Stimulation of dispersed nasal polyp cells by hyperosmolar solutions

Effectiveness of pediatric nasal irrigation solution with or without xylitol

OBJECTIVES

/Hypothesis: The aim of this study was to compare the efficacy and outcome of daily hypertonic saline irrigation versus saline/xylitol for treating pediatric chronic rhinosinusitis (CRS).

STUDY DESIGN

This was a prospective, randomized, single-blinded study.

METHODS

One hundred and twenty-five children diagnosed with CRS were enrolled in this study. The patients were randomized to twice-daily hypertonic irrigations with saline or saline/xylitol for 6 weeks. The treatment outcomes were measured using: Sinonasal Quality of Life Survey (SN-5) completed at baseline and after 6 weeks of irrigation.

RESULTS

There were statistically significant improvements in the hypertonic nasal saline group's (reduction in SN-5 domain scores) four domains and an increase in the overall QoL score within each group after 6 weeks of treatment compared to baseline; however, there were no differences in the activity limitation (p = 0.1803). The xylitol solution groups had no differences between the two groups in the SN-5 scores in any of the domains or the overall score at baseline, and post irrigation treatment.

CONCLUSIONS

Due to low tolerance, compliance, and the side effects, xylitol irrigation is not recommended as a first-line treatment for pediatric CRS. The use of a large volume of low pressure, twice-daily intranasal hypertonic irrigation for 6 weeks is safe and effective in the treatment of pediatric CRS; therefore, it can be used as a baseline treatment for pediatric CRS before considering surgical interventions.

Comparison of nasal hyperosmolar xylitol and xylometazoline solutions on quality of life in patients with inferior turbinate hypertrophy secondary to nonallergic rhinitis

BACKGROUND

The purpose of this study was to objectively determine and compare the efficacy and effectiveness of xylitol solution (Xlear Nasal Sprey®) compared with xylometazoline and physiological saline with respect to quality of life (QoL) in patients with nasal congestion.

METHODS

A prospective, randomized study was performed in 42 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. The study population was randomized into 3 groups according to the application of xylometazoline, physiological saline, and xylitol hyperosmolar solution. The efficacy of treatment was evaluated objectively (4-phase rhinomanometry) and subjectively (visual analogue scale VAS.) before and after the application of the nasal solutions. QoL was evaluated by means of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).

RESULTS

VAS scores and 4-phase rhinomanometry scores were better in the group treated with xylometazoline compared to those treated with xylitol or saline. The xylitol procedure yielded better results than the saline procedure, but differences were not statistically significant in both objective and subjective evaluation methods. For overall QoL, there was a significant improvement from baseline for the xylometazoline and xylitol groups. However, the improvement in the xylometazoline group was significantly greater than that obtained in the xylitol group.

CONCLUSION

Xlear Nasal Spray® is an effective modality in the treatment of nasal congestion and has positive effect on the QoL of patients. Further studies are needed in order to plan an ongoing treatment of Xlear Nasal Sprey® at certain intervals for continuous relief of symptoms and a better and longstanding QoL.

Oxidative stress status in umbilical cord blood from neonates born to mothers with atopic asthma

OBJECTIVE

Our objective was to assess the oxidative stress status and analyse the relationship between an oxidant/antioxidant imbalance and the mediator release properties of cord blood basophils from neonates born to mothers with atopic asthma.

METHODS

Cord blood was collected from the neonates of 16 asthmatic mothers and 18 healthy mothers Basophils were purified and stimulated by Dermatophagoides farinae (Df), hyperosmotic mannitol or peptidoglycan (PGN). Immunoblotting detected nuclear factor κB (NFκB) as a measure of functional receptor response. The linear correlations between IL-4 levels in the supernatants and 3-nitrotyrosine (3-NT), glutathione peroxidase (GSH-Px) in the serum were evaluated.

RESULTS

Compared with the healthy group, the levels of 3-NT in maternal blood and cord blood were significantly higher in allergic asthma group, whereas the GSH-Px activity were lower. After stimulation, cord blood basophils from the neonates born to atopic mothers produced more IL-4 involving NF-κB pathways. There was a significant relationship between the IL-4 levels produced by basophils and 3-NT (or GSH-Px) in cord blood from allergic asthma group.

