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El Khoury P, Abou Hamad W, Khalaf MG, El Hadi C, Assily R, Rassi S, Khoueir N. Ipratropium Bromide Nasal Spray in Non-Allergic Rhinitis: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:3247-3255. [PMID: 37067019 DOI: 10.1002/lary.30706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE This study aims to compare the effectiveness of intranasal ipratropium bromide (INIB) to a placebo in reducing nasal symptoms, particularly rhinorrhea, and enhancing quality of life in non-allergic rhinitis (NAR) patients. STUDY DESIGN Systematic review and meta-analysis. METHODS A comprehensive review of the literature was conducted on Medline, Embase, and Cochrane libraries. Randomized controlled trials (RCTs) and non-randomized comparative parallel group trials comparing IB nasal spray to placebo were included. RESULTS Five RCTs assessed a total of 472 participants with a diagnosis of NAR. IB nasal spray 0.03% were used across all studies. IB has a better impact on decreasing rhinorrhea than the placebo, with a standardized mean difference (SMD) of 0.93 (95% CI 0.06-1.8). The mean change in rhinorrhea severity was 85% (95% CI 77-92%) and I^2 26% (p = 0.24). IB outperformed the placebo in terms of shortening the symptom's duration/day, as shown by an SMD of 0.35 (95% CI 0.15-0.55). The difference between treatments was noticeable within the first week and remained consistent throughout the treatment. Patients who were administered IB experienced a substantially greater improvement in physical and mental outcomes. Nasal adverse events with IB were generally intermittent and brief. CONCLUSION Compared with a placebo, IB nasal spray is both safe and effective in treating the rhinorrhea associated with NAR. IB significantly reduces the severity and duration of rhinorrhea. The treatment was determined to be beneficial by both patients and physicians and resulted in a better quality of life. LEVEL OF EVIDENCE 1 Laryngoscope, 133:3247-3255, 2023.
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Affiliation(s)
- Patrick El Khoury
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Walid Abou Hamad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christopher El Hadi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ralph Assily
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Simon Rassi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadim Khoueir
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Diamine Oxidase Activity Deficit and Idiopathic Rhinitis: A New Subgroup of Non-Allergic Rhinitis? Life (Basel) 2023; 13:life13010240. [PMID: 36676189 PMCID: PMC9865160 DOI: 10.3390/life13010240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Idiopathic rhinitis represents more than 50% of non-allergic rhinitis, a heterogeneous group that involves the symptomatic inflammation of the nasal mucosa. The TRPV1 receptor of unmyelinated C-type neurons appears to be involved in its pathophysiology. Histamine, whose main catabolic enzyme is DAO, is one of the mediators that can activate this receptor. The failure of DAO causes an increase in the level of histamine in the body and, consequently, the activation of TRPV1. The objective was to investigate the existence of a DAO enzyme activity deficit in idiopathic rhinitis and its correlation with symptoms. A cross-sectional study was conducted in 116 idiopathic rhinitis patients, and DAO activity, nasal peak inspiratory flow, and rhinitis severity were recorded. The prevalence of a DAO activity deficit was 41.38% (95%CI 0.33−0.50; p = 0.05). The DAO activity in patients with mild rhinitis was 52.93 ± 8.72 HDU/mL, in those with moderate rhinitis it was 120.33 ± 71.63 HDU/mL, and in those with severe rhinitis it was 92.58 ± 27.75 HDU/mL (p = 0.006). The NPIF in patients with a DAO activity deficit was 107.92 ± 34.05 L/min, compared to 72.35 ± 27.16 L/min in patients with normal enzymatic activity (p < 0.001), demonstrating a linear correlation between activity levels and nasal obstruction (−0.45; p < 0.001). Therefore, patients with a DAO deficiency and idiopathic rhinitis could present a milder disease course, because the repeated and continuous activation of TRPV1 led to a partial or total decrease in their response (desensitization). This new theory represents a different perspective for the study of idiopathic rhinitis and its relationship with TRPV1, with the regulation or modulation of the desensitization of TRPV1 being an important therapeutic target for patients with idiopathic rhinitis in the future.
