1
|
Trevizan-Bau P, Mazzone SB. Neuroimmune pathways regulating airway inflammation. Ann Allergy Asthma Immunol 2023; 131:550-560. [PMID: 37517657 DOI: 10.1016/j.anai.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
Airways diseases are typically accompanied by inflammation, which has long been known to contribute to obstruction, mucus hypersecretion, dyspnea, cough, and other characteristic symptoms displayed in patients. Clinical interventions, therefore, often target inflammation to reverse lung pathology and reduce morbidity. The airways and lungs are densely innervated by subsets of nerve fibers, which are not only impacted by pulmonary inflammation but, in addition, likely serve as important regulators of immune cell function. This bidirectional neuroimmune crosstalk is supported by close spatial relationships between immune cells and airway nerve fibers, complementary neural and immune signaling pathways, local specialized airway chemosensory cells, and dedicated reflex circuits. In this article, we review the recent literature on this topic and present state-of-the-art evidence supporting the role of neuroimmune interactions in airway inflammation. In addition, we extend this evidence to synthesize considerations for the clinical translation of these discoveries to improve the management of patients with airway disease.
Collapse
Affiliation(s)
- Pedro Trevizan-Bau
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
2
|
Nishiyama H, Kanemitsu Y, Hara J, Fukumitsu K, Takeda N, Kurokawa R, Ito K, Tajiri T, Fukuda S, Uemura T, Ohkubo H, Maeno K, Ito Y, Oguri T, Takemura M, Niimi A. Bronchial thermoplasty improves cough hypersensitivity and cough in severe asthmatics. Respir Med 2023:107303. [PMID: 37307903 DOI: 10.1016/j.rmed.2023.107303] [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: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cough is a troublesome symptom of asthma because it is associated with disease severity and poor asthma control. Bronchial thermoplasty (BT) may be effective in improving cough severity and cough-related quality of life in severe uncontrolled asthma. OBJECTIVE To evaluate the efficacy of BT for cough in severe uncontrolled asthma. METHODS Twelve patients with severe uncontrolled asthma were enrolled in this study between 2018 May and March 2021 and arbitrarily divided into cough-predominant [cough severity Visual Analog Scale (VAS) ≥ 40 mm, n = 8] and typical asthma (cough VAS <40 mm, n = 4) groups. Clinical parameters, such as capsaicin cough sensitivity [C-CS: the concentrations to inhaled capsaicin required to induce at least two (C2) and five (C5) coughs], lung function, and type-2-related biomarkers (fractional nitric oxides and absolute eosinophil counts) and cough-related indices [cough severity VAS and the Leicester Cough Questionnaire (LCQ)] were evaluated before and 3 months after performing BT. RESULTS BT significantly improved both cough-related indices and C-CS in the cough-predominant group. Changes in C-CS were significantly correlated with changes in the LCQ scores (C5: r = 0.65, p = 0.02 for all patients, and r = 0.81, p = 0.01 for the cough-predominant group). CONCLUSIONS BT may be effective for cough in severe uncontrolled asthma by improving C-CS. However, further larger cohort studies are necessary to confirm the effect of BT for cough in asthma. CLINICAL TRIAL REGISTRATION This study was registered in the UMIN Clinical Trials Registry (Registry ID UMIN: 000031982).
Collapse
Affiliation(s)
- Hirono Nishiyama
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Johsuke Hara
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryota Kurokawa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keima Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomoko Tajiri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takehiro Uemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
3
|
Toy HI, Yildiz AB, Tasdemir Kahraman D, Ilhan S, Dikensoy O, Bayram H. Capsaicin suppresses ciliary function, while inducing permeability in bronchial epithelial cell cultures of COPD patients. Front Pharmacol 2022; 13:996046. [PMID: 36278231 PMCID: PMC9582664 DOI: 10.3389/fphar.2022.996046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022] Open
Abstract
Take Home Message: Capsaicin modified inflammatory response and caused toxicity in bronchial epithelial cultures from patients with COPD. More importantly, capsaicin decreased ciliary beat frequency and induced epithelial permeability and these effects were partially prevented by formoterol and roflumilast. Tear gas is widely used to halt mass demonstrations. Studies have reported its adverse effects on multiple organ systems; however, its effect on individuals with chronic respiratory diseases and the underlying mechanisms of these effects are unclear. For the first time in the literature, we investigated the effects of capsaicin, the active ingredient of tear gas, on bronchial epithelial cell (BEC) cultures obtained from well-characterized groups of nonsmokers, smokers, and patients with chronic obstructive pulmonary disease (COPD). BEC cultures were incubated with 50-500 μM capsaicin in the absence and presence of formoterol (1μM) and roflumilast (0.1 μM) for 24 h. Ciliary beat frequency (CBF) and transepithelial electrical resistance (TEER) were assessed at T1/4, T1/2, T1, T2, T4, T6, and T24 h, whereas the release of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-8, and lactate dehydrogenase (LDH) was measured at T24 h. Capsaicin (250 µM) significantly decreased CBF of all BEC cultures from T1/4 h to T24 h (p<0.05). Formoterol significantly prevented decreases in CBF induced by capsaicin. Higher concentrations of capsaicin (250-500 μM) significantly reduced TEER of BECs from nonsmokers (T2-T24 h), smokers (T24 h) and COPD patients (T2 and T24 h), which was partially prevented by roflumilast. Capsaicin (500 μM) decreased release of IL-8 (p<0.0001) and GM-CSF (p<0.05) while inducing release of LDH in BECs (p<0.05), and this was more prominent in BEC from patients with COPD. In conclusion, our findings demonstrate that capsaicin can suppress ciliary activity and cytokine release from BECs, induce BEC culture permeability and cellular toxicity and that these effects can be partially prevented by formoterol and roflumilast.
Collapse
Affiliation(s)
- Halil Ibrahim Toy
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Izmir Biomedicine and Genome Center, Izmir, Türkiye
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Türkiye
- Department of Epidemiology and Cancer Control, St. Jude Childrens Research Hospital, Memphis, TN, United States
| | | | - Demet Tasdemir Kahraman
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Gaziantep University, Faculty of Medicine, Department of Medical Biochemistry, Gaziantep, Türkiye
| | - Sedat Ilhan
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Gaziantep University, Institute of Health Sciences, Department of Respiratory Biology, Gaziantep, Türkiye
| | - Oner Dikensoy
- Department of Chest Diseases, Gaziantep University School of Medicine, Gaziantep, Türkiye
| | - Hasan Bayram
- Gaziantep University School of Medicine, Respiratory Research Laboratory, Gaziantep, Türkiye
- Department of Chest Diseases, Gaziantep University School of Medicine, Gaziantep, Türkiye
- Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Türkiye
- Koc University Research Centre for Translational Medicine (KUTTAM), Koç University, Istanbul, Türkiye
- *Correspondence: Hasan Bayram,
| |
Collapse
|
4
|
Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Ilgaz A, Uyanusta FÇK, Arbak P, Müezzinoğlu A, Çiftçi TU, Akpınar S, Fırat H, Güven SF, Çiftçi B, Karaoğlanoğlu S, Dağlı E, Erkan F. Extensive Exposure to Tear Gases in Ankara. Turk Thorac J 2019; 20:108-113. [PMID: 30958982 DOI: 10.5152/turkthoracj.2018.18096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The most common chemical substances used as mass control agents are chloroacetophenone, chlorobenzylidene malononitrile, and oleoresin capsicum. These agents not only have local and rapid effects but also have systemic and long-term effects. The aim of the present study was to discuss the patterns of tear gas exposure and to investigate its effects on respiratory functions. MATERIALS AND METHODS A face-to-face survey was conducted in 86 individuals who had been exposed to tear gas indoor and outdoor during the public protests in June 2013. RESULTS The most frequently reported respiratory complaints included cough, dyspnea, phlegm, and chest pain. Spirometry measurements including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were also performed. Indoor exposers have lower mean % predicted FVC and FEV1 values than outdoor exposers. All complaints and signs were more common in indoor exposure to tear gas than in outdoor exposure. CONCLUSION Safety of the chemicals used as mass control agents during protests is doubtful as these agents are associated with several health risks.
Collapse
Affiliation(s)
- Aslıhan Ilgaz
- Clinic of Pulmonary Diseases, Middle East Technical University, Medical Center, Ankara, Turkey
| | | | - Peri Arbak
- Department of Chest Diseases, Düzce University School of Medicine, Düzce, Turkey
| | - Arif Müezzinoğlu
- Ankara Chamber of Medical Doctors, Commission of Workers' Health and Occupational Physicians, Ankara, Turkey
| | - Tansu Ulukavak Çiftçi
- Department of Pulmonary Diseases, Gazi University School of Medicine, Ankara, Turkey
| | - Serdar Akpınar
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hikmet Fırat
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Selma Fırat Güven
- Sleep Disorders Center, Atatürk Chest Diseases, Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Bülent Çiftçi
- Department of Pulmonary Diseases, Bozok University School of Medicine, Yozgat, Turkey
| | - Selen Karaoğlanoğlu
- Department of Pulmonary Diseases, Ordu University School of Medicine, Ordu, Turkey
| | - Elif Dağlı
- Clinic of Child Chest Diseases, Acıbadem Fulya Hospital, İstanbul, Turkey
| | - Feyza Erkan
- Department of Pulmonary Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| |
Collapse
|
6
|
Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_23-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
7
|
Foster SL, Seehus CR, Woolf CJ, Talbot S. Sense and Immunity: Context-Dependent Neuro-Immune Interplay. Front Immunol 2017; 8:1463. [PMID: 29163530 PMCID: PMC5675863 DOI: 10.3389/fimmu.2017.01463] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/19/2017] [Indexed: 12/21/2022] Open
Abstract
The sensory nervous and immune systems, historically considered autonomous, actually work in concert to promote host defense and tissue homeostasis. These systems interact with each other through a common language of cell surface G protein-coupled receptors and receptor tyrosine kinases as well as cytokines, growth factors, and neuropeptides. While this bidirectional communication is adaptive in many settings, helping protect from danger, it can also become maladaptive and contribute to disease pathophysiology. The fundamental logic of how, where, and when sensory neurons and immune cells contribute to either health or disease remains, however, unclear. Our lab and others’ have begun to explore how this neuro-immune reciprocal dialog contributes to physiological and pathological immune responses and sensory disorders. The cumulative results collected so far indicate that there is an important role for nociceptors (noxious stimulus detecting sensory neurons) in driving immune responses, but that this is highly context dependent. To illustrate this concept, we present our findings in a model of airway inflammation, in which nociceptors seem to have major involvement in type 2 but not type 1 adaptive immunity.
