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Rhinitis
Kinds of Rhinitis Terms modified by Rhinitis Selected AbstractsRecognizing And Treating Non-Infectious RhinitisJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2003Terrye Mastin APRN Purpose To increase clinicians' familiarity with nonallergic and mixed rhinitis and to differentiate these from allergic rhinitis, thus providing for an accurate diagnosis and facilitating a successful initial treatment program. Data Sources A Medline search of published journal articles was supplemented with known books and proceedings pertaining to rhinitis. Conclusions Although there is significant overlap of symptoms among the three types of rhinitis (i.e., allergic, nonallergic, and mixed), the patient history often contains clues that can aid in establishing a correct diagnosis. The new Patient Rhinitis Screen, a questionnaire developed for use in the primary care arena, facilitates the diagnostic process. Implications for Practice As the most common condition in the outpatient practice of medicine, rhinitis is frequently treated by primary care practitioners. Recent guidelines for the diagnosis and management of rhinitis suggest that a specific diagnosis of allergic, nonallergic, or mixed rhinitis leads to more effective treatment strategies. The result is successful and efficient care utilizing, as appropriate, broad-based and symptom-specific therapies. [source] Pregnancy Rhinitis and Rhinitis MedicamentosaJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2002Betty Rambur DNSc Purpose To present guidelines for the recognition, management, and referral of pregnancy rhinitis with a goal of improving the quality of the pregnancy experience for women afflicted with this condition. Data Sources A case study illustrating the presentation of a severe case of pregnancy rhinitis is followed a literature review of etiology, diagnosis, and management strategies. Conclusions Pregnancy rhinitis is a condition of clinical importance that is frequently exacerbated by use of intranasal decongestant sprays. The resulting rhinitis medicamentosa exacerbates the nasal obstruction, with resulting sleep disruptions that negatively impact the experience of pregnancy. Implications for Practice Nurse practitioners may miss opportunities to provide support, anticipatory guidance, and symptom relief. Anticipatory guidance that stresses the critical necessity of avoiding nasal spray decongestants, environmental modification, use of intranasal saline, moderate exercise, and nasal strips for subjective relief may have the potential to markedly decrease escalation of the condition to a serious disorder. [source] Development and implementation of guidelines in allergic rhinitis , an ARIA-GA2LEN paperALLERGY, Issue 10 2010J. Bousquet To cite this article: Bousquet J, Schünemann HJ, Zuberbier T, Bachert C, Baena-Cagnani CE, Bousquet PJ, Brozek J, Canonica GW, Casale TB, Demoly P, Gerth van Wijk R, Ohta K, Bateman ED, Calderon M, Cruz AA, Dolen WK, Haughney J, Lockey RF, Lötvall J, O'Byrne P, Spranger O, Togias A, Bonini S, Boulet LP, Camargos P, Carlsen KH, Chavannes NH, Delgado L, Durham SR, Fokkens WJ, Fonseca J, Haahtela T, Kalayci O, Kowalski ML, Larenas-Linnemann D, Li J, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Papadopoulos N, Passalacqua G, Rabe KF, Pawankar R, Ryan D, Samolinski B, Simons FER, Valovirta E, Yorgancioglu A, Yusuf OM, Agache I, Aďt-Khaled N, Annesi-Maesano I, Beghe B, Ben Kheder A, Blaiss MS, Boakye DA, Bouchard J, Burney PG, Busse WW, Chan-Yeung M, Chen Y, Chuchalin AG, Costa DJ, Custovic A, Dahl R, Denburg J, Douagui H, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Kaliner MA, Keith PK, Kim YY, Klossek JM, Kuna P, Le LT, Lemiere C, Lipworth B, Mahboub B, Malo JL, Marshall GD, M vale-Manuel S, Meltzer EO, Morais-Almeida M, Motala C, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Ouedraogo S, Palkonen S, Popov TA, Price D, Rosado-Pinto J, Scadding GK, Sooronbaev TM, Stoloff SW, Toskala E, van Cauwenberge P, Vandenplas O, van Weel C, Viegi G, Virchow JC, Wang DY, Wickman M, Williams D, Yawn BP, Zar HJ, Zernotti M, Zhong N, In collaboration with the WHO Collaborating Center of Asthma and Rhinitis (Montpellier). Development and implementation of guidelines in allergic rhinitis , an ARIA-GA2LEN paper. Allergy 2010; 65: 1212,1221. Abstract The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients' values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved. [source] Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthmaALLERGY, Issue 8 2010J. A. Fonseca To cite this article: Fonseca JA, Nogueira-Silva L, Morais-Almeida M, Azevedo L, Sa-Sousa A, Branco-Ferreira M, Fernandes L, Bousquet J. Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthma. Allergy 2010; 65: 1042,1048. Abstract Background and aim:, The Control of Allergic Rhinitis and Asthma Test (CARAT) was developed to be used in the concurrent management of these diseases, as recommended by the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. However, it was necessary to statistically identify and remove redundant questions and to evaluate the new version's factor structure, internal consistency and concurrent validity. Methods:, In this cross-sectional study 193 adults with allergic rhinitis and asthma from 15 outpatient clinics in Portugal were included. The CARAT questionnaire was reduced using descriptive analysis, exploratory factor analysis and internal consistency. Spearman's correlations were used to compare the CARAT scores with a medical evaluation and other measures of control, including the Asthma Control Questionnaire and symptoms' visual analogue scales. The performance against physician rating of control was summarized using the area under the curve (AUC) from receiver operating characteristic analysis. In addition, CARAT was compared with the physician's decision to reduce, maintain or increase treatment. Results:, The