1
|
Terada T, Inui T, Moriyama K, Noro K, Kikuoka Y, Omura S, Suzuki M, Kawata R. Effects of Endoscopic Sinus Surgery for Eosinophilic Chronic Rhinosinusitis on Respiratory Functions and FeNO Production in the Lower Respiratory Tract. EAR, NOSE & THROAT JOURNAL 2024; 103:49-54. [PMID: 34281413 DOI: 10.1177/01455613211032006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To confirm the relevance of upper and lower airway inflammation in eosinophilic chronic rhinosinusitis (ECRS), the effects of endoscopic sinus surgery (ESS) on lower airway functions and inflammation need to be examined in ECRS patients. METHODS Chronic rhinosinusitis patients with nasal polyps (25 non-ECRS, 28 ECRS) were enrolled. The 12 patients in the ECRS group had comorbid asthma, in contrast to none in the non-ECRS group. We divided ECRS patients into 2 groups of ECRS with and without asthma. Clinical markers, including fraction of exhaled nitric oxide (FeNO), respiratory functions, and the Asthma Control Test (ACT) questionnaire, were investigated before and after ESS. RESULTS The FeNO levels in the ECRS with asthma group decreased after ESS. The mean FeNO levels in this group were 56.3 ppb before ESS and 24.9, 25.1, 25.0, and 15.5 ppb 1, 2, 3, and 4 months, respectively, after ESS. The mean forced expiratory rates in 1 second before and after ESS were 67.6% and 73.0%, respectively. The mean maximal expiratory flow rates at 50% of the vital capacity before and after ESS were 45.8% and 58.0%, respectively. Significant differences were observed in respiratory functions before and after ESS. The mean ACT scores in the ECRS with asthma group before and after ESS were 17.5 and 23.5, respectively. The ACT scores were significantly higher after than before ESS. CONCLUSIONS The present results indicate that ECRS and bronchial asthma are common eosinophilic airway inflammatory diseases, and ESS for eosinophilic sinusitis may improve lower airway function.
Collapse
Affiliation(s)
- Tetsuya Terada
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takaki Inui
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kou Moriyama
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Keiki Noro
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yusuke Kikuoka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shuji Omura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Manabu Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| |
Collapse
|
2
|
de Kam PJ, Zielen S, Bernstein JA, Berger U, Berger M, Cuevas M, Cypcar D, Fuhr-Horst A, Greisner WA, Jandl M, Laßmann S, Worm M, Matz J, Sher E, Smith C, Steven GC, Mösges R, Shamji MH, DuBuske L, Borghese F, Oluwayi K, Zwingers T, Seybold M, Armfield O, Heath MD, Hewings SJ, Kramer MF, Skinner MA. Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy. Allergy 2023; 78:2756-2766. [PMID: 37366581 DOI: 10.1111/all.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial. METHODS In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response. RESULTS The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated. CONCLUSIONS This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.
Collapse
Affiliation(s)
| | - S Zielen
- Children and Adolescents Department, Allergology, Pulmonology & Cystic Fibrosis, Goethe University, Frankfurt, Germany
| | - J A Bernstein
- Bernstein Clinical Research Center, LLC, Cincinnati, Ohio, USA
| | - U Berger
- Aerobiology and Pollen Research Unit, Department of Oto-Rhino-Laryngology, Medical University Vienna, Vienna, Austria
| | - M Berger
- Department of Otorhinolaryngology, Wiener Gesundheitsverbund, Hospital Hietzing, Vienna, Austria
| | - M Cuevas
- Clinic and Polyclinic of Otorhinolaryngology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - D Cypcar
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | - A Fuhr-Horst
- ENT Research- Institut für klinische Studien, Essen, Germany
| | - W A Greisner
- Bluegrass Allergy Research, Lexington, Kentucky, USA
| | - M Jandl
- Hamburger Institut für Therapieforschung GmbH, Hamburg, Germany
| | - S Laßmann
- Studienzentrum Dr. Sabine Laßmann, Saalfeld, Germany
| | - M Worm
- Department of Dermatology and Allergy-Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany
| | - J Matz
- Chesapeake Clinical Research, Inc, White Marsh, Maryland, USA
| | - E Sher
- Allergy Partners of New Jersey, Ocean Township, New Jersey, USA
| | - C Smith
- Certified Research Associates, Cortland, New York, USA
| | - G C Steven
- Allergy Asthma & Sinus Center, S.C., Greenfield, Wisconsin, USA
| | - R Mösges
- IMSB (Institute of Computational Biology and Medical Statistics), University at Cologne, Cologne, Germany
- ClinCompetence, Cologne, Germany
| | - M H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK
| | - L DuBuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University Hospital, Washington, DC, USA
| | | | - K Oluwayi
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M Seybold
- Allergy Therapeutics PLC, Worthing, UK
| | | | - M D Heath
- Allergy Therapeutics PLC, Worthing, UK
| | | | | | | |
Collapse
|
3
|
Wu PW, Lee TJ, Wang CH, Huang CC, Chang PH, Fu CH, Huang CC. The Role of Surgery in Treating Nasal Obstruction to Control Asthma. J Asthma Allergy 2020; 13:625-632. [PMID: 33235473 PMCID: PMC7678713 DOI: 10.2147/jaa.s284111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/31/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction Most patients with asthma, either allergic or non-allergic, usually exhibit some level of concurrent rhinitis. Treatments for rhinitis and asthma can affect both conditions. Objective The present study aimed to examine asthma-specific outcomes in patients with chronic rhinitis (CR) and asthma after surgery for nasal obstruction, and to identify the patient group most likely to experience improved asthma control after surgery. Methods Asthmatic patients with CR and nasal obstruction were prospectively recruited for evaluations of nasal and asthma-specific outcomes before and after surgery for nasal obstruction. Results Twenty-eight participants were enrolled. There was a significant association between the Asthma Control Test (ACT) and the Sino-Nasal Outcome Test-22 scores, both at the preoperative and 3-month postoperative assessments. Patients demonstrating ACT improvement after nasal surgery had worse preoperative ACT scores and predicted forced expiratory volume in 1 s. Conclusion Nasal symptom severity was closely associated with the extent of asthma control in asthmatic patients with CR and nasal obstruction. Assessment of CR and nasal obstruction in patients with poorly controlled asthma should be considered an essential approach to improve the response to treatment and patients’ quality of life.
