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Carvalho T, Salgado DC, Mion ODG, de Mello JF, Voegels RL. The Effect of Turbinate Injection of Botulinum Toxin A on the Symptoms of Idiopathic Rhinitis. Int Arch Otorhinolaryngol 2021; 26:e191-e198. [PMID: 35602280 PMCID: PMC9122764 DOI: 10.1055/s-0041-1730307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction
Idiopathic rhinitis is a nonallergic and noninfectious rhinitis characterized mainly by nasal obstruction and rhinorrhea, resulting from an autonomic imbalance. Botulinum toxin type A (BTX-A) demonstrated its action in reducing rhinorrhea and nasal obstruction when injected into the nasal turbinates or septum.
Objective
To analyze the effects of intranasal BTX-A injection to control the symptoms of idiopathic rhinitis and its possible adverse effects.
Method
Patients with idiopathic rhinitis were divided into two groups. Group A had 15 participants (8 female and 6 male), of ages from 47 to 84 years (mean 66.57 years), and these received 60 U of Dysport (Ipsen Ltd, Maidenhead, Berkshire, UK) in each inferior nasal turbinate; group B had 12 participants (1 male and 11 female), of ages from 50 to 76 years (mean 60 years), and they received 1 ml of 0.9% saline. The individuals were reevaluated in the 1
st
, 2
nd
, 4
th
, 8
th
, and 12
th
weeks after injection by a questionnaire, accompanied by nasal inspiratory peak flow and acoustic rhinometry.
Results
Group A showed significant improvement, mainly regarding the symptoms of sneezing/itching and nasal obstruction, over time and when compared to group B. Acoustic rhinometry confirmed the improvement in nasal obstruction. There was no relationship between the nasal peak flow data and the nasal obstruction score. No major adverse effects have been reported.
Conclusion
The injection of botulinum toxin in the inferior nasal turbinates of patients with idiopathic rhinitis reduces the symptoms of sneezing, itching, nasal obstruction, and runny nose without significant adverse effects, suggesting that it is an option in the treatment of these patients.
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Affiliation(s)
- Thiago Carvalho
- Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
| | - Daniel Calduro Salgado
- Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
| | - Olavo de Godoy Mion
- Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
| | - João Ferreira de Mello
- Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
| | - Richard Louis Voegels
- Department of Otorhinolaryngology, Faculdade de Medicina da Universidade de São Paulo , São Paulo, SP, Brazil
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2
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Papadopoulos NG, Aggelides X, Stamataki S, Prokopakis E, Katotomichelakis M, Xepapadaki P. New concepts in pediatric rhinitis. Pediatr Allergy Immunol 2021; 32:635-646. [PMID: 33475171 DOI: 10.1111/pai.13454] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Rhinitis-and especially allergic rhinitis (AR)-remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Xenophon Aggelides
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Stamataki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, University of Crete, School of Medicine, Heraklion, Greece
| | | | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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3
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Berest IE. [Halotherapy in patients with vasomotor rhinitis after surgical treatment]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2020; 97:31-36. [PMID: 32687298 DOI: 10.17116/kurort20209704131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of rehabilitation of a patient with vasomotor rhinitis after surgery due to the high percentage of relapses is relevant in the practice of an otorhinolaryngologist. The use of halotherapy in the postoperative period is pathogenetically substantiated in connection with its multifactorial effect on the nasal mucosa. THE PURPOSE OF THIS STUDY Was to investigate the effectiveness of using dry sodium chloride in the postoperative period in patients with vasomotor rhinitis. MATERIAL AND METHODS 56 patients were examined after bilateral submucosal vasotomy with laterofixation of the lower turbinates. Patients were divided into 2 groups depending on the ongoing rehabilitation. The 1st group (comparison) included 28 patients who underwent standard measures, the 2nd (main) group included 28 patients who were additionally prescribed a course of halotherapy. The clinical effectiveness of the treatment was evaluated on a 4-point scale according to subjective and objective signs on the 5th, 8th and 10th postoperative days. RESULTS After treatment on the 10th day, the total score in the group of patients undergoing halotherapy was significantly lower than in the comparison group - 245 and 310 points, respectively. Significantly in the main group, in comparison with the 1st group, the patency of the nasal passages improved (1.8±0.7 points versus 3.2±0.7 points), the swelling of the lower turbinates was reduced (1.0±0.3 points versus 1.5±0.6 points). The average score by the criterion «mucociliary transport time» was 1.5±0.6 points in patients in the 1st group and 1.0±0.3 points in the 2nd group. In the 2nd group, the normalization of mucociliary transport time occurred faster than in patients who underwent standard therapy. CONCLUSION Halotherapy has shown high efficiency and safety, therefore it is advisable to use it in clinical practice along with generally accepted treatment regimens to reduce the drug load, including the need for decongestants. In addition, halotherapy contributes to an earlier restoration of the functional state of the nasal cavity.
