Disturbed cognitive functions after nasal provocation in patients with seasonal allergic rhinitis

Background Allergic rhinitis (AR) reduces quality of life as a result of impaired psychological well-being and perceived impaired cognitive functioning. Few studies have measured cognitive functions objectively and it remains uncertain whether AR leads to an objective reduction in cognitive functions.
Objective The present study investigated whether AR is associated with a decrement in several aspects of cognitive functioning. Furthermore, the study investigated whether AR patients invest more 'mental effort' in order to achieve the same cognitive performances as healthy controls.
Methods Twenty five patients with seasonal allergic rhinitis (SAR) and 26 healthy controls, matched for age, education and sex, were tested on a battery of time-demanding and strenuous objective cognitive tests and subjective questionnaires, both before and after nasal provocation (NP). The cognitive functions assessed were sustained attention, short- and long-term memory and speed of information processing. Mental effort was assessed using visual rating scales.
Results Sustained but not short cognitive performance was impaired in patients after NP. Patients showed an increased effort on short cognitive tests.
Conclusion SAR patients suffer from cognitive performance decrements that can be compensated by additional mental effort for short tasks only.     

Elevated soluble tumor necrosis factor receptor levels in seasonal allergic rhinitis patients

In this study, we examined the symptom scores and tumor necrosis factor-alpha (TNF-alpha), p55 soluble tumor necrosis factor receptor (sTNFR1), and p75 soluble tumor necrosis factor receptor (sTNFR2) levels in the sera and nasal epithelial lining fluids (ELF) of 20 patients with Japanese cedar pollinosis from the pre- to the postseason period, and compared the results with those of 10 nonallergic control subjects. The symptom scores of the allergic subjects were significantly (P<0.01) higher than those of the nonallergic subjects during the early stage and mid-stage of the season. There were no statistical differences between the allergic and nonallergic subjects in the TNF-alpha levels in sera and ELF from the pre- to the postseason. In the allergic subjects, however, the levels of sTNFR1 and sTNFR2 in ELF were significantly elevated during the early stage (P<0.05) and mid-stage (P<0.01) of the season, whereas those in sera did not change from the pre- to the post-season period. The levels of TNF-alpha in ELF were more than 10 times higher than those in sera, whereas the levels of sTNFR1 and sTNFR2 in ELF were less than half of those in sera in the allergic and nonallergic subjects. These results suggest that sTNFR1 and sTNFR2 may play a role in the pathogenesis of nasal allergic reaction.     

Decongestant efficacy of desloratadine in patients with seasonal allergic rhinitis

Recent advances in experimental immunologic approaches to seasonal allergic rhinitis (SAR) have led to a shift in the concepts of its pathogenesis. The conventional view of SAR as a local response to inhaled allergens has largely given way to a new view of this disorder as a systemic condition with local tissue manifestations. This concept, together with an increasing recognition of specific mediators' distinct roles in driving the early- and late-phase allergic responses, has opened multiple lines of therapeutic attack within the allergic cascade. Potent inhibition of inflammatory mediator release at distinct points in this cascade is conferred by desloratadine. In addition to the familiar range of SAR symptoms amenable to antihistamine therapy, desloratadine uniquely attenuates patient ratings of nasal congestion. This novel, nonsedating histamine H₁-receptor antagonist is the only once-daily antiallergic product with a consistent decongestant effect that begins within hours of the first morning dose and is sustained for the entire treatment period.     

Loratadine-pseudoephedrine combination versus placebo in patients with seasonal allergic rhinitis

Two hundred sixty-four patients with moderate to severe seasonal allergic rhinitis were treated with loratadine 5 mg plus pseudoephedrine 120 mg twice a day or placebo in a 28-day multicenter study. Four nasal and four non-nasal symptoms were evaluated for efficacy. At the last evaluable visit, the active treatment group had significantly lower (P = .05) mean combined nasal and non-nasal symptom scores than the placebo group. Also, the physician's rating of overall therapeutic response was significantly better in the active-treatment group (P = .03). Dry mouth, insomnia, and nervousness were reported by a significantly greater proportion (P less than or equal to .04) in the active-treatment group. Sedation occurred in 7% of patients in each treatment group and 6% of patients in each group discontinued the study because of adverse experiences. Loratadine plus pseudoephedrine was safe and significantly more effective than placebo in relieving the symptoms of allergic rhinitis.     

