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Nabavizadeh SH, Moghtaderi M, Alyasin S, Esmaeilzadeh H, Hosseini Teshnizi S, Jabbari-Azad F, Barzegar-Amini M, Momen T, Sadinejad M, Abolnezhadian F, Iranparast S, Namavari N, Houshmand H, Sartipi M, Safari M, Eslamian MH, Darougar S, Ahmadiafshar A, Amirsoleymani M, Fouladvand A, Ghaffari J, Bazargan N, Ebrahimi S, Sedighi GR, Mohammadzadeh I, Araghi M, Darabi B, Babaei M, Javidi Alesaadi S. Epidemiology, Sociodemographic Factors and Comorbidity for Allergic Rhinitis, Asthma, and Rhinosinusitis Among 15 to 65-year-Old Iranian Patients. Med J Islam Repub Iran 2022; 36:128. [PMID: 36620471 PMCID: PMC9805810 DOI: 10.47176/mjiri.36.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Indexed: 11/07/2022] Open
Abstract
Background: It is well established that upper and lower airways are often clumped together when diagnosing and treating a disease. This study was designed to determine the prevalence of upper and lower airway diseases and to assess the effect of sociodemographic factors on the prevalence and the comorbidity of these disorders. Methods: This cross-sectional population-based study included patients with ages ranging between 15 to 65 years, who were referred to allergy outpatient clinics in various provinces of Iran from April to September 2020. A modified global Allergy and Asthma European Network (GA2LEN) screening questionnaire was filled out by local allergists of the 12 selected provinces in Iran. Information about the patients and sociodemographic factors was also recorded. Statistical analysis was done by univariate statistical analyses and multiple logistic regressions in SPSS software Version 26. Results: Out of 4988 recruited patients, 1078 (21.6%) had the symptoms of allergic rhinitis (AR) and 285 (5.7%) met the criteria of asthma. The prevalence of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) was 21.6 % and 22%, respectively. The highest prevalence of AR and ARS was in Tehran with the arateof of 33.9% each. Asthma was more prevalent in Khuzestan (14.2%) and CRS in Baluchestan (57.5%). Our analysis showed that the patients with asthma were most likely to have other allergic diseases as well-CRS (OR = 4.8; 95% CI, 2.02- 5.82), AR (OR= 2.5, 95% CI, 2.10-3), ARS (OR = 1.8; 95% CI, 2.10-3), followed by eczema (OR = 1.4; 95% CI, 1.13-1.67).We found that those individuals with CRS were most likely to have painkiller hypersensitivity (OR= 2.1; 95% CI, 1.21-3.83). Furthermore, smoking has been found more than 1.5 folds in patients with ARS. After adjusting variables, there was no correlation between education, occupation, and ethnicity with the studied diseases. Conclusion: Rhinosinusitis is a common condition among Iranian patients. This study confirmed that inflammation of the upper and lower airways can occur simultaneously. Gender, education, occupation, and ethnicity were found to be irrelevant in the development of either AR, asthma, ARS, or CRS.
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Affiliation(s)
| | - Mozhgan Moghtaderi
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Dr Mozhgan Moghtaderi,
| | - Soheila Alyasin
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Saeed Hosseini Teshnizi
- Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | | | - Tooba Momen
- Research Institute of Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Sadinejad
- Department of Allergy and Clinical Immunology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhad Abolnezhadian
- Department of Pediatrics, Abuzar Children’s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Iranparast
- Department of Immunology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran & Student Research Committee, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Hamidreza Houshmand
- Department of Pediatrics Division of Allergy and Clinical Immunology, Urmia University of Medical Sciences, Urmia Iran
| | - Majid Sartipi
- Health Promotion Research Center, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mojgan Safari
- Department of Allergy and Clinical Immunology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Hossein Eslamian
- Department of Allergy and Clinical Immunology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sepideh Darougar
- Department of Pediatrics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Akefeh Ahmadiafshar
- Zanjan Social Determinants of Health Research Center, Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mobina Amirsoleymani
- Student Research Committee, Department of Immunology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Fouladvand
- Department of Pediatrics, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorram Abad, Iran
| | - Javad Ghaffari
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasrin Bazargan
- Department of Pediatrics, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Gholam Reza Sedighi
- Department of Pediatric, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Iraj Mohammadzadeh
- Non-Communicable Pediatrics Diseases Research Center, Babol University of Medical Sciences, Babol, Iran
| | | | - Behzad Darabi
