factors, such as the association of the various factors and immunologic mechanisms, may contribute to the pathogenesis of chronic sinusitis in allergic patients.

Topics: Adolescent; Adult; Airway Resistance; Antigens, Dermatophagoides; Case-Control Studies; Chronic Disease; Endoscopy; Female; Glycoproteins; Humans; Male; Middle Aged; Nasal Cavity; Nasal Mucosa; Nose; Paranasal Sinuses; Rhinitis, Allergic, Perennial; Risk Factors; Sinusitis; Skin Tests; Tomography, X-Ray Computed

In atopic subjects with multiple sensitizations to inhalant allergens the relationship between the specific serum immunoglobulin (Ig) E and the in vivo response to each allergen is not well established.. To investigate the relationship between the specific serum IgE expressed as amount (kU/L) or density (specific IgE/total IgE percentage) with the in vivo response to inhaled allergens in rhinitic and asthmatic subjects with multiple sensitization.. By means of Reverse Enzyme AllergoSorbent Test (REAST) the absolute values and the density of specific IgE for each sensitizing allergen was determined. Rhinitics (n = 12) underwent nasal and asthmatics (n = 11) bronchial allergen challenges with the two to three sensitizing allergens for a total of 33 nasal and 32 bronchial challenges. Correlations and degree of concordance between specific serum IgE and results of challenges were calculated.. IgE density significantly correlated with nasal challenge score (rs = 0.72, P < 0.001), bronchial challenge score (rs = 0.56, P < 0.001) and late asthmatic response (rp = 0.53, P < 0.005). Among subjects with three sensitizations, comparison of values of IgE density with the results of challenges showed significant concordance in graduation (chi2 = 11.3, P < 0.005).. In subjects with multiple sensitizations, the nasal and bronchial response to the different sensitizing allergens may be predicted, at least in part, by the IgE density. A satisfactory agreement between graduation of the IgE density to the different allergens and the in vivo response to the same allergens has been found within subject.

Topics: Administration, Inhalation; Adolescent; Adult; Allergens; Asthma; Bronchi; Bronchial Provocation Tests; Female; Humans; Immunoglobulin E; Male; Methacholine Chloride; Middle Aged; Nose; Predictive Value of Tests; Radioallergosorbent Test; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Nasal endoscopy was carried out in 83 patients with perennial allergic rhinitis to evaluate endonasal anatomic variation and to find the correlation between the symptoms of patients and the endoscopic findings. All of the patients had nasal symptoms, 7.2% of the patients were runner, 7.2% were blocker and 85.6% were both. 86.75% of the patients had allergy-related symptoms, i.e. throat symptoms (73.5%), sinus headache (50.6%), and smell disturbance (10.8%). 95.2% of patients had abnormal endoscopic findings, i.e. deviated nasal septum (72.3%), abnormal middle turbinate (49.4%), narrowing of the entrance into the frontal recess (30.1%), septal spur (25.3%), obstruction of the entrance into the frontal recess (19.3%), nasal polyps (15.7%), mucopurulent discharge (14.5%), inferior turbinate hypertrophy (10.8%), abnormal uncinate process (9.6%), abnormal ethmoid bullae (7.2%), and enlargement of aggar nasi cells (2.4%). There was no significant correlation between each symptom and each endoscopic finding. However, there was a significant correlation between sinus headache and all of the combined abnormal endoscopic findings (P<0.05). These findings suggested that variations in endonasal anatomy was not by itself a pathology or a cause of symptoms. However, a combination of these variations may narrow the cleft of the ostiomeatal unit and cause contact area or stenosis, which predisposed patients to persistent symptoms, recurrent infection or resistance to therapy in patients with perennial allergic rhinitis. The endoscope might be a very useful tool for allergists, immunologists, and rhinologists, who work in the nose to deal with these cases.