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Smoking behavior might affect allergic rhinitis and vasomotor rhinitis differently: A mendelian randomization appraisal. World Allergy Organ J 2022; 15:100630. [PMID: 35228855 PMCID: PMC8844647 DOI: 10.1016/j.waojou.2022.100630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Allergic rhinitis and vasomotor rhinitis are harassing numerous patients and their risk factors have not been well investigated. Here, we try to identify their risk factors and distinguish these 2 diseases. Methods A two-sample Mendelian randomization (MR) study was implemented to discover the risk factors of allergic and vasomotor rhinitis. Based on previous studies, we selected 15 potential risk factors and the genome-wide summary statistics were extracted from the non-FinnGen consortium. The genome-wide summary statistics of rhinitis were obtained from the FinnGen consortium. Both univariable MR and multivariable MR analyses were performed to identify the causal risk factors. The Cochrane's Q value was calculated to appraise the heterogeneity. MR-Egger intercept and MR-RPESSO were utilized to appraise the pleiotropy. Results In the univariable model, the number of cigarettes per day can decrease the risk of allergic rhinitis (IVW OR = 0.29[0.18, 0.47], p-value = 2.70 × 10−7) while increasing the risk of vasomotor rhinitis (IVW OR = 1.30[1.04, 1.62], p-value = 0.022). Besides, no other risk factors could affect the risk of either allergic or vasomotor rhinitis. After adjusting for age of smoking initiation and alcohol intake, the cigarettes per day could still decrease the risk of allergic rhinitis (IVW OR = 4.66 × 10−3 [1.99 × 10−4, 0.11], p-value = 0.003) while not affecting the risk of vasomotor rhinitis (IVW OR = 0.92[0.44, 1.96], p-value = 0.834). Conclusion Smoking can affect the risk of allergic and vasomotor rhinitis differently where it decreases the risk of allergic rhinitis and increases the risk of vasomotor rhinitis.
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Liu Y, Xing Z, Ma X, Yu L. Association between migraine and vasomotor rhinitis. Int Forum Allergy Rhinol 2021; 11:1378-1380. [PMID: 33713559 DOI: 10.1002/alr.22790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/17/2021] [Accepted: 02/09/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Yan Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Zhimin Xing
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Beijing, China
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余 力, 马 鑫. [Advanced understanding of migraine and central sensitization syndrome]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:97-100. [PMID: 33540986 PMCID: PMC10127884 DOI: 10.13201/j.issn.2096-7993.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 06/12/2023]
Affiliation(s)
- 力生 余
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)
| | - 鑫 马
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)
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Abstract
This paper summarizes the currently accepted concepts of the pathogenetic mechanisms underlying the morphological and functional changes in intranasal mucosa of the patients having a long history of the application of the long-acting topical vasoconstrictor agents. The author presents the data illustrating the effectiveness of various methods for the pharmacotherapeutic treatment of medically-induced rhinitis.
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Affiliation(s)
- E V Nosulya
- Department of Otorhinolaryngology, Russian Medical Academy of Continuous Post-Graduate Education, Moscow, Russia, 125367
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Abstract
PURPOSE OF REVIEW Rhinitis is a common clinical entity. Besides nasal obstruction, itching, and sneezing, one of the most important symptoms of rhinitis is nasal hypersecretion produced by nasal glands and exudate from the nasal vascular bed. Allergic rhinitis is an IgE-mediated inflammatory reaction of nasal mucosa after exposure to environmental allergens. Idiopathic rhinitis describes rhinitis symptoms that occur after non-allergic, noninfectious irritants. Specific allergen avoidance, topical nasal decongestants, nasal corticosteroids, immunotherapy, and sinonasal surgery are the main treatment options. Because the current treatment modalities are not enough for reducing rhinorrhea in some patients, novel treatment options are required to solve this problem. RECENT FINDINGS Botulinum toxin is an exotoxin generated by Clostridium botulinum. It disturbs the signal transmission at the neuromuscular and neuroglandular junction by inhibiting the acetylcholine release from the presynaptic nerve terminal. It has been widely used in neuromuscular, hypersecretory, and autonomic nerve system disorders. There have been a lot of published articles concerning the effect of this toxin on rhinitis symptoms. Based on the results of these reports, intranasal botulinum toxin A administration appears to be a safe and effective treatment method for decreasing rhinitis symptoms in rhinitis patients with a long-lasting effect. Botulinum toxin type A will be a good treatment option for the chronic rhinitis patients who are resistant to other treatment methods.
