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Ayoub NF, Glicksman JT. Artificial Intelligence in Rhinology. Otolaryngol Clin North Am 2024:S0030-6665(24)00068-9. [PMID: 38821734 DOI: 10.1016/j.otc.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Rhinology, allergy, and skull base surgery are fields primed for the integration and implementation of artificial intelligence (AI). The heterogeneity of the disease processes within these fields highlights the opportunity for AI to augment clinical care and promote personalized medicine. Numerous research studies have been published demonstrating the development and clinical potential of AI models within the field. Most describe in silico evaluation models without direct clinical implementation. The major themes of existing studies include diagnostic or clinical decisions support, clustering patients into specific phenotypes or endotypes, predicting post-treatment outcomes, and surgical planning.
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Affiliation(s)
- Noel F Ayoub
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear/Harvard Medical School, Boston, MA, USA.
| | - Jordan T Glicksman
- Department of Otolaryngology-Head & Neck Surgery, Mass Eye and Ear/Harvard Medical School, Boston, MA, USA
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El Khoury P, Abou Hamad W, Khalaf MG, El Hadi C, Assily R, Rassi S, Khoueir N. Ipratropium Bromide Nasal Spray in Non-Allergic Rhinitis: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:3247-3255. [PMID: 37067019 DOI: 10.1002/lary.30706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE This study aims to compare the effectiveness of intranasal ipratropium bromide (INIB) to a placebo in reducing nasal symptoms, particularly rhinorrhea, and enhancing quality of life in non-allergic rhinitis (NAR) patients. STUDY DESIGN Systematic review and meta-analysis. METHODS A comprehensive review of the literature was conducted on Medline, Embase, and Cochrane libraries. Randomized controlled trials (RCTs) and non-randomized comparative parallel group trials comparing IB nasal spray to placebo were included. RESULTS Five RCTs assessed a total of 472 participants with a diagnosis of NAR. IB nasal spray 0.03% were used across all studies. IB has a better impact on decreasing rhinorrhea than the placebo, with a standardized mean difference (SMD) of 0.93 (95% CI 0.06-1.8). The mean change in rhinorrhea severity was 85% (95% CI 77-92%) and I^2 26% (p = 0.24). IB outperformed the placebo in terms of shortening the symptom's duration/day, as shown by an SMD of 0.35 (95% CI 0.15-0.55). The difference between treatments was noticeable within the first week and remained consistent throughout the treatment. Patients who were administered IB experienced a substantially greater improvement in physical and mental outcomes. Nasal adverse events with IB were generally intermittent and brief. CONCLUSION Compared with a placebo, IB nasal spray is both safe and effective in treating the rhinorrhea associated with NAR. IB significantly reduces the severity and duration of rhinorrhea. The treatment was determined to be beneficial by both patients and physicians and resulted in a better quality of life. LEVEL OF EVIDENCE 1 Laryngoscope, 133:3247-3255, 2023.
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Affiliation(s)
- Patrick El Khoury
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Walid Abou Hamad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christopher El Hadi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ralph Assily
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Simon Rassi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadim Khoueir
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Zamora-Sifuentes J, Poole JA. Occupational Rhinitis: An Update. Curr Allergy Asthma Rep 2023; 23:579-587. [PMID: 37452992 PMCID: PMC10896593 DOI: 10.1007/s11882-023-01103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW Occupational rhinitis is an underdiagnosed disease with significant morbidity and implications in the workplace. Multiple factors associated with this disease continue to pose a challenge to investigators. This review aims to summarize recent literature in occupational rhinitis, including classifications, pathogenesis, diagnosis, and treatment, as well as the impact of occupational rhinitis on individuals. Additionally, it identifies areas in need of further research and investigation. RECENT FINDINGS We highlight current research on the association between occupational rhinitis and occupational asthma and the role of immunotherapy in this disease. Discussion includes the impact of social trends on workers and the wider consequences of occupational rhinitis including decreased work productivity, absenteeism, and socioeconomic burden. Occupational rhinitis remains a challenging disease entity due to the numerous potential causative factors, reduced recognition, morbidity in asthma, and therapeutic limitations. Additional research is needed to better identify disease predictors and develop effective management strategies.
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Affiliation(s)
- Jose Zamora-Sifuentes
- Division of Allergy and Immunology, Department of Internal Medicine, Medical Center, University of Nebraska, University of Nebraska Medical Center, Omaha, NE, 68198-5990, USA.
