Increased capsaicin cough sensitivity in patients with multiple chemical sensitivity

Multiple chemical sensitivity (MCS) is characterized by chemically induced symptoms from multiple organ systems. No consistent physical findings or laboratory abnormalities have been determined for the associated symptoms. Twelve patients with chemically induced airway symptoms, who satisfied Cullen's criteria for MCS, were provoked double-blind, randomized with saline and three increments of inhaled capsaicin. The recordings were compared with those of a control group of healthy individuals. The results found that the patients coughed more than the control subjects at each dose of capsaicin (P < 0.05 for 0.4 mumol/L capsaicin and P < 0.005 for 2 mumol/L and 10 mumol/L). The capsaicin provocation also induced significantly more symptoms in patients with MCS. We conclude that airway sensory reactivity is increased in patients with MCS, a finding which suggests that neurogenic factors may be of importance in this condition.

Capsaicin inhalation test for identification of sensory hyperreactivity

BACKGROUND

Patients with upper and lower airway symptoms and with pronounced sensitivity to chemical odours, such as perfumes, flower scents and tobacco smoke, have been suggested to have sensory hyperreactivity (SHR). The symptoms have been difficult to identify with physiological measurements and the effects of various medications are doubtful. However, these patients have been found to be more sensitive to inhalation of capsaicin than healthy people. The aim of this study was to establish limit values with the capsaicin inhalation test in patients with SHR.

METHODS

Ninety-five consecutive patients with upper and lower airway problems, who were admitted for allergy testing, underwent a capsaicin inhalation test with three different concentrations. The number of coughs was registered during each challenge. Score systems were used for symptoms and influence on social life of sensitivity to odours. In relation to scored symptoms, the patients were grouped as SHR or not, and compared with 73 healthy controls.

RESULTS

All patients and controls coughed on capsaicin in a dose-dependent manner. Symptom score of odour sensitivity in patients was positively correlated to the response of the test. Out of 95 patients, 15 (16%) were scored to SHR. Patients with SHR reacted more to the capsaicin inhalation test than the other patients and the healthy controls. The limit values for a positive capsaicin inhalation test for the SHR were determined to be 10, 35 and 55 coughs at 0.4, 2.0 and 10 microM capsaicin, respectively.

CONCLUSION

The capsaicin inhalation test well reflects the degree of airway sensitivity to chemicals and to what extent the social life is influenced. The cut-off values of the test can distinguish patients with pronounced sensitivity to odours.

Different IgE reactivity profiles in birch pollen-sensitive patients from six European populations revealed by recombinant allergens: an imprint of local sensitization

BACKGROUND

Sensitivity to birch pollen allergens is a common feature among European patients with seasonal pollen allergy. In this in vitro study, we examined the specific serum IgE binding profiles to individual birch pollen allergens in birch-sensitive patients from six European populations.

METHODS

The study included 242 patients from Finland, Sweden, Austria, France, Switzerland and Italy. All suffered from seasonal rhinoconjunctivitis and/or asthma. Their sera were analyzed for specific IgE reactivity to individual birch pollen allergens (recombinant Bet v 1, Bet v 2 and Bet v 4) and natural birch pollen extract using Pharmacia CAP System and immunoblotting.

RESULTS

Almost all Finnish, Swedish and Austrian sera contained IgE specific for Bet v 1 (>or=98%). Bet v 1-specific IgE antibodies were found in 90% of the French sera, and in 65 and 62% of the sera from Switzerland and Italy, respectively. Few Finnish (2%) and Swedish (12%) patients had IgE to Bet v 2, while Bet v 2 reactivity was more common in the other populations (20-43%). Reactivity to Bet v 4 was rare in all populations (5-11%) except for the Italian patients, in whom 3 of 11 sera were positive (27%). The immunoblot results supported the specific IgE profiles obtained with Pharmacia CAP System showing a broader IgE reactivity profile in patients from central and southern Europe as compared to northern Europe.

CONCLUSION

Component-resolved allergy diagnosis with recombinant allergens reveals that the IgE reactivity profiles to individual birch pollen allergens vary between European populations. This observation may be explained by sensitization to different allergen sources and will have an impact on allergen-specific prevention and therapy strategies.

A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis

BACKGROUND

Using conventional methods, it has been difficult to show differences in efficacy between intranasal corticosteroids in perennial rhinitis.

