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Kais A, Hunt C, Makary CA, Ramadan HH. Impact of allergic rhinitis on quality of life in patients with chronic rhinosinusitis. Am J Otolaryngol 2024; 45:104325. [PMID: 38696896 PMCID: PMC11180425 DOI: 10.1016/j.amjoto.2024.104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES To evaluate the impact of allergic rhinitis (AR) on the quality of life (QoL) in patients with chronic rhinosinusitis (CRS). METHODS Retrospective cross-sectional study of adult patients with CRS presenting to our clinic between August 2020 and February 2023 was performed. AR was diagnosed based on a positive skin or blood allergy test. Patients' characteristics, AR status, comorbidities, endoscopy scores, and SNOT-22 scores were collected. RESULTS A total of 514 CRS patients were included, with 265 (51.6 %) patients with AR. CRS patients with AR were younger (p = 0.004), more likely to be female (p < 0.001), and more likely to have asthma (p < 0.001). Polyp status and endoscopy scores did not differ between patients with and without AR. Baseline SNOT-22 scores were slightly worse in the AR cohort (43.6 vs 38.7, p = 0.007), which was mainly secondary to rhinologic (p = 0.002), extrarhinologic (p = 0.007), and ear/facial (p = 0.007) subdomains. Worse rhinologic and extrarhinologic scores were associated with the presence of AR after adjusting for confounding variables (Coef = 1.55, p = 0.011; and Coef = 0.83, p = 0.021 respectively). CONCLUSION The impact of allergic rhinitis on QoL is mainly on the nasal symptoms. Further studies should look at the role of AR on the QoL of different CRS endotypes; and at the role of AR-specific treatment, such as immunotherapy, on the QoL of patients with CRS.
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Affiliation(s)
- Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Connor Hunt
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America.
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
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Shih MC, Edwards TS, Snyder J, Germroth M, Nguyen SA, Schlosser RJ. Impact of Nasal Cavity CT Opacification Upon Sinonasal Quality of Life. Ann Otol Rhinol Laryngol 2023; 132:1590-1599. [PMID: 37246346 DOI: 10.1177/00034894231176329] [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] [Indexed: 05/30/2023]
Abstract
BACKGROUND Current methods of quantifying inflammation in chronic rhinosinusitis (CRS) on computed tomography (CT) imaging focus on opacification of the paranasal sinuses and show limited correlation with patient-reported outcome measures. OBJECTIVE This study aimed to determine if quantifying CT opacification of the nasal cavity correlated with Sino-Nasal Outcomes Test scores (SNOT-22). METHODS Thirty patients with CRS were enrolled. Lund-Mackay and SNOT-22 scores were measured. Nasal cavity regions of interest (ROIs) were measured by 2 independent raters using ImageJ at 3 points on coronal CT scans: anteriorly at the lacrimal duct, at the approximate midpoint demarcated by the posterior aspect of the globe, and posteriorly at the transition from the hard to soft palate. Superior and inferior regions were defined based upon the root of the inferior turbinate. Percent opacification was calculated for each ROI. Analyses were conducted bilaterally and for the side with greater opacification (worse side). RESULTS Interrater reliability was strong for all ROIs. Lund-Mackay scores correlated with nasal blockage only (r = .495, P = .01) and did not correlate with nasal cavity ROI opacification. Inferior nasal cavity opacification for worse-sided anterior ROI and middle ROI correlated with SNOT-22 scores for nasal blockage (anterior r = .41, P = .03) (middle r = .42, P = .023) and runny nose (anterior r = .44, P = .02) (middle r = .38, P = .04). Posterior ROIs did not correlate with SNOT-22. CONCLUSIONS Traditional CT scoring of sinus opacification does not correlate well with nasal cavity opacification or SNOT-22. Inferior nasal cavity inflammation provides unique correlations with SNOT-22 nasal questions and may guide targeted interventions in these regions.