| | - Jill A Poole
- Division of Allergy and Immunology, Department of Internal Medicine, Medical Center, University of Nebraska, University of Nebraska Medical Center, Omaha, NE, 68198-5990, USA
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Choi JE, Kim YW, Jee S, Sohn MK. Clinical characteristics of chronic rhinitis following stroke. Front Neurol 2023; 14:1081390. [PMID: 36756250 PMCID: PMC9901202 DOI: 10.3389/fneur.2023.1081390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Background We previously observed that patients with stroke complained of rhinitis symptoms that developed following the occurrence of stroke. Objectives To investigate the relationship between chronic rhinitis (CR) and stroke. Methods This retrospective study analyzed the medical records and questionnaires of patients with stroke who visited our outpatient clinic from June to December 2020. Stroke lesions were mainly classified as supratentorial, infratentorial, and supra/infratentorial lesions. Supratentorial lesions were further divided into cortex, subcortex, and mixed. Participants were screened for CR and were subsequently divided into the CR and non-CR groups. The Sino-Nasal Outcome Test questionnaire and a questionnaire on autonomic nervous system symptoms were administered to all patients. Results Clinically evaluated indicators were not significantly different between the two groups. The number of patients with lesions in both the cortex and subcortex was significantly higher in the CR group than in the non-CR group. The risk of CR was higher in male patients with stroke than their female counterparts; additionally, the risk of CR was higher in patients with stroke who had both cortical and subcortical lesions, as well as autonomic dysfunction. Conclusions Individuals with subcortical stroke damage had a greater probability of developing CR. The risk was increased in men, as compared with that in women, when autonomic symptoms were present.
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Affiliation(s)
- Jae Eun Choi
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yeong Wook Kim
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea,Chungnam Regional Cardiocerebrovascular Center, Chungnam National University, Daejeon, Republic of Korea,*Correspondence: Sungju Jee ✉
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University, Daejeon, Republic of Korea,Min Kyun Sohn ✉
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Kim J, Waugh DW, Zaitchik BF, Luong A, Bergmark R, Lam K, Roland L, Levy J, Lee JT, Cho DY, Ramanathan M, Baroody F, Takashima M, O'Brien D, Lin SY, Joe S, Chaaban MR, Butrymowicz A, Smith S, Mullings W, Smith S, Mullings W. Climate change, the environment, and rhinologic disease. Int Forum Allergy Rhinol 2022; 13:865-876. [PMID: 36575965 DOI: 10.1002/alr.23128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The escalating negative impact of climate change on our environment has the potential to result in significant morbidity of rhinologic diseases. METHODS Evidence based review of examples of rhinologic diseases including allergic and nonallergic rhinitis, chronic rhinosinusitis, and allergic fungal rhinosinusitis was performed. RESULTS The lower socioeconomic population, including historically oppressed groups, will be disproportionately affected. CONCLUSIONS We need a systematic approach to improve healthcare database infrastructure and funding to promote diverse scientific collaboration to address these healthcare needs.
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Affiliation(s)
- Jean Kim
- Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Darryn W Waugh
- Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin F Zaitchik
- Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amber Luong
- Otolaryngology-Head and Neck Surgery, McGovern Medical School of University of Texas Health Science Center, Houston, Texas, USA
| | - Regan Bergmark
- Otolaryngology-Head and Neck Surgery, Harvard Medical School and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kent Lam
- Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Lauren Roland
- Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, USA
| | - Joshua Levy
- Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jivianne T Lee
- Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Do-Yeon Cho
- Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Murugappan Ramanathan
- Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, USA
| | - Mas Takashima
- Otolaryngology-Head and Neck Surgery, Houston Methodist Research Institute, Houston, Texas, USA
| | - Daniel O'Brien
- Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Y Lin
- Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stephanie Joe
- Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mohamad R Chaaban
- Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
| | - Anna Butrymowicz
- Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Smith
- Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Warren Mullings
- Otolaryngology-Head and Neck Surgery, Ear, Nose and Throat Department, Kingston Public Hospital, Kingston, Jamaica
| | - Stephanie Smith
- Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Warren Mullings
- Otolaryngology-Head and Neck Surgery, Ear, Nose and Throat Department, Kingston Public Hospital, Kingston, Jamaica
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Huang Y, Zhang Y, Wang J, Li X, Wang C, Chen R, Zhang L. Impact of Air Pollutants and Pollen on the Severity of Nonallergic Rhinitis: A Data-Oriented Analysis. J Asthma Allergy 2022; 15:1045-1054. [PMID: 35967096 PMCID: PMC9364988 DOI: 10.2147/jaa.s372927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Rhino-conjunctivitis symptoms are more severe in nonallergic rhinitis (NAR) patients during pollen season than in other seasons. Little is known about the role of pollen and air pollutants on the severity of NAR. Objective The aim of this study is to assess the cross-sectional effects of both pollen and air pollutants on NAR patients during the pollen and non-pollen seasons, and to further explore the possible relationship among these triggers. Methods A total of 2411 clinically diagnosed NAR outpatients from 2018 to 2019 were recruited for this study. The severity of NAR was measured using rhinoconjunctivitis symptom scores. Associations of daily exposure to pollen, PM2.5, PM10, NO2, SO2, CO, O3, and rhinoconjunctivitis symptom scores were evaluated using Logistic regression models. Distributed Lag Nonlinear models were used to explore single-day and accumulative Lag effects of environmental factors mentioned above. Results During the pollen season, pollen concentration, higher exposure levels of PM10, PM2.5, NO2, and SO2 increased the severity of NAR group when compared with the low-moderate severity group. The high severity group was associated with lower exposure levels of O3. However, during non-pollen seasons, no significant association was found in air pollutant metrics, pollen concentration, and severity of NAR. The exposure-severity effects of pollen were different when different ambient pollutants were stratified. Conclusion Synergistic effect of pollen and air pollutants, including PM2.5, PM10, SO2, NO2, and O3, might be responsible for aggravating the symptoms of NAR patients during pollen seasons.
