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Maniaci A, Calvo-Henriquez C, Cammaroto G, Garcia-Magan C, Garcia-Paz V, Iannella G, Jiménez-Huerta I, La Mantia I, Lechien JR, Leong SC, Lobo-Duro D, Maza-Solano J, Mitchell R, Otero-Alonso A, Peng Y, Radulesco T, Simon F, Teissier N, Cocuzza S, Saibene AM. Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement. Laryngoscope 2024; 134:1437-1444. [PMID: 37497872 DOI: 10.1002/lary.30907] [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: 03/23/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies. METHODS A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available. RESULTS A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus. CONCLUSIONS Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures. LEVEL OF EVIDENCE 5 Laryngoscope, 134:1437-1444, 2024.
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Affiliation(s)
- Antonino Maniaci
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Christian Calvo-Henriquez
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Service of Otolaryngology, Rhinology Unit, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giovanni Cammaroto
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Carlos Garcia-Magan
- Department of Pediatrics, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanesa Garcia-Paz
- Allergy Department, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giannicola Iannella
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otorhinolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Ignacio Jiménez-Huerta
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Service of Otolaryngology, Pediatric Otolaryngology Unit, Gregorio Marañon University Hospital, Madrid, Spain
| | - Ignazio La Mantia
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Jérome R Lechien
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Samuel C Leong
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- The Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - David Lobo-Duro
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan Maza-Solano
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Ron Mitchell
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Andrea Otero-Alonso
- Allergy Department, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - You Peng
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Thomas Radulesco
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, APHM, IUSTI, CNRS, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - François Simon
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Université Paris Cité, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Natasha Teissier
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Pediatric Otolaryngology Department, Robert-Debré Hospital, Paris 7 Denis Diderot University, Paris, France
| | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alberto M Saibene
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Unit, ASST Santi Paolo E Carlo, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
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Giotakis AI, Verius M, Steinbichler TB, Runge A, Kolk A, Hupp LC. Rhinoresistometry as a Cost-Efficient and Time-Saving Alternative to Acoustic Rhinometry for Longitudinal Assessment of Nasal Patency in Orthognathic Surgery. J Craniofac Surg 2024:00001665-990000000-01293. [PMID: 38260959 DOI: 10.1097/scs.0000000000009931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 01/24/2024] Open
Abstract
Rhinoresistometry (RRM) is implemented along with active anterior rhinomanometry (AAR) and can evaluate nasal dimensions [hydraulic diameter (HD)]. As acoustic rhinometry (AR) is time-consuming, the authors investigated if RRM can be an efficient alternative to AR in nasal dimension assessment in orthognathic surgery. In patients undergoing maxillary advancement and impaction (cases) and removal of maxillary cysts (controls), the authors evaluated RRM and AR, before and 1 year after surgery. Furthermore, the authors investigated the correlation of HD with Nasal Obstruction Symptom Evaluation score and volume by computed tomography and AAR. Lastly, the authors measured RMM reproducibility by the Bland-Altman agreement method in controls. In 14 cases, AR and RMM revealed a significant increase on both sides (all P < 0.011) and the right side, respectively (P = 0.028). The authors noted no changes in 14 controls. Hydraulic diameter correlated only with AAR (most P < 0.004). Acoustic rhinometry lasted ~4 minutes before or after decongestion. In controls, HD after surgery was as large (1.05 times larger) as before surgery (up to 39% error rates). Rhinoresistometry can reproducibly assess nasal dimension changes in orthognathic surgery in a way that is different from AR and correlates with nasal function. Rhinoresistometry can help clinicians avoid AR and save significant time, as well as financial and human resources.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck
| | - Teresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Annette Runge
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Linus C Hupp