reduced version has 10 questions and 2 factors (CARAT10). The Cronbach's alpha was 0.85. All correlation coefficients of CARAT10 and factors with the different measures of control met the a priori predictions, ranging from 0.58 to 0.79. The AUC was 0.82. For the physician's decision groups of reduce, maintain or increase treatment, the mean (IC95%) scores of CARAT10 were 24 (21.4;26.6), 21 (19.4;21.9) and 15 (13.6;16.5), respectively. Conclusion:, CARAT10 has high internal consistency and good concurrent validity, making it useful to compare groups in clinical studies. [source] Rhinitis: a complication to asthmaALLERGY, Issue 7 2010J. W. Hansen To cite this article: Hansen JW, Thomsen SF, Nolte H, Backer V. Rhinitis: a complication to asthma. Allergy 2010; 65: 883,888. Abstract Background:, Asthma and rhinitis often co-occur, and this potentially increases the disease severity and impacts negatively on the quality of life. We studied disease severity, airway responsiveness, atopy, quality of life and treatment in subjects with both asthma and rhinitis compared to patients with asthma or rhinitis alone. Methods:, We examined 878 patients: 182 with asthma, 362 with rhinitis and 334 with both asthma and rhinitis. All had a clinical interview concerning severity of symptoms, treatment, and quality of life, a skin prick test, a lung function test and a bronchial provocation with methacholine. Results:, Patients with both asthma and rhinitis had less severe asthma based on the frequency of respiratory symptoms compared to patients with asthma alone (55%vs 66%P = 0.01). On the contrary, they were more airway responsive (P < 0.05) and had more perennial allergy (P < 0.001). Asthmatics had poor perception of the general health, independent of rhinitis (P < 0.001). No differences were found in asthma-specific quality of life, whereas rhinitis-specific quality of life was worse in those with both asthma and rhinitis compared to those with rhinitis alone (P < 0.01). Subjects with both diseases were undertreated in 85% of the cases. Conclusion:, We encourage that these observations be used in the evaluation and treatment of patients with asthma and rhinitis and that they contribute to the understanding of asthma and rhinitis as a uniform airways disease. [source] Does asthma control correlate with quality of life related to upper and lower airways?ALLERGY, Issue 6 2009A real life study Background:, The goal of asthma therapy is to achieve an optimal level of disease control, but the relationship between asthma control, impact of comorbid rhinitis and health related quality of life (HRQoL) in real life remains unexplored. Objective:, The aims of this real life study were to evaluate asthma control, the impact of asthma (with and without rhinitis) on HRQoL, the relationship between asthma control and HRQoL, and the role of rhinitis on asthma control and HRQoL. Methods:, 122 asthma patients completed the Asthma Control Test, Rhinitis Symptoms score (T5SS) and RHINASTHMA. Results:, Asthma control was unsatisfactory (44.27% of uncontrolled patients), as well as HRQoL. Controlled patients controlled showed significantly lower scores in all the RHINASTHMA domains compared to uncontrolled. Irrespective of their level of control, patients with rhinitis symptoms showed worse HRQoL in Upper Airways (UA) (P < 0.0001), Lower Airways (LA) (P < 0.001), and Global Summary (GS) (P < 0.0001). In patients with symptomatic rhinitis, RHINASTHMA were lower in controlled asthma patients (UA P = 0.002; LA P < 0.0001; RAI P < 0.01; GS P < 0.0001). Asthma control was associated with lower T5SS score (P = 0.034). Conclusion:, Asthma control in real life is unsatisfactory. Rhinitis and asthma influence each other in terms of control and HRQoL. The control of rhinitis in asthma patients can lead to an optimization of HRQoL related to the upper airways, while this phenomenon is not so evident in asthma. These results suggest to strengthen the ARIA recommendation that asthma patients must be evaluated for rhinitis and vice versa. [source] Rhinitis and asthma represent hot topics for AllergyALLERGY, Issue 1 2009J. Bousquet First page of article [source] Comparison of the efficacy and safety of bilastine 20 mg vs desloratadine 5 mg in seasonal allergic rhinitis patientsALLERGY, Issue 1 2009C. Bachert Background:, Bilastine is a novel, nonsedating H1 -antihistamine developed for symptomatic treatment of Allergic Rhinitis and Chronic Idiopathic Urticaria. The objective of this study was to compare the efficacy and safety of bilastine 20 mg vs placebo and desloratadine 5 mg in subjects with seasonal allergic rhinitis (SAR). Methods:, This randomized, double blind, placebo-controlled, parallel-group multicentre study evaluated the effect of 2 weeks' treatment with bilastine 20 mg, desloratadine 5 mg or matched placebo once daily, in 12,70 years old symptomatic SAR patients. All subjects assessed the severity of nasal (obstruction, rhinorrhoea, itching, and sneezing) and nonnasal (ocular itching, tearing, ocular redness, itching of ears and/or palate) symptoms on a predetermined scale to provide a total symptom score (TSS), composed of nasal and nonnasal symptom scores (NSS and NNSS, respectively). The primary efficacy measure was the area under the curve (AUC) for the TSS over the entire treatment period. Results:, Bilastine 20 mg significantly reduced the AUC of TSS to a greater degree from baseline compared to placebo (98.4 with bilastine vs 118.4 with placebo; P < 0.001), but not compared to desloratadine 5 mg (100.5). Bilastine 20 mg was not different from desloratadine 5 mg but significantly more effective than placebo in improving the NSS, NNSS, and rhinitis-associated discomfort scores (P < 0.05), and rhinoconjunctivitis quality of life questionnaire total (P < 0.005) and four out of seven individual domain (P < 0.05) scores. The incidence of treatment emergent adverse events was similar for bilastine (20.6%), desloratadine (19.8%), and placebo (18.8%). Conclusion:, Bilastine 20 mg once daily was efficacious, safe and not different from desloratadine 5 mg once daily in the treatment of SAR symptoms. [source] Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update, in collaboration with GA2LENALLERGY, Issue 2007A. A. Cruz This update aimed to review the new evidence available to support or refute prior Allergic Rhinitis and its Impact on Asthma (ARIA) statements. A Medline search of publications between 2000 and 2005 was conducted, with articles selected by experts. New evidence supports previous ARIA statements, such as: (i) allergic rhinitis (AR) is a risk factor for asthma; (ii) patients with persistent rhinitis should be evaluated for asthma; (iii) most patients with asthma have rhinitis; (iv) a combined strategy should be used to treat the airways and (v) in low- to middle-income countries, a different strategy may be needed. The increased risk of asthma has also been found among sufferers from non-AR. Recent reports show AR is a global problem. Many studies demonstrated parallel increasing prevalence of asthma and rhinitis, but in regions of highest prevalence, it may be reaching a plateau. Factors associated with a reduced risk of asthma and AR have been identified, confirming previous findings of protection related to exposure to infections. Treatment of rhinitis with intranasal glucocorticosteroids, antihistamines, leukotriene antagonists or immunotherapy may reduce morbidity because of asthma. To take advantage of the paradigm of unified airways, there is a need to rationalize diagnosis and treatment to optimize management. [source] Increased Nerve Fiber Expression of Sensory Sodium Channels Nav1.7, Nav1.8, and Nav1.9 in Rhinitis,,THE LARYNGOSCOPE, Issue 4 2008Siew M. Keh MRCS Abstract Introduction: Voltage-gated sodium channels Nav1.7, Nav1.8, and Nav1.9 are involved in nerve action potentials and have been proposed to underlie neuronal hypersensitivity. We have therefore studied their levels in allergic and nonallergic rhinitis. Materials and Methods: Inferior turbinate biopsies from 50 patients (n = 18 controls, n = 20 allergic, and n = 12 nonallergic rhinitis) were studied by immunohistology using antibodies to Nav1.7, Nav1.8, and Nav1.9, the structural nerve marker (protein gene product [PGP]9.5), nerve growth factor (NGF), mast cells (c-kit), macrophages (CD68), and T cells (CD3). Sodium channel-positive nerve fibers were counted per millimeter length of subepithelium, and immunoreactivity for inflammatory cell markers PGP9.5 and NGF were image analyzed. Results: All three sodium channel-immunoreactive nerve fiber numbers were significantly increased in allergic (Nav1.7, P = .0004; Nav1.8, P = .028; Nav1.9, P = .02) and nonallergic (Nav1.7, P = .006; Nav1.8, P = .019; Nav1.9, P = .0037) rhinitis. There was a significant increase of subepithelial innervation (PGP9.5, P = .01) and epithelial NGF immunoreactivity (P = .03) in nonallergic rhinitis, comparable with our previous report in allergic rhinitis. Inflammatory cell markers were significantly increased in allergic (mast cells, P = .06; macrophages, P = .044; T cells, P = .007) but not nonallergic rhinitis. Conclusion: The increased levels of sensory sodium channels in allergic and nonallergic rhinitis may contribute to the hypersensitive state, irrespective of the degree of active inflammation. Selective blockers of these sodium channels, administered topically, may have therapeutic potential in rhinitis. [source] Persistent Allergic Rhinitis Includes Different Pathophysiologic TypesTHE LARYNGOSCOPE, Issue 3 2008Giorgio Ciprandi MD Abstract Background: Allergy rhinitis is typically classified as seasonal allergy rhinitis (SAR) and perennial allergy rhinitis (PAR). More recently, the Allergic Rhinitis and its Impact on Asthma document proposed the intermittent (ITR) and persistent forms (PER). However, it has been previously reported that each single allergen may induce different clinical and pathophysiologic features. Objective: The aim of the study was to test the hypothesis that the type of causal allergen might characterize pathophysiologic differences in a cohort of patients with PER. Methods: Three hundred nineteen patients, sailors of the Italian Navy, with moderate-severe PER were prospectively and consecutively evaluated with clinical evaluation, skin prick test, rhinomanometry, and nasal decongestion test. Results: Patients with pollen allergy showed significantly more severe symptoms, lower nasal airflow, and higher response to decongestion test than patients with allergy to perennial allergens (P < .0001). Conclusion: This study provides evidence that patients with PER may show different pathophysiologic patterns depending on the type of causal allergen. [source] Effects of Dexamethasone on the Expression of Transforming Growth Factor-, in the Mouse Model of Allergic RhinitisTHE LARYNGOSCOPE, Issue 8 2007Seung-Sin Lee MD Abstract Objectives/Hypothesis: This study aimed to evaluate the effect of dexamethasone on the expression of transforming growth factor (TGF)-, in the mouse model of allergic rhinitis. Study Design: Female BALB/c mice were randomly assigned to four groups, including two control groups and two treatment groups. Methods: General sensitization and local challenge were performed with ovalbumin (OVA). In the treatment groups, dexamethasone was injected intraperitoneally 3 hours before general sensitization or local challenge. Symptom score, eosinophil infiltration, and immunostaining for TGF-,1 and CD4 in nasal mucosa, and TGF-,1 and OVA-specific immunoglobulin E (IgE) in sera were analyzed. Results: Dexamethasone administration before general sensitization reduced the symptom score, OVA-specific IgE, and eosinophil infiltration and increased the serum level of TGF-,1 significantly. Dexamethasone administration before local challenge reduced only the eosinophil infiltration