OBJECTIVE

To compare the effects of budesonide and mometasone on nasal symptoms and nasal airflow in perennial allergic rhinitis.

METHODS

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).

RESULTS

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.

CONCLUSION

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.

Sensitivity of a new grading system for studying nasal polyps with the potential to detect early changes in polyp size after treatment with a topical corticosteroid (budesonide)

We have previously compared different scoring systems for endoscopic staging of nasal polyps. Of the five methods evaluated, we found that two were better than the others with regard to reproducibility and agreement between physicians. One method was lateral imaging, developed by the authors, and the other was a scoring system developed by Lildholdt et al. The main objective of the present study was to compare the sensitivity of these two methods. Another aim was to study the effect on nasal polyposis of topical nasal corticosteroids over a 2-week period. Patients with bilateral nasal polyposis (n = 100) were randomized to a 2-week treatment with a topical corticosteroid (budesonide aqueous nasal spray: 128 microg b.i.d.) or placebo in a double-blind manner. Nasal symptoms were scored before treatment and after 3, 7 and 14 days of treatment, and the patients underwent nasal endoscopy at clinical visits. Patients treated with active substance had an improvement in their symptoms, an effect already detectable after 3 days of treatment, compared with those who received placebo. In addition, a statistically significant decrease in polyp size could be registered after 14 days using lateral imaging but not with the other scoring system. In conclusion, lateral imaging was more sensitive and could detect effects earlier than the other scoring system and can be recommended for the endoscopic staging of nasal polyps in clinical studies.

Relationship between subjective nasal stuffiness and nasal patency measured by acoustic rhinometry

Nasal geometry measured by acoustic rhinometry was compared with the subjective sensation of nasal stuffiness in healthy subjects before and after provocation with histamine. The correlation was poor at rest, but it was significant after histamine provocation in children and adults. It is easier to find a relationship between subjective and objective nasal obstruction afer inducing congestion. (American Journal of

Capsaicin cough sensitivity is decreased in smokers

Although capsaicin provocation has been used to evaluate treatment against cough, which is one of the most common respiratory symptoms, there are still methodological considerations that are not fully known. Capsaicin stimulates the unmyelinated slow C-fibres of the sensory nervous system, which leads to coughing. Smoking often leads to respiratory symptoms with cough and phlegm. The aim of this study was to examine the effect of smoking on capsaicin provocation. Subjectively healthy smokers and non-smokers were challenged with capsaicin in increasing doses. The coughs were counted and irritation of the lower airways was graded on a symptom score. Smokers reacted to provocation with significantly fewer coughs, but there was no difference regarding other symptoms. These results are in agreement with the hypothesis that nicotine inhibits or blocks C-fibres of the sensory nervous system of the lower respiratory tract. Clinically, this may serve to explain increasing airway symptoms that are often seen after cessation of smoking.

Nasobronchial relationship after cold air provocation

Provocation with cold air in the nose causes broncho-obstruction while warm air causes bronchodilation in patients with asthma, but not in healthy subjects. These findings have suggested the existence of a nasobronchial reflex. The present study aimed to block this effect and evaluate the mechanisms underlying the effect on lung function after cold stimulation of the nose. Lung function, as measured with specific conductance and forced expiratory flow, was reduced after cold stimulation of the nose, but this effect could not be blocked by anesthetizing the nose or by inhaling an anti-cholinergic drug before the provocation. These results confirm the presence of a nasobronchial relationship, but not of a nasobronchial reflex.

Quality of life and capsaicin sensitivity in patients with sensory airway hyperreactivity

BACKGROUND

A group of patients with asthma-like symptoms and sensitivity to chemical irritants has shown an increased cough sensitivity to inhaled capsaicin compared to patients with asthma and to healthy controls. The condition is called sensory hyperreactivity (SHR), and the patients often feel that they are socially handicapped because of the risk of exposure to chemical irritants in daily life.

METHODS

Twenty-six patients with asthma-like symptoms after exposure to nonspecific irritating stimuli, but without IgE-mediated allergy or demonstrable bronchial obstruction, were selected for a study of the response to a capsaicin test and measurement of quality of life by a general health profile (the Nottingham Health Profile [NHP]). We also investigated whether there was a correlation between quality of life and sensitivity to capsaicin.

