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Roditi RE, Veling M, Shin JJ. Age: An effect modifier of the association between allergic rhinitis and Otitis media with effusion. Laryngoscope 2015; 126:1687-92. [PMID: 26422779 DOI: 10.1002/lary.25682] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/31/2015] [Accepted: 08/26/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS 1) To determine whether there is a significant relationship between allergic rhinitis and otitis media with effusion (OME), Eustachian tube dysfunction (ETD), or tympanic membrane retraction (TMR) in children in a nationally representative population; and 2) to determine whether age is an effect modifier of any such association because this hypothesis has yet to be tested. STUDY DESIGN Retrospective analysis of cross-sectional national databases with limited potential for referral bias. SETTING AND SUBJECTS National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2005-2010. METHODS Univariate, multivariate, stratified, and subgroup analyses were performed as defined a priori. The primary outcomes were OME, ETD, or TMR; the primary predictor variable was allergic rhinitis, with age evaluated as an effect modifier. RESULTS Data representing 1,491,045,375 pediatric visits were examined and demonstrated that age was an effect modifier of the assessed association. More specifically, in children 6 years of age or older, the presence of allergic rhinitis significantly increased the odds of OME, ETD, or TMR (odds ratio [OR] 4.20; 95% confidence interval [CI] 2.17, 8.09; P < 0.001), whereas in children less than 6 years of age there was no significant association (OR 1.13; 95% CI 0.53, 2.46; P = 0.745). CONCLUSION Age is an effect modifier of the association between allergic rhinitis and OME; a significant relationship is observed in children 6 years of age and older, whereas there is no significant association in younger children. LEVEL OF EVIDENCE 2c. Laryngoscope, 126:1687-1692, 2016.
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Affiliation(s)
| | - Maria Veling
- University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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Wang M, Ye T, Liang N, Huang Z, Cui S, Li Y, Huang Q, Zhou B. Differing roles for TGF-β/Smad signaling in osteitis in chronic rhinosinusitis with and without nasal polyps. Am J Rhinol Allergy 2015; 29:e152-9. [PMID: 26265084 DOI: 10.2500/ajra.2015.29.4241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP) is reported to involve different inflammatory processes in sinonasal mucosa and bone tissue, and these processes remain uncharacterized. OBJECTIVE We aimed to investigate the molecular mechanisms of osteitis in Chinese patients with CRS to better understand the pathogenesis of CRS. METHODS The study included 10 controls, 16 patients with CRSsNP, and 23 patients with CRSwNP. Ethmoid bone tissue samples were evaluated by histologic examination. Quantitative real-time reverse transcription polymerase chain reaction was used to assess expression of transforming growth factor (TGF) β1, TGF-β receptor I and II, Smad2, and Smad3. Immunohistochemical examination of osteoblast expression of TGF-β1, TGF-β receptor I and II, phosphorylated (p) Smad2, and p-Smad3 in ethmoid bone tissue was also performed. RESULTS The histopathologic evaluation of ethmoid sinus bone tissue showed that eosinophils had infiltrated the periosteum and induced TGF-β1 expression, periosteal thickening, increased osteoblast activity, and neo-osteogenesis. Messenger RNA levels of TGF-β1, TGF-β receptor I, and Smad3 in CRSwNP ethmoid bone tissues were significantly higher than those in ethmoid bone tissues of patients with CRSsNP and the controls. Immunohistochemical staining showed that TGF-β1, TGF-β receptor I, p-Smad2, and p-Smad3 protein expression was upregulated in patients with CRSwNP, consistent with the corresponding messenger RNA levels. CONCLUSION Different signaling pathways are involved in osteitis in CRS and are activated by the TGF-β/Smad signaling pathway in CRSwNP versus the TGF-β/Smad-independent signaling pathway in CRSsNP. Eosinophil infiltration of the periosteum, along with TGF-β1 expression, in CRSwNP indicates that eosinophils may play an important role in the bone remodeling process in CRSwNP.
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Affiliation(s)
- Mingjie Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing
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Steele TO, Mace JC, DeConde AS, Xiao CC, Storck KA, Gudis DA, Schlosser RJ, Soler ZM, Smith TL. Does comorbid obesity impact quality of life outcomes in patients undergoing endoscopic sinus surgery? Int Forum Allergy Rhinol 2015. [PMID: 26201473 DOI: 10.1002/alr.21599] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS). METHODS Adult patients with medically refractory CRS (n = 241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5 to 24.9, overweight: 25.0 to 29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index [RSDI] and the 22-item Sino-Nasal Outcome Test [SNOT-22]) were evaluated compared across BMI groups and obesity subclasses. RESULTS The prevalence of comorbid obesity was 41% (n = 99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p ≤ 0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p ≥ 0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs 55%, respectively) and SNOT-22 total score (29% and 40% vs 48%, respectively). CONCLUSION Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without.
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Affiliation(s)
- Toby O Steele
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Christopher C Xiao
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University, Portland, OR
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Belafsky PC, Peake J, Smiley-Jewell SM, Verma SP, Dworkin-Valenti J, Pinkerton KE. Soot and house dust mite allergen cause eosinophilic laryngitis in an animal model. Laryngoscope 2015. [DOI: 10.1002/lary.25467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Janice Peake
- Center for Health and the Environment, University of California Davis; Davis
| | - Suzette M. Smiley-Jewell
- Department of Otolaryngology; UC Davis Health System; Sacramento
- Center for Health and the Environment, University of California Davis; Davis
| | - Sunil P. Verma
- Department of Otolaryngology; University of California Irvine; Irvine California
| | | | - Kent E. Pinkerton
- Center for Health and the Environment, University of California Davis; Davis
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Yawn J, Lawrence LA, Carroll WW, Mulligan JK. Vitamin D for the treatment of respiratory diseases: is it the end or just the beginning? J Steroid Biochem Mol Biol 2015; 148:326-37. [PMID: 25625665 DOI: 10.1016/j.jsbmb.2015.01.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/16/2014] [Accepted: 01/22/2015] [Indexed: 12/22/2022]
Abstract
A large number of human, animal and in vitro studies have suggested that vitamin D3 (VD3) plays a critical role in inflammatory airway diseases such as asthma, chronic rhinosinusitis, and allergic rhinitis. VD3 acts upon a broad range of immune cells involved in the pathogenesis of these diseases including T-cells, dendritic cells (DCs), macrophages, and B-cells. In addition, VD3 can also regulate the functions of a number of non-immune cells including epithelial cells, fibroblasts, and smooth muscle cells. Given that VD3 has known effects on the immune system, it seems logical that supplementation with VD3 would prove efficacious in the treatment of these three diseases. While many studies, most of which are observational, have suggested that VD3 deficiency is associated with more severe disease, VD3 supplementation trials in humans have resulted in varied outcomes in terms of efficacy. In this review article we will discuss the role of VD3 in these three commonly associated respiratory diseases. We will explore the literature describing associations of VD3 deficiency with patient outcomes, cells in the respiratory microenvironment susceptible to VD3 regulation, conflicting results of VD3 supplementation trials, and potential gaps in our knowledge that may be limiting the widespread use of VD3 for the treatment of respiratory diseases such asthma, chronic rhinosinusitis and allergic rhinitis. This article is part of a Special Issue entitled '17th Vitamin D Workshop'.