Collapse
Affiliation(s)
- Simmie L Foster
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, United States.,Department of Neurobiology, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Depression Clinical Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Corey R Seehus
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, United States.,Department of Neurobiology, Harvard Medical School, Boston, MA, United States
| | - Clifford J Woolf
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, United States.,Department of Neurobiology, Harvard Medical School, Boston, MA, United States
| | - Sébastien Talbot
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
8
|
Abstract
Evolution has yielded multiple complex and complementary mechanisms to detect environmental danger and protect tissues from damage. The nervous system rapidly processes information and coordinates complex defense behaviors, and the immune system eliminates diverse threats by virtue of mobile, specialized cell populations. The two systems are tightly integrated, cooperating in local and systemic reflexes that restore homeostasis in response to tissue injury and infection. They further share a broad common language of cytokines, growth factors, and neuropeptides that enables bidirectional communication. However, this reciprocal cross talk permits amplification of maladaptive feedforward inflammatory loops that contribute to the development of allergy, autoimmunity, itch, and pain. Appreciating the immune and nervous systems as a holistic, coordinated defense system provides both new insights into inflammation and exciting opportunities for managing acute and chronic inflammatory diseases.
Collapse
Affiliation(s)
- Sébastien Talbot
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts 02115; .,Department of Neurobiology, Harvard Medical School, Boston, Massachusetts 02115
| | - Simmie L Foster
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts 02115; .,Department of Neurobiology, Harvard Medical School, Boston, Massachusetts 02115
| | - Clifford J Woolf
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts 02115; .,Department of Neurobiology, Harvard Medical School, Boston, Massachusetts 02115
| |
Collapse
|
9
|
Changani K, Hotee S, Campbell S, Pindoria K, Dinnewell L, Saklatvala P, Thompson SA, Coe D, Biggadike K, Vitulli G, Lines M, Busza A, Denyer J. Effect of the TRPV1 antagonist SB-705498 on the nasal parasympathetic reflex response in the ovalbumin sensitized guinea pig. Br J Pharmacol 2014; 169:580-9. [PMID: 23441756 DOI: 10.1111/bph.12145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 10/10/2012] [Accepted: 10/15/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Nasal sensory nerves play an important role in symptoms associated with rhinitis triggered by environmental stimuli. Here, we propose that TRPV1 is pivotal in nasal sensory nerve activation and assess the potential of SB-705498 as an intranasal therapy for rhinitis. EXPERIMENTAL APPROACH The inhibitory effect of SB-705498 on capsaicin-induced currents in guinea pig trigeminal ganglion cells innervating nasal mucosa was investigated using patch clamp electrophysiology. A guinea pig model of rhinitis was developed using intranasal challenge of capsaicin and hypertonic saline to elicit nasal secretory parasympathetic reflex responses, quantified using MRI. The inhibitory effect of SB-705498, duration of action and potency comparing oral versus intranasal route of administration were examined. KEY RESULTS SB-705498 concentration-dependently inhibited capsaicin-induced currents in isolated trigeminal ganglion cells (pIC50 7.2). In vivo, capsaicin ipsilateral nasal challenge (0.03-1 mM) elicited concentration-dependent increases in contralateral intranasal fluid secretion. Ten per cent hypertonic saline initiated a similar response. Atropine inhibited responses to either challenge. SB-705498 inhibited capsaicin-induced responses by ∼50% at 10 mg·kg⁻¹ (oral), non-micronized 10 mg·mL⁻¹ or 1 mg·mL⁻¹ micronized SB-705498 (intranasal) suspension. Ten milligram per millilitre intranasal SB-705498, dosed 24 h prior to capsaicin challenge produced a 52% reduction in secretory response. SB-705498 (10 mg·mL⁻¹, intranasal) inhibited 10% hypertonic saline responses by 70%. CONCLUSIONS AND IMPLICATIONS The paper reports the development of a guinea pig model of rhinitis. SB-705498 inhibits capsaicin-induced trigeminal currents and capsaicin-induced contralateral nasal secretions via oral and intranasal routes; efficacy was optimized using particle-reduced SB-705498. We propose that TRPV1 is pivotal in initiating symptoms of rhinitis.
Collapse
Affiliation(s)
- Kumar Changani
- Platform Technology and Science, GlaxoSmithKline, Stevenage, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Fabbri NZ, Abib E, de Lima Zollner R. Azelastine and budesonide (nasal sprays): Effect of combination therapy monitored by acoustic rhinometry and clinical symptom score in the treatment of allergic rhinitis. ALLERGY & RHINOLOGY 2014; 5:78-86. [PMID: 24988550 PMCID: PMC4124582 DOI: 10.2500/ar.2014.5.0089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to objectively evaluate the effects of intranasal therapy with azelastine (AZE), budesonide (BUD), and combined AZE plus BUD (AZE/BUD) using a nasal provocation test (NPT) and acoustic rhinometry in patients with allergic rhinitis. A randomized, single-blind, crossover study with three treatment sequences was used. Thirty patients with persistent AR received the three treatments using a nasal spray twice daily for 30 days and were evaluated by an NPT with histamine before and after each period of treatment. The treatment comparison, assessed by the nasal responsiveness to histamine, was monitored based on subjective (symptom score) and objective parameters (acoustic rhinometry). The minimal cross-area 2 (MCA2) was measured by acoustic rhinometry at 1, 4, 8, and 12 minutes after NPT for each histamine concentration administered (0.5, 1, 2, 4, and 6 mg/mL) up to at least a 20% reduction in the MCA2 from baseline (NPT20). The subjects were scored regarding nasal response encompassing histamine dose and time after histamine administration that caused nasal obstruction (NPT20 score) to assess the treatments' effects. Combination therapy produced a significant increase in baseline MCA2, viz., the improvement of nasal patency (p = 0.005). The symptoms score was significantly decreased after treatment with AZE (p = 0.03), BUD (p < 0.0001), and AZE/BUD (p < 0.0001), compared with pretreatment. The NPT20 score was significantly higher (p = 0.0009) after AZE/BUD, compared with AZE and BUD on their own. Thus, AZE therapy combined with BUD might provide more therapeutic benefits than the isolated drugs for improving nasal patency.
Collapse
Affiliation(s)
- Natalia Zanellato Fabbri
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Sao Paulo, Brazil
| | | | | |
Collapse
|
11
|
Analysis of acute impact of oleoresin capsicum on rat nasal mucosa using scanning electron microscopy. Eur Arch Otorhinolaryngol 2014; 272:9-13. [PMID: 24627077 DOI: 10.1007/s00405-014-2987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/25/2014] [Indexed: 11/27/2022]
Abstract
Analysis of acute cellular changes seen in nasal mucosa of Wistar-Albino rats exposed to different doses of oleoresin capsicum for various time periods by means of scanning electron microscopy. Thirty-five Wistar-Albino rats were divided into five groups of seven rats each. 6-gram oleoresin capsicum per second was sprayed into cages of the groups except group 1. Spray times and duration of exposure to pepper gasses were different for each group. Thirty minutes after the exposure, the animals were killed and specimens from their nasal mucosas were harvested and examined under scanning electron microscope. Mucosal damage was scored from 0-4 points. Mean values of nasal mucosa damage scores of the groups were calculated and compared statistically. Average damage scores of the groups exposed to identical doses of oleoresin capsicum for various exposure times were compared and a statistically significant difference was seen between Groups 2 and 3 (p < 0.05), however the difference between Groups 4 and 5 was insignificant (p > 0.05). Average damage scores of the groups exposed to various doses for identical exposure times were compared, and statistically significant differences were observed between Groups 2 and 4 and also Groups 3 and 5 (p < 0.05). Outcomes of our study have demonstrated that pepper gas exerts destructive changes on rat nasal mucosa. The extent of these destructive changes increases with the prolonged exposure to higher doses. Besides, exposure time also stands out as an influential factor on the extent of the destructive changes.
Collapse
|
12
|
Undem BJ, Taylor-Clark T. Mechanisms underlying the neuronal-based symptoms of allergy. J Allergy Clin Immunol 2014; 133:1521-34. [PMID: 24433703 DOI: 10.1016/j.jaci.2013.11.027] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/05/2013] [Accepted: 11/13/2013] [Indexed: 12/13/2022]
Abstract
Persons with allergies present with symptoms that often are the result of alterations in the nervous system. Neuronally based symptoms depend on the organ in which the allergic reaction occurs but can include red itchy eyes, sneezing, nasal congestion, rhinorrhea, coughing, bronchoconstriction, airway mucus secretion, dysphagia, altered gastrointestinal motility, and itchy swollen skin. These symptoms occur because mediators released during an allergic reaction can interact with sensory nerves, change processing in the central nervous system, and alter transmission in sympathetic, parasympathetic, and enteric autonomic nerves. In addition, evidence supports the idea that in some subjects this neuromodulation is, for reasons poorly understood, upregulated such that the same degree of nerve stimulus causes a larger effect than seen in healthy subjects. There are distinctions in the mechanisms and nerve types involved in allergen-induced neuromodulation among different organ systems, but general principles have emerged. The products of activated mast cells, other inflammatory cells, and resident cells can overtly stimulate nerve endings, cause long-lasting changes in neuronal excitability, increase synaptic efficacy, and also change gene expression in nerves, resulting in phenotypically altered neurons. A better understanding of these processes might lead to novel therapeutic strategies aimed at limiting the suffering of those with allergies.
