601
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Sinonasal manifestations of cystic fibrosis: A correlation between genotype and phenotype? J Cyst Fibros 2014; 13:442-8. [DOI: 10.1016/j.jcf.2013.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/11/2013] [Accepted: 10/21/2013] [Indexed: 12/26/2022]
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602
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Georgalas C, Vlastos I, Picavet V, van Drunen C, Garas G, Prokopakis E. Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation. Allergy 2014; 69:828-33. [PMID: 24815699 DOI: 10.1111/all.12413] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 01/30/2023]
Abstract
The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief.
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Affiliation(s)
- C. Georgalas
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - I. Vlastos
- Department of Otorhinolaryngology; University of Crete School of Medicine; Heraklio Crete Greece
| | - V. Picavet
- Department of Otorhinolaryngology; University Hospital Ulm; Ulm Germany
| | - C. van Drunen
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - G. Garas
- Department of Otorhinolaryngology and Head & Neck Surgery; Queens Medical Centre; Nottingham University Hospitals; Nottingham UK
| | - E. Prokopakis
- Department of Otorhinolaryngology; University of Crete School of Medicine; Heraklio Crete Greece
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603
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Immune imbalance in nasal polyps of Caucasian chronic rhinosinusitis patients is associated with a downregulation of E-selectin. J Immunol Res 2014; 2014:959854. [PMID: 24995349 PMCID: PMC4065747 DOI: 10.1155/2014/959854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 01/13/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) in Caucasians is a chronic Th2 inflammatory disease of the nasal and paranasal mucosa and the recruitment of leukocytes to the site of inflammation is poorly understood. We studied mRNA and protein expression profiles of adhesion molecules in nasal polyp and associated inferior turbinate tissues using molecular, biochemical, and immunohistological methods. Analysis showed a strongly decreased E-selectin expression in nasal polyps with a significant difference between eosinophil and neutrophil counts in nasal polyps and balanced counts in inferior turbinates. E-selectin expression is known to be downregulated in a Th2 milieu and has an essential role in immunosurveillance by locally activating neutrophil arrest and migratory function. A downregulation of E-selectin may come along with an immune imbalance in Caucasian nasal polyps due to a significant inhibition of neutrophil recruitment. Therefore, we suggest that an upregulation of E-selectin and the associated influx of neutrophils may play a significant role in the resolution of inflammation as well as for the pathophysiology of nasal polyps of Caucasian chronic rhinosinusitis patients.
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604
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Thermal water applications in the treatment of upper respiratory tract diseases: a systematic review and meta-analysis. J Allergy (Cairo) 2014; 2014:943824. [PMID: 24987423 PMCID: PMC4058810 DOI: 10.1155/2014/943824] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/23/2014] [Indexed: 01/01/2023] Open
Abstract
Background. Thermal water inhalations and irrigations have a long tradition in the treatment of airway diseases. Currently there exists no systematic review or meta-analysis on the effectiveness of thermal water treatment in upper respiratory tract diseases. Methods. A systematic search in the databases of MEDLINE, EMBASE, CENTRAL, ISI Web of Science, and MedPilot was accomplished. Results. Eight evaluable outcome parameters from 13 prospective clinical studies were identified for 840 patients. Mucociliary clearance time improves significantly (P < 0.01) for the pooled thermal water subgroup and the sulphurous subgroup after 2 weeks (-6.69/minutes) and after 90 days (-8.33/minutes), not for isotonic sodium chloride solution (ISCS). Nasal resistance improved significantly after 2 weeks (Radon, ISCS, and placebo), after 30 days (sulphur and ISCS), and after 90 days (sulphur). Nasal flow improved significantly with the pooled thermal water, radon alone, and ISCS subgroups. For the IgE parameter only sulphurous thermal water (P < 0.01) and ISCS (P > 0.01) were analyzable. Adverse events of minor character were only reported for sulphurous treatment (19/370). Conclusion. Thermal water applications with radon or sulphur can be recommended as additional nonpharmacological treatment in upper airway diseases. Also in comparison to isotonic saline solution it shows significant improvements and should be investigated further.
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605
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Yang Y, Zhang N, Lan F, Van Crombruggen K, Fang L, Hu G, Hong S, Bachert C. Transforming growth factor-beta 1 pathways in inflammatory airway diseases. Allergy 2014; 69:699-707. [PMID: 24750111 DOI: 10.1111/all.12403] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 12/11/2022]
Abstract
Transforming growth factor-beta 1 (TGF-β1) has been reported being involved in the remodeling and immunosuppression processes of inflammatory airway diseases; understanding the regulation of TGF-β1 is therefore a key to unravel the pathomechanisms of these diseases. This review briefly summarizes the current knowledge on the influencing factors for driving TGF-β1 and its regulatory pathways in inflammatory airway diseases and discusses possible therapeutic approaches to TGF-β1 control. The factors include smoking and oxidative stress, prostaglandins (PGs), leukotrienes (LTs), bradykinin (BK), and microRNAs (miRs). Based on the summary, new innovative treatment strategies may be developed for inflammatory airway diseases with an impaired expression of TGF-β1.
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Affiliation(s)
- Y. Yang
- Department of Oto-Rhino-Laryngology; The First Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - N. Zhang
- Upper Airway Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University; Ghent Belgium
- Division of Nose, Throat and Ear Diseases; Clintec; Karolinska Institute; Stockholm Sweden
| | - F. Lan
- Upper Airway Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University; Ghent Belgium
- Division of Nose, Throat and Ear Diseases; Clintec; Karolinska Institute; Stockholm Sweden
| | - K. Van Crombruggen
- Upper Airway Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University; Ghent Belgium
- Division of Nose, Throat and Ear Diseases; Clintec; Karolinska Institute; Stockholm Sweden
| | - L. Fang
- Department of Oto-Rhino-Laryngology; The First Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - G. Hu
- Department of Oto-Rhino-Laryngology; The First Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - S. Hong
- Department of Oto-Rhino-Laryngology; The First Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - C. Bachert
- Upper Airway Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University; Ghent Belgium
- Division of Nose, Throat and Ear Diseases; Clintec; Karolinska Institute; Stockholm Sweden
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606
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Newson RB, van Ree R, Forsberg B, Janson C, Lötvall J, Dahlén SE, Toskala EM, Baelum J, Brożek GM, Kasper L, Kowalski ML, Howarth PH, Fokkens WJ, Bachert C, Keil T, Krämer U, Bislimovska J, Gjomarkaj M, Loureiro C, Burney PGJ, Jarvis D. Geographical variation in the prevalence of sensitization to common aeroallergens in adults: the GA(2) LEN survey. Allergy 2014; 69:643-51. [PMID: 24654915 DOI: 10.1111/all.12397] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Geographical variation in the prevalence of sensitization to aeroallergens may reflect differences in exposure to risk factors such as having older siblings, being raised on a farm or other unidentified exposures. OBJECTIVE We wanted to measure geographical variation in skin prick test positivity and assess whether it was explained by differences in family size and/or farm exposure. We also compared prevalence in younger and older subjects. METHODS Within the Global Allergy and Asthma European Network (GA(2) LEN) survey, we measured the prevalence of skin prick positivity to a panel of allergens, and geometric mean serum total immunoglobulin E (IgE), in 3451 participants aged 18-75 years in 13 areas of Europe. Estimated prevalence was standardized to account for study design. We compared prevalence estimates in younger and older subjects and further adjusted for age, gender, smoking history, farm exposure, number of older siblings and body mass index (BMI). RESULTS Skin prick test positivity to any one of the measured allergens varied within Europe from 31.4% to 52.9%. Prevalence of sensitization to single allergens also varied. Variation in serum total IgE was less marked. Younger participants had higher skin prick sensitivity prevalence, but not total IgE, than older participants. Geographical variation remained even after adjustment for confounders. CONCLUSION Geographical variation in the prevalence of skin prick test positivity in Europe is unlikely to be explained by geographical variation in gender, age, smoking history, farm exposure, family size and BMI. Higher prevalence in younger, compared to older, adults may reflect cohort-associated increases in sensitization or the influence of ageing on immune or tissue responses.
