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Malinowska K, Kowalski A, Merecz-Sadowska A, Paprocka-Zjawiona M, Sitarek P, Kowalczyk T, Zielińska-Bliźniewska H. PD-1 and PD-L1 Expression Levels as a Potential Biomarker of Chronic Rhinosinusitis and Head and Neck Cancers. J Clin Med 2023; 12:jcm12052033. [PMID: 36902820 PMCID: PMC10004389 DOI: 10.3390/jcm12052033] [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: 02/03/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Inflammation is an etiological factor of various chronic diseases contributing to more than 50% of worldwide deaths. In this study, we focus on the immunosuppressive role of the programmed death-1 (PD-1) receptor and its ligand (PD-L1) in inflammatory-related diseases, including chronic rhinosinusitis and head and neck cancers. The study included 304 participants. Of this number, 162 patients had chronic rhinosinusitis with nasal polyps (CRSwNP), 40 patients had head and neck cancer (HNC) and there were 102 healthy subjects. The expression level of the PD-1 and PD-L1 genes in the tissues of the study groups was measured by qPCR and Western blot methods. The associations between the age of the patients and the extent of disease and genes' expression were evaluated. The study showed a significantly higher mRNA expression of PD-1 and PD-L1 in the tissues of both the CRSwNP and HNC patient groups compared to the healthy group. The severity of CRSwNP significantly correlated with the mRNA expression of PD-1 and PD-L1. Similarly, the age of the NHC patients influenced PD-L1 expression. In addition, a significantly higher level of PD-L1 protein was noticed also for both the CRSwNP and HNC patient groups. The increased expression of PD-1 and PD-L1 may be a potential biomarker of inflammatory-related diseases, including chronic rhinosinusitis and head and neck cancers.
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Affiliation(s)
- Katarzyna Malinowska
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, 90-725 Lodz, Poland
- Correspondence:
| | - Andrzej Kowalski
- Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, 90-549 Lodz, Poland
| | - Anna Merecz-Sadowska
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, 90-725 Lodz, Poland
| | - Milena Paprocka-Zjawiona
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, 90-725 Lodz, Poland
| | - Przemysław Sitarek
- Department of Biology and Pharmaceutical Botany, Medical University of Lodz, 90-151 Lodz, Poland
| | - Tomasz Kowalczyk
- Department of Molecular Biotechnology and Genetics, University of Lodz, 90-237 Lodz, Poland
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Hayes SM, Biggs TC, Goldie SP, Harries PG, Walls AF, Allan RN, Pender SLF, Salib RJ. Staphylococcus aureus internalization in mast cells in nasal polyps: Characterization of interactions and potential mechanisms. J Allergy Clin Immunol 2019; 145:147-159. [PMID: 31254531 DOI: 10.1016/j.jaci.2019.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) with nasal polyps is a common chronic condition. The exact cause of nasal polyps remains unknown. Recently, we made the novel observation of intracellular localization of Staphylococcus aureus within mast cells in nasal polyps. OBJECTIVE This follow-up study aimed to further characterize interactions between S aureus and mast cells in this setting and elucidate potential internalization mechanisms with particular emphasis on the role of staphylococcal enterotoxin B (SEB). METHODS A prospective study was performed using an explant tissue model with ex vivo inferior turbinate mucosa obtained from patients with chronic rhinosinusitis with nasal polyps (n = 7) and patients without CRS (n = 5). Immunohistochemistry was used to characterize S aureus uptake into mast cells and investigate the effects of SEB on this process. An in vitro cell-culture model was used to investigate mast cell-S aureus interactions by using a combination of fluorescent in situ hybridization, confocal laser scanning microscopy, scanning electron microscopy, transmission electron microscopy, and proliferation assays. RESULTS S aureus was captured by extracellular traps and entered mast cells through phagocytosis. Proliferating intracellular S aureus led to the expansion and eventual rupture of mast cells, resulting in release of viable S aureus into the extracellular space. The presence of SEB appeared to promote internalization of S aureus into mast cells. CONCLUSION This study provides new insights into the interactions between S aureus and mast cells, including the internalization process, and demonstrates a prominent role for SEB in promoting uptake of the bacteria into these cells.
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Affiliation(s)
- Stephen M Hayes
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Southampton NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Timothy C Biggs
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Southampton NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Simon P Goldie
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Southampton NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Philip G Harries
- Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Andrew F Walls
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Raymond N Allan
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Department of Biological Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Sylvia L F Pender
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Rami J Salib
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Southampton NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Department of Otorhinolaryngology/Head & Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
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Naclerio R, Blair C, Yu X, Won YS, Gabr U, Baroody FM. Allergic Rhinitis Augments the Response to a Bacterial Sinus Infection in Mice: A Review of an Animal Model. ACTA ACUST UNITED AC 2018; 20:524-33. [PMID: 17063749 DOI: 10.2500/ajr.2006.20.2920] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Sinusitis is a poorly understood disease. Despite the significant morbidity and the enormous cost of treating sinusitis, little progress has been made at improving our understanding of its pathophysiology. One reason for restricted progress in understanding the disease is the lack of a satisfactory animal model that mimics sinusitis in man. Objective We review data establishing the development of sinusitis in mice after instillation of Streptococcus pneumoniae, the most common pathogen responsible for acute sinusitis in man. We also review data showing that allergic inflammation in mice worsens a subsequent bacterial sinusitis. We use this data to hypothesize how allergic inflammation worsens a bacterial sinus infection. Methods Different strains of mice were made allergic and/or infected. Results We show our ability to generate an allergic reaction in the nose after sensitization to ovalbumin. Our data further show that an ongoing allergic nasal reaction worsens acute sinusitis. Conclusion A mouse model has been created for a study of the interaction of allergic rhinitis and acute bacterial sinusitis.
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Affiliation(s)
- Robert Naclerio
- Section of Otolaryngology-Head and Neck Surgery, The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637, USA.