Collapse
Affiliation(s)
- Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
4
|
Cancelliere N, Iglesias I, Ayuga Á, Enrique Miranda E. Cross-reactivity between Parietaria judaica and Parietaria officinalis in immunotherapy extracts for the treatment of allergy to Parietaria. Biomed Rep 2020; 12:326-332. [PMID: 32346476 DOI: 10.3892/br.2020.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/02/2020] [Indexed: 11/05/2022] Open
Abstract
Parietaria judaica and P. officinalis are the two most common subspecies of the Parietaria genus. P. judaica and P. officinalis have exhibited cross-reactivity in previous studies. P. judaica pollen is the main cause of allergy in the Mediterranean area. It has been shown that a high percentage of patients sensitized to P. judaica with allergic rhinitis (AR) have an increased risk of developing asthma. The present study aimed to confirm the cross-reactivity between P. judaica and P. officinalis and to evaluate the use of a single P. officinalis extract in patients allergic to both subspecies as a preferable option for the diagnosis and treatment of allergy in a highly pollinated area of the Spanish Mediterranean coast. The present study was a single centre, observational cross-sectional study of adult patients diagnosed with AR and/or bronchial asthma who were sensitized to Parietaria pollen. A total of 24 patients were enrolled in the study and included in the analysis. Allergovit® immunotherapy extracts were selected for the study based on the protein content (P. officinalis pollen extract). The results of an in vitro ELISA revealed that 79.1% (n=19) of the patient sera were reactive to immunotherapy extracts. ELISA inhibition assay of the IgE binding to P. officinalis demonstrated inhibition values >70% in the sera of highly reactive patients, confirming the cross-reactivity between the two Parietaria subspecies. In addition, all patients enrolled in the study exhibited double skin positivity against P. judaica and P. officinalis extracts, as assessed by the skin prick test, further supporting the in vivo reactivity between the two subspecies. The present study demonstrated that P. judaica and P. officinalis pollen extracts were highly cross-reactive, and that a unique P. officinalis pollen extract may be used for the diagnosis and immunotherapy of patients allergic to Parietaria.
Collapse
Affiliation(s)
| | - Irene Iglesias
- Department of Allergology, Hospital of Sagunto, 46520 Valencia, Spain
| | - Ángel Ayuga
- Medical Department, MERCK SLU, 28006 Madrid, Spain
| | | |
Collapse
|
5
|
Zappia CD, Soto A, Granja‐Galeano G, Fenoy I, Fernandez N, Davio CA, Shayo C, Fitzsimons CP, Goldman A, Monczor F. Azelastine potentiates antiasthmatic dexamethasone effect on a murine asthma model. Pharmacol Res Perspect 2019; 7:e00531. [PMID: 31687162 PMCID: PMC6818730 DOI: 10.1002/prp2.531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/03/2022] Open
Abstract
Glucocorticoids are among the most effective drugs to treat asthma. However, the severe adverse effects associated generate the need for its therapeutic optimization. Conversely, though histamine is undoubtedly related to asthma development, there is a lack of efficacy of antihistamines in controlling its symptoms, which prevents their clinical application. We have reported that antihistamines potentiate glucocorticoids' responses in vitro and recent observations have indicated that the coadministration of an antihistamine and a synthetic glucocorticoid has synergistic effects on a murine model of allergic rhinitis. Here, the aim of this work is to establish if this therapeutic combination could be beneficial in a murine model of asthma. We used an allergen-induced model of asthma (employing ovalbumin) to evaluate the effects of the synthetic glucocorticoid dexamethasone combined with the antihistamine azelastine. Our results indicate that the cotreatment with azelastine and a suboptimal dose of dexamethasone can improve allergic lung inflammation as shown by a decrease in eosinophils in bronchoalveolar lavage, fewer peribronchial and perivascular infiltrates, and mucin-producing cells. In addition, serum levels of allergen-specific IgE and IgG1 were also reduced, as well as the expression of lung inflammatory-related genes IL-4, IL-5, Muc5AC, and Arginase I. The potentiation of dexamethasone effects by azelastine could allow to reduce the effective glucocorticoid dose needed to achieve a therapeutic effect. These findings provide first new insights into the potential benefits of glucocorticoids and antihistamines combination for the treatment of asthma and grants further research to evaluate this approach in other related inflammatory conditions.
Collapse
Affiliation(s)
- Carlos D. Zappia
- Facultad de Farmacia y BioquímicaUniversidad de Buenos AiresBuenos AiresArgentina
- Instituto de Investigaciones Farmacológicas (ININFA)CONICET – Universidad de Buenos AiresBuenos AiresArgentina
| | - Ariadna Soto
- Centro de Estudios en Salud y Medio Ambiente (CESyMA)Escuela de Ciencia y TecnologíaUniversidad Nacional de San Martín – CONICETBuenos AiresArgentina
| | - Gina Granja‐Galeano
- Facultad de Farmacia y BioquímicaUniversidad de Buenos AiresBuenos AiresArgentina
- Instituto de Investigaciones Farmacológicas (ININFA)CONICET – Universidad de Buenos AiresBuenos AiresArgentina
| | - Ignacio Fenoy
- Centro de Estudios en Salud y Medio Ambiente (CESyMA)Escuela de Ciencia y TecnologíaUniversidad Nacional de San Martín – CONICETBuenos AiresArgentina
| | - Natalia Fernandez
- Facultad de Farmacia y BioquímicaUniversidad de Buenos AiresBuenos AiresArgentina
- Instituto de Investigaciones Farmacológicas (ININFA)CONICET – Universidad de Buenos AiresBuenos AiresArgentina
| | - Carlos A. Davio
- Facultad de Farmacia y BioquímicaUniversidad de Buenos AiresBuenos AiresArgentina
- Instituto de Investigaciones Farmacológicas (ININFA)CONICET – Universidad de Buenos AiresBuenos AiresArgentina
| | - Carina Shayo
- Laboratorio de Patología y Farmacología MolecularInstituto de Biología y Medicina Experimental CONICETBuenos AiresArgentina
| | - Carlos P. Fitzsimons
- Center for NeuroscienceSwammerdam Institute for Life SciencesFaculty of ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Alejandra Goldman
- Centro de Estudios en Salud y Medio Ambiente (CESyMA)Escuela de Ciencia y TecnologíaUniversidad Nacional de San Martín – CONICETBuenos AiresArgentina
| | - Federico Monczor
- Facultad de Farmacia y BioquímicaUniversidad de Buenos AiresBuenos AiresArgentina
- Instituto de Investigaciones Farmacológicas (ININFA)CONICET – Universidad de Buenos AiresBuenos AiresArgentina
| |
Collapse
|
6
|
Suh MJ, Park JA, Chang SW, Kim JH, Lee KH, Hong SC, Lee HS, Kang JW. Chronological changes in rhinitis symptoms present in school-aged children with allergic sensitization. PLoS One 2019; 14:e0210840. [PMID: 30653594 PMCID: PMC6336313 DOI: 10.1371/journal.pone.0210840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction It is difficult to accurately predict the natural course of allergic rhinitis (AR), because it is affected by a wide variety of environmental influences, as well as genetic predisposition. Considering the high prevalence of allergic rhinitis in children and adolescents, caregivers should be given appropriate information regarding the disease course. This study aimed to understand the prognosis of allergic rhinitis by examining the relationship between allergic sensitization and rhinitis symptoms during this developmental period. Methods This cross-sectional study included 1069 children aged 9–16 years from the Korean International Study of Asthma and Allergies in Childhood Survey database who had completed health questionnaires, and for whom skin prick test results were available. Data were collected during May 2016. The distribution of sensitization and allergic symptoms was compared by age groups (elementary, middle, and high school). Data were analyzed using linear-by-linear analysis. Results Sensitization to at least one tested allergen differed by age (59.2%, 58.3%, 68.2%, in elementary, middle, and high school students, respectively; p = 0.025), and seasonal allergen sensitization (35.0%, 37.1%, 53.9%, respectively) increased with age (p < 0.001). Conversely, the proportion of rhinitis symptoms among sensitized children decreased as age increased (58.80%, 52.90%, 49.70%, respectively; p = 0.047). However, the rate of non-allergic rhinitis was age-independent. Conclusion With increasing age during childhood and adolescence, symptomatic allergic rhinitis decreases; thus, subclinical allergic rhinitis increases. This suggests that the symptoms of later-sensitized children are less clearly manifested, or that the symptoms reduce as previously sensitized children mature. This should be clarified further in a longitudinal study.
