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Murtomäki A, Helevä A, Torkki P, Haukka J, Julkunen‐Iivari A, Lemmetyinen R, Mäkelä M, Dietz A, Nuutinen M, Toppila‐Salmi S. Comorbidities of chronic rhinosinusitis in children and adults. Clin Transl Allergy 2024; 14:e12354. [PMID: 38658181 PMCID: PMC11043011 DOI: 10.1002/clt2.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and paranasal sinuses lasting ≥12 weeks. CRS may exist with (CRSwNP) or without (CRSsNP) nasal polyps. The aim was to evaluate conditions associated with CRS in a randomized hospital cohort. We hypothesized that comorbidities and surgical procedures differ between pediatric and adult patients. METHODS This study consisted of hospital registry data of a random sample of rhinosinusitis patients (age range 0-89 years) with the diagnosis of J32 or J33, correspondingly, registered during outpatient visits from 2005 to 2019 (n = 1461). The covariates of interest were collected from electronic health records based on ICD-10 codes and keyword searches. RESULTS Among pediatric patients (n = 104), the relative proportions of CRSsNP and CRSwNP were 86% and 14% respectively. The relative proportions of adult patients (n = 1357) with CRSsNP and CRSwNP were 60% and 40%, respectively. The following comorbidities significantly differed (p < 0.05) between pediatric and adult populations: allergy, chronic otitis media, and tonsillar diseases. In total, 41 % of the children and 46% of the adults underwent baseline endoscopic sinus surgery (ESS). Additional surgeries of the ear, nose and pharynx were significantly more common among children compared with adults. Risk of revision after baseline ESS was associated (p < 0.05) with allergy, asthma, eosinophilia, CRSwNP, immunodeficiency or its suspicion, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and number of any diseases ≥2. CONCLUSIONS Our study showed that comorbidities differ between pediatric and adult rhinosinusitis patients, as allergy, asthma and allergy, chronic otitis media, mental health disorders, and tonsils disease were significantly more prevalent among pediatric patients. Children and adults were equally treated with ESS. Notably, children underwent additional surgery on adenoids and tonsils more frequently. The effectiveness of ESS in multimorbid adults should be assessed at an individual level.
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Affiliation(s)
- Aada Murtomäki
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of OtorhinolaryngologyUniversity of Eastern FinlandJouensuu, KuopioFinland
| | - Alma Helevä
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Programme of the Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Paulus Torkki
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Jari Haukka
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Anna Julkunen‐Iivari
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Riikka Lemmetyinen
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Mika Mäkelä
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aarno Dietz
- Department of OtorhinolaryngologyUniversity of Eastern FinlandJouensuu, KuopioFinland
- Department of OtorhinolaryngologyKuopio University HospitalWellbeing Services County of North SavoKuopioFinland
| | - Mikko Nuutinen
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Sanna Toppila‐Salmi
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of OtorhinolaryngologyUniversity of Eastern FinlandJouensuu, KuopioFinland
- Department of OtorhinolaryngologyKuopio University HospitalWellbeing Services County of North SavoKuopioFinland
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Baumann I, Yılmaz Topçuoğlu MS, Hackenberg S, Sommerburg O. [Pediatric chronic rhinosinusitis]. HNO 2024; 72:250-256. [PMID: 38157011 DOI: 10.1007/s00106-023-01405-8] [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] [Accepted: 10/21/2023] [Indexed: 01/03/2024]
Abstract
Pediatric chronic rhinosinusitis (PCRS) differs from adult chronic rhinosinusitis (CRS) in several aspects. The confrontation with the environment takes place in the growing sinus system, and the immune system is also developing. The inflammatory mechanisms differ to some extent from those of adult CRS patients. The adenoid vegetations play an important role, particularly during the first 6 years of life. Other pathogenetic aspects are important (e.g., asthma, gastroesophageal reflux disease, immunodeficiency). Genetically determined systemic diseases such as cystic fibrosis cause specific challenges in diagnostics and treatment already in childhood. Consistent conservative therapy is often successful, but surgical procedures that have been proven to be effective and associated with few complications are also increasingly used.
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Affiliation(s)
- Ingo Baumann
- Universitäts-HNO-Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | | | - Stephan Hackenberg
- Universitäts-HNO-Klinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Olaf Sommerburg
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Ferraiolo PN, Dortas SD, Cruz FCD, Ramos PCDS, Elabras Filho J, Marques MDPC, Valete-Rosalino CM. Development of a mobile app for the evaluation of patients with chronic rhinosinusitis. Braz J Otorhinolaryngol 2024; 90:101375. [PMID: 38237485 PMCID: PMC10828589 DOI: 10.1016/j.bjorl.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. METHODS A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. RESULTS Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. CONCLUSION The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Priscila Novaes Ferraiolo
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil.
| | - Sergio Duarte Dortas
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Fabiana Chagas da Cruz
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Priscilla Campos de Souza Ramos
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - José Elabras Filho
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Imunologia, Rio de Janeiro, RJ, Brazil
| | - Marise da Penha Costa Marques
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Serviço de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Cláudia Maria Valete-Rosalino
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brazil
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Ramadan HH. Pediatric chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2024; 281:1131-1137. [PMID: 37899371 DOI: 10.1007/s00405-023-08307-z] [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: 09/25/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE An up-to-date overview of diagnosis, differential diagnosis, comorbidities, and current medical and surgical management of pediatric chronic rhinosinusitis (PCRS). METHODS Review of current evidence-based literature on PCRS. RESULTS Diagnosis of PCRS seems to be improving based on recent evidence using nasal endoscopy as well as computed tomography scanning. Recent literature supports the fact that chronic adenoiditis can be an independent etiology of symptoms of chronic sinusitis, that are very similar to chronic adenoiditis. Allergic rhinitis and immune deficiency play important roles in the management of PCRS. Surgery for PCRS has evolved significantly in the last 15-20 years to include adenoidectomy as well as endoscopic sinus surgery. CONCLUSIONS PCRS is very common in children causing poor QOL for these children. Medical management remains the main stay of treatment with attention to management of co-morbidities that may contribute to the disease severity. Making the correct diagnosis will help with the choice of surgical intervention if medical management fails.
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Affiliation(s)
- Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Health Sciences Center, West Virginia University School of Medicine, PO Box 9200, Morgantown, WV, USA.
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Gu Z, Wei P, Kou W, Tang XY, Yao HB, Liu EM. Analysis of Multimorbidity of Moderate to Severe Allergic Rhinitis in Children: A Real-World Study. Int Arch Allergy Immunol 2023; 184:882-892. [PMID: 37290409 DOI: 10.1159/000530842] [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: 01/12/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data. METHODS In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs). RESULTS The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899). CONCLUSION AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.
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Affiliation(s)
- Zheng Gu
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China,
| | - Ping Wei
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Wei Kou
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Xin-Ye Tang
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Hong-Bing Yao
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - En-Mei Liu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
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Wang X, Shen Y, Hong S, Kang H, Ke X. Changes in type 2 innate lymphoid cells and serum cytokines in sublingual immunotherapy in pediatric patients with allergic rhinitis. BMC Pediatr 2023; 23:13. [PMID: 36624390 PMCID: PMC9827662 DOI: 10.1186/s12887-022-03788-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Type 2 innate lymphoid cells (ILC2) are upregulated in childhood allergic rhinitis (AR) and are associated with AR severity. This study aimed to investigate changes in the ILC2 milieu in pediatric patients with AR after sublingual immunotherapy (SLIT). METHODS Forty- pediatric patients with AR received house dust mite (HDM) allergen extract for SLIT group and thirty pediatric patients received placebo in the study, respectively. The levels of ILC2, ILC2-related cytokines (IL-5/IL-13) and their transcription factors (GATA binding protein 3, retinoic acid-related orphan receptor α) in the circulation were assessed after 1- and 2-year SLIT. Moreover, peripheral blood mononuclear cells (PBMCs) in patients were prepared and stimulated by recombinant thymic stromal lymphopoietin, IL-25, and IL-33 after 2-year SLIT. Subsequently, the levels of ILC2, IL-5, and IL-13 were tested. RESULTS The frequency of ILC2 and the levels of their transcription factors in the circulation were significantly decreased after SLIT in the SLIT group. The levels of ILC2-related cytokines in the SLIT group showed the same trend. The frequency of ILC2 was positively correlated with transcription factors and cytokines after SLIT. SLIT was observed to reduce the ability of HDM sensitization to generate the ILC2 milieu in PBMCs. CONCLUSIONS Changes in the ILC2 milieu may be correlated with the curative effect and immune regulation function of SLIT. Our results suggested that the regulatory effect on ILC2 is part of the therapeutic mechanism of SLIT.
