The human nasal mucosa in the menopause (A histochemical and electron microscopic study)

Chronic cough in postmenopausal women and its associations to climacteric symptoms

BACKGROUND

Postmenopausal women often have chronic cough. Hormonal changes might be affecting lung function and the mucous membrane of the airways, causing hypersensitivity of the cough reflex. Therefore, postmenopausal hormonal changes could play a key role in the association between increased cough and menopause. The aim of this study is to evaluate the relation of chronic cough and postmenopausal symptoms.

METHODS

We performed a questionnaire-based cohort study in generally healthy postmenopausal women (age 45-65 years). Women with cough explained by a pre-existing diagnosis were excluded. Comorbidities, medication and baseline data were collected. The Menopause Rating Scale II (MRS II) was combined with the Leicester Cough Questionnaire. Groups were divided in chronic cough versus non-coughing participants, chronic cough was defined as symptoms over 8 weeks. We performed correlations and logistic regression for predicting cough based on postmenopausal symptoms.

RESULTS

Sixty-six of 200 women (33%) reported symptoms of chronic cough over 8 weeks. No significant differences in baseline data (age, BMI, onset of menopause, years since menopause, concomitant diseases, and medication) were found between coughing and non-coughing women. The MRS II showed higher menopausal symptoms in patients with cough, with significant differences in 2 of the 3 MRS-domains (urogenital (p < 0.001) and somato-vegetative (p < 0.001)). Climacteric symptoms correlated strongly with parameters of cough (p < 0.001). On the basis of the MRS total score (p < 0.001) and the somato-vegetative and urogenital domains (p < 0.05), the prediction for respiratory complaints could be shown.

DISCUSSION

Chronic cough was significantly associated with menopausal symptoms. Therefore chronic cough as a possible climacteric symptom and its underlying mechanisms should be further explored.

New insights into the variability of upper airway morphology in modern humans

The biological adaptation of the human lineage to its environment is a recurring question in paleoanthropology. Particularly, how eco-geographic factors (e.g., environmental temperature and humidity) have shaped upper airway morphology in hominins have been subject to continuing debate. Nasal shape is the result of many intertwined factors that include, but are not limited to, genetic drift, sexual selection, or adaptation to climate. A quantification of nasal airway (NA) morphological variation in modern human populations is crucial to better understand these multiple factors. In the present research, we study 195 in vivo CT scans of adult individuals collected in five different geographic areas (Chile, France, Cambodia, Russia, and South Africa). After segmentation of the nasal airway, we reconstruct 3D meshes that are analyzed with a landmark-free geometric morphometrics method based on surface deformation. Our results highlight subtle but statistically significant morphological differences between our five samples. The two morphologically closest groups are France and Russia, whose NAs are longer and narrower, with an important protrusion of the supero-anterior part. The Cambodian sample is the most morphologically distinct and clustered sample, with a mean NA that is wider and shorter. On the contrary, the Chilean sample form the most scattered cluster with the greatest intra-population variation. The South African sample is morphologically close to the Cambodian sample, but also partially overlaps the French and Russian variation. Interestingly, we record no correlation between NA volume and geographic groups, which raises the question of climate-related metabolic demands for oxygen consumption. The other factors of variation (sex and age) have no influence on the NA shape in our samples. However, NA volume varies significantly according both to sex and age: it is higher in males than in females and tends to increase with age. In contrast, we observe no effect of temperature or humidity on NA volume. Finally, we highlight the important influence of asymmetries related to nasal septum deviations in NA shape variation.

[Symptoms, causes, and treatment options of geriatric nose]

With increasing age, structures of the internal and external nose change. Many elderly patients complain about rhinitis with nasal obstruction, endonasal crusting, epistaxis, intermittent rhinorrhea, and olfactory disorders. These symptoms are mainly caused by atrophy of the mucosa and the olfactory epithelium, but may also be an expression of drug side effects. Additionally, there are changes in the shape of the nose (continuous growth, altered elasticity of supporting structures) and in the dermis, which may develop tumors due to its sun-exposed position. These multiple internal and external changes of the nose can be summarized by the collective term "aging nose," whose treatment options are complex. These range from conservative (nasal care, medication changes, hemostatic measures) to surgical lines of therapy (septorhinoplasty, tumor excision, vascular ligation) and will require further scientific study in the future.