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Affiliation(s)
- Michael C Shih
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas S Edwards
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jacob Snyder
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew Germroth
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Maspero J, Adir Y, Al-Ahmad M, Celis-Preciado CA, Colodenco FD, Giavina-Bianchi P, Lababidi H, Ledanois O, Mahoub B, Perng DW, Vazquez JC, Yorgancioglu A. Type 2 inflammation in asthma and other airway diseases. ERJ Open Res 2022; 8:00576-2021. [PMID: 35923421 PMCID: PMC9339769 DOI: 10.1183/23120541.00576-2021] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/22/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic inflammatory airway diseases, including asthma, chronic rhinosinusitis, eosinophilic COPD and allergic rhinitis are a global health concern. Despite the coexistence of these diseases and their common pathophysiology, they are often managed independently, resulting in poor asthma control, continued symptoms and poor quality of life. Understanding disease pathophysiology is important for best treatment practice, reduced disease burden and improved patient outcomes. The pathophysiology of type 2 inflammation is driven by both the innate immune system triggered by pollutants, viral or fungal infections involving type 2 innate lymphoid cells (ILC2) and the adaptive immune system, triggered by contact with an allergen involving type 2 T-helper (Th2) cells. Both ILC2 and Th2 cells produce the type-2 cytokines (interleukin (IL)-4, IL-5 and IL-13), each with several roles in the inflammation cascade. IL-4 and IL-13 cause B-cell class switching and IgE production, release of pro-inflammatory mediators, barrier disruption and tissue remodelling. In addition, IL-13 causes goblet-cell hyperplasia and mucus production. All three interleukins are involved in trafficking eosinophils to tissues, producing clinical symptoms characteristic of chronic inflammatory airway diseases. Asthma is a heterogenous disease; therefore, identification of biomarkers and early targeted treatment is critical for patients inadequately managed by inhaled corticosteroids and long-acting β-agonists alone. The Global Initiative for Asthma guidelines recommend add-on biological (anti IgE, IL-5/5R, IL-4R) treatments for those not responding to standard of care. Targeted therapies, including omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab and tezepelumab, were developed on current understanding of the pathophysiology of type 2 inflammation. These therapies offer hope for improved management of type 2 inflammatory airway diseases. Asthma is a heterogenous disease. Targeted therapies have been developed based on the pathophysiology of type 2 inflammation. These therapies offer hope for improved management of type 2 inflammatory airway diseases.https://bit.ly/3HCkrvQ
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Talat R, Speth MM, Gengler I, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Chronic Rhinosinusitis Patients With and Without Polyps Experience Different Symptom Perception and Quality of Life Burdens. Am J Rhinol Allergy 2020; 34:742-750. [DOI: 10.1177/1945892420927244] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective We sought to determine if chronic rhinosinusitis (CRS) patients with nasal polyps (CRSwNP) differentially perceived CRS symptom burden compared to patients without nasal polyps (CRSsNP) and to what extent CRS symptom severity was associated with quality of life (QOL) and patient-reported symptom control in the 2 groups. Methods A total of 600 patients (266 CRSwNP and 334 CRSsNP) presenting with CRS were recruited. CRS symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). SNOT-22 nasal, sleep, ear/facial discomfort, and emotional subdomain scores were calculated. General health-related QOL was assessed with the visual analog scale of the 5-dimensional EuroQol questionnaire (EQ-5D VAS). Patients rated their CRS symptom control on a 5-point scale. Results SNOT-22 scores did not differ between CRSwNP (mean: 35.6) and CRSsNP (mean: 36.3). There were no differences in nasal, sleep, and emotional subdomains of the SNOT-22. CRSsNP had higher ( P = .003) ear/facial subdomain scores than CRSwNP, while CRSwNP reported greater hyposmia ( P < .001). EQ-5D VAS was significantly lower ( P = .011) in CRSsNP (mean: 68.9) compared to CRSwNP (mean: 73.2). However, CRSwNP patients reported significantly less symptom control, compared to CRSsNP, in association with nasal and emotional symptoms. Conclusion CRSwNP and CRSsNP have differences in symptom profile, effect on health-related QOL, and patient-perceived symptom control. CRSsNP experience significantly greater burden of ear/facial discomfort, while CRSwNP report greater hyposmia. Although CRSsNP reports lower general health-related QOL overall, CRSwNP patients had lower levels of CRS symptom control for every incremental increase in symptom burden suggesting greater sensitivity/intolerance to CRS symptoms.