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Affiliation(s)
- Cengiz Ozcan
- Department of Otorhinolaryngology, School of Medicine, Mersin University, Mersin, Turkey.
| | - Onur Ismi
- Department of Otorhinolaryngology, School of Medicine, Mersin University, Mersin, Turkey
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Kim YH, Yang HJ, Choi JH, Kim DK, Yoo Y, Lee B, Kim MA, Kim BS, Kim WY, Kim JH, Park Y, Park SY, Bae WY, Song K, Yang MS, Lee SM, Lee YM, Lee HJ, Cho JH, Jee HM, Koh YI. Clinical diagnostic guidelines for allergic rhinitis: diagnosis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young Hyo Kim
- Department of Otorhinolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University College of Medicine, Seoul, Korea
- SCH Biomedical Informatics Research Unit, Seoul, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Allergy Immunology Center, Korea University, Seoul, Korea
| | - Bora Lee
- Department of Biostatistics, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | | | - Jeong Hee Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Yang Park
- Department of Pediatrics, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | | | - Woo Yong Bae
- Department of Otorhinolaryngology, Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Keejae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong Universtiy College of Medicine, Incheon, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | | | | | | | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Young-Il Koh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Kirtsreesakul V, Hararuk K, Leelapong J, Ruttanaphol S. Clinical Efficacy of Nasal Steroids on Nonallergic Rhinitis and the Associated Inflammatory Cell Phenotypes. Am J Rhinol Allergy 2015; 29:343-9. [DOI: 10.2500/ajra.2015.29.4234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Although good response to nasal steroid therapy has been documented in allergic rhinitis (AR), the efficacy of this treatment in non-AR, and the associated inflammatory cell phenotypes has not been fully investigated. Objective To compare the response to steroids in non-AR versus AR and to assess the impact of inflammatory cell phenotypes on non-AR treatment outcomes. Methods A total of 149 patients with rhinitis were divided into non-AR and AR groups by using the allergy skin-prick test. Based on nasal cytology, the non-AR group was further divided into inflammatory non-AR (INAR) and noninflammatory non-AR (NINAR) groups, and the INAR groups were further subdivided into four phenotypes according to inflammatory cell type: non-AR with eosinophils (NARES), non-AR with mast cells (NARMA), non-AR with neutrophils (NARNE), and NARES and mast cells (NARESMA). All the patients were treated over 28 days with 220 μg of nasal triamcinolone acetonide once daily. Nasal symptom score, peak inspiratory flow index, and nasal mucociliary clearance time (NMCCT) were used to evaluate treatment outcomes. Results The initial screening found 67 patients with non-AR and 82 patients with AR. At 28 days after nasal steroid treatment, all nasal symptom score, peak inspiratory flow indexes, and NMCCTs were significantly improved within each group; however, the non-AR group recorded significantly lower levels of improvement in blocked nose, rhinorrhea, sneezing, nasal itching, peak flows, and NMCCTs than the AR group. The NINAR group overall indicated lower levels of improvement than the INAR group. Among the INAR subgroups, the NARESMA, NARES, and NARMA phenotypes had similar outcome improvements, all better than the NARNE phenotype. Conclusion Although both patients with non-AR and those with AR had good steroid response, the patients with non-AR had less improvement than the patients with AR. Patients with NINAR had the worst treatment outcome among the non-AR phenotypes.
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Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Kodchakorn Hararuk
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Jitanong Leelapong
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Suwalee Ruttanaphol
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Hoshino T, Hoshino A, Nishino J. Relationship between environment factors and the number of outpatient visits at a clinic for nonallergic rhinitis in Japan, extracted from electronic medical records. Eur J Med Res 2015; 20:60. [PMID: 26152217 PMCID: PMC4502595 DOI: 10.1186/s40001-015-0151-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the influence of the environmental factors (meteorological factors, air pollutant levels, etc.) on the number of clinic consultations for nonallergic rhinitis (NAR). METHODS Among the 9056 outpatients visiting a general internal medicine clinic in Japan between August 2012 and the end of July 2013 (counting return visitors as multiple cases), the total daily number of first visits for NAR plus the number of extraordinary visits by patients with NAR for acute exacerbation of the disease was investigated using electronic medical records and analyzed. RESULTS Major parameters with significant Spearman's correlation coefficients and significant correlation coefficients also in the multiple regression analysis were the mean vapor pressure (coefficient of determination 27.3 %) throughout the year, mean vapor pressure (58.4 %), mean temperature (44.4 %), maximum 10-min precipitation (12.0 %) only during the autumn-winter period, and temperature difference (13.3 %) only during the spring-summer period. CONCLUSIONS The mean vapor pressure is the most important environmental factor associated with acute exacerbation of NAR.
