微波选择性热凝治疗变应性鼻炎的临床应用研究及治疗机制探讨

目的　研究微波热凝治疗变应性鼻炎的临床意义。方法　将 14 0例变应性鼻炎随机分为两组 ,观察组 6 8例施以微波选择性多点热凝治疗 ,对照组 72例服用抗组胺药物氯雷他定治疗。结果　两组的近期有效率分别为 95 .5 9%和 93.0 6 % (P >0 .0 5 ) ,远期有效率为 83.6 8%和 4 1.30 % (P <0 .0 1)。结论　微波治疗变应性鼻炎是一种安全有效的方法 ,具有临床应用价值。     

Sublingual Immunotherapy in Allergic Rhinitis: Efficacy,Safety, Adherence and Guidelines

Allergic rhinitis (AR) is a globally increasing health problem affecting the quality of life. Specific immunotherapy is an available causal treatment changing the basic allergic mechanisms of the disease. Over one hundred years, subcutaneous immunotherapy (SCIT) was developed and proved its efficacy but many adverse effects were recorded including anaphylaxis. In 1986, sublingual immunotherapy (SLIT) was introduced as an alternative solution to solve this problem. Our study aims to discuss SLIT from the points of efficacy, safety, adherence and guidelines developed. A literature search was conducted in Medline/PubMed and the Cochrane Library in January 2013 using the keywords "allergic rhinitis, sublingual immunotherapy, efficacy, safety, compliance, adherence, guidelines." All types of publications were included. We augmented our study by searching the reference lists of identified reviews. SLIT has been established in many guidelines as an evidence-based effective treatment in AR with safer profile than SCIT. The meta-analyses confirmed its efficacy and showed a significant reduction in both symptoms and medication scores. The most common recorded adverse effects were minor local effects in the mouth, gastrointestinal reactions with few cases of anaphylaxis and no fatality. Adherence is more favorable for SLIT mainly because it is safe, noninvasive and easily taken at home. We support the call to conduct large multi-centric studies to gain more statistical power and overcome the problem of heterogeneity observed in the meta-analyses.     

Assessment of Allergic Rhinitis Websites in Korea

Objectives

The internet has become an important source of medical information and a great amount of information related to allergic rhinitis (AR) is available on the internet. However, the quality of this information is still a matter of debate. Therefore, this study was conducted to assess the AR-related information on Korean websites.

Methods

The key word "allergic rhinitis" was entered into 4 popular search engines, and this led to identifying 40 websites. After being categorized according to authorship, the informational value of these websites was evaluated using 4 different assessment tools such as the Journal of the American Medical Association (JAMA) benchmarks, the DISCERN questionnaire, the Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update and the Health On the Net (HON) code.

Results

The 40 websites containing AR-related information were categorized according to their authorship as Western physician: 20, Oriental physician: 14, commercial: 1, and others: 5. The mean citation frequencies of the JAMA benchmarks and the ARIA 2008 Update concepts was 1.23 out of 4 and 4.33 out of 8, respectively, while the mean DISCERN score was 1.92 out of 5. When the websites were evaluated based on the type of authorship, the mean citation frequencies of the ARIA 2008 Update concepts were Western physician: 5.35, Oriental physician: 2.64. Additionally, three websites authored by Western physicians and 13 authored by Oriental physicians contained unreliable information. Among these 16 websites, only 3 websites met the requirements for the HON code "Justification".

Conclusion

AR-related information available on Korean websites is of variable quality and not all of the information provided is justifiable. Thus, performing surveillance of the medical information on these websites is necessary. Furthermore, common criteria that can be used to evaluate the websites created by both Western and Oriental physicians are also needed.     

Nasal and Exhaled Nitric Oxide in Allergic Rhinitis

Objectives

The primary aim of this study was to assess whether one can use levels of nasal nitric oxide (nNO) and exhaled nitric oxide (eNO) as a means of evaluation in allergic rhinitis.

Methods

We used a chemiluminescence analyzer to measure nNO and eNO in normal controls (n=34) and allergic rhinitis patients (n=35), and compared these measurements with various parameters of clinical symptoms and laboratory data.

