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Trevino Gonzalez JL, Fuentes Torres AS, Morales Del Angel JA. The Prevalence of the Nasal Vestibular Body in Patients With Nasal Obstruction. Cureus 2024; 16:e56194. [PMID: 38618310 PMCID: PMC11016136 DOI: 10.7759/cureus.56194] [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] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background and aim Nasal obstruction is one of the most common reasons for consultation addressed by otolaryngologists. There are anatomical, physiological, and pathological etiologies. Sometimes the treatment can become a challenge for the specialist, so a detailed evaluation of the etiologies must be carried out. The involvement of the nasal vestibular body (NVB) in obstructive symptoms has been described. Therefore, we must be familiar with its anatomy, presentation, and contribution to this symptomatology. This study aimed to highlight the importance of NVB in the role of nasal obstruction and know the impact that it adds to the symptoms of patients through a validated instrument on their quality of life. Material and methods A retrospective, descriptive, and analytical study was conducted on 113 patients with nasal obstruction who attended the outpatient clinic of the Otolaryngology and Head and Neck Surgery Service in a tertiary-level hospital in Monterrey, Mexico from January 2021 to January 2023. The Nasal Obstruction Symptom Evaluation (NOSE) scale was applied to assess the impact of this symptom on the quality of life of the subjects. The causes involved in the obstructive symptoms were identified by physical examination, including NVB. Two groups were made as follows: with the presence of the NVB and with the absence of the NVB, and the means of the NOSE scale were compared. Results A total of 113 patients were included, 59 male patients (52.20%) and 54 female patients (47.80%). The presence of NBV was found in 72 patients (63.70%). Other causes of nasal obstruction were found in 35 patients (31%), with chronic rhinitis being the most frequent in 27 subjects (23.90%). The mean NOSE scale score was higher in the group with the presence of the NVB than in the group with the absence of the NVB (p<0.05). The primary outcome of this study was to know the prevalence of NVB in the Hispanic population with nasal obstruction who attends the otolaryngology clinic. The secondary outcome was to know the relationship between the presence of NVB and the NOSE scores. Conclusion In this study, we observed that NVB is frequently present in patients with nasal obstruction in northeastern Mexico. There is an association between the presence of NVB and higher scores on the NOSE scale. New research will be needed to assess the effectiveness of NVB surgery in improving nasal obstruction and to determine the impact of NVB on nasal obstruction in isolation.
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Affiliation(s)
- Jose Luis Trevino Gonzalez
- Otolaryngology - Head and Neck Surgery, Hospital Universitario Dr. José Eleuterio González, Monterrey, MEX
| | - Aldo Sergio Fuentes Torres
- Otolaryngology - Head and Neck Surgery, Hospital Universitario Dr. José Eleuterio González, Monterrey, MEX
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van Breugel M, Fehrmann RSN, Bügel M, Rezwan FI, Holloway JW, Nawijn MC, Fontanella S, Custovic A, Koppelman GH. Current state and prospects of artificial intelligence in allergy. Allergy 2023; 78:2623-2643. [PMID: 37584170 DOI: 10.1111/all.15849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/08/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
The field of medicine is witnessing an exponential growth of interest in artificial intelligence (AI), which enables new research questions and the analysis of larger and new types of data. Nevertheless, applications that go beyond proof of concepts and deliver clinical value remain rare, especially in the field of allergy. This narrative review provides a fundamental understanding of the core concepts of AI and critically discusses its limitations and open challenges, such as data availability and bias, along with potential directions to surmount them. We provide a conceptual framework to structure AI applications within this field and discuss forefront case examples. Most of these applications of AI and machine learning in allergy concern supervised learning and unsupervised clustering, with a strong emphasis on diagnosis and subtyping. A perspective is shared on guidelines for good AI practice to guide readers in applying it effectively and safely, along with prospects of field advancement and initiatives to increase clinical impact. We anticipate that AI can further deepen our knowledge of disease mechanisms and contribute to precision medicine in allergy.
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Affiliation(s)
- Merlijn van Breugel
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- MIcompany, Amsterdam, the Netherlands
| | - Rudolf S N Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Faisal I Rezwan
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Computer Science, Aberystwyth University, Aberystwyth, UK
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Martijn C Nawijn
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sara Fontanella
- National Heart and Lung Institute, Imperial College London, London, UK
- National Institute for Health and Care Research Imperial Biomedical Research Centre (BRC), London, UK
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
- National Institute for Health and Care Research Imperial Biomedical Research Centre (BRC), London, UK
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Yan B, Ren Y, Liu C, Shu L, Wang C, Zhang L. Cystatin SN in type 2 inflammatory airway diseases. J Allergy Clin Immunol 2023; 151:1191-1203.e3. [PMID: 36958985 DOI: 10.1016/j.jaci.2023.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 03/25/2023]
Abstract
Cystatin SN, encoded by CST1, belongs to the type 2 (T2) cystatin protein superfamily. In the past decade, several publications have highlighted the association between cystatin SN and inflammatory airway diseases including chronic rhinosinusitis, rhinitis, asthma, chronic obstructive pulmonary disease, and chronic hypersensitivity pneumonitis. It is, therefore, crucial to understand the role of cystatin SN in the wider context of T2 inflammatory diseases. Here, we review the expression of cystatin SN in airway-related diseases with different endotypes. We also emphasize the physiological and pathological roles of cystatin SN. Physiologically, cystatin SN protects host tissues from destructive proteolysis by cysteine proteases present in the external environment or produced via internal dysregulated expression. Pathologically, the secretion of cystatin SN from airway epithelial cells initiates and amplifies T2 immunity and subsequently leads to disease. We further discuss the development of cystatin SN as a T2 immunity marker that can be monitored noninvasively and assist in airway disease management. The discovery, biology, and inhibition capability are also introduced to better understand the role of cystatin SN in airway diseases.