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Affiliation(s)
- Takayuki Hoshino
- Information Management Officer, Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo, Japan. .,Akagi-kohgen Hospital, Gunma, Japan. .,Department of Internal Medicine, Gohyakuyama Clinic, Gunma, Japan. .,Graduate School of Environmental Information, Teikyo Heisei University, Tokyo, Japan.
| | - Ayami Hoshino
- Department of Internal Medicine, Gohyakuyama Clinic, Gunma, Japan.
| | - Junya Nishino
- Graduate School of Environmental Information, Teikyo Heisei University, Tokyo, Japan.
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Halderman A, Sindwani R. Surgical Management of Vasomotor Rhinitis: A Systematic Review. Am J Rhinol Allergy 2015; 29:128-34. [DOI: 10.2500/ajra.2015.29.4141] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Vasomotor rhinitis (VMR) is one of the most prevalent forms of nonallergic rhinitis. In the past, when maximal medical therapy failed, surgical options were limited. Vidian neurectomy (VN) was one option; however, it was fraught with complications and limited success. The advent of endoscopic sinus surgery revitalized interest in surgical procedures for VMR. This study was designed to review the available literature and assess the safety and efficacy of surgery on the vidian and posterior nasal nerves for treatment of VMR and when possible, compare the different approaches to one another in regard to safety and efficacy. Methods A systematic review was performed of English language articles using Ovid and PubMed. Search terms included “endoscopic vidian neurectomy,” “vidian neurectomy,” “endoscopic posterior nasal neurectomy” (EPNN), and “posterior nasal neurectomy.” Only clinical trials performed on humans with safety and or efficacy data were included. Independent extraction of articles by two authors using predefined data fields was performed. Safety defined by complication rates and efficacy defined as objective improvement on outcomes scores along with the overall length of benefit were the primary measures of treatment effect. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement for reporting systematic reviews was followed. Results In comparison with open VN, endoscopic techniques were not associated with any long-term sequelae. Rhinorrhea and nasal obstruction were shown to improve after endoscopic VN (EVN) and the benefits were maintained for several years after surgery. Conclusion EVN is well tolerated, safe, and effective in a majority of patients. Overall, the literature has shown that the endoscopic approach is associated with less morbidity than the traditional transantral approach. Currently, no literature exists on the effect of EPNN in patients with vasomotor rhinitis and further study is needed to elucidate the efficacy of this procedure in this subset of patients.
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Affiliation(s)
- Ashleigh Halderman
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Raj Sindwani
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Abstract
Rhinitis is normally defined by the symptoms of nasal congestion, postnasal drainage, rhinorrhea, and sneezing. It has been associated with various pathologic changes, but can occur in the absence of any inflammation. Thus, the diagnosis is based on the clinical presentation. There are no clear-cut criteria to distinguish when rhinitis becomes chronic, but in its chronic form, it can be complex. Chronic forms of rhinitis that occur in the absence of any detectable specific IgE against relevant aeroallergens in its broadest sense can be called chronic nonallergic rhinitis. This review will concentrate on chronic nonallergic rhinitis in its various forms, discussing the epidemiology, underlying mechanisms, and its therapy.