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Affiliation(s)
- Xiaoqiang Wang
- grid.452206.70000 0004 1758 417XDepartment of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Yang Shen
- grid.452206.70000 0004 1758 417XDepartment of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Suling Hong
- grid.452206.70000 0004 1758 417XDepartment of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Houyong Kang
- grid.452206.70000 0004 1758 417XDepartment of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Xia Ke
- grid.452206.70000 0004 1758 417XDepartment of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
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Brown HJ, Khalife S, Ganesan V, Escobedo P, Filip P, Jeffe J, Karas A, Papagiannopoulos P, Gattuso P, Batra PS, Tajudeen BA. Histopathologic differences between adult and pediatric patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2023; 13:25-30. [PMID: 35708908 DOI: 10.1002/alr.23037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Adult and pediatric patients with chronic rhinosinusitis (CRS) may have differing philosophies in therapeutic management. Few studies have examined sinonasal tissue-level comparisons of these groups. This study examines histopathologic differences between children and adults with CRS, with the goal of understanding disease pathogenesis and optimizing medical management for both populations. METHODS In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery (FESS), demographic factors, pertinent comorbidities, and a structured histopathologic report of 13 variables were compared across pediatric and adult CRS patients with and without nasal polyps (pCRSwNP, pCRSsNP, aCRSwNP, aCRSsNP, respectively). RESULTS A total of 378 adult (181 aCRSsNP, 197 aCRSwNP) and 50 pediatric (28 pCRSsNP, 22 pCRSwNP) patients were analyzed. Significantly more children compared with adults had a comorbid asthma diagnosis (64.5% vs. 37.2%, p = 0.003). Adults with CRS exhibited significantly more tissue neutrophilia (28.9% vs. 12.0%, p = 0.006), basement membrane thickening (70.3% vs. 44.0%, p < 0.001), subepithelial edema (61% vs. 30.0%, p < 0.001), squamous metaplasia (22.0% vs. 4.0%, p < 0.001), and eosinophil aggregates (22.8% vs. 4.0%, p < 0.001) than children with CRS. The majority (66.5%) of adult CRS patients exhibited a lymphoplasmacytic-predominant inflammatory background, whereas the majority (57.8%) of children with CRS exhibited a lymphocyte-predominant inflammatory background. CONCLUSIONS Sinonasal tissue of adult and pediatric CRS patients demonstrates clear histopathologic differences. Our findings provide insight into differing pathophysiology, which may enable optimization of targeted therapies for patients in each of these unique clinical groups.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Khalife
- Department of Otorhinolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Veena Ganesan
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Pedro Escobedo
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Filip
- Department of Otorhinolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jill Jeffe
- Department of Otorhinolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Anatoli Karas
- Department of Otorhinolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Pete S Batra
- Department of Otorhinolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Chen RX, Dai MD, Zhang QZ, Lu MP, Wang ML, Yin M, Zhu XJ, Wu ZF, Zhang ZD, Cheng L. TLR Signaling Pathway Gene Polymorphisms, Gene-Gene and Gene-Environment Interactions in Allergic Rhinitis. J Inflamm Res 2022; 15:3613-3630. [PMID: 35769128 PMCID: PMC9234183 DOI: 10.2147/jir.s364877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/04/2022] [Indexed: 01/01/2023] Open
Abstract
Background Allergic rhinitis (AR) is a nasal inflammatory disease resulting from a complex interplay between genetic and environmental factors. The association between Toll-like receptor (TLR) signaling pathway and environmental factors in AR pathogenesis remains to be explored. This study aims to assess the genetic association of AR with single nucleotide polymorphisms (SNPs) in TLR signaling pathway, and investigate the roles of gene–gene and gene–environment interactions in AR. Methods A total of 452 AR patients and 495 healthy controls from eastern China were enrolled in this hospital-based case–control study. We evaluated putatively functional genetic polymorphisms in TLR2, TLR4 and CD14 genes for their association with susceptibility to AR and related clinical phenotypes. Interactions between environmental factors (such as traffic pollution, residence, pet keeping) and polymorphisms with AR were examined using logistic regression. Models were stratified by genotype and interaction terms, and tested for the significance of gene–gene and gene–environment interactions. Results In the single-locus analysis, two SNPs in CD14, rs2563298 (A/C) and rs2569191 (C/T) were associated with a significantly decreased risk of AR. Compared with the GG genotype, the GT and GT/TT genotypes of TLR2 rs7656411 (G/T) were associated with a significantly increased risk of AR. Gene–gene interactions (eg, TLR2 rs7656411, TLR4 rs1927914, and CD14 rs2563298) was associated with AR. Gene–environment interactions (eg, TLR4 or CD14 polymorphisms and certain environmental exposures) were found in AR cases, but they were not significant after Bonferroni correction. Conclusion The genetic polymorphisms of TLR2 and CD14 and gene–gene interactions in TLR signaling pathway were associated with susceptibility to AR in this Han Chinese population. However, the present results were limited to support the association between gene–environment interactions and AR.
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Affiliation(s)
- Ruo-Xi Chen
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Meng-Di Dai
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Qing-Zhao Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Mei-Ping Lu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Mei-Lin Wang
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Min Yin
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xin-Jie Zhu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhong-Fei Wu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zheng-Dong Zhang
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,International Centre for Allergy Research, Nanjing Medical University, Nanjing, People's Republic of China
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Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of Chronic Rhinosinusitis: Prevalence and Risk Factors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1395-1403. [PMID: 35092822 DOI: 10.1016/j.jaip.2022.01.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022]
Abstract
Knowledge of chronic rhinosinusitis (CRS) epidemiology may directly impact patient care: aiding patient identification and establishing accurate diagnosis as well as informing treatment decisions. The objective of this review is to summarize the current evidence on the epidemiology of CRS, with a focus on prevalence and risk factors. Although the presence of either symptoms or objective findings alone have yielded CRS prevalence estimates of over 10%, the presence of both-consistent with guideline-based diagnostic criteria for CRS-has suggested that the true prevalence of CRS is consistently less than 5%, with approximately one-third of patients with CRS having nasal polyps, in epidemiologic studies from around the world. In comparison, the prevalence of CRS endotypes-pathophysiologic subclassification of CRS most commonly as related to type 2 or non-type 2 inflammation-has been found to vary significantly by region. The epidemiology of CRS is modified and ultimately determined by risk factors: genetic/hereditary, demographic, environmental, and imparted by predictive pre-/comorbid disease. The understanding of these epidemiologic relationships may help the provider to optimally identify and understand each individual's CRS disease process, thereby improving both diagnosis and treatment.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Edward C Kuan
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine, Orange, Calif
| | - Glenis K Scadding
- Royal National ENT Hospital, University College Hospitals London, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
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10
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Pediatric chronic sinusitis: diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2022; 30:68-77. [PMID: 34958324 DOI: 10.1097/moo.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Review the diagnosis and management of pediatric chronic sinusitis given recent advances in both surgical and medical management. RECENT FINDINGS Balloon catheter dilation (BCD) of the sinuses has been used as an adjunct to adenoidectomy or in lieu of traditional endoscopic sinus surgery. BCD has been shown to be a safe technique in children although its efficacy compared to maxillary sinus irrigation or traditional sinus surgery cannot be determined based on current studies. SUMMARY New advances in BCD and biologics may serve as useful adjuncts in surgical and medical therapy respectively with additional research needed to better delineate the optimal indications for each in the treatment continuum.
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11
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Virgin FW, Thurm C, Sanders DB, Freeman AJ, Cogen J, Gamel B, Sawicki G, Fink AK. Prevalence, variability, and predictors of sinus surgery in pediatric patients with cystic fibrosis. Pediatr Pulmonol 2021; 56:4029-4038. [PMID: 34648689 DOI: 10.1002/ppul.25669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/21/2021] [Accepted: 09/04/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Chronic rhinosinusitis is common among individuals with cystic fibrosis (CF) and has an impact on quality of life. Sinus surgery is a treatment option, but minimal literature exists regarding prevalence and indications. METHODS Using the linked CF Foundation Patient Registry (CFFPR) - Pediatric Health Information Systems (PHIS) database, we investigated variability in receipt of surgery, predictors of surgery, and time to first surgery. We included individuals less than 18 receiving care between 2006 and 2015 at a CF Foundation care program that is also a PHIS-participating-hospital. We used logistic regression to examine predictors of receipt of surgery and a Kaplan-Meier curve to examine time to first surgery among those born 2005-2007. RESULTS There were 11,545 children and adolescents and 2156 (18.7%) received at least one surgery. Variation in number of surgeries was observed across hospitals (median: 63 [IQR, 33-110]). There was an inconsistent pattern between receipt of surgery and markers of disease severity; those receiving surgery having increased odds of treatment use and pulmonary exacerbations and decreased odds of lower lung function and body mass index. Among the cohort of young children, 159 (14%) had at least one surgery with a median age at first surgery of 5.6 (IQR, 3.9-7.0). CONCLUSIONS The use of sinus surgery is frequent, but variable, among children and adolescents. Clinical factors are associated with receipt of surgery, but further understanding is needed on other factors that impact variability in use. Our study indicates the need for additional evaluation of the management of CF-related CRS and indications for surgery.