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Affiliation(s)
- Bing Yan
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, China; Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yimin Ren
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, China; Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chang Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, China; Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Linping Shu
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, China; Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, China; Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, 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 Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, China; Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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Dodi G, Di Filippo P, Ciarelli F, Porreca A, Cazzato F, Matonti L, Di Pillo S, Neri G, Chiarelli F, Attanasi M. The Role of Nasal Cytology and Serum Atopic Biomarkers in Paediatric Rhinitis. Diagnostics (Basel) 2023; 13:diagnostics13030555. [PMID: 36766659 PMCID: PMC9914856 DOI: 10.3390/diagnostics13030555] [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: 12/28/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
A Nasal Provocation Test allows the differentiation of allergic and non-allergic rhinitis, but it is difficult and expensive. Therefore, nasal cytology is taking hold as an alternative. We carried out a cross-sectional study, including 29 patients with persistent rhinitis according to ARIA definition and negative skin prick tests. Nasal symptoms were scored from 0 to 5 using a visual analogue scale, and patients underwent blood tests to investigate blood cell count (particularly eosinophilia and basophilia), to analyze serum total and specific IgE and eosinophil cationic protein (ECP), and to perform nasal cytology. We performed a univariate logistical analysis to evaluate the association between total serum IgE, serum eosinophilia, basophils, and ECP and the presence of eosinophils in the nasal mucosa, and a multivariate logistic model in order to weight the single variable on the presence of eosinophils to level of the nasal mucosa. A statistically significant association between serum total IgE levels and the severity of nasal eosinophilic inflammation was found (confidence interval C.I. 1.08-4.65, odds ratio OR 2.24, p value 0.03). For this reason, we imagine a therapeutic trial with nasal steroids and oral antihistamines in patients with suspected LAR and increased total IgE levels, reserving nasal cytology and NPT to non-responders to the first-line therapy.
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Affiliation(s)
- Giulia Dodi
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
- Correspondence:
| | - Paola Di Filippo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesca Ciarelli
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Fiorella Cazzato
- Department of Otolaryngology, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Lorena Matonti
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabrina Di Pillo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giampiero Neri
- Department of Otolaryngology, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Chiarelli
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marina Attanasi
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
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Kim JY, Lee S, Suh DI, Kim DW, Yoon HJ, Park SK, Rhee CS, Han DH. Distinct Endotypes of Pediatric Rhinitis Based on Cluster Analysis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:730-741. [PMID: 36426400 PMCID: PMC9709680 DOI: 10.4168/aair.2022.14.6.730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/23/2022] [Accepted: 09/02/2022] [Indexed: 06/11/2024]
Abstract
PURPOSE Despite the wide spectrum of pediatric rhinitis, endotyping of rhinitis based on type 2 inflammation and bronchial hyper-responsiveness (BHR) is lacking. This study aimed to investigate endotypes of pediatric rhinitis using cluster analysis. METHODS Cluster analysis was performed on data from 241 children with rhinitis by using 12 variables reflecting clinical characteristics of skin prick, laboratory, and pulmonary function tests. After extracting clusters, between-cluster differences in clinical features, such as nasal symptom scores and asthma comorbidity, were assessed to investigate the association between the endotypes and clinical features. RESULTS Four clusters were extracted by hierarchical cluster analysis. Cluster 1 (n = 32 [13.3%]) was the non-allergic rhinitis dominant cluster with low type 2 inflammation and the lowest rate of BHR. Patients in cluster 1 had the mildest nasal symptoms and no asthma comorbidity. Cluster 2 (n = 114 [47.3%]) was the largest cluster and exhibited intermediate type 2 inflammation and low BHR. Cluster 3 (n = 65 [27.0%]) showed high type 2 inflammation and intermediate BHR. However, the severity of nasal symptoms and asthma comorbidity in this cluster were comparable with those in cluster 2. Cluster 4 (n = 30 [12.4%]) revealed high type 2 inflammation and BHR with potential functional airway impairment. Additionally, cluster 4 displayed the most severe nasal symptoms and frequent asthma comorbidity. CONCLUSIONS Four distinct endotypes of pediatric rhinitis based on allergen sensitization, type 2 inflammation, and BHR correlate to symptoms and asthma comorbidity. These endotypes may aid clinicians in understanding the wide spectrum of pediatric rhinitis.
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Affiliation(s)
- Jin Youp Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Korea
| | - Sangjun Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyung-Jin Yoon
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
- Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Biomedical Research Center, Seoul, Korea
- Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea.
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Li F, Wang X, Shen S, Huang K, Wang M, Liu X, Wang C, Jin J, Zhang L. Risk factors associated with comorbid asthma in patients with chronic rhinosinusitis with nasal polyps: a cross-sectional study. BMC Pulm Med 2022; 22:338. [PMID: 36071399 PMCID: PMC9454111 DOI: 10.1186/s12890-022-02138-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Although 20–60% of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have asthma, the risk factors associated with comorbid asthma are not clear. The aim of the study was to investigate the factors associated with asthma, and develop a practical scoring system to screen asthma comorbidity in CRSwNP patients.
Methods This report describes a cross-sectional study with consecutive CRSwNP patients. Two cohorts of CRSwNP patients named “modelling” group and “validation” group were investigated respectively. Logistic regression analysis was performed based on demographic and clinical data collected from patients in the modelling group to determine the risk factors associated with asthma, and establish a scoring system for screening comorbid asthma. Receiver operating characteristic curve was constructed to evaluate the screening system; the optimal cut-off point was established by means of the Yoden Index. The consistency between the diagnosis of asthma by the Global Initiative for Asthma (GINA) criteria and by the screening system was assessed by Kappa value in the validation group. Results Totally 150 patients in modelling group and 78 patients in validation group were enrolled. Female gender (odds ratio [OR] = 6.4; P < 0.001), allergic rhinitis (OR = 2.9; P = 0.021), serum total (T)-immunoglobulin (Ig) E ≥ 69.0kU/L (OR = 12.0; P < 0.001), and blood eosinophil count ≥ 0.35 × 109/L (OR = 4.0; P = 0.001) were shown to be independent risk factors for asthma in patients with CRSwNP. Based on these variables, a scoring system (FAIE) ranging from 0(no risk) to 6(high risk); was developed. The area under the receiver operating characteristic curve of the system was 0.823, and the optimal cut-off value was 3 points, with sensitivity 83.8% and specificity 68.6% for screening asthma. The asthma comorbidity determined with FAIE score ≥ 3 points in the validation group, was moderately consistent with that defined by GINA (Kappa = 0.513, P < 0.001), with sensitivity 76.9% and specificity 74.4%. Conclusions Female gender, allergic rhinitis, serum T-IgE level, and blood eosinophil count are independent risk factors for asthma comorbidity in patients with CRSwNP, and the FAIE system may be practical for screening comorbid asthma in these patients.