Topics: Adolescent; Adult; Aged; Chi-Square Distribution; Child; Endoscopy; Female; Headache; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nose; Rhinitis, Allergic, Perennial; Turbinates

The reliable interpretation of the nasal provocation test in allergy diagnosis requires objective and measurable monitoring parameters for clinical practice. The clinical usefulness of the nasal provocation test has been limited by scanty knowledge of the specificity and sensitivity of the test and a lack of reference values.. To test and compare three objective monitoring parameters of a nasal provocation test in occupational allergic rhinitis. To evaluate the magnitude of the nasonasal effects in a unilateral allergen challenge.. The monitoring parameters of the nasal reaction were derived from the minimum cross-sectional area on acoustic rhinometry, the nasal resistance on active anterior rhinomanometry and the amount of nasal secretion measured at 15 min intervals for 60 min. Twenty-three bovine-allergic dairy and beef cattle farmers and 19 exposed, non-allergic control subjects were challenged first with a control solution and then with the cow allergen.. All the three monitoring parameters showed high specificity and sensitivity in finding allergic and non-allergic subjects. The secretion parameter was found to be slightly superior to the acoustic rhinometry and rhinomanometry parameters. The side difference in the nasal response between the allergen-challenged and the contralateral diluent-challenged cavity was significant for all the parameters among the allergic subjects. The contralateral secretion amount was 1/3 of the ipsilateral secretion, indicating the magnitude of the contralateral nasonasal reflex. A nasonasal reflex was also noted in the nasal patency monitoring. The coefficient of variation was significantly lower for the acoustic rhinometry than for the rhinomanometry (P=0.0001). The optimal threshold values for a positive test were a secretion amount of 100 mg, a 15% decrease in the minimum cross-sectional area and a 50% increase in the resistance for the observation period of 30 min and correspondingly 210 mg, 30% and 100% for 60 min.. The low-pressure aspiration of the nasal secretion from the anterior part of the nasal cavity was found to be a reliable and practical monitoring parameter to be used together with acoustic rhinometry or rhinomanometry in the nasal provocation test for clinical purposes. Although significant nasonasal effects took place in the unilateral allergen challenge, the response was more prominent in the allergen-challenged than in the contralateral diluent-challenged nasal cavity in most allergic subjects.

Topics: Acoustics; Adolescent; Adult; Airway Resistance; Animals; Cattle; Cell Extracts; Epithelial Cells; Female; Humans; Male; Manometry; Middle Aged; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nasal Provocation Tests; Nose; Occupational Diseases; Occupational Exposure; Radioallergosorbent Test; Rhinitis; Rhinitis, Allergic, Perennial; Skin Tests

Topics: Carrier State; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Joint Diseases; Knee Joint; Knee Prosthesis; Middle Aged; Nose; Respiratory Therapy; Rhinitis, Allergic, Perennial; Staphylococcal Infections; Staphylococcus aureus; Steroids

The concentration of biomarkers from vessels and inflammatory cells in nasal lavage fluid reflects the degree of hyperresponsiveness in patients with allergic rhinitis. The lavage has usually been performed of both nasal cavities together after prewashings and administration of decongestants. To improve the technique, we introduced a modification involving lavage of the nasal cavities separately without any prewashings or decongestants. We challenged 20 rhinitic subjects sensitive to timothy unilaterally with timothy extract. In nasal lavages performed before, immediately after, and 6 h after the challenge, we determined the concentrations of albumin, histamine, bradykinin, TAME (N-alpha-tosyl-L-arginine methyl ester)-esterase, and leukotriene C4 (LTC4). In eight subjects, the procedure was repeated 1 and 2 weeks later. After the challenge, albumin, bradykinin, TAME-esterase, and LTC4 in the nasal lavage fluid increased on the ipsilateral side but not on the contralateral side. Histamine did not increase after antigen challenge. After 6 h, the biomarkers were not increased. The concentrations of biomarkers did not differ between sides before the challenge and not between visits. Thus, the modified nasal lavage technique is reliable and improved compared to previous methods because it involves reproducible determinations of different biomarkers, and it is simple and easy to perform.

Topics: Adolescent; Adult; Albumins; Allergens; Antigens; Biomarkers; Bradykinin; Female; Histamine; Humans; Male; Nasal Lavage Fluid; Nose; Peptide Hydrolases; Poaceae; Pollen; Rhinitis, Allergic, Perennial; Seasons; Therapeutic Irrigation; Time Factors

The effects of nasal provocation on the rheologic properties of nasal mucus were investigated in patients with allergic rhinitis provoked by house dust. The elastic modulus (G') and the dynamic viscosity (eta') of nasal mucus were determined by an oscillating sphere magnetic rheometer. Before and after the allergen challenge, G' increased, whereas eta' decreased with increasing oscillatory frequency; these findings indicate that the nasal mucus under these conditions is a non-newtonian fluid and has the cross-linked gel-like nature typical of mucus. Both G' and eta' values after nasal provocation were significantly lower than before. The values of G' and eta' after allergen challenge were in the optimal viscoelasticity range for mucociliary transport.