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Affiliation(s)
- Frank W Virgin
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cary Thurm
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Don B Sanders
- Pediatric Pulmonology, Indiana University, Indianapolis, Indiana, USA
| | - Alvin J Freeman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan Cogen
- Department of Pulmonary Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Breck Gamel
- Children's Medical Center, Dallas, Texas, USA
| | - Greg Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Aliza K Fink
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
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12
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Di Cicco ME, Bizzoco F, Morelli E, Seccia V, Ragazzo V, Peroni DG, Comberiati P. Nasal Polyps in Children: The Early Origins of a Challenging Adulthood Condition. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110997. [PMID: 34828710 PMCID: PMC8620101 DOI: 10.3390/children8110997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/03/2022]
Abstract
Nasal polyps (NPs) are benign inflammatory masses causing chronic nasal obstruction, usually associated with underlying chronic rhinosinusitis (CRS), which are rarely reported in childhood. The interest in NPs has recently increased due to new therapeutic options, namely biological agents, such as dupilumab, and an update of the European position paper on this topic was released in 2020, providing a detailed classification for these lesions and also discussing diagnostic and therapeutic approaches also in children. In childhood, NPs usually represent red flags for systemic diseases, such as cystic fibrosis and immunodeficiencies. This review outlines the recent data on NPs in childhood, focusing on predisposing factors for CRS as well as on the potential endotypes in this particular age group, for which further studies are required in order to better clarify their pathogenesis and to identify molecular biomarkers that could help achieve more personalized treatments.
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Affiliation(s)
- Maria E. Di Cicco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
- Correspondence: ; Tel.: +39-050-992797
| | - Francesca Bizzoco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Elena Morelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Via Trivella, 56124 Pisa, Italy;
| | - Vincenzo Ragazzo
- Paediatrics and Neonatology Division, Women’s and Children’s Health Department, Versilia Hospital, Via Aurelia n. 335, 55049 Lido di Camaiore, Italy;
| | - Diego G. Peroni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
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13
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Casula E, Manca ML, Perra M, Pedraz JL, Lopez-Mendez TB, Lozano A, Calvo E, Zaru M, Manconi M. Nasal Spray Formulations Based on Combined Hyalurosomes and Glycerosomes Loading Zingiber officinalis Extract as Green and Natural Strategy for the Treatment of Rhinitis and Rhinosinusitis. Antioxidants (Basel) 2021; 10:1109. [PMID: 34356342 PMCID: PMC8301047 DOI: 10.3390/antiox10071109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 01/09/2023] Open
Abstract
A total green nanotechnological nasal spray has been manufactured and proposed as an alternative treatment of rhinitis and rhinosinusitis. It was obtained by combining the strengthening effect of liposomes on barrier function, the hydrating and lubricating properties of sodium hyaluronan and the anti-inflammatory and antioxidant activities of the extract of Zingiber officinalis. To this purpose, the extract was loaded in special phospholipid vesicles immobilized with hyaluronic acid (hyalurosomes), which were further enriched with glycerol in the water phase. Liposomes and glycerosomes were prepared as well and used as reference. Vesicles were oligolamellar and multicompartment, as confirmed by cryogenic transmission electron microscopy (cryo-TEM) observation, small in size (~140 nm) and negatively charged (~-23 mV). Spray characteristics were evaluated by using the Spraytec® and instant images, from which the plume angle was measured. The range of the droplet size distribution and the narrow spray angle obtained suggest a good nebulization and a possible local deposition in the nasal cavity. In vitro studies performed by using human keratinocytes confirmed the high biocompatibility of vesicles and their ability to effectively counteract oxidative damage on cells induced by hydrogen peroxide. The overall collected data suggest that our vesicles are suitable as nasal spray.
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Affiliation(s)
- Eleonora Casula
- Department of Scienze della Vita e dell’Ambiente, University of Cagliari, via Ospedale 72, 09124 Cagliari, Italy; (E.C.); (M.P.); (M.M.)
| | - Maria Letizia Manca
- Department of Scienze della Vita e dell’Ambiente, University of Cagliari, via Ospedale 72, 09124 Cagliari, Italy; (E.C.); (M.P.); (M.M.)
| | - Matteo Perra
- Department of Scienze della Vita e dell’Ambiente, University of Cagliari, via Ospedale 72, 09124 Cagliari, Italy; (E.C.); (M.P.); (M.M.)
| | - Jose Luis Pedraz
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain; (J.L.P.); (T.B.L.-M.)
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 01006 Vitoria-Gasteiz, Spain
- Bioaraba, NanoBioCel Research Group, 01006 Vitoria-Gasteiz, Spain
| | - Tania Belen Lopez-Mendez
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain; (J.L.P.); (T.B.L.-M.)
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 01006 Vitoria-Gasteiz, Spain
| | - Antonio Lozano
- LIFTEC, CSIC—Universidad de Zaragoza, María de Luna 10, 50018 Zaragoza, Spain; (A.L.); (E.C.)
| | - Esteban Calvo
- LIFTEC, CSIC—Universidad de Zaragoza, María de Luna 10, 50018 Zaragoza, Spain; (A.L.); (E.C.)
| | - Marco Zaru
- Icnoderm Srl, Sardegna Ricerche Ed. 5, Pula, 09010 Cagliari, Italy;
| | - Maria Manconi
- Department of Scienze della Vita e dell’Ambiente, University of Cagliari, via Ospedale 72, 09124 Cagliari, Italy; (E.C.); (M.P.); (M.M.)
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14
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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15
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Lee K, Kim TH, Lee SH, Kang CH, Je BK, Oh S. Predictive Value of Radiologic Central Compartment Atopic Disease for Identifying Allergy and Asthma in Pediatric Patients. EAR, NOSE & THROAT JOURNAL 2021; 101:593-599. [PMID: 33689496 DOI: 10.1177/0145561321997546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Central compartment atopic disease (CCAD) has recently been suggested as a phenotype of chronic rhinosinusitis (CRS). This study aims to investigate the prevalence of the radiologic CCAD phenotype in CRS within a pediatric population and identify its ability to predict comorbid allergy and asthma. METHODS Computed tomography and endoscopic examination were conducted on pediatric patients with CRS either with or without nasal polyps. Allergen sensitization was determined with the multiple-allergen simultaneous test and skin prick test. Serum total immunoglobulin E (IgE), peripheral blood eosinophil percentage, and presence of asthma were also evaluated. RESULTS A total of 82 pediatric patients were enrolled. Overall, 55 (67.1%) of the participants demonstrated aeroallergen sensitization, and 31 (18.9%) of the 164 sides of sinuses were radiologically defined to fit the CCAD phenotype. Patients having CRS with the CCAD phenotype had a higher prevalence of aeroallergen sensitization (87.1% vs 62.4%, P = .008), particularly house dust mite (74.2% vs 53.4%, P = .035), and a higher incidence of asthma (16.1% vs 3.8%, P = .010). Additionally, patients having CRS with the CCAD phenotype demonstrated a high serum total IgE levels (51.6% vs 30.1%, P = .023) in comparison to patients having CRS without CCAD. CONCLUSION In pediatric CRS, the radiological CCAD phenotype was associated with allergen sensitization and asthma. Furthermore, the CCAD phenotype was associated with high serum total IgE levels, suggesting allergy etiology should be considered with this type of pediatric patients with CRS.
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Affiliation(s)
- Kijeong Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Sang Hag Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Chang Ho Kang
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bo-Kyung Je
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Saelin Oh
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
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16
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Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review. Curr Allergy Asthma Rep 2020; 20:68. [PMID: 32889648 PMCID: PMC7474513 DOI: 10.1007/s11882-020-00967-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
Purpose of the Review We provide a systematic review of experimental and clinical evidences linking allergy to acute, including common cold, and chronic rhinosinusitis in children. Furthermore, we questioned if anti-allergy treatment may prevent the occurrence of rhinosinusitis or improve outcomes of its specific management. Recent Findings Allergic rhinitis is a common childhood disease in industrialized countries that is responsible for a major impact on quality of life and healthcare resources. Over the years many authors tried to correlate allergy with comorbidities and in particular to the onset of rhinosinusitis including common cold, even though conflicting results are frequently reached. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process. Our search yielded 7103 that were finally screened. This resulted in 25 publications of which the full texts were assessed and included in a qualitative analysis per different phenotypes of rhinosinusitis. Summary The evidence suggests that allergy may lead to overall impairment of mechanical and immunological defense function of the nasal mucosa against viruses and that anti-allergy treatment may significantly decrease the number and severity of upper respiratory tract infections including common colds in children. It was not possible to perform the analysis for allergy and post-viral acute rhinosinusitis, bacterial acute rhinosinusitis, and recurrent acute rhinosinusitis because of paucity and heterogeneity of data. Although there is no definitive proof of causation linking allergy to chronic rhinosinusitis, studies lead to suppose that anti-allergy treatment may improve outcomes of specific CRS treatments.