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Rivero A, Liang J. Anti-IgE and Anti-IL5 Biologic Therapy in the Treatment of Nasal Polyposis: A Systematic Review and Meta-analysis. Ann Otol Rhinol Laryngol 2017; 126:739-747. [PMID: 28918644 DOI: 10.1177/0003489417731782] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the role of biologic therapy on sinonasal symptoms and objective outcomes in chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS PubMed, OVID MEDLINE, and Cochrane Central were reviewed from 2000 to 2015. Inclusion criteria included English-language studies containing original data on biologic therapy in CRSwNP patients with reported outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools. RESULTS Of 495 abstracts identified, 7 studies fulfilled eligibility: 4 randomized control trials (RCT), 1 case-control, and 2 case series. Outcome measures included nasal polyp score (NPS,6), computer tomography score (5), and symptom scores (5). Meta-analysis was performed on 5 studies: Anti-IL5 therapy (mepolizumab/reslizumab) and anti-IgE therapy (omalizumab) demonstrated a standard mean difference of NPS improvement of -0.66 (95% CI, -1.24 to -0.08) and -0.75 (95% CI, -1.93 to 0.44), respectively, between biologic therapy and placebo. Quality assessment indicated a low to moderate risk of bias for the RCTs. CONCLUSION Biologic therapies may prove beneficial in the treatment of recalcitrant nasal polyposis in select populations. In meta-analysis, anti-IL5 therapy demonstrates a reduction in nasal polyp score. Anti-IgE therapy reduces nasal polyp score in patients with severe comorbid asthma. Additional high-level evidence is needed to assess clinical efficacy.
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Ahmadi N, Christensen JM, Barham HP, Oakley GM, Sacks R, Harvey RJ. Allergic sensitization does not predispose to sinus inflammation in externalized paranasal sinuses. Am J Rhinol Allergy 2017; 31:3-6. [PMID: 28234140 DOI: 10.2500/ajra.2017.31.4388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has a multifactorial etiology, with a debate about the role of inhalant allergy in the pathogenesis of CRS. OBJECTIVE This study assessed the impact of allergy status on externalized paranasal sinuses after tumor resection to determine if a predisposition to inhalant allergy brought about additional inflammation after sinus surgery. METHODOLOGY A case-control study was performed on patients who had no history of CRS who underwent paranasal sinus tumor resection. Allergic sensitization was defined by a positive serum ImmunoCAP test result. Outcomes were measured at least 6 months after surgery by using the modified Lund-MacKay endoscopic score and the 22-item Sino-Nasal Outcome test, with rhinitis, sleep, psychological, ear and/or facial, and sinus subscores to assess the impact of allergy status on mucosal inflammation. RESULTS A total of 103 patients (53.44 ± 17.46 years; 46% women) were assessed. Of these, 61.17% were allergically sensitized at the time of surgery. Postsurgery endoscopic assessment was similar [the modified Lund-Mackay endoscopic score allergic sensitized 0.5 (1.7) versus nonallergic sensitized 0.0 (0.9); p = 0.15]. Sinonasal symptoms were also similar between the groups' 22-item Sino-Nasal Outcome test scores, allergic sensitized versus allergic nonsensitized, (allergic 28.9 ± 20.8 versus nonallergic 33.5 ± 19.7; p = 0.31), rhinitis score (5.9 ± 5.5 versus 6.4 ± 4.7; p = 0.66), sleep score (6.9 ± 5.9 versus 7.7 ± 4.8; p = 0.50), ear and/or facial symptom score (3.4 ± 3.6 versus 4.3 ± 3.3; p = 0.22), psychological score (6.9 ± 6.0 versus 8.3 ± 6.7; p = 0.29), and of nasal symptom score (6.4 ± 5.2 versus 7.0 ± 5.3; p = 0.61). CONCLUSIONS Externalization of the sinuses in patients with inhalant allergy did not bring about significant additional inflammation in patients after tumor surgery.
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Affiliation(s)
- Navid Ahmadi
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
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Sabarinath V, Harish MR, Divakaran S. Triamcinolone Impregnated Nasal Pack in Endoscopic Sinus Surgery: Our Experience. Indian J Otolaryngol Head Neck Surg 2017; 69:88-92. [PMID: 28239586 PMCID: PMC5305642 DOI: 10.1007/s12070-016-1041-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022] Open
Abstract
The selection of an effective packing method to prevent postoperative complications and recurrence following Endoscopic Sinus Surgery remains ambiguous at present. This study was conducted to evaluate the efficacy of Triamcinolone impregnated nasal pack in Endoscopic Sinus Surgery, in the prevention of postoperative crusting, edema, infection and recurrence. This study was an interventional randomized placebo-controlled study, conducted at a tertiary care centre in South India between February 2015 and May 2016, after getting approval from Institute Ethical Committee. 75 patients with bilateral chronic rhinosinusitis undergoing Endoscopic Sinus Surgery were selected for the study. After surgery, each patient was randomized to receive Polyvinyl Acetal (Merocel) nasal pack soaked with Triamcinolone to one side, while the contralateral side was packed with Merocel soaked with saline. Incidence of postoperative crusting, edema, polypoidal change and mucosal discharge was evaluated using the Endoscopic Staging System at 1st and 2nd weeks and at 1st and 3rd months of surgery. A significant reduction in mucosal edema was observed in the test group at all stages of follow up (p values <0.05). Incidence of crusting was found to be significantly lower in the test group (p values <0.05) except at 3 months (p value >0.05). However, there was no significant difference in the occurrence of polypoidal change and mucosal discharge between the groups. Triamcinolone impregnated nasal pack is an effective method to reduce the incidence of early postoperative complications following Endoscopic Sinus Surgery.
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Affiliation(s)
- V. Sabarinath
- Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry India
| | - M. R. Harish
- Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry India
| | - Shilpa Divakaran
- Pondicherry Institute of Medical Sciences, Kalapet, Puducherry India
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Poletti SC, Hummel T, Stuck BA. Riechfunktion bei allergischer Rhinitis: eine systematische Übersichtsarbeit. ALLERGO JOURNAL 2016. [DOI: 10.1007/s15007-016-1092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Lin SY, Mabry RL. Allergy Practice in the Academic Otolaryngology Setting: Results of a Comprehensive Survey. Otolaryngol Head Neck Surg 2016; 134:25-27. [PMID: 16399175 DOI: 10.1016/j.otohns.2005.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES: To survey academic otolaryngology centers and obtain information regarding their practice of otolaryngic allergy. STUDY DESIGN: A 12-item multiple-choice survey was sent to all academic otolaryngology department chairmen and program directors, as well as all academic liaisons known to the American Academy of Otolaryngic Allergy. RESULTS: Representatives of 71 of 102 (69.6%) accredited otolaryngology programs responded; 52 of 84 respondents reported an active otolaryngic allergy practice at their institution. The testing method most widely employed by those surveyed is intradermal dilutional testing (IDT). The majority of respondents (74.5%) felt that the addition of allergy increased referrals to their department, and a similar majority (72%) were operating at a profit. The most common reasons cited for adding allergy services were to meet educational and residency requirements. CONCLUSIONS: The majority of academic otolaryngology programs in the United States currently offer otolaryngic allergy services. The primary reason cited for adding these services is for educational purposes, but there appear to be potential financial benefits as well. EBM rating: C-4
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Affiliation(s)
- Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, 601 North Caroline Street #6254, Baltimore, MD 21287-0910, USA.
