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El-Kashef DH, Rahim MA. Levocetrizine attenuates cyclophosphamide-induced lung injury through inhibition of TNF-α, IL-1β, TGF-β and MMP-9. BMC Pharmacol Toxicol 2023; 24:76. [PMID: 38082292 PMCID: PMC10712110 DOI: 10.1186/s40360-023-00717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Cyclophosphamide (CP) is an antineoplastic drug commonly used worldwide. Despite its spread, it causes fatal organ toxicity. Lung toxicity is a serious side effect of CP. Actually, in the past three years the world has been facing an un-predicted crisis following COVID-19 pandemic and the associated high-mortality rates attributed to respiratory distress. Accordingly; this study aimed to probe the potential prophylactic role of levocetrizine against CP-induced lung injury. Animals were allocated into three sets; control; CP and CP/Levo. CP was intraperitoneally injected in rats 150 mg/kg once on day 7. Levocetrizine was given orally for 14 days starting 7 days before CP injection. On the last day, all rats were sacrificed and lung tissues were kept for analysis. CP significantly elevated lung/body weight index, inflammatory cell counts, LDH, total protein, TNF-α, IL-1β, TGF-β and histamine levels in bronchoalveolar lavage (BAL). Moreover, it markedly increased expression of MMP-9 and contents of MDA, hydroxyproline, collagen and NOx besides decreasing GSH level and SOD activity in lung tissues. These biochemical results were further confirmed by histopathological examination. In contrast, treatment with levocetrizine significantly attenuated CP-induced pathological alterations. These findings propose that levocetrizine can attenuate CP-induced lung injury via exerting antioxidant, anti-inflammatory and anti-fibrotic effects.
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Affiliation(s)
- Dalia H El-Kashef
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.
| | - Mona Abdel Rahim
- Urology and Nephrology center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Hong D, Weng J, Ye M, Liu Y. Efficacy of different oral H 1 antihistamine treatments on allergic rhinitis: a systematic review and network meta-analysis of randomized controlled trials. Braz J Otorhinolaryngol 2023; 89:101272. [PMID: 37271114 PMCID: PMC10250918 DOI: 10.1016/j.bjorl.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/02/2022] [Accepted: 03/25/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Oral H1 antihistamines are the first-line treatment for patients with allergic rhinitis, while it is uncertain which kind and dosage of the antihistamines are more effective in improving symptoms of patients. OBJECTIVE To evaluate the efficacy of different oral H1 antihistamine treatments on patients with allergic rhinitis by performing a network meta-analysis. METHODS The search was executed in PubMed, Embase, OVID, the Cochrane Library and ClinicalTrials.gov for relevant studies. The network meta-analysis was performed by using Stata 16.0, and the outcome measures of the analysis were symptom score reductions of patients. Relative risks with 95% Confidence Intervals were used in the network meta-analysis to compare the clinical effect of treatments involved, and Surface Under the Cumulative Ranking Curves (SUCRAs) were also calculated to rank the treatments' efficacy. RESULTS 18 eligible randomized controlled studies, involving a total of 9419 participants, were included in this meta-analysis. All the antihistamine treatments outperformed placebo in total symptom score reduction and each individual symptom score reduction. According to the results of SUCRA, rupatadine 20 mg and rupatadine 10 mg were ranked relatively high in reductions of total symptom score (SUCRA: 99.7%, 76.3%), nasal congestion score (SUCRA: 96.4%, 76.4%), rhinorrhea score (SUCRA: 96.6%, 74.6%) and ocular symptom score (SUCRA: 97.2%, 88.8%); rupatadine 20 mg and levocetirizine 5 mg were ranked relatively high in reductions of nasal itching score (SUCRA: 84.8%, 83.4%) and sneezing score (SUCRA: 87.3%, 95.4%); loratadine 10 mg was ranked the lowest in each symptom score reduction besides placebo. CONCLUSION This study suggests that rupatadine is the most effective in alleviating symptoms of patients with allergic rhinitis among different oral H1 antihistamine treatments involved, and rupatadine 20 mg performs better than rupatadine 10 mg. While loratadine 10 mg has inferior efficacy for patients to the other antihistamine treatments.
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Affiliation(s)
- Dongdong Hong
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China
| | - Juanling Weng
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China
| | - Meiting Ye
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China
| | - Yuanxian Liu
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China.