Results

Mean nNO (389±119 ppb) in allergic rhinitis patients was significantly higher than normal controls (276±88 ppb). Without asthma, mean eNO (64.8±55.9 ppb) in allergic rhinitis patients was significantly higher than normal controls (33.0±24.0 ppb). In the persistent allergic rhinitis group, eNO concentration was significantly higher, while nNO concentration was significantly lower than the intermittent group.

Conclusion

We can use nNO and eNO levels for evaluation of allergic rhinitis. However, we should consider the fact that nNO levels can be reduced, when symptoms are severe and long-lasting. Additionally, in allergic rhinitis, eNO can be elevated without asthma.     

The Effect of Nano-Silver on Allergic Rhinitis Model in Mice

Objectives

Silver has long been known as a strong antimicrobial and disinfectant. Several types of nano-silver coated products have been developed. However, the antimicrobial and disinfectant characteristics of nano-silver have not been well studied. The aim of this study was to investigate the effect of nano-silver on allergic inflammation in a mouse model.

Methods

Female BALB/C mice were sensitized by intraperitoneal injection of ovalbumin (OVA) and aluminium hydroxide on days 0, 7, 14, and 21. Mice were challenged with intranasal instillation of OVA. Nano-silver was also administered nasally prior to intranasal instillation of OVA. Severity of allergic rhinitis was assessed according to nasal symptoms, serum OVA-specific IgE level, interleukin (IL)-4, IL-10, and interferon (INF)-γ levels in nasal lavage fluid. Hematoxylin-eosin stain and periodic acid-Schiff stain were performed for evaluation of histological change.

Results

Nano-silver attenuated manifestation of nasal symptoms in sensitized mice and inhibited production of OVA-specific IgE, IL-4, and IL-10, however, it had no effect on INF-γ level. In addition, the degree of inflammatory cell infiltration and goblet cell hyperplasia was attenuated by nano-silver.

Conclusion

These results suggest that nano-silver may effectively reduce allergic inflammation in a mouse model of allergic rhinitis. Through its properties as an anti-inflammatory agent, nano-silver may be a useful therapeutic strategy.     

Early Compliance and Efficacy of Sublingual Immunotherapy in Patients with Allergic Rhinitis for House Dust Mites

Objectives

Sublingual immunotherapy (SLIT) has recently received much attention around the world as a treatment for allergic rhinitis. This study aimed to investigate the efficacy and adverse effects of SLIT in Korean patients with allergic rhinitis caused by house dust mites. The treatment compliance and the patient satisfaction with SLIT were also assessed.

Methods

The patients who were sensitized to Dermatophagoides pteronyssinus and Dermatophagoides farinae and who started SLIT between November 2007 and July 2008 were included in this study. The symptom questionnaires, which included items on rhinorrhea, sneezing, nasal obstruction, itchy nose, olfactory disturbance, eye discomfort and sleep disturbance, were obtained before and 6 months after SLIT. The patient satisfaction and the adverse effects were also investigated.

Results

One hundred forty-two patients started SLIT and 98 of them continued SLIT for 6 months or more. Ninety-two of the 98 patients completed the questionnaires. The duration of receiving SLIT was 9.8 months on average (range, 6 to 13 months). All the symptoms of allergic rhinitis were improved with SLIT. Forty-five percent of the patients were satisfied for SLIT, while 12% were unsatisfied. The incidence of adverse effects was 12% during maintenance therapy, although it was 48% during the up-dosing phase. The drop-out rate of SLIT was 31.0%.

Conclusion

The subjective symptoms were improved with SLIT in Korean patients with allergic rhinitis for house dust mites. Yet the drop out rate was high despite of the symptomatic improvement.     

Effects of Topical Intranasal Doxycycline Treatment in the Rat Allergic Rhinitis Model

Objectives

Allergic rhinitis (AR) is a chronic upper respiratory tract disease that inflames the mucous membranes of the nose and occurs when circulating inflammatory cells including eosinophils and basophils migrate to and accumulate in the inflammation area by passing through the interstitium and capillary walls. To pass through these barriers, the inflammatory cells degrade extracellular matrix proteins. Matrix metalloproteinases (MMPs) released by inflammatory cells mediate the degradation of these proteins. MMPs have synthetic inhibitors and doxycycline, a tetracycline antibiotic, inhibits MMPs. This study investigated the efficiency of intranasal doxycycline in decreasing the symptoms and inflammatory cell infiltration in an animal model of AR.

