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Silva DL, de Barayazarra S, Valero A, Garcia E, Uriarte S, Peñaranda A, Chapman E, Garcia MB, Ocampo J, Valencia V, Moreno S, Corelli S, Lopez B, Ramírez LF, Pérez LC, Jares E, Serrano CD. Control of allergic rhinitis in four latin american countries: Rinola study. FRONTIERS IN ALLERGY 2022; 3:980515. [PMID: 36092279 PMCID: PMC9448887 DOI: 10.3389/falgy.2022.980515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAllergic rhinitis (AR) affects up to 40% of the general population, there are large-scale multicenter studies that have described its characteristics and few studies have focused on studying patients with AR in Latin America (LA).MethodologyA cross-sectional, descriptive, multicenter study was carried out in four LA countries (Colombia, Argentina, Cuba and Peru). Patients diagnosed with AR between November 2017 and June 2020 were included. Sociodemographic and clinical data, sensitization profile and current treatment were collected in the Electronic Data Collection (BDClinic). Patients also filled out this questionnaires: Rhinitis Control Assessment Test (RCAT), Reflexive Total Nasal Symptom Score (rTNSS), Modified ARIA Criteria for AR Severity (mARIA) and ESPRINT-15. Risk of bias was examined by applying the STROBE checklist.ResultsThe study included 412 patients. Median age was 25 years (15–39). Two hundred and twenty four (54.3%) were women. Nasal obstruction was present in 303 (73.5%). Three hundred and thirty four (81%) had a persistent AR. One hundred and twenty one (31.3%) had associated asthma. The most frequently positive skin tests were: Dermatophagoides pteronyssinus in 365 (88.6%) and Dermatophagoides farinae in 331 (81.3%). Four hundred and eleven patients (99%) reported that AR affected their quality of life. The median score of ESPRINT-15 was 1.87 (0.93–2.93), The mean values of RCAT and rTNSS were 19.01 (±4.59) and 5.4 (±2.97) respectively. Two hundred and fifty (60%) were receiving only oral antihistamines. Physicians decided to start nasal corticosteroids in 296 (71.8%). Only seventy patients (16.9%) were receiving immunotherapy.ConclusionThese findings confirm that most of patients with AR in LA have a persistent disease with a negative impact on quality of life. Dust mites are the main sensitizers. These findings will allow to know the true impact of AR and can lead to a better disease management.
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Affiliation(s)
- Diana L Silva
- Unidad de Alergologia, Fundación Valle del Lili, Cali, Colombia
| | | | - Antonio Valero
- Unidad De Alergia, Hospital Clínic, IDIBAPS, Barcelona, España
| | | | - Silvia Uriarte
- Departamento de Alergologia, Hospital Cayetano Heredia, Lima, Perú
| | | | | | - Maria B Garcia
- Departamento de Alergologia, Unimeq ORL, Bogotá, Colombia
| | - Jaime Ocampo
- Departamento de Alergologia, Unimeq ORL, Bogotá, Colombia
| | | | - Sergio Moreno
- Departamento de Alergologia, Unimeq ORL, Bogotá, Colombia
| | - Silvana Corelli
- Departamento de Alergologia, Hospital San Roque, Córdoba, Argentina
| | - Belkis Lopez
- Unidad De Alergia, Hospital Universitario General Calixto García, La Habana, Cuba
| | - Luis F Ramírez
- Unidad de Alergologia, Fundación Valle del Lili, Cali, Colombia
| | | | - Edgardo Jares
- Unidad De Alergia, Fundación LIBRA, Buenos Aires, Argentina
| | - Carlos D Serrano
- Unidad de Alergologia, Fundación Valle del Lili, Cali, Colombia
- Correspondence: Carlos Daniel Serrano Reyes
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Chen H, Zhang L, Lou H, Wang Y, Cao F, Wang C. A Randomized Trial of Comparing a Combination of Montelukast and Budesonide With Budesonide in Allergic Rhinitis. Laryngoscope 2019; 131:E1054-E1061. [PMID: 31782814 DOI: 10.1002/lary.28433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/19/2019] [Accepted: 10/26/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS It is not unequivocally proven whether a combination of an intranasal corticosteroids (INSs) and a cysteinyl leukotriene receptor antagonist has greater efficacy than INSs in the treatment of seasonal allergic rhinitis (SAR). STUDY DESIGN Single-center, randomized, open-label study. METHODS Study subjects included 46 participants with SAR. Participants were randomized to receive budesonide (BD; 256 μg) plus montelukast (MNT; 10 mg) (BD + MNT) or BD alone (256 μg) for 2 weeks. Visual analog scale scores for five major symptoms of SAR, nasal cavity volume (NCV), nasal airway resistance (NAR), and fractional exhaled nitric oxide (FeNO) were assessed before and at the end of treatments. RESULTS Both treatments significantly improved the five main SAR symptoms from baseline; however, BD + MNT produced significantly greater improvements in nasal blockage and nasal itching compared to BD alone. At baseline, the nasal blockage score was significantly correlated with NCV and NAR (r = -0.473, P = .002 and r = -0.383, P = .013, respectively). After 2 weeks of treatment, BD + MNT significantly improved NCV, but not NAR, to a greater level than BD. The number of patients with FeNO concentration ≥ 30 ppb at baseline was significantly decreased after BD + MNT treatment, but not after BD treatment. Similarly, BD + MNT treatment led to a significantly greater decrease in FeNO concentration than BD treatment. CONCLUSIONS BD + MNT treatment may have an overall superior efficacy than BD monotherapy for patients with SAR, especially in improvement of nasal blockage, itching, and subclinical lower airway inflammation. Also, NCV and NAR could be used to assess nasal blockage more accurately. LEVEL OF EVIDENCE 1b Laryngoscope, 131:E1054-E1061, 2021.
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Affiliation(s)
- Hui Chen
- Department of Otolaryngology-Head and Neck Surgery.,and Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology-Head and Neck Surgery.,and Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Hongfei Lou
- Department of Otolaryngology-Head and Neck Surgery.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | | | - Feifei Cao
- and Department of Allergy, 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.,and Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
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Sapsaprang S, Tanticharoenwiwat P, Kulalert P, Poachanukoon O, Setabutr D. Comparison of exhaled nitric oxide levels in pediatric patients with allergic rhinitis. Int J Pediatr Otorhinolaryngol 2019; 126:109603. [PMID: 31369971 DOI: 10.1016/j.ijporl.2019.109603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether the measurement of exhaled nitric oxide (eNO) can help distinguish children with allergic rhinitis (AR) from healthy controls and whether eNO in children with AR correlates with disease severity. METHODS From August 2015 to 2016, children aged 5-15 years of age grouped into those with allergic rhinitis (n = 40) and those classified as healthy control subjects (n = 40) had exhaled nitric oxide (eNO) levels measured. The eNO level was additionally compared to the patient's clinical disease severity according to the ARIA (Allergic Rhinitis and its Impact on Asthma) classification. RESULTS Mean eNO in children with AR (12.64 ± 14.67 ppb) was significantly higher than that in the healthy control group (7.00 ± 6.33 ppb) (p-value = 0.046). In the persistent AR group (17.11 ± 18.40 ppb), eNO level was significantly higher than individuals in the intermittent AR group (8.59 ± 8.88 ppb, p-value = 0.024) and the healthy control group (7.00 ± 6.33 ppb, p-value = 0.008). Among children with AR, eNo was not significantly different with relationship to gender, age, weight and passive smoking exposure. CONCLUSIONS Exhaled nitric oxide may be elevated in children with AR that do not have concomitant asthma. This suggests exhaled nitric oxide may show utility as a parameter to monitor the severity of allergic rhinitis and to monitor the efficacy of the treatment. Physicians should consider comorbid AR when utilizing exhaled nitric oxide as a monitoring parameter in the treatment of asthma.
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Affiliation(s)
- Siwaporn Sapsaprang
- Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Pattara Tanticharoenwiwat
- Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University Hospital, Pathum Thani, Thailand
| | - Prapasri Kulalert
- Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University Hospital, Pathum Thani, Thailand
| | - Orapan Poachanukoon
- Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University Hospital, Pathum Thani, Thailand
| | - Dhave Setabutr
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University Hospital, Pathum Thani, Thailand.