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Al-Azzawi S, Masheta D. Impact of the COVID-19 pandemic on dispensing medicines in the community pharmacy. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2023; 34:295-311. [PMID: 37355915 DOI: 10.3233/jrs-220061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND The world has faced an unprecedented challenge since COVID-19 emerged as a pandemic, which has led to quarantine and disruptions in drug services. During the pandemic, drug use habits and availability changed, causing a shift in behaviors and, in turn, medicine misuse. In Iraq, this is a major problem because many medicines can be easily obtained. OBJECTIVE The study aims to describe the pattern of dispensing medications during the pandemic and to evaluate the biochemical and pathological consequences. METHOD The analytical, observational, cross-sectional study was performed via a compiled questionnaire for 400 random pharmacists, and the analysis and interpretation of the biochemical changes and medical reports. RESULTS Results revealed that dispensing of medications since the COVID-19 outbreak has increased by 74%, and the demand for medicines seems higher than required in comparison to the periods before the pandemic, while 60% of the dispensed medicines were taken just in case needed. In addition, the availability of medicines decreased by 61%, and the dispensing of common medicines increased due to the belief in their prophylactic action. Several biochemical abnormalities and pathological consequences were recorded due to the irrational use of medicines, and the highest percentage (12%) was seen in hepatic and liver enzymatic dysfunction and 8% for the endocrine and hormonal abnormalities. CONCLUSION It can be concluded that most of the dispensed medicines were not used on a therapeutic or scientific basis during the pandemic.
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Affiliation(s)
- Shafq Al-Azzawi
- College of Pharmacy, University of Babylon, Babylon, Iraq
- PhD/Pharmacy, University of Brighton, Brighton, UK
| | - Dhafir Masheta
- College of Pharmacy, University of Babylon, Babylon, Iraq
- PhD/Pharmacy, University of Brighton, Brighton, UK
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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Calvo-Henriquez C, Mariño-Sánchez F, Lechien JR, Maldonado-Alvarado B, Maniaci A, Maza-Solano J, Martínez-Capoccioni G, Neves JC, Martin-Martin C. Radiofrequency ablation turbinoplasty improves the sense of smell in pediatric patients: A prospective study. Int J Pediatr Otorhinolaryngol 2021; 150:110935. [PMID: 34649156 DOI: 10.1016/j.ijporl.2021.110935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The olfactory sense is of paramount importance for the adequate development of a child. Olfactory loss in children might have different origins. One of the most common is conductive, when nasal obstruction prevents odorants from reaching the olfactory epithelium. Rhinitis and turbinate enlargement have been proven to diminish the sense of smell in pediatric patients. A common treatment for resistant rhinitis in these patients is turbinate radiofrequency ablation (TRA). However, despite an increasing research effort in this field, there are no studies instrumentally assessing olfaction in children undergoing turbinate surgery to date. This study was designed with the aim of assessing changes in olfaction through validated instrumental tools in pediatric patients undergoing TRA for the first time. METHODS A prospective uncontrolled intervention clinical trial design was conducted. Two cohorts of children ranging 4-15 years old were consecutively selected from a third level referral Hospital and subjected to the universal sniff test (U-Sniff), alcohol sniff test (AST), and sniffin sticks threshold test (SST) before and 1, 3 and 6 months after surgery. Cohort A consisted of children solely undergoing TRA. Cohort B consisted of children on whom adenoidectomy and TRA had been performed. Additionally, a cohort of Spanish healthy controls, paired by sex and age, were asked to perform the U-Sniff. RESULTS A total of 81 participants with a mean age of 10.31 ± 2.56 years were included. Fifty-three patients underwent TRA exclusively and 28 were subjected to associated adenoidectomy. Despite a tendency toward improvement in the U-sniff scores, there were no statistically significant differences after surgery. However, statistically significant differences were obtained for threshold tasks measured with SST and AST, revealing differences at 1, 3 and 6 months after surgery compared to preoperative scores. CONCLUSIONS In summary, this research demonstrated adequate levels in the sense of smell regarding identification tasks, but decreased olfactory threshold scores in pediatric patients suffering from TE. TRA, alone or with adenoidectomy, improved smell threshold scores, but had no significant effect on identification tasks.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Franklin Mariño-Sánchez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Foch Hospital, University of Paris Saclay, Paris, France
| | - Byron Maldonado-Alvarado
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonino Maniaci
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, ENT Department of University of Catania, Catania, Italy
| | - Juan Maza-Solano
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Rhinology and Skull Base Surgery Unit, Otolaryngology Department, Hospital Virgen de la Macarena, Seville, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Carlos Neves
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; MyFace Clinics and Academy, Lisbon, Portugal
| | - Carlos Martin-Martin
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Zhang K, Li AR, Miglani A, Nguyen SA, Schlosser RJ. Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2021; 36:269-280. [PMID: 34546814 DOI: 10.1177/19458924211041438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow. OBJECTIVE To provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow. METHODS A systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis. RESULTS Twenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [P = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36; P < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65; P < .001], with a trend toward improvement in TNSS. CONCLUSION Overall, INCS resulted in a clinically and statistically meaningful improvement in symptom scores and physiologic measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their impacts upon nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly for mild AR. Future studies should assess the effect of treatment for each of these patient-reported measures.