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Brindisi G, Gori A, Anania C, Martinelli I, Capponi M, De Castro G, Zicari AM. Subcutaneous Immunotherapy (SCIT) with the New Polymerized Molecular Allergoid Alt a1: A Pilot Study in Children with Allergic Rhinitis Sensitized to Alternaria Alternata. J Clin Med 2023; 12:4327. [PMID: 37445362 DOI: 10.3390/jcm12134327] [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: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We followed the effects of a new SCIT with a chemically polymerized allergen Alt a1, evaluating the trend of clinical and functional parameters in an observational-prospective study. METHODS 42 children with AR and intermittent asthma sensitized to A.A.: 17 patients started SCIT (Modigoid®), and 25 continued symptomatic therapy. At the initial visit (T0), all patients performed total IgE (tIgE) and specific IgE (sIgE) for Alt a1, nasal nitric oxide (nFeNo), nasal cytology, anterior active rhinomanometry (AAR) and spirometry. After 24 months (T1), they repeated the same procedures as in T0. RESULTS Patients treated with Modigoid presented a statistically significant (p < 0.001) reduction of nFeNO (T0:1651.06 ± 149.18; T1: 1394.12 ± 108.98), tIgE (T0: 311.48 ± 144.18; T1: 164.73 ± 50.69), sIgE for Alt a1 (T0: 28.59 ± 12.69; T1: 19.54 ± 7.37), an improvement of nasal airflow (T0: 71.62 ± 8.66; T1: 95.12 ± 5.91), nasal eosinophils (T0: 20.59 ± 2.35; T1: 14.88 ± 1.65) and FEV1 (T0: 95.58 ± 7.91; T1: 116.64 ± 5.94). CONCLUSIONS The new SCIT for Alt a1 significantly improves AR symptoms from a subjective, objective point of view and laboratory and functional parameters.
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Affiliation(s)
- Giulia Brindisi
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandra Gori
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Caterina Anania
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Ivana Martinelli
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Capponi
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Giovanna De Castro
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
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4
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Luzzi V, DE Filippo M, Guarnieri R, Fioravanti M, Guaragna M, Marasca B, Pirro V, Altieri F, Vozza I, Ndokaj A, Brindisi G, Barbato E, Polimeni A, Zicari AM. Evaluation of nasal airway resistance in a cohort of children with primary snoring and maxillary deficiency. Minerva Dent Oral Sci 2023; 72:54-59. [PMID: 36345835 DOI: 10.23736/s2724-6329.22.04727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to test whether rapid palatal expansion is effective to improve nasal airway patency in a sample of pediatric patients with primary snoring. METHODS A group of 21 subjects, 11 girls (52%) and 10 boys (48%), with a mean age of 7.1 years (SD=1.3; range 4-9 years) were treated with a rapid maxillary expansion (RME) device. Nasal airway resistance was assessed via rhinomanometric exam before (pre-) and 6 months after (post-) the rapid palatal expansion treatment. RESULTS Data analysis showed a statistically significant increase in the mean scores of the results of the rhinomanometric exam between the pre- and post-measurements with a significant reduction in total inspiratory and expiratory air resistance values after rapid palatal expansion. CONCLUSIONS Our results show that RME treatment is associated with an improvement in nasal airway resistance due to a substantial reduction in nasal resistance associated with the orthopedic action of the orthodontic device.
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Affiliation(s)
- Valeria Luzzi
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Maria DE Filippo
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Rosanna Guarnieri
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Miriam Fioravanti
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy -
| | - Mariana Guaragna
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Beatrice Marasca
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Valentina Pirro
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Federica Altieri
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Iole Vozza
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Artnora Ndokaj
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Giulia Brindisi
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Ersilia Barbato
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
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Shtina IE, Savinkov MA, Valina SL, Ustinova OY. [Substantiating reference values of active anterior rhinomanometry in children aged 4-14]. Vestn Otorinolaringol 2023; 88:57-63. [PMID: 36867145 DOI: 10.17116/otorino20228801157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
RELEVANCE Objective diagnostics of nasal breathing disorders in children is a vital issue given frequent inconsistency between patients' subjective feelings and actual nasal patency. Active anterior rhinomanometry (AAR) is an objective procedure and the golden standard for nasal breathing evaluation. But still, there are no actual data in literature on relevant criteria used to evaluate nasal breathing in children. OBJECTIVE To determine reference values for indicators evaluated by active anterior rhinomanometry in Caucasian children aged 4-14 based on statistical data. MATERIAL AND METHODS Overall, we examined 659 healthy children of both sexes who were divided into 7 groups as per their height. All children included into our research underwent AAR according to the conventional procedure. AAR indicators (Summary Flow left, Summary Flow right, Summary Flow, Summary Resistance left, Summary Resistance right and Summary Resistance Flow) are given as median (Me) and values of 2.5, 25, 75, and 97.5 percentiles. RESULTS We determined direct moderate, significant and strong correlations between summary speed of the flow and resistance in both nasal passages and separate speeds of the flow and right and left resistance in inhalation and exhalation (r=0.46-0.98, p<0.001). We also established weak correlations between AAR indicators and age (r= -0.08-0.11), and between ARR indicators and height (r= -0.07-0.15). Reference values for AAR indicators were successfully determined. CONCLUSIONS AAR indicators are likely to be determined bearing a child's height in mind. Determined reference intervals can be applied in clinical practice.
