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Surda P, Tornari C, Putala M, Walker A. Exercise and Rhinitis in Athletes. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10310443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood, and its association with asthma, can clearly compromise athletic ability. Nasal health is therefore of key importance to the athlete. While not a limiting factor in a single exercise effort, the effects of nasal dysfunction can have repercussions in the post-exercise recovery period. Furthermore, it is linked with the development of asthma and may increase susceptibility to upper respiratory tract symptoms. This review aims to investigate the physiology of the nose during exercise, examine the relationship between exercise and nasal dysfunction, and consider the impact that dysfunction may have on an athlete. Lastly, the authors describe the diagnosis and treatment of rhinitis in athletes.
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Affiliation(s)
- Pavol Surda
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
| | - Matus Putala
- Department of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Abigail Walker
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
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Rosenwasser LJ. Current Understanding of the Pathophysiology of Allergic Rhinitis. Immunol Allergy Clin North Am 2011; 31:433-9. [DOI: 10.1016/j.iac.2011.05.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Unilateral rhinorrhea after translabyrinthine surgery due to parasympathetic hypersensitive syndrome: differentiation from cerebrospinal fluid leakage. Otol Neurotol 2010; 31:1160-2. [PMID: 20657327 DOI: 10.1097/mao.0b013e3181ec1d7d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Unilateral rhinorrhea after translabyrinthine surgery for vestibular or facial schwannoma usually suggests cerebrospinal fluid (CSF) leakage and requires specific measures, including revision surgery. OBJECTIVE To draw attention to the possibility of postoperative unilateral rhinorrhea with concomitant hyperlacrimation and hypersialorrhea without a CSF origin and reflecting more a neuroplastic phenomenon. STUDY DESIGN Retrospective study in a tertiary care center university clinic. PATIENTS AND INTERVENTION For 1 case of intratemporal facial schwannoma and 2 cases of vestibular schwannoma, surgery was by a translabyrinthine approach with sacrifice of the facial nerve and hypoglossofacial anastomosis in the first case. Postoperative unilateral hydrorhinorrhea associated with various degrees of lacrimation and/or salivary hypersecretion occurred mainly during exercise or under stressful situations. CONCLUSION With unilateral rhinorrhea after translabyrinthine surgery for vestibular or facial schwannoma, concomitant symptoms such as lacrimation or hypersialorrhea may not be explained by CSF leakage through the eustachian tube. Misinterpretation may lead to detrimental revision surgery. The pathophysiogenetic mechanism suggests a neuroplastic phenomenon involving a denervation hypersensitivity reaction of the autonomous system. A simple diagnostic test with a nasal anticholinergic agent may be beneficial.
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Miri S, Farid R, Akbari H, Amin R. Prevalence of allergic rhinitis and nasal smear eosinophilia in 11- to 15 yr-old children in Shiraz. Pediatr Allergy Immunol 2006; 17:519-23. [PMID: 17014627 DOI: 10.1111/j.1399-3038.2006.00424.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Allergic rhinitis (AR) is a common condition among schoolchildren. The prevalence rate of AR differs among countries and even among regions within the same country. The objective of this study was to determine the prevalence of nasal symptoms and signs of AR and nasal smear eosinophilia in 11- to 15-yr-old children in Shiraz. A total of 4584 children aged 11-15 yr of both sexes were surveyed from May 1995 to April 1996, and nasal symptoms and signs of AR (sneezing, rhinorrhea, nasal blockage, itching, color change, mucosal swelling, nasal wetness, and nasal crease), based on questionnaire and ear, nose and throat (ENT) examination were recorded. In addition, smears were taken from nasal secretions and stained. The results compared with nasal smears related to 340 healthy children. 1008 (22%) schoolchildren had nasal symptoms of AR (based on the questionnaire), 445 (9.7%) were identified as having nasal symptoms and signs of AR (based on the questionnaire and ENT specialist examination), and 226 (5.8%) had nasal symptoms and signs of AR associated with nasal eosinophilia (based on the questionnaire, ENT specialist examination and positive nasal smear for eosinophilia). Nasal eosinophilia was present in 274 (62%) children with nasal symptoms and signs of AR. This survey showed that prevalence of nasal symptoms and signs of AR was high in schoolchildren in Shiraz. Nasal smear eosinophilia had a diagnostic specificity of 96% and sensitivity of 62% and seems to be a potentially valuable test for AR.