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Hancı D, Altun H, Çetinkaya EA, Muluk NB, Cengiz BP, Cingi C. Cinnamaldehyde is an effective anti-inflammatory agent for treatment of allergic rhinitis in a rat model. Int J Pediatr Otorhinolaryngol 2016; 84:81-7. [PMID: 27063758 DOI: 10.1016/j.ijporl.2016.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The effect of cinnamaldehyde on the treatment of allergic rhinitis (AR) was investigated in rat model. METHODS Twenty-eight female Wistar albino rats were randomly divided into four groups: Group 1 (control) (C), Group 2 (AR with no treatment) (AR+NoTr), Group 3 (AR+Azelastine HCl) (AR+Aze), and Group 4 (AR+cinnamaldehyde) (AR+Cin). At day 21, AR+Aze rats were given an Azelastine HCl drop, and AR+Cin rats were given cinnamaldehyde intranasally. In all groups, allergic symptoms histopathological results were evaluated. RESULTS The AR+NoTr group showed the worst allergic symptoms, cilia loss and greater inflammation. In the AR+Aze and AR+Cin groups, allergic symptom scores were higher than those in the control group. However, between AR+Aze and AR+Cin groups, there were no significant differences in the allergic symptom scores Histopathological analysis revealed vascular congestion and an increase in goblet cell numbers in the AR+Cin group. However, AR+Cin rat nasal mucosa had less plasma cell infiltration compared with the AR+NoTr group. In rats from the AR+Aze group, analysis of the nasal mucosa revealed less eosinophil infiltration than that seen in the AR+NoTr group. A lower score for mast cell (MC) infiltration was observed in the nasal mucosa of rats treated with Azelastine HCl compared with cinnamaldehyde. CONCLUSIONS In this study we observed that both Azelastine HCl and cinnamaldehyde reduced allergic symptoms in an AR rat model. Cinnamaldehyde decreased vascular congestion as well as plasma cell, eosinophil, and inflammatory cell infiltration into the lamina propria.
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Affiliation(s)
- Deniz Hancı
- Okmeydanı Training and Research Hospital, ENT Clinics, Istanbul, Turkey
| | - Hüseyin Altun
- Yunus Emre Hospital, ENT Department, Uskudar, Istanbul, Turkey
| | | | - Nuray Bayar Muluk
- Kırıkkale University, Medical Faculty, ENT Department, Kırıkkale, Turkey.
| | | | - Cemal Cingi
- Eskişehir Osmangazi University, Medical Faculty, ENT Department, Eskişehir, Turkey
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10
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Stuck BA, Hummel T. Olfaction in allergic rhinitis: A systematic review. J Allergy Clin Immunol 2015; 136:1460-1470. [PMID: 26409662 DOI: 10.1016/j.jaci.2015.08.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 02/03/2023]
Abstract
Olfactory dysfunction is a key symptom in patients with allergic rhinitis (AR). Despite the implications for quality of life, relatively few articles have tested olfactory function in their investigations. The current systematic review aimed to investigate the following 2 questions: (1) What does AR do to human olfaction? (2) How effective is the treatment of AR in restoring the sense of smell? A comprehensive literature search was performed, and human studies of any design were included. A total of 420 articles were identified, and 36 articles were considered relevant. Data indicate that the frequency of olfactory dysfunction increases with the duration of the disorder, and most studies report a frequency in the range of 20% to 40%. Although olfactory dysfunction does not appear to be very severe in patients with AR, its presence seems to increase with the severity of the disease. There is very limited evidence that antihistamines improve olfactory function. In addition, there is limited evidence that topical steroids improve the sense of smell, especially in patients with seasonal AR. This is also the case for specific immunotherapy. However, many questions remain unanswered because randomized controlled trials are infrequent and only a few studies rely on quantitative measurement of olfactory function.
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Affiliation(s)
- Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Head and Neck Surgery, TU Dresden, Dresden, Germany
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Anselmo-Lima WT, Sakano E, Tamashiro E, Nunes AAA, Fernandes AM, Pereira EA, Ortiz É, Pinna FDR, Romano FR, Padua FGDM, Mello Junior JF, Teles Junior J, Dolci JEL, Balsalobre Filho LL, Kosugi EM, Sampaio MH, Nakanishi M, Santos MCJD, Andrade NAD, Mion ODG, Piltcher OB, Fujita RR, Roithmann R, Voegels RL, Guimarães RES, Meirelles RC, Paula Santos R, Nakajima V, Valera FCP, Pignatari SSN. Rhinosinusitis: evidence and experience: October 18 and 19, 2013 - São Paulo. Braz J Otorhinolaryngol 2015; 81:S1-S49. [PMID: 25697512 PMCID: PMC10157818 DOI: 10.1016/j.bjorl.2015.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Wilma T Anselmo-Lima
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Eulália Sakano
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Edwin Tamashiro
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | | | - Érica Ortiz
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fábio de Rezende Pinna
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Fabrizio Ricci Romano
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | - João Teles Junior
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | - Olavo de Godoy Mion
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | - Renato Roithmann
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Richard Louis Voegels
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Roberto Campos Meirelles
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Victor Nakajima
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil
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Georgalas C, Vlastos I, Picavet V, van Drunen C, Garas G, Prokopakis E. Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation. Allergy 2014; 69:828-33. [PMID: 24815699 DOI: 10.1111/all.12413] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 01/30/2023]
Abstract
The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief.