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Affiliation(s)
- I E Shtina
- Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, Perm, Russia
| | - M A Savinkov
- Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, Perm, Russia
| | - S L Valina
- Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, Perm, Russia
| | - O Yu Ustinova
- Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, Perm, Russia.,Perm State National Research University, Perm, Russia
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Fritszching B, Porsbjerg C, Buchs S, Larsen JR, Freemantle N, Contoli M. High baseline prevalence of atopic comorbidities and medication use in children treated with allergy immunotherapy in the REAl-world effeCtiveness in allergy immunoTherapy (REACT) study. Front Pediatr 2023; 11:1136942. [PMID: 37063677 PMCID: PMC10098718 DOI: 10.3389/fped.2023.1136942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
Background Respiratory allergy, commonly manifesting as allergic rhinitis (AR) and asthma, is a chronic progressive disease that frequently starts in childhood. Allergy immunotherapy (AIT) is the only causal treatment for respiratory allergy with the potential to modify the underlying cause of allergy and, ultimately, prevent disease progression. This analysis aimed to determine if AIT is received sufficiently early to halt the progression of allergic disease, by characterizing the burden and progression of disease in children prior to AIT initiation in real-life clinical practice. Methods The REAl-world effeCtiveness in allergy immunoTherapy (REACT) study was a large retrospective cohort study using German claims data between 2007 and 2017. Characteristics of two pre-defined AIT age cohorts from the REACT study - children (aged <18 years) and adults (aged ≥18 years) - were evaluated during the 1-year period before the first AIT prescription. For comparison, a control group of all subjects with a confirmed diagnosis of AR and without prescriptions for AIT was included. Burden of disease was assessed using diagnostic codes for atopic comorbidities [e.g., atopic dermatitis (AD), asthma, and acute allergic conjunctivitis] and non-atopic comorbidities (e.g., migraine, headache); medication use, recorded as prescriptions for symptom-relieving AR medication and reliever/controller medication for asthma, was also assessed. Data were analyzed descriptively, using summary statistics. Results Both children (n = 11,036) and adults (n = 30,037) showed a higher prevalence of atopic comorbidities and a greater drug burden prior to AIT initiation compared to AR patients not treated with AIT (n = 1,003,332). In the two age-specific AIT cohorts, children consistently showed the highest prevalence of atopic comorbidities compared to adults (AIT children, AIT adults - asthma: 41.4%, 34.5%; AD: 19.9%, 10.2%; acute allergic conjunctivitis: 13.6%, 10.2%). Generally, prescriptions per year for symptom-relieving AR and asthma treatments were also higher for children initiating AIT vs. adults (AIT children, AIT adults - AR prescriptions per subject: 1.72, 0.73; asthma prescriptions per subject: 1.42, 0.79). Conclusions Children with AR who are offered AIT in real-life show considerable disease burden prior to initiation. As AIT may alleviate the burden and halt the progression of allergic disease, considering AIT earlier in the disease course may be warranted.