- Department of Pediatrics, Ilam University of Medical Sciences, Ilam, Iran
| | - Maryam Babaei
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Wong MM, Keith PK. Presence of positive skin prick tests to inhalant allergens and markers of T2 inflammation in subjects with chronic spontaneous urticaria (CSU): a systematic literature review. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2020; 16:72. [PMID: 32944029 PMCID: PMC7491258 DOI: 10.1186/s13223-020-00461-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Current guidelines do not recommend performing aeroallergen skin prick testing (SPT) in chronic spontaneous urticaria (CSU). OBJECTIVE The objective of this review was to investigate the presence of aeroallergen sensitization and markers of T2 inflammation in subjects with CSU. METHODS Systematic literature reviews to identify all studies that evaluated the presence of T2 markers of allergic inflammation in CSU subjects were performed. RESULTS In 16 studies that assessed the prevalence of positive SPT to multiple aeroallergens in CSU, 38.5% of CSU subjects had positive SPT. In three controlled studies, 34.2% of CSU subjects had positive SPT to multiple aeroallergens, compared to 13.6% of controls (p = 0.047). In 18 studies that assessed the prevalence of house dust mite (HDM) positive SPT in CSU, 27.5% of CSU subjects had positive SPT. In three controlled studies, 27.5% of CSU subjects had positive SPT to HDM, compared to 2.1% of controls (p = 0.047). Overall, CSU subjects were 3.1 times more likely to be aeroallergen-sensitized (95% CI 1.7-5.8, p = 0.0002) and 6.1 times more likely to be HDM-sensitized (95% CI 3.7-9.9, p < 0.00001) than controls. Mean total serum IgE (tIgE) levels were 238 kU/L and median tIgE levels were 164 kU/L, which was greater than the upper 90th percentile of normal (< 137 kU/L). Compared to healthy controls, CSU subjects were 6.5 times more likely to have IgG autoantibody against FcεR1α (p = 0.001), 2.4 times more likely to have IgG anti-IgE antibody (p = 0.03) and 5 times more likely to have anti-thyroid peroxidase (anti-TPO) antibody (p = 0.02). When corticosteroids were withheld for ≥ 28 days, mean blood eosinophil percentage was elevated at 5.9% (normal < 4%), but other studies reporting absolute count found the mean was in the normal range, 239 × 10 6 / L (normal < 400 × 10 6 / L). CONCLUSION Increased aeroallergen sensitization, tIgE, autoantibodies and blood eosinophil percentage in the CSU subjects indicates the possible importance of T2 inflammation in the pathogenesis of CSU. Further studies may be warranted to determine if specific allergen avoidance, desensitization or improvement in the mucosal allergic inflammation present in asthma and/or rhinitis has any benefit in the management of CSU.
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Affiliation(s)
- Melanie Mitsui Wong
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Paul Kevin Keith
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Health Sciences Centre 3V47, 1280 Main St West, Hamilton, ON L8S 4K1 Canada
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Gajewska D, Kęszycka PK, Szkop M. Dietary salicylates in herbs and spices. Food Funct 2019; 10:7037-7041. [PMID: 31625548 DOI: 10.1039/c9fo01660k] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this study was to determine dietary salicylate content in selected culinary herbs and spices, using the RP-HPLC method with fluorescence detection. The highest concentrations of salicylates were found in dried basil and cumin, followed by dried oregano and cloves. Our research contributes to the global database of salicylate content in food products.
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Affiliation(s)
- Danuta Gajewska
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences - SGGW, Nowoursynowska 159, 02-776 Warsaw, Poland.
| | - Paulina Katarzyna Kęszycka
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences - SGGW, Nowoursynowska 159, 02-776 Warsaw, Poland.
| | - Michał Szkop
- Department of Biochemistry, Faculty of Agriculture and Biology, Warsaw University of Life Sciences - SGGW, Nowoursynowska 159, 02-776 Warsaw, Poland
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Hangouche AJE, Lamliki O, Oukerraj L, Dakka T, Doghmi N, Zarzur J, Cherti M. Kounis syndrome induced by oral intake of aspirin: case report and literature review. Pan Afr Med J 2018; 30:301. [PMID: 30637085 PMCID: PMC6320451 DOI: 10.11604/pamj.2018.30.301.14948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/18/2018] [Indexed: 01/23/2023] Open
Abstract
The Kounis-Zavras syndrome is defined as the coincidental occurrence of acute coronary events and hypersensitivity reactions following an allergic reaction including a mast-cell degranulation of vasospastic mediators. This report describes a case of Kounis-Zavras syndrome in the setting of aspirin-induced asthma also known as Samter-Beer triad combining nasal polyps, asthma, and aspirin allergy leading to vasospasm and myocardial infarction. All physicians should be aware of The Kounis syndrome and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction.