significantly. Immunoreactivity of TGF-,1 and CD4 was lower in both treatment groups. Conclusion: These results suggest that dexamethasone may play an important role in the regulation of allergic reactions by at least two mechanisms; one by suppressing allergic sensitization through decrease of CD4+ T cells and increase of TGF-,, and the other by suppressing late allergic reactions through the inhibition of proliferation and chemotaxis of inflammatory cells such as eosinophils. [source] Inverse Association between T-Cell Immunoglobulin and Mucin Domain-1 and T-bet in a Mouse Model of Allergic Rhinitis,THE LARYNGOSCOPE, Issue 6 2007Geng Xu MD Abstract Background: It has been suggested that human hepatitis A virus cellular receptor, also known as T-cell immunoglobulin and mucin domain-1 (TIM-1), plays an important role in the development of allergic diseases on the basis of epidemiologic data, but the molecular mechanism has been unclear. In a murine model of ovalbumin (OVA)-sensitized allergic rhinitis (AR), we examined the expression of TIM-1 and its correlation with T helper1-associated transcription factor, T-bet, as a potential mediator of T-cell immunoglobulin expression. Methods: Mice were challenged intranasally with OVA to elicit AR. The expression of TIM-1 in nasal tissues was examined by real-time reverse-transcription polymerase chain reaction (RT-PCR), and the surface expression of TIM-1 in peripheral blood mononuclear cells was evaluated by means of flow cytometry. In addition, the expression of TIM-1 as well as T-bet in splenic lymphocytes was examined by Western blotting. Results: TIM-1 mRNA was increased significantly in nasal tissues (P < .05) as seen by real-time RT-PCR. Flow cytometry indicated a differential TIM-1 expression of 135.5 ± 34.2 in the AR group versus 51.1 ± 10.9 in the control group (P < .05). The mean values of normalized TIM-1 were 0.43 ± 0.18 and 0.21 ± 0.10 in AR and control groups, respectively, whereas the mean values of normalized T-bet were 0.22 ± 0.13 and 0.67 ± 0.17 in the AR and control groups, respectively. There was a significant difference in the production of TIM-1 as well as T-bet in AR mice versus control mice (P < .05). The increased production of TIM-1 correlated significantly with the decreased T-bet in spleen tissue of AR mice (r = ,0.52, P < .05). Conclusion: Our experimental model recapitulates an increase in lymphocyte TIM-1 expression seen in AR both locally and systemically. Our results also demonstrate an inverse relationship between lymphocyte TIM-1 and T-bet expression, suggesting a possible mechanism that TIM-1 influences the development of AR. [source] A Possible Role of CD4+CD25+ T Cells as Well as Transcription Factor Foxp3 in the Dysregulation of Allergic RhinitisTHE LARYNGOSCOPE, Issue 5 2007Geng Xu MD Abstract Background: Allergic rhinitis (AR) is a Th2 predominant disease, and its pathogenic mechanism is still poorly understood. CD4+CD25+ T cells account for approximately 5% to 10% peripheral CD4+ T cells and has been shown to regulate the activation of effector T cells in the periphery. The activity of CD4+CD25+ T cells is associated with the transcription factor Foxp3. The present study aimed to evaluate the possible role of CD4+CD25+ T cells as well as Foxp3 in the pathogenesis of AR. Methods: Nasal tissues and peripheral blood mononuclear cells (PBMCs) were obtained from 17 patients with AR and 11 control subjects. Foxp3 was detected in nasal tissues by immunohistochemistry and real-time reverse transcription-polymerase chain reaction (RT-PCR). CD4+CD25+ T cells and Foxp3 were evaluated in PBMCs by using flow cytometry. Concentrations of interleukin-2 (IL-2) and interferon-, (IFN-,) were measured by enzyme-linked immunosorbent assay (ELISA) in cultured PBMCs in the presence or absence of stimulation with phorbol ester (PMA) and Ionomycin. Results: The numbers of Foxp3+ cells was 129.5 ± 35.6 and 44.2 ± 20.5 cells/mm2 in nasal mucosa of two groups (P < .05). There were less Foxp3+ lymphocytes and decreased Foxp3 mRNA in AR compared with the control (P < .05). The frequencies of the CD4+CD25+ population in PBMCs of two groups were 1.99 ± 0.95% and 3.55 ± 1.27% (P < .05). There was significant difference in the frequencies of the Foxp3+CD4+ CD25+ population (1.81 ± 0.77 vs 3.37 ± 1.04, P < .05) and mean fluorescence intensity (MFI) of Foxp3 (5.93 ± 2.64 vs 11.72 ± 4.29, P < .05) in PBMCs of two groups. After stimulation, the concentrations of IL-2 and IFN-, were 182.72 ± 85.11 pg/mL and 348.94 ± 151.88 pg/mL in PBMCs with AR, while those were 90.6 ± 61.5 pg/mL and 155.64 ± 68.33 pg/mL in controls (P < .05). Conclusion: Our results indicate that CD4+ CD25+ regulatory T cells as well as Foxp3 may play a crucial role in immunological imbalance of AR. These findings suggest that increasing Foxp3 and CD4+CD25+ T cells have the potential to be new therapeutic targets for the treatment of AR. [source] Prolonged Allergen Challenge in Murine Nasal Allergic Rhinitis: Nasal Airway Remodeling and Adaptation of Nasal Airway ResponsivenessTHE LARYNGOSCOPE, Issue 5 2007Muneo Nakaya MD Abstract Background: Nasal airway remodeling exists in allergic rhinitis, but it appears to be far less extensive than in asthma. However, there has been little study about nasal airway remodeling and no study using mice models. It has been reported that airway hyperresponsiveness decreased after prolonged allergen challenge in a chronic murine asthma model together with the progression of remodeling. However, there has been no study of the relation of remodeling and airway responsiveness in nasal allergy. Therefore, we have undertaken this investigation to characterize nasal airway structural changes after prolonged allergen challenge and to examine the relationship between nasal airway hyperresponsivity and remodeling. Methods: We prepared murine allergic rhinitis for ovalbumin. Mice were subsequently challenged three times a week with