Collapse
Affiliation(s)
- Bradley J Undem
- Division of Allergy & Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Md.
| | - Thomas Taylor-Clark
- Department of Molecular Pharmacology & Physiology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| |
Collapse
|
13
|
Singh U, Bernstein JA. Intranasal Capsaicin in Management of Nonallergic (Vasomotor) Rhinitis. CAPSAICIN AS A THERAPEUTIC MOLECULE 2014; 68:147-70. [PMID: 24941668 DOI: 10.1007/978-3-0348-0828-6_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
14
|
Nam YH, Jin HJ, Hwang EK, Shin YS, Ye YM, Park HS. Occupational rhinitis induced by capsaicin. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 4:104-6. [PMID: 22379606 PMCID: PMC3283791 DOI: 10.4168/aair.2012.4.2.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 08/19/2011] [Accepted: 08/24/2011] [Indexed: 11/20/2022]
Abstract
Capsaicin is the spice component of red pepper. It can be easily inhaled, inducing a reproducible cough and provokes a secretory response from the human nasal mucosa. To date, there has been no report of occupational rhinitis (OR) caused by capsaicin. We report the case of a 44-year-old female mill worker who developed occupational rhinitis after 4 years of exposure to capsaicin. She developed nasal congestion, rhinorrhea, and itchy nose, which were all aggravated upon exposure at the workplace. The patient had negative responses to all common inhalant allergens, including capsaicin, by skin prick tests. The nasal provocation test with capsaicin showed that the nasal symptom score and eosinophil count increased 10 minutes after the provocation and decreased after 1 to 3 hours; no significant response was noted to house dust mite allergen. The patient's work-related rhinitis improved 1 month after she relocated and started pharmacological treatment. To our knowledge, this is the first case of OR caused by capsaicin exposure in the workplace. We provide evidence suggesting that OR may be mediated by a non-immunological mechanism.
Collapse
Affiliation(s)
- Young-Hee Nam
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | | | | | | | | | | |
Collapse
|
15
|
Tamura T. Investigation of the antiallergic activity of olopatadine on rhinitis induced by intranasal instillation of antigen in sensitized rats using thermography. Asia Pac Allergy 2011; 1:138-44. [PMID: 22053310 PMCID: PMC3206240 DOI: 10.5415/apallergy.2011.1.3.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 06/22/2011] [Indexed: 11/14/2022] Open
Abstract
Background The main symptoms of allergic rhinitis (AR) are sneezing, rhinorrhea and nasal obstruction. It was reported that the nasal skin temperature after intranasal administration of histamine or grass pollen rose. In patients with AR, the levels of nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) have increased in nasal fluids and mucosa. Objective The present study were to determine the temperature changes of the nose in rat allergic rhinitis model, and if olopatadine, an antiallergic agent with histamine H1 receptor antagonistic action, proved to be effective, were studied the productions of NGF and VEGF in nasal lavage fluids (NALF). In the present study, we used ovalbumin (OVA)-sensitized rats as an animal model of nasal allergy and examined the effects of olopatadine on the skin temperature of the nose area, and the productions of NGF and VEGF in NALF. Methods The temperature changes of the nose area were carried out with thermo tracer in rat passively sensitized with OVA antiserum. The numbers of sneezing episodes were counted and, NGF and VEGF levels in NALF were examined using the specific ELISA. Results In OVA-sensitized rats, the number of sneezing episodes increase and the nasal skin temperature rise were provoked after OVA challenge. The levels of NGF and VEGF in NALF also were increased. Olopatadine reduced the increased frequency of sneezing and the nasal skin temperature rise. It also inhibited the increased NGF and VEGF productions in NALF. Conclusion The nasal skin temperature after OVA challenge rose even in OVA-sensitized rats. These results suggest that the suppression of the increased NGF and VEGF levels might partially be involved in the improvement of allergy-like behavior (sneezing and nasal skin temperature rise) by the treatment of olopatadine.
Collapse
Affiliation(s)
- Tadafumi Tamura
- Pharmacological Research Laboratories, Research Division, Kyowa Hakko Kirin Co., Ltd., Shizuoka 411-8731, Japan
| |
Collapse
|
16
|
Kushnir NM. The Role of Decongestants, Cromolyn, Guafenesin, Saline Washes, Capsaicin, Leukotriene Antagonists, and Other Treatments on Rhinitis. Immunol Allergy Clin North Am 2011; 31:601-17. [DOI: 10.1016/j.iac.2011.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
17
|
Scadding G, Hellings P, Alobid I, Bachert C, Fokkens W, van Wijk RG, Gevaert P, Guilemany J, Kalogjera L, Lund V, Mullol J, Passalacqua G, Toskala E, van Drunen C. Diagnostic tools in Rhinology EAACI position paper. Clin Transl Allergy 2011; 1:2. [PMID: 22410181 PMCID: PMC3294630 DOI: 10.1186/2045-7022-1-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/10/2011] [Indexed: 01/10/2023] Open
Abstract
This EAACI Task Force document aims at providing the readers with a comprehensive and complete overview of the currently available tools for diagnosis of nasal and sino-nasal disease. We have tried to logically order the different important issues related to history taking, clinical examination and additional investigative tools for evaluation of the severity of sinonasal disease into a consensus document. A panel of European experts in the field of Rhinology has contributed to this consensus document on Diagnostic Tools in Rhinology.
Collapse
|
18
|
Capsaicin-induced vasodilatation in human nasal vasculature is mediated by modulation of cyclooxygenase-2 activity and abrogated by sulprostone. Naunyn Schmiedebergs Arch Pharmacol 2011; 383:613-26. [PMID: 21523557 DOI: 10.1007/s00210-011-0638-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
Abstract
Extensively based on evidence gained from experimental animal models, the transient receptor potential vanilloid receptor type 1 (TRPV1)-activator capsaicin is regarded as a valuable tool in the research on neurogenic inflammation. Although capsaicin-related drugs gained renewed interest as a therapeutic tool, there is also controversy as whether neurogenic inflammation actually takes place in humans. In this study, we verified the involvement of capsaicin in vascular responses that are regarded to be implicated in the cascade of neurogenic inflammatory mechanisms. By means of ex vivo functional experiments on human nasal mucosal vascular beds, the effect and mechanism of action of capsaicin was assessed in the absence and presence of various agents that interfere with potentially related transduction pathways. Ten micromolars of capsaicin induced vasodilatations that were reduced by the selective EP(1) prostanoid receptor antagonist SC19220 (10 μM) and almost abolished by the selective COX-2 inhibitor NS398 (1 μM) and the EP(1/3) receptor agonist sulprostone (0.1-10 nM), but not affected by the TRPV1-antagonists capsazepine (5 μM), the neurokinin NK(1) receptor antagonist GR20517A (1 μM), and the calcitonin-gene-related peptide (CGRP) receptor antagonist CGRP8-37 (100 nM). Spontaneously released PGE(2) and PGD(2) levels were significantly reduced in the presence of capsaicin. In conclusion, capsaicin-at concentrations clinically applied or under investigation for diverse disease backgrounds-induces a vasodilatory response in human nasal mucosa via a mechanism involving TRPV1-independent reduction of PGE(2) production by modulation of COX-2 enzymatic activity. These vasodilatations can be suppressed by the EP(1/3) receptor agonist sulprostone at subnanomolar concentrations.
Collapse
|
19
|
Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2011. [DOI: 10.1007/978-3-642-03827-3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
20
|
Na L, Mao S, Wang J, Sun W. Comparison of different absorption enhancers on the intranasal absorption of isosorbide dinitrate in rats. Int J Pharm 2010; 397:59-66. [PMID: 20599486 DOI: 10.1016/j.ijpharm.2010.06.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 06/08/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
The objective of this work was to study the influence of different absorption enhancers on the intranasal absorption of isosorbide dinitrate (ISDN). First of all, an in situ nasal perfusion technique in rats was used to investigate the effect of pH, concentration of drug solution and different absorption enhancers on the intranasal absorption of ISDN. The absorption enhancers investigated include hydroxypropyl-beta-cyclodextrin (HP-beta-CD), chitosans (CS) of different molecular weight, and poloxamer 188. All of them enhanced the intranasal absorption of ISDN remarkably. It was found that poloxamer 188 had better permeation enhancing effect than that of HP-beta-CD and CS of the same concentration. Thereafter, in vivo behaviors of the selected formulations were studied in rats and the pharmacokinetic parameters were calculated and compared with that of intravenous injection. Both in situ and in vivo studies demonstrated that poloxamer 188 played a key role in promoting intranasal absorption of ISDN. In nasal ciliotoxicity test, all the absorption enhancers investigated showed good safety profiles. Taking both enhancing effect and safety into account, we suggest poloxamer 188 is the most promising as an intranasal absorption enhancer.