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Affiliation(s)
- Rehab Talat
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marlene M. Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Isabelle Gengler
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katie M. Phillips
- Department of Otolaryngology—Head and Neck Surgery, Stanford University, Stanford, California
| | - 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—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Ho J, Alvarado R, Rimmer J, Sewell WA, Harvey RJ. Atopy in chronic rhinosinusitis: impact on quality of life outcomes. Int Forum Allergy Rhinol 2019; 9:501-507. [PMID: 30604578 DOI: 10.1002/alr.22272] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS), in particular with nasal polyps (CRSwNP), has been linked with skewed T-helper 2 and immunoglobulin E (IgE)-mediated allergic responses. The role of atopy in CRS, however, remains unclear. Correlations between immunological allergic markers and patient-reported outcomes measures (PROMs) were investigated. METHODS A cross-sectional study of adult patients with CRS undergoing endoscopic sinus surgery was conducted. Immunological allergic markers included automated immunoassay testing for serum-specific IgE to common allergens (house dust mite, grass, mold, animal epithelia) and total IgE. PROMs were assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). Patients were defined as atopic based on either a positive specific IgE or elevated total IgE (>160 kU/L). RESULTS A total of 446 patients (45.7% female, age 49.05 ± 14.96 years) were recruited, of which 42.8% had asthma, 51.6% had CRSwNP, and 63.0% had eosinophilic CRS. Positive allergen sensitization was detected in 52.9% patients. Total IgE levels were elevated in 28.0% with mean IgE level of 161 ± 269 kU/L. Atopy was associated with younger age at the time of surgery, CRSwNP, asthma, and eosinophilic CRS (eCRS). Atopy was also associated with increased severity in nasal symptom score (13.1 ± 6.4 vs 11.9 ± 6.0, p = 0.04), as well as worse scores in the loss of smell/taste (χ2 (1) = 5.97, p = 0.02) and need to blow nose (χ2 (1) = 4.26, p = 0.04) questions in the CRS population. In the CRSwNP population, there was no significant association between atopy and PROMs. CONCLUSION Comorbid atopy in CRS is associated with additional symptom burden, reflected mainly within the nasal symptom quality of life markers. Atopy assessment in CRS is important to ensure appropriate and successful treatment of the disease.
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Affiliation(s)
- Jacqueline Ho
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Woolcock Institute, University of Sydney, Sydney, Australia.,Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - William A Sewell
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Immunology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Hull BP, Chandra RK. Refractory Chronic Rhinosinusitis with Nasal Polyposis. Otolaryngol Clin North Am 2017; 50:61-81. [PMID: 27888916 DOI: 10.1016/j.otc.2016.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents a subset of chronic sinusitis with various causes. Some forms of the disease are driven by allergy, often in association with asthma. Refractory CRSwNP can be associated with cystic fibrosis and other clinical syndromes. More recent literature is presented regarding roles of innate immunity and superantigens. Effective treatment of CRSwNP requires careful endoscopic sinus surgery followed by an individualized treatment plan that often includes oral and topical steroids. Recidivism of polyps is common, and patients require long-term follow-up.
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Affiliation(s)
- Benjamin P Hull
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA.
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Abstract
A high rate of ENT doctors were murdered by nasal disordered patients in China recently. It is obviously important and urgent to find out whether there is any potential relationship between nasal diseases (ND) and psychological distress that might contribute to violent behavior. For this purpose, we carried out this literature review. There is a complex relationship between ND and psychiatric distress, which is mainly considered as a bidirectional causal relationship with other controversy opinions. However, most of the previous studies were found to be focused on allergic rhinitis and chronic rhinosinusitis, while reports about other ND were rare. Further study is still needed to uncover the secret aspects in this field, and more attentions need to be paid to other ND.