Collapse
Affiliation(s)
- Michelle J. Suh
- Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
| | - Jin A. Park
- Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
| | - Suk Won Chang
- Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
| | - Jeong Hong Kim
- Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
- The Environmental Health Center (Atopic Dermatitis and Allergic Rhinitis), Jeju National University, Jeju, South Korea
| | - Keun-Hwa Lee
- The Environmental Health Center (Atopic Dermatitis and Allergic Rhinitis), Jeju National University, Jeju, South Korea
| | - Seong-Chul Hong
- The Environmental Health Center (Atopic Dermatitis and Allergic Rhinitis), Jeju National University, Jeju, South Korea
| | - Hye-Sook Lee
- The Environmental Health Center (Atopic Dermatitis and Allergic Rhinitis), Jeju National University, Jeju, South Korea
| | - Ju Wan Kang
- Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
- The Environmental Health Center (Atopic Dermatitis and Allergic Rhinitis), Jeju National University, Jeju, South Korea
- * E-mail:
| |
Collapse
|
7
|
Ndika J, Airaksinen L, Suojalehto H, Karisola P, Fyhrquist N, Puustinen A, Alenius H. Epithelial proteome profiling suggests the essential role of interferon-inducible proteins in patients with allergic rhinitis. J Allergy Clin Immunol 2017. [PMID: 28633877 DOI: 10.1016/j.jaci.2017.05.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Seasonal allergic rhinitis (SAR) caused by intermittent exposure to seasonal pollen causes itching, nasal congestion, and repeated sneezing, with profound effects on quality of life, work productivity, and school performance. Although both the genotype and environmental factors can contribute to the immunologic basis of allergic reactions, the molecular underpinnings associated with the pathogenesis of allergic rhinitis are not entirely clear. METHODS To address these questions, nasal epithelial brushings were collected from 29 patients with SAR and 31 control subjects during and after the pollen season. We then implemented an orbitrap-based, bottom-up, label-free quantitative proteomics approach, followed by multivariate analyses to identify differentially abundant (DA) proteins among the 4 sample groups. RESULTS We identified a total of 133 DA proteins for which the most significantly overrepresented functional category was found to be interferon 1 signaling. Two proteins, cystatin 1 and myeloblastin, the former of which protects against protease activity of allergens and the latter with a role in epithelial barrier function, were DA in patients with SAR and control subjects, irrespective of season. Moreover, interferon-inducible protein with tetratricopeptide repeats 1, cystatin 1, and interferon-inducible protein with tetratricopeptide repeats 3 were found to be differentially regulated between patients with SAR and control subjects, with inverse abundance dynamics during the transition from fall to spring. CONCLUSION We identified type 1 interferon-regulated proteins as biomarkers in patients with SAR, potentially playing an important role in its pathogenesis. Moreover, when compared with patients with SAR, healthy subjects exhibit an antagonistic proteomic response across seasons, which might prove to be a therapeutic target for disease prevention.
Collapse
Affiliation(s)
- Joseph Ndika
- Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, Finland
| | - Liisa Airaksinen
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Piia Karisola
- Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, Finland
| | - Nanna Fyhrquist
- Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, Finland
| | - Anne Puustinen
- Department of Clinical Chemistry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Alenius
- Department of Bacteriology and Immunology, Medicum, University of Helsinki, Helsinki, Finland; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
8
|
Moreno V, Alvariño M, Rodríguez F, Roger A, Peña-Arellano MI, Lleonart R, Pagán JA, Navarro JA, Navarro LA, Vidal C, Ponte-Tellechea A, Gómez-Fernández MC, Madariaga-Goirigolzarri B, Asturias JA, Hernández-Fernandezde Rojas D. Randomized dose–response study of subcutaneous immunotherapy with a Dermatophagoides pteronyssinus extract in patients with respiratory allergy. Immunotherapy 2016; 8:265-77. [DOI: 10.2217/imt.15.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Aim: To evaluate the efficacy of Dermatophagoides pteronyssinus (DPT) subcutaneous immunotherapy in allergic rhinoconjunctivitis patients. Patients & methods: This 17-week double-blind study randomized 136 patients (95 evaluable) to five dose groups of DPT depot extract (0.0625–0.75 skin prick test [SPT] units) or placebo, administered in a six updosing schedule. Results: A dose–response was observed for clinical efficacy (allergen concentration needed to induce a positive nasal provocation test response from baseline to final visit) and safety (adverse reactions). Local and systemic reactions occurred with 14.8 and 6.4% of administered doses, respectively; a single anaphylactic reaction occurred in each of Groups 3, 4 and 5 (0.3% of doses). Conclusion: The risk–benefit profile appeared most favorable with a DPT dose of 0.125 SPT units.