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Affiliation(s)
- Fangyuan Li
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Xuechen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Shen Shen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Kai Huang
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Ming Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Xiaofang Liu
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Jianmin Jin
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China. .,Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China. .,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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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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9
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Huang K, Li F, Wang X, Yan B, Wang M, Li S, Yu W, Liu X, Wang C, Jin J, Zhang L. Clinical and cytokine patterns of uncontrolled asthma with and without comorbid chronic rhinosinusitis: a cross-sectional study. Respir Res 2022; 23:119. [PMID: 35546400 PMCID: PMC9092818 DOI: 10.1186/s12931-022-02028-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 04/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Asthma is significantly related to chronic rhinosinusitis (CRS) both in prevalence and severity. However, the clinical patterns of uncontrolled asthma with and without comorbid CRS are still unclear. This study aimed to explore the clinical characteristics and cytokine patterns of patients with uncontrolled asthma, with and without comorbid CRS.
Methods 22 parameters associated with demographic characteristics, CRS comorbidity, severity of airflow obstruction and airway inflammation, and inflammation type of asthma were collected and assessed in 143 patients with uncontrolled asthma. Different clusters were explored using two-step cluster analysis. Sputum samples were collected for assessment of Th1/Th2/Th17 and epithelium-derived cytokines. Results Comorbid CRS was identified as the most important variable for prediction of different clusters, followed by pulmonary function parameters and blood eosinophil level. Three clusters of patients were determined: Cluster 1 (n = 46) characterized by non-atopic patients with non-eosinophilic asthma without CRS, demonstrating moderate airflow limitation; Cluster 2 (n = 54) characterized by asthma patients with mild airflow limitation and CRS, demonstrating higher levels of blood eosinophils and immunoglobulin E (IgE) than cluster 1; Cluster 3 (n = 43) characterized by eosinophilic asthma patients with severe airflow limitation and CRS (46.5% with nasal polyps), demonstrating worst lung function, lowest partial pressure of oxygen (PaO2), and highest levels of eosinophils, fraction of exhaled nitric oxide (FeNO) and IgE. Sputum samples from Cluster 3 showed significantly higher levels of Interleukin (IL)-5, IL-13, IL-33, and tumor necrosis factor (TNF)-α than the other two clusters; and remarkably elevated IL-4, IL-17 and interferon (IFN)-γ compared with cluster 2. The levels of IL-10 and IL-25 were not significantly different among the three clusters. Conclusions Uncontrolled asthma may be endotyped into three clusters characterized by CRS comorbidity and inflammatory cytokine patterns. Furthermore, a united-airways approach may be especially necessary for management of asthma patients with Type 2 features. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02028-3.
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Affiliation(s)
- Kai Huang
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Fangyuan Li
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Xuechen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Bing Yan
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Ming Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Shuling Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wenling Yu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xiaofang Liu
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China
| | - Jianmin Jin
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China.
| | - Luo Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China. .,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, 100730, China. .,Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China. .,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Malizia V, Ferrante G, Cilluffo G, Gagliardo R, Landi M, Montalbano L, Fasola S, Profita M, Licari A, Marseglia GL, La Grutta S. Endotyping Seasonal Allergic Rhinitis in Children: A Cluster Analysis. Front Med (Lausanne) 2022; 8:806911. [PMID: 35155483 PMCID: PMC8825866 DOI: 10.3389/fmed.2021.806911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Seasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children. Methods This cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL. Results Out of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; Cluster 3 showed higher levels of IL-17, IL-23, and IFN-γ and intermediate levels of IL-5. Cluster 1 showed intermediate values of nasal pH and nasal nitric oxide (nNO), and a lower percentage of neutrophils at nasal cytology than Clusters 2 and 3. Cluster 2 had a lower level of nasal pH, a higher nNO, higher scores in the ocular domain of PRQLQ, and worse sleep quality than Clusters 1 and 3. Cluster 3 showed a higher percentage of neutrophils at nasal cytology than Clusters 1 and 2. Conclusions Our study identified three endotypes based on the evaluation of cytokines in NL, highlighting that childhood SAR is characterized by heterogeneous inflammatory cytokines.
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Affiliation(s)
- Velia Malizia
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Paediatric Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Giovanna Cilluffo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Rosalia Gagliardo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Massimo Landi
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy.,Pediatric National Healthcare System, Turin, Italy
| | - Laura Montalbano
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Salvatore Fasola
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Mirella Profita
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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11
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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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12
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Diagnosis and Treatment of Local Allergic Rhinitis. Pathogens 2022; 11:pathogens11010080. [PMID: 35056028 PMCID: PMC8780326 DOI: 10.3390/pathogens11010080] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/05/2023] Open
Abstract
Some patients with chronic rhinitis have a positive nasal allergen provocation test (NAPT) without systemic IgE sensitization by skin prick tests or serum allergen-specific IgE (sIgE). This novel concept is called local allergic rhinitis (LAR) and affects children and adults worldwide, but is underdiagnosed. LAR is not just the initial state of allergic rhinitis (AR), it is a unique form of chronic rhinitis that is neither classical AR nor non-AR. Many of the features of AR and LAR are similar, such as a positive NAPT, positive type 2 inflammatory markers, including the nasal discharge of sIgE, and a high incidence of asthma. A differential diagnosis of LAR needs to be considered in patients with symptoms suggestive of AR in the absence of systemic atopy, regardless of age. The diagnostic method for LAR relies on positive responses to single or multiple allergens in NAPT, the sensitivity, specificity, and reproducibility of which are high. The basophil activation test and measurement of IgE in nasal secretions also contribute to the diagnosis of LAR. Treatment for LAR is similar to that for AR and is supported by the efficacy and safety of allergen exposure avoidance, drug therapy, and allergen immunotherapy. This review discusses current knowledge on LAR.