Topics: Adolescent; Adult; Allergens; Child; Dust; Elasticity; Female; Humans; Male; Mucus; Nasal Provocation Tests; Nose; Rheology; Rhinitis, Allergic, Perennial; Viscosity

Topics: Air; Air Pollutants; Antigens; Environmental Health; Humans; Nose; Ozone; Respiratory System; Rhinitis, Allergic, Perennial

This paper summarizes an ENT surgeon's view of allergic rhinitis and deals with the presenting complaints and symptoms of allergic and non-allergic rhinitis, suggests the important features of the history and examination and indicates the more important special investigations; the medical and surgical treatments available to deal with the symptoms of rhinitis are discussed.

Topics: Adult; Humans; Nasal Polyps; Nose; Nose Diseases; Physical Examination; Respiratory Hypersensitivity; Rhinitis, Allergic, Perennial; Sinusitis

Release of high molecular weight-neutrophil chemotactic activity from human tissues, cells and secretion was studied in vivo and in vitro. Lung, nasal turbinate, nasal polyps, skin of neurofibromatosis, basophils from chronic myeloid leukemia and cultured basophilic cells from cord blood released this mediator following calcium ionophore, antigen, anti-IgE or homogenization in vitro. Its release was also demonstrated in human nasal secretions from patients with allergic rhinitis following antigen challenge. Regarding mononuclear cells no release of this mediator was observed from normal donors or asthmatic patients having no active attack upon challenge with calcium ionophore, phytohemagglutinin or antigen. Homogenized duodenum released high molecular weight-neutrophil chemotactic activity but less activity in comparison with other tissues or cells mentioned above.

Topics: Asthma; Basophils; Chemotactic Factors; Chemotaxis, Leukocyte; Duodenum; Humans; Leukocytes, Mononuclear; Lung; Nasal Polyps; Nasal Provocation Tests; Neurofibromatosis 1; Neutrophils; Nose; Rhinitis, Allergic, Perennial

We determined nasal peak flow using a peak flowmeter with a face mask (PALROD peak expiratory flowmeter) and nasal airway patency with an anterior rhinomanometer (Nihon Koden MPR-1100) at a minimum time interval in the same individual. We compared the values obtained by two kinds of measurements to evaluate the usefulness of the peak flowmeter for nasal airway patency. In this study, the nasal patencies were experimentally changed and measured in 30 patients using alpha-1 stimulant spray and in 25 patients with nasal allergy using nasal provocation of antigens. We also measured the natural circadian changes of nasal patency in 21 patients with nasal allergy and in 18 normal persons every two hours from 8:00 A.M. to 8:00 P.M. and from 9:00 A.M. to 9:00 P.M., respectively. As a result, we found close correlations between percent change of the peak flow and the nasal airway patency measured after spraying alpha-1 stimulant (r = 0.699, p less than 0.01), after antigen provocation (r = 0.585, p less than 0.01), and during circadian change (r = 0.464, p less than 0.01 in normal persons and r = 0.251, p less than 0.05 in allergy patients). In conclusion, peak flowmeter is handier and cheaper than rhinomanometer and is useful in evaluating the effect of vasoconstrictors and nasal provocation on nasal patency and in measuring the circadian changes of nasal patency. Since nasal secretion in the nose affects the measurement of peak flow, it should be removed as much as possible immediately before the flowmeter is used.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Airway Resistance; Circadian Rhythm; Female; Humans; Male; Manometry; Middle Aged; Nose; Predictive Value of Tests; Rheology; Rhinitis, Allergic, Perennial