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Ostovar A, Fokkens WJ, Pordel S, Movahed A, Ghasemi K, Marzban M, Farrokhi S. The prevalence of asthma in adult population of southwestern Iran and its association with chronic rhinosinusitis: a GA 2LEN study. Clin Transl Allergy 2019; 9:43. [PMID: 31497279 PMCID: PMC6717339 DOI: 10.1186/s13601-019-0283-6] [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: 06/26/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Asthma is recognized as a major public health concern in the world. The aim of this investigation was to evaluate the prevalence of asthma by using the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire and examine its association with chronic rhinosinusitis, in the province of Bushehr, Southwestern of Iran. Methods In a cross-sectional, population-based study, a total of 5420 invited individuals, aged 15–65, were selected through a multi-stage, stratified, cluster random sampling and from which 5201 completed the GA2LEN questionnaire (response rate = 95.9%). The prevalence of asthma, current, and physician-diagnosed asthma were analyzed by using sex and age groups and the association of asthma and chronic rhinosinusitis (CRS) was investigated using a multiple logistic regression model. Results Based on the information from the GA2LEN questionnaire, the overall prevalence of asthma in the population under study was 10.0% (95% CI 9.2–10.8). Moreover, the prevalence of current asthma was 8.9% (95% CI 8.1–9.7). Further, the prevalence of current early, late-onset and physician-diagnosed asthma within the asthma group was 51.1% (95% CI 46.5–55.7), 48.9% (95% CI 44.3–53.5) and 3.9% (95% CI 2.1–2.5), respectively. Additionally, CRS was more frequent among the participants with asthma [(57.3%, OR = 2.3; 95% CI 2.1–2.5)], and there was a significant association between CRS and current, early and late-onset of asthma (P < 0.001; OR = 4.4, 3.2 and 6, respectively). Conclusion This large population study conducted in the southwestern part of Iran suggests that the prevalence of asthma is high. Moreover, the result of this study showed a strong association of asthma with CRS; also after adjusting for sex, age, educational level, and smoking.
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Affiliation(s)
- Afshin Ostovar
- 1Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Wytske J Fokkens
- 2Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Safoora Pordel
- 3Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Sangi St, PO Box: 75 16 68 88 76, Bushehr, Iran
| | - Ali Movahed
- 4The Persian Gulf Tropical Research Center, Biochemistry Group, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Khadijeh Ghasemi
- 5Department of Pediatrics, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Maryam Marzban
- 6Department of Epidemiology, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Shokrollah Farrokhi
- 3Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Sangi St, PO Box: 75 16 68 88 76, Bushehr, Iran
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Kim MK, Lee SY, Park HS, Yoon HJ, Kim SH, Cho YJ, Yoo KH, Lee SK, Kim HK, Park JW, Park HW, Chung JH, Choi BW, Lee BJ, Chang YS, Jo EJ, Lee SY, Cho YS, Jee YK, Lee JM, Jung J, Park CS. A Randomized, Multicenter, Double-blind, Phase III Study to Evaluate the Efficacy on Allergic Rhinitis and Safety of a Combination Therapy of Montelukast and Levocetirizine in Patients With Asthma and Allergic Rhinitis. Clin Ther 2018; 40:1096-1107.e1. [PMID: 29945738 DOI: 10.1016/j.clinthera.2018.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and safety of a fixed-dose combination of montelukast and levocetirizine in patients with perennial allergic rhinitis with mild to moderate asthma compared with the efficacy and safety of montelukast alone. METHODS This study was a 4-week, randomized, multicenter, double-blind, Phase III trial. After a 1-week placebo run-in period, the subjects were randomized to receive montelukast (10 mg/day, n = 112) or montelukast (10 mg/day)/levocetirizine (5 mg/day) (n = 116) treatment for 4 weeks. The primary efficacy end point was mean daytime nasal symptom score. Other efficacy end points included mean nighttime nasal symptom score, mean composite symptom score, overall assessment of allergic rhinitis by both subjects and physicians, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, asthma control test score, and the frequency of rescue medication used during the treatment period. FINDINGS Of 333 patients screened for this study, 228 eligible patients were randomized to treatment. The mean (SD) age of patients was 43.32 (15.02) years, and two thirds of subjects were female (66.67%). The demographic characteristics were similar between the treatment groups. Compared with the montelukast group, the montelukast/levocetirizine group reported significant reductions in mean daytime nasal symptom score (least squares mean [SE] of combination vs montelukast, -0.98 [0.06] vs -0.81 [0.06]; P = 0.045). For all other allergic rhinitis efficacy end points, the montelukast/levocetirizine group showed greater improvement than the montelukast group. Similar results were observed in overall assessment scores and in FEV1, FVC, FEV1/FVC, and asthma control test score changes from baseline for the 2 treatment groups. Montelukast/levocetirizine was well tolerated, and the safety profile was similar to that observed in the montelukast group. IMPLICATIONS The fixed-dose combination of montelukast and levocetirizine was effective and safe in treating perennial allergic rhinitis in patients with asthma compared with montelukast alone. ClinicalTrials.gov identifier: NCT02552667.