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Affiliation(s)
- Deping Wang
- a Department of Otorhinolaryngology-Head and Neck Surgery , The Second Affiliated Hospital of Chongqing Medical University , Chongqing 400010 , China
| | - Wenlong Luo
- a Department of Otorhinolaryngology-Head and Neck Surgery , The Second Affiliated Hospital of Chongqing Medical University , Chongqing 400010 , China
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9
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Dávila I, Rondón C, Navarro A, Antón E, Colás C, Dordal MT, Ibáñez MD, Fernández-Parra B, Lluch-Bernal M, Matheu V, Montoro J, Sánchez MC, Valero A. Aeroallergen sensitization influences quality of life and comorbidities in patients with nasal polyposis. Am J Rhinol Allergy 2013; 26:e126-31. [PMID: 23168143 DOI: 10.2500/ajra.2012.26.3792] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal polyposis (NP) is a chronic inflammatory disease of unknown etiology that impairs quality of life (QoL). The role of atopy in NP is not established. The aim of this study was to describe the clinical characteristics and QoL in a broad sample of patients with NP and to evaluate the influence of allergy on this disease. METHODS A multicenter, observational, cross-sectional study was conducted in 67 allergy units in Spain. NP and nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity were diagnosed following EP(3)OS guidelines. Rhinitis and asthma were classified following Allergic Rhinitis and Its Impact on Asthma and the Global Initiative for Asthma guidelines, respectively. Skin tests with a battery of aeroallergens were performed on all patients. A visual analog scale (VAS) and Short-Form 12 (SF-12) and 31-item Rhinosinusitis Outcome Measure (RSOM 31) questionnaires were completed by all the patients. RESULTS Of the 671 patients included, 611 were evaluable. Mean age was 46 years and 50% of patients were men. Also, 50% were atopic. Asthma was present in 66% of patients and NSAID hypersensitivity was present in 26%. The most frequent symptoms were nasal congestion and rhinorrhea. Mean value of VAS was 58.6. Global health and bodily pain were the items most frequently identified in the SF-12 questionnaire and nasal and ocular symptoms in the RSOM-31 questionnaire. There was a good correlation between VAS score and QoL (p < 0.0001). Rhinitis was more severe in nonallergic patients. Asthma was more frequent in atopic patients, whereas ASA triad was more frequent in nonatopic patients. Atopic patients showed higher VAS scores and worse QoL. CONCLUSION Atopic NP patients showed worse QoL, higher incidence of asthma and a less severe form of rhinitis than non-atopic patients.
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Affiliation(s)
- Ignacio Dávila
- Allergy Service, University Hospital of Salemanca, Spain.
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Mullol J, Picado C. Rhinosinusitis and nasal polyps in aspirin-exacerbated respiratory disease. Immunol Allergy Clin North Am 2012; 33:163-76. [PMID: 23639706 DOI: 10.1016/j.iac.2012.11.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The presence of aspirin-exacerbated respiratory disease (AERD) in a patient with chronic rhinosinusitis with nasal polyps and asthma is associated with severe eosinophilic upper and lower airway disease. This article deals with the inflammatory disease of the respiratory tract as it relates to the sinuses. Involvement of the sinuses in AERD is almost universal, depending on the stage of onset of the disease and evaluation by computed tomography. This article explores the clinical aspects, physiopathology, and treatment of rhinosinusitis as it relates to AERD.
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Affiliation(s)
- Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, University of Barcelona, Barcelona, Catalonia, Spain.
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11
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Contreras JI, Ferguson BJ, Wang EW, Lee S. The Role of Allergy Therapy in Chronic Rhinosinusitis: A Systematic Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2012. [DOI: 10.1007/s40136-012-0001-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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12
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Ehnhage A, Olsson P, Kölbeck KG, Skedinger M, Stjärne P. One year after endoscopic sinus surgery in polyposis: asthma, olfaction, and quality-of-life outcomes. Otolaryngol Head Neck Surg 2012; 146:834-41. [PMID: 22287580 DOI: 10.1177/0194599811435638] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Nasal polyposis is a disease known to be associated with asthma. The long-term effects of surgical treatment on lower airways have not been sufficiently studied. STUDY DESIGN One-year follow-up of a double-blind, randomized, placebo-controlled study. SETTING The study was conducted at the Karolinska University Hospital, Stockholm, Sweden. SUBJECTS AND METHODS Fifty-one patients, age 18 years or older, with nasal polyposis and asthma were evaluated 1 year after endoscopic sinus surgery (ESS). Outcomes included dyspnea/cough scores, mean daily peak expiratory flow rate, spirometry, butanol test, olfaction scores, peak nasal inspiratory flow, polyp scores, and health-related quality of life (SF-36). RESULTS The short-term postsurgery improvements in asthma symptom scores, daily peak expiratory flow rate, all nasal parameters including olfaction, and quality-of-life scores were generally maintained 1 year after ESS. CONCLUSION Endoscopic sinus surgery had beneficial long-term effects on asthma, olfaction, and quality of life in patients with nasal polyposis. This is the first study to show long-term benefits of ESS on butanol tests in patients with nasal polyposis.
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Affiliation(s)
- Anders Ehnhage
- Department of Clinical Science, Intervention and Technology, Division of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden.