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Affiliation(s)
- Kathy Zhang
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Andraia R Li
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Amar Miglani
- 2345Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- 2345Medical University of South Carolina, Charleston, SC, USA
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Fried J, Yuen E, Li A, Zhang K, Nguyen SA, Gudis DA, Rowan NR, Schlosser RJ. Rhinologic disease and its impact on sleep: a systematic review. Int Forum Allergy Rhinol 2020; 11:1074-1086. [PMID: 33275331 DOI: 10.1002/alr.22740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Rhinologic disease can be responsible for systemic symptoms affecting mood, cognition, and sleep. It is unclear whether sleep disturbance in specific rhinologic disorders (chronic rhinosinusitis [CRS], rhinitis, and nasal septal deviation [NSD]) is an obstructive phenomenon or due to other mechanisms. In this review we examine the impact of CRS, rhinitis, and NSD on objective and subjective sleep outcome metrics and draw comparisons to normal controls and patients with known obstructive sleep apnea (OSA). METHODS A systematic review of 4 databases (PubMed, Scopus, Cochrane Library, and Web of Science) was performed. Studies reporting on objective (apnea-hypopnea index [AHI], respiratory disturbance index [RDI], oxygen nadir) and subjective (Epworth Sleepiness Scale [EpSS], Pittsburgh Sleep Quality Index [PSQI], Fatigue Severity Scale [FSS]) sleep parameters and disease-specific patient-reported outcome measures (PROMs; 22-item Sino-Nasal Outcome Test [SNOT-22], Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ], Nasal Obstruction Symptom Evaluation [NOSE]) were included. RESULTS The database search yielded 1414 unique articles, of which 103 were included for analysis. Baseline PROMs were at the high end of normal to abnormal for all 3 conditions: EpSS: CRS (9.8 ± 4.0), rhinitis (9.7 ± 4.3), and NSD (8.9 ± 4.6); and PSQI: CRS (11.0 ± 4.5), rhinitis (6.1 ± 3.7), and NSD (8.6 ± 3.5). Objective measures demonstrated a mild to moderate OSA in the studied diseases: AHI: CRS (10.4 ± 11.5), rhinitis (8.6 ± 8.8), and NSD (13.0 ± 6.9). There were significant differences when compared with reported norms in all measured outcomes (p < 0.001). CONCLUSION Sleep quality is impacted by rhinologic (CRS, rhinitis, NSD) disease. There is likely a mild obstructive component contributing to poor sleep, but other contributing factors may be involved.
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Affiliation(s)
- Jacob Fried
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Erick Yuen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Andraia Li
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Elsürer Ç, Bozkurt B, Aksoy Md C, Bozkurt MK. Evaluation of Olfactory Function in Children With Vernal Keratoconjunctivitis. Am J Rhinol Allergy 2020; 35:535-540. [PMID: 33225727 DOI: 10.1177/1945892420975650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a chronic, severe allergic disease of the conjunctiva, which mostly affects young males in early to mid-childhood. There is a high incidence of asthma, allergic rhinitis (AR) and eczema among patients with VKC. It is unknown if VKC patients have abnormal olfactory dysfunction, and if so, whether this is related to AR. OBJECTIVE Our aim was to evaluate olfactory function in children with VKC, with and without comorbid AR, in comparison to healthy children without VKC. MATERIALS AND METHODS Thirty-nine VKC patients and 32 healthy children were included in the study. After eye and ear, nose and throat (ENT) examination, acoustic rhinometry and modified Connecticut Chemosensory Clinical Research Center (CCCRC) tests were performed and the test results were compared between VKC and control groups and between VKC children with or without AR. A p value <0.05 was regarded as statistically significant. RESULTS The VKC group included 25 males (64.1%) with a mean age of 11.13 ± 3.22 years, while the control group included 26 males (81.3%) with a mean age of 12.50 ± 2.13 years (p > 0.05 for both age and gender). Fourteen VKC patients (35.9%) had either positive prick test or elevated serum specific IgE levels against house dust mites and pollens. Mean odor thresholds did not differ between the two groups (p = 0.084), while mean odor identification and CCCRC score were statistically significantly lower in VKC group (6.00 ± 1.02 and 6.81 ± 0.75, respectively) compared to control group (7.06 ± 0.77 and 7.5 ± 0.41, respectively) (p < 0.05, both). Thirteen VKC patients had co-associated AR (33.3%). In VKC patients with AR, mean odor threshold and identification scores were even lower (5.31 ± 0.95 and 6.23 ± 0.78, respectively) (p < 0.05, both). CONCLUSION Olfactory function was found to be mildly impaired in children with VKC, especially when co-associated with AR. Therefore, loss of smell should be asked as an extraocular symptom.