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Affiliation(s)
- James Yawn
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Lauren A Lawrence
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - William W Carroll
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Jennifer K Mulligan
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson VA Medical Center, Charleston, SC, United States.
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Wang ET, Zheng Y, Liu PF, Guo LJ. Eosinophilic chronic rhinosinusitis in East Asians. World J Clin Cases 2014; 2:873-882. [PMID: 25516863 PMCID: PMC4266836 DOI: 10.12998/wjcc.v2.i12.873] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/28/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a common disease worldwide, with a prevalence rate of 5%-15% in the general population. CRS is currently classified into two types: CRS with and without nasal polyps. CRS may also be divided into eosinophilic CRS (ECRS) and non-ECRS subtypes based on the presence of tissue eosinophilic infiltration or not. There are significant geographic and ethnic differences in the tissue eosinophilic infiltration, which is predominant in Western white patients and less common in East Asians, despite an increasing tendency for its prevalence in East Asia countries. ECRS differs significantly from non-ECRS in clinical characteristics, treatment outcomes and strategies, and underlying pathogenic mechanisms. ECRS commonly demonstrates more severe symptoms, polyp diseases with a higher incidence of bilateral polyps and sinonasal diseases on computed tomography, and the increase in blood eosinophils. ECRS is considered a special and recalcitrant subtype of CRS, commonly with poor treatment outcomes compared to non-ECRS. The differentiation of specific subtypes and clinical features of CRS will be important for developing novel treatment strategies and improving treatment outcomes for individual phenotypes of CRS. This review discusses clinical features, diagnosis, treatment and prognosis of ECRS in East Asians.
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57
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Does the type of rhinitis influence development of otitis media with effusion in children? Curr Allergy Asthma Rep 2014; 14:472. [PMID: 25183363 DOI: 10.1007/s11882-014-0472-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear cavity behind an intact eardrum and is considered a multifactorial condition with Eustachian tube dysfunction as the underlying pathophysiologic condition. One of the most debated causes of OME is allergy, in particular allergic rhinitis. The aim of this paper is to review the role of rhinitis in the development of OME and in particular the role of both allergic (AR) and non-allergic rhinitis (NAR). Most of the recent literature confirms the role of AR in the development of OME, while there are few reports on the role of NAR. In non-allergic children affected by obstructive adenoid hypertrophy, the presence of mast cells in the nasal smear was associated with a high risk of developing a chronic OME.
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Abstract
PURPOSE OF REVIEW The timing and role of surgery in the management of pediatric chronic rhinosinusitis (pCRS) remains unclear. This review attempts to summarize the existing literature regarding this topic. RECENT FINDINGS pCRS is a complex clinical syndrome that results from multiple potential causes. Multimodal medical therapy is the accepted primary treatment. Adenoidectomy continues to be the appropriate first-line surgical therapy, and the addition of antral lavage or balloon dilation to this procedure may improve outcomes. Functional endoscopic sinus surgery (FESS) in children is safe and effective in relieving symptoms in the majority of patients. Failure to respond to maximal medical therapy continues to be a commonly cited, although poorly defined, requisite for proceeding to surgery. Recent literature has been focused on the outcomes after FESS rather than specifically defining when this intervention should be considered. Nevertheless, the literature seems to continue to support FESS in children with persistent symptoms despite adenoidectomy and appropriate medical treatment for pCRS. As the symptoms of chronic rhinosinusitis (CRS) may result from multiple underlying causes, clinicians must understand that the role and timing of surgery may vary with particular patients' disease. SUMMARY Surgical management of CRS in children continues to be a frequent topic of study in the otolaryngology literature. As recent research tends to be focused on outcomes after surgery, further prospective studies comparing surgical versus nonsurgical treatment of CRS will likely be required to better define indications for proceeding to surgery at all.
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Brook C, Noordzij JP, Russell K, Aliphas A, Platt M. Predictive findings of allergic disease in fiberoptic nasolaryngoscopy. Laryngoscope 2014; 125:286-90. [DOI: 10.1002/lary.24880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 07/09/2014] [Accepted: 07/16/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Christopher Brook
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - J. Pieter Noordzij
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Kimberly Russell
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Avner Aliphas
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Michael Platt
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
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Georgopoulos R, Krouse JH, Toskala E. Why otolaryngologists and asthma are a good match: the allergic rhinitis-asthma connection. Otolaryngol Clin North Am 2014; 47:1-12. [PMID: 24286674 DOI: 10.1016/j.otc.2013.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Consideration of the unified airway model when managing patients with rhinitis and or asthma allows a more comprehensive care plan and therefore improved patient outcomes. Asthma is linked to rhinitis both epidemiologically and biologically, and this association is even stronger in individuals with atopy. Rhinitis is not only associated with but is a risk factor for the development of asthma. Management of rhinitis improves asthma control. Early and aggressive treatment of allergic rhinitis may prevent the development of asthma. In patients with allergic rhinitis that is not sufficiently controlled by allergy medication, allergen-directed immunotherapy should be considered.