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Affiliation(s)
- Yanran Huang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People’s Republic of China
| | - Yuan Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People’s Republic of China
| | - Jiajia Wang
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, People’s Republic of China
- School of Public Health, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaobo Li
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, People’s Republic of China
- School of Public Health, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Chengshuo Wang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Rui Chen
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, People’s Republic of China
- School of Public Health, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
- Rui Chen, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, 10 Xitoutiao, You’anmen, Fengtai District, Beijing, 100069, People’s Republic of China, Email
| | - Luo Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People’s Republic of China
- Correspondence: Luo Zhang, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong, DongCheng District, Beijing, 100005, People’s Republic of China, Email
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Mometasone Furoate in Non-Allergic Rhinitis: A Real-Life Italian Study. J Pers Med 2022; 12:jpm12071179. [PMID: 35887676 PMCID: PMC9322075 DOI: 10.3390/jpm12071179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background: In order to evaluate the efficacy of intranasal mometasone furoate in patients with non-allergic rhinitis (NAR), a real-life, observational, prospective study is performed. Methods: Thirty-one patients (age 18–64 years) receive intranasal (mometasone furoate, 200 µg b.i.d. for 15 consecutive days per month for 6 consecutive months), plus isotonic nasal saline. The cytologic pattern of local inflammation, nasal airflow, through peak nasal inspiratory flow (PNIF), quality of life (QoL), through the rhinitis quality of life questionnaire (RQLQ), the sinonasal outcome test (SNOT-22), the short-form 36-item health survey (SF-36v2), and the combined symptom medication score (CSMS), and, finally, olfactory function, through Sniffin’ sticks-16 identification test (SSIT-16), are evaluated at baseline and after treatment. Results: NARNE is the most frequent cytological pattern (48% of the total sample). The therapeutic response shows improvement in olfactory function and QoL. Conclusions: The results of this study confirm that intranasal mometasone furoate is an effective treatment for patients with NAR.
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Clinical Efficacy of Sanfeng Tongqiao Diwan in the Treatment of Allergic Rhinitis: A Randomized Controlled Trial. DISEASE MARKERS 2022; 2022:2916223. [PMID: 35789604 PMCID: PMC9250434 DOI: 10.1155/2022/2916223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
Objective. To explore the clinical effect of Sanfeng Tongqiao Diwan in the treatment of allergic rhinitis. Methods. Allergic rhinitis patients included in this study were randomly divided into control group and study group for 7 days of treatment. The control group was treated with Tongqiao Biyan Pian, while the study group was treated with Sanfeng Tongqiao Diwan. Results. After 7 days of treatment, the total effective rate of Sanfeng Tongqiao Diwan was 75.76%, which was higher than that of Tongqiao Biyan Pian (65.62%). The scores of visual analogue scale (VAS), symptom relief, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and Epworth sleepiness scale (ESS) in both groups were significantly improved before and after treatment (
), and the improvement was most significant 24 hours after treatment. The adverse reactions in both groups were low. Conclusion. Sanfeng Tongqiao Diwan can significantly alleviate the symptoms and improve the quality of life of patients with allergic rhinitis, with less adverse reactions.
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Senanayake P, Wong E, McBride K, Singh N. Efficacy of Vidian Neurectomy and Posterior Nasal Neurectomy in the Management of Nonallergic Rhinitis: A Systematic Review. Am J Rhinol Allergy 2022; 36:849-871. [PMID: 35695191 DOI: 10.1177/19458924221105933] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonallergic rhinitis (NAR) is characterized by rhinorrhea, nasal obstruction, and sneezing, in the absence of systemic sensitization to allergens. For cases refractory to medical therapy and conservative surgical interventions, more targeted procedures, such as endoscopic vidian neurectomy (EVN) and posterior nasal neurectomy (PNN), including surgical (SPNN) and cryoablative (CPNN) methods, may reduce symptoms of NAR. OBJECTIVE The purpose of this study was to compare the efficacy, side effect profile, and complication rate between EVN and PNN for NAR. METHODS A systematic review of primary articles that reported original patient data for either EVN or PNN was conducted using Embase, Medline, PubMed, and Cochrane databases since 2006, according to PRISMA guidelines. The primary outcome of the study was an improvement in NAR symptom severity. Secondary outcomes included the incidence of postoperative side effects or complications. RESULTS In total, 58 articles met the search criteria with a total of 9 studies (including 2 RCTs) eligible for inclusion. There was a pooled sample of 229 NAR patients that underwent EVN (n = 65; 28.4%), SPNN (n = 50; 21.8%), or CPNN (n = 114; 49.8%). For all 3 techniques, there was a statistically significant improvement in nasal symptoms, particularly rhinorrhea, nasal congestion, and obstruction along with quality of life. Heterogeneity in outcome reporting prevented meta-analysis and direct comparison of efficacy. The pooled incidence of postoperative complications for EVN (n = 65), SPNN (n = 50), and CPNN (n = 70) was 30.8% versus 0% versus 2.9% for dry eye, 16.9% versus 0% versus 1.4% for palatal/cheek numbness, and 0% versus 6% versus 4.3% for bleeding. CONCLUSION EVN, SPNN, and CPNN are similarly efficacious for patients with NAR refractory to medical management. SPNN and CPNN are associated with lower rates of complications (dry eye and palatal/cheek numbness) compared with EVN.