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Affiliation(s)
- Mi-Kyeong Kim
- Subdivision of Allergy, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sook Young Lee
- Division of Allergy, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ho Joo Yoon
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Joo Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Ha Yoo
- Pulmonary-Allergy Division, Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Republic of Korea
| | - Soo-Keol Lee
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Hee-Kyoo Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jung-Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Hong Chung
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Byoung Whui Choi
- Division of Respirology and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun-Jung Jo
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Republic of Korea
| | - Sang-Yeub Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - You Sook Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jong-Myung Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jina Jung
- Hanmi Pharmaceutical Co, Seoul, Republic of Korea
| | - Choon-Sik Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
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Saranz RJ, Lozano A, Lozano NA, Ponzio MF, Cruz ÁA. Subclinical lower airways correlates of chronic allergic and non-allergic rhinitis. Clin Exp Allergy 2017; 47:988-997. [PMID: 28421631 DOI: 10.1111/cea.12938] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The upper and lower airways behave as a physiological and pathophysiological unit. Subclinical lower airways abnormalities have been described in patients with rhinitis without asthma. These are expressed as bronchial hyperreactivity, abnormalities in lung function and bronchial inflammation, likely as a result of the same phenomenon with systemic inflammatory impact that reaches both the nose and the lungs, which for unknown reasons does not always have a full clinical expression. Patients with rhinitis are at increased risk of developing asthma; therefore, most authors suggest a careful clinical evaluation and monitoring of these patients, especially if symptoms related to inflammation in the lower airways are observed. Although current treatments, such as H1-antihistamines, intranasal steroids and allergen immunotherapy, are quite effective for the management of rhinitis, it is difficult to prove their capacity to prevent asthma among subjects with rhinitis. Evidence showing that the treatment of rhinitis has a favourable impact on indicators of bronchial hyperreactivity and inflammation among subjects that have no symptoms of asthma is more frequently described. In this review, we address the frequency and characteristics of lower airway abnormalities in subjects with rhinitis, both in paediatric and adult populations, their likely predictive value for the development of asthma and the possibilities for therapeutic intervention that could modify the risk of subjects with rhinitis towards presenting asthma.