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Affiliation(s)
- Benedikt Fritszching
- Paediatric Pulmonology and Allergy, Children’s Doctor Service, Heidelberg, Germany
- Correspondence: Benedikt Fritzsching
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Buchs
- Global Market Access, ALK-Abelló, Hørsholm, Denmark
| | | | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Marco Contoli
- Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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7
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Brindisi G, Spalice A, Anania C, Bonci F, Gori A, Capponi M, Cinicola B, De Castro G, Martinelli I, Pulvirenti F, Matera L, Mancino E, Guido CA, Zicari AM. COVID-19, Anosmia, and Allergies: Is There a Relationship? A Pediatric Perspective. J Clin Med 2022; 11:jcm11175019. [PMID: 36078947 PMCID: PMC9457095 DOI: 10.3390/jcm11175019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Between June and July 2020, we evaluated children and adolescents concerning post-infection surveillance after a COVID-19 positivity during the lockdown. We aimed to assess whether the anamnestic presence of allergies could correlate with the presence of SARS-CoV-2 symptoms, and in particular with anosmia. Material and methods: For each patient, we collected anamnestic data, the presence of allergies documented by performing skin prick tests, and COVID-19 symptoms. Then, if over six years of age, each patient underwent an active anterior rhinomanometry. Results: A total of 296 patients were enrolled, of whom 105 (35.4%) reported allergies. Considering COVID-19 symptoms, 74 subjects (25%) presented an asymptomatic form, 222 (75%) reported symptoms, and anosmia recurred in 60 subjects (27.03%). A statistically significant relationship was found between allergies and symptomatic COVID-19 (p = 0.042), allergies, and anosmia (p = 0.05), and allergies and anosmia in males (p = 0.007). Moreover, anosmic patients presented a higher body mass index, older age, and a longer COVID-19 duration with statistical significance (p = 0.001, 0.001, 0.006, respectively). Conclusions: Allergic subjects seem to develop symptomatic COVID-19 more frequently and allergies appear to be a protective factor from anosmia’s onset in males.
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Affiliation(s)
- Giulia Brindisi
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-49979333
| | - Alberto Spalice
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Caterina Anania
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Flaminia Bonci
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandra Gori
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Capponi
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Bianca Cinicola
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Giovanna De Castro
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Ivana Martinelli
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Federica Pulvirenti
- Primary Immune Deficiencies Unit, Department of Internal Medicine and Infectious Diseases, Azienda Ospedaliera Universitaria Policlinico Umberto I, 00185 Rome, Italy
| | - Luigi Matera
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Enrica Mancino
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristiana Alessia Guido
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
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Clinical parameters influencing the results of anterior rhinomanometry in children. Eur Arch Otorhinolaryngol 2022; 279:3963-3972. [PMID: 35041066 DOI: 10.1007/s00405-021-07218-1] [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: 09/12/2021] [Accepted: 12/09/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nasal obstruction is a frequent symptom in both adults and children and it is a common reason to see an otorhinolaryngologist. Endoscopy of the nasal cavity and the epipharyngeal space along with anterior rhinomanometry is regarded the gold standard since many years to estimate the severity of nasal obstruction in the particular patient. Endoscopy shows anatomical reasons for an obstruction, whereas the nasal flow volume and nasal resistance can be determined using anterior rhinomanometry. Currently, there are only few data available for rhinomanometry results in children. The purpose of the present study was to evaluate the application of this technique in the pediatric population for objective evaluation of nasal flow. Whether it achieves reproducible results and which clinical parameters have some influence on the results were studied. PATIENTS AND METHODS 427 children (average age of 8.5 years, range 7 months through 17 years) who were admitted to evaluate nasal patency or for allergy testing were examined. After clinical examination and endoscopy of the nasal cavity and epipharyngeal space, anterior rhinomanometry was performed before and after application of decongestant nose drops separately for each nose side in 334 children. The nasal flow with a pressure of 150 Pasc was measured and served for statistical evaluation. Flow values were correlated to clinical and endoscopic parameters along with results of allergy tests (prick tests). RESULTS Reproducible rhinomanometric measurements were possible in children age 3 years and older. However, the standard deviation and variation of measurements were significant in this cohort of patients. Statistically highest significant correlations were found between flow measurements and body height along with the age of the children (p < 0.01) and status following adenoidectomy (p < 0.05). No statistically significant correlations were found between rhinomanometry and results of prick tests. CONCLUSIONS The study demonstrates that rhinomanometry can be applied in the pediatric population for objective evaluation of nasal obstruction and for determining the effects of decongestant nose drops. The highest correlation was found between nasal flow and children's body height, children's age and status following adenoidectomy. The correlation between nasal flow and clinically/endoscopically determined degree of nasal obstruction was lower. However, definition of normal flow values for particular age groups is challenging since the results showed high variation and standard deviation. Yet with regard to individual patient, the technique achieves reliable results in nasal provocation tests, which are widely used for allergy testing in children. When performed in children it should always be considered that there are age-specific requirements for the examination and interpretation of results in this patient cohort.