Collapse
Affiliation(s)
- Victoria Moreno
- Servicio de Alergología, Hospital Blanca Paloma, Huelva, Spain
| | - Marta Alvariño
- Servicio de Alergología, Hospital de Manises, Manises, Spain
| | - Fernando Rodríguez
- Servicio de Alergología, Hospital Marqués de Valdecilla, Santander, Spain
| | - Albert Roger
- Unidad de Alergología, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Ramón Lleonart
- Servicio de Alergología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | | | - Carmen Vidal
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago (Hospital de Conxo), Santiago de Compostela, Spain
| | | | | | | | | | | |
Collapse
|
9
|
Kariya S, Okano M, Higaki T, Noyama Y, Haruna T, Nishizaki K. Pulmonary function in never-smoker patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2015; 5:990-5. [PMID: 26283509 DOI: 10.1002/alr.21628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/26/2015] [Accepted: 07/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND A close relationship between upper and lower respiratory tract diseases has been reported. The purpose of this study was to evaluate lung function in patients with chronic rhinosinusitis (CRS) who have never smoked. METHODS A total of 208 patients with CRS were enrolled in this study. Of these subjects, 96 patients were ever smokers and 112 patients were never smokers. CRS patients with lower pulmonary diseases including chronic obstructive pulmonary disease (COPD) and asthma were excluded from this study. Age-matched normal control subjects (n = 55) who were never smokers were also recruited. Pulmonary function testing was performed using spirometry. Lund-Mackay computed tomography (CT) score, peripheral blood eosinophil count, and immunoglobulin E (IgE) level in serum samples were examined. Nasal obstruction was evaluated by active anterior rhinomanometry. RESULTS CRS patients who were ever smokers have decreased lung function. Never-smoking patients with CRS also showed significant obstructive lung function changes as compared with normal controls. No significant correlation was detected between the clinical parameters (CT score, eosinophil count, IgE level, and nasal resistance) and lung function. CONCLUSION Asymptomatic obstructive lung function changes were observed in never-smoking patients with CRS. Our findings suggest that patients with CRS should be followed carefully in order to detect lung diseases.
Collapse
Affiliation(s)
- Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuhiro Okano
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takaya Higaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuyuki Noyama
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takenori Haruna
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
10
|
Kariya S, Okano M, Higaki T, Noyama Y, Haruna T, Ishihara H, Makino T, Onoda T, Nishizaki K. Chronic rhinosinusitis patients have decreased lung function. Int Forum Allergy Rhinol 2014; 4:828-33. [PMID: 25132678 DOI: 10.1002/alr.21370] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 06/07/2014] [Accepted: 06/10/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The relationship between upper and lower airway diseases has been reported. However, the pulmonary function of patients with chronic rhinosinusitis (CRS) has not been fully examined. METHODS Pulmonary function was measured in 273 patients with CRS and 100 age-matched normal control subjects. No patients with chronic obstructive pulmonary disease (COPD) were included in this study. The patients with CRS were divided into 8 subgroups based on the presence of asthma, sensitization to common inhaled antigens, and nasal polyposis. The relationships between pulmonary function and clinical parameters, including radiographic severity of CRS according to the Lund-Mackay computed tomography (CT) staging system, eosinophil count in the peripheral blood, and serum total immunoglobulin E (IgE) levels, were assessed. RESULTS In pulmonary function testing, the CRS patients had affected pulmonary function. The CRS patients without asthma showed latent obstructive pulmonary function changes when compared to normal controls. No significant correlations were observed between pulmonary function and any clinical parameters (Lund-Mackay CT staging score, eosinophil count in the peripheral blood, and serum total IgE levels). CONCLUSION CRS patients had significant obstructive lung function changes regardless of the presence of asthma. The patients with CRS who had not been clinically diagnosed as having lower respiratory tract diseases might have had subclinical lower airway diseases. Therefore, clinicians should be aware of pulmonary function and lower lung diseases in patients with CRS.
Collapse
Affiliation(s)
- Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Pulmonary function in patients with chronic rhinosinusitis and allergic rhinitis. The Journal of Laryngology & Otology 2014; 128:255-62. [PMID: 24621450 DOI: 10.1017/s0022215114000450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A close relationship between upper and lower respiratory tract diseases has been reported. However, little is known about pulmonary function in patients with upper respiratory tract diseases. METHODS Pulmonary function was measured in: 68 patients with chronic rhinosinusitis without nasal polyps, 135 patients with chronic rhinosinusitis with nasal polyps, 89 patients with allergic rhinitis and 100 normal control subjects. The relationships between pulmonary function and clinical parameters were assessed. These parameters included radiographic severity of chronic rhinosinusitis, serum total immunoglobulin E levels, concentrations of cytokines in nasal secretions and exhaled nitric oxide levels. RESULTS The pulmonary function of patients with chronic rhinosinusitis was significantly affected. The level of interleukin-5 in nasal secretions was significantly correlated with pulmonary function in patients with chronic rhinosinusitis. CONCLUSION The findings indicated latent obstructive lung function changes in chronic rhinosinusitis patients. The cytokines in nasal secretions might be related to obstructive lung function changes in chronic rhinosinusitis.
Collapse
|
12
|
Chang CC, Incaudo GA, Gershwin ME. Sinusitis, Rhinitis, Asthma, and the Single Airway Hypothesis. DISEASES OF THE SINUSES 2014. [PMCID: PMC7121820 DOI: 10.1007/978-1-4939-0265-1_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The one airway, one disease hypothesis proposes that the upper and lower airways share the same physiology and histomorphology. Epidemiological clinical studies support a link between rhinosinusitis and asthma. The relationship can occur in both directions, with nasal allergen challenge leading to inflammatory changes in the lower airway and bronchoprovocation studies of the lower airway leading to inflammatory changes in the upper airway. In addition, both similarities and differences exist in the pathogenesis of nasal polyps and asthma. The mechanism for the connection between the upper and lower airways is a matter of great debate. It has been proposed that inflammatory changes in the lower airway may lead to systemic inflammatory effects that play a role in increased bronchial hyperresponsiveness. Similarly, lower airway inflammatory changes may affect nasal airway patency via systemic effects. Moreover, nasopharyngeal-bronchial reflexes may play a non-immunologic role in the interaction between the lower and upper airways. An example of the connection between the upper and lower airways is found in aspirin-exacerbated respiratory disease whereby leukotrienes play a role in the pathology of chronic rhinosinusitis with polyps and asthma. It is also been observed that the treatment of asthma is hindered by untreated rhinosinusitis.