In order to clarify the pathophysiological role of the chemical mediators, the releases of kinins, histamine and leukotriene C4(LTC4) into the nasal cavity were measured following nasal allergic challenge in ovalbumin(OA)-sensitized guinea pigs, or following nasal stimulation with one of these chemical mediators in OA-non-sensitized animals. In sensitized animals, an increased vascular permeability of nasal mucosa was recognized immediately after antigenic stimulation and lasted for 60-90 minutes. Releases of kinins and LTC4 into the nasal lavage fluid augmented not only immediately after the antigenic challenge, but also during 60 to 90 minutes after the stimulation. Release of histamine into the nasal lavage fluid was observed only immediately after the antigenic stimulation. In non-sensitized guinea pigs, nasal stimulation with bradykinin accelerated nasal vascular permeability. Nasal stimulation with histamine or LTC4 resulted in increase of nasal vascular permeability and of kinins concentration in the nasal lavage fluid. These results suggest that kinins might be concerned with the immediate and later vascular permeability during the allergic response.

Topics: Animals; Bradykinin; Capillary Permeability; Disease Models, Animal; Guinea Pigs; Histamine; Kinins; Male; Nose; Rhinitis, Allergic, Perennial; SRS-A

For the clinical evaluation of vidian neurectomy, questionnaires were sent to 250 cases operated on from 1971 to 1982, with answers obtained from 171. For sneezing, 56.8% of cases were evaluated markedly effective, 36.7% effective, 4.3% unchanged, and 2.2% aggravated. For rhinorrhea, markedly effective was 54.7%; effective, 39.4%; unchanged, 3.7%; aggravated, 2.2%. For nasal obstruction, markedly effective was 67.5%; effective, 27.4%; unchanged, 5.1%; and aggravated, 0%. On the other hand, 20% of cases complained of relapse of nasal allergic symptoms. Concerning the side effects, 28.7% of cases complained of cheek, upper lip, or palate numbness. Decrease of lacrimation was noted in 9.4% of cases. Several kinds of disturbances in the eye movement were observed in 4% of cases. Among them, 16 cases showed complete recovery within 24 h. In 3 cases, abducens paralysis continued for several months. Postoperative arterial bleeding occurred in one case. My recent strategy for the treatment of allergic rhinitis is conservative treatment at first, secondary nasal surgery such as septoplasty or turbinotomy, and at last vidian neurectomy if the patient agrees to be operated on after understanding the side effects.

Topics: Abducens Nerve; Cranial Nerve Diseases; Evaluation Studies as Topic; Eye Movements; Follow-Up Studies; Humans; Lacrimal Apparatus Diseases; Nasal Obstruction; Nose; Paralysis; Postoperative Complications; Rhinitis, Allergic, Perennial; Sneezing; Surveys and Questionnaires

Posterior rhinometric measurements of nasal resistance were conducted on two groups of patients with perennial rhinitis: those whose symptom of nasal stuffiness responded to a topical steroid spray and those in whom it did not. The anterior ends of the inferior turbinates in 48 patients were treated with either cryosurgery or cautery, and in half of the subjects the erectile tissue of the septum was also thermally ablated. Measurements were made before and 10-16 weeks after therapy. It is concluded from statistical comparison that there is no benefit to treating the septum, and that cryosurgery is more effective in those whose symptoms respond to topical steroids, while cautery works better in those who do not. Histology showed no change in the capacitance vessels (sinusoids) after either modality, and xylometazoline caused a marked decrease in nasal resistance, suggesting that vascular smooth muscle function was intact. Irrespective of the change in airway resistance, most subjects felt that there had been an improvement. The mechanism is discussed.

Topics: Adult; Airway Obstruction; Airway Resistance; Beclomethasone; Cryosurgery; Electrocoagulation; Female; Humans; Male; Manometry; Nasal Septum; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Perennial; Turbinates

Topics: Diagnosis, Differential; Histamine H1 Antagonists; Humans; Male; Middle Aged; Nasal Decongestants; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Topics: Adolescent; Adult; Airway Resistance; Biological Factors; Female; Histamine; Humans; Male; Middle Aged; Nasal Mucosa; Nasal Provocation Tests; Nose; Platelet Activating Factor; Prostaglandin D2; Rhinitis, Allergic, Perennial; Sneezing; SRS-A

Topics: Adult; Airway Resistance; Female; Humans; Male; Nose; Posture; Rhinitis, Allergic, Perennial