Methods

AR was created in female Wistar rats by repeated intranasal challenge with ovalbumin by intraperitoneal injection. For 15 days, topical intranasal doxycycline was administered one hour before ovalbumin administration. Following intranasal administration, nasal symptoms were scored and the nasal mucosae of all rats were evaluated histopathologically. To investigate tissue changes, hematoxyline-eosin and Alcian blue/periodic acid Schiff stains were used. As well, cilia loss, goblet cell changes, vascular congestion, vascular proliferation, inflammatory cell infiltration, eosinophil infiltration and the degree of hypertrophy in chondrocytes were evaluated with light microscopy.

Results

Typical symptoms of AR were decreased by intranasal doxycycline administration. These effects were stable after repeated intranasal ovalbumin administration. Histological evaluation of doxycycline treated rats did not reveal typical inflammatory changes associated with AR.

Conclusion

MMPs may have crucial functions in AR and topical intranasal doxycycline, which decreases inflammatory cell infiltration, may offer an alternative therapy for AR.     

Effects of Rhinophototherapy on Quality of Life in Persistant Allergic Rhinitis

Objectives

To investigate the effect of rhinophototherapy with medical therapy on quality of life in persistent allergic rhinitis.

Methods

A prospective, randomized study was being performed between December 2009 and March 2010. The study included 65 patients with persistent allergic rhinitis. The diagnosis was confirmed with positive skin tests. All of the patients had house dust mite allergies. We divided the patients into two groups. First group (n=33) was given topical mometasone furoate 200 mcg/day and levocetirizine 5 mg/day for a month. Rhinophototherapy was applied with the same medical therapy to the second group (n=32), twice a week for three weeks continuously. Rhinophototherapy included visible light, ultraviolet A and ultraviolet B. We evaluated patients before the treatment, at the first month and at the third month after treatment with rhinoconjunctivitis quality of life questionnaire, nasal symptom scores and visual analogue scale (VAS) scores.

Results

Improvements of all variables of the quality of life questionnaire, nasal symptom scores and VAS were statistically significant in the second group both on the first and the third months when compared with the first group.

Conclusion

Allergic rhinitis is a social problem and impairs quality of life. Rhinophototherapy with medical therapy improves the quality of life in allergic rhinitis.     

Prevalence of Self-reported Allergic and Non-allergic Rhinitis Symptoms in Stockholm: Relation to Age,Gender, Olfactory Sense and Smoking

Objective--To estimate the prevalence of isolated self-reported allergic and non-allergic rhinitis symptoms in an adult population and to explore the relations to age, gender, olfaction and smoking habits. Material and methods--Self-judged health and environmental exposures were investigated by means of a questionnaire survey administered to a stratified random sample of 15,000 adults in Stockholm County. Results--A total of 10,670 individuals were included in the analysis, corresponding to a response rate of 73%. The results revealed a high prevalence of self-reported non-allergic rhinitis, 19%, almost as high as the prevalence of self-reported allergic rhinoconjunctivitis, 24%. In contrast to current clinical opinion, we did not find a significant increase in the prevalence of non-allergic symptoms with increased age. There were no statistically significant gender differences in the prevalence of either allergic or non-allergic symptoms. A reduced sense of smell was twice as common in the non-allergic group, 23%, as in the healthy population. The prevalence of rhinitis symptoms differed according to smoking habits. Conclusion--Both self-reported allergic rhinitis symptoms and non-allergic nasal symptoms are frequent in the population sample. Self-reported non-allergic nasal symptoms seem to occur independent of age and reduced olfactory sense is a common complaint among these subjects. The prevalence of self-reported allergic and non-allergic nasal symptoms did not differ much between men and women or between individuals with different smoking habits.     