Different serum soluble Fas levels in patients with allergic rhinitis and bronchial asthma

BACKGROUND: The pathogeneses of allergic rhinitis and bronchial asthma are believed to be closely mutually related because of the similar dynamics of allergy-inducing cells and molecules and clinical overlap. In this study, we compared these diseases in the dynamics of cell apoptosis-regulating molecules. METHODS: Allergic rhinitis patients (n=36), bronchial asthma patients (n=22), and healthy subjects (n=32) were subjected to measurement of serum (soluble Fas) (sFas) levels during the stable and attack disease phases by a sandwich enzyme-linked immunosorbent assay. RESULTS: Serum sFas levels in patients with allergic rhinitis during the attack phase were significantly lower (P<0.0001) than those in healthy individuals. There were no differences between them during the attack and stable disease phases. In contrast, serum sFas levels in patients with bronchial asthma during the attack phase were higher (P<0.0005) than those in healthy individuals. Interestingly, the levels during the attack phase were lower (P<0.002) than those during the stable phase. CONCLUSIONS: Our results suggest a different pathogenesis for allergic rhinitis and bronchial asthma at the cell apoptosis-linked step.     

Characteristics of patients with seasonal allergic rhinitis and concomitant asthma

BACKGROUND: Allergic rhinitis and asthma often co-exist and appear to produce a continuum of airway disease, but whether the clinical characteristics of asthma in patients with seasonal rhinitis differ from those of persistent asthma has not been examined. OBJECTIVE: The aim of this retrospective study was to characterize the clinical features of patients with seasonal allergic rhinitis with concomitant asthma and to compare them with those in patients with persistent asthma. METHODS: The patient populations for this study were derived from nine prospective, placebo-controlled planned clinical trials of similar design. Six studies (958 patients) enrolled patients with seasonal allergic rhinitis and concomitant asthma; three (607 patients) involved patients with persistent asthma. In all studies, patients were excluded from oral corticosteroid therapy in the preceding 3 months, and from inhaled corticosteroids in the preceding month. RESULTS: Patients with seasonal rhinitis and asthma had a significantly (P<0.001) higher total asthma symptom score than those with persistent asthma. In particular, cough was three times more severe. The need for beta(2)-agonist as a rescue medication and the ratio of forced expiratory volume in 1 s/forced vital capacity (FVC) were similar in the two groups whereas forced expiratory fraction 25-75%/FVC was significantly (P<0.02) reduced in the persistent asthmatics. Asthma and nasal symptom severity scores were correlated in patients with seasonal rhinitis and asthma (P<0.0001). CONCLUSIONS: Patients with seasonal allergic rhinitis and concomitant asthma appear to differ from those with persistent asthma. A prospective study should be designed to discover whether patients with seasonal rhinitis and asthma may represent a distinct nosological entity, 'allergic airway disease'.     

Vitamin D serum levels and allergic rhinitis

In addition to its role in the regulation of calcium metabolism, vitamin D has a number of immunological effects. Several studies in children found an effect of oral supplementation on allergic sensitization but so far there are no population-based studies of vitamin D serum levels. We therefore examined 25(OH)-D(3) status in 18,224 adults of the Third National Health and Nutrition Examination Survey. There was no effect on sensitization to a single allergen while the prevalence of allergic rhinitis increased across quartile groups of current vitamin D serum levels. The association could be due to unrecognized confounding, however, could also point towards an altered metabolism or an increased sensitivity to vitamin D in allergic patients.     

A pilot study of pemirolast in patients with seasonal allergic rhinitis

Pemirolast is a potent, long-acting, orally effective antiallergic agent evaluated for clinical activity in prevention of symptoms of seasonal allergic rhinitis. It was evaluated in a randomized, double-blind, placebo-controlled parallel group in season trials to test its safety, tolerance, and prophylactic activity. Thirty-one patients with a history of fall seasonal allergic rhinitis were treated for 6 weeks with pemirolast, 50 mg bid, or placebo beginning approximately 2 weeks before the onset of the ragweed season in Atlanta. Daily evaluation of symptom scores disclosed statistically significantly less sneezing, rhinorrhea, and stuffy nose during treatment with pemirolast. There was, however, no difference for other evaluated symptoms or for the use of rescue medicines. There were no side effects during this short study. This preliminary study indicates that pemirolast may warrant further evaluation for the treatment of allergic rhinitis.     