The effects of inhaled warm air on nasal patency and on allergic rhinitic symptoms were studied in 102 patients. Treatment consisted of two consecutive 30-minute sessions, during which the patient inhaled saturated, hot (42-44 degrees C) air through the nose. The treatment was repeated 1 week later. During the week following each treatment, every patient recorded his or her subjective response on a daily symptom score card. Nasal patency was determined before and after each treatment by measuring peak nasal inspiratory and expiratory air flow and by measuring the area covered with vapor formed by the exhaled air on a plate. Highly reproducible results were obtained by using these three objective methods. Inhalation of humidified warm air resulted in amelioration of allergic rhinitis symptoms and in increased nasal patency in a high proportion of patients. There were no adverse side effects. This form of therapy seemed effective in the 2-week period in which it was used and would be an additional form of therapy available for those suffering discomfort from allergic rhinitis.

Topics: Adolescent; Adult; Aged; Air; Child; Female; Hot Temperature; Humans; Humidity; Male; Middle Aged; Nose; Peak Expiratory Flow Rate; Pulmonary Ventilation; Respiration; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Rhinitis causes both clinical and social discomfort to patients, and in clinical practice is often underdiagnosed. We have examined a simple method for the assessment of a positive nasal provocation test to help in the diagnosis of rhinitis. In patients with histories suggestive of house dust mite (HDM) sensitivity and positive skin-prick tests or specific IgE to Dermatophagoides pteronyssinus, there was a fall in nasal inspiratory peak flow (NIPF) following nasal challenge with allergen. This was not seen in control subjects or in pollen-sensitive patients when challenged with house dust mite. Frequency of sneezing and degree of rhinorrhoea increased in these patients following challenge, and based on these findings we propose a simplified scoring system for the diagnosis of allergic rhinitis. We examined non-specific nasal reactivity using hyperosmolar solutions as a challenge system and found that allergic subjects responded with a fall in NIPF, although the clinical response was not identical to that seen with allergen. Control subjects did not respond to hyperosmolar challenge.

Topics: Adolescent; Adult; Allergens; Female; Humans; Male; Middle Aged; Nose; Osmolar Concentration; Palate; Rhinitis, Allergic, Perennial; Sneezing

To find whether patients with chronic rhinitis might be congested because of hyporesponsiveness to adrenergic vasoconstrictive influences, we measured nasal airway resistance (NAR) in normals and allergic and non-allergic rhinitics during intravenous infusion of graded doses of phenylephrine. All responded with decreases in NAR and first evidences of NAR fall appeared no later in those with rhinitis than in normals. Nasal congestion and response were asymmetrical; absolute NAR in the low resistance side was similar in all groups and there was little response to phenylephrine. In the high resistance side, NAR reached its minimum by the time the total infused dose was 1400 mcg, indicating maximum response to drug was achieved within the dose range studied. Minimum NAR achieved on the high resistance side was higher in rhinitics suggesting residual vascular engorgement resistant to phenylephrine or non-vascular mucosal swelling. Resistance to adrenergic vasoconstriction does not appear to be the primary contributor to mucosal swelling in chronic rhinitis.

Topics: Airway Resistance; Chronic Disease; Humans; Nose; Phenylephrine; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Patients presenting with typical signs and symptoms of allergic rhinitis may respond to avoidance of allergens and to medications for symptomatic relief. Treatment may include antihistamines, decongestants, cromolyn sodium, and/or topical nasal steroids. Patients whose symptoms are refractory to these therapeutic measures should be referred to an allergist for further evaluation and consideration for possible allergen immunotherapy.

Topics: Allergens; Diagnosis, Differential; Histamine H1 Antagonists; Humans; Immunotherapy; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

This study analyzed the effect of perennial allergic rhinitis on dental and facial skeletal characteristics. Twenty-five allergic children who were apparent mouth breathers, their 25 siblings who did not have the disease and were apparent nose breathers, and 14 nasal breathing control subjects were examined medically, dentally, and cephalometrically. Compared with their siblings, the allergic subjects had more nasal mucosal edema, a higher proportion of eosinophils in their nasal secretions, and greater nasal power. The allergic subjects were characterized by deeper palatal height, retroclined mandibular incisors, increased total anterior facial height and lower facial height, a larger gonial angle, and greater SN, palatal, and occlusal planes to mandibular plane angles. All of these measures except gonial angle were also significantly different between the allergic children and the nonconsanguineous controls. Also, the allergic subjects compared with controls had smaller SNB and SN-pogonion angles and an increased overjet. Both allergic and nonallergic sibling groups showed larger mean adenoid size on radiographs than controls. For most variables the nonallergic siblings fell between the allergic children and the control subjects. Overall, the allergic children had longer, more retrusive faces than controls. This retrusive characteristic was present in nonallergic siblings and cannot be ascribed to the apparent breathing mode at the time of the study. These results confirm earlier reports that allergic rhinitis may be associated with altered facial growth. Controlled longitudinal studies to analyze a possible cause-and-effect relationship and the effects of medical and surgical treatments should be undertaken.