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Affiliation(s)
- Rachel Georgopoulos
- Department of Otolaryngology, Temple University Health System, 3509 North Broad Street, Philadelphia, PA 19140-4105, USA
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Outcomes and cost benefits of functional endoscopic sinus surgery in severely asthmatic patients with chronic rhinosinusitis. The Journal of Laryngology & Otology 2014; 128:512-7. [PMID: 24877745 DOI: 10.1017/s0022215114001133] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the outcomes (using validated outcome tools) and cost benefits of functional endoscopic sinus surgery in a population of severely asthmatic patients with chronic rhinosinusitis. METHODS A prospective cohort study was conducted. The study comprised consecutive patients diagnosed with asthma and chronic rhinosinusitis for whom medical treatment had failed and who were scheduled for functional endoscopic sinus surgery. General health and disease-specific outcome questionnaires were completed pre- and post-operatively. Costs associated with both functional endoscopic sinus surgery and out-patient visits to a comprehensive asthma clinic were calculated. RESULTS A total of 47 patients completed the surveys. The average improvement in Chronic Sinusitis Survey scores following functional endoscopic sinus surgery was 17 per cent. The average reduction in out-patient asthma clinic visits was 50 per cent, which translates to an average cost saving of $1035 Canadian dollars per patient per year. CONCLUSION Functional endoscopic sinus surgery is a cost-effective treatment modality for asthmatic patients with chronic rhinosinusitis. This information is important for: the distribution and planning of resources, prioritising health programmes, and establishing practice guidelines.
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Dabholkar YG, Saberwal AA, Velankar HK, Shetty AK, Chordia NP, Budhwani SR. Correlation of nasal nitric oxide measurement with computed tomography findings in chronic rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2014; 66:92-6. [PMID: 24605309 PMCID: PMC3938702 DOI: 10.1007/s12070-013-0689-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022] Open
Abstract
Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.
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Affiliation(s)
- Yogesh G. Dabholkar
- />Department of ENT, Dr D.Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India
| | - Akanksha A. Saberwal
- />Department of ENT, Dr D.Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India
- />603, Brooklyn Hills Co-op Hsg Soc, T-34, Opp Shastri Nagar, Lokhandwala, Andheri West, Mumbai, 400053 Maharashtra India
| | - Haritosh K. Velankar
- />Department of ENT, Dr D.Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India
| | - Adip K. Shetty
- />Department of ENT, Dr D.Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India
| | - Nilesh P. Chordia
- />Department of ENT, Dr D.Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India
| | - Sneha R. Budhwani
- />Department of ENT, Dr D.Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India
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Cheng HM, Kim S, Park GH, Chang SE, Bang S, Won CH, Lee MW, Choi JH, Moon KC. Low vitamin D levels are associated with atopic dermatitis, but not allergic rhinitis, asthma, or IgE sensitization, in the adult Korean population. J Allergy Clin Immunol 2013; 133:1048-55. [PMID: 24388009 DOI: 10.1016/j.jaci.2013.10.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of vitamin D on allergic conditions is unclear. In particular, large-scale, population-based studies examining this relationship in adult Asian populations are lacking. OBJECTIVE To evaluate the association between serum vitamin D levels and allergic conditions in the general adult Korean population. METHODS A cross-sectional study was performed by using data collected from 15,212 individuals 19 years or older who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2010. The confounder-adjusted mean serum 25-hydroxyvitamin D (25[OH]D) levels of participants with and without allergic conditions (including atopic dermatitis, asthma, allergic rhinitis, and increased total and allergen-specific serum IgE) were compared by using multiple linear regression analyses. Multiple logistic regression analyses with confounder adjustment estimated the odds ratios (ORs) for developing each condition according to adequate, inadequate, or deficient serum 25(OH)D levels. RESULTS After adjusting for potential confounders, mean serum 25(OH)D levels were significantly lower in participants diagnosed with atopic dermatitis than in those without this diagnosis (mean ± SE, 18.58 ± 0.29 ng/mL vs 19.20 ± 0.15 ng/mL; P = .02). Compared with participants with adequate vitamin D levels (≥20 ng/mL), confounder-adjusted ORs of atopic dermatitis were significantly higher in those with inadequate (12-19.99 ng/mL) or deficient (<12 ng/mL) levels (OR [95% CI], 1.50 [1.10-2.06] and 1.48 [1.04-2.12], respectively; P = .02). This relationship was not observed in participants with the other allergic conditions. CONCLUSION Vitamin D-insufficient adult individuals within the general Korean population have an increased likelihood of atopic dermatitis, but not asthma, allergic rhinitis, or IgE sensitization.
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Affiliation(s)
- Hui Mei Cheng
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sunmi Kim
- Department of Family Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Chan Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ocampo CJ, Peters AT. Antibody deficiency in chronic rhinosinusitis: epidemiology and burden of illness. Am J Rhinol Allergy 2013; 27:34-8. [PMID: 23406598 DOI: 10.2500/ajra.2013.27.3831] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A subset of patients with chronic rhinosinusitis (CRS) has refractory disease. The risk factors for refractory CRS include atopy, a disrupted mucociliary transport system, medical conditions affecting the sinonasal tract mucosa, and immunodeficiency. METHODS We review four primary immunodeficiencies reported in individuals with CRS: common variable immune deficiency (CVID), selective IgA deficiency, IgG subclass deficiency, and specific antibody deficiency. We also review treatment options for individuals with both CRS and a concomitant immune defect. RESULTS There is a high prevalence of CRS in individuals with CVID and selective IgA deficiency. While many reports describe IgG subclass deficiency in individuals with CRS, the clinical relevance of this is unclear. Specific antibody deficiency may play a more significant role in the pathogenesis of refractory CRS. CONCLUSION Screening for a primary immunodeficiency should be part of the diagnostic workup of refractory CRS, as its identification may allow for more effective long-term therapeutic options.