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Affiliation(s)
- Abdelkader Jalil El Hangouche
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco.,Exercise Physiology and Autonomic Nervous System Team "EPE-SNA", Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.,Laboratory of Physiology, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaâdi University, Tangier, Morocco
| | - Ouiame Lamliki
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Latifa Oukerraj
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Taoufiq Dakka
- Exercise Physiology and Autonomic Nervous System Team "EPE-SNA", Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Nawal Doghmi
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Jamila Zarzur
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Mohammed Cherti
- Department of Cardiology B, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
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Philpott CM, Erskine S, Hopkins C, Kumar N, Anari S, Kara N, Sunkaraneni S, Ray J, Clark A, Wilson A, Erskine S, Philpott C, Clark A, Hopkins C, Robertson A, Ahmed S, Kara N, Carrie S, Sunkaraneni V, Ray J, Anari S, Jervis P, Panesaar J, Farboud A, Kumar N, Cathcart R, Almeyda R, Khalil H, Prinsley P, Mansell N, Salam M, Hobson J, Woods J, Coombes E. Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study. Respir Res 2018; 19:129. [PMID: 29945606 PMCID: PMC6020303 DOI: 10.1186/s12931-018-0823-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/08/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes. METHODS All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests. RESULTS The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001. CONCLUSIONS The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway.
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Affiliation(s)
- Carl M Philpott
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK. .,Rhinology and Olfactology, University of East Anglia, Norwich, UK.
| | - Sally Erskine
- James Paget University Hospital NHS Foundation Trust, Gorleston, UK
| | | | - Nirmal Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Shahram Anari
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | | | - Jaydip Ray
- Sheffield Teaching Hospitals, Sheffield, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
| | - Andrew Wilson
- Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
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6
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Rodríguez-Jiménez JC, Moreno-Paz FJ, Terán LM, Guaní-Guerra E. Aspirin exacerbated respiratory disease: Current topics and trends. Respir Med 2018; 135:62-75. [PMID: 29414455 DOI: 10.1016/j.rmed.2018.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/22/2017] [Accepted: 01/08/2018] [Indexed: 12/21/2022]
Abstract
Aspirin-exacerbated respiratory disease is a chronic and treatment-resistant disease, characterized by the presence of eosinophilic rhinosinusitis, nasal polyposis, bronchial asthma, and nonsteroidal anti-inflammatory drugs hypersensitivity. Alterations in arachidonic acid metabolism may induce an imbalance between pro-inflammatory and anti-inflammatory substances, expressed as an overproduction of cysteinyl leukotrienes and an underproduction of prostaglandin E2. Although eosinophils play a key role, recent studies have shown the importance of other cells and molecules in the development of the disease like mast cells, basophils, lymphocytes, platelets, neutrophils, macrophages, epithelial respiratory cells, IL-33 and thymic stromal lymphopoietin, making each of them promissory diagnostic and treatment targets. In this review, we summarize the most important clinical aspects of the disease, including the current topics about diagnosis and treatment, like provocation challenges and aspirin desensitization. We also discuss recent findings in the pathogenesis of the disease, as well as future trends in diagnosis and treatment, including monoclonal antibodies and a low salicylate diet as a treatment option.
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Affiliation(s)
| | | | - Luis Manuel Terán
- Department of Immunogenetics, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Eduardo Guaní-Guerra
- Department of Medicine, University of Guanajuato, León, Guanajuato, Mexico; Department of Immunology, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, Mexico.
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Sakalar EG, Muluk NB, Kar M, Cingi C. Aspirin-exacerbated respiratory disease and current treatment modalities. Eur Arch Otorhinolaryngol 2016; 274:1291-1300. [PMID: 27538737 DOI: 10.1007/s00405-016-4273-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/16/2016] [Indexed: 01/14/2023]
Abstract
Aspirin-exacerbated respiratory disease (AERD) refers to the combination of asthma, chronic rhinosinusitis with nasal polyposis, and acute upper and lower respiratory tract reactions to the ingestion of aspirin (acetylsalicylic acid, ASA) and other cyclooxygenase-1 inhibiting non-steroidal anti-inflammatory drugs. AERD affects 0.3-0.9 % of the general population. AERD generally occurs due to abnormalities in mediators and expression of arachidonic acid biosynthesis. Local IgE responses to staphylococcal enterotoxins may also be responsible for eosinophilic activation in the nasal polyp tissues of AERD patients. Clinical features of AERD include the onset of nasal congestion with anosmia, progressing to chronic pansinusitis and nasal polyps that regrow rapidly after surgery. Aspirin desensitization, Leukotriene-modifying agents, biologic agents, management of asthma, chronic rhinosinusitis, and nasal polyposis are recommended as treatment modalities. Immunotherapy is prescribed only to those AERD patients who experience clear seasonal or perennial allergy symptoms in addition to the symptoms attributable to chronic nasal polyposis. There are also investigational and dietary therapies. In this review, the important aspects of AERD will be presented, along with a literature survey.