RESULTS

The patients demonstrated a dose-dependent response to the capsaicin provocation, with coughing and respiratory and other symptoms, that significantly differed from 12 healthy controls. The health profile showed that patients with SHR had a significantly reduced quality of life compared to reference values, and there was a significant correlation between the health profile and sensitivity to capsaicin.

CONCLUSIONS

Patients with asthma-like symptoms verified by the capsaicin inhalation test for sensory hyperreactivity have a poor quality of life. The correlation between quality of life and sensitivity to capsaicin objectively demonstrates the validity of this general health profile study.

Effect of nasal air temperature on FEV1 and specific airways conductance

We investigated whether changes in nasal air temperature affect specific airway conductance (SGaw) and one second forced expiratory volume (FEV1) in 10 asthmatic patients with a history of cold-sensitive asthma and eight healthy subjects. An air-stream (0.6 l s-1) of -15 degrees C, +22 degrees C or +37 degrees C was blown into both nostrils during a Valsalva manoeuvre. Each provocation consisted of 10 puffs of air, each of 15 s duration, at 1 min intervals. Before and at regular intervals after the provocations, SGaw and FEV1 were determined. In asthmatics, after cold air provocation, SGaw fell 23% (P<0.01) and FEV1 8% (P<0.01). After the warm air provocations, SGaw rose 15% (P<0.01) and FEV1 6% (P<0.01). After the ambient air provocations, no significant changes occurred in SGaw or FEV1. In the healthy subjects, the nasal provocations caused no significant changes in lung function. The present study shows that cold air in the nose causes a slight obstruction and warm air possibly a slight dilatation of the lower airways in patients with a history of cold-sensitive asthma but not in healthy subjects.

Evaluation of methods for endoscopic staging of nasal polyposis

Endoscopy is needed for reliable evaluation of the treatment of nasal polyposis. In this study, we compared the reproducibility of various score systems for staging nasal polyposis and the inter-individual variations between investigators. The mass of the polyps was assessed by five methods, three new techniques (numbers 1, 2 and 3) and two established ones (numbers 4 and 5). These were: 1, lateral imaging projecting the extension of the polyps by drawing on a schematic picture of the lateral wall of each nasal cavity; 2, assessment of polyp obstruction estimating the proportion of the total nasal cavity volume occupied by polyps; 3, nasal airway patency--determining the relationship between the patient's patent airway lumen and an imaginary maximal nasal airway lumen; 4, a score system with four steps ad modum Lildholdt et al.--determining their relationship to fixed anatomical landmarks; and 5, a score system with three steps ad modum Lund and Mackay--determining their relationship to the middle meatus. High correlations were found between the first and the second assessments by a given investigator with all five methods used to score nasal polyposis. High correlations were also shown between the various methods. When three investigators examined a given patient, there were no significant differences between the investigators using score systems 1, 3 and 4. However, with score systems 2 and 5, there was insufficient agreement between the investigators. The patient's symptom of nasal blockage was not a good indicator of the size of the polyps, especially as regards small polyps. Two of the best methods tested (1 and 4) were selected for further clinical studies regarding evaluation of the sensitivity of score systems to detect changes in polyp size during treatment.

Nasal stuffiness during pregnancy

OBJECTIVE

To investigate the occurrence of nasal stuffiness during pregnancy.

STUDY DESIGN

Prospective longitudinal study, with collection of data during 1 year in a cohort of 2,264 pregnant women.

METHODS

Self-reported nasal stuffiness in gestational weeks 12, 20, 30, and 36 was correlated to age, parity, body mass index, and smoking habits.

RESULTS

The prevalence of nasal stuffiness increased during pregnancy and occurred in 27% of the women at 12 weeks of gestation, in 37% at 20 weeks, in 40% at 30 weeks and in 42% at 36 weeks. Sixty-five percent of the women reported stuffiness at some time when asked. It was commoner in multiparous than in nulliparous women. Age, body mass index, and smoking habits were not associated with nasal stuffiness.

CONCLUSION

Self-reported nasal stuffiness for 3 or more weeks was common during pregnancy and could occur at any time in two thirds of the women. Treatment regimens to alleviate this symptom should be developed.