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MESH Headings
- Adolescent
- Child
- Eosinophilia/diagnosis
- Eosinophilia/epidemiology
- Female
- Humans
- Iran/epidemiology
- Male
- Nasal Mucosa/metabolism
- Neutrophils/immunology
- Prevalence
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/pathology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/pathology
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Affiliation(s)
- Sara Miri
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Bonini S, Bonini M, Bousquet J, Brusasco V, Canonica GW, Carlsen KH, Corbetta L, Cummiskey J, Delgado L, Del Giacco SR, Haahtela T, Jaeger S, Moretti C, Palange P, Passalacqua G, Passali D, Pedersen BK, Popov T, Rasi G, Ventura MT, Vignola AM. Rhinitis and asthma in athletes: an ARIA document in collaboration with GA2LEN. Allergy 2006; 61:681-92. [PMID: 16677236 DOI: 10.1111/j.1398-9995.2006.01080.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This consensus document is aimed at reviewing evidence that the rhinitis-asthma links have peculiar features in athletes. Beside a review of epidemological data on the high prevalence of rhinitis and asthma in athletes, the effects on intense physical exercise on the immune system and repiratory functions are discussed, with special reference to the role of allergens and pollutants. In extending the Allergic Rhinitis and its Impact on Asthma (ARIA) recommendations to athletes, the issue is addressed of adapting diagnosis and management to criteria set by the International Olympic Committee (IOC) and regulations adopted by the World Anti-Doping Agency (WADA).
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MESH Headings
- Asthma/diagnosis
- Asthma/drug therapy
- Asthma/etiology
- Asthma/physiopathology
- Exercise/physiology
- Humans
- Rhinitis/diagnosis
- Rhinitis/drug therapy
- Rhinitis/etiology
- Rhinitis/physiopathology
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/etiology
- Rhinitis, Allergic, Seasonal/physiopathology
- Sports
- Sports Medicine
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Baroody FM. Allergic Rhinitis: Broader Disease Effects and Implications for Management. Otolaryngol Head Neck Surg 2003; 128:616-31. [PMID: 12748554 DOI: 10.1016/s0194-59980300257-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Allergic rhinitis is a burdensome disease for a significant part of the population in both adults and children. Poorly controlled allergic rhinitis can trigger exacerbations of asthma, sinusitis, and otitis media, diseases with which it shares common pathophysiologic elements. Consequently, early diagnosis and treatment should be a priority for patients and physicians, not only to control the symptoms of allergic rhinitis but also to improve the management of associated diseases. Several pharmacologic therapies can be considered in an armamentarium that includes antihistamines (intranasal and systemic), intranasal cromolyn, intranasal anticholinergic agents, intranasal steroids, systemic steroids, immunotherapy, and, most recently, leukotriene receptor antagonists. Often, combinations of these treatments are used to maximize control of refractory symptoms.
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MESH Headings
- Adult
- Asthma/epidemiology
- Asthma/therapy
- Child
- Comorbidity
- Cost of Illness
- Humans
- Inflammation Mediators/immunology
- Otitis Media/epidemiology
- Otitis Media/therapy
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/physiopathology
- Sinusitis/epidemiology
- Sinusitis/therapy
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Affiliation(s)
- Fuad M Baroody
- Section of Otolaryngology and Head and Neck Surgery, Pritzker School of Medicine, The University of Chicago, Illinois, USA.