Collapse
Affiliation(s)
- Christopher C. Chang
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware USA
| | - Gary A. Incaudo
- Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
| | - M. Eric Gershwin
- The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
| |
Collapse
|
13
|
Canbaz P, Uskudar-Teke H, Aksu K, Keren M, Gulbas Z, Kurt E. Nasal eosinophilia can predict bronchial hyperresponsiveness in persistent rhinitis: evidence for united airways disease concept. Am J Rhinol Allergy 2011; 25:120-4. [PMID: 21679516 DOI: 10.2500/ajra.2011.25.3574] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal eosinophils may be indicative of bronchial hyperresponsiveness (BHR) in rhinitis concerning the "united airways disease" theory. This study was designed to evaluate the relationship between nasal eosinophilia and BHR in persistent perennial rhinitis patients. METHODS Thirty-seven patients (12 males and 25 females, mean age: 33.3 ± 10.4 years) were included in the study. Skin-prick test, nasal symptom score, nasal smears, methacholine bronchial challenge test, and nasal rhinometry were obtained in all patients. Eosinophil count in nasal smears was expressed as a percentage of the total cells. None of the patients had asthma. RESULTS There was no difference between the number of atopic and nonatopic patients having BHR (4/20 versus 4/17; chi-squared = 0.07; p > 0.05). Total nasal flow was lower and percentage of nasal eosinophils was higher in the patients with BHR than in patients without BHR (p = 0.012 and p = 0.009, respectively). A cutoff point of 68% nasal eosinophils yielded a sensitivity of 100% (63.1-100) and a specificity of 58.6% (38.9-76.5) to determine the presence of BHR. Positive likelihood ratio for the value of eosinophils above cutoff value was 2.42 (1.8-3.3). CONCLUSION This study shows the relationship between nasal eosinophils and BHR in persistent perennial rhinitis patients. Nasal eosinophil percentage below cutoff value indicates that a patient does not have BHR.
Collapse
Affiliation(s)
- Pelin Canbaz
- Department of Pulmonary Diseases-Allergy, Eskisehir Osmangazi University Medical Faculty, Turkey.
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW The recognition of eosinophils as complex immunomodulatory cells has been increasing in recent years. One prominent novel immunomodulatory function of eosinophils is their role as antigen-presenting cells (APCs). This review will examine the evidence that has enhanced the understanding of eosinophils as APCs in the context of allergic inflammation, with a focus on data applicable to allergic upper airway disease. RECENT FINDINGS Recent studies expand on prior findings that eosinophils can express major histocompatibility complex class II and costimulatory molecules. Eosinophils have also been found to traffic to regional lymph nodes and act as professional APCs in various experimental settings. SUMMARY Accumulating evidence of the ability of eosinophils to act as APCs suggests that eosinophils may have more complex immunomodulatory roles in allergic upper airway disease than previously appreciated.
Collapse
|
15
|
Abstract
Respiratory allergies include allergic rhinitis, sinusitis and asthma. Increasing attention on pathogenesis of allergic airway diseases has given rise to "atopic march" hypothesis i.e. clinical features of atopic eczema occur first and precede the development of asthma and allergic rhinitis. The "hygiene hypothesis" proposes that the increase in allergic diseases reflects a decrease in infections during childhood. Clinical trials also suggest that the exposure to microbes through the gastrointestinal tract powerfully shapes immune function. Probiotics are live organisms which exert a beneficial effect in the prevention as well as treatment of allergic diseases through modification of immune system of host via gut ecosystem. Intestinal microbiota differs in infants who later develop allergic diseases, and feeding probiotics to infants at risk has been shown to reduce their rate of developing eczema. This has prompted studies of feeding probiotics in prevention as well as treatment of respiratory allergy. We hereby discuss the status of probiotics in respiratory allergy.
Collapse
Affiliation(s)
- Meenu Singh
- Post-Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | | |
Collapse
|
16
|
Canonica GW, Compalati E. Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies. Clin Exp Immunol 2009; 158:260-71. [PMID: 19765020 PMCID: PMC2792821 DOI: 10.1111/j.1365-2249.2009.04017.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2009] [Indexed: 12/21/2022] Open
Abstract
Patients with allergic rhinitis have traditionally been placed into 'seasonal' and 'perennial' categories, which do not account for the subclinical inflammatory state that exists in many patients. In subjects with seasonal and perennial allergic rhinitis, even subthreshold doses of allergen have been found to cause inflammatory cell infiltration in the nasal mucosa, including increases in expression of cellular adhesion molecules, nasal and conjunctival eosinophilia, and other markers of inflammation, which do not result in overt allergy symptoms. This state - which has been termed 'minimal persistent inflammation'- may contribute to hyperreactivity and increased susceptibility to development of clinical symptoms as well as common co-morbidities of allergic rhinitis, such as asthma. Treating overt allergy symptoms as well as this underlying inflammatory state requires agents that have well-established clinical efficacy, convenient administration, potent anti-inflammatory effects and proven long-term safety, so that long-term continuous administration is feasible. Of the three major classes of commonly used allergic rhinitis medications - intranasal corticosteroids, anti-histamines, and anti-leukotrienes - intranasal corticosteroids appear to represent the most reasonable therapeutic option in patients who would benefit from continuous inhibition of persistent inflammation.
Collapse
MESH Headings
- Administration, Intranasal
- Allergens/immunology
- Asthma/etiology
- Chronic Disease
- Glucocorticoids/therapeutic use
- Histamine H1 Antagonists/therapeutic use
- Humans
- Intercellular Adhesion Molecule-1/immunology
- Leukotriene Antagonists/therapeutic use
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
Collapse
Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases, Clinic Dipartmento di Medicina Interna e Specialita Mediche (DIMI), University of Genova, Genova, Italy.
| | | |
Collapse
|
17
|
Cassano M, Maselli A, Mora F, Cassano P. Rhinobronchial syndrome: pathogenesis and correlation with allergic rhinitis in children. Int J Pediatr Otorhinolaryngol 2008; 72:1053-8. [PMID: 18485492 DOI: 10.1016/j.ijporl.2008.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Accepted: 03/16/2008] [Indexed: 10/22/2022]
Abstract
AIM In the rhinobronchial syndrome a direct causal relationship exists between local nasal irritation and bronchopulmonary disease. Although allergic rhinitis has often been associated with lower airway hyperresponsiveness, no direct relationship between the two has been shown to date. The aim of this study was to determine the role of allergic rhinitis in the pathogenesis of the rhinobronchial syndrome in children by evaluating the effect of topical nasal treatment on lower airway hyperresponsiveness. MATERIALS AND METHODS A total of 168 children presenting with aeroallergy and nasal disease associated with bronchopulmonary disease (asthma, chronic cough, bronchopulmonary infection) were evaluated at baseline and at 1 year of follow-up. Nearly half (83) were noted to have signs of allergic rhinitis and were treated with topical nasal medications (cortisones and antihistamines). Changes in upper and lower airway diseases were evaluated and potential causal relationships established. RESULTS Allergic rhinitis treatment improved nasal disease symptoms in 67 (80.7%) patients; partial remission or lower healing rates were found in those with asthma (16.4%) and chronic cough (11.1%). CONCLUSIONS Although often associated with lower airway hyperresponsiveness, allergic rhinitis in children does not appear to be a pathogenetic factor, as confirmed by the scarce effect the nasal treatment had on the bronchopulmonary disease. Instead, the frequent co-existence of nasal and bronchial symptoms may come under the concept of global allergy of the airways.