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9
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Brindisi G, Marazzato M, Brunetti F, De Castro G, Loffredo L, Carnevale R, Cinicola B, Palamara AT, Conte MP, Zicari AM. Allergic rhinitis, microbiota and passive smoke in children: A pilot study. Pediatr Allergy Immunol 2022; 33 Suppl 27:22-26. [PMID: 35080308 PMCID: PMC9306473 DOI: 10.1111/pai.13621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is one of the most common allergic diseases affecting children. Objective assessment of nasal obstruction is possible through active anterior rhinomanometry (AAR). Several factors, such as passive smoke exposure (PSE), are triggers for worsening nasal obstruction and chronic inflammation. PSE affects bacterial eubiosis in the upper respiratory tract. This study evaluates the influence of PSE and cotinine levels on both nasal obstruction and local microbiome composition in children with AR. METHODS Fifty patients (aged between 6 and 16 years) with AR monosensitized grass pollen were enrolled. They underwent skin prick tests, a nasal swab to evaluate the microbial composition of the anterior nostrils, a basal AAR, a post-decongestion AAR, and spirometry. Serum cotinine levels were assessed to evaluate PSE. RESULTS A significantly lower percentage of mean nasal flow (mNF%) was observed before and after hydrazine administration in subjects exposed to passive smoke (Exp group) compared with the non-exposed group. In contrast, higher cotinine levels were observed in the Exp group than in the controls. PSE has been associated with a decrease in biodiversity and a change in the nasal microbiome composition; instead, although to a different extent, the abundance of specific taxa resulted in being correlated to cotinine levels and nasal flow. CONCLUSION Children with AR exposed to passive smoke with positive serum cotinine could represent a risk factor for developing nasal obstruction and microbial dysbiosis, suggesting their possible role in pathophysiological processes.
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Affiliation(s)
- Giulia Brindisi
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Marazzato
- Department of Public Health and Infectious Diseases, Microbiology Section, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Brunetti
- Department of Public Health and Infectious Diseases, Microbiology Section, "Sapienza" University of Rome, Rome, Italy
| | - Giovanna De Castro
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Loffredo
- Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Bianca Cinicola
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, Rome, Italy
| | - Anna Teresa Palamara
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Laboratory Affiliated to Istituto Pasteur Italia - Fondazione Cenci Bolognetti, San Raffaele Pisana, IRCCS, Rome, Italy
| | - Maria Pia Conte
- Department of Public Health and Infectious Diseases, Microbiology Section, "Sapienza" University of Rome, Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, Rome, Italy
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10
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Avrunin OG, Nosova YV, Abdelhamid IY, Pavlov SV, Shushliapina NO, Bouhlal NA, Ormanbekova A, Iskakova A, Harasim D. Research Active Posterior Rhinomanometry Tomography Method for Nasal Breathing Determining Violations. SENSORS 2021; 21:s21248508. [PMID: 34960601 PMCID: PMC8708127 DOI: 10.3390/s21248508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
This study analyzes the existing methods for studying nasal breathing. The aspects of verifying the results of rhinomanometric diagnostics according to the data of spiral computed tomography are considered, and the methodological features of dynamic posterior active rhinomanometry and the main indicators of respiration are also analyzed. The possibilities of testing respiratory olfactory disorders are considered, the analysis of errors in rhinomanometric measurements is carried out. In the conclusions, practical recommendations are given that have been developed for the design and operation of tools for functional diagnostics of nasal breathing disorders. It is advisable, according to the data of dynamic rhinomanometry, to assess the functioning of the nasal valve by the shape of the air flow rate signals during forced breathing and the structures of the soft palate by the residual nasopharyngeal pressure drop. It is imperative to take into account not only the maximum coefficient of aerodynamic nose drag, but also the values of the pressure drop and air flow rate in the area of transition to the turbulent quadratic flow regime. From the point of view of the physiology of the nasal response, it is necessary to look at the dynamic change to the current mode, given the hour of the forced response, so that it will ensure the maximum possible acidity in the legend. When planning functional rhinosurgical operations, it is necessary to apply the calculation method using computed tomography, which makes it possible to predict the functional result of surgery.