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Affiliation(s)
- Christopher J Ocampo
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Ramakrishnan VR, Ferril GR, Suh JD, Woodson T, Green TJ, Kingdom TT. Upper and lower airways associations in patients with chronic rhinosinusitis and bronchiectasis. Int Forum Allergy Rhinol 2013; 3:921-7. [PMID: 23881553 DOI: 10.1002/alr.21204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/21/2013] [Accepted: 06/18/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bronchiectasis is an uncommon disease of the lower airways characterized by bronchial wall destruction and permanent bronchiolar dilation. Several etiologic categories exist, and patients with bronchiectasis often complain of symptoms suggestive of chronic rhinosinusitis (CRS). The present study investigates the association between bronchiectasis and CRS using radiologic and bacteriologic data. METHODS Retrospective chart review from a tertiary care respiratory hospital was performed. Sinus computed tomography (CT) scans were examined for extent of disease and relationship to pulmonary disease severity. Statistical analysis was performed with Student t test and linear regression. Upper and lower airway cultures from patients with both bronchiectasis and CRS were compared using the chance adjusted agreement. RESULTS Patients with bronchiectasis were found to have a significantly higher Lund-Mackay score when compared to patients with allergic rhinitis (p = 0.047). Lund-Mackay CT score did not correlate with forced expiratory volume in 1 second (FEV1 ) and FEV1 :forced vital capacity (FVC), or presence of Pseudomonas aeruginosa. Correlation of upper and lower airway bacterial cultures in patients with both bronchiectasis and CRS was noted (kappa = 0.294, p = 0.004), particularly when P. aeruginosa was present (kappa = 0.49, p < 0.0001). CONCLUSION The current study suggests that the upper and lower airways may be linked in CRS and bronchiectasis from both an objective radiologic standpoint and a bacteriologic perspective. This finding carries implications for disease pathogenesis, clinical care, and future research.
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Affiliation(s)
- Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
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Bhattacharyya N. Associations between obesity and inflammatory sinonasal disorders. Laryngoscope 2013; 123:1840-4. [DOI: 10.1002/lary.24019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/14/2012] [Accepted: 01/07/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology; Brigham and Women's Hospital and Department of Otology and Laryngology; Harvard Medical School; Boston; Massachusetts; U.S.A
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Detwiller KY, Smith TL, Mace JC, Trune DR, Sautter NB. Steroid-independent upregulation of matrix metalloproteinase 9 in chronic rhinosinusitis patients with radiographic evidence of osteitis. Int Forum Allergy Rhinol 2013; 3:364-8. [PMID: 23401274 DOI: 10.1002/alr.21135] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/25/2012] [Accepted: 11/17/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chronic sinonasal inflammation is associated with tissue remodeling, such as osteitis, which may be a marker of refractory disease; however, the pathophysiology of osteitis in chronic rhinosinusitis (CRS) is insufficiently understood. METHODS Ethmoid mucosa and bone samples were obtained from 35 medically refractory CRS patients and 9 control subjects. Quantitative real-time polymerase chain reaction (RT-PCR) was performed separately on bone and mucosa for matrix metalloproteinase 2 and 9 (MMP2, MMP9) and tissue inhibitor of matrix metalloproteinase 1 (TIMP1). Osteitis was classified as mild, moderate, or severe by measuring bone thickness of the maxillary, sphenoid, and ethmoid sinuses on multiplanar computed tomography (CT). Patients were classified based on severity of osteitis and compared to controls. RESULTS Nine patients demonstrated radiographic evidence of osteitis (mild = 3, moderate/severe = 6). Bone PCR revealed biologically significant upregulation of MMP9 in all patients with CRS, but the magnitude of the upregulation decreased with severity of osteitis. Mucosa PCR showed upregulation of MMP9 in moderate/severe osteitis only. No significant changes were seen in MMP2 or TIMP1 regulation. CONCLUSION This is the first study to evaluate the role of MMP in the bone and mucosa of patients with sinonasal osteitis. The pattern of expression suggests there may be a time- and tissue-dependent role for MMP9 in the pathophysiology of osteitis. In addition, MMP9 overexpression is seen despite preoperative oral and intranasal steroid use, suggesting that if MMP9 is an important factor in the development of osteitis then steroids may not be the best treatment in prevention of osteitis.
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Affiliation(s)
- Kara Y Detwiller
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA
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Abstract
The upper and lower respiratory tracts function as an interdependent physiologic mechanism, and stimuli that trigger pathophysiologic changes in one portion of the airway can provoke similar changes throughout the airway. The unified airway model acknowledges these shared airway features, suggesting the importance of comprehensive evaluation of patients with any respiratory symptoms. Two areas are of specific importance to the septoplasty/rhinoplasty surgeon: (1) preoperative evaluation of the patient with rhinitis undergoing nasal surgery, and (2) perioperative and postoperative management of the nose. Management of potential cardiopulmonary risks among susceptible individuals is vital in the perioperative management of these patients.
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Affiliation(s)
- John H Krouse
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, 3440 North Broad Street, Kresge West #300, Philadelphia, PA 19140, USA.
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Thorstensen WM, Bugten V, Sue-Chu M, Fossland NPW, Romundstad PR, Steinsvåg SK. Sino-nasal characteristics in asthmatic patients. Otolaryngol Head Neck Surg 2012; 147:950-7. [PMID: 22714421 DOI: 10.1177/0194599812451408] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Unified Airways Hypothesis suggests an involvement of the upper airways in asthma. We aimed to evaluate the association between subjective sino-nasal complaints, nasal air flow, and sino-nasal quality of life (QOL) in patients with asthma compared with nonasthmatic subjects. STUDY DESIGN Case-control study. SETTING A tertiary referral center. SUBJECTS AND METHODS Symptoms, quality of life, and nasal airflow were assessed in 91 asthmatics and 95 nonasthmatic controls with Visual Analog Scale (VAS, 0-100), Sino-Nasal Outcome Test (SNOT-20), and Peak Nasal Inspiratory Flow (PNIF), respectively. Asthma and allergy status were assessed by Asthma Control Questionnaire (ACQ) and skin prick test or specific IgE. RESULTS Asthmatic patients (men/women, 37/54; mean age, 43.7 years; range, 19-64 years) reported significantly more nasal obstruction (mean VAS, 37 mm; SD = 26, 95% CI, 32-43 vs 9 mm, SD = 11, 95% CI, 7-11, P < .001) and lower sino-nasal quality of life (mean SNOT-20, 1.3; SD = 0.8, 95% CI, 1.1-1.5 vs 0.4, SD = 0.5, 95% CI, 0.3-0.5, P < .001) than controls (men/women, 42/53; mean age, 43.8 years; range, 20-65 years). PNIF was significantly lower in asthmatic patients than controls (mean PNIF, 84 l/min; SD = 24, 95% CI, 79-89 vs 100 l/min SD = 24, 95% CI, 95-105, P < .001). CONCLUSION Both allergic and nonallergic asthma were associated with increased sino-nasal symptoms, reduced sino-nasal QOL, and reduced inspiratory nasal air flow compared to controls. This provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthma patients beyond the scope of allergy.