Collapse
Affiliation(s)
- Lidong Na
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China
| | | | | | | |
Collapse
|
21
|
Abstract
Histamine plays a major role in allergic rhinitis. In susceptible individuals, allergen induces nasal mast cell degranulation and the release of histamine into the nasal mucosa. Histamine has been detected after controlled challenges with allergen and, when administered into the nasal cavity, elicits signs and symptoms similar to those elicited by allergen. All four histamine receptors have been demonstrated in the nasal mucosa. The role of the four histamine receptors in the pathophysiology of allergic rhinitis are discussed.
Collapse
Affiliation(s)
- Thomas Taylor-Clark
- Department of Molecular Pharmacology and Physiology, School of Basic Biomedical Sciences, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, Florida 33612, USA.
| |
Collapse
|
22
|
Nathan RA. The pathophysiology, clinical impact, and management of nasal congestion in allergic rhinitis. Clin Ther 2008; 30:573-86. [PMID: 18498908 DOI: 10.1016/j.clinthera.2008.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nasal congestion is a cardinal symptom of allergic rhinitis (AR). It is difficult to treat and is associated with decreased quality of life. OBJECTIVE This article reviews the clinical features of nasal congestion, its complex pathophysiology in the context of AR, its clinical impact, and the strengths and weaknesses of available treatments. METHODS Primary studies and reviews in the peer-reviewed, English-language literature were identified through searches of MEDLINE (1966-2008) and the Cochrane Library (1996-2008) using the terms nasal congestion, allergic rhinitis, pathophysiology, quality of life, and burden. Additional references were obtained by searching the reference lists of the identified articles. Abstracts from the 2006 and 2007 meetings of the American Academy of Allergy, Asthma, and Immunology were also searched. Pertinent articles were included in the review if they were recently published and patient-focused, and if their authors were recognized leaders in the field. RESULTS A survey of 2355 patients with AR or their guardians found that almost half of respondents rated nasal congestion the most bothersome symptom; in a survey of 2500 adults with AR, 78% rated nasal congestion either extremely or moderately bothersome. Histamine and leukotrienes are major mediators of the allergic inflammation associated with nasal congestion, as indicated by reductions in nasal cross-sectional area in response to histamine challenge (P<0.001) and increases in nasal airway resistance in response to leukotriene challenge (P<0.05).Therapy for nasal congestion in AR is often hampered by limitations associated with the individual agents; for example, decongestants are effective in the control of nasal congestion, but their use is restricted by their adverse-event profiles. A meta-analysis of 16 controlled studies involving 2267 patients with AR found that intranasal corticosteroids provided significantly greater relief of nasal congestion than oral antihistamines (95% CI for combined standardized mean difference, -0.73 to -0.53). The results of several clinical trials have suggested that leukotriene-receptor antagonists may be associated with reduced nasal congestion; however, no agents in this class are currently approved for the treatment of nasal congestion in AR. CONCLUSION There is a need for therapies that are well tolerated and effective in relieving nasal congestion in AR.
Collapse
Affiliation(s)
- Robert A Nathan
- Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
| |
Collapse
|
23
|
Miyahara S, Miyahara N, Lucas JJ, Joetham A, Matsubara S, Ohnishi H, Dakhama A, Gelfand EW. Contribution of allergen-specific and nonspecific nasal responses to early-phase and late-phase nasal responses. J Allergy Clin Immunol 2007; 121:718-24. [PMID: 18155286 DOI: 10.1016/j.jaci.2007.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 11/02/2007] [Accepted: 11/05/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The relative contributions of the allergen-specific early-phase nasal response and nonspecific nasal response and mast cells to the pathophysiology of allergic rhinitis are not well defined. OBJECTIVES To determine the contributions of specific reactivity, nonspecific reactivity, and mast cells to the development of early-phase and late-phase responses using a mouse model of allergic rhinitis. METHODS Sensitized wild-type and FcvarepsilonRI-deficient (FcvarepsilonRI-/-) mice were exposed to allergen for 3, 5, or 12 days. As indicators of nasal reactivity, respiratory frequency and nasal resistance were monitored. RESULTS Sensitized mice exposed to 3 days of nasal allergen challenge showed a nonspecific early-phase response. As the number of allergen exposures increased, there was progressive diminution in nonspecific responses with increased allergen-specific early-phase responses and a late-phase response. Sensitized FcvarepsilonRI-/- mice did not develop nonspecific nasal responses or late-phase responses, but transfer of in vitro-differentiated wild-type mast cells into FcvarepsilonRI-/- mice restored nonspecific early-phase nasal responses but not the late-phase response. CONCLUSION These data identify the nonspecific nasal response as a major contributor to the early-phase response, especially during initial allergen exposure, and is dependent on mast cells. Increasing allergen exposure results in increasing allergen-specific responses, converting the nonspecific early-phase response to a late-phase response that is allergen-specific and mast cell-independent.
Collapse
Affiliation(s)
- Satoko Miyahara
- Division of Cell Biology, Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO 80206, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Nathan RA, Eccles R, Howarth PH, Steinsvåg SK, Togias A. Objective monitoring of nasal patency and nasal physiology in rhinitis. J Allergy Clin Immunol 2007; 115:S442-59. [PMID: 15746882 PMCID: PMC7112320 DOI: 10.1016/j.jaci.2004.12.015] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Nasal obstruction can be monitored objectively by measurement of nasal airflow, as evaluated by nasal peak flow, or as airways resistance/conductance as evaluated by rhinomanometry. Peak flow can be measured during inspiration or expiration. Of these measurements, nasal inspiratory peak flow is the best validated technique for home monitoring in clinical trials. The equipment is portable, relatively inexpensive, and simple to use. One disadvantage, however, is that nasal inspiratory peak flow is influenced by lower airway as well as upper airway function. Rhinomanometry is a more sensitive technique that is specific for nasal measurements. The equipment, however, requires an operator, is more expensive, and is not portable. Thus, it is applicable only for clinic visit measures in clinical trials. Measurements require patient cooperation and coordination, and not all can achieve repeatable results. Thus, this objective measure is best suited to laboratory challenge studies involving smaller numbers of selected volunteers. A nonphysiological measure of nasal patency is acoustic rhinometry. This sonic echo technique measures internal nasal luminal volume and the minimum cross-sectional area. The derivation of these measures from the reflected sound waves requires complex mathematical transformation and makes several theoretical assumptions. Despite this, however, such measures correlate well with the nasal physiological measures, and the nasal volume measures have been shown to relate well to results obtained by imaging techniques such as computed tomography scanning or magnetic resonance imaging. Like rhinomanometry, acoustic rhinometry is not suitable for home monitoring and can be applied only to clinic visit measures or for laboratory nasal challenge monitoring. It has advantages in being easy to use, in requiring little patient cooperation, and in providing repeatable results. In addition to nasal obstruction, allergic rhinitis is recognized to be associated with impaired mucociliary clearance and altered nasal responsiveness. Measures exist for the monitoring of these aspects of nasal dysfunction. Although measures of mucociliary clearance are simple to perform, they have a poor record of reproducibility. Their incorporation into clinical trials is thus questionable, although positive outcomes from therapeutic intervention have been reported. Measures of nasal responsiveness are at present largely confined to research studies investigating disease mechanisms in allergic and nonallergic rhinitis. The techniques are insufficiently standardized to be applied to multicenter clinical trials but could be used in limited-center studies to gain insight into the regulatory effects of different therapeutic modalities.
Collapse
MESH Headings
- Humans
- Monitoring, Immunologic/methods
- Nasal Mucosa/immunology
- Nasal Mucosa/pathology
- Nasal Obstruction/immunology
- Nasal Obstruction/pathology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/pathology
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/pathology
- Rhinomanometry
- Rhinometry, Acoustic
Collapse
Affiliation(s)
- Robert A Nathan
- Asthma and Allergy Associates, 2709 North Tejon, Colorado Springs, CO 80907, USA.
| | | | | | | | | |
Collapse
|
25
|
Nassenstein C, Kammertoens T, Veres TZ, Uckert W, Spies E, Fuchs B, Krug N, Braun A. Neuroimmune crosstalk in asthma: dual role of the neurotrophin receptor p75NTR. J Allergy Clin Immunol 2007; 120:1089-96. [PMID: 17716721 DOI: 10.1016/j.jaci.2007.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 06/21/2007] [Accepted: 07/09/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Neurotrophins have been implicated in the pathogenesis of asthma because of their ability to induce airway inflammation and to promote hyperreactivity of sensory neurons, which reflects an important mechanism in the pathogenesis of airway hyperreactivity. Neurotrophins use a dual-receptor system consisting of Trk-receptor tyrosine kinases and the structurally unrelated p75NTR. Previous studies revealed an important role of p75NTR in the pathogenesis of allergic asthma. OBJECTIVES The aim of the study was to investigate the precise mechanisms of neurotrophins in neuroimmune interaction, which can lead to both airway inflammation and sensory nerve hyperreactivity in vivo. METHODS Mice selectively expressing p75NTR in immune cells or nerves, respectively, were generated. After sensitization and allergen provocation, hyperreactivity of sensory nerves was tested in response to capsaicin. Airway inflammation was analyzed on the basis of differential cell counts and cytokine levels in bronchoalveolar lavage fluids. RESULTS Allergic mice selectively expressing p75NTR in immune cells showed normal inflammation but no sensory nerve hyperreactivity, whereas mice selectively expressing p75NTR in nerve cells had a diminished inflammation and a distinct sensory nerve hyperreactivity. CONCLUSION Our data indicate that p75NTR plays a dual role by promoting hyperreactivity of sensory nerves and airway inflammation. Additionally, our study provides experimental evidence that development of sensory nerve hyperreactivity depends on an established airway inflammation in asthma. In contrast, development of airway inflammation seems to be independent from sensory nerve hyperreactivity. CLINICAL IMPLICATIONS Because of its dual function, antagonization of p75NTR-mediated signals might be a novel approach in asthma therapy.