Collapse
Affiliation(s)
- Michele Cassano
- Department of Otorhinolaryngology, University of Foggia, Foggia, Italy.
| | | | | | | |
Collapse
|
18
|
Abstract
Asthma is a dynamic and complex inflammatory disease. Recent research suggests that it is a manifestation of a systemic disorder of the entire respiratory system including both upper and lower airways. The diagnosis of asthma can be made based on clinical history, physical findings, and pulmonary function tests such as spirometry. In children, spirometry may be difficult; therefore, diurnal changes in peak expiratory flow rate can be used instead to assist in the diagnosis of asthma. Increasing the use of objective pulmonary measures will help better identify and monitor treatment of lower respiratory inflammatory disease.
Collapse
Affiliation(s)
- Michael W Chu
- Division of Rhinology & Endoscopic Sinus and Skull Base Surgery, Department of Otolaryngology & Head and Neck Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 510, Norfolk, VA 23507, USA
| | | |
Collapse
|
19
|
Erel F, Gulec M, Kartal O, Caliskaner Z, Ozturk S, Yaman H, Kurt Y, Gocgeldic E, Ors F, Karaayvaz M. Serum leptin levels and lipid profiles in patients with allergic rhinitis and mild asthma. Allergol Immunopathol (Madr) 2007; 35:232-8. [PMID: 18047813 DOI: 10.1157/13112988] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite improved understanding of the pathophysiology of allergic rhinitis and asthma, the effect of serum leptin level is still controversial. Only a few studies have been performed to investigate the serum leptin levels in allergic rhinitis and asthma, and contradictory results have been observed. OBJECTIVE We aimed to investigate the association between leptin, lipid profiles and allergic rhinitis and mild asthma, and to determine whether inhaled and/or intranasal steroids affect the leptin levels. PATIENTS AND METHODS We studied 43 patients with allergic rhinitis (10 of with mild asthma) (mean age 29.81, range 18-45 yr) and 32 volunteers as a control group (mean age 30.53, range 20-45 yr). RESULTS Serum leptin levels in patients were 8.49 +/- 10.76 microg/ml, and did not differ from volunteers 5.42 +/- 6.63 microg/ml. (p > 0.05). We found a direct link between increased body mass index (BMI) and serum leptin levels (p = 0.008). No association was seen between leptin and triglyceride, HDL-cholesterol, VLDL-cholesterol, eosinophil, total IgE (p > 0.05); except for total cholesterol and LDL-cholesterol (p < 0.05). Although, no correlation between allergic rhinitis and mild asthma and serum level of leptin was shown, these parameters and age correlations were stronger in female than in male (p = 0.39 for male and p = 0.011 for female), and also found direct link between increased BMI and sex and patients group (p = 0.008 for male and p = 0.0001 for female). We also determined that there was no effect of inhaled and/or intranasal steroids statistically on serum leptin levels. CONCLUSION Our data demonstrate that the serum levels of leptin and lipid profiles on allergic rhinitis and mild asthma were not different than those in controls.
Collapse
Affiliation(s)
- F Erel
- Department Internal Medicine and Division of Allergy. Gülhane Military Medical Academy and Medical School. Ankara. Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Cassano M, Cassano P, Luigi M, Gelardi M, Farràs AC, Fiorella ML. Rhino-bronchial syndrome in children: pathogenic correlations and clinical-experimental aspects. Int J Pediatr Otorhinolaryngol 2006; 70:507-13. [PMID: 16214227 DOI: 10.1016/j.ijporl.2005.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 07/30/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aims at defining the incidence of rhino-bronchial syndrome (RBS) in children in order both to verify the influence of nasal obstructions on the disease and to determine therapeutic strategies which may cure the syndrome effectively at its early stage. METHODS The investigation includes 128 non-allergic children with obstructive disorders (adenoid hypertrophy, septal deviation, etc.) and rhino-sinus inflammations associated with bronchopulmonary diseases (asthma, chronic cough, bronchopulmonary infections). Medical and/or surgical treatment was chosen in consideration of the type and entity of the patients' main nasal pathology. At least 1 year follow-up was provided for each case to establish the improvement in the disorders affecting both the lower and upper airways. The results were statistically assessed. RESULTS Medical and mainly surgical treatment always cured the upper airways disorders in patients with chronic nasal obstruction and rhino-sinus inflammation. Improvement of bronchopulmonary disease was reported in about half of the patients (49.4%). Statistically significant results were obtained only in the group with recurrent bronchopulmonary infections (80.9%, p<0.05). CONCLUSIONS The study confirms that RBS may be quite frequent in childhood. This disorder has a multifactorial pathogenesis prevalently due to nasal obstruction and rhino-sinus infections. In the population studied, among the lower airways disorders, only infective bronchopulmonary inflammation showed a significant correlation in the assessment between lower and upper airways disorders. In order to prevent the progression of the syndrome to serious pathologic events of the lower airways, a prompt and effective treatment of children's nasal disorders is thus recommended.
Collapse
Affiliation(s)
- Michele Cassano
- Department of Otorhinolaryngology, University of Bari, Via F. Crispi 34/C, 70123 Bari, Italy.
| | | | | | | | | | | |
Collapse
|
21
|
Casado B, Pannell LK, Iadarola P, Baraniuk JN. Identification of human nasal mucous proteins using proteomics. Proteomics 2005; 5:2949-59. [PMID: 15996010 DOI: 10.1002/pmic.200401172] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The determination of possible biomarkers in nasal secretion of healthy subjects can have a role in early diagnosis of diseases such as rhinosinusitis. For this purpose, nasal lavage fluids (NLFs) from ten volunteers, collected before and after they had been submitted to nasal provocations, were investigated. Separation and analysis of proteins present in this complex matrix was performed using a capillary liquid chromatography-electrospray-quadrupole-time of flight mass spectrometry equipment. From among a total of 111 proteins found (89 known and two unknown proteins), 42 of which had never been previously described in this fluid, such as Deleted in Malignant Brain Tumors 1 isoform a precursors, and cytoskeletal proteins were identified with high statistical score. Three proteins of palate lung nasal epithelial clone (PLUNC) family: SPLUNC1, LPLUNC1, and LPLUNC2 were identified. Proteins involved in innate (27%) and acquired immunity (21%) systems were major components of NLF. Cellular (52% of all proteins identified) such as cytoskeletal (33%), functional (15%), and regulatory (4%) proteins, normally present in the nasal cavity, have also been identified. The proteomic approach presented here allowed us to identify the proteins involved in acquired and innate immune response in the nose against microbial infections and unclean inhaled air.