An independent association between obstructive sleep apnoea and coronary artery disease

Previous studies of sleep and breathing suggest an independent association between coronary artery disease (CAD) and obstructive sleep apnoea (OSA) in middle-aged males and females. These studies, however, were criticized because they did not properly adjust for all important confounding factors. In order to better control for the impact of these confounders, a case-control study was performed, matching for age, sex and body mass index (BMI), and additionally adjusting for hypertension, hypercholesterolemia, diabetes mellitus and current smoking. A consecutive selection of 62 patients (44 males and 18 females, mean age 69 yrs, range 44-88 yrs) requiring intensive care for angina pectoris or myocardial infarction at the County Hospital of Skaraborg, Skövde, Sweden, as well as 62 age-, sex- and BMI- matched control subjects without history or signs of heart disease underwent an overnight sleep/ventilatory monitoring study. The time interval between discharge from the intensive care unit and the overnight study ranged between 4 and 21 months. OSA, defined as a Respiratory Disturbance Index (RDI) of > or =10 x h(-1), was present in 19 CAD patients but only in eight control subjects (p=0.017). Using a univariate logistic regression analysis, current smoking (odds ratio (OR) 8.1, 95% confidence interval (CI) 2.2-29.0), diabetes mellitus (OR 4.2, 95% CI 1.1-16.1) and OSA (OR 3.0, 95% CI 1.2-7.5), but not hypertension (OR 1.5, 95% CI 0.7-3.2) and hypercholesterolaemia (OR 1.8, 95% CI 0.7-4.1) were significantly correlated with CAD. In a multiple logistic regression model, current smoking (OR 9.8, 95% CI 2.6-36.5), diabetes mellitus (OR 4.2, 95% CI 1.1-17.1) and OSA (OR 3.1, 95% CI 1.2-8.3) all remained independently associated with CAD. In summary, these data suggest a high occurrence of obstructive sleep apnoea in middle-aged and elderly patients with coronary artery disease requiring intensive care, which should be taken into account when considering risk factors for coronary artery disease.

Sensory hyperreactivity--a possible mechanism underlying cough and asthma-like symptoms

BACKGROUND

Investigations of patients referred for suspected asthma have revealed a little-known group with symptoms suggesting hyperreactive airways in whom provocation with methacholine does not lead to bronchial obstruction. The underlying mechanisms are not known, and no objective diagnostic method has been available.

METHODS

Provocations by inhalation of capsaicin solutions in stepwise increasing concentrations were used. Ten patients with asthma-like symptoms after exposure to nonspecific irritating stimuli, but without IgE-mediated allergy or demonstrable bronchial obstruction, were compared to 10 patients with verified bronchial asthma and 28 healthy controls.

RESULTS

The patients with asthma-like symptoms reacted with cough in a dose-dependent way. The number of coughs was significantly greater than in asthmatic patients and healthy controls. The latter two groups did not differ significantly.

CONCLUSIONS

The capsaicin provocation test may be a valuable method for showing not only a greater cough sensitivity, but also asthma-like symptoms. The pathophysiology underlying the symptoms may be related to increased sensitivity of free, overactive nerve endings in the respiratory mucosa. Therefore, we suggest that this overreaction in the lower airways be called "sensory hyperreactivity".

Evaluation of side effects after nicotine nasal spray in patients with chronic rhinitis

Thirty-three subjects with chronic rhinitis used nicotine nasal spray in an open study as an aid in smoking cessation. Thirty-eight percent of them were completely abstinent at 12 weeks, whereas 35% were completely abstinent at 20 weeks. The nasal spray was associated with irritant nasal side effects, which occurred most often in the early stages of treatment. Clinical nasal examinations could not observe any significant impairment in nasal conditions following spray use. In conclusion, this study confirms the short-term safety of the nicotine nasal spray as an aid in smoking cessation.

Reference values for acoustic rhinometry in subjects without nasal symptoms

Reference values for acoustic rhinometry are presented from 334 individuals without nasal symptoms between 4 years and 61 years old. There was a significant correlation between the minimal cross-sectional area (MCA) and nasal volume. Although the reproducibility of the method was good, the MCA varied widely. MCA correlated weakly to weight, height, age, and body mass index. Our data suggest that acoustic rhinometry is valuable for inter-individual comparisons.