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Affiliation(s)
- Praween Senanayake
- Department of Otolaryngology, Head and Neck Surgery, 8539Westmead Hospital, Sydney, NSW, Australia.,School of Medicine, 67422Western Sydney University, Campbelltown, NSW, Australia
| | - Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, 8539Westmead Hospital, Sydney, NSW, Australia
| | - Kate McBride
- School of Medicine, 67422Western Sydney University, Campbelltown, NSW, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, 8539Westmead Hospital, Sydney, NSW, Australia.,Sydney Medical School, 4334University of Sydney, Camperdown, NSW, Australia
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Avdeeva KS, Fokkens WJ, Segboer CL, Reitsma S. The prevalence of non-allergic rhinitis phenotypes in the general population: A cross-sectional study. Allergy 2022; 77:2163-2174. [PMID: 35038765 PMCID: PMC9306544 DOI: 10.1111/all.15223] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/01/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022]
Abstract
Background Non‐allergic rhinitis (NAR) can be subdivided into several phenotypes: rhinorrhea of the elderly, rhinitis medicamentosa, smokers', occupational, hormonal, drug‐induced, gustatory, and idiopathic rhinitis. There are two pathophysiological endotypes of NAR: inflammatory and neurogenic. Phenotypes may serve as an indicator of an underlying endotype and, therefore, help to guide the treatment. The prevalence of each phenotype in the general population is currently unknown. Methodology/Principal Cross‐sectional questionnaire‐based study in the general population of the Netherlands. Results The prevalence of chronic rhinitis in the general population was 40% (N = 558, of those, 65% had NAR and 28% AR, in 7% allergy status is unknown). Individuals with NAR (N = 363) had significantly more complaints in October–February. Those with AR (N = 159) had significantly more complaints in April–August. The most common NAR phenotypes were idiopathic (39%) and rhinitis medicamentosa (14%), followed by occupational (8%), smokers' (6%), hormonal (4%), gustatory (4%), and rhinorrhea of the elderly (4%). The least prevalent phenotype was drug induced (1%). Nineteen percent of the NAR group could not be classified into any of the phenotypes. Conclusions This is the first study to describe the prevalences of NAR phenotypes in the general population. AR and NAR have a distinct seasonality pattern with NAR being more prevalent in autumn/winter and AR in spring/summer. Our data on the prevalence of phenotypes may help clinicians to anticipate the type of patients at their clinic and help guide a tailored treatment approach. The high prevalence of rhinitis medicamentosa is alarming, since this is a potentially preventable phenotype.
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Affiliation(s)
- Klementina S. Avdeeva
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
| | | | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam UMC Location Academic Medical Centre Amsterdam The Netherlands
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Avdeeva KS, Fokkens WJ, Reitsma S. Towards a new epidemiological definition of chronic rhinitis: prevalence of nasal complaints in the general population. Rhinology 2021; 59:258-266. [PMID: 34091655 DOI: 10.4193/rhin20.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic rhinitis (CR) is currently defined as the presence of at least two nasal symptoms for at least 1 hour per day for more than 12 weeks per year. Such definition lacks evidence-based foundation. CR patients are often divided into "runners" and "blockers", although the evidence supporting such subdivision is limited. The aim of the study was to define CR, to estimate its prevalence and the proportion of "runners" and "blockers". METHODS Cross-sectional, questionnaire-based study in a random sample of participants representing the general population of the Netherlands. RESULTS The questionnaire was sent to 5000 residents of the Netherlands; the response rate was 27%. CR was defined as at least 1 nasal complaint present for more than 3 weeks per year. The prevalence of CR in the general population was 40%. Participants who would have been excluded by the former CR definition were shown to have a significantly higher VAS compared to the controls. The larger part of CR group was represented by non-allergic rhinitis (NAR): 70% vs 30%. There were 25% "Blockers" and 22% "Runners" in the CR group, whereas more than a half of the CR group could be classified in neither of these subgroups. CONCLUSION Based on our data, we suggest that the current definition of CR should be revised and propose a new definition: at least one nasal complaint present for at least 3 weeks per year; although future studies are needed to further validate the proposed definition.