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Affiliation(s)
- I E Berest
- St. Luke Lugansk State Medical University, Lugansk, LPR
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4
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Zebda D, Jiang ZY, Gibson MM, Pham C, Ahmadi S, Floren S, Yao WC, Citardi MJ, Luong AU. Double-blinded randomized prospective trial of intranasal capsaicin treatment for nonallergic rhinitis. Int Forum Allergy Rhinol 2020; 11:24-30. [PMID: 33045140 DOI: 10.1002/alr.22637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/03/2020] [Accepted: 05/13/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nonallergic rhinitis (NAR) is currently a diagnosis of exclusion with an unclear pathophysiologic mechanism and limited treatment options. In patients diagnosed with NAR based on symptoms, negative skin testing and positive optical rhinometry (ORM), the study's objective was to evaluate the therapeutic action of intranasal capsaicin in the management of rhinitic symptoms and the effect on ORM readings. METHODS Patients with a history of NAR underwent screening by a diagnostic intranasal capsaicin challenge with ORM and skin-prick testing. Twenty-two NAR patients were enrolled and randomized to either treatment with 0.1mM capsaicin (n = 11) or placebo (n = 11). Treatment consisted of 5 consecutive intranasal applications separated by 1 hour with follow-up at 4 and 12 weeks. At each visit, subjects underwent intranasal capsaicin challenge with ORM reading and a visual analog scale scoring of rhinitis symptoms. RESULTS Treatment with intranasal capsaicin resulted in a median change with improvement in total symptom score (TSS) of -5 from baseline vs an increase of 2 with placebo at 4 weeks, which remained significantly different between the groups at 12 weeks (p = 0.03). At 12 weeks posttreatment, 60% of the intervention group vs 80% of placebo-treated patients still met objective criteria for NAR by ORM. CONCLUSION Using ORM in the objective diagnosis of NAR, this trial showed that intranasal 0.1mM capsaicin not only improved rhinitic symptoms but also objectively reduced nasal reactivity and nasal congestion with a 40% responder rate at 12 weeks as noted by ORM.
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Affiliation(s)
- Denna Zebda
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Micah M Gibson
- Department of Otolaryngology, Emory University, Atlanta, GA
| | | | - Sorour Ahmadi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Samuel Floren
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
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5
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Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT. Current and Future Treatments of Rhinitis and Sinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1522-1531. [PMID: 32004747 DOI: 10.1016/j.jaip.2020.01.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
Advances in understanding the pathogenic mechanisms of both rhinitis and chronic rhinosinusitis have resulted in new treatment options, especially for chronic rhinosinusitis. A review of relevant medical and surgical clinical studies shows that intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis. Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps. Omalizumab, mepolizumab, and benralizumab may have a future role in the treatment of chronic rhinosinusitis. Novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids. Surgical management tailored to the underlying disease process improves clinical outcomes in chronic rhinosinusitis with or without nasal polyposis. Advances in the understanding of the heterogeneous nature of rhinitis and rhinosinusitis have resulted in more precise treatments. Improving the understanding of different endotypes should provide better knowledge to determine appropriate current and new therapies to treat these diseases.
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Affiliation(s)
- Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Park Hae-Sim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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6
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Huang Y, Zhang Y, Zhang L. Prevalence of allergic and nonallergic rhinitis in a rural area of northern China based on sensitization to specific aeroallergens. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2018; 14:77. [PMID: 30479630 PMCID: PMC6247523 DOI: 10.1186/s13223-018-0299-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most epidemiologic studies reporting prevalence of allergic rhinitis (AR) and nonallergic rhinitis (NAR) have assessed solely self-reported prevalence, without confirmation by objective measures. Furthermore, reports of prevalence of NAR in Chinese subjects are scarce. Thus, we aimed to explore the prevalence and risk factors of AR and NAR in a Chinese, based on both clinical manifestation and allergic status. METHODS We conducted a population-based cross-sectional survey, involving 1084 local residents from a rural area of Beijing, China. Participants were enrolled using a stratified two-stage cluster sampling method. All adult participants or the guardians of children completed standardized questionnaires to provide relevant demographic and clinical information. Skin prick tests were also performed to determine sensitization to specific aeroallergens. AR/NAR was classified according to Allergic Rhinitis and its Impact on Asthma criteria. RESULTS Prevalence of self-reported AR was 46.80%. Based on SPT results, the confirmed standardized prevalence of AR and NAR were 16.78% and 24.60%, respectively. Severity scores for nasal itching, sneezing, rhinorrhea and congestion were significantly higher in subjects with AR, than subjects with NAR (P < 0.05 for all). The three most common aeroallergens in self-reported AR group were Blattella germanica (16.6%), Dermatophagoides farinae (14.6%), and Dermatophagoides pteronyssinus (13.9%). Family history of AR and atopic dermatitis were significantly associated with AR (adjusted OR: 4.97 and 2.69, respectively), whereas family history of AR and asthma were significantly associated with NAR (adjusted OR: 3.53 and 2.45, respectively). Similarly, comorbid asthma, CRS, and atopic dermatitis were significant risk factors for both AR and NAR. CONCLUSIONS Combination of standardized questionnaires and specific allergen tests may provide more accurate estimates of prevalence of AR and NAR and associated risk factors.