Collapse
Affiliation(s)
- Christina Nassenstein
- Department of Immunology, Allergology and Immunotoxicology, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | | | | | | | | | | | | | | |
Collapse
|
26
|
van Rijswijk JB, Gerth van Wijk R. Capsaicin treatment of idiopathic rhinitis: the new panacea? Curr Allergy Asthma Rep 2006; 6:132-7. [PMID: 16566863 DOI: 10.1007/s11882-006-0051-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The management of patients with perennial nonallergic or idiopathic rhinitis is difficult. Diagnosis and treatment are hampered by several factors. First, the diagnosis is made by exclusion of other nasal diseases. As a consequence, idiopathic rhinitis is not defined according to clear-cut criteria. A commonly accepted phenotype of idiopathic rhinitis does not exist. Second, the pathophysiology of idiopathic rhinitis is not yet fully elucidated. In contrast with allergic rhinitis, inflammation does not appear to play an important role in idiopathic rhinitis. Recent studies indicate a neural dysregulation of the nasal mucosa. Additionally, the available therapeutic arsenal comprising both pharmacotherapy and surgery is at best partially efficacious in these patients. The efficacy of repeated capsaicin application has been established in several randomized controlled trials. This treatment modality may be the first step to more specific and better treatment options for patients with idiopathic rhinitis that is unresponsive to standard treatment.
Collapse
|
27
|
Nassenstein C, Kutschker J, Tumes D, Braun A. Neuro-immune interaction in allergic asthma: role of neurotrophins. Biochem Soc Trans 2006; 34:591-3. [PMID: 16856869 DOI: 10.1042/bst0340591] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The nature of persistent airway hyperreactivity and chronic inflammation in asthma remains unclear. It has been suggested that bi-directional neuro-immune interaction plays an important role in the pathogenesis of this disease, leading to enhanced airway narrowing after contact with unspecific stimuli, as well as infiltration, activation and degranulation of several immune cell subtypes. Important mediators in neuro-immune cross-talk are neurotrophins, which are produced by cells at the site of inflammation. In addition to modulating the function of several leucocyte subsets, they play an important role in the synthesis of neuropeptides by sensory nerve cells. Neuropeptides have been shown to cause smooth-muscle contraction and, in addition, modulate the production of pro-inflammatory molecules by leucocytes. The aim of the present review is to provide an overview of the molecular mechanisms by which neurotrophins and neuropeptides are involved in neuro-immune cross-talk in allergic asthma.
Collapse
Affiliation(s)
- C Nassenstein
- Immunology and Allergology, Fraunhofer Institute of Toxicology and Experimental Medicine, Nikolai-Fuchs-Strasse 1, Hannover, Germany.
| | | | | | | |
Collapse
|
28
|
Szallasi A. Small molecule vanilloid TRPV1 receptor antagonists approaching drug status: can they live up to the expectations? Naunyn Schmiedebergs Arch Pharmacol 2006; 373:273-86. [PMID: 16773387 DOI: 10.1007/s00210-006-0072-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 04/10/2006] [Indexed: 01/05/2023]
Abstract
The cloning of the transient receptor potential vanilloid type-1 (TRPV1) receptor initiated the discovery of potent small molecule antagonists, many of which are in preclinical phase or already undergoing clinical trials. While animal experiments imply a therapeutic value for these compounds as novel analgesic-antiphlogistic drugs, new findings with TRPV1 deficient (trpv1 -/-) mice signal troubles for TRPV1 antagonists as clinical research gains impetus. An emerging concept with important implications for drug development is that TRPV1 may be differentially regulated under physiological and pathological conditions. If so, it is conceivable that such TRPV1 ligands can be synthesized that specifically target TRPV1 in diseased (e.g. inflamed or neoplastic) tissues but spare TRPV1 that subserves its physiological functions in healthy organs. This review explores the current status of this field and seeks an answer to the question how these new discoveries could be factored into TRPV1 drug discovery and development.
Collapse
Affiliation(s)
- Arpad Szallasi
- Department of Pathology, Monmouth Medical Center, 300 Second Avenue, Long Branch, NJ 07740, USA.
| |
Collapse
|
29
|
Abstract
BACKGROUND Allergic rhinitis represents a global health problem. Non-specific nasal hyperresponsiveness is an important feature of allergic and non-allergic rhinitis. This phenomenon is believed to result from the effect of allergic inflammation on the sensory nerves that supply the upper airway mucosa. A pharmacologic agent that has proved useful in the investigation of effects of neuronal stimulation is capsaicin, the pungent component of hot pepper. Intranasal capsaicin specifically stimulates afferent nerves consisting mostly of unmyelinated C fibers and some myelinated A-delta fibers. As a result it can trigger central and axonal reflexes, the latter being putatively mediated by the release of neuropeptides. Capsaicin as a blocking agent of neuropeptides, blocks the axon reflex and may exert a curative effect on allergic rhinitis. OBJECTIVES To assess the effectiveness of capsaicin for allergic rhinitis in adults. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to 2006) and EMBASE (1974 to 2006). We assessed bibliographies from included studies, and contacted authors of known studies for additional information about published and unpublished trials. The date of the most recent search was January 2006. SELECTION CRITERIA Randomised controlled trials of capsaicin for allergic rhinitis in adults were included. DATA COLLECTION AND ANALYSIS Three reviewers read each paper, blind to its identity. Decisions concerning inclusion were made by simple majority. We all performed quality assessment independently. MAIN RESULTS One small trial did not find evidence that intranasal capsaicin had a therapeutic effect in allergic rhinitis. A small pharmacological effect on clinical histamine dose response was found. After treatment, leukotriene levels in nasal lavage did not increase in the capsaicin group. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the use of capsaicin in clinical practice.
Collapse
Affiliation(s)
- J Cheng
- Guangdong College of Pharmacy, Clinical Department, Guangzhou, China, 510224.
| | | | | | | |
Collapse
|
30
|
Abstract
In the context of this review, civil unrest is defined as disharmony, expressive dissatisfaction and/or disagreement between members of a community, which leads to a situation of competitive aggression that may find expression as disruption of organisation, conflicts, damage to property and injuries. Such a breakdown of harmonious relationships, which may result in property damage and human injuries that may be threatening to life, varies in magnitude from participation of a very few individuals up to the involvement of large crowds of people, which may evolve into a full-scale riot. It is the latter situation often involving demonstrators, opposing groups and law enforcement personnel that can result in multiple casualties and present a very significant challenge to the resources of local healthcare institutions. The causation of civil unrest incidents is multifactorial and has generic, specific and potentiating elements. With the current national and international societal, political and discriminatory problems, it is likely that civil unrest incidents on both small and large scales will continue to occur at a high and possibly increasing rate on a worldwide basis, and for these not infrequent incidents, the medical community should be in a state of informed preparation. The circumstances of civil unrest incidents are very variable with respect to causation, overall magnitude, frequency, timing, geographical location, numbers of persons involved, demographics of participants, influence of extremists, confrontation with opposing groups and control measures used by law enforcement agencies. Methods used by police and security forces for the control of civil unrest incidents, if advanced negotiations with organisers and verbal warnings have failed, fall basically into two categories: physical and chemical measures. Physical methods include restraint holds, truncheons, batons, mounted horses, projectiles (such as bean bags, plastic and rubber bullets), water cannons, tasers and (rarely) live ammunition. All of these physical measures are associated with pain and immobilisation, and there is a high potential for soft tissue and bone injuries. Some of the more severe physical methods, including plastic and rubber bullets, may cause lethal injuries. The basis for using chemicals in civil unrest incidents is that they cause distraction, transient harassment and incapacitation, temporary impairment of the conduct of coordinated tasks and cause a desire to vacate the area of unrest. Although screening smokes and malodors have sometimes been employed, the major group of chemicals used are peripheral chemosensory irritants (PCSIs), which reversibly interact with sensory nerve receptors in exposed skin and mucosal surfaces, resulting in the production of local uncomfortable sensations and associated reflexes. Major effects are on the eye, respiratory tract and (to a lesser degree) skin. Thus, the induced transient pain and discomfort in the eye, respiratory tract and skin, together with associated lacrimation, blepharospasm, rhinorrhoea, sialorrhoea, cough and breathing difficulties, produce temporary incapacitation and interference with the conduct of coordinated tasks, and form the basis for harassment of malefactors. Currently used peripheral chemosensory irritants are 1-chloroacetophenone, 2-chlorobenzylidene malononitrile, dibenz(b.f)-1,4-oxazepine, oleoresin capsicum and pelargonic acid vanillylamide. Depending on operational circumstances, irritants may be dispersed as a smoke, powder cloud, aerosol, vapour, or in solution; the mode of generation and dispersion of irritant can influence hazard. Brief acute exposure to chemosensory irritants produces effects that generally resolve within an hour, leaving no long-term sequelae. However, sustained exposure to high concentrations may produce tissue injury, notably to the eye, respiratory tract and skin. With solutions of sensory irritants, other formulation constituents may enhance PCSI toxicity or introduce additional local and/or systemic toxicity. By the very circumstances of civil unrest incidents, injuries are inevitable, particularly when emotions are heightened and police and security forces have to resort to various chemical and/or physical means of control. Trauma may include slight to severe physical and/or chemical injuries, psychological problems and occasional deaths. Hospitals should be prepared for a wide range of casualties, and the fact that those seeking help will constitute a heterogeneous group, including wide age range, male, female, and individuals with pre-existing ill health. A major civil unrest incident necessitates that the local receiving hospital should be prepared and equipped for decontamination and triage processes. It is necessary to reassure patients who have been exposed to sensory irritants that the signs and symptoms are rapidly reversible, and do not result in long-term sequelae. With respect to chemical exposures, detailed evaluation should be given to possible ocular, cutaneous, respiratory and gastrointestinal effects. Also, exposure to chemosensory irritants results in transient increases in blood pressure, bradycardia and increased intraocular pressure. This indicates that those with cardiovascular diseases and glaucoma may be at increased risk for the development of complications. This article details the pharmacological, toxicological and clinical effects of chemicals used in civil disturbance control and discusses the management of contaminated individuals. Additionally, the potential for adverse effects from delivery systems and other physical restraint procedures is summarised. Due to the emergency and specialised circumstances and conditions of a civil unrest incident, there is a clear need for advanced planning by healthcare institutions in the event that such an incident occurs in their catchment area. This should include ensuring a good information base, preparations for medical and support staff readiness, and availability of required equipment and medications. Ideally, planning, administration and coordination should be undertaken at both local (regional) and central (governmental) centres. Regional centres should have responsibilities for education, training, ensuring facilities and staffing are appropriate, and that adequate equipment and medicines are available. There should be cooperative interactions and communications with local police and other emergency services. Centrally directed functions should include ensuring adequacy of the information base, coordinating activities and agreeing approaches between the regional centres, and periodic audits of regional centres with respect to the staffing, facility, equipment and training needs. Also, there is a need for most countries to introduce detailed guidelines and formal (regulatory) schemes for the assessment of the safety-in-use of chemicals and the delivery systems that are to be used against heterogeneous human populations for the control of civil unrest incidents. Such regulatory approval schemes should also cover advisory functions for safe use and any required restrictions.