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Affiliation(s)
- Çağdaş Elsürer
- Department of Otolaryngology, Selcuk University School of Medicine, Konya, Turkey
| | - Banu Bozkurt
- Department of Ophthalmology, Selcuk University School of Medicine, Konya, Turkey
| | - Ceren Aksoy Md
- Department of Otolaryngology, Selcuk University School of Medicine, Konya, Turkey
| | - Mete K Bozkurt
- Department of Otolaryngology, Selcuk University School of Medicine, Konya, Turkey
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Li S, Zhang X, Li Z, Jiang X, Zhang N, Zhang J, Huang Y, Zhao H, Jiang Y, Li N. Desloratadine Ameliorates Olfactory Disorder and Suppresses AMPA Receptor GluA1 Expression in Allergic Rhinitis Rat. Arch Immunol Ther Exp (Warsz) 2020; 68:6. [PMID: 32076842 DOI: 10.1007/s00005-020-00569-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
Allergic rhinitis (AR) is an IgE-mediated inflammation which causes olfactory dysfunction. Antihistamines have been widely used to treat AR while few studies have investigated the effect of antihistamines on improving the sense of smell. In addition, the underlying mechanisms are not well elucidated. We established the ovalbumin (OVA)-induced allergic rhinitis rat model and administrated desloratadine to AR rats. The AR symptoms, serum level of OVA-specific IgE and IL-17, and expression of IL-4, IL-5 and IL-13 in nasal mucosa were measured. The olfactory dysfunction was monitored by buried food test and the expression of GluR1 was measured. Desloratadine treatment alleviated AR symptoms, decreased serum level of OVA-specific IgE and IL-17 in AR rats. Desloratadine decreased IL-4, IL-5, and IL-13 expression in nasal mucosa of AR rats. Desloratadine ameliorated olfactory dysfunction in AR rats and decreased GluR1 expression in AR rats. Desloratadine treatment alleviated AR symptoms and ameliorated olfactory dysfunction in AR rats. The expression of AMPA receptor subunit GluR1 in olfactory bulb was associated with olfactory disorder.
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Affiliation(s)
- Shenling Li
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Xiaotian Zhang
- Department of Anesthesiology, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Zhiyuan Li
- Department of Otolaryngology-Head and Neck Surgery, Key Laboratory, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Xiaodan Jiang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Niankai Zhang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Jisheng Zhang
- Department of Otolaryngology-Head and Neck Surgery, Key Laboratory, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Yichuan Huang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Han Zhao
- Department of Pathology, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China
| | - Yan Jiang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China.
| | - Na Li
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, 266000, China.
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10
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Bozkurt G, Elhassan HA, Sözen E, Soytaş P, Erol ZN, Güvenç MG, Coşkun BU. Assessment of taste functions in allergic rhinitis patients undergoing allergen-specific immunotherapy. Eur Arch Otorhinolaryngol 2018; 276:439-445. [PMID: 30515608 DOI: 10.1007/s00405-018-5236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 12/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND We evaluated taste functions of patients with perennial allergic rhinitis (AR) before and after allergen-specific immunotherapy (AIT). METHODS The study was designed as a prospective clinical study in our tertiary care hospital. Patients (n = 21) who were diagnosed with perennial AR on the basis of physical examination, skin prick test of at least 3* for HDM allergen and treated with AIT were enrolled in this study. A control group (n = 21) was selected from patients who were given intranasal steroids (INS) for perennial AR. Both groups had self-reported hyposmia and subjective loss of the sense of taste before treatment. Taste strips (Burghart, Wedel, Germany) were used for the taste identification scores before and after 6 months treatment. RESULTS A total of 42 subjects were included, with a mean age of 24.1 ± 7.9 years (range 15-43 years). Overall, the AIT group showed more of an improvement of taste function, observed in the total average test scores, compared to the INS group (p < 0.05), but no change was detected between the groups before treatment. No difference was found for the bitter taste scores between the study groups (p = 0.053). CONCLUSION Subcutaneous allergen immunotherapy resulted in more of an improvement in taste function than intranasal steroids. Further studies are needed.
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Affiliation(s)
- Gülpembe Bozkurt
- Department of Otorhinolaryngology, Acıbadem University Hospital, Istanbul, Turkey.
| | | | - Esra Sözen
- Department of Otorhinolaryngology, School of Medicine, Aydın University, Istanbul, Turkey
| | - Pınar Soytaş
- Department of Otorhinolaryngology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Zeynep Nur Erol
- Department of Otolaryngology, Hopa State Hospital, Artvin, Turkey
| | - Melih Güven Güvenç
- Department of Otorhinolaryngology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Berna Uslu Coşkun
- Department of Otorhinolaryngology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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11
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Yu C, Li L, Xia Q, Tang Y. Expression and localization of histamine H 1, H 2, and H 3 receptors in rat olfactory epithelium. Int J Pediatr Otorhinolaryngol 2017; 101:102-106. [PMID: 28964277 DOI: 10.1016/j.ijporl.2017.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Histamine is an important chemical mediator in the development of allergic rhinitis and plays a key role in eliciting the nasal symptoms of the disorder. Histamine may also affect smell as a neurotransmitter. However, whether histamine receptors are present in the mammalian olfactory epithelium has not yet been examined. The aim of this study was to investigate the expression and distribution of histamine H1, H2, and H3 receptors in rat olfactory epithelium. METHODS Real-time quantitative PCR and immunohistochemical staining were performed to examine the mRNA level and protein expression and localization of histamine receptors (H1, H2, and H3) in rat olfactory epithelium. RESULTS We demonstrated that mRNAs encoding histamine H1, H2, and H3 receptors were detected in rat olfactory epithelium. Immunohistochemistry also showed strong positive staining for these receptors. Co-localization of histamine H1, H2, and H3 receptors with olfactory mature protein revealed that these three histamine receptors were mainly localized in olfactory receptor neurons. CONCLUSIONS These findings indicate that histamine H1, H2, and H3 receptors are present in rat olfactory epithelium and may play a physiological role in olfactory transmission.