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13
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Fokkens WJ, Landis BN, Hopkins C, Reitsma S, Sedaghat AR. Rhinology in review: from COVID-19 to biologicals. Rhinology 2021; 59:490-500. [PMID: 34812433 DOI: 10.4193/rhin21.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We look back at the end of what soon will be seen as an historic year, from COVID-19 to real-world introduction of biologicals influencing the life of our patients. This review describes the important findings in Rhinology over the past year. A large body of evidence now demonstrates loss of sense of smell to be one of the most common symptoms of COVID-19 infection; a meta-analysis of 3563 patients found the mean prevalence of self-reported loss to be 47%. A number of studies have now shown long-term reduced loss of smell and parosmia. Given the high numbers of people affected by COVID-19, even with the best reported recovery rates, a significant number worldwide will be left with severe olfactory dysfunction. The most prevalent causes for olfactory dysfunction, besides COVID-19 and upper respiratory tract infections in general, are trauma and CRSwNP. For these CRSwNP patients a bright future seems to be starting with the development of treatment with biologics. This year the Nobel prize in Medicine 2021 was awarded jointly to David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch which has greatly enhanced our understanding of nasal hyperreactivity and understanding of intranasal trigeminal function. Finally, a new definition of chronic rhinitis has been proposed in the last year and we have seen many papers emphasizing the importance of endotyping patients in chronic rhinitis and rhinosinusitis in order to optimise treatment effect.
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Affiliation(s)
- W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - B N Landis
- Department of Otorhinolaryngology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Hopkins
- Department of Otorhinolaryngology, Guy's Hospital, London, UK
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - A R Sedaghat
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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14
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Yao Y, Zeng M, Liu Z. Revisiting Asian chronic rhinosinusitis in the era of type 2 biologics. Clin Exp Allergy 2021; 52:231-243. [PMID: 34854144 DOI: 10.1111/cea.14065] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 01/08/2023]
Abstract
Chronic rhinosinusitis (CRS) is a highly heterogeneous disorder exhibiting considerable epidemiological, clinical and immunopathological variations across patients with distinct ethnic backgrounds and in different geographic locations. Asian CRS patients present less eosinophilic and type 2 (T2) inflammation, but more prominent neutrophilic inflammation compared with patients in Western countries. Although several biologics targeting important elements of T2 inflammation, such as IL-4, IL-5, IL-13 and IgE, demonstrate promising benefit for Caucasian patients with recurrent nasal polyps, their efficacy in Asian patients remains poorly defined. The distinct endotypes in Asian patients warrant the identification and selection of patients who would benefit from T2 biologics in Asian countries. Additionally, developing novel treatments targeting neutrophilic, type 1, and type 3 inflammation may benefit approximately 50% of Asian CRS patients with non-T2 inflammation. In this review, we summarized and discussed recent progress in the study of Asian CRS endotypes in comparison with those in patients in Western countries, and the methods of identifying Asian patients with eosinophilic or T2 inflammation. T2 biologic treatment of Asian CRS patients, potential therapeutic candidates targeting non-T2 inflammation in Asian CRS patients and the progress on developing other T2 biologics were discussed.
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Affiliation(s)
- Yin Yao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Zhang Y, Lan F, Zhang L. Advances and highlights in allergic rhinitis. Allergy 2021; 76:3383-3389. [PMID: 34379805 DOI: 10.1111/all.15044] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
Allergic rhinitis (AR) is a growing public health, medical and economic problem worldwide. The current review describes the major discoveries related to AR during the past 2 years, including risk factors for the prevalence of AR, the corresponding diagnostic strategy, precise underlying immunological mechanisms, and efficient therapies for AR during the ongoing global "coronavirus disease 2019" (COVID-19) pandemic. The review further attempts to highlight future research perspectives. Increasing evidence suggests that environmental exposures, climate changes, and lifestyle are important risk factors for AR. Consequently, detailed investigation of the exposome and the connection between environmental exposures and health in the future should provide better risk profiles instead of single predictors, and also help mitigate adverse health outcomes in allergic diseases. Although patients with dual AR, a newly defined AR phenotype, display perennial and seasonal allergens-related nasal symptoms, they are only allergic to seasonal allergens, indicating the importance of measuring inflammation at the local sites. Herein, we suggest that a combination of precise diagnosis in local sites and traditional diagnostic methods may enhance the precision medicine-based approach for management of AR; however, this awaits further investigations. Apart from traditional treatments, social distancing, washing hands, and disinfection are also required to better manage AR patients in the ongoing global COVID-19 pandemic. Despite recent advances in understanding the immune mechanisms underlying the effects of allergen immunotherapy (AIT), further understanding changes of cell profiles after AIT and accurately evaluate the efficacy of AIT are required.