Topics: Adolescent; Airway Resistance; Cephalometry; Child; Child, Preschool; Edema; Facial Bones; Female; Humans; Male; Mouth Breathing; Nasal Mucosa; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Perennial; Tooth

Topics: Anti-Bacterial Agents; Bone Plates; Ear, External; Face; Humans; Lacrimal Apparatus; Nose; Otorhinolaryngologic Diseases; Paranasal Sinuses; Prostheses and Implants; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Rhinoplasty; Surgery, Plastic; Zygomatic Fractures

We investigated the effect of aerosols inhaled into the lungs on nasal airflow resistance (Rnaw) using a constant inflow pressure method with measured airflow. Isotonic saline and water aerosols produced no immediate significant change in Rnaw and forced expired volume in 1 s (FEV1); however, water gradually decreased FEV1 and increased Rnaw, the response being maximal 10-15 min after provocation. Histamine aerosol significantly increased Rnaw in healthy subjects, asthmatics and asthmatics with allergic rhinitis. There was also a corresponding decrease in FEV1. The increase in Rnaw and the decrease in FEV1 were reversed by inhalation of terbutaline (10 mg . ml-1). Similarly, terbutaline in patients with mild asthmatic attacks decreased Rnaw and increased FEV1. Since terbutaline applied locally into the nose is known to increase Rnaw, we conclude that lung provocation can increase nasal Rnaw, presumably via nervous pathways.

Topics: Adolescent; Adult; Aerosols; Aged; Airway Resistance; Asthma; Bronchial Provocation Tests; Forced Expiratory Volume; Histamine; Humans; Isotonic Solutions; Middle Aged; Nose; Rhinitis, Allergic, Perennial; Sodium Chloride; Terbutaline; Water

Vasomotor rhinitis is a nonallergic, noninfectious cause of nasal obstruction and rhinorrhea. The etiology is believed to be an imbalance of the autonomic neural supply to the nasal mucosa with resultant vasodilation and hypersecretion. Management hinges on identification of a treatable diagnostic entity, such as rhinitis medicamentosa or allergic rhinitis. Psychotherapy, medical therapy, and surgery all have roles in the treatment of vasomotor rhinitis. Response to therapy is often disappointing.

Topics: Autonomic Nervous System; Blood Vessels; Humans; Nose; Parasympathetic Nervous System; Psychotherapy; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Rhinitis, Vasomotor; Turbinates

Nasal mucociliary clearance was measured using a saccharin technique in 172 patients with perennial rhinitis (76 also had asthma) and in 121 patients with chronic infected rhinosinusitis (40 had asthma, 35 had bronchiectasis). All patient groups had significantly longer mean nasal mucociliary clearance times than that of a group of healthy subjects. Grossly prolonged clearance (greater than 60 minutes) occurred in significantly more patients with the clinical syndrome of chronic infected rhinosinusitis and bronchiectasis than in the syndromes of chronic infected rhinosinusitis with or without asthma, and perennial rhinitis with or without asthma. The abnormal clearance was shown not to be due to an intrinsic ciliary defect by in vitro examination of nasal cilia but probably to be due to a combination of mucus and ciliary factors in vivo.

Topics: Adolescent; Adult; Asthma; Bronchiectasis; Cilia; Female; Humans; Male; Middle Aged; Mucus; Nose; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Saccharin; Sinusitis

The authors studied the histamine threshold (endpoint concentration for a 100% pressure gradient increase at a flow of 0.25 liter/second) in a group of 29 patients suffering from non specific allergic rhinopathy and a control group of 15 normal subjects. The result of the nasal challenge was measured with two different methods of rhinomanometry: the passive anterior rhinomanometry (P.A.R.) and the active anterior rhinomanometry (A.A.R.). There existed a slightly significant difference (P less than or equal to 0.05) in histamine threshold between the patient and the control group. The 21 in duplo performed histamine challenges showed the very good reproducebility of the method. Finally, the A.A.R. method turned out to be slightly more sensitive than the P.A.R.-method.