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Affiliation(s)
- Wenche Moe Thorstensen
- Department of Otolaryngology, Head and Neck Surgery, St Olavs Hospital, University Hospital of Trondheim, Norway.
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Halpern LR. Allergic Rhinitis and the Unified Airway: A Therapeutic Dilemma. Oral Maxillofac Surg Clin North Am 2012; 24:205-17, viii. [DOI: 10.1016/j.coms.2012.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lin L, Zhao X, Yan W, Qi W. Influence of Orai1 intervention on mouse airway epithelium reactions in vivo and in vitro. Ann Allergy Asthma Immunol 2012; 108:103-12. [PMID: 22289729 DOI: 10.1016/j.anai.2011.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 09/14/2011] [Accepted: 09/19/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orai1 is crucial for store-operated Ca2(+) entry and Ca2(+) release-activated Ca2(+) channel activities. However, little is known about its function in allergic diseases. OBJECTIVE To assess the influence of Orai1 intervention on mouse airway epithelium reactions in vivo and in vitro. METHODS We used immunohistochemical staining, enzyme-linked immunosorbent assay, and real-time reverse transcription-polymerase chain reaction to evaluate Orai1 expression in nasal and tracheal mucosa epithelium of nonsensitized, control, and 2-aminoethoxydiphenyl borate (2-APB)-treated groups in vivo and in vitro. In addition, we analyzed concentrations of interleukin 1β, interleukin 6, macrophage inflammatory protein 2, and tumor necrosis factor α in nasal lavage fluid, bronchoalveolar lavage fluid, and culture supernatant and their messenger RNAs in nasal and tracheal mucosa and cultured nasal and tracheal epithelium. RESULTS Administration of 2-APB into the nostrils suppressed Orai1 expression in nasal and tracheal mucosa of treated mice compared with that in control mice and restrained the mediators in nasal lavage fluid, bronchoalveolar lavage fluid, and airway mucosa of treated groups compared with those in control groups. Similarly, the 2-APB intervention also alleviated Orai1 and the production of the mediators in culture supernatant and cultured airway epithelium under allergic conditions. CONCLUSIONS Our results indicate that 2-APB could effectively ameliorate reactions of upper and lower airway epithelial cells in mice in allergic states in vivo and in vitro.
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Affiliation(s)
- Lin Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China.
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Turley R, Cohen SM, Becker A, Ebert CS. Role of rhinitis in laryngitis: another dimension of the unified airway. Ann Otol Rhinol Laryngol 2011; 120:505-10. [PMID: 21922973 DOI: 10.1177/000348941112000803] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We evaluated the prevalence of dysphonia and secondary laryngeal symptoms among patients with allergic rhinitis (AR), nonallergic rhinitis (NAR), and no rhinitis symptoms (controls). METHODS Patients with rhinitis symptoms with positive and negative allergy tests were recruited from allergy clinics, and patients without rhinitis symptoms were recruited from an orthopedic clinic. All groups completed the Voice-Related Quality of Life survey (VRQOL),the mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ), and the Reflux Symptom Index (RSI). RESULTS Completing the study were 134 patients with AR, 54 patients with NAR, and 62 controls. Both AR and NAR patients had an increased prevalence of dysphonia compared to controls (32.8% and 26.9% versus 8.1%, respectively; p = 0.001). When we controlled for confounding variables such as asthma, inhaled steroid use, and gastroesophageal reflux, patients with either AR or NAR had higher odds of dysphonia (odds ratio, 4.22; 95% confidence interval, 1.03 to 17.32). Patients with worse mini-RQLQ scores had lower VRQOL scores and higher RSI scores (Spearman correlation of -0.47 and p < 0.001 and Spearman correlation of 0.6 and p <0.001, respectively). CONCLUSIONS Patients with rhinitis (AR or NAR) had a higher prevalence of dysphonia than did controls. Patients with worse rhinitis symptoms had worse voice-related quality of life and more severe chronic laryngeal symptoms.
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Affiliation(s)
- Richard Turley
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Vitamin D: immunomodulation of asthma, allergic rhinitis, and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2011; 19:224-8. [PMID: 21499100 DOI: 10.1097/moo.0b013e3283465687] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW To discuss the role of vitamin D in asthma, allergic rhinitis, and chronic rhinosinusitis (CRS). RECENT FINDINGS Over the last several years, the role of vitamin D in immunomodulation has been studied and shown to have a significant impact on immune function. A causal relationship exists between vitamin D function and innate and adaptive immunity to infections. The mechanisms underlying vitamin D immune actions could be attributed to a paracrine feedback loop that reduces inflammation as well as influencing the differentiation fate of activated CD4 T cells, or the enhancement of suppressor T-cell function; indeed, a combination of these factors may underlie the actions of vitamin D. SUMMARY Recent findings on the function of vitamin D may explain aspects of the pathophysiology of allergic rhinitis and CRS and may help direct future interventions and treatment of these diseases.