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Ciprandi G, Tosca MA, Passalacqua G, Canonica GW. Intranasal mometasone furoate reduces late-phase inflammation after allergen challenge. Ann Allergy Asthma Immunol 2001; 86:433-8. [PMID: 11345288 DOI: 10.1016/s1081-1206(10)62491-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Allergen specific nasal challenge (ASNC) is an optimal model to study the pathophysiologic mechanisms sustaining allergic inflammation, particularly the adhesion molecules promoting cellular infiltration of nasal mucosa. Topical corticosteroids have been accepted as a highly effective anti-inflammatory therapy for allergic rhinitis. OBJECTIVE The aim of this double-blind, randomized, placebo-controlled study was the evaluation of inflammatory events, during the late-phase, after a 2-week treatment with nasal mometasone furoate (MF), 200 microg daily, or placebo, using the model of ASNC. METHODS A total of 42 patients with allergic rhinitis underwent nasal challenge before and after treatment. The following parameters were evaluated at baseline, and 6 hours (late-phase) after ASNC: 1) nasal symptoms (rhinorrhea, itching, sneezing, obstruction); 2) inflammatory cells (eosinophils and neutrophils); 3) eosinophil cationic protein (ECP) and tumor necrosis factor-alpha (TNF-alpha) in nasal lavage; and 4) intercellular adhesion molecule-1 expression on nasal epithelial cells. RESULTS MF nasal spray was associated with late-phase reductions of: 1) clinical symptoms (P < 0.03); 2) eosinophil (P < 0.004) and neutrophil (P < 0.003) infiltration; 3) ECP (P < 0.001) and TNF-alpha (P < 0.05); and 4) intercellular adhesion molecule-1 expression on nasal epithelial cells (P < 0.001). CONCLUSIONS The present results demonstrate that MF has a significant effect on late-phase events, reducing the cellular influx and activation.
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Affiliation(s)
- G Ciprandi
- Allergy & Respiratory Diseases, Department of Internal Medicine, University of Genoa, Italy.
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Canonica GW, Ciprandi G, Passalacqua G. Nonsteroidal antiallergic treatments in allergic rhinitis. AMERICAN JOURNAL OF RHINOLOGY 2000; 14:319-23. [PMID: 11068657 DOI: 10.2500/105065800781329591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allergic rhinitis is characterized by an inflammatory reaction consequent to an initial IgE-dependent mast cell activation. The conventional treatment is mainly based on antihistamine and topical corticosteroid prescriptions. In this article the authors consider the antiallergic-antiinflammatory activity exerted by some nonsteroidal drugs or immunologic treatments. Clinical and experimental evidence demonstrates that these treatments are able to control allergic inflammation in patients with allergic rhinitis. In conclusion, treatment of allergic rhinitis may also be based on the prescription of nonsteroidal drugs with antiallergic activity.
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Affiliation(s)
- G W Canonica
- Department of Internal Medicine, Genoa University, Genova, Italy
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Gentile DA, Friday GA, Skoner DP. MANAGEMENT OF ALLERGIC RHINITIS. Radiol Clin North Am 2000. [DOI: 10.1016/s0033-8389(22)00199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Naclerio R. Clinical manifestations of the release of histamine and other inflammatory mediators. J Allergy Clin Immunol 1999; 103:S382-5. [PMID: 10069897 DOI: 10.1016/s0091-6749(99)70216-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article reviews the symptoms that are characteristic of the early- and late-phase allergic reaction. Each of the cardinal symptoms of seasonal allergic rhinitis (sneezing, pruritus, rhinorrhea, congestion) is discussed, as is the role of various chemical mediators in the expression of these clinical manifestations.