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Affiliation(s)
- Oleg G. Avrunin
- Department of Biomedical Engineering, Faculty of Electronic and Biomedical Engineering, National University of Radio Electronics, 61166 Kharkiv, Ukraine; (Y.V.N.); (I.Y.A.)
- Correspondence: (O.G.A.); (D.H.); Tel.: +380-505980086 (O.G.A.); +48-815384313 (D.H.)
| | - Yana V. Nosova
- Department of Biomedical Engineering, Faculty of Electronic and Biomedical Engineering, National University of Radio Electronics, 61166 Kharkiv, Ukraine; (Y.V.N.); (I.Y.A.)
| | - Ibrahim Younouss Abdelhamid
- Department of Biomedical Engineering, Faculty of Electronic and Biomedical Engineering, National University of Radio Electronics, 61166 Kharkiv, Ukraine; (Y.V.N.); (I.Y.A.)
| | - Sergii V. Pavlov
- Department of Biomedical Engineering, Vinnytsia National Technical University, 21021 Vinnytsia, Ukraine;
| | - Natalia O. Shushliapina
- Department of Otorhinolaryngology, Stomatological Faculty, Kharkiv National Medical University, 61022 Kharkiv, Ukraine;
| | - Natalia A. Bouhlal
- Azov Maritime Institute, National University “Odessa Maritime Academy”, 65000 Odessa, Ukraine;
| | - Ainur Ormanbekova
- Faculty of Information Technology, Al-Farabi Kazakh National University, Al-Farabi Avenue 71, Almaty 050040, Kazakhstan;
| | - Aigul Iskakova
- Institute of Automation and Information Technologies, Satbayev University, Satpaev Street 22, Almaty 050000, Kazakhstan;
| | - Damian Harasim
- Faculty of Electrical Engineering and Computer Science, Institute of Electronic and Information Technologies, Lublin University of Technology, 20-618 Lublin, Poland
- Correspondence: (O.G.A.); (D.H.); Tel.: +380-505980086 (O.G.A.); +48-815384313 (D.H.)
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11
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Prieto A, Rondón C, Eguiluz-Gracia I, Muñoz C, Testera-Montes A, Bogas G, Nuñez Cuadros E, Campo P, Torres MJ. Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents. Pediatr Allergy Immunol 2021; 32:953-962. [PMID: 33598969 DOI: 10.1111/pai.13474] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Three allergic phenotypes of rhinitis have been described in adults: allergic rhinitis (AR), local allergic rhinitis (LAR), and dual allergic rhinitis (DAR, coexistence of AR and LAR). Nevertheless, most centers follow a diagnostic approach only based on skin prick test and serum allergen-specific IgE (collectively called atopy tests, AT). This approach prevents the recognition of LAR and DAR, the diagnosis of which requires a nasal allergen challenge (NAC). Here, we investigate the existence of LAR and DAR phenotypes in children and adolescents, and the misdiagnosis rate associated with a work-up exclusively based on AT. METHODS Clinical data were obtained during physician-conducted interviews, and AT and NAC were systematically performed in 5- to 18-year-old patients with chronic rhinitis. The misdiagnosis rate was defined as the proportion of cases where AT and NAC results were discordant. RESULTS A total of 173 patients (mean age 15.1 years, 39.9% male) completed the study. AR (positive AT and NAC), LAR (negative AT and positive NAC), DAR (positive AT and NAC for some allergens and negative AT and positive NAC for other allergens), and non-allergic rhinitis (negative NAC) were diagnosed in 45.7%, 24.9%, 11.6%, and 17.9% of individuals, respectively. The clinical profile was comparable among allergic phenotypes, but allergic patients had a significantly earlier rhinitis onset, higher conjunctivitis prevalence, and more severe disease than NAR individuals. A diagnostic work-up exclusively based on AT misclassified 37.6% of patients. CONCLUSIONS LAR and DAR represent relevant differential diagnosis in pediatric rhinitis. NAC increases the diagnostic accuracy of clinical algorithms for rhinitis in children and adolescents.