鼻内镜下单侧翼管神经切断术对变应性鼻炎合并哮喘的疗效观察

目的评估鼻内镜下单侧翼管神经切断术治疗药物治疗效果不佳的变应性鼻炎(AR)合并哮喘患者的临床疗效。方法收集整理26例AR合并哮喘且均经鼻内镜下行单侧翼管神经切断术患者的临床资料,应用视觉模拟量表(VAS)、鼻结膜炎生存质量调查问卷(RQLQ)以及哮喘控制量表(ACT)来评估手术前后患者的生活质量。结果所有患者术后均随访3年以上,采用SPSS 21.0统计学分析,VAS评分和RQLQ平均得分术后6个月(10.00±4.22、32.58±15.31)、1年（8.35±6.88、28.62±12.06）、3年（7.46±4.22、28.69±5.66）均显著低于术前（24.34±8.66、59.81±21.20）;ACT评分术后6个月（22.65±1.52）、1年（22.27±2.27）及3年（22.85±2.38）均高于术前（20.92±2.64）,差异均具有统计学意义(P均<0.05)。结论鼻内镜下单侧翼管神经切断术对药物治疗效果不佳的AR合并哮喘患者疗效显著且持久,哮喘临床控制水平、用药量均保持稳定。     

特异性免疫治疗对过敏性鼻炎和哮喘的同步控制和远期疗效

近年来，过敏性鼻炎(AR)和哮喘的患病率呈明显增加的趋势。随着对特异性免疫治疗(SIT)的不断了解与深入，目前认为该方法可能是惟一通过调节免疫机制从而改变变应性疾病的自然进程，并且可以在治疗停止之后获得长期疗效。综述了SIT对AR和哮喘的同步控制和远期疗效，通过国内外文献回顾及分析对比，认为SIT在治疗AR和哮喘的过程中起着十分重要且积极的作用，并且能够预防AR向哮喘进展。但是，SIT也存在一些问题,值得进一步研究及探讨。     

变应性鼻炎母代与子代变应性疾病发病的相关性研究

目的通过调查分娩后母代变应性鼻炎（allergic rhinitis,AR）的流行病学特征和子代变应性疾病的发病情况,分析母亲患有AR和支气管哮喘与子代变应性疾病发病的相关性。方法收集2007年9月～2008年12月,确诊为AR的592例25～40岁分娩后妇女作为调查对象,根据面访、查体和实验室检查、问卷调查,将分娩妇女分为A组（AR伴哮喘组）和B组（单纯AR组）,分析两组患者的AR分型、病情严重程度、分娩年龄及子代变应性疾病发病率,分析上述因素与子代变应性疾病发病率的关系。采用比值比（odds ratio,OR）作为评价危险度的指标。结果①全部病例中,A组患者213例,其中持续性中-重度106例,持续性轻度36例,间歇性中-重度54例,间歇性轻度17例;B组患者379例,其中持续性中-重度178例,持续性轻度81例,间歇性中-重度47例,间歇性轻度72例。②592例患者中384例子代发生变应性疾病,发病率为64.86%,A、B组子代变应性疾病发病率分别为82.63%（176/213）、63.85%（242/379）,母代中有AR伴哮喘的子代变应性疾病的发作明显高于母代仅有AR的子代（OR=3.91,OR的95%可信区间为2.33,5.74）。③两组中284例持续性中-重度AR患者中子女变应性疾病发病率为71.48%（203/284）,A、B两组子女变应性疾病的发病率分别为85.85%（91/106）、62.92%（112/178）,组间差异有统计学意义（P〈0.05）。④A组25～30岁年龄段分娩其子代发病率较高（85.42%）,各年龄段A、B二组间的差异有统计学意义（P〈0.05）。结论①AR伴哮喘的母代其子代变应性疾病的发病率高于单纯AR组。②25～30岁分娩的母亲有持续性中-重度AR伴哮喘为子代变应性疾病高发的危险因素。     

Effect of Botulinum Toxin Type A on Nasal Symptoms in Patients with Allergic Rhinitis: A Double-blind,Placebo-controlled Clinical Trial

Objective—To investigate the possible beneficial effects of botulinum toxin type A (BTX-A) on nasal symptoms in patients with allergic rhinitis (AR).