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Affiliation(s)
- Phil Lieberman
- Clinical Professor of Medicine and Pediatrics, University of Tennessee College of Medicine, Allergy and Asthma Care, 7205 Wolf River Blvd, Suite: 200, Germantown, TN, 38138, USA,
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Abstract
CONCLUSION Kinetic oscillation stimulation (KOS) of nasal mucosa at low frequency seems to be a possibly effective and safe short-term treatment of non-allergic nasal stuffiness. OBJECTIVE To assess the relief of rhinitis symptoms, especially stuffiness, by comparing active treatment, i.e. KOS at low frequency of the nasal mucosa, with placebo. METHODS Patients were randomized to active or placebo treatment in this double-blinded parallel design study. Treatment with an inflatable oscillating catheter was administered on day 0, and symptom scores (stuffiness, secretion, and itching) were graded daily until day 14. An overall grading of symptoms from 1 week before treatment and during 14 days thereafter was made at day 14. Eighty-six patients (52 with non-allergic perennial rhinitis, NAR; 34 with rhinitis medicamentosa, RM) were randomized, and 71 were evaluated (active treatment, n = 35; placebo, n = 36). RESULTS Patients with either NAR or RM who received active treatment reported reduced symptom scores by some measures, e.g. median RQSS stuffiness measure fell from 2 to 1 on a scale from 0 to 3 during the week following treatment. No significant effect was observed for patients treated with placebo. Mild side effects were reported.
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Affiliation(s)
- Jan-Erik Juto
- Division of ENT Department, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Axelsson
- Division of ENT Department, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Ma Y, Tan G, Zhao Z, Li W, Huang L, Liu G. Therapeutic effectiveness of endoscopic vidian neurectomy for the treatment of vasomotor rhinitis. Acta Otolaryngol 2014; 134:260-7. [PMID: 24433056 DOI: 10.3109/00016489.2013.831478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Our results indicate that vidian neurectomy may be recommended as an effective method for the treatment of vasomotor rhinitis (VMR). OBJECTIVE The aim of this work was to study the feasibility and effectiveness of vidian neurectomy treatment under the nasal endoscope for VMR. METHODS The study included 45 patients with VMR. They were all assigned to functional endoscopic surgery with vidian neurectomy. RESULTS The obtained data showed that, using the rhinoconjunctivitis quality of life questionnaire, vidian neurectomy treatment relieved the symptoms of VMR in 82.2% of the patients. Vidian neurectomy also led to the reduction of expression of several cytokines, including vasoactive intestinal polypeptide, calcitonin gene-related peptide, substance P, interleukin (IL)-4, and IL-5.
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Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW, Papadopoulos NG, Rotiroti G, Scadding G, Timmermans F, Valovirta E. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2013; 68:1102-16. [PMID: 23952296 DOI: 10.1111/all.12235] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2013] [Indexed: 12/13/2022]
Abstract
Rhinitis is a common problem in childhood and adolescence and impacts negatively on physical, social and psychological well-being. This position paper, prepared by the European Academy of Allergy and Clinical Immunology Taskforce on Rhinitis in Children, aims to provide evidence-based recommendations for the diagnosis and therapy of paediatric rhinitis. Rhinitis is characterized by at least two nasal symptoms: rhinorrhoea, blockage, sneezing or itching. It is classified as allergic rhinitis, infectious rhinitis and nonallergic, noninfectious rhinitis. Similar symptoms may occur with other conditions such as adenoidal hypertrophy, septal deviation and nasal polyps. Examination by anterior rhinoscopy and allergy tests may help to substantiate a diagnosis of allergic rhinitis. Avoidance of relevant allergens may be helpful for allergic rhinitis (AR). Oral and intranasal antihistamines and nasal corticosteroids are both appropriate for first-line AR treatment although the latter are more effective. Once-daily forms of corticosteroids are preferred given their improved safety profile. Potentially useful add-on therapies for AR include oral leukotriene receptor antagonists, short bursts of a nasal decongestant, saline douches and nasal anticholinergics. Allergen-specific immunotherapy is helpful in IgE-mediated AR and may prevent the progression of allergic disease. There are still a number of areas that need to be clarified in the management of rhinitis in children and adolescents.
