Efficacy of a leukotriene receptor antagonist in the treatment of perennial allergic rhinitis

The objectives of this study were to investigate the efficacy of leukotriene receptor antagonists in the treatment of perennial allergic rhinitis. The study was designed as a randomized, 14-day treatment to compare the efficacy of zafirlukast, loratadine, and the combination of loratadine and pseudoephedrine in the treatment of perennial allergic rhinitis. Rhinitis symptom scores, acoustic rhinometry, and rhinomanometry were used to evaluate the efficacy. The results showed that after a 14-day treatment period, patients in all treatment groups had a lower mean score for the symptoms of rhinorrhea, nasal itching, and nasal obstruction (p < .05). Patients who took zafirlukast did not report a significant decrease in sneezing score (p = .1456), but the decrease in nasal obstruction score was more pronounced than in those who took loratadine or loratadine- pseudoephedrine (p = .014). However, the results of acoustic rhinometry and rhinomanometry did not have a significant difference among the three groups (p > .05). The study concluded that zafirlukast seemed to have a better effect on relieving the symptom of nasal obstruction in patients with perennial allergic rhinitis, but the actual mechanism needs further investigation.     

Current pathophysiologic aspects of allergic rhinitis. I

Allergic rhinitis is a classic example of a type I immunological reaction. After allergic provocation tests a biphasic reaction is seen in the respiratory tract that is more pronounced in the lower than in the upper respiratory tract due to the physiological changes during the nasal cycle. The early phase of the immediate reaction starts some minutes after allergen provocation. After 5-10 h the nasal symptoms (discharge, blockage, sneezing and itching of the nose) reappear, a phenomenon which is called the "late-phase response" (LPR). The LPR is of great clinical importance in the pathophysiology of perennial allergic rhinitis and phenomena such as nasal priming and nasal hyper-reactivity. The most important effector cell of the early phase of the immediate reaction is the mast cell, whereas basophils, eosinophils and neutrophil granulocytes seem to be more important for the LPR. There is also evidence for morphological and functional heterogeneity of mast cells in man. The role of the chemotactically immigrated eosinophils in allergic reactions has not been clear until now: the eosinophil-derived mediators may enhance or inhibit the allergic reaction. Also the eosinophils show different morphological and functional states (so-called hypo- and hyperdense eosinophils). The symptoms of allergic rhinitis (sneezing, discharge, blockage, itching of the nose) are caused by different mediators, of which the most important is histamine. Other mediators or modulators of the allergic reactions are leucotrienes, prostaglandins, PAF, serotonin, and the kallikrein-kinine and complement systems. In recent years many regulatory peptides have been detected in the human nasal mucosa.(ABSTRACT TRUNCATED AT 250 WORDS)     

Patients with positive allergen test have less favorable outcome after endoscopic microdebrider-assisted inferior turbinoplasty

BACKGROUND: Endoscopic microdebrider-assisted inferior turbinoplasty is a newly developed surgical technique to treat patients with nasal obstruction. Although the procedure has been reported to be safe and effective, we tested the hypothesis that the prognosis might deteriorate with time in allergic rhinitis patients as identified by a positive allergen test in patients who have a persistent regional inflammation of the nose. We assessed the degree of nasal obstruction in a prospective cohort to investigate whether positive allergen test predicts outcome. METHODS: In 70 consecutive patients, the symptom of nasal obstruction was evaluated subjectively by a visual analog scale (VAS) and objectively by acoustic rhinometry using cross-sectional area of the second notch (CSA-2) and nasal cavity volume before operation, and 3 months, 12 months after operation, respectively. Then, patients were classified and compared according to the multiple-antigen simultaneous test (MAST). RESULTS: Both MAST(+) and MAST(-) groups showed statistically significant improvement in VAS score, CSA-2, and nasal cavity volume at 12 months after operation (p < 0.01). Of note, MAST(+) patients showed less favorable results than MAST(-) patients at 12 months after operation (p < 0.05). CONCLUSION: Microdebrider-assisted inferior turbinoplasty provides effective relief for patients with nasal obstruction. However, such turbinate surgery may be successful only for a short period of time in patients with allergic rhinitis. Our finding suggests that, in selecting appropriate candidates, surgeons should consider criteria other than symptomatology, especially in patients with allergic rhinitis who may have manifestations other than at the level of the inferior turbinate contributing to nasal blockage.     

