Treatment Effect of Phototherapy with Low-Level Energy in Patients with Allergic Rhinitis: A Single-Arm Observational Study

Allergic rhinitis is one of the most common health challenges and has a chronic and repetitive course that requires symptomatic treatment. We aimed to investigate the effect of phototherapy on allergic rhinitis and how long it takes to demonstrate treatment effect. Twenty-one patients who were diagnosed with allergic rhinitis using the skin prick test were enrolled. Red light (660 nm) and infrared light (940 nm) with a low power energy of 5 mW were used three times a day at intervals of at least 5 h. The Rhinoconjuntivitis Quality of Life Questionnaire (RQLQ) and a visual analog scale (VAS) were used to measure the changes in symptoms. The median RQLQ and VAS scores before treatment were 62 (49-81.5) and 3 (2-5) points, respectively. The RQLQ score improved significantly at two and four weeks after treatment (52 [39-62.5]) and 46.0 [30.5-57.0], respectively). The VAS scores also improved significantly at two and four weeks after treatment. Nasal obstruction and rhinorrhea improved significantly at one week after the procedure. Low-power (5 mW) light irradiation (660 nm red light and 940 nm infrared) was effective in improving the symptoms of allergic rhinitis. In addition, symptom improvement became clear approximately a week after use. Further studies are required to reach a definitive conclusion.

Allergies and Natural Alternatives

Complementary and integrative medicine therapies in the treatment of allergy and allergic rhinitis (AR) are divided broadly into the categories of nutritional supplements, herbal supplements, Ayurvedic, and Chinese traditional medicine. Some therapies are likely completely safe, such as Manuka honey, with no known side effects. Others have significant risks, such as ephedra, which was ultimately banned for use by the Food and Drug Administration. The efficacy of these therapies is varied and under-researched. The therapies with the strongest evidence in the treatment of allergy and AR are Manuka honey, butterbur, and Sinupret.

Effect of rhinophototherapy on nasal congestion in patients with seasonal allergic rhinitis

Objective

The aim of the present study was to objectively and subjectively evaluate the effects of adding rhinophototherapy to intranasal beclomethasone dipropionate to treat nasal congestion in patients with seasonal allergic rhinitis.

Method

Seventy-five seasonal allergic rhinitis patients were randomly divided into two groups. Patients in Group 1 received intranasal beclomethasone dipropionate for two weeks and patients in Group 2 had rhinophototherapy added to the same medical therapy as Group 1. The effectiveness of treatments was evaluated with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Nasal Obstruction Symptom Evaluation scale (NOSE) questionnaires and active anterior rhinomanometry.

Results

After treatment, significant improvement was observed in Group 2 vs Group 1 in terms of RQLQ (p = 0.011) and NOSE (p = 0.001) scores. In Group 2, significant differences were observed between before and after treatment for inspiratory total nasal resistance (p = 0.004). However, no significant differences vs. baseline were observed in Group 1.

Conclusion

Our study shows that adding intranasal phototherapy with a combination of UVA, UVB and visible light therapy to nasal beclomethasone dipropionate treatment objectively improves nasal patency in patients with seasonal allergic rhinitis.

Rhinophototherapy, an alternative treatment of allergic rhinitis: Systematic review and meta-analysis

Introduction

Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa, mediated by immunoglobulin E, affecting 1 in 6 individuals. The treatment aims at attaining symptomatic control with minimal side effects, a requirement for new alternative therapies, including phototherapy, as it has an immunosuppressive and immunomodulatory effect.

Objective

To identify the effectiveness of phototherapy in the treatment of allergic rhinitis through a meta-analysis.

Methods

We searched Web of Science, Scielo, PubMed, SCOPUS, PEDro, and LILACS databases, using the terms: “intranasal irradiation”, “phototherapy” and “allergic rhinitis”. The R software Metafor package was used for the meta-analysis and the effect size was calculated for each symptom individually.

Results

All symptoms decreased considerably after phototherapy: rhinorrhea (ES• = −1.35; p < 0.0001; I² = 91.84%), sneezing (ES• = −1.24; p <  0.0001; I² = 91.43%), nasal pruritus (ES• = −1.10; p < 0.0001; I² = 91.43%); nasal obstruction (ES• = −1.11; p < 0.0001; I² = 91.88%). The effects were more significant in perennial allergic rhinitis than in the seasonal type.

Conclusion

Considering the effect size and the statistical significance attained in our study, rhinophototherapy showed to be an effective treatment for reducing the nasal symptom scores triggered by AR.