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Phillips PS, Sacks R, Marcells GN, Cohen NA, Harvey RJ. Nasal nitric oxide and sinonasal disease: a systematic review of published evidence. Otolaryngol Head Neck Surg 2011; 144:159-69. [PMID: 21634057 DOI: 10.1177/0194599810392667] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To critically and systematically review the data available on the sinonasal application of nasal nitric oxide measurement, particularly its use as a diagnostic, prognostic, or treatment effect indicator. DATA SOURCES EMBASE 1980 to February 10, 2010; Medline 1950 to February 10, 2010; Cochrane Collaboration database; NHS Evidence Health Information Resources database. Review Methods. The databases were searched using a search strategy designed to include manuscripts relevant both to nitric oxide measurement and sinus or nasal problems. A title search was carried out on these manuscripts to select those relevant to clinical or basic science aspects of nitric oxide measurement. A subsequent abstract search selected those manuscripts concerning the application of nitric oxide measurement to sinonasal problems. The manuscripts selected were subject to a full-text review to extract data sets of nasal nitric oxide readings for different patient groups. RESULTS Initially, 1088 manuscripts were selected. A title search found 335 manuscripts of basic scientific or clinical interest. An abstract search found 35 manuscripts directly relating to nitric oxide measurement in sinonasal disease. Full-text analysis produced 20 studies with extractable data on nasal nitric oxide levels in clearly defined patient groups. Studies did not show sufficient homogeneity to enable substantial meta-analysis of aggregated data. CONCLUSION Current evidence shows that nasal nitric oxide is not a clinically useful measure for sinonasal disease. Although there is some evidence that sinus surgery is associated with lowered nasal nitric oxide levels, there is no evidence that this is associated with deterioration in sinus health.
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Affiliation(s)
- P Seamus Phillips
- Department of Otorhinolaryngology, St Vincent's Hospital, Sydney, New South Wales, Australia.
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75
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Abstract
The role of allergy in chronic otitis media with effusion (OME) is controversial. New evidence from cellular biology and immunology explain the basics of allergic reactions and allow more accurate diagnosis of allergies and inflammatory disease throughout the unified airway. This article examines the epidemiologic, methodological, and immunologic studies of allergic causes of OME, including (1) evidence for and against OME as an allergic disease, (2) allergy as a cause for eustachian tube obstruction, (3) examination of the most sensitive diagnostic tests for allergy, and (4) the effect of treatment of underlying allergies in improving and resolving middle ear disease.
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Marple BF. Allergic rhinitis and inflammatory airway disease: interactions within the unified airspace. Am J Rhinol Allergy 2011; 24:249-54. [PMID: 20819460 DOI: 10.2500/ajra.2010.24.3499] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Allergic rhinitis (AR), the most common chronic allergic condition in outpatient medicine, is associated with immense health care costs and socioeconomic consequences. AR's impact may be partly from interacting of respiratory conditions via allergic inflammation. This study was designed to review potential interactive mechanisms of AR and associated conditions and consider the relevance of a bidirectional "unified airway" respiratory inflammation model on diagnosis and treatment of inflammatory airway disease. METHODS MEDLINE was searched for pathophysiology and pathophysiological and epidemiologic links between AR and diseases of the sinuses, lungs, middle ear, and nasopharynx. RESULTS Allergic-related inflammatory responses or neural and systemic processes fostering inflammatory changes distant from initial allergen provocation may link AR and comorbidities. Treating AR may benefit associated respiratory tract comorbidities. Besides improving AR outcomes, treatment inhibiting eosinophil recruitment and migration, normalizing cytokine profiles, and reducing asthma-associated health care use in atopic subjects would likely ameliorate other upper airway diseases such as acute rhinosinusitis, chronic rhinosinusitis (CRS) with nasal polyposis (NP), adenoidal hypertrophy, and otitis media with effusion. CONCLUSION Epidemiological concordance of AR with several airway diseases conforms to a bidirectional "unified airway" respiratory inflammation model based on anatomic and histological upper and lower airway connections. Epidemiology and current understanding of inflammatory, humoral, and neural processes make links between AR and disorders including asthma, otitis media, NP, and CRS plausible. Combining AR with associated conditions increases disease burden; worsened associated illness may accompany worsened AR. AR pharmacotherapies include antihistamines, leukotriene antagonists, intranasal corticosteroids, and immunotherapy; treatments attenuating proinflammatory responses may also benefit associated conditions.
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Affiliation(s)
- Bradley F Marple
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas 75390-9035, USA.
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Rochat MK, Illi S, Ege MJ, Lau S, Keil T, Wahn U, von Mutius E. Allergic rhinitis as a predictor for wheezing onset in school-aged children. J Allergy Clin Immunol 2010; 126:1170-5.e2. [PMID: 21051078 DOI: 10.1016/j.jaci.2010.09.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 09/07/2010] [Accepted: 09/08/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhinitis in older children and adults has been shown to be a predictor for adolescent- and adult-onset asthma. These findings suggest an interaction between the upper and lower airways. Whether rhinitis is a predictor for childhood-onset asthma is unknown. OBJECTIVE We sought to investigate whether rhinitis in early childhood is an independent predictor for wheezing between the ages of 5 and 13 years in the German Multicentre Allergy Study birth cohort. METHODS The German Multicentre Allergy Study cohort initially included 1314 healthy children. They were followed from birth to the age of 13 years with regular questionnaires and interviews. Specific IgE levels were measured at yearly intervals. Airway hyperresponsiveness was assessed at 7 years. RESULTS Allergic rhinitis until the age of 5 years was found to be a predictor for developing wheezing between the ages of 5 and 13 years, with an adjusted relative risk of 3.82 (P < .001). This association was not attributable to the type of sensitization, the severity of sensitization, or atopic dermatitis during the first 2 years of life. In this group of children, 41.5% of all new cases of wheezing occurred among children with preceding allergic rhinitis. CONCLUSIONS The first manifestation of allergic rhinitis occurs in preschool children in whom it is a predictor for subsequent wheezing onset. Preschool children with rhinitis might thus benefit from early assessment of allergic sensitization to identify the children at high risk of wheezing.