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Affiliation(s)
- R J Saranz
- Allergy and Immunology Division, Clínica Universitaria Reina Fabiola, Facultad de Medicina Universidad Católica de Córdoba, Córdoba, Argentina
| | - A Lozano
- Allergy and Immunology Division, Clínica Universitaria Reina Fabiola, Facultad de Medicina Universidad Católica de Córdoba, Córdoba, Argentina
| | - N A Lozano
- Allergy and Immunology Division, Clínica Universitaria Reina Fabiola, Facultad de Medicina Universidad Católica de Córdoba, Córdoba, Argentina
| | - M F Ponzio
- INICSA-CONICET, Cátedra de Fisiología Humana, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Á A Cruz
- ProAR-Nucleo de Excelência em Asma da Universidade Federal da Bahia, and CNPq, Salvador, Brazil
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Izuhara Y, Matsumoto H, Nagasaki T, Kanemitsu Y, Murase K, Ito I, Oguma T, Muro S, Asai K, Tabara Y, Takahashi K, Bessho K, Sekine A, Kosugi S, Yamada R, Nakayama T, Matsuda F, Niimi A, Chin K, Mishima M. Mouth breathing, another risk factor for asthma: the Nagahama Study. Allergy 2016; 71:1031-6. [PMID: 26991116 DOI: 10.1111/all.12885] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allergic rhinitis, a known risk factor for asthma onset, often accompanies mouth breathing. Mouth breathing may bypass the protective function of the nose and is anecdotally considered to increase asthma morbidity. However, there is no epidemiological evidence that mouth breathing is independently associated with asthma morbidity and sensitization to allergens. In this study, we aimed to clarify the association between mouth breathing and asthma morbidity and allergic/eosinophilic inflammation, while considering the effect of allergic rhinitis. METHODS This community-based cohort study, the Nagahama Study, contained a self-reporting questionnaire on mouth breathing and medical history, blood tests, and pulmonary function testing. We enrolled 9804 general citizens of Nagahama City in the Shiga Prefecture, Japan. RESULTS Mouth breathing was reported by 17% of the population and was independently associated with asthma morbidity. The odds ratio for asthma morbidity was 1.85 (95% CI, 1.27-2.62) and 2.20 (95% CI, 1.72-2.80) in subjects with mouth breathing alone and allergic rhinitis alone, which additively increased to 4.09 (95% CI, 3.01-5.52) when mouth breathing and allergic rhinitis coexisted. Mouth breathing in nonasthmatics was a risk for house dust mite sensitization, higher blood eosinophil counts, and lower pulmonary function after adjusting for allergic rhinitis. CONCLUSION Mouth breathing may increase asthma morbidity, potentially through increased sensitization to inhaled allergens, which highlights the risk of mouth-bypass breathing in the 'one airway, one disease' concept. The risk of mouth breathing should be well recognized in subjects with allergic rhinitis and in the general population.
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Affiliation(s)
- Y. Izuhara
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - H. Matsumoto
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - T. Nagasaki
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Y. Kanemitsu
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - K. Murase
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - I. Ito
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - T. Oguma
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - S. Muro
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - K. Asai
- Department of Oral and Maxillofacial Surgery; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Y. Tabara
- Center for Genomic Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - K. Takahashi
- Department of Oral and Maxillofacial Surgery; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - K. Bessho
- Department of Oral and Maxillofacial Surgery; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - A. Sekine
- Pharmacogenomics Project; Kyoto University Graduate School of Medicine; Kyoto Japan
- Center for Preventive Medical Science; Chiba University; Chiba Japan
| | - S. Kosugi
- Department of Medical Ethics and Medical Genetics; Kyoto University School of Public Health; Kyoto Japan
| | - R. Yamada
- Center for Genomic Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - T. Nakayama
- Department of Health Informatics; Kyoto University School of Public Health; Kyoto Japan
| | - F. Matsuda
- Center for Genomic Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - A. Niimi
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
- Department of Respiratory Medicine Allergy and Clinical Immunology; Nagoya City University School of Medical Sciences; Aichi Japan
| | - K. Chin
- Department of Respiratory Care and Sleep Control Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - M. Mishima
- Department of Respiratory Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