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Affiliation(s)
- Chao Yu
- Department of Otorhinolaryngology Head and Neck, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li Li
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qingjie Xia
- Department of Ophthalmology, Laboratory of Molecular Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yuedi Tang
- Department of Otorhinolaryngology Head and Neck, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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12
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Dalgic A, Dinc M, Ulusoy S, Dizdar D, Is A, Topak M. Comparison of the effects of nasal steroids and montelukast on olfactory functions in patients with allergic rhinitis. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:213-216. [DOI: 10.1016/j.anorl.2016.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/26/2016] [Accepted: 05/30/2016] [Indexed: 11/25/2022]
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13
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Cingi C, Gevaert P, Mösges R, Rondon C, Hox V, Rudenko M, Muluk NB, Scadding G, Manole F, Hupin C, Fokkens WJ, Akdis C, Bachert C, Demoly P, Mullol J, Muraro A, Papadopoulos N, Pawankar R, Rombaux P, Toskala E, Kalogjera L, Prokopakis E, Hellings PW, Bousquet J. Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report. Clin Transl Allergy 2017; 7:17. [PMID: 28572918 PMCID: PMC5452333 DOI: 10.1186/s13601-017-0153-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/12/2017] [Indexed: 12/14/2022] Open
Abstract
This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms, recommendations for diagnosis and treatment of AR, and to define the needs in this neglected area by a literature review. AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic oesophagitis (EoE), conjunctivitis, chronic middle ear effusions, rhinosinusitis, adenoid hypertrophy, olfaction disorders, obstructive sleep apnea, disordered sleep and consequent behavioural and educational effects. This report provides up-to-date usable information to: (1) improve the knowledge and skills of allergists, so as to ultimately improve the overall quality of patient care; (2) to increase interest in this area; and (3) to present a unique contribution to the field of upper inflammatory disease.
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Affiliation(s)
- C. Cingi
- Department of Otorhinolaryngology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
| | - P. Gevaert
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - R. Mösges
- Institute of Medical Statistics, Informatics, and Epidemiology, Medical Faculty, University of Köln, Cologne, Germany
| | - C. Rondon
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - V. Hox
- Clinical division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Louvain, Belgium
| | - M. Rudenko
- London Allergy and Immunology Centre, London, UK
| | - N. B. Muluk
- ENT Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - G. Scadding
- Royal National Throat, Nose and Ear Hospital, London, UK
| | - F. Manole
- Faculty of Medicine, ENT Department, University of Oradea, Oradea, Romania
| | - C. Hupin
- Institut de Recherche Expérimentale et Clinique (IREC), Pole de Pneumologie, ORL & Dermatologie, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - C. Akdis
- Christine Kuhne-Center for Allergy Research and Education, Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland
| | - C. Bachert
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - P. Demoly
- Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - J. Mullol
- Unitat de Rinologia i Clinica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia Spain
| | - A. Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - N. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | | | - P. Rombaux
- Service d’ORL, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - E. Toskala
- Department of Otorhinolaryngology-Head and Neck Surgery, Temple University, Philadelphia, PA USA
| | - L. Kalogjera
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Sestre milosrdnice, Zagreb, Croatia
| | - E. Prokopakis
- Department of Otorhinolaryngology, University Hospital of Crete, Crete, Greece
| | - P. W. Hellings
- Clinical division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Louvain, Belgium
| | - J. Bousquet
- Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
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14
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Mariño-Sánchez FS, Valls-Mateus M, Ruiz-Echevarría K, Alobid I, Cardenas-Escalante P, Jiménez-Feijoo R, Lozano-Blasco J, Giner-Muñoz MT, Rodríguez-Jorge J, Haag O, Plaza-Martin AM, Mullol J. Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study). Pediatr Allergy Immunol 2017; 28:176-184. [PMID: 27801958 DOI: 10.1111/pai.12679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). METHODS In a prospective, real-life study, 130 paediatric PER patients (13.1 ± 2.8 years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). RESULTS After 2 months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. CONCLUSIONS In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.