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17
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Alvarado J, Stolovitzky P. Management of Pediatric Chronic Rhinosinusitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Snidvongs K, Sangubol M, Poachanukoon O. Pediatric Versus Adult Chronic Rhinosinusitis. Curr Allergy Asthma Rep 2020; 20:29. [PMID: 32506185 DOI: 10.1007/s11882-020-00924-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Pediatric and adult chronic rhinosinusitis (CRS) have some similarities but a number of differences. This article reviews the similarities and differences between pediatric and adult CRS. RECENT FINDINGS Rhinosinusitis is an inflammatory disease of the nose and the paranasal sinuses. In adults, inflammation in CRS without polyps (CRSsNP) mainly manifests with T-helper 1 lymphocytes while in CRS with polyps (CRSwNP) manifests with T-helper 2 lymphocytes and eosinophilic inflammation. In children, CRS inflammation manifests with neutrophils, macrophages, and lymphocytes. The associations between the ostiomeatal complex occlusion and CRS are revealed in adults but are not so evident in children. Although the relationship between the CRS and allergic rhinitis is still controversial, recent findings have shown an association between allergen sensitization and a specific group of adults with rhinosinusitis. Intranasal corticosteroids and saline constitute the first-line of medical treatment for both pediatric and adult rhinosinusitis. Low-dose macrolides are used for immunomodulatory activities and beneficial effects to adult patients with CRSsNP were demonstrated by recent meta-analyses. For surgical treatment, adenoidectomy is a key strategy to eradicate mature biofilms in pediatric CRS and effective in treating children with CRS regardless of the adenoid size. Although endoscopic sinus surgery has been proven to improve quality of life outcomes in adult CRS, it should be only considered in the pediatric CRS after failure of adenoidectomy. Pediatric and adult CRS are different in many aspects, including immunopathogenesis and management. Investigations should be considered in specific cases. After failure of medical treatments, endoscopic sinus surgery is recommended for adults, while adenoidectomy is primarily considered for children.
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Affiliation(s)
- Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | | | - Orapan Poachanukoon
- Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University Hospital, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Thammasat University, Bangkok, Thailand
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Chronic Rhinosinusitis and Allergy: Increased Allergen Sensitization Versus Real Allergic Rhinitis Multimorbidity: a Systematic Review. Curr Allergy Asthma Rep 2020; 20:19. [PMID: 32430789 DOI: 10.1007/s11882-020-00913-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The objective of this article is to provide a recent update of the association between allergic inflammation and chronic rhinosinusitis. The systematic approach of this review article critically evaluates the literature published over the past few years and summarizes the specific pathophysiologic pathway of chronic sinonasal inflammation that has been postulated. RECENT FINDINGS From a systematic search of the Ovid Medline and Embase, 11 studies were included in a qualitative analysis of the association between systemic allergy and chronic rhinosinusitis (CRS). Of the 11 studies, four showed an association, three were inconclusive, and four did not show any association. From the systematic search, 50 studies suggested four possible pathophysiologic pathways that may explain the association of allergic inflammation and CRS, namely, (1) staphylococcal enterotoxin, (2) the innate immunity pathway, (3) mast cell-associated inflammation, and (4) dysbiosis of microbiota. The association of systematic allergy and CRS remains inconclusive. The recent advances in the study of the pathophysiologic pathway of CRS may lead to the possibility of a targeted treatment option for CRS.
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20
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Updates to the Current Understanding of the Relationship Between Allergy and Chronic Sinusitis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00287-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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21
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Mohebbi A, Hosseinzadeh F, Mohebbi S, Dehghani A. Determining the effect of platelet-rich plasma (PRP) on improving endoscopic sinus surgery: A randomized clinical trial study (RCT). Med J Islam Repub Iran 2019; 33:150. [PMID: 32280656 PMCID: PMC7137829 DOI: 10.34171/mjiri.33.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Indexed: 11/28/2022] Open
Abstract
Background: Rhinosinusitis is an inflammatory disease of the nasal and paranasal sinus mucosa, and it becomes chronic when it lasts longer than 3 months without symptom improvement. The aim of this study was to determine the effect of PRP on improvement of endoscopic sinus surgery.
Methods: This was a randomized clinical trial (RCT) designed and implemented on 21 patients with chronic rhinosinusitis in Rasool Akram hospital in Tehran during 2016-2017. In this study, one side of the nose was randomly selected as the control and the other side as the case, and at the end of the surgery, PRP was sprayed onto the surface where the polyp was removed in the side that was intended as the case. The nasal endoscopy findings were graded according to Meltzer’s criteria before and after surgery and CT findings were classified according to the Lund-Mackay scoring system. Then, all patients were followed for 6 months. The SNOT-22 questionnaire, charts of Meltzer’s criteria, and Lund-Mackay were used for data collection. Kolmogorov–Smirnov test, Wilcoxon Signed Rank test, and Mann-Whitney U test were used to analyze data in SPSS-22 software. P value<0.05 was considered significant.
Results: The mean and standard deviation of patients' age were 36.55 and 7.91, respectively. The median Lund-McKay Pre-op CT score before treatment was 10 (9.5-11), and no significant difference was found between the 2 sides of the nose (left and right). The items that showed statistically significant improvement after surgery was SNOT-22 (p<0.05). The mean of Meltzer scores in each side of the nose was significantly different before and after intervention (p<0.05). However, the mean of Meltzer scores in the 2 sides of the nose was not significantly different before and after intervention.
Conclusion: The treatment by PRP may be effective in reducing symptoms of patients showing recurrence of CRS symptoms following endoscopic sinus surgery subjectively but not objectively.
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Affiliation(s)
- Alireza Mohebbi
- ENT and Head & Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Farideh Hosseinzadeh
- ENT and Head & Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Saleh Mohebbi
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Dehghani
- ENT and Head & Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
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22
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Torretta S, Drago L, Marchisio P, Gaini L, Guastella C, Moffa A, Rinaldi V, Casale M, Pignataro L. Review of Systemic Antibiotic Treatments in Children with Rhinosinusitis. J Clin Med 2019; 8:E1162. [PMID: 31382570 PMCID: PMC6723210 DOI: 10.3390/jcm8081162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/02/2023] Open
Abstract
Antibiotic treatment in paediatric rhinosinusitis is still a matter of debate, as the current guidelines have been drafted mainly based on clinical studies published before 2013. Recent modifications in the epidemiological basis of the disease might mean that current treatments are not completely adequate considering the evolving microbiological profile of the disease. The present paper reviews the role of systemic antibiotics in children with acute (ARS), chronic (CRS), recurrent (RARS), and complicated acute (CoARS) rhinosinusitis. A total of 14 studies (including 3 prospective non-randomised studies, 8 retrospective studies, and 3 prospective randomised studies) of the 115 initially identified papers were included in this review, corresponding to 13,425 patients. Five papers dealt with ARS, four papers with RARS or CRS, and five papers with CoARS; the remaining papers included patients with either ARS or CRS. Data about the effectiveness of antibiotic treatment in children with ARC, CRS, and CoARS is scarce, as only three randomised controlled trials have been published in the last decade, with contrasting results. There is an urgent need for dedicated controlled trials not only to test the actual clinical benefits deriving from the routine use of systemic antibiotics in different categories of patients but also to compare the effectiveness of various therapeutic protocols in terms of the type of antibacterial molecules and the duration of treatment.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20100, Italy.
| | - Lorenzo Drago
- Department of Biomedical Sciences for Health, University of Milan, Milan 20100, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20100, Italy
| | - Lorenzo Gaini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
| | - Claudio Guastella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
| | - Antonio Moffa
- Unit of Otolaryngology, University of Foggia, Foggia 71121, Italy
| | - Vittorio Rinaldi
- Unit of Otolaryngology, UOS ORL TI, Campus Bio-medico University, Rome 00128, Italy
| | - Manuel Casale
- Unit of Otolaryngology, UOS ORL TI, Campus Bio-medico University, Rome 00128, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20100, Italy
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23
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Giallongo A, Parisi GF, Licari A, Pulvirenti G, Cuppari C, Salpietro C, Marseglia GL, Leonardi S. Novel therapeutic targets for allergic airway disease in children. Drugs Context 2019; 8:212590. [PMID: 31391855 PMCID: PMC6668505 DOI: 10.7573/dic.212590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of precision medicine is setting up targeted therapies for selected patients that would ideally have high effectiveness and few side effects. This is made possible by targeted therapy drugs that selectively act on a specific pathway. Precision medicine is spreading to many medical specialties, and there is increasing interest in the context of allergic airway diseases, such as allergic rhinitis, chronic rhinosinusitis, and asthma. This review is an update of new targets in the treatment of childhood allergic upper airway diseases and asthma, including the most recent biologic drugs that have already been licensed or are in the pipeline to be tested with children.