Collapse
Affiliation(s)
- Bryan Ballantyne
- Occupational and Clinical Toxicology, Charleston, West Virginia 25304, USA
| |
Collapse
|
31
|
Abstract
The term rhinitis in daily practice is used for nasal dysfunction causing symptoms-like nasal itching, sneezing, rhinorrhea and or nasal blockage. Chronic rhinitis can roughly be classified into allergic, infectious or nonallergic/noninfectious. When allergy, mechanical obstruction and infections have been excluded as the cause of rhinitis, a number of poorly defined nasal conditions of partly unknown aetiology and pathophysiology remain. The differential diagnosis of nonallergic noninfectious rhinitis is extensive. Although the percentage of patients with nonallergic noninfectious rhinitis with a known cause has increased the last decades, still about 50% of the patients with nonallergic noninfectious rhinitis has to be classified as suffering from idiopathic rhinitis (IR), or rather e causa ignota. Specific immunological, clinical and sometimes radiological and functional tests are required to distinguish known causes. Research to the underlying pathophysiology of IR has moved from autonomic neural dysbalans to inflammatory disorders (local allergy), the nonadrenergic noncholinergic (NANC) sensory peptidergic neural system and central neural hyperaesthesia, still without solid ground or proof. This review summarizes the currently known causes for nonallergic noninfectious rhinitis and possible treatments. Also possible pathophysiological mechanisms of IR are discussed.
Collapse
Affiliation(s)
- J B van Rijswijk
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, Rotterdam, the Netherlands
| | | | | |
Collapse
|
32
|
Wagenmann M, Schumacher L, Bachert C. The time course of the bilateral release of cytokines and mediators after unilateral nasal allergen challenge. Allergy 2005; 60:1132-8. [PMID: 16076297 DOI: 10.1111/j.1398-9995.2005.00867.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Late phase reactions after allergen challenge can be understood as a correlate of the inflammatory reaction in allergic rhinitis. METHODS To investigate which cytokines are involved in it and to dissect direct and indirect effects of nasal allergen challenge, we performed unilateral nasal allergen provocation with the disc method in 12 seasonal allergic volunteers. Symptom scores, nasal secretions and nasal airflow were quantified. In the secretions that were collected in the early phase and for 8 h after provocation, we measured histamine, and the cytokines interleukin (IL)-1beta, IL-8, IL-4, and the natural antagonist of IL-1beta, IL-1 receptor type 1 (IL-1Ra) using enzyme-linked immunosorbent (ELISA)-assays. Control challenges with diluent instead of allergen were performed in all subjects. RESULTS We demonstrated a bilateral increase in nasal secretion weights in the early and late phase. Histamine was significantly increased in the early and late phase in nasal secretions from both nostrils. IL-1beta increased in the late phase only, where it was also found on the unchallenged, contralateral side. Its antagonist IL-1Ra was found in very high quantities (1000-fold higher than IL-1beta) but demonstrated only marginal changes after provocation. IL-8 was increased in both nostrils early and late after challenge, whereas IL-4 was significantly elevated in the late phase. CONCLUSIONS We described the time course of mediator and cytokine release into nasal secretions after allergen challenge. We hypothesize that the observed indirect effects on the unchallenged, contralateral side can be at least partially attributed to neuronal reflexes.
Collapse
Affiliation(s)
- M Wagenmann
- ENT Department, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | | |
Collapse
|
33
|
Li J, Saito H, Crawford L, Inman MD, Cyr MM, Denburg JA. Haemopoietic mechanisms in murine allergic upper and lower airway inflammation. Immunology 2005; 114:386-96. [PMID: 15720440 PMCID: PMC1782093 DOI: 10.1111/j.1365-2567.2005.02109.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Eosinophil recruitment to the airways, including involvement of haemopoietic eosinophil-basophil progenitors (Eo/B-CFU), is primarily regulated by interleukin-5 (IL-5) and eotaxin. In this study, we investigated the haemopoietic mechanisms in upper and lower airway eosinophilic inflammation. Ovalbumin (OVA) sensitized and challenged BALB/c mice were used to establish isolated upper (UAC), isolated lower (LAC), or combined upper and lower airway (ULAC) inflammation. Airway, blood and bone marrow responses were evaluated in each model. Numbers of airway eosinophils and CD4(+) cells were increased significantly in the nasal mucosa in UAC and ULAC mice, and in the lung tissue in LAC and ULAC groups. Levels of IL-5 and eotaxin were increased significantly in the nasal lavage fluid (NL) in UAC and ULAC mice, and in the bronchoalveolar lavage fluid (BAL) in LAC and ULAC groups. The proportion of IL-5-responsive bone marrow Eo/B-CFU was significantly higher than the control in all treatment groups, but peaked much earlier in the ULAC group. Kinetic studies revealed that IL-5 and eotaxin in NL, BAL and serum peaked between 2 and 12 hr after OVA challenge in ULAC mice, and at 24 hr in UAC mice, related to the timing of maximal progenitor responses. These data support the concept that the systemic mechanisms linking rhinitis to asthma depend on the location and extent of airway allergen exposure.
Collapse
Affiliation(s)
- Jing Li
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
34
|
Abstract
Nonallergic non-infectious perennial rhinitis (NANIPER) is a heterogeneous disorder comprising several pathophysiological entities. The etiology of some of these disorders (e.g. drug-induced rhinitis, nonallergic rhinitis with eosinophilia syndrome [NARES], occupational rhinitis, hormonal rhinitis, emotion-induced rhinitis, physical/chemical irritant-induced rhinitis) is well established. In contrast, the aetiology of idiopathic forms of rhinitis (also known as vasomotor rhinitis) is largely unknown. Mechanistic studies have suggested that non-IgE-mediated inflammatory and/or neurogenic processes may be involved. There is evidence that localized inflammation is the underlying cause of symptoms in drug-induced rhinitis and NARES, since eosinophilia is an important pathophysiological component in these conditions. In contrast, neurogenic reflex mechanisms initiated by environmental factors appear to be involved in idiopathic rhinitis. It has been suggested that there may be an imbalance of the sympathetic and parasympathetic nervous systems, with parasympathetic hyper-activity and sympathetic hypo-activity resulting in nasal congestion and rhinorrhoea. Indirect evidence suggests that C-fibres may also play an important role in the pathophysiology of idiopathic rhinitis.
Collapse
Affiliation(s)
- R Garay
- INSERM U400, Faculté de Médecine de Créteil, France.
| |
Collapse
|
35
|
Abstract
Although rhinitis has been classified as being either allergic, noninfectious, or "other forms" (nonallergic noninfectious), these categories lack strict classification criteria and often overlap. The term "nonallergic noninfectious rhinitis" is commonly applied to a diagnosis of any nasal condition, in which the symptoms are similar to those seen in allergic rhinitis but an allergic aetiology has been excluded. This group comprises several subgroups with ill-defined pathomechanisms, and includes idiopathic rhinitis, irritative-toxic (occupational) rhinitis, hormonal rhinitis, drug-induced rhinitis, and other forms (non-allergic rhinitis with eosinophilia syndrome [NARES], rhinitis due to physical and chemical factors, food-induced rhinitis, emotion-induced rhinitis, atrophic rhinitis). Unlike allergic rhinitis, there are no specific diagnostic tests and diagnosis is primarily based on a history of reaction to specific irritant-toxic triggering agents (either general or occupational), drugs, infections, and hormonal status, coupled with exclusion of allergic rhinitis and other forms of non-allergic rhinitis by skin prick testing. Accordingly, from a clinical standpoint NARES, irritative-toxic, hormonal, drug-induced and idiopathic rhinitis are possibly the least difficult forms of nonallergic rhinitis to diagnose.