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Affiliation(s)
- C. Georgalas
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - I. Vlastos
- Department of Otorhinolaryngology; University of Crete School of Medicine; Heraklio Crete Greece
| | - V. Picavet
- Department of Otorhinolaryngology; University Hospital Ulm; Ulm Germany
| | - C. van Drunen
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - G. Garas
- Department of Otorhinolaryngology and Head & Neck Surgery; Queens Medical Centre; Nottingham University Hospitals; Nottingham UK
| | - E. Prokopakis
- Department of Otorhinolaryngology; University of Crete School of Medicine; Heraklio Crete Greece
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Manes RP, Batra PS. Etiology, diagnosis and management of chronic rhinosinusitis. Expert Rev Anti Infect Ther 2013; 11:25-35. [PMID: 23428100 DOI: 10.1586/eri.12.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common health care problem, yet many aspects of this diagnosis remain poorly understood. Its etiology is often debated and remains a significant area of research. The diagnosis of CRS is based on subjective symptoms, duration of symptoms and objective evidence of inflammation. Each of these criteria must be met to make a diagnosis of CRS. Management of CRS often involves a combination of systemic and topical therapies with surgery reserved for patients who fail medical therapy. This review provides a comprehensive view of the etiology, diagnosis and management of CRS.
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Affiliation(s)
- R Peter Manes
- Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Shahid SK. Rhinosinusitis in children. ISRN OTOLARYNGOLOGY 2012; 2012:851831. [PMID: 23762621 PMCID: PMC3671714 DOI: 10.5402/2012/851831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/01/2012] [Indexed: 11/25/2022]
Abstract
Rhinosinusitis is the inflammation of the mucous membranes of nose and paranasal sinus(es). 5-13% of upper respiratory tract infections in children complicate into acute rhinosinusitis. Though not life threatening, it profoundly affects child's school performance and sleep pattern. If untreated, it could progress to chronic rhinosinusitis (CRS). The pathogens involved in perpetuation of CRS consist of multidrug-resistant mixed microflora. CRS is challenging to manage and could further extend to cause eye or intracranial complications. In children, CRS diagnosis is often either missed or incomprehensive. Due to this, morbidity and strain on healthcare budget are tremendous. Flexible fiberoptic endoscopy has revolutionized management of CRS. Its utility in children is being increasingly recognized. Optimal management entails specific appropriate antimicrobials as well as treatment of underlying causes. The aim is to normalize sinus anatomy and physiology and regain normal mucociliary function and clearance.
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Affiliation(s)
- Sukhbir K. Shahid
- Department of Pediatrics and Neonatology, Shahid Clinic and Hospital, Maharashtra, Mumbai 400 077, India
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The Correlation between Butanol Threshold Test (BTT) and Cross Cultural Smell Identification Test (CC-SIT) According to Causes of Olfactory Disorders. ACTA ACUST UNITED AC 2012. [DOI: 10.3342/kjorl-hns.2012.55.10.637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Boita M, Garzaro M, Raimondo L, Riva G, Mazibrada J, Vizio B, Bellone G, Pecorari G, Bucca C, Rolla G, Giordano C. The expression of TSLP receptor in chronic rhinosinusitis with and without nasal polyps. Int J Immunopathol Pharmacol 2011; 24:761-8. [PMID: 21978707 DOI: 10.1177/039463201102400322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic Rhinosinusitis with or without Nasal Polyps (CRSwNP and CRSsNP) may be characterized by different cytokine profiles. Generally, Th2 cytokines and eosinophilic infiltration have been reported to be more specific of CRSwNP compared to CRSsNP, where neutrophils seem to play a major role. The epithelial cell-derived thymic stromal lymphopoietin (TSLP) has been recently identified as a key factor in Th2-inflammatory response. The aim of this study is to investigate the expression of TSLP Receptor (TSLP R) in surgical specimens obtained from patients affected by CRSwNP (n=10) and CRSsNP (n=5) by immunohistochemical techniques (immunostaining score, IS). TSLP R expression was significantly higher in the inflammatory infiltrate and in the epithelial cells of CRSwNP, CRSsNP patients compared to the control group (IS 4.5±0.68, 4.4±1.44 and 0.43±0.3 respectively, p=0.0024 for inflammatory infiltrate and IS 5.8±0.92, 7.8±2.06 and 0.86±0.55 respectively, p=0.0018 for epithelial cells). No significant difference was observed in IS of inflammatory infiltrate and epithelial cells in CRSwNP compared to CRSsNP. Very low IS for TSLP R was found in connective tissue of all the samples, with no difference among the groups. TSLP receptor is highly expressed in CRS compared to controls and independently from the polyps suggesting an early common inflammatory pathway in the two CRS phenotypes.
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Affiliation(s)
- M Boita
- Molecular Biology Laboratory, Clinical Physiopathology Department, University of Turin, Italy
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18
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Ono N, Kase K, Homma H, Kusunoki T, Ikeda K. Maxillary sinus infundibulum narrowing influences sinus abnormalities in spite of the presence or absence of allergy. Acta Otolaryngol 2011; 131:1193-7. [PMID: 21846296 DOI: 10.3109/00016489.2011.584904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Maxillary sinus abnormalities were demonstrated to be associated with maxillary sinus infundibulum narrowing as well as nasal airflow resistance secondary to nonspecific nasal inflammation. OBJECTIVES There is no consensus regarding the pathogenetic roles of allergy and anatomic variations in sinus mucosa abnormalities. We investigated the correlation between allergy and anatomic variations in sinus abnormalities in chronic rhinitis patients in the presence or absence of allergy. METHODS In all, 148 adult patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) were enrolled. Opacification of sinuses, the size of the maxillary sinus infundibulum, Haller cells, and concha bullosa were evaluated based on computed tomography (CT) images. Simultaneously, nasal airflow resistance was measured. RESULTS The AR group comprising 105 patients showed maxillary sinus opacification in 45 patients. In the NAR group including 43 patients, soft tissue opacification was observed in 13 patients. There was no significant difference in the incidence of sinus opacification between the AR and NAR groups. Both nasal resistance and the infundibulum size in both the AR and NAR groups with sinus opacification showed significant differences from those without sinus abnormalities. The presence of concha bullosa influenced the sinus opacification in both the AR and NAR groups.
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Affiliation(s)
- Noritsugu Ono
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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19
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Abstract
Allergic rhinitis (AR) typically presents after the second year of life, but the exact prevalence in early life is unknown. AR affects 10-30% of the population, with the greatest frequency found in children and adolescents. It appears that the prevalence has increased in the pediatric population. As the childs' immune system develops between the 1st and 4th yr of life, those with an atopic predisposition begin to express allergic disease with a clear Th(2) response to allergen exposure, resulting in symptoms. In pediatric AR, two or more seasons of pollen exposure are generally needed for sensitization, so allergy testing to seasonal allergens (trees, grasses, and weeds) should be conducted after the age of 2 or 3 years. Sensitization to perennial allergens (animals, dust mites, and cockroaches) may manifest several months after exposure. Classification of AR includes measurement of frequency and duration of symptoms. Intermittent AR is defined as symptoms for <4 days/wk or <4 consecutive weeks. Persistent AR is defined as occurring for more than 4 days/wk and more than 4 consecutive weeks. AR is associated with impairments in quality of life, sleep disorders, emotional problems, and impairment in activities such as work and school productivity and social functioning. AR can also be graded in severity - either mild or moderate/severe. There are comorbidities associated with AR. The chronic effects of the inflammatory process affect lungs, ears, growth, and others. AR can induce medical complications, learning problems and sleep-related complaints, such as obstructive sleep apnea syndrome and chronic and acute sinusitis, acute otitis media, serous otitis media, and aggravation of adenoidal hypertrophy and asthma.