Clinical Efficacy and Safety of Low-Level Laser Therapy in Patients with Perennial Allergic Rhinitis: A Randomized, Double-Blind, Placebo-Controlled Trial

Allergic rhinitis (AR) is a common disease that interferes with the daily activities and reduces the quality of life. Conventional treatments often do not provide complete resolution of the symptoms, and many new treatment modalities have been tried. This study aimed to evaluate the efficacy and safety of low-level laser therapy (LLLT) for AR in a randomized, double-blind, placebo-controlled trial. Patients diagnosed with AR were randomly allocated to receive LLLT or sham treatment. The primary outcome was a change in the reflective total nasal symptom score (TNSS). The secondary outcome was quality of life scores assessed using the Rhinoconjunctivitis Quality of Life Questionnaire. Incidences of adverse events were also recorded. Among 67 randomized subjects, 41 subjects (22 in LLLT group and 19 in sham treatment group) were included for efficacy analysis. The LLLT group showed a significantly improved TNSS score compared to the sham treatment group for decreasing AR symptom severity (p = 0.011) and improving quality of life regarding nasal symptoms (p = 0.036) at the end of treatment. Throughout the treatment period, no severe adverse events occurred. This clinical trial showed that LLLT is an effective and safe option for the management of AR regarding symptom relief and quality of life improvement.

Topical Oral and Intranasal Antiviral Agents for Coronavirus Disease 2019 (COVID-19)

With the largest viral loads in both symptomatic and asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) present in the oral and nasal cavities, agents that act on these two areas have the potential for large therapeutic and prophylactic benefit. A literature review was conducted to elucidate the possible agents useful in treatment of SARS-CoV-2. These agents were evaluated for their current applications, adverse reactions, their current state of study, and any future considerations in their management of coronavirus disease 2019 (COVID-2019). Our review has found that, while there are many promising agents with proven efficacy in their in-vitro efficacy against SARS-CoV-2, more clinical trials and in-vivo studies, as well as safety trials, must be conducted before these agents can be effectively implemented.

Effects and safety of intranasal phototherapy for allergic rhinitis: Study protocol for a single-center, randomized, double-blind, parallel, placebo-controlled, investigator-initiated, pilot study

INTRODUCTION

Allergic rhinitis (AR) is an immunoglobulin E (Ig E)-mediated inflammatory disease. Intranasal phototherapy is a promising treatment modality because it has a profound immunosuppressive effect, but the available evidence of its use for AR is insufficient. Therefore, rigorously designed randomized controlled trials (RCTs) are needed. Our objective is to describe the protocol for a feasibility trial to assess the effects and safety of intranasal phototherapy for the treatment of AR.

METHODS AND ANALYSIS

This is a study protocol for a single-center, randomized, double-blind, parallel, placebo-controlled, investigator-initiated pilot study. A total of 40 patients with AR will be randomly assigned to the medical device or sham device group in a 1:1 ratio. The participants will receive intranasal phototherapy with a medical or sham device for 20 min 5 times a week for 2 weeks. The primary outcome will be the mean change in the Total Nasal Symptom Score (TNSS) from baseline to 2 weeks. The secondary outcomes will include the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, Nasal Endoscopy Index, total serum Ig E level, and eosinophil count.

DISCUSSION

The findings of this study will provide the basis for subsequent large-scale definitive RCTs to confirm the effects and safety of intranasal phototherapy for the treatment of nasal symptoms in patients with AR who do not respond well to conventional therapy. This study may assist in the development of noninvasive treatment for patients with AR.

TRIAL REGISTRATION

This study was registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0003253).

Intranasal Antiviral Drug Delivery and Coronavirus Disease 2019 (COVID-19): A State of the Art Review

OBJECTIVE

To provide a state of the art review of intranasal antiviral drug delivery and to discuss current applications, adverse reactions, and future considerations in the management of coronavirus disease 2019 (COVID-19).

DATA SOURCES

PubMed, Embase, and Clinicaltrials.gov search engines.

REVIEW METHODS

A structured search of the current literature was performed of dates up to and including April 2020. Search terms were queried as related to topics of antiviral agents and intranasal applications. A series of video conferences was convened among experts in otolaryngology, infectious diseases, public health, pharmacology, and virology to review the literature and discuss relevant findings.

CONCLUSIONS

Intranasal drug delivery for antiviral agents has been studied for many years. Several agents have broad-spectrum antiviral activity, but they still require human safety and efficacy trials prior to implementation. Intranasal drug delivery has potential relevance for future clinical trials in the settings of disease spread prevention and treatment of SARS-CoV-2 and other viral diseases.

IMPLICATIONS FOR PRACTICE

Intranasal drug delivery represents an important area of research for COVID-19 and other viral diseases. The consideration of any potential adverse reactions is paramount.