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Affiliation(s)
- Alessandro Giallongo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giulio Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Caterina Cuppari
- Department of Human Pathology of the Adult and Developmental Age 'Gaetano Barresi,' Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Carmelo Salpietro
- Department of Human Pathology of the Adult and Developmental Age 'Gaetano Barresi,' Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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24
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Wu PW, Huang CC, Yang SW, Huang Y, Huang CC, Chang PH, Lee YS, Lee TJ. Endoscopic sinus surgery for pediatric patients: Prognostic factors related to revision surgery. Laryngoscope 2019; 130:1051-1055. [PMID: 31169921 DOI: 10.1002/lary.28106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In the past two decades, endoscopic sinus surgery (ESS) has been performed frequently in children with medically recalcitrant chronic rhinosinusitis (CRS). However, surgical success rates vary according to age. The causes of failure and prognostic factors for revision ESS remain unclear. The aims of the present study were to evaluate prognostic factors related to revision surgery after ESS, and to determine the most optimal timing for surgery in the pediatric population. METHODS This was a retrospective review in a tertiary medical center. Children who underwent ESS for CRS between 2004 and 2017 were enrolled. Demographics, sinonasal examination findings, previous operation history, laboratory data, comorbidities, and computed tomography (CT) results were collected from medical records. Prognostic factors for revision surgery were analyzed. RESULTS A total of 188 pediatric patients were enrolled in this study. Twenty-four patients (12.8%) required revision surgery. Multivariate logistic regression analysis identified patients with nasal allergy (OR = 6.258; P = .010) and higher Lund-Mackay score on preoperative sinus CT (OR = 1.658; P = .043) had worse outcomes, while older age was a positive prognostic factor (OR = 0.702; P = .018). A cut-off point of 15.68 years of age and mean Lund-Mackay score of 10.5 showed the best predictive power for revision surgery. CONCLUSION Because ESS is performed with increasing frequency in children, knowledge of prognostic factors for revision surgery is important. In this study, patients with younger age, nasal allergy, and higher Lund-Mackay score on preoperative sinus CT had worse outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1051-1055, 2020.
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Affiliation(s)
- Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Linkou branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Keelung branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Linkou branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Wei Yang
- Department of Otolaryngology-Head and Neck Surgery, Keelung branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yenlin Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Linkou branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Linkou branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Linkou branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Xiamen Chang Gung Hospital, Xiamen, People's Republic of China
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25
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Anamika A, Chakravarti A, Kumar R. Atopy and Quality of Life in Pediatric Chronic Rhinosinusitis. Am J Rhinol Allergy 2019; 33:586-590. [PMID: 31161768 DOI: 10.1177/1945892419854266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Anamika Anamika
- 1 Department of ENT and Head & Neck Surgery, Lady Hardinge Medical College and Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Arunabha Chakravarti
- 1 Department of ENT and Head & Neck Surgery, Lady Hardinge Medical College and Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Raj Kumar
- 2 National Centre of Respiratory Allergy, Asthma and Immunology, Department of Respiratory Allergy and Applied Immunology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
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26
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Torretta S, Guastella C, Ibba T, Gaffuri M, Pignataro L. Surgical Treatment of Paediatric Chronic Rhinosinusitis. J Clin Med 2019; 8:jcm8050684. [PMID: 31096610 PMCID: PMC6571701 DOI: 10.3390/jcm8050684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022] Open
Abstract
Rhinosinusitis (RS) is a common disease in children, significantly affecting their quality of life. Chronic rhinosinusitis (CRS) is frequently linked to other respiratory diseases, including asthma. Children affected by CRS may be candidates for surgery in the case of failure of maximal medical therapy comprising three to six weeks of broad-spectrum systemic antibiotics with adjunctive therapies. Although endoscopic sinus surgery (ESS) is the surgical treatment of choice in adult patients with CRS, different surgical procedures are scheduled for refractory paediatric CRS and include adenoidectomy, paediatric ESS (PESS), and balloon catheter sinuplasty (BCS). The present paper discusses the indications and limitations of each treatment option in children with CRS. Given the amount of current evidence, it is reasonable to suggest that, in young and otherwise healthy children with refractory CRS, an adenoidectomy (eventually combined with BCS) should be offered as the first-line surgical treatment. Nevertheless, this approach may be considered ineffective in some patients who should be candidates for traditional ESS. In older children, those with asthma, or in the case of peculiar conditions, traditional ESS should be considered as the primary treatment.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
| | - Claudio Guastella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
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27
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McKeon M, Medina G, Kawai K, Cunningham M, Adil E. Readmissions following ambulatory pediatric endoscopic sinus surgery. Laryngoscope 2019; 129:2681-2686. [PMID: 30821352 DOI: 10.1002/lary.27898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/27/2018] [Accepted: 02/11/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES/HYPOTHESIS Endoscopic sinus surgery (ESS) is indicated in select pediatric patients with medically refractory sinus disease. Our objectives were to examine indications and rates of readmission following ambulatory pediatric ESS and identify specific subgroups that may benefit from inpatient admission. STUDY DESIGN Retrospective database review. METHODS The Pediatric Health Information Systems (PHIS) 2004-2016 database was retrospectively reviewed for patients age <18 years who underwent ambulatory ESS between January 2011 and December 2016 and were readmitted within 30 days postoperatively. Data regarding demographics, extent of surgery, comorbidities, adjunctive procedures, and cost were collected. A multivariable mixed-effects logistic regression model was employed for analysis. RESULTS We identified 3,669 unique pediatric ESS cases with 128 readmissions within 30 days (3.5%; 95% confidence interval [CI]: 2.9%-4.1%). Median cost of readmission was $980 (mean, $5,890; standard deviation, $13,421). The most common indication for readmission was epistaxis (17.2%), followed by nausea/abdominal pain (14.1%). Respiratory infection (13.3%) and sinusitis (10.2%) presented a combined readmission rate exceeding that of epistaxis alone. Multivariable analysis indicated age <3 years (odds ratio [OR]: 3.41, 95% CI: 1.96-5.93) and a prior diagnosis of asthma (OR: 2.88, 95% CI: 1.99-4.18) or cystic fibrosis (OR: 1.57, 95% CI: 1.00-2.44) significantly increased the risk of readmission. Extent of ESS and simultaneous adenoidectomy, septoplasty, or turbinate reduction had no significant impact on readmission rates. CONCLUSIONS ESS is a relatively safe outpatient surgical procedure in pediatric patients, with an overall readmission rate of 3.5%. Clinicians should consider careful preoperative evaluation of very young patients and those with cystic fibrosis or asthma to optimize perioperative management and determine if postoperative admission is warranted, given their significantly higher readmission rates. LEVEL OF EVIDENCE NA Laryngoscope, 129:2681-2686, 2019.
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Affiliation(s)
- Mallory McKeon
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Genevieve Medina
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Michael Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eelam Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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28
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de Benedictis FM, Carloni I, Comberiati P, Shields MD, Bush A, Chang AB. Wet Cough and Nasal Symptoms in Children: Can We Do Better? Front Pediatr 2019; 7:459. [PMID: 31956642 PMCID: PMC6949513 DOI: 10.3389/fped.2019.00459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.
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Affiliation(s)
| | - Ines Carloni
- Department of Child and Mother Health, Salesi Children's Hospital, Ancona, Italy
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michael D Shields
- Centre for Experimental Medicine, Royal Belfast Hospital for Sick Children, Queen's University of Belfast, Belfast, United Kingdom
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial School of Medicine, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
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29
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Xiang R, Zhang QP, Zhang W, Kong YG, Tan L, Chen SM, Deng YQ, Tao ZZ, Xu Y. Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol 2018; 276:115-130. [PMID: 30446828 PMCID: PMC6338715 DOI: 10.1007/s00405-018-5195-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
Abstract
Background Allergic rhinitis (AR) has been reported to be associated with chronic rhinosinusitis (CRS). The objective of this study was to investigate the effect of AR on nasal mucosa remodeling in CRS. Methods Patients were enrolled and divided into the following groups: CRS with nasal polyps (NP) with allergic rhinitis (AR)(CRSwNPwAR; n = 20), CRS with NP without AR (CRSwNPsAR; n = 20), CRS without NP with AR (CRSsNPwAR; n = 20), CRS without NP without AR (CRSsNPsAR; n = 20), AR without CRS (AR; n = 20) and controls (n = 14). Eosinophil infiltration, mucus production, and collagen deposition were examined by hematoxylin and eosin, periodic acid schiff and masson’s trichrome staining, respectively. VEGF-A and microvessel density were detected by immunohistochemistry. The expression of remodeling markers, including TGF-β1, MMP-7, MMP-9 and TIMP-1 were measured by Western blot. Results The expression of remodeling factors, including VEGF-A, CD31, CD34 and TIMP-1 were significantly increased in CRSwAR compared to CRSsAR. Goblet cell hyperplasia, as well as VEGF-A, CD31, CD34, and MMP-9 expression were significantly higher in CRSwNPwAR compared to CRSwNPsAR. However, the expression of collagen fibers, MMP-7 and TGF-β1 were significantly higher in CRSsNPwAR compared to CRSsNPsAR. Conclusions AR could enhance the remodeling process in CRS. Moreover, AR had different effects on CRSwNP and CRSsNP.