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Affiliation(s)
- Yuan Zhang
- Department of Allergy Beijing TongRen HospitalCapital Medical University Beijing China
- Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology Beijing China
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen HospitalCapital Medical University Beijing China
| | - Feng Lan
- Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology Beijing China
| | - Luo Zhang
- Department of Allergy Beijing TongRen HospitalCapital Medical University Beijing China
- Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology Beijing China
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen HospitalCapital Medical University Beijing China
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16
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Xu X, Qin L, Ren L, Wang C, Zhang Y, Zhang L. Comparative analysis of chronic rhinitis patient profiles during autumn pollen season between grassland and non-grassland cities in North China. Allergy Asthma Clin Immunol 2021; 17:106. [PMID: 34635159 PMCID: PMC8503993 DOI: 10.1186/s13223-021-00591-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background The symptoms of patients with respiratory disease are influenced by local environmental factors. The incidence of allergic rhinitis in grassland areas was significantly higher than that in non-grassland areas. We aimed to compare the profiles of chronic rhinitis patients obtained during the autumn pollen season in Baotou (grassland city) and Beijing (non-grassland city), China. Methods Questionnaire surveys and allergen testing were conducted on 1170 and 1232 patients with chronic rhinitis visiting the Second Affiliated Hospital of Baotou Medical College and Beijing Tongren Hospital, respectively, during the autumn pollen period. Information regarding medical history, severity of symptoms, and diagnosis and treatment was collected. Results More patients with moderate to severe chronic rhinitis and asthma (both, P < 0.001) were present in Baotou than in Beijing. Mugwort was the most abundant allergen in both regions, but the number of patients sensitized to outdoor allergens in Baotou was higher than that in Beijing (P < 0.001). Indoor allergens in Beijing represented a considerable proportion of allergens, especially dust mites (33.4%). For patients with allergic rhinitis, nasal congestion, nasal itching, and runny nose were more severe in Baotou than in Beijing (P < 0.001). In both Baotou and Beijing, allergy (P < 0.001 vs. P = 0.004) and combined asthma (P = 0.049 vs. P = 0.005) were common factors affecting the severity of the clinical symptoms chronic rhinitis. In Baotou, age (rs = 0.195, P < 0.001) and family allergy history (P = 0.010) were also associated with symptom severity. Although significantly more patients in Baotou received oral antihistamines, nasal corticosteroids, and surgical treatment than in Beijing (P < 0.001), the number of people receiving allergy immunotherapy in Baotou was lower (P = 0.004) and post-treatment symptom control was worse (P < 0.001) that that in Beijing. Conclusions During the pollen period, there were significant differences in the allergen spectrum between Baotou and Beijing. Allergy and combined asthma were common factors affecting the severity of clinical symptoms. Patients in Baotou presented with more severe clinical symptoms that were not satisfactorily managed due to the impact of pollen exposure, inconsistent access to care, and differing treatment modalities. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00591-w.
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Affiliation(s)
- Xu Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China.,Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Long Qin
- The Second Affiliated Hospital of Baotou Medical College, Baotou Medical College, Baotou, China
| | - Lei Ren
- Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China. .,Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, No. 17, Hou Gou Hu Tong, Dong Cheng District, 100005, Beijing, People's Republic of China. .,Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.
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17
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González-Pérez R, El-Qutob D, Letrán A, Matheu V. Precision Medicine in Mite Allergic Rhinitis. FRONTIERS IN ALLERGY 2021; 2:724727. [PMID: 35387006 PMCID: PMC8974769 DOI: 10.3389/falgy.2021.724727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
It is well-known that a correct diagnosis is necessary for effective treatment. In the case of allergic rhinitis due to mites, imprecise diagnosis with effective but improvable methods means that in many cases an optimal result is not reached in patients. The diagnosis of allergic rhinitis due to mite sensitization have to require more homogeneously reproducible diagnostic tests that try to encompass many more of the protein antigens contained in them. With the few proteins that the problem has usually focused on, there is no they would cover many of the clinically relevant allergens in a large proportion of patients. In this mini-review we try to highlight the importance of having good allergenic sources and briefly gather information on various allergenic proteins included in mites that could be clinically relevant. All this to try to get closer to a more accurate diagnosis. We are also talking about two diagnostic tools that are clearly out of use and that should be promoted in the consultations to obtain an even greater and better outcome in patients.
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Affiliation(s)
- Ruperto González-Pérez
- Allergy Department, Complejo Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - David El-Qutob
- Allergy Unit, University Hospital of La Plana, Villarreal, Spain
| | - Antonio Letrán
- Allergy Unit, Hospital HLA Jerez Puerta del Sur, Jerez de la Frontera, Spain
| | - Víctor Matheu
- Allergy Department, Complejo Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
- *Correspondence: Víctor Matheu
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18
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Branicka O, Jura-Szołtys E, Rogala B, Glück J. sCD48 is elevated in non-allergic but not in allergic persistent rhinitis. Immunopharmacol Immunotoxicol 2021; 43:724-730. [PMID: 34477021 DOI: 10.1080/08923973.2021.1973492] [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: 10/20/2022]
Abstract
BACKGROUND CD48 is a costimulatory receptor of the immune response. Interactions between CD48 and CD244 (2B4) on mast cells and eosinophils suggest that these cells can act synergistically in the 'allergic effector unit' to promote inflammation. This report explores the role of CD48 in persistent allergic (PAR) and non-allergic rhinitis (NAR). METHODS In this study, serum was obtained from 70 subjects (45 female, 64%; mean age, 36; range 18-70 years) to estimate the levels of sCD48 and two eosinophils-related parameters, ECP and eotaxin-1/CCL11. Twenty patients with PAR, 15 patients with NAR, and 35 healthy controls were included. The intensity of rhinitis symptoms was estimated by the Total Nasal Symptom Score. We also assessed the fractional exhaled nitric oxide bronchial and nasal fractions (FeNO) and neutrophil to lymphocyte (NLR) and eosinophil to lymphocyte (ELR) ratios. RESULTS Significantly higher sCD48 serum levels were observed in the NAR group than in the PAR and control groups, and significant correlations were found between the serum level of sCD48 and the number and percentage of eosinophils. ECP and eotaxin-1/CCL11 serum levels were also found to be significantly higher in the NAR group. CONCLUSIONS CD48 may be involved in eosinophilic pathophysiological reactions in non-allergic rhinitis.