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Affiliation(s)
- Tania Sih
- University of São Paulo, Laboratorio de Investigações Médicas Number 40. São Paulo, Brazil.
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20
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Chronic rhinosinusitis with and without nasal polyps: What is the difference? Curr Allergy Asthma Rep 2009; 9:213-20. [DOI: 10.1007/s11882-009-0031-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Baudoin T, Kalogjera L, Geber G, Grgić M, Cupić H, Tiljak MK. Correlation of histopathology and symptoms in allergic and non-allergic patients with chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2008; 265:657-61. [PMID: 18004580 DOI: 10.1007/s00405-007-0530-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
The aim of this study was to estimate and compare some histopathologic predictors of efficacy of endoscopic sinus surgery (ESS) in allergic and non-allergic patients with chronic rhinosinusitis (CRS). Symptomatology was rated in 50 allergic and 50 non-allergic patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were scored for goblet cells, subepithelial thickening, mast cells and eosinophils. The correlation between histopathology and symptoms was evaluated. Goblet cells and subepithelial thickening were the best predictors in both groups of patients. These parameters are significant global outcome predictors for allergic, but not for non-allergic patients. It is concluded that certain histopathologic parameters in CRS correlate with certain symptoms. Certain histopathologic changes are predictable for persistence of some bothersome symptoms after ESS. Pathologic evaluation might give prediction of response to ESS in allergic and non-allegic patients with CRS.
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Affiliation(s)
- Tomislav Baudoin
- Department of Otolaryngology-Head and Neck Surgery, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
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22
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Gelincik A, Büyüköztürk S, Aslan I, Aydin S, Ozşeker F, Colakoğlu B, Dal M. Allergic vs nonallergic rhinitis: which is more predisposing to chronic rhinosinusitis? Ann Allergy Asthma Immunol 2008; 101:18-22. [PMID: 18681079 DOI: 10.1016/s1081-1206(10)60829-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of allergy on chronic rhinosinusitis (CRS) is controversial. OBJECTIVE To evaluate whether a history of CRS is more prevalent in patients with allergic rhinitis than in those with nonallergic persistent rhinitis. METHODS A total of 115 patients (78 females; mean age, 31.9 years; age range, 14-64 years) with persistent rhinitis were included in the study. A 7-point analog scale was used to report the severity of individual and global CRS symptoms and to determine the impact of rhinosinusitis symptoms on quality of life. The allergic status of the patients was evaluated using skin prick tests for common inhalant allergens, and asthma was evaluated by means of history, physical examination, and respiratory function tests. Rhinoscopy and paranasal sinus computed tomography were used to determine CRS. RESULTS Asthma and CRS were not significantly different in allergic and nonallergic patients. Nasal polyps were found equally in both groups (8 patients). However, mean Lund-Mackay staging scores, postnasal drainage, dental pain, and global CRS scores were significantly higher in patients with nonallergic rhinitis (P = .045, P = .001, P = .02, and P = .01, respectively). No significant correlations, except for dental pain (correlation coefficient, 0.250; P = .008), were found between Lund-Mackay scores and CRS symptoms. In rhinoscopy, the only conspicuous difference was nasal purulence in allergic patients (P = .002). CONCLUSION Allergic and nonallergic rhinitis may contribute similarly to the development of CRS.
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Affiliation(s)
- Asli Gelincik
- Allergy Division, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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23
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3035] [Impact Index Per Article: 189.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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24
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Smart BA. The impact of allergic and nonallergic rhinitis on pediatric sinusitis. Curr Allergy Asthma Rep 2006; 6:221-7. [PMID: 16579872 DOI: 10.1007/s11882-006-0038-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is a great deal of published evidence that there is a relationship between both allergic and nonallergic rhinitis and sinusitis in both pediatric and adult patients. The relationship between rhinitis and sinusitis may involve inflammation in one compartment leading to secondary inflammation in the other compartment, such as in the case of rhinitis leading to obstruction of the osteomeatal complex. The relationship may also involve individual manifestations of a shared process, such as allergic disease. A better understanding of the relationship between rhinitis and sinusitis may significantly influence the treatment of these common and important conditions.
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Affiliation(s)
- Brian A Smart
- Asthma and Allergy Center, DuPage Medical Group, 454 Pennsylvania Avenue, Glen Ellyn, IL 60137, USA.
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25
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Abstract
Allergic rhinitis (AR) is a disease with growing impact on everyday medical practice, as its prevalence has steadily increased during the last decades. Immunoglobulin-E (IgE)-mediated airway inflammation may manifest itself as AR, asthma or both. Allergic inflammation in upper and lower airways is now considered as one airway disease, with manifestation of symptoms in upper, lower or global airway. This insight into allergic inflammation of the whole respiratory tract has consequences for the diagnostic and therapeutic approach of affected patients, as highlighted in the ARIA document. In contrast to asthma, the link between AR and associated conditions in the upper airways like rhinosinusitis, nasal polyps, recurrent viral infections, adenoid hypertrophy, tubal dysfunction, otitis media with effusion and laryngitis remains less explored. It is however of utmost importance to consider the aetiological role of IgE-mediated inflammation of the nasal mucosa in several diseases of the upper respiratory tract, as they represent a large body of patient population seen by the general practitioner as well as the paediatrician, allergologist and otorhinolaryngologist. We here aim at reviewing the current literature on the relationship between AR and conditions in upper airways frequently encountered in everyday clinical practice, and highlight the need for further studies exploring the role of allergic inflammation in the development of these diseases.