变应性鼻炎与慢性鼻窦炎的关系

目的:观察常年性变应性鼻炎患者鼻窦炎发生的原因及发生率。方法:回顾性分析57例常年性变应性鼻炎患者的临床资料。结果:18例并发鼻窦炎,发生率为32%;其中17例伴有不同程度不同类型的鼻腔解剖结构异常,包括鼻中隔偏曲、中鼻甲气化、钩突肥大、中鼻甲曲线异常和鼻丘气房过度发育等。39例单纯变应性鼻炎者只有7例伴有鼻腔解剖结构异常。结论:变应性鼻炎并发鼻窦炎的基础可能是鼻腔解剖结构异常,变态反应导致的鼻腔黏膜水肿和鼻腔分泌物性质的改变是鼻窦炎的诱发因素之一。     

Clinical and immunohistoenzymatic investigations in patients with vasomotor and perennial allergic rhinitis

The aim of our study was evaluation of the results of clinical examination in patients with vasomotor and perennial allergic rhinitis and assessment of number of blood vessels, nerve fibres and mast cells on the basis of immunohistoenzymatic examination. There were 42 patients examined aged from 18 to 50 and divided into three groups: I--16 patients with vasomotor rhinitis and II--14 patients with perennial allergic rhinitis and III--12 patients (control) with nasal septum deviation. On the basis of the patient's history data, clinical otorhinolaryngologic examination and active anterior rhinomanometry the patients were qualified to bilateral inferior turbinectomy. The nasal mucosa removed during surgery underwent immunohistoenzymatic examination using the monoclonal antibody against the tryptase of mast cells (MCT company, DAKO), the endothelin of blood vessels (EC - DAKO) and the neurospecific enolase (NSE - DAKO). In examined groups of patients with vasomotor and perennial allergic rhinitis and control group similar escalation of clinical symptoms expressed by means of points index were stated. In immunohistoenzymatic studies the differences in mean number of blood vessels and nerve fibres between examined groups were not statistically significant, however statistically significant difference concerned higher number of mast cells patients with vasomotor rhinitis in comparison to perennial allergic rhinitis.     

Submucous electrocautery following submucous resection of turbinate bone--a rationale of surgical treatment for allergic rhinitis

OBJECTIVE: Since the majority of the key elements such as trigeminal nerves, parasympathetic nerves, nasal glands, and blood vessels targeted by histamine and leukotrienes are found in the lamina propria of the nasal mucosa, its selective electrocautery has a rationale to improve the symptoms of allergic rhinitis with preservation of epithelial layer. To achieve the above goal, we performed the submucous electrocautery of the lamina propria (SECLP) following the submucous resection of the inferior turbinate bone (submucous turbinectomy: SMT). This paper discusses the efficacy of this procedure for the patients with persistent perennial allergic rhinitis. METHODS: An intranasal initial incision was made along the piriform aperture. The mucoperiosteum was elevated from the inferior turbinate bone followed by its complete resection. The SECLP was performed by applying a high-frequency coagulation current with a ball tip electrode, which was inserted into the mucoperiosteal sack after the completion of the SMT and was drawn forward on the medial surface of the mucoperiosteum with drawing a wavy line. We performed this surgery in 43 patients with perennial allergic rhinitis who were refractory to pharmacotherapy or were reluctant to take medicine. Symptoms, macroscopic intranasal findings, the results of allergic tests, nasal resistance, mucociliary function with saccharin, and the number of mast cells were compared pre- and postoperatively. RESULTS: The patients exhibited satisfactory improvement in symptoms only with a few crust formations. The macroscopic intranasal findings and allergic tests improved after surgery. Saccharin transport time remained normal. The number of anti-tryptase positive mast cells significantly decreased in the epithelial layer and in the superficial layer of the lamina propria of the postoperative inferior turbinate mucosa. CONCLUSION: The SECLP following the SMT is evaluated to be a useful surgical modality for allergic rhinitis with preservation of the nasal mucosal function.     

Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] > 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.     

Allergic Rhinitis does not Constitute a Risk Factor for Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] &gt; 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.     

Vasomotor rhinitis

Vasomotor rhinitis is a nonallergic, noninfectious cause of nasal obstruction and rhinorrhea. The etiology is believed to be an imbalance of the autonomic neural supply to the nasal mucosa with resultant vasodilation and hypersecretion. Management hinges on identification of a treatable diagnostic entity, such as rhinitis medicamentosa or allergic rhinitis. Psychotherapy, medical therapy, and surgery all have roles in the treatment of vasomotor rhinitis. Response to therapy is often disappointing.     

Distilled water nasal provocation in hyperreactive patients.

Nonisotonic aerosol may act as a provocation agent in the upper and lower airways of hyperreactive individuals. The purpose of the study was to compare the results of nasal challenge with distilled water in patients with allergic rhinitis to those with noninfective nonallergic rhinitis (NINAR), with respect to the potential clinical use of the obtained data. A group of 68 ambulatory patients with allergic rhinitis or NINAR (39 perennial allergic, 6 seasonal, 23 NINAR) were challenged with 10 mL of distilled water aerosol after the baseline active anterior rhinomanometry. Patients with nasal polyposis at endoscopy, significant unilateral septal deviation, positive bacteriologic swab, recent nasal surgery, and uncertain anamnestic data about the medication taken 6 weeks before the provocation were excluded from the study. After 10 minutes of nasal provocation, rhinomanometry was repeated to assess the response. In 15 patients of the perennial allergic group, the same measurements were performed after a 2-week oral antihistamine and topical steroid therapy. Nasal resistance was significantly increased on the more patent side of the nose after nasal provocation with distilled water aerosol in allergic patients in comparison to the nasal resistance before provocation. In the patients with NINAR, the provocation resulted in a significant rise on the more patent side, but the total nasal airway resistance (NAR) levels were also significantly increased. The systemic antihistamine and topical steroid 2-week therapy in patients with perennial allergic rhinitis significantly reduced the response to nasal distilled water provocation. Nasal provocation with distilled water aerosol is a cheap, simple, and acceptable method that provides useful clinical data on the level of nonspecific nasal hyperreactivity and the therapy success.     

局部变应性鼻炎的研究进展

局部变应性鼻炎(LAR)是近年来新提出的一种变应性鼻炎(AR)表型,为非特应性患者中出现的鼻腔局部I型变态反应.患者有鼻痒、喷嚏、流涕、鼻堵等症状及鼻腔局部特异性IgE(sIgE)和(或)鼻腔变应原激发试验(NPT)阳性,可向AR转化并合并哮喘、结膜炎.虽皮肤点刺实验(SPT)及血清sIgE无阳性结果,但该类患者对变应...     

鼻炎冲剂治疗变应性鼻炎的临床观察与实验研究

目的 对常年性变应性鼻炎８９例分鼻炎冲剂治疗组和辛芩冲剂治疗组进行治疗,并比较其疗效,观察鼻炎冲剂对变应性鼻炎的治疗作用。方法 鼻炎冲剂治疗组和辛芩冲剂治疗组有效率分别为８８％和５３％。疗效间有极显著差异（Ｐ〈０．０１）。观察鼻炎冲剂对实验性变应性鼻炎动物模型鼻粘膜的影响。在整个治疗过程中观察记录鼻喷嚏反射,鼻部抓痒症状,并观察各线鼻粘膜组织学改变。结果 鼻炎冲剂治疗组症状得分明显低于其他组。鼻粘     

Effects of beclomethasone dipropionate nasal spray on subjective and objective findings in perennial allergic rhinitis