The Scandinavian Odor-Identification Test: development, reliability, validity and normative data

The Scandinavian Odor-Identification Test (SOIT) was developed to address the need for a culturally valid odor-identification test for clinical use on the Scandinavian population that (i) has good ability to generalize performance to olfactory status, (ii) assesses olfactory and trigeminal function separately, (iii) requires only limited cognitive demands, (iv) has normative data and good sensitivity and specificity, and (v) is fast, easy to administer and inexpensive. Sixteen odorous test stimuli were selected that were relatively identifiable, familiar, strong in intensity and pleasant according to healthy participants. Four response alternatives were then selected for each test stimulus based on a confusion matrix of identification rates obtained from healthy participants, in a manner that controlled for task difficulty. Results on the SOIT from healthy persons and hyposmic patients showed satisfactory test-retest reliability, split-half reliability and validity. Cut-off scores for olfactory diagnosis (normosmia, hyposmia, anosmia) based on normative data obtained from 171 healthy persons showed a satisfactory sensitivity and specificity of the SOIT. Assessment of 22 anosmic patients with the SOIT revealed that three of the test stimuli were significant trigeminal stimulants.

Perceptual learning in olfaction: professional wine tasters versus controls

By having professional wine tasters and controls perform olfactory tasks of absolute detection (1-butanol), discrimination (lemon and cloves), and identification (common household odors), the present two experiments studied (a) if perceptual odor learning takes place from odor experience acquired under nonlaboratory conditions, (b) if this learning generalizes to odors for which experience is limited, and (c) if generalized learning can be referred to increased general interest for odors that increases attention to odorous features. The results showed that whereas wine tasters were not better than controls on detection, they were superior to controls on discrimination and identification, the latter due to only a few odors. Ratings of experience with certain odors during professional evaluation suggest that generalized perceptual learning may take place in discrimination but not in identification. Wine tasters did not show more general interest for odorous features than did controls. The nonsuperiority in detection may be explained by the fact wine tasters have no professional experience of a detection task per se, implying that perceptual odor learning does not generalize from the olfactory tasks of discrimination and identification to detection.

Reduced hospitalization with cardiovascular and pulmonary disease in obstructive sleep apnea patients on nasal CPAP treatment

Cardiovascular and pulmonary disease (CVPD) is common in patients with obstructive sleep apnea syndrome (OSAS). This retrospective study addressed the accumulated in-hospital time during 2 years prior to treatment with nasal continuous positive airway pressure (nCPAP) as compared to 2 years after initiating of nCPAP in patients with OSAS and CVPD. A cohort representing all patients (n = 88) receiving nCPAP during the period 1988-1994 at the Skövde Central Hospital, Skövde, Sweden, was studied. Data collection was based on interviews with patients as well as reviews of clinic charts. All hospitalizations and diagnostic codes by any type were thereby successfully gathered for the whole group. Six patients with confounding serious diseases were excluded from the analysis. A CVPD diagnosis (ICD-9, codes 401-435 and 490-496) was found in 54 out of 82 patients (66%), of whom 36 of 58 were nCPAP users (62%) and 18 of 24 were nonusers (75%). In 54 sleep apneics with CVPD, 31 were hospitalized acutely under one or more of these diagnostic codes during the study period of 4 years. The total number of in-hospital days due to CVPD in the nCPAP users (n = 19) before nCPAP prescription was 413 days (median 10, range 3-66) compared to 54 days (median 0, range 0-25) after nCPAP (p < 0.0001). The corresponding values for the nonuser group (n = 12) was 137 days (median 8.5, range 0-42) before and 188 days (median 9.5, range 0-47) after the nCPAP prescription (ns). We conclude that nCPAP treatment reduces the need for acute hospital admission due to CVPD in patients with OSAS. This reduction of concomitant health care consumption should be taken into consideration when assessing the cost-benefit evaluation of nCPAP therapy.

Glucocorticoid treatment for nasal polyps. The use of topical budesonide powder, intramuscular betamethasone, and surgical treatment

BACKGROUND

The treatment of nasal polyps is controversial, and medical treatment alone has been little investigated to our knowledge.

OBJECTIVE

To examine the efficacy of therapy using only topical budesonide powder and topical budesonide powder supplemented with surgical removal or intramuscular betamethasone.