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Marple BF. Allergic rhinitis and inflammatory airway disease: interactions within the unified airspace. Am J Rhinol Allergy 2011; 24:249-54. [PMID: 20819460 DOI: 10.2500/ajra.2010.24.3499] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Allergic rhinitis (AR), the most common chronic allergic condition in outpatient medicine, is associated with immense health care costs and socioeconomic consequences. AR's impact may be partly from interacting of respiratory conditions via allergic inflammation. This study was designed to review potential interactive mechanisms of AR and associated conditions and consider the relevance of a bidirectional "unified airway" respiratory inflammation model on diagnosis and treatment of inflammatory airway disease. METHODS MEDLINE was searched for pathophysiology and pathophysiological and epidemiologic links between AR and diseases of the sinuses, lungs, middle ear, and nasopharynx. RESULTS Allergic-related inflammatory responses or neural and systemic processes fostering inflammatory changes distant from initial allergen provocation may link AR and comorbidities. Treating AR may benefit associated respiratory tract comorbidities. Besides improving AR outcomes, treatment inhibiting eosinophil recruitment and migration, normalizing cytokine profiles, and reducing asthma-associated health care use in atopic subjects would likely ameliorate other upper airway diseases such as acute rhinosinusitis, chronic rhinosinusitis (CRS) with nasal polyposis (NP), adenoidal hypertrophy, and otitis media with effusion. CONCLUSION Epidemiological concordance of AR with several airway diseases conforms to a bidirectional "unified airway" respiratory inflammation model based on anatomic and histological upper and lower airway connections. Epidemiology and current understanding of inflammatory, humoral, and neural processes make links between AR and disorders including asthma, otitis media, NP, and CRS plausible. Combining AR with associated conditions increases disease burden; worsened associated illness may accompany worsened AR. AR pharmacotherapies include antihistamines, leukotriene antagonists, intranasal corticosteroids, and immunotherapy; treatments attenuating proinflammatory responses may also benefit associated conditions.
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Affiliation(s)
- Bradley F Marple
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center at Dallas, Dallas, Texas 75390-9035, USA.
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Bella Z, Kadocsa E, Kemény L, Koreck A. Narrow-band UVB phototherapy of nasal polyps: results of a pilot study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2010; 100:123-7. [PMID: 20566294 DOI: 10.1016/j.jphotobiol.2010.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 04/22/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
Abstract
Nasal polyposis (NP) is characterized by high recurrence rate despite medical and/or surgical treatment. The major mechanism of action of ultraviolet B light (UVB) is induction of apoptosis in inflammatory cells. Therefore phototherapy may represent a new therapeutic approach in NP. A pilot feasibility study was performed to assess the tolerability and clinical efficacy of UVB phototherapy in NP. Thirteen subjects with bilateral grade 1-3 NP were enrolled in an open-labeled prospective pilot study. Patients were exposed to gradually increasing doses of UVB light over a 12 week period (3 exposures/week). Subjects rated their nasal obstruction symptom scores weekly on a visual analogue scale from 0 to 6. The NOSE quality of life questionnaire was used at baseline and end of treatment period. Adverse events were monitored by endoscopy. Ten subjects completed the study. Nasal obstruction symptom scores and quality of life (NOSE) improved at end of treatment compared to baseline. Treatments were well tolerated and no device related adverse events were reported. The results suggest that phototherapy may represent a potential new treatment option in nasal polyps.
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Affiliation(s)
- Zsolt Bella
- Department of Otolaryngology, Head and Neck Surgery, University of Szeged, Hungary
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15
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Mortuaire G, Vandeville S, Chevalier D. Psychometric evaluation of the SinoNasal Outcome Test-16 for quality of life in chronic rhinosinusitis with nasal polyps. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127:91-6. [DOI: 10.1016/j.anorl.2010.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Min YG. The pathophysiology, diagnosis and treatment of allergic rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2010; 2:65-76. [PMID: 20358020 PMCID: PMC2846743 DOI: 10.4168/aair.2010.2.2.65] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/27/2022]
Abstract
Treatment of AR requires a stepwise approach depending on the severity and duration of symptoms. Treatment options for AR consist of allergen avoidance, pharmacotherapy, immunotherapy and surgery. For the mechanisms of AR, anti-IgE antibody and specific antibody to cytokines such as IL-4 or IL-5 that correlate with allergic inflammation have recently emerged. SLIT is currently widely used due to its efficacy, safety and convenience, which replaces subcutaneous immunotherapy. Although allergen avoidance and immunotherapy are theoretically ideal, antihistamines and intranasal corticosteroids will play the main role in the management of AR until an innovative treatment develops. However, patients' main symptom, the duration and severity of AR, patients' compliance, safety of medication and cost-effectiveness should be considered when treatment options are chosen. In conclusion, physicians should be aware of etiology, pathophysiology, symptoms, signs and diseases related to AR in order to make a correct diagnosis and choose a proper treatment option for each patient.