Role of VPAC1 anD VPAC2 receptors in the etiology of pregnancy rhinitis: an experimental study in rats

Introduction

Pregnancy rhinitis is a common sex hormone-related otorhinolaryngological disorder. There are some epidemiological and physiological studies on pregnancy rhinitis, but histopathological and biomolecular changes have not been studied thoroughly.

Objectives

The receptors VPAC1 and VPAC2 are known for their roles in allergic rhinitis. On the other hand, activation of subclinical allergy has been suggested in the pathophysiology of pregnancy rhinitis. Therefore, we aimed to compare the physiological and gestational pattern of VPAC1 and VPAC2 expression in rat nasal mucosa.

Methods

Twenty adult Wister albino female rats were enrolled into the study. Two groups constituted as 10 control (group A) and 10 pregnant (group B) rats. They were fed ad libitum and sheltered at room temperature (22°±2 °C). The rats were sacrificed at the 20th day of gestation by intraperitoneal injection of 400 mg/kg Na-pentobarbitone. Then, 10 − 15 mL of blood was taken, and samples were reserved for the detection of serum estradiol and progesterone levels by ELISA test. The nasal septum was resected and divided in half for immunohistochemical analyses and real time polymerase chain reaction testing of VPAC1 and VPAC2.

Results

VPAC1 and VPAC2 were found to be in all layers of septal specimens, but the immunostaining of surface epithelium was more distinct in specimens of both groups. We demonstrated higher overall staining intensity in the pregnant group. PCR revealed significant increase in expression of VPAC1 (p = 0.023) and VPAC2 (p = 0.021) in pregnant group when compared with control group. In addition, we demonstrated upregulatory effect of estradiol and progesterone on the vasoactive intestinal peptide receptor expression.

Conclusions

Gestational up-regulation of nasal VPAC1 and VPAC2 was shown both by PCR and immunohistochemical analysis. These findings support the hypothesis that PR is caused by the activation of subclinical allergy that is present before pregnancy.

The effect of premature ovarian insufficiency on nasal mucociliary clearance time

Premature ovarian insufficiency (POI) is a global health concern for women and affects several systems, such as cardiovascular system, autoimmune disease, and psychological status. The aim of this study was to investigate the effect of POI on nasal mucociliary clearance time via saccharin test by comparing postmenopausal women and healthy controls. Thirty-five (35) patients with POI, 35 healthy postmenopausal women and 35 healthy controls were recruited in this study. All study participants underwent measurements of nasal mucociliary clearance time via saccharine test. When women with POI and postmenopausal women compared with the controls, nasal mucociliary clearance time was longer in both women with POI and postmenopausal women. When women with POI were compared with postmenopausal women, the nasal mucociliary clearance time was not difference between two groups. There was a significant prolonged nasal mucociliary clearance time in the women with POI and postmenopausal women. Lower serum estradiol levels in women with POI as well as postmenopausal women had an adverse effect of nasal mucociliary clearance time.

Nasal cytology: Methodology with application to clinical practice and research

Nasal cytology is an easy, cheap, non-invasive and point-of-care method to assess nasal inflammation and disease-specific cellular features. By means of nasal cytology, it is possible to distinguish between different inflammatory patterns that are typically associated with specific diseases (ie, allergic and non-allergic rhinitis). Its use is particularly relevant when other clinical information, such as signs, symptoms, time-course and allergic sensitizations, is not enough to recognize which of the different rhinitis phenotypes is involved; for example, it is only by means of nasal cytology that it is possible to distinguish, among the non-allergic rhinitis, those characterized by eosinophilic (NARES), mast cellular (NARMA), mixed eosinophilic-mast cellular (NARESMA) or neutrophilic (NARNE) inflammation. Despite its clinical usefulness, cheapness, non-invasiveness and easiness, nasal cytology is still underused and this is at least partially due to the fact that, as far as now, there is not a consensus or an official recommendation on its methodological issues. We here review the scientific literature about nasal cytology, giving recommendations on how to perform and interpret nasal cytology.