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Affiliation(s)
- R. B. Newson
- Respiratory Epidemiology and Public Health Group; National Heart and Lung Institute; Imperial College London; London UK
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - B. Forsberg
- Occupational and Environmental Medicine; Umeå University; Umeå Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; University of Uppsala; Uppsala Sweden
| | - J. Lötvall
- Krefting Research Centre; Institute of Medicine; University of Gothenburg; Gothenburg Sweden
| | - S.-E. Dahlén
- CfA - The Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - E. M. Toskala
- Skin and Allergy Hospital; Helsinki University; Helsinki Finland
- Department of ORL-HNS; Temple University; Philadelphia PA USA
| | - J. Baelum
- Department of Occupational and Environmental Medicine; Odense Patient Extended Network; Odense University Hospital; Odense University; Odense Denmark
| | - G. M. Brożek
- Department of Epidemiology; Medical University of Silesia in Katowice; Katowice Poland
| | - L. Kasper
- Department of Medicine; Jagiellonian University Medical College; Krakow Poland
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - P. H. Howarth
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | | | - C. Bachert
- Upper Airways Research Laboratory; University of Ghent; Ghent Belgium
- Division of Ear, Nose, and Throat Diseases, Clintec; Karolinska Institutet; Stockholm Sweden
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
- Institute of Clinical Epidemiology and Biometry; University of Würzburg; Würzburg Germany
| | - U. Krämer
- IUF - Leibniz Research Institute for Environmental Medicine; Düsseldorf Germany
- Department of Dermatology and Allergy am Biederstein; Technical University Munich; Munich Germany
| | - J. Bislimovska
- Institute for Occupational Health of Republic of Macedonia; Skopje Macedonia
| | - M. Gjomarkaj
- Institute of Biomedicine and Molecular Immunology; National Research Council; Palermo Italy
| | - C. Loureiro
- Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - P. G. J. Burney
- Respiratory Epidemiology and Public Health Group; National Heart and Lung Institute; Imperial College London; London UK
- MRC-PHE Centre for Environment and Health; Imperial College; London UK
| | - D. Jarvis
- Respiratory Epidemiology and Public Health Group; National Heart and Lung Institute; Imperial College London; London UK
- MRC-PHE Centre for Environment and Health; Imperial College; London UK
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607
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Cantone E, Castagna G, Sicignano S, Ferranti I, Rega F, Di Rubbo V, Iengo M. Impact of intranasal sodium hyaluronate on the short-term quality of life of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2014; 4:484-7. [PMID: 24591296 DOI: 10.1002/alr.21310] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/21/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery (FESS) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis (CRS) and nasal polyps. Despite the consolidated use of different treatments, the postoperative period is often very painful and uncomfortable, especially during the first month. Although evidence on the effectiveness of sodium hyaluronate (SH) on postoperative care following FESS is available, data on the quality of life (QoL) from the patients' perspective are still lacking. This study aimed to evaluate for the first time the effectiveness of nasal douche with SH in reducing patients' discomfort during the first month following FESS. METHODS A double-blind randomized controlled study was carried out on 124 subjects undergoing FESS for CRS with nasal polyposis. They were divided into 2 groups: group I was treated with nasal douche containing 9 mg of high molecular weight SH plus saline solution and group II was treated with saline solution alone. To assess QoL in CRS patients, the Short Form-36 (SF-36) test, the Sino-Nasal Outcome Test-22 (SNOT-22), and the visual analogue scale (VAS) questionnaires were administered. RESULTS At baseline, there were no statistically significant differences between the 2 groups. However, after 30 days of long postoperative treatments, we found clinically significant improvements in QoL of subjects treated with SH, as evidenced by all QoL scales. CONCLUSION Our data indicate that SH significantly improves patients' short-term QoL following FESS in terms of both general health and specific sinonasal status.
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Affiliation(s)
- Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatologic Science, ENT Unit, "Federico II" University, Naples, Italy; Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy
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608
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Outcome prediction in endoscopic surgery for chronic rhinosinusitis - a multidimensional model. Adv Med Sci 2014; 59:13-8. [PMID: 24797967 DOI: 10.1016/j.advms.2013.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/12/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE Chronic rhinosinusitis (CRS) is one of the most common diseases in the modern society. In recent years endoscopic sinus surgery (ESS) has become the treatment of choice for patients with CRS refractory to medical therapy. ESS proved to be successful in most, but not all patients with CRS. Currently there is no direct method available to distinguish between patients who are likely to benefit from ESS and those who are not. The aim of this study was to build multidimensional models (artificial neural networks) to predict early outcomes of ESS in individual patients. MATERIAL/METHODS The study group comprised of 115 patients operated for CRS in the Department of Otolaryngology, Jagiellonian University Collegium Medicum, Cracow. The neural models were created using the Statistica Neural Network computer software package. The models required only information easily achievable for every patient before surgery. Consequently, the models could be readily applicable in everyday clinical practice. To define the results of surgery three different mathematical descriptions were compared. The models' predictions were compared with the actual results of surgery 3-6 months postoperatively. RESULTS The models were able to predict the early outcome of surgery in 90% of the patients but their quality depended on mathematical representation of the surgery result. The best models were characterized by 93% sensitivity and 86% specificity. CONCLUSIONS The results of ESS depend on many factors, so reliable outcome prognoses can be produced only by multidimensional models. Artificial neural networks are a promising multidimensional tool facilitating clinical decision making in patients with CRS.
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609
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Hedlin G. Management of severe asthma in childhood--state of the art and novel perspectives. Pediatr Allergy Immunol 2014; 25:111-21. [PMID: 24102748 DOI: 10.1111/pai.12112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/30/2022]
Abstract
The majority of children with asthma have mild or moderate disease and can obtain adequate control of symptoms through avoidance of triggering factors and/or with the help of medications. There is still a group of children with severe asthma in whom symptom control is poor depending either on identifiable aggravating factors or on true therapy resistance. These children have a poor quality of life and are limited by the severity of their disease. There is a need for a staged approach to the assessment and treatment of this small but vulnerable and resource-consuming group. The current review will provide an overview of a possible standardized approach to characterize this heterogeneous group of severely sick children including some newly developed ways of assessing asthma severity and potentialities of new asthma therapies. Furthermore, the umbrella term 'problematic severe asthma' is described. The term encompasses children whose severe asthma is due to identifiable exacerbating factors, as well as children who are resistant to any conventional therapeutic approach. Characteristics of these two groups of children are described, as are possible biomarkers and current and emerging diagnostic tools for allergy evaluation. Some recent advances and future possibilities for treatment of severe asthma are also presented in this review.
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Affiliation(s)
- Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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610
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Hox V, Steelant B, Fokkens W, Nemery B, Hellings PW. Occupational upper airway disease: how work affects the nose. Allergy 2014; 69:282-91. [PMID: 24397491 DOI: 10.1111/all.12347] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 01/24/2023]
Abstract
Chronic inflammation of the upper airways is common and can arbitrarily be divided into rhinitis and rhinosinusitis. Infection and allergy represent two well-characterized and most frequently diagnosed etiologies of upper airway inflammation. Persistent upper airway inflammation caused by agents inhaled in the work environment represents a diagnostic challenge in clinical practice, and its pathophysiology has been little studied. Occupational rhinitis is a recognized medical condition with diagnostic and therapeutic guidelines. In contrast, only limited evidence is available about the relationship between work exposures and rhinosinusitis. This review aims at providing a comprehensive overview of the available literature on occupational upper airway disease with a focus on pathophysiological mechanisms and with an emphasis on the current unmet needs in work-related upper airway disease.
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Affiliation(s)
- V. Hox
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Laboratory of Clinical Immunology; Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
| | - B. Steelant
- Laboratory of Clinical Immunology; Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
| | - W. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - B. Nemery
- Research Unit of Lung Toxicology; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
| | - P. W. Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Laboratory of Clinical Immunology; Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
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611
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High and low doses of clarithromycin treatment are associated with different clinical efficacies and immunomodulatory properties in chronic rhinosinusitis. The Journal of Laryngology & Otology 2014; 128:236-41. [PMID: 24555753 DOI: 10.1017/s0022215114000279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low-dose clarithromycin has been recommended for the treatment of chronic rhinosinusitis without nasal polyps. However, it is uncertain whether a high dose of clarithromycin is more effective than a low dose. METHODS Forty-three chronic rhinosinusitis patients were randomised to low-dose or high-dose clarithromycin groups, and clinical efficacy was evaluated. Pre- and post-treatment measures included: nasal symptom assessment, endoscopic inspection (Lund-Kennedy system), a quality of life questionnaire (the Sino-Nasal Outcome Test 20) and examination of cytokine levels (interleukin-5 and -8) in nasal secretions. RESULTS The high dose of clarithromycin was significantly better in terms of clinical efficacy than the low dose for the treatment of chronic rhinosinusitis (p < 0.025). Significant differences in nasal cytokine levels (interleukin-5 and -8) were also observed between the low-dose and high-dose groups after short-term clarithromycin treatment (p < 0.025). CONCLUSION Short-term, high-dose clarithromycin appears to be more effective for the treatment of chronic rhinosinusitis than low-dose clarithromycin.
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612
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Immunoregulatory effects of bone marrow-derived mesenchymal stem cells in the nasal polyp microenvironment. Mediators Inflamm 2014; 2014:583409. [PMID: 24707116 PMCID: PMC3943259 DOI: 10.1155/2014/583409] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/20/2013] [Accepted: 12/26/2013] [Indexed: 12/21/2022] Open
Abstract
Nasal polyposis is a severe, chronic inflammatory condition of the paranasal sinuses and is frequently associated with asthma and aspirin sensitivity. Mesenchymal stem cells exhibit a potent immunosuppressive effect in several inflammatory conditions, and their role in nasal polyposis remains little explored. Hence, we investigated whether bone marrow-derived mesenchymal stem cells could modulate cell phenotype in the nasal polyp milieu. After coculture with mesenchymal stem cells, the frequency of these inflammatory cells was found to decrease. Furthermore, mesenchymal stem cells promoted strong inhibition of CD4+ and CD8+ T cell proliferation, increased the frequency of CD4+CD25+Foxp3 T cells, and changed the global cytokine profile from an inflammatory to an anti-inflammatory response. We believe that mesenchymal stem cells may be a very useful adjunct for investigation of the inflammatory process in nasal polyposis, contributing to better understanding of the inflammatory course of this condition.
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613
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Wise SK, Laury AM, Katz EH, Den Beste KA, Parkos CA, Nusrat A. Interleukin-4 and interleukin-13 compromise the sinonasal epithelial barrier and perturb intercellular junction protein expression. Int Forum Allergy Rhinol 2014; 4:361-70. [PMID: 24510479 DOI: 10.1002/alr.21298] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/31/2013] [Accepted: 01/07/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Altered expression of epithelial intercellular junction proteins has been observed in sinonasal biopsies from nasal polyps and epithelial layers cultured from nasal polyp patients. These alterations comprise a "leaky" epithelial barrier phenotype. We hypothesize that T helper 2 (Th2) cytokines interleukin (IL)-4 and IL-13 modulate epithelial junction proteins, thereby contributing to the leaky epithelial barrier. METHODS Differentiated primary sinonasal epithelial layers cultured at the air-liquid interface were exposed to IL-4, IL-13, and controls for 24 hours at 37°C. Epithelial resistance measurements were taken every 4 hours during cytokine exposure. Western blot and immunofluorescence staining/confocal microscopy were used to assess changes in a panel of tight and adherens junction proteins. Western blot densitometry was quantified with image analysis. RESULTS IL-4 and IL-13 exposure resulted in a mean decrease in transepithelial resistance at 24 hours to 51.6% (n = 6) and 68.6% (n = 8) of baseline, respectively. Tight junction protein junctional adhesion molecule-A (JAM-A) expression decreased 42.2% with IL-4 exposure (n = 9) and 37.5% with IL-13 exposure (n = 9). Adherens junction protein E-cadherin expression decreased 35.3% with IL-4 exposure (n = 9) and 32.9% with IL-13 exposure (n = 9). Tight junction protein claudin-2 showed more variability but had a trend toward higher expression with Th2 cytokine exposure. There were no appreciable changes in claudin-1, occludin, or zonula occludens-1 (ZO-1) with IL-4 or IL-13 exposure. CONCLUSION Sinonasal epithelial exposure to Th2 cytokines IL-4 and IL-13 results in alterations in intercellular junction proteins, reflecting increased epithelial permeability. Such changes may explain some of the phenotypic manifestations of Th2-mediated sinonasal disease, such as edema, nasal discharge, and environmental reactivity.