Collapse
Affiliation(s)
- Begoña Casado
- Proteomics Laboratory, Georgetown University Medical Center, Washington, DC 20057, USA.
| | | | | | | |
Collapse
|
22
|
Sommers D. Allergic Rhinitis. S Afr Fam Pract (2004) 2005. [DOI: 10.1080/20786204.2005.10873284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
23
|
Elhini A, Abdelwahab S, Ikeda K. Th1 and Th2 cell population in chronic ethmoidal rhinosinusitis: a chemokine receptor assay. Laryngoscope 2005; 115:1272-7. [PMID: 15995520 DOI: 10.1097/01.mlg.0000165380.64445.ee] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is necessary for the immune system in the nasal and paranasal sinus mucosa to possess appropriate responses to infective agents as well as allergic responses. Recently, the T helper (Th)1/Th2 paradigm has been proposed as a new concept to explain various immunologic phenomena. OBJECTIVE Toward the goal of better understanding chronic rhinosinusitis, we have tried to define the predominating helper T-cell subsets among patients with chronic rhinosinusitis through characterizing the expressed chemokine receptors by these cells to find out the relation between these chemokine receptors' expression and the underlying pathogenesis of chronic rhinosinusitis. METHODS Thirty patients with ethmoidal chronic rhinosinusitis were used in our study. Patients were divided into atopic and nonatopic groups according to their serum immunoglobulin (Ig)E levels. Samples from ethmoidal sinus mucosa were processed as follows: frozen sections were examined immunohistochemically for detection of CCR4, CCR5, and EG2 positive cells and the mRNA of CCR4, and CCR5 transcripts were then examined by real-time quantitative polymerase chain reaction (PCR). RESULTS By immunohistochemistry, atopic patients showed high expression of CCR4 and EG2 positive cells, whereas nonatopic patients showed high expression of CCR5 positive cells. The expression of CCR4 and CCR5 mRNA, detected by real-time quantitative PCR, supported the data obtained by immunohistochemistry. CONCLUSION The present study suggests that eosinophil recruitment associated with Th2 cell infiltration is the main factor responsible for the pathology of atopic rhinosinusitis.
Collapse
Affiliation(s)
- Ahmed Elhini
- Department of Otorhinolaryngology, Juntendo University School of Medicine, Tokyo, Japan.
| | | | | |
Collapse
|
24
|
Dahl R, Nielsen LP, Kips J, Foresi A, Cauwenberge P, Tudoric N, Howarth P, Richards DH, Williams M, Pauwels R. Intranasal and inhaled fluticasone propionate for pollen-induced rhinitis and asthma. Allergy 2005; 60:875-81. [PMID: 15932376 DOI: 10.1111/j.1398-9995.2005.00819.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies suggest that nasal treatment might influence lower airway symptoms and function in patients with comorbid rhinitis and asthma. We investigated the effect of intranasal, inhaled corticosteroid or the combination of both in patients with both pollen-induced rhinitis and asthma. METHODS A total of 262 patients were randomized to 6 weeks' treatment with intranasal fluticasone propionate (INFP) 200 microg o.d., inhaled fluticasone propionate (IHFP) 250 microg b.i.d., their combination, or intranasal or inhaled placebo, in a multicentre, double-blind, parallel-group study. Treatment was started 2 weeks prior to the pollen season and patients recorded their nasal and bronchial symptoms twice daily. Before and after 4 and 6 weeks' treatment, the patients were assessed for lung function, methacholine responsiveness, and induced sputum cell counts. RESULTS Intranasal fluticasone propionate significantly increased the percentages of patients reporting no nasal blockage, sneezing, or rhinorrhoea during the pollen season, compared with IHFP or intranasal or inhaled placebo. In contrast, only IHFP significantly improved morning peak-flow, forced expiratory volume in 1 second (FEV1) and methacholine PD20, and the seasonal increase in the sputum eosinophils and methacholine responsiveness. CONCLUSIONS In patients with pollen-induced rhinitis and asthma, the combination of intranasal and IHFP is needed to control the seasonal increase in nasal and asthmatic symptoms.
Collapse
Affiliation(s)
- R Dahl
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Allergic rhinitis (AR) is the most common chronic atopic disease, and it is associated with considerable costs and comorbidities. The management of AR includes environmental control measures, pharmacotherapy, and immunotherapy. This article discusses several developments and findings that have recently emerged in these three areas. The effectiveness of traditional methods of mitigating allergen exposure, such as the use of impermeable dust mite-proof bedding covers, has been rendered debatable. Exposure to environmental factors, such as household pets, is known to provoke exacerbation of allergic disease but now is proposed to have protective effects in certain settings. Changes in the choices of pharmacotherapy continue to occur as antileukotrienes and derivatives of certain antihistamines are added to the armamentarium against AR. However, a critical review of the clinical trials involving these drugs suggests that the changes are not necessarily incremental. Innovative methods of immunomodulation are currently being developed, with the objective of optimizing efficacy and safety. These include alternative routes or forms of delivering immunotherapy and other novel approaches in altering the pathobiology of AR.