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Affiliation(s)
- K S Avdeeva
- Department of Otorhinolaryngology, Amsterdam UMC, location Academic Medical Centre, Amsterdam, The Netherlands
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC, location Academic Medical Centre, Amsterdam, The Netherlands
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam UMC, location Academic Medical Centre, Amsterdam, The Netherlands
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Huang Y, Wang C, Zhang Y, Zhang L. Developing nomograms for identifying allergic rhinitis among chronic rhinitis: A real-world study. World Allergy Organ J 2021; 14:100534. [PMID: 33912321 PMCID: PMC8054181 DOI: 10.1016/j.waojou.2021.100534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/10/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background It is difficult to discriminate allergic rhinitis (AR) and nonallergic rhinitis (NAR) in clinical practice due to the similar clinical manifestations. The study was to assess both the demographical and clinical features of AR and NAR in the real-world data of outpatients in China. Methods It was a cross-sectional real-world study. AR and NAR were defined based on both subjective symptoms and objective specific serum IgE test. General demographic characteristics as well as clinical information were documented. Patients were further classified according the seasons of initial visiting hospital (during pollen seasons or not). A scoring system presented as nomograms for presence of AR was performed. Results In the pollen season group, age distribution, the duration of rhinitis, comorbidity of asthma, food allergies, and score of coughing were found significantly associated with AR. Additionally, in the non-pollen season group, we found that ethnicity, age distributions, duration of rhinitis, comorbidity of asthma, food allergies, and family history of allergy, together with scores of gritty eyes were associated factors of AR. Based on multivariate logistic model, we built two nomograms which included previously identified significant risk factors that could be acquired easily during clinical practice with predictive variables to assess their roles in predicting the risk of AR among outpatients with rhinitis. Conclusions The characteristics of patients with different phenotypes of chronic rhinitis are distinctive in different seasons and the developed nomogram in this study might be beneficial for clinical practice.
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Affiliation(s)
- Yanran Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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14
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Sonoda S, Murakami D, Saito Y, Miyamoto Y, Higuchi R, Kikuchi Y, Sawatsubashi M, Nakagawa T. Long-term effectiveness, safety, and quality of life outcomes following endoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis. Auris Nasus Larynx 2021; 48:636-645. [PMID: 33446371 DOI: 10.1016/j.anl.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/13/2020] [Accepted: 12/26/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In recent decades, posterior nasal neurectomy (PNN) with submucosal inferior turbinectomy (ST) has been increasingly used for the treatment of intractable severe rhinitis; however, to the best of our knowledge, there have been few studies regarding its long-term therapeutic effects or its influence on patient quality of life (QOL). Therefore, this study examined the long-term therapeutic effects in patients who underwent PNN with ST, as well as their QOL and medication use after surgery. METHODS This retrospective cohort study initially included 16 consecutive patients who underwent PNN with ST from January 2010 to December 2011. Ten of the 16 patients participated in a paper-based survey questionnaire between June 2018 and November 2018; the responses of these 10 patients were used for analysis in this study. To clarify the effects of surgical treatment on symptoms, QOL, and medication status, data recorded before and 3 months after surgery were compared with data recorded at 8 years after surgery using the Japan Rhinoconjunctivitis Quality of Life Questionnaire No. 1 and Classification of the Severity of Allergic Rhinitis Symptoms I and II. RESULTS Nasal symptoms including runny nose and nasal congestion, medication score, respective total symptoms medication scores (i.e., combined average total symptoms score and medication score), and the scores of troubles with daily life and total QOL were significantly improved at 3 months and 8 years after surgery, compared with before surgery; scores were not significantly worsened at 8 years after surgery, compared with 3 months after surgery. In addition, there were no adverse events requiring treatment after surgery. CONCLUSION Our findings suggest that PNN with ST is effective and safe for long-term treatment of severe chronic rhinitis symptoms, as well as reduction of medication use and improvement of QOL.
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Affiliation(s)
- Serika Sonoda
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Murakami
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yuichi Saito
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Miyamoto
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryota Higuchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshikazu Kikuchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Sawatsubashi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Otolaryngology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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15
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Avdeeva KS, Reitsma S, Fokkens WJ. Direct and indirect costs of allergic and non-allergic rhinitis in the Netherlands. Allergy 2020; 75:2993-2996. [PMID: 32544253 PMCID: PMC7689759 DOI: 10.1111/all.14457] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Klementina S. Avdeeva
- Department of Otorhinolaryngology Amsterdam UMCLocation Academic Medical Centre Amsterdam The Netherlands
| | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam UMCLocation Academic Medical Centre Amsterdam The Netherlands
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam UMCLocation Academic Medical Centre Amsterdam The Netherlands
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16
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Vandenplas O, Hox V, Bernstein D. Occupational Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3311-3321. [PMID: 32653647 DOI: 10.1016/j.jaip.2020.06.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Abstract
There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.
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Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Valérie Hox
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - David Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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17
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Vandenplas O, Suarthana E, Rifflart C, Lemière C, Le Moual N, Bousquet J. The Impact of Work-Related Rhinitis on Quality of Life and Work Productivity: A General Workforce-Based Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1583-1591.e5. [DOI: 10.1016/j.jaip.2019.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/05/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022]
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18
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Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT. Current and Future Treatments of Rhinitis and Sinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1522-1531. [PMID: 32004747 DOI: 10.1016/j.jaip.2020.01.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
Advances in understanding the pathogenic mechanisms of both rhinitis and chronic rhinosinusitis have resulted in new treatment options, especially for chronic rhinosinusitis. A review of relevant medical and surgical clinical studies shows that intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis. Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps. Omalizumab, mepolizumab, and benralizumab may have a future role in the treatment of chronic rhinosinusitis. Novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids. Surgical management tailored to the underlying disease process improves clinical outcomes in chronic rhinosinusitis with or without nasal polyposis. Advances in the understanding of the heterogeneous nature of rhinitis and rhinosinusitis have resulted in more precise treatments. Improving the understanding of different endotypes should provide better knowledge to determine appropriate current and new therapies to treat these diseases.