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Affiliation(s)
- Franklin S Mariño-Sánchez
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya)
| | - Meritxell Valls-Mateus
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Paulina Cardenas-Escalante
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Jaime Lozano-Blasco
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - María T Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | | | - Oliver Haag
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana M Plaza-Martin
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
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15
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Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Drugs 2017; 77:175-186. [DOI: 10.1007/s40265-016-0682-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Poletti SC, Hummel T, Stuck BA. Riechfunktion bei allergischer Rhinitis: eine systematische Übersichtsarbeit. ALLERGO JOURNAL 2016. [DOI: 10.1007/s15007-016-1092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Clinically relevant outcome measures for new pharmacotherapy, allergen avoidance and immunotherapy trials in allergic rhinoconjunctivitis. Curr Opin Allergy Clin Immunol 2016; 15:197-203. [PMID: 25899694 DOI: 10.1097/aci.0000000000000164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a current overview on both primary and secondary measures of efficacy of therapeutic interventions for clinical trials in allergic rhinoconjunctivitis (ARC) patients. In particular, this review highlights similarities and differences regarding endpoints in trials involving allergen immunotherapy (AIT), pharmacotherapy and allergen avoidance and addresses unmet needs regarding these measures in the future. RECENT FINDINGS In 2014, the European Academy of Allergy and Clinical Immunology (EAACI) proposed a standard for the definition of the primary endpoint for AIT trials in ARC and, moreover, emphasized the advantages and disadvantages as well as unmet needs considering outcome measures for this treatment. Recently, as an (indirect) comparison of clinical efficacy of different interventions, the relative clinical impact (RCI) has been used to determine the percentage reduction of symptom scores in active versus placebo treatment. SUMMARY Several primary and secondary clinical endpoints of therapeutic interventions for clinical trials in ARC patients such as AIT or pharmacotherapy have been proposed by the U.S. Food and Drug Administration (FDA) as well as by the European Medicines Agency (EMA). Moreover, recommendations for the implication of these endpoints in clinical trials have been promoted by academia such as the World Allergy Organization (WAO) or the European Academy of Allergy and Clinical Immunology (EAACI).However, an urgent need for the future will be a thorough international harmonization regarding the definition of clinical endpoints, timing of assessments of clinical efficacy and determination of the clinically meaningful and relevant magnitude of efficacy of therapeutic interventions for clinical trials in ARC patients.
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18
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Klimek L, Mullol J, Hellings P, Gevaert P, Mösges R, Fokkens W. Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. Expert Opin Pharmacother 2016; 17:657-69. [PMID: 26800187 DOI: 10.1517/14656566.2016.1145661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) has a major negative impact on patients' quality of life (QoL) and carries a high socio economic burden. This is particularly the case for patients who experience symptoms for extended periods of time (i.e. those with perennial (PAR) or persistent AR (PER), depending on the classification system used). This review covers available pharmacological advances and recent developments in the treatment of PAR or PER. AREAS COVERED Pharmacological AR treatment is used to reduce symptom burden and help restore patients' normal daily routine. Traditionally, non-sedating antihistamines and intranasal corticosteroids (INS) were the two drug classes recommended for use first line. These, along with antileukotrienes, decongestants, mast cell stabilizers and anticholinergics, constituted the bulk of the AR treatment arsenal. MP-AzeFlu (Dymista®, Meda, Solna, Sweden) is the most recent addition to that arsenal. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray and has surpassed available therapies in terms of symptom control and treatment response. Other relatively new treatments for PAR or PER include H3 antihistamines, toll-like receptor (TLR) agonists, cellulose powders and micro-emulsions, novel biomolecular formulations and omalizumab. Each of these new additions is reviewed here. EXPERT OPINION A new AR drug class has recently been introduced (i.e. RO1AD58). Currently MP-AzeFlu is the only treatment option within this drug class. It can be estimated that combination treatments like MP-AzeFlu will become the mainstay of PAR and PER therapy since use will result in better compliance, improved efficacy over INS and a faster response together with good levels of tolerability. The challenge is to find other equally, or more effective, combination treatments, as has been the therapeutic standard in bronchial asthma for decades. The potential of biologics, as well as TLR-agonists and other new treatment options needs to be further evaluated.
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Affiliation(s)
- Ludger Klimek
- a Center for Rhinology and Allergology , Wiesbaden , Germany
| | - Joaquim Mullol
- b Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; Rhinology and Smell Clinic, ENT Department , Hospital Clínic , Barcelona , Spain
| | - Peter Hellings
- c Laboratory of Clinical Immunology , University Hospitals Leuven , Leuven , Belgium
| | - Philippe Gevaert
- d Upper Airways Research Laboratory, Department of Otorhinolaryngology , Ghent University Hospital , Ghent , Belgium
| | - Ralph Mösges
- e Institute of Medical Statistics , Informatics and Epidemiology (IMSIE) , Cologne , Germany
| | - Wytske Fokkens
- f Department of Otorhinolaryngology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
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Caimmi D, Calderon MA, Bousquet J, Demoly P. Allergen Immunotherapy Outcomes and Unmet Needs. Immunol Allergy Clin North Am 2016; 36:181-9. [DOI: 10.1016/j.iac.2015.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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20
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Long-term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study. Eur Arch Otorhinolaryngol 2015; 273:1809-17. [PMID: 26688432 DOI: 10.1007/s00405-015-3853-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Little is known about the long-term effects of either transnasal transsphenoidal endoscopic approach (TTEA) or expanded endonasal approach (EEA). This study assessed the long-term impact of endoscopic skull base surgery on olfaction, sinonasal symptoms, mucociliary clearance time (MCT), and quality of life (QoL). Patients with pituitary adenomas underwent TTEA (n = 38), while patients with other benign parasellar tumours who underwent an EEA with vascularised septal flap reconstruction (n = 17) were enrolled in this prospective study between 2009 and 2012. Sinonasal symptoms (Visual Analogue Scale), subjective olfactometry (Barcelona Smell Test-24, BAST-24), MCT (saccharin test), and QoL (short form SF-36, rhinosinusitis outcome measure/RSOM) were evaluated before, and 12 months after, surgery. At baseline, sinonasal symptoms, MCT, BAST-24, and QoL were similar between groups. Twelve months after surgery, both TTEA and EEA groups experienced smell impairment compared to baseline. Moreover, EEA (but not TTEA) patients reported increased posterior nasal discharge and longer MCTs compared to baseline. No significant changes in olfactometry or QoL were detected in either group 12 months after surgery. Over the long-term, expanded skull base surgery, using EEA, produced more sinonasal symptoms (including loss of smell) and longer MCTs than pituitary surgery (TTEA). EEA showed no long-term impact on smell test or QoL. LEVEL OF EVIDENCE IIb.