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Affiliation(s)
- Rong Xiang
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Qing-Ping Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Suizhou Hospital, Hubei University of Medicine, 60 Longmen Rd, Suizhou, 441300, Hubei, People's Republic of China
| | - Wei Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Yong-Gang Kong
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Lu Tan
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Shi-Ming Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Yu-Qin Deng
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Ze-Zhang Tao
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Yu Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China.
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30
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Abstract
PURPOSE OF REVIEW To review the recent literature of pediatric endoscopic sinus surgery (ESS). RECENT FINDINGS Sinus balloon catheter dilation is an important addition to the surgical treatment tools for pediatric chronic rhinosinusitis (PCRS). ESS is a safe and effective therapeutic modality for uncomplicated PCRS. For PCRS complicated by comorbidities including cystic fibrosis and primary ciliary dyskinesia, ESS and adjuvant medical therapy confers significant sinus, pulmonary, and quality of life benefits to pediatric patients. SUMMARY ESS is a safe and effective treatment modality in the management of pediatric acute and chronic sinus disorders.
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31
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Poddighe D, Brambilla I, Licari A, Marseglia GL. Pediatric rhinosinusitis and asthma. Respir Med 2018; 141:94-99. [PMID: 30053979 DOI: 10.1016/j.rmed.2018.06.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 05/11/2018] [Accepted: 06/18/2018] [Indexed: 12/24/2022]
Abstract
Both asthma and rhinosinusitis are complex and heterogeneous diseases and, importantly, they often coexist: these diseases can be concomitant in 35-65% of affected children, according to different studies. Thus, evaluating this comorbidity in the clinical practice should be paramount. In this review, we focused our discussion on the multiple pathophysiological aspects that may link rhinosinusitis and asthma in the pediatric population. Although rhinosinusitis may exacerbate asthma through several mechanisms occurring by contiguity, actually this aspect seems to be only one component of the complex interplay between upper and lower airways. In particular, the onset of an important and persistent Th2-driven inflammatory process dominated by eosinophils presence at one site of the airways, may release into the bloodstream several cytokines; in their turn, those can lead to the stimulation of the bone marrow, which may function as a systemic amplifier of such an eosinophilic inflammation.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan; Department of Pediatrics, Università Degli Studi, Pavia, Italy.
| | - Ilaria Brambilla
- Department of Pediatrics, Università Degli Studi, Pavia, Italy; Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Department of Pediatrics, Università Degli Studi, Pavia, Italy; Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Università Degli Studi, Pavia, Italy; Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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32
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Speth MM, Hoehle LP, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Changes in chronic rhinosinusitis symptoms differentially associate with improvement in general health-related quality of life. Ann Allergy Asthma Immunol 2018; 121:195-199. [PMID: 29860050 DOI: 10.1016/j.anai.2018.05.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/12/2018] [Accepted: 05/23/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Previous work has shown that the symptoms of chronic rhinosinusitis (CRS) differentially associate with decreased general health-related quality of life (QOL). OBJECTIVE We sought to determine whether longitudinal changes in different types of CRS symptomatology lead to correspondingly different magnitude changes in general health-related QOL. METHODS Prospective observational study of 145 patients undergoing medical management for CRS. Chronic rhinosinusitis symptom severity was measured using the 22-item Sinonasal Outcome Test (SNOT-22) and associated nasal, sleep, ear/facial discomfort, and emotional subdomains of the SNOT-22. General health-related QOL was measured using the 5-dimensional EuroQoL questionnaire's visual analog scale (EQ-5D VAS). These data were collected at 2 time points: at enrollment and at a subsequent follow-up visit within the next 2 to 6 months. Associations were sought between the changes in SNOT-22 and EQ-5D VAS. RESULTS The change in SNOT-22 was associated with change in EQ-5D VAS (adjusted linear regression coefficient [β] = -0.37, 95%CI: -0.51 to -0.24, P < .001). The change in EQ-5D VAS was only associated with changes in the sleep (adjusted β = -0.42, 95% confidence interval [95%CI]: -0.81 to -0.04, P = .034) and ear/facial discomfort (adjusted β = -1.00, 95%CI: -1.89 to -0.10, P = .031) subdomains but not nasal (adjusted β = -0.12, 95%CI: -0.52 to 0.28, P = .564) or emotional (adjusted β = -0.17, 95%CI: -1.83 to 1.49, P = .840) subdomains. CONCLUSION Changes in the severity of sleep and ear/facial discomfort symptoms associate most greatly with the change in general health-related QOL that CRS patients experience during routine medical management. Reduction of these extranasal symptoms of CRS may therefore lead to the greatest improvement in general health-related QOL.
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Affiliation(s)
- Marlene M Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland
| | - Lloyd P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Katie M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts.
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33
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Heath J, Hartzell L, Putt C, Kennedy JL. Chronic Rhinosinusitis in Children: Pathophysiology, Evaluation, and Medical Management. Curr Allergy Asthma Rep 2018; 18:37. [PMID: 29845321 DOI: 10.1007/s11882-018-0792-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Pediatric chronic rhinosinusitis (CRS) is a common disorder that carries significant morbidity. The diagnosis requires sinus symptoms that persist despite standard medical therapy greater than 3 months. Viral infections, allergies, and anatomic differences in children lead to chronic obstruction of the osteomeatal complex. RECENT FINDINGS Chronic rhinosinusitis as a diagnosis is a conglomeration of multiple phenotypes and endotypes. As such, the diagnosis and management are complex. New survey studies provide some consensus on prevalence and management of this disease in children. In this review, we highlight the differential diagnosis of pediatric CRS, including non-eosinophilic/infectious variants, eosinophilic variants with and without nasal polyps, allergic fungal sinusitis, aspirin-exacerbated respiratory disease, primary immunodeficiency, and disorders of mucociliary clearance. Further, we detail treatment options that should be considered. Finally, we feature emerging potential treatment options of CRS, including anti-immunoglobulin E, interleukin-5, and interleukin-4 receptor alpha subunit.
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Affiliation(s)
| | - Larry Hartzell
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Claire Putt
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua L Kennedy
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA. .,Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA. .,Arkansas Children's Research Institute, 13 Children's Way, Slot 512-13, Little Rock, AR, 72202, USA.
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Could seasonal allergy be a risk factor for acute rhinosinusitis in children? The Journal of Laryngology & Otology 2018; 132:150-153. [PMID: 29343309 DOI: 10.1017/s0022215118000038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the incidence of acute rhinosinusitis in children with grass pollen induced rhinitis during the period of grass pollinosis. METHODS Children with nasal symptoms from grass pollen induced rhinitis but without rhinosinusitis symptoms were selected. Their parents were asked to complete a diary during pollen exposure to report nasal symptoms and drugs used daily. When rhinosinusitis was suspected, the confirmatory diagnosis of acute rhinosinusitis was made by fibro-endoscopy. Children without inhalant allergy served as controls. RESULTS Seventeen out of 242 children (7.0 per cent) had a diagnosis of acute rhinosinusitis, confirmed by fibro-endoscopy, during grass pollination, compared to 3 out of 65 (4.6 per cent) in the control group (p = 0.49). Among allergic children, those with acute rhinosinusitis had symptoms for a greater number of days and/or a higher symptoms score than children without acute rhinosinusitis. CONCLUSION Children with grass pollen induced rhinitis during exposure to pollen have an incidence of endoscopically confirmed acute rhinosinusitis comparable to non-allergic children. This suggests that grass pollen induced rhinitis is a negligible risk factor for acute rhinosinusitis.
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Licari A, Brambilla I, De Filippo M, Poddighe D, Castagnoli R, Marseglia GL. The role of upper airway pathology as a co-morbidity in severe asthma. Expert Rev Respir Med 2017; 11:855-865. [PMID: 28918658 DOI: 10.1080/17476348.2017.1381564] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Severe asthma is a complex heterogeneous disease that is refractory to standard treatment and is complicated by multiple co-morbidities and risk factors. Several co-morbidities may contribute to worsen asthma control and complicate diagnostic and therapeutic management of severe asthmatic patients. Areas covered: A prevalent cluster of chronic upper airway co-morbid diseases is recognized in severe asthma. Evaluation for these disorders should always be considered in clinical practice. The aim of this review is to provide an updated overview of the prevalence, the pathogenetic mechanisms, the clinical impact and the therapeutic options for upper airway pathology in severe asthma, focusing on chronic rhinosinusitis and allergic rhinitis. Expert commentary: In the context of severe asthma, the clinical significance of upper airway co-morbidities is based on mutual interactions complicating diagnosis and management. A better analysis and understanding of phenotypes and endotypes of both upper and lower airway diseases are crucial to further develop targeted treatment.