Seasonal variations of total histamine in patients with seasonal allergic rhinitis

Seasonal variations of total blood histamine were examined in twenty patients with seasonal allergic rhinitis (Japanese cedar pollinosis). In blood specimens taken in the pollen season of 1978, the symptom-free season of 1978. and the pollen season of 1979, the mean values of blood histamine were 61.6, 50.0 and 84.2 ng/ml respectively. The differences in blood histamine levels between the pollen season of 1978 and the symptom-free season of 1978 and between the symptom-free season of 1978 and the pollen season of 1979 were statistically significant. In the symptom-free season of 1978, the blood histamine levels of twenty normal subjects were also examined: the mean value was 58.2 ng/ml. The blood histamine levels of the patients in the symptom-free season were not statistically different from those of the normal subjects.     

Effects of seasonal allergic rhinitis on fatigue levels and mood

OBJECTIVE: Many allergy patients complain of fatigue, moodiness, and dysphoria during their allergy seasons. This study evaluated the effect of symptomatic allergic rhinitis on both fatigue level and mood. METHOD: Symptomatic ragweed allergic rhinitis patients on no medications and healthy control subjects completed the Multi-Dimensional Fatigue Inventory and the Positive Affect-Negative Affect mood rating scales in an in-out-in ragweed season research design. RESULTS: During ragweed seasons, allergic patients reported higher levels of general fatigue and mental fatigue, but not physical fatigue, as well as reduced motivation. Patients described experiencing feelings of greater sadness and reduced pleasurable engagement. Increased anxiety or emotional distress was not reported. CONCLUSIONS: These findings suggest that having allergic reactions to ragweed pollen causes significant fatigue and mood changes in at least a subgroup of patients. Psychoneuroimmunology and medical genetics research suggests that allergic reactions engender biochemical changes that directly affect the central nervous system.     

Rhinosinusitis among the patients with perennial or seasonal allergic rhinitis

Although no hypothesis is universally accepted, allergic rhinitis (AR) may play an important role in the occurrence of rhinosinusitis. This study was carried out to investigate the frequency and severity of rhinosinusitis among patients with seasonal or perennial AR. This study included 73 patients with AR. Findings related to rhinosinusitis of these patients were demonstrated by computed tomography (CT), and were scored according to the Lund-Mackay CT scan staging system. Fifty-two of the 73 patients (71.2%) were shown to have findings of rhinosinusitis. Of these 52, twenty-four patients (77.4%) had perennial AR and 28 (66.7%) patients had seasonal AR. The mean total CT staging score of rhinosinusitis was 4.2 +/- 3.2 in patients with perennial AR and 2.6 +/- 1.3 in patients with seasonal AR. Although the frequency of rhinosinusitis among patients with perennial AR was higher than among seasonal ones, this was statistically insignificant (p = 0.32). But CT staging scores of rhinosinusitis among the patients with perennial AR were significantly higher than among the seasonal AR group (p = 0.014). Although there was no significant difference between the frequency of rhinosinusitis of seasonal and perennial AR, the severity of rhinosinusitis was more severe in cases with perennial AR, in this study. Early management of an allergic disease is essential if its long-term consequences are to be prevented or minimized.     

Increased carbon monoxide in exhaled air of patients with seasonal allergic rhinitis

BACKGROUND: Carbon monoxide (CO) can be detected in exhaled air and is increased in asthmatic patients. However, it is uncertain whether exhaled CO is increased in patients with allergic rhinitis. OBJECTIVE AND METHODS: To study whether exhaled CO is increased in patients with allergic rhinitis, exhaled CO concentrations were measured on a CO monitor by vital capacity manoeuvre in 86 patients with seasonal allergic rhinitis during and out of the cedar pollen season. RESULTS: During the season, exhaled CO concentrations were 3. 6 +/- 0.3 p.p.m. and decreased to 1.2 +/- 0.1 p.p.m. out of the season. The values of exhaled CO out of the season were similar to those in age-matched non-smoking healthy control subjects (1.2 +/- 0. 1 p.p.m.). Exhaled CO concentrations were significantly higher in patients with symptoms than in those without symptoms (P < 0.01). Exhaled CO concentrations in patients did not differ significantly among oral and nasal exhalation, and oral exhalation with an expiratory resistance (P > 0.20). CONCLUSION: These findings suggest that allergic rhinitis increases the concentration of CO in exhaled air and increases in exhaled CO may be derived from lower airways.     