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Affiliation(s)
- Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Park Hae-Sim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Bousquet J, Akdis CA, Grattan C, Eigenmann PA, Hoffmann‐Sommergruber K, Agache I, Jutel M. Highlights and recent developments in airway diseases in EAACI journals (2018). Allergy 2019; 74:2329-2341. [PMID: 31573676 DOI: 10.1111/all.14068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) supports three journals: Allergy, Pediatric Allergy and Immunology, and Clinical and Translational Allergy. EAACI's major goals include supporting the promotion of health, in which the prevention of allergy and asthma plays a critical role, and disseminating the knowledge of allergic disease to all stakeholders. In 2018, the remarkable progress in the identification of basic mechanisms of allergic and respiratory diseases as well as the translation of these findings into clinical practice were observed. Last year's highlights include publication of EAACI guidelines for allergen immunotherapy, many EAACI Position Papers covering important aspects for the specialty, better understanding of molecular and cellular mechanisms, identification of biomarkers for disease prediction and progress monitoring, novel prevention and intervention studies, elucidation of mechanisms of multimorbidities, introduction of new drugs to the clinics, recently completed phase three clinical studies, and publication of a large number of allergen immunotherapy studies and meta-analyses.
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Affiliation(s)
- Jean Bousquet
- Fondation partenariale FMC VIA‐LR MACVIA‐France Montpellier France
- INSERM U 1168 VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- EUFOREA Brussels Belgium
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Clive Grattan
- St John's Institute of Dermatology Guy's Hospital London UK
| | | | | | - Ioana Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - Marek Jutel
- Department of Clinical Immunology ALL‐MED Medical Research Institute Wroclaw Medical University Wrocław Poland
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20
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Segboer C, Gevorgyan A, Avdeeva K, Chusakul S, Kanjanaumporn J, Aeumjaturapat S, Reeskamp LF, Snidvongs K, Fokkens W. Intranasal corticosteroids for non-allergic rhinitis. Cochrane Database Syst Rev 2019; 2019:CD010592. [PMID: 31677153 PMCID: PMC6824914 DOI: 10.1002/14651858.cd010592.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Non-allergic rhinitis is defined as dysfunction and non-infectious inflammation of the nasal mucosa that is caused by provoking agents other than allergens or microbes. It is common, with an estimated prevalence of around 10% to 20%. Patients experience symptoms of nasal obstruction, anterior rhinorrhoea/post-nasal drip and sneezing. Several subgroups of non-allergic rhinitis can be distinguished, depending on the trigger responsible for symptoms; these include occupation, cigarette smoke, hormones, medication, food and age. On a cellular molecular level different disease mechanisms can also be identified. People with non-allergic rhinitis often lack an effective treatment as a result of poor understanding and lack of recognition of the underlying disease mechanism. Intranasal corticosteroids are one of the most common types of medication prescribed in patients with rhinitis or rhinosinusitis symptoms, including those with non-allergic rhinitis. However, it is unclear whether intranasal corticosteroids are truly effective in these patients. OBJECTIVES To assess the effects of intranasal corticosteroids in the management of non-allergic rhinitis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 7); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 July 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing intranasal corticosteroids, delivered by any means and in any volume, with (a) placebo/no intervention or (b) other active treatments in adults and children (aged ≥ 12 years). DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcomes were patient-reported disease severity and a significant adverse effect - epistaxis. Secondary outcomes were (disease-specific) health-related quality of life, objective measurements of airflow and other adverse events. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 34 studies (4452 participants); however, only 13 studies provided data for our main comparison, intranasal corticosteroids versus placebo. The participants were mainly defined as patients with perennial rhinitis symptoms and negative allergy tests. No distinction between different pheno- and endotypes could be made, although a few studies only included a specific phenotype such as pregnancy rhinitis, vasomotor rhinitis, rhinitis medicamentosa or senile rhinitis. Most studies were conducted in a secondary or tertiary healthcare setting. No studies reported outcomes beyond three months follow-up. Intranasal corticosteroid dosage in the review ranged from 50 µg to 2000 µg daily. Intranasal corticosteroids versus placebo Thirteen studies (2045 participants) provided data for this comparison. These studies used different scoring systems for patient-reported disease severity, so we pooled the data in each analysis using the standardised mean difference (SMD). Intranasal corticosteroid treatment may improve patient-reported disease severity as measured by total