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Affiliation(s)
- Ana Prieto
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Carmen Rondón
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Candelaria Muñoz
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain
| | - Gador Bogas
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | | | - Paloma Campo
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Maria J Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain.,Laboratory for Nanostructures for the Diagnosis and Treatment of Allergic Diseases, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
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12
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Brindisi G, De Vittori V, De Nola R, Di Mauro A, De Castro G, Baldassarre ME, Cicinelli E, Cinicola B, Duse M, Zicari AM. The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice. J Asthma Allergy 2021; 14:265-274. [PMID: 33790581 PMCID: PMC8006956 DOI: 10.2147/jaa.s275692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background Allergic rhinitis (AR) and asthma are two common atopic diseases, often associated with a common ethiopathogenesis characterized by a Th2 inflammatory response with the release of many biomarkers, such as nitric oxide (NO). Purpose To evaluate and compare inflammatory (nFeNO and eFeNO) and functional (mNF and FEV1) parameters in AR children with or without asthma in comparison to controls. Secondly, we aimed to identify nFeNO cut-off values and verify their reliability to predict the presence of rhinitis or asthma alone or in combination. Patients and Methods We enrolled 160 children (6-12 years of age) with AR and/or asthma divided into four groups: controls, AR, asthma, and AR + asthma. All children underwent the following inflammatory and functional measurements: nFeNO, eFeNO, mNF and FEV1. Results We observed that levels of nFeNO were extremely higher in children with AR and even more in those with AR + asthma in respect to controls. Notably, all the pathological conditions, especially AR + asthma, showed significantly lower values of mNF compared to healthy children. A negative correlation linked mNF and nFeNO. Then, we found eFeNO values significantly higher in all the pathological groups compared to controls, with major values of this marker in patients affected by asthma and AR + asthma, as well as FEV1 values significantly lower in all the disease groups, especially in children with asthma and AR+ asthma. ROC curve analysis showed that nFeNO was a great predictor for rhinitis alone or with asthma, revealing an accurate cut-off of 662 ppb. Conclusion nFeNO measurement is non-invasive, easy to perform, economic and a valuable test in case of AR alone or in association with asthma. Thus, it should be used in patients with rhinitis, together with anterior active rhinomanometry (AAR) to diagnose and estimate the degree of nasal obstruction but also in children with asthma to assess their nasal involvement and improve the therapeutic management.