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Leaker BR, Nicholson GC, Ali FY, Daudi N, O'Connor BJ, Barnes PJ. Bronchoabsorption; a novel bronchoscopic technique to improve biomarker sampling of the airway. Respir Res 2015; 16:102. [PMID: 26338015 PMCID: PMC4559920 DOI: 10.1186/s12931-015-0268-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/26/2015] [Indexed: 02/03/2023] Open
Abstract
Background Current techniques used to obtain lung samples have significant limitations and do not provide reproducible biomarkers of inflammation. We have developed a novel technique that allows multiple sampling methods from the same area (or multiple areas) of the lung under direct bronchoscopic vision. It allows collection of mucosal lining fluid and bronchial brushing from the same site; biopsy samples may also be taken. The novel technique takes the same time as standard procedures and can be conducted safely. Methods Eight healthy smokers aged 40–65 years were included in this study. An absorptive filter paper was applied to the bronchial mucosa under direct vision using standard bronchoscopic techniques. Further samples were obtained from the same site using bronchial brushings. Bronchoalveolar lavage (BAL) was obtained using standard techniques. Chemokine (C-C Motif) Ligand 20 (CCL20), CCL4, CCL5, Chemokine (C-X-C Motif) Ligand 1 (CXCL1), CXCL8, CXCL9, CXCL10, CXCL11, Interleukin 1 beta (IL-1β), IL-6, Vascular endothelial growth factor (VEGF), Matrix metalloproteinase 8 (MMP-8) and MMP-9 were measured in exudate and BAL. mRNA was collected from the bronchial brushings for gene expression analysis. Results A greater than 10 fold concentration of all the biomarkers was detected in lung exudate in comparison to BAL. High yield of good quality RNA with RNA integrity numbers (RIN) between 7.6 and 9.3 were extracted from the bronchial brushings. The subset of genes measured were reproducible across the samples and corresponded to the inflammatory markers measured in exudate and BAL. Conclusions The bronchoabsorption technique as described offers the ability to sample lung fluid direct from the site of interest without the dilution effects caused by BAL. Using this method we were able to successfully measure the concentrations of biomarkers present in the lungs as well as collect high yield mRNA samples for gene expression analysis from the same site. This technique demonstrates superior sensitivity to standard BAL for the measurement of biomarkers of inflammation. It could replace BAL as the method of choice for these measurements. This method provides a systems biology approach to studying the inflammatory markers of respiratory disease progression. Trial registration NHS Health Research Authority (13/LO/0256).
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Affiliation(s)
- B R Leaker
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - G C Nicholson
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - F Y Ali
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - N Daudi
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - B J O'Connor
- Respiratory Clinical Trials Ltd., 18-22 Queen Anne Street, London, W1G 8HU, UK.
| | - P J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK.
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9
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Chang CC, Incaudo GA, Gershwin ME. Sinusitis, Rhinitis, Asthma, and the Single Airway Hypothesis. DISEASES OF THE SINUSES 2014. [PMCID: PMC7121820 DOI: 10.1007/978-1-4939-0265-1_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The one airway, one disease hypothesis proposes that the upper and lower airways share the same physiology and histomorphology. Epidemiological clinical studies support a link between rhinosinusitis and asthma. The relationship can occur in both directions, with nasal allergen challenge leading to inflammatory changes in the lower airway and bronchoprovocation studies of the lower airway leading to inflammatory changes in the upper airway. In addition, both similarities and differences exist in the pathogenesis of nasal polyps and asthma. The mechanism for the connection between the upper and lower airways is a matter of great debate. It has been proposed that inflammatory changes in the lower airway may lead to systemic inflammatory effects that play a role in increased bronchial hyperresponsiveness. Similarly, lower airway inflammatory changes may affect nasal airway patency via systemic effects. Moreover, nasopharyngeal-bronchial reflexes may play a non-immunologic role in the interaction between the lower and upper airways. An example of the connection between the upper and lower airways is found in aspirin-exacerbated respiratory disease whereby leukotrienes play a role in the pathology of chronic rhinosinusitis with polyps and asthma. It is also been observed that the treatment of asthma is hindered by untreated rhinosinusitis.