ovalbumin from day 19 to days 53, 88, and 130. We examined allergen-induced nasal symptoms and objective nasal hyperresponsiveness using the enhanced pause system. Moreover, the pathologic changes were investigated after allergen challenge. Results: The extended allergen challenge protocol caused significant nasal airway remodeling. Specifically, remodeling was characterized by goblet cell hyperplasia and deposition of collagen in the submucosal area. Allergen-induced nasal hyperresponsiveness was first increased but gradually decreased in nasal symptoms and Penh after prolonged allergen challenge. Conclusions: We have demonstrated that a remodeling of nasal mucosa in a murine allergic rhinitis model prolonged allergen exposure. Moreover, prolonged allergen exposure induced a reduction of nasal hyperresponsiveness together with a progression of nasal remodeling. [source] Heme Oxygenase (HO)-1 Is Upregulated in the Nasal Mucosa With Allergic Rhinitis,THE LARYNGOSCOPE, Issue 3 2006Ahmed Elhini MD Abstract Background: Heme oxygenase (HO) is considered to be an antioxidant enzyme that catabolizes heme to produce carbon monoxide (CO) and biliverdin. Three isoforms of HO have been discovered. Recently, HO-1 has been found to be upregulated after allergic inflammations of the lower airway. Objective: The objective of this study was to address the expression of HO isoenzymes 1 and 2 in the nasal mucosa of patients with allergic rhinitis as well as normal control subjects. Methods: Nasal mucosa from 30 patients with persistent allergic rhinitis as well as from 10 normal volunteers was used in this study. We used immunofluorescent technique, Western blotting, and real-time quantitative polymerase chain reaction to localize and quantify the expression of these isoenzymes in normal and allergic human nasal tissues. Results: We found that HO-1 is expressed in the epithelial cells of seromucinous glands and macrophages with significant upregulation of its glandular expression in allergic rhinitis but with no difference in its macrophage expression between the study groups in contrast to HO-2 that is expressed in the vascular endothelial lining cells as well as macrophages with no marked difference between the study groups. Conclusion: We demonstrated that expression of HO-1, but not HO-2, was upregulated within the nasal tissues in allergic rhinitis inflammation, and understanding the induction of HO-1 expression may provide for better management of allergic rhinitis that involves oxidative stress. [source] Upregulation of Oncostatin M in Allergic RhinitisTHE LARYNGOSCOPE, Issue 12 2005Hee Joon Kang MD Abstract Objectives: Oncostatin M is a multifunctional cytokine belonging to the interleukin-6 family of cytokines. It has been implicated as an important modulator of lower airway remodeling in the setting of asthma. However, there have been few studies regarding a similar role for the upper airway epithelium in the setting of allergic rhinitis. This study was undertaken to investigate the expression of oncostatin M mRNA and protein in normal and allergic rhinitis nasal mucosa and to localize the expression of the oncostatin M protein in allergic rhinitis. Materials and Methods: Inferior turbinate mucosa samples from 20 patients with perennial allergic rhinitis and 20 matched normal control subjects were obtained. Oncostatin M mRNA was extracted from the inferior turbinate mucosae, then reverse transcriptase-polymerase chain reaction was performed and analyzed semiquantitatively. Differences in expression levels of oncostatin M protein between samples from allergic rhinitis patients and normal control subjects were analyzed through Western blot, and oncostatin M protein was localized immunohistochemically. Results: The expression levels of oncostatin M mRNA and protein were significantly upregulated in patients with allergic rhinitis mucosa. Oncostatin M protein was predominantly localized in the surface epithelium, infiltrating inflammatory cells, vascular endothelium, and submucosal glands and was more strongly expressed in the nasal mucosa of patients with allergic rhinitis than in normal control subjects. Conclusions: Oncostatin M is expressed in the human nasal mucosa and is upregulated in the setting of allergic nasal inflammation. These results suggest a possible contribution of oncostatin M in the remodeling of the nasal mucosa in allergic rhinitis. [source] Nasal Allergic Response Mediated by Histamine H3 Receptors in Murine Allergic RhinitisTHE LARYNGOSCOPE, Issue 10 2005Muneo Nakaya MD Abstract Background: Histamine is one of the most important chemical mediators causing nasal allergic symptoms, and H1 receptor antagonist have been used as the treatment first choice in nasal allergy. The presence of H3 receptors has also been determined in the human nasal mucosa, but few studies have investigated the involvement of H3 receptors in nasal allergy. Objective: We used a murine allergic model to investigate the presence of nasal mucosa H3 receptor mRNA and any H3 receptor agonist or antagonist influences on clinical nasal allergic symptoms. Methods: H3 receptor mRNA in nasal mucosa was investigated by reverse-transcription polymerase chain reaction. OVA-sensitized mice were given an intraperitoneal injection of H3 receptor agonist or antagonist, and clinical nasal allergic symptoms were scored over 10 minutes after nasal provocation of OVA. Inhibition of nasal allergic symptoms was also examined using an H1 receptor antagonist alone and using a both an H3 receptor agonist and an H1 receptor antagonist. Results: H3 receptor mRNA was identified in the murine nasal mucosa. The H3 receptor agonist (R)-,-metylhistamine significantly inhibited clinical nasal allergic symptoms of OVA-sensitized mice. The H3 receptor agonist and H1 receptor antagonist inhibited clinical nasal allergic symptoms in the murine allergic model more strongly than the single drug. Conclusion: The foregoing results