Collapse
MESH Headings
- Diagnosis, Differential
- Female
- Humans
- Incidence
- Male
- Nasal Mucosa/immunology
- Nasal Mucosa/physiology
- Prognosis
- Rhinitis, Allergic, Perennial/classification
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Atrophic/classification
- Rhinitis, Atrophic/diagnosis
- Rhinitis, Atrophic/epidemiology
- Rhinitis, Vasomotor/classification
- Rhinitis, Vasomotor/diagnosis
- Rhinitis, Vasomotor/epidemiology
- Risk Factors
- Severity of Illness Index
Collapse
|
36
|
Horak F, Stübner P, Zieglmeyer R, Harris AG. Comparison of the effects of desloratadine 5-mg daily and placebo on nasal airflow and seasonal allergic rhinitis symptoms induced by grass pollen exposure. Allergy 2003; 58:481-5. [PMID: 12757447 DOI: 10.1034/j.1398-9995.2003.00148.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nasal congestion is a chronic symptom of seasonal allergic rhinitis (SAR) that is often difficult to treat with antihistamines. Desloratadine, a new, potent, H1-receptor antagonist has been shown to decrease nasal congestion in clinical trials and to maintain nasal airflow in response to grass pollen exposure. We compared the effects of desloratadine 5 mg and placebo on nasal airflow, nasal secretion weights and SAR symptoms, including nasal congestion, in patients exposed to grass pollen in an environmental exposure unit. METHODS Forty-six grass pollen allergic SAR patients received desloratadine or placebo for 7 days, followed by a 10-day washout, and then crossed over to the other treatment for 7 days. A 6-h allergen exposure was performed at the end of each treatment period. RESULTS Desloratadine was significantly superior to placebo in maintaining nasal airflow (P <or= 0.014) and lessening the increase in nasal secretion weights (P < 0.001) throughout allergen exposure. SAR symptom scores, including nasal congestion, were significantly less with desloratadine than placebo (P <or= 0.001). Desloratadine was well tolerated. CONCLUSIONS This study confirms that, compared with placebo, desloratadine can maintain nasal airflow and reduce nasal secretion weights and the severity of SAR symptoms, including nasal congestion, in SAR patients exposed to grass pollen allergen.
Collapse
Affiliation(s)
- F Horak
- ENT-Universitätsklinik, Vienna, Austria
| | | | | | | |
Collapse
|
37
|
Neurogenic inflammation in the airways. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1567-7443(03)80057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
38
|
Doyle WJ, Alper CM. Prevention of otitis media caused by viral upper respiratory tract infection: vaccines, antivirals, and other approaches. Curr Allergy Asthma Rep 2003; 3:326-34. [PMID: 12791210 PMCID: PMC7088701 DOI: 10.1007/s11882-003-0093-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Otitis media (OM) imposes significant morbidity on the pediatric age group and a large financial burden on the general population. Because standard medical treatments are not highly efficacious in resolving the accompanying middle ear (ME) inflammation, a goal of current research is OM prevention. Past studies show that new episodes of OM are usually a complication of viral upper respiratory infection (vURI), and therefore, a rational approach to achieving that goal is to develop intervention strategies that target vURI-associated OM. However, past experiences with antibiotics show that, in the absence of well-defined treatment protocols that maximize expected efficacy, the adoption of prophylactic or active treatments for OM can have negative consequences for the patient and for the general population. In this review, we discuss the hypothesized mechanisms by which a vURI is translated into an acute OM episode and describe different strategies for aborting that process. Limitations to deployment of each strategy are outlined.
Collapse
Affiliation(s)
- William J Doyle
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
39
|
Recer GM, Johnson TB, Gleason AK. An evaluation of the relative potential public health concern for the self-defense spray active ingredients oleoresin capsicum, o-chlorobenzylidene malononitrile, and 2-chloroacetophenone. Regul Toxicol Pharmacol 2002; 36:1-11. [PMID: 12383713 DOI: 10.1006/rtph.2002.1569] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In 1996, the New York State Department of Health was charged by the State Legislature to develop regulations regarding the types of self-defense spray devices which could lawfully be purchased, possessed, and used in New York State. Prior to this legislation, sale or possession of self-defense spray devices in New York State was illegal. The Department of Health used existing data to evaluate three commonly used self-defense spray active ingredients (oleoresin capsicum, o-chlorobenzylidene malononitrile, and 2-chloroacetophenone) with respect to their relative toxicity and their involvement in accidental poisonings. Based on the balance of the available information, the Department of Health determined that oleoresin capsicum posed a lower public health concern than o-chlorobenzylidene malononitrile or 2-chloroacetophenone, and developed a rule that specifies oleoresin capsicum as the only active ingredient to be used in self-defense sprays for sale and use in New York State.
Collapse
Affiliation(s)
- Gregg M Recer
- Bureau of Toxic Assessment, Center for Environmental Health, New York State Department of Health, New York 12180-2216, USA.
| | | | | |
Collapse
|
40
|
Abstract
Afferent nerves, derived from the trigeminal ganglion, and postganglionic autonomic nerves, derived from sympathetic and parasympathetic ganglia expressing many different neurotransmitters, innervate the nose. Reflexes that serve to optimize the air-conditioning function of the nose by altering sinus blood flow, or serve to protect the nasal mucosal surface by mucus secretion, vasodilatation, and sneezing, can be initiated by a variety of stimuli, including allergen, cold air, and chemical irritation. Activation of nasal afferent nerves can also have profound effects on respiration, heart rate, blood pressure, and airway caliber (the diving response). Dysregulation of the nerves in the nose plays an integral role in the pathogenesis of allergic rhinitis. Axon reflexes can precipitate inflammatory responses in the nose, resulting in plasma extravasation and inflammatory cell recruitment, while allergic inflammation can produce neuronal hyper-responsiveness. Targeting the neuronal dysregulation in the nose may be beneficial in treating upper airway disease.
Collapse
Affiliation(s)
- Brendan J Canning
- Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| |
Collapse
|
41
|
Abstract
BACKGROUND Hypertonic saline (HTS) acts as an airway irritant in human nasal mucosa by stimulating nociceptive nerves and glandular secretion. HTS does not change vascular permeability. In asthma, HTS causes airflow obstruction. OBJECTIVE To determine the effect of HTS on mucosal swelling using acoustic rhinometry (AcRh). Potential vasodilator effects were controlled by maximally constricting mucosal vessels with oxymetazoline (Oxy). METHOD Normal subjects had AcRh before and 30 min after either 0.05% Oxy or saline (0.9% NaCl) nasal treatments. Nasal provocations followed immediately with five step-wise incremental escalating doses of HTS administered at 6-min intervals. AcRh was performed 1, 3 and 5 min after each HTS administration, and then after blowing the nose at 5 min. The minimum cross-sectional area (Amin), volume of the anterior 6 cm of nasal cavity (V6) and incremental changes from pre-drug treatment baseline levels (delta, mean +/- SEM) were calculated. RESULTS Oxy increased Amin by 46% (delta = 0.48 +/- 0.07 cm2, P = 0.0001) and V6 by 53% (Delta = 9.9 +/- 1.5 mL, P < 1 x 10-7) during the first 30 min. Saline (vehicle) treatment had no effect. The maximum HTS dose had no effect after 1 or 3 min. However, in the 4th and 5th minutes there were reductions in Amin (delta = 0.07 +/- 0.03 cm2, P = 0.035) and V6 (delta = 1.57 +/- 0.42 mL, P = 0.004) with an increase in the weight of secretions (delta = 700 +/- 100 mg, P < 0.05). Blowing the nose returned Amin and V6 towards baseline. Oxy had no effect on HTS-induced changes in Amin, V6, pain, rhinorrhea or weight of secretions. CONCLUSION HTS induced nociceptive nerve stimulation and mucus secretion, and reduced V6 and Amin. Oxy caused vasoconstriction but did not alter HTS-induced effects. HTS may stimulate neurogenic axon response-mediated glandular secretion that contributes to perceptions of nasal obstruction in normal subjects.
Collapse
Affiliation(s)
- J N Baraniuk
- Division of Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC 20007, USA.
| | | | | |
Collapse
|
42
|
Affiliation(s)
- Jason Smith
- Department of Emergency Medicine, Defence Medical Services, United Kingdom
| | | |
Collapse
|
43
|
Abstract
Nonallergic noninfectious rhinitis is a diagnosis by exclusion, meaning that a number of poorly defined nasal conditions that have in common allergy and infection as a cause of the rhinitis have been excluded. The etiology of some subgroups of nonallergic noninfectious rhinitis, like nonallergic rhinitis with eosinophilia (NARES) and drug-induced rhinitis, are quite well defined, but in the majority of the patients, the etiology and pathophysiology are unknown. These patients are classified as idiopathic rhinitis patients. A careful determination of the intensity of the symptoms combined with modern diagnostic tools enables us to discriminate idiopathic rhinitis patients from normal controls. This review discusses the possible pathophysicologic mechanisms of nonallergic noninfectious rhinitis, with emphasis on idiopathic rhinitis.