Pharmacological Management of Allergic Rhinitis in the Elderly

Recent studies suggest that allergic rhinitis is highly prevalent in the elderly population, but is underdiagnosed and undertreated. This review article briefly introduces allergic rhinitis in the elderly (epidemiology and pathophysiology) and identifies the main goals of treatment in these patients with respect to age-related physiological factors, comorbid conditions and polypharmacy. The primary focus of the article is a narrative review of the literature concerning the different types of treatment options in elderly patients aged 60+ years (pharmacological therapy and allergen-specific immunotherapy). The main management trend for allergic rhinitis in elderly patients is the same as the trend in young patients. Second-generation antihistamines and nasal glucocorticosteroids are also the first-line therapies in seniors. In a few trials, allergen-specific immunotherapy for grass pollen or house dust mites has been shown to be effective and safe in patients aged 60 years or older with allergic rhinitis. In conclusion, undertreatment of allergic rhinitis in the elderly is a reality. Pharmacological treatment is quite similar in both older and younger patients with allergic rhinitis.

Influence of estradiol administration on estrogen receptors of nasal mucosa: an experimental study on guinea pigs

Introdução

A literatura indica uma correlação entre estrogênio elevado no soro e sintomas nasais ou alterações inflamatórias na mucosa nasal. Os receptores de estrogênio tendem a ser controlados por retroalimentação negativa, para evitar um estímulo nocivo sobre as diversas funções corporais em períodos de hiperestrogenismo. Propomos uma hipótese em que os mecanismos que regulam a expressão de receptores de estradiol na mucosa nasal estão ausentes em alguns pacientes, e a sua concentração permanece estável mesmo em períodos de elevada concentração sérica hormonal, o que pode conduzir a sintomas locais na mucosa nasal.

Desenho do estudo

estudo prospectivo experimental.

Objetivo

Determinar se altos níveis de estrogênio induzem à redução no número de receptores de estrogênio na mucosa nasal.

Material e método

Trinta cobaias foram submetidas à biópsia da concha nasal, recebendo 0,5 ml de cipionato de estradiol por via intraperitoneal por trinta dias consecutivos. Em seguida foram obtidas amostras da concha nasal contralateral. As análises imuno-histoquímicas dos receptores de estrógeno foram realizadas antes e depois da hormonioterapia.

Resultados

O grupo pós-tratamento mostrou uma redução da expressão dos receptores (p = 5,2726-5).

Conclusão

Redução na expressão do receptor de estrogênio nasal foi encontrada após trinta dias de administração de estradiol.

© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.

Does menopause effect nasal mucociliary clearance time?

The aim of this study was to investigate the effect of menopause on nasal mucociliary clearance time by comparing the results of premenopausal and postmenopausal women. A total of 60 women met the criteria and were divided into two groups: premenopausal women (n = 30) and postmenopausal women (n = 30). Nasal mucociliary clearance time of these women was measured and compared. Moreover, the correlation between nasal mucociliary clearance time and menopause duration in postmenopausal women was evaluated. Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences) 13.0 Evaluation for Windows. Normal distribution of continuous variables was tested with Kolmogorov-Smirnov test. Chi square test was used for comparisons between categorical variables. Kruskal-Wallis test and Mann-Whitney U tests were used for continuous variables when comparing the groups. The statistically significant level was accepted as p value <0.05. The mean nasal mucociliary clearance time in premenopausal and postmenopausal women was 11.43 ± 2.81 (7-16) and 16.76 ± 2.73 (12-22), respectively. The mean nasal mucociliary clearance time in postmenopausal women was significantly longer than in premenopausal women (p < 0.0001). Also, there was positive correlation between menopause duration and nasal mucociliary clearance time in postmenopausal women (r = 0.833, p < 0.0001). The clinicians must keep in mind that nasal mucociliary clearance time in postmenopausal women is prolonged and must follow up women in postmenopausal period more closely for respiratory tract diseases, sinonasal and middle ear infections.

The impact of menopause and hormone therapy on nasal resonance

The purpose of this study was to investigate the impact of menopause and hormone therapy on nasal resonance by comparing premenopausal women and postmenopausal women with and without hormone therapy. A total of 147 middle-aged Flemish (Dutch)-speaking women participated in the study and were divided into three groups: premenopausal women (n =42), and postmenopausal women with (n =63) and without (n =42) hormone therapy. Nasal resonance scores of isolated sounds and connected speech were measured using the Nasometer. For the isolated sounds as well as for the reading texts, no differences were found in nasal resonance scores between the three groups (ANCOVA). The results of this study indicate that menopause and hormone therapy do not have an impact on the nasal resonance in middle-aged women.