nasal symptom score compared with placebo at up to four weeks (SMD -0.74, 95% confidence interval (CI) -1.15 to -0.33; 4 studies; 131 participants; I2 = 22%) (low-certainty evidence). However, between four weeks and three months the evidence is very uncertain (SMD -0.24, 95% CI -0.67 to 0.20; 3 studies; 85 participants; I2 = 0%) (very low-certainty evidence). Intranasal corticosteroid treatment may slightly improve patient-reported disease severity as measured by total nasal symptom score change from baseline when compared with placebo at up to four weeks (SMD -0.15, 95% CI -0.25 to -0.05; 4 studies; 1465 participants; I2 = 35%) (low-certainty evidence). All four studies evaluating the risk of epistaxis showed that there is probably a higher risk in the intranasal corticosteroids group (65 per 1000) compared to placebo (31 per 1000) (risk ratio (RR) 2.10, 95% CI 1.24 to 3.57; 4 studies; 1174 participants; I2 = 0%) (moderate-certainty evidence). The absolute risk difference (RD) was 0.04 with a number needed to treat for an additional harmful outcome (NNTH) of 25 (95% CI 16.7 to 100). Only one study reported numerical data for quality of life. It did report a higher quality of life score in the intranasal corticosteroids group (152.3 versus 145.6; SF-12v2 range 0 to 800); however, this disappeared at longer-term follow-up (148.4 versus 145.6) (low-certainty evidence). Only two studies provided data for the outcome objective measurements of airflow. These data could not be pooled because they used different methods of outcome measurement. Neither found a significant difference between the intranasal corticosteroids and placebo group (rhinomanometry SMD -0.46, 95% CI -1.06 to 0.14; 44 participants; peak expiratory flow rate SMD 0.78, 95% CI -0.47 to 2.03; 11 participants) (very low-certainty evidence). Intranasal corticosteroids probably resulted in little or no difference in the risk of other adverse events compared to placebo (RR 0.99, 95% CI 0.87 to 1.12; 3 studies; 1130 participants; I2 = 0%) (moderate-certainty evidence). Intranasal corticosteroids versus other treatments Only one or a few studies assessed each of the other comparisons (intranasal corticosteroids versus saline irrigation, intranasal antihistamine, capsaicin, cromoglycate sodium, ipratropium bromide, intranasal corticosteroids combined with intranasal antihistamine, intranasal corticosteroids combined with intranasal antihistamine and intranasal corticosteroids with saline compared to saline alone). It is therefore uncertain whether there are differences between intranasal corticosteroids and other active treatments for any of the outcomes reported. AUTHORS' CONCLUSIONS Overall, the certainty of the evidence for most outcomes in this review was low or very low. It is unclear whether intranasal corticosteroids reduce patient-reported disease severity in non-allergic rhinitis patients compared with placebo when measured at up to three months. However, intranasal corticosteroids probably have a higher risk of the adverse effect epistaxis. There are very few studies comparing intranasal corticosteroids to other treatment modalities making it difficult to draw conclusions.
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Affiliation(s)
- Christine Segboer
- Academic Medical CentreDepartment of OtorhinolaryngologyMeibergdreef 9, A2‐234, 1105 AzAmsterdamNetherlands
| | - Artur Gevorgyan
- University of TorontoDepartment of Otolaryngology ‐ Head and Neck Surgery117 King Street East5th floorOshawaONCanadaL1H 1B9
| | - Klementina Avdeeva
- Academic Medical CentreDepartment of OtorhinolaryngologyMeibergdreef 9, A2‐234, 1105 AzAmsterdamNetherlands
| | - Supinda Chusakul
- Chulalongkorn UniversityDepartment of Otolaryngology, Faculty of MedicineBangkokThailand
| | - Jesada Kanjanaumporn
- Chulalongkorn UniversityDepartment of Otolaryngology, Faculty of MedicineBangkokThailand
| | - Songklot Aeumjaturapat
- Chulalongkorn UniversityDepartment of Otolaryngology, Faculty of MedicineBangkokThailand
| | - Laurens F Reeskamp
- Academic Medical CentreDepartment of OtorhinolaryngologyMeibergdreef 9, A2‐234, 1105 AzAmsterdamNetherlands
| | - Kornkiat Snidvongs
- Chulalongkorn UniversityDepartment of Otolaryngology, Faculty of MedicineBangkokThailand
| | - Wytske Fokkens
- Academic Medical CentreDepartment of OtorhinolaryngologyMeibergdreef 9, A2‐234, 1105 AzAmsterdamNetherlands
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Reitsma S, Subramaniam S, Fokkens WWJ, Wang DY. Recent developments and highlights in rhinitis and allergen immunotherapy. Allergy 2018; 73:2306-2313. [PMID: 30260494 DOI: 10.1111/all.13617] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/09/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023]
Abstract
This review paper aims to provide an overview of recent developments in the field of allergic and non-allergic rhinitis, as well as allergen immunotherapy. Recent advances in phenotyping and endotyping various forms of rhinitis have brought us one step closer towards tailoring treatment more appropriately for a given patient. Updates on local allergic rhinitis are also covered. Allergen immunotherapy (AIT) is an area of significant interest, with multiple original papers and recent position papers and guidelines published. Evidence related to the application of AIT in seasonal and perennial allergic rhinitis (AR), local allergic rhinitis and novel and expanded applications is discussed in the publication.