Effects of beclomethasone dipropionate nasal spray on subjective and objective findings in perennial allergic rhinitis It was the aim of this trial to study the effect of intranasal beclomethasone dipropionate on symptoms and signs of perennial allergic rhinitis in Japanese patients. In a multicenter trial 183 patients, children and adults, were treated with placebo or with 400 μgbeclomethasone dipropionate a day for 2 weeks. The active treatment had an effect on all nasal symptoms: sneezing, nose blowing, and blockage being reduced to 34%, 44% and 63% (P <0 01) of the values in the placebo group. A considerable carry-over effect was found, suggesting a group comparative design to be preferable for a cross over trial for the study of intranasal steroids. The beclomethasone dipropionate therapy had a significant inhibitory effect on the immediate response to nasal allergen provocation. The number of secretion eosinophils was reduced during treatment, and the appearance of the mucous membrane tended to normalize. Local side effects were few and insignificant. It is concluded that beclomethasone dipropionate is a valuable drug for the treatment of perennial allergic rhinitis.     

Assessment of the hearing organ in the patients with allergic perennial and seasonal allergic rhinitis

We studied 60 patients with allergic rhinitis (30 with seasonal and 30 with perennial rhinitis). Assessment of atopic status was based on medical history, physical examination, skin-prick testing, total IgE levels and nasal smears. Audiometry and tympanometry have been performed. Audiometric conductive hearing loss was found in 26.7% patients with perennial rhinitis and in 10% patients with seasonal rhinitis. Type B tympanogram were found in 20% of the patients with perennial rhinitis and in 3.33% of the patients with seasonal rhinitis. Type C tympanogram were found in 20% of the patients with perennial and in 6.67% with seasonal rhinitis. Secretory otitis media and retraction pockets were more common in patients with perennial rhinitis allergy. Local allergic reaction in the middle ear and dysfunction of the Eustachian tube can be the most responsible for these disorders. Tympanostomy and ventilation tubes were needed in secretory otitis and myringoplasty in the cases of the retraction pockets. Appropriate treatment of allergic rhinitis may decrease the need and frequency of surgical procedures and may reduce costs associated with hospitalization.     

持续性变应性鼻炎患者鼻中隔中神经肽的初步研究

目的：探讨持续性变应性鼻炎患者鼻中隔软骨及骨性鼻中隔中的神经肽含量较正常个体有无变化,从而探讨鼻中隔矫正手术对于变应性鼻炎的治疗意义。方法：接受鼻中隔黏膜下切除术患者45例,其中持续性变应性鼻炎患者20例,单纯性鼻中隔偏曲患者25例。以放射免疫分析法测定手术切除的鼻中隔软骨及骨性鼻中隔中的神经肽SP、VIP及cGRP含量,并比较其差异。结果：正常组骨性鼻中隔中SP、VIP及CGRP含量较鼻中隔软骨高（P〈0．05）;鼻炎组鼻中隔软骨与骨性鼻中隔中SP、VIP含量无明显差异（P〉0．05）,鼻中隔软骨中CGRP含量较骨性鼻中隔高（P〈0．05）;鼻炎组鼻中隔软骨中SP、VIP含量较正常组高（P〈0．05）,CGRP含量无明显差异（P〉0．05）,骨性鼻中隔中SP、VIP及CGRP含量较正常组无明显差异（P〉0．05）。结论：持续性变应性鼻炎患者鼻中隔中神经肽含量较正常个体增高,主要是鼻中隔软骨中的神经肽增高,因此鼻中隔黏骨膜下切除术后,变应性鼻炎能够得到缓解。     