Evaluation of estrogenic receptors in the nasal mucosa of women taking oral contraceptives

BACKGROUND

There is evidence that the nasal mucosa is affected by estrogen influence. Some authors have already detected estrogen receptors (ER) in the nasal mucosa. However, there doesn't seem to be a consensus about the concentration and distribution of the ER or the possible influence of hormonal contraceptives in the nasal mucosa.

OBJECTIVE

The study was conducted to evaluate the influence of oral contraceptives on the distribution and concentration of estrogenic receptors in nasal mucosa.

STUDY DESIGN

Two groups of 32 women with regular menstrual cycles were selected. One group of women was taking oral contraceptives and the other was not. Samples of mucosa of inferior nasal turbinate were analyzed by immunohistochemical staining for alpha and beta ER.

RESULTS

The use of oral contraceptives induced a decrease of beta-receptors only in lamina propria cells. In both groups, there was a predominance of beta-receptors.

CONCLUSION

Women who took oral contraceptives showed a decrease of beta-receptors in some cells of the lamina propria. These findings show us the possibility of effects of contraceptive pills on the cells such as fibroblasts, mast cells, plasmocytes, and other inflammatory cells.

Incidence of allergic diseases in an elderly population

Recent years have shown a progressive increase of allergic disease in the elderly population worldwide. Naturally, this phenomenon has coincided with attempts to guarantee the best possible quality of life for this age group. As a result, diseases that were previously overlooked are attracting ever greater attention. An epidemiological study of allergic manifestations in the elderly conducted in all consecutive patients referred to an Allergology Unit over a three-month period at the beginning of 2008 showed that 15% belonged to the elderly population and among these, 51.8 % were suffering from an allergic reaction to drugs. Skin manifestations, including both urticaria and eczema, accounted for 71.4% of cases but only in 13.8% of these patients was there a diagnosis of an allergic reaction made and the allergen responsible individuated. Rhinitis was present in 16.8 % of the patients and food allergy in 8 %. Certainly, age-induced modifications in the immunological system can be responsible for allergic reactions. In fact, non specific immunity components such as the production of mucus or a reduced function of the T- and IL-2 cells can induce the onset of symptoms referable to allergic disease. Further studies are ongoing to gain a better understanding of the pathogenic mechanisms that could justify the development in the elderly population of a cytokine phenotype that is more prone to develop allergic manifestations, and to assess the true incidence of respiratory, food and drug allergies in this stage of life.

Characteristics of nasal epithelial cells in naturally postmenopausal women receiving hormone therapy with 1 mg 17beta-estradiol and 2 mg drospirenone: a prospective study

OBJECTIVE

To investigate the effects of drospirenone on nasal respiratory epithelium in postmenopausal women who are treated with hormone therapy (HT).

DESIGN

Thirty-five naturally postmenopausal women participated in the prospective study. Women received continuous-combined HT containing 1 mg 17beta-estradiol and 2 mg drospirenone. Cytological changes of nasal middle and inferior turbinate respiratory epithelium were evaluated by using the maturation index, performed at baseline and on the sixth cycle of HT.

RESULTS

Hematoxylin-eosin staining for the maturation index of the epithelial nasal cells of women reached better trophic aspects during 17beta-estradiol/drospirenone intake with respect to those observed at baseline (P < 0.001). The smears during HT emphasized the superficial and the intermediate types of cells, with a ratio index greater than 2. The parabasal cell content was less than 20%, and the karyopyknotic index showed degenerative changes in superficial and intermediate cells.

CONCLUSIONS

Our study confirmed that the nasal respiratory epithelium is an ovarian steroid target. Drospirenone acts on nasal cells similarly to other progestogens.

Prospective study on the cytological aspects of the nasal respiratory epithelium in premenopausal women taking 30 mcg ethinylestradiol and 3 mg drospirenone oral contraceptive

BACKGROUND

This study was conducted to determine the effects of the monophasic oral contraceptive (OC) containing 30 mcg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) on the nasal respiratory epithelium in premenopausal women.