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Affiliation(s)
- Christopher C. Chang
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware USA
| | - Gary A. Incaudo
- Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
| | - M. Eric Gershwin
- The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
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10
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Simões T, Charro N, Blonder J, Faria D, Couto FM, Chan KC, Waybright T, Isaaq HJ, Veenstra TD, Penque D. Molecular profiling of the human nasal epithelium: A proteomics approach. J Proteomics 2011; 75:56-69. [PMID: 21621024 PMCID: PMC7185466 DOI: 10.1016/j.jprot.2011.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/05/2011] [Indexed: 12/25/2022]
Abstract
A comprehensive proteomic profiling of nasal epithelium (NE) is described. This study relies on simple subcellular fractionation used to obtain soluble- and membrane-enriched fractions followed by 2-dimensional liquid chromatography (2D-LC) separation and tandem mass spectrometry (MS/MS). The cells were collected using a brushing technique applied on NE of clinically evaluated volunteers. Subsequently, the soluble- and the membrane-protein enriched fractions were prepared and analyzed in parallel using 2D-LC-MS/MS. In a set of 1482 identified proteins, 947 (63.9%) proteins were found to be associated to membrane fraction. Grand average hydropathy value index (GRAVY) analysis, the transmembrane protein mapping and annotations of primary location deposited in the Human Protein Reference Database (HPRD) confirmed an enrichment of hydrophobic proteins on this dataset. Ingenuity Pathway Analysis (IPA) of soluble fraction revealed an enrichment of molecular and cellular functions associated with cell death, protein folding and drug metabolism while in membrane fraction showed an enrichment of functions associated with molecular transport, protein trafficking and cell-to-cell signaling and interaction. The IPA showed similar enrichment of functions associated with cellular growth and proliferation in both soluble and membrane subproteomes. This finding was in agreement with protein content analysis using exponentially modified protein abundance index (emPAI). A comparison of our data with previously published studies focusing on respiratory tract epithelium revealed similarities related to identification of proteins associated with physical barrier function and immunological defence. In summary, we extended the NE molecular profile by identifying and characterizing proteins associated to pivotal functions of a respiratory epithelium, including the control of fluid volume and ionic composition at the airways' surface, physical barrier maintenance, detoxification and immunological defence. The extent of similarities supports the applicability of a less invasive analysis of NE to assess prognosis and treatment response of lung diseases such as asthma, cystic fibrosis and chronic obstructive pulmonary disease.
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Affiliation(s)
- Tânia Simões
- Laboratório de Proteómica, Departamento de Genética, Instituto Nacional de Saúde Dr. Ricardo Jorge, INSA I.P., Portugal
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11
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p38 MAPK regulates Th2 cytokines release in PBMCs in allergic rhinitis rats. ACTA ACUST UNITED AC 2010; 30:222-5. [PMID: 20407878 DOI: 10.1007/s11596-010-0218-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Indexed: 10/19/2022]
Abstract
Th2 cytokines play a pivotal role in the pathogenesis of allergic rhinitis. To investigate the effect of p38 mitogen-activated protein kinase (MAPK) on the production of Th2 cytokines such as IL-4 and IL-5 in allergic rhinitis, a model of allergic rhinitis was established in SD rats. The expression level of p38 MAPK mRNA in PBMCs was detected by means of real time quantitative RT-PCR. The p38 MAPK activity in PBMCs was detected by Western blotting. PBMCs were cultured with various concentrations of p38 MAPK inhibitor SB 239063 or without the treatment, and then IL-4, IL-5 levels of the supernatant were determined by using sandwich ELISA. The results showed that mRNA expression and activity of p38 MAPK in PBMCs were significantly higher in allergic rhinitis rats than in control rats (P<0.05). The p38 MAPK inhibitor SB 239063 decreased the production of IL-4 and IL-5 in a dose-dependent manner. It is concluded that p38 MAPK plays an important role in the pathogenesis of allergic rhinitis which is associated with Th2 cytokines release.
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12
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[Allergic rhinitis and related diseases]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009; 15:891-8. [PMID: 19649546 DOI: 10.1016/s0873-2159(15)30184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Allergic disease prevalence including allergic rhinitis has increased. It's relationship with other allergic diseases including asthma makes imperative it's diagnosis as well as co- -morbidity identification and associated complications. The most recent classification of the disease highlights the duration of symptoms and it's interference in the quality of life. The therapeutic strategy presented is based on eviction measures, pharmacological treatment, immunotherapy and, in selected cases, surgery. Pharmacological treatment should be done by "steps" according to the severity of the disease.