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Affiliation(s)
- Amelia Licari
- a Department of Pediatrics , Foundation IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Ilaria Brambilla
- a Department of Pediatrics , Foundation IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Maria De Filippo
- a Department of Pediatrics , Foundation IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Dimitri Poddighe
- a Department of Pediatrics , Foundation IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy.,b Department of Pediatrics , ASST Melegnano e Martesana , Milan , Italy
| | - Riccardo Castagnoli
- a Department of Pediatrics , Foundation IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Gian Luigi Marseglia
- a Department of Pediatrics , Foundation IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
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Bacterial lysate for the prevention of chronic rhinosinusitis recurrence in children. The Journal of Laryngology & Otology 2017; 131:523-528. [DOI: 10.1017/s0022215117000524] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AbstractBackground:Chronic rhinosinusitis is a common nasal disorder in children that is prone to recurrence. This study investigated the prevention of chronic rhinosinusitis recurrence with bacteria lysate in children.Methods:Bacteria lysate was administered 10 days per month for 3 months to children with chronic rhinosinusitis, who had just entered a remission phase. Visual analogue score, nasal symptoms scores, rhinitis attack frequency and antibiotic use were assessed at three months and one year.Results:At one year of follow up, the visual analogue score, nasal discharge and obstruction scores, number of days with rhinitis attacks per month and number of days with antibiotic use per month were significantly decreased in the prevention group versus the control group (p< 0.05).Conclusion:Bacterial lysate used in the remission period of rhinosinusitis in children was shown to provide long-term prophylaxis. Bacterial lysate can effectively reduce the frequency of rhinosinusitis attacks and ameliorate attack symptoms.
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Poachanukoon O, Koontongkaew S, Monthanapisut P, Pattanacharoenchai N. Mometasone Furoate Suppresses PMA-Induced MUC-5AC and MUC-2 Production in Human Airway Epithelial Cells. Tuberc Respir Dis (Seoul) 2016; 80:60-68. [PMID: 28119748 PMCID: PMC5256341 DOI: 10.4046/trd.2017.80.1.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/24/2015] [Accepted: 06/15/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mucus hypersecretion from airway epithelium is a characteristic feature of airway inflammatory diseases. Tumor necrosis factor α (TNF-α) regulates mucin synthesis. Glucocorticoids including mometasone fuorate (MF) have been used to attenuate airway inflammation. However, effects of MF on mucin production have not been reported. METHODS Effects of MF and budesonide (BUD) on the phorbol-12-myristate-13-acetate (PMA)-induction of mucin and TNF-α in human airway epithelial cells (NCI-H292) were investigated in the present study. Confluent NCI-H292 cells were pretreated with PMA (200 nM) for 2 hours. Subsequently, the cells were stimulated with MF (1-500 ng/mL) or BUD (21.5 ng/mL) for 8 hours. Dexamethasone (1 µg/mL) was used as the positive control. Real-time polymerase chain reaction was used to determine MUC2 and MUC5AC mRNA levels. The level of total mucin, MUC2, MUC5AC, and TNF-α in culture supernatants were measured using enzyme-linked immunosorbent assay. RESULTS MF and BUD significantly suppressed MUC2 and MUC5AC gene expression in PMA-stimulated NCI-H292 cells. The inhibitory effects of the two steroid drugs were also observed in the production of total mucin, MUC2 and MUC5AC proteins, and TNF-α. CONCLUSION Our findings demonstrated that MF and BUD attenuated mucin and TNF-α production in PMA-induced human airway epithelial cells.
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Affiliation(s)
- Orapan Poachanukoon
- Department of Pediatrics, Faculty of Medicine, Thammasat University (Rangsit Center), Pathum Thani, Thailand
| | - Sittichai Koontongkaew
- Oral Biology Laboratory, Faculty of Dentistry, Thammasat University (Rangsit Center), Pathum Thani, Thailand
| | - Paopanga Monthanapisut
- Oral Biology Laboratory, Faculty of Dentistry, Thammasat University (Rangsit Center), Pathum Thani, Thailand
| | - Napaporn Pattanacharoenchai
- Oral Biology Laboratory, Faculty of Dentistry, Thammasat University (Rangsit Center), Pathum Thani, Thailand
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Association of severity of chronic rhinosinusitis with degree of comorbid asthma control. Ann Allergy Asthma Immunol 2016; 117:651-654. [DOI: 10.1016/j.anai.2016.09.439] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/12/2016] [Accepted: 09/23/2016] [Indexed: 12/13/2022]
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Direct measurement of upper airway inflammation in children with chronic rhinosinusitis: implications for asthma. Curr Opin Allergy Clin Immunol 2016; 16:18-23. [PMID: 26694036 DOI: 10.1097/aci.0000000000000237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a common heterogenous multifactorial disorder affecting children and adults. The exact mechanism is not completely understood. In this review, we aim to summarize our recent findings regarding etiologies and pathogenesis of CRS in children and review recent studies investigating inflammatory patterns in the upper airways in children and adults with CRS. RECENT FINDINGS There are only a few small studies measuring upper airway inflammation in children with CRS. These studies demonstrated more toward eosinophilic and T-cell driven inflammatory pattern. Cytokine patterns in upper airways seem to correlate with asthma symptoms in children with CRS. Adult studies demonstrate eosinophilic and Th-2 (T helper-1) driven inflammation in CRS with nasal polyps and Th-1 (T helper-2) driven inflammation in CRS without nasal polyps. SUMMARY Current knowledge about the characteristics of tissue inflammation in upper airways in children with CRS is limited. More studies are needed to better understand the pathogenesis and better define the subgroups of CRS. The findings of such studies will lead to identifying the biological targets to treat this condition.
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Harrow B, Sedaghat AR, Caldwell-Tarr A, Dufour R. A Comparison of Health Care Resource Utilization and Costs for Patients with Allergic Rhinitis on Single-Product or Free-Combination Therapy of Intranasal Steroids and Intranasal Antihistamines. J Manag Care Spec Pharm 2016. [DOI: 10.18553/jmcp.2016.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Rhinosinusitis, is defined as an inflammation of the paranasal and nasal sinus mucosae. Chronic rhinosinusitis (CRS)is a common problem in the pediatric age group and the diagnosis and treatment are challenging due to the chronicity and similarity of symptoms with allergic rhinitis and adenoid hypertrophy. Although it is less common than acute rhinosinusitis, CRS is becoming more frequent and significantly affects the quality of life in children and can substantially impair daily function. CRS is characterized by sinus symptoms lasting more than 3 months despite medical therapy. Many factors are involved in the pathogenesis of this disease and include a primary insult with a virus followed bybacterial infection and mucosal inflammation, along with predisposition to allergies. The standard treatment of pediatricacute bacterial rhinosinusitis (ABRS) is nasal irrigation and antibiotic use. Medical treatment of pediatric CRS includes avoidance of allergens in allergic patients (environmental or food) and therapy with nasal irrigation, nasal corticosteroids sprays, nasal decongestants, and antibiotics directed at the most common sinonasalorganisms (Haemophilusinfluenzae, Streptococcus pneumoniae, and Moraxella catarrhalis). Surgical therapy is rarely needed after appropriate medical therapy. Referral to an otolaryngologist and allergy specialist is recommended in case of failure of medical treatment.
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Larenas-Linnemann D. How does the efficacy and safety of Oralair(®) compare to other products on the market? Ther Clin Risk Manag 2016; 12:831-50. [PMID: 27313458 PMCID: PMC4892828 DOI: 10.2147/tcrm.s70363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Due to differences between allergen immunotherapy (AIT) trials in patient populations, trial design (including primary efficacy variables), the definition of a pollen season, data analysis, and comparisons between AIT products with existing data, is not possible nor valid. The efficacy of two grass pollen AIT tablets, Oralair® and Grazax®/Grastek®, should not be compared by looking at the percentage of score improvement in their respective trials. However, the evidence available concerning the efficacy and safety in trials can be compared by paying close attention to the scientific quality of the trials, details in the administration schedules, and safety issues. It can be concluded due to the high level of evidence available, that Oralair® is effective in a pre (2-months)-coseasonal schedule to reduce symptoms and medication use, and improve a patients’ quality of life during the treatment season. For the long-term, where the quality of efficacy evidence is moderate at 2-year posttreatment due to a high dropout rate, the pre (4-months)-coseasonal schedule should be used. No clinical efficacy data exists for starting treatment in-season, but the clinical onset of action of Oralair® is detectable after only 1 month of treatment. In the pivotal trials in Europe and the USA, no tablet-related epinephrine was needed, though some rare severe local reactions have been reported. Research for Grazax®/Grastek® showed that the long-term efficacy needs a continuous 3-year administration (moderate-low quality evidence available), and in two patients, tablet-related epinephrine was given. Further details on the comparative efficacy of both tablets would only be possible if both were evaluated in the same, adequately powered trial.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Pediatric Allergy and Asthma Clinic, Department of Investigation, Hospital Médica Sur, México City, México
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Mustakov TB, Popov TA, Kralimarkova TZ, Staevska MT, Dimitrov VD. Clinical characteristics of patients seeking medical advice for nasal symptoms in Bulgaria with special focus on children. World Allergy Organ J 2016; 9:11. [PMID: 27092204 PMCID: PMC4819277 DOI: 10.1186/s40413-016-0103-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background In an attempt to circumvent low response rates and high cost of classical epidemiological trials, we carried out a real-life survey among practicing physicians consulting patients for nasal symptoms. In this fragment of our work we analyze similarities and differences between children and adults and within the different strata of pediatric age. Methods A survey was carried out by 69 physicians across Bulgaria (general practitioners, allergists and otorhinolaryngologists) and made possible calculation of the proportion of subjects with nasal symptoms from all other patients seen. Its structure allowed classification of rhinitis according the ARIA guidelines. Results Out of the 1685 completed survey forms, 506 pertained to the age group below 18 years. The gender predominance differed in children and adults: 57.3 % vs. 42.8 % of males respectively, P < 0.001. The prevalence of persistent rhinitis in children was 55.7 %, lower than in adults, 63.3 %, P = 0.004. In both pediatric and adult patients moderately severe and severe forms of rhinitis prevailed, 93.7 % vs. 94.6 %, with nasal obstruction as leading symptom: 59.9 % vs. 58.8 %. Cough was significantly more prevalent among children, 72.5 %, gradually decreasing until reaching adulthood, 58.7 %, P < 0.001. Prevalence of doctor diagnosed asthma was also higher among children, 25.1 %, than in adults, 19.5 %, P = 0.011. A gradient for characteristics, which were different in children, emerged across the pediatric age strata. Discussion Our study uses an unorthodox design targeting the patient population visiting physicians’ offices because of nasal symptoms, achieving a much higher level of credibility of the results at minimal expense. As we base our survey on international guidelines, we believe this approach demonstrates the applicability of such consensus documents for practical purposes when in the hands of qualified physicians. Conclusions Moderate and severe rhinitis symptoms motivate patients and their guardians to seek medical advice. While nasal congestion is a leading bothersome symptom in both adults and children, specific other features characterize the pediatric age and differ across its strata.