STUDY DESIGN

Fifty premenopausal women participated in the prospective study. Baseline endovaginal ultrasound examination and blood test to measure serum progesterone to confirm an ovulatory cycle were performed. The cytologic changes on the nasal respiratory epithelium were evaluated with the maturation index, performed during the follicular, periovular and luteal phases of the menstrual cycle, and on the sixth cycle of pill intake.

RESULTS

The maturation indexes of the nasal smears were higher during both the follicular and periovular phases than during the luteal phase of the menstrual cycle (p<.05). Women on the OC pill had similar changes in the nasal epithelium as those seen during the follicular phase (p NS), and less than the periovular phase (p<.05) and higher than the luteal phase (p<.05). The maturation index of the nasal respiratory epithelium seems to depend on the variation of the ovarian steroids during the menstrual cycle and on the iatrogenic effects of oral contraception.

CONCLUSIONS

DRSP+EE seems to provoke cytological changes that are different from previously shown gestodene plus EE.

Cytological aspects of the nasal respiratory epithelium in reproductive-age women taking oral contraceptives

OBJECTIVE

To determine the effects of monophasic oral contraceptives on the nasal respiratory epithelium in premenopausal women.

DESIGN

Prospective open clinical trial.

SETTING

Outpatient Family Planning Centre.

PATIENT(S)

Eighty-eight premenopausal women, with ovulatory cycle, who were planning to take oral contraceptives.

INTERVENTION(S)

Baseline endovaginal ultrasound examination and blood test to measure serum progesterone to confirm ovulatory cycle. Thirty-eight women on pill containing 30 microg ethinylestradiol (EE) plus 75 microg gestodene, and 35 women on pill containing 15 microg ethinylestradiol plus 60 microg gestodene. MAIN OUTCOMES/MEASURE(S): Cytological changes on the nasal respiratory epithelium evaluated with the maturation index performed during the follicular, periovular, and luteal phases of the menstrual cycle, and on the sixth cycle of pill intake.

RESULT(S)

Hematoxylin-eosin staining for the maturation index showed similar trophic cytological aspects between the nasal and vaginal epithelium during the menstrual cycle and pill usage. Both the nasal and vaginal cytological samples showed higher maturation indexes during both the follicular and the periovular phases than during the luteal phase. Women on pill containing 15 microg EE showed lower trophic aspects in the nasal cytological samples compared with those on pill with 30 microg EE.

CONCLUSION(S)

Along with the vaginal cells, the nasal respiratory epithelium is an ovarian steroid target. The maturation index of the nasal respiratory epithelium seems to depend on the variation of the ovarian steroids during the menstrual cycle and on the iatrogenic effects of oral contraceptives.

A scanning electron microscopic study of nasal respiratory epithelium in pregnant rats

Pregnancy is a very important period in mammals. Various morphological and functional changes can be observed. Some studies examining nasal epithelial structure deal with changes found in pregnancy. In this study, a total of 16 adult female Sprague Dawley rats (8 control and 8 pregnant) were used. They were anesthetized with ketamine and sacrificed via cardiac perfusion with 2.5%-glutaraldehyde solution (in 0.1 M sodium phosphate buffer, pH 7.4). The heads of the rats were bisected midsagittally and one half was completely passed through the routine histological procedures for SEM examination. On the apical surfaces of ciliated cells of pregnant rat respiratory epithelium disoriented cilia and cilia with dilated blebs at their free ends were observed. In addition, some masses of mucus due to hypersecretion were striking. Goblet cells appeared swollen and their apical surfaces showed microvilli varying considerably in length and number.

Rhinitis in the elderly

The effects of aging on the nose include structural, hormonal, mucosal, olfactory, and neural changes. As the US population ages and remains in overall better health, we will have more patients with rhinologic problems related to aging. In this manuscript, we review the available evidence on the structural and physiologic changes of the nose caused by aging, and we briefly describe management of common causes of rhinitis in the elderly.

Comparison of intranasal and transdermal estradiol on nasal mucosa in postmenopausal women

OBJECTIVE

To compare nasal symptomatology and function and local concentrations of estradiol (E2), estradiol receptor (ERalpha), vasoactive intestinal peptide (VIP), substance P (SP) and neuropeptide Y (NPY) in nasal biopsies of 20 postmenopausal women complaining of paradoxical nasal stuffiness before and after treatment with intranasal or transdermal E2.