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Affiliation(s)
| | - Nuray Bayar Muluk
- Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey. .,, Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 blok, No: 6-3/43, 06610, Çankaya, Ankara, Turkey.
| | - Murat Kar
- ENT Clinics, Kumluca State Hospital, Antalya, Turkey
| | - Cemal Cingi
- Department of Otorhinolaryngology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
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Pham DL, Kim JH, Trinh THK, Park HS. What we know about nonsteroidal anti-inflammatory drug hypersensitivity. Korean J Intern Med 2016; 31:417-32. [PMID: 27030979 PMCID: PMC4855107 DOI: 10.3904/kjim.2016.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/05/2016] [Indexed: 02/07/2023] Open
Abstract
Nonsteroidal anti-inf lammatory drugs (NSAIDs) are widely prescribed for the treatment of inflammatory diseases, but their use is frequently related to hypersensitivity reactions. This review outlines our current knowledge of NSAID hypersensitivity (NHS) with regard to its pathogenic, molecular, and genetic mechanisms, as well as diagnosis and treatment. The presentation of NHS varies from a local (skin and/or airways) reaction to systemic reactions, including anaphylaxis. At the molecular level, NHS reactions can be classified as cross-reactive (mediated by cyclooxygenase inhibition) or selective (specific activation of immunoglobulin E antibodies or T cells). Genetic polymorphisms and epigenetic factors have been shown to be closely associated with NHS, and may be useful as predictive markers. To diagnose NHS, inhalation or oral challenge tests are applied, with the exclusion of any cross-reactive NSAIDs. For patients diagnosed with NHS, absolute avoidance of NSAIDs/aspirin is essential, and pharmacological treatment, including biologics, is often used to control their respiratory and cutaneous symptoms. Finally, desensitization is recommended only for selected patients with NHS. However, further research is required to develop new diagnostic methods and more effective treatments against NHS.
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Affiliation(s)
- Duy Le Pham
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Korea
| | - Ji-Hye Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Tu Hoang Kim Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Korea
- Correspondence to Hae-Sim Park, M.D. Department of Allergy and Clinical Immunology, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5150 Fax: +82-31-219-5154 E-mail:
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9
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Abstract
PURPOSE OF REVIEW This review updates the status of chronic rhinosinusitis with nasal polyps (CRSwNP) in aspirin-exacerbated respiratory disease (AERD) in the contexts of epidemiology, diagnosis, pathogenesis, and treatment. RECENT FINDINGS Recent studies have shown that prostaglandin E₂ (PGE₂) deficiency induces an AERD phenotype in PGE₂ synthase-1 knock-out mice and also PGE₂ resistance in granulocytes of AERD patients. The numbers of platelet-adherent leukocytes increase in AERD patients, enhancing production of cysteinyl leukotrienes (CysLTs) via transcellular metabolism of arachidonate. INF-γ released from eosinophils of the sinus tissue of AERD patients promotes eosinophil maturation, increases leukotriene-associated gene expression, and releases CysLTs. The serum periostin level has been suggested to be a useful biomarker predicting the AERD/CRSwNP phenotype. Aspirin desensitization was reported to decrease the levels of CD4⁺ T cell-derived cytokines, including INF-γ and IL-10, in line with the newly defined role of INF-γ in AERD. SUMMARY Recent findings further support the notion that arachidonic acid metabolism is dysregulated in AERD patients. This is reflected by resistance to PGE₂, overproduction of CysLTs by enhanced numbers of platelet-adherent leukocytes, and cellular stimulation by INF-γ released from eosinophils. Aspirin desensitization may be a useful treatment option in AERD patients exhibiting recalcitrant CRSwNP.