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Affiliation(s)
- Olga Branicka
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Edyta Jura-Szołtys
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Barbara Rogala
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Joanna Glück
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia in Katowice, Katowice, Poland
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19
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Rhinitis Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1492-1503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
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20
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Meng Y, Lu H, Wang C, Wang Y, Meng N, Yang K, Jie Y, Zhang L. Naso-ocular neuropeptide interactions in allergic rhinoconjunctivitis, rhinitis, and conjunctivitis. World Allergy Organ J 2021; 14:100540. [PMID: 34035875 PMCID: PMC8131918 DOI: 10.1016/j.waojou.2021.100540] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 01/22/2023] Open
Abstract
Background Ocular as well as nasal symptoms contribute to allergic response but remain poorly characterized. The aim of this study was to analyze the levels of substance P (SP), vasoactive intestinal peptide (VIP), and calcitonin gene-related peptide (CGRP) in tears and nasal secretions of patients with allergic rhinoconjunctivitis (ARC), allergic rhinitis, and allergic conjunctivitis, while exploring possible mechanisms of naso-ocular interactions. Methods A total of 21 patients with ARC, 17 with allergic rhinitis, 13 with allergic conjunctivitis, and 15 healthy controls were enrolled in the study. Nasal secretions and tears were collected. Patient demographics and clinical characteristics were recorded and levels of substance P, VIP, and CGRP were measured. Results SP levels in nasal secretions and tears were significantly higher in the ARC, AR, and AC groups. Similar results were obtained for VIP levels. CGRP levels in tears were also significantly higher in the 3 patient groups. The level of SP was significantly higher in the nasal secretions than in the tears of the ARC, AR, and AC patient groups. The level of VIP was significantly higher in the nasal secretions than in the tears in the ARC and AR groups. The level of CGRP was significantly higher in the nasal secretions than in the tears in the ARC and AC groups. Finally, both of the nasal and tear levels of SP and VIP but not CGRP were positively correlated with the visual analog scale (VAS) score in the patients with ARC. Conclusion The results of this study suggested that SP, VIP, and CGRP play important roles in the mechanism of ARC and that nasal neurotransmitters and neuropeptides might have more important roles than those of ocular origin.
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Affiliation(s)
- Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Hongshuang Lu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Yang Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Na Meng
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Ke Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
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21
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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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22
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Meng Y, Wang C, Zhang L. Diagnosis and treatment of non-allergic rhinitis: focus on immunologic mechanisms. Expert Rev Clin Immunol 2020; 17:51-62. [PMID: 33259234 DOI: 10.1080/1744666x.2020.1858804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Non-allergic rhinitis (NAR) is a heterogeneous nasal disease with high global prevalence. NAR can be subclassified as nonallergic rhinitis with eosinophilia syndrome (NARES), vasomotor rhinitis (VMR), and local allergic rhinitis (LAR). Although the precise factors involved in the etiology of NAR are not clear, there is evidence that immunological factors play an important role in the pathogenesis of NAR. This review provides a comprehensive overview of the immunological and neurogenic mechanisms involved in the diagnosis and treatment of NAR. AREAS COVERED This review provides a comprehensive overview of the immunological basis of diagnostic and treatment strategies for NARES, VMR, and LAR. In particular, recently documented molecular and immunological mechanisms of NAR are discussed, which may help to better understand the mechanisms underlying the pathologies of the different endotypes of NAR. EXPERT OPINION An increasing number of studies investigating the pathogenesis of NAR suggest that the immunological mechanisms underlying the different subtypes of NAR vary greatly, and are still not fully understood to accurately diagnose these subtypes. Thus, further studies should focus on making diagnosis and treatment of NAR more precise, safe, and effective. A better understanding of the immunological mechanisms involved in NAR should help in the discovery of new diagnostic and treatment strategies.
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Affiliation(s)
- Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences.,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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23
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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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24
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Hong H, Liao S, Chen F, Yang Q, Wang D. Role of IL-25, IL-33, and TSLP in triggering united airway diseases toward type 2 inflammation. Allergy 2020; 75:2794-2804. [PMID: 32737888 DOI: 10.1111/all.14526] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 12/25/2022]
Abstract
Under the concept of "united airway diseases," the airway is a single organ wherein upper and lower airway diseases are commonly comorbid. The upper and lower airways are lined with respiratory epithelium that plays a vital role in immune surveillance and modulation as the first line of defense to various infective pathogens, allergens, and physical insults. Recently, there is a common hypothesis emphasizing epithelium-derived cytokines, namely IL-25, IL-33, and TSLP, as key regulatory factors that link in immune-pathogenic mechanisms of allergic rhinitis (AR), chronic rhinosinusitis (CRS), and asthma, mainly involving in type 2 inflammatory responses and linking innate and adaptive immunities. Herein, we review studies that elucidated the role of epithelium-derived triple cytokines in both upper and lower airways with the purpose of expediting better clinical treatments and managements of AR, CRS, asthma, and other associated allergic diseases via applications of the modulators of these cytokines.
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Affiliation(s)
- Haiyu Hong
- Department of Otolaryngology Allergy Center The Fifth Affiliated Hospital of Sun Yat‐sen University Zhuhai China
- Department of Otolaryngology National University of Singapore National University Health System Singapore Singapore
| | - Shumin Liao
- Department of Otolaryngology Allergy Center The Fifth Affiliated Hospital of Sun Yat‐sen University Zhuhai China
| | - Fenghong Chen
- Otorhinolaryngology Hospital The First Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - Qintai Yang
- Department of Otolaryngology The Third Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - De‐Yun Wang
- Department of Otolaryngology National University of Singapore National University Health System Singapore Singapore
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25
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Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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26
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Zhang M, Yan B, Wang Y, Wang C, Zhang L. Charcot-Leyden Crystal Protein in Nasal Secretions of Patients with Nonallergic Rhinitis with Eosinophilia Syndrome. Int Arch Allergy Immunol 2020; 181:888-896. [PMID: 32694242 DOI: 10.1159/000509252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Charcot-Leyden crystal (CLC) protein has been regarded as a hallmark of eosinophilic inflammation. OBJECTIVE The purpose of this study was to investigate the role and levels of CLC protein in patients with nonallergic rhinitis with eosinophilia syndrome (NARES). METHODS Overall, 39 NARES patients and 19 controls were recruited. The severity of nasal symptoms was measured by visual analogue scale and serum and local specific immunoglobulin E were determined in all patients. Nasal eosinophilia was assessed by semiquantitative analysis of eosinophils in nasal scrapings. Nasal secretion CLC protein concentrations were evaluated by ELISA. RESULTS CLC protein concentrations were significantly higher in NARES patients than in controls (p < 0.0001). Nasal secretion CLC protein levels were significantly correlated with the degree of eosinophilia in nasal scrapings (rs = 0.331; p = 0.04) in NARES patients. Patients with high CLC protein concentrations displayed more severe nasal symptoms than patients with low CLC protein concentrations (p = 0.0080), particularly, nasal itching (p = 0.0029). Pilot study in 8 NARES patients demonstrated that treatment for 1 month with intranasal fluticasone propionate significantly decreased the nasal secretion CLC protein concentrations from baseline levels (p = 0.0335) and markedly attenuated the degree of swelling of inferior turbinate. CONCLUSIONS CLC protein levels are significantly higher in nasal secretions of NARES patients and associated with the degree of nasal eosinophilia and the severity of nasal symptoms. Significantly, nasal secretion CLC protein levels obviously decreased after treatment with intranasal corticosteroids, suggesting its possible role in evaluating the medical treatment.