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Affiliation(s)
- Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA
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614
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615
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Lange B, Holst R, Thilsing T, Baelum J, Kjeldsen A. Quality of life and associated factors in persons with chronic rhinosinusitis in the general population: A prospective questionnaire and clinical cross-sectional study. Clin Otolaryngol 2013; 38:474-80. [DOI: 10.1111/coa.12189] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 01/27/2023]
Affiliation(s)
- B. Lange
- Department of Otorhinolaryngology; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - R. Holst
- Department of Biostatistics; University of Southern Denmark; Odense Denmark
| | - T. Thilsing
- Department of Occupational and Environmental Medicine; Odense University Hospital; Odense Denmark
| | - J. Baelum
- Department of Occupational and Environmental Medicine; Odense University Hospital; Odense Denmark
| | - A. Kjeldsen
- Department of Otorhinolaryngology; Odense University Hospital; University of Southern Denmark; Odense Denmark
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616
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Bhattacharyya N, Kepnes LJ. Medications Prescribed at Ambulatory Visits for Nasal Polyposis. Am J Rhinol Allergy 2013; 27:479-81. [DOI: 10.2500/ajra.2013.27.3969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Nasal polyps occur in a significant fraction of patients with chronic rhinosinusitis. However, patterns of medical management in nasal polyp cases are unknown. We sought to determine actual national estimates and contemporary prescribing patterns for ambulatory care visits with a diagnosis of nasal polyposis (NP). Methods The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey 2004–2010 were accessed, extracting all adult office visits with a diagnosis of NP. Demographic, provider type, and medication classes prescribed were determined. National estimates for the number of ambulatory medical care visits along with medications prescribed by provider type (otolaryngologist versus nonotolaryngologist) were determined. Results There were an estimated 442,024 ± 49,609 adult office visits annually with an NP diagnosis (54.8% men; mean age, 52.3 years); 64.6% of these visits were with otolaryngologists. Medication prescribing rates with a diagnosis of NP were nasal steroids (43.7%), oral steroids (26.9%), antibiotics (26.0%), and oral antihistamines (18.5%). Medication use rates for nasal steroids, oral steroids, oral antihistamines, and antibiotics were 36.3, 25.9, 15.3, and 22.2% for otolaryngology visits, respectively. Analogous medication use rates were 57.1, 28.8, 24.2, and 32.9% of nonotolaryngology visits, respectively. These differences by provider were not statistically significant (all, p ≥ 0.113). Conclusion Although nasal steroids are efficacious in NP, they are likely underprescribed. Oral steroids are also commonly prescribed for NP and should be considered a standard option in the treatment of NP.
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Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
| | - Lynn J. Kepnes
- Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
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617
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Linke R, Pries R, Könnecke M, Bruchhage KL, Böscke R, Gebhard M, Wollenberg B. Increased activation and differentiated localization of native and phosphorylated STAT3 in nasal polyps. Int Arch Allergy Immunol 2013; 162:290-8. [PMID: 24157808 DOI: 10.1159/000353893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 06/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease; the underlying mechanisms of cell signalling are not fully understood. STAT3 (signal transducer and activator of transcription 3) is a phosphokinase and a key signalling molecule implicated in cell cycle regulation. We studied the distribution and expression of STAT3 to examine the role of STAT3 in the pathogenesis of CRSwNP. METHODS We investigated tissue samples of the nasal polyps and inferior turbinate of patients with CRSwNP as well as samples of the inferior turbinate of subjects without chronic sinusitis. The expression levels of STAT3 and its activated form pSTAT3 were analysed using Western blotting, protein array, DNA microarray and immunohistochemistry. RESULTS No significant differences were found in STAT3-mRNA levels between the samples of nasal polyps and inferior turbinates of the same patient. However, the amount of pSTAT3 was increased in the polyp tissue compared to the inferior turbinates from both CRSwNP patients and control subjects (p < 0.01), indicating an activation of STAT3 in polyps. We identified a varying distribution pattern of pSTAT3; pSTAT3 was primarily found in superficial epithelial cells but not in the basal layer of the epithelium of the turbinate, whereas pSTAT3 was located in all layers of the epithelium of the polyp and mostly noted in the basal layer. CONCLUSIONS Our results of the activation and varying localisation of STAT3 and its phosphorylated form in nasal polyps suggest that pSTAT3 plays a crucial role in the proliferative development of nasal polyps.
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Affiliation(s)
- Robert Linke
- Department of Otorhinolaryngology and Facial Plastic Surgery, University of Lübeck, Lübeck, Germany
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618
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Tomassen P, Jarvis D, Newson R, Van Ree R, Forsberg B, Howarth P, Janson C, Kowalski ML, Krämer U, Matricardi PM, Middelveld RJM, Todo-Bom A, Toskala E, Thilsing T, Brożek G, Van Drunen C, Burney P, Bachert C. Staphylococcus aureus enterotoxin-specific IgE is associated with asthma in the general population: a GA(2)LEN study. Allergy 2013; 68:1289-97. [PMID: 24117882 DOI: 10.1111/all.12230] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Specific IgE to Staphylococcus aureus enterotoxins (SE-IgE) has been associated with asthma. In the general population, we aimed to determine the prevalence of and risk factors for serum SE-IgE and to examine the association with asthma. METHODS A postal questionnaire was sent to a random sample of adults in 19 centers across Europe. A random sample of respondents was invited for clinical examination upon which they answered a questionnaire, underwent skin prick tests (SPTs) for common aeroallergens, and provided blood for measurement of total IgE and SE-IgE. Risks were analyzed within centers using weighted logistic regression, and overall estimates calculated using fixed-effects meta-analysis. RESULTS 2908 subjects were included in this analysis. Prevalence of positive SE-IgE was 29.3%; no significant geographic variation was observed. In contrast to positive skin prick tests, SE-IgE was more common in smokers (<15 pack-year: OR 1.11, P = 0.079, ≥15 pack-year: OR 1.70, P < 0.001), and prevalence did not decrease in older age-groups or in those with many siblings. Total IgE concentrations were higher in those with positive SE-IgE than in those with positive SPT. SE-IgE was associated with asthma (OR 2.10, 95% confidence interval [1.60-2.76], P = 0.001) in a concentration-dependent manner. This effect was independent of SPT result and homogeneous across all centers. CONCLUSIONS We report for the first time that SE-IgE is common in the general population throughout Europe and that its risk factors differ from those of IgE against aeroallergens. This is the first study to show that SE-IgE is significantly and independently associated with asthma in the general population.
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Affiliation(s)
- P. Tomassen
- Upper Airways Research Laboratory; Department of Otorhinolaryngology and Head and Neck Surgery; Ghent University; Ghent; Belgium
| | - D. Jarvis
- Respiratory Epidemiology & Public Health; Imperial College London; London; UK
| | - R. Newson
- Respiratory Epidemiology & Public Health; Imperial College London; London; UK
| | - R. Van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; the Netherlands
| | - B. Forsberg
- Department of Public Health and Clinical Medicine; Occupational and Environmental Medicine; Umeå University; Umeå; Sweden
| | | | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; Uppsala University; Uppsala; Sweden
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz; Poland
| | | | - P. M. Matricardi
- Department of Pediatric Pneumonology and Immunology; Charité University Medical Center; Berlin; Germany
| | - R. J. M. Middelveld
- Centre for Allergy Research and Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - A. Todo-Bom
- Immunoallergology Department; Coimbra University; Coimbra; Portugal
| | - E. Toskala
- Center for Applied Genomics; The Children's Hospital of Philadelphia; Philadelphia; PA; USA
| | - T. Thilsing
- Department of Occupational and Environmental Medicine; Odense University Hospital; Odense; Denmark
| | - G. Brożek
- Department of Epidemiology; College of Medicine Medical University of Silesia; Katowice; Poland
| | - C. Van Drunen
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; the Netherlands
| | - P. Burney
- Respiratory Epidemiology & Public Health; Imperial College London; London; UK
| | - C. Bachert
- Upper Airways Research Laboratory; Department of Otorhinolaryngology and Head and Neck Surgery; Ghent University; Ghent; Belgium
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619
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Ek A, Middelveld RJM, Bertilsson H, Bjerg A, Ekerljung L, Malinovschi A, Stjärne P, Larsson K, Dahlén SE, Janson C. Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey. Allergy 2013; 68:1314-21. [PMID: 24107218 DOI: 10.1111/all.12222] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asthma and chronic rhinosinusitis (CRS) both impair quality of life, but the quality-of-life impact of comorbid asthma and CRS is poorly known. The aim of this study was to evaluate the impact of CRS and other relevant factors on quality of life in asthmatic subjects. METHODS This Swedish cohort (age 17-76 years) consists of 605 well-characterized asthmatics with and without CRS, 110 individuals with CRS only, and 226 controls and is part of the Global Allergy and Asthma European Network (GA(2) LEN) survey. The Mini Asthma Quality of Life Questionnaire (mAQLQ), the Euro Quality of Life (EQ-5D) health questionnaire, spirometry, skin prick test (SPT), exhaled nitric oxide (FeNO), smell test, and peak nasal inspiratory flow were used. RESULTS Subjects having both asthma and CRS have lower mAQLQ scores in all domains (P < 0.001) and a lower EQ-5D index value and EQ-5D VAS value (P < 0.001) compared to those with asthma only. Asthmatics with CRS have significantly lower FEV1%pred and FVC%pred (88.4 [85.1-91.7] and 99.9 [96.7-103.0], respectively) compared with asthma only (91.9 [90.3-93.4] and 104.0 [102.5-105.5], respectively P < 0.05). Multiple regression analysis shows that low asthma quality of life is associated with having CRS (P < 0.0001), lower lung function (P = 0.008), current smoking (P = 0.01), BMI > 30 kg/m2 (P = 0.04), high age (P = 0.03), and a negative SPT (P = 0.04). CONCLUSIONS Comorbid CRS was a significant and independent negative predictor of quality of life in asthmatics. Other negative factors were lower lung function, current smoking, obesity, advanced age, and having nonatopic asthma.