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Affiliation(s)
- Giulia Brindisi
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Valentina De Vittori
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Rosalba De Nola
- Department of Biomedical Science and Human Oncology, Gynecology and Obstetrics Section, "Aldo Moro" University of Bari, Bari, 70124, Italy.,Department of Tissues and Organs Transplantation and Cellular Therapies, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Antonio Di Mauro
- Department of Biomedical Sciences and Human Oncology-Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Giovanna De Castro
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Maria Elisabetta Baldassarre
- Department of Biomedical Sciences and Human Oncology-Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Ettore Cicinelli
- Department of Biomedical Science and Human Oncology, Gynecology and Obstetrics Section, "Aldo Moro" University of Bari, Bari, 70124, Italy
| | - Bianca Cinicola
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Marzia Duse
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
| | - Anna Maria Zicari
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy
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13
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Mercier-Letondal P, Marton C, Godet Y, Galaine J. Validation of a method evaluating T cell metabolic potential in compliance with ICH Q2 (R1). J Transl Med 2021; 19:21. [PMID: 33407568 PMCID: PMC7789274 DOI: 10.1186/s12967-020-02672-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Metabolic cell features are able to give reliable information on cell functional state. Thus, metabolic potential assessment of T cells in malignancy setting represents a promising area, especially in adoptive cell therapy procedures. Easy to set up and convenient Seahorse technology have recently been proposed by Agilent Technologies and it could be used to monitor T cells metabolic potential. However, this method demonstrates an inter-assay variability and lacks practices standardization. RESULTS We aimed to overcome these shortcomings thanks to a lymphoblastic derived JURKAT cell line seeding in each experiment to standardize the Seahorse process. We used an adapted XF Cell MitoStress Kit protocol, consisting in the evaluation of basal, stressed and maximal glycolysis and oxidative phosphorylation related parameters, through sequential addition of oligomycin and carbonyl cyanide 4-(trifluoromethoxy)phenylhydrazone (FCCP) to a glucose containing medium. Data were acquired and analyzed through Agilent Seahorse XFe96 analyzer. Indeed, we validated this method in the light of ICH Q2 (R1) guidelines. We were able to confirm the specificity and accuracy of the method. We also demonstrated the precision, linearity and range of the method in our experimental conditions. CONCLUSION The validation of the method consisting in a JURKAT cell line experimental incorporation as a control material contributes to improve the Seahorse technology's robustness. These results lay the groundwork for the implementation of this technology to optimize T cell based cellular therapy products production process and monitoring.
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Affiliation(s)
- Patricia Mercier-Letondal
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France.
| | - Chrystel Marton
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France
| | - Yann Godet
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France
| | - Jeanne Galaine
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France
- Etablissement Français du Sang Bourgogne Franche-Comté, Activité Médicaments de Thérapie Innovante, 25000, Besançon, France
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14
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Wang SY, Wang YF, Pan CC, Sun JW. Serum level and clinical significance of vitamin E in children with allergic rhinitis. BMC Pediatr 2020; 20:362. [PMID: 32736611 PMCID: PMC7394685 DOI: 10.1186/s12887-020-02248-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is one of the most prevalent allergic diseases in children. This study aimed to investigate the association between serum concentrations of vitamin E and AR to determine if the vitamin E level is correlated with the occurrence and severity of AR. METHODS A total of 113 children were enrolled in this cross-sectional study. Sixty-five children in the outpatient group were diagnosed with AR, and 48 healthy children were recruited as controls. All subjects underwent serum vitamin E (adjusted for total cholesterol and triglycerides) measurements. Serum to total IgE (tIgE), the five most common allergen-specific IgE (sIgE) levels and skin prick test (SPT) were measured in children with AR. The severity of AR was assessed with the nasal symptoms score, and the situation of exposure to passive smoking were inquired. RESULTS Serum vitamin E levels were significantly lower in the AR group than in the normal children (P < 0.001). A significant negative correlation was observed between serum vitamin E levels and sIgE as well as the SPT grade. Serum vitamin E levels were also inversely related to the nasal symptoms score; however, statistical significance was not found. CONCLUSIONS A significantly lower vitamin E level was found in children with AR. Lower serum vitamin E levels may have correlation with the occurrence of AR in children. However, serum vitamin E levels were not statistically correlated with the severity of AR.
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Affiliation(s)
- Shi-Yi Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technology of China, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Anhui Provincial Hospital Affiliated Anhui Medical University, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Yangzhou University, No. 368 Hanjiang Middle Road, Yangzhou, Jiangsu Province, 225001, People's Republic of China
| | - Yin-Feng Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technology of China, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Anhui Provincial Hospital Affiliated Anhui Medical University, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China
| | - Chun-Chen Pan
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technology of China, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China. .,Department of Otolaryngology-Head and Neck Surgery, Anhui Provincial Hospital Affiliated Anhui Medical University, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China.
| | - Jing-Wu Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of University of Science and Technology of China, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China. .,Department of Otolaryngology-Head and Neck Surgery, Anhui Provincial Hospital Affiliated Anhui Medical University, No. 17 Lujiang Road, Hefei, Anhui Province, 230001, People's Republic of China.
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