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Affiliation(s)
- P W Hellings
- Laboratory of Experimental Immunology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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26
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Baraniuk JN, Maibach H. Pathophysiological classification of chronic rhinosinusitis. Respir Res 2005; 6:149. [PMID: 16364180 PMCID: PMC1343550 DOI: 10.1186/1465-9921-6-149] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 12/19/2005] [Indexed: 12/22/2022] Open
Abstract
Background Recent consensus statements demonstrate the breadth of the chronic rhinosinusitis (CRS) differential diagnosis. However, the classification and mechanisms of different CRS phenotypes remains problematic. Method Statistical patterns of subjective and objective findings were assessed by retrospective chart review. Results CRS patients were readily divided into those with (50/99) and without (49/99) polyposis. Aspirin sensitivity was limited to 17/50 polyp subjects. They had peripheral blood eosinophilia and small airways obstruction. Allergy skin tests were positive in 71% of the remaining polyp subjects. IgE was<10 IU/ml in 8/38 polyp and 20/45 nonpolyp subjects (p = 0.015, Fisher's Exact test). CT scans of the CRS without polyp group showed sinus mucosal thickening (probable glandular hypertrophy) in 28/49, and nasal osteomeatal disease in 21/49. Immunoglobulin isotype deficiencies were more prevalent in nonpolyp than polyp subjects (p < 0.05). Conclusion CRS subjects were retrospectively classified in to 4 categories using the algorithm of (1) polyp vs. nonpolyp disease, (2) aspirin sensitivity in polyposis, and (3) sinus mucosal thickening vs. nasal osteomeatal disease (CT scan extent of disease) for nonpolypoid subjects. We propose that the pathogenic mechanisms responsible for polyposis, aspirin sensitivity, humoral immunodeficiency, glandular hypertrophy, eosinophilia and atopy are primary mechanisms underlying these CRS phenotypes. The influence of microbial disease and other factors remain to be examined in this framework. We predict that future clinical studies and treatment decisions will be more logical when these interactive disease mechanisms are used to stratify CRS patients.
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Affiliation(s)
- James N Baraniuk
- Georgetown University Proteomics Laboratory, Division of Rheumatology Immunology and Allergy, Room B105, Lower Level Kober-Cogan Building, Georgetown University, 3800 Reservoir Road, NW Washington, DC 20007-2197, USA
| | - Hilda Maibach
- Georgetown University Proteomics Laboratory, Division of Rheumatology Immunology and Allergy, Room B105, Lower Level Kober-Cogan Building, Georgetown University, 3800 Reservoir Road, NW Washington, DC 20007-2197, USA
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27
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Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, Jones N, Kalogjera L, Kennedy D, Kowalski M, Malmberg H, Mullol J, Passali D, Stammberger H, Stierna P. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005; 60:583-601. [PMID: 15813802 DOI: 10.1111/j.1398-9995.2005.00830.x] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- W Fokkens
- Academic Medical Centre, ENT, Amsterdam, The Netherlands
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28
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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
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29
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Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, Lanza DC, Marple BF, Osguthorpe JD, Stankiewicz JA, Anon J, Denneny J, Emanuel I, Levine H. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003; 129:S1-32. [PMID: 12958561 DOI: 10.1016/s0194-5998(03)01397-4] [Citation(s) in RCA: 530] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michael S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
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30
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Baroody FM. Allergic Rhinitis: Broader Disease Effects and Implications for Management. Otolaryngol Head Neck Surg 2003; 128:616-31. [PMID: 12748554 DOI: 10.1016/s0194-59980300257-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Allergic rhinitis is a burdensome disease for a significant part of the population in both adults and children. Poorly controlled allergic rhinitis can trigger exacerbations of asthma, sinusitis, and otitis media, diseases with which it shares common pathophysiologic elements. Consequently, early diagnosis and treatment should be a priority for patients and physicians, not only to control the symptoms of allergic rhinitis but also to improve the management of associated diseases. Several pharmacologic therapies can be considered in an armamentarium that includes antihistamines (intranasal and systemic), intranasal cromolyn, intranasal anticholinergic agents, intranasal steroids, systemic steroids, immunotherapy, and, most recently, leukotriene receptor antagonists. Often, combinations of these treatments are used to maximize control of refractory symptoms.
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MESH Headings
- Adult
- Asthma/epidemiology
- Asthma/therapy
- Child
- Comorbidity
- Cost of Illness
- Humans
- Inflammation Mediators/immunology
- Otitis Media/epidemiology
- Otitis Media/therapy
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/physiopathology
- Sinusitis/epidemiology
- Sinusitis/therapy
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Affiliation(s)
- Fuad M Baroody
- Section of Otolaryngology and Head and Neck Surgery, Pritzker School of Medicine, The University of Chicago, Illinois, USA.
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31
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Abstract
Atopy in its most common forms (asthma, allergic rhinitis, and atopic dermatitis) has a significant impact on society in terms of health care costs and quality of life. Aside from having significant morbidity from these diseases, patients with atopy have also been noted to have a high incidence of comorbidities, including bacterial infections such as otitis media and sinusitis. In this paper, current evidence is reviewed that supports the close associations among allergic rhinitis and the two commonly diagnosed bacterial diseases, otitis media and sinusitis.
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Affiliation(s)
- Samantha M Mucha
- Section of Otolaryngology-Head and Neck Surgery, The Pritzker School of Medicine, The University of Chicago, 5841 S. Maryland Ave, MC 1035, Chicago, IL 60637, USA
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32
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Abstract
Allergy and its relationship to chronic rhinosinusitis are important contemporary topics in the practice of otolaryngology. The relationship may go unrecognized. It is important to understand the current knowledge.
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33
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Blair C, Nelson M, Thompson K, Boonlayangoor S, Haney L, Gabr U, Baroody FM, Naclerio RM. Allergic inflammation enhances bacterial sinusitis in mice. J Allergy Clin Immunol 2001; 108:424-9. [PMID: 11544463 DOI: 10.1067/mai.2001.117793] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although it is not proven, one factor considered important in the development of sinusitis is allergic rhinitis. OBJECTIVE The purpose of this study was to determine whether ongoing allergic rhinitis enhances the infection and inflammation associated with Streptococcus pneumoniae acute sinus infection. METHODS BALB/c mice were sensitized to ovalbumin by intraperitoneal injection. After infection of the sinuses by S pneumoniae, either with or without concomitant administration of ovalbumin to induce allergic inflammation, mice were killed at various times and their heads were prepared for histologic evaluation of the sinuses. RESULTS Mice became allergic to ovalbumin and developed eosinophilia in the sinus and lung cavities in response to ovalbumin administration to each of the respective cavities. In comparison with controls, the mice with ongoing nasal allergic inflammation that were inoculated with S pneumoniae had significantly more bacteria recovered at sacrifice and had significantly more inflammation, as indicated by neutrophil, eosinophil, and mononuclear influx into the sinus mucosa. The percentage of the sinus area occupied by neutrophil clusters was also increased after infection in the allergic mice in comparison with the control mice. CONCLUSION Our data demonstrate that mice can be sensitized to ovalbumin and develop a localized allergic reaction in the skin, nose, or lung. An ongoing local allergic response augments bacterial infection in these animals. We also demonstrate that allergic sensitization alone, allergen exposure alone, or an allergic response at a distal site, the lung, does not augment the sinus infection.