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Affiliation(s)
- A. Ek
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - R. J. M. Middelveld
- The Centre for Allergy Research and Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - H. Bertilsson
- Department of Public Health and Clinical Medicine: Occupational and Environmental Medicine; Umeå University; Umeå; Sweden
| | - A. Bjerg
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - L. Ekerljung
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - A. Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala; Sweden
| | - P. Stjärne
- Department of Clinical Science; Intervention and Technology: Otorhinolaryngology; Karolinska Institutet; Stockholm; Sweden
| | - K. Larsson
- Lung and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - S.-E. Dahlén
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; Uppsala University; Uppsala; Sweden
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620
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Adriaensen GFJPM, Fokkens WJ. Chronic rhinosinusitis: an update on current pharmacotherapy. Expert Opin Pharmacother 2013; 14:2351-60. [DOI: 10.1517/14656566.2013.837450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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621
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Golusiński W. [Recommendation for Sinupret as a supplementary specimen in pharmacological treatment of rhinosinusitis]. Otolaryngol Pol 2013; 67:223-7. [PMID: 24021823 DOI: 10.1016/j.otpol.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/02/2013] [Indexed: 11/26/2022]
Abstract
Due to rhinosinusitis symptoms severity and relatively high treatment resistance, excipients, supplementing basic pharmacological and surgical treatment, have played a significant role in the recent years. Phytotherapy is one of the most dynamically developing studies which focuses on implementing natural active substances into the treatment. 2012 EPOS Report pinpoints the benefits of using substances of natural origin in patients with acute rhinosinusitis. Sinupret drug has been proven effective in clinical trials, as a drug for both acute and chronic rhinosinusitis, in children and adults. Sinupret is a multidirectional drug, which significantly alleviates the symptoms of rhinosinusitis.
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Affiliation(s)
- Wojciech Golusiński
- Przewodniczący Sekcji Rynologii i Chirurgii Plastycznej Twarzy Polskiego Towarzystwa Otolaryngologów, Chirurgów Głowy i Szyi.
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622
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Asthma and physical activity--a population based study results from the Swedish GA(2)LEN survey. Respir Med 2013; 107:1651-8. [PMID: 24055634 DOI: 10.1016/j.rmed.2013.08.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Having asthma has in previous reports been related to a lower physical activity level. At the same time the prevalence of asthma among elite athletes is high. The aim of this study was to investigate the association between physical activity level and asthma. METHODS A postal questionnaire was completed by 25,610 individuals in Sweden. Current asthma was defined as having had an asthma attack during the last 12 months or current use of asthma medication. The participants were asked how often and for how many hours a week they were physically active. RESULTS In the population 1830 subjects (7.1%) had current asthma. There was no significant difference in the proportion of subjects that reported being inactive or slightly physically active between asthmatic and non-asthmatics (57 vs. 58%) while the proportion of subjects that were vigorously physically active (≥2 times a week and ≥7 h per week) was higher among the subjects with asthma (6.7 vs. 4.8%, p < 0.0001). Being vigorously physically active was independently related to current asthma (OR (95% CI)) 1.40 (1.11-1.77)), wheeze (1.39 (1.17-1.65)), wheeze and breathlessness (1.68 (1.38-2.04)), and wheezing without having a cold (1.39 (1.13-1.71)). The association between being vigorously physically active and wheeze was significantly stronger in women compared to men. CONCLUSIONS There was no difference in the proportion of subjects with a reported low level of physical activity between asthmatics and non-asthmatics. Health care professionals should, however, be aware of the increased prevalence of asthma and asthma-related symptoms in vigorously physically active subjects.
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623
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Koskinen A, Penttilä M, Myller J, Hammarén-Malmi S, Silvola J, Haahtela T, Hytönen M, Toppila-Salmi S. Endoscopic sinus surgery might reduce exacerbations and symptoms more than balloon sinuplasty. Am J Rhinol Allergy 2013; 26:e150-6. [PMID: 23232189 DOI: 10.2500/ajra.2012.26.3828] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is considered after medical therapy failure of chronic rhinosinusitis (CRS). The balloon sinuplasty dilates the natural ostium without moving mucosa or bone. It still lacks evidence from randomized controlled trials. The aim of this retrospective controlled study was to compare the symptom outcomes after maxillary sinus surgery with either the ESS or the balloon sinuplasty technique. No previous or additional sinonasal operations were accepted. METHODS Two hundred eight patients with CRS without nasal polyps underwent either balloon sinuplasty or ESS. The patients who met with the inclusion criteria (n = 45 in ESS group and n = 40 in balloon group) replied to a questionnaire of history factors, exacerbations, and a visual analog scale (VAS) scoring of the change in symptoms, on average 28 ± 6 (mean ± SD) months postoperatively. RESULTS The groups were identical in the response rate (64%), patient characteristics, and the improvement in all of the asked symptoms. Patients with CRS-related comorbidity and/or present occupational exposure had a statistically significantly better symptom reduction after ESS than after balloon sinusotomy. Moreover, the balloon sinusotomy group reported a statistically significant higher number of maxillary sinus punctures and antibiotic courses during the last 12 months. CONCLUSION ESS might be superior to balloon sinuplasty, especially in patients with risk factors. There is a need to perform more controlled studies on the treatment choices of CRS.
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Affiliation(s)
- Anni Koskinen
- Helsinki University Central Hospital, Skin and Allergy Hospital, Helsinki, Finland
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624
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Myller JP, Luukkainen AT, Huhtala HSA, Torkkeli TVM, Rautiainen MEP, Toppila-Salmi SK. Satisfaction with maxillary sinus surgery might be influenced by risk factors. ALLERGY & RHINOLOGY 2013; 4:e6-e12. [PMID: 23772330 PMCID: PMC3679571 DOI: 10.2500/ar.2013.4.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting for ≥12 weeks. Endoscopic sinus surgery (ESS) is considered during difficult to treat CRS. The minimally invasive technique focuses on the transition areas rather than on the ostia. The aim of this study was to evaluate symptoms, the number of acute sinusitis episodes, and satisfaction after ESS with either preservation or enlargement of the maxillary sinus ostium. Thirty patients with moderate nonpolypous CRS were enrolled. Uncinectomy only and additional middle meatal antrostomy were randomized for each side of each patient and performed single blindly. The symptoms questionnaires were filled at four time intervals. Significant symptom reduction was achieved independently of operation technique. The number of acute sinusitis episodes indicating the exacerbation rate decreased significantly at 9 and, on average, 68 months postoperatively. However, the exacerbation rate began to increase after 9 months postoperatively. Three revisions were performed on the side with uncinectomy only and one on the side with additional antrostomy. Most patients reported good satisfaction with both procedures. There was a trend for patients with asthma and/or job exposure to report insignificantly more frequently no satisfaction with surgery, especially with the uncinectomy-only procedure. Both procedures seem to be efficient in providing symptom relief and satisfaction. More studies are needed to evaluate if patients with risk factors benefit more from an ostium-enlarging procedure.
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Affiliation(s)
- Jyri P Myller
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland, ; Department of Otorhinolaryngology, Paijat-Hame Central Hospital, Lahti, Finland
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625
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Allergic rhinitis, chronic rhinosinusitis and asthma: unravelling a complex relationship. Curr Opin Otolaryngol Head Neck Surg 2013; 21:79-86. [PMID: 23241653 DOI: 10.1097/moo.0b013e32835ac640] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Allergic rhinitis, chronic rhinosinusitis (CRS) and asthma have a high worldwide prevalence and confer a significant socioeconomic burden. This article reviews the recent advances in allergic rhinitis, CRS and asthma with view to understanding the upper and lower airway as one system. RECENT FINDINGS Allergic rhinitis, CRS and asthma demonstrate strong epidemiological coassociation, and early life risk factors for upper airway disease are now apparent. The absence of demonstrable peripheral IgE does not strictly classify airway disease as nonallergic. Excess mucosal inflammation with immune dysregulation is a common feature to all. An important role for innate immunity is now apparent and offers prospects of novel therapeutic approaches in the future. A role for bacterial superantigens is also emerging in all three diseases. Genetic studies highlight common associations between allergic rhinitis, CRS and asthma. SUMMARY Whether such overlapping pathological findings reflect a manifestation of the same disease but in relation to the different airway locations in individuals with genetic predisposition remains unknown, although likely. This continues under investigation and debate. The current research priorities are to understand what key events predispose to both upper and lower airway disease together and the critical immunological factors that establish and sustain airway inflammation.