DESIGN

Twenty healthy postmenopausal women willing to start hormone therapy (HT) were allocated to one of two groups, using a computer-generated randomization list. Ten postmenopausal women were treated with transdermal 17beta-estradiol 50 microg daily plus nomegestrole acetate 5 mg/day for 12 days per 28-day cycle for 6 months (Group A). Ten postmenopausal women were treated with intranasal 17beta-estradiol 300 microg/day (one spray delivery of 150 microg per nostril) plus nomegestrole acetate 5 mg/day for 12 days per 28-day cycle for 6 months (Group B). Fourteen fertile women undergoing nasal mucosa biopsy during plastic surgery were used as controls for the immunohistochemical evaluation (Group C). All women in groups A and B underwent evaluation of nasal stuffiness score, mucociliary transport time, rhinoscopy, and active anterior rhinomanometry at the beginning of the study and after, VIP, SP, and 6 months of HT. Nasal biopsies and evaluation of local concentrations of E2, ERalpha NPY were performed in groups A and B before and after 6 months of HT and in group C.

RESULTS

Both intranasal and transdermal HT improve nasal symptomatology and nasal mucosa appearance and reduce mean mucociliary transport time. The effectiveness of intranasally administered therapy at improving nasal function is significantly better than transdermal therapy. In comparison with premenopausal controls, untreated postmenopausal women of group A and B showed significantly decreased immunopositivity for E2, ERalpha, and SP. HT induced a significant increase in E2, ERalpha, VIP, and SP and a decrease in NPY immunopositivity. Intranasal therapy was associated with a significantly higher immunopositivity for VIP and SP.

CONCLUSIONS

HT improves nasal function and symptomatology in postmenopausal women with paradoxical nasal stuffiness, modulating nasal mucosa function through an action on cholinergic, adrenergic, and sensory peptides. Intranasally administered HT is more effective at improving nasal function than transdermal HT.

Cytologic aspects of the nasal respiratory epithelium throughout the menstrual cycle

A prospective study was performed to investigate the changes in nasal cytology that occur in healthy premenopausal women throughout the menstrual cycle. Eighty-eight women with an ovulatory menstrual cycle underwent nasal sampling with a cytobrush by direct vision of the middle and inferior nasal turbinates during the follicular, periovular, and luteal phases of the menstrual cycle, and the specimens were evaluated with the maturation index. Hematoxylin-eosin staining showed the cytologic aspects of the nasal respiratory epithelium and of vaginal smears according to the three different phases of the menstrual cycle. Along with the vaginal cells, the nasal respiratory epithelium is an ovarian steroid target.

Cytologic aspects of the nasal respiratory epithelium in postmenopausal women treated with hormone therapy

OBJECTIVE

To investigate the effects of hormone therapy (HT) on nasal respiratory epithelium in postmenopausal women.

DESIGN

Prospective open clinical trial.

SETTING

Outpatient menopausal clinic.

PATIENT(S)

One hundred three healthy postmenopausal women, of whom 55 treated with HT, and 48 untreated women (controls).

INTERVENTION(S)

Different regimens of HT by patch, gel, or oral administration.

MAIN OUTCOME MEASURE(S)

Cytologic changes of nasal, middle and inferior turbinate cells compared with vaginal cytologic findings by using the maturation index.

RESULT(S)

Hematoxylin-eosin staining for the maturation index confirmed similar trophic cytologic aspects between the nasal respiratory epithelium and vaginal smears in HT-treated women and controls. Women treated with sequential HT or estrogen therapy (ET) showed better trophic characteristics in the nasal cytological samples compared with women treated with continuous combined HT.

CONCLUSION(S)

Along with vaginal cells the nasal respiratory epithelium is an estrogen target. The activity of HT in the nasal respiratory epithelium may depend on the type of hormone regimen used.

Nasal mucosal histamine reactivity among young students and teachers, having no or prolonged exposure to a deteriorated indoor climate

BACKGROUND

In a study performed in the spring of 1995, we found a significantly greater nasal mucosal histamine reactivity among teachers, who had worked for several years in a recently renovated moisture-damaged school, than in those in a control school. In the present study we investigated the students who begun their high-school studies at both schools in the autumn of 1995 and compared them with the teachers as regards mucosal reactivity, atopy and symptoms.