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Affiliation(s)
| | - M. Xatzipsalti
- First Department of Pediatrics; P. & A. Kyriakou Children's Hospital; Athens; Greece
| | | | - A. Custovic
- Manchester Academic Health Science Centre; NIHR Respiratory and Allergy Clinical Research Facility; The University of Manchester; University Hospital of South Manchester NHS Foundation Trust; Manchester; UK
| | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense; Denmark
| | - P. W. Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals of Leuven; Catholic University of Leuven; Leuven; Belgium
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens; Greece
| | | | - G. Scadding
- Royal National Throat Nose and Ear; Hospital - Part of UCL Hospitals NHS Foundation Trust; London; UK
| | - F. Timmermans
- Nederlands Anafylaxis Netwerk; Dordrecht; the Netherlands
| | - E. Valovirta
- Terveystalo Turku; Allergy Clinic; University of Turku; Turku; Finland
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Cassano M, Russo L, Del Giudice AM, Gelardi M. Cytologic alterations in nasal mucosa after sphenopalatine artery ligation in patients with vasomotor rhinitis. Am J Rhinol Allergy 2012; 26:49-54. [PMID: 22391083 DOI: 10.2500/ajra.2012.26.3683] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vasomotor rhinitis (VR) seems to be related to an imbalance between cholinergic and adrenergic activity in the autonomic nervous system. The nerve fibers of the sympathetic and parasympathetic nervous systems reach the nose through the posterior nasal nerve, which, after crossing the sphenopalatine foramen, distributes to the mucosa following the branches of the sphenopalatine vessels. This study was designed to evaluate the effect of sphenopalatine artery ligation on nasal function and nasal cytology in patients with VR. METHODS Thirty patients with VR and bilateral inferior turbinate hypertrophy (ITH) were randomly assigned to receive endoscopic inferior turbinoplasty either with or without sphenopalatine artery ligation. Pre- (baseline) and postsurgical (1-year follow-up) assessment included fiber endoscopy, active anterior rhinomanometry, measurement of mucociliary transport time (MTt), and nasal cytology examination. RESULTS At 1-year follow-up there was a statistically significant improvement in nasal resistances in both groups but not on intergroup comparison; MTt significantly decreased in both groups (p < 0.01) and was significantly better (p < 0.05) in the group that had undergone sphenopalatine artery ligation. Among the patients in this group, significantly fewer were found to have altered ciliated cells (p < 0.005) or a hyperchromatic supranuclear stria (p < 0.005) on nasal cytology; the differences were statistically significant also on intergroup comparison (p < 0.005 and p < 0.001, respectively). CONCLUSION In patients with vasomotor rhinopathy and ITH, improvement in symptoms, nasal resistance, ciliated cell trophism, and MTt was observed after sphenopalatine artery ligation.
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Affiliation(s)
- Michele Cassano
- Department of Otorhinolaryngology, University of Foggia, Via Guerrieri 2, Foggia, Italy.
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Fujieda S, Kurono Y, Okubo K, Ichimura K, Enomoto T, Kawauchi H, Masuyama K, Goto M, Suzaki H, Okamoto Y, Takenaka H. Examination, diagnosis and classification for Japanese allergic rhinitis: Japanese guideline. Auris Nasus Larynx 2012; 39:553-6. [PMID: 22402291 DOI: 10.1016/j.anl.2011.12.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/09/2011] [Accepted: 01/13/2012] [Indexed: 11/17/2022]
Abstract
Many countries throughout the world have experienced an increase in the prevalence of allergic rhinitis (AR), which has come to be a major cause of morbidity in developed countries. The pathology underlying AR is regarded as IgE-mediated type I allergy characterized by mucosal inflammation that occurs in response to allergen exposure. In Japan, AR caused by Japanese cedar pollen, the most common allergic disease, has become a salient public health challenge. Almost all primary care physicians and otorhinolaryngologists have been consulted by AR patients between February and April. Although most such patients have received treatment, numerous patients with AR have not received proper examinations for AR. Clinical guidelines are systematically developed statements that are designed to help practitioners make decisions about appropriate and effective health care. Guidelines in many countries including Japan have been published for AR. Unfortunately, those guidelines have remained untested. Moreover, they might be difficult for non-specialists to use. In this review, we specifically examine the present standard examination for diagnosis of AR and optimal classification for AR in Japan. We hope that this review would be used not only for the support of daily practice but also for selection of AR patients for clinical trials.
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Affiliation(s)
- Shigeharu Fujieda
- Department of Otolaryngology-Head & Neck Surgery, University of Fukui, 23-11 Shimoaizuki, Eiheiji-Matsuoka-cho, Yoshida-gun, Fukui, Japan.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:229-30. [DOI: 10.1097/moo.0b013e328347afd0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:58-65. [PMID: 21233627 DOI: 10.1097/moo.0b013e32834344aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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