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Ottaviano G, Cappellesso R, Mylonakis I, Lionello M, Favaretto N, Giacomelli L, Spoladore C, Marchese-Ragona R, Marino F, Staffieri A, Martini A, Marioni G. Endoglin (CD105) expression in sinonasal polyposis. Eur Arch Otorhinolaryngol 2015; 272:3367-73. [PMID: 25559463 DOI: 10.1007/s00405-014-3456-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/15/2014] [Indexed: 12/01/2022]
Abstract
Despite appropriate surgical therapy, 5-10 % of patients with chronic rhinosinusitis (CRS) and nasal polyps (NP) experience disease recurrences. It has been suggested that angiogenesis may relate to the pathogenesis and prognosis of CRS with NP. Endoglin (CD105) is a component of the receptor complex of transforming growth factor-beta, a pleiotropic cytokine that modulates angiogenesis. A series of patients treated surgically for CRS with NP was analyzed to assess the relationship between CD105 expression, main clinicopathological features, and recurrence rate. The immunohistochemical expression of CD105 was assessed in 70 patients consecutively operated for CRS with NP. In the univariate setting, the presence of CD105 (1/0) showed a trend towards a significant association with increasing NP dimensions (p = 0.054). Intensity of CD105 reaction was also significantly associated with NP size (0.04) and with an eosinophilic histology (p = 0.048). In our multivariate setting, only asthma (p = 0.016), hypereosinophilia (p = 0.022), and preoperative polyposis score (p = 0.046) retained their independent prognostic significance in relation to NP recurrence. Further efforts are needed to elucidate the biological, angiogenic and proliferative mechanisms behind recurrent NP. Our preliminary results support the clinical utility of extra postoperative care, in terms of closer follow-ups and medication with oral anti-histamines, topical and/or oral steroids, and antileukotrienes in patients with asthma, advanced nasal polyposis at presentation, and serum hypereosinophilia.
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Affiliation(s)
- Giancarlo Ottaviano
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy.
| | | | - Ioannis Mylonakis
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | - Marco Lionello
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | - Niccolò Favaretto
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | | | | | - Rosario Marchese-Ragona
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | - Filippo Marino
- Department of Medicine DIMED, Padova University, Padua, Italy
| | - Alberto Staffieri
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | - Alessandro Martini
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy
| | - Gino Marioni
- Otolaryngology Section, Department of Neurosciences, Padova University, Via Giustiniani 2, 35100, Padua, Italy
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Głowacki R, Tomaszewski KA, Stręk P, Tomaszewska IM, Zgórska-Świerzy K, Markiewicz B, Składzień J. The influence of bacterial biofilm on the clinical outcome of chronic rhinosinusitis: a prospective, double-blind, scanning electron microscopy study. Eur Arch Otorhinolaryngol 2013; 271:1015-21. [PMID: 23864247 DOI: 10.1007/s00405-013-2635-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/09/2013] [Indexed: 02/01/2023]
Abstract
The aim of this study was to assess the influence of bacterial biofilms in chronic rhinosinusitis (CRS) patients on the clinical outcomes following endoscopic sinus surgery (ESS). This was a prospective, double-blind study. Patients undergoing ESS, because of CRS, were recruited. Overall 80 patients were qualified. For each of these demographic, clinical and radiologic characteristics were recorded. During surgery each patient had at least 7 mucosal specimens taken to assess, using scanning electron microscopy, the possible presence of bacterial biofilms. Prior to mucosa specimen excision, swabs for bacteriological and fungal analyses were taken. Each patient underwent perioperative and follow-up assessment at 3 and 6 months post-ESS. Biofilms were found in 33 (41.3%) patients (study group). From among the 47 patients without the presence of biofilms, 33 (control group) were taken to match the study group in age, gender and clinical characteristics. The intensity of subjective and objective CRS symptoms, as well as patient quality-of-life, did not correlate with the Lund and Mackay score (p > 0.05). Analysis of variance showed that, in the control group or the group as a whole, the intensity of subjective and objective symptoms decreased (p < 0.05), and the quality-of-life increased with time (p < 0.05). In conclusion, biofilm-positive patients tend to have a greater severity of disease preoperatively and continue to have persistent and more severe symptoms post-ESS. This study supports the role of biofilms in maintaining the chronic and recalcitrant nature of CRS. The lack of planktonic bacteria in post-operative sinus swabs does not rule out the presence of bacterial biofilms.
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Affiliation(s)
- Roman Głowacki
- Department of Otolaryngology, Ludwik Rydygier Specialistic Hospital, Kraków, Poland
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