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626
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Piromchai P, Kasemsiri P, Laohasiriwong S, Thanaviratananich S. Chronic rhinosinusitis and emerging treatment options. Int J Gen Med 2013; 6:453-64. [PMID: 23785241 PMCID: PMC3682850 DOI: 10.2147/ijgm.s29977] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This review describes the epidemiology and various treatments in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Evidence for short-term use of systemic corticosteroids has been shown to be favorable in CRSwNP, but still limited in CRSsNP. Topical corticosteroids improve symptom scores in both CRS subgroups. The role of microbes in CRS is still controversial. Culture-directed antibiotics are recommended for CRSsNP with exacerbation. Long-term use of low dosage antibiotics is recommended for CRSsNP for their anti-inflammatory effects. Other emerging treatment options are also discussed.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ; Department of Otolaryngology, Royal Victorian Eye and Ear Hospital/University of Melbourne, East Melbourne, Australia
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627
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Endotypes and phenotypes of chronic rhinosinusitis: a PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2013; 131:1479-90. [PMID: 23587334 DOI: 10.1016/j.jaci.2013.02.036] [Citation(s) in RCA: 408] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 02/11/2013] [Accepted: 02/14/2013] [Indexed: 12/21/2022]
Abstract
Chronic rhinosinusitis (CRS) is a complex disease consisting of several disease variants with different underlying pathophysiologies. Limited knowledge of the mechanisms of these disease subgroups is possibly the greatest obstacle in understanding the causes of CRS and improving treatment. It is generally agreed that there are clinically relevant CRS phenotypes defined by an observable characteristic or trait, such as the presence or absence of nasal polyps. Defining the phenotype of the patient is useful in making therapeutic decisions. However, clinical phenotypes do not provide full insight into all underlying cellular and molecular pathophysiologic mechanisms of CRS. Recognition of the heterogeneity of CRS has promoted the concept that CRS consists of multiple groups of biological subtypes, or "endotypes," which are defined by distinct pathophysiologic mechanisms that might be identified by corresponding biomarkers. Different CRS endotypes can be characterized by differences in responsiveness to different treatments, including topical intranasal corticosteroids and biological agents, such as anti-IL-5 and anti-IgE mAb, and can be based on different biomarkers that are linked to underlying mechanisms. CRS has been regarded as a single disease entity in clinical and genetic studies in the past, which can explain the failure to identify consistent genetic and environmental correlations. In addition, better identification of endotypes might permit individualization of therapy that can be targeted against the pathophysiologic processes of a patient's endotype, with potential for more effective treatment and better patient outcomes.
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628
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Alobid I, Mullol J. Role of medical therapy in the management of nasal polyps. Curr Allergy Asthma Rep 2013; 12:144-53. [PMID: 22274542 DOI: 10.1007/s11882-012-0247-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses regarding its cause, remains poorly understood. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, postnasal drip, and facial pain or pressure. Among the objectives of CRSwNP management are to eradicate nasal polyps from nasal and sinusal cavities, eliminate symptoms, and prevent recurrences. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating CRSwNP. Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.
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Affiliation(s)
- Isam Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic i Universitari, IDIBAPS, Barcelona, Catalunya, Spain
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629
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van Drunen CM, Mjösberg JM, Segboer CL, Cornet ME, Fokkens WJ. Role of innate immunity in the pathogenesis of chronic rhinosinusitis: progress and new avenues. Curr Allergy Asthma Rep 2013; 12:120-6. [PMID: 22311575 PMCID: PMC3296037 DOI: 10.1007/s11882-012-0249-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chronic rhinosinusitis is a heterogeneous and multifactorial disease with unknown etiology. Aberrant responses to microorganisms have been suggested to play a role in the pathophysiology of the disease. Research has focused on the presence, detection, response to, and eradication of these potential threats. Main topics seem to center on the contribution of structural cells such as epithelium and fibroblasts, on the consequences of activation of pattern-recognition receptors, and on the role of antimicrobial agents. This research should be viewed not only in the light of a comparison between healthy and diseased individuals, but also in a comparison between patients who do or do not respond to treatment. New players that could play a role in the pathophysiology seem to surface at regular intervals, adding to our understanding (and the complexity) of the disease and opening new avenues that may help fight this incapacitating disease.
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Affiliation(s)
- Cornelis M van Drunen
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
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630
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Frappé E, Gautier-Guillot M, Barthélémy JC, Maudoux D, Roche F, Costes F. La toux chronique du sujet âgé est associée à une limitation expiratoire des débits. Rev Mal Respir 2013; 30:179-86. [DOI: 10.1016/j.rmr.2012.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
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631
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Lee HS, Kim J. Cigarette smoke inhibits nasal airway epithelial cell growth and survival. Int Forum Allergy Rhinol 2013; 3:188-92. [PMID: 23281305 DOI: 10.1002/alr.21129] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/23/2012] [Accepted: 10/28/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cigarette smoke (CS) exposure has been shown to be associated with chronic rhinosinusitis (CRS). We hypothesized that that CS exposure results in impairment nasal epithelial cell growth and survival necessary for normal cell function. Furthermore, we hypothesized that normal nasal epithelial cell growth is dependent on vascular endothelial growth factor (VEGF) and that CS inhibits normal nasal epithelial cell growth and survival through VEGF-dependent mechanisms. METHODS To examine whether nasal epithelial cell growth is dependent upon VEGF, we exposed in vitro cultures of human primary nasal epithelial cells (PNECs) from normal subjects to blocking antibodies against the VEGF co-receptor, neuropilin-1 (NP1), and measured cell growth using a proliferation assay. To study whether CS inhibits cell growth, we exposed PNECs to cigarette smoke extract (CSE). We also examined the ability of CSE exposure of PNECs to induce apoptosis. RESULTS Exposure of PNECs from normal subjects to VEGF receptor anti-NP1 antibody resulted in inhibition of constitutive cell growth. CSE exposure resulted in dose-dependent inhibition of constitutive cell growth. Addition of anti-NP1 antibody to CSE-exposed cells resulted in no further inhibition of cell growth. CSE exposure also resulted in induction of apoptosis in a dose-dependent manner, comparable to that seen with VEGF blockade using anti-NP1 antibody. CONCLUSION PNECs from normal healthy control subjects display VEGF-dependent constitutive cell growth. CSE impairs cell growth and promotes apoptosis of normal healthy nasal epithelial cells. The effect of CSE may occur in part through VEGF-dependent mechanisms.
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Affiliation(s)
- Hyun Sil Lee
- Department of Medicine: Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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632
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Eriksson J, Ekerljung L, Sundblad BM, Lötvall J, Torén K, Rönmark E, Larsson K, Lundbäck B. Cigarette smoking is associated with high prevalence of chronic rhinitis and low prevalence of allergic rhinitis in men. Allergy 2013; 68:347-54. [PMID: 23346908 DOI: 10.1111/all.12095] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND The harmful effects of tobacco smoke on human health, including respiratory health, are extensive and well documented. Previous data on the effect of smoking on rhinitis and allergic sensitization are inconsistent. We sought to investigate how smoking correlates with prevalence of allergic and chronic rhinitis among adults in Sweden. METHODS The study population comprised 27 879 subjects derived from three large randomly selected cross-sectional population surveys conducted in Sweden between 2006 and 2008. The same postal questionnaire on respiratory health was used in the three surveys, containing questions about obstructive respiratory diseases, rhinitis, respiratory symptoms and possible determinants of disease, including smoking habits. A random sample from one of the cohorts underwent a clinical examination including skin prick testing. RESULTS Smoking was associated with a high prevalence of chronic rhinitis in both men and women and a low prevalence of allergic rhinitis in men. These associations were dose dependent and remained when adjusted for a number of possible confounders in multiple logistic regression analysis. Prevalence of chronic rhinitis was lowest in nonsmokers and highest in very heavy smokers (18.5% vs 34.5%, P < 0.001). Prevalence of sensitization to common airborne allergens was lower in current smokers (25.9%, P = 0.008) and ex-smokers (28.2%, P = 0.022) than in nonsmokers (38.5%). CONCLUSION We found that smoking was associated with a high prevalence of chronic rhinitis in both sexes and a low prevalence of allergic rhinitis in men. The associations were dose dependent and remained when adjusting for several possible confounders.
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Affiliation(s)
- J. Eriksson
- Krefting Research Centre / Department of Internal Medicine and Clinical Nutrition; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - L. Ekerljung
- Krefting Research Centre / Department of Internal Medicine and Clinical Nutrition; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - B.-M. Sundblad
- Lung and Allergy Research; National Institute of Environmental Medicine; Karolinska Institute; Stockholm; Sweden
| | - J. Lötvall
- Krefting Research Centre / Department of Internal Medicine and Clinical Nutrition; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | | | | | - K. Larsson
- Lung and Allergy Research; National Institute of Environmental Medicine; Karolinska Institute; Stockholm; Sweden
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633
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Shields RC, Mokhtar N, Ford M, Hall MJ, Burgess JG, ElBadawey MR, Jakubovics NS. Efficacy of a marine bacterial nuclease against biofilm forming microorganisms isolated from chronic rhinosinusitis. PLoS One 2013; 8:e55339. [PMID: 23441151 PMCID: PMC3575374 DOI: 10.1371/journal.pone.0055339] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background The persistent colonization of paranasal sinus mucosa by microbial biofilms is a major factor in the pathogenesis of chronic rhinosinusitis (CRS). Control of microorganisms within biofilms is hampered by the presence of viscous extracellular polymers of host or microbial origin, including nucleic acids. The aim of this study was to investigate the role of extracellular DNA in biofilm formation by bacteria associated with CRS. Methods/Principal Findings Obstructive mucin was collected from patients during functional endoscopic sinus surgery. Examination of the mucous by transmission electron microscopy revealed an acellular matrix punctuated occasionally with host cells in varying states of degradation. Bacteria were observed in biofilms on mucosal biopsies, and between two and six different species were isolated from each of 20 different patient samples. In total, 16 different bacterial genera were isolated, of which the most commonly identified organisms were coagulase-negative staphylococci, Staphylococcus aureus and α-haemolytic streptococci. Twenty-four fresh clinical isolates were selected for investigation of biofilm formation in vitro using a microplate model system. Biofilms formed by 14 strains, including all 9 extracellular nuclease-producing bacteria, were significantly disrupted by treatment with a novel bacterial deoxyribonuclease, NucB, isolated from a marine strain of Bacillus licheniformis. Extracellular biofilm matrix was observed in untreated samples but not in those treated with NucB and extracellular DNA was purified from in vitro biofilms. Conclusion/Significance Our data demonstrate that bacteria associated with CRS form robust biofilms which can be reduced by treatment with matrix-degrading enzymes such as NucB. The dispersal of bacterial biofilms with NucB may offer an additional therapeutic target for CRS sufferers.