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Affiliation(s)
- C Blair
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, IL 60637, USA
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34
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Emanuel IA, Shah SB. Chronic rhinosinusitis: allergy and sinus computed tomography relationships. Otolaryngol Head Neck Surg 2000; 123:687-91. [PMID: 11112958 DOI: 10.1067/mhn.2000.110961] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The management of chronic or recurrent rhinosinusitis problems is multifaceted and should include consideration of contributory and potentially correctable medical and anatomic factors. To date, the relationship between allergy and rhinosinusitis has not been clearly defined. The purpose of this study is to improve understanding of the relative roles of perennial and seasonal allergens in the cause of chronic rhinosinusitis. A retrospective review of 200 consecutive patients was carried out on patients who had chronic rhinosinusitis refractory to medical therapy and who subsequently underwent functional endoscopic sinus surgery. All of these patients had allergy testing for common perennial and seasonal inhalant allergens before surgery. Each patient had sinus CT imaging before undergoing the surgery. The CT scans of each patient were staged according to a validated, standardized grading system by investigators blinded to allergic profile. Allergy testing indicated that 84% of all patients tested positive for allergies. Moreover, 60% of all patients had significant allergic sensitivity; 52% of all patients had multiple allergen sensitivities. Furthermore, there was a predominance of perennial allergens, especially house dust mite over seasonal allergens. The vast majority of our patients undergoing functional endoscopic sinus surgery had concomitant allergy. This study highlights the potential contribution of perennial allergies to the development of rhinosinusitis. Given this direction, future studies may reveal that in the care of patients with perennial allergic rhinitis, early intervention with identification of the offending allergen(s), and subsequent treatment through avoidance, pharmacotherapy, and/or immunotherapy may help in the prevention of recurrent and chronic rhinosinusitis.
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MESH Headings
- Animals
- Chronic Disease
- Dust
- Endoscopy
- Humans
- Immunoassay
- Mites
- Recurrence
- Retrospective Studies
- Rhinitis/classification
- Rhinitis/diagnostic imaging
- Rhinitis/etiology
- Rhinitis/surgery
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/therapy
- Severity of Illness Index
- Single-Blind Method
- Sinusitis/classification
- Sinusitis/diagnostic imaging
- Sinusitis/etiology
- Sinusitis/surgery
- Skin Tests
- Tomography, X-Ray Computed
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Affiliation(s)
- I A Emanuel
- University of California, San Francisco, USA
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35
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Lavigne F, Nguyen CT, Cameron L, Hamid Q, Renzi PM. Prognosis and prediction of response to surgery in allergic patients with chronic sinusitis. J Allergy Clin Immunol 2000; 105:746-51. [PMID: 10756225 DOI: 10.1067/mai.2000.105218] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) occurs frequently in patients with atopy, but little is known of the prognosis after surgery and of factors that may predict a poor outcome. OBJECTIVE Our purpose was to assess the long-term prognosis in atopic patients with CRS who undergo surgery and whether certain immune markers could predict a worse prognosis in this setting. METHODS Fifteen patients with diffuse involvement of the sinuses on computed tomographic (CT) scan but without nasal polyposis underwent ethmoidectomy with middle meatotomy for CRS when it was clinically indicated. All patients had a biopsy of the inferior turbinate and of the most inflamed areas of the maxillary and ethmoid sinuses at the time of surgery. Follow-up was performed by video endoscopy and by assessment of 2 chronic sinusitis questionnaires at 0, 6, and 24 months postoperatively. The number of lymphocyte subsets (CD3, CD4, CD8), mast cells and eosinophils, and cells expressing IL-4 and IL-5 messenger RNA (mRNA) in all 3 biopsy sites at the time of surgery were compared with the clinical response after surgery. RESULTS Seven patients had persistent improvement after surgery, with a decrease in pain, rhinorrhea, or nasal obstruction and a decrease in the need for medication. Eight patients were unchanged or worsened after surgery with disabling rhinorrhea and repeated sinusitis. We found no difference in the number of inflammatory cells, lymphocyte subsets, or IL-4 mRNA-positive cells in the sinus mucosa between responders and nonresponders. However, an increased number of cells expressing IL-5 mRNA was found in the ethmoid sinus at the time of surgery in patients who did not respond to the surgical intervention (P =.007). CONCLUSION More than 50% of patients with perennial rhinitis and CRS do not improve after surgery, a response that may be predicted by more cells expressing IL-5 mRNA in the ethmoid sinuses. The increased number of cells expressing IL-5 mRNA may have the potential to be used as a marker for prediction of the response to surgery. The worsening of symptoms in some patients with CRS after sinus surgery could be a result of the disturbance of the anatomy of the sinuses and exposure to the environmental allergens.
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Affiliation(s)
- F Lavigne
- Centre Hospitalier de l'Universitaire de Montréal, Notre-Dame Hospital, University of Montreal, Montreal, Quebec, Canada
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36
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Suzuki M, Watanabe T, Suko T, Mogi G. Comparison of sinusitis with and without allergic rhinitis: characteristics of paranasal sinus effusion and mucosa. Am J Otolaryngol 1999; 20:143-50. [PMID: 10326748 DOI: 10.1016/s0196-0709(99)90061-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE The relationship between chronic sinusitis and allergy has been discussed for many years. Type I allergies are believed to be involved in chronic sinusitis. However, there is not enough evidence to allow allergic sinusitis to be distinguished as an exact entity. This study was designed to examine the role of immunoglobulin E-mediated allergic reactions in allergic sinusitis. PATIENTS AND METHODS We investigated the differences between 31 patients with allergic rhinitis and chronic sinusitis (allergic sinusitis) and 48 control subjects with nonallergic chronic sinusitis (chronic sinusitis). The pathological features of paranasal sinus effusion and mucosa were examined and compared in these two groups. RESULTS The number of eosinophils, activated eosinophils, and neutrophils was higher in paranasal sinus effusion from patients with allergic sinusitis. The concentration of interleukin-5 was higher in the effusion of allergic sinusitis patients. In addition, more eosinophils and activated eosinophils infiltrated into the sinus mucosa of patients with allergic sinusitis. CONCLUSION The type I allergic reaction has a significant role in the pathogenesis of sinusitis arising in patients with allergic rhinitis.