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13
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Maeda Y, Akiyama K, Shida T. A clinical study of Japanese cedar (Cryptomeria japonica) pollen-induced asthma. Allergol Int 2008; 57:413-7. [PMID: 18946237 DOI: 10.2332/allergolint.o-08-543] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 06/23/2008] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Grass and birch pollens are known to induce asthma. However there are few reports about other pollen-induced asthma. Japanese cedar is the most common allergen in rhinitis in Japan but is controversial on whether it can provoke asthma. METHODS To clarify Japanese cedar pollen-induced asthma, we studied adult patients who were sensitized only to the Japanese cedar (CAP-RAST > = 2) and had symptoms of asthma during the cedar season. We defined cedar asthma as a patient who satisfied the 2 criteria mentioned above. RESULTS We found 6 adult asthma patients who fulfilled the two criteria. Five patients suffered from cedar pollinosis in addition to asthma, and 1 patient had no pollinosis. The cedar pollinosis preceded asthma in 3 cases and occurred at almost the same time in the other 2 cases. Pulmonary function was normal in these cases (FEV 1%, mean +/- SD, 76.5 +/- 10%), with a high threshold value in the non-specific airway hypersensitivity test (Ach-PC20, 2,696 to 20,000 microg/ml, 9294 +/- 2) and low total IgE (101 +/- 86 IU/ml). In the allergen provocation test, 3 subjects showed both an immediate and late asthmatic reaction. CONCLUSIONS We concluded that Japanese cedar pollen could provoke not only pollinosis but also asthma in adults.
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Affiliation(s)
- Yuji Maeda
- Clinical Center of National Hospital Organization Sagamihara Hospital, Kanagawa, Japan.
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Su D, Zhang X, Sui H, Lü F, Jin L, Zhang J. Association of ADAM33 gene polymorphisms with adult allergic asthma and rhinitis in a Chinese Han population. BMC MEDICAL GENETICS 2008; 9:82. [PMID: 18778489 PMCID: PMC2553063 DOI: 10.1186/1471-2350-9-82] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 09/09/2008] [Indexed: 01/15/2023]
Abstract
Background Rhinitis and asthma are very common diseases involving genetic and environmental factors. Most patients with asthma also have rhinitis, which suggests the concept of 'one airway, one disease.' A disintegrin and metalloproteinase 33 (ADAM33) is the first asthma-susceptible gene to be discovered by positional cloning. To evaluate the potential influence of ADAM33 gene polymorphisms on allergic rhinitis (AR) and allergic asthma (AS), a case-control study was conducted on the Han population of northeast China. Methods Six polymorphic sites (V4, T+1, T2, T1, S1, and Q-1) were genotyped in 128 patients with AR, 181 patients with AS, and 151 healthy controls (CTR). Genotypes were determined by the polymerase chain restriction fragment length polymorphism (PCR-RFLP) method. Data were analyzed using the chi-square test with Haploview software. Results The single nucleotide polymorphisms (SNPs), V4 G/C, T+1 A/G, and T1 G/A, of the ADAM33 gene may be the causal variants in AR, whereas ADAM33 V4 G/C, T2 A/G, T1 G/A, and Q-1A/G may participate in the susceptibility of AS. Conclusion These results suggest that polymorphisms of the ADAM33 gene may modify individual susceptibility to AR and AS in a Chinese Han population.
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Affiliation(s)
- Dongju Su
- Department of Respiratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, PR China.
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Fonseca AL, Arrobas AM. [Allergic inflammatory diseases of the upper airways and their impact on asthma--following on from a case report]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2007; 12:563-79. [PMID: 17117326 DOI: 10.1016/s0873-2159(15)30452-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The authors present a case report of a patient referred to physician for "difficult-to-treat asthma". Clinical evaluation concluded that severe chronic inflammatory upper airway disease was an asthma worsening factor. Patient demonstrated improvement in asthma control, after surgery. In the context of the clinical study, the authors present a review of the most common allergic inflammatory diseases of the upper airways (allergic rhinitis, chronic sinusitis and nasal polyposis) and reflect on their impact on asthma.
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Affiliation(s)
- Ana L Fonseca
- Interna do Complementar de Pneumologia, Serviço de Pneumologia, Hospital Geral do Centro Hospitalar de Coimbra, Quintas dos Vales, Coimbra
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