indicate that H3 receptors are involved in modulation of nasal allergy. H3 receptor agonists can also be useful as a novel therapeutic approach in nasal allergy. Both H3 receptor agonist and H1 receptor antagonist may be more effective than a single drug. [source] Nasal Provocation Testing as an International Standard for Evaluation of Allergic and Nonallergic RhinitisTHE LARYNGOSCOPE, Issue 3 2005Jan Gosepath MD Abstract Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, sneezing and, most importantly, nasal obstruction are assessed as well as ocular, bronchial, cutaneous, and systemic reactions. To achieve objective data on changes in nasal airflow and patency after the challenge, anterior rhinomanometry and acoustic rhinometry have been included in the standard protocol of NPT. By monitoring changes of nasal airflow on one hand and of nasal geometry on the other hand, these methods display nasal function in a graphic way just as speech and pure tone audiometry do for auditory function. Also, by their objective nature, these methods offer a clear and internationally comparable standard. This review outlines a protocol for NPT and discusses practical applications and clinical indications. The use of rhinomanometry and acoustic rhinometry as objective diagnostic tools is emphasized. For the diagnosis of allergic and occupational rhinitis, standardized NPT should be regarded as an international diagnostic standard. [source] Chemokine RANTES Promoter Polymorphisms in Allergic Rhinitis,THE LARYNGOSCOPE, Issue 4 2004Jeong Joong Kim PhD Abstract Objectives/Hypothesis RANTES is one of the most widely studied of the chemokines linked to allergic diseases. Two polymorphisms of the RANTES promoter region (,403 G/A and ,28 C/G) have been found. The authors investigated whether these RANTES promoter polymorphisms were associated with allergic rhinitis. Study Design Case-control study. Methods Blood samples for genetic analysis were obtained from 151 individuals with allergic rhinitis and from 278 healthy individuals without atopic disease. Polymerase chain reaction,based assays for detection of the ,403 G/A and ,28 C/G polymorphisms of the RANTES gene were used for genotyping. Results The frequencies of both the RANTES ,403A and ,28G alleles were significantly higher in patients with allergic rhinitis than in control subjects (P < .05 for both). Conclusion The study results indicated that the ,403 and ,28 alleles in the RANTES promoter region belong to the predictor gene set for allergic rhinitis and could be used in genomic analysis. [source] Autonomic Nervous System Evaluation of Patients With Vasomotor Rhinitis ,THE LARYNGOSCOPE, Issue 11 2000Safwan S. Jaradeh MD Abstract Objective To demonstrate the utility of quantitative neurological laboratory testing of autonomic nervous system dysfunction and to apply this methodology to further study the relation of chronic vasomotor (nonallergic) rhinitis to the autonomic nervous system. Methods It has been suspected that vasomotor rhinitis is due either to a hyperactive parasympathetic nervous system or an imbalance between it and the sympathetic nervous system. The exact relation has not been determined. Recently neurological laboratories have been developed in which a battery of tests can be performed to determine reactivity of the autonomic nervous system. Results Autonomic nervous system testing was performed on 19 patients with symptoms fulfilling the diagnostic criteria for vasomotor rhinitis and the results were compared with 75 sex- and age-matched control subjects. Patients with vasomotor rhinitis had significant abnormalities of their sudomotor, cardiovagal, and adrenergic subscores. Their composite autonomic scale score was significantly impaired at 2.43, as compared with 0.11 for controls (P < .005). Conclusion Autonomic nervous system dysfunction is significant in patients with vasomotor rhinitis. Possible factors that trigger this dysfunction including nasal trauma and extraesophageal manifestations of gastroesophageal reflux are discussed. [source] Nasal Interleukin-5, Immunoglobulin E, Eosinophilic Cationic Protein, and Soluble Intercellular Adhesion Molecule-1 in Chronic Sinusitis, Allergic Rhinitis, and Nasal PolyposisTHE LARYNGOSCOPE, Issue 6 2000Matthias F. Kramer MD Abstract Objective To compare concentrations of interleukin-5 (IL-5), immunoglobulin E (IgE), eosinophilic cationic protein (ECP), and soluble intercellular adhesion molecule-1 (sICAM-1) in nasal secretion and serum of patients with chronic nonallergic sinusitis, allergic rhinitis, and nonallergic nasal polyposis to obtain information about the pathogenesis of these diseases. Methods Nasal secretion and serum were analyzed by routine enzyme-linked immunosorbent assay techniques. Nineteen patients with chronic nonallergic sinusitis, 24 patients with seasonal allergic rhinitis, and 18 patients with nonallergic nasal polyposis were included in the study. Eight healthy, nonallergic probands served as control subjects. Results Significantly elevated concentrations of IL-5 (5-fold, P < .05) and IgE (15-fold, P < .01) were detected in nasal secretion of patients with allergic rhinitis (IL-5, 51.8 ± 13.2 pg/mL; IgE, 41.9 ± 20.9 kU/L) or nonallergic nasal polyposis (IL-5, 57.9 ± 36.9 pg/mL; IgE, 40.5 ± 20.2 kU/L) compared with controls (IL-5, 10.6 ± 7.8 pg/mL; IgE, 2.8 ± 0.5 kU/L) or with patients with chronic nonallergic sinusitis (IL-5, 16.5 ± 13.2 pg/mL; IgE, 5.4 ± 3.1 kU/L). There were no significant differences between patients with allergic rhinitis and those with nonallergic nasal polyposis. Concentrations of ECP were significantly elevated (sixfold, P < .01) in patients with allergic rhinitis (297.8 ng/mL ± 173.1) compared with controls (52.4 ± 28.0 ng/mL) or patients with chronic nonallergic sinusitis (44.8 ± 40.1 ng/mL), whereas twofold higher concentrations (not significant) of ECP were observed in patients with nonallergic nasal polyposis (107.1 ± 26.6 ng/mL). Significantly elevated concentrations of sICAM-1 in nasal secretion (threefold, P < .05) were detected only in patients with chronic nonallergic sinusitis (79.4 ± 45.6 ng/mL). The elevated sICAM-1 nasal secretion values in this group correlated significantly (P < .05) to the serum values. Conclusions Equally elevated concentrations of IL-5 and IgE in patients with allergic rhinitis and nonallergic nasal polyposis implicated similar pathogenic processes in both diseases. Whereas the pathogenesis of allergic rhinitis is IgE-specific, the pathogenesis of nasal polyps is not as clear. IL-5 was suggested to play a pivotal role in tissue eosinophilia, which was confirmed by data in the present study. Elevated concentrations of ECP were suggested to result from tissue eosinophilia,a characteristic of both diseases. Elevated concentrations of sICAM-1 in patients with chronic nonallergic sinusitis pointed to its key role in the recruitment of neutrophils into the inflamed tissue, whereas an important role in eosinophil recruitment was ruled out. [source] Allergic Rhinitis and asthma: are they manifestations of one syndrome?CLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2006R. Pawankar First page of article [source] Rhinitis: allergic or not?CLINICAL & EXPERIMENTAL ALLERGY, Issue 10 2000A. Leimgruber No abstract is available for this article. [source] ARIA: impact of complianceCLINICAL & EXPERIMENTAL ALLERGY REVIEWS, Issue 1 2005P. Van Cauwenberge Summary Epidemiological studies show that the prevalence of asthma and allergic rhinitis (AR) has increased progressively over the past two to three decades. Similarly, there is increasing evidence that asthma and rhinitis frequently co-exist in the same patients and that rhinitis is a risk factor for asthma. Although several guidelines are currently available for the diagnosis and management of AR, the earlier guidelines and their successors were not evidence based, and were developed primarily on the basis of expert opinion, but of course based on the available literature. More recently, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were published in co-operation with the World Health Organization. These guidelines are evidence based and directed towards managing co-morbid rhinitis and asthma as different manifestations of a single airway disease, rather than as two separate diseases of the nose and the lung. They recommend treatment of AR in a step-wise manner (using a combination of allergen avoidance, pharmacotherapy and immunotherapy), based on the duration and severity of disease, rather than on the basis of type of exposure (i.e seasonal, perennial, occupational), as recommended by previous guidelines. The ARIA guidelines recognize that both the availability and the cost of a particular intervention are likely to determine patient compliance, and therefore recommends a flexible approach based on availability and cost of specific interventions in different countries. Despite the availability of treatment guidelines, there is evidence that the severity of disease is often diagnosed and treated inappropriately by general practitioners (GPs), who frequently do not use a guided treatment strategy, leading to low patient satisfaction and compliance. This suggests a clear need to implement the guidelines among GPs, especially since the vast majority of patients generally trust their GPs to provide appropriate information and optimal medication for the management of their disease. [source] Clinical Immunology Review Series: An approach to the patient with allergy in childhoodCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2009R. Sporik Summary Allergic conditions are common, with asthma being the most common chronic illness in childhood in most developed countries. Some 80% of asthmatic children are sensitized to aeroallergens, usually indoor animal dander and house dust mite. Some 80% of asthmatics also have rhinitis. Rhinitis and eczema receive less medical attention than asthma, but they can cause long-term morbidity and have substantial direct and indirect economic costs. Food allergy and anaphylaxis are increasingly recognised and are usually easily diagnosed and managed. Clinicians can use in vivo and in vitro measurements of allergen-specific immunoglobulin E to better time reintroduction of implicated foods. Specific parenteral and sublingual immunotherapy is widely practiced internationally but is uncommon in the UK. It may alter the natural history of aeroallergen reactive diseases in the upper and lower airways. Specific oral tolerance induction represents the current cutting edge in clinical allergy research. It remands resource intensive at present and cannot be adopted into routine clinical practice at this time. [source] International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of lifePEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2010Luis Garcia-Marcos Garcia-Marcos L, Mallol J, Solé D, Brand PLP and EISL group. International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life. Pediatr Allergy Immunol 2010: 21: 878,888. © 2010 John Wiley & Sons A/S Risk factors for wheezing during the first year of life (a major cause of respiratory morbidity worldwide) are poorly known in non-affluent countries. We studied and compared risk factors in infants living in affluent and non-affluent areas of the world. A population-based study was carried out in random samples of infants from centres in Latin America (LA) and Europe (EU). Parents answered validated questionnaires referring to the first year of their infant's life during routine health visits. Wheezing was stratified into occasional (1,2 episodes, OW) and recurrent (3 + episodes, RW). Among the 28687 infants included, the most important independent risk factors for OW and RW (both in LA and in EU) were having a cold during the first 3 months of life [OR for RW 3.12 (2.60,3.78) and 3.15 (2.51,3.97); population attributable