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Affiliation(s)
- Min 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
| | - Bing Yan
- 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
| | - Yang Wang
- 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
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, 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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27
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Eguiluz-Gracia I, Fernandez-Santamaria R, Testera-Montes A, Ariza A, Campo P, Prieto A, Perez-Sanchez N, Salas M, Mayorga C, Torres MJ, Rondon C. Coexistence of nasal reactivity to allergens with and without IgE sensitization in patients with allergic rhinitis. Allergy 2020; 75:1689-1698. [PMID: 31995231 DOI: 10.1111/all.14206] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) and local allergic rhinitis (LAR) are defined by nasal reactivity to aeroallergens with and without positive skin prick test (SPT), respectively. In this study, we aimed to investigate whether both types of allergen-specific reactivity can coexist in the same individual. METHODS Forty-eight patients with perennial rhinitis symptoms and positive SPT with seasonal allergens only (discrepant group) were subjected to consecutive nasal allergen challenges (NAC) with seasonal (NAC-S) and perennial allergens (NAC-P). A nasal lavage was collected before and after the NACs to measure eosinophil cationic protein (ECP). A basophil activation test (BAT) with seasonal and/or perennial allergens was performed in ten patients from the discrepant group and in six seasonal allergic rhinitis (SAR), eight perennial local allergic rhinitis (LAR), six nonallergic rhinitis (NAR), and six healthy control (HC) individuals. RESULTS All patients in the discrepant group tested positive in the NAC-S, and 41 of them (85.4%), also in the NAC-P (group A). Conversely, seven patients tested negative in the NAC-P (group B). ECP in the nasal lavage increased after the NAC-P in the group A (P = .004), but not in the group B. The BAT with seasonal allergens was positive in 100% of SAR and group A cases, whereas the BAT with perennial allergens was positive in 37.5% and 60% of LAR and group A cases, respectively. All NAR and HC subjects tested negative for the BAT. CONCLUSION This study shows that nasal reactivity to aeroallergens with and without positive SPT can coexist in the same patient. We propose the term dual allergic rhinitis for this rhinitis phenotype.
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Affiliation(s)
- Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | | | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain.,Universidad de Málaga-UMA, Málaga, Spain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Paloma Campo
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Ana Prieto
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Málaga, Spain
| | - Natalia Perez-Sanchez
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Maria Salas
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
| | - Maria Jose Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain.,Universidad de Málaga-UMA, Málaga, Spain
| | - Carmen Rondon
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Málaga, Spain
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28
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Meng Y, Yan B, Wang Y, Wu D, Zhang L, Wang C. Diagnosis and management of nonallergic rhinitis with eosinophilia syndrome using cystatin SN together with symptoms. World Allergy Organ J 2020; 13:100134. [PMID: 32577150 PMCID: PMC7301177 DOI: 10.1016/j.waojou.2020.100134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 10/25/2022] Open
Abstract
Background The diagnosis and treatment of nonallergic rhinitis with eosinophilia syndrome (NARES) remain controversial. The aim of this study was to evaluate whether Cystatin SN together with symptoms can be used to diagnose NARES and to measure the efficiency of medical treatment. Methods Seventy-five patients with chronic rhinitis (CR) and 18 control subjects were enrolled. Their clinical characteristics were reviewed and laboratory parameters were evaluated. The concentration of Cystatin SN in nasal secretions was determined using the enzyme-linked immunosorbent assay. The histological assessment of Cystatin SN in the nasal mucosa was conducted by hematoxylin and eosin staining. The logistic regression and receiver operating characteristic curves were used to assess the predictive value of parameters for NARES. Results Nasal obstruction, sneezing, loss of smell, and total visual analogue scale (VAS) score were significantly different among the patients with CR. In particular, olfaction score was higher in patients with NARES than in those without NARES (AR, LAR, or IR). Similarly, the Cystatin SN level was significantly different between the control subjects and patients with CR. After treatment for 2 weeks, the Cystatin SN level and VAS score were significantly decreased in the NARES group. The accuracy of Cystatin SN together with local sIgE and loss of smell to diagnose NARES was up to 0.987 (sensitivity, 100%; specificity, 93.1%). Conclusions Cystatin SN with local sIgE and loss of smell may serve as one of the reliable and alternative biomarkers for the diagnosis of NARES and be used to evaluate disease severity and NARES treatment efficacy.
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Key Words
- AR, allergic rhinitis
- AUC, area under curve
- CR, chronic rhinitis
- Cystatin SN
- Diagnosis
- ECRSwNP, eosinophilic chronic rhinosinusitis with nasal polyps
- GICA, gold immunochromatographic assay
- GINA, Global Initiative for Asthma guidelines
- INS, intranasal corticosteroid
- IR, idiopathic rhinitis
- IgE, immunoglobulin E
- LAR, local allergic rhinitis
- LE, local eosinophils
- NAR, nonallergic rhinitis
- NARES, nonallergic rhinitis with eosinophilia syndrome
- Nonallergic rhinitis with eosinophilia syndrome (NARES)
- ROC, receiver operating characteristic
- SIgE, specific IgE
- Treatment efficacy
- VAS, visual analogue scale
- VIF, variance inflation factor
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Affiliation(s)
- Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Bing Yan
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Yang Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Di Wu
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
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29
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Vardouniotis A, Doulaptsi M, Aoi N, Karatzanis A, Kawauchi H, Prokopakis E. Local Allergic Rhinitis Revisited. Curr Allergy Asthma Rep 2020; 20:22. [PMID: 32430616 DOI: 10.1007/s11882-020-00925-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Local allergic rhinitis (LAR) represents a diagnostic and therapeutic challenge for clinicians. Even though it affects a considerable number of chronic rhinitis patients and a significant number of articles regarding prevalence, evolution, diagnosis, and treatment have been published, the condition remains still largely unrecognized and therefore misdiagnosed and mistreated. RECENT FINDINGS LAR is a unique form of chronic rhinitis; it is neither classical allergic rhinitis (AR) nor non-allergic rhinitis (NAR). The symptoms, duration, severity, and complications of LAR are similar to those of AR and can affect adults and children. Thus, a portion of patients diagnosed with NAR or chronic rhinitis of unknown etiology may have LAR. The relationship between LAR inflammation and systemic allergic inflammation is unclear. Patients are frequently misdiagnosed with idiopathic NAR, and distinguishing between both entities is difficult without specific diagnostic tests. Underdiagnosis of LAR has implications on the management of these patients, as they are deprived of allergen immunotherapy (AIT) that has been demonstrated to modulate the immune mechanisms underlying allergic diseases. This review aims to comprehensively summarize the current knowledge on LAR and address unmet needs in the areas of disease diagnosis and treatment.