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Affiliation(s)
- R Naclerio
- Otolaryngology-Head and Neck Surgery, University of Chicago, Ill., USA
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Jean R, Rufin P, Pfister A, Landais P, Waernessyckle S, de Blic J, Scheinmann P. Diagnostic value of nasal provocation challenge with allergens in children. Allergy 1998; 53:990-4. [PMID: 9821481 DOI: 10.1111/j.1398-9995.1998.tb03802.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A total of 106 children suffering from perennial rhinitis and/or asthma, and all allergic to Dermatophagoides pteronyssinus (DP), underwent nasal provocation challenge (NPC) with DP to determine the best method of diagnosis. Posterior rhinomanometry was uninterpretable in 17 patients and gave negative results in 31. Clinical scores for sneezing and rhinorrhea were more effective but did not diagnose the disorder in 11 children. However, nine of the 11 had significant increases in eosinophil count in the late phase. Clinical scores and cytology were also useful for assessing whether NPC with allergens was positive in children. The feasibility and safety of NPC with DP are high for rhinitic and stable asthmatic patients, but mild reactions may occur during the late phase.
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Affiliation(s)
- R Jean
- Service de Pneumologie et d'Allergologie Pédiatriques, Groupe Hospitalier Necker-Enfants Malades, Paris, France
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Ciprandi G, Ricca V, Passalacqua G, Fasolo A, Canonica GW. Intranasal fluticasone propionate reduces ICAM-1 on nasal epithelial cells both during early and late phase after allergen challenge. Clin Exp Allergy 1998; 28:293-9. [PMID: 9543078 DOI: 10.1046/j.1365-2222.1998.00239.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Allergen specific nasal challenge (ASNC) is an optimal method to study the pathophysiological mechanisms sustaining the allergic inflammation and in particular the adhesion molecule system, which is involved in cellular infiltration of nasal mucosa. Topical steroids have been accepted as a highly effective anti-inflammatory therapy for allergic rhinitis. OBJECTIVE The aim of this double-blind placebo- controlled study was the evaluation of clinical and cytological parameters, including ICAM-1 expression on nasal epithelial cells, after a 4 week treatment with nasal fluticasone propionate (200 microg/daily) or placebo, using the model of ASNC. METHODS Twenty allergic rhinitics underwent nasal challenge before and after treatment. The following parameters were evaluated: (i) nasal symptoms (rhinorrhoea, itching, sneezing, obstruction), (ii) inflammatory cells (eosinophils and neutrophils), (iii) ICAM-1 expression on nasal epithelial cells at baseline, 30 min (early phase) and 6 h (late phase) after ASNC. RESULTS Fluticasone propionate was capable of reducing: (i) clinical symptoms during both early (P<0.001) and late phase (P<0.04), (ii) eosinophil (P<0.002) and neutrophil (P<0.001) infiltrate during late phase, and (iii) ICAM-1 expression on nasal epithelial cells during both early (P < 0.01) and late phase (P < 0.03). CONCLUSIONS The present results demonstrate that fluticasone propionate exerts a significant action on early and late phase clinical events following specific nasal challenge, reducing also the cellular influx during the late phase. This event is likely due to the modulation of ICAM-1 expression on epithelial cells.
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Affiliation(s)
- G Ciprandi
- Department of Internal Medicine, University of Genoa, Italy
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Ciprandi G, Passalacqua G, Mincarini M, Ricca V, Canonica GW. Continuous versus on demand treatment with cetirizine for allergic rhinitis. Ann Allergy Asthma Immunol 1997; 79:507-11. [PMID: 9433365 DOI: 10.1016/s1081-1206(10)63057-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cetirizine is an antihistamine used in the treatment of allergic rhinoconjunctivitis, that has antiallergic activity. OBJECTIVE The aim of this double-blind, placebo-controlled, parallel group study was to evaluate the clinical efficacy and the antiallergic activity of cetirizine, administered either continuously or on demand over a 4-week period of natural allergen exposure. METHODS Twenty patients, with allergic rhinoconjunctivitis due to grass and/or Parietaria pollen, were enrolled. They were randomized into 2 parallel groups: one group received the standard dose of 10 mg cetirizine daily and the other received placebo, all patients were allowed to take an additional daily dose of cetirizine when needed. Variables evaluated were clinical symptoms (recorded on diary cards), number of additional on demand cetirizine doses, nasal inflammatory cells, and pollen counts. RESULTS The results of the present study show that patients treated with continuous administration of cetirizine achieved significant symptomatic relief and inflammatory control (decreases in numbers of infiltrating neutrophils and eosinophils) in comparison to patients treated on demand. CONCLUSION Continuous treatment with cetirizine is more effective than on demand treatment. Continuous treatment reduces clinical and inflammatory variables more than symptomatic treatment and the on demand therapy can determine acceptable clinical control, but does not reduce allergic inflammation.