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79
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Cohen SM. Self-reported impact of dysphonia in a primary care population: an epidemiological study. Laryngoscope 2010; 120:2022-32. [PMID: 20830762 DOI: 10.1002/lary.21058] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study's objectives are to 1) to assess the prevalence of dysphonia in the primary care community, 2) evaluate the severity of dysphonia, 3) explore potential risk factors for dysphonia, 4) examine the treatment of dysphonic patients, and 5) assess treatment-related barriers. The hypotheses are that 1) dysphonia is common in the primary care community, 2) it adversely impacts patients' quality of life (QOL), and 3) patients are underevaluated and experience obstacles with respect to seeking treatment. STUDY DESIGN Cross-sectional, practice-based study in the primary care population. METHODS English-speaking patients 18 years of age and older were recruited from a primary care research network. Patients presenting to their primary care practices were given a packet of questionnaires to complete that documented demographic information, risk factors, presence of dysphonia, prior treatment, and reasons for not seeking treatment. The Voice-Related Quality of Life (VRQOL) and Center for Epidemiological Studies-Depression Scale (CES-D) served as quality-of-life outcome measures. A priori sample size calculations were performed indicating a sample size of 780. Univariate analyses, descriptive statistics, odds ratios and 95% confidence intervals, and multivariate analyses were performed. RESULTS A total of 789 patients with a mean age of 49.9 years and range of 18 to 94 years participated. Lifetime prevalence of dysphonia was 29.1%, point prevalence of dysphonia 7.5%, and 4.3% had had dysphonia for >4 weeks. Of those with current dysphonia, only 46% had not missed work. Of those with current dysphonia, 73.3% had had dysphonia more than once. Patients with dysphonia had lower VRQOL scores and higher CES-D scores (t test, P ≤.001). Risk factors for dysphonia and impaired VRQOL on multivariate analysis included neurologic disease, dry mouth, family history of dysphonia, college or postgraduate level education, allergies or sinus problems, neck pain, medication for depression/anxiety, more than three upper respiratory infections per year, gastroesophageal reflux at least monthly, and asthma or lung disease. Of the patients who had ever had dysphonia, 22.1% received treatment. Common treatment modalities included antireflux treatment, antiallergy treatment, and antibiotics. Speech-language pathology evaluation was rare. Compared to those not interested in treatment, patients wanting treatment were more likely to have chronic dysphonia >4 weeks (30.6% vs. 8.1%; χ(2), P ≤.001), more likely to have dysphonia more than once (85.1% vs. 58.0%; χ(2), P ≤.001), and lower VRQOL scores (median 67.5 vs. 97.5; rank sum test, P <.001). Reasons for not seeking treatment included thinking the dysphonia would go away, physicians did not ask about voice problems, and being unaware of treatment options. CONCLUSIONS At the time one in 13 primary care patients had dysphonia resulting in significant functional impairment with reduced voice-specific QOL and greater depression scores. Risk factors for dysphonia and voice-specific QOL impairment were identified and might be useful for identifying patients at risk for dysphonia. Barriers exist that prevent dysphonic patients from receiving evaluation and treatment. Whether improved methods of dysphonia screening leads to better outcomes and reduced societal impact needs investigation. Laryngoscope, 2010.
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Affiliation(s)
- Seth M Cohen
- Duke Voice Care Center, Duke Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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80
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Yawn BP. Importance of allergic rhinitis management in achieving asthma control: ARIA update. Expert Rev Respir Med 2010; 2:713-9. [PMID: 20477234 DOI: 10.1586/17476348.2.6.713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Asthma continues to be a major burden for the health and healthcare of people worldwide. The recent updates of the Global Initiative for Asthma and the National Heart, Lung and Blood Institute asthma guidelines stress the need for achieving and monitoring asthma 'control', emphasizing the importance of identifying, assessing and treating comorbid conditions. Allergic rhinitis (AR) is a major comorbid condition in people with asthma and is related to inflammation of the upper portions of the airway. Recognizing and treating AR has been shown to improve asthma control, specifically by decreasing rates of asthma attacks or asthma exacerbations. In 2008, updated Allergic Rhinitis in Asthma (ARIA) guidelines were published. The updated version of the guidelines has a familiar look, with classification systems and care algorithms that are similar to those presented in other asthma guidelines. The new ARIA guidelines make one major change that should affect the care of adults and children with asthma: everyone with asthma should be assessed for AR. In addition, AR should be considered a risk factor for asthma, and all children and adults with AR, especially persistent AR, should be assessed for asthma, including testing lung function for reversible obstruction whenever feasible. Treatment for AR follows a similar format to that for asthma, including symptom management, treatment of chronic inflammation, identification and management of triggers, including allergens, and ongoing education for self-management. Pharmacotherapies that address both asthma and AR include corticosteroids (intranasal and inhaled), leukotriene receptor antagonists, immunomodulation or immunotherapy. Too often, pharmacotherapy is not supplemented by the necessary education and evaluation related to allergen, trigger identification and management.
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Affiliation(s)
- Barbara P Yawn
- Olmsted Medical Center, 210 Ninth St SE, Rochester, MN 55904, USA.
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81
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Abstract
Over the past 10 years, there has been increasing recognition of the interaction between the upper and lower airways in patients with a variety of infectious and inflammatory illnesses, including allergic rhinitis, rhinosinusitis, and asthma. Epidemiologic and mechanistic links have been proposed to demonstrate these relationships and to offer possible etiologic explanations to account for these observations. Among patients with upper respiratory illnesses, cough can be seen as a common symptom, both from the direct influences of upper airway inflammation, which incite reflex changes and bronchospasm, and from the exacerbation of associated pulmonary processes, such as asthma. Despite this increasing awareness of interaction between the upper and lower airways, the influence of both upstream and downstream respiratory inflammatory processes on laryngeal pathophysiology has not been extensively studied. Research suggests, however, that both direct stimulatory effects on the larynx and secondary effects of mucus production and mucus trafficking can create a range of laryngeal symptoms, including cough. This review discusses the interaction of the upper and lower airway in respiratory disease, and focuses on the effect of these respiratory processes on laryngeal inflammation, function, and symptoms.