Material and Methods—Thirty-four patients (21 females, 13 males; mean age 28 years) were included in the study. AR was diagnosed by means of history, clinical examination and skin prick test. Patients were randomly divided into 3 subgroups a follows: in Group A, 20 units of BTX-A was injected into each nasal cavity (total 40 units); in Group B, 30 units of BTX-A was injected into each nasal cavity (total 60 units); and in Group C, 2 ml of isotonic saline was injected as placebo. The symptoms of AR (rhinorrhea, nasal obstruction, sneezing, itching) were scored by the patient on a six-point scale (from 0 to 5). All of the patients were followed up at Weeks 1, 2, 4, 6 and 8; at each visit an anterior rhinoscopic examination was done and symptom scores were recorded.

Results—There was no statistically significant difference between Groups A and B in terms of average symptom scores. Rhinorrhea, nasal obstruction and sneezing scores in Groups A and B were significantly better than those in Group C at all time points. Although itching scores were significantly lower at Weeks 1 and 2, there was no difference in the Week 4,6 and 8 scores in Groups A and B. When total symptom scores were evaluated, the results for Groups A and B were similar but significantly better than those for Group C.

Conclusion—In selected cases, injection of 40 units of BTX-A into the turbinates, as a single agent, may help the symptomatic control of AR for up to 8 weeks.     

内质网应激与气道变应性炎症关系的研究进展

内质网(ER)是真核生物维持细胞正常功能及内环境稳定的重要细胞器。ER稳态被打乱,如蛋白质加工负荷过大、营养供应不足、病毒感染和氧化还原反应失衡等就会出现内质网应激(ERS),引发Ca²⁺失衡、ER超载、细胞凋亡途径激活等异常反应,从而影响体内某些重要蛋白质的表达、诱导炎症反应及参与细胞凋亡,导致许多慢性炎症性和自身免疫性疾病的发生。已有研究证实,ERS参与了肥胖症、神经退行性疾病、糖尿病、肺纤维化等多种疾病的发病机制。关于ERS在气道变应性炎性疾病(AAID)中的作用,目前国内外也有一些最新的研究成果。本文将从ERS介导的免疫调节机制方面进行综述,进一步探讨ERS在AAID发病中可能的作用,以期为未来相关疾病的研究和治疗策略提供新思路。     

变应性鼻炎和非变应性鼻炎临床特征比较

目的探讨变应性鼻炎（allergic rhinitis,AR）和非变应性鼻炎（non-allergic rhinitis,NAR）临床特征的差异。方法选取2010年1月～2010年12月在我院门诊就诊的AR和NAR患者1647例,通过病史采集、皮肤点刺实验（skin fastinsertion test,SPT）、鼻分泌物涂片嗜酸性粒细胞计数和血清总IgE检查等评价分析两者的差异。结果鼻炎患者中AR占72.4%,NAR占2 7.6%;AR患者发病年龄（25.8±1 3.5）岁,显著低于NAR患者发病年龄（31.4±16.0）岁,两者比较差异有统计学意义（P〈0.001）;AR发病有明显的季节性,NAR发病受季节性影响不大。鼻部症状中,AR易出现打喷嚏（AR,88.4%;NAR,47.9%）,两组比较差异有统计学意义（P〈0.001）;鼻痒症状AR占8 4.4%,NAR占4 3.6%,两组比较有统计学意义（P〈0.001）;而NAR易出现鼻塞（NAR,9 6.3%,AR,9 1.2%）,两组比较差异有统计学意义（P〈0.001）和流涕（NAR,9 3.5%,AR,91.8%）,两组比较差异有统计学意义（P〈0.05）。AR患者鼻分泌物涂片嗜酸性粒细胞比例占50.1%±33.1%,血总IgE（359.7±323.4）IU/ml,且显著高于NAR患者20.1%±30.5%,123.0IU/ml±205.6 IU/ml,两组比较差异有统计学意义（P均〈0.001）。结论 AR与NAR在发病年龄、发病季节、临床症状、鼻分泌物涂片嗜酸性粒细胞比例和血总IgE上有明显差异。