Efficacy of endonasal phototherapy for relieving the symptoms of allergic rhinitis: Meta-analysis

BACKGROUND

Endonasal phototherapy can relieve the symptoms of allergic rhinitis (AR) for the patient. However, there is no consensus on whether or not endonasal phototherapy is effective in reducing the symptoms of AR.

OBJECTIVE

The goal of this meta-analysis was to perform a systematic review of the available literature on the effects of endonasal phototherapy on symptoms of AR.

METHODS

Two authors independently searched medical literature databases from their inception of article collection to July 2014. Studies that scored the nasal symptoms of AR and quality of life related to AR before and after endonasal phototherapy, and that compared the effects of phototherapy (treatment groups) with sham treatment (sham group) or antihistamine administration (antihistamine group) were included in the analysis. The outcomes of interest were total nasal symptom scores, disease-specific quality of life questionnaire assessments, and endoscopic findings (discharge and turbinate hypertrophy). Overall, a total of 13 trials met the inclusion criteria of this study, with a total sample size of 679 patients.

RESULTS

Phototherapy significantly reduced nasal symptoms compared with pretreatment values and improved quality of life. The endoscopic findings also significantly improved after phototherapy. In addition, the symptom score and disease-specific quality of life after treatment were significantly lower in the treatment group versus the sham group, and were similar to those in the antihistamine group.

CONCLUSIONS

Phototherapy could provide nasal symptom relief and improve quality of life related to AR. However, when considering the insufficient evaluation of the efficacy of phototherapy according to the treatment methods and the high heterogeneity apparent in some parameters, further clinical trials with robust research methodologies should be conducted to confirm the results of this study.

Radiofrequency versus electrocautery for inferior turbinate hypertrophy

AIM

The aims of this study were to compare radiofrequency tissue reduction (RFTR) and electrocautery (EC) techniques by assessing preoperatively and 8 weeks postoperatively the visual analog scale (VAS), inspiratory peak flowmetry (IPF), and magnetic resonance imaging (MRI) volume measurement of the inferior turbinate and to see whether EC still stands as a valid treatment of inferior turbinate hypertrophy.

METHODS

A total of 36 patients were included in the study. An equal number of patients were chosen randomly from 2 groups. Inferior turbinate volumes measured by MRI, IPF, the VAS, and the Sinonasal Outcome Test-20 were used to determine the efficacy of treatment and to compare the 2 groups.

RESULTS

Postoperative IPF increase, VAS score decrease, and Sinonasal Outcome Test-20 score decrease were statistically more significant in the EC group, compared with the RFTR group. Although statistically not significant, postoperative inferior turbinate MRI volume decrease was more evident in the EC group when compared with the RFTR group.

CONCLUSIONS

Both RFTR and EC techniques could be used as an effective treatment of choice for inferior turbinate hypertrophy, and EC technique is superior to RFTR technique to achieve high efficiency.

Association between climate factors, pollen counts, and childhood hay fever prevalence in the United States

BACKGROUND

Climate factors and pollen counts may play a role in hay fever.

OBJECTIVE

We sought to determine the impact of specific climate factors and pollen counts on the US prevalence of hay fever and statewide variation in prevalence.

METHODS

We used a merged analysis of the 2007 National Survey of Children's Health from a representative sample of 91,642 children aged 0 to 17 years and the 2006-2007 National Climate Data Center and Weather Service measurements of relative humidity (%), indoor heating degree days, precipitation, Palmer Hydrological Drought Index, clear sky and issued ultraviolet indices, stratospheric ozone levels, and outdoor air temperature and National Allergy Bureau total pollen counts. Multivariate survey logistic regression models controlled for sex, race/ethnicity, age, household income, and birthplace.

RESULTS

The US prevalence of hay fever in childhood was 18.0% (95% CI, 17.7% to 18.2%), with the highest prevalence in southeastern and southern states. Hay fever prevalence was significantly lower with second and third quartile mean annual relative humidity (logistic regression, P ≤ .01 for both), fourth quartile mean annual Palmer Hydrological Drought Index (P = .02), third and fourth quartile mean annual heating degree days (P < .0001 for both), and third and fourth quartile mean annual stratospheric ozone levels but increased with second, third, and fourth quartile mean annual temperature (P ≤ .02 for both), fourth quartile mean annual precipitation (P = .0007), mean total pollen counts (P = .01), and second, third, and fourth quartile issued ultraviolet index (P ≤ .0001 for all). Principal-component analysis was also used to determine the combined effects of correlated climate variables and pollen counts.

CONCLUSIONS

This study provides evidence of the influence of climate on the US prevalence of childhood hay fever.