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82
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Farid M, Metwalli N. Computed tomographic evaluation of mouth breathers among paediatric patients. Dentomaxillofac Radiol 2010; 39:1-10. [PMID: 20089737 DOI: 10.1259/dmfr/80778956] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Mouth breathing causes many serious problems in the paediatric population. It has been maintained that enlarged adenoids are principally responsible for mouth breathing. This study was designed to evaluate whether other mechanical obstacles might predispose the child to mouth breathing. METHODS 67 children with ages ranging from 10 to 15 years were studied and grouped into mouth-breathers and nose-breathers. The children first underwent axial CT scans of the brain for which they were originally referred. In addition, they were subjected to a limited coronal CT examination of the paranasal sinuses. Congenital anatomical variations as well as inflammatory changes were assessed. RESULTS 87% of mouth-breathing children had hypertrophied adenoids, 77% had maxillary sinusitis, 74% had pneumatized middle concha, 55% had a deviated nasal septum, 55% had hypertrophied inferior conchae, 45% had ethmoidal sinusitis and 23% showed frontal sinusitis. Such changes were significantly less prevalent in nose-breathers. 12.9% of mouth-breathing children did not have adenoids. Of these children, only 3.3% had one or more congenital or inflammatory change whereas the other 9.6% showed a completely normal CT scan signifying the incidence of habitual non-obstructive mouth breathing. CONCLUSIONS It is clear that adenoids have a dominant role in causing mouth breathing. Yet, we recommend that paediatricians should assess other mechanical obstacles if mouth breathing was not corrected after adenoidectomy. Further research should be performed to test the validity of correction of such factors in improving the quality of life of mouth-breathing children.
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Affiliation(s)
- Mm Farid
- Department of Oral Medicine, Periodontology, Diagnosis and Radiology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
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83
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Bhattacharyya N, Kepnes LJ. Additional disease burden from hay fever and sinusitis accompanying asthma. Ann Otol Rhinol Laryngol 2009; 118:651-5. [PMID: 19810606 DOI: 10.1177/000348940911800909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to determine the additional disease burden imparted by sinusitis and hay fever (allergic rhinitis) to patients with asthma. METHODS Patients with a diagnosis of asthma, hay fever, or sinusitis were extracted from the National Health Interview Survey for the 1997 to 2006 adult sample. Disease groups consisting of patients with asthma alone, asthma + hay fever, asthma + sinusitis, and asthma + hay fever + sinusitis were assembled. Disease groups were then compared according to total health-care visits per year, emergency room visits per year, health-care spending per year, and number of workdays lost per year to determine the disease burden. RESULTS We identified 11,813 patients (mean age, 45.5 years) who reported active asthma with or without hay fever or sinusitis comorbidity. Of these, 5,931 patients (50%) were identified with asthma alone, 1,134 (10%) with combined asthma + hay fever, 2,461 (21%) with asthma + sinusitis, and 2,287 (19%) with combined asthma + hay fever + sinusitis. Patients with asthma + sinusitis and those with asthma + sinusitis + hay fever had more total health-care visits and emergency room visits than did those with asthma alone (p <0.001). All three groups with comorbidities had higher healthcare expenditures than did the group with asthma alone (p < or = 0.002). Patients with asthma + sinusitis and those with asthma + hay fever + sinusitis missed more workdays than did patients in the group with asthma alone (10.0 and 13.1 versus 7.2, respectively; p <0.001). Comorbid hay fever alone did not increase workdays lost (6.6 days; p = 0.983). CONCLUSIONS The additional disease burden of sinusitis on asthma is greater than that of hay fever. These data highlight the importance of identifying comorbid diagnoses with asthma.
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Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology, Brigham and Women's Hospital, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
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84
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Current world literature. Curr Opin Allergy Clin Immunol 2009; 9:79-85. [PMID: 19106700 DOI: 10.1097/aci.0b013e328323adb4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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85
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Endam LM, Bossé Y, Filali-Mouhim A, Cormier C, Boisvert P, Boulet LP, Hudson TJ, Desrosiers M. Polymorphisms in the interleukin-22 receptor alpha-1 gene are associated with severe chronic rhinosinusitis. Otolaryngol Head Neck Surg 2009; 140:741-7. [DOI: 10.1016/j.otohns.2008.12.058] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 12/01/2008] [Accepted: 12/24/2008] [Indexed: 01/04/2023]
Abstract
Rationale: Stimulation of interleukin-22 receptor alpha-1 (IL22RA1) was reported to increase the innate immune responses in inflammatory diseases. Moreover, a reduced level of IL22RA1 was found in patients with recalcitrant CRS with nasal polyps. Objective: To explore association between single nucleotide polymorphisms (SNPs) in IL22RA1 and severe CRS. Methods: We extracted DNA from 206 cases with severe CRS and 196 postal code–matched controls. Twenty-three SNPs in the IL22RA1 gene were selected from the pooling-based genome-wide association study and from the CEU HapMap dataset and genotyped. PLINK software was used to determine association. Results: After Bonferroni correction, three SNPs (rs4292900 Pnom = 0.0006, OR = 1.757; rs4648936 Pnom = 0.0011, OR = 1.716; rs16829225 Pnom = 0.0014, OR = 1.977) show significant differences in allelic frequencies between cases and controls. Conclusion: Polymorphisms in IL22RA1 are associated with severe CRS. Replication and functional studies are involved to better understand the mechanism by which these polymorphisms contribute to the pathogenesis of CRS.
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Affiliation(s)
- Leandra Mfuna Endam
- Department of Otolaryngology, Hôtel-Dieu Hospital, Montreal University, Montreal, PQ, Canada
| | - Yohan Bossé
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Quebec, PQ, Canada
- Laval University Hospital Research Center (CRCHUL), Quebec, PQ, Canada
| | - Abdelali Filali-Mouhim
- Department of Otolaryngology, Hôtel-Dieu Hospital, Montreal University, Montreal, PQ, Canada
| | - Chantale Cormier
- Department of Otolaryngology, Hôtel-Dieu Hospital, Montreal University, Montreal, PQ, Canada
| | - Pierre Boisvert
- Department of Otolaryngology, Saint-François d'Assise Hospital, Quebec, PQ, Canada
| | - Louis-Philippe Boulet
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Quebec, PQ, Canada
| | | | - Martin Desrosiers
- Department of Otolaryngology, Hôtel-Dieu Hospital, Montreal University, Montreal, PQ, Canada
- Department of Otolaryngology–Head and Neck Surgery, Montreal General Hospital, McGill University, Montreal, PQ, Canada
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