Collapse
Affiliation(s)
- Alvin M Sanico
- Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA.
| |
Collapse
|
26
|
Takeno S, Yajin K, Hisayuki A, Furukido K, Hirakawa K, Ishino T, Osada R, Ogawa T, Kawamoto H. Comparison of local cytokine gene expression and the distribution of eosinophils and CD4-positive cell subsets in the paranasal sinus mucosa between atopic and non-atopic subjects. Allergol Int 2004. [DOI: 10.1111/j.1440-1592.2004.00316.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
27
|
Cuttitta G, Cibella F, La Grutta S, Hopps MR, Bucchieri S, Passalacqua G, Bonsignore G. Non-specific bronchial hyper-responsiveness in children with allergic rhinitis: relationship with the atopic status. Pediatr Allergy Immunol 2003; 14:458-63. [PMID: 14675473 DOI: 10.1046/j.0905-6157.2003.00067.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An increased prevalence of bronchial hyper-responsiveness (BHR) has been demonstrated in children from a general population, and in non-asthmatic adults with allergic rhinitis. Thus, also children with allergic rhinitis are expected to be at higher risk of BHR. We evaluated the prevalence of BHR in a sample of non-asthmatic children with allergic rhinitis by means of the methacholine (Mch) bronchial challenge, and by monitorizing the airway patency using the daily peak expiratory flow variability (PEFv). Fifty-one children (ranged 6-15 years of age) with allergic rhinitis, ascertained by skin prick test to inhalant allergens, underwent a 14-day peak expiratory flow monitoring, and a Mch bronchial provocation challenge. Thirty healthy children matched for age, and sex served as control group. Thirty-one children in the rhinitis group (61%), and six (20%) in the control group were Mch+ (Mch provocative dose causing a 20% fall of forced expiratory volume in 1 s respect to baseline <2250 microg, equivalent to 11.50 micromol). In rhinitic children the PEFv did not significantly differ between Mch+ and Mch- subjects, but the total serum immunoglobulin E (IgE) were higher among Mch+. The persistent form of rhinitis was significantly associated to Mch positivity. Non-asthmatic children with allergic rhinitis displayed a high prevalence of BHR. The BHR was significantly associated with persistent rhinitis and with higher total IgE levels. Nevertheless, the spontaneous changes in airway patency, as expressed by PEFv, were within normal limits both in Mch+ and Mch- children.
Collapse
Affiliation(s)
- Giuseppina Cuttitta
- Istituto di Biomedicina e Immunologia Molecolare 'Alberto Monroy' del C.N.R., Palermo, Italy.
| | | | | | | | | | | | | |
Collapse
|
28
|
Storms WW. Minimal persistent inflammation, an emerging concept in the nature and treatment of allergic rhinitis: the possible role of leukotrienes. Ann Allergy Asthma Immunol 2003; 91:131-40. [PMID: 12952106 DOI: 10.1016/s1081-1206(10)62167-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review the emerging concept of minimal persistent inflammation in allergic rhinitis and its implications for therapy. DATA SOURCES Relevant clinical studies in the English language were reviewed. STUDY SELECTION Material was taken from academic/scholarly journals. RESULTS Accumulating evidence suggests that allergic rhinitis is a chronic inflammatory disease instead of a disease of acute symptoms. An approach to the therapy for allergic rhinitis should consider that even when symptoms are absent, a minimal level of persistent inflammation may persist. To prevent unexpected exacerbations, the treatment strategy may need to include managing subclinical persistent inflammation. Therapeutic options addressing the major inflammatory elements in allergic rhinitis, including eosinophils, the cysteinyl leukotrienes, and histamine, must be evaluated as management strategies that can achieve effective control. Traditional medications include intranasal corticosteroids, antihistamines, and immunotherapy. Recently, a leukotriene receptor antagonist has been approved for major rhinitis symptoms (congestion, rhinorrhea, sneezing, and pruritus), suggesting a new option for the treatment of allergic rhinitis. CONCLUSIONS Because of the possible presence of a minimal persistent inflammation during rhinitis patients' asymptomatic periods, it is important to consider a prophylactic approach to treating allergic rhinitis to prevent or reduce exacerbations during an acute increase in allergen. In light of the advances in the understanding of the pathogenesis of allergic rhinitis, agents must be considered based on their safety, efficacy, and ability to deal with underlying inflammation as well as symptom relief.
Collapse
|
29
|
Abstract
The early phase of an IgE-dependent allergic reaction is followed by the activation of a complex network of inflammatory phenomena - T lymphocytes, cytokines, mediators, and adhesion molecules - that mediate late and ongoing allergic symptoms. The kinetics of respiratory inflammation following allergen exposure involve the migration of inflammatory cells to the mucosa within about 30 min, increased inflammatory infiltration over the following hours, and then slow subsidence. A relationship between asthma and allergic rhinitis is supported by epidemiological, histological, physiological, and immunopathological data, and by the response of asthma symptoms in rhinitic patients to intranasal corticosteroids and antihistamines. For example, there is no morphological difference between the bronchial inflammatory response following allergen-specific challenge in patients suffering from asthma alone or rhinitis alone. It is the allergen dose that makes the difference in the airway response to allergen in allergic rhinitis and asthma. Recognition of the relationship between asthma and allergic rhinitis has led to the introduction of new diagnostic terminology and treatment recommendations: 1) patients with persistent rhinitis should be evaluated for asthma; 2) patients with persistent asthma should be evaluated for rhinitis; and 3) a strategy should combine the treatment of upper and lower airways in terms of efficacy and safety.
Collapse
Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa University, Genova, Italy
| |
Collapse
|
30
|
Kony S, Zureik M, Neukirch C, Leynaert B, Vervloet D, Neukirch F. Rhinitis is associated with increased systolic blood pressure in men: a population-based study. Am J Respir Crit Care Med 2003; 167:538-43. [PMID: 12446269 DOI: 10.1164/rccm.200208-851oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An association between impaired lower respiratory function and cardiovascular risk factors, such as hypertension, is often reported but it is unknown whether there is a relationship between upper airway disorders and cardiovascular risk factors, despite evidence that upper and lower respiratory tract disorders are closely linked. Our objective was to assess whether rhinitis is associated with arterial blood pressure and hypertension. In a population-based study of 330 adults aged 28-56 years, as part of the European Community Respiratory Health Survey, rhinitis was assessed by means of a questionnaire, and cardiovascular data were obtained using a questionnaire and by measuring blood pressure. Systolic blood pressure (SBP) was higher in men with rhinitis than in men without rhinitis (130.6 +/- 12.7 mm Hg versus 123.5 +/- 13.9 mm Hg; p = 0.002), and it was still the case after adjustment for cardiovascular and respiratory confounding factors. Hypertension was more frequent in men with rhinitis than in men without rhinitis, even after multivariate adjustment (odds ratio = 2.6, 95% confidence interval = [1.14-5.91]). The observation of SBP levels according to whether men have no rhinitis, seasonal rhinitis, or perennial rhinitis was compatible with a dose-response relationship (p for trend = 0.02). In conclusion, rhinitis is strongly associated with SBP and hypertension in men. Blood pressure should be regularly checked in men with rhinitis.
Collapse
Affiliation(s)
- Sabine Kony
- Unit 408, Respiratory Diseases Epidemiology, National Institute of Health and Medical Research (INSERM), Paris, France
| | | | | | | | | | | |
Collapse
|
31
|
|