fraction (PAF) 25.0% and 23.7%]; and attending nursery school [OR for RW 2.50 (2.04,3.08) and 3.09 (2.04,4.67); PAF 7.4% and 20.3%]. Other risk factors were as follows: male gender, smoking during pregnancy, family history of asthma/rhinitis, and infant eczema. Breast feeding for >3 months protected from RW [OR 0.8 (0.71,0.89) in LA and 0.77 (0.63,0.93) in EU]. University studies of mother protected only in LA [OR for OW 0.85 (0.76,0.95) and for RW 0.80 (0.70,0.90)]. Although most risk factors for wheezing are common in LA and EU; their public health impact may be quite different. Avoiding nursery schools and smoking in pregnancy, breastfeeding babies >3 months, and improving mother's education would have a substantial impact in lowering its prevalence worldwide. [source] Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective studyCLINICAL & EXPERIMENTAL ALLERGY, Issue 2 2003V. Di Rienzo Summary Background Subcutaneous immunotherapy for respiratory allergy has shown a long-lasting efficacy after its discontinuation, whereas this evidence is still lacking for sublingual immunotherapy, despite the fact that it is widely used. Objective We aimed to evaluate whether a long-lasting effect of SLIT occurs, in a prospective parallel group controlled study. Methods Sixty children (mean age 8.5 years) suffering from allergic asthma/rhinitis due to mites were subdivided into two matched groups: 35 underwent a 4- to 5-year course of SLIT with standardized extract and 25 received only drug therapy. The patients were evaluated at three time points (baseline, end of SLIT and 4 to 5 years after SLIT discontinuation) regarding presence of asthma, use of anti-asthma drugs, skin prick tests and specific IgE. Results We found that in the SLIT group there was a significant difference vs. baseline for the presence of asthma (P , 0.001) and the use of asthma medications (P , 0.01), whereas no difference was observed in the control group. The mean peak expiratory flow result was significantly higher in the active group than in the control group after 10 years. No change was seen as far as new sensitizations were concerned. Specific IgE showed a near-significant increase (baseline vs. 10 years, P = 0.06) only in the control group. Conclusion Our study demonstrates that sublingual immunotherapy is effective in children and that it maintains the clinical efficacy for 4 to 5 years after discontinuation. [source] FS09.1 Diacetylmorphine (heroin) allergyCONTACT DERMATITIS, Issue 3 2004Aliet J Hogen Esch Since heroin is delivered to a selected group of drug addicts under supervision of nurses in the Netherlands, we reported about several nurses who presented with work-related eczema and positive patch tests to heroin. To investigate the prevalence of heroin contact allergy among all workers in this heroin delivery project, a study was started using questionnaires. Altogether 31 nurses reported work-related complaints out of 100 who returned questionnaires. Besides reports of eczema, mainly of eyelids (probably airborne) and hands, there were mucosal and respiratory complaints. Patch tests were performed in 25 nurses with complaints; in 9 of them a heroin contact allergy could be confirmed. In 6 out of these 9 nurses this was combined with mucosal or respiratory complaints. There were also 6 nurses with mucosal or respiratory complaints without a contact allergy. Contact dermatitis from opioids, such as morphine and codeine, has been documented among opioid industry workers, nurses, doctors, pharmacists, and in patients. In conclusion heroin appears to be a potent contact allergen, causing contact dermatitis. Mucosal and respiratory complaints however, cannot be explained by this contact allergy; they might be caused by a type-1-allergy to heroin, or by a direct histamine liberating effect. Opioids are known histamine liberators causing urticaria, rhinitis and anaphylactoid reactions; therefore intracutaneous tests with heroin are unreliable. In an ongoing research project it will be attempted to detect specific IgE to heroin in the 12 workers with mucosal or respiratory complaints; within the next few months results will be available. [source] P03 Type-I and -IV hypersensitivity to platinum saltsCONTACT DERMATITIS, Issue 3 2004Willeke Kamphof A 28-year-old female analytical chemist visited our patch test clinic with initially complaints of severe hand dermatitis. Later on she developed rhinitis, bronchial asthma and tightness of the chest. The complaints seemed work related: her condition improved during holidays and on sick leaves. She worked in a laboratory with several platinum salts and used different kinds of gloves (latex, nitril, etc.). Methods:, Patch tests were performed with the European Standard series and prick tests with common inhalant allergens. Patch-, prick- and open patch tests were carried out with various aqueous dilutions of platinum chloride (PtCl2). Results:, Patch tests with 0.01,2% PtCl2 were positive on day 2, 3 and 6, and at 0.001% a follicular reaction was found. The prick-test was already positive at the lowest concentration tested (0.001%). The open patch test, carried out retro-auricular, showed a positive reaction at 1 and 2% PtCl2 after 20 min. Controls in healthy volunteers (n = 5) were all negative. Discussion:, It is well known that platinum salts can cause type-I hypersensitivity reactions like allergic rhinitis, conjunctivitis, bronchial asthma and urticaria, also referred to as platinosis. Contact dermatitis to platinum salts, however, is very rare. In our patch test clinic, 78 patients were tested between 1987 and 2001 with PtCl2 2%. Only 2 women showed a positive patch test for PtCl2. The patient presented here, stopped working with platinum salts and recovered from all complaints. We interpret our case as occupational type-I and type-IV hypersensitivity to platinum salts with mucosal and dermal manifestations. [source] | |||||||||||||||||||||||||||||||