Analysis of exhaled leukotrienes in nonasthmatic adult patients with seasonal allergic rhinitis

BACKGROUND: Leukotrienes (LTs) are increased in exhaled breath condensate (EBC) in patients with asthma. So far no data have been reported about LT levels in nonasthmatic patients with seasonal allergic rhinitis (SAR). The aim of the study was to find out whether the LT levels in EBC were increased in the nonasthmatic adult patients with SAR both during and after the pollen season in comparison with healthy controls and to assess the changes of the LT levels after the pollen season. METHODS: Twenty-nine nonasthmatic adult patients with SAR underwent measurement of exhaled LTs in the EBC during and after the pollen season. Leukotrienes B(4), C(4), D(4) and E(4) were analysed by a specific and sensitive gas chromatography/mass spectrometry (GC/MS) assay and compared with 50 healthy nonsmoking controls. Spirometry, skin prick tests and nonspecific IgE were evaluated. RESULTS: Leukotrienes concentrations (B(4), E(4) but not D(4)) were significantly increased in and after the pollen season in patients with SAR in comparison with healthy controls. In most of the samples, LT C(4) was undetectable. The values of all exhaled LTs were significantly decreased after the pollen season compared with the seasonal baseline: LTB(4) (P = 0.023), LTD(4) (P = 0.020), LTE(4) (P = 0.047). CONCLUSIONS: Levels of exhaled LTB(4) and LTE(4) were higher in SAR patients than in healthy controls and decreased after the pollen season as compared with levels in season. The SAR patients with the highest in season LT levels had also the post-season levels elevated and this may be an early marker of inflammatory process in the lower airways despite the absence of clinical symptoms of asthma.     

Comparison of olfactory function in patients with seasonal and perennial allergic rhinitis

Hyposmia is a common symptom in allergic rhinitis. However, little is known about differences in the olfactory function of patients with seasonal or perennial allergy. A prospective controlled study was performed on 28 patients with allergic rhinitis to grass pollen and on 47 patients with allergic rhinitis to mites. Sixty-six healthy volunteers served as a control. Olfactory function was evaluated by a modified Connecticut Chemosensory Clinical Research Center testing procedure for threshold, identification, and discrimination. The grass pollen-allergic patients were tested prcseasonally and after 3 weeks of intraseasonal grass pollen exposure: the mite-allergic patients and the volunteers were tested once. In the mite allergies, olfactory threshold, identification, and discrimination tests were significantly worse than in the volunteers (all P<0.0001). In the grass pollen allergies, the results in olfactory identification and discrimination tests were not different from the controls if tested out of the season (both F>0.05). However, in threshold testing (P=0.0139), the results were worse. Intraseasonally, the grass pollen allergies showed a significant decrease in threshold, identification (both P<0.001), and discrimination testing (P=0.0()29). If the intraseasonal pollen allergies were compared to the mite allergies, they showed better results in identification (F=0.(X)87) and threshold (F<0.001) tests, but worse results m discrimination testing (P=0.(XM)2). Therefore, the different kind of allergen exposure seems to result in a different pattern of allergic olfactory dysfunction.     

Soluble HLA-G and HLA-A,-B,-C serum levels in patients with allergic rhinitis

Background: Allergic rhinitis (AR) is characterized by Th2‐polarized immune response. Soluble HLA (sHLA) molecules play an immunomodulatory activity. So far, however, no study investigated them in AR. Objective: The aim of this study was to evaluate sHLA‐G and sHLA‐A,‐B,‐C serum levels in AR patients with pollen allergy and in a group of healthy controls. Methods: Forty‐nine AR patients were enrolled. A group of healthy nonallergic subjects was considered as control. sHLA‐G and sHLA‐A,‐B,‐C serum levels were determined by immunoenzymatic method. The study was conducted during the winter, such as outside the pollen season. Results: Allergic patients had significantly higher levels of both sHLA‐G (P < 0.0001) and sHLA‐A,‐B,‐C (P = 0.011) molecules than normal controls. Moreover, there was a significant relationship between these two soluble molecules (r = 0.69) in allergic patients. Conclusion: The present study provides the first evidence that both sHLA‐G and sHLA‐A,‐B,‐C serum levels are significantly increased in AR patients with pollen allergy.     