Topics: Aerosols; Bronchial Provocation Tests; Differential Threshold; Histamine; Humans; Manometry; Nose; Osmolar Concentration; Rhinitis, Allergic, Perennial

Topics: Humans; Nose; Occupational Diseases; Rhinitis, Allergic, Perennial

In rhinology, electron microscopy has been a useful research tool for the past 15 years, but provided only a few direct clinical applications. In this review, the author's work on the human nasal mucosa and the studies of other investigators are discussed, with the emphasis on allergic reactions and disturbances of the autonomous nervous system as well as the immotile cilia syndrome.

Topics: Autonomic Nervous System; Ciliary Motility Disorders; Cystic Fibrosis; Epithelium; Humans; Microscopy, Electron; Nasal Mucosa; Nose; Nose Diseases; Nose Neoplasms; Otolaryngology; Papilloma; Rhinitis, Allergic, Perennial

Trauma is the most common problem involving the nose in sports and athletic events. Injury may lead to "vasomotor syndrome" and chronic rhinitis. Nasal and sinus obstruction may cause additional discomfort. Exposure to irritants, particularly solvents, cleaning solutions, paints, and varnishes as well as air pollutants exacerbates vasomotor rhinitis. Allergic rhinitis is another major problem of atopic athletes. It may be caused by exposure to pollens, molds, dust, or animal danders. Treatment is aimed at reducing the exposure to etiologic factors as well as pharmacologic management. Antihistamines, topical cromolyn, and topical steroids may be used to control rhinitis without violating " antidoping " regulations.

Topics: Allergens; Basophils; Cold Temperature; Epinephrine; Epistaxis; Headache; Histamine H1 Antagonists; Humans; Mast Cells; Methacholine Chloride; Methacholine Compounds; Nose; Rhinitis, Allergic, Perennial; Sinusitis; Sports

Since the operation of submucous resection of the septum has been replaced by septoplasty, the indication for nasal surgery in children has increased. They may be divided into four categories, which by order of importance are: Re-establishment of nasal function (95%); severe nasal allergy provoked by deformity; psychological factors associated with deformities and cosmetic factors related to gross congenital deformities. Septoplasty must preserve three zones: Central zone, the anterior edge of the septum and supra-premaxillary region. Rhinoplasty is less dangerous than septoplasty in children. Surgery of the turbinates is often necessary in conjunction with the preceding operations. The authors present several examples of long term results (before and after puberty).

Topics: Child; Child, Preschool; Female; Humans; Male; Nose; Nose Deformities, Acquired; Nose Diseases; Rhinitis, Allergic, Perennial; Rhinoplasty

Topics: Adolescent; Adult; Aged; Airway Resistance; Child; Female; Humans; Male; Middle Aged; Nasal Mucosa; Nasal Provocation Tests; Nose; Rhinitis, Allergic, Perennial

The aim of the present study has been to examine the pathophysiology of allergic rhinitis, and the number, distribution and antigen-reactivity of basophilic cells. Blown nasal secretions, nasal washings, scrapings and excised specimens of nasal mucosa were collected and examined cytologically and histologically in both light and electron microscopes. Antigen-induced histamine release was also studied in these specimens. The results indicate that migration of basophilic cells (mainly basophil leukocytes in the nasal secretion and predominantly mast cells in the epithelium) to the mucosal surface is characteristic for allergy and that the total number and the histamine content of these cells are sufficient to produce the nasal manifestation of allergy. In conclusion, this study provides evidence supporting our concept of the mechanism of nasal allergy, i.e., that allergic reaction to inhaled allergens is initiated on the mucosal surface, and not in the lamina propria.