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Affiliation(s)
- G Ciprandi
- Department of Internal Medicine, Genoa University, Italy
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Mastalerz L, Milewski M, Duplaga M, Nizankowska E, Szczeklik A. Intranasal fluticasone propionate for chronic eosinophilic rhinitis in patients with aspirin-induced asthma. Allergy 1997; 52:895-900. [PMID: 9298173 DOI: 10.1111/j.1398-9995.1997.tb01248.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We performed a double-blind, crossover, placebo-controlled study on the effect of fluticasone propionate (FP) treatment on chronic eosinophilic rhinosinusitis in 15 patients with aspirin-induced asthma (AIA). There were 10 women and five men aged 32-60 years; average: 45 years. After a 10-day run-in period, patients underwent two 4-week treatment courses (FP vs placebo), separated by a 2-week washout interval. Clinical activity of FP was evaluated by daily measurement of peak nasal inspiratory flow (PNIF) and a scoring system of subjective symptoms. Nasal challenges with E-lysine aspirin, using active anterior rhinomanometry, were performed at the entry and on the last day of each treatment period. Weekly mean values of symptom scores were generally lower and PNIF measurements higher during treatment with FP than with placebo. This difference was statistically significant for most recorded parameters for the whole 4-week FP treatment. On average, the reactions evoked by aspirin nasal challenge were significantly shorter and milder after treatment with FP than with placebo. In 8/13 patients, FP completely prevented aspirin-precipitated nasal reaction, whereas protection after placebo was observed in only 2/12 subjects (P = 0.004). We conclude that intranasal FP is an effective therapy for chronic eosinophilic rhinitis in patients with AIA.
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Affiliation(s)
- L Mastalerz
- Jagiellonian University School of Medicine, Department of Medicine, Cracow, Poland
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Abstract
Perennial rhinitis and asthma are clinical syndromes representing a range of overlapping pathologies; accurate classification should therefore precede any comparison. Although the sinonasal cavities, trachea and bronchi have a common respiratory mucosa, there are also anatomical differences. For example, the nose has a capacitance vessel network and the lower airways possess smooth muscle, both of which are responsive to neurohumoral influences. The prevalence of rhinitis and asthma has increased over the last three decades. Rhinitis occurs in around 75% of allergic asthmatics while 20% of perennial allergic rhinitics develop asthma. Eosinophils, and their associated proteins and cytokines, may play a central role in both perennial rhinitis and asthma with and without atopy. The characteristic pathology of asthma can be summarized as a chronic, desquamating, eosinophilic bronchitis. Non-allergic rhinitis with eosinophilia is recognized, but without consistent evidence of epithelial damage. Eosinophils are also present in rhinosinusitis with polyposis, particularly in patients with aspirin sensitivity, in whom asthma also often occurs. Increased mast cell activation and mediator release is evident in both perennial rhinitis and asthma following allergen challenge. The importance of mast cells in non-atopic asthma and polyposis is also recognized. Adhesion molecules may also be upregulated, with an increased number and activation of TH2 lymphocytes. However, allergen-resultant T-cell activation may be less marked in the nose than in the lung. Autonomic imbalance also plays a role in both conditions via changes in neural tone to effector tissues, release of neuropeptides, and interplay with cellular recruitment. Pharmacological manipulation of rhinitis and asthma also illustrates the pathological similarities and differences.
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Affiliation(s)
- J M Rowe-Jones
- ENT Department, Chering Cross and Royal Brompton Hospitals, London, United Kingdom
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