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Affiliation(s)
- Yanran Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong, DongCheng District, Beijing, 100005 People’s Republic of China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong, DongCheng District, Beijing, 100005 People’s Republic of China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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7
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Hellings PW, Klimek L, Cingi C, Agache I, Akdis C, Bachert C, Bousquet J, Demoly P, Gevaert P, Hox V, Hupin C, Kalogjera L, Manole F, Mösges R, Mullol J, Muluk NB, Muraro A, Papadopoulos N, Pawankar R, Rondon C, Rudenko M, Seys SF, Toskala E, Van Gerven L, Zhang L, Zhang N, Fokkens WJ. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2017; 72:1657-1665. [PMID: 28474799 DOI: 10.1111/all.13200] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 12/11/2022]
Abstract
This EAACI position paper aims at providing a state-of-the-art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug-induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called "entopy" or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research.
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Affiliation(s)
- P. W. Hellings
- Clinical division of Otorhinolaryngology Head & Neck Surgery University Hospitals Leuven Leuven Belgium
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - L. Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - C. Cingi
- Department of Otorhinolaryngology Head and Neck Surgery University of Eskisehir Osmangazi Eskisehir Turkey
| | - I. Agache
- Department of Allergy and Clinical Immunology Transylvania University Brasov Romania
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research Christine Kuhne-Center for Allergy Research and Education University of Zurich Davos Switzerland
| | - C. Bachert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - J. Bousquet
- Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
| | - P. Demoly
- Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
| | - P. Gevaert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - V. Hox
- Service d'ORL Cliniques Universitaires St-Luc Brussels Belgium
| | - C. Hupin
- Service d'ORL Cliniques Universitaires St-Luc Brussels Belgium
- Institut de Recherche Expérimentale et Clinique (IREC) Pole de Pneumologie, ORL & Dermatologie Université catholique de Louvain (UCL) Brussels Belgium
| | - L. Kalogjera
- Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Sestre milosrdnice Zagreb Croatia
| | - F. Manole
- ENT Department Faculty of Medicine University of Oradea Oradea Romania
| | - R. Mösges
- Institute of Medical Statistics, Informatics, and Epidemiology Medical Faculty University of Köln Cologne Germany
| | - J. Mullol
- Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia Hospital Clínic Barcelona Catalonia Spain
| | - N. B. Muluk
- ENT Department Faculty of Medicine Kirikkale University Kirikkale Turkey
| | - A. Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region Department of Mother and Child Health University of Padua Padua Italy
| | - N. Papadopoulos
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
- University of Manchestter Manchester UK
| | | | - C. Rondon
- Allergy Service Carlos Haya Hospital Malaga Spain
| | - M. Rudenko
- London Allergyology and Immunology Center London UK
| | - S. F. Seys
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - E. Toskala
- Department of Otorhinolaryngology-Head and Neck Surgery Temple University Philadelphia USA
| | - L. Van Gerven
- Clinical division of Otorhinolaryngology Head & Neck Surgery University Hospitals Leuven Leuven Belgium
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - L. Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing Tongren Hospital Capital Medical University Beijing China
| | - N. Zhang
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology Head & Neck Surgery Academic Medical Centre (AMC) Amsterdam The Netherlands
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8
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Poddighe D, Gelardi M, Licari A, del Giudice MM, Marseglia GL. Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management. World J Methodol 2016; 6:200-213. [PMID: 28074172 PMCID: PMC5183989 DOI: 10.5662/wjm.v6.i4.200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/26/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic rhinitis is a very common disease, as the prevalence in the general population resulted to be 40%. Allergic rhinitis has been considered to be the most frequent form of chronic rhinitis, as non-allergic rhinitis has been estimated to account for 25%. However, several evidences suggested that non-allergic rhinitis have been underrated, especially in children. In pediatrics, the diagnostic definition of non-allergic rhinitis has been often limited to the exclusion of an allergic sensitization. Actually, local allergic rhinitis has been often misdiagnosed as well as mixed rhinitis has not been recognized in most cases. Nasal cytology is a diagnostic procedure being suitable for routine clinical practice with children and could be a very useful tool to characterize and diagnose non-allergic rhinitis, providing important clues for epidemiological analysis and clinical management.