Relationship between inflammation of upper and lower respiratory airways

Dysfunction of the upper and lower airways frequently coexists, and they appear to share key elements of pathogenesis. Data from epidemiologic studies indicate that nasal symptoms are experienced by as many as 78% of patients with asthma and that asthma is experienced by as many as 38% of patients with allergic rhinitis. Among patients with nasal polyps 27-51% have asthma. Polyps of nasal mucosa usually exacerbates symptoms of concomitant asthma. Studies also have identified a temporal relation between the onset of rhinitis and asthma, with rhinitis frequently preceding the development of asthma. Patients with allergic rhinitis and no clinical evidence of asthma commonly exhibit nonspecific bronchial hyperresponsivenes. The mechanisms upper and lower airway dysfunction are under investigation. They include nasal-bronchial reflex, mouth breathing caused by nasal obstruction, and pulmonary aspiration of nasal contents. Nasal allergen challenge results in increases in lower airway reactivity within 30 minutes, suggesting a neural reflex. Improvements in asthma associated with increased nasal breathing may be the result of superior humidification, warming of inspired air, and decreased inhalation of airborne allergens. Postnasal drainage of inflammatory cells during sleep also may affect lower airway responsiveness. The effective management of allergic rhinitis relieves symptoms of asthma. A link between allergic rhinitis and asthma is evident from epidemiologic, pathophysiologic, and clinical studies. The development of differential diagnosis of rhinitis has multiplied their present classifications. This article presents classifications of rhinitis connected with lower airways dysfunction.     

Changes in nasal resistance and quality of life after endoscopic microdebrider-assisted inferior turbinoplasty in patients with perennial allergic rhinitis

OBJECTIVE: To assess objective and subjective outcomes in patients with perennial allergic rhinitis who had undergone endoscopic microdebrider-assisted inferior turbinoplasty. DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Fifty patients with perennial allergic rhinitis who had substantial mucosal hypertrophy of the inferior turbinates and who underwent endoscopic microdebrider-assisted inferior turbinoplasty with follow-up 1 year after surgery. INTERVENTION: A newly designed microdebrider blade incorporated with an elevator was used to perform this procedure in the clinical setting with the patient under local anesthesia and with 30 degrees endoscopic guidance. MAIN OUTCOME MEASURES: Both objective outcome evaluated by total nasal resistance at anterior rhinomanometry and subjective outcome assessed with the Rhinoconjunctivitis Quality of Life Questionnaire were analyzed before and 1 year after surgery. RESULTS: The median total nasal resistance in 50 patients decreased from 0.45 Pa/cm(3) per second preoperatively to 0.28 Pa/cm(3) per second 1 year postoperatively, a statistically significant difference (P<.001). Compared with preoperative scores, the postoperative scores of these patients significantly improved in both 7 separate domain scores and overall Rhinoconjunctivitis Quality of Life Questionnaire scores (P<.005). CONCLUSION: Our results suggest that endoscopic microdebrider-assisted inferior turbinoplasty is effective for decreasing nasal resistance and improving quality of life in patients with perennial allergic rhinitis who have substantial nasal congestion.     

Patient preference survey on the lack of taste and odor of Nasonex nasal spray. Which impact on compliance to treatment?

In order to assess the acceptability of a new scent-free formulation of mometasone furoate (Nasonex) among allergic rhinitis patients, who already have been treated by the scented formulation of Nasonex, a phone survey was performed with a sample of 216 patients recruited by Nasonex GP's prescribers and pharmacists. The aim of this survey is to assess the diagnosis modalities, the allergic rhinitis characteristics and associated symptoms in one hand and in the other hand, the main reasons which led them to prefer a new scent-free formulation, in comparison with the only commercialized scented mometasone furoate (Nasonex) at the time when this survey was conducted. The impact of unscented Nasonex on patient's compliance to treatment was also assessed. This survey confirms that the GP is the key actor who usually establish the allergy diagnosis and the interrogatory is the principle method used. The prick test was more often and significantly used in 35% of the perennial rhinitis instead of 19% in seasonal allergic rhinitis (p < or = 0.05). When the diagnosis of allergy was established by an allergologist, 89% of them used a prick test. In this survey, asthma was associated in 24% of the patients, particularly in who suffering from perennial allergic rhinitis. 85% of patients rate their smell as globally good. 75% of the treated patients were interested by the new unscented formulation of Nasonex, regardless of the type of their rhinitis, seasonal or perennial. About 60% of patients stated that the lack of odor will led them to be more compliant to their treatment.