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Affiliation(s)
- Robert C. Shields
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Norehan Mokhtar
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Michael Ford
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Michael J. Hall
- School of Chemistry, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - J. Grant Burgess
- School of Marine Science and Technology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mohamed Reda ElBadawey
- Department of Otolaryngology and Head & Neck Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Otolaryngology Department, Tanta University, Tanta, Egypt
| | - Nicholas S. Jakubovics
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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634
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Abdalla S, Alreefy H, Hopkins C. Prevalence of sinonasal outcome test (SNOT-22) symptoms in patients undergoing surgery for chronic rhinosinusitis in the England and Wales National prospective audit. Clin Otolaryngol 2013; 37:276-82. [PMID: 22776038 DOI: 10.1111/j.1749-4486.2012.02527.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Review and evaluate the prevalence and severity of individual symptoms in patients with chronic rhinosinusitis (CRS) with or without nasal polyposis. DESIGN AND SETTING Retrospective analysis of data from the National Comparative Audit of Surgery for Nasal Polyposis and CRS, carried out across 87 hospitals in England and Wales between 2000 and 2001. PARTICIPANTS A total of 2573 patients with CRS (1784 had CRS with nasal polyposis, 789 without nasal polyposis) who had undergone sinus surgery. MAIN OUTCOME MEASURES Severity of clinical symptoms scores was graded on the Sino-Nasal Outcome Test 22 questionnaire. Prevalence of these symptoms and mean symptom scores were calculated for each group of patients at baseline and 3 months after surgery. RESULTS In both groups, nasal blockage/congestion had the highest mean symptom score, followed by altered smell/taste and then the need to blow nose. These three symptoms were the most prevalent in the group with nasal polyposis. In the group without nasal polyposis, nasal blockage was also the most prevalent individual symptom (93.5%) followed by altered smell/taste (75.7%). The third most prevalent symptom was waking up tired (69.9%). The average test score preoperatively was 41.5 (group with nasal polyposis) and 44.4 (group without nasal polyposis). This decreased to 18.3 and 14.1, respectively, 3 months after surgery (P < 0.001). CONCLUSION The leading three symptoms were nasal blockage/congestion, altered taste/smell and the need to blow the nose in terms of severity and prevalence. The total Sino-Nasal Outcome Test 22 and all individual symptom scores improved significantly after surgery.
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Affiliation(s)
- S Abdalla
- ENT Department, Guy's Hospital, London, UK.
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635
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Sundbom F, Lindberg E, Bjerg A, Forsberg B, Franklin K, Gunnbjörnsdottir M, Middelveld R, Torén K, Janson C. Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: results from the GA(2)LEN survey. Allergy 2013; 68:213-9. [PMID: 23176562 DOI: 10.1111/all.12079] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2012] [Indexed: 01/25/2023]
Abstract
BACKGROUND Asthma and rhinitis have been related to insomnia. The aim of this study was to further analyse the association between asthma, nasal symptoms and insomnia and to identify risk factors for sleep disturbance among patients with asthma, in a large population-based set of material. METHOD In 2008, a postal questionnaire was sent to a random sample of 45 000 adults in four Swedish cities. The questionnaire included questions on insomnia, asthma, rhinitis, weight, height, tobacco use and physical activity. RESULTS Twenty-five thousand six hundred and ten subjects participated. Asthma was defined as either current medication for asthma or at least one attack of asthma during the last 12 months, and 1830 subjects (7.15%) were defined as asthmatics. The prevalence of insomnia symptoms was significantly higher among asthmatics than non-asthmatics (47.3% vs 37.2%, <0.0001). In the subgroup reporting both asthma and nasal congestion, 55.8% had insomnia symptoms compared with 35.3% in subjects without both asthma and nasal congestion. The risk of insomnia increased with the severity of asthma, and the adjusted OR for insomnia was 2.65 in asthmatics with three symptoms compared with asthmatics without symptoms. Nasal congestion (OR 1.50), obesity (OR 1.54) and smoking (OR 1.71) also increased the risk of insomnia. CONCLUSION Insomnia remains a common problem among asthmatics. Uncontrolled asthma and nasal congestion are important, treatable risk factors for insomnia. Lifestyle factors, such as smoking and obesity, are also risk factors for insomnia among asthmatics.
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Affiliation(s)
- F. Sundbom
- Department of Medical Sciences, Respiratory Medicine & Allergology; Uppsala University; Uppsala; Sweden
| | - E. Lindberg
- Department of Medical Sciences, Respiratory Medicine & Allergology; Uppsala University; Uppsala; Sweden
| | | | - B. Forsberg
- Environmental and Occupational Medicine; Department of Public Health and Clinical Medicine; Umea University; Umea; Sweden
| | | | | | - R. Middelveld
- Centre for Allergy Research and Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - K. Torén
- Occupational and Environmental Medicine; Sahlgrenska School of Public Health; University of Gothenburg; Göteborg; Sweden
| | - C. Janson
- Department of Medical Sciences, Respiratory Medicine & Allergology; Uppsala University; Uppsala; Sweden
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636
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Abstract
Chronic rhinosinusitis (CRS) is a common disorder characterized by mucosal inflammation of the nose and paranasal sinuses with sinonasal symptoms persisting for greater than 12 weeks. The etiology of CRS is incompletely understood. Current understanding supports inflammation, rather than infection, as the dominant etiologic factor. CRS significantly impacts patients' quality of life and health care expenditure. There is no standard management of CRS. Treatment strategies differ based on divergent etiologies of the various CRS subclasses. Both systemic and topical agents are used. These interventions differ in CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP) and specific situations such as allergic fungal rhinosinusitis or aspirin-exacerbated respiratory disease. Antibiotics are the most commonly prescribed medication for CRS, but their role in management is not strongly supported by high-level studies. This paper provides a succinct review of the evidence supporting or refuting common therapeutic agents in the management of CRS. Novel and emerging strategies will also be discussed.
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Affiliation(s)
- Rachel B Cain
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, AZ, USA
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637
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Hellings PW, Fokkens WJ, Akdis C, Bachert C, Cingi C, Dietz de Loos D, Gevaert P, Hox V, Kalogjera L, Lund V, Mullol J, Papadopoulos NG, Passalacqua G, Rondón C, Scadding G, Timmermans M, Toskala E, Zhang N, Bousquet J. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today? Allergy 2013; 68:1-7. [PMID: 23025484 DOI: 10.1111/all.12040] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2012] [Indexed: 01/15/2023]
Abstract
State-of-the-art documents like ARIA and EPOS provide clinicians with evidence-based treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), respectively. The currently available medications can alleviate symptoms associated with AR and RS. In real life, a significant percentage of patients with AR and CRS continue to experience bothersome symptoms despite adequate treatment. This group with so-called severe chronic upper airway disease (SCUAD) represents a therapeutic challenge. The concept of control of disease has only recently been introduced in the field of AR and CRS. In case of poor control of symptoms despite guideline-directed pharmacotherapy, one needs to consider the presence of SCUAD but also treatment-related, diagnosis-related and/or patient-related factors. Treatment-related issues of uncontrolled upper airway disease are linked with the correct choice of treatment and route of administration, symptom-oriented treatment and the evaluation of the need for immunotherapy in allergic patients. The diagnosis of AR and CRS should be reconsidered in case of uncontrolled disease, excluding concomitant anatomic nasal deformities, global airway dysfunction and systemic diseases. Patient-related issues responsible for the lack of control in chronic upper airway inflammation are often but not always linked with adherence to the prescribed medication and education. This review is an initiative taken by the ENT section of the EAACI in conjunction with ARIA and EPOS experts who felt the need to provide a comprehensive overview of the current state of the art of control in upper airway inflammation and stressing the unmet needs in this domain.
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Affiliation(s)
- P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; The Netherlands
| | - C. Akdis
- Swiss Intitute of Allergy; Davos; Switzerland
| | - C. Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery; Univeristy of Ghent; Ghent; Belgium
| | - C. Cingi
- Department of Otorhinolaryngology-Head and Neck Surgery; Osmangazi University; Eskilehir; Turkey
| | - D. Dietz de Loos
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam; The Netherlands
| | - P. Gevaert
- Department of Otorhinolaryngology-Head and Neck Surgery; Univeristy of Ghent; Ghent; Belgium
| | - V. Hox
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - L. Kalogjera
- University Department of ENT; Head and Neck Surgery; Sestre Milosrdnice University Hospital Center; Zagreb; Croatia
| | - V. Lund
- Royal National Throat, Nose and Ear Hospital; University College; London; UK
| | - J. Mullol
- Rhinology Unit and Smell Clinic; Department of Otorhinolaryngology; Hospital Clinic; Athens; Greece
| | - N. G. Papadopoulos
- Department of Allergy; 2nd Pediatric Clinic; University of Athens; Athens; Greece
| | - G. Passalacqua
- Allergy and Respiratory Diseases; Department of Internal Medicine; University of Genoa; Genoa; Italy
| | - C. Rondón
- IDIBAPS; CIBERES; Barcelona; Catalonia; Spain
| | - G. Scadding
- Royal National Throat, Nose and Ear Hospital; University College; London; UK
| | - M. Timmermans
- Department of Otorhinolaryngology-Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - E. Toskala
- Center for Applied Genomics; Children's Hospital Philadelphia; Philadelphia; PA; USA
| | - N. Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery; Univeristy of Ghent; Ghent; Belgium
| | - J. Bousquet
- Department of Respiratory Disease; University Hospital Arnaud de Villeneuve; Montpellier; France
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638
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Mullol J, Picado C. Rhinosinusitis and nasal polyps in aspirin-exacerbated respiratory disease. Immunol Allergy Clin North Am 2012; 33:163-76. [PMID: 23639706 DOI: 10.1016/j.iac.2012.11.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The presence of aspirin-exacerbated respiratory disease (AERD) in a patient with chronic rhinosinusitis with nasal polyps and asthma is associated with severe eosinophilic upper and lower airway disease. This article deals with the inflammatory disease of the respiratory tract as it relates to the sinuses. Involvement of the sinuses in AERD is almost universal, depending on the stage of onset of the disease and evaluation by computed tomography. This article explores the clinical aspects, physiopathology, and treatment of rhinosinusitis as it relates to AERD.