METHODS

Twenty-eight teachers in the target school, 18 teachers in the control school and 45 students from each school underwent a nasal histamine provocation test and a skin-prick test. They also answered a standardized questionnaire.

RESULTS

The teachers in both schools had more marked nasal mucosal histamine reactivity at the lowest provocation concentrations than the students. The histamine provocation curve of the target school teachers had consistently higher values than that of the students (P = 0.0001), but its slope and shape were similar (P = 0.15), while the slope of the provocation curve of the control school teachers was flatter. However, there was only a borderline significance in this respect compared to the students (P = 0.07). Teachers with a dry and crusty appearance of the nasal mucosa on anterior rhinoscopy reacted more strongly to histamine provocation than those without this finding (P = 0.0004). There was a significantly higher frequency of skin-prick test positivity (SPT+) among the students (P = 0.03). There were no significant differences in nasal mucosal histamine reactivity between atopic and non-atopic subjects out of pollen season.

CONCLUSIONS

Teachers had a significantly greater mucosal histamine reactivity than the students, whereas the latter had a significantly higher frequency of atopy. These results are compatible with an age-related pattern of mucosal reactivity. A crusty appearance of the nasal mucosa seems to predispose to an increase in histamine reactivity. There were no significant differences according to histamine reactivity between atopic and non-atopic subjects.

Comparative morphology and histochemistry of glands associated with the vomeronasal organ in humans, mouse lemurs, and voles

The vomeronasal organ (VNO) is a chemosensory structure of the vertebrate nasal septum that has been recently shown to exist in nearly all adult humans. Although its link to reproductive behaviors has been shown in some primates, its functionality in humans is still debated. Some authors have suggested that the human VNO has the capacity to detect pheromones, while others described it as little more than a glandular pit. However, no studies have utilized histochemical techniques that would reveal whether the human VNO functions as a generalized gland duct or a specialized chemosensory organ. Nasal septal tissue from 13 humans (2-86 years old) were compared to that of two adult lemurs (Microcebus murinus) and eight adult voles (four Microtus pennsylvanicus and four Microtus ochrogaster). Sections at selected intervals of the VNO were stained with periodic acid-Schiff (PAS), alcian blue (AB), AB-PAS, and PAS-hematoxylin procedures. Results revealed typical well-developed VNOs with tubuloacinar glands in Microtus and Microcebus. VNO glands were AB-negative and PAS-positive in voles and mouse lemurs. Homo differed from Microtus and Microcebus in having more branched, AB and PAS-positive glands that emptied into the VNO lumen. Furthermore, the human VNO epithelium had unicellular mucous glands (AB and PAS-positive) and cilia, similar to respiratory epithelia. These results demonstrate unique characteristics of the human VNO which at once differs from glandular ducts (e.g., cilia) and also from the VNOs of mammals possessing demonstrably functional VNO.

Noninfectious, nonallergic rhinitis (NINAR): considerations on possible mechanisms

Most patients who suffer from chronic noninfectious, nonallergic rhinitis (NINAR) cannot be assigned to a syndrome of known etiology. The symptomatology may well resemble that of allergic rhinitis; however, NINAR has lower prevalence of sneezing, conjunctival symptoms, and pruritus and higher prevalence of symptoms compatible with sinus disease. The triggers for the symptoms of NINAR are mainly irritants and changes in atmospheric conditions. Among individuals who develop chronic rhinitis symptoms, the percentage of nonallergic etiology increases steadily with age and is more than 60% beyond the fifth decade of life. Our strategy regarding the pathophysiology of NINAR should be to identify functional abnormalities of nasal mucosa that can potentially result in the alleged nasal symptoms. In this respect, comparison of patients with NINAR to patients with allergic rhinitis and to healthy individuals could shed light into the cause(s) of NINAR. Three potential functional abnormalities are discussed in this article: those associated with the aging process of the nasal mucosa, those resulting in various forms of nasal hyperreactivity, and those reflecting imbalanced neuronal control of end organs of the nose. The most interesting development in the therapy of NINAR is the use of capsaicin. Although placebo-controlled studies are scarce and participants have not been adequately characterized, it is possible that abnormal nociceptor nerve endings play a role in the generation of the symptoms of NINAR. Alternatively, NINAR may represent a condition of increased perceptual acuity to irritants and to environmental changes. This problem may also benefit from defunctionalization of nociceptors.