CONCLUSION

In asthma, mediator release properties of human basophils induced by environmental allergens and irritants are associated with oxidative stress, which may be one of the pathogenesis of allergic diseases.

Release of inflammatory mediators from eosinophils following a hyperosmolar stimulus

Airway dehydration and subsequent hyperosmolarity of periciliary fluid are considered critical events in exercise-induced bronchoconstriction (EIB). It has been shown that an in vitro hyperosmolar stimulation of basophils and mast cells with mannitol can induce the release of histamine and leukotrienes. The aim of this study was to establish if a hyperosmolar challenge could trigger activation of eosinophils to release chemokines and lipid mediators. Peripheral blood eosinophils were isolated from seven asthmatic and six non-asthmatic subjects. Hyperosmolar stimulation of eosinophils with mannitol (0.7 M), resulted in a significant increase in LTC4 levels compared to baseline in both asthmatic (15.2+/-4.6 vs. 70.1+/-9.5; P = 0.0002) and control subjects (14.3+/-4.0 vs. 55.6+/-5.6; P = 0.0001). ECP levels did not increase significantly above baseline following mannitol stimulation in either group. This study shows that eosinophils can be activated by a hyperosmolar stimulus. Therefore it seems reasonable to suggest that eosinophils could contribute to EIB.

Nasal hyperosmolar challenge with a dry powder of mannitol in patients with allergic rhinitis. Evidence for epithelial cell involvement

BACKGROUND

The responses to airway hyperosmolar challenges probably involve various inflammatory mediators. However, it is not fully understood which cell type/types are the source of these mediators. Potential cell types include mast cell, epithelial cell and the sensory c-fibre nerve cell.

OBJECTIVE

To clarify which cell types are involved with the mediator response to hyperosmolarity in the human airway.

METHODS

Ten healthy subjects, 11 patients with nonactive allergic rhinitis, and nine with active allergic rhinitis were challenged intranasally with mannitol powder, and with sham provocation, on separate days. Symptoms were assessed by visual analogue scales and nasal patency by measuring the nasal peak inspiratory flow (nPIF). Nasal lavage fluid levels of alpha(2)-macroglobulin (an index of plasma extravasation), substance P (an index of sensory nerve cell activation), tryptase (an index of mast cell activation) and 15-hydroxyeicosatetraenoic acid (15-HETE, an index of epithelial cell activation) were analysed.

RESULTS

Immediate, although transient burning was the most prominent symptom in all groups whereas only the patients with active rhinitis experienced a fall in nPIF. Mannitol significantly increased the nasal lavage fluid 15-HETE levels in the allergic patients (P < 0.01 vs the sham challenge), but not in the healthy subjects. The increase in 15-HETE correlated with nasal symptoms for itching (r(s) = 0.65, P = 0.019) and burning (r(s) = 0.72, P = 0.009). Detectable levels of tryptase was found only in five allergic subjects. Lavage levels of substance P and alpha(2)-macroglobulin did not not change.

CONCLUSION

Epithelial cell seems to be involved with the mediator response to airway hyperosmolar challenge. The roles of sensory c-fibre nerve cell and mast cell remained less clear.

Selective stimulation of jugular ganglion afferent neurons in guinea pig airways by hypertonic saline

We evaluated the ability of hyperosmolar stimuli to activate afferent nerves in the guinea pig trachea and main bronchi and investigated the neural pathways involved. By using electrophysiological techniques, studies in vitro examined the effect of hyperosmolar solutions of sodium chloride (hypertonic saline) on guinea pig airway afferent nerve endings arising from either vagal nodose or jugular ganglia. The data reveal a differential sensitivity of airway afferent neurons to activation with hypertonic saline. Afferent fibers (both A delta and C fibers) with cell bodies located in jugular ganglia were much more sensitive to stimulation with hypertonic saline, compared with afferent neurons with cell bodies located in nodose ganglia. Additional studies in vivo demonstrated that inhalation of aerosols of hypertonic saline induced plasma extravasation in guinea pig trachea that was mediated via tachykinin NK1 receptors. Identification of a differential sensitivity of guinea pig airway afferent nerves to hypertonic saline leads to the speculation that airway responses to hyperosmolar stimuli may result from activation of afferent neurons originating predominantly from the jugular ganglion.