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Affiliation(s)
- M Suzuki
- Department of Otolaryngology, Oita Medical University, Japan
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37
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Abstract
Allergic rhinitis is a problematic disorder that is common. The practicing physician recognizes the majority of the overt clinical symptoms of sneezing, nasal itching, postnasal discharge, and eye symptoms but may not be attuned to the more subtle symptoms of lethargy, headache, and loss of productivity they create. Food sensitivities may complicate the evaluation and treatment of the sensitive patient, and frequently the idea of foods causing problems with rhinitis is ignored. For most patients, practical medications are beneficial in reducing symptoms without producing the side effects of sedation. The newer topical nasal steroids are becoming the first line of therapy, and nonsedating antihistamines are still useful because they have few side effects. Immunotherapy is recommended for treatment failures in the appropriate patient. Specialty referral then should be considered.
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MESH Headings
- Administration, Topical
- Anti-Inflammatory Agents/therapeutic use
- Food Hypersensitivity/complications
- Food Hypersensitivity/diagnosis
- Glucocorticoids
- Headache/physiopathology
- Histamine H1 Antagonists/therapeutic use
- Humans
- Immunotherapy
- Nasal Decongestants/therapeutic use
- Pruritus/physiopathology
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/physiopathology
- Sleep Stages/physiology
- Sneezing/physiology
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Affiliation(s)
- J A Hadley
- Department of Otolaryngology, University of Rochester Medical Center, New York, USA
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38
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Yawn BP, Yunginger JW, Wollan PC, Reed CE, Silverstein MD, Harris AG. Allergic rhinitis in Rochester, Minnesota residents with asthma: frequency and impact on health care charges. J Allergy Clin Immunol 1999; 103:54-9. [PMID: 9893185 DOI: 10.1016/s0091-6749(99)70525-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Asthma is a common and costly condition. Concomitant asthma and allergic rhinitis (AR) have been shown to increase the medication costs for people with asthma. No studies have compared medical care costs of those with and without concomitant AR. OBJECTIVES We sought to determine the prevalence and incremental medical care costs of concomitant AR. METHODS For each member of a population-based asthma cohort, we used all their medical charts within Olmsted County to record age at first diagnosis of asthma; the presence and age of any diagnosis of AR; and the total, ambulatory, and respiratory care-related costs of medical care. Costs were compared for age- and sex-specific strata of people with asthma who did and did not have AR. RESULTS AR was most commonly diagnosed in people whose asthma was diagnosed before age 25 (prevalence of 59%) and uncommonly diagnosed in anyone after age 40 (prevalence <15%). Yearly medical care charges were on average 46% higher for those with asthma and concomitant AR than for persons with asthma alone, controlling for age and sex. We were unable to assess the impact of treatment of AR on medical care charges. CONCLUSIONS Physicians should consider the diagnosis of AR (prevalence >50%) in all symptomatic children and young adults with asthma. Further evaluation is necessary to evaluate the ability of treatment to decrease the incremental costs of AR in persons with asthma.
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Affiliation(s)
- B P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minn, USA. Research, and the Allergic Diseases D
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39
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Ferguson BJ, Mabry RL. Laboratory Diagnosis. Otolaryngol Head Neck Surg 1997; 117:S12-26. [PMID: 9334784 DOI: 10.1016/s0194-59989770003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- B J Ferguson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA
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Abstract
The management of rhinosinusitis depends on a number of variables related to the duration and severity of symptoms in the individual patient. Furthermore acute rhinosinusitis is managed differently than chronic rhinosinusitis. Because a variety of conservative and pharmacologic interventions are available, the physician can find it difficult to develop a cohesive and logical approach to treatment. An understanding of the pathophysiology, microbiology, and natural history of rhinosinusitis is necessary to formulate the best treatment plan for the individual patient.
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Affiliation(s)
- M S Benninger
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA
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41
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Gable CB, Jones JK, Lian JF, Rajan M, Kennedy C. Chronic sinusitis: Temporal occurrence and relationship to medical claims for upper respiratory infections and allergic rhinitis. Pharmacoepidemiol Drug Saf 1994. [DOI: 10.1002/pds.2630030607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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42
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Nishioka GJ, Cook PR, Davis WE, McKinsey JP. Immunotherapy in patients undergoing functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 1994; 110:406-12. [PMID: 8170685 DOI: 10.1177/019459989411000410] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A total of 283 consecutive patients with chronic sinusitis underwent functional endoscopic sinus surgery. There were 72 allergic patients and 211 nonallergic patients. Data were collected on the effect of immunotherapy on middle meatotomy patency, synechiae formation, and recurrent polyps in allergic patients. Data supported the following conclusions: (1) Immunotherapy given either before or after surgery does not statistically influence middle meatotomy patency, synechiae formation, or recurrence of polyps after functional endoscopic sinus surgery. However, the data do suggest, for all three outcome parameters, that allergic patients who undergo immunotherapy do better than those who do not undergo immunotherapy and, with the exception of recurrent polyps, do as well as nonallergic patients. (2) The prevalence of preoperative polyps is the same for allergic and nonallergic patients in this study, but polyp recurrence is higher in allergic patients. (3) Approximately 40% of allergic patients who began preoperative immunotherapy stopped immunotherapy after surgery because their allergic symptoms resolved or were minimal. A comment regarding this observation is provided.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Chronic Disease
- Combined Modality Therapy
- Endoscopy/methods
- Female
- Follow-Up Studies
- Humans
- Immunotherapy/methods
- Male
- Middle Aged
- Nasal Polyps/complications
- Nasal Polyps/epidemiology
- Nasal Polyps/therapy
- Postoperative Care
- Preoperative Care
- Prevalence
- Radioallergosorbent Test
- Recurrence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/therapy
- Sinusitis/etiology
- Sinusitis/surgery
- Skin Tests
- Tissue Adhesions
- Treatment Outcome
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Affiliation(s)
- G J Nishioka
- Department of Surgery, University of Missouri-Columbia 65212
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