Collapse
Affiliation(s)
- Wytske J Fokkens
- Department of Otorhinolaryngology, Erasmus Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, The Netherlands.
| |
Collapse
|
44
|
Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001; 108:S147-334. [PMID: 11707753 DOI: 10.1067/mai.2001.118891] [Citation(s) in RCA: 2090] [Impact Index Per Article: 90.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
| | | | | |
Collapse
|
45
|
Granstrand P, Nylander-French LA, Lacks G, Holmström M, French JE. Absence of proinflammatory cytokine gene expression in nasal biopsies from wood surface-coating industry workers. Acta Otolaryngol 2001; 121:743-9. [PMID: 11678174 DOI: 10.1080/00016480152583692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Symptoms of nasal, pharyngeal and ocular discomfort have been reported among workers in the wood surface-coating industry. Symptoms were reported more often by workers using ultraviolet radiation-curable acrylate coatings (UV coatings), which contain potential chemical sensitizers, than by those using acid-curing coatings. Furthermore, increased levels of eosinophil cationic protein (ECP) and albumin, but not tryptase, in nasal lavage from workers exposed to UV coatings have been observed. To further examine whether air contaminants present in the UV-coating industry are causing the observed increase in symptoms, the inflammatory process in the nasal mucosa of workers exposed to UV coatings was investigated. Clinical and biochemical endpoints were selected to distinguish between specific and non-specific hypersensitivity and to test the hypothesis that the symptoms were consistent with Type IV hypersensitivity. The nasal lavage and nasal biopsy were performed under local anesthetic at the workplace during working hours after a minimum of 2 h of work in both the exposed and control groups. Albumin and ECP, and the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8), were used as inflammatory markers. A multi-probe ribonuclease protection assay was used to attempt to detect cytokine variation in human nasal biopsies. The cytokine genes analyzed were TNF-alpha, GM-CSF, interferon-gamma, IL-2, IL-4 and IL-5. L32 and GAPDH were used as control genes for mRNA expression levels. Mucosal inflammation symptoms correlated with increased levels of albumin, but not with increased levels of ECP, secreted proinflammatory cytokines or cytokine gene mRNA expression. We conclude that the symptoms are non-specific and do not correlate with occupational exposure to UV coatings under the conditions of this investigation.
Collapse
Affiliation(s)
- P Granstrand
- Department of Otorhinolaryngology, Huddinge University Hospital, Karolinska Institute, Sweden
| | | | | | | | | |
Collapse
|
46
|
Feron VJ, Arts JH, Kuper CF, Slootweg PJ, Woutersen RA. Health risks associated with inhaled nasal toxicants. Crit Rev Toxicol 2001; 31:313-47. [PMID: 11405443 DOI: 10.1080/20014091111712] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Health risks of inhaled nasal toxicants were reviewed with emphasis on chemically induced nasal lesions in humans, sensory irritation, olfactory and trigeminal nerve toxicity, nasal immunopathology and carcinogenesis, nasal responses to chemical mixtures, in vitro models, and nasal dosimetry- and metabolism-based extrapolation of nasal data in animals to humans. Conspicuous findings in humans are the effects of outdoor air pollution on the nasal mucosa, and tobacco smoking as a risk factor for sinonasal squamous cell carcinoma. Objective methods in humans to discriminate between sensory irritation and olfactory stimulation and between adaptation and habituation have been introduced successfully, providing more relevant information than sensory irritation studies in animals. Against the background of chemoperception as a dominant window of the brain on the outside world, nasal neurotoxicology is rapidly developing, focusing on olfactory and trigeminal nerve toxicity. Better insight in the processes underlying neurogenic inflammation may increase our knowledge of the causes of the various chemical sensitivity syndromes. Nasal immunotoxicology is extremely complex, which is mainly due to the pivotal role of nasal lymphoid tissue in the defense of the middle ear, eye, and oral cavity against antigenic substances, and the important function of the nasal passages in brain drainage in rats. The crucial role of tissue damage and reactive epithelial hyperproliferation in nasal carcinogenesis has become overwhelmingly clear as demonstrated by the recently developed biologically based model for predicting formaldehyde nasal cancer risk in humans. The evidence of carcinogenicity of inhaled complex mixtures in experimental animals is very limited, while there is ample evidence that occupational exposure to mixtures such as wood, leather, or textile dust or chromium- and nickel-containing materials is associated with increased risk of nasal cancer. It is remarkable that these mixtures are aerosols, suggesting that their "particulate nature" may be a major factor in their potential to induce nasal cancer. Studies in rats have been conducted with defined mixtures of nasal irritants such as aldehydes, using a model for competitive agonism to predict the outcome of such mixed exposures. When exposure levels in a mixture of nasal cytotoxicants were equal to or below the "No-Observed-Adverse-Effect-Levels" (NOAELs) of the individual chemicals, neither additivity nor potentiation was found, indicating that the NOAEL of the "most risky chemical" in the mixture would also be the NOAEL of the mixture. In vitro models are increasingly being used to study mechanisms of nasal toxicity. However, considering the complexity of the nasal cavity and the many factors that contribute to nasal toxicity, it is unlikely that in vitro experiments ever will be substitutes for in vivo inhalation studies. It is widely recognized that a strategic approach should be available for the interpretation of nasal effects in experimental animals with regard to potential human health risk. Mapping of nasal lesions combined with airflow-driven dosimetry and knowledge about local metabolism is a solid basis for extrapolation of animal data to humans. However, more research is needed to better understand factors that determine the susceptibility of human and animal tissues to nasal toxicants, in particular nasal carcinogens.
Collapse
Affiliation(s)
- V J Feron
- Toxicology Division, TNO Nutrition and Food Research, Zeist, The Netherlands.
| | | | | | | | | |
Collapse
|
47
|
Abstract
Changes in neural activity play a key role in many symptoms of allergic disease, including sneezing, coughing, itching, and ocular irritation, among others. The mechanisms underlying allergen-induced changes in neural activity (reflexes) are largely unknown and under active investigation. Allergic inflammation can affect neural activity on a variety of levels, including at the primary afferent sensory nerve, integrative centers of the central nervous system, autonomic ganglia, and autonomic neuroeffector junction. At the level of the afferent sensory nerve, mediators released after allergen exposure either directly or indirectly increase neuronal firing. At the level of sensory ganglia, which contain cell bodies that innervate a variety of organs, changes in neuronal excitability may lead to a generalization of allergic symptoms. In the central nervous system, where afferent inputs from throughout the body converge, allergic inflammation may be associated with central sensitization, leading to the modulation of the neural reflexes. Finally, at the autonomic ganglia and neuroeffector junction, allergic inflammation appears to be associated with enhanced ganglionic transmission and neurotransmitter release, respectively. Mechanisms by which allergen challenge affects neuronal activity at various levels of the nervous system are reviewed, with a primary emphasis on studies of airway physiologic factors.
Collapse
Affiliation(s)
- B J Undem
- Department of Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA
| | | | | | | |
Collapse
|
48
|
Affiliation(s)
- B J Undem
- Johns Hopkins University School of Medicine at the Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland, USA
| | | | | |
Collapse
|
49
|
Baraniuk JN, Ali M, Yuta A, Fang SY, Naranch K. Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans. Am J Respir Crit Care Med 1999; 160:655-62. [PMID: 10430743 DOI: 10.1164/ajrccm.160.2.9805081] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hypertonic saline (HTS) induces bronchoconstriction. Potential mechanisms were evaluated in a human nasal provocation model. Aliquots of normal saline (1 x NS, 100 microliters) and higher concentrations (3 x NS, 6 x NS, 12 x NS, 24 x NS) were sprayed into one nostril at 5-min intervals. Lavage fluids were collected from the ipsilateral and contralateral sides to determine the concentrations of specific mucus constituents. Nasal cavity air-space volume was assessed by acoustic rhinometry (AcRh). The distribution of substance-P-preferring neurokinin-1 (NK-1) receptor mRNA was assessed by in situ reverse transcriptase-polymerase chain reaction. Unilateral HTS induced unilateral dose-dependent increases in sensations of pain, blockage, and rhinorrhea, the weights of recovered lavage fluids, and concentrations of total protein, lactoferrin, mucoglycoprotein markers, and substance P. Contralateral, reflex-mediated effects were minor. There were no changes in IgG or AcRh measurements. NK-1 receptor mRNA was localized to submucosal glands. HTS caused pain with unilateral substance P release. The presumed nociceptive nerve efferent axon response led to glandular exocytosis, presumably through actions on submucosal gland NK-1 receptors. Vascular processes, including plasma exudation, filling of venous sinusoids, and mucosal edema were not induced in these normal subjects.
Collapse
Affiliation(s)
- J N Baraniuk
- Division of Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC, USA.
| | | | | | | | | |
Collapse
|
50
|
Sanico AM, Philip G, Lai GK, Togias A. Hyperosmolar saline induces reflex nasal secretions, evincing neural hyperresponsiveness in allergic rhinitis. J Appl Physiol (1985) 1999; 86:1202-10. [PMID: 10194204 DOI: 10.1152/jappl.1999.86.4.1202] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigated whether hyperosmolar saline (HS), applied via paper disk onto the septum of one nostril, induces a nasal secretory response. Furthermore, we examined whether this response is accentuated in patients with active allergic rhinitis (AR) compared with healthy volunteers. Unilateral HS produced significant nasal secretions both ipsilateral and contralateral to the site of challenge in the AR group and only ipsilaterally in the healthy group. The HS-induced nasal secretions were significantly greater in the AR vs. the healthy subjects. In a separate study, we ascertained that the nasal response to HS is neurally mediated and found that ipsilateral nerve blockade with lidocaine significantly attenuates the HS-induced secretions bilaterally. In another group of AR subjects, we determined whether nociceptive fibers were involved in this response and found that sensory nerve desensitization with repeated application of capsaicin attenuated the HS-induced nasal secretions. Finally, we determined whether the secretory hyperresponsiveness in AR is attributable to increased reactivity of submucosal glands rather than of nerves. We found that the dose response to methacholine, which directly stimulates the glands, was identical among AR and healthy subjects. We conclude that, in AR, nasal challenge with HS induces significantly greater reflex secretions involving capsaicin-sensitive nerve fibers, consistent with the notion of neural hyperresponsiveness in this disease.
Collapse
Affiliation(s)
- A M Sanico
- Division of Clinical Immunology, Department of Medicine, Johns Hopkins Asthma & Allergy Center, Baltimore, Maryland 21224-6801, USA
| | | | | | | |
Collapse
|