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Stuck BA, Hummel T. Olfaction in allergic rhinitis: A systematic review. J Allergy Clin Immunol 2015; 136:1460-1470. [PMID: 26409662 DOI: 10.1016/j.jaci.2015.08.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 02/03/2023]
Abstract
Olfactory dysfunction is a key symptom in patients with allergic rhinitis (AR). Despite the implications for quality of life, relatively few articles have tested olfactory function in their investigations. The current systematic review aimed to investigate the following 2 questions: (1) What does AR do to human olfaction? (2) How effective is the treatment of AR in restoring the sense of smell? A comprehensive literature search was performed, and human studies of any design were included. A total of 420 articles were identified, and 36 articles were considered relevant. Data indicate that the frequency of olfactory dysfunction increases with the duration of the disorder, and most studies report a frequency in the range of 20% to 40%. Although olfactory dysfunction does not appear to be very severe in patients with AR, its presence seems to increase with the severity of the disease. There is very limited evidence that antihistamines improve olfactory function. In addition, there is limited evidence that topical steroids improve the sense of smell, especially in patients with seasonal AR. This is also the case for specific immunotherapy. However, many questions remain unanswered because randomized controlled trials are infrequent and only a few studies rely on quantitative measurement of olfactory function.
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Affiliation(s)
- Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Head and Neck Surgery, TU Dresden, Dresden, Germany
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Abstract
Among the main causes of olfactory disorders are chronic rhinosinusitis, head trauma, acute infections of the upper respiratory tract and neurodegenerative diseases. Olfactory disorders can impose major restrictions on our lives. Although there are numerous approaches for the therapy of olfactory disorders, double-blind comparison studies are needed to distinguish between the effects of these therapies and spontaneous remission of olfactory disorders. The most significant aspects of treatments seem to be anti-inflammatory measures and the regenerative capabilities of the olfactory neuroepithelium.
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Affiliation(s)
- A Hähner
- Universitäts-HNO-Klinik, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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The optimal evaluation and management of patients with a gradual onset of olfactory loss. Curr Opin Otolaryngol Head Neck Surg 2014; 22:34-41. [PMID: 24370953 DOI: 10.1097/moo.0000000000000013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of the causes of olfactory dysfunction, their evaluation and management, with a main focus on the gradual/progressive loss of smell. RECENT FINDINGS As the sense of smell gives us essential information about our environment, its loss can cause nutritional and social problems while threatening an individual's safety. Recent surveys have shown quite a substantial prevalence of hyposmia (one out of four people) and anosmia (one out of 200 people) in a variety of populations. SUMMARY Nasal inflammatory diseases such as allergic rhinitis and predominantly chronic rhinosinusitis account for the major and common causes of gradual/progressive loss of smell. However, they are also among the most successfully treated forms of olfactory dysfunction. The management of gradual/progressive smell deficit must always address its etiological causes. In most cases, a detailed medical history and nasal examination, smell testing, and imaging will help to establish an appropriate diagnosis. In addition to anti-inflammatory therapy, mainly nasal and systemic corticosteroids, recent investigations on smell training suggest that the controlled exposure to selected odors may increase olfactory performance. VIDEO ABSTRACT AVAILABLE See the Video Supplementary Digital Content 1 (http://links.lww.com/COOH/A8).