DESIGN

Randomized, double-blind comparison of 2 dosages and additional treatment, if therapy failed. After 1 year, treatment with medication was stopped, and the demand for renewed treatment was monitored for another year.

PATIENTS

Patients with bilateral nasal polyps who demanded treatment were consecutively enrolled in a hospital outpatient clinic or specialty private practice. During a 15-month period from 1990 to 1992, a total of 126 patients entered the 2-year study.

INTERVENTIONS

In phase 1, randomized and double-blind treatment with a topical medication, budesonide powder, 800 micrograms or 400 micrograms daily, or a placebo was given for 1 month. In phase 2, randomized and double-blind treatment with budesonide powder, 800 micrograms or 400 micrograms daily, was given. At the end of phase 1, failed therapy was supplemented by randomly assigned treatment of either surgical removal or a single injection of sustained released betamethasone. In phase 3, treatment with the medication was discontinued, and patients were monitored for another year. The time when treatment was required again was noted. The present article deals with phases 2 and 3.

MAIN OUTCOME MEASURES

Patients' scores of treatment efficacy as well as symptoms and signs. Semiquantitative measurement of sense of smell and calculation of peak expiratory flow rate index based on nasal and oral peak expiratory flow.

RESULTS

In all outcome measures, a comparison of the data before treatment with the corresponding figures during phase 2 showed statistically significant efficacy. The clinical course was described at the end of phase 2. About 85% of the patients, including those who received additional therapy because the initial therapy failed, rated total or substantial control over the symptoms. The 2 dosages investigated showed equal results. These findings were consistent with the signs recorded and the peak expiratory flow rate index. The results of phase 3 showed that 50% of patients had demanded treatment after 4 months, while 34% managed without medication after 1 year.

CONCLUSIONS

The clinical course in this study showed that most patients with nasal polyps do well with medical treatment. Therefore, surgery was required in few patients. However, the potential of medical treatment should be further explored in future studies.

Infectious mononucleosis treated by an antihistamine: a comparison of the efficacy of ranitidine (Zantac) vs placebo in the treatment of infectious mononucleosis

This study investigated whether the course of infectious mononucleosis was influenced by medication with ranitidine (Zantac). A double-blind, placebo-controlled study enrolled 117 patients and either ranitidine 300 mg or placebo were given twice daily for 2 wk. Patients were examined on day 5, 10, 15 and 30. Efficacy variables included severity and duration of fever, scores of cervical lymph node size and tonsil size, eating problems, fatigue, influence on general condition, the use of analgesics and blood analyses. Results were analysed in 91/117 patients. Small differences were found between treatment groups in favour of the active drug. However, they were not statistically significant. After 2 wks of treatment abnormal 'liver enzymes' (ALAT/ASAT) were found in 13/48 (0.27) of the ranitidine group in contrast with 18/36 (0.50) of the placebo group (P = 0.03). The conclusion is that the course of infectious mononucleosis is little influenced by ranitidine treatment for 2 wks. The faster normalization of the 'liver enzymes' may reflect modulation of the immune system by ranitidine.

Nasal mucosal congestion during the menstrual cycle

A relationship between the reactivity of the nasal mucosa and changes in female sex hormones have been debated for a long time, although no evidence has been presented to prove or disprove this relationship. Nasal patency was therefore measured by nasal expiratory peak-flow in 26 women for two months in order to study changes in nasal mucosal congestion during the menstrual cycle. In another eight women, nasal congestion was measured by acoustic rhinometry, and symptoms of nasal stuffiness were registered during periods when there were various levels of plasma oestradiol and progesterone. Finally, nasal mucosal biopsies were taken for preparation of receptors for oestradiol and progesterone. This study could not verify the effects of female sex hormones on the nasal mucosa. This could be explained by the fact that no receptors for oestradiol and progesterone were found.

Olfactory threshold after nasal allergen challenge

Olfactory threshold was investigated in patients with verified allergic rhinitis to birch pollen. In 20 patients the olfactory threshold was measured before and after challenge with topically applied birch pollen allergen during a non-symptomatic period. After provocation a statistically significant impaired detection sensitivity was found. The change in olfactory threshold was correlated with the measured amount of nasal secretions but not with subjectively or objectively registered nasal obstruction. A pronounced allergic reaction after allergen challenge is accompanied by an elevated olfactory threshold.