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9
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Poletti D, Iannini V, Casolari P, Contoli M, Papi A, Kirkham P, Hansel TT, Chung KF, Barnes PJ, Pastore A, Pelucchi S, Adcock IM, Caramori G. Nasal inflammation and its response to local glucocorticoid regular treatment in patients with persistent non-allergic rhinitis: a pilot study. JOURNAL OF INFLAMMATION-LONDON 2016; 13:26. [PMID: 27493587 PMCID: PMC4973027 DOI: 10.1186/s12950-016-0134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The pathogenesis of non-allergic rhinitis (NAR) is still largely unknown. Furthermore, it is unclear whether there is a correlation between the effect of nasal glucocorticoids on nasal inflammation and on nasal symptoms and quality of life. METHODS In this pilot study we recruited 12 healthy subjects and 24 patients with recently diagnosed persistent NAR [12 untreated and 12 under regular treatment with nasal fluticasone furoate (two sprays of 27.5 μg each in each nostril once daily, total daily dose = 110 μg) for at least 20 days]. Each subject filled a mini rhinoconjunctivitis quality of life questionnaire (mini RQLQ). Nasal scrapings were obtained from each subject and used to prepare slides for Diff-Quik and immunocytochemical staining for inflammatory and epithelial cells count, MUC5AC expression and the general pro-inflammatory transcription factor nuclear factor kB (NF-kB) activation. RESULTS The nasal score of the mini RQLQ, the number of nasal inflammatory cells (neutrophils, eosinophils) and the number of goblet cells are significantly higher in untreated patients with persistent NAR compared with control subjects and treated NAR patients. The percentage of MUC5AC+ nasal epithelial cells is significantly increased in untreated patients with persistent NAR compared with the control subjects (41.8 ± 6.4 vs 22.3 ± 4.8, respectively; p = 0.0403) without significant differences between control subjects and patients with persistent NAR on regular fluticasone furoate treatment (33.9 ± 5.0 %; p = 0.0604) nor between the 2 groups of persistent NAR subjects (p = 0.3260). The number of cytosolic and/or nuclear p65+ nasal epithelial and inflammatory cells was not significantly different between the three groups. CONCLUSIONS Patients with persistent untreated NAR, compared with normal control subjects and patients with persistent NAR under regular treatment with nasal fluticasone furoate by at least 20 days, have more nasal symptoms, worst quality of life and an increased number of nasal inflammatory cells (neutrophils, eosinophils), goblet cells and MUC5AC+ nasal epithelial cells. This nasal inflammation seems unrelated to NF-kB activation.
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Affiliation(s)
- Donatella Poletti
- ORL, Azienda USL Ferrara, Italy, Sezione di Scienze Otorinolaringoiatriche e Fisica Medica, Departimento di Scienze Biomediche e Chirurgico Specialistiche, University of Ferrara, Ferrara, Italy
| | - Valeria Iannini
- Sezione di Scienze Otorinolaringoiatriche e Fisica Medica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, University of Ferrara, Ferrara, Italy
| | - Paolo Casolari
- Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF), Dipartimento di Scienze Mediche, Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Via Ludovico Ariosto 35, 44121 Ferrara, Italy
| | - Marco Contoli
- Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF), Dipartimento di Scienze Mediche, Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Via Ludovico Ariosto 35, 44121 Ferrara, Italy
| | - Alberto Papi
- Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF), Dipartimento di Scienze Mediche, Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Via Ludovico Ariosto 35, 44121 Ferrara, Italy
| | - Paul Kirkham
- Department of Biomedical Sciences, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Trevor T Hansel
- Centre for Respiratory Infection, National Heart and Lung Institute at Imperial College, St. Mary's Hospital, Mint Wing, Entrance C, Paddington, London, W2 1NY UK
| | - Kian Fan Chung
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter J Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Antonio Pastore
- Sezione di Scienze Otorinolaringoiatriche e Fisica Medica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, University of Ferrara, Ferrara, Italy
| | - Stefano Pelucchi
- Sezione di Scienze Otorinolaringoiatriche e Fisica Medica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, University of Ferrara, Ferrara, Italy
| | - Ian M Adcock
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Gaetano Caramori
- Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF), Dipartimento di Scienze Mediche, Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Via Ludovico Ariosto 35, 44121 Ferrara, Italy
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