Topics: Humans; Leukocytes; Mast Cells; Nose; Reference Values; Rhinitis, Allergic, Perennial

Changes in pulmonary resistance induced by various nasal stimuli were recorded in 16 subjects with nasal allergy and 16 laryngectomized subjects. To avoid human errors in sampling respiratory curves, computer analysis was performed breath by breath, automatically and continuously. In the subjects with nasal allergy the nasal mucosa was stimulated with pressure using a nasal balloon, and by a paper patch with 0.1 ml of 5% histamine hydrochloride. Laryngectomized subjects were stimulated with pressure and by pepper powder. Nasal pressure stimulation up to 50 cm H2O did not cause a statistically significant change in the pulmonary resistance of both groups of subjects. Pepper stimulation caused a statistically significant increase of the pulmonary resistance amounting to 40.4 +/- 28.2% of the prestimulatory level. Histamine stimulation caused a statistically significant change of the pulmonary resistance, but it was difficult to discern whether it caused an increase or a decrease of the resistance. Maximum efforts were used to control the respiratory pattern using the metronome and by visual monitoring of the peak flow rate on the cathode ray oscilloscope, but pepper and histamine stimulation caused a statistically significant increase, although slight, of tidal volume. The effect of slight changes of respiratory patterns induced by nasorespiratory reflex on the observed change of pulmonary resistance could not be ruled out in this human study.

Topics: Adult; Aged; Airway Resistance; Computers; Esophagus; Humans; Laryngectomy; Middle Aged; Nose; Physical Stimulation; Respiratory Function Tests; Rhinitis, Allergic, Perennial

Topics: Airway Obstruction; Female; Humans; Male; Malocclusion; Maxillofacial Development; Nose; Rhinitis, Allergic, Perennial

Thirty-five patients with perennial rhinitis were treated with beclomethasone dipropionate nasal aerosol three times daily for 48 weeks. There was no evidence at the end of the study of any adverse effects from the topical steroid as assessed by biopsy studies of the nasal mucus membrane and by negative nasal cultures for C. albicans.

Topics: Aerosols; Beclomethasone; Biopsy; Candida; Double-Blind Method; Drug Evaluation; Female; Humans; Male; Nasal Mucosa; Nose; Placebos; Rhinitis, Allergic, Perennial

Nasal tissues can be affected by a greater variety of stimuli than is generally considered, stimuli which can produce many different diseases. The manner in which the nose can respond symptomatically and physically is limited so that symptoms and findings in different diseases frequently overlap and the conditions may be difficult to diagnose. An understanding of nasal diseases is only in its infancy. This report outlines some of these diseases and speculates about the presence of others. Classification of nasal disease is presented based on the suspected presence or absence of an immunological mechanism.

Topics: Chronic Disease; Humans; Hypersensitivity, Delayed; Hypothyroidism; Nasal Mucosa; Nasal Polyps; Nose; Nose Diseases; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Nasal response to a large number of stimuli is almost invariably the same, with sneezing, watery rhinorrhoea and nasal obstruction constituting the three major conventional symptoms of the so-called vasomotor (autonomic) rhinitis. These symptoms are not specific to allergic reactions but can be seen in viral infections, sudden changes in temperature, inhalation of irritant fumes or of certain smells. The aetiological diagnosis of vasomotor rhinitis therefore is sometimes very difficult but seems to be greatly facilitated by intranasal challenge tests associated with anterior rhinomanometry.

Topics: Allergens; Bronchial Provocation Tests; Humans; Immunoglobulin E; Manometry; Nasal Provocation Tests; Nose; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Rhinitis, Vasomotor; Skin Tests

Forty-eight perennial rhinitis patients completed a six weeks' open trial of intranasal beclomethasone dipropionate aerosol. Each received a daily dose of 400 micrograms. Thirty-five responded excellently, seven reported satisfactory improvement and six failed. This study indicated that patients with a demonstrable allergic component responded favorably. However, due to the wide margin of safety the authors suggest that it be tried on the non-infective perennial rhinitis with no demonstrable allergic component as well.

Topics: Administration, Intranasal; Adolescent; Adult; Asthma; Beclomethasone; Eosinophils; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Mucosa; Nose; Radiography; Rhinitis, Allergic, Perennial; Skin Tests

Topics: Animals; Nose; Perciformes; Rhinitis; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Seasons

Topics: Anaphylaxis; Hypersensitivity; Immune System Diseases; Nose; Rhinitis, Allergic, Perennial; Seasons