Effects of rhinophototherapy on quality of life in persistant allergic rhinitis

Objectives

To investigate the effect of rhinophototherapy with medical therapy on quality of life in persistent allergic rhinitis.

Methods

A prospective, randomized study was being performed between December 2009 and March 2010. The study included 65 patients with persistent allergic rhinitis. The diagnosis was confirmed with positive skin tests. All of the patients had house dust mite allergies. We divided the patients into two groups. First group (n=33) was given topical mometasone furoate 200 mcg/day and levocetirizine 5 mg/day for a month. Rhinophototherapy was applied with the same medical therapy to the second group (n=32), twice a week for three weeks continuously. Rhinophototherapy included visible light, ultraviolet A and ultraviolet B. We evaluated patients before the treatment, at the first month and at the third month after treatment with rhinoconjunctivitis quality of life questionnaire, nasal symptom scores and visual analogue scale (VAS) scores.

Results

Improvements of all variables of the quality of life questionnaire, nasal symptom scores and VAS were statistically significant in the second group both on the first and the third months when compared with the first group.

Conclusion

Allergic rhinitis is a social problem and impairs quality of life. Rhinophototherapy with medical therapy improves the quality of life in allergic rhinitis.

A comparative pilot study of symptom improvement before and after phototherapy in Korean patients with perennial allergic rhinitis

Although allergic rhinitis is not life threatening, it significantly influences the quality of a patient's life. This study is intended to evaluate the safety and efficacy of phototherapy with low-level energy of a 650 nm laser irradiation system in perennial allergic rhinitis patients. This clinical trial was an open-label, single-center study with 42 perennial allergic rhinitis subjects. Following laser irradiation in the nasal cavity with a laser irradiation system, the efficacy at weeks 1 through 4 was determined. The symptoms were scored with four parameters (nasal obstruction, rhinorrhea, sneezing and itching) before and after illumination of the laser, and the total score was recorded. A survey of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was conducted by patients before and after treatment. Following treatment, significant improvement in the clinical symptoms of nasal obstruction (P < 0.001), rhinorrhea (P = 0.005), sneezing (P = 0.001) and itching (P = 0.003) was reported by 68% of perennial allergic rhinitis patients. The overall RQLQ scores significantly improved by 45% from the baseline with the treatment after 4 weeks. These results indicate that phototherapy is an effective modality for treating perennial allergic rhinitis and is another option in the steroid-free management of immune-mediated mucosal diseases.

Histopathological evaluation of the effect of intranasal phototherapy on nasal mucosa in rabbits

Allergic rhinitis is a high-incidence allergic inflammation of the nasal airways that impacts quality of life. Of the numerous therapies used to treat allergic rhinitis, intranasal phototherapy has emerged as a promising new treatment modality for inflammatory airway disease. Phototherapy is widely used for the treatment of immune-mediated skin diseases because its profound immunosuppressive effect inhibits hypersensitivity reactions in the skin. Intranasal phototherapy using a combination of Ultraviolet-A (UVA) and Ultraviolet-B (UVB) plus Visible light (VIS) has been shown to suppress the clinical symptoms of allergic rhinitis, but limited data regarding its adverse effects on the nasal mucosa currently exists. In this study, we demonstrate that UV displays no harmful effects on the nasal mucosa cells of rabbits following 2 weeks of intranasal phototherapy.

Endonasal phototherapy significantly alleviates symptoms of allergic rhinitis, but has a limited impact on the nasal mucosal immune cells

The literature documents the fact that UV irradiation of cutaneous Langerhans cells (LC) in vivo prevents the development of contact allergy and produces long-lasting immunosuppression. However, not much is known about the effect of UV irradiation on the LC of the nasal mucosa and their connection with clinical scores. Local antigen presentation may be necessary for both primary and recall T cell responses to birch pollen in patients with hay fever. Endonasal phototherapy combination of UVB (5%), UVA (25%) and visible light (70%) utilises the immunosuppressive effects of UV irradiation. The aim of this study was to correlate clinical symptom scores with possible changes in the LC of the nasal mucosa induced by UV radiation. The clinical effectiveness of this form of treatment is discussed. Nasal biopsies were obtained from ten birch pollen-sensitive patients with seasonal rhinitis before and after endonasal phototherapy. All patients showed a significant clinical benefit post-treatment as assessed by standardised instruments, including total nasal symptom score, nasal congestion score, nasal itching score, sneezing score, nasal secretion score and impairment-to-health score. However, we found no significant morphological changes, to, or quantitative differences in, the CD1a+, CD4, CD8 or CD31 cells before and 14 days after treatment. Despite the positive clinical effect, the study revealed no effect of UV irradiation on the LC and other analysed cells of the nasal mucosa immune system. Possible reasons for this are discussed.