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Affiliation(s)
- Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, University of Barcelona, Barcelona, Catalonia, Spain.
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639
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The Pathogenesis of CRS: An Update. CURRENT OTORHINOLARYNGOLOGY REPORTS 2012. [DOI: 10.1007/s40136-012-0002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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640
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Linke R, Pries R, Könnecke M, Bruchhage KL, Böscke R, Gebhard M, Wollenberg B. Glycogen synthase kinase 3 in chronic rhinosinusitis: two faces of a single enzyme in one disease. Ann Allergy Asthma Immunol 2012; 110:101-6. [PMID: 23352529 DOI: 10.1016/j.anai.2012.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/01/2012] [Accepted: 11/20/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The origin and pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) remain unclear. Glycogen synthase kinase 3 (GSK-3) is a unique multitasking kinase involved in the regulation of inflammation and apoptosis and is an important messenger in the downstream signaling of interleukin 6. OBJECTIVE To analyze the possible role of GSK-3 in the pathogenesis of CRSwNP. METHODS We examined tissue samples of nasal polyps and the inferior turbinate of patients with CRSwNP and the inferior turbinate of individuals without chronic sinusitis (healthy mucosa). Expression levels of GSK-3 and its inactivated form phosphorylated GSK-3 (pGSK-3) were analyzed using DNA microarray, protein array, Western hybridization, and immunohistochemical analysis. RESULTS We found increased expression of GSK-3 in both the nasal polyps and the inferior turbinate of patients with CRSwNP compared with those with healthy mucosa (P < .01). We did not observe a difference between nasal polyps and the inferior turbinate of patients with CRSwNP, but a highly significant increase in the phosphorylation rate of GSK-3 was detected in the tissue of nasal polyps compared with the turbinates of patients with CRSwNP (P < .01). CONCLUSION GSK-3 may play a crucial role in the inflammatory process in CRSwNP. Nasal polyps originate mainly in the mucosa of the middle meatus of the nose and rarely occur in the region of the inferior turbinate. The inhibition of GSK-3 by phosphorylation in nasal polyps, in contrast to the inferior turbinate, is a possible explanation for the different behavior of the mucosa of the middle meatus and the inferior turbinate.
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Affiliation(s)
- Robert Linke
- Department of Otorhinolaryngology and Facial Plastic Surgery, University of Luebeck, Luebeck, Germany.
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641
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Transforming growth factor-β1 promotes Treg commitment in nasal polyposis after intranasal steroid treatment. Inflamm Res 2012. [DOI: 10.1007/s00011-012-0576-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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642
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Pezato R, Świerczyńska-Krępa M, Niżankowska-Mogilnicka E, Derycke L, Bachert C, Pérez-Novo CA. Role of imbalance of eicosanoid pathways and staphylococcal superantigens in chronic rhinosinusitis. Allergy 2012; 67:1347-56. [PMID: 22978320 DOI: 10.1111/all.12010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 12/30/2022]
Abstract
Chronic rhinosinusitis (CRS) is a multifactorial disease of the upper airways with a high prevalence (approximately 11%) in the general population. Different immune and inflammatory mechanisms are involved in its pathogenesis. Alterations in the arachidonic acid pathway (leading to an imbalanced production of eicosanoids) have been linked to the pathophysiology of different diseases especially nasal polyposis, asthma, and aspirin-exacerbated respiratory disease. Furthermore, viral and bacterial infections have been identified as important factors amplifying the pro-inflammatory reactions in these pathologies. This review summarizes the impact of an imbalance in the eicosanoid pathway and the effect of Staphylococcus aureus enterotoxins on the regulation of the pro-inflammatory network in CRS and their translation into disease severity.
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Affiliation(s)
| | | | | | - L. Derycke
- Upper Airways Research Laboratory; Department of Otorhinolaryngology; Ghent University; Ghent; Belgium
| | - C. Bachert
- Upper Airways Research Laboratory; Department of Otorhinolaryngology; Ghent University; Ghent; Belgium
| | - C. A. Pérez-Novo
- Upper Airways Research Laboratory; Department of Otorhinolaryngology; Ghent University; Ghent; Belgium
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643
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The impact of mental health on chronic rhinosinusitis symptom scores. Eur Arch Otorhinolaryngol 2012; 270:1361-4. [PMID: 23095946 DOI: 10.1007/s00405-012-2230-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
We aimed to assess whether anxiety and depression influence a patient's subjective symptom scores in chronic rhinosinusitis (CRS). Fifty-seven consecutive patients referred with CRS were asked to complete Sinonasal Outcome Test-22 (SNOT22) and Hospital Anxiety and Depression Score (HADS) questionnaires. Spearman's rank correlation was used to test association between SNOT22 and HADS. Linear regression was used to simultaneously analyse SNOT, HADS, patient age and gender. Mean anxiety score was 7.9 (range 0-19) with 32 % scoring over 11 (A score of ≥ 11 for either anxiety or depression is suggestive). Mean depression score was 5.0 (range 0-17), with 11 % scoring over 11. Five patients scored over 11 for both domains in the HADS questionnaire. Total SNOT22 and both anxiety (Spearman's ρ = 0.48, p = 0.0002) and depression scores (ρ = 0.44, p = 0.0007) revealed a strong association. We also identified a very strong association between psychological symptoms (questions 11-20) in SNOT22 and anxiety (ρ = 0.60, p = 0.0001) and depression scores (ρ = 0.341, p = 0.002). However, there was no association between nose-specific symptoms in SNOT22 and anxiety score in HADS (ρ = 0.18, p = 0.1775), but there was a strong association between nose-specific symptoms of SNOT22 and depression score in HADS (ρ = 0.32, p = 0.02). There is a strong association between total SNOT 22 and HADS score, but this appears to be due to the impact on generic quality of life items rather than disease-specific symptoms. This supports inclusion of global items in the SNOT22, but also use of two separate subscales when interpreting data.
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644
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Okano M, Fujiwara T, Makihara S, Fujiwara R, Higaki T, Kariya S, Noda Y, Haruna T, Nishizaki K. Characterization of IL-18 expression and release in the pathogenesis of chronic rhinosinusitis. Int Arch Allergy Immunol 2012; 160:275-86. [PMID: 23075512 DOI: 10.1159/000341668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 07/06/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Interleukin-18 (IL-18) is a member of the IL-1 cytokine family that affects chronic inflammation. We sought to characterize IL-18 expression and investigate its release during chronic rhinosinusitis (CRS). METHODS The expression of IL-18 in nasal polyps (NPs) and uncinate tissues (UTs) from both CRS and non-CRS patients was examined via immunohistochemistry. After culturing dispersed NP cells (DNPCs) with or without various stimulations, IL-18 levels were measured in the culture supernatants. Furthermore, the effect of IL-18 neutralization on staphylococcus enterotoxin B (SEB)-induced cytokine production was also examined. RESULTS Similar expression of IL-18 in the epithelial layers was observed between the NPs and UTs. However, there was a significantly higher number of IL-18(+) cells in the lamina propria from NPs compared to UTs without CRS. This increased number was significantly correlated with the radiological severity of sinusitis and local eosinophilia. After the dispersion, IL-18 was spontaneously released by NP cells in a phase-dependent manner. While SEB, fungal antigens, and TLR agonists did not enhance the release, exposure to protease or one cycle of a freeze-and-thaw treatment did induce release of IL-18 from rested DNPCs. In addition, neutralization of IL-18 significantly suppressed SEB-induced IL-5, IL-13, and IFN-γ, but not IL-17A production. CONCLUSIONS These results suggest that the pro-inflammatory effect of IL-18 released by danger signals may be involved in the pathogenesis of CRS, which includes eosinophilic inflammation and NP formation, via the augmentation of both Th2- and Th1-associated cytokine production.
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Affiliation(s)
- Mitsuhiro Okano
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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645
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Huang Z, Zhou B, Zhang Q, Huang Q, Sun Y, Wang M, Wang X, Wang C, Li Y, Cui S. The role of upper and lower airway patency in chronic rhinosinusitis with nasal polyps and asthma. Laryngoscope 2012; 123:569-73. [PMID: 23070787 DOI: 10.1002/lary.23649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/25/2012] [Accepted: 07/17/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the role of airway patency and factors associated with airway patency in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. STUDY DESIGN Retrospective study. METHODS The upper and lower airway patency of 140 patients with CRSwNP and asthma (asthma group) and 42 patients with CRSwNP without asthma (nonasthma control group) was measured using acoustic rhinometry, rhinomanometry, and spirometry. Total serum immunoglobulin E and eosinophil counts were also compared. The severity of nasal diseases in these patients was assessed via the Lund-Mackay score (LMS) and Lund-Kennedy score (LKS). RESULTS There was no difference between the asthma and nonasthma groups in terms of total nasal resistance at 75 Pa (R(75T)), bilateral minimum cross-sectional area (MCA(R+L)), or bilateral nasal cavity volume between 0 and 7.0 cm(3) (V7(R+L)). Forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF(25-75)) of the asthma group were significantly lower than those of the nonasthma group. FEV(1) and FEF(25-75) were not correlated with R(75T), MCA(R+L), V7(R+L), or severity of nasal disease. For the patients with asthma, LMS and serum eosinophil counts were independent predictors of MCA(R+L). CONCLUSIONS The presence of asthma may not influence upper airway patency in CRSwNP patients. In CRSwNP patients with asthma, impairment of upper airway patency was associated with changes in LMS and eosinophilia, and in these patients lower airway patency was significantly lower than that of the control group (without asthma). In CRSwNP patients with asthma, there was little or no association between upper and lower airway patency.