Nasal reactivity to capsaicin in patients with seasonal allergic rhinitis during and after the pollen season

BACKGROUND: We aimed to study the participation of neurogenic mechanisms in nasal allergic inflammation by assessing the effect of neurogenic stimulation on the secretory and cellular responses of nasal mucosa in patients with allergic rhinitis. METHODS: A group of patients suffering from seasonal allergic rhinitis was challenged intranasally with incremental doses of capsaicin (0.3, 3, 12 microg) during and after the pollen season. Clinical symptoms after provocations were monitored, and unilateral nasal lavages were obtained. The nasal lavage fluid (NAL) was assayed for concentration of total protein, albumin, lactoferrin, and number of leukocytes, following by differential count. RESULTS: Capsaicin challenge during the pollen season produced greater congestion (P < 0.01) and rhinorrhea (P < 0.05) than after the season. The intensity of burning sensation (pain) was similar on both occasions. Capsaicin failed to increase albumin content in NAL both during and after the season. Total protein was increased only after the highest dose of capsaicin (P < 0.03) after the season. The number of eosinophils in basal lavages was higher during the season. During the season, the total number of leukocytes at least doubled in 7/12 patients and the percentage of eosinophils increased in 6/12 patients after the capsaicin challenge. CONCLUSIONS: Our study demonstrated that during the symptomatic period the nasal mucosa of allergic patients is more susceptible to neurogenic stimulation, showing enhanced secretory and inflammatory (cellular) responses.     

Eosinophil markers in seasonal allergic rhinitis

Background The purpose was to study activation markers of the eosinophil granulocytes in seasonal allergic rhinitis, and the impact of topical steroid therapy thereupon.
Methods Sixty-three rhinitis patients with monoallergy to grass were examined before and at peak pollen season. Blood eosinophil count, eosinophil cationic protein (ECP), and eosinophil peroxidase (EPO) in serum and nasal lavage fluid were measured. During the season, patients were randomized to treatment with intranasal fluticasone propionate 0.1 mg o.d. ( n =26), 0.2 mg o.d. ( n =25), or placebo (n = 12). Six healthy persons served as controls.
Results During the season, all parameters, except nasal lavage ECP, increased in the placebo group (P<0.001 – P<0.05). Significant differences were seen between the steroid grotips and the placebo group for all parameters (P<0.001–F<0.05). Higher eosinophil count (P<0.05), serum EPO (F<0.02), and nasal lavage EPO (P<0.05) were found in patients before season than in controls. The following winter, 44 patients returned for repeated measurement. Lower levels of nasal lavage EPO were observed for patients than levels at the beginning of the season (P<0.0001).
Conclusions Intranasal fluticasone propionate reduced inflammation of the nasal mucosa, demonstrated locally by nasal lavage ECP and EPO, and systemically by blood eosinophils, serum ECP, and serum EPO. EPO seemed more sensitive than ECP as indicator of allergic inflammation. EPO demonstrated some perennial eosinophil activity in hay fever patients, increasing locally during spring.     

Specific IgE serum concentration is associated with symptom severity in children with seasonal allergic rhinitis

Background: The impact of allergen‐specific and total IgE serum levels before and during the pollen season on symptom severity as well as efficacy of treatment with anti‐IgE requires further delineation. Methods: Birch and grass pollen allergic patients aged 6–17 years with seasonal allergic rhinitis (SAR) were analyzed for the association of IgE serum concentration with symptom severity and rescue medication use (combination: symptom load, SL) during the grass pollen season. Reference group A (n = 53) received placebo, while group B (n = 54) received Omalizumab (anti‐IgE) monotherapy before and during the grass pollen season. Results: Patients on placebo with high baseline specific grass pollen IgE (>50 kU/l) had a significantly higher SL compared with those with low IgE levels (≤50 kU/l): SL 1.28 vs 0.61, P = 0.015. This association was nonexistent in patients treated with anti‐IgE. In contrast, baseline total IgE levels did not correlate with SL in any group. Patients with anti‐IgE treatment and high free total IgE levels (>16.7 ng/ml) had a significantly higher SL compared with those with low free total IgE levels (≤16.7 ng/ml): SL 0.63 vs 0.23, P = 0.031. Conclusions: Baseline specific IgE, but not total IgE, is associated with symptom severity during the pollen season in children with SAR. Likewise, the symptom load in SAR patients with anti‐IgE correlates with free total IgE levels. Although further research in larger populations is needed to confirm our findings, our data suggest that specific IgE can be used as a parameter for patient selection for this kind of treatment.