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Shawky NM, Shehatou GS, Abdel Rahim M, Suddek GM, Gameil NM. Levocetirizine ameliorates high fructose diet-induced insulin resistance, vascular dysfunction and hepatic steatosis in rats. Eur J Pharmacol 2014; 740:353-63. [DOI: 10.1016/j.ejphar.2014.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/15/2022]
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Mullol J, Pujols L, Alobid I, Pérez-Gonzalez M, Fuentes M, de Borja Callejas F, Valero A, Picado C, Roca-Ferrer J. Fluticasone furoate inhibits cytokine secretion from nasal epithelial cells and reduces eosinophil survival in an in vitro model of eosinophilic inflammation. Int Arch Allergy Immunol 2014; 163:225-33. [PMID: 24603043 DOI: 10.1159/000358489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fluticasone furoate (FF) is an intranasal corticosteroid indicated for the treatment of allergic rhinitis (AR). However, the anti-inflammatory effects of FF in the nasal mucosa have yet to be investigated thoroughly. The aim of this study was to investigate the effect of FF on eosinophil survival and cytokine secretion from nasal mucosa epithelial cells. METHODS Epithelial cells obtained from nasal mucosa were stimulated with 10% fetal bovine serum (FBS) in the presence of FF (from 10(-12) to 10(-7)M) for 6-24 h. Cytokine [granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-6 and IL-8] concentrations in supernatants were measured by ELISA. Peripheral blood eosinophils were incubated for 4 days with epithelial cell secretions in the presence or absence of FF (from 10(-12) to 10(-7)M) and survival was assessed by Trypan blue dye exclusion. Results are expressed as medians of the minimum effective concentration and IC values. RESULTS FBS stimulated the secretion of GM-CSF, IL-6 and IL-8. FF significantly inhibited GM-CSF (up to 10(-10)M, IC25 = 12.6 pM), IL-6 (up to 10(-10)M, IC25 = 65.8 pM) and IL-8 (up to 10(-11)M, IC25 = 8.6 pM) secretion induced by FBS (n = 8). Epithelial cell secretions induced eosinophil survival from day 1 to day 4 (n = 6). This effect was significantly inhibited by FF (up to 10(-12)M) at day 3 (IC50 = 3.22 nM) and day 4 (IC50 = 1.29 nM). CONCLUSIONS The results obtained in this in vitro model suggest that FF may reduce upper airway eosinophilic inflammation through decreasing cytokine secretion from epithelial cells and reducing eosinophil survival.
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Affiliation(s)
- Joaquim Mullol
- Clinical and Experimental Respiratory Immunoallergy, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Alobid I, Enseñat J, Mariño-Sánchez F, de Notaris M, Centellas S, Mullol J, Bernal-Sprekelsen M. Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors. Neurosurgery 2013; 72:540-6. [PMID: 23246823 DOI: 10.1227/neu.0b013e318282a535] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic skull base surgery is now the preferred treatment option to remove skull base tumors. OBJECTIVE To evaluate the patient's sense of smell and mucociliary clearance time (MCT) after skull base surgery. METHODS Patients with pituitary adenoma underwent a transnasal transsphenoidal endoscopic approach (TTEA group, n = 36), whereas patients with other benign parasellar tumors underwent an expanded endonasal approach (EEA group, n = 14) with a vascularized septal flap. Assessment of symptoms (Visual Analogue Scale), olfactometry (Barcelona Smell Test, BAST-24), and MCT (saccharin test) were performed before and 3 months after surgery. RESULTS Before surgery, patients reported poorer BAST-24 scores on detection, identification, and forced choice than the healthy population, but both study groups had similar sinonasal symptoms, BAST-24, and MCT scores. After surgery, no changes in symptom scores (Visual Analogue Scale) were observed except for the loss of smell (26.7 ± 30.5 mm, P < .05) and posterior nasal discharge (29.7 ± 30.3 mm, P < .05) compared with baseline (5.2 ± 11.3, 19.1 ± 25.3, respectively). EEA patients reported higher loss of smell and posterior nasal discharge compared with TTEA. TTEA and EEA groups had similar scores on postoperative BAST-24. After surgery, however, patients showed prolonged saccharin test (15.6 ± 10.8 min, P < .05) compared with baseline (8.4 ± 4.4 min). In addition, EEA patients reported longer MCT than TTEA patients. CONCLUSION EEA but not TTEA has a short-term (3 months) negative impact on patient's olfaction and mucociliary clearance. Patients should be informed about smell loss as a consequence of skull base surgery to prevent legal claims. Likewise, further research and some modifications on reconstruction flaps are encouraged to avoid damaging the olfactory neuroepithelium.
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Affiliation(s)
- Isam Alobid
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
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Keller A, Malaspina D. Hidden consequences of olfactory dysfunction: a patient report series. BMC EAR, NOSE, AND THROAT DISORDERS 2013; 13:8. [PMID: 23875929 PMCID: PMC3733708 DOI: 10.1186/1472-6815-13-8] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/15/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND The negative consequences of olfactory dysfunction for the quality of life are not widely appreciated and the condition is therefore often ignored or trivialized. METHODS 1,000 patients with olfactory dysfunction participated in an online study by submitting accounts of their subjective experiences of how they have been affected by their condition. In addition, they were given the chance to answer 43 specific questions about the consequences of their olfactory dysfunction. RESULTS Although there are less practical problems associated with impaired or distorted odor perception than with impairments in visual or auditory perception, many affected individuals report experiencing olfactory dysfunction as a debilitating condition. Smell loss-induced social isolation and smell loss-induced anhedonia can severely affect quality of life. CONCLUSIONS Olfactory dysfunction is a serious condition for those affected by it and it deserves more attention from doctors who treat affected patients as well as from scientist who research treatment options.
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Affiliation(s)
- Andreas Keller
- Laboratory of Neurogenetics and Behavior, Rockefeller University, New York, NY, USA
| | - Dolores Malaspina
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Creedmoor Psychiatric Center, New York State Office of Mental Health, New York, NY, USA
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