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Affiliation(s)
- Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital and Key Laboratory of Otolaryngology-Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
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646
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Yang YC, Zhang N, Van Crombruggen K, Hu GH, Hong SL, Bachert C. Transforming growth factor-beta1 in inflammatory airway disease: a key for understanding inflammation and remodeling. Allergy 2012; 67:1193-202. [PMID: 22913656 DOI: 10.1111/j.1398-9995.2012.02880.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 01/07/2023]
Abstract
Airway diseases such as chronic rhinosinusitis, asthma, and chronic obstructive pulmonary disorder are characterized by inflammation and remodeling. Among inflammatory and extracellular matrix regulatory cytokines, transforming growth factor-beta (TGF-β) stands central, as it possesses both important immunomodulatory and fibrogenic activities, and should be considered a key for understanding inflammation and remodeling processes. This review will briefly summarize the recent findings on the role of TGF-β1, from the view points of inflammation and remodeling, and discuss the role of TGF-β in the upper and lower airway diseases. This may reveal new perspectives in the understanding of airway inflammation and remodeling processes and may open innovative treatment strategies for the regulation of TGF-β1.
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Affiliation(s)
| | - N. Zhang
- Upper Airway Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University; Ghent; Belgium
| | - K. Van Crombruggen
- Upper Airway Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University; Ghent; Belgium
| | - G. H. Hu
- Department of Oto-Rhino-Laryngology; the First affiliated Hospital; Chongqing Medical University; Chongqing; China
| | - S. L. Hong
- Department of Oto-Rhino-Laryngology; the First affiliated Hospital; Chongqing Medical University; Chongqing; China
| | - C. Bachert
- Upper Airway Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University; Ghent; Belgium
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Role of fungi in pathogenesis of chronic rhinosinusitis: the hypothesis rejected. Curr Opin Otolaryngol Head Neck Surg 2012; 20:19-23. [PMID: 22157167 DOI: 10.1097/moo.0b013e32834e9084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Fungi have been suggested to play an important role in the pathogenesis of chronic rhinosinusitis (CRS). This review describes the recent knowledge concerning the role of fungi in the pathogenesis of CRS and allergic fungal rhinosinusitis (AFRS) and the clinical implications for treatment. RECENT FINDINGS Recent studies show that, although there are several potential deficits in the innate and potentially also in the acquired immunity of CRS patients that might reduce or change their ability to react to fungi, there are not many arguments to suggest a causative role for fungi in CRS with or without nasal polyps. However, due to the intrinsic or induced change in immunity of CRS patients, fungi might have a disease-modifying role. The fact that AFRS is more prevalent in warm and humid areas may point to fungi as a factor in this disease. SUMMARY Almost a decade after the launching of the hypothesis by Ponikau, the absence of convincing immunological data or evidence for clinical improvement of CRS upon therapy with antifungal agents now means that the hypothesis that fungi play a role in a majority of the cases of CRS has to be rejected and antifungal treatment should not be used.
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Bousquet J, Anto JM, Demoly P, Schünemann HJ, Togias A, Akdis M, Auffray C, Bachert C, Bieber T, Bousquet PJ, Carlsen KH, Casale TB, Cruz AA, Keil T, Lodrup Carlsen KC, Maurer M, Ohta K, Papadopoulos NG, Roman Rodriguez M, Samolinski B, Agache I, Andrianarisoa A, Ang CS, Annesi-Maesano I, Ballester F, Baena-Cagnani CE, Basagaña X, Bateman ED, Bel EH, Bedbrook A, Beghé B, Beji M, Ben Kheder A, Benet M, Bennoor KS, Bergmann KC, Berrissoul F, Bindslev Jensen C, Bleecker ER, Bonini S, Boner AL, Boulet LP, Brightling CE, Brozek JL, Bush A, Busse WW, Camargos PAM, Canonica GW, Carr W, Cesario A, Chen YZ, Chiriac AM, Costa DJ, Cox L, Custovic A, Dahl R, Darsow U, Didi T, Dolen WK, Douagui H, Dubakiene R, El-Meziane A, Fonseca JA, Fokkens WJ, Fthenou E, Gamkrelidze A, Garcia-Aymerich J, Gerth van Wijk R, Gimeno-Santos E, Guerra S, Haahtela T, Haddad H, Hellings PW, Hellquist-Dahl B, Hohmann C, Howarth P, Hourihane JO, Humbert M, Jacquemin B, Just J, Kalayci O, Kaliner MA, Kauffmann F, Kerkhof M, Khayat G, Koffi N'Goran B, Kogevinas M, Koppelman GH, Kowalski ML, Kull I, Kuna P, Larenas D, Lavi I, Le LT, Lieberman P, Lipworth B, Mahboub B, Makela MJ, Martin F, Martinez FD, Marshall GD, Mazon A, Melen E, Meltzer EO, Mihaltan F, Mohammad Y, Mohammadi A, Momas I, Morais-Almeida M, Mullol J, Muraro A, Naclerio R, Nafti S, Namazova-Baranova L, Nawijn MC, Nyembue TD, Oddie S, O'Hehir RE, Okamoto Y, Orru MP, Ozdemir C, Ouedraogo GS, Palkonen S, Panzner P, Passalacqua G, Pawankar R, Pigearias B, Pin I, Pinart M, Pison C, Popov TA, Porta D, Postma DS, Price D, Rabe KF, Ratomaharo J, Reitamo S, Rezagui D, Ring J, Roberts R, Roca J, Rogala B, Romano A, Rosado-Pinto J, Ryan D, Sanchez-Borges M, Scadding GK, Sheikh A, Simons FER, Siroux V, Schmid-Grendelmeier PD, Smit HA, Sooronbaev T, Stein RT, Sterk PJ, Sunyer J, Terreehorst I, Toskala E, Tremblay Y, Valenta R, Valeyre D, Vandenplas O, van Weel C, Vassilaki M, Varraso R, Viegi G, Wang DY, Wickman M, Williams D, Wöhrl S, Wright J, Yorgancioglu A, Yusuf OM, Zar HJ, Zernotti ME, Zidarn M, Zhong N, Zuberbier T. Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper. Int Arch Allergy Immunol 2012; 158:216-31. [PMID: 22382913 DOI: 10.1159/000332924] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.
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Affiliation(s)
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- Centre Hospitalier Universitaire Montpellier, Montpellier Cedex 05, France.
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Mori F, Fiocchi A, Barni S, Beghi G, Caddeo A, Calcinai E, Contestabile S, de Martino M, Pucci N, Rossi ME, Terracciano L, Novembre E. Management of acute rhinosinusitis. Pediatr Allergy Immunol 2012; 23 Suppl 22:27-31. [PMID: 22762851 DOI: 10.1111/j.1399-3038.2012.01321.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute rhinosinusitis (ARS) is one of the most common reasons for physician visits and for significant school absenteeism, although precise data on its prevalence and incidence are still lacking. RS is defined as acute if there are symptoms lasting <12 wk with complete resolution. Superinfection by bacteria following a viral infection is the most important mechanism of ARS. Diagnosis of ARS should be made on clinical grounds alone. Typically, acute bacterial RS is self-limited and goes through spontaneous recovery within 4 wk. Recognizing the occurrence of bacterial superinfections of the sinuses during a common viral respiratory infection is fundamental to making the decision to start an appropriate antibiotic treatment. Topical treatments such as saline irrigation, nasal decongestants, steroids, antihistamines, and fungicides are all in widespread pediatric use, but analyzing the literature gives poor evidence of efficacy, except for topical steroids. RS is a multifactorial condition that poses a diagnostic and management challenge to infectivologist and ear-nose-throat specialists as well as to pediatricians.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, A. Meyer Children's Hospital, Department of Pediatrics, University of Florence, Viale Pieraccini 24, Florence, Italy
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Bachert C, Zhang N, van Zele T, Gevaert P. Chronic rhinosinusitis: from one disease to different phenotypes. Pediatr Allergy Immunol 2012; 23 Suppl 22:2-4. [PMID: 22762847 DOI: 10.1111/j.1399-3038.2012.01318.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chronic rhinosinusitis (CRS) has now been discovered as a frequent disease affecting about 11% of the European population. In clinical terms, CRS may be differentiated in two phenotypes, CRS with and without nasal polyps. This differentiation is also confirmed by immunohistochemical studies on the remodeling pattern of those diseases, identifying TGF-ß as the key regulator. Further differentiation may be based on the inflammatory patterns, differentiating endotypes based on prominent T helper cell cytokines such as interleukin-5 and the presence of IgE antibodies against Staphylococcus aureus enterotoxins. The importance of those endotypes has been confirmed by innovative studies using humanized antibodies applied to nasal polyp disease, and by their predictive value for asthma comorbidity. Biomarkers may thus be needed to fully appreciate the CRS disease spectrum and its link to asthma.
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Affiliation(s)
- Claus Bachert
- Upper Airway Research Laboratory (URL), Department of Oto-Rhino-Laryngology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
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