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Affiliation(s)
- Sietze Reitsma
- Department of Otorhinolaryngology; Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Soma Subramaniam
- Department of Otolaryngology; Ng Teng Fong General Hospital; Singapore Singapore
| | - Wytske W. J. Fokkens
- Department of Otorhinolaryngology; Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - De Yun Wang
- Department of Otolaryngology; National University of Singapore; Singapore Singapore
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22
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Kucuksezer UC, Ozdemir C, Akdis M, Akdis CA. Chronic rhinosinusitis: pathogenesis, therapy options, and more. Expert Opin Pharmacother 2018; 19:1805-1815. [PMID: 30345822 DOI: 10.1080/14656566.2018.1527904] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION When rhinosinusitis - the inflammation of the nasal cavity and paranasal sinuses - persists for over 12 weeks, it is termed 'chronic rhinosinusitis' (CRS). Both innate and adaptive immunity contribute to the heterogeneous inflammatory pathogenesis of CRS, which is driven by genetic and environmental factors and the microbiome. CRS is classified by the presence of polyps. Molecular mechanisms in CRS with nasal polyps are similar to those in atopic diseases. AREAS COVERED This review focuses on the immune pathogenesis of CRS, differences between the two CRS subtypes, and latest treatments that may aid in the provision of personalized medicine. EXPERT OPINION Basic research in the last decade has helped significantly in enhancing our knowledge of the pathophysiologic processes of CRS, due to which there is now a better understanding of the associated natural history, physiopathology, novel treatments, and prevention strategies. Treatment success depends on the clarification of the underlying pathogenesis and disease-contributing factors. The exploration of disease endotypes and introduction of novel agents are important advancements. Prior studies performed without disease-endotyping resulted in the inefficiency of certain drugs and insignificant results. The identification of biomarkers, development of personalized approaches, and utilization of disease algorithms are required for CRS therapy success.
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Affiliation(s)
- Umut Can Kucuksezer
- a Department of Immunology, Aziz Sancar Institute of Experimental Medicine , Istanbul University , Istanbul , Turkey
| | - Cevdet Ozdemir
- b Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology , Istanbul University , Istanbul , Turkey.,c Department of Pediatric Basic Sciences, Institute of Child Health , Istanbul University , Istanbul , Turkey
| | - Mubeccel Akdis
- d Swiss Institute of Allergy and Asthma Research (SIAF) , University of Zurich , Davos , Switzerland.,e Christine Kühne-Center for Allergy Research and Education (CK-CARE) , Davos , Switzerland
| | - Cezmi A Akdis
- d Swiss Institute of Allergy and Asthma Research (SIAF) , University of Zurich , Davos , Switzerland.,e Christine Kühne-Center for Allergy Research and Education (CK-CARE) , Davos , Switzerland
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23
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Ylitalo-Heikkilä M, Virkkula P, Sintonen H, Lundberg M, Roine RP, Hytönen M. Different rhinologic diseases cause a similar multidimensional decrease in generic health-related quality of life. Clin Otolaryngol 2018; 43:1487-1493. [DOI: 10.1111/coa.13190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/11/2018] [Accepted: 07/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Maija Ylitalo-Heikkilä
- Department of Otorhinolaryngology - Head and Neck Surgery; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Paula Virkkula
- Department of Otorhinolaryngology - Head and Neck Surgery; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Harri Sintonen
- Department of Public Health; University of Helsinki; Helsinki Finland
| | - Marie Lundberg
- Department of Otorhinolaryngology - Head and Neck Surgery; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Risto P. Roine
- Research Centre for Comparative Effectiveness and Patient Safety; University of Eastern Finland; Kuopio Finland
- Group Administration; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology - Head and Neck Surgery; Helsinki University Hospital and University of Helsinki; Helsinki Finland
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24
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Endotyping of non-allergic, allergic and mixed rhinitis patients using a broad panel of biomarkers in nasal secretions. PLoS One 2018; 13:e0200366. [PMID: 30048449 PMCID: PMC6061980 DOI: 10.1371/journal.pone.0200366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/25/2018] [Indexed: 12/21/2022] Open
Abstract
Background Endotyping chronic rhinitis has proven hardest for the subgroup of non-allergic rhinitis (NAR) patients. While IgE-related inflammation is typical for allergic rhinitis (AR), no markers have been found that can be seen to positively identify NAR. A further complication is that AR and NAR might co-exist in patients with mixed rhinitis. As previous studies have considered only a limited number of inflammatory mediators, we wanted to explore whether a wider panel of mediators could help us refine the endotyping in chronic rhinitis patients. Objective To endotype chronic rhinitis, and non-allergic rhinitis in particular, with help of molecular or cellular markers. Method In this study we included 23 NAR patients without allergen sensitizations and with persistent rhinitis symptoms, 22 pollen sensitized rhinitis patients with seasonal symptoms, 21 mixed rhinitis patients with pollen-related symptoms and persistent symptoms outside of the pollen season, and 23 healthy controls without any symptoms. Nasal secretions were collected outside of pollen season and differences between the endotypes were assessed for a broad range of inflammatory mediators and growths factors using a multiplex ELISA. Results Although we were able to identify two new nasal secretion makers (IL-12 and HGF) that were low in mixed and AR patients versus NAR and healthy controls, the most intriguing outcome is that despite investigating 29 general inflammatory mediators and growth factors no clear profile of non-allergic or mixed rhinitis could be found. Conclusion Classical inflammatory markers are not able to differentiate between non-allergic or mixed rhinitis patients and healthy controls.
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