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Affiliation(s)
- Yang-Gi Min
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
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Alobid I, Bernal-Sprekelsen M, Mullol J. Chronic rhinosinusitis and nasal polyps: the role of generic and specific questionnaires on assessing its impact on patient's quality of life. Allergy 2008; 63:1267-79. [PMID: 18782106 DOI: 10.1111/j.1398-9995.2008.01828.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chronic rhinosinusitis (CRS) including nasal polyps is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses of its cause, remains poorly understood. Primary symptoms are nasal blockage, loss of smell, rhinorrhea, and facial pain or pressure. Chronic rhinosinusitis causes significant physical symptoms, has a negative impact on quality of life (QoL), and can substantially impair daily functioning. A global evaluation of patients must include, together with nasal symptoms, nasal endoscopy, and CT scan, the measurement of QoL. To assess QoL in CRS, specific and generic questionnaires may be used. Chronic rhinosinusitis has a considerable impact on a patient's QoL but comorbidities, such as asthma and atopy, have an accumulative negative effect. Both medical and surgical treatments lead to a similar improvement on the QoL of CRS and nasal polyp patients.
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Affiliation(s)
- I Alobid
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i Universitari, Barcelona, Spain
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3035] [Impact Index Per Article: 189.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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Erbek SS, Erbek S, Topal O, Cakmak O. The role of allergy in the severity of nasal polyposis. ACTA ACUST UNITED AC 2008; 21:686-90. [PMID: 17883886 DOI: 10.2500/ajr.2007.21.3062] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although patients with nasal polyposis frequently exhibit concomitant allergy, there is limited information about the impact of allergy on the severity of nasal polyposis. The goal of this study was to evaluate the role of allergy in the severity of nasal polyposis. METHODS Polyp sizes, computed tomography (CT) scores, skin-prick test results, blood total eosinophil count, serum levels of total immunoglobulin E, symptom scores, and recurrences were analyzed in 83 patients with nasal polyposis. The results were compared between allergic and nonallergic patients with nasal polyposis. RESULTS No association was found between the presence of allergy per skin-prick testing and polyp size, CT opacification, symptom scores, or recurrences (p > 0.05). In allergic patients, only the serum total eosinophil count correlated strongly with the results of CT (p = 0.005) but not with other parameters (p > 0.05). CONCLUSIONS The results of this study show that, although patients with nasal polyposis frequently have allergies, the presence of allergy does not correlate with polyp size, symptom scores or rate of recurrence.
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Affiliation(s)
- Selim S Erbek
- Department of Otolaryngology, Baskent University Faculty of Medicine, Ankara, Turkey.
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Bibliography. Current world literature. Nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 2007; 15:48-55. [PMID: 17211184 DOI: 10.1097/moo.0b013e32802e6d9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Erbek SS. Correlation of atopy and sinus opacification in patients with nasal polyposis. Otolaryngol Head Neck Surg 2007; 135:994; author reply 994-5. [PMID: 17141107 DOI: 10.1016/j.otohns.2006.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 07/12/2006] [Indexed: 11/30/2022]
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Editorial Comment. J Urol 2007. [DOI: 10.1016/j.juro.2006.08.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Alobid I, Guilemany JM, García-Piñero A, Mullol J. Severe nasal polyposis and its impact on sinus opacification. Otolaryngol Head Neck Surg 2006. [DOI: 10.1016/j.otohns.2006.07.016] [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]
Affiliation(s)
- Isam Alobid
- Department of Otorhinolaryngology (ICEMEQ) Hospital Clínic, Barcelona, Spain
| | | | | | - Joaquim Mullol
- Department of Otorhinolaryngology (ICEMEQ) Hospital Clínic, Barcelona, Spain
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