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Affiliation(s)
- Tihomir B Mustakov
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Todor A Popov
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Tanya Z Kralimarkova
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Maria T Staevska
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
| | - Vasil D Dimitrov
- Clinic of Allergy and Asthma, Medical University, 1, Georgi Sofiyski St., 1431 Sofia, Bulgaria
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Min H, Chung H, Seong S, Sim N, Yoon JH, Lee JG, Kim CH, Cho HJ. Differential characteristics of pediatric sinusitis in patients who underwent endoscopic sinus surgery: childrenvs.adolescents. Clin Otolaryngol 2016; 41:579-84. [DOI: 10.1111/coa.12568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- H.J. Min
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - H.J. Chung
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - S.Y. Seong
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - N.S. Sim
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - J.-H. Yoon
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
- The Airway Mucus Institute; Yonsei University College of Medicine; Seoul South Korea
| | - J.-G. Lee
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
| | - C.-H. Kim
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
- The Airway Mucus Institute; Yonsei University College of Medicine; Seoul South Korea
| | - H.-J. Cho
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul South Korea
- The Airway Mucus Institute; Yonsei University College of Medicine; Seoul South Korea
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Mouse Sensitivity is an Independent Risk Factor for Rhinitis in Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:82-8.e1. [PMID: 26441149 DOI: 10.1016/j.jaip.2015.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although mouse and cockroach allergy is known to be important in urban children with asthma, the independent association of mouse and cockroach sensitization with rhinitis in these children is unknown. OBJECTIVE To determine the association of mouse and cockroach sensitization with rhinitis in urban children with asthma. METHODS As part of the Mouse Allergen and Asthma Intervention Trial, 499 urban children (5-17 years) with persistent asthma underwent spirometry, skin prick testing to 14 common environmental allergens, and serology for mouse-specific IgE. In 269 subjects, cockroach-specific IgE serology was also obtained. Patient/parent-reported rhinitis in the last 2 weeks and the last 1 year was the primary outcome measure. Mouse/cockroach exposure was measured by reported frequency of sightings. Mouse allergen-settled bedroom dust samples were also measured in mouse-sensitized children. RESULTS Rhinitis was reported in 49.9% and 70.2% of the participants within the last 2 weeks and the last 1 year, respectively. Serum mouse IgE level of 0.35 IU/mL or more was associated with rhinitis in the past 2 weeks (adjusted odds ratio, 2.15; 95% CI, 1.02-4.54; P = .04) and the past 1 year (adjusted odds ratio, 2.40; 95% CI, 1.12-5.1; P = .02) after controlling for age, race, sex, the presence of any smokers at home, primary caregiver education level, number of allergen sensitivities, cockroach IgE level of 0.35 IU/mL or more, and study site (Boston or Baltimore). Measures of home mouse exposure were not associated with rhinitis, regardless of mouse sensitivity. Cockroach sensitivity was not associated with rhinitis regardless of sensitization to other allergens. CONCLUSIONS In urban children with asthma, increased mouse IgE, but not cockroach IgE, in the sera (mouse IgE ≥ 0.35 IU/mL) may be associated independently with rhinitis.
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Sensitization Rates for Various Allergens in Children with Allergic Rhinitis in Qingdao, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10984-94. [PMID: 26371014 PMCID: PMC4586656 DOI: 10.3390/ijerph120910984] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the prevalence of sensitization to common allergens in children with allergic rhinitis (AR) living in Qingdao, China. We conducted a retrospective analysis for AR cases, who underwent skin prick tests (SPT) in Qingdao. A total of 2841 children with AR qualified for the inclusion criteria (Age 3-5 years: 1500 children; Age 6-12 years: 1341 children). The most common inhaled allergens to which the AR children were sensitive were Dermatophagoides pteronyssinus (69.3%), Dermatophagoides farinae (66.2%) and mould 1 (Penicillium notatum 38.9%); while the corresponding ingested allergens were mussel (39.2%), shrimp (36.3%) and carp (36.5%). The prevalence of sensitization to inhaled allergens and food allergens was higher in children >6 years of age as compared to that in children 3-5 years of age (all p < 0.05). Children >6 years old were more sensitive to dust mite as compared to children 3-5 years old (p < 0.05). Sensitization to dust mite was more common in males than in females (p = 0.05). In this study, Dermatophagoides pteronyssinus and Dermatophagoides farinae were the most common allergens causing AR in children in Qingdao, China. Older children with AR, particularly males, were found to be more sensitive to dust mite.
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Brietzke SE, Shin JJ, Choi S, Lee JT, Parikh SR, Pena M, Prager JD, Ramadan H, Veling M, Corrigan M, Rosenfeld RM. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg 2015; 151:542-53. [PMID: 25274375 DOI: 10.1177/0194599814549302] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To develop a clinical consensus statement on the optimal diagnosis and management of pediatric chronic rhinosinusitis (PCRS). METHODS A representative 9-member panel of otolaryngologists with no relevant conflicts of interest was assembled to consider opportunities to optimize the diagnosis and management of PCRS. A working definition of PCRS and the scope of pertinent otolaryngologic practice were first established. Patients of ages 6 months to 18 years without craniofacial syndromes or immunodeficiency were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus. RESULTS After 2 iterative Delphi method surveys, 22 statements met the standardized definition of consensus while 12 statements did not. Four statements were omitted due to redundancy. The clinical statements were grouped into 4 categories for presentation and discussion: (1) definition and diagnosis of PCRS, (2) medical treatment of PCRS, (3) adenoiditis/adenoidectomy, and (4) endoscopic sinus surgery (ESS)/turbinoplasty. CONCLUSION Expert panel consensus may provide helpful information for the otolaryngologist in the diagnosis and management of PCRS in uncomplicated pediatric patients.
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Affiliation(s)
- Scott E Brietzke
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Sukgi Choi
- University of Pittsburgh/Children's Hospital of Pittsburgh of UMPC, Pittsburgh, Pennsylvania, USA
| | - Jivianne T Lee
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Sanjay R Parikh
- University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Maria Pena
- Children's National Medical Center, Washington, DC, USA
| | - Jeremy D Prager
- University of Colorado/Children's Hospital Colorado, Aurora, Colorado, USA
| | - Hassan Ramadan
- West Virginia University, Morgantown, West Virginia, USA
| | - Maria Veling
- University of Texas-Southwestern Medical Center/Children's Medical Center-Dallas, Dallas, Texas, USA
| | - Maureen Corrigan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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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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Licari A, Caimmi S, Bosa L, Marseglia A, Marseglia GL, Caimmi D. Rhinosinusitis and asthma: a very long engagement. Int J Immunopathol Pharmacol 2015; 27:499-508. [PMID: 25572729 DOI: 10.1177/039463201402700405] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Upper and lower airways may be considered as a unique entity, interested by coexisting inflammatory processes that share common etiopathogenic mechanisms. Previous studies have strongly demonstrated a relationship between rhinosinusitis and asthma. This has led to the introduction of the concept of United Airways, which has also been included in the WHO document Allergic Rhinitis and its Impact on Asthma (ARIA); this concept has important consequences also on the treatment of these disorders. To better summarize the evident connection between upper and lower airway disease we decided to describe it as a multilayered construction, each level pointing out more deeply the relationship between these entities.
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Affiliation(s)
- A Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - S Caimmi
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - L Bosa
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - A Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - G L Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - D Caimmi
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
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