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Affiliation(s)
| | - Maria Doulaptsi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Nori Aoi
- Faculty of Medicine, Department of Otorhinolaryngology, Shimane University, Matsue, Shimane, Japan
| | - Alexander Karatzanis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Hideyuki Kawauchi
- Faculty of Medicine, Department of Otorhinolaryngology, Shimane University, Matsue, Shimane, Japan
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece.
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30
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Breiteneder H, Diamant Z, Eiwegger T, Fokkens WJ, Traidl‐Hoffmann C, Nadeau K, O’Hehir RE, O’Mahony L, Pfaar O, Torres MJ, Wang DY, Zhang L, Akdis CA. Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care. Allergy 2019; 74:2293-2311. [PMID: 31056763 PMCID: PMC6973012 DOI: 10.1111/all.13851] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/28/2019] [Accepted: 04/12/2019] [Indexed: 12/16/2022]
Abstract
The specialties of allergy and clinical immunology have entered the era of precision medicine with the stratification of diseases into distinct disease subsets, specific diagnoses, and targeted treatment options, including biologicals and small molecules. This article reviews recent developments in research and patient care and future trends in the discipline. The section on basic mechanisms of allergic diseases summarizes the current status and defines research needs in structural biology, type 2 inflammation, immune tolerance, neuroimmune mechanisms, role of the microbiome and diet, environmental factors, and respiratory viral infections. In the section on diagnostic challenges, clinical trials, precision medicine and immune monitoring of allergic diseases, asthma, allergic and nonallergic rhinitis, and new approaches to the diagnosis and treatment of drug hypersensitivity reactions are discussed in further detail. In the third section, unmet needs and future research areas for the treatment of allergic diseases are highlighted with topics on food allergy, biologics, small molecules, and novel therapeutic concepts in allergen‐specific immunotherapy for airway disease. Unknowns and future research needs are discussed at the end of each subsection.
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Affiliation(s)
- Heimo Breiteneder
- Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital Lund University Lund Sweden
- Department of Respiratory Medicine, First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
| | - Thomas Eiwegger
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Department of Pediatrics The Hospital for Sick Children Toronto Ontario Canada
- Research Institute, The Hospital for Sick Children, Translational Medicine Program Toronto Ontario Canada
- Department of Immunology The University of Toronto Toronto Ontario Canada
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam University Medical Centres, Location AMC Amsterdam The Netherlands
| | - Claudia Traidl‐Hoffmann
- Chair and Institute of Environmental Medicine UNIKA‐T, Technical University of Munich and Helmholtz Zentrum München Augsburg Germany
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
| | - Kari Nadeau
- Sean N. Parker Center for Allergy & Asthma Research Stanford University Stanford California
| | - Robyn E. O’Hehir
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Central Clinical School Monash University Melbourne Victoria Australia
- Allergy, Asthma and Clinical Immunology Service Alfred Health Melbourne Victoria Australia
| | - Liam O’Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland National University of Ireland Cork Ireland
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy University Hospital Marburg, Philipps‐Universität Marburg Marburg Germany
| | - Maria J. Torres
- Allergy Unit Regional University Hospital of MalagaIBIMA‐UMA‐ARADyAL Malaga Spain
| | - De Yun Wang
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery and Department of Allergy Beijing Tongren Hospital Beijing China
| | - Cezmi A. Akdis
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich Davos Switzerland
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How to Diagnose and Treat Local Allergic Rhinitis: A Challenge for Clinicians. J Clin Med 2019; 8:jcm8071062. [PMID: 31331047 PMCID: PMC6678883 DOI: 10.3390/jcm8071062] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic rhinitis is a very common disease that can be divided in various phenotypes. Historically, the condition has been classified into the allergic rhinitis (AR) and non-allergic non-infectious rhinitis (NAR) forms, based on the results of the classical biomarkers of atopy: skin prick test and serum allergen-specific IgE However, this classification does not reflect the complexity of the rhinitis syndrome, as illustrated by the existence of non-atopic rhinitis patients who display a nasal reactivity to environmental allergens. This new phenotype has been termed local allergic rhinitis (LAR) and can be only recognized if an additional test such as the nasal allergen challenge (NAC) is integrated in the diagnostic algorithm for chronic rhinitis. Recent data shows that the NAC is a very safe and reliable technique ready for the clinical practice. LAR is a differentiated rhinitis phenotype which often commences during childhood and quickly progresses towards a clinical worsening and the association of comorbidities in other mucosal organs. Recent evidence supports the existence of a bronchial counterpart of LAR (local allergic asthma), which highlights the pathophysiological links between the upper and lower airways and reinforces the united airways concept. Importantly, several controlled studies have demonstrated the ability of allergen immunotherapy to control LAR symptoms while the therapy is being administered. This review emphasizes the need to implement the NAC in the clinical practice in order to facilitate the recognition of LAR patients, allowing for an early prescription of specific therapies with disease-modifying potential.
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